Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: Decreased appetite, Haemophilus test, Human metapneumovirus test, Hypoglycaemia, Hypoxia
Clinical narrative: ED to Hosp-Admission Discharged  4/28/2021 - 5/4/2021 (6 days)  CRNP Last attending ? Treatment team COVID-19 virus infection Principal problem HPI: For complete history and physical see the H&P dictated by Dr. on 4/28/2021.  This is a 76-year-old male who presented to the emergency department with upper respiratory symptoms for three days.  He reports having cough, sneezing, runny nose and poor appetite.  His caregiver had Covid recently and he was exposed.  He was admitted for further evaluation and treatment.   Hospital Course:  Patient was admitted inpatient to the medical surgical floor.  He was not on telemetry.  Patient reports that his caregiver had recently tested positive for Covid and he was exposed.  He has been having upper respiratory symptoms including cough, sneezing, and runny nose.  His COVID-19 test was positive.       He was started on the COVID-19 treatment protocol which included IV remdesivir and IV dexamethasone.  He underwent a CT scan of the chest which showed small patchy areas of groundglass infiltrates in the peripheral portions of the left and right upper lobes and also the posterior aspects of the right lung base.  These findings are probably due to pneumonia.        Hospital course consisted of gentle hydration with IV normal saline.  He was also started on antibiotic therapy oral azithromycin and IV Rocephin.  He had completed the course of antibiotics while on the unit, therefore, at the time of discharge no antibiotics were prescribed.  He initially was hypoxic and started on nasal cannula oxygen to maintain pulse oximetry greater than 92%.  Eventually, oxygen was weaned and pulse oximetry on room air has remained in the 95-96% range.       He has a history of diabetes mellitus and while on the unit blood glucose levels have fluctuated.  His point-of-care glucose have been in the 80-500 range.  He has had numerous episodes of hypoglycemia and insulin has been adjusted.  The fluctuations of the blood glucose levels may be secondary to IV dexamethasone.  At the time of discharge he will continue dexamethasone 6mg daily for the next three days.  He was advised to increase insulin 70/25 insulin five units daily for the next thre days.  After that time he can return to his normal dose of insulin.  He also had been treated with IV remdesivir and had completed the 5-day course.      On examination today he has been asymptomatic.  He denies any chest pain, dyspnea, abdominal pain, nausea, or vomiting.  The initial lab studies showed an elevated creatinine level, although he has a history of chronic kidney disease.  At the time of discharge the creatinine level trended downward and he was advised to follow-up with the primary care provider for possible repeat BMP in 1 to 2 weeks.  All other lab studies have been within normal limits.        The systolic blood pressure has been in the 120-150 range.  The most recent systolic blood pressure was 151/66 mmHg with a heart rate of 66 bpm.  He denies any lightheadedness or dizziness.  He was advised to continue all of his current medications.  While on the unit he was in isolation secondary to COVID-19.  At the time of discharge he should maintain social distancing/isolation, mask wearing and good handwashing.  He will will need to follow-up with the primary care provider.  He was also advised if the oxygen level dips below 89% he will need to return to the emergency department.  At this time he is resting comfortably, offers no complaints and is stable for discharge.       Patient is alert, oriented answering all questions appropriately.  He is continent of bowel and bladder.   Heis able to make his own decisions.  He is able to performhis own ADLs.  .  At this time he is in agreement with the plan and feels comfortable to be discharged home. Thank you.