CHIEF COMPLAINT: Shortness of Breath

PRESENT ILLNESS: 74yo F with HTN, DM, CVA, CRI and hx of frequent falls s/p ORIF
[**11-30**] who presented from her NH ([**Hospital3 2558**]) because she was
noted to be unresponsive with pulse ox of 64%. The pt is a poor
historian, therefore the bulk of the note was created by [**Name9 (PRE) 103558**]
from the ED as well as information obtained by the primary team.
As per report, the pt was responsive and A&O x3 when she was
found by EMS. She does note that she started feeling "lousy and
dizzy" for several days PTA. She reported feeling short of
breath several days prior to admission on the morning of. She
does not recall the period of her unresponsiveness. The pt was
unable to elaborate further. She denies dysuria, cough,
diarrhea, n/v, ab pain, fevers, pain at all, HA, CP. All of the
above information was by report.

MEDICAL HISTORY: PAST MEDICAL HISTORY:
1. Hypertension.
2. Diabetes mellitus.
3. History of paranoid schizophrenia.
4. History of frequent falls.
5. History of hypercholesterolemia.
6. Iron deficiency anemia.
7. Status post cerebrovascular accident in [**2149**].
8. History of granulomatous hepatitis in [**2139**].
9. Chronic renal insufficiency with a baseline creatinine of
3.2
10. OA
11. Recent ORIF

MEDICATION ON ADMISSION: 1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2

ALLERGIES: Penicillins / Aspirin

PHYSICAL EXAM: VS: Tm 98.2 HR 75-82 BP 176-206/82-92 R 16-18 Sat 85%RA-->94%4L
NC
GEN: pleasant elderly AA female in NAD, a and ox 2 (unable to
give time/date).
HEENT: EOMI, anicteric, pupils contricted, muddy sclerae, dry
MM, white cereal noted in back of OP
Neck: no LAD, no JVD, no bruits
CV: rrr, S1, S2, no m/r/g appreciated
Chest: bibasilar rales, mild end expiratory diffuse wheezes,
decreased BS throughout, no dullness to percussion
Abd: obese, soft, NT, ND, BS+
Ext: wwp, 2+pitting in LLE up to knee, staples on L thigh c/d/i,
full DP/PT pulses
Neuro: CN II-XII grossly intact, grip strength 4-/5 BL, 2+hip
extension (unclear if pt was following commands)

FAMILY HISTORY: NC

SOCIAL HISTORY: No ETOH or IVDA.  No smoking.
Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Paranoid type schizophrenia, unspecified,Chronic kidney disease, unspecified,Pure hypercholesterolemia,Depressive disorder, not elsewhere classified,Iron deficiency anemia, unspecified,Unspecified essential hypertension,Unspecified disorder of kidney and ureter,Other anaphylactic reaction,Unspecified drug or medicinal substance causing adverse effects in therapeutic use
Food/vomit pneumonitis,Urin tract infection NOS,Paranoid schizo-unspec,Chronic kidney dis NOS,Pure hypercholesterolem,Depressive disorder NEC,Iron defic anemia NOS,Hypertension NOS,Renal & ureteral dis NOS,Other anaphylactic react,Adv eff medicinal NOS
Admission Date:  [**2156-12-27**]              Discharge Date:   [**2156-12-31**]

Date of Birth:  [**2082-2-26**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Aspirin

Attending:[**First Name3 (LF) 5827**]
Chief Complaint:
Shortness of Breath

Major Surgical or Invasive Procedure:
none

History of Present Illness:
74yo F with HTN, DM, CVA, CRI and hx of frequent falls s/p ORIF
[**11-30**] who presented from her NH ([**Hospital3 2558**]) because she was
noted to be unresponsive with pulse ox of 64%. The pt is a poor
historian, therefore the bulk of the note was created by [**Name9 (PRE) 103558**]
from the ED as well as information obtained by the primary team.
As per report, the pt was responsive and A&O x3 when she was
found by EMS. She does note that she started feeling "lousy and
dizzy" for several days PTA. She reported feeling short of
breath several days prior to admission on the morning of. She
does not recall the period of her unresponsiveness. The pt was
unable to elaborate further. She denies dysuria, cough,
diarrhea, n/v, ab pain, fevers, pain at all, HA, CP. All of the
above information was by report.


