Age: 87.0
Sex: M
Vaccine: COVID19
Symptoms: Procalcitonin normal, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive, Transaminases increased
Clinical narrative: Hospitalized (10.14.21 - 10.21.21);  COVID-19 positive (10.14.21);  Fully Vaccinated  Admission Date: 10/14/2021 Discharge Date: Oct 21, 2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Transaminitis  Hypoxia Generalized weakness AMS (altered mental status) COVID-19 virus infection COVID-19 HOSPITAL COURSE: Patient is an 87-year-old male with past medical history of hypothyroidism, type 2 diabetes, chronic systolic heart failure status post pacemaker, history of CVA with residual left-sided weakness, wheelchair bound who presented to the hospital with COVID-19 infection.  Patient was fully vaccinated.  Patient was admitted to the hospital due to altered mental status and generalized weakness in the setting of a scope infection.  Patient was not hypoxic but for a brief moment during admission.  The patient was globally weak and had progressive difficulty ambulating at home until the 20th brought into the ER.  In the ER he was found to have elevated LFTs, general weakness.  Neurology was consulted who recommended CT of the head which was unremarkable aside from chronic changes.  Chest x-ray was done which showed no cardiopulmonary disease.  due to his LFT elevation of the liver ultrasound was performed which showed no evidence of portal vein thrombosis.  Patient was a candidate for monoclonal antibody therapy which he received and tolerated well.  For about 20 the patient had an aspiration event, became more confused, and had 1 fever.  Chest x-ray showed aspiration pneumonitis, white blood cell count was normal, procalcitonin was normal.  Patient recovered quickly, never required oxygen.  Short of breath was consulted who recommended NPO while the patient was confused, this resolved and the patient was able to advance back to a general diet prior to discharge.  patient was evaluated by Physical therapy and Occupational therapy who recommended subacute rehab given the patient's profound weakness in the setting of his recent infection.  Patient was unable to stand without significant assistance.  The patient's wife and daughter were insistent that the patient would do better at home and wanted to set up home health nursing and were adamant that they can't care for the patient better at home than at rehab.  Patient's daughter was heavily involved in the patient's care, she was very concerned about specifically his thyroid medication and felt that missing a few doses of his thyroid medication contributed significantly to his acute decompensation in the hospital.  Given has improvement in mental status, improvement in his vitals, he was afebrile, he was tolerating a general diet, and received adequate therapy for his COVID-19 infection the patient was considered stable for discharge home with home health care with the family support.  I discussed with the daughter that the patient be brought back if caring for him at home becomes unsafe, overwhelming, or cumbersome for the patient and her family.  Patient and family were in agreement this plan discharge home in stable condition