Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Fatigue, Hypertension, Hypoxia, Inflammatory marker test, Insomnia
Clinical narrative: Vaccinated patient admitted for COVID Admit 8/28/2021, discharge 9/2/2021 to home  Event Description: Pt received COVID-19 vaccine and tested positive for COVID. This is just to report that pt got the vaccine  Date of Positive COVID test and admission 8/28 Moderna Vaccine Date 1/28/2021 Left Deltoid-Lot 007M20A-location unknown-Moderna Date 3/4/2021 Left Deltoid- lot 003A21A-Location unknown -Moderna Monitoring: Pt was started on Remdesivir and Dexamthasone    Reason for consult: Hypertension urgency, COVID-19 PNA Assessment/Recommendations: Admit to inpatient    History Of Present Illness Patient is a 79 y.o. female with PMH of breast cancer not actively on chemo, PE on eliquis, diabetes who presented to the hospital for cough and chest pains.    She notes that she started to have significant coughing spells on Thursday night and has not been able to sleep well. She denies active shortness of breath or dyspnea on exertion. She presented to the ED today due to have right sided chest pain that is pronounced with coughing spells. She has been having productive cough with clear sputum. She noted she has been feeling fatigue since Thursday as well. No reported fever.  No apparent sick contacts but thinks that her daughter is working in school may have passed around the virus. She has completed receiving the vaccine in 3/2021.    She was evaluated in the ED and was found to be + covid. She was also noted to be hypertensive which she reports that she has not been taking her medication in the last 2-3 days. Notably, she was not hypoxic on presentation but was found to be hypoxic around 89% on RA after arrival to hospital.   Social History She reports that she has quit smoking. She has never used smokeless tobacco. She reports that she does not drink alcohol and does not use drugs.  Acute hypoxic respiratory failure  COVID-19 PNA - Noted to be symptomatic around 3 days ago and tested positive for COVID-19 today. Initially did not appear to be hypoxic but was found to be in frequent desaturations to the high 80s on RA on arrival hospital. X-ray supportive of bilateral infiltrates.  - will add inflammatory markers and trend - Start decadron and remdesivir - Supplement 2 L NC to titrate for SPO2 > 90% - Hold abx as low suspicion for co-infection. - No indication for monoclonal ab now.  - Start tessalon pearls for cough, ibuprofen for chest pain as needed    Hypertension urgency  - Noted to have significant BP elevation to 220 mmHg SBP, patient asymptomatic, no end-organ damage - Has been off home meds in the past 3 days. Will resume home amlodipine, hold cozaar due to hyperK, change metoprolol to labetalol  - Added PRN hydralazine for goal of SBP today < 180 mmHg SBP  - Monitor vital signs    Atypical Chest pain  - Likely related to MSK as able to pin-point the right lateral chest - No trop leak. EKG without apparent ST-T changes  - Pain management as above    Hx of CKD stage IV Hyperkalemia - Creatine around baseline, having urine output - K is noted to be elevated at 5.9, will trend evening K - If above 6, will start hyperk protocol.  - Continue home dose lasix, received 1 x IV lasix today.     Hx of PE on eliqiuis - Continue eliquis    Urinary incontinence - Continue oxybutynin    Depression/anxiety - Fluoxetine/topomax   Hx of breast cancer - Continue on anastrozole   Obesity  - Complicates all aspects of care   Hospitalization Admit Date/Time: 8/28/2021  9:36 AM Admitting Attending: Discharge Date: 9/2/2021 Discharge Attending Physician:  PCP name and Address:   Referring provider name and address:  No referring provider defined for this encounter.   Chief Concern, Brief History of Present Illness, and Hospital Course Patient is a 79 y.o. female with PMH of breast cancer not actively on chemo, PE on eliquis, diabetes who presented to the hospital for cough and chest pains. She was found to have COVID-19 + with hypoxia in the high 80s. She was also found to have Hypertension urgency + started on oral meds.    COVID-19: Started on supplemental oxygen, also started on remdesivir and dexamethasone.  She complained of pleuritic chest pain (EKG, Troponin were negative). Chest pain resolved after admission. She completed the remdesivir course and was discharged on home oxygen (2L/min) along with dexamethasone for the next 5 days.    HTN urgency: She missed her meds in last 33 days before admission, resumed meds with good appropriate response. She was discharged on same home medications.   Hyperkalemia with CKD: Resolved with diuresis, and controlling her blood pressure. She was discharged with Creat level at her baseline.    Her Eliquis dose was increased during admisison to 5mg BID as it is more appropriate for her history of DVT though she has CKD.