Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Asymptomatic COVID-19, Blood creatinine increased, Blood loss anaemia, Cardiac stress test abnormal, Clostridium difficile colitis
Clinical narrative: Patient ID:   70 y.o.    Admit Date:  7/18/2022   Discharge Date:   8/9/2022   Discharge Diagnosis:  Principal Problem:   Septic shock Active Problems:   NSTEMI (non-ST elevated myocardial infarction)   Acute renal failure with acute tubular necrosis superimposed on stage 4 chronic kidney disease   Atonic bladder   Severe protein-calorie malnutrition   UTI (urinary tract infection) due to urinary indwelling Foley catheter   COVID-19 virus infection   Acute blood loss anemia   C. difficile colitis   Retained ureteral stent   Type 2 diabetes mellitus, without long-term current use of insulin   Essential hypertension     Hospital Course:  70 year old female with atonic bladder was admitted initially for acute on chronic renal failure with Cr 3.4. She was initially treated with antibiotics. She was transferred to ICU for developing septic shock. She required vasopressors. Due to anemia nad shock, ASA and Plavix were stopped. Foley was maintained. She had NSTEMI. She became very weak from this. She finally improved and was transferred to the floor but later developed C diff colitis and was treated for that with oral Vancomycin, She was started on PT and OT. Stress test on 8/6 show LVEF 65%. TTE on 7/19 showed it to be 30-35%. Dr. reviewed the films and decided she does not require Life Vest for now. Hgb is stable at 8.6. Renal function stable with Cr 2 today. She has been accepted at a HCF for rehab and the family agreed. She will be transferred there today. She initially tested (+) for Covid-19 on admission and is still testing (+) today even though she is asymptomatic. She will be transferred today. Total discharge time >30 minutes. Patient educated on appropriate level of care post-discharge. Follow up with nephrology and cardiology.   Physical Exam on the day of discharge: Last Recorded Vital Signs: Temp: 97.6 °F (36.4 °C) Heart Rate (Monitor): 100 Pulse: 104 BP: 134/65 Respirations: 15 SpO2: 99 % O2 Flow Rate (l/min): 3 l/min General Appearance: no distress  Eyes: PERRLA ENT: moist mucus membranes, no adenopathy Lungs: clear to auscultation bilaterally  Heart: regular rate and rhythm Abdomen: soft, non-tender  Skin: No rashes or lesions  Extremities: no edema Neuro: alert   Consults:  IP CONSULT TO UROLOGY IP CONSULT TO NEPHROLOGY IP CONSULT TO SOCIAL WORK IP CONSULT TO WOUND CARE IP CONSULT TO INFECTIOUS DISEASES IP CONSULT TO INFECTIOUS DISEASES IP CONSULT TO CARDIOLOGY IP CONSULT TO VASCULAR SURGERY IP CONSULT TO GASTROENTEROLOGY IP CONSULT TO WOUND CARE IP CONSULT TO WOUND CARE IP CONSULT TO DIETARY IP CONSULT TO SUPPORTIVE CARE SERVICES IP CONSULT TO SOCIAL WORK IP CONSULT TO GASTROENTEROLOGY IP CONSULT TO SUPPORTIVE CARE SERVICES IP CONSULT TO PASTORAL CARE   Significant Diagnostic Studies:   CT abdomen and pelvis, VQ scan, TTE, stress teat   Operations: EGD, colonoscopy   Disposition:  SNF   Discharge Condition:  Fair    Discharge Medications:   Current Discharge Medication List   START taking these medications   Details midodrine (PROAMATINE) 5 mg tablet 3 Tabs by Per Tube route Three times a day. Refills: 0   Associated Diagnoses: Acute blood loss anemia   torsemide (DEMADEX) 10 mg tablet Take 1 Tablet by mouth Once Daily. Refills: 0   Associated Diagnoses: Acute blood loss anemia     CONTINUE these medications which have NOT CHANGED   Details simvastatin (ZOCOR) 40 mg tablet Take 1 Tablet by mouth At bedtime. Qty: 30 Tablet, Refills: 5   Associated Diagnoses: Hyperlipidemia, unspecified hyperlipidemia type   sertraline (ZOLOFT) 50 mg tablet Take 50 mg by mouth Once Daily.   