Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: Chronic obstructive pulmonary disease, Condition aggravated, Dyspnoea, Dyspnoea exertional, Hypoxia
Clinical narrative: BRIEF OVERVIEW: Admission Date: 9/1/2024 Discharge Date: Sep 4, 2024 Discharge Disposition:  home or self care   Active Issues Requiring Follow-up:  #acute on chronic hypoxic respiratory failure due to COVID 19 pneumonia  #COPD with exacerbation due to above - RPP positive for COVID - Completed 4 days of Remdesivir, and 4/10 of decadron - c/w mucinex, symbicort - c/w daliresp nightly - follow up with PCP  #Type 2 diabetes mellitus with hyperglycemia, with long-term current use of insulin blood sugars elevated on steroids.   - continue home meds  #Acquired hypothyroidism levothyroxine  #Bipolar affective disorder, current episode depressed: olanzapine, sertraline  #Gastroesophageal reflux disease without esophagitis; on famotidine at home, on hold since admission.    #Insomnia ESZOPICLONE   #OSA on CPAP (RN encouraged patient to bring in home CPAP)  #Class 1 obesity with serious comorbidity and body mass index (BMI) of 33.0 to 33.9 in adult - counseled Pending Labs     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Chronic obstructive pulmonary disease with acute lower respiratory infection (HCC) [J44.0] Acute on chronic respiratory failure with hypoxia (HCC) [J96.21] COVID-19 [U07.1] Acute on chronic respiratory failure (HCC) [J96.20]  HOSPITAL COURSE: 59 y.o. female with history of severe COPD with chronic hypoxic respiratory failure on 2L O2, OSA on CPAP, h/o tobacco abuse, diabetes mellitus type 2, anxiety, bipolar, hypothyroidism, obesity, and insomnia who presented to ER again today with complaints of increased shortness of breath, fever, chills, and productive cough that started yesterday.  She presented to the ER yesterday, given a breathing treatment and then discharged home on oral antibiotics.  The patient reports not taking the antibiotics at home prior to return to ER.  She continued to feel fever, chills, and increased shortness of breath.  She was found to be covid positive.  She was given doxycycline and Rocephin in the emergency room.  The CXR in the ER does not show a new consolidation therefore we will not continue antibiotics at this time.  She was given duonebs and steroids in ER.  Remdesevir ordered and will be couriered from pharmacy soon.  The patient is normally on 2L O2 per nasal canula and currently is on 3L with pulse ox 92%.    Vital signs overall stable.  She denies pain but states she does feel short of breath with moving and even talking if more than short answer.  She looks comfortable in the bed, she was eating fast food during my assessment/interview.  She uses a CPAP at night at home, we will have RT place her on CPAP at bedtime with 4L O2.Completed remdesivir and  Decadron daily, continuous pulse ox, and cardiac monitor.  She does not have a new consolidation on the chest x-ray and she has a normal white count therefore we will not continue antibiotics.  Patient completed 4 days of remdesivir and steroids, with significant improvement in symptoms. She was medically optimized and hemodynamically stable at time of discharge.   Discharged to Home