Age: 69.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Nodule, Peritoneal disorder, Pleural effusion, Poikilocytosis, Procalcitonin normal
Clinical narrative: 1/10/22  70 yr/o female who presents with covid. HPI 70 y/o F here with nausea, HA.  PT was dx'ed with covid this AM.  PT has been sick since last admission (12/23).  Last chemo was while inpatient in Dec (24th).  Patient denies any history of blood clots, heart disease.  States she has had ongoing issues since recent hospitalization of fatigue, headache.  Has had some mild shortness of air.  This is not worsening.  Denies any chest pain.  Has had a slightly productive cough and did vomit recently.  No diarrhea or constipation.  No signs of GI bleed otherwise. 1/15/22  Hospital Course: Patient is a 70-year-old female with a past medical history of asthma, arthritis, hypertension, hyperlipidemia, kidney stones, atrial fibrillation, ovarian and endometrial cancer on chemotherapy, malignant ascites, urinary tract infections, GERD, and vitamin D deficiency.  She presented to emergency department with complaints of known COVID-19 positive, nausea, and headache.  She reports she has been sick since last admission on 12/23/21, and was diagnosed with COVID yesterday morning.  She is currently followed by Dr.  with Oncology, with her last chemotherapy treatment on December 24.  She reports having continued fatigue, headache, and shortness of breath since being discharged.  She has had a productive cough but no nausea, vomiting, or diarrhea.  Upon further work-up in the ED her labs showed sodium 134, potassium 3.2, chloride 93, CO2 30, albumin 2.6, calcium 8.3, D-dimer 6180, RBC 3.59, hemoglobin 10.7, hematocrit 32, with a CT head showing no acute abnormalities, urinalysis with 30 protein, CTA chest for PE with no evidence of pulmonary embolism or aortic dissection, new interstitial pulmonary infiltrate and mild groundglass opacity infiltrates, mild pulmonary edema, new small to moderate left pleural effusion, moderate to large right pleural effusion concerning for metastatic disease, CT abdomen and pelvis with mild thickening of the peritoneal surfaces, moderate to large abdominal and pelvic ascites, persistent, relatively stable retroperitoneal and mesenteric lymph nodes concerning for metastatic disease.  She was given fluid bolus, IV Zofran, and initiated on IV remdesivir while in the ED with plans for admission for further evaluation and treatment.  Upon assessment this morning she is resting in bed comfortably.  She appears in no acute distress at this time.   Review of Systems  Constitutional: Negative for chills and fever.  HENT: Negative for congestion, nosebleeds, postnasal drip, rhinorrhea, sinus pressure, sinus pain, sneezing and sore throat.   Eyes: Negative for pain and visual disturbance.  Respiratory: Positive for cough and shortness of breath. Negative for chest tightness.        +sputum production  Cardiovascular: Negative for chest pain and leg swelling.  Gastrointestinal: Positive for nausea and vomiting (a few days ago). Negative for abdominal pain, anal bleeding, blood in stool and diarrhea.  Genitourinary: Negative for flank pain and vaginal bleeding.  Musculoskeletal: Negative for arthralgias, back pain, myalgias and neck pain.  Skin: Negative for rash.  Neurological: Positive for headaches. Negative for dizziness, syncope, speech difficulty, weakness, light-headedness and numbness.  All other systems reviewed and are negative.