CHIEF COMPLAINT: SOB, abdominal pain

PRESENT ILLNESS: Ms. [**Known lastname 72408**] is a 79 yo female with COPD,CHF, dementia who was
transferred from [**Hospital 100**] Rehab due to increasing SOB and
abdominal pain. Per PCP note, pt has had increasing "moans",
SOB, and abd pain/distension over past week, which is a change
from baseline. She was seen by psychiatry at NH, who questioned
psychotic depression and started Seroquel and Paxil. Pt also had
non-contrast Abd CT at [**Hospital1 882**] on [**3-1**], which reportedly showed
"no acute process." She had CXR on [**3-1**] which showed "interval
improvement" of bilateral opacities. Per the pt's daughter, pt
had pneumonia in [**1-9**] and has had gradually decreasing function
since then. The daughter also reports pt's mental status has
decreased significantly over the past week. She has had frequent
"panic attacks." R arm contracture has also occurred over the
past several weeks, however the daughter is unsure of the cause.

MEDICAL HISTORY: 1)Primary intermedullary ependymoma/astrocytoma, spinal cord
tumor (in the process of being worked up per daughter, s/p XRT
and steroid taper at [**Hospital1 2025**], oncologist Dr. [**Last Name (STitle) **]
2)Remote hx of brain tumor s/p VP shunt placement
3)h/o thoracic aneurysm
4)s/p recent PNA
5)COPD
6)CHF (unknown EF)
7)MVR (bioprosthetic MV)
8)Atrial fibrillation (on coumadin)
9)dementia
10)h/o urinary retention (had foley cath at rehab)

MEDICATION ON ADMISSION: coumadin 3.5 mg qd
flovent 110mcg 1 puff [**Hospital1 **]
gabapentin 300mg qhs
MOM 30ml qd prn
Verapamil 120mg qd
Amoxicillin 2g prn dental procedures
Klonopin 0.25mg [**Hospital1 **]
Doxycycline 100mg [**Hospital1 **] (started [**3-2**] to be completed [**3-9**])
Levaquin (started [**2-26**], finished [**3-1**])
Digoxin 0.125mg qd
Morphine (Roxanol) 2mg q2h prn
Morphine (Roxanol) 4mg q12h
Seroquel 25mg [**Hospital1 **]
Maalox 15ml q6h prn
Atrovent nebs q4h prn
Albuterol nebs q4h prn
Lasix 40mg qd
Sorbitol 15ml qd
Colace 250mg qd
Senna 2 tabs qhs
Paxil 20mg [**Hospital1 **]
Dulcolax 10mg qhs
Dexamethasone 0.125mg q12h (started [**3-2**])

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T 99.5 BP 147/110 HR 87 RR 17 O2sat 100% on BiPAP
10/4/40%
Gen: pt in resp distress, using accessory muscles, on BiPAP,
awake, alert, moaning
HEENT: OP slightly dry, but not fully examined due to BiPAP
machine
Neck: Supple. JVD approximately to earlobe
Cardio: irregularly irregular, 2/6 SEM @ apex
Resp: diffuse exp wheezes bilaterally (although difficult to
discern from pt making "squeeking" noises while exhaling)
Abd: soft, nt, mildly distended, +BS, no rebound/guarding
Ext: trace BL LE edema. LUE ecchymoses
Neuro: awake, alert, R arm with contracture. Knows she is in
"hospital", but unable to speak further due to agitation and
BiPAP machine. Asked her to squeeze my fingers, and she nodded
"no".

FAMILY HISTORY: Fam hx of depression.

SOCIAL HISTORY: Lives at [**Hospital 100**] Rehab. Pt needs total care with ADL's. Other
social hx not obtained.
Methicillin susceptible pneumonia due to Staphylococcus aureus,Acute respiratory failure,Atrial fibrillation,Congestive heart failure, unspecified,Retention of urine, unspecified,Other and unspecified angina pectoris,Pressure ulcer, lower back,Hyposmolality and/or hyponatremia,Malignant neoplasm of brain, unspecified,Chronic airway obstruction, not elsewhere classified,Heart valve replaced by transplant,Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere,Constipation, unspecified,Other alteration of consciousness,Kyphosis (acquired) (postural),Presence of cerebrospinal fluid drainage device,Other dependence on machines, supplemental oxygen
Meth sus pneum d/t Staph,Acute respiratry failure,Atrial fibrillation,CHF NOS,Retention urine NOS,Angina pectoris NEC/NOS,Pressure ulcer, low back,Hyposmolality,Malig neo brain NOS,Chr airway obstruct NEC,Heart valve transplant,Hypertension NOS,Mental disor NEC oth dis,Constipation NOS,Other alter consciousnes,Kyphosis NOS,Ventricular shunt status,Depend-supplement oxygen
Admission Date:  [**2191-3-5**]              Discharge Date:   [**2191-3-24**]

