Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: Lipoma, Major depression, Metabolic encephalopathy, Nephrolithiasis, Nothing by mouth order
Clinical narrative: Patient is a 71 y.o. male patient of with history of diabetes, hypertension, hyperlipidemia, asthma, neuropathy presented to Hospital with encephalopathy on 9/4/2023.  Hospitalization has been prolonged and complicated by COVID-19 pneumonia and subsequently aspiration pneumonia with MRSA.  Patient status post PEG tube this hospitalization.   The following describes as Hospital course in further detail by problem:     Hospital-acquired aspiration pneumonia Elevated risk for aspiration Failed swallow eval Initially finished cefepime per ID ID following - now back on vanco after sputum culture from 9/30 growing mrsa That is post 10-day course of vancomycin for MRSA pneumonia.  Antibiotics completed at time of discharge Status post NGT feeds, now s/p PEG tube 10/2 Started on tube feeds, now at goal, tolerating well Continue aspiration precaution   Acute hypoxic respiratory failure Infectious disease following throughout admission and treated for both COVID-19 pneumonia with steroids and remdesivir and subsequently aspiration pneumonia as above. Oxygen patient stable at time of discharge on nasal cannula Discharge to skilled nursing facility PEG tube placed as above.  Remains n.p.o. at time of discharge.  Continue speech and language pathology services on discharge   Metabolic encephalopathy Delirium with agitation Continue Seroquel at night, increased dose to 50 mg 9/29 Neurology was consulted-EEG negative.  Rec to continue Wellbutrin, Zoloft, Seroquel, PT OT   Hypertension Better controlled Currently on Coreg, losartan, amlodipine   Recurrent major depression Seen by psychiatry  Currently on Wellbutrin, sertraline, Seroquel Acute kidney injury-improved  Hyperkalemia, improved obstructive uropathy, POA Nonobstructing right renal calculi Mild bilateral hydronephrosis Prostatomegaly Hematuria Initially, mostly due to obstructive uropathy CT C/A/P on admission showed moderate to severe bilateral hydronephrosis Urology  recommended continuing Foley on discharge Continue Flomax.  Had to be switched to doxazosin due to NG tube use. Nephrology signed off S/p ivf Discharge with foley and follow-up with urology   Acute hypoxic respiratory failure due to COVID 19 Covid-19 Virus Infection Date of onset of symptoms: Unknown yes Symptoms present on admission: yes Date of covid positive test: 9/4/2023 Vaccination status: pt says he Is vaccinated but isn't sure how many he got s/p dexamethasone for 10 days No remdesivir due to AKI. Status post IV Lasix.    New onset A-fib Rate controlled.  EKG reviewed from 2 days ago. Eliquis on hold for possible surgery next week.  Was changed to heparin dip Continue apixaban and Coreg on discharge   Hyperlipidemia Continue statin   Type 2 diabetes  currently controlled Continue aspirin statin Last A1c 7 in 8/28/2023 Continue to hold metformin. SSI   Hypothyroidism, primary Continue levothyroxine 25 TSH within normal limits 2.3 in 9//2023 Right middle lobe lung nodule 12 mm identical finding CT in 3 to 6 months as outpatient   Neck lipomas Ultrasound soft tissue of the neck showed lipomas