Age: 60.0
Sex: F
Vaccine: COVID19
Symptoms: AST/ALT ratio, Acute respiratory failure, Alanine aminotransferase normal, Angiogram pulmonary abnormal, Anion gap
Clinical narrative: Discharge Summary Date of Service Aug-21-2022 0829  Date of Admission Admit Date: Aug-17-2022  Date of Discharge Date of discharge Aug-21-2022  Allergies TETRACYCLINE - when patietn was a child  Chief Complaint SOB  Procedure(s) Performed None  Lab Results Aug-20-2022 0745 Hematology WBC  11.7RBC  6.94HGB  19.9HCT  63.2MCV  91.1MCH  28.7MCHC  31.5RDW  16.6RDWSD  48.7PLT  641MPV  11.2AUTONEU%  66.1AUTOLYM%  22.6AUTOMON%  8.5AUTOEOS%  0.7AUTOBAS%  1.3AUTONEU#  7.7AUTOLYM#  2.6AUTOMON#  1.0AUTOBAS#  0.2AUTOEOS#  0.1NRBC%  0.0NRBC  0.0HGB/HCT  3.2IG#  0.09IG%  0.8 Aug-20-2022 0745 Chemistry GLUCOSE  101BUN  30CREAT  0.9MDRD GFR  64NA  148K  4.0CL  103CALCIUM  8.8ALK PHOS  59CO2  43.4AST  14ALT  15AST/ALT  0.9TL PROT  6.0ALBUMIN  2.6TBILI  0.4DBILI  0.1OSMO  300.6ANION GP  5.6BUN/CRE  33.3 Aug-20-2022 0745 Blood Gas PH VEN  7.430PCO2 VEN  68.8PO2 VEN  70.0BICARB V  45.0BE VEN  15.1CO2 CT V  36.0O2 SAT V  95.6 Aug-18-2022 0710 Chemistry PROBNP  9522 Aug-18-2022 0615 Chemistry TROPI-HS  83 Aug-18-2022 0410 Serology PROCALC  <0.05 Aug-18-2022 0410 Hematology WBC  6.2RBC  6.21HGB  17.8HCT  57.5MCV  92.6MCH  28.7MCHC  31.0RDW  14.9RDWSD  50.1PLT  430MPV  11.5AUTONEU%  81.1AUTOLYM%  11.1AUTOMON%  4.0AUTOEOS%  1.9AUTOBAS%  0.8AUTONEU#  5.0AUTOLYM#  0.7AUTOMON#  0.3AUTOBAS#  0.1AUTOEOS#  0.1NRBC%  0.0NRBC  0.0IG#  0.07IG%  1.1 Aug-18-2022 0410 Coagulation D-DIMER  0.47 Aug-18-2022 0410 Chemistry GLUCOSE  125BUN  20CREAT  1.0MDRD GFR  56NA  143K  4.2CL  104CALCIUM  8.8CO2  34.8OSMO  289.1ANION GP  8.4BUN/CRE  20.0CRP  2.40HGBA1C  5.6MEAN GLU  122MAGNESIU  1.6TROPI-HS  86 Aug-18-2022 0410 Blood Gas PH VEN  7.26PCO2 VEN  79.3PO2 VEN  64BICARB V  34.0BE VEN  3.1CO2 CT V  29.7O2 SAT V  90.6 Imaging Results CTA showed no evidence of pulmonary artery embolism. Severe centrilobular emphysema present. Small right pleural effusion. No consolidation. Contrast reflux into hepatic veins. Consistent with elevated right cardiac pressure.  Echocardiogram showed LVEF greater than 60% moderate tricuspid regurgitation. RVSP 64. Moderate enlargement of right ventricle. Severe right ventricular hypokinesis that later improved on repeat echo. Severely enlarged right atrium measuring greater than 50 mm that improved on repeat echo. Small pericardial effusion no echocardiographic evidence to suggest pericardial tamponade. Dilated inferior vena cava with no respiratory collapse. Pulmonary hypertension.  Chest x-ray stable chest.  Social History tobacco use Current Every Day Smoker, 1/2 Packs Per Day, 40 yrs, Smoking Cessation Yes  alcohol use No Known Use  drug use No Known Use  marital status Single  occupation Works as a home health nurse  travel No recent travel  Health Concerns Right ventricular failure  Essential hypertension  Acute pulmonary edema  Myocarditis due to COVID-19  Pulmonary hypertension  COVID-19  Dyspnea  Current Every Day Smoker, 1/2 Packs Per Day, 40 yrs  Father Deceased Cerebrovascular accident @ 86  Mother Deceased Myocardial infarction @ 41  Vital Signs Aug-21-2022 0730 T 98.6 HR 68 RR     24 BP   150 / 93 O2Sat 95 Aug-21-2022 0300 HR 71 RR 19 BP       157  / 97 O2Sat 93 Aug-20-2022 2224 T 98.2 PHYSICAL EXAM Constitutional:  Nontoxic appearing, appears stated age, in no acute distress. Cardio: Regular rate and rhythm. No murmur, rub, gallop or edema.  