In ED, the pt was found to have a pulse ox of 85%-->95% on
100%NRB-->94% on 4L. The pt was given ASA and BB IV upon arrival
in the ED for her sob. The pt was found to have a RUL infiltrate
on CXR and was given ceftriaxone 1 gm IV x 1 and azithro 500 mg
IV x1. Her UA was dirty with 50 WBC, +nitrate, but large amt of
epithelial cells. Her head CT was negative, as were LENIs. Pt
noted to be hypertensive with SBP up to 200s and was given
metoprolol 5 mg IV x3.


The pt was seen in the ED by the medicine team and while
awaiting a bed, developed tongue swelling and worsening
difficulty breathing. The pt was then given solumedrol and
benadryl 25mg once IV in the ED for presumed allergic reaction
and transferred to the ICU for further management. In the [**Hospital Unit Name 153**],
the pt reports worsening of herbreathing but denied any overt
chest pain, palpitations, abdominal pain, n/v/d.


Past Medical History:
PAST MEDICAL HISTORY:
1. Hypertension.
2. Diabetes mellitus.
3. History of paranoid schizophrenia.
4. History of frequent falls.
5. History of hypercholesterolemia.
6. Iron deficiency anemia.
7. Status post cerebrovascular accident in [**2149**].
8. History of granulomatous hepatitis in [**2139**].
9. Chronic renal insufficiency with a baseline creatinine of
3.2
10. OA
11. Recent ORIF

Social History:
No ETOH or IVDA.  No smoking.


Family History:
NC

Physical Exam:
VS: Tm 98.2 HR 75-82 BP 176-206/82-92 R 16-18 Sat 85%RA-->94%4L
NC
GEN: pleasant elderly AA female in NAD, a and ox 2 (unable to
give time/date).
HEENT: EOMI, anicteric, pupils contricted, muddy sclerae, dry
MM, white cereal noted in back of OP
Neck: no LAD, no JVD, no bruits
CV: rrr, S1, S2, no m/r/g appreciated
Chest: bibasilar rales, mild end expiratory diffuse wheezes,
decreased BS throughout, no dullness to percussion
Abd: obese, soft, NT, ND, BS+
Ext: wwp, 2+pitting in LLE up to knee, staples on L thigh c/d/i,
full DP/PT pulses
Neuro: CN II-XII grossly intact, grip strength 4-/5 BL, 2+hip
extension (unclear if pt was following commands)


