Age: 71.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Angiogram abnormal, Angiogram pulmonary abnormal, Anticoagulant therapy, Asthma
Clinical narrative: Date of admission: 11/25/2022 Date of discharge: 12/6/2022 Readmitted: 12/7/2022 - 12/19/2022 Chief complaint: Shortness of breath Discharge diagnoses: Pneumonia of both lower lobes due to infectious organism, acute DVT of calf muscle vein of right lower extremity, acute pancreatitis, elevated D-dimer, leukocytosis, cerebral palsy, sepsis, hypernatremia, persistent asthma with acute exacerbation, nonverbal, DNR  Hospital course: 71-year-old female with cerebral palsy, dysphagia with G-tube, congestive heart failure, chronic respiratory failure on 2 L of oxygen via nasal cannula at baseline presented to the hospital from a nursing home with increased oxygenation requirements for the last 24 to 48 hours, requiring 6 L of oxygen on admission.  Has a left lower lobe pneumonia and is on antibiotics. Has mild pancreatitis which is resolved.  She was also found to have a calf muscle vein DVT and is on Lovenox.  Transition this to Eliquis on discharge. She completed her antibiotics for pneumonia.  On CT scan she did have some atelectasis.  Its more difficult to totally treat this with her history of cerebral palsy and hard to really do incentive spirometry and the fact that she is stuck in bed.  We did do bronchodilators as well as chest physiotherapy which did improve her clinically and she was able to decrease her oxygen requirements down to 3 L. She was maintained on tube feeds.  She did have some hypokalemia which is resolved.  She had some hypernatremia which was up and down and have made some adjustments to her free water with her tube feeding.  I recommend a BMP in the next couple days and then we can adjust her free water with her tube feedings as directed by her treating physician. READMISSION: Date of admission: 12/7/2022 Date of discharge: 12/19/2022 Chief complaint: Shortness of breath Discharge diagnoses: Hypernatremia; infarction of the spleen; prediabetes; dysphagia; neurogenic bladder; intellectual disability; chronic pancreatitis; active UTI; hypothyroidism; DNR; cerebral palsy; congestive heart failure; bronchial asthma; essential hypertension; hyperglycemia; persistent pneumonia; acute hypoxemic respiratory failure Hospital course: Patient readmitted for persistent hypoxia.  She was seen in consultation with pulmonary, gastroenterology, hematology, and nephrology.  Patient was found to have new splenic infarcts on CT scan which developed while patient was on Eliquis.  For this reason hematology recommended switching her from apixaban to Arixtra (patient had thrombocytopenia previously with Lovenox).  Patient was also evaluated by GI for chronic pancreatitis.  They recommended no additional treatment at this time and possible consideration of outpatient evaluation with University of Louisville pancreatic specialist if consistent with goals of care.  Unfortunately the patient has cerebral palsy and as a result has intellectual disability and she is now nonverbal at baseline.  As noted by several specialists, it is very difficult to completely ascertain the exact etiology of some of her chronic medical problems given her inability to communicate.  However at this time she is back to her baseline and is stable for discharge.  There are no acute issues requiring additional work-up.  She will be discharged to continue Arixtra for the problems as mentioned above.  It is definitely recommended that she follow-up with PCP in order to continue to manage her chronic medical problems.  She will return to her group home at this time. Discharge plan: Splenic infarctions -   occurred while on apixaban; per hematology recommendations transitioned to and will continue Arixtra indefinitely