Age: 88.0
Sex: F
Vaccine: COVID19
Symptoms: Asthma, COVID-19 pneumonia, Chest X-ray abnormal, Delirium, Fall
Clinical narrative: 11/24/2023    Date of Discharge:  11/28/2023    Primary Care Physician:  MD   Pending Study Results at Discharge:  Unresulted Lab Orders    Date and Time Order Name Status Specimen Source   11/24/2023  6:15 PM BLOOD CULTURE 2 Preliminary BLOOD   11/24/2023  5:58 PM BLOOD CULTURE Preliminary BLOOD       Issues to be Addressed in Follow-up: 1) Finish antibiotic therapy for pneumonia 2) Follow-up on ongoing chronic medical conditions   Reason for Hospital Admission (Admitting Diagnosis):  COVID PNA    HPI on admission:  91 y/o F w/ known dementia, lives in a memory care facility - presents to the ER d/t witnessed mechanical fall. Was brought here to be checked but upon arrival pt was noted to be febrile. Unable to determine exactly source as pt demented and unable to provide meaningful hx. Daughter did note productive cough while at the ER bedside so CXR was ordered which showed reticular opacities in the lung bases which could be from edema vs infectious vs inflammatory process. UA is negative so fever is presumed to be d/t PNA given hx of cough and + CXR. She received 2 lit of IVF bolus, tylenol and a dose of CTX and zithromax.   Hospital Course: 91-year-old female admitted for fall, found have COVID-19 infection. Chest x-ray on admission was concerning for bacterial pneumonia, for which patient was started on antibiotic therapy. Throughout the admission, patient's oxygen saturation was adequate on room air. Patient was given 5-day course of Remdesivir. Patient developed delirium during the hospitalization, which improved with conservative management. Patient was found safe for discharge back to her memory care. Patient's daughter was instructed to follow-up with PCP within 1 week. Daughter voiced understanding and agreed with the plan.   Patient Vitals for the past 24 hrs:    Temp Temp Source Pulse BP Resp SpO2 O2 Delivery 11/28/23 0700 97.5 °F (36.4 °C) Axillary 76 141/73 18 95 % RA 11/27/23 2345 97.7 °F (36.5 °C) Oral 98 108/68 18 95 % RA 11/27/23 1556 97.7 °F (36.5 °C) Oral 90 182/88 19 94 % RA       Physical exam General appearance - alert, well appearing, and in no distress Mental Status - alert, oriented to self only Chest - clear to auscultation, no wheezes, rales or rhonchi Heart - normal rate, regular rhythm, normal S1, S2, no murmurs, rubs Abdomen - soft, nontender, nondistended, no masses or organomegaly Neurological - motor and sensory grossly normal bilaterally Extremities - no clubbing, cyanosis or edema Skin - warm and dry     Hospital Course By Problem: Patient Active Hospital Problem List: SEVERE SEPSIS W ACUTE ORGAN DYSFUNCTION (2/24/2015) PNEUMONIA (11/24/2023) COVID  - clinically stable and mostly asymptomatic  - continue Remdesivir (start 11/25/23 -end 11/28/23). Start Decadron if becoming hypoxic  - continue empiric CTX (start 11/25/23 - end 11/28/23) and doxy (start 11/25/23 - end 11/29/23) - blood culture show no growth at 24 hours - will follow closely and address accordingly    FALL - no obvious injuries noted  - physical therapy evaluation  - will follow    MILD PERSISTENT ASTHMA, CONTROLLED (4/13/2015) - clinically stable and asymptomatic  - continue alvesco, flonase, claritin - will follow    HYPERTENSION (3/17/2003) - continue Amlodipine 5 mg daily and Losartan 100 mg daily - will follow and adjust medications as needed    HYPERLIPIDEMIA (3/17/2003) - continue Lovastatin 20 mg daily  THALASSEMIA (1/18/2019)  - noted   MAJOR NEUROCOGNITIVE DISORDER DUE TO ALZHEIMERS