Age: 68.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Joint effusion, Joint noise, Joint swelling, Lethargy, Malabsorption
Clinical narrative: Hospitalized; COVID-19 positive (2.17.22); fully vaccinated PLUS booster Discharge Provider:  MD Primary Care Provider: MD Admission Date: 2/16/2022 Discharge Date: Feb 23, 2022 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia [J18.9]   HOSPITAL COURSE: Patient is a 68 y.o. female with a past medical history of CKD3, T2DM, hypothyroidism, asthma, bronchiectasis, HTN, NASH Cirrhosis, MVA in 2016 leading to multiple ortho surgeries and chronic osteomyelitis as well as subtotal colectomy and ileostomy, dysphagia requiring feeding tube, chronic pain, GERD, OSA on 2L nightly. Patient took a home COVID test a week prior to presentation due to symptoms of sore throat and congestion. She was noted to be positive. She presented to the ED on 2/17 with productive cough and shortness of breath.   In the ED, patient was on 100% non-rebreather, although no desaturation documented. Labs were significant for elevated pro calcitonin of 0.72, VBG was unremarkable, mild hyponatremia of 132, normal WBC of 9.22. She was found to be COVID positive. CXR was unremarkable. Patient had mild swelling in her right lower extremity so US right lower extremity was obtained and was negative for DVT. CTA was obtained and showed mild left lower lobe pneumonia. Blood cultures were obtained. Patient was started on vancomycin and zosyn. She was admitted to medicine for further management.    Patient was treated with zosyn for left lower lobe pneumonia given her history of pseudomonas. Dexamethasone was started for COVID. Remdesivir was not given as patient initially had symptoms a week prior and her renal function was borderline. Pulmonology was consulted and recommended treated COVID with 10 days of dexamethasone as well as continuing to cover for pseudomonas. Bronchopulmonary hygiene was encouraged with acapella and incentive spirometer. 1/2 blood cultures came back positive for gram positive cocci in pairs and chains which later speciated to micrococcus luteus and streptococcus salivarius/vestibularis. Patient was restarted on vancomycin when cultures came back positive prior to speciation. Repeat blood cultures were obtained and were negative. The positive culture was thought to be a contaminant. ID was consulted. Levofloxacin was added. Vancomycin and zosyn were discontinued. Patient had high ileostomy output and oral vancomycin was added per ID recs as patient had history of c diff infection.    Patient's hospital stay was complicated by hyperglycemia due to steroid use. Was consulted and assisted with diabetes management.    Patient continued to oxygenate well on room air during her admission. She was discharged home in stable condition with plans to complete 10 day course of dexamethasone, 10 day course of levofloxacin and oral vancomycin.    CONSULTS / RECOMMENDATION: - Infectious disease was consulted and assisted with antibiotic management. - Pulmonary was consulted due to history of pseudomonas and recommended to cover for pseudomonas and continue with bronchopulmonary hygiene.  - was consulted to assist with diabetes management, gave home insulin recommendations.