Age: 83.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Fibrin D dimer increased, Gastrostomy, Glycosylated haemoglobin increased, Heart valve calcification, Hypernatraemia
Clinical narrative: Patient with 2 COVID vaccines who admitted to hospital with COVID detected PCR.  Provider d/c note:  "Reason for Admission: From, NP 84-year-old male patient with past medical history of Alzheimer's dementia, advanced, cerebral infarction, subdural hematoma, dysphagia, gastrostomy tube, chronic obstructive pulmonary disease, hypertension, NSTEMI, diabetes mellitus type 2, BPH with urinary retention, indwelling Foley catheter, resident of Timbers skilled nursing facility, presented with worsening altered mental status   Brief Summary of Hospital Stay: (Include Significant Findings and Invasive Procedures) found to be hypernatremic on admission, pressure ulcer infection   Blood sugars on the high side , 250   PEG feeds changed to Glucerna gotCTA of the pulmonary artery rule out PE due to tachypnea, x2, negative Mild leukocytosis, improved at the time of discharge to 11 K  Failure to thrive, due to advanced Alzheimer's dementia On PEG feeds, dietitian following Hypernatremia resolved   Pressure ulcers Without evidence of osteomyelitis on MRI,  repeated for inadequate imaging due to motion artifact, repeat MRI from 10/18 shows no evidence of osteomyelitis On Zosyn and doxycycline, from 10/11 and 10/14 respectively wound care, discontinued antibiotics 10/20  Being discharged on oral Augmentin for 1 week   Leukocytosis- 13.4   COVID Off isolation, room air   History of subdural hematoma Staph epidermidis 1/2 blood culture positive from 10/06 follow-up blood cultures negative, most likely contaminant     DVT Evident on ultrasound imaging on admission, was discussed with family members, in the light of subdural hematoma it was decided not to anticoagulate the patient  10/19 has elevated D-dimer, had CTA 10/6 no evidence of pulmonary embolism   10/20 CTA pulmonary- No evidence of pulmonary embolism. 2.  Patchy consolidation within the left lower lobe and a few scattered tree-in-bud nodular opacities within the right lower lobe, suspicious for multifocal pneumonia including atypical etiologies. 3.  Extensive coronary artery and aortic valve leaflet calcifications. 4.  Incidental note of a 4.3 x 6.7 cm intramuscular lipoma within the right shoulder musculature with areas of calcification and a 2.0 cm soft tissue component posteriorly, raising concern for possible liposarcoma. Further evaluation with MRI without and  with contrast is recommended. 5.  Indeterminate left adrenal nodule and partially visualized probable right adrenal nodule. These could be further evaluated with adrenal protocol CT or MRI on a nonemergent basis.   Reviewed CTA pulmonary report with daughter, reassured that there is no PE however incidental finding of   Right shoulder 4.3 3 x 6.7 intramuscular lipoma, with possible concerns of liposarcoma, she is okay and agreed to have it worked up outpatient Urinary retention, chronic Foley 10/20 Will get CT of the pulmonary artery rule out PE due to tachypnea   Diabetes Last hemoglobin A1 c of 7.6, Lantus insulin, Glucerna tube feeds 10/18 increase Lantus insulin for  high blood sugars of 250       Iron deficiency anem Was treated with IV Venofer in the beginning,repeat iron parameters, high ferritin of 800, cannot give IV iron No evidence of overt bleeding   Kept daughter, guardian informed Got cognition to evaluation by speech, 10/20 however patient did not cooperate     Condition at the time of discharge Vss  Constitutional:  No distress HENT:  Normocephalic, Atraumatic, Normal oropharynx, Nose normal.  Cardiovascular:  Normal heart rate, Normal rhythm, No murmurs, No rubs, No gallops.  Respiratory:  Normal breath sounds, No respiratory distress, No wheezing, No chest tenderness.  GI:  Bowel sounds normal, PEG tube+ Soft, No tenderness, No masses, No pulsatile masses. , Foley catheter + Sacral wound noted ,  stage III bases appear clear, please see the picture from 10/nineteen wound care note Extremities:  Intact distal pulses, No edema, No tenderness, No cyanosis, No clubbing. .  Bilateral malleolar pressure ulcer, with clean base, Neurologic:  Alert & oriented x1  , No focal deficits noted. Skin:  Warm and dry   Issues Requiring Follow Up: (Who, what, when, and how communicated?)  Patient to follow-up with multiple specialist follow-up appointments fair med, For right shoulder lipoma/liposarcoma follow-up with general surgery, follow-up with Cardiology for calcification of coronaries, follow-up with Pulmonary Medicine for CT showing consolidation/atelectasis, follow-up with GI These appointments were made after discussing with the daughter, POA