Age: 92.0
Sex: F
Vaccine: COVID19-2
Symptoms: Cardiac murmur, Chest X-ray abnormal, Chromaturia, Chronic kidney disease, Chronic obstructive pulmonary disease
Clinical narrative: Date of Service Jan-18-2023 1040  Date of Admission Admit Date: Jan-17-2023  Date of Discharge Date of discharge Jan-18-2023  Allergies No Known Allergies  Chief Complaint Weakness, fatigue, shortness of breath  Final Diagnoses Acute exacerbation of chronic obstructive airways disease  Acute hypoxemic respiratory failure  Acute COVID-19  Procedure(s) Performed None  Lab Results Jan-18-2023 0455 Hematology WBC  4.3RBC  3.03HGB  10.3HCT  32.3MCV  106.6MCH  34.0MCHC  31.9RDW  13.5RDWSD  53.3PLT  260MPV  10.1AUTONEU%  78.6AUTOLYM%  20.2AUTOMON%  0.7AUTOEOS%  0.0AUTOBAS%  0.0AUTONEU#  3.4AUTOLYM#  0.9AUTOMON#  0.0AUTOBAS#  0.0AUTOEOS#  0.0NRBC%  0.0NRBC  0.0HGB/HCT  3.1IG#  0.02IG%  0.5 Jan-18-2023 0455 Chemistry GLUCOSE  126BUN  31CREAT  1.7MDRD GFR  28NA  140K  5.2CL  108CALCIUM  8.6ALK PHOS  61CO2  24.9AST  20ALT  12AST/ALT  1.7TL PROT  5.9ALBUMIN  2.5TBILI  0.2DBILI  <0.1OSMO  287.5ANION GP  12.3BUN/CRE  18.2 Jan-17-2023 1528 Urinalysis Department SPECGRAV  1.020U-PH  6.0LEUCOCYT  NegativeNITRITES  NegativePROTEIN  TraceGLUCOSE  NegativeKETONES  NegativeUROBILIN  0.2BILRUBIN  NegativeBLOOD  NegativeCOLOR  Lt. YellowCLARITY  ClearMICROSCP  NCULTURE  NCULTIND  Not Indicated Jan-17-2023 1220 Serology PROCALC  0.06 Jan-17-2023 1220 Hematology WBC  3.8RBC  3.14HGB  10.9HCT  33.5MCV  106.7MCH  34.7MCHC  32.5RDW  13.5RDWSD  53.1PLT  247MPV  10.1AUTONEU%  51.0AUTOLYM%  36.6AUTOMON%  10.2AUTOEOS%  1.6AUTOBAS%  0.3AUTONEU#  2.0AUTOLYM#  1.4AUTOMON#  0.4AUTOBAS#  0.0AUTOEOS#  0.1NRBC%  0.0NRBC  0.0HGB/HCT  3.1IG#  0.01IG%  0.3 Jan-17-2023 1220 Chemistry GLUCOSE  106BUN  33CREAT  1.8MDRD GFR  26NA  143K  4.9CL  107CALCIUM  8.9ALK PHOS  71CO2  28.7AST  18ALT  13AST/ALT  1.4TL PROT  5.9ALBUMIN  2.8TBILI  0.3OSMO  292.7ANION GP  12.2BUN/CRE  18.3LDH  201CRP  2.20LACTATE  0.60 Jan-16-2023 1210 Serology COVID  Pos Imaging Results 1V CXR 1/17/23: Stable chronic interstitial changes with chronic reticulonodular opacities. Heart size is stable. No focal consolidations or pulmonary edema. No pneumothorax. Read by: MD  Echocardiogram 01/18/2023: LVEF over 60%. Grade 2 diastolic dysfunction. Sigmoid septum. Mild concentric left ventricular hypertrophy. Mild left atrial enlargement. Mild mitral regurgitation. Mild mitral stenosis. Mild anterior leaflet mitral valve prolapse. Aortic cusps mildly calcified. Trileaflet aortic valve. Mild aortic root dilatation. Aortic valve sclerosis. Mild tricuspid valve regurgitation without pulmonary artery hypertension. Read by: D.O.  Functional Status* Impaired mobility (Uses walker), Visual impairment (Wears glasses), Hearing Impaired (Wears hearing aids)  Mental Status* Normal Cognition  Social History tobacco use Never Smoked, 1/2 Packs Per Day, Smoking Cessation Not Applicable  alcohol use No Known Use  drug use No Known Use  marital status Widowed  general comment Lives at home with her son.  She carries out many tasks of daily living, and uses a walker to ambulate.  Health Concerns Acute exacerbation of chronic obstructive airways disease  Acute hypoxemic respiratory failure  Acute COVID-19  Father Deceased Cardiomegaly  Mother Deceased Hypertensive disorder; Malignant tumor of colon  Brother Deceased Hypertensive disorder  Sister Alive Hypertensive disorder  Tobacco Cessation* Non-Smoker, Non Tobacco product user  Vital Signs Jan-18-2023 0630 T 97.4 HR 68 RR 14 BP   133 / 66 O2Sat 95 Jan-17-2023 2000 T 98.6 HR 61 RR     22 BP   150 / 67 O2Sat 96 O2L 1.5 PHYSICAL EXAM CONSTITUTIONAL: Patient sitting in bedside recliner, looking at window. In no acute distress. Pleasant cooperative. EYES: Vision is grossly intact, pupils are equal, and conjunctivae are without injection and pallor. EARS, NOSE, & THROAT: Oral mucosa is moist and the tongue is without fissures. CARDIOVASCULAR: Regular rate and rhythm without gallops or rubs. 3+ systolic murmur. Pulses are 2+ in the bilateral upper and lower extremities. No edema noted. RESPIRATORY: Lungs are clear to auscultation bilaterally without rales and wheezes. Respiratory effort is not labored. No retractions or accessory muscle use noted. On 2L NC. GASTROINTESTINAL: Abdomen is soft, nontender, and nondistended. Bowel sounds are normoactive. SKIN: Skin is warm, dry, and without wounds, rashes, and concerning lesions. Senile purpura. NEUROLOGICAL: Patient is alert and oriented to person, place, time, and event. Sensation is grossly intact in the bilateral upper and lower extremities. PSYCHIATRIC: The patient?s mood is euthymic and affect is appropriate. RASS of 0.  