CHIEF COMPLAINT: shortness of breath, fatigue

PRESENT ILLNESS: 79 yo F with COPD, DMII, HTN who lives at [**Location **] presented to an OSH
early today with fever, increasing sputum production, and
shortness of breath. Per report, she has been having increased
shortness of breath and productive cough over the proceeding
week and was completing a course of Levofloxacin (started [**1-18**]).
The patient is unable to report why she was brought to the
hospital today and denies productive cough. She denies chest
pain, palpitations, fevers, chills, sweats, nausea, vomiting,
diarrha, dysuria. She has had no recent hospitalizations.
.
At [**Hospital1 **], she received albuterol/ipratropium nebs,
levofloxacin IV, methylprednisolone 250mg IV, morphine IV,
budesonide nebs. Due to persistent hypercarbia, she was
transferred to [**Hospital1 18**] for non-invasive ventilation when her ABG
was 7.36/61/98 on 2-4L NC. Most recent ABG at the time of
transfer to the [**Hospital1 18**]-[**Location (un) 86**]: 7.38/54/107/31.9.
.
On arrival to the [**Hospital Unit Name 153**], patient reports that she is uncertain
how she got to the hospital, but acknowledges 1 week of
shortness of breath and fatigue and a new scratchy sore throat.

MEDICAL HISTORY: Diabetes Mellitus Type II
Iron deficiency Anemia
Hypertension
COPD/Emphysema
Asthma
Anxiety
Arthropathy
CHF (EF unknown)

MEDICATION ON ADMISSION: Advair 250/50 [**Hospital1 **]
Spiriva 18mcg daily
Fortical 200u NAS daily
Senna 2 tabs qHS
Requip 0.5mg qHS
Zocor 10mg qHS
Colace 200mg PO qHS
Omeprazole 20mg PO daily
Multivitamin PO daily
Prednisone 5mg PO daily
Aspirin 81mg PO daily
Calcium 500 + D 1 tab [**Hospital1 **]
Vitamin B-12 1000mcg daily
Theophylline 100mg PO QID
Xopenex 1.25ml/3ml Neb PRN
Tylenol 650mg PO PRN
Milk of Magnesia PRN
Bisacodyl 10mg PR PRN
Fleet Enema PRN

ALLERGIES: Nifedipine / Singulair

PHYSICAL EXAM: Vitals: T: BP:153/81 P:123 R:19 O2: 95% 2L
General: Alert, oriented (hospital, [**2199-1-21**]), in mild
respiratory distress sitting upright in bed (sleeps this way at
baseline)
HEENT: Sclera anicteric, MMD, oropharynx mildly erythematous
Neck: supple, JVP not elevated, no LAD
Lungs: Purse lipped breathing, deminished through out, prolonged
expiratory phase with diffuse expiratory wheezing, no rhonchi or
crackles
CV: Tachy, reg, heart sounds very distant
Abdomen: obese, soft, non-tender, non-distended, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, 1+ edema to mid calf b/l,
no cynanosis or clubbing

FAMILY HISTORY: NC

SOCIAL HISTORY: Patient was a homemaker, raised 14 children. She now lives by
herself at [**Location (un) 1036**].
Tobacco: 45 pack years, quit 5-6 months ago
EtOH: None
Illicits: None
Pneumonia, organism unspecified,Acute respiratory failure,Acidosis,Chronic obstructive asthma with (acute) exacerbation,Unspecified essential hypertension,Other convulsions,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anxiety state, unspecified,Congestive heart failure, unspecified,Tachycardia, unspecified
Pneumonia, organism NOS,Acute respiratry failure,Acidosis,Ch obst asth w (ac) exac,Hypertension NOS,Convulsions NEC,DMII wo cmp nt st uncntr,Anxiety state NOS,CHF NOS,Tachycardia NOS
Admission Date:  [**2199-1-24**]              Discharge Date:   [**2199-1-26**]

Date of Birth:  [**2119-3-22**]             Sex:   F

Service: MEDICINE

Allergies:
Nifedipine / Singulair

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
shortness of breath, fatigue

Major Surgical or Invasive Procedure:
none

History of Present Illness:
79 yo F with COPD, DMII, HTN who lives at [**Location **] presented to an OSH
early today with fever, increasing sputum production, and
shortness of breath. Per report, she has been having increased
shortness of breath and productive cough over the proceeding
week and was completing a course of Levofloxacin (started [**1-18**]).
The patient is unable to report why she was brought to the
hospital today and denies productive cough. She denies chest
pain, palpitations, fevers, chills, sweats, nausea, vomiting,
diarrha, dysuria. She has had no recent hospitalizations.
.
At [**Hospital1 **], she received albuterol/ipratropium nebs,
levofloxacin IV, methylprednisolone 250mg IV, morphine IV,
budesonide nebs. Due to persistent hypercarbia, she was
transferred to [**Hospital1 18**] for non-invasive ventilation when her ABG
was 7.36/61/98 on 2-4L NC. Most recent ABG at the time of
transfer to the [**Hospital1 18**]-[**Location (un) 86**]: 7.38/54/107/31.9.
.
On arrival to the [**Hospital Unit Name 153**], patient reports that she is uncertain
how she got to the hospital, but acknowledges 1 week of
shortness of breath and fatigue and a new scratchy sore throat.



