Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: Malnutrition, Neutropenia, Sepsis, Thrombocytopenia, Urinary tract infection
Clinical narrative: Date of Admission: 11/16/2023   Date of Discharge: 11/21/2023   Issues to be Addressed at Follow-up: Possible hospice when applicable    Pending Study Results at Discharge:  Unresulted Lab Orders    Date and Time Order Name Status Specimen Source   11/16/2023  6:37 PM BLOOD CULTURE 2 Preliminary BLOOD   11/16/2023  4:45 PM BLOOD CULTURE Preliminary BLOOD       Final Diagnoses: UTI (URINARY TRACT INFECTION) (5/15/2015) - with Ampicillin sensitive enterococcus - will change to Amoxicillin  - clinically stable and mostly asymptomatic  - follow up with primary care physician as needed    NEUTROPENIA THROMBOCYTOPENIA -Likely due to sepsis - no signs of bleeding      COVID-19 DISEASE (11/17/2023) - no symptoms. Incidental finding  - may stop isolation after 5 days in outpatient setting       ATRIAL FIBRILLATION, UNSPECIFIED (8/12/2017) - heart rate stable  -Not on rate control or anticoagulation     CKD STAGE 3A (GFR 45-59) (2/26/2019)   -renal function stable    ELEVATED BP  - patient probably has undiagnosed hypertension       MAJOR NEUROCOGNITIVE DISORDER DUE TO ALZHEIMERS DISEASE (ALZHEIMERS DEMENTIA) (5/12/2023) CALORIE MALNUTRITION (1/3/2006) -Continue donepezil, sertraline, seroquel, trazodone -delirium team consulted and appreciated        Discharge Disposition:  ALF    Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings: BRIEF HOSPITAL SUMMARY: 81 year old woman with dementia, malnutrition, CKD, atrial fibrillation, hx MDR ecoli UTI, admitted 11/16/23 with lethargy, worsening confusion, found to have UTI and COVID.  Urine culture grew enterococcus, sensitive to Ampicillin so antibiotics was change to Ampicillin.  Patient did not have respiratory symptoms from her incidental finding of COVID.    Overall patient has been refusing medications and treatment. She becomes agitated at times and would scratch staffs. Delirium team has been consulted and assisted with medications. However, patient would refuse to take them at times.    Palliative care was consulted.    I also had a lengthy discussion with patient's DPOA about patient's condition and poor prognosis. She understands and agrees that allowing patient to go back to her memory unit might benefit patient the most. Her prognosis is poor and she may fall and injure herself anytime.    Will discharge back to memory unit now. Enroll in hospice when applicable.  Follow up with primary care physician as needed      Primary Procedures:  None   Secondary Procedures: None   Reason for Hospital Admission (Admitting Diagnosis):  As above    Complications: none   Consults:  HOSPITAL MEDICINE - ONGOING INPATIENT CONSULTATION. PALLIATIVE CARE - INITIAL INPATIENT CONSULTATION. PALLIATIVE CARE - ONGOING INPATIENT CONSULTATION. Smoker: No.   Condition on Discharge: deteriorating overall    Code Status at Time of Discharge: DNR       Note Details  Author (M.D.) File Time 11/21/2023  2:52 PM Author Type Physician Status Signed Last Editor  (M.D.) Specialty Hospital Medicine Hospital Acct #  Admit Date 11/16/2023  ED to Hosp-Admission (Discharged) on 11/16/2023  ED to Hosp-Admission (Discharged) on 11/16/2023   Routing History   Detailed Report  Note viewed by proxy Additional Orders and Documentation   Results    Meds    Orders    Flowsheets   Encounter Info:  History, Allergies, Education, Care Plan, Detailed Report   Hospital Problem List   CALORIE MALNUTRITION  ATRIAL FIBRILLATION, UNSPECIFIED  CKD STAGE 3A (GFR 45-59)  MAJOR NEUROCOGNITIVE DISORDER DUE TO ALZHEIMERS DISEASE (ALZHEIMERS DEMENTIA)  UTI (URINARY TRACT INFECTION)  COVID-19 DISEASE Care Timeline  11/16   Admitted from ED (Observation) 2054 11/19   Admitted 1133 11/21   Discharged 1844  Discharge   Other - not listed elsewhere   Discharge Instructions (AVS) (Printed 11/21/2023) Medication List at Discharge   amoxicillin 500 mg Oral 3 TIMES A DAY  donepezil HCl 10 mg Oral EVERY BEDTIME  loperamide HCl 2 mg Take 2 tablets by mouth after the first loose stool, then 1 tablet after each subsequent loose stool. Do not exceed 4 tablets in 24 hours. Take with 4 to 8 ounces of water  loratadine 10 mg Oral DAILY AS NEEDED  melatonin 5 mg Dissolve 1 tablet under the tongue half-hour before bedtime  psyllium seed Dissolve 1 rounded teaspoonful in 8 ounces of water and drink 2 times a day. Drink additional fluid after taking medication  quetiapine fumarate   12.5 mg Oral EVERY EVENING  25 mg Oral EVERY 6 HOURS AS NEEDED  sertraline HCl 100 mg Oral DAILY  trazodone HCl 50 mg Oral EVERY BEDTIME