Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Cast application, Culture wound positive, Dysphagia, Electrocardiogram
Clinical narrative: Patient is a 87 y.o. female patient of DO with history of left lower lobe squamous cell carcinoma, hypertension, hyperlipidemia presented to Hospital with covid and generalized weakness.    Chronic respiratory failure Squamous cell lung cancer Baseline oxygen needs: Intermittently on 2 L NC- states sometimes she takes her O2 off and only requires it at night  Currently: Requiring 2 L NC 100%, weaned down to 1L NC CTPA (9/16) no evidence of pulmonary embolism.  Moderate and slightly decreased consolidation/atelectasis of left lower lobe.  Filling defect in the distal aspect of the left mainstem bronchus measuring 1.5 cm could be due to mass or mucous plugging.  Consolidation is up against left hilar region and additional central mass cannot be excluded.  Stable 1.4 cm mass in the right medial lung base. Pulm consulted-continue remdesivir.  Recommendation to hold off on steroids for now.  We will give a week of antibiotics.  Will need palliative radiation for the lesion.  She is not a candidate for surgical resection.  Doubt she will be a candidate for systemic therapy.  Restrictive transfusion strategy for hemoglobin less than 7.  Consider palliative care involvement. DDx COVID 19 infection +/- lung CA +/- postobstructive pneumonia Will initiate remdesivir Follow-up on procalcitonin- 0.1   Covid-19 Virus Infection Date of onset of symptoms: 9/15 Symptoms present on admission: headache and fatigue Date of covid positive test: 9/16/23 Vaccination status: vaccinated CTPA (9/16) no evidence of pulmonary embolism.  Moderate and slightly decreased consolidation/atelectasis of left lower lobe.  Filling defect in the distal aspect of the left mainstem bronchus measuring 1.5 cm could be due to mass or mucous plugging.  Consolidation is up against left hilar region and additional central mass cannot be excluded.  Stable 1.4 cm mass in the right medial lung base. Baseline oxygen needs: Intermittently on 2 L NC Currently: 2L NC Medical therapy: remdesivir Anticipated special isolation end date: TBD Epigastric pain EKG nonischemic Troponin flat at 14?15 Minimal improvement with Maalox. Denies any indigestion or nausea Describes as worsening with deep breath in.  Toradol dose x1 and lidocaine patch ordered- improvement in sx   Non-healing wound S/P infected sebaceous cyst Prior hx of wound: Seen by Dr. (surgery) on 7/31/23, recommended continued local wound care.  Daughter reports continued drainage from the sebaceous chest area.  Of note patient completed course of bactrim back in July for this She also completed course of doxycycline in august  Wound care following  Preliminary wound culture growing MRSA ID consulted-patient started on vanco, appreciate input  Transitioned to p.o. doxycycline 9/3 Picture in H&P Consulted wound care-primary dressing Triad and secondary dressing with mepilex   Recent Right Forearm Fracture after fall 7/11/23. Short cast exchanged with splint 8/22/23 per otho as Xrays with stable healing. Follow up with ortho Family concerned about wrist and requesting an ortho eval  Repeat x-ray x-ray of the wrist on 9/02 ordered for an eval which showed interval placement of a stent at right wrist, no significant interval change in alignment/dorsal subluxation of the proximal carpals in relation to the distal radius Ortho was consulted and saw patient 9/3?she had a right distal radius fracture on 7/17 with no acute surgical intervention.  Recommendation to maintain right wrist removable brace, WBAT right upper extremity and follow-up with Dr. as scheduled    Adult failure to thrive Generalized weakness Decreased mobility secondary to multiple comorbidities Recently taking home by family from SNF Consult PT/OT/UM-PT and OT with AMPAC of 9.  COVID SNF not able to accept will likely need to finish quarantine during hospitalization with SNF afterwards Dysphagia History of tonsillar cancer protein calorie malnutrition S/P radiation and chemotherapy 2017 Resuming as needed cellulitis. ?  Follows with medical facility Patient was declining SLP eval last admission May need reassessment this admission- declined 9/18,  Per patient she does not have her dentures with her and be amenable to trying a ground or puréed diet - doing well so far with ground diet  Nutrition   Anxiety and depression Resuming Cymbalta 30 mg daily   Left renal lesion Noted on CTPA (8/2022) Daughter reports that this had been there a long time for her last discharge summary note Patient declined further evaluation per daughter