Age: 54.0
Sex: M
Vaccine: COVID19
Symptoms: Lithotripsy, Musculoskeletal disorder, Renal cyst, Renal stone removal, Ureteral stent insertion
Clinical narrative: Patient ID: MRN:  Name:  Age: 56 y.o. Birthday:   Admit Date: 7/18/2022  7:03 PM Discharge Date:  7/20/2022 Unit:  Admitting Physician:  Discharge Physician: , MD   Discharge Diagnosis: Principal Problem:   Calculus of proximal left ureter Active Problems:   COVID-19 virus infection       HPI: Patient is a 56 y.o. male who has had Covid-19 infection since 7/15 came to the ER due to persistent left flank pain. States he started having the pain intermittently 2 days ago but it became constant today. He had had kidney stone problem for the past 25 years. CT abdomen show obstructing proximal ureteral calculus in the left side. The calculus measures 4 x 4 mm. Cr 1.5. he complains of significant cough. He was prescribed Paxlovid today but has not started yet. s/p cystoscopy with retrogrades, ureteroscopy, laser/stone       extraction and ureteral stent placement     Pt doing well, pt want to DC home with f/u PCP and urology as outpatient    Hospital Course:    Calculus of proximal left ureter      CT showed an obstructing 4mm left ureter stone S/p cycto with stent placement Urology involved. S/p cystoscopy with retrogrades, ureteroscopy, laser/stone extraction and ureteral stent placement     COVID-19 virus infection Treatment started including Remdesivir. - no need -stop  If renal function get worse -will DC remdesivir  He is not hypoxic. Steroid not included yet. Ancillary therapy initiated.   AKI      Secondary to obstructive uropathy       s/p VF, IV AB pain mgmt , antiemetics       s/p cystoscopy with retrogrades, ureteroscopy, laser/stone       extraction and ureteral stent placement     Pt doing well, pt want to DC home with f/u PCP and urology as outpatient    Physical Exam on the Date of Discharge: Constitutional:      General: He is not in acute distress.    Appearance: He is well-developed.  HENT:     Head: Normocephalic.  Eyes:     General: No scleral icterus.    Pupils: Pupils are equal, round, and reactive to light.  Cardiovascular:     Rate and Rhythm: Regular rhythm.     Heart sounds: No murmur heard. Pulmonary:     Effort: No respiratory distress.  Abdominal:     General: Bowel sounds are normal. There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is abdominal tenderness.  Musculoskeletal:        General: No tenderness.     Cervical back: Neck supple.  Skin:    General: Skin is warm and dry.     Findings: No rash.  Neurological:     Mental Status: He is alert and oriented to person, place, and time.     Cranial Nerves: No cranial nerve deficit.             Consults:   IP CONSULT TO UROLOGY IP CONSULT TO SOCIAL WORK   Significant Diagnostic Studies:      Imaging and Procedures CT abdomen/pelvis  There is a delayed left nephrogram with mild perinephric  stranding. Hydronephrosis noted with proximal hydroureter terminating in a  calculus measuring 4 x 4 mm. Distal ureter is decompressed. At least 1 punctate  intrarenal stone remains on the left. No stones are seen on the right. There is  an exophytic simple cyst projecting from the upper pole of the right kidney.    s/p cystoscopy with left retrograde pyelogram, ureteroscopy, laser lithotripsy, SBE and ureteral stent insertion.   Disposition:  home   Discharge Condition:  good   Discharge Medications and Orders:   Current Discharge Medication List   START taking these medications   Details ascorbic acid, vitamin C, 500 mg tablet Take 1 Tablet by mouth Twice a day. Qty: 20 Tablet, Refills: 0   Associated Diagnoses: Ureterolithiasis   cholecalciferol, vitamin D3, 4,000 unit Tab Take 4,000 Units by mouth Once Daily. Indications: COVID-19 Positive Qty: 20 Tablet, Refills: 0   Associated Diagnoses: Ureterolithiasis   zinc sulfate (ZINCATE) 220 (50) mg Take 1 Capsule by mouth Once Daily. Indications: suspected or positive COVID-19 Qty: 20 Capsule, Refills: 0   Associated Diagnoses: Ureterolithiasis   HYDROcodone-acetaminophen (NORCO) 5-325 mg per tablet Take 1 Tablet by mouth EVERY 6 TO 8 HOURS PRN. Qty: 15 Tablet, Refills: 0   Associated Diagnoses: Ureterolithiasis   phenazopyridine (PYRIDIUM) 200 mg tablet Take 1 Tablet by mouth Three times a day. Qty: 15 Tablet, Refills: 0   Associated Diagnoses: Ureterolithiasis   cephALEXin (KEFLEX) 500 mg capsule Take 1 Capsule by mouth Three times a day for 5 days. Qty: 15 Capsule, Refills: 0   Associated Diagnoses: Ureterolithiasis     CONTINUE these medications which have NOT CHANGED   Details Promethazine-DM (PROMETHAZINE-DM) 6.25-15 mg/5 mL syrup Take 5 mL by mouth Every 4 hours as needed for up to 5 days. Qty: 118 mL, Refills: 0   Associated Diagnoses: Acute COVID-19   nirmatrelvir-ritonavir (PAXLOVID) 300 mg (150 mg x 2)-100 mg tablet therapy pack Take two 150mg tablets of nirmatrelvir with one 100mg tablet of ritonavir, (three tablets taken together), by mouth twice daily for 5 days. May be taken with or without food.  Indications: COVID-19 (emergency use authorization) Qty: 30 Tablet, Refills: 0   Associated Diagnoses: COVID-19   escitalopram oxalate (LEXAPRO) 10 mg tablet Take 1 Tablet by mouth Once Daily. Qty: 90 Tablet, Refills: 1   Associated Diagnoses: GAD (generalized anxiety disorder)   metaxalone (SKELAXIN) 800 mg tablet Take 1 Tablet by mouth Three times a day as needed (back pain). Qty: 90 Tablet, Refills: 3   Associated Diagnoses: Musculoskeletal strain   omeprazole magnesium (PRILOSEC) 20 mg DR tablet Take 20 mg by mouth Daily.