Age: 100.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Angiogram normal, Asthenia, COVID-19, Chest X-ray normal
Clinical narrative: Patient is 101 years old with past medical history of COPD, CAD, hypertension, osteoporosis, GERD presented to the hospital with complaint of shortness of breath associated with fever and reduced oral intake.  Patient was also experiencing generalized weakness unable to do her daily living.  She typically lives independently.  Patient tested positive for COVID at home.  Confirmed COVID-positive testing in the ER.  When seen, patient resting in bed comfortably.  Her only complaint currently is generalized weakness.  Admits to intermittent cough.  Otherwise patient has no chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, difficulty with urination, dysuria.   In the ED, patient had CT thoracic and lumbar spine no acute traumatic changes.  CT angio no acute traumatic changes.  Chest x-ray no acute cardiopulmonary abnormality.  There is currently a pending urinalysis.  Patient noted to have elevated troponin but a negative delta.  EKG no ACS   Clinical Summary This is essentially extremely pleasant on 101-year-old who was admitted for an episode of acute hypoxic respiratory insufficiency ultimately was determined to be secondary to combination of COVID 19 pulmonary infection.  She may also had superimposed bacterial pneumonia and decision was to go ahead and treat given her risk for decompensation. The patient was extremely pleasant and responded well but I would have expected.  There were concerns for deconditioning but the patient responded quite well with antibiotics and she was able to ambulate with assistance and walk up the stairs weightbearing and would have expected.  I met with the patient and caregiver outside she is extremely pleasant talkative and quite sharp.  In no distress whatsoever tolerating p.o. route and wants to leave the floor at this time Given that she is hemodynamically stable in no distress we will proceed and release her home with indication follow-up with PCP in a week I did noted variations in blood pressure.  Hydralazine was started but I did speak to patient and caregiver at length as I anticipate she will not require this medication for long blood pressure on daily basis and bring log to PCP to further adjust medication.  COVID+ Acute hypoxic respiratory insufficiency requiring supplemental oxygen on admission but now on room air in no distress 2/13: . Started on decadron/remdesivir, empiric abx for possible superimposed bacterial pna.  Given rapid improvement of the patient's symptoms she will be released at this time We will complete a total of 10 days worth of steroids with Decadron She will be prescribed with a short course of antibiotics she has high risk of superimposed bacterial anemia and responded appropriately to initial regimen.   Hypovolemia - Due to reduced oral intake - eating/drinking well today, DC IVF   Generalized weakness and debility - typically mobile, lives independently with family near by - unfortunately multiple family members are sick, concern pt will have minimal help if she goes home Functional ability improved prior to release.  She did well working at this  Elevated troponin - Plateaued, no chest pain symptoms, EKG no ACS - Doubt ACS, likely demand ischemia due to COVID infection - Recent evaluation by cardiology and patient was deemed not a candidate for interventions - limited echo obtained: no new WMA - no further ischemic w/u is recommended per cards   COPD exacerbation, mild - on decadron as above  - continue albuterol HFA - IS/acapella/chest physiotherapy - on exam today, minimal wheezing  Hypertension - lisinopril  - continue norvasc  - has been started on hydralazine PO TID in the interim,  -Her blood pressure was in the 170s when she was started with Zosyn.  I spoke with this patient at length and the caregiver about only using this medication essentially on a as needed basis and to hold this medication if systolic is less than 120.  I do expect her able to get off this medication as she gets out of the steroids and her respiratory status improves.  I have advised her that in this stage in life the last thing I would want to do is add extra medications that she does not really need.    Hyperlipidemia - continue statin