CHIEF COMPLAINT: Dyspnea

PRESENT ILLNESS: Ms. [**Known lastname 53693**] is a [**Age over 90 **] F with h/o aflutter, HTN, CVA who
presented to ER initially with dyspnea, LE edema and was found
to have elevated JVD, Atach vs aflutter, CXR c/w CHF. She
started having dyspnea on exetrtion 7 days prior to admission
with a nonprod cough, without CP. When she arrived to the ED,
her BP was 208/110, HR 122, T 98.2, RR 30, Sat 90% on RA. She
received Aspirin 325mg, Acetaminophen 650mg, Furosemide 40mg x
2, Nitroglycerin gtt, Metoprolol 5mg x 3, Lorazepam 2mg. While
in the ER she vomited into her face mask and had an acute
worsening of her respiratory distress at which time repeat CXR
showed bibasilar opacities consistent with aspiration and
possible worsening edema. She then received Vancomycin 1g,
Piperacillin-Tazobactam Na 2.25 gm. Discussion at that time with
her family and PCP resulted in decision to make pt DNR/DNI/CMO
and start a morphine drip for relief of respiratory distress or
discomfort. The plan was to admit her to Medicine for further
supportive comfort care. However, while in the ED her resp
status seemed to improve, and the family requested to treat her
conservatively for her pneumonia/CHF. She is to remain DNR/DNI
per family, but to receive appropriate antibiotics and diuresis.
Of note, while on the morphine gtt her BP dropped to 83/30. She
had a lactate of 2.3. Her morphine gtt was decreased and her BP
rose to 99/39, then back 86/50 (MAP 62) before transport to the
[**Hospital Unit Name 153**]. The ED staff spoke with her family about pressors/central
line, and they said that would be OK if necessary to keep her
alive.

MEDICAL HISTORY: PMHx:
- Strokes-first was prior to [**2094**], grandson does not know
details. Next was in [**2094**] p/w slurred speech. Next was in [**2099**]
with severe left sided weakness. All required physical therapy
rehab. Currently on coumadin and baby asa. PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 11139**] at
[**Location (un) 2312**]. Etiology of strokes is unclear to the family.
- hard of hearing, + tinnitus
- hypothyroidism
- HTN
- high cholesterol
- cataract surgery bilaterally
-? CAD and CHF- no old records here.
.

MEDICATION ON ADMISSION: 1.Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H
(every 4 to 6 hours) as needed
2.Atorvastatin 20 mg PO DAILY
3.Aspirin 81 mg PO DAILY
4.Tolterodine 4 mg DAILY
5.Levothyroxine 50 mcg PO DAILY
6.Glucosamine 1 tab po qday
7.Digoxin 125 mcg PO DAILY
8. Senna 8.6 mg PO BID
9.Docusate Sodium 100 mg PO BID
10.Metoprolol Tartrate 50 mg PO TID
11.Warfarin 3mg po qday- adjust to INR
12.MVI po qday
*** of note, was on Lasix 20 mg PO DAILY, but this was stopped
at her last clinic appt ***

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: Tc 97.2, Tm 101 in ED, BP 83/58(65), HR 93 in Aflut, RR 23,
Sat 100% on NRB
Gen: frail, elderly caucasian woman, lying in bed, HOB 15
degrees, asleep and in no respiratory or other distress
HEENT: no bruises or lacerations, eyelids closed, NRB mask in
place
Neck: supple, JVP elevated @ 10cm
Lungs: diffusely rhonchorous, with insp and exp wheezes
CV: irreg irreg, difficult to hear HS over her breathing; faint
systolic murmur loudest at LUSB
Abd: soft, mildly distended, no grimace to palpation, decreased
BS, no guarding
Ext: 1+ LE edema to ankles, inapprop warm for low BP
Neuro: sedated from morphine and ativan in ED, unable to assess
mental status

