Age: 93.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Alanine aminotransferase normal, Anion gap, Aortic arteriosclerosis, Arthritis
Clinical narrative: Hospitalized (1.5.22 - 1.12.22); COVID-19 positive (1.5.22); Fully vaccinated  - moderna x2 d/c summary: Discharge Summary MD (Physician) ? ? Hospitalist  BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider: PA-C Admission Date: 1/5/2022 Discharge Date: Jan 12, 2022    Active Hospital Problems   Diagnosis Date Noted POA ? COVID-19 01/05/2022 Yes  Discharge Disposition:  home health care svc    Active Issues Requiring Follow-up:    Sinusitis Follow-up with primary care provider Patient received 7 days of doxycycline in the hospital and was sent home with 3 more days to complete a 10 day total course   COVID-19 infection with pneumonia and acute hypoxic respiratory failure Follow-up with primary care provider Patient received 8 days of Decadron in the hospital and was quickly weaned off of oxygen during her stay.  I did not send any more steroids home with her.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Sinusitis   HOSPITAL COURSE: Patient is a 93-year-old woman admitted to the hospital with COVID-19 pneumonia and acute hypoxic respiratory failure.  She was also complaining of some sinus congestion and discomfort.  She was started on Decadron for her COVID-19 infection.  She was also started on doxycycline for sinusitis.  She was quickly weaned off of oxygen supplementation during her stay.  She had generalized weakness and was seen by Physical therapy and Occupational therapy.  Recommendation for her to go home with assistance.  She said that she did not have much help at home because her kids that live with her were also sick.  She then wanted to go to a subacute rehab but after couple days of looking for placement she decided that she wanted to actually go home instead.  She was then discharged home with 3 more days of doxycycline to complete a 10 day course.  She was not set home on any more Decadron as she was doing well with her COVID-19 infection.  She will have in-home physical therapy and occupational therapy.   BP 126/100  | Pulse 69  | Temp 36.7 °C (Oral)  | Resp 16  | Ht 1.6 m  | Wt 85.4 kg  | SpO2 93%  | BMI 33.35 kg/m²  FIO2 (%): 21 % Physical Exam Vitals reviewed.  Constitutional:      General: She is not in acute distress.    Appearance: She is well-developed. She is not diaphoretic.  HENT:     Head: Normocephalic.  Eyes:     General:        Right eye: No discharge.        Left eye: No discharge.     Conjunctiva/sclera: Conjunctivae normal.  Neck:     Vascular: No JVD.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Heart sounds: Normal heart sounds. No murmur heard.    Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: Normal breath sounds. No stridor. No wheezing or rales.  Abdominal:     General: Bowel sounds are normal. There is no distension.     Palpations: Abdomen is soft. There is no mass.     Tenderness: There is no abdominal tenderness. There is no guarding or rebound.  Musculoskeletal:     Right lower leg: No edema.     Left lower leg: No edema.  Skin:    General: Skin is warm.     Findings: No rash.  Neurological:     Mental Status: She is alert and oriented to person, place, and time.  Psychiatric:        Mood and Affect: Mood normal.        Behavior: Behavior normal.   H&P: CHIEF COMPLAINT: Not feeling well   Subjective      HISTORY OF PRESENT ILLNESS: Patient is a 93-year-old female with PMH of OSA, nonischemic dilated cardiomyopathy, GERD, hypertension, hypothyroidism, DM 2 that presented to the ED because she was not feeling well.  Patient states that she started feeling ill on the weekend of Christmas (25/26th) with what she thought was a sinus infection as she had pressure/congestion in her head, sneezing, and coughing.  She continued to feel poorly and went to see her PCP on Monday.  She was tested for COVID and received the results today that she was positive.  She endorses feeling worse yesterday including weakness and nausea.  This morning she felt nauseated, had some dry heaves, and felt she was so weak she could hardly get out of bed so she presented to the ED.  She does note that she has fallen 2-3 times in the last few days that she associates with generalized weakness and her underlying chronic equilibrium issues.  She does endorse her lower back being sore since a fall a couple days ago.  She additionally endorses hitting her nose a couple days ago as well, but denies pain.  Denies further complaint or LOC.   Review of Systems Review of Systems Constitutional:  Positive for chills (yesterday). Negative for fatigue and fever.  HENT: Negative for congestion, rhinorrhea (3 weeks) and sore throat.  Eyes: Negative for visual disturbance.  Respiratory:  Positive for cough and sputum production. Negative for shortness of breath.   Cardiovascular:  Negative for chest pain and palpitations.  Gastrointestinal:  Positive for nausea, vomiting (dry heaves) and diarrhea (yesterday x1). Negative for abdominal pain, constipation and blood in stool.  Genitourinary:  Negative for difficulty urinating and dysuria.  Musculoskeletal:  Positive for falls. Negative for neck pain, joint pain and edema.       Lower back sore since falling yesterday .  Neurological:  Positive for weakness (generalized weakness). Negative for headaches, dizziness, light-headedness and numbness/tingling.       Equilibrium issues at baseline unchanged .  Skin:  Negative for rash and wound.                  Objective    OBJECTIVE:   Physical Exam BP 139/69  | Pulse 77  | Temp 98.4 °F (36.9 °C) (Oral)  | Resp 20  | SpO2 95%    Physical Exam Constitutional:      General: She is not in acute distress. HENT:     Head: Normocephalic.     Mouth/Throat:     Mouth: Mucous membranes are moist.  Eyes:     Extraocular Movements: Extraocular movements intact.     Pupils: Pupils are equal, round, and reactive to light.  Cardiovascular:     Rate and Rhythm: Normal rate.     Pulses: Normal pulses.     Heart sounds: No murmur heard. No friction rub. No gallop.   Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Comments: Diminished bases, no accessory muscle use, able to speak in full sentences. O2 2l/min NC Abdominal:     General: Bowel sounds are normal. There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness. There is no guarding.  Musculoskeletal:        General: No tenderness or deformity.     Right lower leg: No edema.     Left lower leg: No edema.     Comments: Moves all extremities.  No tenderness of pain with palpation of extremities, joints, head, back, or neck  Skin:    General: Skin is warm and dry.  Neurological:     Mental Status: She is alert.     Comments: A &Ox3, no focal deficits noted  ASSESSMENT/PLAN: Severe COVID 19 Pneumonia with hypoxia              - First Symptoms:  December 25/26              - Symptom Day #11              - Steroid:  Decadron in ED - continue                    - Remdesivir:  Not a candidate              - Anticoagulation: Lovenox              - Oxygen requirement:  2l/min NC              - Daily CMP, CBC w diff, D-Dimer, CRP              - continuous pulse ox, IS, encourage prone position              - CXR pending             Generalized weakness Falls              - patient endorses chronic equilibrium issues that are unchanged              - Covid positive              - bruise to nose, endorses hitting nose previously, denies pain or complaint              - endorses sore lower back, no deformity or bruising noted              - lumbar x-ray             OSA              - CPAP DM2              - diet controlled              - AC & HS accuchecks              - Glucose 185, anticipate increase given steroid use              - will start               - Hgb A1c 6.2 on 4/8/21               - Hgb A1c Hypothyroidism              - start home synthroid CAD s/p stent in 2013 Non-ischemic cardiomyopathy s/p Biventricular ICD Dyslipidemia              - Echo 10/18/21: EF 45% with global hypokinesis              - start home coreg              - Takes bumex Monday and Thursday               - statin intolerant              - start home aspirin H/o Paroxysmal atrial flutter               - not on anticoagulant due to brevity and frequent falls HTN              - on Coreg and bumex as above             GERD              - home Nexium to protonix per formulary Anxiety, depression              - start home buspar Code Status: DNR, okay with intubation for short time