Date of Birth:  [**2111-9-9**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 7455**]
Chief Complaint:
SOB, abdominal pain

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Ms. [**Known lastname 72408**] is a 79 yo female with COPD,CHF, dementia who was
transferred from [**Hospital 100**] Rehab due to increasing SOB and
abdominal pain. Per PCP note, pt has had increasing "moans",
SOB, and abd pain/distension over past week, which is a change
from baseline. She was seen by psychiatry at NH, who questioned
psychotic depression and started Seroquel and Paxil. Pt also had
non-contrast Abd CT at [**Hospital1 882**] on [**3-1**], which reportedly showed
"no acute process." She had CXR on [**3-1**] which showed "interval
improvement" of bilateral opacities. Per the pt's daughter, pt
had pneumonia in [**1-9**] and has had gradually decreasing function
since then. The daughter also reports pt's mental status has
decreased significantly over the past week. She has had frequent
"panic attacks." R arm contracture has also occurred over the
past several weeks, however the daughter is unsure of the cause.


In the [**Name (NI) **], pt was found to have a PNA on CXR and was started on
BiPAP for hypercarbic resp failure. Her BP initially was up to
206/88, but this decreased without antihypertensive therapy.
Temp was up to 100.6, with O2 sat 92% on 4L NC (increased to
100% on BiPAP). Her code status was reportedly reversed from
DNR/DNI to only DNR (but intubatable). She was given Solumedrol
125mg IV, 2L NS, Levofloxacin 500mg IV, and Morphine 2mg IV.

She currently is not able to converse due to resp distress,
agitation, and BiPAP machine, however she nods "yes" to almost
every question.

Past Medical History:
1)Primary intermedullary ependymoma/astrocytoma, spinal cord
tumor (in the process of being worked up per daughter, s/p XRT
and steroid taper at [**Hospital1 2025**], oncologist Dr. [**Last Name (STitle) **]
2)Remote hx of brain tumor s/p VP shunt placement
3)h/o thoracic aneurysm
4)s/p recent PNA
5)COPD
6)CHF (unknown EF)
7)MVR (bioprosthetic MV)
8)Atrial fibrillation (on coumadin)
9)dementia
10)h/o urinary retention (had foley cath at rehab)

Social History:
Lives at [**Hospital 100**] Rehab. Pt needs total care with ADL's. Other
social hx not obtained.

Family History:
Fam hx of depression.

Physical Exam:
Vitals: T 99.5 BP 147/110 HR 87 RR 17 O2sat 100% on BiPAP
10/4/40%
Gen: pt in resp distress, using accessory muscles, on BiPAP,
awake, alert, moaning
HEENT: OP slightly dry, but not fully examined due to BiPAP
machine
Neck: Supple. JVD approximately to earlobe
Cardio: irregularly irregular, 2/6 SEM @ apex
Resp: diffuse exp wheezes bilaterally (although difficult to
discern from pt making "squeeking" noises while exhaling)
Abd: soft, nt, mildly distended, +BS, no rebound/guarding
Ext: trace BL LE edema. LUE ecchymoses
Neuro: awake, alert, R arm with contracture. Knows she is in
"hospital", but unable to speak further due to agitation and
BiPAP machine. Asked her to squeeze my fingers, and she nodded
"no".


