CHIEF COMPLAINT: chest pain x 1 day

PRESENT ILLNESS: This is a 75 y/o w/ MMP including recent CABG and AVR [**2144-6-5**],
ex lap and [**Location (un) **] patch for duodenal perforation who p/w chest
pain x 1 day and new RBBB. Pt notes that she had 1 hour of sharp
SSCP that was sudden in onset, but gradually subsided on its own
over 1 hour time. She notes that it was similar to "gas pain"
that she has [**2-12**]/x month but did not go away with rubbing of her
belly as it usually does and was associated w/SOB and
palpitations which her gas pain usually is not. She notes that
at the time of her CABG, she did not have angina and is unable
to relate this as an anginal equivalent. She is bedridden at
this time and thus this was not exertional in nature. Also
unable to assess positional pain b/c she does not move much. She
was resting, not eating or exerting herself otherwise at the
time of onset. She denies associated N/V/diaphoresis/visual
changes. Also denies cough/fever/chills/HA/dizzyness. Is
depressed but denies recent new onset fatigue.
.
Per OSH records, she has had guiac + stool on and off since the
beginning of her stay at NESH.  She has been transfused for HCT
drops in the setting of guiac + stool on multiple occassions.
She takes iron supplements and her stool is often dark. She
denies
.
In the [**Name (NI) **], pts vitals on presentation were T 98 HR 77 BP 126/54
RR 14 100% on her home vent settings. EKG showed a new RBBB, CK
was negative, but TNI was up from baseline. CT surgery was
notified of her admission. She received Aspirin 325mg, Morphine
4mg IV x 1 for lower back pain, not for chest pain.  While in
the ED, she was CP free.
.
Currently, she denies pain, notes that she did have an episode
of pain en route from the ED, sharp, lasting for minutes,
associated w/SOB. Resolved on its own once she arrived in the
unit. EKG was done and was unchanged from the ones prior, still
revealing new RBBB. Notes that had severe edema weeks ago but it
has greatly improved. Denies any LE cramping/pain. She has
chronic LBP.

MEDICAL HISTORY: - Aortic valve replacement([**Street Address(2) 6158**]. [**Hospital 923**] Medical Biocor tissue
valve)[**2144-6-5**] for severe AS
- Coronary artery bypass grafting x2(left internal mammary
artery graft to left anterior descending and reversed saphenous
vein graft to the posterior descending artery) [**2144-6-5**]
- Respiratory failure s/p tracheostomy [**2144-6-23**] full vent at
NESH is SIMV 12/500 PEEP 8 50%FIO2, but was in process of
weaning
- jejunostomy [**2144-6-23**]
- Perforated duodenal ulcer s/p exploratory laparotomy, [**Location (un) **]
patch [**2144-7-7**]
- hypertension
- hypercholesterolemia
- sleep apnea (CPAP dependent)
- diabetes mellitus type 2
- diverticulosis
- poor balance
- frequent falls
- fractured vertebrae (L2, L5)
- recent subdural hematoma ([**12-18**])
- s/p cholecystecomy
- s/p appendectomy
- s/p partial colectomy for diverticulitis
- knee arthroscopy x3
- s/p pilonidal cyst removal
- Depression

MEDICATION ON ADMISSION: Acetaminophen
Paroxetine HCl 10 mg/5 mL PO DAILY
Atorvastatin 20 mg PO DAILY
Amitriptyline 25 mg PO HS
Docusate Sodium 50 mg/5 mL Liquid [**Month/Day (4) **]: [**2-12**]  PO BID (2 times a
day).
Zestril 5 mg PO DAILY
Hydrochlorothiazide 25 mg PO DAILY
Spironolactone 25 mg PO DAILY
Metoprolol Tartrate 50 mg PO TID
Insulin Glargine 25 units Subcutaneous BREAKFAST
Nexium 40mg once daily
Bumex 2 mg PO once a day
Roxicodone 10 mg Q6 hours prn pain
Nystatin swish and swallow
Xopenex 1.25 Q8h
MOM
[**Name (NI) 77399**] powder
iron supplementaion
vitamin C

