Age: 80.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19, COVID19
Symptoms: Vertigo positional, Vestibular disorder, Vestibular neuronitis, White blood cell count decreased, X-ray normal
Clinical narrative: (D.O.)  PHYSICIAN (D.O.) Specialty:  Hospital Medicine Progress Notes    Signed  Signed    PROGRESS NOTE    Events:  --off Lisinopri --Orthostatics negative this am   Subjective: Requesting BP cuff/machine for home   Objective: BP 111/70  | Pulse 60  | Temp 97.3 °F (36.3 °C)  | Resp 20  | Ht 5' 10"  | Wt 77 kg (169 lb 12.1 oz)  | SpO2 95%  | BMI 24.36 kg/m²  Physical Exam: General appearance - alert, well appearing, and in no distress Chest - clear to auscultation, no wheezes, rales or rhonchi Heart - regular rate and rhythm Abdomen - soft, nontender, nondistended, no masses or organomegaly Extremities - no clubbing, cyanosis or edema     Selected Results:  Recent Labs   08/13/23 0644 08/12/23 0632 08/11/23 0639 08/10/23 1035 WBC 2.9* 4.0 3.5* 4.8 HGB 14.2 15.4 14.0 14.7 HCT 43.7 47.0 42.9 45.5 PLT 145 141 124* 163 MCV 94 94 94 93    Recent Labs   08/13/23 0644 08/12/23 0632 08/11/23 0639 08/10/23 1035 08/10/23 1035 08/07/23 1554 NA 133* 134* 134*  --  133*  --  K 4.6 4.5 4.4  --  4.6 4.7 CO2 28 25 26  --  27  --  CL 100 99* 101  --  98*  --  BUN 18 24 26   < > 25  --  CR 0.90 0.98 1.01  --  1.13 1.20 RBS 84 81 73  --  94  --   < > = values in this interval not displayed.    Recent Labs   08/10/23 1035 PT 14.0 INR 1.1   CXR: 8/10/23  Impression No acute disease.     8/10/23 EKG:  Reviewed- Sinus +PACs   Abdominal Film 8/120/23  Impression Mild amount of stool noted in the abdomen.             Assessment and Plan:  Active Hospital Problems   Diagnosis   ? (Principal) COVID-19 DISEASE --Completed RDV --Isolation can end tomorrow --No oxygen or Dex required     ? DIZZINESS --ACE held  --BP cuff for home --No PT needs --Supportive --Orthostatics negative           11/12/2022- Established diagnosis. Briefly reviewed plan today. Continue current regimen.   There was no findings of cerebellar or brain stem dysfunction that would suggest central process of vertigo. Of not I was not able to reproduce the dizziness on exam, however when the room became warmer the patient described return of symptoms. There is a high suspicion for peripheral etiology of vertiginous symptoms - vestibular neuritis/ vestibular dysfunction, vs Benign Paroxysmal Positional vertigo. I counseled the patient that there were no findings showing acute stroke.    I provided reassurance that symptoms could progressively improve and provided guidelines for exercise to help address vertigo. For sever symptoms limiting his ability to function. I prescribed Meclizine   1. - 12.5 mg of Meclizine 2 times a day as needed 2. - Do daily vertigo exercises 3. - Return to clinic if symptoms worsen or become more frequent. 4. - Consider referral to vestibular PT, will discuss this with PCP   10/20/2022 - Chart Update Neurology to evaluate    10/2022 MRI brain   Limited examination secondary to extensive motion artifact.   No gross evidence of acute intracranial abnormality. No acute infarct identified.       ? LOWER URINARY TRACT SYMPTOMS --   ? HX OF ALCOHOL USE DISORDER --Counseled     ? HYPONATREMIA --Follow up outpatient with PCP     ? OSTEOPOROSIS --Supplements     ? HTN --Hold ACE     DVT PPx: SCDs/Lovenox   DISPO: Home today [] BP cuff [] Pulse Ox            Note Details  Author  File Time 8/14/2023  3:47 PM Author Type PHYSICIAN (D.O.) Status Signed Last Editor  (D.O.) Specialty Hospital Medicine Hospital Acct # Admit Date 8/10/2023  ED to Hosp-Admission (Discharged) on 8/10/2023  ED to Hosp-Admission (Discharged) on 8/10/2023   Detailed Report  Note shared with patient Care Timeline  08/10   Admitted from ED (Observation) 1701 08/13   Admitted 0741 08/14   Discharged 1243