Age: 92.0
Sex: M
Vaccine: COVID19
Symptoms: Anion gap, Anticoagulant therapy, Arrhythmia, Asthenia, Bladder catheterisation
Clinical narrative: Hospitalized (1.12.22 - 1.18.22); COVID-19 positive (1.12.22); fully vaccinated PLUS Booster - moderna x3 D/c summary: Discharge Summary General Medicine Hospitalist Discharge Summary    BRIEF OVERVIEW: Admission Date: 1/12/2022 Discharge Date: 01/18/2022      Active Hospital Problems   Diagnosis Date Noted POA ? Enterococcus faecalis infection 01/18/2022 Unknown ? UTI (urinary tract infection) 01/18/2022 Unknown ? COVID-19 01/12/2022 Yes ? Generalized weakness 01/12/2022  PRESENTING PROBLEM: Acute cystitis with hematuria COVID-19 Generalized weakness Proctitis HOSPITAL COURSE:   Patient is 92M who presented to the ED with cough, fever, and generalized weakness. Patient has hisetory of dementia, baseline oriented x2, deaf and blind. He has history of urinary retention s/p SPC. In the ER, UA was collected showing evidence of infection for which he was started on Rocephin. He tested positive for COVID 19 and noted to be fully vaccinated and boosted. CXR was unremarkable and patient was not hypoxic, thus did not qualify for Decadron or Remdesivir. Patient's home care was unable to resume care due to postiive COVID status, so was admitted for further monitoring.    Urine culture grew E faecalis so he was treated with Ampicillin (discharged on amoxicillin) to complete 7 day course. Patient stayed inpatient until he could return to his facility with COVID precautions.  PT/OT recommended discharge to extended care facility. He was discharged back to his independent living facility with escalated home care     BP 117/64  | Pulse 102  | Temp 36.3 °C (Axillary)  | Resp 18  | Ht 1.82 m  | Wt 79.7 kg  | SpO2 90%  | BMI 24.06 kg/m²    Physical Exam Vitals and nursing note reviewed.  Constitutional:      General: He is not in acute distress. HENT:     Head: Normocephalic and atraumatic.     Mouth/Throat:     Mouth: Mucous membranes are dry.  Eyes:     Conjunctiva/sclera: Conjunctivae normal.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.  Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: No wheezing or rhonchi.  Abdominal:     General: Bowel sounds are normal. There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness. There is no guarding.  Musculoskeletal:        General: No swelling.  Skin:    General: Skin is warm and dry.     Capillary Refill: Capillary refill takes less than 2 seconds.  Neurological:     Mental Status: He is alert.     Comments: Oriented to person and place   H&P:  CHIEF COMPLAINT: COVID-19     Assessment/Plan    ASSESSMENT / PLAN: # COVID-19 with Generalized Weakness -tested positive (1/12/22) and fully vaccinated (booster with Moderna 11/5/21) -CXR without acute findings and no hypoxia              -monitor for development of respiratory decline              -no indication for decadron or remdesivir at this time              -PT/OT, consulted    # History of Urinary Retention with Suprapubic Catheter -Cystoscopy and placement of SPC (8/2020 with Dr.) -foley exchanged in ED (1/12/22) with UA demonstrating WBC, no nitrite              -follow urine culture and will obtain peripheral cultures x2              -Oxybutynin (5 mg BID), Flomax (0.4 mg HS),               -given reported fever will continue antibiotics with Rocephin (1 gm IV daily)   # Paroxysmal Atrial Fibrillation -not on any rate controlling medication and obtain EKG as appears irregular -PAF going back to 2018 and decision made in the past not to start anticoagulation due to fall risk   # Dementia -advance directive in chart and reviewed (DNR/DNI) -clear diet and will have SLP evaluate for advancement of oral intake   # Normocytic Anemia -Hgb baseline 11-12 and stable -monitor CBC q72 hours while on Lovenox   # Depression with Insomnia -Obtain EKG and if QTc not prolonged continue home Trazodone (50 mg HS) and Celexa (10 mg HS)   Telemetry: rates stable and therefore not indicated VTE prophylaxis: lovenox give COVID-19 Nutrition: clears and SLP consulted Code Status: DNR/DNI (advanced directive in place HISTORY OF PRESENT ILLNESS: Patient is a 92 y.o. male who presented to ED today due to cough, fever and generalized weakness. Per report to ED by spouse, patient is normally oriented x2 with confusion at baseline, he is also blind and deaf. Patient noted to have a suprapubic catheter and UA was initially obtained but when foley was last changes was not known. Patient was given dose of Ciprofloxacin prior to foley exchange, after which UA was repeated. Patient tested positive for COVID-19 and was noted to be fully vaccinated including having received his booster. CXR was unremarkable and patient without hypoxia. Lab work was largely unremarkable. Patient lives at home and receives 2 hour in home care. However, patients home care refused continued care at this time for patient due to COVID-19 (+) status and therefore patient being admitted until safe discharge plan can be arranged. Patient seen upon arrival to medical unit. No family at bedside and patient with noted dementia and unable to provide any reliable history. Denies any concerns.  OBJECTIVE: BP 126/56  | Pulse 78  | Temp 37.6 °C (Oral)  | Resp 14  | Wt 79.7 kg  | SpO2 95%  | BMI 23.83 kg/m²    Physical Exam Vitals and nursing note reviewed.  Constitutional:      General: He is not in acute distress.    Appearance: He is not toxic-appearing or diaphoretic.  HENT:     Head: Normocephalic.  Cardiovascular:     Rate and Rhythm: Normal rate. Rhythm irregular.  Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: No wheezing.  Abdominal:     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness. There is no guarding.  Musculoskeletal:     Right lower leg: No edema.     Left lower leg: No edema.  Neurological:     Mental Status: He is alert.     Comments: Knows he is here, but not aware he is in the hospital, unable to correctly state current month, but able to state his own name  Psychiatric:        Behavior: Behavior normal