Pertinent Results:
Laboratory Results:
[**2191-3-4**] 06:00PM BLOOD WBC-10.6 RBC-3.89* Hgb-12.5 Hct-36.6
MCV-94 MCH-32.0 MCHC-34.0 RDW-15.9* Plt Ct-506*
[**2191-3-13**] 06:10AM BLOOD WBC-12.7* RBC-3.08* Hgb-10.1* Hct-31.2*
MCV-101* MCH-32.8* MCHC-32.4 RDW-15.8* Plt Ct-411
[**2191-3-20**] 05:27AM BLOOD WBC-8.1 RBC-2.89* Hgb-9.2* Hct-28.1*
MCV-97 MCH-31.8 MCHC-32.7 RDW-16.1* Plt Ct-398
[**2191-3-5**] 03:25AM BLOOD PT-25.9* PTT-24.2 INR(PT)-2.6*
[**2191-3-20**] 05:27AM BLOOD PT-20.4* PTT-27.2 INR(PT)-2.0*
[**2191-3-4**] 06:00PM BLOOD Glucose-121* UreaN-19 Creat-0.7 Na-135
K-4.6 Cl-92* HCO3-31 AnGap-17
[**2191-3-4**] 06:00PM BLOOD ALT-21 AST-39 LD(LDH)-536* CK(CPK)-128
AlkPhos-70 Amylase-68 TotBili-0.4
[**2191-3-13**] 06:10AM BLOOD ALT-41* AST-26 LD(LDH)-373* AlkPhos-51
TotBili-0.4
[**2191-3-4**] 06:00PM BLOOD CK-MB-4 cTropnT-0.09*
[**2191-3-15**] 11:29AM BLOOD CK-MB-NotDone cTropnT-0.07*
[**2191-3-16**] 06:19AM BLOOD CK-MB-NotDone cTropnT-0.08*
[**2191-3-17**] 06:00AM BLOOD proBNP-1752*
[**2191-3-5**] 01:00AM BLOOD Calcium-8.9 Phos-4.3 Mg-1.9
[**2191-3-14**] 04:40AM BLOOD VitB12-1446* Folate-14.8
[**2191-3-5**] 03:12PM BLOOD Lactate-1.2

Relevant Imaging:
1)Cxray ([**3-4**]): Retrocardiac opacity, possibly representing
atelectasis versus focal consolidation. Likely small bilateral
pleural effusions.

2)CT abdomen/pelvis ([**3-4**]): 1. No evidence of pulmonary embolism.
2. Bibasilar consolidation, likely atelectasis, although
evolving infection cannot be entirely excluded. Moderate right
and small left pleural effusion. 3. Coronary artery
calcifications. 4. Multiple hepatic cysts. 5. Sigmoid
diverticula without evidence of diverticulitis

3)CT Head ([**3-6**]): Limited study due to motion. No acute
intracranial hemorrhage. No mass effect. No evidence of
dilatation of the ventricles.

4)Abdomen xray ([**3-10**]): No evidence of obstruction.

5)ECHO ([**3-17**]): Symmetric LVH with preserved global and regional
biventricular systolic function. Minimal aortic stenosis with
mild regurgitation. Normally-functioning mitral bioprosthesis.
Moderate tricuspid regurgitation. EF 70-80%.
.
6) CT abdomen/pelvis [**3-17**]:
IMPRESSION:
1. Airspace opacity of the dependent bilateral lower lobes is
thought more likely to represent atelectasis; however,
underlying infection cannot be definitively excluded.
2. Small right pleural effusion and minimal left pleural
effusion.
3. Multiple well-defined hypodense foci scattered throughout the
liver, the larger of which are consistent with cysts. Several
smaller lesions are too small to definitively characterize.
4. Numerous sigmoid diverticula without evidence of acute
diverticulitis.
.
7) CXR [**3-16**]:
Feeding tube present, with distal tip directed cephalad in the
fundus. Right PICC line remains in place in the superior vena
cava. Cardiac and mediastinal contours are widened but without
change from the prior radiograph. Previously reported pulmonary
edema has slightly progressed with increased perihilar haziness.
Bilateral pleural effusions are present, best visualized on the
lateral view, small in size.
.
Discharge labs:
[**2191-3-23**] 08:21AM BLOOD WBC-8.4 RBC-2.89* Hgb-9.2* Hct-28.2*
MCV-98 MCH-31.9 MCHC-32.7 RDW-15.9* Plt Ct-377
[**2191-3-24**] 05:28AM BLOOD PT-16.0* PTT-29.5 INR(PT)-1.5*
[**2191-3-23**] 08:21AM BLOOD Glucose-107* UreaN-14 Creat-0.6 Na-141
K-3.7 Cl-104 HCO3-33* AnGap-8

Brief Hospital Course:
Ms. [**Known lastname 72408**] is a 79 yo female with COPD, dementia, here with PNA,
hypercarbic respiratory failure, abd pain, and abnormal EKG.

