CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 85-year-old
female with a history of severe chronic obstructive pulmonary
disease and congestive heart failure.

MEDICAL HISTORY: 1.  Bilateral hip fracture; status post open
reduction/internal fixation.
2.  Chronic obstructive pulmonary disease.
3.  Atrial fibrillation.
4.  Congestive heart failure.
5.  Anemia.
6.  Osteopenia.
7.  History of lung cancer; left upper lobe with resection in
[**2079**].
8.  Obstructive sleep apnea.

MEDICATION ON ADMISSION: 1.  Flovent.
2.  Home oxygen of 2 liters to 3 liters.
3.  Coumadin 2 mg p.o. every other day and 1 mg p.o. every
other day.
4.  Lasix 40 mg p.o. once per day.
5.  Detrol p.o. twice per day.
6.  Amiodarone 200 mg p.o. once per day.
7.  Fosamax 70 mg p.o. every week.
8.  Potassium chloride.

ALLERGIES: The patient has an allergy to MORPHINE.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute kidney failure, unspecified,Pneumonia, organism unspecified,Congestive heart failure, unspecified,Atrial fibrillation,Unspecified pleural effusion,Acidosis,Anemia, unspecified,Personal history of malignant neoplasm of bronchus and lung
Acute kidney failure NOS,Pneumonia, organism NOS,CHF NOS,Atrial fibrillation,Pleural effusion NOS,Acidosis,Anemia NOS,Hx-bronchogenic malignan
Admission Date:  [**2108-6-10**]       Discharge Date:  [**2108-6-12**]


Service:

HISTORY OF PRESENT ILLNESS:  The patient is an 85-year-old
female with a history of severe chronic obstructive pulmonary
disease and congestive heart failure.

A chest x-ray done in the Emergency Department subsequently
revealed a left lower lobe pneumonia.  Meanwhile, the patient
had an episode of hypotension with a systolic blood pressure
in the 70s despite a 500-cc intravenous fluid bolus.
Dopamine was started briefly until approximately 2 liters to
3 liters of normal saline was infused with a systolic blood
pressure increasing to 95.  The patient was on initial
intravenous antibiotics of ceftriaxone and azithromycin along
with nebulizers.

PAST MEDICAL HISTORY:
1.  Bilateral hip fracture; status post open
reduction/internal fixation.
2.  Chronic obstructive pulmonary disease.
3.  Atrial fibrillation.
4.  Congestive heart failure.
5.  Anemia.
6.  Osteopenia.
7.  History of lung cancer; left upper lobe with resection in
[**2079**].
8.  Obstructive sleep apnea.

ALLERGIES:  The patient has an allergy to MORPHINE.

MEDICATIONS ON ADMISSION:
1.  Flovent.
2.  Home oxygen of 2 liters to 3 liters.
3.  Coumadin 2 mg p.o. every other day and 1 mg p.o. every
other day.
4.  Lasix 40 mg p.o. once per day.
5.  Detrol p.o. twice per day.
6.  Amiodarone 200 mg p.o. once per day.
7.  Fosamax 70 mg p.o. every week.
8.  Potassium chloride.

PHYSICAL EXAMINATION ON PRESENTATION:  Temperature was 100.8,
blood pressure was 92/34, heart rate was 76, respiratory rate
was 14.  The patient was saturating 92% on 50% mask.  The
patient is an elderly female in no acute distress.  Head,
eyes, ears, nose, and throat examination revealed the
oropharynx was clear.  Mucous membranes were dry.  Neck
examination revealed no jugular venous distention.  Lungs
showed diffuse wheezes bilaterally.  No crackles.
Cardiovascular examination revealed a regular rate and
rhythm.  Normal first heart sounds and second heart sounds
noted.  A II/VI systolic ejection murmur was noted.  The
abdomen was soft, nontender, and nondistended.  Bowel sounds
were present.  Extremity examination revealed bilateral trace
lower extremity edema.  On neurologic examination, the
patient was sleepy but arousable.  The patient was alert and
oriented times three.  She was moving all extremities.

