Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Arteriovenous fistula site complication, Asthenia, Blood culture, Blood glucose decreased, COVID-19
Clinical narrative: CHIEF COMPLAINT: Generalized weakness   This is a 66-year-old female with PMHx of DM, ESRD on dialysis T,TH,sat, hypotension, anemia, hyperparathyroidism, atrial fibrillation?on Eliquis, COPD, CHF is being admitted for Generalized weakness, possible PNA.   Of note, last hospitalization in November for fall sustaining rib fractures and possible pubic fracture, admitted to trauma service, evaluated by ortho, did not require any surgical intervention, discharged on 11/15/2021.   Patient reports feeling generally weak for the past several weeks, decreased p.o. intake and appetite for several days, intolerance to food, typically vomits when she tries to eat.  Today she was talking to her brother, patient sounded very weak and the staff had not attended to her call light so he called 911. EMS brought the pt to the ER. Pt additionally reports sx of productive cough and exertional shob. Her last dialysis was on Thursday, but states that her dialysis team had a hard time accessing her fistula.  She denies any CP, abdominal pain, fevers, congestion, urinary sx, headaches, vision changes, focal weakness.    She is vaccinated for Covid  PROGRESS NOTE 1/30/2022 ASSESSMENT: 66 y.o. female, with PMHx of DM, ESRD on dialysis T,TH,sat, hypotension, anemia, hyperparathyroidism, atrial fibrillation?on Eliquis, COPD, CHF admitted for Generalized weakness, diarrhea, positive for Covid infection.  Patient was started on broad-spectrum antibiotics for possible pneumonia. Problems list:  Covid infection/GI symptoms-diarrhea Suspected pneumonia Patient chest x-ray showed patchy opacities in the left mid to lower lung.  Started on broad-spectrum antibiotics and admission.  Patient has diarrhea, likely related to Covid illness. -MRSA nares was negative, vancomycin was discontinued.  Continue cefepime and Doxycycline. -C diff negative, continue Imodium as needed. -Procalcitonin on admission was 1.18 elevated, downtrending, follow blood cultures, inflammatory markers. Hypotension, chronic, improving Likely multifactorial from poor oral intake, possible pneumonia, diarrhea from Covid. -Continue PTA midodrine -Patient is nontachycardic, normal white count, afebrile, no concern for septic shock. ESRD, HD dependent, TTH SAT Metabolic acidosis -Nephrology consulted, appreciate input, dialysis per nephrology -Continue bicarb drip -Patient was supposed to get outpatient fistulogram, s/p fistulogram on 1/27 during hospital stay, per nephrology.  Left AV fistula infiltrated on dialysis of 1/25 aVF difficult to cannulate, s/p PCAD on 1/28/2022 Hypokalemia, chronic -Continue PTA potassium supplementation -Could not place potassium protocol due to ESRD, HD dependent.  Replace potassium intermittently as needed. Hypernatremia Resolved.  Treated with D5 5W infusion.  Hypoglycemia, improving -Blood glucose level was 23.  Patient received 1 dose of D50.  Blood glucose level has improved to 164.  History of atrial fibrillation, rate controlled -Continue PTA Eliquis 2.5 mg twice daily -Hold on beta-blocker due to softer blood pressures  History of COPD, not in exacerbation -Continue as needed albuterol  History of CVA Incidental finding of subacute to chronic infarct at the right inferior parietal to temporal lobe on CT done 11/12/21. No focal neuro deficits at this time.     DVT prophylaxis: Eliquis 2.5 mg twice daily.