text: Respiratory  On admission   the patient had what appeared to be acute respiratory distress syndrome secondary to community  acquired pneumonia .', 'She was maintained on a ventilator and ventilated according to ARDSNet protocol . For antibiotic coverage of her pneumonia   she was started on Levaquin   ceftriaxone   and vancomycin .', 'Over the next two days after admission   the patient s vent settings were gradually weaned   and she was extubated two days after being transferred to this hospital .', 'After extubation   the patient was oxygenating well on face mask . She did continue to have a persistent fairly severe cough  however   her cough was weak due to abdominal muscle pain from repeated coughing .', 'The cough was mostly nonproductive . The patient was breathing comfortably . As there was no identified bacterial pathogen on any cultures', 'the patient was continued on the triple antibiotics for first several days of the hospitalization . She was also on round-the-clock Atrovent and albuterol nebulizers .', 'Once the patient was transferred out of the ICU and after extubation   the antibiotics were gradually narrowed . The vancomycin and Levaquin were discontinued after approximately four days in the hospital .', 'The ceftriaxone was discontinued after four days in the hospital   and the patient was to continue on Levaquin . The patient had gradual improvement in her oxygenation .', 'Pain control  The patient had fairly significant abdominal pain secondary to persistent cough . She was started on a regimen of MS Contin with oxycodone for breakthrough pain .', 'This helped her somewhat though she has continued to have difficulty coughing due to the pain . Tylenol and ibuprofen were also added for better control .', 'Transaminitis  The patient was noted to have mild transaminitis on admission . However   this was felt to be due to her significant infection .', 'This should continue to be followed as an outpatient to assure that it returns back to normal . Anemia  The patient s reticulocyte count showed inadequate production .', 'Iron studies showed a mixed picture with decreased iron and decreased iron to TIBC ratio suggestive of iron-deficiency anemia   but also normal to high MCV .', 'B12 was noted to be low and the patient was given an injection of IM B12 while in the hospital .', 'She was also started on iron supplementation . Hypothyroidism  The patient was continued on Synthroid for her chronic hypothyroidism .