Age: 76.0
Sex: F
Vaccine: COVID19
Symptoms: Clostridium test negative, Computerised tomogram thorax abnormal, Diarrhoea, Dyspnoea, Encephalopathy
Clinical narrative: Date of Admission  01/04/2022   Date of Discharge  01/15/2022   Reason for Hospitalization   pt husband "reports my wife had low oxygen saturation at urgent care today. my wife has also had increased weakness, shortness of breath and fatigue.  Hospital Course   Patient is a 77 year old female with past medical history significant for Alzheimer's dementia (A&Ox1-2, but able to perform ADLs), MV repair (3/2021), and chronic UI and UTIs (bladder stimulator, on TMP chronically) who presented to ED on 1/4 for hypoxia. She was positive for COVID in the ED, initially requiring 7L but quickly escalated to HHFNC and NIPPV. Acute hypoxic respiratory failure may be due to COVID, but given the fact that she is vaccinated and her quick escalation of oxygen needs in the setting of encephalopathy there was concern for aspiration pneumonia. She was started on ertapenem. She also had a positive MRSA nasal swab and was started on vancomycin. She reported diarrhea starting a few days prior to presentation and was incontinent, C dif and GI PCR grossly negative. She was in the ICU from 1/5-1/7 and then transferred to floor after transitioning to NC and at discharge patient was on RA and home oxygen evaluation was unremarkable for hypoxia with ambulation.  Discharge Diagnoses      Acute hypoxic respiratory failure  Acute COVID pneumonia Acute Aspiration pneumonia-Concern for secondary bacterial pneumonia -resolved  Leukocytosis, resolved  -CT-PE 1/4 negative for PE, + for GGO in RML, RLL and bilateral subsegmental atelectasis  -s/p Dexamethasone (1/5-1/12), remdesivir (1/5-1/9),  -baricitinib (1/5-1/19) - 4 pills sent to pharmacy -s/p Vancomycin for MSRA+ (stop date 1/14)  - s/p Ertapenem for pneumonia (1/7-1/11)  * MICROBIOLOGY  - Antimicrobials:   Azithromycin 1/5-1/7   Ceftriaxone 1/5   Piperacillin-tazobactam 1/5-1/7   Vancomycin 1/5-p   Ertapenem 1/7-1/11  Diarrhea - resolved  -KUB 1/5 w/ nonobstructive bowel gas pattern  -C. difficile and GI PCR panel negative.  Chronic UTI  -UA on admission negative for infection  -held home Myrbetriq and TMP  Alzheimer's Dementia  Encephalopathy secondary to acute infection, resolved  -continue home memantine  -TSH low, FT4 WNL, T3 low  Other Diagnoses   Ongoing  Alzheimer disease  Anxiety and depression  Aphthous ulcer  Melanoma  Migraine headache  Osteoarthritis of hip  Urge urinary incontinence  Urinary, incontinence, stress female  Historical  Diarrhea  Major neurocognitive disorder    Consultants  Medicine Pulmonary     Discharge Disposition  Home    Medications  New, Changed, or Refilled Medications  baricitinib (baricitinib 2 mg) 4 mg, 2 Tablet(s), Oral, Daily, for 4 day(s), 8 Tablet(s), 0 Refill(s)    benzonatate (benzonatate 100 mg) 100 mg, 1 capsule(s), Oral, tid, for 14 day(s), PRN: Cough, 20 capsule(s), 0 Refill(s)    nystatin topical (nystatin 100,000 units/g topical cre 1 Application, Topical, tid, for 14 day(s), 15 g, 0 Refill(s)      Medications to be Continued  aspirin (aspirin 81 mg , chewable) mg, Tablet(s), Daily, 0 Refill(s)    bacillus coagulans-inulin (Probiotic Formula (Bacillus 1 capsule(s), Oral, Daily, 0 Refill(s)    memantine (memantine 10 mg) 10 mg, 1 Tablet(s), Oral, bid, for 30 day(s), 60 Tablet(s), 11 Refill(s)    mirabegron (Myrbetriq (mirabegron) 25 mg , extended re 25 mg, 1 Tablet(s), Oral, Daily, for 30 day(s), 30 Tablet(s), 11 Refill(s)    multivitamin, prenatal (MULTIVITAMIN, ADULT, STANDARD) 1 tablet, Oral, Daily, 0 Refill(s)    triamcinolone topical (triamcinolone 0.1% topical crea See Instructions, APPLY 1 APPLICATION TOPICALLY TWICE A DAY, 30 g, 0 Refill(s)  Instructions:APPLY 1 APPLICATION TOPICALLY TWICE A DAY  trimethoprim (trimethoprim 100 mg) See Instructions, TAKE 1 TABLET DAILY BEDTIME, 90 Tablet(s), 3 Refill(s)  Instructions:TAKE 1 TABLET DAILY BEDTIME   Addendum on January 22, 2022 11:24:09 CST (Verified)    Attestation  on January 22, 2022 11:24 I personally saw and evaluated the patient on the result date found in the header of this document.  I independently performed the critical/key portions of the Evaluation and Management service and discussed the management with the author of this document.  I agree with everything documented above with the following exceptions/additions:    None