Past Medical History:
Diabetes Mellitus Type II
Iron deficiency Anemia
Hypertension
COPD/Emphysema
Asthma
Anxiety
Arthropathy
CHF (EF unknown)


Social History:
Patient was a homemaker, raised 14 children. She now lives by
herself at [**Location (un) 1036**].
Tobacco: 45 pack years, quit 5-6 months ago
EtOH: None
Illicits: None


Family History:
NC

Physical Exam:
Vitals: T: BP:153/81 P:123 R:19 O2: 95% 2L
General: Alert, oriented (hospital, [**2199-1-21**]), in mild
respiratory distress sitting upright in bed (sleeps this way at
baseline)
HEENT: Sclera anicteric, MMD, oropharynx mildly erythematous
Neck: supple, JVP not elevated, no LAD
Lungs: Purse lipped breathing, deminished through out, prolonged
expiratory phase with diffuse expiratory wheezing, no rhonchi or
crackles
CV: Tachy, reg, heart sounds very distant
Abdomen: obese, soft, non-tender, non-distended, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, 1+ edema to mid calf b/l,
no cynanosis or clubbing


Pertinent Results:
Labs: OSH
WBC 9.5 RBC 4.39 HGB 13.2 HCT 39.7 MCV 90.3 MCH 30.1 MCHC 33.4
PLT 190 RDWCV 14.0 SEG 74.8 [**Last Name (un) **] 11.2 MON 11.7 EO 2.1 BAS 0.3
.
INR 1.1 PTT 28
.
139 97 12
------------< 133
4.1 34.3 0.7
.
ABG 7.36/61/97
.
Lactate 1.0 Trop <0.01
Theophylline 8.5L


Brief Hospital Course:
Mrs. [**Known lastname **] is a 79 yo F with DMII, HTN, COPD who presented to the
[**Hospital Unit Name 153**] as an OSH transfer for 2 weeks of shortness of breath,
fever, and cough productive of yellow sputum.
.
At 03:15 on [**2199-1-26**], the patient was noted by her RN who was in
her room to begin seizing (no seizure history). She was given
Ativan 2 mg IV x 2, and found to be non-responsive. She was
noted to be desaturating, and given her DNI status, was placed
on a non-rebreather.  An ABG done with the patient on the
non-rebreather showed a marked acidosis: 7.11/132/397/45. An EKG
done at that time showed NSR. The family was called.  The
seizure was felt to be secondary to acidemia and hypercarbia vs.
PFO with embolus vs. mass lesion or other CNS event. Given the
goals of care decided by the patient's family, the patient was
made CMO later on [**2199-1-26**], and a morphine drip was initiated.
The patient expired at 3:05 PM on [**2199-1-26**] with her family
present.
.
Below is her detailed hospital course by problem.
.
She was found to be in respiratory distress with fever. She had
a h/o COPD/Asthma requiring oral steroids at home. Per
documentation, patient had a fever to 102, cough productive of
yellow sputum, and shortness of breath x 1 week for which she
completed a 5 day course of Levaquin without improvement in
symptoms. An ABG at OSH suggested chronic CO2 retention and a
CXR did not demonstrate a consolidation or infiltrate. Concern
for a pulmonary infection with resulting COPD exacerbation was
high at the time of admission. She was treated with steroids,
ipratropium and albuterol nebs, and antibiotics. Initially she
was placed on vancomycin and ceftrixone for HAP, but as culture
data was unrevealing, and our suspicion for CAP became  higher,
these were switched to Azithromycin. The patient was doing well
on ICU day #2, with resolution of her fever and improvement in
her respiratory status.
.
On presentatation to the OSH, the patient was noted to be
tachycardic-and remained tachycardic here to the 120's. ECG
demonstrates sinus tachycardia. She did not receive any IVF's or
nodal agents at the OSH given concern for her uncertain h/o
heart failure. Her tachycardia seemed c/w COPD exacerbation with
possible concomitant infection, a repeat EKG showed no acute
changes. Her heart rate was noted to improve with resolution of
her fever and improvement of her respiratory status.
.
She was also hypertensive on presentation to 170's per report
from [**Hospital1 18**]-[**Location (un) 620**]. She did not receive any medication for her
hypertension and this was also noted to resolve with treatment
of her COPD exacerbation.
.
The patient was a type II diabetic: unknown HgbA1c.
Diet-controlled at home, but received high dose steroids at
[**Hospital1 18**]-[**Location (un) 620**] for COPD exacerbation, so was maintained on QACHS
fingersticks and Humalog SS.
.
CHF (EF unknown): Patient with unknown/uncertain history of
congestive heart failure. No recent echocardiograms, not on any
cardiac medications at home aside from a statin. ECG
demonstrates RBBB. She was continued on her home Zocor 10mg PO
qHS.
.
Communication: Patient & patient's daughters ([**Name (NI) **] [**Doctor Last Name 4048**] or [**First Name4 (NamePattern1) **]
[**Name (NI) **] [**Telephone/Fax (1) 86385**])


