Age: 85.0
Sex: F
Vaccine: COVID19
Symptoms: Chronic obstructive pulmonary disease, Condition aggravated, Cough, Decreased appetite, Dyspnoea
Clinical narrative: BRIEF OVERVIEW: Admission Date: 9/30/2024 Discharge Date: Oct 3, 2024 Discharge Disposition:  home health care svc  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COPD exacerbation [J44.1] COPD with acute exacerbation [J44.1] SVT (supraventricular tachycardia) [I47.10] Acute respiratory insufficiency [R06.89]  HOSPITAL COURSE: Patient is a 87 y.o. female who presents today with weakness and SOB.  Pleasant 87 F who lives alone and remains independent. She is active and likes to mow her lawn. Non current smoker, she stopped smoking many years ago. She has "COPD" and is on daily Anoro. She does not have a rescue inhaler. She has not been hospitalized for Resp issues the last 12 months. Never had a severe resp issue that warranted ventilator use. Not yet had a flu shot this year.  Has been feeling unwell, progressively weaker, anorexic, and with a runny nose the last 4 days. No fever or chills, occl cough, non purulent phlegm. Denies known exposure to someone knowingly ill. Due to non-improvement in her condition, she was brought to the ED for evaluation.  ED eval shows unremarkable labwork. CXR is clear without lung infiltrates. RSV/Flu and COVID-19 markers were negative. She was observed hypoxic however on ambulation and thus was recommended for hospital admission. (HPI per Dr)  Patient is an 87yr old female with a history of HTN, COPD, lives alone and presented due to worsening progressive weakness and difficulty breathing. According to niece she was otherwise independent but of recent has been able to carry out some basic activities and her legs even got so weak she was hardly able to walk.  Rapid response was called on 10/01 as patient went into SVT. She received 5mg of IV lopressor and was controlled with vagal maneuvers including vasalva and carotid massage.   Acute Respiratory Insufficiency secondary to COVID infection in setting of COPD  - Initial rapid RSV, Inf A, Inf B and COVID were negative but in the full RVP panel COVID pcr was detected.  Chest xray however shows no acute cardiopulmonary abnormalities and she is not hypoxic and saturating 100% on RA.  She however complains about slight dyspnea and has been somewhat tachypneic. I will continue duonebs, steroids, LABA/LAMA, flonase, doxycycline and other supportive management. No indication for remdesivir or other COVID directed therapy as patient is not hypoxic.   SVT - Had episode on 10/01 for which a Rapid response was called, she received 5mg of IV lopressor but resolved with vagal maneuvers including vasalva and carotid massage. She was transfered to PCU and went on to have multiple other transient episodes. Mg resulted as 1.8 and was replenished with IV Mag. No episodes overnight.  Echo doen revealed mildly impaired LV systolic function with EF 45-50%. However no clinical signs of CHF. Cards consulted and said to treat respiratory problem, no indication for further cardiac intervention.   Generalized weakness - likely multifactorial due to COVID, chronic illness, worsening debility in setting of COPD and advancing age. PT/OT recommending Home with services.  Discharged to Home Health Care Services