CHIEF COMPLAINT: Fevers

PRESENT ILLNESS: 74 yo F w/ DMII, ESRD on HD, dCHF, afib who presents with
hypoxia, tachycardia and hypertension after dialysis. She
presented to [**Hospital1 112**] yesterday with increased lethargy, rigors,
tachycardia, and a fingerstick above 600. She had a WBC of 22
and a positive urinalysis. Bcxs grew CONS 3/4 bottles on [**11-18**]
and NGTD on [**11-19**]. She was started on vanc/ceftaz. Her urine
grew klebs sensitive to everything except ampicillin. Her INR
was notable for an elevation to 7.4. She received 5 mg of oral
vitamin K. Repeat INR was 9.6.
.
Overnight she was complaining of some chest pressure. Her
troponin increased from 2.4 to 3.7. Cardiology was consulted at
[**Hospital1 112**]. They felt that the increase in troponin was related to
demand ischemia. Her hematocrit decreased significantly during
the admission without obvious signs of bleeding. She was 34.3 on
arrival and decreased to 25. This was felt to be related to
IVF's.
.
She was transferred to [**Hospital1 18**] for continuity and was doing well
on the floor until this afternoon when she went to dialysis.
When she came back she was noted to be hypoxic then also noted
to be tachycardic and hypertense w/ systolics in the 200s. An
ABG showed acute respiratory acidosis. She was given 80mg IV
lasix as she still makes urine. When she arrived in the ICU she
was somnolent, not answering questions and so was intubated. At
intubation she became hypotense and was started on peripheral
neo. A RIJ was attempted but curled back into the subclavian. A
femoral line was then placed.

MEDICAL HISTORY: # ESRD on hemodialysis secondary to diabetes; qMWF schedule at
[**Location (un) **] [**Location (un) **]
# DM2 on insulin
# HTN
# Chronic diastolic CHF (LVEF >75%) with a history of
tachycardia-induced acute LVOT obstruction
# Hyperlipidemia
# PVD s/p bilateral BKAs (left in [**2156**]; right in [**2157**])
# Paroxysmal a-flutter s/p failed ablation with subsequent
atrial fibrillation; on warfarin
# Chronic nighttime hypoxemia on 3 L/min nc
# Secondary hyperparathyroidism
# No occlusive coronary disease on cardiac cath [**12/2162**]
# Left eye blindness since [**2161**] after cataract surgery, per the
pt.
# Mild functional mitral stenosis
# GERD
# Tobacco use-- still smokes up to 6 cigarettes per day as of
[**9-28**]
# h/o VRE UTI's
# H/o Tibial fracture

MEDICATION ON ADMISSION: 1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO every
twelve (12) hours.
2. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
5. Warfarin 1 mg Tablet Sig: One (1) Tablet PO 3X/WEEK
(MO,WE,FR).
6. Warfarin 2 mg Tablet Sig: One (1) Tablet PO 4X/WEEK
([**Doctor First Name **],TU,TH,SA).
7. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
8. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
9. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Calcium Acetate 667 mg Capsule Sig: One (1) Capsule PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
11. Dorzolamide-Timolol 2-0.5 % Drops Sig: One (1) Drop
Ophthalmic [**Hospital1 **] (2 times a day).
12. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS
(at bedtime).
13. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
14. Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2
times a day).
15. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
1-2 Puffs Inhalation Q4H (every 4 hours) as needed for SOB,
wheezing.
16. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
17. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
18. Acetaminophen 500 mg Capsule Sig: [**12-23**] Capsules PO Q6H (every
6 hours) as needed for Headache, pain .
19. NPH Insulin Human Recomb 100 unit/mL Suspension Sig: Four
(4) units Subcutaneous twice a day: Inject 4 units twice per
day: once at breakfast and once at bedtime.
20. Verapamil 40 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours): On hemodialysis days, please do not take your afternoon
dose of this medication.
Vancomycin 1g QHD
Ceftazidime

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals - T: 98.4 BP: 93/46 HR: 103 RR: 24 02 sat: 100 on FIO2
70%
GENERAL: Sedated on the vent
HEENT: NO elevation in JVP appreciated
CARDIAC: 2/6 systolic murmur, irregularly irregular
LUNG: Diffuse expiratory rhonchi
ABDOMEN: +BS, NT, ND
EXT: bilateral lower extremity amputations
NEURO: moving upper extremities spontaneously

FAMILY HISTORY: Father with DM2, Mother deceased of stroke.  Siblings died of
cancer (unknown type), stroke and brain cancer.  Seven health
children.  Extended family history positive for CAD, cancer and
DM.

