Age: 68.0
Sex: F
Vaccine: COVID19-2
Symptoms: Anticoagulant therapy, Anticoagulation drug level above therapeutic, Atrial fibrillation, Blood albumin decreased, Blood loss anaemia
Clinical narrative: Patient is a 68 y.o. female patient of MD with history of anxiety, atrial fibrillation, cervical cancer, constipation, COPD, depression, fibromyalgia, glaucoma, IBS, lumbosacral disease, nephrolithiasis, osteoporosis, PTSD, peripheral neuropathy, seizure, spinal stenosis presented to the hospital with progressive shortness of breath   Abdominal pain SBO-resolved  P/w left sided sharp abdominal/flank pain. No CVAT or hematuria, urinary sxs. Suspected constipation however, patient w/ large BM but continued pain KUB: Stomach is distended.  Overall nonobstructive bowel gas pattern.  Large amount of stool in the right colon.  In the left abdomen there is likely some artifactual lucency from superimposed bowel loops rather than abnormal gas within the bowel wall.  CT: There is a high-grade partial-to-complete obstruction of the distal small bowel.   Gastrograffin challenge: No passage of Gastrografin in the colon.  Findings are very suspicious for high-grade small bowel obstruction. S/p exploratory laparotomy, converted to open, lysis of adhesions with Dr. 2/10 Removed NGT (2/12) Advanced to full liquid (2/14) 02/17 CT abdomen persistent postsurgical ileus, no obstruction Advanced to regular diet (2/18) tolerating well and having regulat BM's     Atypical Chest Pain-resolved  Patient reports LUQ abdominal pain that radiates to her back and into her left chest, worse with inspiration. Left chest TTP when auscultating heart sounds. EKG sinus tachycardia without acute ischemic changes Serial troponin normal CT PA without e/o PE, shows  moderately sized layering bilateral pleural effusion partial consolidation of the lower lobes bilaterally (L>R) Suspect largely 2/2 MSK due to frequent retching PRN flexeril    Acute on Chronic Hypoxic Respiratory Failure Bilateral Pleural Effusions  Patient reports worse DOE than baseline and BLE edema CXR 2/13 with bilateral pleural effusions CT PA shows bilateral pleural effusions, as above Echo with EF 65% normal diastolic fxn.  Could be due to low albumin/poor nutritional status and/or as a result of recent covid infection  Encourage increased protein intake as able. Limited at this time due to full liquid diet Continue home lasix  Strict I/O Sepsis, COVID-19 multifocal pneumonia - Resolved Superimposed Commnity Acquired Pneumonia - Resolved Date of onset of symptoms:  Symptoms present on admission: SOB Date of covid positive test: 1/25 Vaccination status: vaccinated x5 Imaging: CTPA 2/3 multifocal pneumonia/pneumonitis in right middle lobe, RLL and left posterior medial base Oxygen requirements on admission: 3L NC (wears 2.5L NC at baseline) Current oxygen requirements: 3L NC Medical therapy: Completed course of remdesivir and Decadron Completed 5 days of ceftriaxone and azithromycin  Out of isolation   Hypokalemia-resolved  K 3.6 (02/20) Normal Mag level  Replace and recheck  Monitor    Acute blood loss anemia Hgb baseline 13-15 stable 10.1 (2/20)   Paroxysmal A-fib Supra therapeutic INR - Resolved  Currently in NSR Continued home metoprolol and Coumadin. Pharmacy to dose INR 2.9 on admit; s/p 4u plasma and vitK pre-op  INR now subtherapeutic at 1.1; pharmacy to dose. No need to bridge peri-operatively  Controlled heart rate 80's (02/18) Resume home coumadin, bridge with Lovenox for 3 days Follow up with coumadin clinic    Hypothyroidism Continue home levothyroxine.   Depression/anxiety Continue home Xanax as needed    Severe protein calorie malnutrition BMI 15.34