CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 57-year-old
female with a history of obesity, severe obstructive sleep
apnea, pulmonary hypertension, and diastolic congestive heart
failure who was recently discharged from the hospital on
[**3-23**] who returned for evaluation of persistent nausea and
headache that has been progressive since discharge.

MEDICAL HISTORY: 1.  Hodgkin's disease; status post radiation therapy and
splenectomy.
 2.  Pulmonary hypertension.
 3.  Obesity.
 4.  Congestive heart failure with diastolic dysfunction with
an ejection fraction of 70%.
 5.  Hypertension.
 6.  Obstructive sleep apnea; on home [**Hospital1 **]-level positive
airway pressure.
 7.  Hiatal hernia.
 8.  Depression.
 9.  Anxiety.
10.  Hypothyroidism.
11.  Chronic facial pain with parotid enlargement.
12.  Degenerative joint disease with severe pain and on
chronic home pain medications.

MEDICATION ON ADMISSION: 

ALLERGIES: Her allergies include PENICILLIN and question to
INTRAVENOUS IODINE.

PHYSICAL EXAM: 

FAMILY HISTORY: Son with congestive heart failure.  Father
and mother with hypertension.

SOCIAL HISTORY: She lives with her husband.  She quit
tobacco 25 years ago.
Nausea alone,Acute respiratory failure,Diastolic heart failure, unspecified,Primary pulmonary hypertension,Unspecified sleep apnea,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Peripheral vascular disease, unspecified,Personal history of hodgkin's disease
Nausea alone,Acute respiratry failure,Diastolc hrt failure NOS,Prim pulm hypertension,Sleep apnea NOS,Hypertension NOS,Hypothyroidism NOS,Periph vascular dis NOS,Hx-hodgkin's disease
Admission Date:  [**2187-4-6**]       Discharge Date:  [**2187-4-10**]

Date of Birth:   [**2129-9-11**]       Sex:  F

Service:  Medicine, [**Hospital1 **] Firm

HISTORY OF PRESENT ILLNESS:  The patient is a 57-year-old
female with a history of obesity, severe obstructive sleep
apnea, pulmonary hypertension, and diastolic congestive heart
failure who was recently discharged from the hospital on
[**3-23**] who returned for evaluation of persistent nausea and
headache that has been progressive since discharge.

She was admitted on [**3-19**] with hypoxia and started on
[**Hospital1 **]-level positive airway pressure for obstructive sleep apnea
in the hospital and discharged on [**3-23**] with home [**Hospital1 **]-level
positive airway pressure at night.  She reported mild nausea
before discharge but reports progressive symptoms over the
past two weeks not associated with eating.  The patient
states her symptoms seem worse when she was off the [**Hospital1 **]-level
positive airway pressure machine.  She was also complaining
of a headache that is sometimes associated with nausea but
not always.  She denies any other urinary symptoms.  She
denies gastrointestinal complaints such as diarrhea,
abdominal pain, or constipation.  She denies any urinary
complaints such a dysuria, frequency, or hematuria.  No chest
pain.  No increase in her lower extremity edema.  No increase
in her baseline shortness of breath.  She states her [**Hospital1 **]-level
positive airway pressure has not been fitting well, and she
uses it less than three to four hours per night.

In the Emergency Room the patient was noted to be
hypertensive with a systolic blood pressure of 214.  She was
given 12 mg of Zofran, 2 mg of Ativan, and 4 mg of morphine.

PAST MEDICAL HISTORY:
 1.  Hodgkin's disease; status post radiation therapy and
splenectomy.
 2.  Pulmonary hypertension.
 3.  Obesity.
 4.  Congestive heart failure with diastolic dysfunction with
an ejection fraction of 70%.
 5.  Hypertension.
 6.  Obstructive sleep apnea; on home [**Hospital1 **]-level positive
airway pressure.
 7.  Hiatal hernia.
 8.  Depression.
 9.  Anxiety.
10.  Hypothyroidism.
11.  Chronic facial pain with parotid enlargement.
12.  Degenerative joint disease with severe pain and on
chronic home pain medications.

ALLERGIES:  Her allergies include PENICILLIN and question to
INTRAVENOUS IODINE.

MEDICATIONS AT HOME:
1.  Levoxyl 175 mcg by mouth once per day.
2.  Valsartan 120 mg in the morning and 80 mg in the evening.
3.  Hydrochlorothiazide 25 mg once per day.
4.  Lopressor 12.5 mg twice per day.
5.  Lasix 20 mg once per day.
6.  Prilosec 20 mg once per day.
7.  Ativan as needed (up to 8 mg once per day).
8.  Percocet as needed.
9.  Oxycodone (up to 50 mg once per day).

SOCIAL HISTORY:  She lives with her husband.  She quit
tobacco 25 years ago.

FAMILY HISTORY:   Son with congestive heart failure.  Father
and mother with hypertension.

PHYSICAL EXAMINATION ON PRESENTATION:  Her vital signs on
admission revealed a temperature of 99.2 degrees Fahrenheit,
her blood pressure was 153/94 after getting multiple
medications and a systolic blood pressure of 214, her heart
rate was 80, her respiratory rate was 20, and her oxygen
saturation was 88% on 1.5 liters and 96% on 3 liters.  In
general, pleasant and in no acute distress.  Head, eyes,
ears, nose, and throat examination revealed the sclerae were
anicteric.  The oropharynx was clear.  The pupils were equal,
round, and reactive to light.  Cardiovascular examination
revealed a regular rate and rhythm.  No murmurs, rubs, or
gallops.  A loud second heart sound.  Lungs revealed
decreased breath sounds at the bases with crackles.  No
egophony.  The abdomen was obese, soft, ventral hernia, mild
epigastric pain, with some right upper quadrant tenderness.
No guarding.  No rebound.  There were positive bowel sounds.
Extremities revealed 1+ pitting edema to the low calf.
Distal pulses were 2+.  Neurologic examination was grossly
intact.  She was moving all four extremities with 4+/5
strength throughout.

PERTINENT LABORATORY VALUES ON PRESENTATION:  Chemistry-7
revealed sodium was 142, potassium was 4, notable for a
chloride of 95, bicarbonate was 40, blood urea nitrogen was
10, and her creatinine was 0.5.  Her INR was 1.2.  Calcium
was 10.1.  Her magnesium was 2.1.  Liver function tests were
within normal limits.  Complete blood count revealed her
white blood cell count was 10.7, her hematocrit was 43.3, and
her platelets were 376.

PERTINENT RADIOLOGY/IMAGING:  A chest x-ray showed moderate
bilateral pleural effusions (left greater than right) with
mild congestive heart failure.

An electrocardiogram showed sinus tachycardia with normal
axis.  No significant changes compared to [**3-19**].

BRIEF SUMMARY OF HOSPITAL COURSE BY ISSUE/SYSTEM:  The
patient was sent to the floor.  On [**4-7**], the patient was
noted to have worsening hypoxia with increasing nausea and
nonbloody and nonbilious vomiting as well as a headache.

On the morning of [**4-7**], the patient became belligerent
with dropping oxygen saturations.  Room air saturation was
87% which improved to 94% on 4 liters.  A half hour later she
was noted to have a desaturation to 63% on 4 liters, and
[**Hospital1 **]-level positive airway pressure was initiated and improved
to 97% on 4 liters and [**Hospital1 **]-level positive airway pressure with
settings of 14 and 7.  An arterial blood gas performed on
room air revealed a pH of 737, a PCO2 of 71, and a PAO2 of
34.  Her [**Hospital1 **]-level positive airway pressure was increased to 7
liters at that point.

Her Medical Intensive Care Unit course was significant for
diuresis with intravenous Lasix.  The patient received 20 mg
of intravenous Lasix times two over a 2-day period with a
good response.  She diuresed a total of approximately 3
liters while in the Medical Intensive Care Unit for 48 hours.
The thought was the patient may have developed acute
pulmonary edema secondary to an elevated blood pressure plus
or minus tachycardia.  Her quick resolution, however, would
most likely be consistent with a mucous plug.  However, her
improvement with diuresis would lean more towards a pulmonary
edema picture with her chest x-ray confirming that diagnosis.

The patient was then transferred to the floor after diuresis
and initiation of [**Hospital1 **]-level positive airway pressure at night.

1.  OBSTRUCTIVE SLEEP APNEA ISSUES:  The patient was
maintained on overnight [**Hospital1 **]-level positive airway pressure
with settings of 14 and 7 with 3 liters nasal cannula.  She
tolerated this well for six to eight hours per night and was
encouraged to continue this at home.  The patient has a
follow-up pulmonary studies at the end of this month and will
follow up with Dr. [**Last Name (STitle) **] of Pulmonary at that point.

The patient will have mask refitting at home for a more
comfortable device.

2.  CONGESTIVE HEART FAILURE ISSUES:  The patient has a
history of diastolic congestive heart failure likely from
long-term hypertension.  She was diuresed well while in the
Intensive Care Unit.  She came to the floor and was switched
to a by mouth regimen of 20 once per day.  The patient's goal
will likely to be to control blood pressure and heart rate
for avoidance of pulmonary edema.  She will be maintained on
her doses of Valsartan 120 in the morning and 80 in the
evening, as well as Lopressor twice per day, and
hydrochlorothiazide.

She was to have a follow-up appointment to evaluate her blood
pressure and current medications.  In addition, the patient
was told to maintain a low-sodium diet and to closely monitor
her weight.

3.  CHRONIC PAIN ISSUES:  Chronic pain issues secondary to
osteoarthritis.  The Pain Service was consulted while the
patient was in house, and given their recommendations it was
difficult to implement secondary to her baseline hypercapnia.
Therefore, we maintained her current regimen of as needed
Percocet.  She was to have a follow-up outpatient visit the
[**First Name4 (NamePattern1) 1193**] [**Last Name (NamePattern1) 1194**] Management Center.  The patient was to be
maintained on her current dose Percocet and 5 mg to 10 mg of
oxycodone every six hours as needed for her pain.  The
patient and her husband were warned of the signs of
hypercapnia and oversedation.

4.  NEW SCLEROTIC LESION ISSUES:  The patient has a history
of new osteoarthritic/sclerotic lesions consistent with
possible metastatic disease on a computed tomography of the
bad done during her last hospital stay as well as a note of
subcutaneous lesions; likely sebaceous cysts, but metastatic
melanoma could not be ruled out.

Because of these findings, the patient was to have a
follow-up Hematology/Oncology appointment within the next one
to three weeks.

CONDITION AT DISCHARGE:  The patient's condition on discharge
was stable on 2 liters nasal cannula (her home dose) with
minimal complaints of pain.

DISCHARGE DIAGNOSES:
1.  Severe obstructive sleep apnea.
2.  Diastolic congestive heart failure.
3.  Hypothyroidism.
4.  Peripheral vascular disease.
5.  Status post Hodgkin's disease with splenectomy and
radiation therapy in [**2175**].
6.  New sclerotic lesions and subcutaneous nodules.

MEDICATIONS ON DISCHARGE:
1.  Levoxyl 175 mcg by mouth once per day.
2.  Valsartan 120 mg in the morning and 80 mg in the evening.
3.  Percocet 5/325-mg tablets one to two tablets by mouth
q.6h. as needed.
4.  Metoprolol 25 mg by mouth twice per day.
5.  Hydrochlorothiazide 25 mg once per day.
6.  Ativan 1 mg q.6h. as needed (for agitation and anxiety).
7.  Lasix 20 mg once per day.
8.  Prilosec 20 mg once per day.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was instructed to follow up with Dr. [**Last Name (STitle) 3478**]
and Dr. [**Last Name (STitle) 19**] on [**2187-4-27**] for evaluation of her new
lesions.
2.  The patient was instructed to follow up with Dr. [**Last Name (STitle) **]
on [**2187-5-4**] at 10:15 a.m. for pulmonary function tests
as well as evaluation.
3.  The patient was instructed to follow up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
who will be seeing the patient in Dr.[**Name (NI) 3479**] place on [**4-12**]
at 3 p.m.
4.  The patient was instructed to follow up with the Pain
Management Center on [**4-19**] at 3:40 p.m.
5.  The patient was also instructed to continue with her
[**Hospital1 **]-level positive airway pressure at the current settings of
14 and 7 at 3 liters per minute nasal cannula.
6.  The patient was also to have home physical therapy.





                         DR.[**First Name (STitle) 2416**],[**First Name3 (LF) 2415**] 12-929

Dictated By:[**Last Name (NamePattern1) 3480**]
MEDQUIST36

D:  [**2187-4-10**]  18:24
T:  [**2187-4-10**]  18:34
JOB#:  [**Job Number 3481**]
{"Nausea alone,Acute respiratory failure,Diastolic heart failure, unspecified,Primary pulmonary hypertension,Unspecified sleep apnea,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Peripheral vascular disease, unspecified,Personal history of hodgkin's disease"}


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: 

PRESENT ILLNESS: The patient is a 57-year-old
female with a history of obesity, severe obstructive sleep
apnea, pulmonary hypertension, and diastolic congestive heart
failure who was recently discharged from the hospital on
[**3-23**] who returned for evaluation of persistent nausea and
headache that has been progressive since discharge.

MEDICAL HISTORY: 1.  Hodgkin's disease; status post radiation therapy and
splenectomy.
 2.  Pulmonary hypertension.
 3.  Obesity.
 4.  Congestive heart failure with diastolic dysfunction with
an ejection fraction of 70%.
 5.  Hypertension.
 6.  Obstructive sleep apnea; on home [**Hospital1 **]-level positive
airway pressure.
 7.  Hiatal hernia.
 8.  Depression.
 9.  Anxiety.
10.  Hypothyroidism.
11.  Chronic facial pain with parotid enlargement.
12.  Degenerative joint disease with severe pain and on
chronic home pain medications.

MEDICATION ON ADMISSION: 

ALLERGIES: Her allergies include PENICILLIN and question to
INTRAVENOUS IODINE.

PHYSICAL EXAM: 

FAMILY HISTORY: Son with congestive heart failure.  Father
and mother with hypertension.

SOCIAL HISTORY: She lives with her husband.  She quit
tobacco 25 years ago. 

### Response:
{"Nausea alone,Acute respiratory failure,Diastolic heart failure, unspecified,Primary pulmonary hypertension,Unspecified sleep apnea,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Peripheral vascular disease, unspecified,Personal history of hodgkin's disease"}
