Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Dyspnoea, Echocardiogram abnormal, Ejection fraction decreased, Encephalopathy, End stage renal disease
Clinical narrative: Patient discharged after (4) day inpatient admission. 11/27-12/1/21 Patient readmitted 12/2/2021.  current H & P and plan. Patient is a 77 y.o. male past medical history significant for CAD s/p stent placement, ICM, ESRD on HD, PAF on Eliquis, GI bleed, HTN, HLD, IDDM, OSA and recent hospitalization 11/27-12/1 for COVID pneumonia discharged home on continuous 2L oxygen. The patient presented to the ED today with worsening generalized weakness requiring more care/assistance at home than his wife can provide.  Since the patient was discharged yesterday he has been mainly lying in his bed at home. He hasn't been eating much or taking his medications. PT/OT had evaluated him during his hospitalization recommending home with assistance. The patient denies worsening SOB or cough. Denies fever, chills, chest pain, diarrhea, or vomiting. He is supposed to be on 2L oxygen continuously and 4L oxygen with ambulation.   11/27 admission hospital stay details: Pt is a 77 yr old M with PMHx of CAD s/p PCI, ICMP, ESRD on HD, PAF on Eliquis, Hx of GI bleed, HTN, HPL, IDDM II, and OSA presented to ED on 11/26 with AMS. Per his wife, he started feeling ill on 11/17-11/18 with cough, weakness, fevers, and diarrhea. Found to be COVID positive on 11/20 at Hospital.  Admitted for Encephalopathy due to COVID-19, ESRD/uremia, HTN Urgency, COVID 19 PNA, IDDM II. Found to have volume overload in the setting of missed HD. Nephrology was consulted and he had several hemodialyses with fluid removal which helped. He will restart hemodialysis on TTS on 12/2/21 due to positive COVID-19. Encephalopathy was felt to be due to volume overload and COVID-19 Pneumonia. Encephalopathy resolved.  Due to COVID-19 he had worsening hypoxia, he was initially on 2L NC but later transitioned to Ventimask. At the time of discharge, he was on O2 2 l/min and home O2 was arranged. He was initially treated with Decadron and was switched to IV Solumedrol 40 mg bid on 11/29. He was discharged home on Decadron 6 mg PO daily for 5 more days. Due to worsening hypoxia, he was pan-cultured and all cultures were negative except one which was positive for Staph. Epid. Which was contamination. He had empiric IV Rocephin/Doxycycline for 3 days, will continue 2 more days after discharge.  Repeat CXR on 12/1 showed improving infiltrate. He is out of isolation. He was discharged home on O2 2 l/min at rest and 4 l/min with activity. He also had hypertensive urgency on admission, which resolved. During hospitalization, his BP was on the low side. He was discharged home on Imdur and Norvasc. Procardia was stopped. Limited Echo 11/29 showed: Mild global hypokinesis with more prominent anteroseptal and apical wall motion abnormality. EF 43%, it was 45% on 03/14/2021. Regarding he was seen . HbA1c of 11.7. Will discharge home on Lantus 20 units QAM and Humalog 4 units for a full meal (50-60 grams carbs) or 2 units for a small meal (30 grams carbs) plus correction 1:85>150 while on Decadron. Once he stops Decadron may restart Lantus 10 units qhs. Baqsimi to use in the setting of severe hypoglycemia. Advise close follow up Center for Diabetes and Endocrinology and/or PCP. Per Dr.  consult note 3/29: The patient again will be counseled on the necessity for direct oversight and his wife has continued to verbalize her inability to help in his medical care.  The patient would do best by moving toward assisted living or 24-hour care to minimize acute issues in the future. If going home without the supervision of insulin dosing would be at risk of reoccurring blood glucose management issues/safety concerns. PT/OT recommended Home with an assist, home PT/O, and nursing. The patient was discharged home on 12/1/2021 only to be readmitted for weakness, fatigue.