Age: 35.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Cough, Dyspnoea, Exposure during pregnancy, Obesity, Positive airway pressure therapy
Clinical narrative: Hospitalized (11.30.21);  COVID-19 positive (11.30.21);  fully vaccinated  patient is pregnant  ESTIMATED DUE DATE: Estimated Date of Delivery: 4/7/22 GESTATIONAL AGE AT DELIVERY: 22w4d  G6P2032 Admission Date: 11/30/2021 Discharge Date: 12/6/2021  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM:  Severe persistent asthma with exacerbation [J45.51] 22 weeks gestation of pregnancy [Z3A.22] COVID-19 virus infection [U07.1] Acute asthma exacerbation [J45.901] COVID-19 affecting pregnancy, antepartum [O98.519, U07.1] Chief Complaint: Shortness of breath, cough   ASSESSMENT / PLAN: Patient is a 36 y.o. female G6P2032 at 21w5d who presents with shortness of breath thought to be secondary to asthma exacerbation and COVID 19 infection in pregnancy. Severe persistent asthma with acute exacerbation - Presenting with 3 days of shortness of breath and cough; noted to have conversational dyspnea on presentation to the ED  - CXR unremarkable - Saturating 99-100% on room air  - As below, new diagnosis of COVID on admission  - Asthma controlled with symbicort, spivira, singulair, and prn albuterol at home; increased albuterol use at home, 3-4 times additional use per day  - Given DuoNeb, albuterol neb, IV solumedrol, and IV magnesium sulfate in the ED with some improvement in her symptoms  - Follows with pulmonology as outpatient - Last admitted in July of this year with asthma exacerbation and parainfleunza virus; required IV steroids and PO prednisone taper  Plan: - Admit to 4C for further monitoring of respiratory status - Continuous pulse ox  - Continue DuoNebs every four hours, sooner if needed; continue home inhalers - Pulmonology consulted, appreciate assistance  COVID-19 in pregnancy  - Endorses symptoms since 11/28 (day 3 of symptoms), +COVID-19 PCR 11/30  - symptoms of: Shortness of breath and Cough - Vitals: SpO2: 98 % BP 122/67  | Pulse 112  | Temp 36.8 °C (Oral)  | Resp 24  | Wt 122.4 kg  | SpO2 98%  | BMI 49.35 kg/m²  Attending Note: Patient seen and examined with Dr. and I agree with her A/P as above. Patient is a 36 y/o G6P2032 at 21 5/7 wks gest admitted due to worsening SOB with cough in the setting of severe asthma and found to have +Covid, likely exacerbating. S/p Neb treatments in ED prior to diagnosis of Covid with significant improvement in symptoms. Plan to admit for observation and treatment of asthma and Covid as above. Pulmonology and MFM consulted to assist with mgmt. Her pregnancy is also complicated by obesity (BMI 49), Anxiety/depression, cHtn, OSA and HX of 2 prior CS. She has not yet had her anatomy US and was noted to have an abnormal result on her NIPT. Await MFM input and recs for further evaluation while in-patient vs previously scheduled out-patient follow-up with them and Genetics. Reviewed plan of care with patient and all questions answered. CXR normal and no current O2 requirements. note 12/6/21: She is doing well this AM, resting comfortably.  Has her CPAP on and is tolerating this mask well.  She has occasional tightness but it is improved with her inhalers.  Residual cough is mild.  She denies fevers or chills.   She is feeling her baby move and denies any painful contractions, bleeding, or leakage of fluid.