Age: 62.0
Sex: M
Vaccine: COVID19
Symptoms: Hypertension, Hyponatraemia, Hypoosmolar state, Hypoxia, Immune thrombocytopenia
Clinical narrative: Date of Admission  01/17/2022   Date of Discharge  02/04/2022   Reason for Hospitalization   Pt was at cancer center for blood work follow up due to thrombocytopenia following prior covid vaccine. Pt presented with cough, fatigue, weakness, and fever. Denies known exposure to any illness but sent here for further work up  Hospital Course   Patient is a 62 y/o M w/ ITP, recurrent PEs on Eliquis, obesity, GERD, COPD (no home O2), HTN, and HLD initially admitted to FM service 1/17 for COVID PNA with new O2 requirement. Known to have COVID vaccine-mediated thrombocytopenia for which he was hospitalized at the hospital prior to admission. CTPE on admission showed PE's decreased compared to prior. S/p tocilizumab 1/20 and remdesivir x 5 days. Completed course of Rocephin/azith with concern for superimposed bacterial PNA. Hospital course complicated by worsening hypoxia for which he was transferred to the ICU 1/21 for BiPAP, weaned and transferred back to unit 1/24. 1/26 pt had worsening LUQ pain, with palpable mass and US confirmed rectus abdominis hematoma, underwent embolization of inferior and superior epigastric arteries by IR on 1/26. Ultimately required 2 units pRBCs for associated anemia; Eliquis restarted 1/31 and has been stable since. During his stay his steroid taper for his ITP was restarted but upon decreasing the dose, his platelets began to worsen. Therefore he will be discharged on his current dose of 16 and 8 mg in morning and evening and follow up in the hematology clinic closely for further tapering instruction. Was initially recommended IPR by PT/OT but PMR consulted and feel his function is quite good and would not be a candidate for IPR. Plan for discharge home with oxygen 2/4. He did have some abdominal pain at the site of his procedure on his abdomen. This area was noted to be stable in appearance and on palpation for several days prior to discharge. For reassurance, an US was ordered for the same day as his upcoming Heme onc appointment to ensure no development of bleeding in this area after discharge.   Also found to have balanitis and was prescribed miconazole x 14 days for that. Was noted to be tachycardic for much of his stay. Home metoprolol given on day of discharge given concurrent high BPs. Will hold home losartan as it has not yet been restarted and can be started in follow up with his regular provider.  The patient was seen and discussed with attending physician,  Discharge Diagnoses      Chronic obstructive pulmonary disease    Ordered:   DME - Home Oxygen Discharge     COVID-19    Ordered:   DME - Home Oxygen Discharge     Hematoma      Hypo-osmolality and hyponatremia      Hypoxia      Requires supplemental oxygen      Shortness of breath      Immune thrombocytopenia  Acute blood loss anemia  Tachycardia  Balanitis  Other Diagnoses   Ongoing  + MDQ screen, possible Bipolar  Abnormal echocardiogram  Anxiety  Choroidal neovascular membrane  Choroidal rupture, right eye  Chronic back pain s/p MVA  Disc disease, degenerative, cervical  Disc disease, degenerative, lumbar or lumbosacral  Erectile dysfunction  Foraminal stenosis of cervical region  Foraminal stenosis of lumbar region  Gastroesophageal reflux disease  Glaucoma associated with ocular trauma moderate  History of prostate cancer  History of pulmonary embolism  Hypertension  Pacemaker  Reactive airway disease  Historical  Anxiety state (panic sx)  Asthma  Cataract  Cholesteatoma  Chronic back pain  Chronic pain  Cortical cataract of both eyes  Eczema  Eczema  Elevated PSA  GERD (gastroesophageal reflux disease)  Glaucoma  Gun shot wound of thigh/femur  Hypertension  Hypertension  MVA (motor vehicle accident)  Primary open angle glaucoma of both eyes, severe stage  Prostate cancer screening  Pseudophakia of both eyes  Raised prostate specific antigen  Smoker     Consultants  Family Medicine General    Interventional Radiology    PMR   Pending Labs  None  Discharge Disposition  Home  Medications  New, Changed, or Refilled Medications  docusate-senna (docusate-senna 50 mg-8.6 mg) 2 Tablet(s), Oral/per Tube, bid, 30 Tablet(s), 0 Refill(s)    losartan (losartan 25 mg) 25 mg, 1 Tablet(s), Oral, Daily, hold this medicine until you see your doctor and have your blood pressure checked, 30 Tablet(s), 0 Refill(s)  Instructions:hold this medicine until you see your doctor and have your blood pressure checked  miconazole topical (miconazole 2% topical cream) 1 Application, Topical, bid, for 10 day(s), to affected area, 30 g, 0 Refill(s)  Instructions:to affected area  oxyCODONE (oxyCODONE 5 mg) 5 mg, 1 Tablet(s), Oral, q6h, PRN: Pain, Moderate, 24 Tablet(s), 0 Refill(s)    pantoprazole (pantoprazole 40 mg oral delayed rel 40 mg, 1 Tablet(s), Oral, Daily, 30 Tablet(s), 1 