Age: 83.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute kidney injury, Acute respiratory failure, Anticoagulant therapy, Aortic stenosis, Atrial fibrillation
Clinical narrative: Patient is a 83 y.o. male admitted to the hospital on 11/4/2022 for shortness of breath, chest pain, and cough, found to have left lower airspace changes on chest x-ray consistent with community acquired pneumonia.  He was also found to test positive for COVID-19.  Infectious disease was involved, he completed a course of remdesivir.  He was treated with IV antibiotics per infectious disease (blood cultures showed group A strep).  He was recommended to complete a course of oral amoxicillin on discharge, with stop date 11/16/2022. He remained hypoxic on RA and was discharged home on supplemental 02. He will follow up closely with his PCP.  Acute hypoxic respiratory failure, resolved - likely CAP and covid as the causes - previously on O2 but reports discontinued 2-3 months ago - CXR interstitial markings increased with LLL airspace changes - antibiotics and covid treatment as below. Dry lung strategy - sp02 in the 88-90% range on room air - sp02 currently on 2L at 90% - will ask to have assist with home going oxygen   COVID-19 Pneumonia - Presented with: dyspnea, CP, fatigue, chills - Symptom onset: 11/3/22 - Positive COVID-19: 11/4/22  - Decadron: started on admission, then discontinued, as suspect most of symptoms are related to bacterial pneumonia given onset/ type of symptoms, bacteremia - Remdesivir: completed - DVT prophylaxis:Currently on full anticoagulation   Sepsis, lactic acidosis resolved GAS bacteremia CAP - blood cultures, sputum culture if able, strep/legionella ur ag negative  - ceftriaxone-> PCN per ID, appreciate assistance - repeat BCx 11/6 - no growth so far - repeat CXR with PA and lateral views on 11/7 - still with left sided pleural effusion and pulmonary edema - continue treatment as above along with home 02 and diuretics   Non oliguric AKI, resolved - pre-renal/ATN due to diuretics, impaired autoregulation on MRA, sepsis - Cr baseline 1.0-1.1, 1.5 on admit - given IVF - resumed diuretics 11/7, follow kidney function   Bacteruria -PSA in urine. Unclear why UA/UCx obtained. No new urinary symptoms, has chronic urinary frequency which is unchanged   Chronic HFpEF (EF 57% 10/5/22)  Pulmonary HTN (WHO II) with moderately reduced RV function Moderate - severe aortic stenosis  - follows with dr for HFpEF and structural heart for AS (monitoring q6 months with TTEs) - NYHA IIIb / AHA C - home torsemide 20 daily and aldactone 25 daily resumed 11/6 - echo EF 50 to 55%, degenerative aortic and mitral valvular changes with severe increase in aortic valve gradients and moderate mitral regurgitation.  No evidence of endocarditis but difficult to assess due to severe degenerative abnormalities  Paroxysmal atrial fibrillation  - home xarelto 20 daily - EKG currently in accelerated junctional rhythm  - monitor on telemetry, continue AC   Non-obstructive CAD - no reported exertional chest pain - continue lipitor 40 and xarelto, not on BB   History of PE - diagnosed 3/2022 - remains on xarelto (AFib), no leg pain or swelling on exam, denies missed doses    CLL - follows with oncology, off acalbrutinib since early 2022 - continue OP follow up   Thrombocytopenia  - likely from sepsis, resolved - monitor    NIDDM2 - home metformin 500 BID - holding metformin here, continue cSSI, follow blood sugar trend   BPH - s/p turp   Renal mass - see previous d/c summary for plan 5/2022, patient is unsure of events since this discharge - likely continue OP follow up (MR kidney ordered but no results)   Depression - continue cymbalta 90 mg daily