Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Metabolic function test abnormal, Monocyte count decreased, Monocyte percentage increased, Neutrophil count, Neutrophil count normal
Clinical narrative: Hospitalized (12.31.21 - 1.2.2022); COVID-19 positive (12.29.21); Fully vaccinated - pfizer x2 d/c summary: Discharge Summary  Admission Date: 12/31/2021 Discharge Date: Jan 2, 2022    Active Hospital Problems   Diagnosis Date Noted POA ? COVID-19 12/31/2021 Yes ? COPD exacerbation (HCC) 08/05/2021 Unknown ? COPD with acute exacerbation (HCC) 07/08/2020 Yes   Resolved Hospital Problems No resolved problems to display.    Pre-Existing Active Problems   Diagnosis Date Noted POA ? Community acquired pneumonia 10/23/2021 Unknown ? Acute on chronic respiratory failure (HCC) 10/23/2021 Unknown ? Leukocytosis 01/27/2021 Unknown ? Diverticulitis 01/21/2021 Unknown ? Migraine 01/21/2021 Unknown ? Asthma 01/21/2021 Unknown ? Type 2 diabetes mellitus with diabetic polyneuropathy (HCC)   Unknown ? TIA (transient ischemic attack)   Unknown ? Osteoarthritis   Unknown ? OSA on CPAP   Unknown ? Interstitial lung disease (HCC)   Unknown ? Interstitial cystitis   Unknown ? Hypertension   Unknown ? Hyperlipidemia   Unknown ? History of crack cocaine use   Unknown ? History of alcohol abuse   Unknown ? GERD (gastroesophageal reflux disease)   Unknown ? Essential tremor   Unknown ? Diverticulosis   Unknown ? Chronic diastolic congestive heart failure    Unknown ? Chest pain at rest   Unknown ? Anxiety and depression   Unknown ? Lung granuloma  12/17/2020 Unknown ? Parotid nodule 12/16/2020 Unknown ? Obesity 12/16/2020 Unknown ? Chronic hypoxemic respiratory failure  07/09/2020 Unknown ? Physical deconditioning 07/09/2020 Unknown ? Tobacco use 05/28/2020 Unknown ? Acute on chronic respiratory failure with hypoxia and hypercapnea 01/31/2019 Unknown ? OSA (obstructive sleep apnea) 05/17/2013 Unknown ? COPD (chronic obstructive pulmonary disease)    Unknown     Discharge Disposition:  home or self care    Active Issues Requiring Follow-up:  PCP follow up in 1 week    DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COPD exacerbation  [J44.1] COPD with acute exacerbation  [J44.1]   HOSPITAL COURSE Patient is a 69F who presented to the hospital for SOB.  She has a known history of chronic obstructive pulmonary disease and chronic hypoxic respiratory failure requiring 3lpm NC of O2 at baseline.  She was recently in the hospital October due to rhino and enterovirus and COPD exacerbation.  She reports that her symptoms started 9 days prior to admission.  She reports having cough which is nonproductive and worsening shortness of breath fatigue lack of sense of taste and smell.  She denies diarrhea.  She admits to overall body aches and fever.  She came to the emergency department and eventually tested positive for COVID-19.  She was also noted to have diffuse wheezing, tachypneic but not hypoxic.   She was admitted for acute chronic obstructive pulmonary disease exacerbation in the setting of COVID-19.  She has remained stable on her 3 L of O2 by nasal cannula.  She was treated on prednisone, Dulera, DuoNeb.  Procalcitonin at 0.02.  Chest x-ray with subtle area of increased  density in the right upper lobe could represent inflammatory infiltrate.  She does not qualify for remdesivir. She continues to improve and was discharged in stable condition to home  on a tapering dose of prednisone.    CONSULTS / RECOMMENDATION:  Consult Orders (From admission, onward)   None     INPATIENT PROCEDURES:    Surgery and Procedures    None   Non-surgical Procedures (From admission, onward)   None     BP 110/58  | Pulse 61  | Temp 36.4 °C (Oral)  | Resp 18  | Ht 1.651 m  | Wt 82.5 kg  | SpO2 100%  | BMI 30.27 kg/m²    Physical Exam Vitals and nursing note reviewed.  Constitutional:      General: She is not in acute distress.    Appearance: Normal appearance. She is well-developed. She is not ill-appearing.  HENT:     Head: Normocephalic and atraumatic.     Nose: Nose normal. No congestion.     Mouth/Throat:     Mouth: Mucous membranes are moist.     Pharynx: No oropharyngeal exudate.  Eyes:     General: No scleral icterus.    