Age: 81.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Bronchiolitis, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chills
Clinical narrative: 1/5/22 82-year-old male presents from nursing home by EMS with history of DNR, Parkinson's, CLL, A. fib presents emergency room with complaints of increased shortness of breath and fever/chills, malaise and fatigue.  Presents by ambulance who gave him a neb treatment in route and placed on nasal cannula oxygen.  He was recently admitted for approximately 1 week and discharged 2 days ago after admission for pneumonia with respiratory difficulty requiring supplemental oxygen and steroid treatment.  No significant abdominal pain vomiting diarrhea or GI symptoms.  No chest pressure palpitations or near syncope. 1/13/22 82-year-old male with past medical history of chronic lymphocytic leukemia, Parkinson's disease,  MI, CVA, hypertension, A. fib on Eliquis and GERD who presented with worsening dyspnea after recently being discharged from Hospital with COVID PNA. He was treated for respiratory failure. Pulmonology was consulted and patient was given bronchodilators, cefepime/vanc, mucinex, solumedrol, ZnSO4. The patient repeatedly made comments to staff and the family indicating a desire to be allowed to die.  Hospice was consulted.  His family has met with hospice and wishes to honor his wishes.  He was discharged to hospice scatter bed and expired at time and date listed above. Parkinson's disease, MI, CVA, hypertension, A. fib on Eliquis and GERD who presented with worsening dyspnea after recently being discharged from hospital with COVID PNA. He was treated for respiratory failure. Pulmonology was consulted and patient was given bronchodilators, cefepime/vanc, mucinex, solumedrol, ZnSO4. The patient repeatedly made comments to staff and the family indicating a desire to be allowed to die.  Hospice was consulted.  His family has met with hospice and wishes to honor his wishes.  He was discharged to hospice scatter bed and expired at time and date listed above.  Admission date: 1/13/2022   Date of death: 1/14/2022 Time of death: 6:55 AM       Principal Problem:   Hospice care (1/13/2022) POA: Not Applicable   Acute respiratory failure with hypoxia (1/5/2022) POA: Yes   Chronic lymphocytic leukemia (2/6/2012) POA: Yes   Chronic kidney disease (6/30/2016) POA: Yes   Benign prostatic hyperplasia (5/23/2019) POA: Yes   Parkinson's disease (5/1/2005) POA: Yes   History of cerebrovascular accident (1/1/2008) POA: Not Applicable   Gastroesophageal reflux disease (10/24/2011) POA: Yes   Atrial fibrillation (5/1/2019) POA: Yes   Coronary artery disease involving native coronary artery (6/21/2018) POA: Yes   Post-acute COVID-19 syndrome (12/29/2021) POA: Not Applicable   HCAP (healthcare-associated pneumonia)/gram-negative pneumonia (1/8/2022) POA: Yes   Hyperkalemia (1/11/2022) POA: No     Admit date: 1/5/2022    Discharge date:  1/13/2022   Discharged Condition: Good    Hospital Course: From initial H&P: "82-year-old male with past medical history of chronic lymphocytic leukemia, Parkinson's disease, MI, CVA, hypertension, A. fib on Eliquis and GERD who presented to ED with increasing shortness of breath and fever. Of note, patient was recently admitted to Hospital for Covid PNA and discharged on 1/3/2022.  However patient reports increasing dyspnea with O2 sats in 80s on 4L NC and temp of 100.5.  Patient is a DNR."    He was treated for the following:    Respiratory failure/COVID, treating for HCAP: pulmonology following. Giving scheduled and PRN bronchodilators, cefepime/vanc, mucinex, solumedrol, ZnSO4. - r required    CLL: WBC >72K on 1/10 and suspect some elevation related to CLL.    