Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: International normalised ratio increased, Left ventricular failure, Malaise, Mycobacterium avium complex infection, Obstructive sleep apnoea syndrome
Clinical narrative: DISCHARGE SUMMARY    Date of Admission:  11/7/2023   Date of Discharge:  11/11/2023    Patient instructions: ? COVID swab 11/7/2023 was positive.  Recommend isolation x 3 weeks through 11/26/23; as long as symptoms improving and no ongoing fevers, okay to lift isolation precautions as of 11/27/23. ? You received treatment for COVID while in the hospital, including 5 days of IV remdesivir and Decadron steroid x5 days.   Diagnoses:  COVID-19 Acute on chronic hypoxemic respiratory failure History of chronic lung disease History of pulmonary nocardiosis Prior history Mycobacterium avium intracelulare COPD OSA DM 2 History of systolic CHF History embolic stroke, on Coumadin GERD BPH Levothyroxine   Consults:  None    Primary Procedures:  Chest x-ray   Hospital Course:    See history and physical for full detail.  Briefly, 74-year-old male, history of COPD, pumonary nocardia on chronic Bactrim therapy, prior myobacterium avium-intracellulare, bronchiectasis, OSA (CPAP uses 3 to 4 L oxygen; also uses oxygen during the day, usually 2 L if needed), CAD with prior PCI, paroxysmal supraventricular tachycardia, HTN, DM 2, dCHF (TTE 2021 EF 50 to 55%), history of embolic CVA with residual right-sided weakness now on Coumadin, prior COVID-19 , wheelchair-bound baseline and dependent on family for all basic tasks (can get out bed to chair with minimal assist, otherwise wife shaves and, bathes him, dresses him, feeds him etc.) who was brought in by ambulance 11/7/2023 with generalized weakness, loss of appetite, feeling unwell x2 days and admitted with COVID-19.  Initial management included LR bolus 30 mL/kg, RDV + Decadron, CTX+doxy.   11/8: On 3 to 4 L nasal cannula.   11/9:  On 3L nasal cannula   11/10:  No acute events.  On 3L NC.   11/11: No acute events.  On 2 L nasal cannula (i.e. baseline).  Completed full 5 days of remdesivir and Decadron.  Discharged in satisfactory condition.   #.  Acute on chronic hypoxemic respiratory failure, COVID-19 pneumonia; chronic lung disease. ?Chest x-ray with no new consolidations, thus antibiotics were not continued. ?Completed 5-day course remdesivir/steroids ?Respiratory isolation precautions enacted   #.  COPD, minimal wheeze ? Continue scheduled DuoNeb ?Continue Advair, Spiriva   #.  OSA, CPAP nightly while in hospital   #.  History of pulmonary nocardiosis.  Continued usual Bactrim.   #.   Prior history myobacterium avium intracellulare.  Noted.   #.  DM2, ?: House, use NPH 15 units twice daily ?coverage   #.  History systolic CHF, not in exacerbation, history of CAD including multivessel PCI in August 2004, history of paroxysmal supraventricular tachycardia, hypertension. ?Continued medical management, atorvastatin, Lasix, Imdur, metoprolol, digoxin.   #.  History embolic stroke: Continue Coumadin, goal INR 2-3.   #.  History GERD, Barrett's esophagus, continue home Protonix.   #.  History of BPH, continued Flomax.   #.  Hypothyroidism, levothyroxine.   #.  Code, DNR per POLST   BP 131/73  | Pulse 91  | Temp 97.6 °F (36.4 °C)  | Resp 18  | Ht 6' 1"  | Wt 88.3 kg (194 lb 9.6 oz)  | SpO2 94%  | BMI 25.67 kg/m²        Exam: General: Male, partially reclined, speaking in short sentences, pleasant, no acute distress. Eyes: Sclera anicteric, pupil 3 mm bilateral. HEENT: Mucous membranes moist, dentition fair. Lungs: Good airflow bilateral anterior, +mild wheeze. Heart: Normal rate, regular rhythm, no murmur appreciated. Abdomen: Nondistended no guarding. Neuro: Detailed strength exam was deferred. Skin: Nonjaundiced, dry.   Condition on Discharge:  stable    Code Status : Do Not Resuscitate    Discharge Disposition:  Home    Medications:  See discharge instructions for discharge medications              Note Details  Author (D.O.) File Time 11/12/2023  7:15 AM Author Type PHYSICIAN (D.O.) Status Addendum Last Editor (D.O.) Specialty Hospital Medicine Hospital Acct #  Admit Date 11/7/2023  Hospital Problem List   GERD (GASTROESOPHAGEAL REFLUX DISEASE)  HEART FAILURE W REDUCED LVEF 31-40%, UNSPECIFIED ACUITY  DM 2 W CKD STAGE 3A (GFR 45-59)  PULMONARY MYCOBACTERIAL AVIUM INTRACELLULARE  CHRONIC HYPOXEMIC RESPIRATORY FAILURE  HYPOTHYROIDISM  COVID-19 DISEASE  BPH (BENIGN PROSTATIC HYPERPLASIA)  HX OF EMBOLIC STROKE  ANTICOAGULATION MONITORING, INR 2.0-3.0  PULMONARY NOCARDIOSIS  LATE EFFECT OF STROKE  COPD STAGE 3 SEVERE (FEV1 30-49%)  HYPERLIPIDEMIA  BARRETTS ESOPHAGUS  HTN  DM 2  VENTRICULAR TACHYCARDIA, NONSUSTAINED  OBSTRUCTIVE SLEEP APNEA