Age: 87.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Anxiety, Asthenia, Back pain, COVID-19
Clinical narrative: patient admitted 7/2/2021 for weakness, fever, dry cough , vaccinated for COVID 5/1/2021, tested positive for COVID 7/2/2021, 7/9/2021, 7/13/2021, 7/17/2021  Discharged 7/23/2021 to Nursing Facility  Allergies (drug/food and reaction):sulfacetamide  Date of Vaccination:5/1/2021 Dose:  2 Vaccine Manufacturer: Moderna Lot #: Not obtained- pt unsure of clinic site  Clinic Administering Vaccine: Store  Injection site:R delt  Description of event/reaction: + Covid test  Date of Clinic Visit or Hospitalization: 7/2/2021  Reason for clinic visit or hospitalization: Flank pain w/o pulmonary consolidation COVID-19 positive test result: Yes ; if Yes, date 7/2/2021  Plans to monitor (include medications if prescribed):s/p dexamethasone/remdesivir  History Of Present Illness Patient is a 87 y.o. female presenting with weakness, fever.  Has not been feeling well for the last 3 days complaining of weakness unable to ambulate.  And also had a low-grade fever and dry cough which has been persistent.  complaining of right-sided lower flank/rib pain.    No chest pain palpitations.c/o difficulty in breathing, no orthopnea or PND. No h/o CHF. No leg edema.   She has chronic back pain for which she takes Tylenol twice a day.  As her symptoms were not improving she came into the ER for evaluation.  She has had a history of UTI in the past.  No recent contact with anyone who has been ill.  She lives with her husband , patient is accompanied by her daughter-in-law.  No abdominal pain nausea vomiting.  Denies any dysuria hematuria.  Has not been drinking enough water and the family had noticed patient is not urinating that much. Underlying history of dementia.  On evaluation in the emergency room patient was hypoxic and not been on home oxygen in the past.  Requiring 2-3 L oxygen nasal cannula and also hypotensive started 5 cc fluid bolus.  His systolic Bp 87.  Patient also was given a dose of Zosyn and vancomycin in the emergency room Hospital Medicine consulted for admission.  Review of Systems  Constitutional: Positive for fever. Negative for appetite change, chills and unexpected weight change.  HENT: Negative.   Eyes: Negative.   Respiratory: Positive for cough and shortness of breath. Negative for chest tightness.   Gastrointestinal: Negative for diarrhea and vomiting.  Endocrine: Negative.   Genitourinary: Negative.  Negative for dysuria and frequency.  Musculoskeletal: Positive for back pain and myalgias.  Skin: Negative.   Neurological: Positive for weakness.  Psychiatric/Behavioral: The patient is nervous/anxious.  Assessment/Plan  Principal Problem:   Pneumonia 87-year-old female with a past medical history of hypertension hypothyroidism admitted for hypoxemia probable pneumonia and hypotension.   1. Left lower lobe pneumonia with hypoxemia Requiring oxygen 3 L nasal cannula. white count is normal she has a prior history of neutropenia.  Continue to trend.  Empiric antibiotic coverage for pneumonia recommend doing ceftriaxone and Zithromax. Will add cough suppressant as needed.  2. Hypotension Probably secondary to decreased oral intake.   500 cc fluid bolus followed by maintenance at 80 an hour for 1 L.   Continue to monitor I's and O's.  3. Hypothyroidism resume levothyroxine.   4. Dementia stable continue donepezil.   5. Anxiety patient on sertraline and lorazepam 1 mg at night.   6. Hypokalemia - replace potassium  7. Thrombocytopenia - new No s/s of liver disease. H/o Hydatid cyst.