Age: 81.0
Sex: M
Vaccine: COVID19
Symptoms: Confusional state, Deep vein thrombosis, Delirium, Dementia, Dysarthria
Clinical narrative: Date of Admission: 11/25/2023   Date of Discharge: Medically stable as of 11/28/23.    Issues to be Addressed at Follow-up: - Started on Xarelto for bilateral DVTs. Plan for 21 day load, then transition to next anticoagulation medicine, as prescribed by PCP              - E-consult sent to anticoagulation services after discharge on 12/4     Pending Study Results at Discharge:  Unresulted Lab Orders    No orders found from 10/29/2023 to 11/29/2023.       Final Diagnoses:  Active Hospital Problems   Diagnosis   ? (Principal) ACUTE HYPOXEMIC RESPIRATORY FAILURE   ? MAJOR NEUROCOGNITIVE DISORDER DUE TO UNSPECIFIED DISEASE (UNSPECIFIED DEMENTIA)   ? HTN (HYPERTENSION)   ? HX OF SMOKING   ? ACUTE EXACERBATION OF COPD   ? ACUTE DVT OF BILAT CALF MUSCULAR VEINS   ? DM 2   ? COVID-19 DISEASE   ? BILAT GLAUCOMA SUSPECT   ? BPH (BENIGN PROSTATIC HYPERPLASIA)     Resolved Hospital Problems No resolved problems to display.     Discharge Disposition:  Memory care   Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings: Pt is a 83 Y male with PMH of dementia, COPD, tobacco use, CAD, HTN, T2DM, who presented on 11/23 to QOV with shortness of breath, in setting of outpatient positive COVID test. Found to be hypoxic to mid-80s%. Noted to have left-sided facial droop and dysarthria, so Code Stroke was called. CT head with chronic basal ganglia CVA but no acute findings. CTA H/N negative for thrombus or stenosis. He was treated for TIA with DAPT and statin. CXR showed bibasilar atelectasis. CTA negative for PE or infiltrate. He was treated for COVID with remdesivir/decadron. Also found to have bilateral popliteal DVT on BLE US.    He was repatriated on 11/25. On admission, he was weaned down to room air. He was continued on steroids and remdesivir, as well as duonebs for COPD. He developed delirium, so steroids were stopped, with improvement in confusion. He completed course of remdesivir. Regarding his DVTs, Neurology recommended continuing statin and plavix, but holding ASA to start AC for bilateral leg DVT. He was started on lovenox, then switched to Xarelto load.      Primary Procedures:  None   Secondary Procedures: None   Reason for Hospital Admission (Admitting Diagnosis):  Shortness of breath   Complications: none   Consults:  None Smoker: Yes - Reason Medication or Counseling not ordered: Patient unable to participate in smoking cessation counseling because of cognitive impairment   Condition on Discharge: stable   Code Status at Time of Discharge: Full Code      Current Facility-Administered Medications Medication Dose Route ? Rivaroxaban Tablet 15 mg (XARELTO)  15 mg Oral ? hydrALAZINE Inj 20 mg (APRESOLINE)  20 mg intraVENOUS ? Losartan Tab 75 mg (COZAAR)  75 mg Oral ? Potassium Chloride TBTQ SR Tab 40 mEq (KLOR-CON M20)  40 mEq Oral ? PHOS-NAK Packet 2 Packet (Potassium & Sodium Phosphates)  2 Packet Oral ? OLANZapine Tab 2.5 mg (ZyPREXA)  2.5 mg Oral ? amLODIPine Tab 