Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Presyncope, SARS-CoV-2 test positive, Transient ischaemic attack, Vertebral artery stenosis, Walking aid user
Clinical narrative: Attestation signed by (M.D.) at 12/18/2023  9:31 PM   I have reviewed and verified the content of this Discharge Summary. The Discharge Summary accurately reflects the outcome of the patient?s hospitalization and/or treatment, the disposition of the patient, and the patient?s final diagnosis. I have verified that the Discharge Summary also provides for appropriate follow-up care to facilitate proper continuity of care. Electronically signed by  MD   12/18/2023   9:31 PM      Date of Admission: 12/13/2023   Date of Discharge: 12/17/2023   Issues to be Addressed at Follow-up: 1. TIA - ASA 81 x 21d, last day 1/4/24 - plavix 75 mg PO daily  - PT recommend home health PT. Patient's family already has an aid at the house daily to help him ambulate.     2. Near syncope, orthostatic hypotension   - midodrine 2.5mg tid and behavioral modifications for orthostatic hypotension given  3. COVID-19 DISEASE - asymptomatic s/p remdesivir  4. Dementia - PTA meds continued   5. Goals of Care: Goals of Care discussion with primary care physician regarding multiple medications for dementia and requiring midodrine for persistent orthostatic hypotension, consider discussion on level of intervention for medical care and safety of multiple medications while elderly.   Pending Study Results at Discharge:  Unresulted Lab Orders    Date and Time Order Name Status Specimen Source   12/14/2023  7:32 AM LIPID PANEL, (CHOL, DHDL, TRIG, CALC LDL), FASTING In process --   12/14/2023  7:32 AM PREALBUMIN In process --     Final Diagnoses:  Active Hospital Problems   Diagnosis   ? (Principal) HX OF TRANSIENT ISCHEMIA ATTACK   ? ORTHOSTATIC HYPOTENSION   ? MAJOR NEUROCOGNITIVE DISORDER DUE TO UNSPECIFIED DISEASE (UNSPECIFIED DEMENTIA)   ? COVID-19 DISEASE     Resolved Hospital Problems   Diagnosis Date Resolved ? NEAR SYNCOPE 12/14/2023   Discharge Disposition:  Home   Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings: Patient is a 81 Y male with PMH of Adenocarcinoma of R lung s/p lobectomy and chemotherapy, Bronchogenic cancer of R Lung, Former Tobacco Smoker, CKD4, Nephrolithiasis, UTI, BPH, CAD w/ MI s/p stents, HFrEF (LVEF 45%), HLD, HTN, Dementia and BPV presenting w/ concerns of expressive aphasia, sudden weakness and presyncope. Last well time 8AM 12/13. At baselline, he lives at home with wife and son and ambulates with a walker. In the ED he also had an episode of dysarthria and expressive aphasia. VS WNL. Labs notable for Cr 1.56, HGB 10.5. CT head without intracranial hemorrhage. CTA showed significant atherosclerotic plaque and narrowing at the origins of the vertebral arteries greater than 50% but remains patent throughout the entire course of both vertebral arteries. MRI brain showed no acute abnormality. CXR showed asymmetry of hila, triangular opacity in R cardiophrenic angle, likely RLL atelectasis. He received full dose ASA and plavix 300 mg. He was also found to be COVID+. Speech therapy evaluated him and cleared him for thin liquids and regular solids. Occupational therapy recommended no further needs. PT recommended home health PT. He remained largely asymptomatic from COVID during his hospitalization and did not have any additional neurological events or abnormalities on telemetry.    BP 104/79  | Pulse 81  | Temp 98.6 °F (37 °C)  | Resp 12  | Ht 5' 9"  | Wt 54.4 kg (120 lb)  | SpO2 99%  | BMI 17.72 kg/m²    Physical Exam Vitals reviewed.  Constitutional:      Appearance: Normal appearance.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.  Pulmonary:     Effort: Pulmonary effort is normal.     Breath sounds: Normal breath sounds.  Abdominal:     General: Abdomen is flat.     Palpations: Abdomen is soft.  Skin:    General: Skin is warm.     Capillary Refill: Capillary refill takes less than 2 seconds.  Neurological:     Mental Status: He is alert.         Primary Procedures:  None   Secondary Procedures: None   Reason for Hospital Admission (Admitting Diagnosis):  TIA   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      Cosigned by: (M.D.) at 12/18/2023  9:31 PM  Note Details  Author (D.O.) File Time 12/18/2023  9:31 PM Author Type PHYSICIAN, RESIDENT Status Addendum Last Editor (D.O.) Specialty GENERAL, OTHER Admit Date 12/13/2023  ED to Hosp-Admission (Discharged) on 12/13/2023  ED to Hosp-Admission (Discharged) on 12/13/2023   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   MAJOR NEUROCOGNITIVE DISORDER DUE TO UNSPECIFIED DISEASE (UNSPECIFIED DEMENTIA)  HX OF TRANSIENT ISCHEMIA ATTACK  NEAR SYNCOPE Resolved  COVID-19 DISEASE  ORTHOSTATIC HYPOTENSION Care Timeline  12/13   Admitted from ED (Observation) 2149 12/16   Admitted 0603 12/17   Discharged 1610  Discharge   Home with Home Health   Discharge Instructions (AVS) (Printed 12/17/2023) Medication List at Discharge   aspirin 81 mg Oral DAILY, Last dose 1/4/24  benzonatate 100 mg Oral EVERY 6 HOURS AS NEEDED  clopidogrel bisulfate 75 mg Oral DAILY  midodrine HCl 2.5 mg Oral 3 TIMES A DAY WHILE AWAKE, Give first dose upon getting out of bed in the morning. Give doses 3-4 hours apart to help blood pressure remain normal when sitting/standing. Do not give less than 2 hours before bed. Do not give if blood pressure is >140/90.