Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Breath sounds abnormal, COVID-19, COVID-19 pneumonia, Capillary nail refill test, Cardiac telemetry
Clinical narrative: Hospitalized (3.1.22 - 3.4.22); COVID-19 positive (3.1.22); Fully vaccinated  - J&J x1 d/c summary:Discharge Summary MD (Resident) Hospitalist Cosigned by: DO at 3/5/2022  4:06 PM DISCHARGE SUMMARY   BRIEF OVERVIEW: Discharge Provider: DO Primary Care Provider at Discharge: MD Admission Date: 3/1/2022 Discharge Date: 3/4/2022   HOSPITAL PROBLEMS 1. Acute hypoxic respiratory failure-resolved 2. Covid-19 pneumonia 3. Influenza 4. Tobacco use disorder 5. Alcohol use disorder 6. Abnormal UA   PROCEDURES/IMAGING CXR: No findings to suggest acute pulmonary parenchymal process.   DETAILS OF HOSPITAL STAY: HOSPITAL COURSE: Patient is a 66 y.o. female admitted to the hospital with acute hypoxic respiratory failure secondary to Covid-19 and Influenza infections.   Covid-19: Patient was dyspneic and hypoxic on admission, requiring 1L NC. Symptom onset 2/27/2022. Had been experiencing cough, congestion, nausea and headache. She was started on Dexamethasone and Remdesivir, as well as lovenox for DVT prophylaxis. Patient was weaned off oxygen to room air with improvement in SOB. Had symptomatic improvement although cough continued to linger, causing chest pain. Patient wished to discharge home given improvement in symptoms. Was discharged after receiving 3 doses of Remdesivir and 3 dose of Dexamethasone. Will complete 10 day course of Dexamethasone as outpatient.    Influenza: Symptoms as noted above. Was started on Oseltamivir. Will finish 5 day course as outpatient.     Abnormal UA: UA with  Negative nitrates, trace leukocytes, 2.8 WBC, many bacteria. Received one dose of Ceftriaxone 1g. As patient was not demonstrating symptoms likely asymptomatic bacteruria so Ceftriaxone was discontinued.   Alcohol use disorder: Patient drink 0.5-1pint once a week. Last drink was two days prior to admission. Patient did not develop withdrawal symptoms.    Tobacco use disorder: Patient is a current everyday smoker. Cessation counseling given.    BP 131/88  | Pulse 74  | Temp 36.9 °C (Oral)  | Resp 20  | Ht 1.651 m  | Wt 73 kg  | SpO2 93%  | BMI 26.78 kg/m²    Physical Exam Constitutional:      General: She is not in acute distress.    Appearance: She is normal weight.  HENT:     Head: Normocephalic and atraumatic.     Nose: No congestion or rhinorrhea.     Mouth/Throat:     Mouth: Mucous membranes are moist.  Eyes:     General:        Right eye: No discharge.        Left eye: No discharge.     Conjunctiva/sclera: Conjunctivae normal.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Pulses: Normal pulses.     Heart sounds: Normal heart sounds. No murmur heard. Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Comments: Crackles lower lung zones Abdominal:     General: There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness.  Musculoskeletal:     Right lower leg: No edema.     Left lower leg: No edema.  Skin:    General: Skin is warm and dry.     Capillary Refill: Capillary refill takes less than 2 seconds.  Neurological:     General: No focal deficit present.     Mental Status: She is alert.  Psychiatric:        Mood and Affect: Mood normal.     DISCHARGE RECOMMENDATIONS: Finish 10 day course of Dexamethasone 6mg daily (7 remaining doses) Finish 5 day course of Oseltamivir 75mg BID (4 remaining doses)  DISCHARGE DISPOSITION: Home without services  CONDITION ON DISCHARGE: Stable, on room air.   3/2/22 H&P:  CHIEF COMPLAINT: Dyspnea HISTORY OF PRESENT ILLNESS: 66-year-old female who presented with fevers and dyspnea.  66-year-old female who presented with fever, chills, sore throat, cough, and shortness of breath.  In the emergency room patient was found to be both positive for COVID-19 and influenza.  Patient was hypoxic and required 1 L nasal cannula.  Hospitalist service was asked to admit patient for further management of these issues.  At the time of this providers exam patient is resting quietly in bed,  Patient has been sick for 24 hours.  Patient has had fever, chills, nasal congestion, mild shortness of breath, nausea (no vomiting), diarrhea (non-bloody, non-tarry), headaches (6/10, pain on top of head)  Increased urinary frequency.  