1) Respiratory failure: Patient presented with respiratory
acidosis and was admitted to the MICU for closer monitoring.
Respiratory decompensation likely occurred in the setting of
pneumonia seen on cxray, COPD, and CHF exacerbation. She was
placed on Levaquin, then vancomycin and zosyn. Zosyn and
Levaquin were stopped and she was continued on Vancomycin for 2
weeks since sputum cultures grew MRSA. Her oxygen saturations
improved with antibiotics and agressive diuresis. She also
completed a short Prednisone taper for her COPD. Per daughter,
she requires at least 2L at baseline at rehab. She was continued
on 2L NC with O2 sats in high 90s.  She was continued on lasix
PO and this was progressively decreased to 20mg daily.

2)Abdominal pain: Patient presented with several week history of
diffuse abdominal pain. All imaging studies, including CT scan
abdomen/pelvis, were negative for acute pathology that could
explain her symptoms. It was thought that she was constipated.
She did have bowel movements that were extremely loose in
nature. Lactate was normal and guiac negative suggestive of
mesenteric ischemia being unlikely. GI was consulted and they
recommended a repeat CT abdomen/pelvis which was unchanged. She
was started on oxycodone standing and narcotics were tapered due
to effects on her bowels. Her bowel regimen was optimized with
Colace, senna, and Miralax. Her abdominal pain and distention
improved following bowel movements.  She was decreased to
oxycodone 2.5mg q8hr prn pain.

3)Elevated troponins/EKG changes: Patient presented with mildly
elevated troponins and diffuse ST depressions in the
anterolateral leads. Likely demand ischemia given respiratory
distress and underlying infection. Given patient's persistent
abdominal pain, it was thought that this may be an anginal
equivalent. Cardiology was consulted and agreed with agressive
diuresis as well as change from CCB to b-blocker. There were no
new wall motion abnormalities on both ECHOs. She did have
significant LVH with hyperdynamic EF~70-80's. No further imaging
or studies were recommended.

4)Atrial fibrillation: Patient remained in afib throughout her
hospital stay. Her digoxin was d/c'ed in the MICU. She was
continued on Verapamil for rate control. Verapamil was changed
to Metoprolol, per cardiology recommendation, as a result of
increasing abdominal pain and distention. She was continued on
Coumadin with close monitoring of her INR. Her INR became
supratherapeutic to >6 at which point her coumadin was held for
one dose and she was given vitamin K.  Her INR then became
subtherapeutic and her coumadin was continued.  Her INR on the
day of discharge was 1.5

5)Hypertension: Patient presented with SBP in 200's on admission
but quickly returned to baseline. She was continued on
outpatient regimen of Verapamil, but this was changed to
Metoprolol during her hospital stay.

6) Delirium/Dementia/agitation: Per patient's daughter, she has
had an acute decline in her mental status over past several
weeks. The daughter and PCP denied any history of dementia.  She
was initially started on Quetiapine and Lorazepam but given the
increased sedative effects of the quetiapine this medication was
stopped. She was continued on Ativan prn and her mental status
contineud to wax and wane throughout her hospital stay likely
from her comorbidities.  She remained oriented to self but not
to time or place.  The etiology of her delirium was thought to
be multifactorial with a prolonged hospital stay and significant
comorbitities contributing.  She remained afebrile with a stable
WBC count so infection was thought not to be contributing.  Her
electrolytes were wnl and her B12 and folate were also normal.
She was started on depakote for mood stabilization at 250mg [**Hospital1 **].
She was also started on paxil 30mg daily for her depression. She
was evaluated by psychiatry given her delirium and history of
depression and they recommended seroquel 12.5 mg tid prn for
anxiety/agitation.  They also recommended decreasing her paxil
to 20mg daily.  On the day of discharge the patient was more
alert and appropriate following these medication adjustments.

7) h/o brain/spinal tumors: Patient being followed closely at
[**Hospital1 2025**]. She received XRT in [**Month (only) 404**] and was supposed to undergo a
repeat MRI of her C-spine. This was attempted during this
admission but given her agitation this could not be done.
Further work-up will be deferred to as an outpatient.  She will
likely need MRI c-spine as an outpatient at [**Hospital1 2025**].
.
8) FEN: NGT was initially placed since patient had poor mental
status. When her mental status improved the NGT was removed and
she tolerated PO intake appropriately.  She was evalauted by
speech and swallow who determined that she could tolerate a
regular diet without signs of aspiration.  She requires
significant encouragement to take PO.
.
9) Sacral decubitus ulcer: patient was evaluated by wound care
nurse who recommended dressing changes every 2-3 days with
following protocol: clean with commercial cleanser, pat dry,
apply protective barrier wipe to periwound tissue, apply duoderm
gel, cover with Allevyn Foam adhesive 5x5".  This should be
continued at rehab.  She also requires repositioning every 2
hours.  There was no sign of infection at the site.