SOCIAL HISTORY: Significant for the presence of current tobacco use, [**5-27**]
cigarettes per day and [**12-23**] PPD x 50 years. There is no history
of alcohol or IV drug abuse. She lives in [**Hospital3 **]
facility with once weekly [**Hospital3 269**] and 5 day a week home health aide.
She uses a mobile wheelchair or a walker with prostheses.
Other staphylococcal septicemia,End stage renal disease,Acute on chronic diastolic heart failure,Septic shock,Acute respiratory failure,Other encephalopathy,Infection and inflammatory reaction due to other vascular device, implant, and graft,Urinary tract infection, site not specified,Acidosis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Atrial flutter,Secondary hyperparathyroidism (of renal origin),Intestinal infection due to Clostridium difficile,Severe sepsis,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Long-term (current) use of insulin,Other and unspecified hyperlipidemia,Below knee amputation status,Tobacco use disorder
Staphylcocc septicem NEC,End stage renal disease,Ac on chr diast hrt fail,Septic shock,Acute respiratry failure,Encephalopathy NEC,React-oth vasc dev/graft,Urin tract infection NOS,Acidosis,Hyp kid NOS w cr kid V,Atrial flutter,Sec hyperparathyrd-renal,Int inf clstrdium dfcile,Severe sepsis,DMII renl nt st uncntrld,Klebsiella pneumoniae,Long-term use of insulin,Hyperlipidemia NEC/NOS,Status amput below knee,Tobacco use disorder
Admission Date:  [**2164-11-19**]              Discharge Date:   [**2164-11-27**]

Date of Birth:  [**2090-1-9**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
Fevers

Major Surgical or Invasive Procedure:
Hemodialysis catheter placement

History of Present Illness:
74 yo F w/ DMII, ESRD on HD, dCHF, afib who presents with
hypoxia, tachycardia and hypertension after dialysis. She
presented to [**Hospital1 112**] yesterday with increased lethargy, rigors,
tachycardia, and a fingerstick above 600. She had a WBC of 22
and a positive urinalysis. Bcxs grew CONS 3/4 bottles on [**11-18**]
and NGTD on [**11-19**]. She was started on vanc/ceftaz. Her urine
grew klebs sensitive to everything except ampicillin. Her INR
was notable for an elevation to 7.4. She received 5 mg of oral
vitamin K. Repeat INR was 9.6.
.
Overnight she was complaining of some chest pressure. Her
troponin increased from 2.4 to 3.7. Cardiology was consulted at
[**Hospital1 112**]. They felt that the increase in troponin was related to
demand ischemia. Her hematocrit decreased significantly during
the admission without obvious signs of bleeding. She was 34.3 on
arrival and decreased to 25. This was felt to be related to
IVF's.
.
She was transferred to [**Hospital1 18**] for continuity and was doing well
on the floor until this afternoon when she went to dialysis.
When she came back she was noted to be hypoxic then also noted
to be tachycardic and hypertense w/ systolics in the 200s. An
ABG showed acute respiratory acidosis. She was given 80mg IV
lasix as she still makes urine. When she arrived in the ICU she
was somnolent, not answering questions and so was intubated. At
intubation she became hypotense and was started on peripheral
neo. A RIJ was attempted but curled back into the subclavian. A
femoral line was then placed.

