Age: 84.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Asthenia, COVID-19, Chest X-ray normal
Clinical narrative: Discharge Provider: MD Primary Care Provider: DO Admission Date: 11/14/2022 Discharge Date: 11/15/22 COVID positive date: 11/14/2022 PRESENTING PROBLEM: Altered mental status, unspecified altered mental status type [R41.82] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is doing well.  He has no complaints and wants to go home.  He is near back to baseline from a energy standpoint.  He is able to ambulate without assist.   Son reports that cognitively back to baseline as well.  No residual confusion.  No fever overnight.   This is likely sequela from COVID and wounds continue to improve day by day.  Status post IV hydration.   The discharge patient was doing well tolerating a diet and safe to be discharged.  2nd admission 11/17/2022-11/19/2022 Discharge Physician: DO Primary Care Physician: DO Date of Admission: 11/17/2022 Discharge Date: 11/19/2022 COVID positive date: 11/14/2022 PRESENTING PROBLEM: AKI (acute kidney injury) [N17.9] Leukocytosis, unspecified type [D72.829] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] Acute respiratory disease due to COVID-19 virus [U07.1, J06.9]   HOSPITAL COURSE: Patient is an 85 year old male presenting to hospital with generalized weakness.  Patient was recently admitted to our facility from November 14 through 15th, with COVID and generalized weakness.  He improved significantly and was discharged home with family assistance.  He represented on the 17th again with significant generalized weakness.  Additionally in the emergency department he was found to have an acute kidney injury, he was also noted to be hypoxic.  Chest x-ray did not demonstrate any acute process.  Urinalysis demonstrated a possible urinary tract infection, so we started antibiotics and a urine culture was sent off.  Repeat labs following morning demonstrate his acute kidney injury was very mildly worse.  He had a renal ultrasound which I demonstrate any obstruction.  Did note that he was having some mild urinary retention.  He worked with physical therapy and occupational therapy, they felt he was safe for home discharge with family assistance but recommended home physical therapy.  The patient was also given some fluids for his acute kidney injury.  Today the patient states he is feeling significantly better.  States he is not short of breath when he is ambulating.  His kidney function has improved back to baseline.  His son at bedside did state he was mildly hesitant to take him home as this is the 2nd admission this week.  I discussed with him how we do feel it is safe for him to go home, but did recommend the patient continue ambulating and moving around.  His son is concerned as his wife just turned up positive for COVID as well, and he is worried about his ability to care for him if he gets COVID himself.  The patient himself did state he would prefer to be at home.  I did encourage him to continue to up in movement increases activity.  Patient's urine culture did not demonstrate any acute bacteria, it does demonstrate resident flora.  Antibiotics were discontinued.   Electrolytes were monitored and repleted PRN throughout the admission. Patient clinically improved and hemodynamically stable for discharge.  Discussed plan of care discharge with patient including outpatient follow-up PCP within 7 days. Patient voiced understanding was agreeable with plan of care discharge.