Refill(s)      Medications to be Continued  acetaminophen-oxyCODONE (acetaminophen-oxycodone 1 Tablet(s), Oral, bid, PRN: as needed for pain, 0 Refill(s)    albuterol (ProAir HFA 90 mcg/inh inhalation aeros 2 Puff, Inhalation, q6h, PRN: Wheezing    albuterol (albuterol 2.5 mg/3 mL (0.083%) inhalat 2.5 mg, 3 mL, Hi-Flow Neb, q6h, PRN: Shortness of Breath    albuterol-ipratropium (Combivent Respimat 20 mcg- 1 Puff, Inhalation, qid    amLODIPine (amLODIPine 10 mg) 10 mg, 1 Tablet(s), Oral, Daily    apixaban (Eliquis 5 mg) 5 mg, 1 Tablet(s), Oral, bid    aspirin (Aspirin Low Dose 81 mg , chewable) 81 mg, 1 Tablet(s), Oral, Daily    bisacodyl (Dulcolax Laxative 5 mg oral delayed re 5 mg, 1 Tablet(s), Oral, Daily, PRN: as needed for constipation    cetirizine (cetirizine 10 mg) 10 mg, 1 Tablet(s), Oral, Daily    cholecalciferol (cholecalciferol 1000 intl units) 1,000 IntUnits, 1 capsule(s), Oral, Daily, 90 capsule(s), 0 Refill(s)    citalopram (citalopram 20 mg) 20 mg, 1 Tablet(s), Oral, Daily    clobetasol topical (clobetasol 0.05% topical oint 1 Application, Topical, bid    desonide topical (desonide 0.05% topical ointment 1 Application, Topical, bid, on face  Instructions:on face  diphenhydrAMINE (diphenhydrAMINE 25 mg) 50 mg, 2 capsule(s), Oral, tid, PRN: as needed for itching    finasteride (finasteride 5 mg) 5 mg, 1 Tablet(s), Oral, Daily    fluticasone (Flovent HFA 110 mcg/inh inhalation a 2 Puff, Inhalation, bid    latanoprost ophthalmic (latanoprost 0.005% ophtha 1 Drop(s), Each Eye, qEvening, for 21 day(s), 2.5 mL, 11 Refill(s)    methylPREDNISolone (methylPREDNISolone 4 mg) 16 mg, 4 Tablet(s), Oral, qAM    methylPREDNISolone (methylPREDNISolone 4 mg) 8 mg, 2 Tablet(s), Oral, qEvening    metoprolol (Metoprolol Succinate ER 50 mg , exten 50 mg, 1 Tablet(s), Oral, At Bedtime    ocular lubricant (Refresh ophthalmic solution) 1 Drop(s), Each Eye, qid, PRN: Dry Eyes    prednisoLONE ophthalmic (prednisoLONE acetate 1% 1 Drop(s), Right Eye, Daily, PRN: as needed for pain    sildenafil (sildenafil 100 mg) 100 mg, 1 Tablet(s), Oral, Daily, PRN: intercourse    sodium chloride nasal (Saline Mist 0.65% nasal sp 2 Spray, IntraNasal, qid, PRN: Dry Nasal Passages    timolol ophthalmic (timolol maleate 0.5% ophthalm 1 Drop(s), Right Eye, qAM, for 21 day(s), 5 mL, 11 Refill(s)    traZODone (traZODone 50 mg) 50 mg, 1 Tablet(s), Oral, At Bedtime, 30 Tablet(s), 0 Refill(s)    triamcinolone topical (triamcinolone 0.025% topic 1 Application, Topical, Daily      Discontinued Medications  omeprazole (omeprazole 40 mg oral delayed release 40 mg, 1 capsule(s), Oral, Daily       Physical Exam at Discharge  Vitals & Measurements  T: 36.5 °C  TMIN: 36.5 °C  TMAX: 36.8 °C  HR: 111  RR: 16  BP: 146/82  SpO2: 96%  WT: 105 kg  BMI: 32.2      GENERAL: Well-appearing, no acute distress. HEART: Normal rate, regular rhythm, no murmur, rubs, or gallops. LUNGS: Nonlabored breathing, clear to auscultation bilaterally, no wheezes, crackles, or rhonchi. ABDOMEN: Soft, mildly tender, nondistended. No masses or organomegaly appreciated. Stable appearing bruising from hematoma within the drawn boundaries MUSCULOSKELETAL: No edema in lower extremities, no tenderness to palpation. SKIN: No pallor or rash noted. NEUROLOGIC: Alert. No focal neurological deficits. PSYCHIATRIC: Cooperative. Answers questions appropriately.     Follow Up Appointments     Follow Up Appt Family Medicine, Clinic Name/Phone: Clinic, Provider Name: FNP, Within 7 Days, No tests    Appointment Type  When  With  Where  Contact Information  Status   02/08/2022 11:00 AM MD, Medical Oncology  Clinic  06/28/2022 MD,  Glaucoma  Eye Clinic     Nursing/Other Orders   DME - Home Oxygen Discharge. 02/03/22 12:35:00 CST, Once, 02/03/22 12:35:00 CST, 02/02/2022, SpO2 at Rest but Awake Without Oxygen: 92, At Rest but Awake SpO2: 92, Exercise without Oxygen SpO2: 87, Exercise with Oxygen SpO2: 92, O2 Required to Return to Ordered SpO2: 4, O2 Liter Flow/FlO2: 4, With exercise, Portable gas needed? Yes, Titrate for conserver: Yes, Length of need: 12 months, Nasal Cannula, Chronic obstructive pulmonary disease, COVID-19   Regular Diet. Ordered on 01/26/22 13:50:00, Meal Start Time Lunch 1115 to 1245   Intake and Output. 01/17/22 19:19:00, Continuous Order   Intake and Output. 01/21/22 0:41:00, Continuous Order   Activity As Tolerated. 01/17/22 19:19:00, Continuous Order, activity as tolerated with patient confined to room.   Code Status. Code Status Description: Full Code   Attestation by MD on February 09, 2022 15:37 I personally saw and evaluated the patient on the result date found in the header of this document.  I independently performed the critical/key portions of the Evaluation and Management service and discussed the management with the author of this document.  I agree with everything documented above with the following exceptions/additions:    <30 minutes spent day of discharge