Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Anion gap, Anticoagulant therapy, Asymptomatic COVID-19, Atrial fibrillation, Atrioventricular block first degree
Clinical narrative: Hospitalized (1.27.22 - still admitted currently); COVID-19 positive (1.27.22); Fully vaccinated -pfizer x2 1/28/22 H&P: Attestation signed by privacy at 1/30/2022 10:16 AM I have personally interviewed and examined the patient on 1/28/2022. I agree with the documented findings and plan of care in his/her note.   Brief exam:  General:  No acute distress Respiratory:  Clear to auscultation bilaterally, no wheezing, rhonchi, or crackles Cardiovascular:  elevated cardiac rate, regular rhythm, Gastrointestinal: soft, non-tender, non-distended; normal bowel sounds in all 4 quadrants Integumentary:  Warm, dry, intact, no rash or lesions Musculoskeletal: no bony abnormalities noted; able to move all 4 extremities spontaneously Neurologic:  disoriented, no focal neurological deficits    Brief history and medical decision making: 71-year-old man with likely rapid progressive Alzheimer's dementia with significant neurological workup performed at Hospital during the latter part 2021. Presenting with worsening hallucinations, increased level of care unable to be obtained under current living situation.  Patient tested positive for COVID-19 PCR in the emergency department though is currently asymptomatic for a respiratory standpoint.  Patient is admitted for placement.  Psychiatry consulted and recommending increasing Seroquel 50 mg nightly. CHIEF COMPLAINT: Hallucination ASSESSMENT / PLAN: Acute COVID-19 infection -not currently a candidate for remdesivir Decadron due to unknown onset -currently 99-100% on room air; continue to monitor -he is vaccinated but due for booster -continue supportive care Paroxysmal Atrial fibrillation -EKG currently sinus rhythm with first-degree AV block -continue Cardizem, flecainide and Eliquis Hypothyroidism -continue levothyroxine 80 Dementia -continue memantine and Seroquel facility for placement Full code VT prophylaxis-on Eliqui  HISTORY OF PRESENT ILLNESS: Patient is a 71 y.o. male with atrial fibrillation on Eliquis, hypertension, OSA, hypothyroidism and rapidly progressing dementia who presents today with hallucination.Lives with family who report he has been having hallucinations, thinks he is seeing people enter home and wants to contact police. They are unable to provide 24 hour supervision and believe he needs higher level of care.  He states "I have a driver's license but I don't use it because I have dementia and it is really awful. I have motorcycles I can't ride ."  He was evaluated while in ED and attempts to place in facility with increased level of care. Unfortunately patient tested positive for COVID 19 so he will be admitted to service for ongoing care awaiting placement.  He denies any fever, chest pain, shortness of breath or cough. Patient Active Problem List Diagnosis ? Atrial fibrillation, persistent ? HTN (hypertension) ? OSA on CPAP ? Hypothyroid ? High cholesterol ? Obesity ? Pre-operative cardiovascular examination ? Hallucination OBJECTIVE: BP 112/64  | Pulse 59  | Temp 37 °C (Oral)  | Resp 16  | Ht 1.93 m  | Wt 92.1 kg  | SpO2 95%  | BMI 24.72 kg/m²    Physical Exam Constitutional:     General: He is not in acute distress.    Appearance: He is well-developed. He is not ill-appearing.  HENT:    Head: Normocephalic and atraumatic.     Right Ear: External ear normal.     Left Ear: External ear normal.     Mouth/Throat:     Mouth: Mucous membranes are moist.     Pharynx: Oropharynx is clear.  Eyes:    Conjunctiva/sclera: Conjunctivae normal.     Pupils: Pupils are equal, round, and reactive to light.  Cardiovascular:    Rate and Rhythm: Normal rate and regular rhythm.     Heart sounds: Normal heart sounds.  Pulmonary:    Effort: Pulmonary effort is normal.     Breath sounds: Normal breath sounds.  Abdominal:    General: Bowel sounds are normal.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness.  Musculoskeletal:       General: Normal range of motion.     Cervical back: Normal range of motion and neck supple.  Skin:   General: Skin is dry.    Findings: No rash.  Neurological:     Sensory: No sensory deficit.     Motor: No weakness.     Comments: Oriented x1  Psychiatric:        Mood and Affect: Mood normal.        Behavior: Behavior normal  2/7/22 General Med Progress note:  CHIEF COMPLAINT:    Hallucination ASSESSMENT / PLAN: Hallucinations Dementia and behavioral disturbance  Follows with neurology at hospital Continue memantine and Seroquel Psych Consulted; have signed off; appreciate recommendations - seroquel increased on 1/28/22 - continue outpatient f/u with neuro - placement: assisted living vs home with services -Patient has been calm, cooperative and pleasant.   Asymptomatic COVID-19 infection Unclear onset, not candidate for remdesivir or Decadron given lack of hypoxia Vaccinated, overdue for booster COVID test positive 1/27; now out of isolation continue supportive care   Hypokalemia - resolved   Paroxysmal Atrial fibrillation - continue diltiazem, flecainide and Eliquis   Hypothyroidism - continue levothyroxine   Code: DNR/DNI, per discussion with DPOA/DIL and Son at admission DVT prophylaxis: on Eliquis Disposition:  Mentation stable after seroquel increased. No acute changes. Remains asymptomatic from COVID standpoint; out of isolation today. Continues to be medically stable for discharge, pending placement. SUBJECTIVE: Patient seen and examined in bed. He is smiling and pleasant. Oriented to self and that he is in the hospital. No current complaints. He denies any current SOB, chest pain, nausea. Still denies any cough, diarrhea although not reliable historian. Ate breakfast. Review of Systems Unable to perform ROS: dementia  OBJECTIVE: BP 112/70  | Pulse 66  | Temp 36.9 °C (Oral)  | Resp 18  | Ht 1.93 m  | Wt 92.1 kg  | SpO2 100%  | BMI 24.72 kg/m²    Physical Exam Constitutional:      General: He is not in acute distress.    Appearance: He is normal weight. He is not ill-appearing or diaphoretic.  HENT:     Mouth/Throat:     Mouth: Mucous membranes are moist.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Heart sounds: No murmur heard.    Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: Normal breath sounds.  Abdominal:     General: Bowel sounds are normal. There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness.  Skin:    General: Skin is warm and dry.  Neurological:     Mental Status: He is alert.     Comments: Oriented to self/DOB and that he is at the hospital although does not know what hospital.Does not know why he is here. States day at October 24th. Not oriented to day, month or year.   Psychiatric:        Cognition and Memory: Memory is impaired.     Comments: Pleasant, cooperative. Does not appear to be responding to any internal stimuli