Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Agitation, Blood bicarbonate normal, Blood creatinine increased, Blood urea increased, COVID-19
Clinical narrative: Patient is a 70yoF with a h/o HTN and DM2, spinal stenosis and chronic pain/neuropathy, ESRD (on iHD) who presents with URI sx and worsening chronic pain that she states is being suboptimally managed, found to have COVID-19.   To briefly summarize patient's baseline state of health and wellbeing: she lives alone. She previously worked as a graphic designer and says she was on faculty at a university, but ever since she started dialysis she has not been working. When asked how she spends her time, she says "nothing--I don't have any time to spend; I'm in dialysis or I'm not, and I'm always in pain." She has a history of chronic pain throughout her body (she cannot localize it at all) managed by an outpt pain provider that has been worse ever since starting iHD. Her chronic pain has also made her mobility worse- she now uses a walker and at times a wheelchair to get around. She has a ride to take her two and from dialysis but says she has no other home services (though PCP notes suggest she does have one home health aid, as of 7/2021]; it is not clear how she does her shopping, etc (she does not articulate this when asked a few times). Overall, she has been suffering significantly since she started dialysis, but when asked if she would ever consider stopping dialysis she says she has not pursued this option.    Patient was at her baseline until about a week ago when she developed nasal discharge, a mildly sore throat, and a cough, initially minimally productive but later productive of some phlegm w/ scant blood. No loss of smell or taste; she denies N/V or diarrhea (at baseline has constipation on opioids), but she says her PO intake and appetite have been reduced. She has felt warm but unclear if fevers at home; she has been having myalgias, which have made her chronic pain (throughout her body) much worse than her baseline. Given this worsening pain, and her sense that iHD tends to make her pain much worse, she decided to skip a session of iHD--this did not help with her worsening pain at all. Therefore, on 10/23/21, she presented to the ED for further evaluation.   In the ED, the patient was afebrile (Tmax 99.1), mildly tachycardic to 104, and hypertensive, w/ BPs ranging from 160s-200s/70s-100s (though in the context of pain and agitation); initial las demonstrated bicarb 25, SCr 6.7 (on iHD), BUN 57; Hgb 9.8 (stable), other cell lines wnl. A COVID test was found to be POSITIVE. A CXR demonstrated a patchy opacity in the left lung base. The patient received 2 mg of oral dilaudid x1. Renal was consulted for inpt iHD. She was then admitted to medicine for further mgmt.   Upon admission to medicine, the patient confirms the above history. She says her pain outpatient has never been adequately controlled, thought he dilaudid--when she takes it--does reduce the pain somewhat. Though asked several times, she cannot quantify on the 10-scale her degree of pain, past or present. Her goal for this hospitalization is to have her chronic pain "treated better." She also worries about her new COVID infection. Finally, she is worried she does not have enough services at home.    With regard to her COVID infection: she received both doses of the moderna vaccine, though not yet any booster. She denies any sick contacts.