Past Medical History:
# ESRD on hemodialysis secondary to diabetes; qMWF schedule at
[**Location (un) **] [**Location (un) **]
# DM2 on insulin
# HTN
# Chronic diastolic CHF (LVEF >75%) with a history of
tachycardia-induced acute LVOT obstruction
# Hyperlipidemia
# PVD s/p bilateral BKAs (left in [**2156**]; right in [**2157**])
# Paroxysmal a-flutter s/p failed ablation with subsequent
atrial fibrillation; on warfarin
# Chronic nighttime hypoxemia on 3 L/min nc
# Secondary hyperparathyroidism
# No occlusive coronary disease on cardiac cath [**12/2162**]
# Left eye blindness since [**2161**] after cataract surgery, per the
pt.
# Mild functional mitral stenosis
# GERD
# Tobacco use-- still smokes up to 6 cigarettes per day as of
[**9-28**]
# h/o VRE UTI's
# H/o Tibial fracture

Social History:
Significant for the presence of current tobacco use, [**5-27**]
cigarettes per day and [**12-23**] PPD x 50 years. There is no history
of alcohol or IV drug abuse. She lives in [**Hospital3 **]
facility with once weekly [**Hospital3 269**] and 5 day a week home health aide.
She uses a mobile wheelchair or a walker with prostheses.


Family History:
Father with DM2, Mother deceased of stroke.  Siblings died of
cancer (unknown type), stroke and brain cancer.  Seven health
children.  Extended family history positive for CAD, cancer and
DM.


Physical Exam:
Vitals - T: 98.4 BP: 93/46 HR: 103 RR: 24 02 sat: 100 on FIO2
70%
GENERAL: Sedated on the vent
HEENT: NO elevation in JVP appreciated
CARDIAC: 2/6 systolic murmur, irregularly irregular
LUNG: Diffuse expiratory rhonchi
ABDOMEN: +BS, NT, ND
EXT: bilateral lower extremity amputations
NEURO: moving upper extremities spontaneously

Pertinent Results:
[**2164-11-19**] 09:15PM BLOOD WBC-20.3*# RBC-3.43* Hgb-9.6* Hct-31.9*
MCV-93 MCH-28.0 MCHC-30.1* RDW-18.2* Plt Ct-229
[**2164-11-21**] 03:02AM BLOOD WBC-22.5* RBC-3.25* Hgb-8.8* Hct-30.3*
MCV-93 MCH-27.0 MCHC-28.9* RDW-18.0* Plt Ct-233
[**2164-11-24**] 02:42AM BLOOD WBC-26.9* RBC-2.74* Hgb-7.7* Hct-24.9*
MCV-91 MCH-27.9 MCHC-30.8* RDW-18.5* Plt Ct-234
[**2164-11-25**] 03:58AM BLOOD WBC-28.2* RBC-2.95* Hgb-8.0* Hct-27.2*
MCV-92 MCH-27.0 MCHC-29.3* RDW-18.3* Plt Ct-220
[**2164-11-26**] 03:14AM BLOOD WBC-37.5* RBC-3.13* Hgb-8.5* Hct-28.9*
MCV-92 MCH-27.3 MCHC-29.5* RDW-18.7* Plt Ct-244
[**2164-11-19**] 09:15PM BLOOD PT-140.6* PTT-59.8* INR(PT)-18.7*
[**2164-11-20**] 06:10AM BLOOD PT-21.4* PTT-36.4* INR(PT)-2.0*
[**2164-11-20**] 07:30AM BLOOD Vanco-19.1
[**2164-11-22**] 05:05AM BLOOD Vanco-16.1
[**2164-11-23**] 04:00PM BLOOD Vanco-17.7
[**2164-11-25**] 03:58AM BLOOD Vanco-18.8
[**2164-11-26**] 05:39AM BLOOD Vanco-16.9
[**2164-11-26**] 11:44AM BLOOD Type-ART pO2-136* pCO2-33* pH-7.48*
calTCO2-25 Base XS-2 Comment-GREEN TOP
[**2164-11-25**] 01:06PM BLOOD Glucose-163* Lactate-2.5*
[**2164-11-25**] 05:01PM BLOOD Glucose-147* Lactate-2.1*
[**2164-11-25**] 10:20PM BLOOD Glucose-191* Lactate-2.2*
[**2164-11-26**] 03:34AM BLOOD Lactate-2.0
[**2164-11-26**] 11:44AM BLOOD Lactate-4.9*
[**2164-11-27**] 12:38AM BLOOD VoidSpe-CLOTTY SPE

