Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Leukocytosis, Mental status changes, Nephrolithiasis, Protein urine present, Pseudomonas test positive
Clinical narrative: Admit date: 2/19/2024   Discharge date: 02/26/24  Admitting Physician: MD   Attending Physician at the Time of Discharge: MD  Primary Care Physician: FNP Reason for Admission: AMS  Brief Summary of Hospital Stay: (Include Significant Findings and Invasive Procedures) This is a 79 y.o male with a PMH of HTN, GERD, prior stroke, DM II and dementia, who is s/p renal stents ans suprapubic catheter exchange on 2/19 who presented to the ED with altered mental status which started shortly after returning from his surgical procedure. Patient denies any cardiac or GI symptoms. He denies any chills. He denies headache, lightheadedness ot dizziness. He denies all other discomfort at this time  Patient was found to be tachycardic and febrile in the ED. Labs showed a leukocytosis (14.9), elevated lactic acid (3.5), anemia around his baseline, hyperglycemia and hyperkalemia (5.4). UA was abnormal for protein, glucose, moderated blood, small leukocytes, more than 100 WBCs and few bacteria. Patient was also found to be COVID-19 positive. He received 2.5 L of NS bolus, Zosyn, Tylenol and Insulin. Urology has been consulted by the ED. Hospitalists were asked to admit for sepsis (HPI per NP)  Hospital Course: No notes on file patient is a 79yr old male with a history of HTN, DM, GERd, Depression, recent Left  Left ureteroscopy with basket stone extraction and double-J ureteral stent exchange on 2/19 for Left nephrolithiasis who presented with AMS, fever and is being managed for sepsis likely from urinary source. Today he is seen laying in bed, sleeping but arousable. He says he feels tired but otherwise a bit better. He denies any breathing issues or lower abdominal pain.    Sepsis secondary to MRSA bacteremia - this is possibly secondary to urinary source in the setting of recent cystourethroscopy with stone extraction and stent exchange on 02/19/24, though he does have a stage 2 sacral ulcer. Urine culture now growing 13,000 CFU of MRSA and 5,000 CFU of Pseudomonas. He is on zosyn day#6, and IV vancomycin day#4 started following MRSA positive blood culture. Had an episode of fever, tachycardia and hypotension on 2/21 but has now been afebrile for 72hrs. Repeat blood cultures from 2/22 no growth till date and TTE negative for endocarditis ID consulted, recommends IV vancomycin 1 g daily until March 6 and cefepime 1 g q.12 until 02/29/2024. Check labs complete blood count, BMP, vancomycin trough on March 1st .  CM on board - Return to Medical Care Facility for continued rehab and now with IV abx - no earlier than Monday 2/26. Meds to facility.    Abdominal issues - Resolved. CT abdomen showed No evidence of bowel obstruction; Marked wall thickening of the rectosigmoid colon which appears to be edematous, suspicious for an infectious or inflammatory colitis and Moderate to large amount of stool throughout the remainder of the colon. Now having bowel movements. I will keep on bowel regimen prn.   COVID infection - Patient was tested positive for COVID here on 02/19 but per Medical Care Facility, he had tested + for covid on 1/16/24 while at there facility. Case reviewed with infection prevention team and it was decided to take him out of isolation. He remains asymptomatic for this.   Left Nephrolithiasis - recently had cystoscopy, Left urethroscopy with stone extraction and stent exchange on 02/19/24. Urology contacted and will follow up with him outpatient  Discharged to SNF.