Age: 84.0
Sex: M
Vaccine: COVID19
Symptoms: Embolic stroke, Extra dose administered, Facial paralysis, Fibrin D dimer increased, Haematochezia
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 6/15/2022 Discharge Date: Jun 20, 2022  PRESENTING PROBLEM: Facial paralysis [G51.0] Pneumonia [J18.9] Failure to thrive in adult [R62.7] Aspiration into airway, subsequent encounter [T17.908D] Pneumonia of left upper lobe due to infectious organism [J18.9] COVID-19 [U07.1]   HOSPITAL COURSE: 84 y.o. male with known vascular dementia solitary kidney with history of left RCC, hypertension, dysphagia, GERD, history of prostate cancer. who presented with weakness on 6/15/2022.  Patient reportedly has been following his dysphagia diet restrictions per spouse/patient but per ER provider who spoke with patient's son there may be some confusion about what the patient can eat.  Patient recently diagnosed with atrial fibrillation, thromboembolic right frontal CVA, Bell's palsy and OAC initiation was not done due to rectal bleeding. Patient was started on prednisone and valcyclovir x 7 days, eye patch and eye drops.   He was in observation in ER for 2 days 6/7 - 6/9.     In ER patient is afebrile and hemodynamically stable.  Patient is oxygenating well on RA with sats of 99 - 96%.  Patient's CXR with LUL pneumonia. WBC count WNL.  Tested positive for Covid and has been fully vaccinated and boosted twice.     On admission, patient was continued on empiric cover age for CAP but with normal Procalcitonin antibiotics discontinued. CRP unremarkable. Ddimer were elevated and started Lovenox prophylaxis. D dimer had shown down trending throughout hospital stay.  SLP consulted for his known dysphagia and followed.  PTOT evaluation recommended acute rehab placement.  Patient's respiratory status were stable throughout hospital stay and had not required any oxygen.  With patient stable he was discharged to acute rehab when bed available.   Also with reported hematochezia, it was determined that patient's claim was unreliable per family because of his ongoing dementia.  Patient did not have any episodes of hematochezia during this hospital stay and his hemoglobin had remained stable around 14 g/dL.   With patient's known vascular dementia during this hospital stay, DPOA had been activated.   Discharge Provider: DO Primary Care Provider at Discharge: MD Admission Date: 6/20/2022 Discharge Date: 6/27/2022  PRESENTING PROBLEM:  Pneumonia   HOSPITAL COURSE: Functional and mobility deficits This patient is noted with decreased independence with transfers, ambulation, ADLs, IADLs, decreased endurance.  We will continue PT and OT to evaluate and treat regarding these deficits.  They will continue 3 hours per day, 5 days per week. 6/21  supervision ambulating going 160'  6/24 independent with transfers, supervision ambulation without AD   Covid 19 pneumonia 6/20 monitor respiratory status, first tested positive of 6/15. Follow up CXR recommended in 3 weeks 6/23 tolerating room air 6/27 precautions lifted today   Subacute R frontal lobe CVA Vascular dementia Impairments of dysphagia, cognition 6/20 Cont ASA 325mg, statin. Goal SBP <130 6/27 home with 24hr supv   Oropharyngeal dysphagia 6/20 Cont SLP therapies, dysphagia diet and aspiration precautions 6/23 SLP concerned for coughing on current diet, planning VFSS   New onset atrial fibrillation 6/20 No AC currently due to intermittent rectal bleeding. Cont metoprolol 6/27 HR 80   HTN 6/20 Cont metoprolol 6/23 133/78 stable 6/24 107/83 stable 6/27 147/97 prior to AM meds   Chronic diarrhea 6/20 monitor outpatient, would consider loperamide   L Bells palsy 6/20 just completed prednisone and valcyclovir, will monitor for improvement   GERD 6/20 Cont pepcid   Hx of prostate Ca Hx of RCC with solitary kidney   GI Patient will be started on a bowel regimen to yield a daily bowel movement. Will start patient on senna-docusate 6/27 BRBPR - known hx of hemorrhoids, wife indicates that she has f/u scheduled   GU  Will monitor voids and check PVR to ensure that patient is not retaining urine.   Nociceptive and neuropathic pain  Will monitor for uncontrolled pain as this may limit participation in therapy   Integumentary Will order patient to be turned q2h hours to minimize skin breakdown.   DVT Ppx Patient is high risk of DVT, with no contraindications for chemical prophylaxis. lovenox will be used for DVT prophylaxis.   FEN  Will follow electrolytes and replace as clinically indicated. Pt is on dysphagia diet. Monitor intake.    Dispo Will be working closely with case manager and rehab team to coordinate safe discharge