Brief Hospital Course:
Mrs. [**Known lastname 1007**] was admitted with fevers and rigors initially to [**Hospital1 112**].
Blood cultures there grew coag negative staphylococcus and urine
cultures grew Klebsiella. She was started on vancomycin and
ceftriaxone. She was transferred to [**Hospital1 18**] and determined to have
a HD line infection. Her HD line was removed and replaced 2 days
later. While on the floor she had two episodes of afib w/ rvr
resulting in flash pulmonary edema and then intubation. She was
extubated in the ICU and her  WBC was noted to continue to
climb, after the HD catheter was removed so a stool sample was
sent for c.diff which was positive. She was started on oral
vancomycin and IV metronidazole but her WBC continued to climb
and her mental status deteriorated. The possibility of colectomy
was discussed with her health care proxy [**Name (NI) 1154**] who decided
that her mother would not want a major surgery. Her abdomen
remained benign but her lactate continued to climb in the face
of volume resuscitation. She remained hemodynamically stable
without an O2 requirement and on [**2164-11-27**] she developed
bradycardia during her amiodarone infusion which then developed
into PEA arrest with a narrow complex bradycardia. She was coded
for approximately 45 minutes and expired at 12:45.

Medications on Admission:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO every
twelve (12) hours.
2. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
5. Warfarin 1 mg Tablet Sig: One (1) Tablet PO 3X/WEEK
(MO,WE,FR).
6. Warfarin 2 mg Tablet Sig: One (1) Tablet PO 4X/WEEK
([**Doctor First Name **],TU,TH,SA).
7. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
8. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
9. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Calcium Acetate 667 mg Capsule Sig: One (1) Capsule PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
11. Dorzolamide-Timolol 2-0.5 % Drops Sig: One (1) Drop
Ophthalmic [**Hospital1 **] (2 times a day).
12. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS
(at bedtime).
13. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
14. Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2
times a day).
15. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
1-2 Puffs Inhalation Q4H (every 4 hours) as needed for SOB,
wheezing.
16. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
17. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
18. Acetaminophen 500 mg Capsule Sig: [**12-23**] Capsules PO Q6H (every
6 hours) as needed for Headache, pain .
19. NPH Insulin Human Recomb 100 unit/mL Suspension Sig: Four
(4) units Subcutaneous twice a day: Inject 4 units twice per
day: once at breakfast and once at bedtime.
20. Verapamil 40 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours): On hemodialysis days, please do not take your afternoon
dose of this medication.
Vancomycin 1g QHD
Ceftazidime

Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
Deceased

Discharge Condition:
Deceased

Discharge Instructions:
Deceased

Followup Instructions:
Deceased


Completed by:[**2164-11-27**]
{"Other staphylococcal septicemia,End stage renal disease,Acute on chronic diastolic heart failure,Septic shock,Acute respiratory failure,Other encephalopathy,Infection and inflammatory reaction due to other vascular device, implant, and graft,Urinary tract infection, site not specified,Acidosis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Atrial flutter,Secondary hyperparathyroidism (of renal origin),Intestinal infection due to Clostridium difficile,Severe sepsis,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Long-term (current) use of insulin,Other and unspecified hyperlipidemia,Below knee amputation status,Tobacco use disorder"}


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: Fevers

PRESENT ILLNESS: 74 yo F w/ DMII, ESRD on HD, dCHF, afib who presents with
hypoxia, tachycardia and hypertension after dialysis. She
presented to [**Hospital1 112**] yesterday with increased lethargy, rigors,
tachycardia, and a fingerstick above 600. She had a WBC of 22
and a positive urinalysis. Bcxs grew CONS 3/4 bottles on [**11-18**]
and NGTD on [**11-19**]. She was started on vanc/ceftaz. Her urine
grew klebs sensitive to everything except ampicillin. Her INR
was notable for an elevation to 7.4. She received 5 mg of oral
vitamin K. Repeat INR was 9.6.
.
Overnight she was complaining of some chest pressure. Her
troponin increased from 2.4 to 3.7. Cardiology was consulted at
[**Hospital1 112**]. They felt that the increase in troponin was related to
demand ischemia. Her hematocrit decreased significantly during
the admission without obvious signs of bleeding. She was 34.3 on
arrival and decreased to 25. This was felt to be related to
IVF's.
.
She was transferred to [**Hospital1 18**] for continuity and was doing well
on the floor until this afternoon when she went to dialysis.
When she came back she was noted to be hypoxic then also noted
to be tachycardic and hypertense w/ systolics in the 200s. An
ABG showed acute respiratory acidosis. She was given 80mg IV
lasix as she still makes urine. When she arrived in the ICU she
was somnolent, not answering questions and so was intubated. At
intubation she became hypotense and was started on peripheral
neo. A RIJ was attempted but curled back into the subclavian. A
femoral line was then placed.