FAMILY HISTORY: FamHx: DM, HTN, stroke

SOCIAL HISTORY: SHx: lives with daughter and grandson, walks with a cane,
daughter (60 YO) does all cooking and finances. Widowed since
WWII. Former
farmer from [**Country 5881**], moved to US over 20 yrs ago. No
Tob/etoh/drugs.
Unspecified septicemia,Acute respiratory failure,Septic shock,Pneumonitis due to inhalation of food or vomitus,Diastolic heart failure, unspecified,Acute kidney failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Hyperosmolality and/or hypernatremia,Atrial fibrillation,Severe sepsis,Unspecified acquired hypothyroidism,Unspecified essential hypertension
Septicemia NOS,Acute respiratry failure,Septic shock,Food/vomit pneumonitis,Diastolc hrt failure NOS,Acute kidney failure NOS,DMII wo cmp uncntrld,Hyperosmolality,Atrial fibrillation,Severe sepsis,Hypothyroidism NOS,Hypertension NOS
Admission Date:  [**2106-7-8**]              Discharge Date:   [**2106-7-16**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2160**]
Chief Complaint:
 Dyspnea

Major Surgical or Invasive Procedure:
none


History of Present Illness:
Ms. [**Known lastname 53693**] is a [**Age over 90 **] F with h/o aflutter, HTN, CVA who
presented to ER initially with dyspnea, LE edema and was found
to have elevated JVD, Atach vs aflutter, CXR c/w CHF. She
started having dyspnea on exetrtion 7 days prior to admission
with a nonprod cough, without CP. When she arrived to the ED,
her BP was 208/110, HR 122, T 98.2, RR 30, Sat 90% on RA. She
received Aspirin 325mg, Acetaminophen 650mg, Furosemide 40mg x
2, Nitroglycerin gtt, Metoprolol 5mg x 3, Lorazepam 2mg. While
in the ER she vomited into her face mask and had an acute
worsening of her respiratory distress at which time repeat CXR
showed bibasilar opacities consistent with aspiration and
possible worsening edema. She then received Vancomycin 1g,
Piperacillin-Tazobactam Na 2.25 gm. Discussion at that time with
her family and PCP resulted in decision to make pt DNR/DNI/CMO
and start a morphine drip for relief of respiratory distress or
discomfort. The plan was to admit her to Medicine for further
supportive comfort care. However, while in the ED her resp
status seemed to improve, and the family requested to treat her
conservatively for her pneumonia/CHF. She is to remain DNR/DNI
per family, but to receive appropriate antibiotics and diuresis.
Of note, while on the morphine gtt her BP dropped to 83/30. She
had a lactate of 2.3. Her morphine gtt was decreased and her BP
rose to 99/39, then back 86/50 (MAP 62) before transport to the
[**Hospital Unit Name 153**]. The ED staff spoke with her family about pressors/central
line, and they said that would be OK if necessary to keep her
alive.

Past Medical History:
PMHx:
- Strokes-first was prior to [**2094**], grandson does not know
details. Next was in [**2094**] p/w slurred speech. Next was in [**2099**]
with severe left sided weakness. All required physical therapy
rehab. Currently on coumadin and baby asa. PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 11139**] at
[**Location (un) 2312**]. Etiology of strokes is unclear to the family.
- hard of hearing, + tinnitus
- hypothyroidism
- HTN
- high cholesterol
- cataract surgery bilaterally
-? CAD and CHF- no old records here.
.

Social History:
SHx: lives with daughter and grandson, walks with a cane,
daughter (60 YO) does all cooking and finances. Widowed since
WWII. Former
farmer from [**Country 5881**], moved to US over 20 yrs ago. No
Tob/etoh/drugs.


