Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Atrial fibrillation, Benign prostatic hyperplasia, COVID-19, Chest X-ray normal, Condition aggravated
Clinical narrative: Attestation signed by (M.D.) at 12/5/2023  2:37 PM   I have reviewed and verified the content of this Discharge Summary. The Discharge Summary accurately reflects the outcome of the patient?s hospitalization and/or treatment, the disposition of the patient, and the patient?s final diagnosis. I have verified that the Discharge Summary also provides for appropriate follow-up care to facilitate proper continuity of care.    Date of Admission: 12/2/2023   Date of Discharge: 12/4/2023   Issues to be Addressed at Follow-up: COVID-19 DISEASE (12/2/2023) No signs of PNA on CXR. Symptom onset 11/30 with + home COVID19 test 12/2. Case discussed with ID and recommended IV remdesivir rather than paxlovid given risk of toxicity with amiodarone. s/p remdesivir  200mg and 100mg IV.  - Continue isolation for 10 days since symptom onset - Supportive care for symptoms   MULTIPLE SCLEROSIS (1/8/2001) WEAKNESS OF LEFT LEG (12/2/2023) LLE weakness in setting of acute illness. Baseline LLE weakness. Neurology, per ED physician report, recommended MRI brain and C-spine, which showed no new lesions. - defer to Neuro for imaging of thoracic spine   ATRIAL FIBRILLATION, UNSPECIFIED (12/2/2023)  rate-controlled (HR <110) and asymptomatic - cont amiodarone and digoxin  - cont dabigatran   DM 2 W DYSLIPIDEMIA (12/11/2015)  A1c within goal (6.8 Sept 2023). - cont Glargine 30u and Insulin 25u with meals   OBSTRUCTIVE SLEEP APNEA (11/24/2021) CPAP   BPH (BENIGN PROSTATIC HYPERPLASIA) (5/2/2023) stable, no signs of acute urinary retention  - cont finasteride and tamsulosin   Pending Study Results at Discharge:  Unresulted Lab Orders    No orders found from 11/4/2023 to 12/5/2023.       Final Diagnoses:  Active Hospital Problems   Diagnosis   ? (Principal) COVID-19 DISEASE   ? LONG TERM NON WARFARIN ORAL ANTICOAGULANT THERAPY       Dabigatran (Pradaxa) 150mg BID Indications:  atrial fibrillation Expected length of therapy: Lifelong (Provider to assess risk vs benefits periodically)   Considerations:    HC pool: PHARMACY SERVICE    Periop Guideline Reference:   Go to Clinical Library ==>  Search: Anticoagulation Management - Perioperative- Anticoagulation Services Guideline         ? WEAKNESS OF LEFT LEG   ? ATRIAL FIBRILLATION, UNSPECIFIED   ? BPH (BENIGN PROSTATIC HYPERPLASIA)   ? SLEEP APNEA       Date: 11/23/2021  Study Type: WatchPAT  pAHI: 44.4  BMI: 34.6   ESS: 9  Min SpO2: 83% SpO2<90%: 0 minutes  Severe Sleep Apnea.     ? DM 2 W DYSLIPIDEMIA   ? MULTIPLE SCLEROSIS       Secondary progressive      Resolved Hospital Problems No resolved problems to display.     Discharge Disposition:  Home   Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings: Patient 76 Y male h/o MS w/ baseline LLE weakness,DM2, atrial fibrillation on digoxin and amiodarone dabigatran, BPH admit 12/2/2023 for COVID19 management with O2 need and worsening LLE weakness. Neurology consulted by ED physician and recommended MR spine/head which showed no new changes from baseline. s/p  Remdesivir 200mg and 100mg IV. Did not give Paxlovid due to toxicity effects with amiodarone for Afib. Pt improved- VSS and no O2 need.   