Pulses 2+ out of 4 at the radial and posterior tibial bilaterally. Pulmonary:  On 2L NC saturating 94%.  Non-labored breathing. No wheeze or rales Gastrointestinal:  Abdomen is non-distended without scar or lesion. Bowel sounds present x4, no reproducible tenderness to palpation. No organomegaly palpated. Neuro:  Alert and oriented x3.  Language is clear.  CN II-XII grossly intact, sensation to light touch intact. Skin: Warm, dry and supple without new lesion or ulcer Psych: appropriate affect and mood is euthymic.  Consultations cardiology, Dr.  Hospital Course Came to the ED short of breath. Shortness of breath had been chronic and now was acute on chronic. Found to be positive for COVID-19 pneumonia. Treated with remdesivir, dexamethasone, inhaled medications. Diagnosed with likely COPD in acute exacerbation, dehydration. Patient does have a history of tobacco abuse. Throughout her hospital stay the patient did improve clinically and biochemically 8 and is now stable, ready for discharge.  Discharge Medications ALBUTEROL SULFATE HFA 108 (90 Base) MCG/ACT 2 PUF INHALATION EVERY 4 HOURS AS NEEDED for SHORTNESS OF BREATH (Printed by RESIDENT on Aug-21-2022 0826) Anoro Ellipta Inhalation Aerosol Powder Breath Activated 62.5-25 MCG/INH 1 PUF INHALATION ONCE A DAY (Printed by  RESIDENT on Aug-21-2022 0826) ASPIRIN LOW DOSE 81 MG ORALLY ONCE A DAY CALCIUM ANTACID 1000 MG ORALLY EVERY 4 HOURS AS NEEDED for DYSPEPSIA CARVEDILOL 6.25 MG ORALLY TWICE DAILY BLOOD PRESSURE MEDS (Printed by RESIDENT on Aug-21-2022 0826) FAMOTIDINE 10 MG ORALLY TWICE DAILY Lasix Oral Tablet 20 MG 10 MG ORALLY ONCE A DAY (Printed by RESIDENT on Aug-21-2022 0826) SACUBITRIL-VALSARTAN 49-51 MG 1 TAB ORALLY TWICE DAILY (Printed by RESIDENT on Aug-21-2022 0826) Sertraline HCl Oral Tablet 25 MG 25 MG ORALLY ONCE A DAY (Printed by RESIDENT on Aug-21-2022 0826) Plan ASSESSMENT: -Acute hypoxic respiratory failure secondary to COVID-19 pneumonia with suspected COPD exacerbation   -Pneumonia in the setting of COVID-19, Moderna vaccine x 2, Suspected underlying COPD with acute exacerbation -  Likely COPD in acute exacerbation  -Dehydration secondary to poor oral intake  -hypertension, etiology unknown, possibly secondary to COVID-19 versus primary hypertension -Polycythemia, Hgb 19.1, Hct 60.3, likely multifactorial, secondary to dehydration, suspected COPD, smoking -Thrombocytosis, platelet count 457,000, likely reactive to viral illness -Tobacco abuse disorder  PLAN:   discharge the patient into the care of her daughter, anticipated to stay with daughter until she recovers more fully.   Discharge with home O2, 2 L is needed at rest.  After discharge, needs to establish primary care provider   For ongoing care, refills.   Needs pulmonary function test in the outpatient setting. She will be discharged with  breathing medications for COPD.  Discontinue steroids.   Discontinue remdesivir.  Encourage oral intake of both fluid and meals.  Primary Care Provider None established  Electronically signed by RESIDENT on Aug-21-2022 0838 I have seen and physically examined the patient on [aug 21, 2022] and agree with the documentation of [name of the resident]. I have also discussed my findings and plan of care with [dr resident]. Any changes and additional information are listed below. cvs s1s2 abd soft nt nd lungs wheeze bilateral walking home oxygen fu pulmonary , pmd pft Electronically signed by MD MD on Aug-21-2022 1047 PrintPrevious Next  current encounter previous encounters New Note Filter