Age: 69.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Pyrexia, Red blood cell count normal, Red cell distribution width increased, Scan normal, Skin turgor decreased
Clinical narrative: Chief Complaint Fever   History of Present Illness This is a 69 year old female with breast cancer status post left mastectomy, diabetes mellitus, hypertension, and past transient ischemic attack who presented to  ED for fever. The patient reports that she began experiencing sudden onset of fever and chills last night (05/15/2021), and she additionally complains of persistent sore throat and cough beginning the previous week. She has undergone radiation and chemotherapy treatment for breast cancer in the past but these treatments have been suspended for several months with mammography performed on 03/10/2021 failing to identify any malignant growths. In the ED, the patient was found to have acute bronchitis due to COVID-19, fevers and systemic inflammatory response syndrome.   Review of Systems  Constitutional: Positive for chills and fever.  HENT: Positive for sore throat.   Respiratory: Positive for cough. Negative for shortness of breath.   Cardiovascular: Negative for chest pain and leg swelling.  Gastrointestinal: Negative for abdominal pain, diarrhea, nausea and vomiting.  Genitourinary: Negative for dysuria.  Musculoskeletal: Negative for gait problem.  Neurological: Negative for syncope.  All other systems reviewed and are negative.  Vitals Blood pressure 123/75, pulse 95, temperature 37.1 °C (98.7 °F), temperature source Oral, resp. rate 29, height 1.651 m (5' 5"), weight 106.6 kg, SpO2 95 %.   Physical Exam Vitals reviewed.  Constitutional:      General: She is not in acute distress.    Appearance: Normal appearance. She is well-developed. She is morbidly obese. She is not ill-appearing.  HENT:     Head: Normocephalic and atraumatic.     Nose: Congestion present.     Mouth/Throat:     Mouth: Mucous membranes are dry.     Dentition: Abnormal dentition.     Pharynx: Oropharynx is clear.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Pulses: Normal pulses.     Heart sounds: Normal heart sounds.  Pulmonary:     Effort: Pulmonary effort is normal.     Breath sounds: Normal breath sounds.  Chest:     Comments: Port in place to the upper right chest.  Abdominal:     General: Bowel sounds are normal. There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness.  Musculoskeletal:        General: Normal range of motion.     Cervical back: Normal range of motion and neck supple.  Skin:    General: Skin is warm and dry.     Comments: Chronic venous stasis changes to the bilateral lower extremities. Decreased skin turgor throughout.  Neurological:     General: No focal deficit present.     Mental Status: She is alert and oriented to person, place, and time.   Plan Admit to hospital ? cardiac telemetry unit Continuous pulse oximetry and telemetry monitoring Control pain, nausea and vomiting as needed Respiratory treatments (MDI) and supplemental oxygen prn IVF hydration; serial neurological checks every four hours Initiate dexamethasone therapy 6 mg IV once daily Ascorbic acid, zinc sulfate, and vitamin D3 supplementation Serial BMP, Mag, CBC, hepatic panel; ESR/CRP, PT/INR Serial lactic acid and procalcitonin; check respiratory PCR Follow up on blood cultures as available; check urinalysis Electrolyte correction/replacement as indicated Fall precautions; PT/OT evaluations during this visit FSBS and SSI every AC/HS for glycemic control Resume selected home medications with hold parameters DVT prophylaxis ? SCDs only GI prophylaxis ? Famotidine