Age: 84.0
Sex: F
Vaccine: COVID19
Symptoms: Depressed level of consciousness, Dysarthria, Enterobacter infection, Eosinophil count, Eosinophil percentage decreased
Clinical narrative: Expand All Collapse All Date of Admission: 12/2/2023   Date of Discharge: 12/5/2023    Issues to be Addressed at Follow-up: 1.  Improving symptoms   Pending Study Results at Discharge:  Unresulted Lab Orders    Date and Time Order Name Status Specimen Source   12/2/2023  1:12 PM BLOOD CULTURE Preliminary BLOOD   12/2/2023 12:59 PM BLOOD CULTURE 2 Preliminary BLOOD       Final Diagnoses:  Active Hospital Problems   Diagnosis   ? (Principal) COVID-19 DISEASE   ? HYPOTHYROIDISM   ? HYPERLIPIDEMIA   ? PREDIABETES   ? POSTPOLIOMYELITIS SYNDROME   ? HTN (HYPERTENSION)     Resolved Hospital Problems No resolved problems to display.     Discharge Disposition:  Home with Home Health   Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings: 87 year old with a medical history significant for HTN on losartan and amlodipine,  HTN with CKD stage 3A/3B (GFR 41 on 11/30/2023, 48 on 9/13/2023, serum creatinine 1.27 on 11/30/2023,  1.12 on 9/13/2023), GERD on Pepcid, history of Poliomyelitis back in 1952 with post Polio syndrome (uses a wheelchair-lives at Assisted living faciity) to get around for decrease PO intake, weakness, fatigue, loss of taste.   Found to be positive for COVID.   Of note, had normal MRI brain without contrast on 11/29/2023.   Hypothermic at 92.6 F.  Urine culture from 11/30 shows Enterobacter UTI.   TSH Slightly elevated 11/30 at 8.7    Started on rocephin to cover for enterobacter UTI. And remdesevir for COVID.   Repeat TSH/free T4 on 12/3/2023 done-free T4 normal, TSH 7.4.  NOT hypoxic from COVID so no decadron.   Previous HBS had long conversation with daughter->concerned that patient's persistent issues with slurring of speech, fatigue (difficulty sustaining alertness).   Possible sequale of Post Polio Syndrome exacerbated by infection (COVID and Enterobacter UTI).  To exclude other causes of failure to thrive, fatigue-ordered pan CT chest and CT abdomen/pelvis with IV Contrast to rule out malignant focus, undisclosed nidus of infection.  The CT chest revealed obvious COVID sequelae.  Discussed with her daughter that there may be a concern for risk of PNA but that I cannot keep her in the hospital to monitor for this.  Scheduled on mucinex to help bring up mucus and PRN robitussin.  Initially MRI brain with contrast ordered, but given no obvious stroke symptoms and patient improving, daughter was ok with cancelling this.   Patient improving, eating and drinking on her own, answering questions appropriately, and following commands.  Baseline, not ambulatory so PT felt no new needs. Lastly daughter asked about possible sepsis, discussed labs and vitals and lack of evidence suggesting sepsis.  She did have a bandemia, but with normal WBCs and known infection with neg blood cultures, not felt to warrant additional workup and complete her antibiotic course.     Primary Procedures:  None   Secondary Procedures: None   Reason for Hospital Admission (Admitting Diagnosis):  altered   Complications: none   Consults:  None Smoker: No.   