Pertinent Results:
Labs on Admission
[**2156-12-27**] 10:00AM URINE  COLOR-Straw APPEAR-Hazy SP [**Last Name (un) 155**]-1.009
[**2156-12-27**] 10:00AM URINE  BLOOD-SM NITRITE-NEG PROTEIN-100
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-8.0
LEUK-MOD
[**2156-12-27**] 10:00AM URINE  RBC-[**2-13**]* WBC->50 BACTERIA-MOD YEAST-NONE
EPI-[**5-21**] RENAL EPI-0-2
[**2156-12-27**] 10:00AM URINE  3PHOSPHAT-FEW
[**2156-12-27**] 09:55AM   GLUCOSE-220* UREA N-57* CREAT-2.8* SODIUM-134
POTASSIUM-5.4* CHLORIDE-100 TOTAL CO2-24 ANION GAP-15
[**2156-12-27**] 09:55AM   ALT(SGPT)-26 AST(SGOT)-26 CK(CPK)-34 ALK
PHOS-232* AMYLASE-56 TOT BILI-0.3
[**2156-12-27**] 09:55AM   LIPASE-67*
[**2156-12-27**] 09:55AM   cTropnT-0.16*
[**2156-12-27**] 09:55AM   CK-MB-NotDone
[**2156-12-27**] 09:55AM   ALBUMIN-3.4
[**2156-12-27**] 09:55AM   WBC-11.7* RBC-3.50* HGB-10.0* HCT-31.0*
MCV-89 MCH-28.6 MCHC-32.3 RDW-14.5
[**2156-12-27**] 09:55AM   NEUTS-89.0* LYMPHS-7.8* MONOS-2.3 EOS-0.7
BASOS-0.1
[**2156-12-27**] 09:55AM   PLT COUNT-682*#
[**2156-12-27**] 09:55AM   PT-13.5* PTT-21.9* INR(PT)-1.2
.
Labs on Discharge
[**2156-12-30**] 06:10AM BLOOD WBC-12.6* RBC-3.15* Hgb-9.0* Hct-28.5*
MCV-90 MCH-28.6 MCHC-31.7 RDW-15.4 Plt Ct-474*
[**2156-12-28**] 01:10AM BLOOD Neuts-98.1* Lymphs-1.4* Monos-0.5*
Eos-0.1 Baso-0
[**2156-12-30**] 06:10AM BLOOD Plt Ct-474*
[**2156-12-28**] 01:10AM BLOOD PT-13.9* PTT-25.4 INR(PT)-1.3
[**2156-12-30**] 06:10AM BLOOD Glucose-151* UreaN-69* Creat-2.8* Na-134
K-5.2* Cl-99 HCO3-28 AnGap-12
[**2156-12-30**] 06:10AM BLOOD Calcium-8.8 Phos-3.8 Mg-3.8*
.
Cardiac Enzymes
[**2156-12-27**] 09:55AM BLOOD cTropnT-0.16*
[**2156-12-27**] 09:55AM BLOOD CK(CPK)-34
[**2156-12-27**] 04:29PM BLOOD CK-MB-NotDone cTropnT-0.13*
[**2156-12-27**] 04:29PM BLOOD CK(CPK)-41
[**2156-12-28**] 01:10AM BLOOD CK-MB-3 cTropnT-0.11*
[**2156-12-28**] 01:10AM BLOOD CK(CPK)-38
.
Radiology
HIP UNILAT MIN 2 VIEWS LEFT  [**2156-12-30**]
Mild-to-moderate degenerative change involves the right hip
joint. The bilateral sacroiliac joints and the pubic symphysis
is unremarkable. Vascular calcifications are noted.

IMPRESSION:

ORIF left intertrochanteric femur fracture.


Brief Hospital Course:
A/P: 74yo F with HTN, DM, CVA, recent ORIF of hip fx found
unresponsive with desat to 64%, found to have RUL PNA, UTI and
?anaphylactic reaction.
.
# Anaphylaxis: Given the patient's allergy to penicillin and
tongue swelling after the administration of ceftriaxone, there
was concern that she was having an anaphylactic reaction.  The
patient received Solemdrol and benadryl. The patient was
observed in the [**Hospital Unit Name 153**]. The patient was then transferred to the
medicine service where she was monitored for respiratory
compromise.  The patient never decompensated. Her O2sats were
stable. At the time of discharge she had decreased swelling of
her tongue.

#PNA: On CXR the patient was found to have a RUL infiltrate.
She was initially treated with Azithromycin and ceftriaxone.
However given her adverse reaction to the ceftriaxone, this was
discontinued and the patient was started on Vancomycin.  Given
the patient's residence at [**Location (un) **], she was treated as if she
had a community acquired pneumonia. The patient also has a h/o
pseudomonal UTI. If the she had decompensated, the plan was to
start an abx such as meropenem for wider coverage.
.
Of note the patient Vanc level was low at 10.5 on [**2156-12-29**].  The
patient was scheduled for dosing on the [**12-29**].  At the time of
discharge our recommendations will be to check another vanc
level prior to dosing.

#.  UTI: Pt seems to have a dirty UA with 50 WBC, +nitrates, mod
bacteria. Repeat UA showed greater than 62 WBCs. At the time of
discharge the patient was being treated with Levofloxacin.

#SOB: The patient was treated for her PNA. If her condition
deteriorated we would have considered CHF secondary to a
hypertensive heart. The differential would have also included a
PE given the patient's recent ORIF.  However, the patient had
been maintained on Lovenox. As discharge approached the patient
was weaned off of oxygen. Her O2sat was 95% RA.
.
Of note the patient was ruled out for an MI.  The patient was
monitored on telemetry in the ICU.  An ECG was done which was
normal.
.
#HTN: The patient was maintained on Lopressor, Imdur and
Hydralazine.  Her hydralazine was increased to 50 TID because of
elevated pressures.  At the time of discharge her blood pressure
was stable.
.
#. CVA prevention: Tight glycemic and BP control was maintained.
 The patient also received a statin.
.
#. Acute on CRI: The patient has a history of chronic renal
insufficiency. With low urine outputs she received boluses and
diuresed appropriately. The patient's creatinine remained at
baseline. Following her ORIF her creatinine has ranged from 2.8
to 3.2.

