CHIEF COMPLAINT: Dyspnea

PRESENT ILLNESS: 72 y/o F w/ h/o COPD (?on 3L NC at home) w/ previous trach x1
year removed and recently treated for pneumonia with
CTX/Vanco/Flagyl now p/w abd pain and SOB.  Describes abdominal
pain as crampy.  Report of low grade fevers at rehab, cough.
Got CTX for pneumonia.  no n/v or change in ostomy output
patient is aware of with regards the abdominal pain.
.
In the ED, in mild distress T100.1, HR 115, BP 108/61, RR 38,
98% 2L, decreased BS b/l.  Belly soft.  Diffusely TTP in
abdomen, no rebound or guarding.  No CVA tenderness.  AOx2-3.
CXR: with pneumonia.  With enlarged WBC count 4%bandemia,  Nml
coags.  CT abdomen done in ED negative, but CT chest confirms
pna.  Lactate 3.3.  ECG nml with borderling IVCD.  Vanco/levo
for antibiotics but held given possible reaction.  On transfer
HR 111.  BP 130/80, RR 37, 96% 2L NC, DNI.  Access: 2 PIV's 20,
and 22 guage.  IVF's given 2L NS.  ICU admission for monitoring
given age/PORT score.
.
Review of sytems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denied cough, shortness of breath. Denied chest pain
or tightness, palpitations. Denied nausea, vomiting, diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits. No dysuria. Denied arthralgias or myalgias.

MEDICAL HISTORY: - MI
- DM
- COPD s/p ruptured diverticulum with prolonged resp failure and
trach in rehab for approximately 1 year, patient reports that
she uses 3L NC at home at baseline.
- h/o trach removed in [**10/2160**]
- HTN
- CHF [**3-2**] diastolic dysfunction
- Prior CVA
- colostomy [**3-2**] to multiple hernia repair(?)
- h/o MRSA, C. Diff, pseudomona, VRE

MEDICATION ON ADMISSION: Tylenol 650 q6H
amlodipine 10mg daily
aspirin 325 mg daily
buspiron 5mg [**Hospital1 **]
ceftriaxone 1g IV
fluticasone 220 2 puffs [**Hospital1 **]
Gabapentin 400/400/600
Toprol XL 100mg daily
Omeprazole 20mg daily
Senna 8.6mg [**Hospital1 **]
atrovent/albuterol
lorazepam 0.5mg q4-6
nitroglycerin 0.3mg SL PRN
oxycodone 10mg q4-6 prn

ALLERGIES: Penicillins / Levaquin

PHYSICAL EXAM: Pertinent Results:
[**2161-3-26**] 03:30PM   PT-14.9* PTT-20.3* INR(PT)-1.3*
[**2161-3-26**] 03:30PM   WBC-33.9* RBC-4.46 HGB-12.0 HCT-35.5* MCV-80*
MCH-27.0 MCHC-33.9 RDW-16.2*
[**2161-3-26**] 03:30PM   CK-MB-NotDone
[**2161-3-26**] 03:30PM   cTropnT-<0.01
[**2161-3-26**] 03:30PM   ALT(SGPT)-11 AST(SGOT)-18 LD(LDH)-204
CK(CPK)-41 ALK PHOS-142* TOT BILI-0.3
[**2161-3-26**] 03:51PM   LACTATE-3.0*
[**2161-3-26**] 08:45PM   WBC-29.2* RBC-4.42 HGB-11.6* HCT-35.4*
MCV-80* MCH-26.3* MCHC-32.8 RDW-16.3*
[**2161-3-26**] 08:56PM   LACTATE-2.2*
[**2161-3-26**] 08:56PM   TYPE-[**Last Name (un) **] PO2-62* PCO2-53* PH-7.34* TOTAL
CO2-30 BASE XS-0 COMMENTS-GREEN TOP
[**2161-3-27**] 05:14AM BLOOD WBC-22.2* RBC-4.07* Hgb-10.8* Hct-32.5*
MCV-80* MCH-26.4* MCHC-33.1 RDW-16.3* Plt Ct-429
[**2161-3-26**] 08:45PM BLOOD Neuts-90.4* Lymphs-7.1* Monos-1.8*
Eos-0.3 Baso-0.5
[**2161-3-27**] 05:26AM BLOOD Lactate-1.6

