Age: 68.0
Sex: F
Vaccine: COVID19
Symptoms: Blood lactic acid, Bordetella test negative, Chest X-ray normal, Chlamydia test negative, Constipation
Clinical narrative: ED to Hosp-Admission  Discharged  10/10/2021 - 10/13/2021 (3 days) COVID-19 Principal problem     Hospital Problems          POA   * (Principal) COVID-19 Yes       Essential hypertension Yes       Gastroesophageal reflux disease Yes       Hospital Course     Per Initial HPI By CRNP: patient is an 69 y.o. female who presented to the emergency department with cough, congestion, body aches, weakness, nausea and shortness of breath.  She began with symptoms approximately 5 days ago.  Both her mother and stepfather are admitted to the hospital for COVID-19.  She had a negative Covid test a few days ago, but had increasing shortness of breath.  Hospitalist was consulted for admission.          On examination today she was resting comfortably in bed.  She states for the last five days she had increased shortness of breath and a dry unproductive cough that is getting worse.  Shewas tested on Monday for COVID-19 which was negative.  Her mother was evaluated by the primary care provider on Wednesday, tested positive and was admitted to the hospital.  She reports having chest pain, but most likely musculoskeletal in nature with the cough.  She denies any abdominal pain, has had episodes of nausea without any vomiting.  She had diarrhea   since Friday, but has not had any bowel movement today.  She denies any urinary issues.  She  is vaccinated for COVID-19.         On presentation to the emergency department she underwent a chest x-ray which showed no acute pulmonary, pericardial or vascular process suspected.  There is no acute pleural process identified.  Initial lab study showed normal WBC 6.0, hemoglobin and hematocrit of 13.7 and 43.1 respectfully, all other lab studies have been within normal limits.  The cardiac biomarker was negative and lactate was 1.7.  Blood cultures are pending.  The EKG showed normal sinus rhythm at a rate of 85 bpm with no acute ST changes.  She was treated with IV fluids, IV Zosyn, IV Toradol and started on IV dexamethasone 10 mg daily.        The initial systolic blood pressure was 109/70 mmHg with a heart rate of 98 bpm with a pulse oximetry of 96% on room air.  On reexamination pulse oximetry dipped to 89% on room air and she was placed on supplemental oxygen at 2 L/minute.  The most recent systolic blood pressure was 107/56 mmHg  with a heart rate is 70 bpm and a pulse oximetry of 99% on 2 L/minute.  She denies any lightheadedness or dizziness.  She is resting comfortably, offers no complaints and will be admitted for further evaluation and treatment   Hospital Course:    During the patient brief facility stay, patient was started on supplemental oxygen,  IV remdesivir, she was also started on IV Decadron.  Patient shows great improvement and was weaned off supplemental oxygen.  Patient's cough was treated with Mucinex and Tessalon as needed.   Patient showed great improvement, so much so that she requested to be discharged.  Patient upon discharge, patient denies nausea, vomiting, diarrhea, chest pain, shortness of breath, Chills, rigors, fever, hematemesis, hematochezia, difficulty urinating, hematuria, and difficulty breathing..   Patient encouraged to follow-up with PCP, she is also to take Decadron 6 mg by mouth for 7 days, she is to follow-up with the remote monitoring program.  She has been asked to come back to the hospital emergency room if she develop any worsening condition including elevated temperature difficulty breathing and chest pain.  Patient evaluated for discharge and was considered stable enough for discharge patient discharged in stable condition with discharge instruction including instruction for follow-up.  Patient and caregiver verbalizes understanding of discharge instruction all of patient questions were answered satisfactorily.  Case discussed with my collaborating physician who agrees with the assessment and discharge plan   Discharge Instruction Follow-up with your PCP Resume all your medication as prescribed Take Decadron 6 mg p.o. daily for 7 days Follow all the Covid precautions including high wash, mass, isolation Follow-up with the remote monitoring program If your condition worsen please report to the hospital ED for further evaluation  Medical Problems                Plan:  Acute respiratory failure with hypoxia most likely secondary to COVID-19:            Begin dexamethasone 6 mg IV daily for total of 10days first dose 10/10/2021.            