Age: 88.0
Sex: F
Vaccine: COVID19
Symptoms: Coronary artery disease, Dementia, Depressed level of consciousness, Differential white blood cell count, Fracture
Clinical narrative: Date of Admission  01/10/2022   Date of Discharge  01/20/2022   Reason for Hospitalization   decreased LOC/HYPOTENSIVE, BSG W/ EMS 93, RECEIVED 250NL NS BOLUS, PT RESPONSIVE TO VERBAL  Hospital Course    89-year-old female patient with past medical history of dementia, COPD, CAD.  Patient was presented to the hospital on 10 January with AMS and hypotension likely due to adrenal insufficiency and UTI.  Patient was found to have positive COVID-19, asymptomatic status post vaccination.  Her hospital course was complicated as having hemoglobin of 7 status post 1 unit of blood transfusion with good results.  Patient completed a course of antibiotics for questionable UTI.  To continue on prednisone 5 mg for adrenal insufficiency.  Patient did have erratic behavior during hospitalization with psychotic breakdown and agitation with concern of background history of Alzheimer's requiring a sitter.  Patient currently in integrative medicine pending Geri psych placement. patient discharged today in good condition to Geripsych facility.  Assessment:  #1  AMS, multifactorial, currently at baseline  -Likely due to history of dementia with adrenal insufficiency and questionable new UTI   #2  Adrenal insufficiency  -Patient on prednisone 5 mg from previous history   #3  Questionable UTI   #4  Asymptomatic COVID-19 positive  -Currently on room air, diagnosed on 8 January   #5  History of dementia with agitation and erratic behavior  -Patient had mood fluctuations with aggressive behavior toward her husband  Chronic condition:  COPD on Breo, CAD on aspirin Lipitor, depression on citalopram  Discharge Diagnoses      Anemia     CAD (coronary artery disease)     COVID-19     Dementia     Hip fracture     Hypokalemia     Hypotensive episode     Leukocytosis     Urinary tract infection     Orders:   predniSONE, 5 mg = 1 Tablet(s), Oral, Daily, # 30 Tablet(s), Refill(s) 0, Pharmacy: Pharmacy, 160, cm, 01/11/22 16:01:00, Height (cm), kg, 01/11/22 16:01:00, Weight (kg), 44  QUEtiapine, 12.5 mg, form: Tablet, Oral, q8h, PRN for Agitation, first dose 01/19/22 10:36:00   QUEtiapine, 12.5 mg = 0.5 Tablet(s), Oral, q8h, Scheduled / PRN PRN Agitation, # 30 Tablet(s), Refill(s) 0, Pharmacy:  Pharmacy, 160, cm, 01/11/22 16:01:00, Height (cm), kg, 01/11/22 16:01:00, Weight (kg), 44  umeclidinium, 62.5 = mcg 1 Inhalation, Inhalation, Daily, # 1 Each, Refill(s) 0, Pharmacy: Pharmacy, 160, cm, 01/11/22 16:01:00, Height (cm), kg, 01/11/22 16:01:00, Weight (kg), 44  CBC with Auto Differential  Comprehensive Metabolic Panel  Other Diagnoses   Ongoing  CAD (coronary artery disease)  Closed nondisplaced odontoid fracture with type II morphology  COPD with hypoxia  Dementia  HTN (hypertension)  Occlusion and stenosis of left vertebral artery  Traumatic closed displaced fracture of left shoulder with anterior dislocation  Historical  No qualifying data        Discharge Disposition  Nursing Home Placement-Return    Medications  New, Changed, or Refilled Medications  QUEtiapine (QUEtiapine 25 mg) 12.5 mg, 0.5 Tablet(s), Oral, q8h, for 30 day(s), PRN: Agitation, 30 Tablet(s), 0 Refill(s)    predniSONE (predniSONE 5 mg) 5 mg, 1 Tablet(s), Oral, Daily, 30 Tablet(s), 0 Refill(s)    umeclidinium (Incruse Ellipta 6 62.5 mcg, 1 Inhalation, Inhalation, Daily, for 30 day(s), 1 Each, 0 Refill(s)      