Family History:
FamHx: DM, HTN, stroke

Physical Exam:
VS: Tc 97.2, Tm 101 in ED, BP 83/58(65), HR 93 in Aflut, RR 23,
Sat 100% on NRB
Gen: frail, elderly caucasian woman, lying in bed, HOB 15
degrees, asleep and in no respiratory or other distress
HEENT: no bruises or lacerations, eyelids closed, NRB mask in
place
Neck: supple, JVP elevated @ 10cm
Lungs: diffusely rhonchorous, with insp and exp wheezes
CV: irreg irreg, difficult to hear HS over her breathing; faint
systolic murmur loudest at LUSB
Abd: soft, mildly distended, no grimace to palpation, decreased
BS, no guarding
Ext: 1+ LE edema to ankles, inapprop warm for low BP
Neuro: sedated from morphine and ativan in ED, unable to assess
mental status


Pertinent Results:
[**2106-7-16**] 10:55AM BLOOD WBC-9.8 RBC-3.65* Hgb-10.8* Hct-32.7*
MCV-90 MCH-29.6 MCHC-33.1 RDW-16.1* Plt Ct-335
[**2106-7-15**] 06:40AM BLOOD WBC-13.8* RBC-4.03* Hgb-12.0 Hct-37.7
MCV-94 MCH-29.8 MCHC-31.8 RDW-16.1* Plt Ct-346
[**2106-7-8**] 04:35AM BLOOD WBC-27.0*# RBC-4.00* Hgb-11.9* Hct-36.2
MCV-91 MCH-29.8 MCHC-32.9 RDW-15.5 Plt Ct-270
[**2106-7-7**] 07:40PM BLOOD WBC-11.9* RBC-4.49 Hgb-13.1 Hct-39.9
MCV-89 MCH-29.2 MCHC-32.9 RDW-16.0* Plt Ct-326
[**2106-7-16**] 10:55AM BLOOD Neuts-78* Bands-0 Lymphs-11* Monos-6
Eos-4 Baso-0 Atyps-0 Metas-1* Myelos-0
[**2106-7-16**] 06:10AM BLOOD PT-20.1* INR(PT)-1.9*
[**2106-7-8**] 04:35AM BLOOD PT-24.6* PTT-34.9 INR(PT)-2.5*
[**2106-7-16**] 06:10AM BLOOD Glucose-144* UreaN-25* Creat-0.7 Na-143
K-3.5 Cl-105 HCO3-28 AnGap-14
[**2106-7-7**] 07:40PM BLOOD Glucose-240* UreaN-23* Creat-0.8 Na-134
K-7.6* Cl-101 HCO3-23 AnGap-18
[**2106-7-15**] 06:40AM BLOOD Glucose-131* UreaN-25* Creat-0.8 Na-147*
K-4.3 Cl-107 HCO3-26 AnGap-18
[**2106-7-15**] 06:40AM BLOOD ALT-33 AST-37 AlkPhos-92 TotBili-1.3
[**2106-7-10**] 02:57AM BLOOD CK-MB-4 cTropnT-0.05*
[**2106-7-7**] 07:40PM BLOOD CK-MB-2 cTropnT-<0.01 proBNP-4035*
[**2106-7-16**] 06:10AM BLOOD Calcium-8.7 Mg-1.9
[**2106-7-8**] 04:35AM BLOOD Albumin-3.8 Calcium-8.6 Phos-3.3 Mg-1.7
[**2106-7-16**] 06:10AM BLOOD Osmolal-301
[**2106-7-14**] 10:30AM BLOOD Osmolal-311*
[**2106-7-8**] 04:35AM BLOOD TSH-3.2
[**2106-7-16**] 06:10AM BLOOD Digoxin-1.1
[**2106-7-8**] 04:35AM BLOOD Digoxin-1.0
[**2106-7-8**] 11:10AM BLOOD Type-ART pO2-233* pCO2-41 pH-7.41
calTCO2-27 Base XS-1
[**2106-7-15**] 11:06AM BLOOD Lactate-7.4*
[**2106-7-16**] 07:25AM BLOOD Lactate-2.2*
[**2106-7-7**] 07:49PM BLOOD Lactate-2.3* K-4.9
[**2106-7-14**] 01:55PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.020
[**2106-7-14**] 01:55PM URINE Blood-NEG Nitrite-NEG Protein-30
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-1 pH-5.0 Leuks-TR
[**2106-7-14**] 01:55PM URINE Hours-RANDOM Creat-93 Na-101

[**2106-7-8**] 12:10 pm SPUTUM      Source: Expectorated.

