Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Urine abnormality, Urine analysis abnormal, Urine ketone body absent, Urine leukocyte esterase, Urobilinogen urine
Clinical narrative: Age: 86 y.o. Admit Date: 7/27/2022 11:31 PM Discharge Date:  8/4/22 Admitting Physician:  Discharge Physician:    Discharge Diagnosis: Principal Problem:   Acute metabolic encephalopathy Active Problems:   Alzheimer's dementia without behavioral disturbance   Acute cystitis without hematuria   COVID-19 virus infection   HTN (hypertension)       HPI: Patient is a 86 y.o. female  with past medical history per below presented to the emergency room by low enforcement due to patient repeatedly calling 911. Patient with known history of dementia lives alone and was reportedly agitated over the past 1-2 days. No reports of any fevers, chills, chest pain, shortness of breath or any other GI or renal symptoms. In the emergency room chest x-ray was done showing no acute changes and lab showed unremarkable CBC and CMP with a negative troponin and normal TSH. Level was negative and pro-calcitonin was low at less than 0.05. However UA was positive with innumerable white blood cells.   Hospital Course: Patient with history of dementia, presented with worsening confusion. Found to have UTI. COVID + but was asymptomatic therefor not treated. Family initially wanted nursing facility placement. Patient accepted at nursing home and family refused. Patient is on room air and will DC home with family to complete abx.      * Acute metabolic encephalopathy History of dementia. Monitor.    COVID-asymptomatic. Not on treatment   Cystitis-continue keflex.    Lovenox Accepted at nursing facility but family not wanting that nursing facility. Home on DC        Physical Exam on the Date of Discharge: Physical Exam Cardiovascular:     Rate and Rhythm: Normal rate.  Pulmonary:     Breath sounds: Normal breath sounds.  Abdominal:     General: Bowel sounds are normal.  Musculoskeletal:     Right lower leg: No edema.     Left lower leg: No edema.  Skin:    General: Skin is warm and dry.  Neurological:     Mental Status: She is alert.       Consults:   CONSULT ED SOCIAL WORK IP CONSULT TO SOCIAL WORK   Significant Diagnostic Studies:    UA for Infection (Reflex Culture) Results Abnormal Status: Final result (Collected: 7/28/2022 00:27)     Order Report   Order Details         Order Providers   Authorizing Provider Encounter Provider       Contains abnormal data UA for Infection (Reflex Culture) Status: Final result   Visible to patient: No (inaccessible)   Next appt: None   Specimen Information: Urine, Straight Cath     0 Result Notes   Component Ref Range & Units 7 d ago  UR GLUCOSE NEGATIVE mg/dL Normal  UR BILIRUBIN NEGATIVE mg/dL Negative  UR KETONE NEGATIVE mg/dL Negative  UR SP GRAVITY 1.005 - 1.030 1.015  UR BLOOD NEGATIVE mg/dL Trace Abnormal   UR PH 5.0 - 9.0 6.5  UR PROTEIN NEGATIVE mg/dL Negative  UR UROBILINOGEN <2.0 Normal  UR NITRITE NEGATIVE mg/dL Negative  UR LEUKOCYTE NEGATIVE Moderate Abnormal   UR COLOR YELLOW Yellow  UR CLARITY CLEAR Turbid Abnormal   UR WBC 1 - 3 [HPF] INNUM Abnormal   UR RBC 1 - 3 [HPF] 1-3  UR SQUAMOUS EPI 3 - 5 [HPF] 1-3  UR NON-SQUAMOUS EPI NONE SEEN [HPF] <1  UR MUCOUS NONE SEEN [HPF] Rare  UR BACTERIA NONE SEEN [HPF] None Seen         Disposition:  home   Discharge Condition:  good   Discharge Medications and Orders:   Current Discharge Medication List   START taking these medications   Details cephALEXin (KEFLEX) 500 mg capsule Take 1 Capsule by mouth Twice a day for 1 day. Indications: inflammation of the bladder Qty: 2 Capsule, Refills: 0   Associated Diagnoses: UTI (urinary tract infection)     CONTINUE these medications which have NOT CHANGED   Details QUEtiapine (SEROQUEL) 25 mg Take 25 mg by mouth Twice a day.   nitrofurantoin, macrocrystal-mono, (MACROBID) 100 mg capsule Take 100 mg by mouth Once Daily.   nitroglycerin (NITROGLYCERIN) 2 % ointment 1 Inch by Topical route Every 6 hours. Qty: 30 g, Refills: 0   Associated Diagnoses: Embolic disease of toe   rivaroxaban (XARELTO PO) Take  by mouth.   memantine (NAMENDA) 10 mg Take 1 Tab by mouth Twice a day. Qty: 60 Tab, Refills: 3   Associated Diagnoses: Memory loss   bisoprolol-hydrochlorothiazide (ZIAC) 5-6.25 mg per tablet Take 1 Tab by mouth Daily.   meloxicam (MOBIC) 7.5 mg tablet Take 7.5 mg by mouth Daily.   tiZANidine (ZANAFLEX) 4 mg Cap capsule Take 1 Tab by mouth At bedtime.   Fexofenadine (ALLEGRA) 180 mg tablet Take 1 Tab by mouth Daily.   omeprazole magnesium (PRILOSEC) 20 mg DR tablet 1 Tab Daily