Age: 79.0
Sex: M
Vaccine: COVID19
Symptoms: Depression, Dyspnoea, Emphysema, Essential hypertension, Hyperlipidaemia
Clinical narrative: COVID+ 11/28/22.  Vaccination status -moderna x3 BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider at Discharge: DO  Admission Date: 11/28/2022 Discharge Date: 12/3/2022   Active Hospital Problems   Diagnosis Date Noted POA ? COVID-19 virus infection 11/28/2022 Yes ? CAP (community acquired pneumonia), right and middle lobe  11/29/2022 Yes ? Acute exacerbation of chronic obstructive pulmonary disease (COPD) 11/28/2022 Yes ? Acute on chronic respiratory failure with hypoxia 11/28/2022 Yes ? Leukocytosis 11/30/2022 Yes ? BPH (benign prostatic hyperplasia) 11/28/2022 Yes ? Hyperlipidemia 11/28/2022 Yes ? Essential hypertension 11/28/2022 Yes ? Depression    DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute exacerbation of chronic obstructive pulmonary disease (COPD)  COPD exacerbation  COVID-19    HOSPITAL COURSE:    Patient is a 80 y.o. male with past medical history of essential hypertension, GERD, CKD3, PVD, COPD, CHF, and BPH. He is on chronic azithromycin 3 days a week, prednisone 10 mg a day per Dr. Patient reports he was diagnosed with renal cancer, but states he is not a surgical candidate. CAT scan from 6/20/2020 demonstrated asbestos pleural plaques scattered bilaterally with calcifications. Severe emphysema and some interstitial fibrosis in the bases not consistent with IPF but suggestive of asbestos related pulmonary fibrosis. At baseline patient wears 2-2.5L nasal canula at night. Reports using wheelchair at baseline for the last 2-3 years. He presented to hospital with productive cough and increased shortness of breath x 3 days despite increasing his home oxygen use from nightly to around the clock and increased duonebs.    In the ER, arrived tachycardic (115), 96% on 2L NC, afebrile. Laboratory revealed lactic 1.5,  procalcitonin is 0.19, WBC 19,000 (long term steroid use), BNP 160, troponin 32 and 31, BMP unremarkable. COVID 19 positive. Chest xray reveals developing infiltrates in right mid and lower lung zone. While ambulating patient desaturated to 87% and tachypnea. Solumedrol and doxycycline given in ER and he was admitted to the hospital for further management.  While hospitalized the patient received remdesivir and was initially started on PO Decadron but transitioned to Solu-Medrol on 11/29/2022 due to limited and 4 in setting of chronic obstructive pulmonary disease exacerbation with COVID-19 infection.  The patient was also treated with scheduled DuoNebs and IV ceftriaxone and azithromycin for right lower lobe and right middle lobe pneumonia, he completed the antibiotic therapy.  Speech language pathology was also consulted due to the location of the pneumonia. No concerns regarding swallow function. The patient's COPD exacerbation was treat with neb treatments and IV steroids, he was transitioned to PO prednisone on 12/2 with continued improvement. Will discharge home with a prednisone taper and mucinex. He was also instructed to use the IS and accapella.  The patient's oxygen 1L while awake, he already is set up with home oxygen and will continue to use this as night. The patient was given a new pulse ox.    One of 2 blood cultures from 11/28 are positive for 2 different coag negative Staph that which are contaminate cultures. The repeat BC from 11/29 are no growth to date.    Recommend outpatient follow-up with PCP in 1-week. Would recommend continued outpatient follow-up for the right renal mass.