ALLERGIES: Tetracycline

PHYSICAL EXAM: VS: T 99.6 BP 117/52 HR 102 sat 100% 40%FIO2, PS 10, PEEP 5
GEN: obese, NAD, awake, alert, appropriate
HEENT: EOMI, PERRL, sclera anicteric, conjunctivae clear, OP
moist and without lesion
NECK: Supple, difficult to asses JVP- lying flat and with trach
collar. Trach in place.
CV: Reg rate, normal S1, S2. +systolic murmur w/soft diastolic
click.
CHEST: Sternotomy scar noted, still two small open areas
w/packing, Resp were unlabored, no accessory muscle use. CTAB,
no crackles, wheezes or rhonchi, diminished BS at bases.
ABD: large midline scar w/multiple open areas w/small amount of
serous drainage, packing inside; Obese Soft, NT, ND, no HSM
EXT: 1+ edema noted, no clubbing/cyanosis
SKIN: unable to assess known sacral decubitus ulcer b/c of pt's
size, no rashes noted
Neuro: CN 2-12 grossly in tact, she has difficulty writing but
has good strength in both upper and lower extremities. She is
oriented x 3.
.

FAMILY HISTORY: father deceased from MI at age 41

SOCIAL HISTORY: retired lab tech
no tobacco
no etoh
Acute myocardial infarction of unspecified site, initial episode of care,Pressure ulcer, buttock,Hemorrhage of gastrointestinal tract, unspecified,Diverticulitis of colon (without mention of hemorrhage),Non-healing surgical wound,Urinary tract infection, site not specified,Right bundle branch block,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Chronic obstructive asthma, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Heart valve replaced by other means,Unspecified essential hypertension,Unspecified sleep apnea,Gastrostomy status,Pure hypercholesterolemia,Depressive disorder, not elsewhere classified,Cardiomegaly,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Tracheostomy status
AMI NOS, initial,Pressure ulcer, buttock,Gastrointest hemorr NOS,Dvrtcli colon w/o hmrhg,Non-healing surgcl wound,Urin tract infection NOS,Rt bundle branch block,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Chronic obst asthma NOS,DMII wo cmp nt st uncntr,Long-term use of insulin,Heart valve replac NEC,Hypertension NOS,Sleep apnea NOS,Gastrostomy status,Pure hypercholesterolem,Depressive disorder NEC,Cardiomegaly,Abn react-surg proc NEC,Accid in resident instit,Tracheostomy status
Admission Date:  [**2144-7-30**]              Discharge Date:   [**2144-8-2**]

Date of Birth:  [**2069-4-18**]             Sex:   F

Service: MEDICINE

Allergies:
Tetracycline

Attending:[**First Name3 (LF) 3556**]
Chief Complaint:
chest pain x 1 day


Major Surgical or Invasive Procedure:
none

History of Present Illness:
This is a 75 y/o w/ MMP including recent CABG and AVR [**2144-6-5**],
ex lap and [**Location (un) **] patch for duodenal perforation who p/w chest
pain x 1 day and new RBBB. Pt notes that she had 1 hour of sharp
SSCP that was sudden in onset, but gradually subsided on its own
over 1 hour time. She notes that it was similar to "gas pain"
that she has [**2-12**]/x month but did not go away with rubbing of her
belly as it usually does and was associated w/SOB and
palpitations which her gas pain usually is not. She notes that
at the time of her CABG, she did not have angina and is unable
to relate this as an anginal equivalent. She is bedridden at
this time and thus this was not exertional in nature. Also
unable to assess positional pain b/c she does not move much. She
was resting, not eating or exerting herself otherwise at the
time of onset. She denies associated N/V/diaphoresis/visual
changes. Also denies cough/fever/chills/HA/dizzyness. Is
depressed but denies recent new onset fatigue.
.
Per OSH records, she has had guiac + stool on and off since the
beginning of her stay at NESH.  She has been transfused for HCT
drops in the setting of guiac + stool on multiple occassions.
She takes iron supplements and her stool is often dark. She
denies
.
In the [**Name (NI) **], pts vitals on presentation were T 98 HR 77 BP 126/54
RR 14 100% on her home vent settings. EKG showed a new RBBB, CK
was negative, but TNI was up from baseline. CT surgery was
notified of her admission. She received Aspirin 325mg, Morphine
4mg IV x 1 for lower back pain, not for chest pain.  While in
the ED, she was CP free.
.
Currently, she denies pain, notes that she did have an episode
of pain en route from the ED, sharp, lasting for minutes,
associated w/SOB. Resolved on its own once she arrived in the
unit. EKG was done and was unchanged from the ones prior, still
revealing new RBBB. Notes that had severe edema weeks ago but it
has greatly improved. Denies any LE cramping/pain. She has
chronic LBP.

