Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Affective disorder, Anxiety, Asthma-chronic obstructive pulmonary disease overlap syndrome, Breath sounds abnormal, Bronchitis
Clinical narrative: (M.D.) Physician Specialty:  Hospital Medicine Discharge Summary     Signed  Signed    Date of Admission: 12/5/2023   Date of Discharge: 12/11/2023   Issues to be Addressed at Follow-up: -none   Pending Study Results at Discharge:  Unresulted Lab Orders    No orders found from 11/11/2023 to 12/12/2023.       Final Diagnoses:  Active Hospital Problems   Diagnosis   ? (Principal) COVID-19 DISEASE   ? ASTHMA COPD OVERLAP SYNDROME (ASTHMA W COPD)       Severe on CCM-Asthma testing 12/2/2020 - DOV  S: recent ER visit for bronchitis. Pt reports she completed prednisone and antibiotics and is back to baseline, using inhalers: asmanex, spiriva, albuterol (MDI or NEB prn).  O:  lungs - clear bilaterally without wheezes or crackles, slightly decreased breath sounds CV - RRR, no murmur, no LE edema  CXR 11/18/2020 - no acute disease A/P: Asthma/copd - pt is stable and will continue her inhalers spiriva, asmanex, and albuterol prn and using her supplemental oxygen.       ? LEUKOPENIA   ? MOOD DISORDER, UNSPECIFIED TYPE   ? DIASTOLIC HEART FAILURE, UNSPECIFIED ACUITY       8/12/2022 MD - Established diagnosis. Briefly reviewed plan today. Continue current regimen.  Pt is controlled. Continue metoprolol.      ? CARDIOMYOPATHY, UNSPECIFIED       Echo EF 45%. Cath with no CAD. Likely ETOH related.    ? CHRONIC RESPIRATORY FAILURE   ? HYPERTENSION       8/12/2022 MD - DOV S: she was in the ER recently for running out of bp meds.  She felt really short of breath.  She specifically ran out of metoprolol. Since getting it refilled she feels much better.  She does not think it was really a COPD exacerbation, just feeling anxious and difficulty breathing due to no metoprolol for 2 weeks.  O: Gen - No acute distress, alert and oriented Lungs  - CTA bilaterally, no wheezes, no crackles, normal effort CV - RRR, no murmur, no LE edema   A/P: hypertension BP is now controlled, heart rate controlled,  Continue current plan.        Resolved Hospital Problems No resolved problems to display.     Discharge Disposition:  Home with Home Health   Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings: 67 Y female w/ h/o HTN, alcohol abuse, alcohol induced cardiomyopathy (LVEf 45-50% on 11/2023), asthma/COPD on home O2.   Presented 12/4 to QOV with cough + SOB found to be COVID+.   12/5 - Repatriated to facility.   Patient continued on COVID-19 treatment with RDV, dexamethasone and IV lasix with improvement. On day of discharge, at rest on room air but needed O2 with exertion (1-2L). Doxycyline also added given possible COPD exacerbation and completed a 5-day course.    Discharged home with as needed O2 supplementation as well as prednisone taper.    Of note patient placed on Valsartan for BP control but developed hyperK+, this was stopped on discharge.   Primary Procedures:  None   Secondary Procedures: CXR   Reason for Hospital Admission (Admitting Diagnosis):  COVID-19   Complications: none   Consults:  None Smoker: No.   Condition on Discharge: stable   Code Status at Time of Discharge: Full Code       Note Details  Author (M.D.) File Time 12/11/2023  3:17 PM Author Type Physician Status Signed Last Editor  (M.D.) Specialty Hospital Medicine Admit Date 12/5/2023  Admission (Discharged) on 12/5/2023  Admission (Discharged) on 12/5/2023   Detailed Report  Note shared with patient Hospital Problem List   HYPERTENSION  CHRONIC RESPIRATORY FAILURE  CARDIOMYOPATHY, UNSPECIFIED  DIASTOLIC HEART FAILURE, UNSPECIFIED ACUITY  MOOD DISORDER, UNSPECIFIED TYPE  COVID-19 DISEASE  LEUKOPENIA  ASTHMA COPD OVERLAP SYNDROME (ASTHMA W COPD) Care Timeline  12/06   Admitted 1342 12/11   Discharged 0245  Discharge   Home with Home Health   Discharge Instructions (AVS) (Printed 12/11/2023)