Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Leukopenia, Loss of personal independence in daily activities, Malnutrition, Metabolic function test, Rash
Clinical narrative: PROVIDER PROGRESS NOTE 2/7/2022 ASSESSMENT Principal Problem:   Weakness Active Problems:   Weakness generalized   Moderate malnutrition      Skin Condition Reddened (Non-Pressure Related);Rash Left;Lower Back (Active) First Observed/Origin Date/First Observed/Origin Time: 01/29/22 1838   Skin Condition Type: Reddened (Non-Pressure Related);Rash  Orientation: Left;Lower  Location: Back     Comments:    Patient is a 81 y.o. female with history of frequent UTIs, dementia, hypertension who presented to the emergency room with generalized weakness.  She was diagnosed with a UTI.  She also had 4 episodes of nonsustained V. tach and a cardiology consult was requested. A TTE was done without significant structural heart disease.  No further interventions per Cardiology.   PLAN     Generalized weakness Suspect d/t combination of COVID-19 infection and possible UTI.  -- PT/OT.  Needs 24/7 assistance - SW working toward TCU placement.   E.coli UTI with MDR, history ESBL, possible CRE On prophylactic Keflex for hx of frequent UTIs.  Per daughter, only 2-3 UTIs in the past couple years.   Suspect likely colonization. UA+ and UC with MDR E.coli (R to ertrapenem but S to meropenem).  -- Discussed and reviewed sensitivities with ID  -- Stopped ceftriaxone 2/1 -- Meropenem IV x3 days completed treating an uncomplicated cystitis per ID recs -- Prophylactic Keflex not necessary given established resistance, the fact she is very likely colonized.  -- ? if prophylactic therapy necessary given only a couple UTIs in the past couple years -- Consider referral to outpt ID and/or Urology on d/c to help determine future appropriateness of prophylactic therapy   COVID-19 infection Incidental finding. No hypoxia. Felt to be contributing to the weakness.  -- Monitor respiratory status -- Patient does not qualify for any COVID-19 directed therapies as she is on RA   Constipation -- Bowel regimen available - prune juice, Senna-S, dulcolax, Miralax -- Encourage oral intake and ambulation   Nonsustained ventricular tachycardia Asymptomatic with these episodes. Felt likely d/t Covid.  -- TTE without significant structural heart disease -- Appreciate input from cardiology, signed off -- High goals for e-lytes    Hyponatremia Suspect d/t poor oral intake which has improved. Hyponatremia resolved. -- Encourage oral intake -- Periodic BMP monitoring   Leukopenia Was previously normal in April. Suspect r/t Covid infection. -- Periodic CBC monitoring    Dementia Patient seemed mildly confused but cooperative -- Continue PTA Aricept   Hypertension Blood pressure intermittently mildly elevated -- Continue PTA Prinivil   Moderate malnutrition Per Dietitian eval.  Loss of Muscle Mass: Not Present. Loss of Subcutaneous Fat: Not Present. Fluid Accumulation: Mild +1. Energy Intake: Less than or equal to 50% of estimated energy requirement for 5 days or greater. Interpretation of Weight Loss: Not Reported (does not meet criteria). -- Supplements per Dietitian     Patient's daughter, POA - updated 2/6/22.     DVT Prophylaxis - Lovenox