Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: Limb injury, Lung infiltration, Patient isolation, Respiratory failure, SARS-CoV-2 test positive
Clinical narrative: Discharge Summary DO (Resident) ? General Medicine Cosigned by: DO at 1/27/2025  5:05 PM  Attestation signed by DO at 1/27/2025  5:05 PM  I have personally interviewed and examined the patient on the date of service of the attached note. Management was discussed with DO. I agree with the documented findings and plan of care in their note.  Brief exam: Patient was alert and oriented times three, wearing his home mask. Lungs CTAB. Cardio RRR. Abdomen soft, bowel sounds present.   Brief history and medical decision making: : Patient was admitted and treated for a sternal wound with cellulitis and a RLE wound. He had been maintained on cefazolin 2 grams IV every 8 hours during his hospital stay. Wound cluture from 1/22 demonstrated MSSA.Blood cultures from 1/21/25 2/2 remain negative. CXR demonstrated Right lung infiltrate versus atelectasis. Strep pneumo and legionella antigens were negative. COVID  19 ws positive and he has been maintained in enhanced respiratory isolation. Paxlovid course was initated.   He has Mulitiple myeloma with leukopenia noted during this admission. He follows with Dr and was undergoing chemotherapy prior to his hospitalization. He has also been treated for acute kidney injury on CKD.   He was evaluated by wound care on the day  of discharge. . Keflex was ordered upon discharge to complete a total 14 day course of antibiotics.   Lasix was transitioned to torsemide 40 mg po daily upon discharge.  Endocrine referral for diabetic management was placed upon discharge.   Physician Discharge Summary  Name:   Medical Record #:   Age:  78 y.o. DOB:   Admit date: 1/21/2025  Discharge date: 1/27/2025  Admitting Physician: No admitting provider for patient encounter.  Attending Physician at the Time of Discharge: DO  Primary Care Physician:  DO,  Reason for Admission: Respiratory insuffiencey, RLE/Sternal wounds  Brief Summary of Hospital Stay: Patient was hospitalized for treatment of COVID and skin wounds.  His clinical status improved with Paxlovid, pulmonary hygiene, and antibiotics with wound care.  Hospital Course:  Patient is a 78 y.o. male with relevant PMH of multiple myeloma in remission, pain from bone metastases, peripheral neuropathy 2/2 T2DM, BPH, coronary artery disease, chronic HFpEF, gout, IDA, HLD, OSA, and CKD 3B presenting for dyspnea.  He was found to be COVID positive, with a wound with eschar on his right lower extremity and a sternal wound/abscess.  He started and completed a course of Paxlovid for his COVID along with pulmonary hygiene.  He was started on vancomycin for his wounds, eventually downgraded to Cefazolin.  He received 5 total days of antibiotics while inpatient.  He was seen by wound care for wound dressings and changes.  His wounds dramatically improved with antibiotics and wound care.  His respiratory status improved as well never requiring oxygen.  He will be sent home to complete a 14 day antibiotics course with Keflex for 9 days.  Additionally his Lasix was transitioned to torsemide 40 mg daily due to better bioavailability, less electrolyte derangements and less risk for AKI/dehydration.  A referral to Endocrine was placed for management of his diabetes.  Discharged to Home Health Care Svcs.