Sex: M
Vaccine: UNK
Symptoms: Localised oedema, Mean cell volume normal, N-terminal prohormone brain natriuretic peptide, Obstructive sleep apnoea syndrome, Oedema peripheral
Clinical narrative: ID:    Date of Admission: 12/11/2023    Date of Discharge: 12/22/2023    Primary Care Physician: MD   Issues to be Addressed in Follow-up: Titration of Diuretics, with repeat labs in 5 days (ordered)   Reason for Hospital Admission (Admitting Diagnosis):  CHF exacerbation    HPI on admission (Prasad): Patient is a 60 Y male with a history of hypertension who is not on any medication, aortic stenosis, severe obesity presents to the emergency department accompanied by sister and daughter with worsening onset of shortness of breath.  History was provided by patient.  Patient states symptoms of swelling of the lower extremity started couple of weeks prior to Thanksgiving.  Patient states symptoms worsen to a point he was getting short of breath with minimal ambulation.  For these reasons patient decided come to the emergency department for further evaluation.  Patient did note worsening edema that started in the lower extremity and now is up to the abdominal region.  Patient also notes of a greater than 30 pound weight gain. ED course: Basic labs, Lasix IV, chest x-ray, proBNP, COVID positive    Hospital Course/Significant Findings: Patient was admitted and started on IV Lasix. Patient had profound diuresis of 80 lbs while admitted, with weight improving from 408 to 328 lbs on admission. Discharge on Lasix 80mg PO BID, with repeat labs in 5 days. COVID not significantly contributory to respiratory symptoms. Patient had venous stasis wounds that were treated by wound care. BP meds stopped on discharge due to patient having lower BP while on Lasix.   Complications: None   Diagnoses:  Active Hospital Problems   Diagnosis   ? (Principal) CHF EXACERBATION, UNSPECIFIED   ? COVID-19 DISEASE   ? OBSTRUCTIVE SLEEP APNEA       Date: 5/13/2020  Study Type: WatchPAT  pAHI: 82.2  BMI: 47.92  Min SpO2: 75% SpO2<90%: 12.3 minutes  Severe Sleep Apnea.   4/23/2021 Patient not using CPAP.  "I just cannot get used to it"   P -strongly encourage CPAP use.  Patient to retrying CPAP.  If CPAP is still comfortable he will email me I will forward this to sleep lab for their consultation.   ? AORTIC VALVE STENOSIS       4/23/2021: Chronic established diagnosis. Briefly reviewed plan today, cont current regimen.    Seen in echo 2/20.   Repeat in 2/22 -mild progression.  TAV on 4/1.  Patient asymptomatic Repeat echo in 2/24.  Earlier if symptoms develop.   ? HTN (HYPERTENSION)       4/23/2021: Chronic established diagnosis. Briefly reviewed plan today, cont current regimen.   BP Readings from Last 3 Encounters: 04/23/21 158/96 02/12/20 137/89 12/02/19 135/81    Basename Value Date/Time ? CREATININE   0.86 02/28/2020   Patient not taking blood pressure medicines for 2 to 3 weeks.   P -represcribed BP meds.  BPMA 2 weeks.       ? SEVERE OBESITY (BMI >= 40)       4/23/2021: Chronic established diagnosis. Briefly reviewed plan today, cont current regimen.  Estimated body mass index is 45.62 kg/m² as calculated from the following:   Height as of 2/12/20: 6' 4".   Weight as of this encounter: 170 kg (374 lb 12.8 oz).  Discussed diet and exercise for treatment of this condition.  Has either been seen by health education or offered health education in the past.             