Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Alanine aminotransferase normal, Anaemia, Aspartate aminotransferase, Asthma-chronic obstructive pulmonary disease overlap syndrome
Clinical narrative: Date of Admission: 12/7/2023   Date of Discharge: 12/8/2023   Issues to be Addressed at Follow-up: Continued recovery from COVID viral illness w/ bronchitis   Pending Study Results at Discharge:  Unresulted Lab Orders    Date and Time Order Name Status Specimen Source   12/8/2023  7:17 AM HEPATITIS B VIRUS SURFACE ANTIBODY (HBSAB) In process --   12/8/2023  7:17 AM HEPATITIS B VIRUS SURFACE ANTIGEN (HBSAG) In process --   12/8/2023  4:00 AM MRSA SCREENING CULTURE In process NARES   12/7/2023  4:55 AM BLOOD CULTURE 2 In process BLOOD   12/7/2023  4:50 AM BLOOD CULTURE In process BLOOD       Final Diagnoses:  Active Hospital Problems   Diagnosis   ? SHORTNESS OF BREATH   ? HTN   ? HYPERLIPIDEMIA        Basename Value Date/Time ? CHOLESTEROL                   147 09/06/2018 ? TRIGLYCERIDE                  159 01/27/2014 ? HDL                            51 09/06/2018 ? LDL CALCULATED                 81 01/27/2014 ? LDL CALCULATED, NONFASTING     59 09/06/2018 ? TRIGLYCERIDE, NONFASTING      186 09/06/2018       ? COVID-19 ACUTE BRONCHITIS   ? ACUTE HYPOXEMIC RESPIRATORY FAILURE   ? HX OF LUNG LOBECTOMY       7/18/2022 Jayaram - Chart Update VATS right upper lobectomy and mediastinal lymph node staging 10/9/2020. Last CT - 4/2022 - clear of cancer     ? HX OF NONSMALL CELL CANCER, RIGHT LUNG       Right upper lobe nodule identified in 2016 during evaluation for possible kidney transplant.  Nodule was followed over time and noted to enlarge.  Biopsy confirmed adenocarcinoma, and staging studies suggested clinical stage I cancer.  The patient underwent right upper lobectomy and mediastinal lymph node staging on October 9, 2020.  Final pathology confirms a 1.4 cm invasive moderately differentiated adenocarcinoma, micropapillary predominant; all margins negative; no visceral pleural, lymphatic, or large vessel invasion; all lymph nodes negative; pT1bN0, stage IA2.   ? ASTHMA COPD OVERLAP SYNDROME (ASTHMA W COPD)       9/15/2020 NO RESULTS FOUND    9/19/2016   Spirometry:   Moderate Obstruction, FEV1 is 1.61 at 71 % of predicted No significant bronchodilator response is observed, however this does not preclude a clinical benefit from a bronchodilator.   Lung volumes:   Air trapping with increased RV/TLC ratio, RV is 2.22 at 133% of predicted Total lung capacity is 4.58 at 102 % of predicted   Diffusing capacity:   Mild reduction in diffusing capacity, DLCO is 13.6 at 64 % of predicted     ? CAD (CORONARY ARTERY DISEASE) WO ANGINA       6/7/2019    Normal Pharmacologic stress only myocardial Perfusion SPECT demonstrating no evidence of stress induced relative ischemia or prior myocardial infarction. Normal left ventricular function.         ardiac Catheterization 5/2/2016:Right Dominant -LM: left main is patent -LAD:mild 10% proximal LAD and mild 20% mid LAD disease. There is also evidence of mild 30-40% mid segment of first diagonal branch. -LCX: mild 10-20% mid LCX disease. -RCA: There is evidence of mild 40-50% distal RCA. The baseline FFR was 0.98 and post IV adenosine (180 mcg/kg/min) FFR was 0.93 which is not hemodynamically significant. Hemodynamics:LV 200/22 mmHg AO 197/72/119 mmHg HR 92 bpm. Distal abnormal aorta and iliac angiogram was done which showed mild atherosclerotic disease but no evidence of significant stenosis.Patient given IV Hydralazine 10mg in CCL.    ? ESRD ON HEMODIALYSIS       TU TH SAT MONDAY   ? MONOCLONAL GAMMOPATHY OF UNDETERMINED SIGNIFICANCE        MGUS labs are stable.  