Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Chest X-ray abnormal, Chronic kidney disease, Chronic obstructive pulmonary disease, Chronic respiratory failure
Clinical narrative: Patient is a 81 y.o. female patient of MD with history of recent diagnosis respiratory failure (requiring supplemental oxygen), recent C. difficile infection, COPD, PAF, hypertension presented to hospital with fevers, myalgias. Recent admission to hospital 8/8/23 - 8/11/23 for acute resp failure due to pneumonia COPD and pulmonary HTN. Was discharged home on doxycycline. Hospital course was complicated by acute diverticulitis and C diff colitis(found on day of discharge)   Covid-19 Virus Infection Date of onset of symptoms: Unsure since patient has had 3 prior hospitalizations in the last month for respiratory issues and pneumonia (approximately beginning of July 2023). Symptoms  Symptoms present on admission: Fevers, malaise, cough Date of covid positive test: 08/14/23 (COVID tests on 07/28/23 and 08/08/23 negative) Vaccination status: vaccinated Imaging: CXR: possible airspace disease in left lung base. CT chest 08/08/23 showed small left-sided pleural effusion/infiltrate.  Oxygen requirements on admission: 2 L nasal cannula, which patient has been using intermittently for the last month. Current oxygen requirements: requiring 1 L n/c, especially with ambulation  Consultants following: Infectious disease  Medical therapy: completed doxycycline(from previous admission), was given 1 dose of IV steroids in ED. Paxlovid contraindicated with Xarelto. Per ID given remdesivir x 3 days(completed 8/17) Anticipated special isolation end date: 08/19/23   Chronic respiratory failure Has been requiring supplemental oxygen (2 L nasal cannula) intermittently with exertion for the last couple of weeks. In setting of recent hospitalizations for COPD exacerbations and pneumonia as well as history of pulmonary hypertension and untreated OSA. Requiring 2 L nasal cannula on admission. Evaluated by pulmonology team during last hospitalization.  Breathing treatments as needed. Home oxygen evaluation completed- 1 L with rest and 2 L with ambulation   C. difficile infection Watery stool for the last 4 days. Diagnosed with C. difficile infection on 08/11/23. Continue oral vancomycin, complete 7 more days on discharge, pt has medication at home from prior hospitalization Diarrhea slowly improving    PAF Rate controlled. Resume xarelto. Not on rate controller medications.  Allergies noted to metoprolol and diltiazem   COPD No gross signs of acute exacerbation. On Trelegy at home, transitioned to Spiriva and Dulera here  Breathing treatments as needed.CKD Creatinine is 0.98; GFR 60 (baseline GFR in the 50s). Monitor renal function closely.   Hypertension Normotensive on admission. Now SBP running 140-160s Restarted home Losartan. Added Hydralazine 25 mg TID, however HRs in 100s, will discontinue Allergies noted to metoprolol and diltiazem Started norvasc 5 mg daily, resume on discharge    Hyponatremia Sodium 130(8/16), likely due to decreased appetite and diarrhoea  Trending down, 128(8/18) LR 500 cc bolus ordered, encouraged oral salt intake Started LR 75 cc/hr x 10 hours  Na improved to 131 today   Generalized weakness Poor appetite Started 8/14. Feels weak PT/OT- no therapy needs