Age: 66.0
Sex: F
Vaccine: COVID19-2
Symptoms: Treatment noncompliance, Ultrasound scan, Wheezing
Clinical narrative: Admission Date: 1/8/2023 Discharge Date: 1/13/2023  COVID positive date 01/08/2023   Clinical Narrative:   The patient is a 66-year-old female with chronic obstructive pulmonary disease who developed COVID pneumonia and required inpatient care for IV remdesivir and IV Decadron.  She was also found to have sigmoid diverticulitis on CT scanning done for abdominal discomfort.  She was treated accordingly with parenteral antibiotics and seen by General surgery.  She is doing well and will be discharged home today at her request.     Please see the following problem-list oriented Hospital Course below:   Sigmoid diverticulitis Assessment & Plan Monitor blood culture results. Monitor procalcitonin. Zosyn every 6 hours. Consult general surgery. CT abdomen pelvis with IV contrast reports sigmoid diverticulosis. There is circumferential thickening of the wall of the sigmoid colon with mild inflammatory changes; patient has abdominal pain on clinical exam suggestive of acute sigmoid diverticulitis however No WBC elevation or fever.   1/13 - the patient was seen by General surgery.  No treatment other than broad-spectrum parental antibiotics recommended.  The patient received Ceftriaxone and metronidazole IV.  She received Cipro and Flagyl during a pair of time in which she was without an IV.  IV placement was difficult but was eventually accomplished with ultrasound.  She returned to ceftriaxone and metronidazole and has largely been treated.  She is concerned about antibiotic therapy on discharge and may extended additional 3 days given the interruption with the IV.     Generalized anxiety disorder Assessment & Plan   Quite symptomatic. Existential issues.  Often upset with the examiner and staff.  Multiple attempts to engage with her regarding her medications.  She will ask for things and subsequently refuse them.  She will suggest things and then subsequently refuse them.  She will often refuse to try her own medications from home for establish indications.  She did seem to respond somewhat better today in the presence of a friend who was in the room and able to provide some redirection.    1/13 - likely exacerbated by steroids.  Serial improvement.  May consider adding BusPar on discharge to her Effexor therapy.  This may also be an effective adjunct for her substance use disorder.   Pneumonia due to COVID-19 virus Assessment & Plan Titrate oxygen to effect.  Encourage prone positioning.  Encourage pulmonary toilet.  Bronchodilator p.r.n.  Pulse oximetry    1/9....  Continue breathing treatments p.r.n., steroids and IV remdesivir Shortness of breath improving she is presently on 1 L nasal cannula oxygen     1/12 - remains on IV Decadron and IV remdesivir.  Oxygenation has improved today.  She has been able to ambulate more and has much less wheezing.  She does however remain on both parenteral corticosteroids and remdesivir.  Dosing through tomorrow.  Hypoxia has not worsened and has not progressed since yesterday's interval exam.  Further BiPAP need seems unlikely.   1/13 - doing much better today.  Lungs are essentially, now, clear.  She will finish her remdesivir today and may be discharged later today.  Decadron may stop as well.     Opioid dependence Assessment & Plan   Continued Suboxone.     Moderate acute exacerbation of asthma Assessment & Plan Supplemental O2. Continuous pulse oximetry. Bronchodilator. Decadron.   1/13....  Improved with intravenous corticosteroid therapy, frequent nebulized treatments, Symbicort, and treatment of her underlying COVID pneumonia.  She does have chronic CO2 retention and will need continued careful follow-up for chronic obstructive pulmonary disease.  PFTs in 6-8 weeks after for recovery may be informative.