Age: 55.0
Sex: F
Vaccine: COVID19
Symptoms: Microcytic anaemia, Nausea, Oedema, Pain, Polyuria
Clinical narrative: Hospitalized (12.16.21 - 12.26.21); COVID-19 positive (12.16.21); Fully vaccinated -J&J x1 d/c summary: Discharge Summary  MD (Physician) ? ? General Medicine BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider: MD Admission Date: 12/16/2021 Discharge Date: Dec 26, 2021    Active Hospital Problems   Diagnosis Date Noted POA ? Hematuria 12/26/2021 Unknown ? Iron deficiency anemia 06/13/2018 Yes ? Type 2 diabetes mellitus with hyperglycemia, without long-term current use of insulin  01/25/2016 Yes   Resolved Hospital Problems   Diagnosis Date Noted Date Resolved POA ? UTI (urinary tract infection), uncomplicated 12/26/2021 12/26/2021 Unknown ? Acute respiratory failure with hypoxia  12/26/2021 12/26/2021 Unknown ? Acute kidney injury  12/26/2021 12/26/2021 Unknown ? COVID-19 12/16/2021 12/26/2021 Unknown    Pre-Existing Active Problems   Diagnosis Date Noted POA ? Cellulitis of left abdominal wall 11/26/2021 Unknown ? History of gastric surgery 06/09/2021 Unknown ? Secondary hyperparathyroidism  04/28/2021 Unknown ? Morbid obesity with BMI of 50.0-59.9, adult  08/31/2020 Unknown ? Post traumatic stress disorder (PTSD) 08/31/2020 Unknown ? Moderate episode of recurrent major depressive disorder  02/13/2020 Unknown ? GAD (generalized anxiety disorder) 12/11/2019 Unknown ? DDD (degenerative disc disease), cervical 07/23/2019 Unknown ? Pancreatic cyst 07/23/2019 Unknown ? Diabetes mellitus type 2 without retinopathy  04/26/2019 Unknown ? Senile nuclear cataract, bilateral 04/26/2019 Unknown ? Myopia of both eyes 04/26/2019 Unknown ? IPMN (intraductal papillary mucinous neoplasm) 10/27/2018 Unknown ? Complications of gastric bypass surgery 08/20/2018 Unknown ? Chronic bilateral low back pain without sciatica 08/01/2018 Unknown ? Venous stasis 07/19/2018 Unknown ? High serum parathyroid hormone (PTH) 06/13/2018 Unknown ? Primary osteoarthritis of both knees 06/13/2018 Unknown ? DDD (degenerative disc disease), lumbosacral 05/25/2018 Unknown ? Primary osteoarthritis involving multiple joints 04/10/2018 Unknown ? Chronic deep vein thrombosis (DVT) of proximal vein of lower extremity, unspecified laterality 02/07/2018 Unknown ? HTN (hypertension) 01/25/2016 Unknown ? OSA (obstructive sleep apnea), moderate 01/25/2016 Unknown     Discharge Disposition:  home health care svc    Active Issues Requiring Follow-up:    1. T2DM: Increased Lantus to 50 units nightly, patient discharged with glucometer and supplies to check blood sugars at home. Patient should follow up with PCP.    2. Hematuria: Follow up with Urology for continued outpatient workup   3. Iron deficiency anemia: Recommend outpatient follow up with PCP for further workup/possible GI referral     Pending Labs    Order Current Status   Medical Cytology Request In process       DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 56 y.o. female with past medical history significant for HTN, DMII, Hx PE/DVT on Xarelto, anxiety/depression, gastric bypass who presented to the hospital with 4 days of shortness of breath, cough, nausea, headaches, loss of taste and smel. She tested positive for COVID-19. Patient received the J&J Vaccine March 2021. In the ED, COVID PCR positive, initially requiring 8L NC. She was treated with decadron and remdesivir and eventually weaned down to room air and remained stable. She did develop an AKI after admission which was treated with fluids and resolved. Renal US was negative. She also endorsed new hematuria as well as dysuria. She was treated for UTI with Ceftriaxone. Dysuria did improve, but patient continued to have hematuria. Urology was consulted and recommend obtaining UA and culture through catheter. UA showed some blood and culture has shown no growth to date. Urology will follow up outpatient for outpatient ct urogram and cystoscopy if culture negative. Patient given Urology office info at discharge. DGMS was also consulted for assistance with sugar control in setting id diabetes and steroids. She was discharged on increased 50 units Lantus daily and home victoza. She was provided with glucometer and diabetic supplies to check blood sugars at home. She was given education on how to check her sugars. She was discharged home in stable condition on 12/26/21.   