text:  BY SYSTEM 1. PULMONARY  She was treated with albuterol and Atrovent continuous nebulizers and was weaned then to intermittent nebulizer treatments and then to her meter-dosed inhalers taking them q.4h. at the time of discharge . She was continued on salmeterol and Flovent . She was continued on Solu-Medrol 80 mg q.8h. then converted to prednisone at 60 mg p.o. q.d. She was started on Singulair 10 mg p.o. q.d. Serial arterial blood gases were followed after an arterial line was placed . Her PCO2 gradually declined to the 48 range . Despite episodes of somnolence the first night which were presumably due to having spent the entire night in the Emergency Department   she never became more hypercarbic   and her PCO2 trended to 48 by the time the arterial line was discontinued . On the night of admission and thereafter   she was noted to have a very stridorous sounding breathing when the patient was asleep . This would disappear whenever she was awake . Her case was discussed with Ear  Nose  Throat and the Medical Intensive Care Unit attending . She was given a trial of 80  20 mixed helium  oxygen to decrease the stridor but had minimal effect . Ear  Nose  Throat recommended not considering this an airway problem unless she was stridorous while awake . The patient was to arrange for Pulmonary and Medicine followup through her primary care physician upon discharge as she has not been seen in the Pulmonary Clinic in two years . 2. CARDIOVASCULAR  The patient ruled out for myocardial infarction with serial creatine kinases   although these did rise to 816 . MB was negative . She was treated with captopril for hypertension   and this was switched to Norvasc 7.5 mg p.o. q.d. on discharge . She had an echocardiogram which showed a hyperdynamic left ventricular of normal thickness and size   and no significant valvular disease . She apparently did not have a cardiovascular component to her wheezing or shortness of breath  however   she was to go home on Lasix 20 mg p.o. q.d. to help with lower extremity edema   as she experiences discomfort with this   and the team felt this may be a limiting factor with her prednisone compliance . 3. ENDOCRINE  She was treated with a sliding-scale of regular insulin while she was in house . She was given 500 mg p.o. q.d. of metformin to treat her steroid-induced diabetes on discharge . This should be followed up by her primary care physician . 4. INFECTIOUS DISEASE  She was treated briefly with levofloxacin because of the gram-positive cocci in her sputum culture  however   her symptoms were felt to be consistent with a viral upper respiratory infection   and levofloxacin was continued at the time of discharge . MEDICATIONS ON DISCHARGE Lasix 20 mg p.o. q.d. Combivent meter-dosed inhaler 2 puffs q.4h. weaning to albuterol meter-dosed inhaler 2 puffs q.4h. Salmeterol 2 puffs q.12h. Flovent 220 mcg 2 puffs q.12h. Prednisone 40 mg p.o. q.d. with taper . Fentress 60 mg p.o. b.i.d. Singulair 10 mg p.o. q.d. Univasc 7.5 mg p.o. q.d. Metformin 500 mg p.o. q.d. Dyazide was discontinued . DISCHARGE STATUS  Discharge services included visiting nursing which was to assess in her inhaler technique   monitor her fasting blood sugars   as well as her blood pressure   monitor her peak flows   and assess her mobility and activities of daily living at home . DISCHARGE FOLLOWUP She was also to seek the next available appointment with Dr. Jeanette Barr or to see another resident in the Saint Vincent Hospital Clinic if she cannot get an appointment within one week . CONDITION AT DISCHARGE  Condition on discharge was good .. CODE STATUS  Full code . DISCHARGE DIAGNOSES Asthma flare . Hypertension . Steroid-induced diabetes . James Z Berg   M.D. 19-421 Dictated By  Melanie L.W. Palevic   M.D. MEDQUIST36 D  2011-06-18 1633 T  2011-06-21 1534 JOB  92012 Signed electronically by  DR. Andrea Trotter on