Age: 83.0
Sex: F
Vaccine: COVID19
Symptoms: Dementia Alzheimer's type, Failed back surgery syndrome, Gastrooesophageal reflux disease, Hypertension, Malaise
Clinical narrative: An 86 y.o. female patient with a history of aortic insufficiency, GERD, Hashimoto's thyroiditis, hyperlipidemia, hypertension, history of migraines, peptic ulcer disease history of TIA and tricuspid insufficiency who originally presented as a transfer from Hospital to another Hospital with malaise and chest pain and found to have a non-STEMI and COVID-positive pneumonia.  Patient was seen in consultation by cardiology and did not recommend any further ischemic testing and medical management only and the patient did well from a cardiac standpoint.  She was also seen in consultation by infectious disease who did treat her care with remdesivir as well as IV Rocephin and doxycycline for presumed secondary bacterial pneumonia and then after a rather prolonged hospitalization the patient was significantly debilitated with severe muscle deconditioning and eventually was transferred to transitional care unit on 9/27/2023.  Now after 7 days of aggressive rehabilitation the patient's condition is much improved over condition at time of admission and she will be discharged to assisted living facility for ongoing home health physical therapy.  The patient's isolation was discontinued yesterday for COVID-19 and she remained completely afebrile, asymptomatic, and normal oxygen saturations on room air.  She is encouraged to follow-up with cardiology in 2 weeks and with her primary care provider in 1 week to 10 days.     Severe muscle deconditioning An 86 y.o. female with a history of aortic insufficiency, GERD, Hashimoto's thyroiditis, hyperlipidemia, hypertension, migraines, peptic ulcer disease, TIA, and tricuspid insufficiency, who presented as a transfer from Hospital where she initially presented with malaise and chest pain, and was found to have an NSTEMI and COVID pneumonia.  The patient was seen in consultation by cardiology who did not recommend any further ischemic testing and medical management only.  She was also seen in consultation by infectious disease who did treat her with remdesivir as well as IV Rocephin and doxycycline for a presumed secondary bacterial pneumonia for which she has completed.  Patient was noted to have some cognitive impairment particularly in the evenings suggestive of sundowning and family is concerned with her progressive deterioration of mental status over the last 2 years.  It was suggested that a formal geriatrics consultation for further diagnostics be pursued at time of discharge.  Now after a rather prolonged hospitalization the patient is noted to be significantly debilitated with severe muscle deconditioning and after a comprehensive evaluation by both physical and occupational therapies the patient has been deemed to be an appropriate candidate for aggressive rehabilitation here at transitional care unit.  On physical exam this a.m. the patient is examined at bedside and is awake alert and oriented x3 at this time and denies any new complaints and specifically denies any chest pain or shortness of breath, nausea or vomiting, diarrhea or constipation, dizziness or headache.  Patient will begin her aggressive rehabilitation plan of care soon as possible.  She will remain in isolation however due to hospital policy until 10/1/2023.       Gastroesophageal reflux disease without esophagitis The patient's symptoms are currently well controlled on Pepcid 20 mg twice daily.   Mixed hyperlipidemia We will continue Lipitor 10 mg daily. Primary hypertension Blood pressures currently well controlled on propranolol 20 mg twice daily, Bumex 0.5 mg twice daily and Norvasc 5 mg daily.   Hashimoto's thyroiditis Current TSH has been normal most recent TSH was 1.52 and will continue to follow-up as outpatient.   Chronic kidney disease, stage III (moderate) (HCC) The patient's current renal function is normal with a serum creatinine of 0.8 and we will continue to monitor periodically.   NSTEMI (non-ST elevated myocardial infarction) (HCC) Patient denies any chest pain or shortness of breath and will continue with all current cardiac medications as was recommended by cardiology.   Mild early onset Alzheimer's dementia without behavioral disturbance, psychotic disturbance, mood disturbance, or anxiety (HCC) The patient exhibited symptoms of sundowning nightly while at Hospital and currently is on Risperdal 1 mg nightly as well as Cymbalta 30 mg daily.  The patient would benefit from an outpatient geriatric consultation to further delineate her dementia type symptoms.   Postlaminectomy syndrome of lumbosacral region Patient is status post laminectomy with postlaminectomy syndrome and SI joint pain which is chronic and follows with pain management and has a morphine pain pump implanted which was recently refilled.  Currently her pain is under good control.  I will add oxycodone 5 mg every 6 hours as needed for any breakthrough pain however.