Age: 69.0
Sex: M
Vaccine: COVID19, VARZOS
Symptoms: Emphysema, Fatigue, Fibrin D dimer increased, Hypoxia, N-terminal prohormone brain natriuretic peptide increased
Clinical narrative: COVID+ 11/8/22.  Vaccination status - moderna x3 BRIEF OVERVIEW: Discharge Provider: DO Primary Care Provider at Discharge: MD  Admission Date: 11/8/2022 Discharge Date: 11/11/2022   Active Hospital Problems   Diagnosis Date Noted POA ? COVID-19 11/08/2022 Yes ? Hypoxemia 11/08/2022 Yes ? AKI (acute kidney injury) (HCC) 11/08/2022 Yes ? Essential hypertension, benign 06/23/2020 Yes ? Tobacco abuse   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Shortness of breath [R06.02] Hypoxia [R09.02] COVID-19 [U07.1] Hypoxemia [R09.02]   HOSPITAL COURSE: Presented to the emergency department on 11/8/22 with complaint of shortness of breath. Although this is chronic in nature, for 2-3 days prior to arrival shortness of breath worsened.  Also complained of fatigue, chills, congestion and runny nose.  Is a 1 pack per day smoker for 48 years.   On arrival to the emergency department, he was found to be tachycardic and tachypneic.  Creatinine was elevated at 1.87, proBNP 745, troponins were 23 and 23 respectively.  D-dimer elevated at 14 50.  COVID testing was positive.  Blood cultures x2 are pending.  Chest x-ray without acute airspace disease or effusion.  Atelectasis with scarring at right lung base.  CT angiogram was completed based on D-dimer and showed no acute pulmonary embolism.  Emphysema was present.  Twelve lead EKG was normal sinus rhythm.  He was given small dose of IV fluid and DuoNeb treatment.  He was admitted to the hospitalist service for shortness of breath with COVID-19 and hypoxia with ambulation which was reported from the emergency department.   During hospitalization, isolation precautions were maintained due to COVID-19.  Medications were continued for chronic conditions.  He was initially diuresed due to suspected heart failure with preserved ejection fraction.  Creatinine increased with Lasix administration resulting in gentle IV fluid rehydration.  Initial suspicion for congestive heart failure led to echocardiogram being completed on 10/08/2022.  This showed LVEF of 55% with normal right and left ventricular systolic functions.   Blood pressure was also difficult to control during hospitalization. Clonidine weaned and discontinued. Norvasc, HCTZ and Terazosin initiated and ordered on discharge. Lasix discontinued. He was instructed to begin daily weights and monitor blood pressure at home. It was also recommended that he follow up with his PCP for referral to Pulmonologist. Albuterol INH also ordered on discharge. Was also instructed to adhere to CDC guidelines for COVID isolation. Follow up labs to monitor renal function to be drawn as outpatient next week with results to be sent to PCP.   No complaints of difficulty breathing, cough, dizziness, or malaise. Significant other at the bedside. He is stable for discharge home to self care. They understand discharge instructions and agree with plan. All questions and concerns answered. Please see discharge instructions for further information.   BP (!) 167/109  | Pulse 88  | Temp 36.8 °C (Oral)  | Resp 18  | Ht 1.778 m  | Wt 78.9 kg  | SpO2 94%  | BMI 24.97 kg/m²      Physical Exam Vitals and nursing note reviewed.  Constitutional:      General: He is not in acute distress.    Appearance: He is well-developed.  HENT:     Head: Normocephalic and atraumatic.     Right Ear: External ear normal.     Left Ear: External ear normal.     Nose: No congestion or rhinorrhea.     Mouth/Throat:     Mouth: Mucous membranes are moist.     Pharynx: Oropharynx is clear.  Eyes:     General:        Right eye: No discharge.        Left eye: No discharge.     Conjunctiva/sclera: Conjunctivae normal.     Pupils: Pupils are equal, round, and reactive to light.  Neck:     Trachea: No tracheal deviation.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Heart sounds: Normal heart sounds. No murmur heard.   No friction rub. No gallop.  Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: No stridor. Examination of the right-lower field reveals decreased breath sounds. Examination of the left-lower field reveals decreased breath sounds. Decreased breath sounds present. No wheezing, rhonchi or rales.  Abdominal:     General: Bowel sounds are normal. There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness. There is no guarding or rebound.  Musculoskeletal:        General: No swelling, tenderness or deformity. Normal range of motion.     Cervical back: Normal range of motion and neck supple.  Skin:    General: Skin is warm and dry.     Coloration: Skin is not pale.     Findings: No erythema or rash.  Neurological:     Mental Status: He is alert and oriented to person, place, and time. Mental status is at baseline.     Sensory: No sensory deficit.     Motor: No weakness.  Psychiatric:        Behavior: Behavior normal.        Thought Content: Thought content normal.        Judgment: Judgment normal.