Age: 79.0
Sex: M
Vaccine: COVID19
Symptoms: Physical deconditioning, Positive airway pressure therapy, Respiratory distress, Respiratory failure, Staphylococcus test positive
Clinical narrative: Patient had 4 day inpatient admission and was discharged to continuing care facility.  79-year-old male with past medical history significant for epilepsy, CVA with residual aphasia, sick sinus syndrome status post pacemaker, hypertension, hypothyroidism and recent hospitalization at a HCF (11/22 - 11/25) for COVID pneumonia who presented to outside hospital ER locally with chief complaint of generalized weakness, multiple falls, labored breathing.  Of note, patient was discharged from HCF on 3 L oxygen.   Upon arrival to ER, patient found to be tachypneic and otherwise hemodynamically stable.  His chest x-ray showed diffuse bilateral COVID pneumonia.  Was noted to have acute kidney injury as well with creatinine 1.49.  Patient had recently completed 10 days of Decadron but was restarted on steroids given he was requiring more oxygen.  He was admitted to hospitalist service with chronic hypoxic respiratory failure and failure to thrive.   After admission, patient's oxygenation stable and in fact he was weaned to 2L; unclear if patient's oxygenation status that much worse on admission from prior discharge and probably is chronic hypoxemia from recent COVID pneumonia.  Suspect patient dealing with deconditioning, failure to thrive after recent COVID illness.  He was started on steroid taper in case longer course of steroids might hope improve oxygenation status.  PT/OT assessed patient and recommended rehab vs home assist with home health care.  Family agreeable to rehab.  Patient hypoxia improved and on room air at discharge. He was discharged to continuing care facility in stable condition.   Noted to have urinary retention.  Urology consulted.  Ditropan stopped, started on Flomax.  Urology recommends follow-up with outpatient urologist. Pt is a 79 y.o. male here today alone.  History is provided by patient, nursing home and past medical records.    Pneumonia due to COVID-19 virus   12/03-12/07 Presented to local Emergency Room with respiratory distress.  He had been diagnosed with COVID on November 22 with symptom onset of November 20. He had been admitted at the HCF from November 22 through November 25 and received steroids and remdesivir and (tocilizumab?) while there.  His last day of oral Decadron had been December 1. EMS was called because family noticed increased difficulty breathing.  On arrival he had a respiratory rate in the 40s.  He was placed on CPAP by EMS.  He had increased falls.  On exam he was tachypneic.  Lab workup showed a sodium of 131 and does normal white blood cell count.  Chest x-ray showed bilateral infiltrates consistent with pneumonia from COVID-19.  Head CT showed no bleeds.  He was given ceftriaxone and azithromycin and IV fluids.  He was eventually admitted to the hospital.   He was given steroids and a long taper.  He received only 1 day of antibiotics.  Blood cultures grew Staph hominis and epidermidis, felt to be contaminants.  Repeat blood cultures were negative.  He was kept on enoxaparin prophylaxis.  Course was complicated by urinary retention.  Oxybutynin was stopped and he was started on tamsulosin.  Acute kidney injury improved and lisinopril was held until blood pressure trended up, then put on discharge medication list.  He had a small wound on his right nose due to glasses.  Speech therapy felt he could have thin liquids, regular solids and liquids via cup and straw.   On December 7 he was discharged to another local Rehab and Nursing Center.  New medicines were a prednisone taper and tamsulosin.   December 9 seen for H&P.  Patient was awake but this examiner had a hard time establishing a reliable yes or no communication strategy.  He seems to nod yes but does not do so reliably.  Later in the day, I spoke with his daughter.  SLP eval added for both cognition and communication strategies.