Age: 89.0
Sex: M
Vaccine: COVID19
Symptoms: Anion gap, Anticoagulant therapy, Arrhythmia, Arthritis, Asthenia
Clinical narrative: Hospitalized (1.10.22 - 1.11.22); COVID-19 positive (1.10.22); Fully vaccinated -moderna x2 D/c summary: Discharge Summary MD (Physician) ? ? General Medicine Expand All Collapse All  BRIEF OVERVIEW: Discharge Provider:  Primary Care Provider: MD Admission Date: 1/10/2022 Discharge Date: Jan 11, 2022    Active Hospital Problems   Diagnosis Date Noted POA ? COVID-19 10/10/2020 Unknown   Resolved Hospital Problems No resolved problems to display.    Pre-Existing Active Problems   Diagnosis Date Noted POA ? Concern for developing Pulmonary fibrosis following Covid-19 (HCC) 11/16/2020 Unknown ? Acute infective cystitis 09/27/2021 Unknown ? Arthritis of left shoulder region 07/01/2021 Unknown ? Herpes zoster retinitis 07/01/2021 Unknown ? Gastroesophageal reflux disease 07/01/2021 Unknown ? History of colonic polyps 07/01/2021 Unknown ? Hyperlipidemia 07/01/2021 Unknown ? Mild intermittent asthma 07/01/2021 Unknown ? Other specified disorders of bladder 07/01/2021 Unknown ? Spinal stenosis of lumbar region 07/01/2021 Unknown ? Hypertension   Unknown ? Atrial fibrillation (HCC)   Unknown ? Preop cardiovascular exam 06/11/2021 Unknown ? Primary osteoarthritis of left shoulder-Severe 11/18/2020 Unknown ? Depression with anxiety 11/16/2020 Unknown ? Protein-calorie malnutrition, moderate (HCC) 11/09/2020 Unknown ? A-fib (HCC) 10/17/2020 Unknown ? Diarrhea due to COVID-19 10/10/2020 Unknown ? COVID-19 virus infection 10/10/2020 Unknown ? Chronic diastolic HF (heart failure) (HCC) 10/07/2020 Unknown ? Acute diastolic heart failure (HCC) 06/17/2020 Unknown ? Leg swelling 12/12/2019 Unknown ? Chest tightness 12/11/2019 Unknown ? Essential hypertension 12/28/2018 Unknown ? OSA on CPAP 08/24/2017 Unknown ? OSA (obstructive sleep apnea) 08/24/2017 Unknown ? Dyspnea 09/21/2016 Unknown ? Paroxysmal atrial fibrillation (HCC) 09/19/2013 Unknown ? Screening/Colonoscopy  03/02/2010 Unknown ? Cancer (HCC) 2008 Unknown     Discharge Disposition:  home or self care         DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Atrial fibrillation with RVR (HCC) [I48.91] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] Respiratory tract infection due to COVID-19 virus [U07.1, J98.8] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 90 y.o. male with past medical history of paroxysmal atrial fibrillation, hypertension.  Heart failure with preserved ejection fraction. ?  Possible pulmonary fibrosis following COVID-19 infection in October of 2020, obstructive sleep apnea on CPAP, presented to Emergency Department with chief complain of cough, shortness of breath, weakness and fatigue and decreased orally intake for the last 2-3 days, patient was initially hemodynamically stable at rest, however his oxygen saturation dropped to 89 with ambulation and heart rate increased to 130, EKG showed AFib with rapid ventricular response, COVID-19 PCR came back positive, chest x-ray showed pulmonary vascular prominence concerning for pulmonary edema otherwise no other focal pulmonary infiltrate.   By the following day, patient was stable on room air.  His oral home medication was started for his AFib and patient's rate became controlled and remained this way during his stay.  He was also restarted on his home blood pressure medications which controlled his blood pressure as well.  Patient was medically stable for discharge.       CONSULTS / RECOMMENDATION:    Consult Orders (From admission, onward)   None     INPATIENT PROCEDURES:   BP 100/64  | Pulse 103  | Temp 36.6 °C (Oral)  | Resp 20  | Ht 1.778 m  | Wt 103.6 kg  | SpO2 94%  | BMI 32.77 kg/m²    Physical Exam Vitals reviewed.  Constitutional:      General: He is not in acute distress.    Appearance: He is not diaphoretic.  HENT:     Mouth/Throat:     Mouth: Mucous membranes are moist.  Eyes:     Conjunctiva/sclera: Conjunctivae normal.  Cardiovascular:     Rate and Rhythm: Normal rate. Rhythm irregular.     Heart sounds: Normal heart sounds.  Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: Normal breath sounds. No wheezing.  Abdominal:     General: Bowel sounds are normal. There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness.  Musculoskeletal:     Cervical back: Neck supple.  Skin:    General: Skin is warm and dry.  Neurological:     Mental Status: He is alert and oriented to person, place, and time.  Psychiatric:        Behavior: Behavior normal.   