Age: 80.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19, COVID19
Symptoms: Hyperkalaemia, Hypothyroidism, Lacunar infarction, Magnetic resonance imaging head abnormal, Urinary tract infection
Clinical narrative: Date of Discharge: 08/30/2023   Issues to be Addressed at Follow-up: Patient needs to follow up with urology for foley management Repeat weakly LFts while on micafungin Adjust diabetic regimen as needed   Pending Study Results at Discharge:  Unresulted Lab Orders    Date and Time Order Name Status Specimen Source   8/26/2023  7:23 AM BLOOD CULTURE 2 Preliminary BLOOD   8/26/2023  7:21 AM BLOOD CULTURE Preliminary BLOOD       Final Diagnoses:  Active Hospital Problems   Diagnosis   ? (Principal) UTI (URINARY TRACT INFECTION)   ? DM 2 W CKD STAGE 3A (GFR 45-59)       1/13/2023 McKee: Chronic established diagnosis. Briefly reviewed plan today, cont current regimen.  DM: see above CKD: on ace-I. Avoid nsaids       ? DM 2 ON INSULIN       8/3/2023: Chronic established diagnosis. Briefly reviewed plan today, cont current regimen.  Meds: metformin 1000mg twice per day, victoza SQ Insulin: requires pen 2/2 hand shaking. Prev on NPH had BG >200 during the day and low overnight. Changed to 70/30.  NPH 70/30, 20u in AM/20u in PM, watching diet better. AM sugars: controlled (118-123). Post prandial PM sugars high (200-284) incr rx 22u in AM, 20u in PM and cont to watch diet more closely (control cookies!)  Lab Results Component Value Date   Hgb A1c % 9.4 (H) 05/12/2023     ? HYPERKALEMIA   ? ACUTE ON CHRONIC RENAL FAILURE   ? COVID-19 DISEASE   ? HEMATURIA   ? CAD WO ANGINA, W HX OF MI       8/3/2023: Chronic established diagnosis. Briefly reviewed plan today, cont current regimen.  2019 had 2 stents placed On asa/brillinta, crestor. On ace-i Not on BBlocker--h/o hypoglycemia with DM/insulin   ? HTN (HYPERTENSION)       8/3/2023: Chronic established diagnosis. Briefly reviewed plan today, cont current regimen.  Lisinopril 20mg daily    BP Readings from Last 3 Encounters: 08/02/23 141/78 08/01/23 166/81 05/22/23 130/54     ? HX OF STROKE WO RESIDUAL DEFICITS       8/3/2023  MRI 6/11/21: chronic lacunar infacrts Cont Brillinta (failed plavix--TIA while on rx), lipitor, and work on DM control.    ? HYPOTHYROIDISM       1/13/2023: Chronic established diagnosis. Briefly reviewed plan today, cont current regimen.  Levothyroxine 50mcg daily  Lab Results Component Value Date   TSH 3.3 12/23/2022     ? HYPERLIPIDEMIA       1/13/2023: Chronic established diagnosis. Briefly reviewed plan today, cont current regimen.  crestor 20mg daily     Resolved Hospital Problems No resolved problems to display.     Discharge Disposition:  SNF   Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings: Patient is a 82 Y male with history of DM2, dementia, chronic foley with urinary retention, history of stroke, HTN, HLD, CAD, hypothyroidism, recent hospitalization for UTI and urinary retention with new foley; who was admitted on 8/202/203 with blocked foley due to hematuria with clots, found to have acute UTI, COVID-19 (onset at home 8/5/2023), diarrhea, AKI, and hyperkalemia. Urine culture with candida albicans. Blood cultures with candida albicans and candida glabrata. ID on board and recommending 2 weeks of iv micafungin from first negative blood culture (which was from 08/23/2023).    Hospital course per problem:   FUNGEMIA DUE TO FUNGAL CYSTITIS - ID following; recommending micofungin until 09/06/2023  - repeat blood cultures results from 8/23, 8/24, 8/26-ngtd - follow LFts weekly, remove midline once completed. - Midline placed on 08/30/2023   HEMATURIA, UTI CHRONIC FOLEY URINARY RETENTION - s/p continuous bladder irrigation; urine is currently clear - on caspofungin per ID recs; urine culture with Candida albicans - on home tamsulosin - foley was changed in the ED;had a 3-way foley due to earlier need for continuous bladder irrigation -this was changed to a regular foley  and per outpaitent urologist, recommending that patient follow up outpatient with them.  - repeat hgb improved. No noted bleeding from any source   DIARRHEA - BMs have slowed down    RECENT COVID-19 DISEASE  - onset of COVID-19 was 8/5/2023  - received remdesivir for 5 day course; end date 8/26/2023 - clinically stable and asymptomatic  - isolation dc as per ID's recommendation    AKI ON CKD STAGE 3 - baseline Cr 1.1-1.4 - on IV fluids - avoid nephrotoxins, renally dose meds - will follow    DM2 - sugar elevated overall  - restart home dosing - continue sliding scale insulin coverage  - will follow    HYPOTHYROIDISM - on home levothyroxine   Code status: full Discussed with wife at bedside Dispo: pending SNF   Primary Procedures:  None   Secondary Procedures: None   Reason for Hospital Admission (Admitting Diagnosis):  Hematuria, uti, covid   Complications: none   Consults:  INFECTIOUS DISEASE - INITIAL INPATIENT CONSULTATION. INFECTIOUS DISEASE - ONGOING INPATIENT CONSULTATION. Smoker: No.   Condition on Discharge: stable   Code Status at Time of Discharge: Full Code       Note Details  Author (M.D.) File Time 8/31/2023  1:37 PM Author Type Physician Status Addendum Last Editor (M.D.) Specialty Hospital Medicine  Admit Date 8/20/2023  ED to Hosp-Admission (Discharged) on 8/20/2023  ED to Hosp-Admission (Discharged) on 8/20/2023   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   CAD WO ANGINA, W HX OF MI  HYPOTHYROIDISM  HTN (HYPERTENSION)  HYPERLIPIDEMIA  UTI (URINARY TRACT INFECTION)  HX OF STROKE WO RESIDUAL DEFICITS  HYPERKALEMIA  ACUTE ON CHRONIC RENAL FAILURE  COVID-19 DISEASE  HEMATURIA  DM 2 ON INSULIN  DM 2 W CKD STAGE 3A (GFR 45-59) Care Timeline  08/20   Admitted from ED (Observation) 2103 08/23   Admitted 0849 08/30   Discharged 1920  Discharge   SNF - Skilled bed (or Subacute)   SNF Orders (Printed 8/30/2023) Medication List at Discharge   aspirin 81 mg Oral DAILY, Take 1 tablet orally daily to protect your heart  cholecalciferol (vitamin D3) 1,000 Units Oral DAILY, Take 1 tablet orally daily for bone health.  cranberry fruit extract 250 mg Oral DAILY, Take 1 capsule orally daily for dietary supplement.  famotidine 40 mg Oral 2 TIMES A DAY  flash glucose sensor CHANGE SENSOR EVERY 14 DAYS PER MANUFACTURER OR AS DIRECTED  glucagon 1 mg Inject as directed  hydrophilic cream Topical DAILY  insulin NPH hum/reg insulin hm 100 unit/mL (70-30) Inject 22 Units subcutaneously daily 30 minutes before breakfast AND 20 Units daily 30 minutes before dinner. Can take additional units in the AM ONLY if sugars high, according to scale below: If fasting sugar is below 180, do not give any additional units other than indicated above. If fasting sugar in AM is 180-230, give an extra 2 units If fasting sugar in AM is 231-270, give an extra 4 units If fasting sugar in AM is 271 or higher, give an extra 5 units.. Strength: 100 unit/mL (70-30)  levothyroxine sodium 50 mcg Oral DAILY  liraglutide 0.6 mg/0.1 mL (18 mg/3 mL) Inject 1.2 mg subcutaneously daily  lisinopril 20 mg Oral DAILY  metformin HCl 1,000 mg Oral 2 TIMES A DAY WITH MEALS  micafungin sodium 150 mg intraVENOUS DAILY  pen needle, diabetic 31 gauge x 5/16" Use as needed for injection. Using 3 total per day. 2 per day for insulin and 1 per day for victoza.  rosuvastatin calcium 20 mg Oral DAILY, to prevent heart attacks and strokes  syringe-needle,insulin,0.5 mL 1/2 mL 31 gauge x 15/64" Use for injection as directed  tamsulosin HCl 0.4 mg Oral DAILY  ticagrelor 90 mg Oral 2 TIMES A DAY