Age: 71.0
Sex: F
Vaccine: COVID19
Symptoms: Onychomycosis, Pulmonary oedema, Respiratory failure, Right ventricular systolic pressure, SARS-CoV-2 test positive
Clinical narrative: Patient is a 74 y.o. female with a PMH of chronic respiratory failure s/p tracheostomy in May 2022, PAF on Eliquis, and COPD.  She presented to Facility on 12/4/2023 with shortness of breath and hemoptysis, found to have acute COVID-19 infection and suspected acute exacerbation of her COPD.  Her sputum culture also contained moderate growth of Serratia species.  She is s/p 5 days of ceftriaxone for Serratia infection, 5 days of remdesivir for acute COVID-19 infection, and 9 days of dexamethasone 6 mg daily for acute COVID-19 infection and COPD exacerbation.  Her oxygen requirements have returned close to baseline.  After discussion with the patient, she feels comfortable with the plan to return home with home heal      After discussion with the patient, she feels comfortable with the plan to return home with home health care on 12/13/2023 with a scheduled follow-up appointment with her pulmonologist (Dr.) outpatient.   Comments/Problems to be Addressed after Discharge - Pulmonology followed, goal SpO2 >85%, wean home oxygen for this goal - Follow up with Dr. as outpatient - Follow up with PCP for further BP regimen titration as indicated   Acute on Chronic Hypoxic Respiratory Failure Acute COVID-19 Infection Acute on Chronic Bronchitis AECOPD - Home exposure to COVID-19 (spouse), positive COVID-19 PCR on 12/5, element of acute on chronic bronchitis - Baseline 6 L home oxygen - Afebrile and no Leukocytosis, sputum culture w/ Moderate growth of Serratia spp. - 12/4 CXR consistent with bronchitis, 12/4 CT Chest with bronchial wall thickening, emphysematous changes, and interstitial edema - s/p ceftriaxone 12/8-12/12 for Serratia, remdesivir 12/5-12/9 for acute COVID-19 infection, dexamethasone 6 mg daily 12-5-12/13 for acute COVID-19 infection - Pulmonology followed, continue supplemental O2 via trach mask, goal SpO2 >85%, currently at 7 L O2, patient will wean oxygen at home for this goal, plan to follow up with Dr. as outpatient, continue home budesonide nebulizer, Duo-neb, and guaifenesin   Hemoptysis - Likely bronchiectatic in the setting of chronic anticoagulation (Eliquis for PAF) - Hgb WNL and hemodynamically stable - TTE 4/22/22 with EF 60%, indeterminate diastolic function, no significant valvular disease. - Pulmonology followed, no plans for bronchoscopy, home DOAC resumed and hemoglobin remained stable   Paroxysmal Atrial Fibrillation - Known history, CHADSVASC 4 - Continue home dlitiazem and Eliquis   Chronic HFpEF - Per history - 4/22/22 TTE with LVEF of 60% with borderline elevated RVSP of 43 mmHg - Continue home empagliflozin, furosemide, and KCl Elevated Blood Pressure - Had some elevated BP while inpatient, thought was that these times correlated with mucous plugging - Regular outpatient follow up for routine BP screening and consideration of an antihypertensive medicine   NIDDM2 - Diet controlled, A1c 5.1% on 1/25/23 - Continue regular outpatient follow up   HLD - Continue home rosuvastatin   Anxiety Depression - Continue home buspirone and escitalopram   Onychomycosis - Continue home Terbinafine (completed 7 weeks of 3-month course)   Obesity Class I - BMI 35 on admission - Recommend diet and lifestyle modifications