Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Deep tissue injury, Delirium, Dementia, Dyspnoea, Epilepsy
Clinical narrative: Date of Admission: 10/7/2023   Date of Discharge: 10/13/2023 skilled rehabilitation pending bed availability   Issues to be Addressed at Follow-up: COVID-19 infection Breakthrough seizures Acute urinary retention Acute delirium   Pending Study Results at Discharge:  Unresulted Lab Orders    Date and Time Order Name Status Specimen Source   10/7/2023  1:54 PM LEVETIRACETAM LEVEL In process --       Final Diagnoses:  Active Hospital Problems   Diagnosis   ? COPD (CHRONIC OBSTRUCTIVE PULMONARY DISEASE)   ? DEEP TISSUE PRESSURE INJURY OF SACRUM   ? URINARY RETENTION   ? EPILEPSY, UNSPECIFIED   ? COVID-19 DISEASE   ? MAJOR VASCULAR NEUROCOGNITIVE DISORDER (VASCULAR DEMENTIA)       MEMORY CENTER 5Ms Mentation: Seen in Memory Center on 9/7/2023 with agency 4/22    Medical decisional capacity: No. Medications: Trial of: Trazodone, Depakote, Alprazolam. Past use of: .    Medical Issues r/t Cognition: Agitation  Mobility: Wheelchair or Bed bound  What Matters Most:  Family.   Primary Memory Care Specialist: GNP-BC Contact Memory Center: for ED/hospitalization follow-up.    ? PREDIABETES   ? CAD (CORONARY ARTERY DISEASE) WO ANGINA   ? HTN (HYPERTENSION)   ? HYPERLIPIDEMIA   ? HX OF STROKE WO RESIDUAL DEFICITS       Reported per patient, .    ? BPH (BENIGN PROSTATIC HYPERPLASIA)     Resolved Hospital Problems   Diagnosis Date Resolved ? (Principal) STATUS EPILEPTICUS 10/13/2023 ? HEMATURIA 10/13/2023 ? NONTRAUMATIC ACUTE KIDNEY INJURY 10/13/2023     Discharge Disposition:  SNF   Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings: 78-year-old male with history of complex partial seizure on Keppra (recent taper recommendation) and Depakote, chronic cough, COPD on chronic O2 2 to 4 L by nasal cannula, hypertension, history of stroke without residual, vascular dementia, prediabetes, history of laryngeal cancer presented from his senior living facility with unresponsiveness with left to right arm twitching.  Placed on nonrebreather bag and transported to ED.  Patient noted right eye deviation without shaking. Admitted for status epilepticus, AKI, hypernatremia. Depakote = 30 on admission, subtherapeutic. Also, incidental Covid positive. Neurology consulted and recommended Dilantin and Keppra and lorazepam as needed for seizures. Likely Covid and subtherapeutic depakote level lowered his seizure threshold.He was started on remdesivir on 10/8 at 8 PM.   Neurology recommends Dilantin 100 mg every 8 hours and Keppra 500 mg twice daily on discharge.  Dilantin level in 1 week.  Possible increase Keppra dosing with outpatient neurologist follow-up.  Would recommend being therapeutic on 1 or the other medication.   Urinary retention noted and after straight cath x 2 and foley placement, developed hematuria. No clots. Heme stable.   10/8:   Started on remdesivir at 8 PM. 10/9:   Mental status improved 10/9.             Neurology made medication recommendations            Swallow evaluation by speech therapy -recommended for pureed diet with honey thick liquids            Hematuria persists, no clots in foley bag   10/10  Discontinued foley. Still on restraints. Resume gentle hydration 10/11 continued to need straight cath due to retention 10/12 replaced foley- urine 1100 residual noted. no hematuria, mentation stable for patient, awareness of the foley catheter, no pulling on catheter. 10/13 stable for discharge pending bed availability   Status epilepticus  (Currently appears to be close to baseline mentation) Continue with Keppra 500 mg twice daily Continue with Dilantin 100 mg 3 times daily Continue with current diet-puréed and moderately thick   Acute kidney injury Hematuria-improved Benign prostate hypertrophy Acute urinary retention. (Likely hematuria in the context of traumatic Foley catheterization) Continue tamsulosin Trial without catheter in the next 5 to 7 days Outpatient urology evaluation.   COVID-19 infection-noted on 10/7/2023 Completed remdesivir Discontinued dexamethasone-last dose received on 10/10/2023 at 8 PM  Last day of isolation 10/17/2023   Chronic hypoxemic respiratory failure COPD As needed albuterol Continue with home oxygen requirement 2 to 4 L through nasal cannula   Coronary artery disease with non-ST episodes of angina History of stroke without residual deficit Vascular dementia Provide high-dose statin ADL support Delirium protocol   Prediabetes mellitus Currently no need for Accu-Cheks   Deep tissue injury-sacrum and coccygeal area-present on admission Wound care evaluation Offloading   Primary Procedures:  None   Secondary Procedures: None   Reason for Hospital Admission (Admitting Diagnosis):    Breakthrough seizure, COVID-19 infection, urinary retention, delirium   Complications: none   Consults:  None Smoker: No.   Condition on Discharge: stable   Code Status at Time of Discharge: DNR       Note Details  Author (M.D.) File Time 10/13/2023  2:15 PM Author Type Physician Status Signed Last Editor (M.D.) Specialty Hospital Medicine Hospital Acct #  Admit Date 10/7/2023  ED to Hosp-Admission (Current) on 10/7/2023  ED to Hosp-Admission (Current) on 10/7/2023   Detailed Report  Note shared with patient Additional Orders and Documentation   Results Imaging   Meds    Orders Procedures   Flowsheets   Encounter Info:  History, Allergies, Education, Care Plan, Detailed Report   Hospital Problem List   STATUS EPILEPTICUS Resolved  HYPERLIPIDEMIA  HTN (HYPERTENSION)  CAD (CORONARY ARTERY DISEASE) WO ANGINA  PREDIABETES  MAJOR VASCULAR NEUROCOGNITIVE DISORDER (VASCULAR DEMENTIA)  EPILEPSY, UNSPECIFIED  BPH (BENIGN PROSTATIC HYPERPLASIA)  HX OF STROKE WO RESIDUAL DEFICITS  NONTRAUMATIC ACUTE KIDNEY INJURY Resolved  COVID-19 DISEASE  DEEP TISSUE PRESSURE INJURY OF SACRUM  URINARY RETENTION  COPD (CHRONIC OBSTRUCTIVE PULMONARY DISEASE)  HEMATURIA Resolved Care Timeline  10/07   Admitted from ED (Observation) 1727 10/09   Admitted 0923  Expected Medication List at Discharge   albuterol sulfate 90 mcg/actuation Inhale 2 puffs by mouth every 4 hours as needed for shortness of breath. Note: Different manufacturer.  atorvastatin calcium 10 mg Take 1 tablet by mouth daily. Please complete labs prior to next refill request.  ciclesonide 80 mcg/actuation 1 Puff Inhalation 2 TIMES A DAY, for asthma prevention and control. Rinse mouth well after use  levetiracetam 500 mg Oral 2 TIMES A DAY  melatonin 3 mg Take 2 tablets by mouth daily at bedtime half-hour before bedtime  phenytoin sodium extended 100 mg Oral 3 TIMES A DAY  pyridoxine HCl (vitamin B6) 25 mg Oral DAILY  tamsulosin HCl 0.8 mg Oral EVERY BEDTIME  thiamine mononitrate (vit B1) 100 mg Oral DAILY  trazodone HCl 150 mg Oral EVERY BEDTIME Pt in house bed