Age: 76.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Hypertension, Hypothyroidism, Infection, Invasive ductal breast carcinoma, Localised infection
Clinical narrative: Date of Admission: 8/11/2023 Date of Discharge: 8/17/2023 Issues to be Addressed at Follow-up: 1) continued optimization of chronic lower extremity infection management, currently on oral antibiotics; 2) continued optimization of all other medical issues as outpatient. 3) out of covid isolation on 8/22/23; Pending Study Results at Discharge: Unresulted Lab Orders Date and Time Order Name Status Specimen Source 8/17/2023  7:13 AM WBC AUTO DIFF In process -- 8/17/2023  7:13 AM CBC W AUTOMATED DIFFERENTIAL In process -- 8/17/2023  7:13 AM MAGNESIUM In process -- 8/17/2023  7:13 AM CHEM 7 (NA, K, CL, CO2, BUN, GLUC, CR) In process --8/17/2023  7:13 AM CBC + DIFF (FAC LAB). In process --Final Diagnoses: Active Hospital Problem; Diagnosis; (Principal) ACUTE OSTEOMYELITIS OF RIGHT FOOT; SEVERE SEPSIS W ACUTE ORGAN DYSFUNCTION. COVID-19 DISEASE. HX OF RIGHT GREAT TOE AMPUTATION. See note on 5/8/2023. For Diagnosis prompt, please delete, modify at PCP's discretion; CACHEXIA; SYSTOLIC HEART FAILURE, CHRONIC; FEMALE BREAST INFILTRATING DUCTAL CARCINOMA, RIGHT OVERLAPPING SITES; Added automatically from request for surgery; UNSPECIFIED ANXIETY DISORDER; HYPOTHYROIDISM; HTN (HYPERTENSION); DM 2 W PERIPHERAL NEUROPATHY Resolved Hospital Problems No resolved problems to display. Discharge Disposition: Board and Care Medications, instructions, follow up information: See patient Discharge Instructions/AVS. Hospital Course and Significant Findings: Patient initially presented to the ER after fall out of bed complaining of bilateral rib pain.  Patient was found to be septic in the ER due to combination of COVID and worsening chronic right foot infection.  Patient was started on remdesivir and broad-spectrum IV antibiotics.  Patient had complete resolution of sepsis and never developed severe COVID disease, did not require oxygen.  Given clinical improvement and after discussion with infectious disease, patient was transition back to cefpodoxime and Flagyl which was her ordinary outpatient dosing.  Patient was evaluated by physical therapy and deemed NOT to be a candidate for skilled nursing facility (due to lack of participation in the past) so well be discharged back to board and care.  Patient will need isolation until 8/22/2023 (10 days from positive test).  Patient will continue to follow-up with primary care and infectious diseases outpatient for medical management chronic lower extremity infection.  Patient will follow-up with primary care for optimization of other medical issues. PHYSICAL EXAM BP 119/78 | Pulse 96 | Temp 97 °F (36.1 °C) | Resp 18 | Wt 49 kg (108 lb 0.4 oz) | SpO2 95% | Breastfeeding No | BMI 17.98 kg/m² General - no distress. Mental status - alert and oriented, pleasant and conversant. CV - RRR. Lungs - clear. Extremities - RLE in dressing. Primary Procedures: none. Secondary Procedures: None Reason for Hospital Admission (Admitting Diagnosis): Right foot osteomyelitis 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 DO Note Details Autho (D.O.) File Time 8/17/2023 11:22 AM Author Type, PHYSICIAN (D.O. Status Signed Last Edito (D.O.) Specialty Hospital Medicine Hospital Acct # Admit Date 8/11/2023 ED to Hosp-Admission (Discharged) on 8/11/2023 ED to Hosp-Admission (Discharged) on 8/11/2023 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 HTN (HYPERTENSION) DM 2 W PERIPHERAL NEUROPATHY HYPOTHYROIDISM FEMALE BREAST INFILTRATING DUCTAL CARCINOMA, RIGHT OVERLAPPING SITES SYSTOLIC HEART FAILURE, CHRONIC CACHEXIA HX OF RIGHT GREAT TOE AMPUTATION UNSPECIFIED ANXIETY DISORDER SEVERE SEPSIS W ACUTE ORGAN DYSFUNCTION COVID-19 DISEASE ACUTE OSTEOMYELITIS OF RIGHT FOOT Care Timeline 08/12 Admitted from ED (Observation) 0610 08/17 Discharged 1900 Discharge SNF - Skilled bed (or Subacute) SNF Orders (Printed 8/17/2023) Medication List at Discharge acetaminophen 650 mg Oral EVERY 4 HOURS AS NEEDED, do not exceed 10 tablets in 24 hours. Do not exceed 4,000 mg of acetaminophen per day from all sources 650 mg Oral EVERY 4 HOURS AS NEEDED, (temperature > 100.4). Do not exceed 10 tablets in 24 hours. Do not exceed 4,000 mg of acetaminophen per day from all sources 650 mg Oral EVERY 4 HOURS AS NEEDED. Do not exceed 10 tablets in 24 hours. Do not exceed 4,000 mg of acetaminophen per day from all sources 650 mg Oral EVERY 4 HOURS AS NEEDED, (temperature > 100.4). Do not exceed 10 tablets in 24 hours. Do not exceed 4,000 mg of acetaminophen per day from all sources anastrozole 1 mg Oral DAILY ascorbic acid 500 mg Oral DAILY bisacodyl 10 mg 1 Suppository Rectal DAILY AS NEEDED,. Use as 2nd line treatment if 1st line treatment is ineffective blood sugar diagnostic 1 Strip Miscell. (Med.Supl.; Non-Drugs) 2 TIMES A DAY, to measure blood sugar blood-glucose meter Use as directed to test blood sugar buspirone HCl 10 mg Oral 2 TIMES A DAY calcium carbonate/vitamin D3 600 mg-10 mcg (400 unit) 1 tablet Oral 2 TIMES A DAY,. Take with food cefpodoxime proxetil 400 mg Oral 2 TIMES A DAY docusate sodium 250 mg Oral DAILY, for bowel regularity. Hold for loose stools empagliflozin 25 mg Oral EVERY MORNING gabapentin 100 mg Oral 2 TIMES A DAY glipizide 2.5 mg Oral DAILY WITH BREAKFAST, or first meal of the day Lactobacillus 3/FOS/pantethine 300-250 million cell-mg 1 capsule Oral 2 TIMES A DAY, ---until 8/16/23 lancets 30 gauge 1 Each Miscell. (Med.Supl.;Non-Drugs) 2 TIMES A DAY, to measure blood sugar levothyroxine sodium 75 mcg Oral DAILY BEFORE BREAKFAST magnesium hydroxide 400 mg/5 mL 30 mL Oral DAILY AS NEEDED, Hold if creatinine is greater than 2.5. Use as 1st line medication meclizine HCl 12.5 mg Oral EVERY 6 HOURS AS NEEDED metformin HCl 1,000 mg Oral 2 TIMES A DAY, with food metronidazole 500 mg Oral 3 TIMES A DAY ondansetron HCl 4 mg Oral EVERY 8 HOURS AS NEEDED quetiapine fumarate 25 mg Take one-quarter tablet by mouth daily at bedtime; sennosides 8.6 mg Take 1 tablet by mouth with each narcotic dose for bowel regularity. Do not exceed 8 tablets in 24 hours. Hold for loose stools; syringe-needle, insulin,0.5 mL 1/2 mL 31-gauge x 15/64" Use for injection as directed.