Date of Admission: 9/2/2023   Date of Discharge: 9/6/2023   Issues to be Addressed at Follow-up: Follow up with rheum (has been about a year since last rheum note)   Pending Study Results at Discharge:  Unresulted Lab Orders    Date and Time Order Name Status Specimen Source   9/3/2023  7:00 AM SODIUM In process --   9/2/2023  5:55 AM BLOOD CULTURE 2 Preliminary BLOOD   9/2/2023  5:31 AM BLOOD CULTURE Preliminary BLOOD       Final Diagnoses:  Active Hospital Problems   Diagnosis   ? (Principal) COVID-19 DISEASE   ? LONG TERM NON WARFARIN ORAL ANTICOAGULANT THERAPY       dabigatran (Pradaxa) 150 mg twice daily Indications:  Acute DVT/PE first episode - unprovoked Expected length of therapy: Indefinite (Provider to assess risk vs benefits periodically)  Considerations:    HC pool: PHARMACY SERVICE        Periop Guideline Reference:   Go to Clinical Library ==>  Search: Anticoagulation Management - Perioperative- Anticoagulation Services Guideline     ? SEPSIS WO ACUTE ORGAN DYSFUNCTION   ? NEUTROPENIA DUE TO CHEMOTHERAPY   ? HYPONATREMIA   ? CANCER METASTATIC TO BILAT LUNGS   ? CANCER METASTATIC TO BONE   ? HX OF PULMONARY EMBOLUS   ? LONG TERM IMMUNOSUPPRESSION THERAPY   ? HTN (HYPERTENSION)   ? POSTOPERATIVE HYPOTHYROIDISM   ? ADULT DERMATOMYOSITIS W MYOPATHY   ? CANCER METASTATIC TO AXILLARY LN       Breast CA,  Declined chemotx    ? FEMALE BREAST INFILTRATING DUCTAL CARCINOMA, LEFT UPPER-INNER QUADRANT   ? SINGLE SEIZURE, UNSPECIFIED TYPE     Resolved Hospital Problems No resolved problems to display.     Discharge Disposition:  Home with Home Health   Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings: This is a 60-year-old female with a past medical history metastatic left breast cancer with subsequent recurrence wih pleural effusions, metastases to bone and pulmonary nodules now on palliative chemotherapy, PE on Pradaxa, and dermatomyositis who presented for cough and generalized weakness found to have COVID-19 and neutropenia. On admission met sepsis criteria with neutropenia, tachycardia and tachypnea, likely secondary to COVID19 infection.  Given neutropenia was empirically covered with cefepime. Per oncology recommendations, was given filgrastim until ANC was >10000.  Blood cultures have remained negative and ANC has recovered, thus no further antibiotics recommended. Patient was instructed to monitor for fevers closely at home.  On discharge day patient was afebrile and hemodynamically stable.   BP 143/85  | Pulse 91  | Temp 98.8 °F (37.1 °C)  | Resp 18  | Wt 61.2 kg (135 lb)  | SpO2 96%  | BMI 25.42 kg/m²    Physical Exam: General appearance - alert, well appearing, and in no distress Mental Status - alert, oriented x 3 Chest - clear to ascultation bilaterally.  Heart - normal rate, regular rhythm, normal S1, S2, no murmurs, rubs Abdomen - soft, nontender, nondistended, no masses or organomegaly Neurological - motor and sensory grossly normal bilaterally Extremities - no clubbing, cyanosis or edema Skin - warm and dry   Primary Procedures:  None   Secondary Procedures: None   Reason for Hospital Admission (Admitting Diagnosis):  COVID19   Complications: none   Consults:  HOSPITAL MEDICINE - ONGOING INPATIENT CONSULTATION. Smoker: No.   Condition on Discharge: stable   Code Status at Time of Discharge: Partial Code       Note Details  Author (M.D.) File Time 9/7/2023  8:13 AM Author Type Physician Status Signed Last Editor (M.D.) Specialty Hospital Medicine Hospital Acct #   Admit Date 9/2/2023  ED to Hosp-Admission (Discharged) on 9/2/2023  ED to Hosp-Admission (Discharged) on 9/2/2023   Detailed Report  Note shared with patient Additional Orders and Documentation   Results Imaging   Meds    Orders    Flowsheets   Encounter Info:  History, Allergies, Education, Care Plan, Detailed Report   Hospital Problem List   SINGLE SEIZURE, UNSPECIFIED TYPE  FEMALE BREAST INFILTRATING DUCTAL CARCINOMA, LEFT UPPER-INNER QUADRANT  CANCER METASTATIC TO AXILLARY LN  ADULT DERMATOMYOSITIS W MYOPATHY  POSTOPERATIVE HYPOTHYROIDISM  HTN (HYPERTENSION)  COVID-19 DISEASE  LONG TERM IMMUNOSUPPRESSION THERAPY  HX OF PULMONARY EMBOLUS  CANCER METASTATIC TO BILAT LUNGS  CANCER METASTATIC TO BONE  SEPSIS WO ACUTE ORGAN DYSFUNCTION  NEUTROPENIA DUE TO CHEMOTHERAPY  HYPONATREMIA  LONG TERM NON WARFARIN ORAL ANTICOAGULANT THERAPY Care Timeline  09/02   Admitted from ED 0841 09/06   Discharged 1746