Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Cardiomegaly, Chest X-ray abnormal, Condition aggravated, Confusional state
Clinical narrative: ASSESSMENT/PLAN:   * COVID-19 Assessment & Plan CXR negative for pneumonia in the ER. COVID positive 11/9 She is vaccinated  Uncertain of the length of symptoms. She thinks she got it from another resident at her facility  Started on dexamethasone (day 1/10), Remdesivir 1/5 Patient initially was on room air but now on 2L NC  She was sent in from her assisted living facility and unable to return back Admitted for placement which will likely be difficult as she has COVID Continue supportive care, mucinex, PRN inhaler and tessalon perles Encourage IS, cough and deep breath as well as pronation Continue to monitor daily labs including CMP, CBC, D-dimer Lovenox for VTE prophylaxis for now and switch to therapeutic treatment as needed  Continue to monitor labs and vitals closely Currently on oxygen, 1-2L (?how much of it might be OSA vs COVID) wean as able    Generalized weakness and falls Assessment & Plan Patient has increased weakness but baseline frequent falls Per daughter she has baseline confusion and falls frequently at baseline but is weaker than normal Sent in from assisted living and attempted to place out of ER without success Admit for PT/OT and placement   Hypertension Assessment & Plan Continue ARB Continue to monitor blood pressure    Depression Assessment & Plan Per daughter has some baseline confusion Continue wellbutrin, paxil and seroquel  Continue to monitor    Type 2 diabetes mellitus (HCC) Assessment & Plan Does not appear to be on home meds  Place on 24 hour corrective insulin Continue to monitor blood sugar closely while on steroids  Adjust insulin as needed    Morbid obesity with BMI of 40.0-44.9, adult (HCC) Assessment & Plan BMI 40.40 Encourage weight loss and lifestyle modifications for improved overall health            Subjective    HISTORY OF PRESENT ILLNESS: Patient is a 82 y.o. female who presents today with falls. She presented to the ER on 11/9. She states that she came in because "I lost my balance and fell a few times." She thinks that she hit her head but it unable to tell me exactly what happened. Patient struggles to tell me where she lives. She is very fatigued and sleepy. Per ER notes patient presented yesterday because she tested positive at her facility and was unable to remain there. They attempted to place her out of the Er but were unsucessful as she is COVID positive and there are limited facilities accepting COVID patients. She denies pain at this time. Patient states that she has a slight cough but is uncertain when it started she thinks maybe last week. She has decreased appetite and lack of sense of taste. Patient states that she did have an episode of emesis but denies abdominal pain or diarrhea. She is not having chest pain or palpitations. She is vaccinated and thinks that she got her booster a few weeks ago too. She is uncertain of sick contacts.     Spoke to daughter over the phone. Daughter states "she had to come in because she is COVID positive." She was COVID tested at her facility because a resident had left and came back and had COVID. Daughter also has COVID. Family has been trying to work with reliance to see if they could get patient into someplace close. Daughter states "her place kicked her out." She is from assisted living and since she is COVID positive her assisted living facility will not take her back at this time. They attempted to find placement out of the ER but were unsuccessful due to her being COVID positive. Daughter states "if she has to she can come here and I will try to take care of her." Per daughter she has some baseline confusion and falls often. She states "she has fallen about 20 times."    In the ER CXR showing no acute process. COVID positive in the ER on 11/9. Labs were fairly stable in the ER. She was initially on room air but this morning is on 1-2L NC. She is being admitted for COVID and placement.    Patient Active Problem List Diagnosis ? Hypertension ? COVID-19 ? Morbid obesity with BMI of 40.0-44.9, adult (HCC) ? Type 2 diabetes mellitus (HCC) ? Generalized weakness and falls ? Depression