Age: 76.0
Sex: F
Vaccine: COVID19
Symptoms: Decreased activity, Decreased appetite, Dyspnoea exertional, Fall, Glomerular filtration rate decreased
Clinical narrative: Currently inpatient admission at (5) days. Patient is a 76 y.o. female with PMH of atrial fib currently on Eliquis, heart failure with EF 65%, hypertension, nephrotic syndrome, and history of pulmonary embolus who presents today with progressive weakness status post fall and positive COVID-19.  Patient has been vaccinated for COVID-19.   According to the patient, she has been feeling progressively weak for the last 3-4 days.  She states that she has been having shortness of breath with activity, cough with white sputum production, chills and nasal congestion that has developed over the last 3 days.  Today she fell at home and landed on her bottom.  She denies hitting her head or loss of consciousness.  She denies recent sick contacts or contact with anyone positive for COVID-19.  Patient was brought to ER for evaluation after fall and for evaluation of progressive weakness.   While in ER, vital signs were notable for temperature of 100.4° oral.  All other vital signs were within defined limits.  Lab values were remarkable for GFR of 59, AST of 50, ALT 61. Patient tested positive for COVID-19.  Chest x-ray negative for acute cardiopulmonary process.  Patient's family felt that patient was too weak to come home and wanted further evaluation in the hospital.  Hospitalist asked to admit for management of COVID-19 and weakness.   Patient seen and evaluated in the ER.  She endorses decreased appetite, decrease in activity, congestion, headache, intermittent shortness of breath with activity, cough with sputum production denies blood in sputum and chills.  She denies numbness or tingling, dizziness, lightheadedness, chest pain or pain with deep breathing, heart palpitations, nausea, vomiting, diarrhea or abdominal pain.  She denies shortness of breath at rest.  At this time we will admit the patient for monitoring of symptoms.  She is currently on room air.  Due to patient's age, comorbidities, and the fact that patient is currently on room air will discuss with day team if patient is a candidate for possible monoclonal antibody therapy treatment.  Will initiate treatment with Decadron, breathing treatments, supplementary oxygen if needed, and continue home medications.  Plan of care was discussed with patient who is agreeable to the plan.  Questions answered to patient's satisfaction.   Patient states that she would be open to treatment with remdesivir if needed.  Patient states she would be open to treatment with monoclonal antibody therapy if necessary.  Explained to patient that due to unpredictable course of COVID-19, patient may require supplemental oxygen via nasal cannula, oxygen mask non-rebreather, on high-flow nasal cannula, BiPAP CPAP or endotracheal intubation with mechanical ventilation.  Patient is agreeable to all noninvasive oxygen therapy.  She states that she would not want endotracheal intubation with mechanical ventilation.   Code status discussed at length with patient.  She states that she a to be a do not resuscitate.  Assessment & Plan Date of Symptom onset: 12/1/21 Date of positive COVID-19 test:12/4/21 CXR: No chest findings    Current oxygen requirement: SpO2: 94 %   on room air    CRP: No results found for requested labs within last 720 hours.  D-dimer: No results found for requested labs within last 720 hours.. Ferritin ordered and pending    Prone patient as tolerated  Albuterol INH 2 puffs q 4 hours Dexamethasone - 6 mg PO day 1/10 Will discuss with oncoming team if patient candidate for monoclonal antibody therapy  DVT prophylaxis: SCDs, on therapeutic eliquis d/t history of PE and afib Daily CBC w/diff, CMP, CRP, D-Dimer