Subjective: denies headaches, pain, SOB, CP, denies worsening leg weakness   Objective: BP 136/58  | Pulse 63  | Temp 98.2 °F (36.8 °C)  | Resp 18  | Wt 104.3 kg (229 lb 14.4 oz)  | SpO2 95%  | BMI 33.95 kg/m²    Physical Exam: Constitutional: Well-developed and well-nourished. No distress. Cooperative. HEENT: Head: Normocephalic and atraumatic. Eyes: PERRL, EOMI, no nystagmus.  Neck: supple, no lymphadenopathy. Skin: Warm, no rash, suspicious lesions. Cardiovascular: Regular rate and rhythm, normal S1 and S2, no murmurs/rubs/gallops, no BLE edema Pulmonary: Clear to auscultation bilaterally, no wheezes, no rhonchi, no accessory muscle use  Abdominal: Soft, nondistended, nontender. No masses Musculoskeletal: Extremities without cyanosis, clubbing, edema. Full and painless ROM.  Neurological: Weakness in LLE. Motor and sensory grossly normal otherwise.   Primary Procedures:  None   Secondary Procedures: None   Reason for Hospital Admission (Admitting Diagnosis):  COVID-19 and LLE weakness   Complications: none   Consults:  HOSPITAL MEDICINE - INITIAL INPATIENT CONSULTATION. HOSPITAL MEDICINE - ONGOING INPATIENT CONSULTATION. Smoker: No.   Condition on Discharge: stable   Code Status at Time of Discharge: Full Code   DO   Discussed with Dr.    Cosigned by: (M.D.) at 12/5/2023  2:37 PM  Note Details  Author (M.D.) File Time 12/5/2023  2:37 PM Author Type PHYSICIAN, RESIDENT Status Signed Last Editor (M.D.) Specialty GENERAL, OTHER  Admit Date 12/2/2023  ED to Hosp-Admission (Discharged) on 12/2/2023  ED to Hosp-Admission (Discharged) on 12/2/2023   Revision & Routing History   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   MULTIPLE SCLEROSIS  DM 2 W DYSLIPIDEMIA  ATRIAL FIBRILLATION, UNSPECIFIED  COVID-19 DISEASE  SLEEP APNEA  BPH (BENIGN PROSTATIC HYPERPLASIA)  WEAKNESS OF LEFT LEG  LONG TERM NON WARFARIN ORAL ANTICOAGULANT THERAPY Care Timeline  12/02   Admitted from ED 2120 12/04   Discharged 1530  Discharge   Home or Self Care.   Discharge Instructions (AVS) (Printed 12/4/2023) Medication List at Discharge   acetaminophen 500 mg Take 2 tablets by mouth every 8 hours around the clock for 30 days, then as needed  Patient not taking:  Reported on 12/2/2023  amiodarone HCl 200 mg Oral DAILY  blood sugar diagnostic Use 1 strip daily to check blood sugars  cholecalciferol (vitamin D3) 2,000 Units Oral DAILY  dabigatran etexilate mesylate 150 mg Take 1 capsule by mouth 2 times a day. Take with a full glass of water. Do not break, chew, or open capsule. Resume on POD#7 after completion of Eliquis.  digoxin 125 mcg Oral DAILY  fexofenadine HCl 60 mg Oral DAILY  finasteride 5 mg Oral DAILY  fluconazole 400 mg Oral DAILY  Patient not taking:  Reported on 12/2/2023  fluticasone propionate 50 mcg/actuation 1 Spray Each nostril DAILY  insulin glargine-yfgn 30 Units Subcutaneous DAILY  Patient taking differently:  Inject 30 Units subcutaneously every morning  insulin lispro 100 unit/mL Inject 25 units subcutaneously daily with breakfast and 25 units daily with lunch and 25 units daily with dinner.  mecobalamin 1,000 mcg Oral  metformin HCl 1,000 mg Oral 2 TIMES A DAY, with food  metoprolol tartrate 50 mg Oral 2 TIMES A DAY  oxycodone HCl 5 mg Oral EVERY 6 HOURS AS NEEDED  Patient not taking:  Reported on 12/2/2023  pen needle, diabetic 32 gauge x 5/32" 1 Syringe Subcutaneous 4 TIMES A DAY AS NEEDED  polyethylene glycol 3350 17 gram/dose Mix 17 Grams in 4 to 8 ounces of water or juice and drink by mouth daily as directed for constipation  Patient not taking:  Reported on 12/2/2023  sertraline HCl 25 mg Oral DAILY  tamsulosin HCl 0.4 mg Oral DAILY, . Take 30 minutes after dinner or before bed