.


Past Medical History:
- Aortic valve replacement([**Street Address(2) 6158**]. [**Hospital 923**] Medical Biocor tissue
valve)[**2144-6-5**] for severe AS
- Coronary artery bypass grafting x2(left internal mammary
artery graft to left anterior descending and reversed saphenous
vein graft to the posterior descending artery) [**2144-6-5**]
- Respiratory failure s/p tracheostomy [**2144-6-23**] full vent at
NESH is SIMV 12/500 PEEP 8 50%FIO2, but was in process of
weaning
- jejunostomy [**2144-6-23**]
- Perforated duodenal ulcer s/p exploratory laparotomy, [**Location (un) **]
patch [**2144-7-7**]
- hypertension
- hypercholesterolemia
- sleep apnea (CPAP dependent)
- diabetes mellitus type 2
- diverticulosis
- poor balance
- frequent falls
- fractured vertebrae (L2, L5)
- recent subdural hematoma ([**12-18**])
- s/p cholecystecomy
- s/p appendectomy
- s/p partial colectomy for diverticulitis
- knee arthroscopy x3
- s/p pilonidal cyst removal
- Depression

Social History:
retired lab tech
no tobacco
no etoh


Family History:
father deceased from MI at age 41

Physical Exam:
VS: T 99.6 BP 117/52 HR 102 sat 100% 40%FIO2, PS 10, PEEP 5
GEN: obese, NAD, awake, alert, appropriate
HEENT: EOMI, PERRL, sclera anicteric, conjunctivae clear, OP
moist and without lesion
NECK: Supple, difficult to asses JVP- lying flat and with trach
collar. Trach in place.
CV: Reg rate, normal S1, S2. +systolic murmur w/soft diastolic
click.
CHEST: Sternotomy scar noted, still two small open areas
w/packing, Resp were unlabored, no accessory muscle use. CTAB,
no crackles, wheezes or rhonchi, diminished BS at bases.
ABD: large midline scar w/multiple open areas w/small amount of
serous drainage, packing inside; Obese Soft, NT, ND, no HSM
EXT: 1+ edema noted, no clubbing/cyanosis
SKIN: unable to assess known sacral decubitus ulcer b/c of pt's
size, no rashes noted
Neuro: CN 2-12 grossly in tact, she has difficulty writing but
has good strength in both upper and lower extremities. She is
oriented x 3.
.


Pertinent Results:
[**2144-7-30**] 08:51PM   GLUCOSE-124* UREA N-39* CREAT-0.6 SODIUM-142
POTASSIUM-3.5 CHLORIDE-103 TOTAL CO2-33* ANION GAP-10
[**2144-7-30**] 08:51PM   HCT-29.0*
[**2144-7-30**] 12:20PM   GLUCOSE-180* UREA N-40* CREAT-0.7 SODIUM-142
POTASSIUM-4.2 CHLORIDE-102 TOTAL CO2-29 ANION GAP-15
[**2144-7-30**] 12:20PM   CK(CPK)-19*
[**2144-7-30**] 12:20PM   CK-MB-NotDone cTropnT-0.14*
[**2144-7-30**] 12:20PM   ALBUMIN-2.7* CALCIUM-10.0 PHOSPHATE-2.7
MAGNESIUM-2.3
[**2144-7-30**] 05:25AM   CK(CPK)-11*
[**2144-7-30**] 05:25AM   CK-MB-NotDone cTropnT-0.15*
[**2144-7-29**] 10:50PM   CK(CPK)-11*
[**2144-7-29**] 10:50PM   cTropnT-0.17*
[**2144-7-29**] 10:50PM   CK-MB-NotDone
[**2144-7-29**] 10:50PM   WBC-12.3*# RBC-3.31* HGB-9.6* HCT-30.4*
MCV-92 MCH-29.0 MCHC-31.6 RDW-16.1*
[**2144-7-29**] 10:50PM   PT-12.1 PTT-23.8 INR(PT)-1.0

