Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Monocyte count, Monocyte percentage, Neutrophil count, Neutrophil percentage increased, Nucleated red cells
Clinical narrative: Hospitalized (11.25.21 - 11.29.21); COVID-19 positive (11.24.21); Fully vaccinated PLUS Booster - moderna  Discharge Summary DO (Physician) ? ? General Medicine BRIEF OVERVIEW: Discharge Provider:  DO Primary Care Provider: DO Admission Date: 11/25/2021 Discharge Date: Nov 29, 2021    Active Hospital Problems   Diagnosis Date Noted POA ? Pneumonia due to COVID-19 virus 11/25/2021 Unknown   Resolved Hospital Problems   Diagnosis Date Noted Date Resolved POA ? Acute respiratory failure with hypoxia  11/29/2021 11/29/2021 Unknown ? Diarrhea due to COVID-19 11/29/2021 11/29/2021 Unknown ? Acute metabolic encephalopathy 11/29/2021 11/29/2021 Unknown    Pre-Existing Active Problems   Diagnosis Date Noted POA ? Cervical myelopathy  10/14/2021 Unknown ? Urinary incontinence 10/14/2021 Unknown ? Hypothyroid 10/14/2021 Unknown ? Schizoaffective disorder  10/14/2021 Unknown ? Dementia  10/14/2021 Unknown ? Acute embolism and thrombosis of left popliteal vein  10/08/2021 Unknown ? Obesity, morbid  10/08/2021 Unknown ? Platelets decreased  10/08/2021 Unknown ? Multiple falls 10/06/2021 Unknown ? Recurrent falls 10/06/2021 Unknown ? Diverticulosis   Unknown ? Essential hypertension, benign 06/14/2013 Unknown ? Iron deficiency anemia 06/14/2013 Unknown ? Psychiatric disorder 06/14/2013 Unknown   Discharge Disposition:  skilled nursing facility    Active Issues Requiring Follow-up:    Resolved acute hypoxic respiratory failure due to COVID pneumonia.  Supportive and symptomatic treatment.  Out of isolation on 12/1/21.     Resolved acute diarrhea due to COVID.  PRN imodium.     Acute metabolic encephalopathy.  Resolved.  Due to COVID and dehydration.     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus [U07.1, J12.82]   HOSPITAL COURSE: Patient is a 69 year old female with a past medical history of HTN, schizoaffective disorder, dementia, hypothyroidism and recent diagnosis of cervical myelopathy who presented from her LTC facility.  She was found to be COVID positive on 11/22 at her facility.  She had cough and SOB.  She was sent to the ED due to worsening symptoms.  In the ED, she was hypoxic requiring 3L NC.  She was given fluids for soft bps due to dehydration.  Chest xray showed B/L opacities that were consistent with COVID pneumonia.  She was given IV Decadron.  She was transferred to hospital for COVID pneumonia.  She was started on Decadron and Remdesivir.  Her hypoxia resolved.  She was noted to have encephalopathy on her chronic dementia, but this resolved.  She developed diarrhea due to COVID.  This resolved.  She was transferred back to her facility on 11/29/21.     CONSULTS / RECOMMENDATION:  Consult Orders (From admission, onward)   None   INPATIENT PROCEDURES:   Surgery and Procedures    None   Non-surgical Procedures (From admission, onward)   None    BP 144/84  | Pulse 56  | Temp 36.5 °C (Oral)  | Resp 24  | Ht 1.727 m  | Wt 130.6 kg  | SpO2 96%  | BMI 43.78 kg/m²    Physical Exam Constitutional:      General: She is not in acute distress.    Appearance: She is obese.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.  Pulmonary:     Effort: No respiratory distress.     Breath sounds: Normal breath sounds. No wheezing or rales.  Abdominal:     General: There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness.  Musculoskeletal:     Right lower leg: No edema.     Left lower leg: No edema.  Skin:    General: Skin is warm and dry.  Neurological:     Mental Status: She is alert.     Cranial Nerves: No cranial nerve deficit.     