Age: 85.0
Sex: F
Vaccine: COVID19-2
Symptoms: Insomnia, Insulin therapy, Iron deficiency, Lung infiltration, Malnutrition
Clinical narrative: Patient is an 85 y.o. female who presented from home on 4/19/2023 with increasing generalized weakness, cough, poor oral intake with weight loss since being diagnosed with COVID initially 4/1/23 at home and again 4/19/23. Hospitalization complicated by acute hypoxemic respiratory failure likely secondary to COVID-19 infection. CT chest 4/21/23 showed new bilateral lower infiltrates. Pulmonology and ID followed and agreed symptoms and CT likely secondary to COVID-19 infection. She completed full 10 days of Decadron and 5 days of Remdesivir and subsequently weaned to room air. Hospitalization was complicated by finding of bilateral provoked distal DVTS (COVID, malignancy, immobility).    Due to history of right frontal cavernoma, neurosurgery evaluated and stated low risk for rupture and CT Head was normal. Therefore, she was initiated on heparin gtt, transitioned to DOAC 4/25/23 with plans for longterm AC. Acute hypoxemic respiratory failure   COVID-19 pneumonia  -Prolonged COVID-19 in setting of immunocompromised state. Sx onset 3/25/23 with predominantly profound weakness, positive test 4/1/23 at home, again 4/19/23 at facility.  -Required O2, weaned to room air and saturating well. -Pulmonary medicine/ID signed off--she completed 10 days decadron (end date 4/30/23) & 5 days of remdesivir (end date 4/25/23)   Hx of Cavernoma Acute Bilateral Distal LE DVTs -History of right frontal cavernoma diagnosed 07/2020.   -Bilateral Venous dopplers 4/24/23: bilateral distal DVTs (provoked in setting of COVID & malignancy & immobility) -Neurosurgery consulted for evaluation of AC given hx of cavernoma and patient appears fairly low risk for rupture, CT Head 4/23/23 non acute, no evidence of hemorrhage -Transitioned to DOAC 4/25/23, recommend lifelong AC as tolerated given provoked.   Sinus Bradycardia -Briefly noted during hospitalization on telemetry with HR 50s-60s, Resolved -No further intervention   Anxiety Insomnia - Likely related to dyspnea and acute illness.  - Melatonin nightly   Severe Malnutrition -Meets ASPEN criteria -Recommend Boost supplements as outpatient.   Follicular lymphoma -Grade 1 of intrathoracic lymph nodes. Follows with Dr. at Center. -Received chemotherapy infusions via chest port, per their notes receiving Gazyva/Treanda with patial response. Appears last treatment was in Feb with Gazyva only. -Recommend OP follow up with Oncologist.   CKD stage IIIb-IV -Outpatient labs 3/9/2023: Creatinine 2, BUN 42.  Previous creat around 1.6-1.7 outpatient. Follows with nephrology, Dr. (nephrology).  Creatinine stable below baseline here. -Avoid NSAIDs, nephrotoxic agents   Diet controlled diabetes mellitus type 2 -A1c less than 6% (3/23). Not on home meds. -Briefly required insulin while inpatient due to Decadron for COVID.  -No further management   Chronic normocytic anemia -Suspect due to CKD. Also with component of iron deficiency given low iron sat. No signs or symptoms of acute blood loss. Baseline Hgb 7-9 range for several years -Follow up outpatient with PCP. Myocardial injury -Likely some element of demand ischemia in the setting of acute illness and poor clearance with chronic renal disease. -Troponin adynamic. EKG without acute ischemia -No plans for ischemic evaluation at this time, continue to monitor as clinically indicated    Hypertension Continue home Lasix, home low-dose losartan stopped as blood pressure has been controlled