Age: 87.0
Sex: M
Vaccine: COVID19
Symptoms: Computerised tomogram head normal, Computerised tomogram thorax abnormal, Condition aggravated, Confusional state, Depressed level of consciousness
Clinical narrative: ED to Hosp-Admission Discharged  5/21/2021 - 5/28/2021 (7 days)  DO Last attending ? Treatment team E coli bacteremia Principal problem Discharge Summary , DO (Physician) ? ? Internal Medicine           Discharge Summary   Hospitalist Medicine        Patient:  Date: 5/28/2021 DOB:  Admission Date: 5/21/2021 PCP: , PA-C Length of Stay: 7 Days Discharging provider: , DO Discharge Date: 5/28/2021     Admission Diagnosis     Medical Problems     Hospital Problems        POA   * (Principal) E coli bacteremia Yes        Atrial fibrillation with RVR (CMS/HCC) Yes       Mitral and aortic valve disease Yes   Overview Signed 11/4/2020  5:08 PM by , LPN      Note: Moderate AR, MR & TR 1'15 Note: Moderate AR, MR & TR 1'15          Type 2 diabetes mellitus (CMS/HCC) Yes       Dementia due to Parkinson's disease without behavioral disturbance (CMS/HCC) Yes       Acute metabolic encephalopathy Yes       Chronic systolic CHF (congestive heart failure) (CMS/HCC) Yes       Sepsis (CMS/HCC) Yes       Anemia Yes       COVID-19 Clinically Undetermined   Overview Signed 5/28/2021 12:11 PM by, DO      Asymptomatic, had been positive back in January, tested negative on admission then tested positive when planning for discharge.  May just be persistent viral shedding from previous Covid infection  Hospital Course      HPI:I refer you to the history and physical for completeness.  Briefly, patient presented to the emergency department with his family stating that he is a little bit more confused, not as alert, and little bit more short of breath and shaky.  Noted to have an elevated white blood cell count lactic acidosis.   Hospital Course:   Patient was cared for in hospital.  Placed on broad-spectrum antibiotics.  Blood cultures revealed gram-negative bacteremia most likely due to to possible mild diverticulitis.  Throughout the course of his hospitalization he steadily improved.  Was transition to oral antibiotics.  His cardiac issues were continue to be managed during his hospitalization.  He did have some mild encephalopathy associated with the bacteremia and as his infection cleared that improved.  Adjustments were made in his home medications.  He is started on therapies.  Due to his severe deconditioning associated with acute medical illness will need some higher level care and increased rehabilitation.  Arrangements were made for him to receive ongoing care at .  When he presented to the hospital he tested negative for COVID-19.  In preparation to going to the  he tested positive.  He was completely asymptomatic as far as COVID-19 symptoms are concerned.  He was previously positive in January 2021 for Covid.  This could just be a prolonged positive testing from his infection in January.  Nondetected COVID-19 test on 5/21/2021 could potentially be a false negative.  At this point would recommend isolation for 10 days from 5/26/2021.  Otherwise his vital signs are stable.  Improved the point where he no longer requires hospital level care and can be discharged to