Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: Respiratory failure, Serum ferritin increased, Sputum retention, Staphylococcus test negative, Transferrin saturation decreased
Clinical narrative: Patient is a 84 years old female patient of, DO with history of chronic hypoxic respiratory failure, COPD, CAD, HTN, HLD, and depression presented to Hospital with shortness of breath, cough.  Admitted and being managed for acute on chronic hypoxic respiratory failure, pneumonia COVID COPD exacerbation. Not much significant success with weaning off supplemental oxygen complicated by patient's inability to expel sputum.   Acute on chronic hypoxic respiratory failure, COVID-19 infection COPD/Asthma with mild acute exacerbation Pulmonary HTN, presumed Group 3 Bacterial pneumonia Presented with 1 week history of non-productive cough and worsening SOB. Patient fully vaccinated and 1 booster  Afebrile, HR 77, RR 15, BP 125/71, satting >94% on 2L NC (2L qHS at home) Initial CBC w slight leukocytosis to 11.76. Hgb 10.5. ProBNP 3.2K CXR: No vascular congestion or consolidation PFT 2016: FEV/FVC 0.54, FEV1 39% (22% reversible), TLC 201% Echo 3/2023 with EF 72%, TRVmax 3.59 m/s (RVSP 62) VBG showed pH of 7.25 with PCO2 66.2 Chest x-ray done showed left infrahilar streaky opacity likely represent focal pneumonia and/or aspiration.  CT of the chest without contrast showed development of a peripheral airspace consolidation left lower lobe and to a lesser extent peripheral IVs in the dependent right lower lobe which may indicate aspiration and/or pneumonia.  There is also numerous scattered bilateral multilobar tree-in-bud nodular opacity indicating underlying small airway inflammatory changes. Switch IV Solu-Medrol to Decadron IV if in case COVID infection contributed to lung finding. Patient started on Zosyn on 9/22, started on vancomycin but stopped as MRSA screen is negative  Cont supplemental O2 to maintain goal SpO2 > 88-90% Continue Mucinex, ipratropium DuoNeb . Fluctuating oxygen requirement, wean down to 2 L baseline Scheduled Mucinex added. Acapella, bedside incentive spirometry Acute normocytic Anemia Presumed ABLA from UGIB  Melena Pt reports 3 month of black, tarry stool with worsening fatigue and SOB  Denies chronic NSAID use. Pt takes eliquis and plavix  Initial Hgb 10.5 (from 12.3 in 7/2023), plts 295. BUN 16. +FOBT Last colonoscopy 11/2020: benign, per patient Type and screen, coags, LFTs Monitor with serial labs, transfuse for Hgb < 7 Additional IVFs as needed Protonix 40mg IV bid Surgery consulted for scope  Iron study showed iron of 13, ferritin is 260, iron saturation is 5%, TIBC is 201, folate 9.8 Hemoglobin remained stable, it is 10.5, was 10.5 on 9/19 Continue home iron tablet.   NSTEMI, likely type 2 due to demand  HTN, HLD Non-obstructive CAD  HFpEF, compensated   Paroxysmal afib with RVR  HDS on admission, complaining of SOB but denies chest pain or palpitations  Initial trop 38 Keep on cardiac monitor 2D echo on 3/25/2023 showed EF of 72% Continue home statin, propafenone, metoprolol and Eliquis   GERD Continue protonix    Anxiety Stable will continue home xanax   Severe malnutrition POA Hypoalbuminemia Cachexia, underweight; BMI 17.56 Encourage nutritional intake. Deconditioning weakness Benefit from extensive rehabilitation PT OT evaluation in progress.   Hypophosphatemia Supplemented with Neutra-Phos   Hypocalcemia In the setting of hypoalbuminemia Corrected serum calcium