Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Renal impairment, Respiratory failure, Respiratory symptom, SARS-CoV-2 test positive, Sputum culture positive
Clinical narrative: Patient is a 73 y.o. male who presented from home on 12/9/2022 with 1 day history of fevers, cough, shortness of breath, malaise.  He was found to be COVID-positive on admission, and requiring up to 3 L nasal cannula of oxygen.  Clinical course further complicated by prerenal AKI.  Acute issues resolving, renal function returned to baseline.  No longer having the rest of her symptoms.  Patient will follow-up with PCP in outpatient setting for ongoing management.   Discharge Diagnosis and Associated Hospital Course   Acute Hypoxic Respiratory Failure, resolved Community acquired pneumonia  Presented with respiratory failure believed due to covid 19 with possible superimposed bacterial pneumonia -See further plan for COVID-19 below -MRSA, Legionella antigen and strep antigen negative. Sputum culture revealed moderate mixed flora -Treated with Rocephin and azithromycin with transition to oral antibiotics on discharge -Weaned off O2 and breathing comfortably, no shortness of breath or other respiratory complaints at this time.  Hemoptysis resolved.   COVID-19 - Presented with: Fevers, cough, shortness of breath, malaise - Symptom onset: 12/9 - Positive COVID-19: 12/9  - Vaccination status: Vaccinated with Pfizer with last dose June 2022 - CXR on admission showed patchy right upper and right lower airspace disease - Oxygen status: Previously on 2 to 3 L nasal cannula, now on room air - Decadron: Treated with steroids on arrival.  Patient has been weaned off oxygen and has no further respiratory symptoms.  Will not discharge with further steroid medications given concern for hyperglycemia, and since his symptoms/hypoxia have resolved - Remdesivir: Does not qualify due to eGFR <30 ml/min.  -Not considered a candidate for Paxlovid due to renal function - DVT prophylaxis:Subcutaneous heparin - Serial COVID labs ordered: yes  - Case Management/Social Services consulted: Yes    Hemoptysis Chronic anemia Likely due to COVID-19 and CAP as well.  History of lung cancer likely also contributing -Hemoptysis resolving, most recent hemoglobin is 8.7  AKI on CKD stage IV Resolving and now appears to be close to baseline.  Baseline creatinine appears to be 3.0. was 3.1 on 8/26/2022 -Creatinine on admission 4.27. Likely prerenal secondary to vomiting, diarrhea, COVID-19 infection -Received IV fluid.  Improved Repeat Cr 3.09. in am 12/10 -Plan to resume Lasix on discharge, continue to hold lisinopril until seen in evaluation by PCP   Diarrhea Likely secondary to COVID-19, patient spouse reports blood in the stool.  Per chart review, patient has a known history of internal and external hemorrhoids which is likely etiology of blood -Would follow with PCP for this issue, if any further bleeding can consider outpatient GI work-up.   Essential hypertension Holding lisinopril on discharge on home medications of Norvasc 5 mg, Coreg 25 mg twice daily, Lasix  -Plan to continue Lasix, hold lisinopril on discharge until seen in reevaluation by PCP   Coronary artery disease -History of CABG in 2019 -Echo 5/17/2022 showed mild LVH with EF 50 to 55%, hypokinesis of the basal inferior segment, grade 2 diastolic dysfunction, and mild MR--unchanged compared to 2019. -Continue statin, aspirin, beta-blocker   Diabetes type 2, insulin-dependent, with nephropathy, and neuropathy -A1c from Aug 2022 was 6.3 -Home insulin regimen includes Lantus 60 units at bedtime and NovoLog 40 units with breakfast and dinner, and then 15 units novolog with lunch.  -Continue home regimen on discharge.  Continue follow-up with PCP in outpatient setting for ongoing monitoring   Hx of CVA -In 2009, with residual left sided deficits of upper and lower extremities -Continue aspirin and statin   RLS  -Continue home magnesium and Requip    Peripheral vascular disease -History of lower extremity stenting.  Continue previous antiplatelet regimen on discharge   History of lung cancer in 2019 -Adenocarcinoma, status post radiation. -Last CT chest 5/13/2022 stable. -Continue ongoing outpatient follow-up with Dr.