MEDICAL HISTORY: # ESRD on hemodialysis secondary to diabetes; qMWF schedule at
[**Location (un) **] [**Location (un) **]
# DM2 on insulin
# HTN
# Chronic diastolic CHF (LVEF >75%) with a history of
tachycardia-induced acute LVOT obstruction
# Hyperlipidemia
# PVD s/p bilateral BKAs (left in [**2156**]; right in [**2157**])
# Paroxysmal a-flutter s/p failed ablation with subsequent
atrial fibrillation; on warfarin
# Chronic nighttime hypoxemia on 3 L/min nc
# Secondary hyperparathyroidism
# No occlusive coronary disease on cardiac cath [**12/2162**]
# Left eye blindness since [**2161**] after cataract surgery, per the
pt.
# Mild functional mitral stenosis
# GERD
# Tobacco use-- still smokes up to 6 cigarettes per day as of
[**9-28**]
# h/o VRE UTI's
# H/o Tibial fracture

MEDICATION ON ADMISSION: 1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO every
twelve (12) hours.
2. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
5. Warfarin 1 mg Tablet Sig: One (1) Tablet PO 3X/WEEK
(MO,WE,FR).
6. Warfarin 2 mg Tablet Sig: One (1) Tablet PO 4X/WEEK
([**Doctor First Name **],TU,TH,SA).
7. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
8. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
9. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Calcium Acetate 667 mg Capsule Sig: One (1) Capsule PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
11. Dorzolamide-Timolol 2-0.5 % Drops Sig: One (1) Drop
Ophthalmic [**Hospital1 **] (2 times a day).
12. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS
(at bedtime).
13. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
14. Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2
times a day).
15. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
1-2 Puffs Inhalation Q4H (every 4 hours) as needed for SOB,
wheezing.
16. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
17. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
18. Acetaminophen 500 mg Capsule Sig: [**12-23**] Capsules PO Q6H (every
6 hours) as needed for Headache, pain .
19. NPH Insulin Human Recomb 100 unit/mL Suspension Sig: Four
(4) units Subcutaneous twice a day: Inject 4 units twice per
day: once at breakfast and once at bedtime.
20. Verapamil 40 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours): On hemodialysis days, please do not take your afternoon
dose of this medication.
Vancomycin 1g QHD
Ceftazidime

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals - T: 98.4 BP: 93/46 HR: 103 RR: 24 02 sat: 100 on FIO2
70%
GENERAL: Sedated on the vent
HEENT: NO elevation in JVP appreciated
CARDIAC: 2/6 systolic murmur, irregularly irregular
LUNG: Diffuse expiratory rhonchi
ABDOMEN: +BS, NT, ND
EXT: bilateral lower extremity amputations
NEURO: moving upper extremities spontaneously

FAMILY HISTORY: Father with DM2, Mother deceased of stroke.  Siblings died of
cancer (unknown type), stroke and brain cancer.  Seven health
children.  Extended family history positive for CAD, cancer and
DM.

SOCIAL HISTORY: Significant for the presence of current tobacco use, [**5-27**]
cigarettes per day and [**12-23**] PPD x 50 years. There is no history
of alcohol or IV drug abuse. She lives in [**Hospital3 **]
facility with once weekly [**Hospital3 269**] and 5 day a week home health aide.
She uses a mobile wheelchair or a walker with prostheses. 

### Response:
{"Other staphylococcal septicemia,End stage renal disease,Acute on chronic diastolic heart failure,Septic shock,Acute respiratory failure,Other encephalopathy,Infection and inflammatory reaction due to other vascular device, implant, and graft,Urinary tract infection, site not specified,Acidosis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Atrial flutter,Secondary hyperparathyroidism (of renal origin),Intestinal infection due to Clostridium difficile,Severe sepsis,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Long-term (current) use of insulin,Other and unspecified hyperlipidemia,Below knee amputation status,Tobacco use disorder"}
