Age: 81.0
Sex: M
Vaccine: COVID19
Symptoms: Aortic stenosis, Asthenia, Atrioventricular block second degree, COVID-19, COVID-19 pneumonia
Clinical narrative: Date of Admission- 01/19/2022. Date of Discharge- 01/23/2022. Reason for Hospitalization: Physical Deconditioning, COVID Pneumonia, Type I second degree AV block. Hospital Course: This is an 81 yo M, with PMHx of HTN and DMII on insulin, who presented to ED for evaluation for weakness. Daughter, who is at bedside, states that the patient fell 5 times in the month of December. Also, patient developed a cough on 1/18 and a fever 1/19 am. Found to be COVID +. Patient was admitted to internal medicine for further management for physical deconditioning. Found to have a Type I second degree AV block. Cardiology consulted, follow-up outpatient. PT/OT consulted, recommend Home Health Therapy and 24/7 assist. The hospital course will be outlined in problem-based format below.  Physical Deconditioning  Hx of Frequent Falls (5 times in 1 month)  - Orthostatics negative.  - TTE: EF 70%, mild aortic stenosis, diastolic function parameters were indeterminate.  - EKG: SR with 2nd degree AVB with 3:2 conduction.  - PT/OT consulted: recommend Home Health Therapy and 24/7 assist. Front-wheeled walker.  - Pt will have 24/7 assist at home given multiple children nearby. - For home: Please encourage fluid intake, at least 8 cups of water each day. There is evidence that he may have been dehydrated, which may have contributed to his falls. Case management will follow-up on Monday regarding home health physical therapy and occupational therapy. Please ensure that patient uses walker with ambulation. Please ensure that patient has help at home at all points during the day.   Type I second degree AV block  - Possibly contributed to falls.  - Cardiology consulted. - Avoid AV nodal blocking agents (BBs, non-dihydropyridine CCBs, opioids, hypo- and hyperkalemia, hypomagnesemia, hypocalcemia). Switched patient to Amlodipine and Hydralazine for HTN for this reason.  - Discharge with 30 day event monitor.  - Follow up in cardiology clinic in 4-6 weeks.  COVID PNA  - Positive on 1/19, SX onset ~1/18. Fully vaccinated.  - RPP otherwise negative.  - Room air since admission.  - Passed home O2 evaluation.  Discharge Diagnoses: 1. Pneumonia due to COVID-19 virus  2. Generalized weakness  3. Postural lightheadedness  4. AV block, Mobitz 1   Other Diagnoses Ongoing:  BMI 34.0-34.9, adult Obesity  Historical  No qualifying data  Operations and Procedures  None.  Consultants  Medicine Cardiology   Pending Labs  None.  Discharge Disposition  Home, Home Health Service    Medications  New, Changed, or Refilled Medications  amLODIPine (amLODIPine 5 mg) 10 mg, 2 Tablet(s), Oral, qAM, 60 Tablet(s), 0 Refill(s)    hydrALAZINE (hydrALAZINE 25 mg) 25 mg, 1 Tablet(s), Oral, q8h, 90 Tablet(s), 0 Refill(s)      Medications to be Continued  aspirin (aspirin 81 mg oral EC tablet delayed release) 81 mg, 1 Tablet(s), Oral, Daily    brimonidine-timolol ophthalmic (Combigan 0.2%-0.5% ophthalmic solution) 1 Drop(s), Each Eye, bid    calcium carbonate (calcium (as carbonate) 500 mg) 500 mg, 1 Tablet(s), Oral, Daily    dexamethasone/neomycin/polymyxin B ophthalmic (dexamethasone/neomycin/polymyxin B 1 mg-3.5 mg-10,000 units/g ophthalmic ointment) 1 Application, Each Eye, As Indicated, PRN: for itching    insulin glargine (Lantus insulin Solostar Pen 100 units/mL subcutaneous solution) 32 units, Subcutaneous, bid    latanoprost ophthalmic (latanoprost 0.005% ophthalmic solution) 1 Drop(s), Each Eye, At Bedtime    multivitamin (Multiple Vitamins) 1 Tablet(s), Oral, Daily    ocular lubricant (Refresh Liquigel ophthalmic gel) 1 Drop(s), Each Eye, qid, PRN: Dry Eyes    omega-3 polyunsaturated fatty acids (omega-3 polyunsaturated fatty acids 500 mg) 500 mg, 1 capsule(s), Oral, Daily    saw palmetto (saw palmetto) 2 capsule(s), Oral, At Bedtime      Discontinued Medications  amLODIPine-olmesartan (amlodipine-olmesartan 5 mg-40 mg) 1 Tablet(s), Oral, Daily    hydroCHLOROthiazide (hydroCHLOROthiazide 12.5 mg) 12.5 mg, 1 capsule(s), Oral, Daily       Physical Exam at Discharge  Constitutional: no acute distress. HEENT: sclera/conjunctiva clear, EOMI, appropriate tracking. Cardiovascular: Regular rate and rhythm; normal S1 and S2 without murmur or gallop; no LE edema.  Respiratory: lungs CTA bilaterally; normal effort; room air. Gastrointestinal: abdomen soft, non-distended, without tenderness or guarding; BS active.  Musculoskeletal: able to move all 4 extremities against gravity; joints without obvious deformities.  Skin: warm, well perfused, dry, intact. Neurologic: alert and oriented X4; CNs grossly intact; No focal deficits. Psychiatric: normal affect; pleasant and cooperative.   Follow Up Appointments  Follow Up Appt Medicine Cardiology, Clinic Name/Phone: Local Clinic, Provider Name: NO , PREFERENCE, Other, No tests, Reason for Follow Up Clinic 2nd degree AV block, Comments see in 6 weeks, AV block, Mobitz 1  Follow Up Appt Primary Care Provider (PCP), Provider Name: 'PRIVATE', Within 7 Days, Laboratory Tests, Reason for Exam Follow-up hospitalization, elevated Cr, HTN monitoring, Comments BMP  Nursing/Other Orders:  DME - Walker. 01/22/22 12:35:00, Once, 01/22/22 12:35:00, Wheeled Walker (E0143), None, Generalized weakness   Home Health. 01/22/22 11:50:00, 01/22/22 11:50:00, Evaluate and Treat, Evaluate and Treat, Generalized weakness   Home Health. 01/25/22 11:45:00 Home Health Start Date 01/23/22, Accepting HH Provider "PRIVATE", 01/25/22 11:45:00, Evaluate and Treat, Evaluate and Treat, Generalized weakness | Effort syncope   Addendum on January 27, 2022 13:22:37 (Verified)  Date of service corrected from 1/26 to 1/23/2022 per request of D. /Note corrections inbox.  Addendum by "PRIVATE" on February 02, 2022 15:52:03 (Verified)  Attestation by "PRIVATE" on February 02, 2022 15:52 I personally saw and evaluated the patient on the result date found in the header of this document. I independently performed the critical/key portions of the Evaluation and Management service and discussed the management with the author of this document. I agree with everything documented above with the following exceptions/additions: