Age: 76.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Blood creatinine increased, Blood gases, Blood pH decreased, Blood urea increased
Clinical narrative: Date of Admission  01/12/2022   Date of Discharge  01/14/2022   Reason for Hospitalization   n/v/d at home. EMS found pt hypotensive (60s/40s) and hypoxic (80% room air). pt now on 4L O2. given 4mg zofran en route. pt reports a family member has covid. given IVF en route with improvement in BP.  Hospital Course   Pt is a 76 year old female with a past medical history of hypertension, depression, tobacco use, osteoarthritis and skin cancer who was brought in to the ED via EMS on (1/12) for nausea, vomiting, and diarrhea. She was hypotensive and requiring 4L O2. COVID PCR +. CXR negative. VBG showed pH 7.25, PCO2 55. CMP showed BUN/Cr 25/1.43. CBC unremarkable. Inflammatory markers elevated: D-dimer >20 and Ferritin 259. She was given duo-nebs, methylprednisolone, doxycycline, and IV fluids in the ED. Family medicine consulted for admission for new onset oxygen requirements 2/2 to COVID. Initially some concern for COPD exacerbation given significant smoking history and new O2 requirement, but she denied respiratory symptoms, was not wheezing on exam, and had reason for new O2 requirement. She got one dose of remdesivir 100mg IV and 2 doses of dexamethasone 6mg IV while here. Her oxygen requirements decreased down to 1L at rest. She reported no more episodes of nausea, vomiting or diarrhea. On day of discharge (1/14) she was hemodynamically stable with o2 sats >92% on 1L at rest. Home O2 eval showed she had need for 2L O2 with ambulation, so we are working with case manager to arrange home O2. With symptom onset and COVID test results on 1/12, we instructed her to remain in insolation for a total of 10 days, ending on the 22nd.  Symptoms significantly improved, and pt OK for discharge.  Discharge Diagnoses      COVID-19 Hypoxia  -symptom onset and positive test date 1/12  -new onset oxygen requirement, on 4L at admission  -s/p 1 dose of remdesivir and 2 doses of dexamethasone  -home O2 eval showed need for 2L O2. working with case manager to set up home oxygen.  -isolation to end 1/22    Nausea/Vomiting Diarrhea  -hypotensive with BUN/Cr - 25/1.43 - on admission -baseline Cr 0.9 in December  -s/p fluid boluses and IVF -diarrhea and vomiting resolved -BP improving, Cr 1.11 at discharge  Chronic Hypertension  -home meds: lisinopril, hydrochlorothiazide  -hypotensive 2/2 to vomiting and diarrhea -held home lisinopril and hydrochlorothiazide in hospital -resuming hydrochlorothiazide 25mg daily with discharge  -discontinued lisinopril 40 daily. follow up with PCP to discuss re-starting  Osteoarthritis  -home meds: vitamin D and meloxicam  -continue home vitamin D -hold home meloxicam given   -follow up with PCP to discuss re-starting  Other Diagnoses   Ongoing  History of nonmelanoma skin cancer  Osteoporosis     Depression     Peripheral Neuropathy     GERD  Consultants   -none  Pending Labs  -none  Discharge Disposition  Home    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  FLUoxetine (FLUoxetine 20 20 mg, 1 capsule(s), Oral, Daily, take with 40mg capsules to make total dose 60mg  Instructions:take with 40mg capsules to make total dose 60mg  FLUoxetine (FLUoxetine 40 40 mg, 1 capsule(s), Oral, Daily, take with 20mg capsule to make total dose of 60mg  Instructions:take with 20mg capsule to make total dose of 60mg  cholecalciferol (Vitamin 125 mcg, 1 Tablet(s), Oral, Daily    famotidine (Pepcid 40 mg) 40 mg, 1 Tablet(s), Oral, At Bedtime, 90 Tablet(s), 3 Refill(s)    gabapentin (gabapentin 30 600 mg, 2 capsule(s), Oral, At Bedtime, 180 capsule(s), 3 Refill(s)    hydroCHLOROthiazide (hydr 25 mg, 1 Tablet(s), Oral, Daily, dosage change, do not fil until pt due, 90 Tablet(s), 3 Refill(s)  Instructions:dosage change, do not fil until pt due    Discontinued Medications  lisinopril (lisinopril 40 40 mg, 1 Tablet(s), Oral, Daily    meloxicam (meloxicam 7.5 7.5 mg, 1 Tablet(s), Oral, Daily       Physical Exam at Discharge  Vitals & Measurements  T: 37 °C  TMIN: 36.6 °C  TMAX: 37.2 °C  HR: 77  RR: 20  BP: 145/70  SpO2: 97%      General: cooperative, female of appropriate age, in no acute distress on 1L NC Head: normocephalic, atraumatic Eyes: sclera white. conjunctiva pink. eyes watery. extraocular movements intact. Chest: Symmetric expansion. Breath sounds equal bilaterally. No wheezing noted. Cardiac: regular rate and rhythm. Normal s1 and s2. Abdomen: flat, bowel sounds present. Soft and nontender upon palpation. Neuro: Patient is alert and oriented. Speech is normal. Thought process is coherent. Psych: cooperative. mood and affect appear appropriate. Derm: warm and pink.   Follow Up Appointments     Follow Up Appt Family Medicine, Clinic Name/Phone:  Provider Name: Within 7 Days, No tests, Reason for Exam f/u hosp NVD & COVID    Appointment Type  When  With  Where  Contact Information  Status   PHY 05/12/2022 08:00 AM CDT    Nursing/Other Orders   Regular Diet. Ordered on 01/12/22 21:03:00 CST, Meal Start Time Breakfast 0700 to 0900   Intake and Output (I&O). 01/12/22 21:03:00 CST, Continuous Order   Fall Precautions. 01/13/22 15:30:17 CST. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation), Discussed With: Patient. Order comment: ok to intubate    Attestation on January 15, 2022 17:46 I have verified the student note and corrections have been made as necessary. I agree with the contents of this note. I independently performed a physical exam and the medical decision-making portion of this service.