Age: 65.0
Sex: M
Vaccine: COVID19
Symptoms: Chronic kidney disease, Condition aggravated, Decreased appetite, Diastolic dysfunction, Dyspnoea
Clinical narrative: Patient ID: MRN:  Name:  Age: 66 y.o. Admit Date: 7/18/2022 12:46 PM Discharge Date:  7/21/2022 Admitting Physician:  Discharge Physician: MD   Discharge Diagnosis: Principal Problem:   Acute renal failure superimposed on stage 3 chronic kidney disease Active Problems:   Essential hypertension   Acute respiratory failure with hypoxia   COVID   Diabetes mellitus type II, non insulin dependent       HPI: Patient is a 66 y.o. male who presents to ED with c/o generalized weakness, dec appetite, shortness of breath and low blood pressure. He tested COVID + on 7/7 and has not felt well since then. Does have h/o "black lung" from the coal mines and has some chronic shortness of breath. He was hypoxic on blood gas - ?venous as sats and exam do not correlate with degree of hypoxia. Having VQ scan to eval for PE. Has h/o CKD and Cr is above baseline. He has not been eating or drinking well. Given worsening renal failure with ?hypoxia, he is being admitted.     Hospital Course:  Acute renal failure superimposed on stage 3 chronic kidney disease Description of the Problem/Progression: Acute on chronic,  baseline Cr ~2.0, now 1.9 ->1.7  previously 2.4 Plan: Hold/avoid nephrotoxic meds.  Daily labs/weights/I&Os. S/p  IV fluids.    COVID Description of the Problem/Progression: Recent, +7/7, negative today   walking test - no need for home O2    Acute respiratory failure with hypoxia Description of the Problem/Progression: Possible Plan: Sats ok. Suspect venous gas. VQ neg low probability for PE. Would not do CTA due to renal failure. US of lower ext.   s/p ECHO: - DD    Essential hypertension Description of the Problem/Progression: chronic Plan: Continue home meds and monitor BP   Diabetes mellitus type II, non insulin dependent Description of the Problem/Progression: chronic Plan: Glucs w/SSI    Disstolic CHF  LV systolic function appears grossly normal although not all walls are well visuallized. Visually estimated LV EF 50%.  Diastolic dysfunction There is mild tricuspid regurgitation. There is moderate concentric left ventricular hypertrophy. Prior echocardiogram report had mildly depressed LV systoplic function with estimated LV EF 45-50%   Physical Exam on the Date of Discharge: Constitutional:      Appearance: He is well-developed. He is obese.  HENT:     Head: Normocephalic.  Eyes:     Pupils: Pupils are equal, round, and reactive to light.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.  Pulmonary:     Effort: Pulmonary effort is normal.  Abdominal:     General: Bowel sounds are normal.     Palpations: Abdomen is soft.  Musculoskeletal:        General: Normal range of motion.     Cervical back: Neck supple.  Skin:    General: Skin is warm and dry.  Neurological:     Mental Status: He is alert and oriented to person, place, and time.       Consults:   IP CONSULT TO NEPHROLOGY IP CONSULT TO SOCIAL WORK   Significant Diagnostic Studies:      CXR:  Impression:  Chronic changes without acute abnormality.   ECHO: Conclusion LV systolic function appears grossly normal although not all walls are well visuallized. Visually estimated LV EF 50%.  