Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Blood glucose increased, Brain natriuretic peptide decreased, COVID-19, Cardiac failure acute
Clinical narrative: Patient is a 67 y.o. female patient of, MD with history of HFpEF, HTN, IDDM2, OSA, metastatic breast cancer, cancer related pain presented to Hospital with leg swelling, shortness of breath, cough, found to have COVID and acute on chronic HFpEF.   Acute on chronic HFpEF On torsemide 20 mg BID at home as well as spironolactone Last TTE in April 2022 with normal LVEF, grade I diastolic dysfunction Volume overload on admission with pulmonary edema, lower extremity swelling BNP is falsely low due to obesity Repeat TTE with normal LVEF, grade II diastolic dysfunction Significantly improved with IV diuresis Discharged on increased home torsemide dosing on discharge to 40 mg qAM and 20 mg qPM   Acute on chronic respiratory failure with hypoxia/hypercapnia Chronic CO2 retention in setting of likely OAHS, baseline using O2 intermittently, requiring 3L on admission, respiratory failure in setting of heart failure and COVID CXR with mild fluid overload with cardiomegaly COVID positive on admission Down to room air by discharge Continue home BiPAP nightly   COVID-19 virus infection Date of onset of symptoms: 10/1 Symptoms present on admission: shortness of breath, cough, sore throat Date of covid positive test: 10/3 Vaccination status: vaccinated without recent booster Imaging: CXR with mild fluid overload Oxygen requirements on admission: 3L Current oxygen requirements: room air Medical therapy: given high risk for severe disease, treated with remdesivir while admitted as well as steroids, plan to continue dexamethasone on discharge for 3 more days Consultants following: n/a Anticipated special isolation end date: 10/11 IDDM2 with hyperglycemia Follows with facility endocrinology Home regimen of Levemir 50 units BID with Novolog 12 units TID AC with SSI and Trulicity Glucoses elevated with steroid use Resume home regimen on discharge   HTN On carvedilol, torsemide, spironolactone at home Continue carvedilol and spironolactone, resume torsemide on discharge with increased dosing   CKD3 Baseline Cr in the 1.2-1.5 range, admit Cr of 1.48 Below baseline by discharge   Pancytopenia Acute on chronic in setting of chemotherapy with Ibrance, recently completed 3 week course WBC 1.26 (ANC 0.35K), Hgb 10.2, platelets 101K on admission Improved since off of Ibrance Will need to follow up with oncology before resuming   Metastatic breast cancer Follows with facility oncology, with mets to bone, initially diagnosed ~10 years ago On Ibrance and letrozole Resume Ibrance as outpatient pending CBC, can continue letrozole   Chronic pain syndrome Cancer related pain Follows with palliative care at facility, pain due to cancer and RA Home regimen of methadone 10 mg q8h with oxycodone 15 mg q6h PRN for breakthrough Continue home regimen   OSA Morbid obesity BMI 53.71, on BiPAP at home Continue BiPAP nightly and at naps Rheumatoid arthritis Continue home hydroxychloroquine   Right leg cellulitis Chronically on penicillin for suppression of cellulitis with known ulceration, currently on ciprofloxacin and amoxicillin given recent worsening Continue ciprofloxacin and amoxicillin, improved, plan 10 day course