Age: 81.0
Sex: M
Vaccine: COVID19
Symptoms: Brain natriuretic peptide normal, C-reactive protein increased, COVID-19, Chest X-ray abnormal, Chlamydia test negative
Clinical narrative: ED to Hosp-Admission Discharged  9/13/2021 - 9/16/2021 (3 days)  Hospital  CRNP Last attending ? Treatment team Shortness of breath  Medical Problems     Hospital Problems        POA   Essential hypertension Yes       Hypothyroidism Yes       Mixed hyperlipidemia Yes       Peripheral vascular disease  Yes       Stage 3b chronic kidney disease Yes       Pulmonary emphysema, unspecified emphysema type  Yes       COPD (chronic obstructive pulmonary disease) with acute bronchitis  Yes            Medical Problems     Problem List        Resolved POA           Resolved Problems   * (Principal) Shortness of breath 9/16/2021 Yes     HPI: Patient is an 82 y.o. male patient of Dr. with past medical history of COPD secondary to emphysema, HLD, HTN, CKD-II, PVD (L iliac and b/l SFA), and hypothyroidism. He presents today with complaints of shortness of breath. It has been increasingly worse. He was admitted recently with COPD exacerbation. Vaccinated for COVID-19. He had been feeling quite well, but woke up today with myalgias and difficulties breathing. Mild cough, no pleuritic chest pain at this time, no vomiting, no diarrhea at this time. No sick contacts noted per him. Low grade temp of 100.5. Creatinine only slightly elevated, troponin normal, XR normal, BNP normal, labs otherwise unremarkable. EKG appropriate.    Hospital Course:  Patient was admitted to general MedSurg observation.  For a brief period of time he did need supplemental oxygen at 2 L via nasal cannula.  By the afternoon of 9/14/2021, he no longer needed supplemental oxygen.  At time of discharge, his O2 sat was 96% on room air.   Additionally, labs were followed.  At time of discharge, blood cultures continue to be negative.  On admission, procalcitonin was 0.09; it did continue to decrease and on 9/16/2021 it was 0.07.  CBC was monitored; WBC continued to be within normal range; hemoglobin on day of discharge was 12.9 (was 13.1 on admission).  Chemistries were also monitored.  On admission, sodium was 132; on discharge sodium had improved to 134.  Potassium continued to be at goal throughout his stay.  Creatinine, BUN and EGFR were also improved at time of discharge and at goal.  Glucose was minimally elevated at 112 on day of discharge.  Of note, CRP on day of admission was 11.8 and on 9/15/2021 it was 8.4.   Again, patient continued to improve over the course of his stay.  When he was admitted he was prescribed Decadron 6 mg daily.  That was continued at time of discharge for a complete 10-day course (he had 3 daily Decadron while in the hospital and prescription was for #7).  He was also prescribed a 30-day course of Eliquis as a prophylaxis for any type of coagulation.  He is to continue the Plavix as prescribed.  No other medications were changed.   Patient is alert, oriented, stable, and answering all questions appropriately. He is able to make his own decisions.  He is able to perform his own ADLs.   At this time, he is in agreement with the plan and feels comfortable to be discharged home.  He is aware that if symptoms return, he is to return to the ER.   He was advised and self quarantining as well as wearing mask when he is within 6 feet of other people including in the car on the way home.    ED to Hosp-Admission  Discharged 9/18/2021 - 9/22/2021 (4 days)  Hospital   MD   Last attending ? Treatment team Right lower lobe pneumonia Hospital Problems          POA   * (Principal) Right lower lobe pneumonia Yes       Essential hypertension Yes       Bereavement Not Applicable       Pulmonary emphysema, unspecified emphysema type  Yes       COPD (chronic obstructive pulmonary disease) with acute bronchitis  Yes       Steroid-induced psychosis with complication  Unknown       Episode of recurrent major depressive disorder  Yes          1 right lower lobe pneumonia: Patient is completing his course of antibiotics at this time.  His procalcitonin level has decreased to 0.08.  He has had a good response to treatment.  He is positive for COVID-19, but is not currently being treated with steroids or remdesivir.  He is not requiring any oxygen.  Felt safe to go home with his son.  Patient needs observation with his son due to his mental health issues.   #2 depression/anxiety/bereavement: Patient has had a history of steroid-induced psychosis.  We should use steroids in the future with caution.  I have also discussed directly with Dr. the plan.  We discussed with his son the plan.  Patient will go home with the son.  They do have home health already set up through Home Care it   #3 hypertension blood pressure under fair control during hospitalization.  Continue to monitor on current medication   #4 COPD: toilet.  Stable.  Does have some wheezing on examination today.  Should have follow-up outpatient    Hospital Course     HPI: Patient is an 82-year-old male with past medical history of COPD/coronary artery disease/hypertension/dyslipidemia who comes to the emergency room related to difficulty breathing.  He was just admitted to the hospital recently for Covid pneumonia and was discharged on Decadron.  He presented to the emergency room for trouble breathing.  Was found to be hypoxemic in the emergency room with an oxygen saturation of 87% on room air.  At the time of his evaluation he was on 2 L of oxygen and seem to be saturating well.  Complained of a dry nonproductive cough.  There was some concern about steroid-induced psychosis.  Patient has had a lot of depression and anxiety issues, which were exacerbated by recent loss of his wife and steroid medication   Hospital Course:   #1 pneumonia: Patient had an x-ray which showed right lower lobe pneumonia.  Patient was started on IV antibiotics.  Was given IV Levaquin initially and switched to oral Levaquin.  Was also given IV Decadron but this was discontinued because of the concern about steroid-induced psychosis.  Patient's initial D-dimer was elevated at 0.97. Initial white count was normal at 9.7.  CRP was initially elevated at 220.8.  Procalcitonin was elevated at 0.53.  Patient was monitored during his hospitalization.  His procalcitonin level decreased gradually 2.33 on 9/19/2021 and subsequently to 0.08 on the day of discharge.  CRP also improved from 220.8 down to 30.5.   Patient was switched to oral Levaquin.  Was monitored closely.  Was not requiring oxygen.  Was felt safe for discharge to home with outpatient pulmonary toilet as written previous.  Remains on Spiriva and Symbicort.  Does have nebulizer treatments at home.   #2 depression/psychosis/bereavement: Patient did have a lot of problems with stress and anxiety.  Dr. evaluated patient during the hospitalization.  Patient was on Risperdal as an outpatient.  Low-dose Celexa was provided to the patient.  Was felt that the patient really needed to be at home with observation.  Will be going home to live with his son and further outpatient follow-up with Dr.  Did not require Ativan during his hospitalization