DISEASE, UNSPECIFIED SEVERITY, W OTHER BEHAVIORAL DISTURBANCE (9/29/2019) - continue aricept, namenda - palliative care following per family's request    Complications:  None   Diagnoses:  Active Hospital Problems   Diagnosis    (Principal) PNEUMONIA    SEVERE SEPSIS W ACUTE ORGAN DYSFUNCTION    GERD (GASTROESOPHAGEAL REFLUX DISEASE)       Discussed anti reflux therapy. She said she takes the codeine very intermittently, and it works well for her. She understands that she probably is addicted to codeine. She denies any side effect from codeine and said she uses is only sporadically. She requests that I continue her prescription.     HYPERTENSION    HYPERLIPIDEMIA    COVID-19 PNEUMONIA    MAJOR NEUROCOGNITIVE DISORDER DUE TO ALZHEIMERS DISEASE, UNSPECIFIED SEVERITY, W OTHER BEHAVIORAL DISTURBANCE    THALASSEMIA       Noted historically by daughter, patient not to take Iron supplements or iron containing supplements     MILD PERSISTENT ASTHMA, CONTROLLED     Resolved Hospital Problems No resolved problems to display.     Primary Procedures:      Secondary Procedures: None   Consults:  None   Condition on Discharge:  Stable    Code Status at Time of Discharge: DNR   Smoker: No.     Discharge Disposition:  Home   Discharge Medications: Medications, instructions, follow up information: See patient instructions (or SNF Admission orders if applicable).        11/28/2023 1:09 PM                Note Details  Author (D.O.) File Time 11/28/2023  2:39 PM Author Type PHYSICIAN (D.O.) Status Signed Last Editor (D.O.) Specialty Hospital Medicine Hospital Acct  Admit Date 11/24/2023  ED to Hosp-Admission (Discharged) on 11/24/2023  ED to Hosp-Admission (Discharged) on 11/24/2023   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   MILD PERSISTENT ASTHMA, CONTROLLED  THALASSEMIA  MAJOR NEUROCOGNITIVE DISORDER DUE TO ALZHEIMERS DISEASE, UNSPECIFIED SEVERITY, W OTHER BEHAVIORAL DISTURBANCE  PNEUMONIA  COVID-19 PNEUMONIA  SEVERE SEPSIS W ACUTE ORGAN DYSFUNCTION  HYPERTENSION  GERD (GASTROESOPHAGEAL REFLUX DISEASE)  HYPERLIPIDEMIA Care Timeline  11/24   Admitted from ED (Observation) 2020 11/27   Admitted 1657 11/28   Discharged 1720  Discharge   Home or Self Care.   Discharge Instructions (AVS) (Printed 11/28/2023) Medication List at Discharge   acetaminophen 500 mg Take 1 to 2 tablets by mouth every 6 hours as needed for pain or fever. Do not exceed 6 tablets in 24 hours  amlodipine besylate 5 mg Oral DAILY  calcipotriene/betamethasone 0.005-0.064 % Apply topically daily at night to scalp as needed for psoriasis rash (NOTE: this medication replaces brand TALCONEX).  ciclesonide 160 mcg/actuation 1 Puff Inhalation 2 TIMES A DAY, for asthma prevention and control. Rinse mouth well after use  cyanocobalamin (vitamin B-12) 1,000 mcg TAKE 1 TAB BY MOUTH EVERY DAY  donepezil HCl 10 mg Oral EVERY BEDTIME  doxycycline monohydrate 100 mg Oral EVERY 12 HOURS  fluticasone propionate 50 mcg/actuation 2 Sprays Each nostril DAILY  ibuprofen 400 mg Oral 3 TIMES A DAY AS NEEDED, Take with food  inhaler, assist devices USE AS DIRECTED WITH INHALER  lidocaine 4 % Apply 1 patch to the affected area(s) every 8 hours for 2 weeks. May stop once pain is controlled  loratadine 10 mg TAKE 1 TAB BY MOUTH EVERY DAY  losartan potassium 100 mg Oral DAILY  lovastatin 20 mg Oral EVERY BEDTIME  memantine HCl 5 mg Oral EVERY BEDTIME  multivitamin 1 tablet Oral DAILY  oxycodone HCl 5 mg Take one-half tablet by mouth every 6 hours as needed for severe pain for up to 4 doses  triamcinolone acetonide 0.1 % APPLY AMPLE AMOUNT TOPICALLY TO KELOID ON CHEST TWICE DAILY AT 8AM AND 4PM