Age: 58.0
Sex: F
Vaccine: COVID19
Symptoms: Hypotension, Liver function test, Malnutrition, Mental status changes, Metabolic encephalopathy
Clinical narrative: A 58 y.o. female patient of CNP with history of HTN, HLD, COPD, chronic hypoxemic respiratory failure, chronic HFPEF who presented with respiratory distress.  Symptoms worsened overnight with altered mental status, required intubation. Shock. Cardiogenic vs Septic; Aspiration Pneumonia; Pneumonia due to COVID-19; CT pulmonary arteries on 8/8/2022: cardiomegaly with sm-mod pericardial effusion; left lower lobe multi segmental mucoid; impaction; negative for PE; Status post intubation on 8/9; No longer requiring pressors; ID following; Repeat echo pending; Critical care signed off; Discontinue cefepime; Finished dexamethasone and remdesivir; Covid-19 Virus Infection; Date of onset of symptoms: 8/8/2022; Symptoms present on admission: shortness of breath, altered mental status, fever; Date of covid positive test: 8/8/2022; Vaccination status: vaccinated; Imaging: CTA pulmonary arteries; Oxygen requirements on admission: 8L; Current oxygen requirements: BiPAP; Medical therapy: steroids; pending hepatic panel - Remdesivir; Consultants following: Pulm CC, ID; Anticipated special isolation end; date: 8/17/2022; Completed treatment; Acute on chronic hypoxemic respiratory failure; COPD; Wears 3.5 liters chronically; AVAPs; Intubated initially; Currently on NC; Continue with nebs, antibiotics; extubated on 8/10; Critical care signed off; Acute Kidney Injury on CKD stage III, with ATN; CKD stage III with baseline creatinine 0.79-1. Likely due to shock; Creatinine peaked at 1.96; Renal neg for stones or hydronephrosis, 5.7 cm adrenal gland mass noted; Continue close monitoring, monitor urine output; Resolved; Acute metabolic encephalopathy -resolved; DM Type II; HgA1c on 6/11/2022: 5.9; Accucheck every 4 hours with ISS coverage; HFpEF; Pericardial Effusion TTE on 7/12/2022: LVEF 66%, grade II diastolic dysfunction, large pericardial effusion; echo densities attached to visceral pericardium. Repeat TTE. Hold diuretics, diurese as BP allows. Paroxysmal Atrial Fibrillation; Eliquis discontinued in mid July due to pericardial effusion; Hold Metoprolol while hypotensive.; Currently rate controlled.  Maintain K>4, Mag >2. Adrenal gland mass; On right per renal ultrasound; Also noted on CT pulmonary angiogram, 5.7 cm; Will handle acute issues at this time and Patient follow-up as outpatient; HTN; Hold antihypertensive medications while on vasoactive medications. Restarted metoprolol. Consider adding lisinopril/hydrochlorothiazide and amlodipine as able. Dyslipidemia. Continue Atorvastatin, Chronic Anemia. Baseline hemoglobin 8-9. Currently 10.8. Continue Ferrous sulfate, Coronary Artery Disease; Continue aspirin, statin; Hold anti hypertensive medications. Severe malnutrition, POA; Consult dietitian; Constipation; Chronic history; Reports no BM since admission; On colace and miralax; Anxiety; Tremors; Patient is on Xanax and paroxetine at home as well as trazodone; Trazodone restarted on 8/13; Per patient request, will restart Xanax on 8/14; Continue paroxetine Patient stable for discharge today home with home health.  However patient's home getting treatment for bugs, therefore discussed with social work case management and patient will be remaining in the hospital until this is completed.