Age: 87.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Adenovirus test, Aortic arteriosclerosis, Bordetella test negative, Bronchiectasis
Clinical narrative: ED to Hosp-Admission Current  - 9/6/2021 - present (9 days) Hospital   Pneumonia due to COVID-19 virus  Assessment/Plan - 88 y.o. female, with past medical history of hypothyroidism, hypertension, rheumatoid arthritis on predisone, DVT, who is admitted on 9/6/2021 with  Pneumonia due to COVID-19 virus   1.  Acute hypoxic respiratory failure due to COVID-19 pneumonia. Per daughter in law, patient only got her first dose of Covid vaccine. She was told not to get the second dose of vaccine due to the correlation between the vaccine and DVT (in April 2021). Her oxygen saturation was 88% on room air.  Patient is put on 4 L nasal cannula oxygen O2 sat 96%. Her D-dimer is elevated 1.54.  Elevated 204.  proCalcitonin is normal 0.18.  CT without contrast shows Multiple foci of ground glass opacification bilaterally. The appearance is consistent with Covid 19.  We will admit patient to telemetry. Start remdesivir for 5 days. Patient is on prednisone 15mg at home for RA. We will hold that and give dexamethasone 6mg daily instead for 10 days. Will trend Ferritin, ALT, CRP. No indication for antibiotics. Will put on Heparin subcutaneous for DVT prophylaxis. It is noted that patient has h/o DVT, but not on anticoagulation due to bleeding (GI, ecchymosis etc). PE can not be ruled out. Since the test won't change the management anyway, we will hold CTA chest for now. Patient's daughter in law in agreement with this plan.    History of left lower extremity DVT, extensive, provoked due to reduced mobility. Patient is not on anticoagulation due to GI bleeding and ecchymosis. Patient declined GI procedure (EGD/colonoscopy). Patient had IVC filter placement on 3/24/2021. Family is aware that even with IVC filter in, there is still risk for pulmonary embolism/DVT.      Acquired hypothyroidism: She is on Synthroid 125 mcg daily (6 times a week from Monday to Saturday).   Essential hypertension:  continue home Lisinopril HCTZ   Rheumatoid arthritis: on steroid as above.    Depression: Mood is relatively stable at this time.  Continue Effexor 25 mg PO BID.   Constipation: Continue MiraLAX and Peri-Colace      o DVT Prophylaxis: Heparin sc    o Disposition:   telemetry o Code Status:  DNR (Do Not Resuscitate)  Patient has a living will with DNR. Confirmed with daughter in law. o Consult Services: none     HPI This is a 88-year-old female with a history of hypertension, rheumatoid arthritis, DVT of the right leg not amenable for anticoagulation due to prior GI bleed who presented to the emergency room with one-week history of increased shortness of breath, cough,  fatigue weakness and found to be with a saturation of 89% on room air.     Patient presents to the emergency room via EMS that placed patient on 4 L.  Patient has only been vaccinated for 1st dose of Covid.  Denies any fever chills denies any chest pain. Patient is a poor historian.   Her Covid is positive. She has IVC filter. CT chest without contrast shows bilateral Multiple foci of ground glass opacification. Consistent with Covid -19.