Age: 78.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Metabolic encephalopathy, Pain, SARS-CoV-2 test positive, Skin ulcer, Spinal fusion surgery
Clinical narrative: Patient required hospitalization due to breakthrough infection. He received Moderna vaccine (2nd dose in series) on 04/21/21. Hospitalized from 08/16/21 - 08/21/21. Below is copied from discharge summary:   Acute metabolic encephalopathy on admission: resolved - GCS scale WNL - CT head wo acute process but with chronic WM changes - Ammonia WNL - TSH WNL - Haldol IV prn for agitation - last dose 8/18/2021 - no restrains - STR accepted   Complicated UTI Urinary retention with chronic Foley: - BP 88/50s initially but now WNL s/p 1L IV fluids - CBC WBL - UA with positive LE; prior cultures review but no bacteria identified - BC x 2 no growth - U/C: Staph 1K colonies, Yeast not candida albicans 18 K colonies - CT A/P with no acute GI process - Vancomycin, Cipro empirically given while inpatient   Atypical PNA COVID 19 pneumonia - Non septic - normal O2 sats at room air - Chest Xray with possible PNA - CT A/P showed possible atypical infection; recent hospitalization this month - COVID test negative - MRSA surveillance not taken - CT chest results reviewed - Duo nebs prn - Contact/ Droplet precautions    Infected sacral ulcer present on admission: - unstageable - continue Vancomycin and Cipro empirically - CT A/P did not showed any bone erosions - Continue Vancomycin, Cipro and Flagyl empirically - Generale surgery signed off 8/20/2021 - s/p I+D 8/19/2021, no wound culture available - Hydrocodone prn for pain - ID consulted - wound care:  Daily wet to dry dressing changes by nursing and WCT' - Infectious Diseases recommendations noted , case discussed: augmentin + linezolid x 4 weeks - monitor CBC weekly while on linezolid   AKI on CKD AKI resolved -Cr 1.6 > 0.98 -Likely med induced -IV fluids given -Renally dose meds   Macrocytic anemia/ Hematuria: - hemoglobin stable 9.3 -UA with hematuria, no blood seen on foley -CT A/P wo masses   Hypernatremia: resolved -145 > 139   Hypomagnesemia - 1.4 - replaced   Atelectasis: - EZPAP   Hx of HTN/ Hypotension: - BP soft s/p IV fluids - Hold amlodipine 5,  HCTZ and Losartan (normotensive): re start as outpatient as needed / indicated   Morbid Obesity, BMI of>40: -would benefit from lifestyles modifications regarding low fat diet, weight loss and daily excercise -F/U OPD with PCP   Chronic Afib on pacemaker: - On Pradaxa  - SCDs - re start carvedilol 25 mg BID - Interrogate pacemaker - IV Metoprolol prn   Chronic pain s/p lumbar fusion, inmobility: - Resume hydrocodone and gabapentin when feasible - Morphine Iv prn for pain - Hold amitryptiline due to AMS   BPH/ urinary retention: - Resume flomax and terazosin  - Foley in place   HLD: - Resume rosuvastatin when feasible   Patient is discharged in stable condition with stable vital signs. All questions rearding hospital course and plan of care after discharge have been answered to satisfaction. Prescriptions for medications needed to be taken after discharge have been given to patient. Patient has been instructed to follow up with PCP within the next 7 days after discharge. Patient verbalizes understanding all given instructions and has no further doubts regarding discharge.