Date of Admission  01/17/2022   Date of Discharge  02/04/2022   Reason for Hospitalization   pt baseline 4 liters. felt sob this am. 47% when ems got to scene. one albuterol and one duo neb given. pt 85 percent on arrival.  Hospital Course: Patient is 75 year old female with asthma, COPD with baseline 5-6 L oxygen at home, CPAP at night, dementia, heart failure with preserved ejection fraction (EF 60% 1/25/2021), HTN, pulmonary HTN, Type II diabetes (Last A1c 5.8% on 11/28/21), may be tomorrow things will be CKD stage III  (BL Cr 1.5-1.9) who was admitted to MICU on 1/17/22 for acute hypoxic respiratory distress requiring BiPAP Likely 2/2 COPD exacerbation 2/2 COVID PNA. COVID positive on 1/18. Off Precautions on 1/27. Completed Steroid and Baricitinib for COVID PNA (1/18-1/25). She completed 5 days of Ceftriaxone and 3 days of Azith for COPD exac possible superimposed bacterial PNA. She has been diuresing for fluid overload 2/2 HF exacerbation, currently on home dose Bumex. She stated to family medicine team on 2/1 for continuation of management.    Patient symptoms improving.  Oxygen weaned to 5 L nasal cannula for 4 days.  She was repleted for hypokalemia. PT OT evaluated, recommended home with home health or home with 24/7 assist. Patient has 247 assists at home.  Patient is medically stable for discharge. She discharged home on 2/4. Planning to F/U with PCP within a week  Discharge Recommendations  -  Home amlodipine hold for soft Bpr, consider restart if Bpr start to elevate  - No other changes to home medications  Discharge Diagnoses      1. Acute on chronic respiratory acidosis     2. Acute on chronic respiratory failure with hypoxemia.     3. Acute hypercapnic respiratory failure     4. Pneumonia due to COVID-19 virus     5. COPD exacerbation     6. Acute exacerbation of congestive heart failure     7. Hypokalemia     8. OSA treated with BiPAP.     9. Contact with and (suspected) exposure to COVID-19     Orders:   Follow Up Appt Family Medicine  Other Diagnoses   Ongoing  Anemia due to vitamin B12 deficiency  Asthma, Unspecified  BMI 40.0-44.9, adult  Cardiomegaly - hypertensive  Chronic obstruct airways disease  COPD with hypoxia  Delusion regarding teeth--improved on abilify  Dementia--MMSE 19 (Nov 2020)  Heart failure, right-sided  Hypertension  Kidney disease  Macrocytic anemia  Malignant Essential Hypertension  Osteoarthritis of knees, bilateral  Osteopenia  Pulmonary hypertension  Severe obesity  Sinus node dysfunction  Status post cardiac pacemaker procedure  Type 2 diabetes mellitus  Vitamin B12 deficiency  Historical  Ineffective health maintenance  Operations and Procedures   None  Consultants  Medicine Pulmonary    Supportive/Palliative Care   Pending Labs  None  Discharge Disposition  Home    Medications  New, Changed, or Refilled Medications  Misc. Medication (23G 1" Syr See Instructions, to use with B-12 injections, 5 Each, 5 Refill(s)  Instructions:to use with B-12 injections  albuterol (albuterol 2.5 mg/ See Instructions, INHALE 3ML EVERY 4 HOURS AS NEEDED FOR COUGH, WHEEZING OR SHORTNESS OF BREATH., 75 mL, 5 Refill(s)  Instructions:INHALE 3ML EVERY 4 HOURS AS NEEDED FOR COUGH, WHEEZING OR SHORTNESS OF BREATH.  cyanocobalamin (cyanocobalam See Instructions, INJECT 1ML INTRAMUSCULARLY EVERY MONTH, 1 mL, 13 Refill(s)  Instructions:INJECT 1ML INTRAMUSCULARLY EVERY MONTH  fluticasone-salmeterol (Adva See Instructions, INHALE ONE PUFF BY MOUTH TWICE DAILY, 60 blister, 5 Refill(s)  Instructions:INHALE ONE PUFF BY MOUTH TWICE DAILY  olodaterol-tiotropium (Stiol See Instructions, INHALE 2 PUFFS BY MOUTH every 24 hours, 4 g, 5 Refill(s)  Instructions:INHALE 2 PUFFS BY MOUTH every 24 hours    Medications to be Continued  ARIPiprazole (ARIPiprazole 2 2 mg, 1 Tablet(s), Oral, Daily    apixaban (Eliquis 5 mg) 5 mg, 1 Tablet(s), Oral, bid    bumetanide (bumetanide 2 mg) 2 mg, 1 Tablet(s), Oral, qAM & Noon    calcium-vitamin D (calcium-v 1 capsule(s), Oral, bid    cetirizine (cetirizine 10 mg 10 mg, 1 Tablet(s), Oral, qAM    citalopram (citalopram 40 mg 40 mg, 1 Tablet(s), Oral, qAM    fluticasone nasal (fluticaso 100 mcg, 2 Spray, Each Nostril, Daily, 15.8 mL, 5 Refill(s)    ibuprofen (ibuprofen 200 mg) 200 mg, 1 Tablet(s), Oral, q6h, PRN: as needed for pain    metoprolol (Metoprolol Tartr 25 mg, 1 Tablet(s), Oral, bid    polyethylene glycol 3350 (Mi 17 g, Oral, Daily, PRN: Constipation    simvastatin (simvastatin 20 20 mg, 1 Tablet(s), Oral, At Bedtime, 30 Tablet(s), 12 Refill(s)      Discontinued Medications  amLODIPine (amLODIPine 5 mg) 5 mg, 1 Tablet(s), Oral, At Bedtime       Physical Exam at Discharge  Vitals & Measurements  T: 36.2 °C  TMIN: 36.2 °C  TMAX: 36.5 °C  HR: 78  RR: 16  BP: 114/76  SpO2: 93%  WT: 85.8 kg  BMI: 36.5      GEN: NAD, interactive Eyes: ECOI, sclera nonicteric, conjunctiva clear HENT: Tongue and mucous membrane moist, hearing intact CV: RRR, systolic murmur 2/6, no gallop,  clicks, rubs PULM: non-labored breathing, on 4- 5 L NC, poor inspiratory efforts, improving coarse crackles B/L, no wheezes, or rhonchi ABD: obese, soft, non-distended, non tender, normoactive BS MSK: No peripheral edema PSYCH: appropriate affect and mood Neurology: alert, oriented x3, no focal deficit  Time Spent  30 minutes   Follow Up Appointments     Follow Up Appt Family Medicine, Clinic Name/Phone: Provider Within 7 Days, No tests    Appointment Type  When  With  Where  Nursing/Other Orders   Regular Diet. Ordered on 01/19/22 7:22:00 CST, Meal Start Time Breakfast 0700 to 0900   Intake and Output. 01/17/22 13:18:36 CST, Continuous Order, q12h. Order comment: Ordered by system rule: ORD_ADD_CHF_TASKS based on indications for congestive heart failure.   Intake and Output. 01/17/22 14:09:00 CST, Continuous Order   Fall Precautions. 01/17/22 15:30:15 CST. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Activity As Tolerated. 01/17/22 14:09:00 CST, Continuous Order   Code Status. Code Status Description: Full Code    I personally saw and evaluated the patient on the result date found in the header of this document.  I independently performed the critical/key portions of the Evaluation and Management service and discussed the management.  I agree with everything documented above with the following exceptions/additions:    feels good.  ready to go home  nonlabored breathing.  up eating bfast  dc today with outpt f/u