Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: Oral candidiasis, Pain, Peripheral swelling, Platelet count decreased, Pneumonia
Clinical narrative: Patient currently inpatient at (3) days admission from 11/29. Patient was hospitalized 11/6/21 with pneumonia not COVID for (8) days. - Hospital course from 11/6/21- 1. Pneumonia/septic shock/respiratory failure:  This is an 82-year-old patient who presented with body aches, productive cough, and general malaise.  She presented to the ER for evaluation and was found to have leukocytosis and increased oxygen demand.  CT angiogram of the chest was consistent with left upper lobe pneumonia.  In the emergency room, the patient developed hypotension that was resistant to fluids and required Levophed.  Treated with Levaquin in the ER, then Rocephin and doxycycline by the admitting provider.  COVID testing negative.  MRSA screen negative.  Sputum culture showed normal upper respiratory flora.  Legionella antigen negative.  Strep antigen negative.  FilmArray negative.  Two blood cultures negative.  Shock resolved and Levophed was weaned off.  She completed 6 days of Rocephin, then the IV site was lost and she had 1 day of Ceftin to complete 7 days of therapy.  She received 7 days of doxycycline.  At discharge, her oxygen requirements were back to her baseline of 2 L per nasal cannula.  She does not require antibiotics at discharge.     2. CHF.  On admission, the patient's Entresto. Aldactone, and Lasix were held due to septic shock.  She was treated with IV fluids.  She did develop pulmonary edema and diuresis was initiated with improvement in pulmonary status.  I's and O's were equal by the time of discharge.  Entresto, Aldactone, and Lasix were resumed home doses at discharge.   3. Asthma and restrictive lung disease.  Treated with Solu-Medrol, then transitioned to prednisone.  Steroids were not needed at discharge.  She will resume her home inhaler regimen.   4. Anemia.  Hemoglobin initially 10.2, dropped to 8.1 and is 9.4 at discharge.  Iron studies revealed low iron and iron saturation.  She received 200 mg Venofer IV on 11/09.  There was felt to be a dilutional component as well as chronic disease.   5. Acute on chronic thrombocytopenia. The patient has chronic thrombocytopenia with platelets in the 120s.  On admission, platelets were 117, reached a nadir of 96 and rebounded to 117 at discharge.  This is felt to be due to sepsis.  Should be monitored outpatient.   6. Anxiety.  The patient had significant anxiety.  Initially, we believed this was due to her respiratory distress, but as the hospitalization went on and her respiratory status improved, she continued to have anxiety, likely precipitated by steroids.  Hydroxyzine tried, but was not particularly effective.  She did have good relief with BuSpar 5 mg 2 times a day and this was prescribed at discharge.   7. Thrush.  The patient developed oral candidiasis and was treated with nystatin swish and swallow.   8. Left TMJ dysfunction.  The patient complained of left ear pain.  The external ear, internal ear, internal ear canal, and TM were normal.  She does have a moderate dislocation of the TMJ ball joint when she opens her mouth.  It does not fully dislocate and when she closes her mouth, it goes back into position.  She was counseled to keep from opening her jaw widely and trying not to yawn widely.   9. Thyroid nodule.  This was seen incidentally on the CT angio of the thyroid.  Outpatient ultrasound recommended.    The rest of the patient's chronic medical problems were stable during the hospitalization.  Hospitalization from 11/29/21- H& P -Patient is a 82 y.o. female with a history of oxygen-dependent chronic diastolic heart failure who presents today with dyspnea.  She had been admitted to the hospital for community-acquired pneumonia and discharged home on November 14th.  At that time she did feel improved.  Her breathing has been essentially baseline since that time until today.  She noted that she had been able to taste anything all day and she became considerably short of breath today.  She called EMS for transport to the emergency department to be evaluated.  She has had some coughing.  She denies any rhinorrhea, vomiting, or diarrhea.  She has not had any fever.  She has had an increase in weight of about 20 lb since discharge and notes significantly increased swelling in her legs and feet.  She has been taking her medication as prescribed.  She has been fully vaccinated for COVID-19 and has received a booster shot.  On arrival, she was noted to be hypoxic on her baseline 2 L of supplemental oxygen.  She tested positive for COVID-19.  She had radiographic evidence of pulmonary vascular congestion.  On exam, she is seated upright in the bed.  She continues to require increased supplemental oxygen from baseline.  She does display increased respiratory effort.  Plans are discussed for admission and she is agreeable.  She wishes to be listed as full code status.