Resolved Hospital Problems No resolved problems to display.   Procedures: None   Consults:  None   Condition on Discharge:  Stable    Code Status at Time of Discharge: Full Code   Smoker: No.   Discharge Disposition:  Home   Discharge Medications: Medications, instructions, follow up information: See patient instructions (or SNF Admission orders if applicable).   Physical Exam on Day of Discharge: BP 97/71  | Pulse 85  | Temp 97.1 °F (36.2 °C)  | Resp 18  | Ht 6' 4"  | Wt 148.8 kg (328 lb)  | SpO2 95%  | BMI 39.93 kg/m²    Intake/Output Summary (Last 24 hours) at 12/22/2023 1111 Last data filed at 12/22/2023 0623  Gross over last 24 hours Intake 1060 ml Output 1600 ml Net -540 ml   General - A&Ox3. Resting comfortably in no acute distress Head - Normocephalic. Atraumatic Eyes - PERLA. EOMI Mouth - Oropharynx moist. No injection Neck - No lymphadenopathy. No JVD Lungs - Clear to auscultation. No wheezes, no crackles Heart - Regular rate and rhythm. (+) systolic murmur, no gallops Abdomen - Soft, nontender, nondistended, no guarding, no rebound Extremities - Good pulses bilaterally, bilateral moderate edema with venous stasis changes, with ongoing improvement. Musculoskeletal - Good strength bilaterally, no spinal tenderness Neuro - CN II-XII grossly intact, no sensory deficits Psych - Patient is of sound mind and proper affect   Selected Lab Results:  Recent Labs   12/22/23 0716 12/21/23 0805 12/20/23 0754 12/19/23 0724 12/18/23 0753 WBC 10.0 8.9 8.6 9.1 9.3 HGB 14.3 14.5 14.7 14.9 14.8 HCT 43.9 44.9 43.7 45.5 45.0 PLT 271 244 222 226 213 MCV 88 91 89 90 90      Recent Labs   12/22/23 0716 12/21/23 0805 12/20/23 0754 12/19/23 0724 12/18/23 0753 NA 137 139 139 138 138 K 3.9 3.9 4.5 4.1 3.7 CO2 28 30 30 27 29 CL 100 99* 100 101 98* BUN 21 20 19 18 19 CR 0.84 0.89 0.80 0.75 0.90 RBS 92 74 76 81 74 MG 2.0 1.9 1.9 1.9 1.8   Time spent on discharge: > 35 minutes   Discussed with the patient and wife. All questions fully answered.   DO   12/22/2023 11:11 AM  HBS Spectralink 4-1256 Pager     Note Details  Author (D.O.) File Time 12/22/2023 11:16 AM Author Type PHYSICIAN (D.O.) Status Signed Last Editor (D.O.) Hospital Medicine Hospital Acct # Admit Date 12/11/2023  ED to Hosp-Admission (Discharged) on 12/11/2023  ED to Hosp-Admission (Discharged) on 12/11/2023   Detailed Report  Note shared with patient Additional Orders and Documentation   Results Imaging   Meds    Orders    Flowsheets   Encounter Info:  History, Allergies, Education, Care Plan, Detailed Report   Hospital Problem List   CHF EXACERBATION, UNSPECIFIED  SEVERE OBESITY (BMI >= 40)  HTN (HYPERTENSION)  OBSTRUCTIVE SLEEP APNEA  AORTIC VALVE STENOSIS  COVID-19 DISEASE Care Timeline  12/12   Admitted from ED (Observation) 1041 12/14   Admitted 1053 12/22   Discharged 1446  Discharge   Home or Self Care.   Discharge Instructions (AVS) (Printed 12/22/2023)   Discharge Orders  BICARBONATE  BUN  CHLORIDE  GLUCOSE  MAGNESIUM  SODIUM  CREATININE W GFR, CALCULATED  POTASSIUM Medication List at Discharge   cadexomer iodine 0.9 % Topical DAILY  fluticasone propion/salmeterol 500-50 mcg/dose USE 1 INHALATION ORALLY 2 TIMES A DAY. RINSE MOUTH WELL AFTER USE  furosemide 80 mg Oral 2 TIMES A DAY  guaifenesin/dextromethorphan 10-100 mg/5 mL 10 mL Oral EVERY 4 HOURS AS NEEDED  potassium chloride 20 mEq 20 mEq Oral DAILY PT NOT Showing being Vaccinated