Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Hemiparesis, Hypertension, Hypervolaemia, Laboratory test abnormal, Left atrial enlargement
Clinical narrative: Patient is a 64 y.o. female patient of local MD with history of covid, carotid occlusion, CKD, DMII, COPD, CVA who is presented to local Medical Center with abnormal labs, flank pain.    Acute on CKD IV Fluid overload  HTN Follows with Dr. as OP Baseline Cr ~ 4 to 5 range  Cr 5.8 on admit; trended to 5.94 / K 4 (01/18)  CXR (01/17) with mild fluid overload  VIR consulted for permacath, placed 1/19 Nephrology consulted-plan to start HD, add renal vitamins Vascular consulted?Vein-mapping duplex resulted; L basilic appears adequate for AVF conduit No BP cuffs/IVs/blood draws to LUE Carotid artery disease; mgmt per neuro VIR. s/p dx cerebral angiogram 1/2022. Ok for discharge from vascular standpoint once duplex completed, signing off; 2 week f/u appt to be scheduled to review said duplex and discuss plan for AVF/AVG.  PT OT recs 2-3 days c/w HHC  O/p HD chair set up Palliative consulted   Covid-19 Virus Infection Date of onset of symptoms: 1/23/23 Symptoms present on admission: Nasal congestion, fever Date of covid positive test: 1/24/23 Vaccination status: vaccinated Imaging: CXR with pulm vascular congestion or bronchitis Oxygen requirements on admission: 2L PRN Current oxygen requirements: RA Medical therapy: not indicated Consultants following: e-consult to ID for Paxolvid Anticipated special isolation end date: 2/2/23   DM type 2 noninsulin dependent, Uncontrolled  A1c 12 Home regimen with Lantus 44U at HS, Lispro 11 U prandial TID Decreased to 40 units nightly, 7 prandial and SSI on admission Has been well controlled on Lantus 20u nightly. Dc home with 24u Nightly and titrate o/p as needed Continue Lantus and sliding scale insulin at reduced dose Glucagon prescribed on discharge and educated    Acute respiratory failure, hypoxic - Resolved H/o COPD Secondary to fluid overload and acute on chronic heart failure preserved EF Required 2L, now weaned off Continuous pulse ox Reports using 2L PRN at home Acute on chronic HFpEF  HTN, benign, controlled TTE (04/2021) w/ EF 61%, moderate LVH, LAE, mild AS Clinically mildly volume overloaded Continue home Coreg, Imdur, Nifedipine, and Aldactone  Continue telemetry    Migraine Headache History of CVA Residual L hemiparesis  Bilateral carotid stenosis Chronic / stable residual left hemiparesis, slight facial asymmetry  CT Brain-No acute intracranial abnormality.  Appearance of the brain is unchanged. Neurology consulted-Start topiramate 25 mg at bedtime Potential side effects discussed Dosage can be titrated upward as needed Pt will need outpatient follow up in 4-6 weeks Continue home Lipitor No home ASA or Plavix  Added Migraine cocktail   Anemia in CKD  Baseline Hgb ~ 10 to 11 Hgb 11 on admit, trended to 9.8 (01/18), 9.6 1/20, 9.8  1/21 HDS without active bleeding, monitor  Follows with Dr. and has had multiple admissions for acute on chronic anemia with GI workup  Seen by GI (last 02/2022); multiple EGD / C scope / push enteroscopy without obvious bleeding  Consulted-received procrit, now on HD, can resume eryhtropoetin with hemodialysis Follow   Itching - Resolved Secondary to CKD stage 4 Added Nivea lotion 1/20 Added prn Benadryl- ok per Nephrology Follow