Age: 50.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Alanine aminotransferase normal, Anion gap, Anticoagulant therapy, Aspartate aminotransferase normal
Clinical narrative: Hospitalized (12.31.21 - 1.1.22); COVID-19 positive (12.31.21); Fully vaccinated - pfizer x2 D/c Summary: Discharge Summary PA-C (Physician Assistant-Certified) ? ? Hospitalist Cosign Needed        BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider at Discharge: ANP  Admission Date: 12/31/2021 Discharge Date: 1/1/2022   DISCHARGE MEDICATIONS:  ? lidocaine (XYLOCAINE) 2 % jelly    ? acetaminophen (TYLENOL) 500 MG tablet Take 500 mg by mouth Every 6 hours as needed for Pain. ? albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler Take 2 puffs by inhalation every 6 hours as needed for Wheezing. ? atorvastatin (LIPITOR) 10 MG tablet Take 1 tablet by mouth once daily ? B Complex Vitamins (B COMPLEX 1 PO) Take  by mouth Daily. ? Calcium Carbonate-Vit D-Min (CALCIUM 1200 PO) Take  by mouth 2 times daily. ? Cholecalciferol (VITAMIN D PO) Take 125 mcg by mouth daily. Vitamin D3 125mcg (5,000 IU) Softgel ? Cyanocobalamin (VITAMIN B 12 PO) Take  by mouth Daily. ? escitalopram (LEXAPRO) 10 MG tablet Take 10 mg by mouth daily. ? hydrOXYzine (VISTARIL) 50 MG capsule Take 50 mg by mouth 3 times daily as needed for Itching. ? insulin glargine (LANTUS SOLOSTAR) 100 UNIT/ML pen-injector Inject 50 Units under the skin nightly. (Patient taking differently: Inject 84 Units under the skin nightly.) ? lamoTRIgine (LAMICTAL) 200 MG tablet Take 200 mg by mouth daily. ? loratadine (CLARITIN) 10 MG tablet Take 10 mg by mouth daily. ? losartan (COZAAR) 25 MG tablet Take 1 tablet by mouth once daily ? melatonin 10 MG TABS tablet Take 10 mg by mouth nightly. ? metformin (GLUCOPHAGE) 1000 MG tablet Take 1 tablet by mouth twice daily ? Multiple Vitamins-Minerals (MULTI COMPLETE PO) Take 1 tablet by mouth Daily. ? omeprazole (PRILOSEC) 20 MG delayed release capsule Take 1 capsule by mouth once daily in the morning (Patient taking differently: Take 20 mg by mouth daily. Take 1 capsule by mouth once daily in the morning) ? prazosin (MINIPRESS) 2 MG capsule Take 2 mg by mouth Nightly. ? predniSONE (DELTASONE) 10 MG tablet Take 4 pills for 2 days followed by 3 pills for 2 days followed by 2 pills for 2 days and finished by 1 pill for 2 days ? pregabalin (LYRICA) 100 MG capsule Take 100 mg by mouth 2 times daily. 200mg in the morning, 100mg in afternoon, and 100mg at night  ? pregabalin (LYRICA) 200 MG capsule Take 200 mg by mouth every morning. Takes 200 mg in the morning, 100 mg in the afternoon, and 100 mg at night. ? quetiapine (SEROQUEL XR) 400 MG 24 hr tablet Take 400 mg by mouth nightly. ? rOPINIRole (REQUIP) 1 MG tablet Take 2 mg by mouth nightly. ? tadalafil (CIALIS) 20 MG tablet Take 1 tablet by mouth if needed for Erectile Dysfunction. use one hour prior ? TRULICITY 3 MG/0.5ML injection Inject 3 mg under the skin per week. (Wed or Thurs)     Active Issues Requiring Follow-up * Pneumonia due to COVID-19 virus Assessment & Plan Date of Symptom onset:12/30/21 Date of positive COVID-19 test:12/31/21 CXR:  Bilateral perihilar opacifications and focal opacification at the left base may indicate infection or edema.  A pleural effusion on the left is not excluded.  There is cardiomegaly and vascular congestion.   Patient appears stable from a respiratory standpoint Discharge patient home with prednisone taper   Chronic respiratory failure with hypoxia   Assessment & Plan Patient has baseline oxygen needs of 2 L of continuous oxygen at night bled into his CPAP   Type 2 diabetes mellitus without complication, with long-term current use of insulin   Assessment & Plan Resume home diabetic regimen   Chronic diastolic congestive heart failure   Assessment & Plan Ejection fraction of 58% on 09/11/2019 Chest x-ray does show cardiomegaly with vascular congestion Continue Cozaar Plan to give IV Lasix 40 mg once now   Bipolar depression   Assessment & Plan Continue Lexapro, Lamictal, Seroquel   Mixed anxiety and depressive disorder Assessment & Plan Continue Lexapro, Lamictal, and Seroquel DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute respiratory failure with hypoxia [J96.01] Pneumonia due to COVID-19 virus [U07.1, J12.82]   HOSPITAL COURSE: Patient is a 51-year-old gentleman with chronic respiratory failure secondary to sleep apnea requiring 2 L of oxygen at night presented with complaints of increasing shortness of breath and cough.  The patient has been vaccinated for COVID but was found to have a COVID infection on presentation.  The patient was admitted for ongoing monitoring as he was requiring 2 L of oxygen on presentation to maintain saturations.  Patient was started on Decadron and remdesivir.  The following day after admission the patient was reporting feeling significantly better.  He was requiring intermittent oxygen supplementation throughout the day but no more than 2 L of oxygen when he had required.  Patient request to be discharged home.  Based on patient's vaccination status and relative stability overnight, this was felt reasonable as the patient already had oxygen set up at home.  Will continue to treat the patient with a prednisone taper at discharge.  Patient has been instructed to return to the hospital should his hypoxia continued to worsen.  