clopidogreL (PLAVIX) 75 mg tablet Take 1 Tablet by mouth Once Daily. Qty: 90 Tablet, Refills: 3   Associated Diagnoses: NSTEMI (non-ST elevated myocardial infarction)   folic acid (FOLVITE) 1 mg tablet Take 1 Tablet by mouth Once Daily. Qty: 90 Tablet, Refills: 3   Associated Diagnoses: Chronic generalized abdominal pain; Folic acid deficiency   magnesium chloride (SLOW-MAG) 64 mg DR tablet Take 1 Tablet by mouth Twice a day. Qty: 60 Tablet, Refills: 2   Associated Diagnoses: Hypomagnesemia   famotidine (PEPCID) 20 mg tablet Take 1 Tablet by mouth At bedtime. Qty: 90 Tablet, Refills: 3   Associated Diagnoses: Gastroesophageal reflux disease without esophagitis   iron polysaccharides (NIFEREX) 150 mg capsule Take 1 Capsule by mouth Once Daily. Qty: 30 Capsule, Refills: 3   Associated Diagnoses: Other iron deficiency anemia   sodium bicarbonate 650 mg tablet Take 1 Tablet by mouth Twice a day for 90 days. Qty: 270 Tablet, Refills: 3   Associated Diagnoses: Metabolic acidosis   levothyroxine (SYNTHROID) 150 mcg tablet Take 1 Tablet by mouth Once Daily for 30 days. Qty: 90 Tablet, Refills: 3   Associated Diagnoses: Acquired hypothyroidism   pantoprazole (PROTONIX) 40 mg DR tablet Take 1 Tablet by mouth Twice a day. Qty: 180 Tablet, Refills: 3   Associated Diagnoses: Gastroesophageal reflux disease with esophagitis without hemorrhage   dicyclomine (BENTYL) 20 mg tablet Take 1 Tablet by mouth Before meals. Qty: 270 Tablet, Refills: 3   Associated Diagnoses: Chronic generalized abdominal pain   isosorbide mononitrate (IMDUR) 30 mg CR tablet Take 1 Tablet by mouth Once Daily. Qty: 90 Tablet, Refills: 1   Associated Diagnoses: NSTEMI (non-ST elevated myocardial infarction); Hypotension due to drugs   insulin aspart U-100 (NOVOLOG) 100 unit/mL injection Administer 0.02 mL subcutaneously As directed. Refills: 0   Associated Diagnoses: Type 2 diabetes mellitus with hyperglycemia, without long-term current use of insulin   nitroglycerin (NITROSTAT) 0.4 mg SL tablet Take 1 Tablet sublingually Every 5 minutes as needed for Chest pain. Qty: 25 Tablet, Refills: 5   Associated Diagnoses: Stable angina pectoris; Coronary artery disease involving native coronary artery of native heart without angina pectoris   insulin glargine (LANTUS) 100 unit/mL injection Administer 10 Units subcutaneously At bedtime. QAM & QHS   !! Miscellaneous Medical Supply Misc 1 Each Daily. Nocturnal hallucinations  Check  Nocturnal pulse ox.x  8 hours. Med assist ( please fax to them) Qty: 1 Each, Refills: 0   Associated Diagnoses: Substance or medication-induced psychotic disorder, with hallucinations   Insulin Needles, Disposable, (BD ULTRA-FINE MINI PEN NEEDLE) 31 gauge x 3/16" Ndle 1 Each Four times a day as needed. Qty: 140 Each, Refills: 11   Associated Diagnoses: Uncontrolled type 2 diabetes mellitus with hyperglycemia; DM type 2, goal HbA1c < 7%   Lancets Misc 1 Each Before meals and at bedtime. Qty: 150 Each, Refills: 11   Associated Diagnoses: Uncontrolled type 2 diabetes mellitus with hyperglycemia; DM type 2, goal HbA1c < 7%   !! Miscellaneous Medical Supply Misc 1 Each Daily. Hospital bed, automatic with HOB at  30 degrees at all times, due to risk GERD aspiration Qty: 1 Each, Refills: 0   Associated Diagnoses: Gastroesophageal reflux disease with esophagitis without hemorrhage; Debilitated; Decreased mobility; Orthopnea; CRF (chronic renal failure), stage 4 (severe); Other osteoarthritis involving multiple joints; History of non-ST elevation myocardial infarction (NSTEMI); Coronary artery disease involving native coronary artery of native heart, angina presence unspecified   Blood Sugar Diagnostic Strp After meals & at bedtime. One touch vera  strips Qty: 150 Strip, Refills: 11   Associated Diagnoses: Uncontrolled type 2 diabetes mellitus with hyperglycemia   !! Miscellaneous Medical Supply Misc 1 Each Daily. Wheelchair  For  Decrease mobility Qty: 1 Each, Refills: 0   Associated Diagnoses: Decreased mobility   blood-glucose meter (ONETOUCH VERIO FLEX START) Kit 1 Kit Before meals and at bedtime. Has coupon Qty: 1 Each, Refills: 0   Associated Diagnoses: Uncontrolled type 2 diabetes mellitus with hyperglycemia    !! - Potential duplicate medications found. Please discuss with provider.   STOP taking these medications     nitrofurantoin, macrocrystal-mono, (MACROBID) 100 mg capsule Comments:  Reason for Stopping:        hydrOXYzine pamoate (VISTARIL) 25 mg capsule Comments:  Reason for Stopping:        Cholecalciferol, Vitamin D3, (VITAMIN D3) 1,000 unit Cap Comments:  Reason for Stopping:        carbamide peroxide (DEBROX) 6.5 % otic solution Comments:  Reason for Stopping:        furosemide (LASIX) 40 mg tablet Comments:  Reason for Stopping:        metoprolol (TOPROL-XL) 100 mg XL tablet Comments:  Reason for Stopping:        ipratropium-albuteroL (DUO-NEB) 0.5 mg-3 mg(2.5 mg base)/3 mL nebulizer solution Comments:  Reason for Stopping:        cyanocobalamin (VITAMIN B-12) 1,000 mcg/mL injection Comments:  Reason for Stopping:        aspirin 81 mg tablet Comments:  Reason for Stopping: