Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Intestinal ischaemia, Organ failure, Physical deconditioning, Sepsis, Small intestinal obstruction
Clinical narrative: Date of Admission: 9/7/2023   Date of Discharge: 9/18/2023   Issues to be Addressed at Follow-up: #C.DIFF - PO vanc through 9/19   #COVID - completed 3d RDV in the hospital and has also completed >10d of isolation    #DECONDITIONING - home health PT, family has been provided w resources for hired in home support. SW to follow w HH as well   Pending Study Results at Discharge:  Unresulted Lab Orders    No orders found from 8/19/2023 to 9/19/2023.       Final Diagnoses:  Active Hospital Problems   Diagnosis   ? C DIFFICILE INFECTION   ? COVID-19 DISEASE   ? HX OF SMALL BOWEL RESECTION   ? LONG TERM NON WARFARIN ORAL ANTICOAGULANT THERAPY       dabigatran (Pradaxa) 150 mg twice daily Indications:  Atrial Fibrillation  Expected length of therapy: Indefinite (Provider to assess risk vs benefits periodically)  Considerations: previously on warfarin     PHARMACY SERVICE    Periop Guideline Reference:      ? ATRIAL FIBRILLATION, UNSPECIFIED W PROTHROMBOTIC STATE     Resolved Hospital Problems   Diagnosis Date Resolved ? (Principal) C DIFFICILE COLITIS, NOT SPECIFIED AS RECURRENT 09/13/2023 ? SEVERE SEPSIS W ACUTE ORGAN DYSFUNCTION 09/17/2023     Discharge Disposition:  Home with Home Health   Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings: Per Dr's summary 9/14: 89 yo F with a history of AF on Pradaxa, prior endometrial cancer, prior breast cancer (status post left mastectomy with adjuvant tamoxifen and Arimidex, HLD recently admitted at the end of August for SBO status post urgent laparoscopic lysis of adhesions and resection of small bowel for ischemia ultimately discharged to complete course of antibiotics who then initially presented to hospital with diarrhea.  She was sent home with a prescription for Imodium but then was called since stool came back C. difficile positive.  Prescription was written for vancomycin p.o. and patient picked up on 9/5  but then came back to ED for worsening diarrhea and increasing weakness.  Patient was then admitted and treated with vancomycin 250 mg every 6 hours as well as Flagyl 500 mg IV every 8 hours.  Patient was also found to have COVID-19 with husband as exposure.  Flagyl was discontinued on 9/13 if patient continues to have loose stools and persistent weakness.  Regarding COVID-19, patient was given remdesivir but not hypoxemic so steroids were held.   I assumed care on 9/15 at which point patient was gradually improving. Over the remainder of her hospital course she continued on RA without shortness of breath. Her stools became soft/formed and less frequent and she was tolerating POs without difficulty, maintaining electrolyte balance within normal limits on labs. She was ambulatory with PT using a walker and standby assist, able to get up to commode and OOB to chair for meals, although she continued to feel quite weak and had difficulty getting to the commode in time when she did need to have a BM. She was kept in the hospital for a few additional days to ensure safe disposition and to facilitate coordination between SW and family to discuss care plan at home.      Primary Procedures:      Secondary Procedures: None   Reason for Hospital Admission (Admitting Diagnosis):  C DIFF     Complications: none   Consults:  GENERAL SURGERY - INITIAL INPATIENT CONSULTATION. HOSPITAL MEDICINE - INITIAL INPATIENT CONSULTATION. HOSPITAL MEDICINE - ONGOING INPATIENT CONSULTATION. Smoker: No.   Condition on Discharge: stable   Code Status at Time of Discharge: DNR       Note Details  Author (M.D.) File Time 9/18/2023  8:53 AM Author Type Physician Status Signed Last Editor (M.D.) Specialty Hospital Medicine  Admit Date 9/7/2023  ED to Hosp-Admission (Discharged) on 9/7/2023  ED to Hosp-Admission (Discharged) on 9/7/2023   Detailed Report  Note shared with patient Additional Orders and Documentation   Results Imaging   Meds    Orders    Flowsheets   Encounter Info:  History, Allergies, Education, Care Plan, Detailed Report   Hospital Problem List   ATRIAL FIBRILLATION, UNSPECIFIED W PROTHROMBOTIC STATE  LONG TERM NON WARFARIN ORAL ANTICOAGULANT THERAPY  C DIFFICILE COLITIS, NOT SPECIFIED AS RECURRENT Resolved  HX OF SMALL BOWEL RESECTION  COVID-19 DISEASE  C DIFFICILE INFECTION  SEVERE SEPSIS W ACUTE ORGAN DYSFUNCTION Resolved Care Timeline  09/07   Admitted from ED 2210 09/17   Discharged 1943  Discharge   Home with Home Health   Discharge Instructions (AVS) (Printed 9/17/2023)