#. Diabetes: The patient was maintained on insulin sliding
scale.
.
#. s/p ORIF The patient was seen by Dr. [**Last Name (STitle) 57373**] during her
hospitalization.  A repeat hip film was done which showed mild
to moderate changes involving the R hip joint and ORIF left
intertrochanteric femur fracture.  Followup with Dr. [**Last Name (STitle) 1005**]
was set up prior to discharge.
.
#Anemia: The pt has a history of iron deficiency anemia, in
addition, has CRI.  She was maintained on iron supplements,
epogen and her stools were guaiac negative.  Her Hct was greated
than 27 throughout her course.  The patient did not require
blood transfusions.
.
#Schizophrenia: The patient's condition remained stable.
.
#FEN: Due to her tongue swelling the patient was kept NPO.  As
her swelling went done her renal, diabetic, cardiac diet was
resumed. The patient was seen by speech and swallow and they
recommended thin liquids and soft foods.  The patient will need
further evaluation by the speech and swallow specialists at
[**Hospital3 2558**]. The patient's lytes were repleted as needed.
She also received kayexylate for hyperkalemia.  Her K peaked at
5.9 during this admission, at the time of discharge it was 5.2.
.
#Line: Patient had PICC line placeon [**2156-12-30**] for ABX
.
#PPX: Protonix, bowel regimen, SQ Lovenox
.
#Code status: FULL CODE
.
#Communication: [**Name (NI) 102399**] [**Name (NI) 98752**] (sister) [**Telephone/Fax (3) 103559**]
(Neither phone number connected to sister)
.
#Dispo: [**Hospital3 2558**]


Medications on Admission:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2

times a day).
4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
6. Diltiazem HCl 240 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO DAILY (Daily).
7. Atorvastatin 20 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).

8. Olanzapine 5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
9. Epoetin Alfa 3,000 unit/mL Solution Sig: 3000 (3000) units
Injection QMOWEFR (Monday -Wednesday-Friday).
10. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24HR
Sig: Three (3) Tablet Sustained Release 24HR PO DAILY (Daily).
11. Hydralazine 25 mg Tablet Sig: Three (3) Tablet PO Q6H (every

6 hours).
12. Enoxaparin 30 mg/0.3 mL Syringe Sig: Thirty (30) mg
Subcutaneous Q24H (every 24 hours) for 4 months. mg
13. Ipratropium Bromide 0.02 % Solution Sig: One (1) neb
Inhalation Q6H (every 6 hours).
14. Metoprolol Tartrate 50 mg Tablet Sig: Three (3) Tablet PO
TID (3 times a day).
15. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

18. SSI

Discharge Medications:
1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
2. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24HR
Sig: Three (3) Tablet Sustained Release 24HR PO DAILY (Daily).
3. Metoprolol Tartrate 50 mg Tablet Sig: Three (3) Tablet PO TID
(3 times a day).
4. Epoetin Alfa 4,000 unit/mL Solution Sig: One (1)  Injection
QMOWEFR (Monday -Wednesday-Friday).
5. Olanzapine 5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO QOD ().
8. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed.
9. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours).
10. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
11. Enoxaparin 30 mg/0.3 mL Syringe Sig: One (1)  Subcutaneous
Q24H (every 24 hours).
12. Insulin Lispro (Human) 100 unit/mL Solution Sig: ASDIR
Subcutaneous ASDIR (AS DIRECTED).
13. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H
(every 4 to 6 hours) as needed.
14. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q48H
(every 48 hours) for 10 days.
Disp:*5 Tablet(s)* Refills:*0*
15. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
16. Atorvastatin 10 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
17. Hydralazine 50 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours).
18. Vancomycin in Dextrose 1 g/200 mL Piggyback Sig: One (1)
Intravenous  Q48H (every 48 hours) for 5 days.
Disp:*5 units* Refills:*0*
19. Diltiazem HCl 240 mg Tablet Sustained Release 24HR Sig: One
(1) Tablet Sustained Release 24HR PO once a day.
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2558**] - [**Location (un) **]

