Age: 84.0
Sex: F
Vaccine: COVID19
Symptoms: Constipation, Coronary artery disease, Cough, Depression, Diastolic dysfunction
Clinical narrative: 10/25--cough and runny nose 10/26--shortness of breath (today) seemingly associated with stuffy nose.  Very weak, much worse than baseline.  Granddaughter-in-law says that she was having hard time even moving her feet after she stood up.  At baseline she needs help getting out of a chair and is standby assist for walking.  No falls as the granddaughter in-law studied her.  Eating well.  Granddaughter lawn notice that she seemed to have trouble breathing this morning.  She asked the patient if she wanted the doctor called and the patient said no, called the ambulance --so they did.   ER:  37.2, 87, 20, 190/71, 96% room air.  COVID test positive.  CMP, CBC normal.  CXR:  NAD.   Patient is being admitted observation for profound weakness.  Granddaughter in-law adamantly opposed to Remdesivir.  Does not believe she has COVID in asked for 2nd test.   ROS:  10 point review of systems negative except as outlined in history of present illness   Exam 37.2, 58, 16, 156/60, 94% room air General:  WDWN, NAD. HEENT:  EOMI, PERRLA, TMs intact, septum midline, oropharynx w/o erythema or exudate, MM moist. Neck:  no masses, JVD, bruits, thyromegaly Heart:  RRR, no S3/S4/m Lungs:  CTA, no rales, ronchi, wheeze Abd:  Soft, NDNT, no G/R/R/M/B  No organomegaly Ext:  No C/C/E Neuro:  CN 2-12 intact, No focal deficites Psych:  Calm, cooperative Skin:  no rashes or open sores MSK:  Generally very weak.  Cannot sit forward in bed w/o assisstance.  Can lift legs off bed about 1 inch.  Dorsi- and planrarflexors are 5/5, though.  Grips 5/5.   Labs:  Reviewed   CXR:  Moderate cardiomegaly with LV configuration.  Indistinct hila and mild chronic disease.  No consolidative opacity, pleural fluid or pneumothorax.  Degenerative changes of the shoulders and spine.   IMPRESSIONS/PLAN   1. Profound weakness.  Obtain film array, UA, PCT, magnesium.  PT/OT evaluations.   2. Rapid COVID test positive.  Not hypoxic.  CXR does not show GGO.  Sx day #2.  Will obtain film array as family requests repeat test and to r/o other viral illnesses.  Introduced monoclonal antibodies to the patient.  We will rediscuss if the 2nd test is positive.  Discussed Remdesivir.  I do not think the granddaughter-in-law changed her mind. Moderna vaccine 2/10/21 and 3/10/21.     3. CAD.  Continue aspirin, statin, beta-blocker, Imdur.  Lexiscan Myoview 2016:  No ischemia, old apical inferolateral infarct.  Echo 2016:  EF 60%, mild concentric LVH, diastolic dysfunction, LA mildly dilated.  I cannot find a heart cath anywhere, although Epic states she had a heart cath with a stent at some point in time..   4. HTN.  Coreg 6.25 mg 2 times a day, Imdur 30 mg daily   5. Chronic pain.  Tylenol 500 mg 3 times a day.   6. GERD.  Protonix 40 mg daily.   7. Tremor.  Mysoline 100 mg a.m., 150 mg bedtime   8. Chronic constipation.  MiraLax 17 g 2 times a day.   9. Hypothyroidism.  Synthroid 88 mcg daily.  TSH 5/8/2021 normal.   10. Anxiety/depression.  Effexor XR 150 mg daily, does a role 100 mg at bedtime.   11. History of vascular dementia (per chart.)  Patient is her own decision maker.       DVT Prophy:  Lovenox Code Status:  DNR