Age: 76.0
Sex: F
Vaccine: COVID19
Symptoms: Fall, Fatigue, Gait disturbance, Hand fracture, International normalised ratio increased
Clinical narrative: Patient currently inpatient at (4) days admission.  Generalized weakness Recent weakness/fatigue in setting of Covid infection  Pt too weak to ambulate  Admit to observation PT/OT eval and treat   Covid 19  Reports feeling unwell since 11/26 Vaccinated, 100% on room air  Day team to contact MAb team in am to see if pt would be candidate for therapy  CXR negative    Right index finger proximal phalanx fracture  Pt reports gripping her walker too hard as she fell/lowered herself down recently  Xray ordered to further evaluate swollen finger, fracture noted on imaging Splint/buddy tape Ortho consult, appreciate recs    Dysphagia Pt states she always takes meds in applesauce or pudding but has no other swallowing issues Will have SLP evaluate for diet recommendations    Urinary incontinence at baseline  Reports new dysuria - check UA    Parkinson's disease Continue home Sinemet   Back pain/compression fracture of L3 lumbar vertebra, chronic  No acute abnormality on imaging    History of mechanical aortic replacement Continue home Coumadin and check daily INR INR 2.7   Neurogenic orthostatic hypotension Continue home midodrine/florinef    Hypothyroidism Continue levothyroxine   Diabetes mellitus, diet controlled   Noted, check a1c   Depression Continue Lexapro   VTE prophylaxis Coumadin    Code status FULL CODE    HISTORY OF PRESENT ILLNESS: Patient is a 76 y.o. female with history of mechanical aortic valve on Coumadin, Parkinson's disease, hypothyroidism who presents with nontraumatic back pain and generalized weakness. Daughter in-law was helping her stand up at home and heard a ?pop" and states " part of her back is sticking out more than normal".  Family members are COVID positive, patient is vaccinated. She fell yesterday but lowered herself to the ground. Pt states she gripped her walker so hard that now her right index finger is swollen, bruised and tender. Pt reports feeling tired and weak since 11/24. Has been eating and drinking fine, endorses a slight dry cough. Had softer stool today. Reports feeling too weak to get up to use her walker.    Patient found to be COVID positive in the ER but 100% on room air.  Plain films of her spine show chronic changes nothing acute. Chest x-ray unremarkable.  Patient does not feel comfortable going home due to her weakness.  She feels her family is unable to take take care of her as they are sick as well.  Patient was too weak to get out of bed on her own in the ER. Admit to observation for generalized weakness. Review of Systems Constitutional:  Positive for fever (100.5 temp yesterday). Negative for appetite change.  HENT: Positive for trouble swallowing (takes meds in applesauce).  Eyes: Negative for visual disturbance.  Respiratory:  Positive for cough (dry). Negative for shortness of breath.   Cardiovascular:  Negative for chest pain and leg swelling.  Gastrointestinal:  Positive for trouble swallowing (takes meds in applesauce). Negative for vomiting and abdominal pain.       Softer stool today .  Genitourinary:  Positive for urinary incontinence (chronic) and dysuria.  Musculoskeletal:  Positive for back pain.  Neurological:  Negative for headaches.  Skin:  Negative for rash.       Bruising and swelling right index finger.