Medications on Admission:
Advair 250/50 [**Hospital1 **]
Spiriva 18mcg daily
Fortical 200u NAS daily
Senna 2 tabs qHS
Requip 0.5mg qHS
Zocor 10mg qHS
Colace 200mg PO qHS
Omeprazole 20mg PO daily
Multivitamin PO daily
Prednisone 5mg PO daily
Aspirin 81mg PO daily
Calcium 500 + D 1 tab [**Hospital1 **]
Vitamin B-12 1000mcg daily
Theophylline 100mg PO QID
Xopenex 1.25ml/3ml Neb PRN
Tylenol 650mg PO PRN
Milk of Magnesia PRN
Bisacodyl 10mg PR PRN
Fleet Enema PRN


Discharge Medications:
n/a

Discharge Disposition:
Expired

Discharge Diagnosis:
hypercarbic respiratory failure
COPD
seizure

Discharge Condition:
expired

Discharge Instructions:
n/a

Followup Instructions:
n/a

                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]

Completed by:[**2199-1-26**]
{'Pneumonia, organism unspecified,Acute respiratory failure,Acidosis,Chronic obstructive asthma with (acute) exacerbation,Unspecified essential hypertension,Other convulsions,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anxiety state, unspecified,Congestive heart failure, unspecified,Tachycardia, unspecified'}


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: shortness of breath, fatigue

PRESENT ILLNESS: 79 yo F with COPD, DMII, HTN who lives at [**Location **] presented to an OSH
early today with fever, increasing sputum production, and
shortness of breath. Per report, she has been having increased
shortness of breath and productive cough over the proceeding
week and was completing a course of Levofloxacin (started [**1-18**]).
The patient is unable to report why she was brought to the
hospital today and denies productive cough. She denies chest
pain, palpitations, fevers, chills, sweats, nausea, vomiting,
diarrha, dysuria. She has had no recent hospitalizations.
.
At [**Hospital1 **], she received albuterol/ipratropium nebs,
levofloxacin IV, methylprednisolone 250mg IV, morphine IV,
budesonide nebs. Due to persistent hypercarbia, she was
transferred to [**Hospital1 18**] for non-invasive ventilation when her ABG
was 7.36/61/98 on 2-4L NC. Most recent ABG at the time of
transfer to the [**Hospital1 18**]-[**Location (un) 86**]: 7.38/54/107/31.9.
.
On arrival to the [**Hospital Unit Name 153**], patient reports that she is uncertain
how she got to the hospital, but acknowledges 1 week of
shortness of breath and fatigue and a new scratchy sore throat.

MEDICAL HISTORY: Diabetes Mellitus Type II
Iron deficiency Anemia
Hypertension
COPD/Emphysema
Asthma
Anxiety
Arthropathy
CHF (EF unknown)

MEDICATION ON ADMISSION: Advair 250/50 [**Hospital1 **]
Spiriva 18mcg daily
Fortical 200u NAS daily
Senna 2 tabs qHS
Requip 0.5mg qHS
Zocor 10mg qHS
Colace 200mg PO qHS
Omeprazole 20mg PO daily
Multivitamin PO daily
Prednisone 5mg PO daily
Aspirin 81mg PO daily
Calcium 500 + D 1 tab [**Hospital1 **]
Vitamin B-12 1000mcg daily
Theophylline 100mg PO QID
Xopenex 1.25ml/3ml Neb PRN
Tylenol 650mg PO PRN
Milk of Magnesia PRN
Bisacodyl 10mg PR PRN
Fleet Enema PRN

ALLERGIES: Nifedipine / Singulair

PHYSICAL EXAM: Vitals: T: BP:153/81 P:123 R:19 O2: 95% 2L
General: Alert, oriented (hospital, [**2199-1-21**]), in mild
respiratory distress sitting upright in bed (sleeps this way at
baseline)
HEENT: Sclera anicteric, MMD, oropharynx mildly erythematous
Neck: supple, JVP not elevated, no LAD
Lungs: Purse lipped breathing, deminished through out, prolonged
expiratory phase with diffuse expiratory wheezing, no rhonchi or
crackles
CV: Tachy, reg, heart sounds very distant
Abdomen: obese, soft, non-tender, non-distended, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, 1+ edema to mid calf b/l,
no cynanosis or clubbing

FAMILY HISTORY: NC

SOCIAL HISTORY: Patient was a homemaker, raised 14 children. She now lives by
herself at [**Location (un) 1036**].
Tobacco: 45 pack years, quit 5-6 months ago
EtOH: None
Illicits: None 

### Response:
{'Pneumonia, organism unspecified,Acute respiratory failure,Acidosis,Chronic obstructive asthma with (acute) exacerbation,Unspecified essential hypertension,Other convulsions,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anxiety state, unspecified,Congestive heart failure, unspecified,Tachycardia, unspecified'}
