Age: 61.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Dysuria, Enterococcus test positive, Escherichia test positive, Fall, Headache
Clinical narrative: Hospitalized 10/24/2021; COVID-19 positive 10/24/2021; fully vaccinated  BRIEF OVERVIEW:  Discharge Provider: MD Primary Care Provider at Discharge: NP  Admission Date: 10/24/2021 Discharge Date: 10/27/2021 HOSPITAL COURSE: PT is a 61 y.o. female, PMH of CAD s/p PCI in 2017, COPD o2 dependent, DM, HLD, who presented to hospital with generalized weakness. EMS received a call for lift assist at her house and found her on the ground supine.  She was lost her balance with her cane and fell over and could not get up.  Neighbor stated that she was not acting herself and EMS thought she felt warm and took a temperature here the temperature is 38.2°. She reported a frontal headache over the past day with no visual acuity changes.  She denied any ear pain, nasal congestion, denies any loss of taste or smell.  She denied any sore throat.  Denied any midline neck or back pain.  She denied any chest pain shortness of breath or cough.  She denied any abdominal pain.  She did report frequency of urine and slight dysuria.  She has no changes in bowel habits including constipation and states she always has loose stool secondary to being on metformin.  Patient received her 3rd COVID-19 immunization 2 days PTA and the symptoms started yesterday.  She was febrile in the emergency room. She was on 3L O2 which is her baseline. CXR did not show any acute process. Her U/A was abnormal, procalcitonin elevated. She was started on Rocephin for UTI. Cultures obtained. Due to her weakness, she could not be discharged home and was admitted for further management. Patient's COVID symptoms started 10/23/21. Tested positive on 10/24/21. She required 3L o2 NC (baseline is around 2L 02), CXR did not show any acute process. There was no need for Decadron or remdesivir at that point.  She was given and Lovenox daily for prophylaxis and supportive management. She remained stable and was weaned down to baseline 2L 02.  She was started on Rocephin for UTI. Cultures grew E. coli and enterococcus; IV antibiotic was changed to Zosyn while awaiting culture sensitivities.  PT OT evaluated patient due to her physical debility and recommended home with home health.  Blood cultures were negative to date.  Patient was given ampicillin secondary to urine culture sensitivities.  Patient improved and she was able to be discharged home in stable condition with home health.  She was given a prescription for amoxicillin 875 mg 2 times a day for 5 days and lactobacillus for new onset diarrhea the day of discharge.  She was instructed to follow-up with her PCP in 5-7 days.  All questions and concerns were addressed prior to discharge. 10/27/2021 H&P note (re-admission): Assessment and Plan Medical Decision Making   * Physical debility Assessment & Plan Patient was admitted for 10/24-10/27 for UTI ( Ecoli and Enterococcus). She was discharged on amoxicillin after improvement in symptoms. PT/OT recommended home health which was set up.    She returned within few hours of her discharge due to continued weakness and inability to care for herself at home. She has part time help with at home for cleaning and cooking, who came and was concerned about her being able to take care of herself as she lives alone. "She states that she felt somewhat weak while she was in the hospital but was having some assistance getting up and once she is standing she is able to get around and stay upright.  Her biggest issue is getting into a standing position from lying down or sitting." PT/OT evaluated her in ED and now recommending SAR Care management to assist with placement 10/30/2021 note: Chief complaint Physical debility Assessment/Plan Medical Decision Making * Physical debility Assessment & Plan Patient was admitted for 10/24-10/27 for UTI ( Ecoli and Enterococcus). She was discharged on amoxicillin after improvement in symptoms. PT/OT recommended home health which was set up.  She returned within few hours of her discharge due to continued weakness and inability to care for herself at home. She has part time help with at home for cleaning and cooking, who came and was concerned about her being able to take care of herself as she lives alone. "She states that she felt somewhat weak while she was in the hospital but was having some assistance getting up and once she is standing she is able to get around and stay upright.  Her biggest issue is getting into a standing position from lying down or sitting." PT/OT evaluated her in ED and now recommending SAR Care management to assist with placement COVID-19 Assessment & Plan She is vaccinated and received her 3rd COVID-19 immunization 2 days PTA  and the symptoms started 10/23/21. Tested positive on 10/24/21.    She was requiring up to 6L NC on 10/29 ( baseline 2-3L). Now down to 3L    She qualified for remdesivir, day 2/5 Continue decadron, day 2 /10 Continuous pulse ox Lovenox daily for prophylaxis CXR was not very clear due to her body habitus 11/1/2021 note: COVID-19 Assessment & Plan She is vaccinated and received her 3rd COVID-19 immunization 2 days PTA  and the symptoms started 10/23/21. Tested positive on 10/24/21.  SUBJECTIVE: Patient seen today without subjective complaint.  She is at her baseline oxygen demand is a -9 L under fluid balance and tolerating medical therapy.  Care management is pursuing placement based on physical and occupational therapy recommendations.