H&:P: CHIEF COMPLAINT:   Shortness of breath, cough, weakness.     Assessment/Plan    ASSESSMENT / PLAN:   Acute hypoxic respiratory insufficiency Secondary to COVID-19 infection Symptoms for 2-3 days PCR positive on January 10, 2022 Patient vaccinated with Moderna with last shot was March 2021 Not boosted  Had COVID-19 infection October 2020 ?  Questionable pulmonary fibrosis following COVID 19/ Continue supportive care Wean oxygen as tolerated Consult pulmonary rehab Given patient not hypoxic on room air will hold off on remdesivir Duration of symptoms less than 7 days, not a candidate for Decadron as well   Atrial fibrillation with rapid ventricular response Rate currently controlled after receiving 1 dose of IV Cardizem Continue home medication (Toprol XL 50 mg twice daily) and Cardizem 240 mg  Adjust as needed Continue Eliquis   Essential hypertension Continue lisinopril and metoprolol   Obstructive sleep apnea CPAP at night   DVT prophylaxis Continue Eliquis Encourage early and progressive mobilization   Diet General Subjective    HISTORY OF PRESENT ILLNESS: Patient is a 90 y.o. male with past medical history of paroxysmal atrial fibrillation, hypertension.  Heart failure with preserved ejection fraction. ?  Possible pulmonary fibrosis following COVID-19 infection in October of 2020, obstructive sleep apnea on CPAP, presented to Emergency Department with chief complain of cough, shortness of breath, weakness and fatigue and decreased orally intake for the last 2-3 days, patient was initially hemodynamically stable at rest, however his oxygen saturation dropped to 89 with ambulation and heart rate increased to 130, EKG showed AFib with rapid ventricular response, COVID-19 PCR came back positive, chest x-ray showed pulmonary vascular prominence concerning for pulmonary edema otherwise no other focal pulmonary infiltrate.  Patient was given 1 dose of 10 mg IV Cardizem, and will be admitted under observation for respiratory insufficiency secondary to COVID-19 infection.         Patient Active Problem List Diagnosis ? Screening/Colonoscopy  ? Paroxysmal atrial fibrillation (HCC) ? Dyspnea ? OSA on CPAP ? Essential hypertension ? Chest tightness ? Leg swelling ? Acute diastolic heart failure (HCC) ? Chronic diastolic HF (heart failure) (HCC) ? Diarrhea due to COVID-19 ? COVID-19 virus infection ? COVID-19 ? A-fib (HCC) ? Protein-calorie malnutrition, moderate (HCC) ? Concern for developing Pulmonary fibrosis following Covid-19 (HCC) ? Primary osteoarthritis of left shoulder-Severe ? Preop cardiovascular exam ? Arthritis of left shoulder region ? OSA (obstructive sleep apnea) ? Hypertension ? Depression with anxiety ? Cancer (HCC) ? Atrial fibrillation (HCC) ? Herpes zoster retinitis ? Gastroesophageal reflux disease ? History of colonic polyps ? Hyperlipidemia ? Mild intermittent asthma ? Other specified disorders of bladder ? Spinal stenosis of lumbar region ? Acute infective cystitis Review of Systems Constitutional:  Positive for activity change, appetite change, fatigue and fever.  HENT: Positive for congestion.  Respiratory:  Positive for cough and shortness of breath. Negative for chest tightness and sputum production.   Cardiovascular:  Negative for chest pain and palpitations.  Gastrointestinal:  Negative for nausea, vomiting, abdominal pain and constipation.  Genitourinary:  Positive for difficulty urinating. Negative for dysuria.  Musculoskeletal:  Negative for edema.  Neurological:  Positive for headaches. Negative for dizziness and light-headedness.          Objective    OBJECTIVE: BP 132/86  | Pulse 130 Comment: ambulatory | Temp 36.5 °C (Oral)  | Resp 22  | Wt 103.6 kg  | SpO2 (!) 89%  | BMI 32.77 kg/m²    Physical Exam Constitutional:      General: He is not in acute distress.    Appearance: He is not ill-appearing.  HENT:     Head: Normocephalic and atraumatic.     Mouth/Throat:     Mouth: Mucous membranes are dry.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.  Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.  Abdominal:     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness.  Musculoskeletal:     Right lower leg: No edema.     Left lower leg: No edema.  Skin:    General: Skin is warm and dry.  Neurological:     Mental Status: He is alert and oriented to person, place, and time.     Comments: Mild fascial asymmetry with depressed right angle of the mouth .  Fascial nerve seems to be intact otherwise .   Psychiatric:        Mood and Affect: Mood normal.        Behavior: Behavior normal.