Age: 83.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Blood sodium normal, Blood thyroid stimulating hormone, Blood urea increased, Blood urea nitrogen/creatinine ratio increased, Blood urine absent
Clinical narrative: Dr. note- PCP:  MD Chief Complaint:  Slurred speech HPI: PT is a 83 y.o. female with a history of DM, CKD, HTN, Hypothyroidism who presents with abnormal speech. Around 14:30 today she had sudden onset of slurred speech and problems getting the words out that she wanted to say. This was also associated with unsteadiness on her feet and mild confusion. She denies any headaches, vision changes, asymmetric neurologic weakness, paresthesia, facial droop. No recent illnesses, fevers, chills, cough, dyspnea, chest pain, nausea, vomiting, diarrhea. Denies having similar symptoms in the past. She came to the ED after a few hours of her symptoms not improving, where she was afebrile and hypertensive in the 160-190 systolic range. Her labs were unremarkable and a head CT was negative. She appeared to have dysarthria and expressive aphasia, thus she was given aspirin and placed in the hospital for further workup.  Assessment/Plan:  PT is a 83 y.o. female who presents with the following: 1. Stroke-Like Symptoms: - Concern for stroke/TIA. NIHSS = 2, due to aphasia and dysarthria.   Dr. note- Chief Complaint:  Weakness and slurred speech HISTORY OF PRESENT ILLNESS PT date of birth 9/7/1938, is a 83 y.o.female who presents to the Emergency Department with general weakness slurred speech.  Family brought the patient in who stated that she had sudden onset of some mild confusion slurred speech earlier today.  The patient is unsure exactly what time this started family is not currently with the patient.  She states she feels ?terrible."She also states that she was driving and in no and this was occurring but when did occur she was afraid she may run off the road hit another car she felt so bad.  She feels ?strange?.  She does not have any lightheadedness or dizziness but feel a squeezing like sensation everywhere.  She also states she has had difficulty getting her words out and slurring her words when she does speak.  - Place in observation and perform neuro checks per stroke protocol. - Place on aspirin 81 mg and Lipitor 40 mg. - Check CTA head/neck, carotid dopplers, brain MRI and TTE. - Lipid panel, B12, Folate, TSH. - Neurology consulted. PT/OT and speech therapy consulted.  2. Type II DM, Controlled: - Place on SSI and resume home Jardiance. - Recent A1C was 8.1%. 3. HTN, Benign: controlled. Use lisinopril in place of lotensin due to hospital formulary.  4. Hypothyroidism: resume synthroid, check TSH.  5. Obesity: Body mass index is 33.84 kg/m². Encourage weight loss.    Med Student note- PCP:  M Chief Complaint:  dysarthria HPI: 83 y.o., female with a history of Type 2 Diabetes Mellitus, Stage 3 chronic kidney disease, and hypertension who presents with generalized weakness and dysarthria. The patient reports that around 3 pm she had been driving to visit someone when she noticed a change and felt like she was accelerating and braking too fast, but didn't know if it was a problem with her or the vehicle. She returned home at that time and was on the phone with someone when they mentioned that her speech was different. Her granddaughter checked on her and also felt that her speech had changed, so they came to the ED at that time. She reports knowing what she would like to say but having difficulty saying it, and reports nausea and dizziness, but denied a headache, changes in her vision, changes in hearing, or chest pain.  COVID-19 vaccination status:  Vaccinated (1-7-21-, 2-4-21, and 11-5-21) COVID-19 test:  Negative today (11-28-21)