Begin remdesivir 200 mg IV x1 followed by 100 mg IV x4 days.  Medication started 10/10/2021            Add Mucinex 600 mg 1 tablet twice daily            Continue nasal cannula oxygen to maintain pulse oximetry greater than 92%            Encourage incentive spirometer and self proning            Continue isolation precautions             Essential hypertension:             Controlled continue current home medications   Disposition:             Follow labs in a.m.             Obtain procalcitonin if elevated will consider antibiotic therapy.  Leukocytosis normal low-grade fever             Continue all current home medication             DC IV fluids             Out of bed to chair             Patient will be admitted inpatient to the medical surgical floor.  Expected length of stay 2 to 4 days             This admission was discussed with my collaborator   VTE prophylaxis: Lovenox Full Code     History of Present Illness    Chief Complaint Patient presents with ? Nausea ? Headache ? Cough     Patient is an 69 y.o. female who presented to the emergency department with cough, congestion, body aches, weakness, nausea and shortness of breath.  She began with symptoms approximately 5 days ago.  Both her mother and stepfather are admitted to the hospital for COVID-19.  She had a negative Covid test a few days ago, but had increasing shortness of breath.  Hospitalist was consulted for admission.          On examination today she was resting comfortably in bed.  She states for the last five days she had increased shortness of breath and a dry unproductive cough that is getting worse.  Shewas tested on Monday for COVID-19 which was negative.  Her mother was evaluated by the primary care provider on Wednesday, tested positive and was admitted to the hospital.  She reports having chest pain, but most likely musculoskeletal in nature with the cough.  She denies any abdominal pain, has had episodes of nausea without any vomiting.  She had diarrhea   since Friday, but has not had any bowel movement today.  She denies any urinary issues.  She  is vaccinated for COVID-19.         On presentation to the emergency department she underwent a chest x-ray which showed no acute pulmonary, pericardial or vascular process suspected.  There is no acute pleural process identified.  Initial lab study showed normal WBC 6.0, hemoglobin and hematocrit of 13.7 and 43.1 respectfully, all other lab studies have been within normal limits.  The cardiac biomarker was negative and lactate was 1.7.  Blood cultures are pending.  The EKG showed normal sinus rhythm at a rate of 85 bpm with no acute ST changes.  She was treated with IV fluids, IV Zosyn, IV Toradol and started on IV dexamethasone 10 mg daily.        The initial systolic blood pressure was 109/70 mmHg with a heart rate of 98 bpm with a pulse oximetry of 96% on room air.  On reexamination pulse oximetry dipped to 89% on room air and she was placed on supplemental oxygen at 2 L/minute.  The most recent systolic blood pressure was 107/56 mmHg  with a heart rate is 70 bpm and a pulse oximetry of 99% on 2 L/minute.  She denies any lightheadedness or dizziness.  She is resting comfortably, offers no complaints and will be admitted for further evaluation and treatment.           Review of Systems  Constitutional: Positive for fatigue. Negative for chills and fever.  HENT: Positive for congestion. Negative for trouble swallowing.   Respiratory: Positive for cough and shortness of breath. Negative for chest tightness.   Cardiovascular: Positive for chest pain.  Gastrointestinal: Positive for nausea. Negative for abdominal pain, diarrhea and vomiting.  Genitourinary: Negative for difficulty urinating, flank pain and frequency.  Musculoskeletal: Positive for back pain. Negative for neck pain.  Skin: Negative for rash.  Neurological: Negative for dizziness, weakness and light-headedness.  Psychiatric/Behavioral: The patient is not nervous/anxious.   All other systems reviewed and are negative.