Age: 82.0
Sex: M
Vaccine: COVID19
Symptoms: Computerised tomogram head normal, Computerised tomogram thorax abnormal, Condition aggravated, Confusional state, Delirium
Clinical narrative: Clinical Summary 83 yo M with a h/o dementia who has had  increased confusion over the last 48 hours. The patient's wife cannot care for him in his current condition. The patient also recently suffered a clavicle fx from a fall.     Delirium on baseline Alzheimer's dementia Likely aggravated by COVID-19 infection Follows up with Dr. of neurology.  Believes the patient has Alzheimer's and some mood disorder Could be normal waning of dementia, delirium, or adverse effect of medications. CT head-no acute intracranial abnormality Reduce memantine back to 5 mg BID.  (Dose increased 8/11) Consulted PT/OT.  Recommended SNF.  SNF accepted and waited for pre-CERT but unfortunately got denied.  Discussed with wife.  Wife decided to take patient home.  DC home with home health care   Covid-19 Virus Infection Acute respiratory failure Date of onset of symptoms: No symptoms other than baseline symptoms symptoms present on admission: None.  Day after admission spiked low-grade fever.  No fever since then Date of covid positive test: 9/13/2022 Vaccination status: vaccinated Imaging: Chest x-ray unremarkable Oxygen requirements: 2 L of oxygen>RA Medical therapy: Started dexamethasone 9/14/22 and continued at discharge to complete 7 days course Anticipated special isolation end date: 9/18/2022 CRP 34.9, ferritin 337.  Mild leukopenia Checked O2 requirement prior to discharge.  Qualified for 2 L of oxygen with exertion       COPD Pulmonary fibrosis Follows up with Dr. as outpatient PFT from 2021-moderate obstruction.  FEV1 (% predicted) 62 Continue home medications   BPH Continue Flomax 0.4 mg daily   Left clavicle Fx Distal third Sling (for comfort) Consulted orthopedic surgery.  Recommended outpatient follow-up in 10 days Supportive care  The patient was discharged to home and the family brought him back to the ED in less than 24 hours and he was readmitted Clinical Summary Patient is a 83 y.o. male patient of MD with history of dementia, nephrolithiasis, osteoarthritis, appendectomy, back surgery and hernia repair who was discharged home from this facility on 9/16/2022 with delirium, COVID-19 infection, acute respiratory distress and left clavicle fracture, was brought back to the emergency department by his wife for worsening confusion and weakness   Delirium, improving Baseline dementia Delirium due to COVID-19 He was admitted to hospital from 9/12/22 through 09/16/2022 with worsening delirium in the setting of COVID-19 infection. Initially he was recommended to go to SNF, after waiting for SNF pre-CERT got denied.  Finally his wife decided to take the patient home with home health care. Unfortunately the patient's delirium has failed to clear, and the patient has become weaker PT/OT still recommends 5 days of therapy DC to nursing home for continued therapy   History of nephrolithiasis and moderate left-sided hydronephrosis. Urinary retention Patient noted to have distended bladder on examination and Foley catheter was placed. Fortunately kidney function is currently stable Consulted urology.  Plan was for ureteroscopy, laser lithotripsy and stent placement.  But holding off now considering COVID-19 and pneumonia DC Foley catheter and was able to void without difficulty Patient to follow-up with Dr. in 1-2 weeks  Covid-19 Virus Infection Complicated by pneumonia Date of onset of symptoms: Unclear due to dementia Date of covid positive test: 9/13/2022 Vaccination status: vaccinated CT chest-asymmetric RLL infiltrate concerning for possible pneumonia Oxygen requirements: 2 L  No fever since 96 hours prior to discharge Medical therapy: Completed 10 days course of dexamethasone Anticipated special isolation end date: 9/23/2022 Levaquin 750 mg daily x7 days for pneumonia   Fall While ambulating to bathroom patient felt weak and PSA had to make him sit on the floor on 9/23/2022.  Did not fall to the floor, hit his head or lost consciousness Patient examined after the fall.  No reports of pain     COPD Pulmonary fibrosis Follows up with Dr. as outpatient PFT from 2021-moderate obstruction.  FEV1 (% predicted) 62 Continue home medications   BPH Continue Flomax 0.4 mg daily   Left clavicle Fx Distal third Sling (for comfort) Consulted orthopedic surgery.  Recomended outpatient follow-up in 1 week Supportive care   Moderate malnutrition Consulted dietitian Continue dietary supplementation