5 mg (NORVASC)  5 mg Oral ? Brimonidine 0.2 % Eye Soln 1 Drop (ALPHAGAN)  1 Drop Both eyes ? Memantine Tab 10 mg (NAMENDA)  10 mg Oral ? Atorvastatin Tab 80 mg (LIPITOR)  80 mg Oral ? Clopidogrel Tab 75 mg (PLAVIX)  75 mg Oral ? Lidocaine 10 mg/mL (1 %) Inj 1 mg (Xylocaine)  0.1 mL Intradermal ? Chlorhexidine Gluconate Oral Soln 15 mL (PERIDEX)  15 mL Oral ? Sodium Chloride 0.9% Inj Syg 3 mL (NORMAL SALINE FLUSH)  3 mL intraVENOUS ? Sodium Chloride 0.9% Inj Syg 3 mL (NORMAL SALINE FLUSH)  3 mL intraVENOUS ? WEB LINK HYPOGLYCEMIA  1 Each Miscell. (Med.Supl.;Non-Drugs) ? D50W Inj Syg 12.5 g  25 mL intraVENOUS ? D50W Inj Syg 25 g  50 mL intraVENOUS ? Glucagon Inj 1 mg (GLUCAGEN DIAGNOSTIC KIT)  1 mg intraMUSCULAR ? D5W IV Premix  100 mL/hr intraVENOUS ? Insulin Lispro Sliding Scale Inj (HumaLOG)   Subcutaneous ? Pneumococcal 20-valent Conj-Dip Cr (PF) Vaccine Inj Syg 0.5 mL (PREVNAR 20)  0.5 mL intraMUSCULAR ? Flu Vaccine QS 2023-24 (65 yrs up) PF IM Syg 0.7 mL (FLUZONE HIGHDOSE QUAD)  1 Each intraMUSCULAR ? Nicotine 7 mg/24 hr 1 Patch (NICODERM CQ)  1 Patch Transdermal ? Nicotine Polacrilex Gum 2 mg (NICORETTE)  2 mg Oral ? Ondansetron (PF) Inj 4 mg (ZOFRAN)  4 mg intraVENOUS ? Melatonin Tab 3 mg (MELATIN)  3 mg Oral ? traZODone Tab 50 mg (DESYREL)  50 mg Oral ? Famotidine Tablet 20 mg (PEPCID)  20 mg Oral ? Acetaminophen Tablet 650 mg (TYLENOL)  650 mg Oral   Or ? Acetaminophen Supp 650 mg (TYLENOL)  650 mg Rectal ? Sennosides Tab 8.6 mg (SENOKOT)  8.6 mg Oral ? Lactulose Oral Soln 20 g  30 mL Oral ? Albuterol 90 mcg/actuation HFA MDI 2 Puff (PROAIR/PROVENTIL/VENTOLIN)  2 Puff Inhalation ? Ipratropium 17 mcg/actuation MDI 2 Puff (ATROVENT HFA)  2 Puff Inhalation         Note Details  Author (M.D.) File Time 12/4/2023  6:39 PM Author Type Physician Status Addendum Last Editor  (M.D.) Specialty Hospital Medicine Hospital Acct #  Admit Date 11/25/2023  Admission (Discharged) on 11/25/2023  Admission (Discharged) on 11/25/2023   Revision History   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   DM 2  ACUTE HYPOXEMIC RESPIRATORY FAILURE  BPH (BENIGN PROSTATIC HYPERPLASIA)  BILAT GLAUCOMA SUSPECT  COVID-19 DISEASE  ACUTE EXACERBATION OF COPD  ACUTE DVT OF BILAT CALF MUSCULAR VEINS  HX OF SMOKING  MAJOR NEUROCOGNITIVE DISORDER DUE TO UNSPECIFIED DISEASE (UNSPECIFIED DEMENTIA)  HTN (HYPERTENSION) Care Timeline  11/25   Admitted 1950 11/29   Discharged 1637  Discharge   Home with Home Health   Discharge Instructions (AVS) (Printed 11/29/2023) Medication List at Discharge   amlodipine besylate 5 mg 1 tab PO daiy  atorvastatin calcium 80 mg Oral DAILY  brimonidine tartrate 0.2 % 1 drop both eyes bid  cholecalciferol (vitamin D3) 25 mcg (1,000 unit) 1 tab PO daily  clopidogrel bisulfate 75 mg Oral DAILY  famotidine 20 mg Oral 2 TIMES A DAY  losartan/hydrochlorothiazide 100-25 mg 1 tab PO daily  memantine HCl 10 mg 1 tab PO BID  rivaroxaban 15 mg Take 1 tablet by mouth 2 times a day for 21 days. On Day 22, start your next anticoagulation medication as directed by your provider  thiamine HCl 1 tab PO daily