                            **FINAL REPORT [**2106-7-10**]**

   GRAM STAIN (Final [**2106-7-8**]):
      >25 PMNs and <10 epithelial cells/100X field.
      4+   (>10 per 1000X FIELD):   BUDDING YEAST WITH
PSEUDOHYPHAE.
      1+    (<1 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS AND CHAINS.
      1+    (<1 per 1000X FIELD):   GRAM NEGATIVE ROD(S).

   RESPIRATORY CULTURE (Final [**2106-7-10**]):
      SPARSE GROWTH OROPHARYNGEAL FLORA.
      Due to mixed bacterial types ( >= 3 colony types) an
abbreviated
      workup will be performed appropriate to the isolates
recovered from
      this site.
      YEAST.    MODERATE GROWTH.
      GRAM NEGATIVE ROD(S).    SPARSE GROWTH.
         OF TWO COLONIAL MORPHOLOGIES.
      YEAST.    SPARSE GROWTH.  2ND TYPE.

[**2106-7-14**] 3:50 pm BLOOD CULTURE      SET #2.

   AEROBIC BOTTLE (Pending):

   ANAEROBIC BOTTLE (Pending):

[**2106-7-14**] 3:30 pm BLOOD CULTURE

   AEROBIC BOTTLE (Pending):

   ANAEROBIC BOTTLE (Pending):

[**2106-8-7**] 4:43 am URINE      Source: Catheter.

                            **FINAL REPORT [**2106-7-9**]**

   URINE CULTURE (Final [**2106-7-9**]):    NO GROWTH.

CXR - IMPRESSION: Marked improvement of previously identified
congestive pattern and parenchymal infiltrates in this elderly
patient. Comparison with the study of [**2106-7-7**] demonstrates
now also improvement of the initially seen fluffy infiltrates on
the right base.

Non-contrast head CT.

COMPARISON: [**2105-11-23**].

FINDINGS: There is no evidence of new infarction or hemorrhage.
There is no mass effect or shift of midline structures. The
ventricles, cisterns, and sulci are enlarged secondary to
involutional change. Marked periventricular white matter
hypodensities are unchanged, and old bilateral basal ganglia
infarcts are again noted. The visualized paranasal sinuses are
aerated, and no fractures are identified.

IMPRESSION: Stable appearance of the brain without intracranial
hemorrhage

Cardiology Report ECG Study Date of [**2106-7-9**]  6:48:26 PM


Atrial fibrillation. Right bundle-branch block with left
anterior fascicular
block. Diffuse ST segment changes could be secondary to
myocardial ischemia or
rapid ventricular rate. Compared to prior tracing of [**2106-7-9**] no
interim
diagnostic change.
TRACING #2


Read by: [**Last Name (LF) **],[**First Name3 (LF) **] V.

  Intervals Axes
Rate PR QRS QT/QTc P QRS T
87 0 142 390/434.42 0 -76 -97

CXR - IMPRESSION: Diffuse fluffy opacities more reminiscent of
edema given cardiomegaly and effusion. Please note atypical
pneumonia may present in a similar fashion. Correlate
clinically. Repeat radiography following diuresis may be
indicated to assess for underlying infection.


Brief Hospital Course:
Sepsis from aspiration pneumonia - the hypotension resolved with
IVF initially. The dyspnea was multifactorial - mostly from a
severe aspiration pneumonia. Aspiration risk is high as
confirmed with swallow therapist and with video swallow.
Appropriate changes were made to the diet. Strict aspiration
precautions were maintained and the patient was assisted with
all meals. The patient specifically aspirated with thin liquids.
She completes a 10 day course of antibiotics (levofloxacin) on
[**2106-7-17**].
Repeat CXR revealed improved pneumonia.

Congestive heart failure - diastolic, pulmonary edema - from
aggressive IVF and rapid A fib. Responded to diuresis and HR
control. Warfarin was held during the hospital stay and the INR
at most times was between [**2-13**] (from drug  interaction with
levofloxacin). The warfarin should be started 1 day after
stopping levofloxacin and close monitoring of INR should be
done.
Lasix was not continued as the patient was very volume depleted
due to decreased po intake and diuresis.

Delerium - multifactorial - from infection and also from
hypovolemia. Refer below.

Hypernatremia - hypovolemia - Due to above reason, the patient
was severly free water restricted. After IV D5water the sodium
returned to [**Location 213**]. Lactic acidosis was from the hypovolemia as
it resolved after volume repletion.

Atrial fibrillation with rapid rate - as above

h/o CVA - warfarin as above. ASA was stopped as she will also be
on anti-coagulation and give her age and risk of fall, is at
high risk of bleeding.

Hypothyroidism - levothyroxine continued at home dose. TSH was
normal.

PT evaluated her and recommended rehab. Discharged to [**Hospital 100**]
rehab. Family involved and aware.

DNR/DNI

Medications on Admission:
1.Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H
(every 4 to 6 hours) as needed
2.Atorvastatin 20 mg PO DAILY
3.Aspirin 81 mg PO DAILY
4.Tolterodine 4 mg DAILY
5.Levothyroxine 50 mcg PO DAILY
6.Glucosamine 1 tab po qday
7.Digoxin 125 mcg PO DAILY
8. Senna 8.6 mg PO BID
9.Docusate Sodium 100 mg PO BID
10.Metoprolol Tartrate 50 mg PO TID
11.Warfarin 3mg po qday- adjust to INR
12.MVI po qday
*** of note, was on Lasix 20 mg PO DAILY, but this was stopped
at her last clinic appt ***


Discharge Medications:
1. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
2. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO TID (3
times a day).
4. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1)  PO BID (2
times a day).
5. Albuterol Sulfate 0.083 % (0.83 mg/mL) Solution Sig: One (1)
Inhalation Q2H (every 2 hours) as needed.
6. Levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Acetylcysteine 10 % (100 mg/mL) Solution Sig: One (1) ML
Miscellaneous Q8H (every 8 hours) as needed.
8. Warfarin 3 mg Tablet Sig: One (1) Tablet PO once a day: Start
1 day after levofloxacin is completed.
9. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 1 days: completes a 10 day course on [**2106-7-17**].
10. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO at bedtime.



Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - LTC

Discharge Diagnosis:
Sepsis from aspiration pneumonia
Congestive heart failure - diastolic, pulmonary edema
Delerium
Hypernatremia - hypovolemia
Lactic acidosis
Atrial fibrillation with rapid rate
h/o CVA
Hypothyroidism


Discharge Condition:
Stable


Discharge Instructions:
Please inform your doctor if you have any new symptoms of
concern to you. The doctors [**First Name (Titles) **] [**Last Name (Titles) 100**] rehab will care further
for your medical issues.

Take medicines as instructed.


Followup Instructions:
[**Last Name (LF) **],[**First Name3 (LF) **] C. [**Telephone/Fax (1) 11144**] - please follow up with Dr [**Last Name (STitle) 11139**]
when discharged from [**Hospital 100**] Rehab.

The doctors [**First Name (Titles) **] [**Last Name (Titles) 100**] rehab will care further for your medical
issues.
{'Unspecified septicemia,Acute respiratory failure,Septic shock,Pneumonitis due to inhalation of food or vomitus,Diastolic heart failure, unspecified,Acute kidney failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Hyperosmolality and/or hypernatremia,Atrial fibrillation,Severe sepsis,Unspecified acquired hypothyroidism,Unspecified essential hypertension'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: Dyspnea