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives at [**Hospital **] rehab, denies etoh, tobacco, IVDU currently
Pneumonia, organism unspecified,Chronic diastolic heart failure,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of Methicillin resistant Staphylococcus aureus,Other emphysema,Abdominal aneurysm without mention of rupture,Coronary atherosclerosis of native coronary artery,Other ventral hernia without mention of obstruction or gangrene
Pneumonia, organism NOS,Chr diastolic hrt fail,Old myocardial infarct,DMII wo cmp nt st uncntr,Hx Methicln resist Staph,Emphysema NEC,Abdom aortic aneurysm,Crnry athrscl natve vssl,Ventral hernia NEC
Admission Date:  [**2161-3-26**]              Discharge Date:   [**2161-3-30**]

Date of Birth:  [**2088-12-23**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Levaquin

Attending:[**First Name3 (LF) 26489**]
Chief Complaint:
Dyspnea

Major Surgical or Invasive Procedure:
none

History of Present Illness:
72 y/o F w/ h/o COPD (?on 3L NC at home) w/ previous trach x1
year removed and recently treated for pneumonia with
CTX/Vanco/Flagyl now p/w abd pain and SOB.  Describes abdominal
pain as crampy.  Report of low grade fevers at rehab, cough.
Got CTX for pneumonia.  no n/v or change in ostomy output
patient is aware of with regards the abdominal pain.
.
In the ED, in mild distress T100.1, HR 115, BP 108/61, RR 38,
98% 2L, decreased BS b/l.  Belly soft.  Diffusely TTP in
abdomen, no rebound or guarding.  No CVA tenderness.  AOx2-3.
CXR: with pneumonia.  With enlarged WBC count 4%bandemia,  Nml
coags.  CT abdomen done in ED negative, but CT chest confirms
pna.  Lactate 3.3.  ECG nml with borderling IVCD.  Vanco/levo
for antibiotics but held given possible reaction.  On transfer
HR 111.  BP 130/80, RR 37, 96% 2L NC, DNI.  Access: 2 PIV's 20,
and 22 guage.  IVF's given 2L NS.  ICU admission for monitoring
given age/PORT score.
.
Review of sytems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denied cough, shortness of breath. Denied chest pain
or tightness, palpitations. Denied nausea, vomiting, diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits. No dysuria. Denied arthralgias or myalgias.


Past Medical History:
- MI
- DM
- COPD s/p ruptured diverticulum with prolonged resp failure and
trach in rehab for approximately 1 year, patient reports that
she uses 3L NC at home at baseline.
- h/o trach removed in [**10/2160**]
- HTN
- CHF [**3-2**] diastolic dysfunction
- Prior CVA
- colostomy [**3-2**] to multiple hernia repair(?)
- h/o MRSA, C. Diff, pseudomona, VRE

Social History:
Lives at [**Hospital **] rehab, denies etoh, tobacco, IVDU currently


Family History:
NC

Physical Exam:

Pertinent Results:
[**2161-3-26**] 03:30PM   PT-14.9* PTT-20.3* INR(PT)-1.3*
[**2161-3-26**] 03:30PM   WBC-33.9* RBC-4.46 HGB-12.0 HCT-35.5* MCV-80*
MCH-27.0 MCHC-33.9 RDW-16.2*
[**2161-3-26**] 03:30PM   CK-MB-NotDone
[**2161-3-26**] 03:30PM   cTropnT-<0.01
[**2161-3-26**] 03:30PM   ALT(SGPT)-11 AST(SGOT)-18 LD(LDH)-204
CK(CPK)-41 ALK PHOS-142* TOT BILI-0.3
[**2161-3-26**] 03:51PM   LACTATE-3.0*
[**2161-3-26**] 08:45PM   WBC-29.2* RBC-4.42 HGB-11.6* HCT-35.4*
MCV-80* MCH-26.3* MCHC-32.8 RDW-16.3*
[**2161-3-26**] 08:56PM   LACTATE-2.2*
[**2161-3-26**] 08:56PM   TYPE-[**Last Name (un) **] PO2-62* PCO2-53* PH-7.34* TOTAL
CO2-30 BASE XS-0 COMMENTS-GREEN TOP
[**2161-3-27**] 05:14AM BLOOD WBC-22.2* RBC-4.07* Hgb-10.8* Hct-32.5*
MCV-80* MCH-26.4* MCHC-33.1 RDW-16.3* Plt Ct-429
[**2161-3-26**] 08:45PM BLOOD Neuts-90.4* Lymphs-7.1* Monos-1.8*
Eos-0.3 Baso-0.5
[**2161-3-27**] 05:26AM BLOOD Lactate-1.6

