Age: 81.0
Sex: F
Vaccine: COVID19
Symptoms: Pyrexia, Renal failure, Respiratory failure, SARS-CoV-2 test positive, Tricuspid valve incompetence
Clinical narrative: Patient is a 82 y.o. female patient, MD with history of A-fib, PAD, CAD, CHF, chronic pain on opioids, diabetic neuropathy, T2DM, GERD, HLD, HTN, ILD, COPD, chronic hypoxemic respiratory failure on 3 L chronically presented to Hospital with cough.     Chronic hypoxemic respiratory failure COPD in acute exacerbation Severe pulmonary hypertension Covid-19 Virus Infection Date of onset of symptoms: 3/17 Symptoms present on admission: Shortness of breath, cough, fever Date of covid positive test: 3/18 Vaccination status: vaccinated Imaging: Chest x-ray Oxygen requirements on admission: 3 L, same as baseline on home Current oxygen requirements: 3 L, same as baseline on home Medical therapy: currently on steroids and remdesivir.  Finished remdesivir.  Discharged on dexamethasone for total 10 days of steroid therapy.  3 days remaining at time of discharge Consultants following: Infectious disease Anticipated special isolation end date: 3/28 Add mucinex X-ray of chest on 3/22/2023 with no acute changes. Patient improved and able to to ambulate in her room without shortness of breath.  Discharge to assisted living facility. CT scan done on 3/18/2023 is not available to us.  Recommend obtaining this records and following up on them.   NSTEMI Paroxysmal atrial fibrillation EKG nonischemic No chest pain at this time Troponin 4114 > 3831 > 3922 Likely due to demand from patient's COVID-19 infection Heparin drip initiated x 48 hours. Seen by cardiology. Echo was done and cardiology reported similar echo to the previous echo in January 2023.  Cardiology recommended based on echo and downtrending troponin, no intervention is needed at this time.  Recommended continuing IV heparin for 48 hours following troponin peak.  Should go back on Eliquis when heparin is stopped.  The patient should continue beta-blocker, statin, and aspirin.  She will be discharged on oral diuretics and potassium supplements.  Cardiology signed off.     Chronic HFpEF not in acute exacerbation Severe tricuspid regurg Mild aortic regurg Moderate aortic stenosis Moderate mitral stenosis Mild mitral regurg Hypertension Hyperlipidemia CAD PAD Volume status seems at baseline.  DC Lasix given mild renal failure Aspirin, statin, Toprol. Heparin drip. Attempt diuresis due to lack of improvement of respiratory status. Discharge the patient on her home regimen   Acute kidney injury on CKD stage III, AKI improved Likely prerenal.  Continue to monitor Follow-up as an outpatient with PCP   T2DM Patient hypoglycemic on admission She is unclear how much insulin she takes, per documentation she is on 60 units of Lantus nightly We will place her on 60 units of Lantus starting in the morning as long as blood glucose >100 Sliding scale insulin Discharge back on home regimen   Atrial fibrillation Continue home metoprolol Eliquis   Hypokalemia, POA Monitor and replete as needed   Overactive bladder Gemtesa not on formulary   Chronic pain Patient is on 15 mg every 12 hours of long-acting OxyContin at home, this is not on formulary.  Discussed with patient and pharmacy.  We will place patient on the 10 mg extended release tablets every 12 hours +5 mg IR every 6 hours Continue home gabapentin Discharge back on home medications