Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: Anticoagulant therapy, Bacteraemia, Blood albumin decreased, Blood culture positive, Blood sodium increased
Clinical narrative: INPATIENT/OBS CLINICAL REVIEW  9/4/23: Covid 19 detected. Temp max 99.9, BP 154/127, O2 at 15 liters via Oxymizer. Trop 1,054 trending down. Gamma Interferon/Blood and Respiratory Cultures pending. NPO, Heparin gtt, IV Dexamethasone, IV Antibiotics, IV Ativan, and IVF. ST eval for swallowing. Cardiology consult. Attempted to call pt over the phone, Staff RN answered and mentioned that pt is non verbal. Permission granted to call caregiver. Caregiver mentioned that pt is being followed by clinic. Caregiver stated they are working for increasing hours and request to call first for information with clinic. Updated Caregiver for the plan and anticipated DCP, denies any other needs at this time. RN  9/4/2023 11:39 AM  9/5/23: Temp max 99.4, O2 @ 95% ON 5 LPM via Reservoir NC.  Blood Cultures 1/2 with Bacteremia,  Na+ 154, ALB 2.8, LFT's trending down. D5W IVF, IV Vanco and IV Remdesivir ordered.  Continues with IV Flagyl, IV Dexamethasone, Nebs RTC and wean O2 as tolerated and follow final Cultures. Left a voice message to clinic for a call back. MSW consult for safe dispo for higher level of care needs. RN  9/5/2023 12:14 PM  Addendum: Received a call back from clinic CM, updated with the plan. CM mentioned that pt will go back home at DC and will discuss with pt for additional hours  Caregiver if he will be agreeable . CM also mentioned that will need a meeting with MSW prior to DC. MSW informed. RN  9/5/2023 1:46 PM 9/6/23: Pt is afebrile, O2 weaning to 3 lpm via RNC. Na+ 152, LFT's trending down. Per MD, IV Antibiotics, IV Dexamethasone, IV Remdesivir and follow Infection work up. RN  9/6/2023 2:07 PM   09/07/2023 Covid isolation observed. Per MD pt is not medically stable for DC today. Cont on IV abx, ceftriaxone, dexamethasone, remdesivir, doxycycline, flagyl, contiues iv fluids. Called pt caregiver, for update,  call back number left to VM. RN  9/7/2023 4:03 PM 09/08/2023 Covid isolation observed. Remain on iv abx, ceftriaxone, doxycycline, flagyl, remdesivir, continues IV fluids D5W at 75ml/hr. Per MD, pt is not medically stable for discharge today. Plan for bronchoscopy today. Seen by OT yesterday for swallowing re eval, pt failed and recs continue NPO. Updated patient caregiver, regarding pt current treatment and dispo plan. Denies any other needs at this time. RN  9/8/2023 4:02 PM 9/9/23 Covid isolation,  Per BS not medically stable for discharge, Discussed with pt regarding OT's recommendation of NPO. Discussed NGT and possibility of PEG tube. Pt used alphabet board to say "let's wait". Pt will think about it and will readdress tomorrow." IVF, reservoir 02 5L IV Decadron, Pepcid, Abx and Decadron, nebulizers, SSI, Heparin, WBC 11.7 RN  9/9/2023 2:49 PM 9/10/23 Pt on Covid isolation so not seen by RN CM in room, 02 4L, declining feeding tube per Palliative Care, possible DNR per them after discussion with pt, sister and brother; IV Ativan x 2 on 9/9/23, IVF and IV Abx x 3, SSI, WBC 15.1 RN  9/10/2023 1:03 PM 9/11/23: Pt continue to require high flow O2. Palliative consulted, code changed to DNR. ST eval for swallowing. Per Palliative, pt sister hopes that pt can continue with high flow until she comes to get here in a few days. Continues with IV Antibiotics, IVF, Dexamethasone, Nebs RTC, and follow ST eval for swallowing. Palliative following. RN  9/11/2023 3:40 PM 9/12/23: O2 weaned off up to 4 lpm via Reservoir NC. Failed swallow eval by OT. TPN ordered. Started on  IV Voriconazole, continue with IV Antibiotics, IV Dexamethasone, IV Pepcid and IVF. ID and Palliative following. RN  9/12/2023 2:28 PM   ANTICIPATED DISCHARGE PLAN Home with HHRN         Case Manager to follow up:  -O2 weaning as tolerated -ID following -Palliative following -HHRN orders at DC. -Will need Pulse Oximeter at DC. -MSW consult for safe dispo for higher level of care needs. Will need a meeting with clinic CM prior to DC.  -CM       DME  -Recommended DME Needs: TBD   -DME Copay: No Copay     DME item      Deliver To: (Home, Hospital Room, B&C, etc)     Order date   Delivery date                    RNCM handout provided to patient: Yes, Date:9/4/2023 Best Practice Post Discharge Meal referral completed: Yes, Date:9/4/2023 letter: N/A letter last given: yes 09/08/23 Transitional Risk Score: Low    Anticipated Transportation for DC: Ambulance.    RN  9/12/2023 2:30 PM                       Note Details  Author (R.N.) File Time 9/12/2023  2:30 PM Author Type REGISTERED NURSE Status Signed Last Editor (R.N.) Specialty GENERAL, OTHER Hospital Acct # Admit Date 9/3/2023  ED to Hosp-Admission (Current) on 9/3/2023  ED to Hosp-Admission (Current) on 9/3/2023   Detailed Report  Note shared with patient Care Timeline  09/04   Admitted from ED 0132 09/08   Transferred to INTENSIVE CARE NURSE UNIT     Transferred out of INTENSIVE CARE NURSE UNIT   pt in house