provider progress note 2/7/2022 assessment principal problem: weakness active problems: weakness generalized moderate malnutrition skin condition reddened (non-pressure related);rash left;lower back (active) first observed/origin date/first observed/origin time: 01/29/22 1838 skin condition type: reddened (non-pressure related);rash orientation: left;lower location: back comments: patient is a 81 y.o. female with history of frequent utis, dementia, hypertension who presented to the emergency room with generalized weakness. she was diagnosed with a uti. she also had 4 episodes of nonsustained v. tach and a cardiology consult was requested. a tte was done without significant structural heart disease. no further interventions per cardiology. plan generalized weakness suspect d/t combination of covid-19 infection and possible uti. -- pt/ot. needs 24/7 assistance - sw working toward tcu placement. e.coli uti with mdr, history esbl, possible cre on prophylactic keflex for hx of frequent utis. per daughter, only 2-3 utis in the past couple years. suspect likely colonization. ua+ and uc with mdr e.coli (r to ertrapenem but s to meropenem). -- discussed and reviewed sensitivities with id -- stopped ceftriaxone 2/1 -- meropenem iv x3 days completed treating an uncomplicated cystitis per id recs -- prophylactic keflex not necessary given established resistance, the fact she is very likely colonized. -- ? if prophylactic therapy necessary given only a couple utis in the past couple years -- consider referral to outpt id and/or urology on d/c to help determine future appropriateness of prophylactic therapy covid-19 infection incidental finding. no hypoxia. felt to be contributing to the weakness. -- monitor respiratory status -- patient does not qualify for any covid-19 directed therapies as she is on ra constipation -- bowel regimen available - prune juice, senna-s, dulcolax, miralax -- encourage oral intake and ambulation nonsustained ventricular tachycardia asymptomatic with these episodes. felt likely d/t covid. -- tte without significant structural heart disease -- appreciate input from cardiology, signed off -- high goals for e-lytes hyponatremia suspect d/t poor oral intake which has improved. hyponatremia resolved. -- encourage oral intake -- periodic bmp monitoring leukopenia was previously normal in april. suspect r/t covid infection. -- periodic cbc monitoring dementia patient seemed mildly confused but cooperative -- continue pta aricept hypertension blood pressure intermittently mildly elevated -- continue pta prinivil moderate malnutrition per dietitian eval. loss of muscle mass: not present. loss of subcutaneous fat: not present. fluid accumulation: mild +1. energy intake: less than or equal to 50% of estimated energy requirement for 5 days or greater. interpretation of weight loss: not reported (does not meet criteria). -- supplements per dietitian patient's daughter, poa - updated 2/6/22. dvt prophylaxis - lovenox