Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Blood sodium decreased, Blood urea normal, COVID-19, Capillary nail refill test, Chest X-ray abnormal
Clinical narrative: "Hospitalized (1.8.22 - 1.12.22); COVID-19 positive (1.8.22); fully vaccinated PLUS Booster - moderna x3 d/c summary: Discharge Summary PA-C (Physician Assistant-Certified) ? ? Vascular Surgery Cosigned by: MD, PhD at 1/18/2022  9:46 AM Vascular Discharge Summary    BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider: DO Admission Date: 1/8/2022 Discharge Date: 01/12/2022 Presenting Problem: COVID-19    Active Hospital Problems   Diagnosis Date Noted POA ? COVID-19 01/09/2022 Unknown   Resolved Hospital Problems No resolved problems to display.    Pre-Existing Active Problems   Diagnosis Date Noted POA ? Pancreatitis 01/07/2022 Unknown ? Arterial occlusion, lower extremity 12/27/2021 Unknown ? Limb ischemia 12/27/2021 Unknown ? Vomiting 03/11/2019 Unknown     Discharge Disposition:  skilled nursing facility      Active Issues Requiring Follow-up Drains at D/C: None Wounds at D/C: none    DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute diarrhea [R19.7] COVID-19 virus infection [U07.1] COVID-19 [U07.1]   ADMISSION CONDITION: Stable DISCHARGE CONDITION: Stable   INDICATION FOR ADMISSION: COVID-19 infection, transferred from SAR to ED due to inability of SAR to care for COVID-19 patients.    HOSPITAL COURSE: He was admitted after he was transferred back to the hospital for COVID-19 infection. He reportedly had diarrhea associated with his COVID infection. On admission, he denied any issues including abdominal pain, chest pain, lower extremity pain, shortness of breath, and worsening diarrhea. He had no issues on admission and his diarrhea resolved. He was discharged to a in stable condition SAR on 1/12.    Pulse exam on discharge: DP/PT signals to RLE, PT signal to LLE    Surgical planning and timeline: No    Quality Measures. Patient has the following risk factors for contrast induced nephropathy (CIN): not applicable for this patient.   CONSULTS: none   SIGNIFICANT DIAGNOSTIC STUDIES: none   PROCEDURES: none   PATIENT INSTRUCTIONS: Activity: early progressive mobility  Diet: dysphagia diet  Wound Care: Instructions given Drain Care: Instructions given  H&P: Attestation signed by MD at 1/9/2022  8:26 AM I discussed the history/exam with the resident.  I agree with the findings and the Plan of Care as documented in the resident's note.  Patient was discharged on Friday after hospitalization for acute limb ischemia.  He began having diarrhea at the care facility and COVID-19 testing was performed which was positive for COVID-19.  That facility has no isolation rooms and therefore the patient was transferred back to the emergency department as he would need to be admitted to a different facility.  There is no concern for vascular insufficiency but given that our hospitalist team was overwhelmed last evening and the patient was known to our service, we admitted the patient to help expedite care and will plan to transfer the patient wants a new facility is identified.    Expand All Collapse All     Hide copied text  Hover for details  Vascular Surgery History and Physical   CHIEF COMPLAINT: COVID-19     Assessment/Plan     ASSESSMENT / PLAN: 83 year old male with COVID 19 infection   Plan:  - admit to vascular service  - Imodium PRN for diarrhea - care management consult for COVID facility placement   COVID 19 - no respiratory symptoms - diarrhea   Acute limb ischemia- resolved - recently admitted for LLE acute limb ischemia, treated with thrombolytics, transitioned to eliquis, will continue   Acute pancreatitis - resolved - seen by GI while inpatient           Subjective     HISTORY OF PRESENT ILLNESS: Patient is a 83 y.o. male who presents today with COVID 19 infection.  Patient was recently admitted for left lower extremity ischemia which was treated with thrombolytics.  Patient is extremely hard of hearing without his hearing aid.  Communication was difficult during the encounter.  But he denies pain in the lower extremities, he is neuro intact, no motor or sensory deficits.  He denies respiratory illness, denies cough, fever and SOB.  Reportedly, he was said to have diarrhea at the facility.  He has a left PT signal and right DP and PT signals, which is the same as when he was discharged.     Patient Active Problem List Diagnosis ? Vomiting ? Arterial occlusion, lower extremity  ? Limb ischemia ? Pancreatitis ? COVID-19 OBJECTIVE: BP 137/78  | Pulse 80  | Temp 36.7 °C (Oral)  | Resp 26  | SpO2 97%    Physical Exam HENT:     Head: Normocephalic.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Comments: Audible signals in his right DP and PT, left PT  Pulmonary:     Effort: Pulmonary effort is normal.  Abdominal:     Palpations: Abdomen is soft.     Tenderness: There is abdominal tenderness.     Comments: Mild tenderness to palpation   Musculoskeletal:        General: Normal range of motion.  Skin:    General: Skin is warm and dry.     Capillary Refill: Capillary refill takes less than 2 seconds.  Neurological:     General: No focal deficit present.     Mental Status: He is alert.