Pupils: Pupils are equal, round, and reactive to light.  Neck:     Thyroid: No thyromegaly.     Vascular: No JVD.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Pulses: Normal pulses.     Heart sounds: Normal heart sounds. No murmur heard.    Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: Wheezing present.  Abdominal:     General: Bowel sounds are normal. There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness.  Musculoskeletal:        General: No swelling or tenderness. Normal range of motion.     Cervical back: Normal range of motion and neck supple.  Lymphadenopathy:     Cervical: No cervical adenopathy.  Skin:    General: Skin is warm and dry.     Findings: No rash.  Neurological:     Mental Status: She is alert and oriented to person, place, and time.     Cranial Nerves: No cranial nerve deficit.  Psychiatric:        Mood and Affect: Mood normal.        Behavior: Behavior normal.  HOSPITALIST                                              CHIEF COMPLAINT   Shortness of breath   Assessment and Plan   Acute COPD exacerbation On 3 L at baseline, has increasing tachypnea Continue breathing treatments                For the, unable to, due to COVID, continue inhalers Continue steroids Continue serial exams, still wheezy   COVID-19 positive Increased interstitial density right upper lobe Possible community-acquired pneumonia but less likely No obvious left shift, no leukocytosis, procalcitonin checked and negative Previous admission showed CT thorax which revealed a possible granuloma in that similar area Hold on antibiotics for possible cap Does not have increasing hypoxia Hold Decadron, considering remdesivir or monoclonal antibiotic   Hypertension stable Continue oral antihypertensives Will titrate subsequent days depending on bp trend   Depression and Anxiety stable, continue anxiolytics and antidepressant   Hyperlipidemia stable, continue statin   Functional status, nutrition, DVT prophylaxis, code status As tolerated General diet Ambulate Full code   Disposition Pending improvement in respiratory status     History of Present Illness   Patient is a 69 y.o. female    Comes in primarily due to shortness of breath   Was recently the hospital October due to rhino and enterovirus and COPD exacerbation   Seen in the emergency department 12/29 At that time came in for a cough, concerned that she might have COVID-19 At that time she had only had symptoms for 4 days She did test positive and was discharged stable condition   Over the last 2 days (6-7 days out from initial onset) has had increasing cough, shortness of breath, fatigue Admits to loss of taste and smell.  Denies any diarrhea. Admits to body aches, fever Claims to be compliant with her inhalers Unfortunately due to her worsening shortness of breath and overall well-being presented to the ED   Found to be tachypneic but not hypoxic Could not get breathing treatments in the emergency department per provider due to Covid Received a dose of an inhaler. Due to increasing tachypnea, was advised admission Review of Systems   Constitutional: +fever, No chills, No sweats, No weakness.  Eye:  No recent visual problem.   Ear/Nose/Mouth/Throat:  No decreased hearing.   Respiratory:  +shortness of breath, No cough. Cardiovascular:  No chest pain, No palpitations, No peripheral edema.   Gastrointestinal:  No nausea, No vomiting, No diarrhea, No constipation, No abdominal pain.  Genitourinary:  No dysuria, No hematuria, No urethral discharge.   Hematology/Lymphatics:  No bruising tendency.   Endocrine:  No polyuria, Immunologic:  Not immunocompromised.   Musculoskeletal:  No back pain, Integumentary:  No rash.   Psychiatric:  Not delusional, No hallucinations.         Objective   BP (!) 110/37  | Pulse 55  | Temp 37.2 °C (Oral)  | Resp 18  | SpO2 98%      General:  Alert and oriented.   +on 3 L Eye:  Normal conjunctiva.   Neck:  Supple, no cervical adenopathy Respiratory:  +wheezes bilateral lung fields. Respirations are non-labored.   Cardiovascular:  Normal rate, Regular rhythm.   Gastrointestinal:  Soft, Non-distended, normoactive  Musculoskeletal:  No swelling.  Integumentary:  Warm, No pallor.   Psychiatric:  Cooperative.