[**3-26**] CXR:
There is a moderate-sized right pleural effusion with adjacent
compressive atelectasis. No definite focal consolidation is
seen, although
the evaluation is limited by the presence of the effusion. The
left lung is
largely clear. There is a tortuous aorta. The cardiac silhouette
size is
difficult to fully assess but is borderline enlarged. There is a

dextroconcave curvature of the thoracic spine with the more
cephalad aspects
of the lumbar spine suggesting a compensatory levoconcave
curvature. No
significant superimposed edema is seen. No underlying
pneumothorax is noted.

IMPRESSION: Moderate-sized right pleural effusion with adjacent
atelectasis.
No definite focal consolidation is seen, although an early
developing
pneumonia cannot be excluded on the basis of this examination.
Short interval
followup imaging recommended as clinically indicated.

[**3-26**] CT torso:
1. Bilateral lower lobe airspace consolidation, left greater
than right.
While there is a component of atelectasis, areas of
heterogeneous enhancement
are worrisome for pneumonia. Air attenuation foci within the
right lower lobe
likely represent areated lung, however, attention on follow-up
studies is
recommended to exclude cavitation/abscess formation.
2. Emphysema.
3. 4-cm infrarenal abdominal aortic aneurysm.
4. Massive ventral abdominal hernia. The liver, gallbladder,
small bowel,
and colon lie directly under the skin surface. This likely
accounts for the
physical exam finding of "crepitus".


Brief Hospital Course:
Mrs. [**Known lastname **] is a 72 y/o F w/ h/o COPD, s/p previous trach with
recent treatment for pneumonia who p/w leukocytosis, fever, and
abdominal pain found to have bilateral lower lobe pneumonias.

1. Healthcare-associated pneumonia: Patient was treated with
vancomycin and cefepime, and will require a total of 10 days of
antimicrobial therapy. A PICC line wsa placed during her
admission without complications.  The patient intially had an
increased O2 requirement above baseline (3L nc), and on
discharge was at baseline O2 requirement.  Instructions for
antimicrobial therapy are:
Vancomycin 1g IV Q12H (STOP [**2161-4-5**])
Cefepime 2g IV Q12H (STOP [**2161-4-5**])

2. Abdominal pain: Patient was complaining of abdominal pain
throughout her admission. On initial presentation, she had a CT
abdomen that did not demonstrate any acute process, and she had
a negative stool C.diff [**Doctor First Name **]. She was treated with prn
oxycodone durin her admission.

3. CAD: Continued on ASA and metoprolol during admission.

4. COPD: Continued on home flovent MDI and nebs during
admission.

5. CHF: On discharge, patient was euvolemic. Her metoprolol was
intially held on admission over concerns of possible sepsis, but
was restarted by the time of discharge.

6. Abdominal aortic aneurysm: Patient found to have 4 cm AAA on
CT, which will require surveillance as an outpatient.

7. Hypertension: Patient's amlodipine and metoprolol were held
on admission over concern of sepsis, but were restarted during
her hospitalization.

