Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: Ischaemic stroke, Lumbar radiculopathy, Mental status changes, Muscle disorder, Muscular weakness
Clinical narrative: Date of Admission: 10/16/2023   Date of Discharge: 10/18/2023   Issues to be Addressed at Follow-up: Continue COVID isolation for 10 days from the positive test until 10/26.    Pending Study Results at Discharge:  Unresulted Lab Orders    Date and Time Order Name Status Specimen Source   10/16/2023 12:49 PM BLOOD CULTURE 2 Preliminary BLOOD   10/16/2023  9:25 AM BLOOD CULTURE Preliminary BLOOD       Final Diagnoses:  Active Hospital Problems   Diagnosis   ? (Principal) HYPONATREMIA   ? HTN       9/12/2023 Her - Established diagnosis. Briefly reviewed plan today. Continue current regimen.  Metoprolol 25mg daily and Losartan 50mg daily   Previously on: Lisinopril 5 BID d/c due to cough Amlodipine d/c due to dizziness    BP Readings from Last 1 Encounters: 08/18/23 122/56   Daughter reports home evening readings tends to be higher, some occasional dizziness but not always   P: Continue Metoprolol in AM and switch Losartan to PM Advise if still persistently >135/85 then increase Losartan to 75mg daily and follow up with me     ? GERD       6/13/2022 Her - Established diagnosis. Briefly reviewed plan today. Continue current regimen.  Dietary control       ? OSTEOPOROSIS       Dexa 2010, s/p tx with alendronate    ? COUGH VARIANT ASTHMA       6/13/2022 Her - Established diagnosis. Briefly reviewed plan today. Continue current regimen.  Stable, does not use inhaler   Exposed to husband PFTs in 2/2003 Dx as asthma cough variant Given inhalers No symptoms since 2006   PFTs 2003 FEV1 83% and after neb 88% (6 % change) FVC 85% and after neb 91% (6% change) FEV!/FVC Ratio 96%    Normal flow volume curve   Claustrophobic cough while in Church.    ? MAJOR DEPRESSIVE DISORDER, RECURRENT EPISODE, IN FULL REMISSION       10/18/2021 Her - Established diagnosis. Briefly reviewed plan today. Continue current regimen.  Mirtazapine 30mg qhs   Husband and grandchild died CP syndrome with negative ETT in 1991 and 1994 CP in 2009 and ETT negative   Intolerant to Wellbutrin (sleepy) Intolerant to Prozac (forgetful) Intolerant to Paxil (not sure the cause of it)       ? COVID-19 DISEASE   ? SEVERE SEPSIS W ACUTE ORGAN DYSFUNCTION   ? ACUTE STROKE DUE TO ISCHEMIA, UNSPECIFIED TYPE AND ARTERY       7/27/2023 Her - TAV  Was hospitalized from 7/19/2023 to 7/21/2023 for ischemic stroke Per discharge summary: "Routine stroke work-up was performed including CTA 2D echo lab work.  Patient was evaluated with CTA which showed high-grade right cervical ICA stenosis.  Patient was evaluated by vascular surgery given patient's recent STEMI with bilateral brain strokes resulting in right-sided weakness she is at high risk for cardiac complications due to CAD and also high risk for cranial nerve injury due to high bifurcation.  There is no procedure was recommended after vascular surgery reviewed with patient and family.  It was felt the risk of surgery outweigh the benefits.  Recommended continued medical management with aspirin statin Plavix.  Could reconsider right carotid stent if patient had new hemispheric stroke per vascular surgery"   Over all pt doing better, had a few fall/slipped off bed without major injury Discussed with pt's daughter about depressed mood, already on Remeron but can consider Prozac if needed   P: Continue all medication as prescribed Continue with HHPT Discussed bed railings for fall prevention Follow up prn   ? WEAKNESS OF RIGHT LEG       6/16/2023 Her - TAV  Daughter also present during the call Pt states right leg weakness for the past few days Feels like her leg is falling asleep on her Daughter feels like patient tends to drift due to leg weakness as well Patient declined any numbness or tingling sensation Does note some associated vertigo   A/P: DDX: Vertigo vs muscular etiology versus lumbar radiculopathy versus other We will schedule for in person appointment with me early next week ER precaution given     ? HX OF ST ELEVATION MI       ACUTE ST ELEVATION MI, UNSPECIFIED [I21.3] » HX OF ST ELEVATION MI [I25.2]   ? CAD W ANGINA, PRESENCE OF STENT       CATH 4/14/2023 anterior STEMI:100% diffuse disease of mid LAD treated by three overlapping DES stents (2.25 by 23 mm, 2.25 by 38 mm, and 2.5 by 28 mm Xience Skypoint), and the then post dilated by a 2.75 mm NC balloon.  - DAPT for minimum six to twelve months followed by monotherapy thereafter.    ? DM 2 W CKD STAGE 3A (GFR 45-59) W HTN       6/13/2022 Her - Established diagnosis. Briefly reviewed plan today. Continue current regimen.  See DM2 and HTN for plan       Resolved Hospital Problems No resolved problems to display.     Discharge Disposition:  Home with Home Health   Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings: Patient is an 82 years old female with past medical history of type 2 diabetes, HFpEF 60-65% on TTE 07/23, CKD stage III, hypertension, hyperlipidemia, history of stroke, IBS, and recent admission to hospital in April 2023 for STEMI status post PCI, another admission in July for acute ischemic stroke (CTA with high-grade stenosis not amenable for intervention given cardiac history, on medical management with dual antiplatelet therapy and statin); who presented to hospital with fever, cough and altered mental status.  Patient had COVID contact at home and she tested positive in the ED. Patient received remdesivir for 3 days.  No any indication for steroid given the patient was not hypoxic.  Acute encephalopathy felt secondary to COVID and hyponatremia which improved with IV fluids.  Patient continued on the rest of her chronic medication.  She was seen by physical therapy and she was cleared for home PT.  Patient to continue isolation for 10 days until 10/26.  She was instructed to follow-up with PCP after discharge.   Primary Procedures:  None   Secondary Procedures: None   Reason for Hospital Admission (Admitting Diagnosis):  COVID   Complications: none   Consults:  HOSPITAL MEDICINE - INITIAL INPATIENT CONSULTATION. HOSPITAL MEDICINE - ONGOING INPATIENT CONSULTATION. Smoker: No.   Condition on Discharge: stable   Code Status at Time of Discharge: Full Code   Physical Exam: BP 132/61  | Pulse 92  | Temp 98.5 °F (36.9 °C)  | Resp 18  | Wt 31.7 kg (69 lb 14.2 oz)  | LMP  (LMP Unknown)  | SpO2 98%  | Breastfeeding No  | BMI 14.61 kg/m²  GENERAL: The patient is in no acute distress. She is awake, alert and oriented to self, place and knows the year. CHEST: Lung fields are clear to auscultation. No wheezes, rhonchi or rales appreciated. HEART: Regular S1, S2. No murmurs, rubs or gallops appreciated. ABDOMEN: Abdomen soft, nontender, nondistended. No rebound noted. Bowel sounds are normal. EXTREMITIES: Reveal no edema, no cyanosis or clubbing. NEUROLOGIC: Grossly intact without focal deficits.       Note Details  Author  (M.D.) File Time 10/23/2023  8:58 PM Author Type Physician Status Signed Last Editor  (M.D.) Specialty Hospital Medicine  Admit Date 10/16/2023  Hospital Problem List   DM 2 W CKD STAGE 3A (GFR 45-59) W HTN  HX OF ST ELEVATION MI  CAD W ANGINA, PRESENCE OF STENT  HYPONATREMIA  WEAKNESS OF RIGHT LEG  ACUTE STROKE DUE TO ISCHEMIA, UNSPECIFIED TYPE AND ARTERY  COVID-19 DISEASE  SEVERE SEPSIS W ACUTE ORGAN DYSFUNCTION  HTN  GERD  COUGH VARIANT ASTHMA  MAJOR DEPRESSIVE DISORDER, RECURRENT EPISODE, IN FULL REMISSION  OSTEOPOROSIS Care Timeline  10/16   Admitted from ED 1254 10/18   Discharged 1810