PRESENT ILLNESS: Ms. [**Known lastname 53693**] is a [**Age over 90 **] F with h/o aflutter, HTN, CVA who
presented to ER initially with dyspnea, LE edema and was found
to have elevated JVD, Atach vs aflutter, CXR c/w CHF. She
started having dyspnea on exetrtion 7 days prior to admission
with a nonprod cough, without CP. When she arrived to the ED,
her BP was 208/110, HR 122, T 98.2, RR 30, Sat 90% on RA. She
received Aspirin 325mg, Acetaminophen 650mg, Furosemide 40mg x
2, Nitroglycerin gtt, Metoprolol 5mg x 3, Lorazepam 2mg. While
in the ER she vomited into her face mask and had an acute
worsening of her respiratory distress at which time repeat CXR
showed bibasilar opacities consistent with aspiration and
possible worsening edema. She then received Vancomycin 1g,
Piperacillin-Tazobactam Na 2.25 gm. Discussion at that time with
her family and PCP resulted in decision to make pt DNR/DNI/CMO
and start a morphine drip for relief of respiratory distress or
discomfort. The plan was to admit her to Medicine for further
supportive comfort care. However, while in the ED her resp
status seemed to improve, and the family requested to treat her
conservatively for her pneumonia/CHF. She is to remain DNR/DNI
per family, but to receive appropriate antibiotics and diuresis.
Of note, while on the morphine gtt her BP dropped to 83/30. She
had a lactate of 2.3. Her morphine gtt was decreased and her BP
rose to 99/39, then back 86/50 (MAP 62) before transport to the
[**Hospital Unit Name 153**]. The ED staff spoke with her family about pressors/central
line, and they said that would be OK if necessary to keep her
alive.

MEDICAL HISTORY: PMHx:
- Strokes-first was prior to [**2094**], grandson does not know
details. Next was in [**2094**] p/w slurred speech. Next was in [**2099**]
with severe left sided weakness. All required physical therapy
rehab. Currently on coumadin and baby asa. PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 11139**] at
[**Location (un) 2312**]. Etiology of strokes is unclear to the family.
- hard of hearing, + tinnitus
- hypothyroidism
- HTN
- high cholesterol
- cataract surgery bilaterally
-? CAD and CHF- no old records here.
.

MEDICATION ON ADMISSION: 1.Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H
(every 4 to 6 hours) as needed
2.Atorvastatin 20 mg PO DAILY
3.Aspirin 81 mg PO DAILY
4.Tolterodine 4 mg DAILY
5.Levothyroxine 50 mcg PO DAILY
6.Glucosamine 1 tab po qday
7.Digoxin 125 mcg PO DAILY
8. Senna 8.6 mg PO BID
9.Docusate Sodium 100 mg PO BID
10.Metoprolol Tartrate 50 mg PO TID
11.Warfarin 3mg po qday- adjust to INR
12.MVI po qday
*** of note, was on Lasix 20 mg PO DAILY, but this was stopped
at her last clinic appt ***

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: Tc 97.2, Tm 101 in ED, BP 83/58(65), HR 93 in Aflut, RR 23,
Sat 100% on NRB
Gen: frail, elderly caucasian woman, lying in bed, HOB 15
degrees, asleep and in no respiratory or other distress
HEENT: no bruises or lacerations, eyelids closed, NRB mask in
place
Neck: supple, JVP elevated @ 10cm
Lungs: diffusely rhonchorous, with insp and exp wheezes
CV: irreg irreg, difficult to hear HS over her breathing; faint
systolic murmur loudest at LUSB
Abd: soft, mildly distended, no grimace to palpation, decreased
BS, no guarding
Ext: 1+ LE edema to ankles, inapprop warm for low BP
Neuro: sedated from morphine and ativan in ED, unable to assess
mental status

FAMILY HISTORY: FamHx: DM, HTN, stroke

SOCIAL HISTORY: SHx: lives with daughter and grandson, walks with a cane,
daughter (60 YO) does all cooking and finances. Widowed since
WWII. Former
farmer from [**Country 5881**], moved to US over 20 yrs ago. No
Tob/etoh/drugs. 

### Response:
{'Unspecified septicemia,Acute respiratory failure,Septic shock,Pneumonitis due to inhalation of food or vomitus,Diastolic heart failure, unspecified,Acute kidney failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Hyperosmolality and/or hypernatremia,Atrial fibrillation,Severe sepsis,Unspecified acquired hypothyroidism,Unspecified essential hypertension'}