Hospital Course Patient is a 92-year-old female who was admitted on 01/17/2023 for weakness, fatigue, and dehydration with an acute exacerbation of her COPD secondary to COVID-19. She tested positive for COVID-19 on 01/16/2023. Patient was placed on maximum 3 L nasal cannula and was able to maintain saturations above 92%. She was started on dexamethasone 6 mg q.d. due to oxygen requirement. Due to her renal function, she is not a candidate for antiviral therapy while inpatient. Patient received normal saline, which slightly improved her renal function likely back to baseline. Patient feels significantly better on day 2 of admission. She was able to walk with physical therapy and her walker. Echocardiogram was performed during admission, with no right heart strain secondary COVID-19. On day of discharge, patient's son is present and is agreeable to discharge home safely.  Condition at Discharge Stable  Discharge Medications ALBUTEROL SULFATE HFA 108 (90 Base) MCG/ACT 2 PUF INHALATION EVERY 4 HOURS AS NEEDED PER RT for SHORTNESS OF BREATH (ePrescribed by RESIDENT on Jan-18-2023 1056) Amiodarone HCl Oral Tablet 100 MG 100 MG ORALLY ONCE A DAY Breo Ellipta Inhalation Aerosol Powder Breath Activated 100-25 MCG/ACT 1 PUF INHALATION ONCE A DAY Carvedilol Oral Tablet 12.5 MG 12.5 MG ORALLY TWICE DAILY Dexamethasone Oral Tablet 6 MG 6 MG ORALLY ONCE A DAY (ePrescribed by RESIDENT on Jan-18-2023 1056) DOXYCYCLINE MONOHYDRATE 100 MG ORALLY TWICE DAILY (ePrescribed by RESIDENT on Jan-18-2023 1056) guaiFENesin-DM 100-10 MG/5 ML 10 ML ORALLY EVERY 4 HOURS AS NEEDED FOR N V for COUGH HYDROcodone-Acetaminophen Oral Tablet 5-325 MG Continue taking same as home Incruse Ellipta Inhalation Aerosol Powder Breath Activated 62.5 MCG/ACT 1 PUF INHALATION ONCE A DAY Levothyroxine Sodium Oral Capsule 50 MCG 50 MCG ORALLY 30 MINUTES BEFORE BREAKFAST Linzess Oral Capsule 72 MCG 72 MCG ORALLY 30 MINUTES BEFORE BREAKFAST LORazepam Oral Tablet 0.5 MG 1 MG ORALLY DAILY AT BEDTIME Ondansetron HCl Oral Tablet 8 MG Continue taking same as home PreserVision/Lutein Oral Capsule 1 CAP ORALLY TWICE DAILY Simvastatin Oral Tablet 20 MG 20 MG ORALLY DAILY AT BEDTIME Vitamin B-12 Sublingual Tablet Sublingual 1000 MCG 1000 MCG SUBLINGUAL ONCE A DAY Vitamin D3 Oral Capsule 250 MCG (10000 UT) 250 MCG ORALLY EVERY WEEK Discharge Disposition Discharge to home  Plan Assessments: -Acute hypoxic respiratory failure, acute, secondary to COVID-19 and AECOPD -Acute exacerbation of chronic obstructive pulmonary disease, likely secondary to COVID-19 infection -COVID-19 infection, tested positive on 1/16/23 -Squamous cell carcinoma of the throat, chronic -Diarrhea, acute -Stage 4 CKD, GFR = 26, chronic -Essential hypertension, unknown control, -Hypothyroidism, unknown control, on thyroid medication -Medication non-compliance via PCP -Hyperlipidemia -History of myocardial infarction -Macrocytic anemia, combined iron deficiency and chronic disease, stable -Paroxysmal atrial fibrillation, unknown chronicity -History of GI Bleed -Anxiety disorder, unspecified, per history   Plan: The patient's condition is stable at this time and will be discharged today to home. We will discharge the patient on their home medications as reconciled above. We recommend the patient follow up with Dr. within 7-10 days for hospital follow-up.  Per respiratory therapy, patient will require 2L NC at all times to maintain oxygen saturation above 92%.  Per physical therapy, patient will be safe to return home with her son. She has a walker at home, which she is encouraged to use.  We are sending the patient home on the following medications: -dexamethasone 6 mg p.o. q.d. x8 days -doxycycline 100 mg p.o. b.i.d. x4 days -albuterol inhaler 2 puffs q.4 hours p.r.n. -Mucinex OTC  Patient was having runny stools on admission, which improved. If she continues to have runny stools, there should be consideration for C. diff testing.  The patient was evaluated by Dr. and the plan of care was discussed with this resident.  PGY-2  Discharge Instructions Diet Cardiac  Activity As tolerated with walker  Follow up Appointments Dr. in 7-10 days  Primary Care Provider DO  Electronically signed by PGY-1 on Jan-18-2023 1125 I have seen and physically examined the patient on [1/18/23] and agree with the documentation of [Dr]. I have also discussed my findings and plan of care with [Dr]. Any changes and additional information are listed below. Electronically signed by MD MD on Jan-18-2023 1140