CHIEF COMPLAINT: Hypoxemia

PRESENT ILLNESS: Mr. [**Known lastname 106273**] is a [**Age over 90 **] yo M with h/o metastatic prostate cancer,
hypothyroidism, and diastolic CHF, who was recently discharged
from [**Hospital1 18**] in [**2-/2168**] s/p fall and with concern for C1 and C7
fractures, who now presents from [**Hospital1 **] [**Location (un) 620**] with hypoxia and
evidence of R-sided pleural effusion on CXR.
.
The patient was discharged to [**Location (un) **] Independent Living
[**2168-2-17**], a skilled nursing facility, and reports that he has
had significant difficulty carrying out his activities of daily
living, and even taking part in his leisure activities as well.
Last night, the patient endorses that his breathing became
significantly more difficult, and due to this noticeable
shortness of breath, the patient's nurses called an ambulance
and had him taken to the [**Hospital1 **] [**Location (un) 620**] ED.
.
At [**Hospital1 **] [**Location (un) 620**], Mr. [**Known lastname 106273**] had an O2 Sat in the 80s and
underwent imaging that showed a large right-sided pleural
effusion. The patient was then placed on 2L oxygen by NC and was
transferred to [**Hospital1 18**] for further care.
.
In the [**Hospital1 18**] ED, initial VS were: T 98.4 HR: 88 BP: 97/61 RR: 22
O2Sat: 97 on 3L NC.  Due to findings on CXR, the patient was
admitted to the MICU for management of his pleural effusions
(which have shown to be malignant effusions in the past), given
that the Interventional Pulmonart team was unable to perform the
procedure this evening.
.
On arrival to the MICU, patient's VS were: T 98.3 HR: 90 BP:
110/57 RR: 22 O2Sat: 97 on 3L NC.  The patient had no other
concerns or complaints.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies  cough, dyspnea or wheezing. Denies chest
pain, chest pressure, palpitations. Denies  constipation,
abdominal pain, diarrhea, dark or bloody stools. Denies dysuria,
frequency, or urgency. Denies arthralgias or myalgias. Denies
rashes or skin changes.

MEDICAL HISTORY: 1) Prostate cancer w known metastases to ribs and lungs, s/p
prostatectomy and XRT to ribs ([**2163**])
2) Recent C1 and C7 Fractures in [**2-/2168**]
3) Diastolic CHF (EF >50% per recent echo at DCFI)
5) HTN
6) Hypothyroidism
7) BPV
8) H/O cataract surgery
9) H/O shoulder pain
10) Appendectomy

MEDICATION ON ADMISSION: 1) Zytiga 4 pills daily (chemo) ****stopped [**3-28**]
2) Prednisone 5 mg daily
3) Levothyroxine 100 mcg daily
4) ASA 81 mg every other day
5) Furosemide 20 mg daily
6) Mirtazipine 15 mg daily
7) Vit D3 Senacot
8) Sorbitol 70% 30mL [**Hospital1 **]
9) Multivitamin
10) Acetaminophen 650 [**Hospital1 **]
11) Senna 2 tabs [**Hospital1 **]
12) Bisacodyl 10mg suppository daily
12) Oxycodone 2.5mg Daily
13) Oxycodone 2.5mg Q4H PRN
14) Milk of mag 30ml daily PRN

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
========================
.
Vitals: T 98.3 HR: 90 BP: 110/57 RR: 22 O2Sat: 97 on 3L NC
Constitutional: AOx3, Comfortable
HEENT: Normocephalic, atraumatic
Chest: Decreased breath sounds at the right base compared
to the left, crackles on the left
Cardiovascular: Regular Rate and Rhythm, [**1-18**] Ejection Murmur
appreciated in the RUSB, [**1-18**] Holosystolic Murmur at the Apex
Abdominal: Soft, ND, Tender to Deep Palpation in the RUQ
GU/Flank: No costovertebral angle tenderness
Extr/Back: Warm, Well-Perfused, Trace Pitting in the Lower
Extremities
Skin: No rash
.
DISCHARGE PHYSICAL EXAM:
========================
.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: He lives at [**Location (un) **] Independent Living.  He quit smoking 20
years ago; prior to that 2 packs a day for 30 years.  Occasional
Secondary malignant neoplasm of lung,Acute on chronic diastolic heart failure,Bacterial pneumonia, unspecified,Malignant pleural effusion,Secondary malignant neoplasm of bone and bone marrow,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Insomnia, unspecified,Personal history of malignant neoplasm of prostate,Personal history of irradiation, presenting hazards to health,Personal history of antineoplastic chemotherapy,Long-term (current) use of steroids,Do not resuscitate status
Secondary malig neo lung,Ac on chr diast hrt fail,Bacterial pneumonia NOS,Malignant pleural effusn,Secondary malig neo bone,Hypothyroidism NOS,Hypertension NOS,Insomnia NOS,Hx-prostatic malignancy,Hx of irradiation,Hx antineoplastic chemo,Long-term use steroids,Do not resusctate status
Admission Date:  [**2168-3-31**]              Discharge Date:   [**2168-4-4**]


Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 2291**]
Chief Complaint:
Hypoxemia


Major Surgical or Invasive Procedure:
Thoracentesis

History of Present Illness:
Mr. [**Known lastname 106273**] is a [**Age over 90 **] yo M with h/o metastatic prostate cancer,
hypothyroidism, and diastolic CHF, who was recently discharged
from [**Hospital1 18**] in [**2-/2168**] s/p fall and with concern for C1 and C7
fractures, who now presents from [**Hospital1 **] [**Location (un) 620**] with hypoxia and
evidence of R-sided pleural effusion on CXR.
.
The patient was discharged to [**Location (un) **] Independent Living
[**2168-2-17**], a skilled nursing facility, and reports that he has
had significant difficulty carrying out his activities of daily
living, and even taking part in his leisure activities as well.
Last night, the patient endorses that his breathing became
significantly more difficult, and due to this noticeable
shortness of breath, the patient's nurses called an ambulance
and had him taken to the [**Hospital1 **] [**Location (un) 620**] ED.
.
At [**Hospital1 **] [**Location (un) 620**], Mr. [**Known lastname 106273**] had an O2 Sat in the 80s and
underwent imaging that showed a large right-sided pleural
effusion. The patient was then placed on 2L oxygen by NC and was
transferred to [**Hospital1 18**] for further care.
.
In the [**Hospital1 18**] ED, initial VS were: T 98.4 HR: 88 BP: 97/61 RR: 22
O2Sat: 97 on 3L NC.  Due to findings on CXR, the patient was
admitted to the MICU for management of his pleural effusions
(which have shown to be malignant effusions in the past), given
that the Interventional Pulmonart team was unable to perform the
procedure this evening.
.
On arrival to the MICU, patient's VS were: T 98.3 HR: 90 BP:
110/57 RR: 22 O2Sat: 97 on 3L NC.  The patient had no other
concerns or complaints.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies  cough, dyspnea or wheezing. Denies chest
pain, chest pressure, palpitations. Denies  constipation,
abdominal pain, diarrhea, dark or bloody stools. Denies dysuria,
frequency, or urgency. Denies arthralgias or myalgias. Denies
rashes or skin changes.

Past Medical History:
1) Prostate cancer w known metastases to ribs and lungs, s/p
prostatectomy and XRT to ribs ([**2163**])
2) Recent C1 and C7 Fractures in [**2-/2168**]
3) Diastolic CHF (EF >50% per recent echo at DCFI)
5) HTN
6) Hypothyroidism
7) BPV
8) H/O cataract surgery
9) H/O shoulder pain
10) Appendectomy

Social History:
He lives at [**Location (un) **] Independent Living.  He quit smoking 20
years ago; prior to that 2 packs a day for 30 years.  Occasional

social drinker.

Family History:
Noncontributory


Physical Exam:
ADMISSION PHYSICAL EXAM:
========================
.
Vitals: T 98.3 HR: 90 BP: 110/57 RR: 22 O2Sat: 97 on 3L NC
Constitutional: AOx3, Comfortable
HEENT: Normocephalic, atraumatic
Chest: Decreased breath sounds at the right base compared
to the left, crackles on the left
Cardiovascular: Regular Rate and Rhythm, [**1-18**] Ejection Murmur
appreciated in the RUSB, [**1-18**] Holosystolic Murmur at the Apex
Abdominal: Soft, ND, Tender to Deep Palpation in the RUQ
GU/Flank: No costovertebral angle tenderness
Extr/Back: Warm, Well-Perfused, Trace Pitting in the Lower
Extremities
Skin: No rash
.
DISCHARGE PHYSICAL EXAM:
========================
.