Discharge Diagnosis:
-Community Acquired Pneumonia
-Urinary Tract Infection
-Anaphylaxis


Discharge Condition:
Good
Vitals stable
Patient eating


Discharge Instructions:
Please seek medical services immediately if you should
experience and shortness of breath, fevers, chills or any other
worrisome symptom.
.
Please continue taking your medications as prescribed.

Followup Instructions:
You are to followup with your primary care physician [**Name Initial (PRE) 176**] [**12-13**]
week  of discharge.
.
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2235**], MD Phone:[**Telephone/Fax (1) 1228**]
Date/Time:[**2157-2-8**] 1:00



Completed by:[**2157-2-14**]
{'Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Paranoid type schizophrenia, unspecified,Chronic kidney disease, unspecified,Pure hypercholesterolemia,Depressive disorder, not elsewhere classified,Iron deficiency anemia, unspecified,Unspecified essential hypertension,Unspecified disorder of kidney and ureter,Other anaphylactic reaction,Unspecified drug or medicinal substance causing adverse effects in therapeutic use'}


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

PRESENT ILLNESS: 74yo F with HTN, DM, CVA, CRI and hx of frequent falls s/p ORIF
[**11-30**] who presented from her NH ([**Hospital3 2558**]) because she was
noted to be unresponsive with pulse ox of 64%. The pt is a poor
historian, therefore the bulk of the note was created by [**Name9 (PRE) 103558**]
from the ED as well as information obtained by the primary team.
As per report, the pt was responsive and A&O x3 when she was
found by EMS. She does note that she started feeling "lousy and
dizzy" for several days PTA. She reported feeling short of
breath several days prior to admission on the morning of. She
does not recall the period of her unresponsiveness. The pt was
unable to elaborate further. She denies dysuria, cough,
diarrhea, n/v, ab pain, fevers, pain at all, HA, CP. All of the
above information was by report.

MEDICAL HISTORY: PAST MEDICAL HISTORY:
1. Hypertension.
2. Diabetes mellitus.
3. History of paranoid schizophrenia.
4. History of frequent falls.
5. History of hypercholesterolemia.
6. Iron deficiency anemia.
7. Status post cerebrovascular accident in [**2149**].
8. History of granulomatous hepatitis in [**2139**].
9. Chronic renal insufficiency with a baseline creatinine of
3.2
10. OA
11. Recent ORIF

MEDICATION ON ADMISSION: 1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2

ALLERGIES: Penicillins / Aspirin

PHYSICAL EXAM: VS: Tm 98.2 HR 75-82 BP 176-206/82-92 R 16-18 Sat 85%RA-->94%4L
NC
GEN: pleasant elderly AA female in NAD, a and ox 2 (unable to
give time/date).
HEENT: EOMI, anicteric, pupils contricted, muddy sclerae, dry
MM, white cereal noted in back of OP
Neck: no LAD, no JVD, no bruits
CV: rrr, S1, S2, no m/r/g appreciated
Chest: bibasilar rales, mild end expiratory diffuse wheezes,
decreased BS throughout, no dullness to percussion
Abd: obese, soft, NT, ND, BS+
Ext: wwp, 2+pitting in LLE up to knee, staples on L thigh c/d/i,
full DP/PT pulses
Neuro: CN II-XII grossly intact, grip strength 4-/5 BL, 2+hip
extension (unclear if pt was following commands)

FAMILY HISTORY: NC

SOCIAL HISTORY: No ETOH or IVDA.  No smoking. 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Paranoid type schizophrenia, unspecified,Chronic kidney disease, unspecified,Pure hypercholesterolemia,Depressive disorder, not elsewhere classified,Iron deficiency anemia, unspecified,Unspecified essential hypertension,Unspecified disorder of kidney and ureter,Other anaphylactic reaction,Unspecified drug or medicinal substance causing adverse effects in therapeutic use'}
