Age: 76.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Capillary nail refill test, Cellulitis, Chest X-ray abnormal, Condition aggravated, Cor pulmonale acute
Clinical narrative: Hospitalized (5.5.22 - 5.9.22); COVID-19 positive (5.5.22); fully vaccinated PLUS Booster - moderna x3 BRIEF OVERVIEW: Discharge Provider: PA-C/ MD Primary Care Provider at Discharge: NP  Admission Date: 5/5/2022 Discharge Date: 05/09/2022   Active Hospital Problems   Diagnosis Date Noted POA ? COVID-19 virus infection 05/06/2022 Unknown  Resolved Hospital Problems No resolved problems to display DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Weakness [R53.1] COVID-19 virus infection [U07.1] Respiratory tract infection due to COVID-19 virus [U07.1, J98.8]  HOSPITAL COURSE: Patient is a 77 y.o. male with a history of Parkinson's dementia, A-Fib, prior PE, HLD, OSA, Obesity and recent DVT/PE on eliquis who presented to ED for malaise, cough, dyspnea, myalgias, generalized weakness, and headache. He is found to be COVID positive but is not hypoxic and has negative CXR. Due to significant weakness he was admitted under observation for PT/OT eval. Therapy evaluated patient and recommended discharge back to ALF with 2-person assist. His facility reported they were able to provide this level of care for him. Patient slowly started to feel better throughout stay and never became hypoxic. He was given supportive care for his COVID.  To note, one blood culture was obtained on admission that grew Staph epidermidis, which is a suspected contaminant. Repeat blood cultures remain NGTD and he remained afebrile and no other signs of systemic infection. He was discharged back to his ALF in stable and improved condition.  CONSULTS / RECOMMENDATION: None  INPATIENT PROCEDURES: None  BP 140/79  | Pulse 50  | Temp 36.5 °C (Axillary)  | Resp 16  | Ht 1.727 m  | Wt 106.1 kg  | SpO2 97%  | BMI 35.57 kg/m²    Physical ExamVitals and nursing note reviewed.  Constitutional:     General: He is not in acute distress.    Appearance: He is not toxic-appearing.  HENT:    Head: Normocephalic and atraumatic.     Mouth/Throat:     Mouth: Mucous membranes are moist.  Eyes:    General: No scleral icterus. Cardiovascular:    Rate and Rhythm: Normal rate and regular rhythm.     Heart sounds: Normal heart sounds. No murmur heard.    Comments: Faint pitting edema bilaterally. DP pulses 2+ bilaterally Pulmonary:    Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: Normal breath sounds. No wheezing.  Abdominal:    General: Bowel sounds are normal. There is no distension.     Palpations: Abdomen is soft.  Musculoskeletal:       General: Normal range of motion.  Skin:   General: Skin is warm and dry.  Neurological:    Mental Status: He is alert. Mental status is at baseline.     Comments: Masked facies. Orientated to person, month only  Psychiatric:       Mood and Affect: Mood normal  H&P: CHIEF COMPLAINT: COVID-19 virus infection ASSESSMENT / PLAN:  COVID-19 viral infection Generalized weakness - Admit to GMF under observation. - Symptom onset 5/5.  COVID PCR+ on 5/5.  Vaccinated but due for booster. - Comfortable breathing, saturating normally on RA alone. - Not presently a candidate for dexamethasone or remdesivir. - Supportive care, symptom management, encourage IS usage. - Admitting primarily for weakness - therapy evals and dispo planning. - Check ambulatory pulse ox once able to ambulate with walker.  Parkinson's disease Dementia Hypotension - Alert and oriented to person only.  Usually better oriented during day per daughter. - Continue home Sinemet, Aricept and midodrine. - Regular reorientation, supportive care, avoid deliriogenic meds.  PAF - Currently in NSR.  Not on chronic rate/rhythm control. - Continue home Eliquis for anticoagulation. - Monitor and optimize electrolytes.  HLD - Continue home ASA and Lipitor.  Anxiety Depression Insomnia - Continue home Zoloft and melatonin.  BPH - Continue Flomax and Vesicare (for Myrbetriq) and monitor for inpatient retention, ISC PRN.  Dysphagia - Nectar thick and general solids per daughter.  SLP consult.  