Age: 97.0
Sex: F
Vaccine: COVID19
Symptoms: Abnormal behaviour, Atrial fibrillation, Blood thyroid stimulating hormone normal, Breath sounds absent, COVID-19
Clinical narrative: In ED on 2/25/21 Chief complaint: Patient's daughter present at bedside stating patient was not vocalizing this morning when she woke up.  Patient's daughter was talking to her and she would orient to her but not answer any of her questions.  EMS called and by the time they arrived patient was acting her normal self.  Daughter states she has had a very difficult time managing patient's behaviors over the last several weeks and it has been getting more difficult.    Daughter states that over the last several weeks her behaviors have been worsening and been more difficult to deal with.  These include her getting up at night and sundowning as well as yelling and screaming during the day.  Daughter states that she gets in the shouting matches with the patient during the day.  Daughter breaks down and starts to cry when discussing that she thinks her mother will need long-term placement as she is having a difficult time dealing with her behaviors.  Of note patient did receive second dose of Covid vaccine yesterday. -Patient has not been complaining of any symptoms over the last several days and daughter has not noticed cough or congestion or other signs of URI/illness -No focal neurologic deficits on exam  -Received 1L IV NS in ED  2/26/21 Covid positive, incidental finding ? tested so she could go to nursing facility -Patient asymptomatic -Vital signs stable, afebrile -She does not need treatment at this time -She will need a repeat Covid test 14 days after the original Covid test prior to going to SNF -Plan- discharge to skilled nursing facility  Discharge summary Principal Problem:   Comfort measures only status Active Problems:   Chronic atrial fibrillation   Essential hypertension   Dementia with behavioral disturbance   Recurrent falls   Dysphagia   COVID-19 Resolved Problems:   Cough with hemoptysis   Leukocytosis   Dehydration   Inadequate oral intake  Patient is a 97-year-old female with a past medical history of dementia, likely combined vascular/Alzheimer's, hypertension, chronic A. Fib, who presented to the ED on 2/25/2021 due to behavioral disturbance as well as need for long-term care placement due to progressive dementia.   She did have an incidental positive Covid test on 2/26/2021 and was planned for discharge to COVID recovery ward of SNF. She did not require medication or oxygen treatment for COIVD-19.  She developed tachycardia/tachypnea and cough later productive for blood after suctioning attempts overnight on 2/28-3/1, which did not recur.   Unfortunately, patient's overall function declined after, and she was refusing/unable to eat or drink. She was transitioned to comfort care status on 03/03/2021.   She eventually slipped into persistent sleep with lack of responsiveness on 3/4/2021. Comfort care was provided.   She had decreased urinary utput and respiratory function indicating expected progression. She was noted to not have a heart rate on 03/08/2021. Auscultation did not reveal any breath sounds or heart sounds; unable to palpate pulse; no pupillary response to light was seen; and patient did not respond to painful stimuli. Death was pronounced on 03/08/2021, 02:58am.   Deceased 3/8/21