Age: 83.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Foaming at mouth, Heart rate increased, Hemiparesis, Mental status changes, Muscle rigidity
Clinical narrative: Hospitalized (9.19.21 - present);  COVID-19 positive (9.25.21);  fully vaccinated Elderly woman with recent long admission with progressive mental status decline. No obvious etiology identified despite workup with neurology service. She was discharged on tube feeds through corpak with plans for hospice if not improving. She is actually still improved from her baseline when I saw her last and discharged her. At that time she could not speak, except to say, "hi" and could not follow commands. She can now follow some commands and can say a few words and seems oriented to person and place. I'm not sure there is significant evidence of encephalopathy given her improvement from discharge still. Can treat for possible UTI given concerns from her facility, but will need to further discuss with her husband regarding goals of care. Given her marked limitations and illness,would continue to recommend hospice.    In regards to her rigidity, doubt this is related to Parkinsonism. She has severe spinal stenosis which can result in spacticity and alterations in resting tone. On one leg she has fairly normal tone (left) which is almost flaccid, which would be odd and atypical for Parkinson's to affect only 3/4 limbs. We will ask neurology (not neuro psych) about Sinamet trial given she is admitted and they have been consulted overnight, but would defer to their expertise in this matter.  I evaluate her ulcer at bedside, doesn't look infected. Does look worse than prior. Unlikely to heal.  Monitor cultures. Reviewed her CT images personally with large stool burden. Add bowel regimen. Overall poor prognosis. Resident Hospitalist Significant Event      Addendum Date of Service:  9/26/2021  5:27 PM        Hover for details Patient did test COVID positive on 09/25/2021.  Attempted to call husband to update him however he was unavailable.  Patient unable to be transferred to Nursing Home due to new COVID-19 diagnosis, they will not accept her until 10 days after positive diagnosis.  Consulted palliative care given most recent discussions about hospice consideration, may need to be considered for hospice in the hospital.  Care manager is aware.  Patient may qualify for regeneron therapy however in the setting of hospice considerations, but not recommended at this time.  Follow-up medicine team will need to follow up conversations with DPOA husband.  Will need to follow-up with palliative Care recommendations for further steps, appreciate their input.  ASSESSMENT / PLAN: Patient is a 83 y.o. female with a PMH of Afib s/p watchman placement, hyperlipidemia, hypertension, HFrEF (33%), mild mitral regurgitation, prior CVA/TIA who presented to the ED on 09/19/21 for fever and altered mental status.    #COVID 19 PNA   Pt tested positive for COVID-19 on 09/25/21.  Patient was recently visited by husband who was also COVID positive, unclear source of COVID pneumonia for patient. Ongoing discussions with the DPOA, husband , will need to be conducted.  Dispo: Patient covid + on 9/25 and needs 10 days of isolation before facility will take her. Plan hospice at discharge with hospice at facility, Corpak will need to be removed. Husband hospitalized at Hospital for Covid infection currently.