Age: 83.0
Sex: F
Vaccine: COVID19
Symptoms: Blood culture positive, Blood thyroid stimulating hormone normal, COVID-19, Clostridium test negative, Condition aggravated
Clinical narrative: Date of Admission: 10/17/2023   Date of Discharge: 10/22/2023   Issues to be Addressed at Follow-up:   Recovery from covid   Avoiding unnecessary antibiotics unless active infection.  Pt colonized with MDR organism       Pending Study Results at Discharge:      Unresulted Lab Orders    Date and Time Order Name Status Specimen Source   10/18/2023  9:41 PM BLOOD CULTURE 2 Preliminary BLOOD   10/18/2023  9:35 PM BLOOD CULTURE Preliminary BLOOD         Final Diagnoses:  Active Hospital Problems   Diagnosis   ? (Principal) UTI (URINARY TRACT INFECTION)   ? SEPSIS WO ACUTE ORGAN DYSFUNCTION   ? COVID-19 DISEASE   ? DIARRHEA     Resolved Hospital Problems No resolved problems to display.     Discharge Disposition:  Board and care     Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings:   Please see full H&P for details.   Briefly, this is a 85 Y F with paroxysmal atrial fibrillation on warfarin, CAD, hypertension ,  Bedbound at Assisted Living Facility, hx of recurrent MDR UTIs who is admitted for diarrhea  (Cdiff negative), poor PO intake, fevers.   Started on IV abx for MDR UTI but ID felt symptoms due to covid instead.        PRIMARY PROBLEM(S):     COVID-19 - Seen by ID Dr. who felt symptoms are due to covid instead of UTI.  Been on Remdesivir and not started on steroids as pt not hypoxic and also had possible UTI.   Been stable on RA.   Pt completed 5 days of remdesivir 10/22/23.         SECONDARY PROBLEM(S):   HX OF MDR UTI POSITIVE URINE CULTURE- was on IV Ertapenem for h/o MDR E. Coli.   Felt by ID to be contaminated sample and colonization.  Ertapenem stopped 10/20/23.   Due to patient's MDR organisms and colonization,  Recommend only give abx when pt has active symptomatic infections .        POSITIVE BLOOD CULTURE -  blood cultures with Staph epi and Staph capitis on 10/17.   Was on vanco.  Felt to be contamination by ID and vanco discontinued 10/20/23.  Repeat Cultures negative, echo negative for vegetations   Acute Community-Acquired Sacral Pressure  - noted. Seen by wound care.   - continue pressure relieving measures     DM2 - last HGBA1C 7 on 9/11/23 on diet control -  continue SSI prn - ADA diet   HYPERTENSION - stable  - continue norvasc, cozaar with holding parameters    H/o stroke - noted.  - cont asa/statin   Hypothyroidism  - recent TSH within normal limits  - cont levothyroxine      H/o Atrial fib - noted.  Not on rate control med -  Coumadin protocol   CAD  - noted - continue imdur, aspirin, statin     Procedures:  None     Reason for Hospital Admission (Admitting Diagnosis):    UTI (URINARY TRACT INFECTION)     If any narcotics was prescribed, I have consulted database prior to prescribing.      Complications: none   Consults:  HOSPITAL MEDICINE - INITIAL INPATIENT CONSULTATION. HOSPITAL MEDICINE - ONGOING INPATIENT CONSULTATION. INFECTIOUS DISEASE - INITIAL INPATIENT CONSULTATION. INFECTIOUS DISEASE - ONGOING INPATIENT CONSULTATION.   Smoker: No.   Condition on Discharge: stable   Code Status at Time of Discharge: DNR       Note Details  Author (M.D.) File Time 10/22/2023 10:07 AM Author Type Physician Status Signed Last Editor  (M.D.) Specialty Hospital Medicine Hospital Acct #  Admit Date 10/17/2023  Hospital Problem List   SEPSIS WO ACUTE ORGAN DYSFUNCTION  COVID-19 DISEASE  DIARRHEA  UTI (URINARY TRACT INFECTION) Care Timeline  10/17   Admitted from ED (Observation) 2306 10/22   Discharged 1531  Discharge   Assisted Living Facility or Board & Care or Residential Care   Discharge Instructions (AVS) (Printed 10/22/2023) Medication List at Discharge   acetaminophen 500 mg 1 tablet orally 4 times daily as needed for mild pain or fever over 100  amlodipine besylate 5 mg Oral DAILY  ascorbic acid 500 mg Oral DAILY, TAKE 1 TABLET ORALLY DAILY  atorvastatin calcium 40 mg Take 1 Tablet By Mouth Daily In The Evening (Note: This Medication Will Help Prevent Heart Attacks and Strokes)  blood sugar diagnostic Use 2 times a day as directed to measure blood sugar  calcium citrate/vitamin D3 315 mg-5 mcg (200 unit) 2 tablets Oral DAILY  docusate sodium 100 mg Oral 2 TIMES A DAY AS NEEDED  estradiol 0.01 % (0.1 mg/gram) Insert 0.5 grams vaginally 2 times a week at bedtime for 2 weeks  ferrous sulfate 325 mg Oral EVERY OTHER DAY  gabapentin 100 mg Take 1 capsule by mouth in the morning and 2 capsules at night for pain control. Do not give if the patient is sleepy, or confused.  isosorbide mononitrate 30 mg Oral EVERY MORNING, Hold for blood pressure below 120  L. acidophilus/L.bulgaricus 1 million cell 1 tablet Oral 3 TIMES A DAY WITH MEALS  lancets 30 gauge Use as directed  lancing device/lancets Use as directed  levothyroxine sodium 100 mcg Oral DAILY  losartan potassium 25 mg Oral DAILY  menthol/zinc oxide 0.44-20.6 % Topical 2 TIMES A DAY  riboflavin (vitamin B2) 200 mg Oral 2 TIMES A DAY  warfarin sodium 3 mg Take by mouth as directed by Anticoagulation Clinic