Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Aortic aneurysm, Biopsy lung normal, Blood glucose decreased, COVID-19
Clinical narrative: Date of Admission  10/02/2021   Date of Discharge  10/05/2021   Reason for Hospitalization   usually only wears O2 at night, has been having SOB and low sats for a week. currently on 5 L NC  Hospital Course     Patient is a 70 year old male  admitted to the ICU on 10/2 for acute hypoxic respiratory failure 2/2 COVID.  PMHx of DM II, hypertension, hyperlipidemia, hypothyroidism, non-hodgkin lymphoma in remission, thoracic aortic aneurysm.  Patient is vaccinated against COVID-19.  The patient started feeling more short of breath about one week prior to presentation.  He wears 5L O2 every night and occasionally during the day.  Patient was admitted to ICU as he required BiPAP.  Patient was started on remdesivir, dexamethasone, and baricitinib.  Patient was transitioned to HFNC evening of 10/2 then transitioned to green tube NC at 8L on 10/3.  Patient was stable for transfer to the PCU. Improved to home O2 (5L) quickly. Pt stayed on O2 at rest and with walking, did not need more than 5L.  Pt did have low sugars throughout stay despite significant decrease in Insulin.  Discussed diet at length with pt and plans to slowly titrate back up as needed in the outpatient setting.  Discharge Diagnoses      SOB (shortness of breath)     Ordered:   Sleep Study Home Sleep Apnea Watch PAT     Orders:   insulin glargine, 30 units, Subcutaneous, At Bedtime, # 10 mL, Refill(s) 5, Pharmacy: Pharmacy 25, 177.5, cm, 10/03/21 3:21:00 CDT, Height (cm), kg, 10/02/21 15:52:00 CDT, Weight (kg), 129  insulin lispro, 1-15 units, Subcutaneous, tid w/Meals, << Sliding Scale Comments >> 150 - 174 1 units Call if less than 80 175 - 199 2 units 200 - 224 3 units 225 - 249 4 units 250 - 274 5 units 275 - 299 6 units 300 - 324 7 units 325 - 34...  Discharge Patient  Follow Up Appt Medicine Endocrinology  Follow Up Appt Medicine Pulmonary Adult  #AHRF 2/2 COVID 19 PNA, on precautions, vaccinated  Date of + test: 10/2 (symptom onset 1w/a) #OHS  #OSA, does not use CPAP  - Sleep study ordered for outpatient  - 5L O2 throguhout the day and at night  - FU with PCP on 10/22  - FU with pulm placed for worsening of restrictive disease (prior to COVID dx)  #DM2  Home regimen: Metformin, pioglitazone, jardiance, Trulicity, 95u Lantus bid, up to 71u tid AC   - Home with 30u q'evening, SSI 1:25, 1-15u  - Restarted PO meds  - Will contact PCP to titrate back up to home dose as diet changes  - Message sent to Endo provider who is aware  #HTN #LEE (2/2 chemo)  Home Regimen: HCTZ 25mg qday,  lisinopril 20mg, metoprolol 50 bid, Lasix 20mg qday PRN - Hold HCTZ, restarted Lisinopril at discharge  - Continue to take Lasix  #Pulmonary Nodule  - Discussed with Radiology that it has improved in size from Biopsy in January, same area that was Bx and negative for neoplasm  - FU with CT in 6mo-1y  Other Diagnoses   Ongoing  Aortic root aneurysm  Diabetes mellitus, type 2  Hyperlipidemia  Hypertension  Hypothyroidism  Lower extremity edema  Non-Hodgkin lymphoma  Obesity  Historical  Diabetes mellitus type 2 in obese        Discharge Disposition  Home    Medications  New, Changed, or Refilled Medications  insulin glargine (Lantus insulin Vial 100 units/mL 30 units, Subcutaneous, At Bedtime, for 30 day(s), 10 