Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Chemotherapy, Chest tube insertion, Chronic respiratory failure
Clinical narrative: Discharge Summary         ADMIT DATE:              08/12/2022                  DISCHARGE DATE:          08/17/2022   ADMITTED:  8/12/2022.   DISCHARGED:  Home in improved condition 8/17/2022.   FINAL DIAGNOSIS(ES):    1. Acute hypoxemic respiratory failure.    2. Chronic hypoxemic respiratory failure.    3. Acute COVID-19 pneumonitis.    4. Right lung carcinoma, stage IV, adenocarcinoma.    5. Right upper lung mass.    6. Right upper lung post-obstructive pneumonia.    7. Recurrent right pleural effusion.    8. Diabetes mellitus, type 2.    9. Hypertension.    10.     History of tobacco use.    11.     Pancytopenia secondary to viremia and chemotherapy.   PROCEDURES:    1. IV antibiotics for post-obstructive bacterial pneumonia.    2. IV Decadron.    3. Breathing treatments.    4. IV Remdesivir for COVID-19 pneumonia.  She completed five days.    5. Interventionally placed chest tube in the right lower lobe to drain pleural effusion.   CONSULTANTS:  Dr. who knows this patient.   Discharged home in improved condition.   HOSPITAL COURSE AND TREATMENT: The patient is a 66-year-old lady who has had chemotherapy one time who was exposed to COVID in the hospital and developed COVID-19 left lung pneumonitis with ground-glass opacities.  She presented quite hypoxemic with a PO2 of less than 60 on 100% nonrebreather and had a chest tube placed in the emergency room by Dr. The cytology on the chest tube drainage is still pending.  I suspect it to be malignant.   She had some re-expansion of her right upper lung but still has a dense and large right lung carcinoma.  She was admitted to the COVID unit on 3A and given intravenous Maxipime and intravenous Flagyl for post-obstructive pneumonia.   She was started on IV Decadron 6 milligram twice daily and Remdesivir.  Her hypoxemia improved and drainage of her pleural effusion improved her shortness of breath.  I asked Dr. to see her whether she would need thrombolysis if this were loculated.  I did not think this was the time for pleurodesis.   The patient's hypoxemia improved and her oxygen requirements improved and she was weaned down to 2.5 to 3 liters nasal oxygen and she felt well.  Her cough is nonproductive.  She current does not have cytokine storm.  She has completed five days of intravenous Remdesivir.  At this time she is being discharged home to the care of her family.   Her discharge medications include:    1. Proventil nebulizer four times daily.    2. Flexeril 10 milligram at bedtime.    3. Trelegy 1 puff  daily.    4. Amaryl 2 milligram two times daily.    5. Compazine 10 milligram every 6 hours p.r.n. nausea.    6. Folic acid 1 milligram daily.    7. She will continue Norco 5/325 1 every 8 hours p.r.n. pain.    8. Combivent Respimat 1 puff four times daily.    9. Ativan 1 milligram twice daily.    10.     Lopressor 25 milligram daily or twice daily depending upon her heart rate.    11.     She will resume her Prilosec 20 milligram daily.    12.     Zoloft 100 milligram daily.    13.     I have prescribed for her Levaquin 750 milligram p.o. daily for the next 10 days as she is pancytopenic from chemotherapy and viremia.    14.     She will be on Prednisone 10 milligram #30  4 p.o. every day for 3 days and then decrease by 10 milligram every 3 days until completed.   A rollator walker was prescribed for her as well.  She will wear home oxygen at 2.5-3 liters and titrate it as needed.   I spoke to the patient during this admission regarding her wishes for further care in the case of cardiopulmonary arrest and she told me she did not want a ventilator at any time nor did she want chest compression.  Therefore, DNR was established.