Age: 84.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Fibrin D dimer increased, Iron deficiency anaemia, Leukocytosis, Magnetic resonance imaging head normal, Mental status changes
Clinical narrative: Patient with history of COVID vaccines who admitted to hospital with COVID detected PCR.  Provider d/c note:  "86-year-old male patient with past medical history of hypertension, MI, stents, bioprosthetic aortic  valve replacement, colostomy for CA colon, prostate CA, status post Chr Foley , Patient was brought by EMS service, 86-year-old due to increasing confusion, status post colostomy, since last 2 years, has indwelling catheter On 12/ 13 patient had the incarcerated his small bowel surgery with little left inguinal hernia repair, but no necrotic bowel Brief Summary of Hospital Stay: (Include Significant Findings and Invasive Procedures) treated for COVID related encephalopathy, with improvement   1/ 4 EEG showed diffuse slowing, no epileptiform activity MRI of the brain no acute abnormality   Awaiting to be transferred to SNF, once COVID isolation is over,  Improving mentation Continued improvement in mentation   1/9, worsening leukocytosis   got chest x-ray- no significant abnormality , has chronically infected Foley/colonization, no fever, no evidence of sepsis   Altered mental status, encephalopathy, acute Fever, COVID 19 positive, mild leukocytosis Not hypoxic, symptomatic COVID treatment Fever has resolved since 24 hours after admission Significant improvement in altered mental status since admission is continued-1/7   CRP is high, D-dimer is also high, Procalcitonin slightly high Chest x-ray without any infiltrate, CT of the head no acute abnormality 1/3 improving altered mental status  MRI of the brain no acute findings Appreciate neurology consultation from 01/02, EEG pending   Retention of urine, history of CA prostate, chronic Foley catheter Urine culture is growing Staphylococcus epidermidis probably contaminant/colonization Blood cultures continue to be negative   Acute kidney injury-baseline creatinine of 1.2 on 12/19/2022, improving serum creatinine following hydration, resolved   Anemia, iron deficiency, IV Venofer   Status post cololostomy-for perianal wound healing    Chronic leukocytosis: supposed to follow up with Heme/Onc, appears to have not showed up for appointment recently 1/10 increasing leukocytosis, but no signs of oral infection     Intermittent claudication: continue ASA, Pletal and Statin        Essential hypertension: currently normotensive - continue Norvasc - was holding Lasix and ARB, losartan being resumed at a lower dose of 50 mg daily     Stage 3a chronic kidney disease: difficult to establish baseline, but baseline SCr seems to be from 1.3 to 1.8.  - IVF overnight     History of small bowel obstruction: recent, finished course of ABX     Colostomy status: colostomy in 2017 for diversion to help with refractory nonhealing perineal wounds     Left inguinal hernia, repair with mesh recently, 12/13, no necrotic bowel   History of bioprosthetic aortic valve replacement Echocardiogram- normal LVEF, mild aortic stenosis   Spoke to daughter and informed her   Condition at the time of discharge-  Vss  Constitutiion , less agitated, no distress HENT:  Normocephalic, Atraumatic, Pupils Reactive, Normal oropharynx, Nose normal.  Cardiovascular:  Normal heart rate, Normal rhythm, No murmurs, No rubs, No gallops.  Respiratory:  Normal breath sounds, No respiratory distress, No wheezing, No chest tenderness.  GI:  Bowel sounds normal, Soft, No tenderness, No masses, No pulsatile masses. , left-sided colostomy, indwelling Foley catheter Left inguinal area recent surgical scar Extremities:  Intact distal pulses, No edema, No tenderness, No cyanosis, No clubbing.  Neurologic:  Alert & oriented x 2 less  confused, more coherent, moves all 4 extremities,  No focal deficits noted. Skin:  Warm and dry   Issues Requiring Follow Up: (Who, what, when, and how communicated?)  To monitor leukocytosis, and consider hematology referral again"