Medications to be Continued  albuterol (ProAir HFA 90 mcg/in 180 mcg, 2 Puff, Inhalation, qid, 3 Each, 0 Refill(s)    aspirin (aspirin 81 mg oral del 81 mg, 1 Tablet(s), Oral, Daily, May restart on 8/20/20, 30 Tablet(s), 5 Refill(s)  Instructions:May restart on 8/20/20  budesonide-formoterol (Symbicor 2 Puff, Inhalation, bid, 0 Refill(s)    calcium carbonate (calcium (as 1,200 mg, 2 Tablet(s), Oral, Daily, 0 Refill(s)    citalopram (CeleXA 20 mg) 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    conjugated estrogens topical (P See Instructions, 1 g Vaginal twice weekly.  Instructions:1 g Vaginal twice weekly.  docusate (docusate sodium 100 m 100 mg, 1 capsule(s), Oral, bid, for 14 day(s), PRN: as needed for constipation, 24 capsule(s), 0 Refill(s)    famotidine (famotidine 20 mg) 20 mg, 1 Tablet(s), Oral, Daily, for 14 day(s), 14 Tablet(s), 0 Refill(s)    ferrous sulfate (ferrous sulfat 325 mg, 1 Tablet(s), Oral, Daily, 30 Tablet(s), 0 Refill(s)    lisinopril (lisinopril 5 mg) 5 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    simvastatin (Zocor 20 mg) 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    simvastatin (simvastatin 20 mg) 20 mg, 1 Tablet(s), Oral, At Bedtime, for 30 day(s), 30 Tablet(s), 5 Refill(s)    tiotropium (Spiriva HandiHaler) 18 mcg, Inhalation, Daily, 0 Refill(s)      Discontinued Medications  LORazepam (Ativan 0.5 mg) 0.5 mg, 1 Tablet(s), Oral, bid, 0 Refill(s)    albuterol-ipratropium (albutero 3 mL, Hi-Flow Neb, qid, 0 Refill(s)    benzonatate (Tessalon Perles 10 100 mg, 1 capsule(s), Oral, tid, PRN: as needed for cough, 0 Refill(s)    calcium carbonate-simethicone ( Oral, q2h, 0 Refill(s)    cranberry (cranberry) 400 mg, Daily, 0 Refill(s)    fluticasone (fluticasone CFC fr 110 mcg, 1 Puff, Inhalation, Daily, for 30 day(s), 1 Each, 5 Refill(s)    guaiFENesin (Mucinex 600 mg , e 600 mg, 1 Tablet(s), Oral, q12h, 0 Refill(s)    mirtazapine (Remeron 15 mg) 15 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    mirtazapine (mirtazapine 7.5 mg 7.5 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    phenylephrine topical (phenylep 1 Supp, Rectal, bid, for 7 day(s), PRN: Hemorrhoids, 7 Supp, 0 Refill(s)    warfarin (warfarin 1 mg) 1 mg, 1 Tablet(s), Oral, Daily, 30 Tablet(s), 0 Refill(s)       Physical Exam at Discharge  Vitals & Measurements  T: 36.4 °C  TMIN: 36 °C  TMAX: 37 °C  HR: 61  RR: 17  BP: 174/69  SpO2: 99%      General: Alert and appropriate Respiratory: Clear to auscultation bilaterally Cardiovascular: Normal Heart sounds Gastrointestinal: Soft Musculoskeletal: Normal range of motion Integumentary: Warm, Intact Neurologic: Awake, alert Psychiatric: Cooperative  Time Spent  I personally spent 31 minutes coordinating discharge including final face to face visit with patient and family, review of facility stay, discharge medication reconciliation, instructions for continuing care and discharge summary        Nursing/Other Orders   Regular Diet. Ordered on 01/11/22 11:31:00, Meal Start Time Breakfast 0700 to 0900   Aspiration Precautions. 01/11/22 6:24:00 q24h   Fall Precautions. 01/11/22 6:24:00 Order comment: Assess Fall Risk Score Qday; Orientation/clarity/mental status;patient stability during ambulation/transfer (ie., gait, balance, streng ); Effectiveness of safety interventions    Activity As Tolerated. 01/11/22 6:24:00, Continuous Order   Up to Chair. 01/12/22 14:58:00, Continuous Order, for meals   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)