Age: 84.0
Sex: M
Vaccine: COVID19
Symptoms: Renal impairment, SARS-CoV-2 test positive, Thrombosis, Ultrasound Doppler abnormal, Venous thrombosis limb
Clinical narrative: Pt reportedly doing well until about 2 nights ago- started feeling some chills, attributed it to worsening winter temps outside. Following morning had a sore throat, some nasal congestion, questionable cough (denied to me, admitted to ED MD). Symptoms seemed to improve after he had a "fruity drink" his wife gave to him. He has since been more fatigued, most notably today, when he was unable to get off the toilet.    Wife states that pt is wheelchair bound at baseline, does not walk. Able to help with transfers out of bed and into the wheelchair (uses a bedside pole). Has been able to do this for the last few days, although wife has noticed it seem to be more difficult than usual. Was able to do this this morning, when she got pt up to go to the bathroom. Pt able to sit on the toilet, use the bathroom, however was too weak to get up. Home Health Nurse happened to stop by shortly thereafter and talked to pt and wife about going to the ED. 911 called. EMS arrived, pt noted to have BG to 44. Temp 100. Pt given orange juice and brought to ED.    ED eval notable for hypertensive pt, otherwise vitally normal with glucose to 28. Given D50. Otherwise had an unremarkable lab workup, renal function decreased but about at baseline. Infectious w/u notable for CXR with patchy opacities R>L, concerning for COVID PNA. UA pending.  Pt with limited admission to symptoms, reluctantly stated he had a sore throat for a day, denied cough (did admit this to ED MD), some nasal congestion. Denies difficulty breathing. No chest pain. No diarrhea.  1/11/2022 PROGRESS NOTE HEMATOLOGY ONCOLOGY We are following this 85 year old male currently hospitalized with covid 19, and found to have right basilic vein thrombosis with edema.    We recommend lovenox 1.5mg/kg daily x 2 weeks and then transition back to coumadin or any other DOAC covered through his insurance.    No further hematology/oncology recommendations at this time. 1/12/2022 patient is seen and examined today.  He is awake, oriented, not in distress.  Responds commands appropriately.  No issues or complaints noted overnight.  Hemodynamics remained stable.  No fevers noted.  O2 sats are normal on room air.  1/14/2022 Discussed with him about overall condition, he keeps repeating me but cannot answer more questions.  Also video swallow evaluation was done which does show that he is aspirating things.  Speech therapy recommended complete n.p.o.  Discussed with his wife in regards to his condition, further treatment plans including feeding tube versus hospice care.  She could not decide at this time.  She would like to talk to patient as well as her brother to discuss more about this.  1/15/2022 He is awake, minimal confusion noted.  Responds commands appropriately.  Saturating well on room air.  He was changed to hospice/comfort care as of 1/14/2022.  No other issues or complaints noted overnight. 1/17/2022 pt new to me today - NAEO - awake in am, asks for sips of cold water - provided at bedside - no report of pain to me (did get pain meds just before)