CONSULTS / RECOMMENDATION:    Consult Orders (From admission, onward)                IP CONSULT TO UROLOGY      Provider:  MD        IP CONSULT TO DIABETES & ENDOCRINOLOGY      Provider:  Diabetes And Endocrinology          INPATIENT PROCEDURES:    Surgery and Procedures    None   Non-surgical Procedures (From admission, onward)   None     BP 131/89  | Pulse 88  | Temp 37 °C (Oral)  | Resp 18  | Ht 1.651 m  | Wt (!) 151.8 kg  | SpO2 98%  | BMI 55.69 kg/m²  FIO2 (%): 40 % Physical Exam Vitals and nursing note reviewed.  Constitutional:      General: She is not in acute distress.    Appearance: She is obese.  HENT:     Head: Normocephalic and atraumatic.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Heart sounds: Normal heart sounds.  Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.  Abdominal:     General: There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness.  Musculoskeletal:     Right lower leg: No edema.     Left lower leg: No edema.  Skin:    General: Skin is warm and dry.  Neurological:     General: No focal deficit present.     Mental Status: She is alert and oriented to person, place, and time.  Psychiatric:        Mood and Affect: Mood normal.   H&P: CHIEF COMPLAINT: Covid19 pneumonia     Assessment/Plan    ASSESSMENT / PLAN:   Acute hypoxic respiratory failure 2/2 COVID19 pneumonia - sxs onset, test positive 12/16, vaccinated w/ J&J, not boosted - cxr w/ bilateral airspace disease - decadron 6 mg x 10 days - remdesivir - continuous pulse ox monitoring, prone position encouraged, daily inflammatory markers - currently on 8L via VM, wean as able   IDDM2 with hyperglycemia - home victoza held - start w/ home glargine 40 units qhs and corrective insulin - suspect needs will be higher with steroids +/- DGMS consult   Chronic microcytic anemia IDA Hx Gastric bypass - hgb stable at 10 - check iron panel   Hx DVT/PE - cont xarelto   Anxiety/Depression - cymbalta, abilify, elavil   Venous stasis of bilateral lower extremities - ted hose   HTN - cont home amlodipine, hctz-losartan, coreg   HLD  - cont statin   Morbid obesity OSA - BMI 55   DVT ppx; on xarelto Dispo: admit for covid 19 pna       Subjective    HISTORY OF PRESENT ILLNESS: Patient is a 56 y.o. female with PMH addendum hypertension, type 2 diabetes, history of PE/DVT on Xarelto, anxiety/depression, gastric bypass.  She presented to emergency department on 12/16 with 4 days of onset of shortness of breath, cough, nausea, headaches, loss of sense of taste and smell.  She denies diarrhea, vomiting, fevers or chills.  She reports receiving a Johnson & Johnson vaccine in March 2021.  Her COVID PCR was positive.  Patient required venturi mask at 8 L to maintain her saturations here.  Labs are relatively unremarkable.  Chest x-ray shows bilateral airspace opacities consistent with COVID 19 pneumonia.  Patient is given Decadron is being admitted with concerns for assessment and management.  The patient was recently hospitalized in November 2021 for abdominal wall cellulitis.  This has since improved.   Patient Active Problem List Diagnosis ? Type 2 diabetes mellitus   ? HTN (hypertension) ? OSA (obstructive sleep apnea), moderate ? Chronic deep vein thrombosis (DVT) of proximal vein of lower extremity, unspecified laterality   ? Primary osteoarthritis involving multiple joints ? DDD (degenerative disc disease), lumbosacral ? High serum parathyroid hormone (PTH) ? Iron deficiency anemia ? Primary osteoarthritis of both knees ? Venous stasis ? Chronic bilateral low back pain without sciatica ? Complications of gastric bypass surgery ? IPMN (intraductal papillary mucinous neoplasm) ? Diabetes mellitus type 2 without retinopathy   ? Senile nuclear cataract, bilateral ? Myopia of both eyes ? DDD (degenerative disc disease), cervical ? Pancreatic cyst ? GAD (generalized anxiety disorder) ? Moderate episode of recurrent major depressive disorder   ? Morbid obesity with BMI of 50.0-59.9, adult   ? Post traumatic stress disorder (PTSD) ? Secondary hyperparathyroidism   ? History of gastric surgery ? Cellulitis of left abdominal wall Objective    OBJECTIVE: BP 131/63  | Pulse 97  | Temp 37.1 °C (Oral)  | Resp 21  | Wt (!) 151.5 kg  | SpO2 95%  | BMI 55.58 kg/m²  FIO2 (%): 40 % Physical Exam Constitutional: no acute distress, obese, appears comfortable HEENT: normocephalic, atraumatic Neck: supple Cardiovascular: regular rate and rhythm, no murmurs, pulses 2+ and equal bilaterally Pulmonary: coarse breath sounds throughout, wearing venturi mask, non labored Gastrointestinal: soft, non-distended, non-tender Musculoskeletal: 1+ BLE edema, no deformities Skin: warm, dry, no rash  Neuro: alert, oriented x4, no focal deficits