CXR: Moderate cardiomegaly is unchanged. There is increased
opacity in the left, filling half of the hemithorax, likely
representing an accumulation of pleural fluid. A tracheostomy
tube, median sternotomy wires, and left subclavian catheter are
unchanged.
IMPRESSION: Large left pleural effusion increased in size since
the most recent study dated [**2144-7-8**].
.
There is mild symmetric left ventricular hypertrophy with normal
cavity size and regional/global systolic function (LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
A bioprosthetic aortic valve prosthesis is present. The
transaortic gradient is normal for this prosthesis. No aortic
regurgitation is seen. The mitral valve leaflets are
structurally normal. Trivial mitral regurgitation is seen. The
estimated pulmonary artery systolic pressure is normal. There is
a trivial/physiologic pericardial effusion.

IMPRESSION: Normal global and regional biventricular systolic
function. Limited study.

Brief Hospital Course:
This is a 75 y/o w/CABG and AVR [**2144-6-5**] who p/w sharp chest pain
associated w/dyspnea and palpitations x 1 day w/new RBBB, and
TNI elevation. EKGs: Review of EKGs from [**7-29**] - [**7-30**] reveal NSR
w/new RBBB morphology not present on [**7-9**] - [**7-12**]. Cardiology was
consulted and felt that the pt's EKGs were c/w prior IMI and
upon consultation of the cardiac surgery service, both services
felt that there was need for heparinization and that with TTE
w/o focal wall motion abnormalities, no indication for surgical
intervention. She was CP free throughout her course though she
did have epigastric tenderness around the site of her healing
wound from the perforated duodenal ulcer. General surgery was
consulted and evaluated the wound. The wound was repacked and
dressed.
She had guiac + stools, but stable HCTs, GI was consulted and
recommended outpt colonoscopy. She was J tube lavage negative
upon arrival.
She was weaned off of the vent and did well on 40%FiO2 via trach
mask.

Medications on Admission:
Acetaminophen
Paroxetine HCl 10 mg/5 mL PO DAILY
Atorvastatin 20 mg PO DAILY
Amitriptyline 25 mg PO HS
Docusate Sodium 50 mg/5 mL Liquid [**Month/Day (4) **]: [**2-12**]  PO BID (2 times a
day).
Zestril 5 mg PO DAILY
Hydrochlorothiazide 25 mg PO DAILY
Spironolactone 25 mg PO DAILY
Metoprolol Tartrate 50 mg PO TID
Insulin Glargine 25 units Subcutaneous BREAKFAST
Nexium 40mg once daily
Bumex 2 mg PO once a day
Roxicodone 10 mg Q6 hours prn pain
Nystatin swish and swallow
Xopenex 1.25 Q8h
MOM
[**Name (NI) 77399**] powder
iron supplementaion
vitamin C

Discharge Medications:
1. Docusate Sodium 50 mg/5 mL Liquid [**Name (NI) **]: One (1)  PO BID (2
times a day).
2. Acetaminophen 160 mg/5 mL Solution [**Name (NI) **]: One (1)  PO Q6H
(every 6 hours) as needed.
3. Aspirin 325 mg Tablet [**Name (NI) **]: One (1) Tablet PO DAILY (Daily).
4. Chlorhexidine Gluconate 0.12 % Mouthwash [**Name (NI) **]: One (1) ML
Mucous membrane [**Hospital1 **] (2 times a day).
5. Insulin Glargine 100 unit/mL Solution [**Hospital1 **]: One (1) 25
Subcutaneous once a day.
6. Insulin Regular Human 100 unit/mL Solution [**Hospital1 **]: One (1)
Injection QACHS: please see attached sliding scale.
7. Lisinopril 5 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).

8. Ferrous Sulfate 325 mg (65 mg Iron) Tablet [**Hospital1 **]: One (1)
Tablet PO DAILY (Daily).
9. Ascorbic Acid 90 mg/mL Drops [**Hospital1 **]: One (1)  PO DAILY (Daily).

10. Nystatin 100,000 unit/mL Suspension [**Hospital1 **]: Five (5) ML PO QID
(4 times a day) as needed.
11. Paroxetine HCl 10 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY
(Daily).
12. Atorvastatin 10 mg Tablet [**Hospital1 **]: Two (2) Tablet PO DAILY
(Daily).
13. Amitriptyline 25 mg Tablet [**Hospital1 **]: One (1) Tablet PO HS (at
bedtime).
14. Ibuprofen 100 mg/5 mL Suspension [**Hospital1 **]: One (1)  PO Q8H (every
8 hours) as needed.
15. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
16. Levalbuterol HCl 0.63 mg/3 mL Solution for Nebulization [**Last Name (STitle) **]:
One (1) ML Inhalation TID (3 times a day).
17. Maalox 200-200-20 mg/5 mL Suspension [**Last Name (STitle) **]: One (1) ML PO QID
(4 times a day) as needed.
18. Spironolactone 25 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY
(Daily).
19. Hydrochlorothiazide 12.5 mg Capsule [**Last Name (STitle) **]: One (1) Capsule PO
DAILY (Daily).
20. Metoprolol Tartrate 50 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO BID
(2 times a day).
21. Bumetanide 2 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily).

22. Heparin (Porcine) 5,000 unit/mL Solution [**Last Name (STitle) **]: One (1)
Injection TID (3 times a day).
23. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet [**Last Name (STitle) **]: One (1)
Tablet PO BID (2 times a day) for 4 days.
24. Oxycodone 5 mg/5 mL Solution [**Last Name (STitle) **]: One (1)  PO Q6H (every 6
hours).


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 701**]

Discharge Diagnosis:
Chest Pain
EKG changes
RBBB


Discharge Condition:
stable


Discharge Instructions:
You were admitted for chest pain, while you were here, your EKGs
showed evidence of possible ischemia. However, there was no
evidence that intervention was indicated while you were here.
You were evaluated by the cardiac and general surgery services.
You were weaned off of your ventilator and you did well.
Please follow up with your primary care physician and present to
the hospital or call your PCP if you have chest pain/shortness
of breath, fever/chills, Nausea/vomiting/headache/dizzyness.

Followup Instructions:
Please follow up with your primary care physician within the
next 1-2 weeks.
Please call PCP: [**Name10 (NameIs) **],[**Name11 (NameIs) 1955**] [**Name Initial (NameIs) **]. [**Telephone/Fax (1) **]


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3559**] MD, [**MD Number(3) 3560**]
{'Acute myocardial infarction of unspecified site, initial episode of care,Pressure ulcer, buttock,Hemorrhage of gastrointestinal tract, unspecified,Diverticulitis of colon (without mention of hemorrhage),Non-healing surgical wound,Urinary tract infection, site not specified,Right bundle branch block,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Chronic obstructive asthma, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Heart valve replaced by other means,Unspecified essential hypertension,Unspecified sleep apnea,Gastrostomy status,Pure hypercholesterolemia,Depressive disorder, not elsewhere classified,Cardiomegaly,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Tracheostomy 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: chest pain x 1 day

PRESENT ILLNESS: This is a 75 y/o w/ MMP including recent CABG and AVR [**2144-6-5**],
ex lap and [**Location (un) **] patch for duodenal perforation who p/w chest
pain x 1 day and new RBBB. Pt notes that she had 1 hour of sharp
SSCP that was sudden in onset, but gradually subsided on its own
over 1 hour time. She notes that it was similar to "gas pain"
that she has [**2-12**]/x month but did not go away with rubbing of her
belly as it usually does and was associated w/SOB and
palpitations which her gas pain usually is not. She notes that
at the time of her CABG, she did not have angina and is unable
to relate this as an anginal equivalent. She is bedridden at
this time and thus this was not exertional in nature. Also
unable to assess positional pain b/c she does not move much. She
was resting, not eating or exerting herself otherwise at the
time of onset. She denies associated N/V/diaphoresis/visual
changes. Also denies cough/fever/chills/HA/dizzyness. Is
depressed but denies recent new onset fatigue.
.
Per OSH records, she has had guiac + stool on and off since the
beginning of her stay at NESH.  She has been transfused for HCT
drops in the setting of guiac + stool on multiple occassions.
She takes iron supplements and her stool is often dark. She
denies
.
In the [**Name (NI) **], pts vitals on presentation were T 98 HR 77 BP 126/54
RR 14 100% on her home vent settings. EKG showed a new RBBB, CK
was negative, but TNI was up from baseline. CT surgery was
notified of her admission. She received Aspirin 325mg, Morphine
4mg IV x 1 for lower back pain, not for chest pain.  While in
the ED, she was CP free.
.
Currently, she denies pain, notes that she did have an episode
of pain en route from the ED, sharp, lasting for minutes,
associated w/SOB. Resolved on its own once she arrived in the
unit. EKG was done and was unchanged from the ones prior, still
revealing new RBBB. Notes that had severe edema weeks ago but it
has greatly improved. Denies any LE cramping/pain. She has
chronic LBP.

