Age: 84.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Disorientation, Dizziness, Dyspnoea, Fatigue, Gait disturbance
Clinical narrative: Hospitalized (5.4.22 - 5.6.22); COVID-19 positive (5.4.22); Fully vaccinated PLUS Booster - moderna x3 D/c Summary: BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider at Discharge: MD  Admission Date: 5/4/2022 Discharge Date: 5/6/2022  Condition on discharge: Improved Active Hospital Problems   Diagnosis Date Noted POA ? COVID-19 05/05/2022 Yes ? Generalized weakness 05/04/2022 Yes ? Diabetes insipidus (HCC) 04/03/2017 Yes ? Secondary hypothyroidism 04/03/2017 Yes ? Secondary adrenal insufficiency 04/03/2017 Yes ? CAD (coronary artery disease) 04/11/2016 Yes ? Dyslipidemia 04/11/2016 Yes ? Other convulsions 07/11/2013 Yes ? OSA (obstructive sleep apnea)   Yes Resolved Hospital Problems No resolved problems to display. CONSULTS: None  INPATIENT PROCEDURES: None  DETAILS OF HOSPITAL STAY: Patient is a 85 y.o. male with PMH of panhypopituitarism, adrenal insufficiency, OSA, CAD, who presented to  Hospital Emergency Department on 5/4/22 with weakness. In the last 24 hours, he has become more weak and confused with cough and SOB. He had fever of up to 103 at home. Wife attempted to improve weakness with stress dose steroids, but patient could not ambulate. He took a home COVID test and was positive. Wife activated EMS as patient could not ambulate. Patient is noted to be awake but poor historian. Wife did not feel she could safely take him home. Will admit observation for continued monitoring.              COVID-19 did not require any O2, decadron or remdesivir. He was vaccinated and boosted in the past. Should stay isolated for 7 more days. He was evaluated by PT/OT who recommended SAR, but there were no available bed. After subsequent evaluation he significantly improved and was discharged home with home PT/OT. He was given stress dose of Florinef on 5/4-6, he will resume standard dose of Florinef tomorrow. Continue DDAVP as before.  Continue other meds as before.  Follow up with PCP if necessary.   BP 139/64  | Pulse 86  | Temp 36.5 °C (Oral)  | Resp 17  | Ht 1.753 m  | Wt 86.2 kg  | SpO2 95%  | BMI 28.06 kg/m²    Physical Exam Vitals and nursing note reviewed.  Constitutional:     Appearance: He is well-developed.     Comments: Pleasant 85 yo gentleman, NAD.  HENT    Head: Normocephalic and atraumatic.  Eyes:    Conjunctiva/sclera: Conjunctivae normal.     Pupils: Pupils are equal, round, and reactive to light.  Neck:    Thyroid: No thyromegaly.     Vascular: No JVD.     Trachea: No tracheal deviation.  Cardiovascular:    Rate and Rhythm: Normal rate and regular rhythm.     Heart sounds: Normal heart sounds. No murmur heard. Pulmonary:    Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: Normal breath sounds. No wheezing or rales.  Abdominal:    General: There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness.  Musculoskeletal:       General: No deformity. Normal range of motion.     Cervical back: Neck supple.  Lymphadenopathy:    Cervical: No cervical adenopathy.  Skin:   General: Skin is warm and dry.     Findings: No erythema or rash.  Neurological: General: No focal deficit present.     Mental Status: He is alert and oriented to person, place, and time.     Cranial Nerves: No cranial nerve deficit.     Sensory: No sensory deficit.     Motor: No weakness.     Coordination: Coordination normal.     Comments: Much more alert and stronger today  Psychiatric:     Behavior: Behavior normal.        Thought Content: Thought content normal.        Judgment: Judgment normal.  