8. DM 2: Continue [**Male First Name (un) **] HISS

9. Prophylaxis: Patient received heparin SQ during her
admission.

Medications on Admission:
Tylenol 650 q6H
amlodipine 10mg daily
aspirin 325 mg daily
buspiron 5mg [**Hospital1 **]
ceftriaxone 1g IV
fluticasone 220 2 puffs [**Hospital1 **]
Gabapentin 400/400/600
Toprol XL 100mg daily
Omeprazole 20mg daily
Senna 8.6mg [**Hospital1 **]
atrovent/albuterol
lorazepam 0.5mg q4-6
nitroglycerin 0.3mg SL PRN
oxycodone 10mg q4-6 prn

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for fever/pain.
2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Buspirone 5 mg Tablet Sig: One (1) Tablet PO twice a day.
4. Fluticasone 110 mcg/Actuation Aerosol Sig: Four (4) Puff
Inhalation [**Hospital1 **] (2 times a day).
5. Gabapentin 400 mg Capsule Sig: One (1) Capsule PO @1400 ().
6. Gabapentin 400 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
7. Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO HS (at
bedtime).
8. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
10. Senna 8.6 mg Capsule Sig: One (1) Tablet PO BID (2 times a
day) as needed.
11. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q6H (every 6 hours).
12. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours).
13. Oxycodone 5 mg/5 mL Solution Sig: One (1)  PO Q6H (every 6
hours) as needed for pain.
14. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY
(Daily).
15. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO QID (4 times
a day) as needed for Anxiety.
16. Norvasc 5 mg Tablet Sig: One (1) Tablet PO once a day.
Tablet(s)
17. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
18. Cefepime 2 gram Recon Soln Sig: Two (2) g Intravenous every
twelve (12) hours: STOP [**2161-4-5**].
19. Vancomycin in Dextrose 1 gram/200 mL Piggyback Sig: One (1)
g Intravenous Q 12H (Every 12 Hours): STOP [**2161-4-5**].
20. Insulin Lispro 100 unit/mL Solution Sig: per sliding scale
Subcutaneous ASDIR (AS DIRECTED).


Discharge Disposition:
Extended Care

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

Discharge Diagnosis:
Primary Diagnosis
1. Healthcare-associated pneumonia
2. Ventral hernia

Secondary Diagnoses
1. Diabetes Mellitus
2. COPD
3. Coronary Artery Disease


Discharge Condition:
Patient was discharged in stable condition.


Discharge Instructions:
1. You were admitted because you had a pneumonia, for which you
received antibiotics. You will need to continue these
antibiotics as directed. The directions for these medications
are:
Vancomycin 1 g IV Q12H (STOP [**2161-4-5**])
Cefepime 2g IV Q12H (STOP [**2161-4-5**])

2. You were also complaining of abdominal pain, and had a CT
scan that did not show any acute abnormalities. We also
determined that you did not have an gastrointestinal infection.

3. It is very important that you take all of your medications as
prescribed.

4. It is very important that you keep all of your doctor's
appointments.

5. If you develop fever, chest pain, shortness of breath, or
other concerning symptoms, tell your doctor [**First Name (Titles) **] [**Last Name (Titles) 100**] Rehab or
go to your local Emergency Department immediately.

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) 6193**] [**Telephone/Fax (1) 74839**] within 2 weeks of
discharge from the hospital.



Completed by:[**2161-3-30**]
{'Pneumonia, organism unspecified,Chronic diastolic heart failure,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of Methicillin resistant Staphylococcus aureus,Other emphysema,Abdominal aneurysm without mention of rupture,Coronary atherosclerosis of native coronary artery,Other ventral hernia without mention of obstruction or gangrene'}


