Age: 47.0
Sex: F
Vaccine: COVID19
Symptoms: Chest X-ray normal, Chest pain, Chronic obstructive pulmonary disease, Condition aggravated, Cough
Clinical narrative: Hospitalized (2.15.22 - 2.23.22); COVID-19 positive (2.15.22);  fully vaccinated with one dose J&J Discharge Provider: DO Primary Care Provider at Discharge: DO Admission Date: 2/15/2022 Discharge Date: 2/23/2022 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Physical deconditioning [R53.81] Intertriginous candidiasis [B37.2] COVID [U07.1] COVID-19 [U07.1] COVID-19 with pulmonary comorbidity [U07.1, J98.4] HOSPITAL COURSE: Patient is a 48 y.o. female who presented today with a history of Alpha-1-antitrypsin, GERD, waiting with baseline 3L NC, Cerebral palsy. Patient complainted of shortness of breath and fatigue lasting for 4-5 days, and stated that "it burned when she urinated". Patient has been home for the past week while her fiance has been hospitalized. During the fiances hospitalization, patient was home alone with minimal assistance until he came home on Sunday. Patient had increased difficulty getting out of her chair and unable to bathe self without help. Patient brought into E.D. because fiance feels like he can not support patient at this time. It the E.D. Patient was found to be sitting in stool on her chair. UA collected was negative for UTI. Patient tested positive for Covid-19 in E.D. Labs and CXR done in E.D. are unremarkable. Hospitalist services contacted to admit patient for PT/OT evaluation and care management for possible discharge home with home services.  Chronic conditions of chronic obstructive pulmonary disease, obesity and cerebral palsy with extreme deconditioning hinder the course.  Chronic anxiety and depression  led to promoting increased air trapping on top of chronic condition of chronic obstructive pulmonary disease.  Continue home medications.  Cannot continue aerosolized albuterol treatments r/t facilitation of the spread of COVID.   Increased wheezing ->  change steroids to Solu-Medrol from Decadron. She was continued on 3 L of oxygen via nasal cannula which is her home supplemental oxygen level.  Symptomatic support for COVID-19 included Solu-Medrol, Symbicort, albuterol inhaler, Flonase, Lovenox for DVT and PE prophylaxis as well as supplemental oxygen. Concern for continuing to fail to thrive as an adult.   Discussed patient needs today.  Discussed completing the paperwork she/her fiance started for additional help in the home.  Discussed the need for physical therapy and to continue to move and do as much as she safely can for herself to reduce continued deconditioning.  Recommended discharge location for PT/ OT assessment: home, with assist, with home health, PT  Case management social worker working on contacting the family to ascertain what additional support she has.  She continued to improve and stabilize and was seen on the day of discharge ready to go home.  Care management made arrangements for HHN and chore worker.  She was discharged home on medrol dose pak and to continue her usual medications.  She is at her baseline O2 requirement.  She can return to activity and diet at usual.  She is recommended to follow up with her PCP to ensure resolution of her symptoms.  She understood these instructions and was discharged home in stable condition