Pertinent Results:
ADMISSION LABS:
===============
.
[**2168-3-31**] 10:27PM BLOOD WBC-4.5# RBC-3.08* Hgb-9.9* Hct-30.5*
MCV-99* MCH-32.2* MCHC-32.5 RDW-16.2* Plt Ct-140*
[**2168-3-31**] 10:27PM BLOOD Neuts-62 Bands-11* Lymphs-14* Monos-10
Eos-1 Baso-1 Atyps-1* Metas-0 Myelos-0
[**2168-3-31**] 10:27PM BLOOD PT-13.8* PTT-27.8 INR(PT)-1.3*
[**2168-3-31**] 10:27PM BLOOD Glucose-93 UreaN-26* Creat-0.8 Na-136
K-3.8 Cl-95* HCO3-37* AnGap-8
[**2168-3-31**] 10:27PM BLOOD Calcium-8.8 Phos-3.1 Mg-1.7
.
DISCHARGE LABS:
===============
.
.
MICRO/PATH:
===========
.
[**2168-4-2**] SPUTUM GRAM STAIN: Inadequate sample
[**2168-4-1**]  GRAM STAIN (Final [**2168-4-1**]):
2+   (1-5 per 1000X FIELD):   POLYMORPHONUCLEAR LEUKOCYTES.
NO MICROORGANISMS SEEN.
This is a concentrated smear made by cytospin method, please
refer to
hematology for a quantitative white blood cell count..
FLUID CULTURE (Preliminary):    NO GROWTH.
ANAEROBIC CULTURE (Preliminary):    NO GROWTH.

[**2168-4-1**] BLOOD CULTURE: NGTD
[**2168-4-1**] BLOOD CULTURE: NGTD
[**2168-4-1**] Cytology PLEURAL FLUID pending
.
IMAGING/STUDIES:
================
.
[**2168-4-3**] Radiology CHEST (PORTABLE AP:
IMPRESSION:
Compared with [**2168-4-1**] at 19:17 p.m., a tiny curvilinear
density at the right lung apex is again noted. I doubt, but
cannot entirely exclude, a tiny right apical pneumothorax. No
interval change is identified.

Otherwise, no significant change is detected. Again seen is
prominent
cardiomediastinal silhouette; R>L effusions with underlying
collapse and/or
consolidation; unusual appearance to the right posterior ribs
and right chest wall, unchanged. Bilateral effusions are grossly
stable in size.
.
[**2168-4-1**] Radiology CHEST (PORTABLE AP):
IMPRESSION:
1. Bilateral effusions and parenchymal changes essentially
unchanged compared with earlier the same day.
2. Possible tiny right apical pneumothorax.
3. Abnormal increased density along right chest wall is
unchanged, but of
uncertain etiology. If clinically indicated, CT could help to
further
characterize this abnormality.
4. Poor visualization of the right posterior fifth and sixth
ribs. Has there been prior surgical resection? Otherwise, rib
lesions would be suspected.
.
[**2168-4-1**] Radiology LIVER OR GALLBLADDER US:
IMPRESSION:
-No biliary dilatation is seen. Cholelithiasis. There are no
specific signs of cholecystitis or other sources of infection
-Bilateral pleural effusions and trace ascites
-Splenomegaly
-Simple right renal cysts
.
[**2168-4-1**] Radiology CHEST (PORTABLE AP):
IMPRESSION:
Moderate right pleural effusion has markedly decreased in
amount. There is no evident pneumothorax. There are persistent
low lung volumes. A small left pleural effusion has increased.
Left lower lobe and left mid perihilar opacities have increased
since [**2-14**], unchanged from the prior study, could be
worsening atelectasis and pleural effusion, but superimposed
infection cannot be excluded. Opacity in the right lower lobe is
a combination of pleural effusion and adjacent consolidation,
could be atelectasis and/or pneumonia. The patient has known
osseous mets.
.
[**2168-3-31**] CHEST (PORTABLE AP):
IMPRESSION:
Large right pleural effusion has recurred, displacing the
mediastinum slightly to the left of midline. Osseous metastasis
involving right ribs are longstanding. Heart is at least mildly
enlarged and there is some engorgement of the vessels in the
left lung.
.

Brief Hospital Course:
Mr. [**Known lastname 106273**] is a [**Age over 90 **] yo M with h/o metastatic prostate cancer,
hypothyroidism, and diastolic CHF, who was recently discharged
from [**Hospital1 18**] in [**2-/2168**] s/p fall and with concern for C1 and C7
fractures, who now presents from [**Hospital1 **] [**Location (un) 620**] with hypoxia and
evidence of R-sided pleural effusion on CXR now s/p
thoracentisis with possible HCAP.

ACTIVE DIAGNOSES:
=================

#) HYPOXEMIA/PLEURAL EFFUSION/CONCERN FOR HCAP: Patient was
admitted to the MICU with recurrent R-sided pleural effusion
with hypoxia requiring no more than 4LNC. Thoracentesis was
performed at bedside with drainage of 1.5L of fluid with
negative gram stain, exudative chemistry, and lymphocyte
predominance with cytology pending at the time of discharge
though overall felt to be c/w prior malignant pleural effusion.
His breathing improved and he felt clinically well but was
occasionally hypotensive to as low as the 70's systolically,
asymptomatic the whole time. Additionally, despite not having
fevers, elevated lactate or a white count, he had a significant
bandemia which was new for him and not felt to be related to his
chemotherapy drug (not a listed side effect) or his steroids
which generally cause demargination of mature neutrophils. As a
result, he was started on vanc/zosyn/azithro for HCAP coverage
for a plan of 8 total days. As part of the infectious workup, he
underwent RUQ U/S which showed no evidence of cholecytitis.
After discussion with [**Female First Name (un) **], his daughter/HCP, the decision was
made not to escalate care and to avoid invasive procedures such
as PICC placement for IV antibiotics or initiation of pressors.
As his blood, urine, and sputum studies were negative, and
pulmonary was the only organ system that could possibly be
involved, he was discharged with four more days of PO levaquin
to finish an 8 day course. The plan was to forego further
thoracentesis in the future if and when these effusions recur
and to instead treat them symptomatically with diuretics and
opiates.

# ASYMPTOMATIC HYPOTENSION: Patient was intermittently
hypotensive to as low as the 70's systolically without
tachycardia and without symptoms. On discussion with his
daughter, it was determined that he has blood pressures that are
this low and asymptomatic at rehab. He was administered albumin
following his thoracentesis with improvement in his pressures.
As the patient is a chronic prednisone patient an AM cortisol
was checked and 15 and he was continued on his 5mg prednisone
daily. Home antihypertensives were initially held but were
restarted at discharge.

# Goals of Care: The patient and his HCP/daughter expressed
their desire not to escalate care with invasive procedures such
as central lines, picc lines, or pressors as patient is in the
process of transitioning to hospice. He also expressed a wish to
no longer be hospitalized.  He is a DNR/DNI/DNH and should be
provided care that is only oriented towards comfort.

CHRONIC DIAGNOSES:
==================
#) DIASTOLIC CHF:  The patient was diagnosed from an ECHO in
[**2163**], but also had an ECHO at DCFI for concern that his
chemotherapy regimen was causing cardiomyopathy, however there
was no evidence of cardiomyopathy and his EF was > 50%.
Furosemide was held for hypotension while in the MICU, and
restarted at discharge when his pressures could tolerate it for
symptomatic management of his effusions.

#) PROSTATE CANCER: Pt has known prostate cancer metastatic to
ribs and lungs, with documented malignant effusion on [**6-22**] and
[**2-22**]. He has been off chemotherapy since [**3-28**] with no plans to
resume. He is on prednisone as per his oncologist's
recommendations for appetite and bony pain.

#) INSOMNIA: Patient had problems with insomnia during his stay.
Trazodone was added to his current regimen of oxycodone and
mirtazapine.

#) HYPOTHYROIDISM: Continued home Levoxyl 100mg PO daily.