Condition on Discharge: stable   Code Status at Time of Discharge: Full Code     Discharge day assessment       Subjective: Doing well; feels well enough for dc   Objective: BP 120/64  | Pulse 71  | Temp 97.4 °F (36.3 °C)  | Resp 18  | SpO2 92%  | Breastfeeding No    Intake/Output Summary (Last 24 hours) at 12/5/2023 1156 Last data filed at 12/5/2023 0827  Gross over last 24 hours Intake 830 ml Output 680 ml Net 150 ml       Physical Exam:  Gen: alert, NAD CV: RRR, s1 and s2 normal, no murmurs Resp: CATB Abd: soft, NT, ND, +BS Ext: no C/C/E PPE Worn:   Mask: N95 Eye Protection: yes Patient Masked: no Hand Hygiene: yes     Selected Results:  Recent Labs Recent Results (from the past 24 hour(s)) CHEM 7 (NA, K, CL, CO2, BUN, GLUC, CR)   Collection Time: 12/05/23  7:33 AM Result Value Ref Range   Sodium 139 135 - 145 mEq/L   Potassium 4.6 3.5 - 5.3 mEq/L   Chloride 105 100 - 111 mEq/L   CO2 28 24 - 33 mEq/L   Anion gap, ser/plas 6 5 - 16 mEq/L   BUN 38 (H) 7 - 27 mg/dL   GLUCOSE, RANDOM 62 60 - 159 mg/dL   Creatinine 0.69 <=1.11 mg/dL ALT   Collection Time: 12/05/23  7:33 AM Result Value Ref Range   ALT 36 0 - 41 U/L AST   Collection Time: 12/05/23  7:33 AM Result Value Ref Range   AST 31 10 - 40 U/L WBC AUTO DIFF   Collection Time: 12/05/23  7:33 AM Result Value Ref Range   Neutrophils, Automated Count 3.3 1.8 - 7.9 K/uL   Lymphocytes, Automated Count 0.5 (L) 0.9 - 3.2 K/uL   Monocytes, Automated Count 0.5 0.3 - 0.9 K/uL   Eosinophils, Automated Count 0.0 0.0 - 0.4 K/uL   Basophils, Automated Count 0.0 0.0 - 0.1 K/uL   Immature Granulocytes, Automated Count 0.0 0.0 - 0.1 K/uL   Neutrophils %, Automated count 76 %   Lymphocytes %, Automated count 11 %   Monocytes %, Automated Count 11 %   Eosinophils %, Automated Count 0 %   Basophils %, Automated Count 0 %   Immature Granulocytes %, Automated Count 1 % CBC W AUTOMATED DIFFERENTIAL   Collection Time: 12/05/23  7:33 AM Result Value Ref Range   WBC COUNT 4.3 3.7 - 11.1 K/uL   Red blood cells count 2.76 (L) 3.60 - 5.70 M/uL   Hgb 7.7 (L) 11.5 - 15.0 g/dL   Hematocrit 24.6 (L) 34.0 - 46.0 %   MCV 89 80 - 100 fL   RDW, RBC 19.6 (H) 12.0 - 16.5 %   Platelets count 145 140 - 400 K/uL   RBC's, nucleated 0 <=0 /100WC                Note Details  Author (M.D.) File Time 12/5/2023  3:25 PM Author Type Physician Status Signed Last Editor (M.D.) Specialty Hospital Medicine Admit Date 12/2/2023  ED to Hosp-Admission (Discharged) on 12/2/2023  ED to Hosp-Admission (Discharged) on 12/2/2023   Detailed Report  Note viewed by patient Additional Orders and Documentation   Results Imaging   Meds    Orders    Flowsheets   Encounter Info:  History, Allergies, Education, Care Plan, Detailed Report   Hospital Problem List   HTN (HYPERTENSION)  POSTPOLIOMYELITIS SYNDROME  HYPERLIPIDEMIA  HYPOTHYROIDISM  COVID-19 DISEASE  PREDIABETES Care Timeline  12/02   Admitted from ED (Observation) 1536 12/05   Discharged 1612  Discharge   Home with Home Health   Discharge Instructions (AVS) (Printed 12/5/2023) Medication List at Discharge   amlodipine besylate 5 mg Oral DAILY  ascorbic acid 500 mg Oral DAILY, AS PER PATIENT, AS A SUPPLEMENT  aspirin 81 mg Oral DAILY, AS PER PATIENT, TO PREVENT BLOOD CLOTS  atorvastatin calcium 20 mg Oral DAILY, to prevent heart attacks and strokes  beta-carotene(A)-vits C,E/mins,vit C/vit... 1 tablet Oral DAILY, AS PER PATIENT, AS A SUPPLEMENT  cefpodoxime proxetil 200 mg Oral 2 TIMES A DAY  famotidine 20 mg Oral DAILY  guaifenesin 600 mg Oral EVERY 12 HOURS  guaifenesin/dextromethorphan 10-100 mg/5 mL 10 mL Oral EVERY 4 HOURS AS NEEDED, for chest congestion. Do not exceed 6 doses in 24 hours  losartan potassium 50 mg Oral 2 TIMES A DAY, for Hypertension  NON-SYSTEM (SEE ADMIN INSTR) CALCIUM/MG/ZINC ( CALCIUM 333 MG, MG 133 MG, ZINCE 5 MG ,VIT D 5 MG ) 1 TABLET ORALLY AT NIGHT  AS PER PATIENT, AS A SUPPLEMENT