Age: 91.0
Sex: M
Vaccine: COVID19
Symptoms: Renal tubular necrosis, SARS-CoV-2 test positive, Sepsis, Skin laceration
Clinical narrative: Date of Admission: 9/13/2023   Date of Discharge: 9/21/2023   Issues to be Addressed at Follow-up: Monitor continued improvement of rash - isolation precautions per current COVID protocol. Last day of isolation is 10/02/2023 per facility guidelines   Pending Study Results at Discharge:  Unresulted Lab Orders    No orders found from 8/22/2023 to 9/22/2023.       Final Diagnoses:  Active Hospital Problems   Diagnosis   ? NONTRAUMATIC ACUTE KIDNEY INJURY   ? PANHYPOPITUITARISM   ? CAD WO ANGINA, PRESENCE OF STENT   ? HYPERLIPIDEMIA   ? HTN   ? HYPOTHYROIDISM       Secondary hypothyroidism, monitor free T4 only   ? GOUT   ? COVID-19 PNEUMONIA   ? FALL RISK   ? CKD STAGE 3A (GFR 45-59)   ? PRESENCE OF STENT, LEFT CORONARY ARTERY, ANTERIOR DESCENDING BRANCH     Resolved Hospital Problems   Diagnosis Date Resolved ? (Principal) SEPSIS WO ACUTE ORGAN DYSFUNCTION 09/15/2023 ? HYPOXIA 09/15/2023     Discharge Disposition:  SNF   Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings: 93 y/o M w/ known CAD, hx of PCI, HTN, HL, CKD st 3, gout, panhypopituitarism, hypothyroidism - presents to the ER due to fall but incidentally found to have fever and hypoxic down to 72% on RA . COVID +. CXR w/ bibasilar infiltrates. Labs unremarkable except for very mild AKI. He was given 2 liters of NS bolus and started on RDV. He has completed RDV at this point and feels well from covid perspective. He was pending transfer to SNF, therefore he voiced frustration yesterday by stating he would want to shoot himself. He was therefoer started on suicidal precautions, however psych cleared him today, as he was not really suicidal. He stated he "would never shoot himself" as he still wants to celebrate "many more birthdays". Sitter has been discontinued   SEPSIS WO ACUTE ORGAN DYSFUNCTION (9/13/2023) COVID-19 PNEUMONIA (9/13/2023) HYPOXIA (9/13/2023) - completed 5 days of RDV - now on RA, and was quickly weaned from O2 - isolation precautions per current COVID protocol. Last day of isolation is 10/02/2023 per facility guidelines   FALL - fall risk precautions, PT c/s - cont local wound care for laceration on neck from fall   NONTRAUMATIC ACUTE KIDNEY INJURY (5/6/2017)-resolved CKD STAGE 3A (GFR 45-59) (5/25/2022) - mild AKI, likely d/t dehydration, ATN from hypotension -- > improved w/ IVF given in the ER - monitor, avoid nephrotoxic meds, renally dose meds   PANHYPOPITUITARISM (11/1/2005) - cont on hydrocortisone 15-5 bid  - cont testosterone gel (has been held d/t high BP)   CAD WO ANGINA, PRESENCE OF STENT (4/10/2003) HYPERLIPIDEMIA (1/18/2001) HTN (1/25/1995) - cont ASA - not on statins d/t hx of rhabdo - cont lisinopril 2.5 qd, lasix 10 qd today   HYPOTHYROIDISM (1/25/1995) - cont LT4   GOUT (5/6/2017) - cont allopurinol   RASH - maculopapular pruritic rash on the upper chest / neck collar area - also some on the R groin area - possible candidal rash, trial of mycolog cream bid-per ID recommending to switch to antifungal rash without steroid component, therefore switched  to clotrimazole. Currently improved   SUICIDAL PRECAUTIONS -NOT suicidal  -cleared by psych -suicidal precautions dc.      Reason for Hospital Admission (Admitting Diagnosis):  Fall Hypoxia 2/2 to covid pneumonia   Complications: rash   Consults:  PSYCHIATRY - INITIAL INPATIENT CONSULTATION. PSYCHIATRY - ONGOING INPATIENT CONSULTATION. Smoker: No.   Condition on Discharge: stable   Code Status at Time of Discharge: Full Code       Note Details  Author (M.D.) File Time 9/21/2023  2:11 PM Author Type Physician Status Signed Last Editor (M.D.) Specialty Hospital Medicine  Admit Date 9/13/2023  ED to Hosp-Admission (Current) on 9/13/2023  ED to Hosp-Admission (Current) on 9/13/2023   Detailed Report  Note shared with patient Additional Orders and Documentation   Results Imaging   Meds    Orders Procedures   Flowsheets   SmartForms:   STATUS FORM  Encounter Info:  History, Allergies, Education, Care Plan, Detailed Report   Hospital Problem List   CKD STAGE 3A (GFR 45-59)  SEPSIS WO ACUTE ORGAN DYSFUNCTION Resolved  PRESENCE OF STENT, LEFT CORONARY ARTERY, ANTERIOR DESCENDING BRANCH  COVID-19 PNEUMONIA  HYPOXIA Resolved  FALL RISK  PANHYPOPITUITARISM  NONTRAUMATIC ACUTE KIDNEY INJURY  HYPERLIPIDEMIA  HTN  CAD WO ANGINA, PRESENCE OF STENT  HYPOTHYROIDISM  GOUT Care Timeline  09/13   Admitted from ED (Observation) 1939 09/14   Admitted 1659  Expected Medication List at Discharge   allopurinol 150 mg Oral DAILY  ascorbic acid 500 mg Oral DAILY  aspirin 81 mg Resume 1 tab orally daily when off Warfarin  blood pressure test kit-large Use as directed to monitor blood pressure three times a day  cholecalciferol (vitamin D3) 1,000 Units Oral DAILY  clotrimazole 1 % Topical 2 TIMES A DAY  colchicine 0.6 mg Oral DAILY, As needed for foot pain  ferrous sulfate 325 mg Oral DAILY, Do not give with antacids or calcium supplements.  finasteride 5 mg Oral DAILY, on an empty stomach for the prostate  furosemide 10 mg Oral DAILY  hydrocortisone 10 mg Take 1 and one-half tablets by mouth every morning AND one-half tablet every evening.  hydrophilic cream Topical DAILY  lactulose 20 g Oral 2 TIMES A DAY AS NEEDED  levothyroxine sodium 50 mcg Oral DAILY  lidocaine 5 % Topical 2 TIMES A DAY  lisinopril 2.5 mg Oral DAILY  magnesium gluconate 27 mg Oral DAILY  multivitamin/iron/folic acid 18-400 mg-mcg Take 1 tablet by mouth daily  olanzapine 5 mg Oral EVERY BEDTIME  polyethylene glycol 3350 17 g Oral DAILY  tamsulosin HCl 0.4 mg Oral DAILY  testosterone 20.25 mg/1.25 gram (1.62 %) 2 pumps Transdermal DAILY, On alternate arms  ubiquinol 200 mg Oral DAILY pt in house bed