Medications on Admission:
coumadin 3.5 mg qd
flovent 110mcg 1 puff [**Hospital1 **]
gabapentin 300mg qhs
MOM 30ml qd prn
Verapamil 120mg qd
Amoxicillin 2g prn dental procedures
Klonopin 0.25mg [**Hospital1 **]
Doxycycline 100mg [**Hospital1 **] (started [**3-2**] to be completed [**3-9**])
Levaquin (started [**2-26**], finished [**3-1**])
Digoxin 0.125mg qd
Morphine (Roxanol) 2mg q2h prn
Morphine (Roxanol) 4mg q12h
Seroquel 25mg [**Hospital1 **]
Maalox 15ml q6h prn
Atrovent nebs q4h prn
Albuterol nebs q4h prn
Lasix 40mg qd
Sorbitol 15ml qd
Colace 250mg qd
Senna 2 tabs qhs
Paxil 20mg [**Hospital1 **]
Dulcolax 10mg qhs
Dexamethasone 0.125mg q12h (started [**3-2**])


Discharge Medications:
1. Fluticasone 110 mcg/Actuation Aerosol [**Month/Year (2) **]: One (1) Puff
Inhalation [**Hospital1 **] (2 times a day).
2. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
3. Docusate Sodium 50 mg/5 mL Liquid [**Last Name (STitle) **]: One Hundred (100) mg
PO BID (2 times a day).
4. Senna 8.6 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO twice a day.
5. Warfarin 3 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO HS (at bedtime).

6. Metoprolol Tartrate 25 mg Tablet [**Last Name (STitle) **]: 0.5 Tablet PO BID (2
times a day).
7. Oxycodone 5 mg Tablet [**Last Name (STitle) **]: 0.5 Tablet PO every eight (8)
hours as needed for pain.
8. Albuterol Sulfate 0.083 % Solution [**Last Name (STitle) **]: One (1) neb
Inhalation every four (4) hours as needed.
9. Ipratropium Bromide 0.02 % Solution [**Last Name (STitle) **]: One (1) neb
Inhalation Q6H (every 6 hours) as needed.
10. Bisacodyl 10 mg Suppository [**Last Name (STitle) **]: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
11. Paroxetine HCl 20 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO once a
day.
12. Acetaminophen 500 mg Tablet [**Last Name (STitle) **]: Two (2) Tablet PO every six
(6) hours.
13. Maalox 200-200-20 mg/5 mL Suspension [**Last Name (STitle) **]: Five (5) ml PO
three times a day.
14. Lasix 20 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO once a day.
15. Polyethylene Glycol 3350 17 g (100%) Powder in Packet [**Last Name (STitle) **]:
One (1) Powder in Packet PO DAILY (Daily).
16. Quetiapine 25 mg Tablet [**Last Name (STitle) **]: 0.5 Tablet PO TID (3 times a
day) as needed for anxiety/agitation.
17. Divalproex 125 mg Capsule, Sprinkle [**Last Name (STitle) **]: Two (2) Capsule,
Sprinkle PO BID (2 times a day).


Discharge Disposition:
Extended Care

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

Discharge Diagnosis:
MRSA pneumonia
COPD
Atrial fibrillation
Constipation
Sacral decubitus ulcer
CHF
Dementia/delirium


Discharge Condition:
Afebrile.  Respiratory status stable.  Tolerating PO.  Moving
bowels.


Discharge Instructions:
Please take all of your medications as directed
.
If you experience difficulty breathing, chest pain, inability to
eat, high fevers or other concerning symptoms, please call your
doctor or come to the emergency room.