PERTINENT LABORATORY VALUES ON PRESENTATION:  Platelets were
252 and mean cell volume was 76.  Sodium was 138, potassium
was 5.4, chloride was 102, bicarbonate was 25, blood urea
nitrogen was 37, creatinine was 1.5, and blood glucose was
104.  Differential with 82 neutrophils, 14 bands, 2
lymphocytes, and 1 monocyte.  Prothrombin time was 17.4,
partial thromboplastin time was 30.1, and INR was 2.
Creatine kinase was 38.  MB was zero.  Troponin was less than
0.3.  Arterial blood gas showed pH of 7.32, PCO2 of 51, PO2
of 52, and a bicarbonate was 27.  Urinalysis revealed
bacteria with a white blood cell sediment of 11 to 20, and
trace nitrites.

PERTINENT RADIOLOGY/IMAGING:  A chest x-ray revealed a left
lower lobe infiltrate.

Electrocardiogram revealed ST depressions of 0.5 mm in V4 to
V6.

HOSPITAL COURSE:  The patient was admitted due to acute renal
failure, likely noted to be prerenal.  Blood cultures and
urine cultures were drawn; [**Location (un) 1131**] about the same the
previous day.

A repeat chest x-ray done in the morning showed a new
effusion in the left lower lobe encompassing almost the
entire left lung.  The decision was made to reverse the
patient's coagulation profile and to perform a thoracentesis
which was performed without any complications.  Approximately
50 cc of straw-colored fluid was removed.

At approximately 9 p.m. later that day (on [**6-11**]), the
patient subsequently desaturated.  The patient was minimally
responsive during this time period.  Thus, a portable chest
x-ray was done which showed worsening effusion.
Electrocardiogram was done and showed a question of a
junctional rhythm with ST-T wave changes.

Due to the patient's deteriorated status, appropriate family
members were called, and there was disagreement among family
members as to the patient's code status.  Due to the fact
that neither family members (sons) involved could produce
documentation showing that they were a health care proxy, it
was felt that the patient's wishes for do not resuscitate/do
not intubate would be maintained if neither son could produce
paperwork showing that they were a health care proxy.

A repeat arterial blood gas showed increasing acidosis.  The
sons met with the on-call (who was Dr. [**Last Name (STitle) **].  After a
lengthy discussion, the son agreed to...................
perform in the event of respiratory failure.  It was known by
the patient that the patient did not want to be intubated.
Subsequent discussions with the patient's husband showed that
the husband was also supportive and in agreement with the
patient's wishes.

Repetitive arterial blood gases demonstrated worsening
respiratory acidosis and worsening hypoxemia.

A 2 a.m., was pronounced at patient's bedside for event.



                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(2) 8038**]

Dictated By:[**Last Name (NamePattern1) 17322**]
MEDQUIST36

D:  [**2108-6-12**]  11:55
T:  [**2108-6-12**]  12:21
JOB#:  [**Job Number 26147**]
{'Acute kidney failure, unspecified,Pneumonia, organism unspecified,Congestive heart failure, unspecified,Atrial fibrillation,Unspecified pleural effusion,Acidosis,Anemia, unspecified,Personal history of malignant neoplasm of bronchus and lung'}


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: 

PRESENT ILLNESS: The patient is an 85-year-old
female with a history of severe chronic obstructive pulmonary
disease and congestive heart failure.

MEDICAL HISTORY: 1.  Bilateral hip fracture; status post open
reduction/internal fixation.
2.  Chronic obstructive pulmonary disease.
3.  Atrial fibrillation.
4.  Congestive heart failure.
5.  Anemia.
6.  Osteopenia.
7.  History of lung cancer; left upper lobe with resection in
[**2079**].
8.  Obstructive sleep apnea.

MEDICATION ON ADMISSION: 1.  Flovent.
2.  Home oxygen of 2 liters to 3 liters.
3.  Coumadin 2 mg p.o. every other day and 1 mg p.o. every
other day.
4.  Lasix 40 mg p.o. once per day.
5.  Detrol p.o. twice per day.
6.  Amiodarone 200 mg p.o. once per day.
7.  Fosamax 70 mg p.o. every week.
8.  Potassium chloride.

ALLERGIES: The patient has an allergy to MORPHINE.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute kidney failure, unspecified,Pneumonia, organism unspecified,Congestive heart failure, unspecified,Atrial fibrillation,Unspecified pleural effusion,Acidosis,Anemia, unspecified,Personal history of malignant neoplasm of bronchus and lung'}
