Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Walking aid user
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 2/1/2023 Discharge Date: 02/06/2023   PRESENTING PROBLEM: Hyponatremia [E87.1] Acute on chronic combined systolic and diastolic CHF (congestive heart failure) [I50.43] Anemia, unspecified type [D64.9] Acute COVID-19 [U07.1] COVID-19 [U07.1]   HOSPITAL COURSE: HOSPITAL COURSE: Patient is a 86 y.o. female with a past medical history paroxysmal atrial fibrillation, coronary artery disease status post CABG, peripheral artery disease, chronic combined systolic and diastolic heart failure who presented to the ED on 2/1 with c/o chest pain and SOB. Chest pain had resolved in route to ED w/ nitro x3. ASA given in ED to reach dose of 324mg day of admission. Troponin delta of +9. Cardiology contacted in ED but no recommendations as patient was chest pain free. Echo was not pursued as invasive intervention has been deferred in past.    Pt had come from rehab after recent admission at hospital due to weakness. She had developed cough 1 day prior to admission and was found to be COVID positive on room air day of admission.  Overnight after admission patient found to be hypoxic on supplemental oxygen support as result was started on dexamethasone 6 mg, and family declined remdesivir.  Total duration of steroid therapy of 10 days, with last dose of dexamethasone 0 2/12.   Ongoing goals of care conversation were held between the primary team, the patient and the family.  The patient was adamant that she would not like to come back to the hospital.  To pursue this, palliative care and hospice team were consulted.  After informational hospice meeting with the hospice team the family and patient elected not to pursue this however would like to follow-up with palliative care outpatient hence referral was placed by the palliative care team to continue to follow-up with the patient.   Pt had also been having hematuria at rehab with blood clots in urine. Eliquis held 1 day prior to admit. She had recently been restarted on aspirin as well (was not on mid-January discharge per Cardiology recs). Hematuria continued to improve during the admission with no frank blood during admission and no concerns from the patient. Given recommendations for age and weight, patient was transitioned to eliquis  2.5 mg BID and her hematuria continued improved.  Hemoglobin remained stable.   During the hospitalization required basal bolus coverage for steroid induced hyperglycemia.  After shared decision-making and discussion with the patient the family we agreed to continue home metformin and glipizide while on steroid therapy and to check blood sugars twice daily.  With the anticipation that her blood sugars will improve after completion of steroid which would only be additional 5 days. With the contingency plan if blood glucose greater than 450+ update primary care provider.   On the day of discharge, provided by Physical therapy and Occupational therapy and recommended home with assist, PT/OT and visiting nurses this was set up for the patient and referrals were placed.  On the day of discharge, patient was on room air, ambulating with the help of walker without any documented desaturations.