Age: 84.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Lip pain, Lung infiltration, Nasal congestion, Oropharyngeal pain, Oxygen saturation decreased
Clinical narrative: Hospitalized 09/26/2021; COVID-19 positive 09/26/2021; fully vaccinated  Patient seen at Urgent care 09/26/2021 and transferred to Hospital ED   HISTORY OF PRESENT ILLNESS Patient is a 84 y.o. female who presents to the Urgent Care with Congestion (onset 4 days, along with headach and dyzziness.)     HPI: Patient is a 84 y.o. female with chronic obstructive pulmonary disease and significant cardiac history who presents to the UC with daughter for evaluation of cough, and dizziness.  Has had a cough for about a week, worsening.  No over the last 4 days she has also developed dizziness, fatigue, headache.  Has nasal congestion and sore throat.  States her mouth feels dry in her lips hurt.  Cough is with chest congestion, increased wheezing and shortness of breath, has tried inhalers for this without relief.  No vomiting, diarrhea or rash.  No leg swelling or leg pain.  Unknown if she has had fevers.  Daughter with similar symptoms.   84-year-old female with significant pulmonary and cardiac history here for cough x1 week and dizziness.  Significant signs of dehydration on exam.  Patients elevated temperature and tachycardia along with low oxygen saturation and abnormal lung sounds also raises concern for pneumonia. I feel patient is in need of further evaluation management than what can be performed in the urgent care setting, I am transferring patient to emergency department.  Daughter will drive, pre arrival placed.   Stable at discharge.   Hospitalization PRESENTING PROBLEM: Atrial fibrillation with rapid ventricular response (HCC) [I48.91] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is an 84-year-old female with history of atrial fibrillation, hypertension, chronic obstructive pulmonary disease, and TIA who presented to the emergency department with complaint of cough, dizziness, fatigue, and headaches.  She required 2 L of oxygen via nasal cannula.  COVID-19 PCR was positive.  Chest x-ray showed mild infiltrates bilaterally.  The patient was admitted to the hospitalist service.  She was started on Decadron and one dose of IV Lasix was given with good result. She was weaned to room air and feeling significantly improved. Ambulatory pulse ox stable on room air. She was seen by PT/OT and care management to arrange for HHC. She was discharged home in stable and improved condition on 9/28. Her daughter plans to stay with her upon discharge and can assist as needed. She will arrange post-hospital follow up with her PCP.   Urgent Care visit 10/3/2021  1. COVID-19  2. Diarrhea, unspecified type   Patient is an 84-year-old female no acute distress, soft blood pressure, a pulse of 101, afebrile, O2 saturation 99%.  She does have moist mucous membranes good skin turgor.  Due to her recent diagnosis of COVID-19, being hospitalized and recent diarrhea I do have concern for C difficile.  The fact that she is unable eat much and has no interest in drinking water makes me concern for progression of worsening symptoms at home.  I do recommend further evaluation in the emergency department and daughter is agreeable, will bring her to hospital.  ED visit  10/3/2021:  Patient had IV established she is given gentle IV hydration.  Laboratory studies did show low magnesium at 1.5.  Patient given 2 g of IV magnesium.  Stool studies are ordered and pending including ova and parasites, culture as well as C difficile toxin. Hemoglobin hematocrit are stable.  Patient was feeling markedly improved following IV fluids. Should be discharged home to continue with oral fluids, Imodium as needed and outpatient follow-up through primary care physician.  Patient should review stool study results with her primary care provider.  If she develops new or worsening symptoms she is encouraged to return to the emergency department for re-evaluation.  Discharged home in stable condition.