Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Agitation, Anion gap, Anticoagulant therapy, Arteriosclerosis coronary artery, Asthma
Clinical narrative: Hospitalized (12.17.21 - 12.21.21); COVID-19 positive (12.17.21); Fully vaccinated-moderna x2 d/c summary:Discharge Summary PRIVACY FNP (Nurse Practitioner) o o Hospital Cosigned by: PRIVACY, DO at 12/23/2021  3:48 PM Attestation signed by PRIVACY, DO at 12/23/2021  3:48 PM I personally examined this patient on the day of discharge.  The case was discussed with the Resident.  I have reviewed the DC Summary; it accurately reflects the hospital course and dc recommendations. 35 minutes spent in the depart process. PRIVACY, DO       Local hospital Discharge Summary   BRIEF OVERVIEW: Discharge Provider: PRIVACY, DO Primary Care Provider at Discharge: PRIVACY Admission Date: 12/17/2021 Discharge Date: 12/21/2021  Discharge Disposition: Home     Code Status: DNR   DISCHARGE DIAGNOSIS: 1. COVID-19 2. AMS (resolved) 3. Mild Cognitive Impairment 4. Abnormal UA 5. Hypokalemia (resolved) 6. Sacral Decubitus ulcer 7. DM Type II 8. Afib 9. Diastolic CHF 10. COPD 11. Asthma 12. RLS 13. Depression 14. OSA 15. Chronic Pain   DISCHARGE MEDICATIONS: See changes in bold; discontinued Elavil, Seroquel, and Norco  o albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulization Take 2.5 mg by nebulization 4 times daily as needed for Wheezing. o albuterol (PROVENTIL) 0.5% (5 mg/mL) nebulizer solution Take 0.5 mL by nebulization 3 (three) times daily. o albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler Take 2 puffs by inhalation every 4 hours as needed for Shortness of Breath or Other (cough). o apixaban (ELIQUIS) 5 MG tablet Take 1 tablet by mouth 2 times daily. o atorvastatin (LIPITOR) 20 MG tablet Take 20 mg by mouth nightly. for cholesterol  o carbidopa-levodopa ER (SINEMET CR) 25-100 MG per tablet Take 1 tablet by mouth 3 (three) times daily. o DULoxetine (CYMBALTA) 30 MG delayed release capsule Take 30 mg by mouth daily. (90mg total) o DULoxetine (CYMBALTA) 60 MG delayed release capsule Take 60 mg by mouth daily. (90mg total) o gabapentin (NEURONTIN) 300 MG capsule Take 300-600 mg by mouth every 8 hours as needed. o metFORMIN (GLUCOPHAGE) 850 MG tablet Take 850 mg by mouth 2 times daily (with meals). o metoprolol succinate-XL (TOPROL-XL) 25 MG 24 hr tablet Take 25 mg by mouth 2 times daily. o omeprazole (PRILOSEC) 40 MG delayed release capsule Take 40 mg by mouth Every evening. o pramipexole (MIRAPEX) 0.25 MG tablet Take 1 tablet by mouth nightly as needed for Other (restless legs). o torsemide (DEMADEX) 20 MG tablet Take 20 mg by mouth daily.   FOLLOW-UP RECOMMENDATIONS: 1) PCP within 1-2 weeks; hospital follow-up of AMS believed 2/2 polypharmacy (discontinued Elavil and stopped Norco and Seroquel). Concern for early dementia and probably needs further outpatient work up for this. NEEDs anticoagulation tx re-prescribed, medication coverage from insurance lapsed until new year; she could not afford either so we paid for 1 month supply at Meijer of Eliquis.   Future Appointments Date Time Provider Department Center 1/27/2022  2:45 PM PRIVACY   Appointments Needing to be Scheduled  Contact information for follow-up     Health care facility   PRIVACY    Next Steps: Follow up   Instructions: They will provide your home nursing, physical and occupational therapies. They will call you within 24-48 hours after discharge to schedule visits. Please call with any questions or concerns.  PRIVACY, MD Specialty: Internal Medicine Relationship: PCP - General   PRIVACY    Next Steps: Follow up in 1 week(s)   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Shortness of breath, altered mental status   HOSPITAL COURSE: Patient is a 68-year-old female who was admitted on 12/17/2021 for symptoms of COVID-19 found to be positive.  Patient is vaccinated but no booster.  Patient never became hypoxic.  The symptoms resolved and she improved.   Abnormal UA Positive for nitrates, leukocytes, and bacteria patient was given Rocephin for 4 days but urine culture came back with mixed flora.  Blood cultures had no growth to date.   Altered mental status Mild cognitive impairment Intermittent confusion, agitation, forgetfulness.  Throughout this she was continually oriented x3, but would intermittently refuse care and even noted herself to feel confused.  This improved per patient, she states she was also hallucinating use and this is improved.  Drug screen was negative, since acute cystitis was ruled out and electrolytes remain normal concluded this is polypharmacy and/or early onset dementia.  During hospitalization patient's Elavil has been discontinued using p.r.n. Mirapex for restless legs, Seroquel a Norco had recently been discontinued but believe patient was continuing to take these at home. HCF did evaluate patient and did diagnosed with a mild cognitive impairment with a Moca-B of 13/22.  Do question a early onset dementia and may need further workup outpatient.  Patient is alert and oriented x3 she is able to make her own decisions.  Due to her waxing and waning decisions, concerns with housing and financial issues social work did consult APS who will check in with patient.  Patient's son told her that he would stay with her in the interim. PT/OT met with patient and did recommend home health which has been set up by care management   AFib Per our records patient had not been feeling her anticoagulation, she has a lapse in her insurance coverage for medications and states that she cannot afford the Eliquis/Xarelto.  Her insurance is supposed to renew with a new year.  We sent Eliquis to my our pharmacy and gave give cards to cover for 1 month coverage.  Will have her follow up closely with her PCP to ensure that insurance has renewed to cover this and re-prescribe.   Now that we have some distant supervision via son and a safe social discharge plan, patient is medically cleared to discharge.    Physical Exam at Discharge Enc Vitals BP: 145/73 Pulse: 95 Respirations: 18 Temperature: 36.3 °C Temp src: Axillary SpO2: 93 % Weight: 97 kg Height: 160 cm Room air   Physical Exam Constitutional: Well nourished, no acute distress. Alert and oriented to person, place and time. Answering questions appropriately. Sitting up on edge of bed eating lunch. Cardiovascular: Normal rate and irregular rhythm. 2+ pedal pulses bilaterally. Baseline edema to lower extremities. Pulmonary/Chest: Unlabored speech and respirations on room air. No use of accessory muscles. Musculoskeletal: Moving all four extremities spontaneously. Integumentary: Warm, pale, and dry.  Neurological: No gross motor or sensory deficits.  nary atherosclerosis of native coronary artery   o OSA (obstructive sleep apnea) 3/10/2011 o Osteoarthrosis   o Restless leg   o RLS (restless legs syndrome)   o SBO (small bowel obstruction) (HCC)   o Sciatica   o Venous stasis