No hematuria or dysuria.  Patient denies  chest pain, falls, syncope, abdominal pain, nausea, constipation,  dysuria, head injury,  numbness, tingling, one-sided weakness, vision changes, skin rashes, homicidal thoughts or suicidal thoughts ED course: Tylenol, albuterol, Motrin, Zofran, Tamiflu, 1 L normal saline Family history: Mom-died by suicide Dad-died of stroke Review of Systems Constitutional:  Positive for chills and fever.  HENT: Positive for congestion.  Eyes: Negative for visual disturbance.  Respiratory:  Positive for cough and shortness of breath. Negative for sputum production.   Cardiovascular:  Negative for chest pain.  Gastrointestinal:  Positive for nausea and diarrhea. Negative for vomiting, abdominal pain and constipation.  Genitourinary:  Negative for dysuria.  Musculoskeletal:  Negative for falls.  Neurological:  Positive for headaches. Negative for numbness/tingling.  Psychiatric/Behavioral:  Negative for behavioral problems.  Skin:  Negative for new spots.  OBJECTIVE: BP 150/65  | Pulse 93  | Temp 37.8 °C (Oral)  | Resp 20  | Ht 1.651 m  | Wt 73 kg  | SpO2 94%  | BMI 26.78 kg/m²    Physical Exam Constitutional:      General: She is not in acute distress.    Appearance: Normal appearance. She is not ill-appearing, toxic-appearing or diaphoretic.  HENT:     Head: Normocephalic and atraumatic.     Nose: Nose normal.     Mouth/Throat:     Mouth: Mucous membranes are moist.     Pharynx: Oropharynx is clear.  Eyes:     Extraocular Movements: Extraocular movements intact.     Pupils: Pupils are equal, round, and reactive to light.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Pulses: Normal pulses.     Comments: No lower extremity edema Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: No wheezing.     Comments: Diminished lung sounds in all posterior fields.  Respiration rate 16 breaths per minute while provider in room.  Patient able to talk to provider in full sentences without becoming short of breath.  No retractions or accessory muscle use.  No acute respiratory distress at this time. Abdominal:     General: Bowel sounds are normal. There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness. There is no guarding.  Musculoskeletal:        General: Normal range of motion.  Skin:    General: Skin is warm and dry.     Capillary Refill: Capillary refill takes less than 2 seconds.  Neurological:     Mental Status: She is alert and oriented to person, place, and time. Mental status is at baseline.     Cranial Nerves: No cranial nerve deficit.     Sensory: No sensory deficit.     Motor: No weakness.  Psychiatric:        Mood and Affect: Mood normal.        Behavior: Behavior normal.        Thought Content: Thought content normal.        Judgment: Judgment normal.  ASSESSMENT/PLAN: COVID-19 pneumonia -patient is symptom day 2 -vaccinated status: had 1 dose about a year ago -continue Decadron -remdesivir-yes -telemetry and continuous pulse ox -supportive care with Tylenol and antitussives -encourage pronating -patient is aware that any close contacts need to to follow current CDC isolation guidelines. -check CMP, complete blood count, D-dimer, and CRP. -if patient's oxygen needs continued to increase and inflammatory markers continue to trend up consider switching to Solu-Medrol from Decadron and full-dose anticoagulation Influenza A -see plan above for 1. -Tamiflu Urinary tract infection -patient complains of increased urinary frequency over the past couple of days -blood cultures, urine culture, start Rocephin GERD -not currently on outpatient medications Tobacco use disorder -encourage cessation Alcohol use disorder -patient endorses drinking half a pint to a pint approximately once a week.  Last alcoholic beverage was 2 days ago. -given that patient does not regularly consume this amount of alcohol on a daily basis and that last drink was 2 days ago do not feel that patient needs Alcohol Assessment at this time -telemetry and continuous pulse ox above -if patient begins to exhibit signs of withdrawal will add Alcohol Assessment. DVT prophylaxis -subcu Lovenox Patient wishes to be a full code