Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Chest X-ray abnormal, Computerised tomogram thorax, Cough, Dyspnoea, Fatigue
Clinical narrative: Patient is a 84 y.o. male patient of MD with history of CAD, CLL (Chronic Lymphocytic Leukemia), DM2, CKD, HTN and HLD presented with fatigue and shortness of breath.  He was provided with oxygen therapy and started on antibiotics and his previously prescribed prednisone taper was continued.  CXR was initially concerning for possible pneumonia.  Testing for pneumonia was negative with sputum cultures pending at the time of discharge.  CT Scan of the patient's chest was completed that was also pending at time of discharge.  The patient's condition significantly improved.  It was determined that his desaturation is likely due to post-covid changes to his lungs. He was evaluated for and discharged with home health services and supplemental oxygen in fair condition.  He was discharged with 3 more days of antibiotics and a bowel regimen.  He was advised to complete his previously prescribed prednisone taper as well.  He was also discharged with Insulin Lantus as his blood sugar levels had been elevated while on steroids.  He was instructed to follow-up closely with his PCP and Pulmonologist on discharge.   Assessment and Plan   Acute Hypoxemic Respiratory Failure Pt with worsening shortness of breath since having COVID ~1 month ago CXR with bilateral lower lobe opacities suspicious for pneumonia WBC is elevated in the setting of steroids 88% on RA, improved to 96% with 2L NC; currently 93% on RA Unlikely CAP; more likely Post-Covid ILD S. Pneumo and Legionella Urinary antigens negative Plan to continue steroid taper previously ordered by pulmonologist (prednisone 10mg daily for 5 more days) Sputum culture pending at time of discharge CT chest w/o contrast ordered; results pending Patient failed Home O2 Eval - requiring oxygen on discharge;  Care Management consulted for home oxygen therapy; medical are setup Plan to discharge the patient with Cefdinir x 3 more days Encouraged patient to complete steroid taper as previously prescribed   Covid-19 Virus Infection Date of onset of symptoms: ~7/17 Symptoms present on admission: shortness of breath, cough Date of covid positive test: 7/17 and again 8/11 Vaccination status: vaccinated Imaging: CXR with bibasilar pneumonia Oxygen requirements on admission: 2L NC Current oxygen requirements: RA Clinically I suspect this is not a repeat COVID infection, but rather post-covid ILD, likely incidental positive related to recent infection   Weakness Likely secondary to CLL and lingering post-COVID SOB PT/OT consulted for further evaluation CM consulted for assistance with discharge; medical recommended on discharge Constipation Family reports no BM in 1 week Continue miralax daily + senna BID Start MoM Will discharge patient with a bowel regimen; encouraged PO intake of fluids and maintaining an adequate fiber diet upon discharge   DM2 Hemoglobin A1c 10.9 on 06/21/22 Hold home dulaglutide and glimepiride Lantus and SSI while hospitalized Lantus 10 units nightly with SSI. Currently on steriods.  Plan to discharge patient with 10 U Solostar (Lantus) Pen nightly with recommendations to follow-up closely with PCP   CKD Baseline Cr 1.5-1.7 Creatinine today 1.59 Monitor   HTN BP stable Continue carvedilol   CLL On ibrutinib chronically Okay to hold while hospitalized