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: Dyspnea

PRESENT ILLNESS: 72 y/o F w/ h/o COPD (?on 3L NC at home) w/ previous trach x1
year removed and recently treated for pneumonia with
CTX/Vanco/Flagyl now p/w abd pain and SOB.  Describes abdominal
pain as crampy.  Report of low grade fevers at rehab, cough.
Got CTX for pneumonia.  no n/v or change in ostomy output
patient is aware of with regards the abdominal pain.
.
In the ED, in mild distress T100.1, HR 115, BP 108/61, RR 38,
98% 2L, decreased BS b/l.  Belly soft.  Diffusely TTP in
abdomen, no rebound or guarding.  No CVA tenderness.  AOx2-3.
CXR: with pneumonia.  With enlarged WBC count 4%bandemia,  Nml
coags.  CT abdomen done in ED negative, but CT chest confirms
pna.  Lactate 3.3.  ECG nml with borderling IVCD.  Vanco/levo
for antibiotics but held given possible reaction.  On transfer
HR 111.  BP 130/80, RR 37, 96% 2L NC, DNI.  Access: 2 PIV's 20,
and 22 guage.  IVF's given 2L NS.  ICU admission for monitoring
given age/PORT score.
.
Review of sytems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denied cough, shortness of breath. Denied chest pain
or tightness, palpitations. Denied nausea, vomiting, diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits. No dysuria. Denied arthralgias or myalgias.

MEDICAL HISTORY: - MI
- DM
- COPD s/p ruptured diverticulum with prolonged resp failure and
trach in rehab for approximately 1 year, patient reports that
she uses 3L NC at home at baseline.
- h/o trach removed in [**10/2160**]
- HTN
- CHF [**3-2**] diastolic dysfunction
- Prior CVA
- colostomy [**3-2**] to multiple hernia repair(?)
- h/o MRSA, C. Diff, pseudomona, VRE

MEDICATION ON ADMISSION: Tylenol 650 q6H
amlodipine 10mg daily
aspirin 325 mg daily
buspiron 5mg [**Hospital1 **]
ceftriaxone 1g IV
fluticasone 220 2 puffs [**Hospital1 **]
Gabapentin 400/400/600
Toprol XL 100mg daily
Omeprazole 20mg daily
Senna 8.6mg [**Hospital1 **]
atrovent/albuterol
lorazepam 0.5mg q4-6
nitroglycerin 0.3mg SL PRN
oxycodone 10mg q4-6 prn

ALLERGIES: Penicillins / Levaquin

PHYSICAL EXAM: Pertinent Results:
[**2161-3-26**] 03:30PM   PT-14.9* PTT-20.3* INR(PT)-1.3*
[**2161-3-26**] 03:30PM   WBC-33.9* RBC-4.46 HGB-12.0 HCT-35.5* MCV-80*
MCH-27.0 MCHC-33.9 RDW-16.2*
[**2161-3-26**] 03:30PM   CK-MB-NotDone
[**2161-3-26**] 03:30PM   cTropnT-<0.01
[**2161-3-26**] 03:30PM   ALT(SGPT)-11 AST(SGOT)-18 LD(LDH)-204
CK(CPK)-41 ALK PHOS-142* TOT BILI-0.3
[**2161-3-26**] 03:51PM   LACTATE-3.0*
[**2161-3-26**] 08:45PM   WBC-29.2* RBC-4.42 HGB-11.6* HCT-35.4*
MCV-80* MCH-26.3* MCHC-32.8 RDW-16.3*
[**2161-3-26**] 08:56PM   LACTATE-2.2*
[**2161-3-26**] 08:56PM   TYPE-[**Last Name (un) **] PO2-62* PCO2-53* PH-7.34* TOTAL
CO2-30 BASE XS-0 COMMENTS-GREEN TOP
[**2161-3-27**] 05:14AM BLOOD WBC-22.2* RBC-4.07* Hgb-10.8* Hct-32.5*
MCV-80* MCH-26.4* MCHC-33.1 RDW-16.3* Plt Ct-429
[**2161-3-26**] 08:45PM BLOOD Neuts-90.4* Lymphs-7.1* Monos-1.8*
Eos-0.3 Baso-0.5
[**2161-3-27**] 05:26AM BLOOD Lactate-1.6

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives at [**Hospital **] rehab, denies etoh, tobacco, IVDU currently 

### Response:
{'Pneumonia, organism unspecified,Chronic diastolic heart failure,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of Methicillin resistant Staphylococcus aureus,Other emphysema,Abdominal aneurysm without mention of rupture,Coronary atherosclerosis of native coronary artery,Other ventral hernia without mention of obstruction or gangrene'}