MEDICAL HISTORY: - Aortic valve replacement([**Street Address(2) 6158**]. [**Hospital 923**] Medical Biocor tissue
valve)[**2144-6-5**] for severe AS
- Coronary artery bypass grafting x2(left internal mammary
artery graft to left anterior descending and reversed saphenous
vein graft to the posterior descending artery) [**2144-6-5**]
- Respiratory failure s/p tracheostomy [**2144-6-23**] full vent at
NESH is SIMV 12/500 PEEP 8 50%FIO2, but was in process of
weaning
- jejunostomy [**2144-6-23**]
- Perforated duodenal ulcer s/p exploratory laparotomy, [**Location (un) **]
patch [**2144-7-7**]
- hypertension
- hypercholesterolemia
- sleep apnea (CPAP dependent)
- diabetes mellitus type 2
- diverticulosis
- poor balance
- frequent falls
- fractured vertebrae (L2, L5)
- recent subdural hematoma ([**12-18**])
- s/p cholecystecomy
- s/p appendectomy
- s/p partial colectomy for diverticulitis
- knee arthroscopy x3
- s/p pilonidal cyst removal
- Depression

MEDICATION ON ADMISSION: Acetaminophen
Paroxetine HCl 10 mg/5 mL PO DAILY
Atorvastatin 20 mg PO DAILY
Amitriptyline 25 mg PO HS
Docusate Sodium 50 mg/5 mL Liquid [**Month/Day (4) **]: [**2-12**]  PO BID (2 times a
day).
Zestril 5 mg PO DAILY
Hydrochlorothiazide 25 mg PO DAILY
Spironolactone 25 mg PO DAILY
Metoprolol Tartrate 50 mg PO TID
Insulin Glargine 25 units Subcutaneous BREAKFAST
Nexium 40mg once daily
Bumex 2 mg PO once a day
Roxicodone 10 mg Q6 hours prn pain
Nystatin swish and swallow
Xopenex 1.25 Q8h
MOM
[**Name (NI) 77399**] powder
iron supplementaion
vitamin C

ALLERGIES: Tetracycline

PHYSICAL EXAM: VS: T 99.6 BP 117/52 HR 102 sat 100% 40%FIO2, PS 10, PEEP 5
GEN: obese, NAD, awake, alert, appropriate
HEENT: EOMI, PERRL, sclera anicteric, conjunctivae clear, OP
moist and without lesion
NECK: Supple, difficult to asses JVP- lying flat and with trach
collar. Trach in place.
CV: Reg rate, normal S1, S2. +systolic murmur w/soft diastolic
click.
CHEST: Sternotomy scar noted, still two small open areas
w/packing, Resp were unlabored, no accessory muscle use. CTAB,
no crackles, wheezes or rhonchi, diminished BS at bases.
ABD: large midline scar w/multiple open areas w/small amount of
serous drainage, packing inside; Obese Soft, NT, ND, no HSM
EXT: 1+ edema noted, no clubbing/cyanosis
SKIN: unable to assess known sacral decubitus ulcer b/c of pt's
size, no rashes noted
Neuro: CN 2-12 grossly in tact, she has difficulty writing but
has good strength in both upper and lower extremities. She is
oriented x 3.
.

FAMILY HISTORY: father deceased from MI at age 41

SOCIAL HISTORY: retired lab tech
no tobacco
no etoh 

### Response:
{'Acute myocardial infarction of unspecified site, initial episode of care,Pressure ulcer, buttock,Hemorrhage of gastrointestinal tract, unspecified,Diverticulitis of colon (without mention of hemorrhage),Non-healing surgical wound,Urinary tract infection, site not specified,Right bundle branch block,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Chronic obstructive asthma, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Heart valve replaced by other means,Unspecified essential hypertension,Unspecified sleep apnea,Gastrostomy status,Pure hypercholesterolemia,Depressive disorder, not elsewhere classified,Cardiomegaly,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Tracheostomy status'}