Diastolic dysfunction There is mild tricuspid regurgitation. There is moderate concentric left ventricular hypertrophy. Prior echocardiogram report had mildly depressed LV systoplic function with estimated LV EF 45-50%   Disposition:  home   Discharge Condition:  good   Discharge Medications and Orders:   Current Discharge Medication List   CONTINUE these medications which have NOT CHANGED   Details cholecalciferol, vitamin D3, (VITAMIN D3) 400 unit Tab tablet Take 1 Tablet by mouth Once Daily for 30 days. Qty: 30 Tablet, Refills: 0   Associated Diagnoses: Pneumonia due to COVID-19 virus   ascorbic acid, vitamin C, 500 mg tablet Take 1 Tablet by mouth Once Daily for 30 days. Qty: 30 Tablet, Refills: 0   Associated Diagnoses: Pneumonia due to COVID-19 virus   zinc sulfate (ZINCATE) 220 (50) mg Take 1 Capsule by mouth Once Daily for 30 days. Qty: 30 Capsule, Refills: 0   Associated Diagnoses: Pneumonia due to COVID-19 virus   albuterol (VENTOLIN HFA) 90 mcg/Actuation inhaler Take 2 Puffs by inhalation Every 4 hours as needed. Qty: 1 Each, Refills: 0   Associated Diagnoses: Pneumonia due to COVID-19 virus   pioglitazone (ACTOS) 30 mg tablet Take 1 Tablet by mouth Once Daily. Qty: 30 Tablet, Refills: 5   Associated Diagnoses: Diabetes mellitus without complication; Type 2 diabetes mellitus with stage 3 chronic kidney disease, without long-term current use of insulin, unspecified whether stage 3a or 3b CKD   glimepiride (AMARYL) 4 mg tablet Take 1 Tablet by mouth Every morning. Qty: 30 Tablet, Refills: 5   Associated Diagnoses: Uncontrolled type 2 diabetes mellitus with stage 3 chronic kidney disease, without long-term current use of insulin   rosuvastatin (CRESTOR) 40 mg tablet Take 1 Tablet by mouth At bedtime. Qty: 30 Tablet, Refills: 11   Associated Diagnoses: Type 2 diabetes mellitus with stage 3 chronic kidney disease, without long-term current use of insulin, unspecified whether stage 3a or 3b CKD; Uncontrolled type 2 diabetes mellitus with stage 3 chronic kidney disease, without long-term current use of insulin   lisinopriL (PRINIVIL) 10 mg tablet Take 1 Tablet by mouth Daily. Qty: 30 Tablet, Refills: 11   Associated Diagnoses: Type 2 diabetes mellitus with stage 3 chronic kidney disease, without long-term current use of insulin, unspecified whether stage 3a or 3b CKD; Uncontrolled type 2 diabetes mellitus with stage 3 chronic kidney disease, without long-term current use of insulin   furosemide (LASIX) 40 mg tablet Take 1 Tablet by mouth Daily. Qty: 30 Tablet, Refills: 11   isosorbide mononitrate (IMDUR) 30 mg CR tablet Take 1 Tablet by mouth Daily. Qty: 30 Tablet, Refills: 11   Associated Diagnoses: ASHD (arteriosclerotic heart disease); Past heart attack; Chronic diastolic congestive heart failure; Essential hypertension; Mixed hyperlipidemia   metoprolol (LOPRESSOR) 25 mg tablet Take 0.5 Tabs by mouth Twice a day. Qty: 60 Tablet, Refills: 11   hydrALAZINE (APRESOLINE) 10 mg tablet Take 1 Tab by mouth Three times a day. Qty: 90 Tab, Refills: 5   Associated Diagnoses: Essential hypertension   Blood Sugar Diagnostic Strp Twice a day. Qty: 100 Strip, Refills: 11   Associated Diagnoses: Uncontrolled type 2 diabetes mellitus with stage 3 chronic kidney disease, without long-term current use of insulin   cyanocobalamin 100 mcg Take 100 mcg by mouth Daily.   Associated Diagnoses: Coronary artery disease involving native coronary artery of native heart, angina presence unspecified; Past heart attack; Chronic diastolic congestive heart failure; Essential hypertension; Mixed hyperlipidemia   potassium chloride (KLOR-CON) 8 mEq tablet Take 8 mEq by mouth Daily.   fluticasone-salmeterol (ADVAIR) 100-50 mcg/dose inhaler Take 1 Puff by inhalation Twice a day.   aspirin 81 mg tablet Take 81 mg by mouth Daily. Indications: Pt takes at bedtime     STOP taking these medications     dexAMETHasone (DECADRON) 2 mg tablet Comments:  Reason for Stopping:        doxycycline (VIBRAMYCIN) 100 mg capsule Comments:  Reason for Stopping: