Age: 21.0
Sex: F
Vaccine: COVID19
Symptoms: Prenatal screening test, SARS-CoV-2 test positive, Sinus tachycardia, Ultrasound scan, Urine analysis normal
Clinical narrative: Date of Admission  01/01/2022   Date of Discharge  01/02/2022   Reason for Hospitalization   COVID  Hospital Course   The patient is a 22yo G2P0010 with EDD 03/27/22 who presented to LDU on 01/01/21 for oxygen desaturation in setting of known COVID. Recently admitted 12/27/21 - 12/31/21 and was discharged on home O2 for intermittent low O2 requirements. Represented 01/01/22 due to saturation into 80s while sleeping, however, immediately back up to high 90s% thereafter. Since admission, has been on room air with reassuring fetal heart tracing. On morning of 01/02/21 reported contractions and back pain which substantially improved with tylenol/flexeril/vistaril and IV fluids. Has follow-up scheduled 01/10/21 with doctor. Will continue supplemental O2 at home if sats <95%; triage precautions reviewed to present to LDU if needs are >2L. Discharged to home with scrips for flexeril and vistaril on HD#2 (01/02/22).        1. Prenatal care  -GCT:  negative  -Flu shot:  due  -TdAP:  due  -GBS: pending  -Aneuploidy screening: declines  -Genetic screening: CF and SMA declines  -EFW: 958g on 12/28 by ultrasound  -Consent obtained for delivery         2. Antenatal testing  -NST BID and weekly BPP while inpatient -Growth scans at 4 week intervals          3. Delivery planning  -Delivery at 39 weeks unless indicated earlier  -Prior CD  no  -Plans TOLAC  no  -Fetal presentation: breech on 12/28          4. Prematurity  -s/p dexamethasone  -Magnesium for neuroprotection if delivery imminent   -Tocolysis not indicated        5. Tachycardia, stable from previous admission  -Presumed 2/2 COVID  -Improved: HR in 90s to low 100s while awake, 70-90s while asleep  -EKG and trop on last admission WNL; repeat EKG demonstrated sinus tachycardia; pro-BNP and TSH WNL  -UA WNL  -CBC revealed anemia to Hgb 8.6 and CMP WNL  -CT PE negative  -Echo pending  6. COVID+  -At admission, reported up to 2L overnight with reported hypoxia to SpO2 84%. Here, has been on RA.  -Reports symptomatic improvement since last admission  -Flu A and B negative  -Continue dexamethasone 6mg IV qd, has prescription at home  -Continuous fetal monitoring while on O2; FHT reactive and reassuring at this time  7. Preterm contractions  -Began overnight.  -Starting IV fluid bolus, new IV as last infiltrated  -Tylenol, flexeril, vistaril  -Will plan to check cervix if continues to report discomfort after above interventions  Prophylaxis: SCDs, Lovenox  Feeding: unsure  Contraception: unsure  Discharge Diagnoses      Acute COVID-19   Other Diagnoses   Ongoing  Pregnant  Historical  Depression  Pregnant  Operations and Procedures   None  Consultants   None  Pending Labs  None  Discharge Disposition  Home  Medications  New, Changed, or Refilled Medications  cyclobenzaprine (cycloben 10 mg, 1 Tablet(s), Oral, tid, for 3 day(s), PRN: Back Pain, 10 Tablet(s), 1 Refill(s)    hydrOXYzine (Vistaril 50 50 mg, 1 capsule(s), Oral, qid, for 3 day(s), PRN: as needed for anxiety, 12 capsule(s), 1 Refill(s)   Medications to be Continued  dexAMETHAsone (dexAMETHAs 6 mg, 1 Tablet(s), Oral, At Bedtime, for 8 day(s), 8 Tablet(s), 0 Refill(s)    doxylamine (Unisom 25 mg) 25 mg, 1 Tablet(s), Oral, At Bedtime    enoxaparin (Lovenox 40 mg 40 mg, 0.4 mL, Subcutaneous, At Bedtime, for 14 day(s), 5.6 mL, 0 Refill(s)    esomeprazole (esomeprazol 20 mg, Oral, Daily, for 90 day(s), 90 Tablet(s), 3 Refill(s)    famotidine (Pepcid 20 mg) 20 mg, 1 Tablet(s), Oral, bid, 60 Tablet(s), 0 Refill(s)    ondansetron (ondansetron 8 mg, 2 Tablet(s), Oral, q8h, PRN: Nausea/Vomiting, 15 Tablet(s), 1 Refill(s)    promethazine (promethazin 25 mg, 1 Supp, Rectal, q6h, PRN: as needed for nausea/vomiting, 12 Supp, 0 Refill(s)    pyridoxine (Vitamin B6 25 25 mg, 1 Tablet(s), Oral, bid   Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.0 °C  TMIN: 36.0 °C  TMAX: 36.2 °C  HR: 91  RR: 18  BP: 137/85  SpO2: 100%  WT: 75.3 kg  BMI: 33.6      General: Slightly uncomfortable-appearing female. No acute distress. HEENT: NC/AT. EOMI. CV: Regular rate. No LE edema. Resp: Nonlabored breathing on RA. Symmetrical chest wall expansion. GI: Soft, no increased tone, mildly tender diffusely, gravid. Skin: Warm, well-perfused, dry. MSK: Normal ROM and strength. Moving all extremities spontaneously. Neuro: A&Ox3. CN II-XII grossly intact. No focal neuro deficits.  Psych: Appropriate affect and mood. Cooperative. Addendum by (Privacy) on January 02, 2022 13:50:01 (Verified)    Attestation by (Privacy) on January 02, 2022 13:51 I personally saw and evaluated the patient on the result date found in the header of this document.  I independently performed the critical/key portions of the Evaluation and Management service and discussed the management with the author of this document.  I agree with everything documented above with the following exceptions/additions:none