Age: 92.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Asthenia, Blood bicarbonate increased, Blood calcium increased, Blood lactic acid normal, Blood pressure increased
Clinical narrative: Hospitalized twice (10.13.21; 10.18.21);  COVID-19 positive (10.13.21);  fully vaccinated  PRESENTING PROBLEM: COVID-19 virus infection [U07.1] COVID-19 [U07.1]   10.13.21 HOSPITAL COURSE: Patient is a 93 y.o. female who presented with weakness. PMHx of HTN, hypothyroid, Afib anticoagulated with coumadin . Patient presented with 2 week of hx progressive generalized weakness and fatigue. Denies focal weakness , numbness or tingling. Denies fall . Use walker at baseline to walk. States now with limited ability to stand or walk. She complained of decreased po intake due to loss of appetite. Recently she has been treated for a possible urinary tract infection. Patient presented at PCP office for ppm interrogation. When she returned home she was unable to stand due to too weak .   In ED covid testing positive. She was not hypoxic . Calcium level elevated at 11.2 other electrolytes normal . Baseline ckd troponin elevated at 30  with delta rise of 4 . Hgb stable 13.6. ct head unremarkable, cxr wit stable chest .   Patient was admitted for management of generalized weakness. She remained on room air. She did not qualify for Covid treatment. She was evaluated by PT OT and was recommended home with assist with home health and 24 hour supervision by family for atleast a week after discharge. Patient's daughter at bedside agreed to provide the above care. She was discharged home in stable condition. 10.18.21 HISTORY OF PRESENT ILLNESS: Patient is a 93 y.o. female who presents today with weakness and fatigue. Daughter is present at the bedside. Patient was in the hospital last Wednesday overnight for fatigue and weakness that started the beginning of October. She had a UTI and was placed on antibiotics. She was struggling to get up and had a hard time on and off. She got tested at the hospital and was COVID positive but family thinks that she was having COVID even prior to her admit. She did get her COVID vaccines x 2 but did not yet get the booster. She lives at independent living at discharge. She has had children staying with her. On Saturday daughter at bedside was with her and she was up and able to walk to the bathroom. She was not eating much or drinking much. Last night her son was with her and she was up almost every hour and she had frequency and incontinence which is not normal for her. She also had a fall with her son last night around 10pm. She had a skin tear to her neck, arms and bruising on her arm and hip. She is on coumadin. She was unable to get up on her own and family is having a hard time caring for her at home so they brought her back in. Per daughter she has been more awake the last few hours than she has been all day. Daughter notes that she is not having a cough or respiratory complaints. Her oxygen has been stable the whole time per daughter. ROS and medical history reviewed with family.  In the ER patient was noted to have UA that was positive she was started on rocephin and IVF. Her renal function was near baseline. She had Ca 13 up from 10.5 the other day. Her bicarb was 33 today. Initial lactic acid was 2.9. She did not meet sepsis criteria. She had normal HR, normal WBC and was afebrile. She had an INR 2.5 and Hgb 12.9. She had elevated BP in the ER but improved now though still high. Due to her fall she had extensive imaging in the ER. XR of the right elbow negative for acute fracture. CXR negative for acute process. CT cervical spine and CT head negative for acute process. EKG showed ventricular paced rhythm with LVH. She will be admitted to the hospitalist team for generalized weakness, hypercalcemia, UTI and COVID.