Age: 64.0
Sex: F
Vaccine: COVID19-2
Symptoms: Somnolence, Urinary tract infection, Vitamin B12 normal
Clinical narrative: Discharge Provider: MD Primary Care Provider at Discharge: PA   Admission Date: 1/28/2023 Discharge Date: 2/4/2023  Condition on discharge: Improving   DETAILS OF HOSPITAL STAY: Patient is a 64-year-old female with history of end-stage renal disease on hemodialysis, Parkinson's disease with dementia, DM II, dilated cardiomyopathy with EF of 25%, s/p AICD, chronic pulmonary HTN, chronic megaloblastic anemia, chest lymphadenopathy, MDR recurrent UTI. She was transferred to Hospital from emergency room where she presented from a local subacute rehab facility with complaints of worsening lethargy/encephalopathy,  fever onset the day prior to presentation.  The patient was found to have a urinary tract infection which appeared to not have responded to outpatient antibiotic therapy.  She was started on Zosyn and vancomycin upon arrival to hospital. Infectious disease switched her to ertapenem, to finish 7 days treatment (EOT 2/2/23). Patient was also found to be COVID-19 positive and was treated with 5 days of remdesivir. The patient responded well to antibiotic and antiviral therapy.  Hemodialysis was continued per nephrologist. Next hemodialysis at hospital on 2/7/23. She had right side Permacath which is no longer used for hemodialysis at hospital (was used here) and RN requested removal. We tried to remove, but couldn't be done on time so patient was discharged. Permacath should be removed in hospital after discharge.     The legal guardian, patient's family and the patient had a meeting with hospice on 1/30/2023. Guardian had discussion with outpatient nephrologist, who thought that due to frequent hypotension (despite midodrine), frequent inability do perform hemodialysis due to hypotension patient should sign with hospice and stop hemodialysis. However patient's guardian declined enrolment into hospice, and wished to continue hemodialysis. Subsequently we heard that she would enroll into hospice after discharge with continuation of hemodialysis due to CHF.              Patient also had metabolic encephalopathy on and off during hospitalization. Discontinued Norco, avoid benzo, keep regular biorhythm. Still very sleep for most of the time, than wakes up and is good for couple hours.               Anemia of ESRD, chronic megaloblastic anemia stable, Hgb 9.6 at discharge. Iron studies, B12, folate normal. Homocysteine elevated, could be due to ESRD. Vit B6 level was pending at the time of DC. PCP to follow up on it.  Patient had extensive chest lymphadenopathy in 12/22. Repeat 3 months follow up CT of chest showed mild decrease in size of several mediastinal lymph nodes as described above. No enlarged axillary lymph nodes identified. Evaluation of the lungs is limited due to motion artifact. There appears to be multifocal scattered streaky opacities, favored to represent multifocal atelectasis.  Dilated cardiomyopathy, chronic HFrEF (EF 25%) s/p AICD, chronic pulmonary HTN well controlled with hemodialysis and home meds. Net IO Since Admission: -9,051 mL [02/04/23 1309].   DM type II well controlled. Hgb. A1c 6.2% in Dec 2022. Discontinue insulin.   Dementia d/t Parkinson's disease, continue supportive care, regular reorientation, normal sleep-wake cycle promotion. Continue Sinemet.    Patient discharged on 2/4/2023.