Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Pleural effusion, Positive airway pressure therapy, Respiratory failure, SARS-CoV-2 test positive, Type 2 diabetes mellitus
Clinical narrative: The patient is a 65 y.o. female who presented to the the Hospital ED from home on 12/20/2022 with generalized weakness and dyspnea.   ED work-up demonstrated acute on chronic respiratory failure believed secondary to CHF with contribution from covid 19 infection.   Her hospitalization was prolonged due to persistent hypoxemia, confusion, and weakness requiring skilled facility placement after completion of COVID isolation.        Assessment and Plan   Acute on chronic hypoxemic respiratory failure  Multifactorial related to decompensated heart failure and SARS-CoV-2 infection requiring supplemental oxygen above her reported baseline of 3-4 L/min -Responded to bronchodilator therapy and heart failure treatment -now on baseline 3L 02   Acute on chronic heart failure with preserved ejection fraction Essential hypertension Trigger initially reported as running out of medications, though this was denied by the patient -Outpatient regimen is noted to include metoprolol tartrate 12.5 mg twice a day, torsemide 50 mg daily, and spironolactone 50 mg daily -Responded well to IV furosemide she transitioned to torsemide 50 mg daily on 12/22/2022 with spironolactone resumed on 12/21/2022   Idiopathic bronchiolitis obliterans Known to clinic pulmonology medicine last assessed via telemedicine visit 12/12/2022; historically managed with nebulized budesonide and formoterol BID with a baseline oxygen level requirement of 3-4 L/min -Per telemedicine notes follow-up has occurred at 6-month intervals -Reinstated home budesonide/formoterol therapy via inhaler; plan for nebulizer at home -Continue albuterol PRN   Obstructive sleep apnea Morbid obesity (BMI 39.72) Prescribed CPAP therapy to which she reports compliance; as above known to clinic pulmonary medicine, however, her home device is not available and there is concern it may have been lost in her moved. -Continue CPAP nightly and with napping if her home machine can be located   SARS-CoV-2 infection / COVID-19  Presented with shortness of breath and generalized weakness - Symptom onset: 48 hours prior to arrival - Positive COVID-19: 12/21/22 - Vaccination status: vaccinated ( J&J 5/2021; boosted with Pfizer 7/27/2022) - CXR on admission showed infiltrates left greater than right and small left effusion - Oxygen status: up to 5 L/min with PRN bipap at presentation since weaned -completed course of decadron and remdesivir while in the hospital -Completed isolation while in the hospital   Diabetes mellitus type 2 with hyperglycemia Baseline hemoglobin A1c at 7.7% in November 2022 with persistent elevations in the setting of dexamethasone use this admission -continue lantus/humalog and metformin on discharge  Enterococcus faecalis urinary isolate Clinical relevance is not clear as the urinalysis and culture result from 12/27/2022 were performed based on order placed on 12/20/2022 -Given finding of Enterococcus species, favor treatment with amoxicillin; will complete 5-day course upon discharge   Multiple sclerosis -Historical diagnosis reported to have been well controlled with baclofen, carbamazepine, and Avonex injections -She remains off Avonex injections in the hospital; she will be able to resume dosing at the facility with her home supply -Outpatient prescription records suggest this was prescribed 12/6/2022, though, it is not clear that this supply was received -She needs to establish with a local neurologist to reassess carbamazepine and baclofen