Physical deconditioning - PT/OT evals for home safety (ALF resident).  NCM for dispo assist.  H/o recent admissions for cellulitis and DVT/PE (Feb-March 2022)  VTE Proph:  Continue home Eliquis.  Code Status:  "FULL CODE" per d/w patient and daughter at bedside. HISTORY OF PRESENT ILLNESS: Patient is a 77 y.o. male ALF resident with h/o Parkinsons dementia, A-Fib, prior PE, HLD, OSA and obesity, presenting to the Blodgett ER on 5/5 with c/o malaise, cough, dyspnea, myalgias and headache.  He also appears weaker than usual baseline, requiring 2-person assist for standing rather than his usual 1-person assist.  He was recently admitted twice in the past few months for DVT/PE and cellulitis, respectively.  He is now off antibiotics, but continues to take Eliquis for anticoagulation.  Venous duplex in February showed acute appearing DVT of left femoral vein, and CTA thorax showed multiple bilateral acute pulmonary emboli with high clot burden on the right, but no evidence of acute right heart strain.  He was in his normal state of health until earlier on 5/5, when the above-noted symptoms started rapidly and progressed throughout the day.  There was recently a member of the care staff that was diagnosed with COVID-19.  The patient has been vaccinated, but is overdue for his booster.  He does not currently smoke, drink alcohol or use recreational drugs.  Family history was reviewed but is noncontributory.  He denies any other specific complaints or concerns at this time.   In the ER, he was afebrile (Tmax 37.7), normotensive, with normal pulse and respiratory rates, and normal oxygen saturation on room air alone.  Initial labs are notable for mild normocytic anemia and thrombocytopenia, as well as a positive COVID screen.  CXR shows low lung volumes, but no acute cardiopulmonary process.  He was treated with Tylenol and 1 L of IV NS.   Review of Systems Constitutional:  Positive for fatigue. Negative for chills, diaphoresis and fever.  HENT: Negative for sore throat and trouble swallowing.  Eyes: Negative for visual disturbance.  Respiratory:  Positive for cough and shortness of breath. Negative for wheezing and sputum production.   Cardiovascular:  Negative for chest pain, palpitations, orthopnea and leg swelling.  Gastrointestinal:  Negative for nausea, vomiting, abdominal pain, constipation, diarrhea and trouble swallowing.  Genitourinary:  Negative for dysuria, frequency and urgency.  Musculoskeletal:  Positive for joint pain and muscle pain.  Neurological:  Positive for headaches and weakness (generalized). Negative for dizziness, light-headedness, speech difficulty, loss of consciousness and numbness/tingling.  Endo/Heme/Allergy:  Negative for adenopathy and easy bleeding or bruising.  Skin:  Negative for color change and rash OBJECTIVE: BP 117/62  | Pulse 85  | Temp 37.7 °C (Oral)  | Resp 20  | SpO2 95%    Physical Exam Vitals reviewed.  Constitutional:      General: He is not in acute distress.    Appearance: He is well-developed. He is ill-appearing. He is not diaphoretic.  HENT:     Head: Normocephalic and atraumatic.     Mouth/Throat:     Mouth: Mucous membranes are dry.  Eyes:     Conjunctiva/sclera: Conjunctivae normal.     Pupils: Pupils are equal, round, and reactive to light.  Neck:     Vascular: No JVD.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.  Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: No wheezing or rales.     Comments: Diminished at bases bilaterally, but no audible wheezes, rales or rhonchi.  Comfortable and saturating appropriately on baseline room air. Abdominal:     General: Bowel sounds are normal. There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness.  Musculoskeletal:        General: Swelling (1-2+ BL LE) present. No tenderness.  Skin:    General: Skin is warm and dry.     Capillary Refill: Capillary refill takes less than 2 seconds.  Neurological:     General: No focal deficit present.     Mental Status: He is alert and oriented to person, place, and time. Mental status is at baseline.  Psychiatric:        Mood and Affect: Mood normal.        Behavior: Behavior normal