Age: 86.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Hypophagia, Limb injury, Malnutrition, Mobility decreased, Nitrite urine present
Clinical narrative: 86-year-old man who presented to the ED with weakness.  His daughter was in the room and provided most of the history.  She states about 2 weeks ago he fell and injured his arm with some bruising but has not done well since that time.  Since that time he has been weak and has not been as active as he normally was prior to the fall.  About a week ago he developed a cough but did not have fevers so they did not think he had coded.  Last Friday he was very weak and after going to bed he did not get out of bed for the next 3 days.  He has eaten very little over the past week as well.  He has been drinking some water and Ensure.  He continues to have a cough.  Denies shortness of breath.  Still with no fevers.  Vitals & T: 98.5  °F (Oral)  HR: 61(Peripheral)  HR: 68(Monitored)  RR: 17  BP: 129/67  SpO2: 98%  WT: 61 kg  VITAL SIGN               LAST CHARTED          MINIMUM                 MAXIMUM            Blood Pressure        129/67 (10/03 22:30)   110/68 (10/03 20:15)    157/63 (10/03 20:00) Heart Rate                61      (10/03 22:30)      47     (10/03 20:00)      80  (10/03 19:04) Respirations             17      (10/03 22:30)      15     (10/03 20:45)     22     (10/03 20:15) Temperature            98.5    (10/03 22:30)     98.5   (10/03 22:30)     98.5  (10/03 22:30) SpO2                         98      (10/03 22:30)      87     (10/03 20:34)      98    (10/03 22:30) O2 Flow Rate           3        (10/03 20:45)        3     (10/03 20:45)       3     (10/03 20:45) Weight                      61     (10/03 19:04)      61     (10/03 19:04)     61     (10/03 19:04) Discharge Diagnoses:  1. Acute respiratory failure with hypoxia, Discharge, 10/03/2021 2. Pneumonia due to COVID-19 virus, Discharge, 10/03/2021 3. Type 1 diabetes, Discharge, 10/03/2021 4. HTN (hypertension), Discharge, 10/03/2021 5. Weakness, Discharge, 10/03/2021 6. Malnutrition, Discharge, 10/03/2021 Secondary Diagnosis and Comorbidities: Hospital Course  Admitted with Acute respiratory failure with hypoxia secondary to covid-19 / Viral Pneumonia Vaccinated  remdesivir d3 - stop at day 3 as improved dexamethasone d3 was on 3L, CXR a little worse, looks like a lot of chronic changes to me and now weaned to room air  Dex causing some confusion/toxic encephalopathy from the steroid, so will stop at d3, especially since he's on room air He has Type 1 diabetes Secondary to prior Whipple procedure Patient uses an insulin pump at 0.4 units/hour as a basal rate.  We removed insulin pump and managed here while on Dex.  Discharged on 10/5/2021.  Readmitted on 10/12/2021. Patient is an 86 yr old male with medical history significant for recent COVID infection, complicated by pneumonia, for which he was hospitalized from 10/3-10/5. Medical history also includes type 1 diabetes r/t whipple procedure, pancreatic insufficiency, and hypertension. He was confused during his last admission, but presents to the ER today with worsening confusion. He is noted to have a temp of 101.3, procalcitonin 0.34, and his urine is positive for nitrite and 4+ bacteria with no epithelial cells. CXR is slightly improved since discharge, he is noted to have expiratory wheezes in bilateral bases and diminished breath sounds on the right. He was also noted to have mild choking when drinking water in the ER. He will be admitted for management of his presumed UTI, and will get swallow study as well.     Still hospitalized in COVID-19 stepdown unit.