MGUS labs q 6-12 m( SPEP/IEP FLCR CBC Ca)   6/23/17  (M.D.) Mildly off K/L ratio but that is very common in severe renal disease. Given no other significant abnormalities (M-protein, SPEP), and the K/L ratio has been stable for the past 3 years, okay to continue to monitor every 6-12 months. Continue to monitor with CBC, Creatinine, calcium, SPEP, IgG/IgA/IgM, and K/L ratio with each blood draw. DM likely to be the cause for the neuropathy, unlikely to be the light chains.             ? ANEMIA DUE TO CKD   ? REFLUX ESOPHAGITIS     Resolved Hospital Problems No resolved problems to display.     Discharge Disposition:  Home   Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings:   66 y/o F w/ ESRD on HD, HTN, HL, CAD, DM, hx of lung CA w/ RUL lobectomy, COPD, chronic hypoxemic resp failure on 2 lit at home - presents to the ER d/t dizziness and weakness. Found to have COVID. Slightly hypoxic to 89% on RA so was started on RDV. CXR showing chronic RLL infiltrate. Pt o/w not septic. She was also started on decadron (though she is at her usual baseline of O2 usage) and doxycycline. Her symptoms improved. She is ambulatory in her room independently. She was discharged in a stable condition to finish a course of doxy, decadron and 1 week of scheduled neb treatments at home.    -------------------     Exam on day of discharge: O:BP 147/61  | Pulse 52  | Temp 98 °F (36.7 °C)  | Resp 20  | Wt 74 kg (163 lb 2.3 oz)  | LMP  (LMP Unknown)  | SpO2 97%  | Breastfeeding No  | BMI 29.84 kg/m²  Temp (24hrs), Avg:98.1 °F (36.7 °C), Min:97.7 °F (36.5 °C), Max:98.3 °F (36.8 °C)   Gen: alert, NAD MS: Ox3 Chest: ronchi Heart: RRR Abd: soft Ext: no edema   Selected Lab Results: Electrolytes  Recent Labs   12/08/23 0717 12/07/23 0415 NA 139 133* K 3.8 4.2 CO2 28 30 CL 96* 90* BUN 23 43* CR 3.79* 6.72* RBS 106 86 CA  --  9.1 PHOS  --  7.7* MG  --  2.0   CBC  Recent Labs   12/08/23 0717 12/07/23 0415 WBC 7.6 11.3* HGB 11.2* 11.6 HCT 33.2* 35.4 PLT 173 165 MCV 96 98 NEUT 77 80 LYMPH 12 | 0.9 10 | 1.1 MONO 0.8 | 10 0.8 | 7 EOS 0 | 0.0 2 | 0.3   Cardiac  Recent Labs   12/07/23 1100 12/07/23 0415 TROP 8 9 BNP  --  95   LFTs  Recent Labs   12/08/23 0717 12/07/23 0415 AST 9* 12 ALT 11 13 ALKP 99 110 TBILI 0.4 0.4 LIPASE  --  16   Coags  Recent Labs   12/07/23 0415 PT 13.9 INR 1.1   ABG No results for input(s): "PH", "PO2", "PCO2" in the last 72 hours. Anti-XA No results for input(s): "HEPUNFR", "FACTXAINHIB" in the last 72 hours.                    Primary Procedures:  None   Secondary Procedures: None   Reason for Hospital Admission (Admitting Diagnosis):  COVID bronchitis, viral illness   Complications: none   Consults:  NEPHROLOGY - ONGOING INPATIENT CONSULTATION. Smoker: No.   Condition on Discharge: stable   Code Status at Time of Discharge: Partial Code - no CPR/shocks, ok w/ intubation       Note Details  Author (M.D.) File Time 12/8/2023  1:13 PM Author Type Physician Status Addendum Last Editor  (M.D.) Specialty Hospital Medicine Hospital Acct #  Admit Date 12/7/2023  ED to Hosp-Admission (Discharged) on 12/7/2023  ED to Hosp-Admission (Discharged) on 12/7/2023   Revision History   Detailed Report  Note shared with patient Hospital Problem List   ANEMIA DUE TO CKD  REFLUX ESOPHAGITIS  ESRD ON HEMODIALYSIS  CAD (CORONARY ARTERY DISEASE) WO ANGINA  ASTHMA COPD OVERLAP SYNDROME (ASTHMA W COPD)  MONOCLONAL GAMMOPATHY OF UNDETERMINED SIGNIFICANCE  HX OF NONSMALL CELL CANCER, RIGHT LUNG  HX OF LUNG LOBECTOMY  ACUTE HYPOXEMIC RESPIRATORY FAILURE  COVID-19 ACUTE BRONCHITIS  SHORTNESS OF BREATH  HTN  HYPERLIPIDEMIA Care Timeline  12/08   Admitted from ED (Observation) 0329    Discharged 1532  Discharge   Home or Self Care.   Discharge Instructions (AVS) (Printed 12/8/2023)