Age: 82.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Sputum discoloured, Stubbornness, Treatment noncompliance
Clinical narrative: Hospitalized (11.25.21 - still currently admitted);  COVID-19 positive (11.25.21);  fully vaccinated  HISTORY OF PRESENT ILLNESS: Paitent is a 83 y.o. male with a history of CKD 3, GERD and major depressive disorder who presents today with shortness of breath, anorexia and extreme fatigue. His niece reported that the patient has cognitive deficits and has been stubborn and won?t answer anyone?s questions including his PCP and family members. Patient did acknowledge having a cough that occasionally produced yellow sputum and feeling very fatigued with no appetite. He was diagnosed with right upper pneumonia, hyperkalemia and renal insufficiency by his PCP on 11/23/2021 and started on Azithromycin but has refused to take his antibiotics.  Reportedly he has not been eating or drinking very much since then.  Due to these circumstances his niece brought him to Emergency Department for evaluation. On presentation he does appear dry on exam. Patient was found hypoxic at 87% on room air on presentation.  He required 6 L of oxygen to maintain sats above 90%. Comprehensive metabolic panel demonstrated renal insufficiency which was improved from previous but still above his baseline. Previous hyperkalemia had resolved. COVID-19 positive. Chest x-ray was consistent with COVID pneumonitis, previously right upper lobe pneumonia was not demonstrated. He was given 1L of IV fluids and 6mg IV Decadron.  Given his hypoxia and failure to thrive he was transported via EMS to Hospital for further care and management of pneumonia due to COVID-19. Pneumonia due to COVID-19 virus Assessment & Plan Patient with a reported 3-5 days of cough, shortness of breath, anorexia and fatigue.  Diagnosed with RUL pneumonia on 11/23/2021 by PCP and was prescribed Azithromycin. Patient refused to take antibiotic. COVID 19 positive Chest x-ray was consistent with COVID pneumonitis, previously right upper lobe pneumonia was not demonstrated. Admitted for supportive care and monitoring. On 6 L 02 to maintain sats above 90% Plan: - Supportive care - Decadron 6 mg daily (1/10) - remdesivir  - Albuterol HFA q4h sch  - monitor on tele and continuous pulse oximetry - ICS, Acapella, Mucinex - daily CBC, CMP, CRP,  D-dimer - wean off oxygen as able. DVT prophylaxis: Lovenox 40 mg sq daily Progress Note from 12.2.21:  Disorientation Assessment & Plan Patient is not alert to place, time, or situation. He has not been since admission. (niece and nephew) whom he lives with say they were concerned about memory and were going to have him worked up for dementia prior to Covid illness. They have noticed confusion and faltering memory for over 2 years. The ACE assessment was completed and the patient is definitely incapable of making medical decisions.  Psych evaluation has occurred.   Per previous discussion with family, patient's wishes at this point would be to discharge home with hospice. Plan hospice meeting in am.  Acute respiratory failure with hypoxia  Assessment & Plan Currently on room air - 1L see COVID plan of care Monitor on continuous pulse oximetry Pneumonia due to COVID-19 virus Assessment & Plan Symptom onset around 11/21, Covid positive 11/25, shortness of breath, anorexia and fatigue.  Patient currently requiring room air to 2 L nasal cannula.  COVID stable.  Patient continues to have decreased oral intake see failure to thrive plan of care.   Plan: - Supportive care - Decadron 6 mg daily (9/10) - remdesivir 5/5 - completed 11/30 - Albuterol HFA q4h sch  - monitor on tele and continuous pulse oximetry - ICS, Acapella, Mucinex - wean off oxygen as able, Patient currently on 1L will do walk saturation to determine if home oxygen is needed.