12/29/21 96 yr/o female with a history of aspiration PNA with sepsis and prolonged hospitalization complicated by COVID pneumonia. The was then discharge dto a subacute rehab but returned to the hospital on 12/26/2021 with concern for infected Gtube as well as being found supine with tube feeds in progress and additional aspiration. She had a CTA of the chest at time of evaluation with lateral lung consolidation in LLL and bilateral lower lung mucous plugging. She had desaturations and acute hypoxic respiratory failure. Initially she was placed on IV antibiotics including vancomycin and zosyn. The Gtube was aspirated by nursing and pus-like material was returned from it. There was noted to be concerns for    The Gtube was aspirated by nursing and pus-like material was returned from it. There was noted to be concerns for possible upper GI bleed as well. The pt remained non-verbal and did not have any significant changes/improvements while at the hospital. Family elected to forego further aggressive interventions and decided to focus on comfort as the primary goal. All aggressive interventions, including antibiotics were discontinued. She was transferred to Facility for further symptom management as she was requiring parenteral lorazepam and morphine.   The pt is unresponsive at this time but family present at bedside. Spoke with sisters and brother at the bedside and they recounted the previously 2 months of medical issues that have led the pt to where she is currently. They remain focused on comfort as the primary goal and don't have any acute questions at this time.  Physical Exam Constitutional:      General: She is not in acute distress.    Appearance: She is ill-appearing. She is not diaphoretic.     Comments: Unresponsive to verbal or tactile stimuli, lying in bed in recovery position; NAD  HENT:     Head:     Comments: Mild temporal wasting present    Mouth/Throat:     Mouth: Mucous membranes are moist.     Pharynx: No oropharyngeal exudate.     Comments: No drainage noted Eyes:     General: No scleral icterus. Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Heart sounds: No murmur heard.   No friction rub. No gallop.  Pulmonary:     Comments: Short, shallow breathing pattern present with rhonchi noted throughout Abdominal:     General: There is no distension.     Palpations: Abdomen is soft. There is no mass.     Tenderness: There is no abdominal tenderness.     Comments: Absent bowel sounds  Musculoskeletal:        General: No swelling or tenderness.  Skin:    General: Skin is warm and dry.  Neurological:     Comments: Unresponsive to verbal or tactile stimuli, no myoclonus    1/2/22 Cause of death: aspiration pneumonia   SECONDARY DIAGNOSES: 1. COVID 19 2. Aortic stenosis 3. HTN 4. Possible GI bleed    HOSPITAL COURSE: The patient was a 96 yr/o-year-old female  with a history of aspiration PNA with sepsis and prolonged hospitalization complicated by COVID pneumonia. She was then discharged to  subacute rehab but returned to the hospital on 12/26/2021 with concern for infected Gtube as well as being found supine with tube feeds in progress and additional aspiration. She had a CTA of the chest at time of evaluation with lateral lung consolidation in LLL and bilateral lower lung mucous plugging. She had desaturations and acute hypoxic respiratory failure. Initially she was placed on IV antibiotics including vancomycin and zosyn. The Gtube was aspirated by nursing and pus-like material was returned from it. There was noted to be concerns for possible upper GI bleed as well. The pt remained non-verbal and did not have any significant changes/improvements while at the hospital. Family elected to forego further aggressive interventions and decided to focus on comfort as the primary goal. All aggressive interventions, including antibiotics were discontinued. She was transferred the Inpatient Care Center for further symptom management as she was requiring parenteral lorazepam and morphine. At time of admission to the Facility the pt had a PPS of 10% and prognosis judged to be limited to days.  Parenteral medications were ordered for comfort including morphine, ativan and haldol.  She continued to decline and died 1/2/22 @ 1759