Age: 82.0
Sex: M
Vaccine: COVID19
Symptoms: Clostridium difficile colitis, Clostridium difficile infection, Delirium, Disorientation, Dysphagia
Clinical narrative: Clinical Summary Patient is a 82 y.o. male patient with history of bladder cancer, HTN, HLD, CKD II, TIA. Presents with shortness of breath and weakness. COVID positive, s/p 10d isolation.  S/p remdesivir, CAP coverage, and steroid treatment. Weaned to RA from initial 5L requirement. Course complicated by recurrent c.diff infection, treating with vancomycin taper per ID. Palliative followed, patient qualifies for hospice and is s/p hospice informational visit this admission. Patient opts to pursue SNF. Discharged to facility.     Problem List Acute Hypoxic Respiratory Failure, resolved Covid-19 Virus Infection, improved  Secondary to COVID-19 viral infection with superimposed bacterial CAP, possible underlying pulmonary fibrosis Covid test (+) 9/6/22, isolation ended 9/13/22 Fully vaccinated   5L O2 via NC -- > SORA  S/p Remdesivir, Decadron, Rocephin, Zithromax  IS, pulm toilet, Duo-nebs Q6H PRN  Per Pulm: outpatient PFTs, repeat CT to follow up pulm infiltrates Discharged to SNF    Recurrent C.difficile Colitis Initial infection 6/3/22 without confirmed treatment  Again positive on 7/13/22 and s/p 14d PO vancomycin This admission, C. dif positive on 9/13/22 ID consulted: NAP-B1 PCR (+). Ongoing Vancomycin Taper.    Goals of Care Patient and family met with Palliative Care this admission  Patient does qualify for Hospice (pulm disease, dementia) Current goals of care: FULL code and SNF placment Discharged SNF placement    Severe malnutrition, POA Generalized weakness In the setting of bladder cancer 105 lb weight loss since 1/2021 Boost supplementation TID, regular diet Nutrition followed  Dementia Delerium Waxing and waning orientation to place, situation Likely delirium on underlying dementia  SLUMS score 10, FAST stage 7B; ambulation is lost   Recurrent Falls Prior admissions for presyncopal, syncopal events Likely due to poor PO intake at home PT following; AMPAC 13 SNF placement    Dysphagia Suspected Chronic Aspiration  CTPA demonstrates debris within distal esophagus Speech Pathology consulted: ground solids, thin liquids, small bites   Chronic Normocytic Anemia History of GIB Multifactorial: iron deficiency, anemia of chronic disease Admission Hgb 9.6, near b/l 10-11 in setting of IVF Daily CBC stable, no evidence of GIB this admit    Elevated troponin without evidence of cardiac ischemia Chronically elevated, flat on admission In setting of AKI, hypovolemia Asymptomatic, EKG without ischemia Okay to discontinue telemetry    Hyponatremia, resolved  Likely secondary to poor PO intake Na nadir 127, Na 135 wnl 9/19 BMP MWF    Bladder Cancer Oncologist: S/p transurethral resection Cystoscopy 05/22 negative 2 years of pembrolizumab (Keytruda) per Oncology Hypertension Hyperlipidemia Continue home atorvastatin Home lisinopril continued   Mediastinal and right hilar adenopathy Grossly stable from previous CTs, including June 2022  Suspected due to immunotherapy  Recent PET scan - no significant uptake Oncology considering referral to pulmonology if pt continues to have progressive cough and respiratory symptoms Recommend outpatient follow-up and monitoring