Reporte zur Charge 039K20-A2

Symptomtext

A 63-year-old female, resident of facility, gets her healthcare through the Health System. She is a kidney transplant patient and sees a nephrologist in city, who follows that. She went to the Clinic on Friday, February 25th, complaining of vaginal itching. She was given a topical cream and an antibiotic for UTI. She went back home and later that same day began having significant abdominal pain. So, she returned to the clinic and for unclear reasons, they tested her for COVID and found her to be COVID positive. She says she has had 4 vaccinations for COVID, has had no respiratory symptoms. She said they really did not address her abdominal pain that night. They had arranged for her to come back today to the clinic to receive sotrovimab because of her COVID positive test. However, she told them about her ongoing abdominal pain, which has been fairly constant since last Friday, and they directed her to the emergency room instead. There, her COVID test was negative and she underwent a CT scan indicating appendicitis. Therefore, she was sent here, apparently not having General Surgery anywhere closer. At the time of her transfer, it was relayed that she also had pneumonia, pyelonephritis, and it was initially suggested they may try Medical Center in city because of her kidney transplant status. They apparently contacted the Medical Center, but they could find no record of her having a transplant there, and declined the transfer. So, she was eventually accepted here. She says that her vaginal itching has cleared up, but she continues to have significant right lower quadrant abdominal pain. She had some nausea, vomiting, and diarrhea when it first started but this has since stopped. She was noted to have temp of 102 at the outside facility. DISCHARGE: 3/6/2022 Transferred from hospital for surgery 1. Acute appendicitis with microperforation. continued meropenem which was started at the outside hospital, until appendix removed, General Surgery consultation appreciated, Doctor took to OR 3/3; can now stop abx 2. Stage 4 chronic kidney disease with renal transplant status. Will continue her cyclosporine and mycophenolate. Do not know her baseline renal function, but certainly she is in the stage IV CKD range right now. She was on 3 days perioperative hydrocortisone in replace of prednisone Back to oral prednisone 3/6 am 3. Chronic anemia, stable 4. Mild hyponatremia, resolved 5. Type 2 diabetes mellitus with hyperglycemia. Hold glipizide. Sliding scale insulin. Stopped DKA protocol, chronic metabolic acidosis due to CKDz 6. Obesity with obstructive sleep apnea. Continue home CPAP if we can find her settings and/or machine for when extubated *** this is likely reason for reintubation post-op 7. Recurrent urinary tract infection. The air seen in the transplanted kidney on CT clinically does not appear to be consistent with emphysematous pyelonephritis. She has been on broad-spectrum antimicrobials anyway in the form of meropenem. 8. Atelectasis. She is not hypoxemic, no evidence of bacterial pneumonia. Again, as above, she will be on fairly broad antibiotic coverage. 9. Rheumatoid arthritis with Sjogren syndrome. She is immunosuppressed. She has chronic changes, but nothing that looks like acute synovitis. 10.Multinodular goiter seen on imaging, chronic and she says they are just following this for now and has an endocrinologist she sees 11.History of Clostridium difficile colitis. Monitored with her being on broad antibiotic therapy, never had diarrhea here. 12.Hypertension. She is normotensive currently