Age: 60.0
Sex: M
Vaccine: COVID19-2, FLUA4, PNC15
Symptoms: Chronic obstructive pulmonary disease, Computerised tomogram thorax abnormal, Condition aggravated, Cough, Dysphagia
Clinical narrative: Discharge Provider:  MD Primary Care Provider at Discharge: FNP Admission Date: 1/16/2023 Discharge Date: 1/27/2023  COVID positive date: 01/16/2023 PRESENTING PROBLEM: COPD with acute exacerbation (HCC) [J44.1] COVID-19 [U07.1] Hyponatremia [E87.1]   HOSPITAL COURSE: 61-year-old male with history of chronic obstructive pulmonary disease, tobacco dependence, and alcohol dependence presented to the emergency department with shortness of breath.  Patient had received his COVID vaccinations including booster.  He was having generalized weakness and shortness of breath with associated cough for couple of weeks prior to presentation.  At the time of presentation patient was found to be tachycardic with a low sodium.  His white count was 3.8.  Patient was COVID positive on presentation.  Because of the length of his symptoms patient was considered to be outside the window for treatment with remdesivir.  Although oxygenation was stable he because of his tachycardia and severe weakness patient was admitted the hospital.  Patient was also noted to have significant protein calorie malnutrition with a decreased weight.  Patient was evaluated by Physical therapy and Occupational therapy who both recommended subacute rehab.  Because of patient being COVID positive he was unable to be transferred at that time.  Initially patient's condition remained relatively stable but on the evening of January 20th his clinical condition worsened.  Patient was more short of breath.  CT of chest was done which did show evidence of bilateral lower lobe pneumonia.  Patient was continued on steroids and IV antibiotics.  A discussion about goals of care was initiated on the evening of the 20th.  Patient had not had any significant oral to intake for 4-5 days.  He he expressed that he would not want any external feeding or TPN.  No feeding tubes were to be placed.  His work of breathing continue to remain elevated.  Overall is felt the patient had a poor prognosis at that time.  Patient did also confirm that he would not want to be placed on a ventilator.  On the day of the 21st patient was much more lethargic with a continued decline in his status.  On the day of the 21st, patient and family elected for comfort care.  After it is doing comfort measures patient started to slowly improve.  Patient was evaluated by hospice.  After discussions with hospice it was determined that family and patient wishes to go to subacute rehab.  Patient did not wish to sign on to hospice at that time.  Patient was transitioned out a comfort care.  Because of COVID he was not able be place in subacute rehab.  While awaiting placement patient's mental status continue to improve.  Patient was able to tolerate diet.  And he has remained on room air.  On the day of discharge, patient is feeling much better.  On room air.  Tolerating diet.  He is urinating on his own.  It has better control of his bowels.  He is anxious to get to rehab.   Discussed his current medications.  There are multiple changes made in his medications when came in.  Patient will be discharged on the medications he is on here.  Patient's avoid alcohol and smoking.  She participate with rehab.  He is currently on a dysphagia diet but as strength improves patient may be able to be placed on a normal diet.