Age: 93.0
Sex: M
Vaccine: COVID19-2
Symptoms: Dysphagia, Dyspnoea, Echocardiogram, Glomerular filtration rate, Hyperkalaemia
Clinical narrative: Patient is a 93 y.o. male admitted to the hospital on 12/15/2022 symptomatic COVID infection. He completed a 10 day course of decadron and 5 day course of paxlovid. Initially requiring 2L O2 but weaned to RA. CT chest with BL infiltrate/honeycombing appearance. Daughter opted in not repeating interval CT chest at this time due to his advance dementia.   He was seen by SLP while admitted and will discharge on pureed thin liquid diet and continue to work with SLP outpatient.   Discharging to Memory care today. Daughter at bedside and will transport.   Discharge Diagnosis and Associated Hospital Course   Covid-19 pneumonia - Presented with: Cough, shortness of breath, malaise.  The symptoms appear to be resolving. - Symptom onset: 12/13. Clinic initiated Paxlovid on 12/15/22 and he had one dose prior to arrival. - Positive COVID-19: 12/15  - Vaccination status: Vaccinated with Moderna with last dose 10/18/2022 - CTPA 12/20: No evidence of pulmonary embolism.  Bilateral lower lobe interstitial infiltrates with honeycombing.  Indicative of chronic interstitial edema, COPD or pulmonary fibrosis - Oxygen status: stable on RA - Decadron: Completed 10-day course of Decadron 12/24 - Paxlovid: Started prior to admission, completed 5-day course 12/20 - Out of isolation as of 12/25 - DVT prophylaxis: Subcutaneous heparin - Serial COVID labs ordered: No - Case Management/Social Services consulted: Yes   Abnormal CT chest Possible intrinsic lung disease -Former smoking history >30-pack-year.  Quit in ~2008 -CT chest on admission 12/20 with bilateral lower lobe infiltrates/honeycombing appearance  -Could consider outpatient CT scan in 3 to 6 months to monitor for resolution or persistence of fibrotic bilateral lower lobe changes. Discussed with patient's daughter 12/22.  She is in favor not repeating an interval CT scan at this time given advanced dementia   Acute hypoxemic respiratory failure-resolved In the setting of COVID-19 PNA and suspected underlying intrinsic lung disease  -stable on RA   BPH Acute urinary retention-resolved -Home Tamsulosin initially on hold due to interaction with Paxil but -Tamsulosin resumed 12/23. -Acute mild urinary tension noted 12/23, mild urinary retention per postvoid residual <300 mL.   -Resolved with continuation of flomax. Discontinue finasteride Dysphagia - Due in combination to acute illness and also losing upper dentures during hospitalization - MBS 12/19 without evidence of aspiration however clinically patient has had 2 episodes of significant concern for aspiration on 12/18 and 12/19 - Diet downgraded to puréed/stones with significant improvement in symptoms. - Continue modified diet with ongoing ST/SLP as tolerated and on discharge, suspect this to improve over the coming days/weeks as he recovers from his acute illness.   Elevated NT proBNP No overt respiratory symptoms at this time.  NT proBNP 3116 on arrival. Concern for component of systolic or diastolic dysfunction. CXR with diffuse bilateral interstitial infiltrates.  -TTE 12/16: EF 60%, mild TR -No further workup indicated at present   CKD stage IIIa Appearing overall stable at this time.  Baseline Cr 1.2, eGFR~60 -Avoid additional nephrotoxic agents. Did receive IV contrast load on admission -f/u outpatient labs   Hyperkalemia-resolved -Mild elevation on serum K noted 12/20. No concomitant renal dysfunction -One dose of lokelma 12/20 and again 12/21 -hold losartan on discharge in setting of mild hyperkalemia    Hypertension -Home regimen: Losartan, amlodipine, atenolol -resumed amlodipine 10mg daily and atenolol at lower dose 25mg daily -hold losartan at discharge   HLD -Atorvastatin held initially on admission due to concern for vaccinated interaction -Atorvastatin resumed 12/23, continue at discharge    Dementia without behavioral disturbance -Per history, lives alone with nearby family help -High risk for delirium, precautions in place   Fall at home -Patient suffered a fall at home while attempting to put on his close he rolled off of the bed and onto the ground striking his right side with associated bruising. No LOC -PT/OT following -discharging to memory care