Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Aspartate aminotransferase increased, Atrial fibrillation, Blood creatinine increased, Blood culture
Clinical narrative: Hospitalized (1.4.22 - still admitted currently); COVID-19 positive (1.4.22); Fully vaccinated -pfizer x2 H&P: CHIEF COMPLAINT: COVID-19     Assessment/Plan    ASSESSMENT / PLAN: Acute hypoxic respiratory failure: COVID pneumonia: Community-acquired pneumonia in an immunocompromised patient: Continue Decadron. Continue vancomycin and Zosyn, broad-spectrum antibiotics chosen in the setting of immunocompromised state.  Deescalate antibiotics as able. Blood cultures, sputum cultures, MRSA screen. Prone as able. Symptoms of 2 weeks duration so not a candidate for remdesivir. Test for atypicals.    Hyponatremia:  Most likely due to poor orally intake. Will recheck CMP in the morning.  If there is no improvement in sodium levels will continue to trend. Continue IV fluids   Hypertension: Continue home medications.   BPH": Continue home medications.   Obstructive sleep apnea: On CPAP   Type 2 diabetes diet controlled: Not on any home medications. Corrective insulin.            A1c ordered. May need corrective insulin if hyperglycemic in the setting of steroid use.   AML: On immunotherapy with              JAKAFI   History of DVT: On Eliquis.   DVT prophylaxis:  Eliquis   PT OT         Subjective    HISTORY OF PRESENT ILLNESS: Patient is a 71 y.o. male with a past medical history of obstructive sleep apnea, hypertension, BPH, type 2 diabetes diet controlled, AML on immunotherapy presented to the emergency department due to worsening shortness of breath.  Patient symptoms started 2 weeks ago when he got exposed to his wife who was positive for COVID.  Patient got 2 shots of Pfizer COVID vaccine.  He did not get his booster yet.  Patient's symptoms started off with dry cough that lasted for 1 week.  Since last Friday his symptoms got worse with nasal congestion sore throat postnasal drip and shortness of breath.  He denies any chest pain.   In the emergency department, patient was hypoxic to 88 hence placed on 4 L of oxygen. His sodium was consistent with 131, glucose 173, AST 61, procalcitonin elevated at 0.7, patient is neutropenic at 3.91.  Chest x-ray consistent with bilateral opacities most likely secondary to COVID pneumonia with superimposed bacterial pneumonia not excluded.  Patient received 1 dose of Decadron and was admitted to internal medicine hospitalist service for further management of acute hypoxic respiratory failure.   Patient Active Problem List Diagnosis ? Obstructive sleep apnea on CPAP ? Essential hypertension ? BPH with obstruction/lower urinary tract symptoms ? Controlled type 2 diabetes mellitus without complication, without long-term current use of insulin  ? Acute myeloid leukemia not having achieved remission  ? AML (acute myeloid leukemia) with failed remission  ? Stem cell transplant candidate ? Arterial thromboembolism  ? Moderate protein-calorie malnutrition  ? COVID-19 Review of Systems Constitutional:  Positive for chills and fatigue. Negative for activity change, appetite change, diaphoresis and fever.  HENT: Positive for congestion, rhinorrhea and sore throat. Negative for nosebleeds.  Respiratory:  Positive for cough, wheezing, shortness of breath and chest tightness. Negative for snoring and choking.   Gastrointestinal:  Positive for diarrhea. Negative for heartburn, nausea, vomiting, abdominal pain and constipation.  Genitourinary:  Negative for difficulty urinating, urinary incontinence, dysuria, frequency, hematuria, urgency and flank pain.  Musculoskeletal:  Negative for joint pain, joint swelling, muscle pain and edema.  Neurological:  Negative for headaches, dizziness, light-headedness, speech difficulty, loss of consciousness, numbness/tingling and weakness.  Psychiatric/Behavioral:  Negative for depression, suicidal ideas, anxiety and hallucinations.          Objective    OBJECTIVE: BP 122/73  | Pulse 64  | Temp 37.3 °C (Oral)  | Resp 24  | Ht 1.753 m  | Wt 111.6 kg  | SpO2 95%  | BMI 36.33 kg/m²    Physical Exam Vitals and nursing note reviewed.  Constitutional:      General: He is in acute distress.     Appearance: He is ill-appearing and diaphoretic.  Eyes:     Extraocular Movements: Extraocular movements intact.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.  Pulmonary:     Effort: No respiratory distress.     Breath sounds: Normal breath sounds.  Abdominal:     Palpations: Abdomen is soft.  Neurological:     General: No focal deficit present.     Mental Status: He is alert and oriented to person, place, and time.  Psychiatric:        Mood and Affect: Mood normal.        Behavior: Behavior normal.   1/10/22 -Infectious Disease Progress Note: ID follow up for: COVID 19   ASSESSMENT/PLAN: * COVID-19 Assessment & Plan o PCR positive 1/4, cycle threshold 16 o Vaccinated 2 pfizer 3/2 and 3/23/21, no booster o Receiving d 5 of remdesivir o 1/5: Strep pneu ag neg, legionella ag neg, mrsa screen neg, sputum culture nl resp flora o Immunocompromised patient AML on Ruxolitinib   Plan: 1.  Continue steroids 2.  Completed 5 day course zosyn, stop 3.  Completed remdesivir 5 day course today 4. Ongoing supportive care     ID to sign off. Please contact ID team if re-evaluation desired.  IDAPP for Dr.  1/10/2022     Subjective:   Interval events: remains afebrile. Today d 5 remdesivir. HFNC.  Patient reports ongoing SOB. unimproved. Denies chest pain.    Per RN at bedside afib with RVR continues. Plan for amiodarone bolus.        Allergies: Patient has no known allergies.   Review of systems: SEE HPI     Objective:   Vitals: BP 115/79  | Pulse 122  | Temp 36.8 °C (Oral)  | Resp 20  | Ht 1.753 m  | Wt 111.6 kg  | SpO2 90%  | BMI 36.33 kg/m²     Gen: appears ill Respiratory: tachypneic,  Cardiovascular: tachycardic (154 on heart monitor), irregular Abdomen: soft, no grimace Skin: not diaphoretic Psych: mood appropriate, cooperative