Age: 57.0
Sex: F
Vaccine: COVID19
Symptoms: Malaise, Metabolic function test normal, Nausea, Obstructive sleep apnoea syndrome, Positive airway pressure therapy
Clinical narrative: COVID+ 11/26/22.  Vaccination status - moderna x2, Pfizer x1   BRIEF OVERVIEW: Discharge Provider: DO Primary Care Provider at Discharge: DO Admission Date: 11/25/2022 Discharge Date: 11/26/2022   Active Hospital Problems   Diagnosis Date Noted POA ? COVID-19 11/25/2022 Yes ? Statin started by Vascular Surgery with Rx to be taken over by patient's PCP 11/26/2022 Unknown ? OSA on CPAP 09/07/2022 Yes ? Stage 3b chronic kidney disease (HCC) 04/20/2021 Yes ? Hypertension associated with diabetes (HCC) 01/01/2021 Yes ? COPD (chronic obstructive pulmonary disease) with chronic bronchitis (HCC) 01/01/2021 Yes ? Class 3 severe obesity with serious comorbidity and body mass index (BMI) of 45.0 to 49.9 in adult, unspecified obesity type (HCC) 03/06/2020 Yes ? Depression 05/31/2018 Yes ? Dyslipidemia associated with type 2 diabetes mellitus (HCC) 04/13/2018 Yes ? Type 2 diabetes mellitus with hyperglycemia, with long-term current use of insulin (HCC) 04/09/2018 Yes ? Fibromyalgia   Yes ? Peripheral neuropathy 05/22/2012 Yes ? Gastro-esophageal reflux disease without esophagitis 08/31/2009 Yes  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute respiratory failure with hypoxemia (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE:  Patient is a 57 y.o. female with an extensive past medical history of chronic obstructive pulmonary disease and asthma. Also hypertension, type 2 diabetes, fibromyalgia, chronic kidney disease, elevated body mass index. Former smoker, quit 3.5 years ago. She presents today to Health clinic with worsening shortness of breath and cough. She tested positive for COVID 6 days ago at home with symptoms starting 7 days prior. For the last four days she has taken Paxlovid. Reports worsening symptoms of cough, shortness of breath, and now chest pressure for the past two days. Reports last fever Tuesday. Reports nausea and diarrhea.    In the ER, patient arrived hypoxic 88 on room air, tachycardic, and tachypnea. EKG revealed sinus rhythm at 109 beats per minute. CTA no acute cardiopulmonary process, no PE. Laboratory- CBC, CMP, troponin unremarkable. Glucose 234 and 224. Will need to monitor glucose trend closely and adjust insulin regimen appropriately. Patient will be admitted for supplemental oxygen, antiviral, and steroid treatment. Patient is agreeable to admission and treatment plan.    During the hospital course, patient was weaned off of supplemental oxygen. Received one dose of remdesivir. Patient able to ambulate in room. Reports she is able to ambulate further and not as short of breath. During ambulation patient's SPO2 > 90%. RT50 completed with recommendations of no need for supplemental oxygen at this time. Discuss with patient in depth the importance of monitoring glucose at home, she does have a test libre. Reports she has a sliding scale insulin regimen from endocrine. Discuss that steroids will increase blood glucose. Patient is establish with endocrine, follow up 1/3/2023. Discuss with patient to call the office and update provider about hospitalization and steroid use, patient should follow up sooner than 1/3/2022. Follow up appointment with PCP on 1/12/2022. Patient is discharged with tessalon, 3 days of prednisone for a 5 day treatment, and 3 days of azithromycin for a 5 day treatment.    Patient seen and examined- she is alert and oriented. She reports she is feeling better and believe she is stable to go home. Denies chest pain, fever, chills, abdominal pain, urinary symptoms. Reports fatigue and shortness of breath with activity. Discuss the findings of RT50. Discuss medication to take at home.  Patient is discharged in stable condition- all labs and imaging reviewed. No concerns at this time. All questions were answered prior to discharge.    * COVID-19 COVID positive at home 6 days ago, will retest with PCR -Reports 4 days of paxlovid  -Acute respiratory failure with hypoxia  -Remdesivir ordered 1 day -Decadron ordered, 2/5 -Monitor respiratory status  -- > Continuous pulse ox ordered -COVID labs ordered OSA on CPAP Continue with CPAP Stage 3b chronic kidney disease (HCC) Monitor renal function with AM labs  - Renally dose medications and avoid nephrotoxic agents  Class 3 severe obesity with serious comorbidity and body mass index (BMI) of 45.0 to 49.9 in adult, unspecified obesity type (HCC) Continue to follow up outpatient Peripheral neuropathy Continue home regimen- Neurontin  Gastro-esophageal reflux disease without esophagitis Prilosec-> formulary protonix Depression Continue Wellbutrin and Cymbalta  Dyslipidemia associated with type 2 diabetes mellitus (HCC) Controlled, not on medications outpatient.  Type 2 diabetes mellitus with hyperglycemia, with long-term current use of insulin (HCC) A1C 9.8 > 2 months ago, repeat A1C 10.9 Holding metformin and actos -On insulin at home -ISS and lantus ordered -Monitor blood glucose -Diabetic diet  Hypertension associated with diabetes (HCC) Continue with lisinopril, hydrochlorothiazide  Fibromyalgia Continue home regimen COPD (chronic obstructive pulmonary disease) with chronic bronchitis (HCC) Continue home regimen- albuterol and tiotopium bromide  -Monitor respiratory status -In acute excerbation due to covid  -Remdesivir and decadron ordered  -DuoNebs ordered