Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Oxygen saturation decreased, Pleural effusion, Pneumonia, Pneumonia bacterial, SARS-CoV-2 test positive
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 10/4/2022 Discharge Date: 10/10/2022     Clinical Narrative:   Patient was admitted with COVID pneumonia exacerbation of chronic obstructive pulmonary disease.  Her oxygen needs were approaching 6 liters/minute per nasal cannula.  She seemed to respond to IV Decadron, remdesivir, and empiric treatment for community-acquired pneumonia.  Please see below.     Please see the following problem-list oriented Hospital Course below:   * COPD exacerbation (HCC) Assessment & Plan   Moderate to Severe chronic obstructive pulmonary disease at baseline.  Impaired diffusion at baseline.  Her initial O2 sats were somewhat low in the emergency room but were back to her baseline at the time of my exam.  Her chest x-ray does reveal tenting of the diaphragm on the right and suggestion of basilar infiltrates.  These are not changed from January of 2022 and the chest x-ray actually looked better.  Her chronic obstructive pulmonary disease is likely exacerbated from an upper respiratory tract infection/her COVID positivity.  She will be on IV Solu-Medrol for her chronic obstructive pulmonary disease exacerbation.  If her oxygen needs are increasing then will consider adding Remdesivir at that time.   10/5 - oxygen needs higher today.   10/8 - Improving. AM CXR stable, per radiology report. Chronic Right Lower Lobe/pleural process without change. Suspect some degree of tinting/trapped lung/scarring but without change from January.   Stable. Oxygen needs back to/near baseline.  Treat empirically for pulmonary pathogens with ceftriaxone and azithromycin.  I do believe this was COVID pneumonia given her progression and she was treated with corticosteroids and remdesivir with improvement.  The COVID did exacerbate her chronic obstructive pulmonary disease, as well.   Pneumonia due to COVID-19 virus Assessment & Plan   No infiltrates on chest x-ray.  Oxygen needs at baseline.  If either of these parameters worsen then will add remdesivir at that time.   10/5 - oxygen needs higher today.  With dysuria did.  Continuing with intravenous corticosteroid therapy.  Risk benefit discussed.   10/6 - oxygen needs still quite elevated but no different than yesterday.  She remains stable from respiratory standpoint.  Will continue her broad-spectrum antibiotic therapy, remdesivir, and corticosteroids.  She had concerns regarding her previous right pleural density/effusion.  This is still present.  This was reviewed in comparison to films of March 2022 and January of 2022.  This is largely without change.  Will repeat film on Saturday.   10/7 - oxygen needs improving.  The patient is less dyspneic.  Less cough.  Discussed her favorable progress.  Also discussed continued broad-spectrum antibiotic therapy given the possibility of superimposed bacterial pneumonia.   10/8 - O2 improving... less dyspneic. Discussed transition to oral steroids. Recommended continuing the Remdesivir through tomorrow. Transitioning away from IV Lasix.   10/9 - Needs am lab. Remdesivir complete later today.   10/10 - doing quite well.  Oxygen needs back to/near baseline.  Discharge planning.  PCP follow-up.  Influenza vaccine prior to discharge.