Age: 89.0
Sex: M
Vaccine: COVID19
Symptoms: Iron deficiency anaemia, Liver function test normal, Melaena, Normocytic anaemia, Occult blood positive
Clinical narrative: 89 YO male w/ PMHx of HTN, HLD, DM2, Gout, CVA, smoking hx, covid vaccinated, p/w sob/dyspnea found with COVID pneumonia and multiple PEs.   #AHRF 2/2 COVID PNA, c/b provoked PE Vaccinated patient, afebrile with progressive shortness of breath, fatigue, productive cough (yellow phlegm COVID, presented w/ 9d hx of prog starting 8/29). Initially treated for CAP prescribed course of doxycycline after d/w clinic MDs. Found COVID positive on 9/6; initially requiring 15L NRB on admission, now on 3L NC s/p 10d course decadron and 5d course remdesivir. CT chest showed PE on 9/6, on xarelto for anticoagulation. Per Dr., isolation precautions d/c'ed on 9/21 given >20 days since symptom onset. CRP downtrending, no cough or fever. Currently satting well on 2LNC, requiring 4LNC on ambulation. - Goal SpO2 >92%. Self proning as tolerated  - Continue to wean O2 as tolerated. - Continue with Xarelto 15 mg BID for PE             - Xarelto loading 15 mg BID for 21 days (until 9/28) then 20 mg QD (staring 9/29) for at least 3 months - S/p Decadron 6mg qD IV/PO for 10 days (9/6/21 - 9/16)  - S/p Remdesivir 100 IV qD (9/7 - 9/10), s/p 200mg IV x1 (9/6) for total 5 days - Trend daily inflammatory marker labs (CRP every other AM) - Continue Remeron 7.5 mg qhs for appetite stimulant     #HYPERKALEMIA - RESOLVED  AM K 5.5 that resolved without intervention on repeat chemistry to 4.7. Will continue to monitor potassium levels on daily chemistries. Pt is not on any medications that can contribute to elevated K. Started patient on low K diet.     #NORMOCYTIC ANEMIA #Iron deficiency Anemia #MELENA Hx of IDA. On admission Hgb 11.6 with downtrending to 6.8 as of 9/21 2/2 GI bleed (guaiac positive, black stools noted). Recent EGD/colo on 11/4/20 showed - gastritis, diverticulosis (sigmoid), hemorrhoids. Pt s/p 1 unit pRBC on 9/17, required 2nd unit pRBC on 9/21 for hgb 6.8. Black stool noted 9/20. Discussed case with GI on 9/21; no scope given 2L O2 req still high for gen anesthesia; also prior EGD shows nothing that would benefit from direct intervention - has hernia which can be easily upset by inflammation. Overall not actively bleeding, just oozing. CTM on protonix BID and should improve. No need to change anticoagulation given no scope. Hgb stable at 8.8 on 9/22. - Daily CBC  - Transfuse if Hgb<7  - Outpatient GI follow-up on discharge - Continue Protonix 40 mg BID - Continue Xarelto for PE   #New onset Afib  New finding on EKG 9/6. CHA2Ds2-VaSc score of 4 (Age, HTN, DM) - S/p heparin gtt. Continue with Xarelto 15 mg BID until 9/28 then 20 mg QD  - Will need echo for further evaluation, after isolation    #DM2 with peripheral neuropathy Hgb A1c 5.4% 3/2021. Not on PTA anti-glycemic meds. - Continue with PTA gabapentin 300 mg QHS     #HTN - Continue with PTA hydralazine    #HLD Daily LFTs WNL. S/p remdesivir, resume statin - Continue with Simvastatin 20 mg qhs   #GERD - Cont PTA protonix   #Gout No active issues. Not on meds. - CTM   #BPH - Continue with PTA Tamsulosin and Finasteride.     FEN:                            replete lytes PRN Diet:                            DIET, CARDIAC DVT Prophylaxis:      Xarelto GI Prophylaxis:         PO pantoprazole daily Activity:                      As tolerated Foley indication:       Patient does not have a urinary catheter Central line:               Not present Bowel:                        Senna, Miralax, Colace Code:                          Partial Code DNR, okay for pressors okay for intubation  Dispo:                         ALF pending