Age: 92.0
Sex: F
Vaccine: COVID19
Symptoms: Dyspnoea, Effusion, Exposure to SARS-CoV-2, Hypertension, Left ventricular failure
Clinical narrative: ASSESSMENT / PLAN: Positive for COVID 19 virus Mildly dyspneic on exam, but also appears quite anxious about COVID positive test and hospitalization. She is otherwise asymptomatic and on baseline 2L NC. Attempted to discharge in ED, but unable to return to facility due to Covid positive status and family unable to care for patient.  Vaccinated w/ Moderna, but did not receive booster yet Will check CBC, CMP Of note May be on chronic prednisone 5 mg daily per med list but this has not been verified by pharmacy. Unclear why she would be on this as patient uncertain about her medications, may be for RA. Would continue pending med rec completion  Low threshold for CXR and escalation to decadron if clinically worsens Monitor on pulse ox, tele   Recent diagnosis of aspiration PNA Aspirated hot chocolate last week. Had CXR on 11/5 at facility and then was started on unknown Abx the next day. Again as above, denies any respiratory symptoms Will check procal Monitor off abx for now Check CXR if clinically worsens    Cardiomyopathy  Chronic combined systolic/Diastolic CHF CAD, severe multivessel disease. Had stents but poor bypass candidate  LBBB Complete heart block s/p pacemaker Aortic stenosis s/p TAVR in 2020 Pulmonary HTN Chronic respiratory failure, on baseline 2L Continue Torsemide, ASA, statin,  Lisinopril, metoprolol, imdur pending med rec completion    Acclerated HTN BP elevated in ED, Suspect primarily due to anxiety Was given home medications w/ improvement Continue home antihypertensives PO hydralazine prn   NIDDM2 Hold oral antihyperglycemics 24 hr corrective insulin   Depression Continue home psych meds   Hypothryoidism Continue synthroid    FULL CODE - long discussion with patient regarding likely poor outcome given age and extensive medical comorbidities in the setting of COVID positive test. Would like to remain full code for now but amenable to further discussion if she decompensates.  DVT PPX - Lovenox    Discussed with Dr. (Privacy) whose insight is reflected above         Subjective    HISTORY OF PRESENT ILLNESS: The patient is a 92 y.o. female with extensive history including cardiomyopathy, chronic combined systolic/diastolic CHF, severe multivessel CAD deemed to be poor surgical candidate for bypass but had stents placed in 2015, aortic stenosis s/p TAVR in 2020, severe pulmonary hypertension, complete heart block s/p pacemaker placement, chronic 2L Oxygen dependence, NIDDM2, Hypothyroidism, HLD, and hypertension. She presents to the ED from assisted living facility for positive COVID test.  Employee at the facility recently tested positive so residents were tested and she was found to be positive.  Facility does not keep COVID positive patients so she was subsequently transported to the emergency department.  The patient is vaccinated with Moderna however has not received a booster yet.  The patient is asymptomatic, denying fevers, chills, chest pain, shortness of breath, nasal congestion, sore throat, abdominal pain, diarrhea, lower extremity edema. She does report chronic cough which is unchanged from baseline.  Patient does report that she was recently diagnosed with pneumonia and started on antibiotics.  She states that she choked on hot chocolate and somewhat perform the Heimlich on her.  She had chest x-ray the following day and was then started on antibiotics for pneumonia.  She does not know what antibiotic she is taking.  She denies ever having respiratory symptoms with this. CXR obtained at facility and unable to be viewed in EMR.   Given asymptomatic presentation and on baseline oxygen no laboratory workup or imaging was obtained emergency department.  S facility is unwilling to accept the patient back she was initially going to discharge home with family, however they did not feel that they have the capacity to take care of her at this time.  PT/OT did evaluate the patient did not feel that she needed SAR.  attempted to pursue other placement however no other facilities are currently accepting new referrals for COVID positive patients. Patient will be admitted to IM service under observation status until further placement can be obtained.