DISCHARGE DISPOSITION:  Home with services - HHA, Occupational therapy and Physical therapy  H&P:  CHIEF COMPLAINT:               Generalized weakness ASSESSMENT / PLAN: COVID-19 Assessment & Plan Symptoms started in last 24 hours Vaccinated with booster No evidence of hypoxia Will admit for monitoring Follow inflammatory markers Oxygen as needed If renal function improves, can consider anti-viral medication * Generalized weakness Assessment & Plan History of pan-hypopituitary with adrenal insuff and Diabetes insipidus He has had fever, cough, confusion and increased weakness in the last 24 hours. He tested positive for COVID at home Wife attempted to give stress dose steroids, but patient was unable to ambulate at home Will admit for monitor, PT/OT and potential SAR Diabetes insipidus  Assessment & Plan Continue DDAVP Monitor urine output Dyslipidemia Assessment & Plan Continue statin CAD (coronary artery disease) Assessment & Plan No complaints of chest pain Monitor on tele Other convulsions Assessment & Plan     History of seizures related to hyponatremia Continue Keppra  OSA (obstructive sleep apnea) Assessment & Plan Oxygen at bedtime as needed  Secondary hypothyroidism Assessment & Plan Continue synthroid  Secondary adrenal insufficiency  Assessment & Plan Wife provided stress dose steroids at home Continue Florinef Additional IV hydrocortisone if hypotension  Code: full VTE Prophylaxis: Lovenox HISTORY OF PRESENT ILLNESS: Patient is a 85 y.o. male who presents today with weakness. Patient has history of panhypopituitary and adrenal insuff. In the last 24 hours, he has become more weak and confused with cough and SOB. He had fever of up to 103 at home. Wife attempted to improve weakness with stress dose steroids, but patient could not ambulate. He took a home COVID test and was positive. Wife activated EMS as patient could not ambulate. Patient is noted to be awake but poor historian. Wife did not feel she could safely take him home. Will admit observation for continued monitoring. Review of Systems Constitutional:  Positive for activity change, appetite change, fatigue and fever.  HENT: Positive for congestion. Negative for rhinorrhea and sneezing.  Eyes: Negative. Negative for visual disturbance.  Respiratory:  Positive for cough and shortness of breath.   Cardiovascular:  Negative. Negative for chest pain and leg swelling.  Gastrointestinal:  Negative. Negative for nausea, vomiting, constipation and diarrhea.  Genitourinary:  Negative. Negative for difficulty urinating, dysuria, frequency and hematuria.  Musculoskeletal:  Positive for gait problem. Negative for falls.  Neurological:  Positive for dizziness, light-headedness and weakness. Negative for loss of consciousness.  Endo/Heme/Allergy:  negative.  Psychiatric/Behavioral:  Negative. Negative for depression and anxiety.  Skin:  Negative for rash and wound. OBJECTIVE: BP 127/67  | Pulse 88  | Temp 36.7 °C (Oral)  | Resp 18  | Ht 1.753 m  | Wt 86.2 kg  | SpO2 100%  | BMI 28.06 kg/m²    Physical Exam Vitals and nursing note reviewed.  Constitutional:      General: He is not in acute distress.    Appearance: He is well-developed.     Comments: Pale, elderly gentleman. He is resting comfortably. No acute distress  HENT:     Head: Normocephalic and atraumatic.  Eyes:     Conjunctiva/sclera: Conjunctivae normal.     Pupils: Pupils are equal, round, and reactive to light.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Heart sounds: Normal heart sounds.  Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: Normal breath sounds.  Abdominal:     General: Bowel sounds are normal. There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness.  Musculoskeletal:        General: No tenderness or deformity. Normal range of motion.     Cervical back: Normal range of motion.  Skin:    General: Skin is warm and dry.     Coloration: Skin is pale.  Neurological:     Mental Status: He is alert. He is disoriented.     Deep Tendon Reflexes: Reflexes are normal and symmetric.     Comments: Disoriented to time. Poor historian. Calm and cooperative  Psychiatric:        Behavior: Behavior normal