Comments: Oriented times 2 to person and place   H&P:: CHIEF COMPLAINT: Pneumonia due to COVID-19 virus    Assessment/Plan    ASSESSMENT / PLAN: Pneumonia due to Covid 19 virus Acute Respiratory Failure with hypoxia  Vaccinated Covid positive on 11/22, symptom onset ~ 11/20 CXR w/ hazy bilateral opacities Procal 0.08 Currently requiring 3L NC, wean as tolerated (baseline RA) Decadron and Remdesivir Daily covid labs Tele, pulse ox Prone PRN   Acute Encephalopathy  Dementia Suspected Parkinsons per recent admission Schizoaffective disorder Worsened mentation likely 2/2 to above. Unclear baseline She had mild hypercapnia at Hospital. Likely has undiagnosed OSA in setting obesity. Consider CPAP/BiPAP if increasing lethargy. Continue home psych meds   Recently diagnosed Cervical Myelopathy Per D/C summary on 10/14, was deemed poor surgical candidate and was supposed to follow up w/ Orthospine in 2 weeks regarding further management. Unclear if she ever followed up. PT/OT   HTN Continue home anithypertensives   Hx of SIADH Stable Continue salt tabs   ?Hx of chronic Diastolic CHF No Echo on file On 20 mg lasix daily, will continue   Hypothyroidism Continue synthroid   Hx of DVT No longer on anticoagulation   DVT PPX - lovenox  FULL CODE - Per prior admission. Patient does not have capacity to answer this question and unable to reach court appointed guardian over the phone   Discussed with Dr. whose insight is reflected above   Subjective    HISTORY OF PRESENT ILLNESS: Patient is a 69 y.o. female with PMH of essential hypertension, schizoaffective disorder, dementia, hypothyroidism, and recent admission for recurrent falls thought to be secondary to cervical myopathy but a poor surgical candidate.  There was also suspected component of UTI, LLE cellulitis, parkinsonism, and polypharmacy contributing.  She has court appointed legal guardian and currently resides at nursing facility. Patient unable to reliably provide any history and unable to reach guardian over the phone. History is severely limited and obtained primarily through chart review. Patient was reportedly more confused than baseline and was found to be COVID positive at nursing facility on 11/22.  She was reportedly having cough and shortness of breath.  Patient denies shortness of breath, chest pain, fevers or chills at this time.  In the emergency department she was hypoxic requiring 3 L nasal cannula.  Blood pressure was initially soft for which she was given 1 L normal saline bolus.  Laboratory workup was fairly unremarkable.  Chest x-ray did show 80 bilateral opacities that could be consistent with COVID pneumonia. She was given IV Decadron and transferred to hospital for further management.  Due to bed availability transfer was delayed for over 24 hours.   Patient Active Problem List Diagnosis ? Diverticulosis ? Essential hypertension, benign ? Iron deficiency anemia ? Psychiatric disorder ? Multiple falls ? Recurrent falls ? Acute embolism and thrombosis of left popliteal vein (HCC) ? Acute hypoxemic respiratory failure (HCC) ? Obesity, morbid (HCC) ? Platelets decreased (HCC) ? Cervical myelopathy (HCC) ? Urinary incontinence ? Hypothyroid ? Schizoaffective disorder (HCC) ? Dementia (HCC) ? Pneumonia due to COVID-19 virus   Past medical, surgical, family and social history reviewed Objective    OBJECTIVE: BP 153/70  | Pulse 73  | Temp 36.5 °C (Oral)  | Resp 24  | Ht 1.727 m  | Wt 130.6 kg  | SpO2 98%  | BMI 43.78 kg/m²    Physical Exam Vitals reviewed.  Constitutional:      General: She is not in acute distress.    Appearance: Normal appearance. She is well-developed. She is obese.  HENT:     Head: Normocephalic and atraumatic.     Mouth/Throat:     Mouth: Mucous membranes are moist.     Pharynx: Oropharynx is clear.  Eyes:     Conjunctiva/sclera: Conjunctivae normal.     Pupils: Pupils are equal, round, and reactive to light.  Neck:     Vascular: No JVD.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Heart sounds: Normal heart sounds. No murmur heard.   Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: Normal breath sounds. No wheezing.  Abdominal:     General: Bowel sounds are normal. There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness.  Musculoskeletal:        General: No tenderness. Normal range of motion.     Cervical back: Neck supple.  Skin:    General: Skin is warm and dry.     Findings: No erythema.  Neurological:     General: No focal deficit present.     Mental Status: She is alert.     Comments: Patient is oriented to person, thinks she is at Hospital. She knows it is thanksgiving but is unable to give me the actual date. Does not know why she is here. Can follow simple commands and answer simple questions but answers are often inappropriate  Psychiatric:        Mood and Affect: Mood normal.        Behavior: Behavior is cooperative.