Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: Hypotension, Hypoxia, Intensive care, Lung opacity, Mental status changes
Clinical narrative: Time Spent  Date of Admission 01/29/2022  Date of Discharge 02/04/2022  Reason for Hospitalization   Hypoxia and altered mentation Hospital Course   62-year-old male with history of COPD, prior alcoholism, schizoaffective disorder who presents from the nursing home for dyspnea, hypotension, and inability to maintain oxygen saturations. Patient was recently discharged on January 28th after being admitted to the MICU for hypoxic respiratory failure secondary to COPD exacerbation from COVID pneumonia. His hospital course was complicated by intubation 1/21-1/24 as well as new onset atrial fibrillation with RVR. The atrial fibrillation resolved with amiodarone. The plan was for the patient to get an event monitor for new Afib and f/u with cardiology within a month. No anticoagulation due to CHADs-VASc being 0.    Patient was admitted 01/30 for persistent hypoxia and altered mentation. Patient found to have new LLL opacity with Pseudomonas bacteremia (pan sensitive). Had been treating with cefepime 1/31-2/2, switched to ciprofloxacin due to clinical improvement back to home O2 2-3L and BCx clear >48 hrs. Pharmacy had recommended cipro over levo due to better Pseudomonal coverage.  Continue ciprofloxacin 2/2-2/5.  Discharge Orders to Facility   Patient Information: (Privacy)               Admit Date: 01/29/2022   Discharge Date: 02/04/2022    Discharging Facility: Hospital Discharge Attending: (Privacy) MD  Accepting Facility: Nursing Home  Discharge Diagnosis:  1:Hypoxia; 2:Dyspnea; 3:COPD exacerbation; 4:Confusion and disorientation  Discharge Vitals:  Vital Signs  (most recent within last year) Temperature      36.2    (02/04/22 09:30) Heart Rate      73    (02/04/22 09:30) Resp Rate      18    (02/04/22 06:00) NIBP      129/61    (02/04/22 09:30) BP Arterial      117/76    (01/20/22 19:00) SpO2      88    (02/04/22 09:30) Pain Score      0    (02/04/22 06:00)  Orders:      Diet: Other Safety Tray Meal        Swallow Precautions:None       Weight Bearing: Full Weight Bearing      Occupation Therapy: Evaluate and Treat      Physical Therapy:  Evaluate and Treat      Speech Therapy: None      IV Antibiotics: n/a      Respiratory Therapy: n/a              Oxygen needed: 3 L  Delivery Device: Nasal Cannula              CPAP Setting: n/a              BiPAP Settings: n/a              Trach Care: n/a      Additional Orders:     Ciprofloxacin through 2/5.   Further Orders to be followed by patient's PCP or supervising physician at facility.    Discharge Diagnoses 1. Hypoxia  2. Dyspnea  3. COPD exacerbation  4. Confusion and disorientation   Pseudomonas Bacteremia Other Diagnoses Ongoing  Lower back pain  Lumbar spinal stenosis  Lumbar spondylosis  Schizoaffective disorder Historical    No qualifying data Pending Labs Blood Culture (Preliminary, InProcess, ordered 01/31/2022, 11:05)   Blood Culture (Preliminary, InProcess, ordered 01/31/2022, 11:05)   Culture Respiratory (Dispatched, Ordered 01/30/2022, 02:19)  Discharge Disposition Skilled Nursing Facility   Medications New, Changed, or Refilled Medications  ciprofloxacin (ciprofloxacin 750 mg) 750 mg, 1 Tablet(s), Oral, bid, 4 Tablet(s), 0 Refill(s)      Medications to be Continued  albuterol (albuterol  HFA 90 mcg/inh inhalation aerosol) 2 Puff, Inhalation, q4h, PRN: Wheezing    fluticasone-vilanterol (Breo Ellipta 100 mcg-25 mcg/inh inhalation powder) 1 Puff, Inhalation, Daily    furosemide (furosemide 20 mg) 20 mg, 1 Tablet(s), Oral, Daily, PRN: Swelling    metoprolol (Metoprolol Succinate ER 50 mg , extended release) 50 mg, 1 Tablet(s), Oral, Daily, 30 Tablet(s), 0 Refill(s)    nystatin topical (nystatin 100,000 units/g topical cream) See Instructions, Apply BID to affected area (buttocks) for 10 days, 30 g, 0 Refill(s)  Instructions:Apply BID to affected area (buttocks) for 10 days  paliperidone (Invega Sustenna 234 mg/1.5 mL intramuscular suspension, extended release) 234 mg, IM, qMonth      Discontinued Medications  None Physical Exam at Discharge    Vitals & Measurements    T: 36.2 °C  TMIN: 36.2 °C  TMAX: 36.7 °C  HR: 73  RR: 18  BP: 129/61  SpO2: 88%  WT: 74.7 kg  General: Alert and oriented, No acute distress.   HEENT: Extraocular movements are intact. Normocephalic, Oral mucosa is dry.   Respiratory: Respirations are non-labored, Breath sounds are equal.   Cardiovascular: Normal peripheral perfusion. No edema.   Gastrointestinal: Soft, Non-distended.   Integumentary: Warm, Dry, Pink, No rash.   MSK: Not joint tenderness, free range of motion.   Neuro: No gross asymmetry.   Psychiatric: Cooperative, Appropriate mood & affect Follow Up Appointments   Follow Up Appt External Clinic or Provider, Clinic Name: (Privacy), Provider Name: (Privacy) FNP, (Privacy) Within 7 Days, No tests, Reason for Exam hospital admission f/u   Follow Up Appt External Clinic or Provider, Clinic Name: (Privacy) Provider Name: FNP, (Privacy) Within 7 Days, No tests, Reason for Exam HOSP DSC F/U   Follow Up Appt Medicine Cardiology, Clinic Name/Phone: Cardiology Clinic, Provider Name: NO , PREFERENCE, Within 1 Month, No tests, Reason for Follow Up Clin new Afib   Follow Up Appt Medicine Pulmonary Adult, Clinic Name/Phone: Pulmonary Clinic, Provider Name: (Privacy) MD Within 7 Days, other Radiology, Reason for Exam 1 month f/u with PFTs, Comments please coordinate with PFTs    Appointment Type   When   With   Where   Contact Information   Status    DC2  02/24/2022 11:00 AM  (Privacy) ACNS, Heart Vasc Cardiology  Heart and Vascular Clinic    Nursing/Other Orders Regular Diet. Ordered on 01/30/22 2:19:00, Meal Start Time Breakfast 0700 to 0900   Intake and Output (I&O). 01/30/22 2:19:00, Continuous Order   Fall Precautions. 01/30/22 21:47:59. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Activity As Tolerated. 01/30/22 2:19:00, Continuous Order   Code Status. Code Status Description: Full Code     Addendum by (Privacy) MD, on February 07, 2022 12:51:53 (Verified)    Attestation by (Privacy) MD, on February 07, 2022 12:51 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:    45 minutes were spent with greater than 50% in counseling and coordination of care