TRANSITIONAL ISSUES:
====================
Patient and family are interested in focusing on symptom
management and avoiding future hospitalization. He will be
followed by the palliative care service at his [**Hospital1 1501**].  He is a
DNR/DNI and DNH at this point forward with comfort measures
only.
.
Blood cultures and pleural fluid cultures are still pending
final results at time of discharge, although there is no growth
to date.

Medications on Admission:
1) Zytiga 4 pills daily (chemo) ****stopped [**3-28**]
2) Prednisone 5 mg daily
3) Levothyroxine 100 mcg daily
4) ASA 81 mg every other day
5) Furosemide 20 mg daily
6) Mirtazipine 15 mg daily
7) Vit D3 Senacot
8) Sorbitol 70% 30mL [**Hospital1 **]
9) Multivitamin
10) Acetaminophen 650 [**Hospital1 **]
11) Senna 2 tabs [**Hospital1 **]
12) Bisacodyl 10mg suppository daily
12) Oxycodone 2.5mg Daily
13) Oxycodone 2.5mg Q4H PRN
14) Milk of mag 30ml daily PRN


Discharge Medications:
1. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for Constipation.
2. mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
3. levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. oxycodone 5 mg Tablet Sig: 0.5 Tablet PO Q4H (every 4 hours)
as needed for pain.
5. acetaminophen 650 mg Tablet Sig: One (1) Tablet PO twice a
day.
6. prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. trazodone 50 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
8. oxycodone 5 mg Tablet Sig: 0.5 Tablet PO QHS (once a day (at
bedtime)).
9. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. bisacodyl 10 mg Suppository Sig: One (1)  Rectal once a day
as needed for constipation.
11. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO every other day.
12. Vitamin D3 400 unit Tablet Sig: Two (2) Tablet PO once a
day.
13. sorbitol 70 % Solution Sig: Thirty (30) mL Miscellaneous
twice a day as needed for constipation.
14. multivitamin     Tablet Sig: One (1) Tablet PO once a day.
15. Milk of Magnesia 400 mg/5 mL Suspension Sig: Thirty (30) mL
PO once a day as needed for constipation.
16. Levaquin 750 mg Tablet Sig: One (1) Tablet PO once a day for
4 days. Tablet(s)


Discharge Disposition:
Extended Care

Facility:
[**Location (un) **] - [**Location (un) 620**]

Discharge Diagnosis:
PRIMARY
Pleural effusion, likely malignant
Metastatic prostate cancer

SECONDARY
Hypertension
Hypothyroidism

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).

Discharge Instructions:
Dear Mr. [**Known lastname 106273**],
  You were admitted to [**Hospital1 18**] for shortness of breath and were
found to have fluid around your lung. The fluid was removed and
your breathing improved. You were initially started on
antibiotics but as samples of the fluid did not grow any
bacteria we stopped these at the time of discharge. You will be
going back to your facility to focus on controlling your pain
and shortness of breath.

The following medications were changed during this
hospitalization:

START
Trazodone 50mg every night to help you sleep. You can take this
in addition to your nighttime dose of oxycodone.
Levoquin 750mg by mouth once per day for 4 more days (last day
[**4-8**])

Followup Instructions:
You will follow-up with the doctors at your facility who will
continue to manage your pain, shortness of breath, and insomnia.
{'Secondary malignant neoplasm of lung,Acute on chronic diastolic heart failure,Bacterial pneumonia, unspecified,Malignant pleural effusion,Secondary malignant neoplasm of bone and bone marrow,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Insomnia, unspecified,Personal history of malignant neoplasm of prostate,Personal history of irradiation, presenting hazards to health,Personal history of antineoplastic chemotherapy,Long-term (current) use of steroids,Do not resuscitate status'}


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: Hypoxemia

PRESENT ILLNESS: Mr. [**Known lastname 106273**] is a [**Age over 90 **] yo M with h/o metastatic prostate cancer,
hypothyroidism, and diastolic CHF, who was recently discharged
from [**Hospital1 18**] in [**2-/2168**] s/p fall and with concern for C1 and C7
fractures, who now presents from [**Hospital1 **] [**Location (un) 620**] with hypoxia and
evidence of R-sided pleural effusion on CXR.
.
The patient was discharged to [**Location (un) **] Independent Living
[**2168-2-17**], a skilled nursing facility, and reports that he has
had significant difficulty carrying out his activities of daily
living, and even taking part in his leisure activities as well.
Last night, the patient endorses that his breathing became
significantly more difficult, and due to this noticeable
shortness of breath, the patient's nurses called an ambulance
and had him taken to the [**Hospital1 **] [**Location (un) 620**] ED.
.
At [**Hospital1 **] [**Location (un) 620**], Mr. [**Known lastname 106273**] had an O2 Sat in the 80s and
underwent imaging that showed a large right-sided pleural
effusion. The patient was then placed on 2L oxygen by NC and was
transferred to [**Hospital1 18**] for further care.
.
In the [**Hospital1 18**] ED, initial VS were: T 98.4 HR: 88 BP: 97/61 RR: 22
O2Sat: 97 on 3L NC.  Due to findings on CXR, the patient was
admitted to the MICU for management of his pleural effusions
(which have shown to be malignant effusions in the past), given
that the Interventional Pulmonart team was unable to perform the
procedure this evening.
.
On arrival to the MICU, patient's VS were: T 98.3 HR: 90 BP:
110/57 RR: 22 O2Sat: 97 on 3L NC.  The patient had no other
concerns or complaints.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies  cough, dyspnea or wheezing. Denies chest
pain, chest pressure, palpitations. Denies  constipation,
abdominal pain, diarrhea, dark or bloody stools. Denies dysuria,
frequency, or urgency. Denies arthralgias or myalgias. Denies
rashes or skin changes.

MEDICAL HISTORY: 1) Prostate cancer w known metastases to ribs and lungs, s/p
prostatectomy and XRT to ribs ([**2163**])
2) Recent C1 and C7 Fractures in [**2-/2168**]
3) Diastolic CHF (EF >50% per recent echo at DCFI)
5) HTN
6) Hypothyroidism
7) BPV
8) H/O cataract surgery
9) H/O shoulder pain
10) Appendectomy

MEDICATION ON ADMISSION: 1) Zytiga 4 pills daily (chemo) ****stopped [**3-28**]
2) Prednisone 5 mg daily
3) Levothyroxine 100 mcg daily
4) ASA 81 mg every other day
5) Furosemide 20 mg daily
6) Mirtazipine 15 mg daily
7) Vit D3 Senacot
8) Sorbitol 70% 30mL [**Hospital1 **]
9) Multivitamin
10) Acetaminophen 650 [**Hospital1 **]
11) Senna 2 tabs [**Hospital1 **]
12) Bisacodyl 10mg suppository daily
12) Oxycodone 2.5mg Daily
13) Oxycodone 2.5mg Q4H PRN
14) Milk of mag 30ml daily PRN

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
========================
.
Vitals: T 98.3 HR: 90 BP: 110/57 RR: 22 O2Sat: 97 on 3L NC
Constitutional: AOx3, Comfortable
HEENT: Normocephalic, atraumatic
Chest: Decreased breath sounds at the right base compared
to the left, crackles on the left
Cardiovascular: Regular Rate and Rhythm, [**1-18**] Ejection Murmur
appreciated in the RUSB, [**1-18**] Holosystolic Murmur at the Apex
Abdominal: Soft, ND, Tender to Deep Palpation in the RUQ
GU/Flank: No costovertebral angle tenderness
Extr/Back: Warm, Well-Perfused, Trace Pitting in the Lower
Extremities
Skin: No rash
.
DISCHARGE PHYSICAL EXAM:
========================
.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: He lives at [**Location (un) **] Independent Living.  He quit smoking 20
years ago; prior to that 2 packs a day for 30 years.  Occasional 

### Response:
{'Secondary malignant neoplasm of lung,Acute on chronic diastolic heart failure,Bacterial pneumonia, unspecified,Malignant pleural effusion,Secondary malignant neoplasm of bone and bone marrow,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Insomnia, unspecified,Personal history of malignant neoplasm of prostate,Personal history of irradiation, presenting hazards to health,Personal history of antineoplastic chemotherapy,Long-term (current) use of steroids,Do not resuscitate status'}
