Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning.