Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: Headache, Hypernatraemia, Hypokalaemia, Lung infiltration, Malaise
Clinical narrative: DISCHARGE DIAGNOSES:  Principal Problem:   Acute hypoxemic respiratory failure due to COVID-19 (HCC) Active Problems:   HTN (hypertension)   Intellectual disability   Cerebral palsy   Spastic paralysis   Dependent for wheelchair mobility   Quadriparesis (HCC)     DISCHARGE FOLLOWUP PLAN:  Followup with PCP in 2 wks , Eval if further cardiac eval needed, watch BP, update records w POLST, consider BMP recheck,  IMPORTANT PENDING TEST RESULTS: None CONSULTS: Pt OT dietary PROCEDURES PERFORMED DURING HOSPITALIZATION: none COMPLICATIONS IN HOSPITAL: None    HOSPITAL COURSE: Briefly, this is a 73 y.o., female, w a PMH of CP, intellectual disability, spatic paralysis, HTN, who was admitted on 1/15/2022, with hypoxia due to COVID19.. For more detail, including PMH, PSH, PFH, Social Hx and further info please see admission H&P.  Hospital course dictated by problem:  Acute hypoxemic respiratory failure due to COVID-19 (HCC) (1/15/2022)   Assessment: Vaccinated, last 3/2021, missed booster. Staff Report positive COVID 1/5/22- had mild cough prior. Sent from group home with being off x 2d, new SOB x1 day, patient complained of headache, fever. PTA chest pain,EMS spo2 85%, requiring 7 L while sleeping, CXR/CT bilateral infiltrates, elevated D-dimer 2.5, Pro-Cal low 0.1, no antibiotics indicated.  Treat with therapeutic Lovenox.  Supplemental oxygen was titrated off to remain on room air by time of discharge.  Did not need IV Lasix.  Stopped on time of discharge.  Follow-up with primary care.  Continue PTA DNR/DNI per guardian.Previously Vaccinated for COVID19, last shot, 3/2021, but had been scheduled for booster but became ill before, recommend boost in a few wks if remains afebrile, will follow-up with staff to get that rescheduled.    Intellectual disability ()  Cerebral palsy ()  Spastic paralysis ()  Dependent for wheelchair mobility (12/31/2020)  Quadriparesis (HCC) (4/25/2019)   Assessment: History of severe cognitive developmental delays Does best w yes/no answer.  In a group home.  Wheelchair-bound.  Requires assistance for all ADLs.  Standby transfer with belt. Able to feed self food minced. . Speak w pt. at HCF-PTA minced/ ? dysphagia diet was continued here..  Seen by PT OT as noted above.    HTN (hypertension) (3/31/2017)-maintained on PTA amlodipine, on time of discharge she was resumed on PTA lisinopril HCTZ.   Troponin elevation, mild CP was a presenting sx w COVID19 SOB.  ECG x2 nonischemic, trend trop-- > 33-- >16 with a 50% drop but could be appropriate for age.  Possible nonMI demand ischemia d.t covid19.  Has remained chest pain-free ever since.-1/17 echocardiogram normal EF 60-65%, no WMA.- outpt f.u w PCP, consider nuc stress   Hypothyroidism  -PTA Synthroid 150 daily   Constipation--PTA docusate 100 twice daily, fiber, senna 1 twice daily    Depression-PTA Wellbutrin continues   IDA-PTA iron 324 daily   Vit D deficiency- incr vitamin D here.  Reeval twice daily dosing outpatient.   Incidental renal cyst and nephrolithiasis-PCP follow-up for further evaluation and management.   Mild hypernatremia, resolved Mild hypokalemia, resolved  -Encourage nursing staff and CNA staff on ensuring adequate oral hydration for this patient.