Age: 67.0
Sex: F
Vaccine: COVID19-2
Symptoms: Dyspnoea, Essential hypertension, Fibrin D dimer increased, Hypoxia, Oxygen saturation decreased
Clinical narrative: COVID+ 12/29/22.  Vaccination Status - Moderna x3 + Moderna BIVALENT x1   BRIEF OVERVIEW: Admission Date: 12/29/2022 Discharge Date: 12/30/2022  Active Issues Requiring Follow-up COPD with acute exacerbation Assessment & Plan Likely secondary to COVID-19 Established with Pulmonology Remains on baseline oxygen requirements 2L  Scheduled and PRN breathing treatments Resume home medications  Maintain oxygen saturation >88% See plan of care as outlined for COVID-19  * COVID-19 Assessment & Plan Date of Symptom onset: 12/27/22 Date of positive COVID-19 test: 12/29/22 CXR: No acute cardiopulmonary process   Current oxygen requirement: SpO2: 97 % O2 Flow Rate (l/min): 2 l/min  CRP: 10.0  D-dimer: 560.  Will discharge home with additional steroid burst of 5 days total of Decadron Patient would not like any further antiviral therapy at this time Education was provided on signs and symptoms to watch for regarding worsening disease  Chronic respiratory failure with hypoxia Assessment & Plan Secondary to COPD  Baseline oxygen requirements: 2L nasal cannula   Current requirements: 2L nasal cannula  Hypothyroid Assessment & Plan May resume home levothyroxine 125 mcg PO q day  OSA (obstructive sleep apnea) Assessment & Plan May use home CPAP/BiPAP DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COPD exacerbation [J44.1] COVID-19 virus infection [U07.1] COVID-19 [U07.1]   HOSPITAL COURSE: The patient is a 67-year-old female who presented the hospital complaints of increasing shortness of breath.  Patient was noted to test positive for COVID-19 on presentation.  Patient was felt to be suffering from acute exacerbation of her chronic obstructive pulmonary disease related to her COVID infection.  She was not noted to be requiring any higher levels of oxygen than her baseline oxygen needs of 2 liters.  Following day of admission the patient was noted to have clear lung sounds and was without complaints of significant shortness of breath.  We discussed increase steroids at discharge for short period of time in addition to monitoring her pulse ox for persistent desaturations and monitoring her temperature for persistent fevers.  The patient was comfortable being discharged home today and felt she would be able to get better rest at home.  She was given 1 dose of remdesivir but did not want to continue antiviral treatment as she felt she was getting a rash from receiving remdesivir.  The patient appears stable from a respiratory standpoint and is being discharged home with follow-up with her PCP.  Pt readmitted - 1/3/2023-1/7/2023:BRIEF OVERVIEW: Admission Date: 1/3/2023 Discharge Date:  01/07/2023   Active Hospital Problems   Diagnosis Date Noted POA ? Type 2 diabetes mellitus, without long-term current use of insulin 01/04/2023 Unknown ? Essential hypertension 01/03/2023 Yes ? COVID-19 12/29/2022 Yes ? Chronic respiratory failure with hypoxia 03/10/2022 Yes ? OSA (obstructive sleep apnea) 06/19/2014 Yes ? Hypothyroid    DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COPD with acute exacerbation [J44.1] Chronic obstructive pulmonary disease with acute exacerbation [J44.1] HOSPITAL COURSE: Patient is a 67-year-old female with medical history of chronic obstructive pulmonary disease on 2 L nasal cannula, obstructive sleep apnea, hypertension who presented on January 3rd for shortness of breath.  Patient was recently hospitalized from December 20 9th to 30th for chronic obstructive pulmonary disease exacerbation and COVID-19.  Was discharged with 5 days of dexamethasone.  States that she was doing well at home but then progressively became more short of breath and began having fevers.  As result the patient came to the emergency department.  Presented hypoxic in the low 80s on 2 L nasal cannula.  D-dimer was somewhat elevated.  Chest x-ray did show airspace disease and CTA was unobtainable as patient was unable to lay flat.  Patient was mostly wheezing and was admitted for chronic obstructive pulmonary disease exacerbation.  Patient slowly progressed and was eventually able to be weaned down to 3 L nasal cannula.  Patient was placed on prednisone with inhaler use.  Patient was desaturating with exertion, however was able to eventually be weaned to 2 L nasal cannula baseline and was feeling at baseline.  As a result patient will be discharged with continued home oxygen and a prednisone taper back to her chronic 20 mg daily.  Follow-up with PCP. Type 2 diabetes mellitus, without long-term current use of insulin Assessment & Plan  Follow-up with primary care physician for diabetic medications Essential hypertension Assessment & Plan  Continue Norvasc 10 mg daily Continue lisinopril 10 mg daily COVID-19 Assessment & Plan  Clinically improved, back to baseline oxygen requirement Prednisone 40 mg taper back to chronic 20 mg daily Symptom onset greater than 10 days ago Follow-up with PCP Chronic respiratory failure with hypoxia Assessment & Plan  Baseline oxygen is 2 L nasal cannula Currently on baseline oxygen requirements Reportedly feeling better Continue home oxygen, may titrate up with exertion Hypothyroid Assessment & Plan  Continue Synthroid OSA (obstructive sleep apnea) Assessment & Plan  Continue home BiPAP setting