Questions have been answered to the patient's satisfaction he is being discharged home in stable condition.   Patient recovered fasted than anticipated leading to a faster than anticipated discharge.     BP 103/60  | Pulse 90  | Temp 36.8 °C (Oral)  | Resp 18  | Ht 1.727 m  | Wt (!) 148.5 kg  | SpO2 91%  | BMI 49.79 kg/m²    Physical Exam Vitals and nursing note reviewed.  Constitutional:      Appearance: He is well-developed. He is obese.  HENT:     Head: Normocephalic and atraumatic.  Eyes:     Extraocular Movements: Extraocular movements intact.     Conjunctiva/sclera: Conjunctivae normal.     Pupils: Pupils are equal, round, and reactive to light.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Pulses: Normal pulses.     Heart sounds: Normal heart sounds.  Pulmonary:     Effort: Pulmonary effort is normal.     Breath sounds: Normal breath sounds.  Musculoskeletal:     Cervical back: Normal range of motion and neck supple.  Skin:    General: Skin is warm and dry.  Neurological:     Mental Status: He is alert and oriented to person, place, and time. Mental status is at baseline.  Psychiatric:        Mood and Affect: Mood normal.        Behavior: Behavior normal.        Thought Content: Thought content normal.        Judgment: Judgment normal.   H&P: CHIEF COMPLAINT: Pneumonia due to COVID-19 virus     Assessment/Plan    ASSESSMENT / PLAN: * Pneumonia due to COVID-19 virus Assessment & Plan Date of Symptom onset:12/30/21 Date of positive COVID-19 test:12/31/21 CXR:  Bilateral perihilar opacifications and focal opacification at the left base may indicate infection or edema.  A pleural effusion on the left is not excluded.  There is cardiomegaly and vascular congestion.   Patient is vaccinated for COVID-19 Current oxygen requirement: SpO2: 98 % O2 Flow Rate (l/min): 1.5 l/min   CRP: No results found for requested labs within last 720 hours.  D-dimer: No results found for requested labs within last 720 hours.   Prone patient Albuterol INH 2 puffs q 6 hours Dexamethasone - 6 mg po/IV day 1/10 Remdesivir - 200 mg IV day 1, followed by 100 mg day 2-5 DVT prophylaxis: Lovenox SCDs Daily CBC w/diff, CMP, CRP, D-Dimer   Chronic diastolic congestive heart failure   Assessment & Plan Ejection fraction of 58% on 09/11/2019 Chest x-ray does show cardiomegaly with vascular congestion Continue Cozaar Plan to give IV Lasix 40 mg once now   Bipolar depression   Assessment & Plan Continue Lexapro, Lamictal, Seroquel   Mixed anxiety and depressive disorder Assessment & Plan Continue Lexapro, Lamictal, and Seroquel   Type 2 diabetes mellitus without complication, with long-term current use of insulin   Assessment & Plan Continue Lantus 84 units nightly Hold home metformin and Trulicity Add lispro corrective scale         Subjective    HISTORY OF PRESENT ILLNESS: Patient is a 51 y.o. male who presents today with shortness of breath and cough.  Patient has a pertinent medical history for CHF, type 2 diabetes, anxiety, depression, bipolar, chronic obstructive pulmonary disease, and OSA with CPAP use with 2 L of oxygen overnight.  The patient reports that he developed a headache and cough on 12/30 and then this morning on 12/31 he developed worsening shortness of breath and cough which brought him to the ER.  The patient or nurses headache, cough, diarrhea, and shortness of breath.  The patient denies dizziness, lightheadedness, sore throat, chest pain, vomiting, leg pains.  The patient has been vaccinated for COVID-19 in March and April of this year.   In the ER the patient was found to be hypoxic at 80% on room air and was placed on 2 L of oxygen nasal cannula.  His white blood cell count was low at 2.75.  Chest x-ray shows vascular congestion and bilateral perihilar opacifications.  I updated patient on the plan of care that includes giving dexamethasone, remdesivir, and monitoring oxygen requirements.  I also give 1 dose of IV Lasix at this time.  The patient agrees with this plan of care all questions and concerns were addressed to patient's satisfaction OBJECTIVE: BP 130/67  | Pulse 86  | Temp 37.9 °C (Oral)  | Resp 18  | Ht 1.727 m  | Wt (!) 148.5 kg  | SpO2 94%  | BMI 49.79 kg/m²    Physical Exam Vitals and nursing note reviewed.  Constitutional:      General: He is not in acute distress.    Appearance: Normal appearance. He is obese. He is not ill-appearing or toxic-appearing.  HENT:     Head: Normocephalic and atraumatic.  Eyes:     Pupils: Pupils are equal, round, and reactive to light.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Pulses: Normal pulses.     Heart sounds: Normal heart sounds.  Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: Rales present. No wheezing.  Abdominal:     General: Abdomen is flat. Bowel sounds are normal.     Palpations: Abdomen is soft.  Musculoskeletal:        General: Normal range of motion.     Cervical back: Normal range of motion.     Right lower leg: Edema present.     Left lower leg: Edema present.  Skin:    General: Skin is warm and dry.     Capillary Refill: Capillary refill takes less than 2 seconds.  Neurological:     General: No focal deficit present.     Mental Status: He is alert and oriented to person, place, and time. Mental status is at baseline.  Psychiatric:        Mood and Affect: Mood normal.        Behavior: Behavior normal.        Thought Content: Thought cont