Followup Instructions:
{'Methicillin susceptible pneumonia due to Staphylococcus aureus,Acute respiratory failure,Atrial fibrillation,Congestive heart failure, unspecified,Retention of urine, unspecified,Other and unspecified angina pectoris,Pressure ulcer, lower back,Hyposmolality and/or hyponatremia,Malignant neoplasm of brain, unspecified,Chronic airway obstruction, not elsewhere classified,Heart valve replaced by transplant,Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere,Constipation, unspecified,Other alteration of consciousness,Kyphosis (acquired) (postural),Presence of cerebrospinal fluid drainage device,Other dependence on machines, supplemental oxygen'}


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: SOB, abdominal pain

PRESENT ILLNESS: Ms. [**Known lastname 72408**] is a 79 yo female with COPD,CHF, dementia who was
transferred from [**Hospital 100**] Rehab due to increasing SOB and
abdominal pain. Per PCP note, pt has had increasing "moans",
SOB, and abd pain/distension over past week, which is a change
from baseline. She was seen by psychiatry at NH, who questioned
psychotic depression and started Seroquel and Paxil. Pt also had
non-contrast Abd CT at [**Hospital1 882**] on [**3-1**], which reportedly showed
"no acute process." She had CXR on [**3-1**] which showed "interval
improvement" of bilateral opacities. Per the pt's daughter, pt
had pneumonia in [**1-9**] and has had gradually decreasing function
since then. The daughter also reports pt's mental status has
decreased significantly over the past week. She has had frequent
"panic attacks." R arm contracture has also occurred over the
past several weeks, however the daughter is unsure of the cause.

MEDICAL HISTORY: 1)Primary intermedullary ependymoma/astrocytoma, spinal cord
tumor (in the process of being worked up per daughter, s/p XRT
and steroid taper at [**Hospital1 2025**], oncologist Dr. [**Last Name (STitle) **]
2)Remote hx of brain tumor s/p VP shunt placement
3)h/o thoracic aneurysm
4)s/p recent PNA
5)COPD
6)CHF (unknown EF)
7)MVR (bioprosthetic MV)
8)Atrial fibrillation (on coumadin)
9)dementia
10)h/o urinary retention (had foley cath at rehab)

MEDICATION ON ADMISSION: coumadin 3.5 mg qd
flovent 110mcg 1 puff [**Hospital1 **]
gabapentin 300mg qhs
MOM 30ml qd prn
Verapamil 120mg qd
Amoxicillin 2g prn dental procedures
Klonopin 0.25mg [**Hospital1 **]
Doxycycline 100mg [**Hospital1 **] (started [**3-2**] to be completed [**3-9**])
Levaquin (started [**2-26**], finished [**3-1**])
Digoxin 0.125mg qd
Morphine (Roxanol) 2mg q2h prn
Morphine (Roxanol) 4mg q12h
Seroquel 25mg [**Hospital1 **]
Maalox 15ml q6h prn
Atrovent nebs q4h prn
Albuterol nebs q4h prn
Lasix 40mg qd
Sorbitol 15ml qd
Colace 250mg qd
Senna 2 tabs qhs
Paxil 20mg [**Hospital1 **]
Dulcolax 10mg qhs
Dexamethasone 0.125mg q12h (started [**3-2**])

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T 99.5 BP 147/110 HR 87 RR 17 O2sat 100% on BiPAP
10/4/40%
Gen: pt in resp distress, using accessory muscles, on BiPAP,
awake, alert, moaning
HEENT: OP slightly dry, but not fully examined due to BiPAP
machine
Neck: Supple. JVD approximately to earlobe
Cardio: irregularly irregular, 2/6 SEM @ apex
Resp: diffuse exp wheezes bilaterally (although difficult to
discern from pt making "squeeking" noises while exhaling)
Abd: soft, nt, mildly distended, +BS, no rebound/guarding
Ext: trace BL LE edema. LUE ecchymoses
Neuro: awake, alert, R arm with contracture. Knows she is in
"hospital", but unable to speak further due to agitation and
BiPAP machine. Asked her to squeeze my fingers, and she nodded
"no".

FAMILY HISTORY: Fam hx of depression.

SOCIAL HISTORY: Lives at [**Hospital 100**] Rehab. Pt needs total care with ADL's. Other
social hx not obtained. 

### Response:
{'Methicillin susceptible pneumonia due to Staphylococcus aureus,Acute respiratory failure,Atrial fibrillation,Congestive heart failure, unspecified,Retention of urine, unspecified,Other and unspecified angina pectoris,Pressure ulcer, lower back,Hyposmolality and/or hyponatremia,Malignant neoplasm of brain, unspecified,Chronic airway obstruction, not elsewhere classified,Heart valve replaced by transplant,Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere,Constipation, unspecified,Other alteration of consciousness,Kyphosis (acquired) (postural),Presence of cerebrospinal fluid drainage device,Other dependence on machines, supplemental oxygen'}