Parkinson's: continue sinemet    A fib: anticoagulated on eliquis    Hyperkalemia:    BPH: flomax    The patient repeatedly made comments to staff and the family indicating a desire to be allowed to die.  Hospice was consulted.  His family has met with hospice and wishes to honor his wishes.  He will be discharged to hospice scatter bed.    Discharge Diagnoses: Principal Problem:   Acute respiratory failure with hypoxia   Active Problems:   Chronic lymphocytic leukemia    Chronic kidney disease    Benign prostatic hyperplasia (5/23/2019)     Parkinson's disease (5/1/2005)     History of cerebrovascular accident (1/1/2008)     Gastroesophageal reflux disease (10/24/2011)     Atrial fibrillation (5/1/2019)     Coronary artery disease involving native coronary artery (6/21/2018)     Post-acute COVID-19 syndrome (12/29/2021)    HCAP (healthcare-associated pneumonia)/gram-negative pneumonia (1/8/2022)     Hyperkalemia (1/11/2022)   Additional information for Item 12: Balance problems      R/T PARKINSON'S USES CANE W/AMBULATION o Blood dyscrasia   o Carpal tunnel syndrome on right     REPAIRED 5/1/18  o Cerebrovascular accident 6/30/2016 o CVA (cerebral vascular accident) 05/2008   "SLOW TO FIND WORDS" PER PT o Diffuse large B-cell lymphoma of lymph nodes of neck 1/26/2017 o Fatigue due to treatment   o GERD (gastroesophageal reflux disease)     DAILY OMEPRAZOLE o History of cancer chemotherapy 2017   R/T EAR SQUAMOUS CA & ORAL CHEMO R/T NON HODGKINS LYMPHEMA  o History of shingles     ABD-BACK , APPROX 2013 o HTN (hypertension)     TOPROL BID-CARDIOLOGIST  o Hx of therapeutic radiation 2016 & 2017   H/O R/T SQUAMOUS CELL CA/LEFT EAR o Infection of prosthetic joint 7/25/2016 o Intestinal malabsorption, unspecified 12/29/2021 o Low vitamin D level 12/28/2021 o Myocardial infarction     "SILENT"  o Non-Hodgkin's lymphoma  1998   ONCOLOGIST o Osteoarthritis     S/P LTHR 2016 , HANDS o Osteoradionecrosis of temporal bone 3/28/2018 o Parkinson disease 05/2005 o SCC (squamous cell carcinoma) 2/27/2018 o Squamous cell cancer of skin of earlobe, left 2016 o Tremor     RIGHT HAND & LEG R/T PARKINSON'S PER PT  1/8/22 XR Chest 1 Vw   IMPRESSION: Progressive right perihilar and unchanged bibasilar infiltrates, suspicious for pneumonia 12/29/21 CT Angiogram Chest For PE    IMPRESSION: 1.No evidence of pulmonary embolism 2.Smooth intralobular septal thickening with mild bronchial wall thickening at the lung bases may relate to mild interstitial pulmonary edema versus bronchiolitis 3.Trace effusions with bibasilar atelectasis 4.Further loss of height at the known L1 compression deformity in comparison to 2017. Please note that all CT scans at this facility use dose modulation, iterative reconstruction, and/or weight based dosing when appropriate to reduce radiation dose to as low as reasonably achievable  Additional information for Item 9: amantadine (SYMMETREL) 100 MG capsule Take 100 mg by mouth 2 (two) times daily.    apixaban (ELIQUIS) 5 MG tablet Take 1 tablet by mouth 2 (two) times daily.    Aspirin (ASPIR-81 PO) Take 81 mg by mouth daily    atorvastatin (LIPITOR) 40 MG tablet    carbidopa-levodopa (SINEMET) 25-100 MG Take by mouth 4 (four) times daily    Melatonin 1 MG/4ML LIQD 15 mg.    metoprolol, TOPROL-XL, 50 MG 24 hr tablet Take 1 tablet by mouth daily.  omeprazole (PRILOSEC) 20 MG capsule Take 20 mg by mouth daily.    tamsulosin (FLOMAX) 0.4 MG CAPS TAKE 1 CAPSULE BY MOUTH ONCE DAILY