Date of Admission  01/30/2022   Date of Discharge  02/10/2022   Reason for Hospitalization   pt brought in via EMS from assisted living for AMS. Facility did not report specific deficits to EMS at this time. Pt not answering orientation questions, conversing. Pt received albuterol neb, 1L NS, and 1mg versed pta  Hospital Course    63-year-old male patient with past medical history of schizophrenia, bipolar disorder, COPD, chronic lower back pain.  Patient lives at assisted living facility, and he was transferred due to concern of dehydration, Covid pneumonia and elevated lactic acid with troponin.  Patient was clearly dehydrated on admission and improved on IV fluids and admitted under family medicine team.  Since patient is uncooperative and refusing vitals labs and evaluation and since 4 February.  Is currently does not require oxygen requirements but was started on Decadron due to 1 day of having oxygen recommend of 2 L.  Patient was transferred to integrated medicine because his facility refused to take him unless his Covid isolation to be completed on 10 February.  Patient does have history of schizoaffective and bipolar disorder refusing take his clozapine and Depakote, at baseline he has paranoid delusions and refuse medication dramatically based on his mood.  Talked to his guardian on 7 February 2022 and took permission to proceed with any necessary medications, precautions and intervention if needed.  Currently today patient was cooperative and taking his oral psych medication.  Still refusing labs.  Patient is discharged on 10 February back to his residential care facility (assisted living facility) after he finished his isolation period for COVID infection. Pt can get COVID vaccines with his PCP follow up in 1-2 weeks if he is not fully vaccinated.   # Schizophrenia/bipolar disorder with uncooperative behavior and psychosis  - continue clozapine 100 mg QAM and 150 mg QPM.  - continue depakote 500 mg TID and 250 mg at bedtime.   # COVID-19 pneumonia:  -Asymptomatic at the current time  - if pt is unvaccinated then can get COVID vaccine as soon as he is off isolation.  # Dehydration due to poor oral intake (improved):  -Troponin leak, mild lactic acid elevation  - received IV fluid on admission.  Chronic condition:  schizophrenia, bipolar disorder, COPD, chronic lower back pain.   Discharge Diagnoses      Bipolar affective     COVID-19     Dehydration     Schizophrenia     Orders:   Discharge Patient  Other Diagnoses   Ongoing  Bipolar affective  BMI 37.0-37.9, adult  BPH (benign prostatic hyperplasia)  Hyperlipidemia  Low back pain  Obesity  Schizophrenia  Historical  No qualifying data    Consultants  Psychiatry   Pending Labs  Clozapine Level- (In-Lab, Ordered 02/08/2022, 09:08)   Discharge Disposition  Skilled Nursing Facility, Other:     Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  Mapap 325 mg oral tablet (M 2 Tablet(s), Oral, q6h, for 24 hour(s), PRN: AS NEEDED, 60 Each, 11 Refill(s)    Misc. Medication (Cane) See Instructions, Use as needed to help with ambulation, 1 Each, 0 Refill(s)  Instructions:Use as needed to help with ambulation  Misc. Medication (Orajel An See Instructions, use BID prn mouth sores, 120 mL, 0 Refill(s)  Instructions:use BID prn mouth sores  Miscellaneous Medication (A See Instructions, apply to affected area no more than 4 times daily, 0 Refill(s)  Instructions:apply to affected area no more than 4 times daily  albuterol (Ventolin HFA 90 See Instructions, INHALE 2 PUFFS BY MOUTH FOUR TIMES A DAY AS NEEDED FOR WHEEZING, 18 g, 11 Refill(s)  Instructions:INHALE 2 PUFFS BY MOUTH FOUR TIMES A DAY AS NEEDED FOR WHEEZING  aspirin (Aspirin Low Dose 8 81 mg, 1 Tablet(s), Oral, Daily, 30 Tablet(s), 11 Refill(s)    atorvastatin (atorvastatin 40 mg, 1 Tablet(s), Oral, Daily, 30 Tablet(s), 11 Refill(s)    cholecalciferol (Vitamin D3 50 mcg, Oral, Daily, 0 Refill(s)    cloZAPine (cloZAPine 100 mg 100 mg, 1 Tablet(s), Oral, bid, 0 Refill(s)    cloZAPine (cloZAPine 50 mg) 50 mg, 1 Tablet(s), Oral, Daily, Give with 100mg dose at bedtime for total of 150mg at bedtime, 0 Refill(s)  Instructions:Give with 100mg dose at bedtime for total of 150mg at bedtime  cyclobenzaprine (cyclobenza 10 mg, 1 Tablet(s), Oral, bid, PRN: Muscle Spasm, 0 Refill(s)    divalproex sodium (Depakote 500 mg, 1 Tablet(s), Oral, tid, 0 Refill(s)    divalproex sodium (Depakote 250 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    docusate (docusate sodium 1 100 mg, 1 Tablet(s), Oral, bid, PRN: as needed for constipation, 60 Tablet(s), 11 Refill(s)    fluticasone-salmeterol (Adv 2 Puff, Inhalation, bid, 1 Each, 11 Refill(s)    magnesium hydroxide (Milk o 2.4 g, 30 mL, Oral, Daily, PRN: as needed for constipation, 480 mL, 11 Refill(s)    psyllium (Metamucil 3.4 g/5 3.4 g, Oral, Daily, 1,042 g, 0 Refill(s)    tamsulosin (tamsulosin 0.4 0.4 mg, 1 capsule(s), Oral, Daily, 30 capsule(s), 11 Refill(s)      Discontinued Medications  hydrOXYzine (Vistaril 25 mg 25 mg, 1 capsule(s), Oral, bid, 0 Refill(s)    naproxen (naproxen 500 mg) 500 mg, 1 Tablet(s), Oral, bid, PRN: Pain (pain score 1-10), 0 Refill(s)       Physical Exam at Discharge  Vitals & Measurements  T: 36.0 °C  TMIN: 36.0 °C  TMAX: 36.7 °C  HR: 87  RR: 18  BP: 122/87  SpO2: 95%  WT: 103.7 kg  BMI: 35.5      # Constitutional: not in acute distress. no pallor or jaundice. # Eyes: PERRLA, EOMI # ENMT: no ear discharge, no nasal discharge, moist mucous membranes. # Cardiovascular: RRR, normal S1, S2, no Murmur, rub or gallop. # Respiratory: CTA. no wheeze # Gastrointestinal: soft, not distended. not tender. no hepatosplenomegaly. # Genitourinary: not performed. # Musculoskeletal: no joint swelling or deformity. # Skin: No skin rash # Neurologic: AAOx3, intact cranial nerves. muscle power is grade 5 in upper and lower limbs. normal sensations. # Psychiatric: normal mood. # Hematologic/lymphatic/immunologic: no lymphadenopathy.   Time Spent  35 minutes spent on discharge.   Follow Up Appointments           With  When  Contact Information       Within 1 to 2 weeks FAMILY MEDICINE     Additional Instructions:         Nursing/Other Orders   Regular Diet. Ordered on 01/31/22 2:02:00, Meal Start Time Breakfast 0700 to 0900   Intake and Output (I&O). 01/31/22 2:02:00, Continuous Order   Fall Precautions. 01/31/22 0:29:05. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: Full Code