mL, 5 Refill(s)    insulin lispro (insulin lispro 100 units/mL injecta 1-15 units, Subcutaneous, tid w/Meals, << Sliding Scale Comments >>  150 - 174   1 units Call if less than 80  175 - 199   2 units   200 - 224   3 units   225 - 249   4 units   250 - 274   5 units   275 - 299   6 units   300 - 324   7 units   325 - 349   8  Instructions:<< Sliding Scale Comments >>150 - 174   1 units Call if less than 80175 - 199   2 u    Medications to be Continued  Misc. Medication 0 Refill(s)    Misc. Medication (BD UF II SHORT 1cc 8mm SYRINGE) See Instructions, USE 3x/DAY, 300 Each, 1 Refill(s)  Instructions:USE 3x/DAY  Misc. Medication (DEXCOM G6 RECEIVER) See Instructions, DEXCOM G6 RECEIVER  UAD  E11.9, 1 Each, 0 Refill(s)  Instructions:DEXCOM G6 RECEIVERUADE11.9  Misc. Medication (DEXCOM G6 SENSOR) See Instructions, DEXCOM G6 SENSOR  UAD--CHANGE Q10 DAYS  E11.9, 3 Each, 2 Refill(s)  Instructions:DEXCOM G6 SENSORUAD--CHANGE Q10 DAYSE11.9  Misc. Medication (DEXCOM G6 TRANSMITTER) See Instructions, DEXCOM G6 TRANSMITTER  UAD--CHANGE Q90 DAYS  E11.9, 1 Each, 2 Refill(s)  Instructions:DEXCOM G6 TRANSMITTERUAD--CHANGE Q90 DAYSE11.9  aspirin (aspirin 81 mg oral delayed release tablet) 81 mg, 1 Tablet(s), Oral, Daily    atorvastatin (atorvastatin 40 mg) See Instructions, Take 1 tablet by mouth once daily, 90 Tablet(s), 6 Refill(s)  Instructions:Take 1 tablet by mouth once daily  dulaglutide (Trulicity Pen 3 mg/0.5 mL subcutaneous 3 mg, Subcutaneous, qWeek, 12 Each, 11 Refill(s)    empagliflozin (Jardiance 25 mg) 25 mg, 1 Tablet(s), Oral, qAM, E11.65, 90 Tablet(s), 3 Refill(s)  Instructions:E11.65  furosemide (Lasix 20 mg) 20 mg, 1 Tablet(s), Oral, Daily, daily as needed for leg swelling, 30 Tablet(s), 0 Refill(s)  Instructions:daily as needed for leg swelling  insulin aspart (NovoLOG insulin Vial 100 units/mL i See Instructions, up to 71 units tid with meals   E11.65, 180 mL, 11 Refill(s)  Instructions:up to 71 units tid with meals E11.65  levothyroxine (levothyroxine 100 mcg (0.1 mg)) See Instructions, Take 1 tablet by mouth once daily, 90 Tablet(s), 7 Refill(s)  Instructions:Take 1 tablet by mouth once daily  lisinopril (lisinopril 20 mg) 20 mg, 1 Tablet(s), Oral, Daily, 90 Tablet(s), 2 Refill(s)    metFORMIN (metFORMIN 1000 mg) 1 Tablet(s), Oral, bid, 180 Tablet(s), 3 Refill(s)    metoprolol (Metoprolol Tartrate 50 mg) 50 mg, 1 Tablet(s), Oral, bid, for 30 day(s), 60 Tablet(s), 12 Refill(s)    omega-3 polyunsaturated fatty acids (omega-3 polyun 2,000 mg, 2 capsule(s), Oral, bid    ondansetron (ondansetron 8 mg) 0 Refill(s)    pioglitazone (pioglitazone 15 mg) 15 mg, 1 Tablet(s), Oral, Daily, for 90 day(s), 90 Tablet(s), 11 Refill(s)      Discontinued Medications  hydrochlorothiazide (hydroCHLOROthiazide 25 mg) See Instructions, Take 1 tablet by mouth once daily, 90 Tablet(s), 9 Refill(s)       Physical Exam at Discharge  Vitals & Measurements  T: 36.6 °C  TMIN: 36.6 °C  TMAX: 36.9 °C  HR: 77  RR: 18  BP: 129/82  SpO2: 92%      GEN: no acute distress,  EYE: normal conjunctiva, EOMI  HENT: nose and ears atraumatic, lips normal  RESP: NC in place, respirations non-labored  CARDIO: Regular rate, +2 peripheral edema b/l  GASTRO: abdomen soft and non-tender, no organomegaly  MUSCULO: no digital cyanosis, no gross deformity  SKIN: no rash, normal turgor  PSYCH: appropriate mood and affect, normal judgement