Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: Blood culture negative, Blood lactic acid increased, COVID-19, Computerised tomogram thorax abnormal, Decreased appetite
Clinical narrative: Patient is a 84 y.o. female patient of CNP with history of dementia, anxiety, hypertension presented to Hospital with lethargy.   Covid-19 Virus Infection Date of onset of symptoms: 10/15 Symptoms present on admission: Shortness of breath, fever, lethargy Date of covid positive test: 10/16 Vaccination status: vaccinated Imaging: CT chest Oxygen requirements on admission: Room air Current oxygen requirements: Room air Medical therapy: rocephin and zithromax; Remdesivir and decadron Consultants following: ID Anticipated special isolation end date: 10/26 Remains on room air Palliative care on case, DNRCC  Hospice consulted, does not meet criteria for hospice  Continue present management along with ID  ID states patient will be ready to discharge in the am.  PT/OT consulted, pt qualifies for SNF, care management following for discharge planning, family no longer interested in SNF    Left lower lobe pneumonia-resolved  Positive for Pneumococcal pneumoniae Consolidation on CT chest Follow-up blood culture negative  Not requiring oxygen Ceftriaxone and s/p azithromycin   DuoNebs Mucinex   Essential Tremor Neurology evaluated, recommending propanolol 10 mg TID   Hypokalemia  Potassium replacement as needed  AKI-improving  Creatinine peaked 1.91->1.82->1.59 D5 0.45 x 500 ml 10/30/23 D5 0.45 at 75 ml/hr during hospitalization  Continue  monitoring    Throat burning Rapid strep ordered : neg   Sepsis- resolved  Elevated lactic acid - POA now resolved Pancytopenia POA Present on admission: yes Etiology: COVID and pneumonia SIRS criteria: Temperature greater than 100.4 or less than 96.8, Heart rate greater than 90, Respiratory rate greater than 20 or PACO2 less than 32mmHg, WBC greater than 12,000, less than 4,000, or greater than 10% bands Evidence of end organ damage: Bilirubin greater than 2, Platelets less than 100, Lactic acid greater than 2.0 Initial lactic acid: 3.4 Repeat lactic acid: 1.3  resolved  Current antibiotic regimen: Ceftriaxone and azithromycin Culture data: Blood cultures NGTD Vasopressors/steroids: none   Anemia Microcytic Decrease appetite Iron, ferritin,  transferrin B12 and folate Reviewed and no replacement needed   Advanced dementia Anxiety Lives at home with her son and daughter-in-law, has a nurse that comes in Consult to case management for help with home needs Consult to palliative care for possible hospice enrollment Continue donepezil Continue Atarax Needs encouragement to take medications and allow lab draws Pt may not respond to nursing staff to take medications or eat because of being in an unfamiliar environment.  As soon as stable and off of IV antibiotics recommend she be discharged home, were she will be in a familiar environment and take medications,    Hypertension Resume lisinopril since AKI has resolved As needed hydralazine   H/o intracranial mass CT head with extra-axial mass posteriorly on the left at the level of the foramen magnum.  A solid dural based mass is possible as he has an aneurysm off the left vertebral artery.  Further evaluation is recommended with pre and postcontrast MRI and MRA of the brain.  No evidence of intracranial bleed.  Mild bilateral acute sinusitis Patient's son aware of the intracranial mass and did not want to do any diagnostic work-up on it   Protein calorie malnutrition Hypoalbuminemia-resolved  Patient has been having poor p.o. intake Consult dietitian Oral supplements   Dysphagia Speech evaluated, recommending thin liquids and reg solids Patient pocketing food this morning 10/31, will re-consult ST for re-evaluation    NSTEMI type 2 due to demand ischemia 10/16  troponin 74, 10/17 troponin 104 and 97 NSTEMI type 2 due to demand ischemia;sepsis