Age: 75.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Chronic obstructive pulmonary disease, Condition aggravated
Clinical narrative: 75-year-old female presents to the emergency room with complaint of cough fever shortness of breath.  It is difficult to tell exactly how long symptoms have been present.  She states 2 weeks off and on but at other times states that most of her symptoms have really only been worse for the past for 5 days.  No diarrhea.  Patient lives alone.  She has tested positive for COVID tonight.  She has had the vaccination.  She knows of no exposure. Review of Systems     Constitutional:  [Patient denies fever, chills, sweats, and weight changes.] Eyes:  [Patient denies any visual symptoms] ENT:  [No difficulties with hearing. No symptoms of rhinitis or sore throat.] Cardiovascular:  [Patient denies any chest pain, palpitations, orthopnea, or PND.] Pulmonary:  As in HPI Gastrointestinal:  [No nausea, vomiting, diarrhea, constipation, abdominal pain, hematochezia, or melena.] GU:  [No urinary hesitancy or dribbling. No nocturia or urinary frequency. No abnormal urethral discharge.] Musculoskeletal:  [No myalgias or arthralgias. No hot, swollen joints.] Neurologic:  [No headaches, no seizures. Patient denies numbness, tingling, or weakness on either side of the body. There are no visual symptoms.] Psychiatric: [Patient denies problems with mood disturbance or anxiety.] Endocrine: [No excessive urination or excessive thirst noted. No heat or cold intolerance. No weight gain or changes in skin or hair.] Dermatologic:  [Patient denies any rashes or skin changes.] Physical Exam  Vitals & Measurements  HR: 89(Peripheral)  HR: 90(Monitored)  RR: 17  BP: 155/80  SpO2: 95%  WT: 114.9 kg   VITAL SIGN               LAST CHARTED          MINIMUM                 MAXIMUM            Blood Pressure        155/80 (10/01 21:15)   120/62 (10/01 20:15)    156/80 (10/01 19:15) Heart Rate                89      (10/01 21:15)      86     (10/01 20:45)     101  (10/01 18:20) Respirations             17      (10/01 21:15)      16     (10/01 20:30)     21     (10/01 19:10) Temperature            99.0    (10/01 18:20)     99.0   (10/01 18:20)     99.0  (10/01 18:20) SpO2                         95      (10/01 21:15)      86     (10/01 19:10)      97    (10/01 20:30) O2 Flow Rate           2        (10/01 19:56)        2     (10/01 19:56)       2     (10/01 19:56) Weight                      114.9  (10/01 18:20)      114.9  (10/01 18:20)     114.9  (10/01 18:20)   General: Alert and oriented, No acute distress.   Eye: Extraocular movements are intact.   HENT: Normocephalic, Atraumatic.   Neck: No jugular venous distention.   Respiratory:  Crackles bilaterally Cardiovascular: Normal rate, Regular rhythm.   Gastrointestinal: Soft, Non-tender, Non-distended, Normal bowel sounds.  Obesity Musculoskeletal:  4+ pitting pedal edema bilaterallyAdmitted with  Principal Diagnosis of COVID-19 pneumonia, Hypoxemia, Acute on Chronic hypoxemic respiratory failure.        Plan:  Vaccinated:         Yes Symptom onset:       9/17/21 Diagnosis:       10/1/21 Dexa day:      4 - wil complete 10 days at dc       Symptom duration likely too long to benefit from remdesivir.  She is on home oxygen 2 liters/minute while sleeping only, but she does not have tanks at home, will arrange home oxygen continuously at least for a few weeks... Diagnosis:  COPD.        Plan: No active wheezing.  On Advair.  Quit smoking in 1991 Diagnosis:  Obesity.   Diagnosis:  E. coli UTI.        Plan: Empiric ceftriaxone appropriate based on culture sensitivities, complete 3rd day here before dc. Diagnosis:  Hypokalemia.        Course: Improving.   Diagnosis:  Leukopenia.        Plan: Likely from virus, monitor.   Diagnosis:  Hypertension.        Course: Well controlled.   Diagnosis:  Elevated liver enzymes.        Plan: Likely from virus Diagnosis:  Type 2 diabetes mellitus with hyperglycemia.        Plan: She says she has been diabetic for 15 years but has never required medicine, always controlled with lifestyle.  Current flare likely from corticosteroid effect.  Checked A1c.  6.2, will be off Dex in a week so will not rx further insulin at dc.