CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: 82 F with history of neurofibromatosis, PVD, [**First Name3 (LF) **], recent
admission for humeral fracture in setting of mechanical fall
treated conservatively (discharged 5 days ago, [**2113-7-4**]) who
presents with acute SOB. Evening of [**2113-7-9**], patient reports dry
cough. 1 hr prior to presentation accutely SOB.
Per EMS, patient was satting mid 80s on non-rebreather. In the
ED, VITALS: T 97.2, HR 94, 220/124, 99% non rebreather. On exam,
negative JVP, no pedal edema, looked dry. Labs notable for:
Bicarb 13, K 6.4 (hemolyzed), AG 22, Phos 6, BNP 17,500, PLT
500, WBC 17, HCT 42, Hb 13, trop 0.02, Lactate 7.0. ABG: 7.42,
CO2 30, O2 130, Bicarb 20. CXR: LLL pna and some pulmonary
edema. For lactate 7, gave 750cc IVF, lactate improved to 2.1, K
4.5. As pt was given fluids, breathing improved.
ABG on non rebreather: pH 7.40, CO2 34, O2 81, HCO3 22,
Temp 100.2 rectally.
Pt was given: zosyn and levofloxacin 750mg.
Vitals on transfer: RR 24, 98.2 axillary, HR 75, 185/93
(150-160s SBP), 100% on non rebreather.
On arrival to the MICU, patient is comfortable on a
non-rebreather at 70%. She denies any chest pressure or
pleuritic component chest pain. She also denies any headache.
She is 79% on Room Air when checked.

MEDICAL HISTORY: - [**Date Range **]
- HLD
- DCIS s/p excision/XRT, on tamoxifen in past but d/c'd due to
side effects
- Osteoporosis
- Neurofibromatosis type II
- Lichen sclerosis
- Left hip fracture s/p hemiarthroplasty
- Carotid stenosis s/p CEA of left ICA in [**2106**].  Right ICA with
80% stenosis as of [**2110**]
- PVD
- Cataracts s/p removal ([**2109**])

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from webOMR.
1. Aspirin 81 mg PO DAILY
2. Atenolol 100 mg PO DAILY
3. Lisinopril 20 mg PO DAILY
4. Simvastatin 20 mg PO DAILY
5. Calcium 600 + D(3) *NF* (calcium carbonate-vitamin D3) 600
mg(1,500mg) -200 unit Oral daily
6. Clobetasol Propionate 0.05% Ointment 1 Appl TP DAILY:PRN
itching
7. Acetaminophen 1000 mg PO Q6H:PRN pain

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Exam:
79% on room air.
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Crackles at bases, otherwise, no wheezes, rales, ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Right leg is tender to palpation in calf
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, 2+ reflexes bilaterally, gait
deferred, finger-to-nose intact

FAMILY HISTORY: Mother:  Deceased, unknown reason.
Father:  Deceased, TB.
Cancer History:  Sister with breast cancer in her 70s.
Coronary Artery Disease History:  None.
Diabetes Mellitus History:  None.

SOCIAL HISTORY: Occupation:  Former homemaker.
Marital:  Married.
Home Situation:  Lives with husband in [**Name (NI) 3146**].
Religion:  Catholic.
Tobacco:  50 years of one-half pack a day. Quit circa [**2100**].
Alcohol:  Occasional.  No prior difficulty.
Other Drugs:  None.
Malignant essential hypertension,Acute edema of lung, unspecified,Acidosis,Paroxysmal ventricular tachycardia,Peripheral vascular disease, unspecified,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Neurofibromatosis, type 2 [acoustic neurofibromatosis],Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Circumscribed scleroderma,Do not resuscitate status,Personal history of tobacco use,Aftercare for healing traumatic fracture of upper arm
Malignant hypertension,Acute lung edema NOS,Acidosis,Parox ventric tachycard,Periph vascular dis NOS,Ocl mlt bi art wo infrct,Neurofibromatosis typ II,Hyperlipidemia NEC/NOS,Osteoporosis NOS,Circumscribe scleroderma,Do not resusctate status,History of tobacco use,Aftrcare traum fx up arm
Admission Date:  [**2113-7-10**]              Discharge Date:   [**2113-7-14**]

Date of Birth:  [**2030-7-10**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 2291**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
none

History of Present Illness:
82 F with history of neurofibromatosis, PVD, [**First Name3 (LF) **], recent
admission for humeral fracture in setting of mechanical fall
treated conservatively (discharged 5 days ago, [**2113-7-4**]) who
presents with acute SOB. Evening of [**2113-7-9**], patient reports dry
cough. 1 hr prior to presentation accutely SOB.
Per EMS, patient was satting mid 80s on non-rebreather. In the
ED, VITALS: T 97.2, HR 94, 220/124, 99% non rebreather. On exam,
negative JVP, no pedal edema, looked dry. Labs notable for:
Bicarb 13, K 6.4 (hemolyzed), AG 22, Phos 6, BNP 17,500, PLT
500, WBC 17, HCT 42, Hb 13, trop 0.02, Lactate 7.0. ABG: 7.42,
CO2 30, O2 130, Bicarb 20. CXR: LLL pna and some pulmonary
edema. For lactate 7, gave 750cc IVF, lactate improved to 2.1, K
4.5. As pt was given fluids, breathing improved.
ABG on non rebreather: pH 7.40, CO2 34, O2 81, HCO3 22,
Temp 100.2 rectally.
Pt was given: zosyn and levofloxacin 750mg.
Vitals on transfer: RR 24, 98.2 axillary, HR 75, 185/93
(150-160s SBP), 100% on non rebreather.
On arrival to the MICU, patient is comfortable on a
non-rebreather at 70%. She denies any chest pressure or
pleuritic component chest pain. She also denies any headache.
She is 79% on Room Air when checked.


Past Medical History:
- [**Date Range **]
- HLD
- DCIS s/p excision/XRT, on tamoxifen in past but d/c'd due to
side effects
- Osteoporosis
- Neurofibromatosis type II
- Lichen sclerosis
- Left hip fracture s/p hemiarthroplasty
- Carotid stenosis s/p CEA of left ICA in [**2106**].  Right ICA with
80% stenosis as of [**2110**]
- PVD
- Cataracts s/p removal ([**2109**])


Social History:
Occupation:  Former homemaker.
Marital:  Married.
Home Situation:  Lives with husband in [**Name (NI) 3146**].
Religion:  Catholic.
Tobacco:  50 years of one-half pack a day. Quit circa [**2100**].
Alcohol:  Occasional.  No prior difficulty.
Other Drugs:  None.


Family History:
Mother:  Deceased, unknown reason.
Father:  Deceased, TB.
Cancer History:  Sister with breast cancer in her 70s.
Coronary Artery Disease History:  None.
Diabetes Mellitus History:  None.


Physical Exam:
Admission Exam:
79% on room air.
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Crackles at bases, otherwise, no wheezes, rales, ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Right leg is tender to palpation in calf
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, 2+ reflexes bilaterally, gait
deferred, finger-to-nose intact

Discharge exam:
Vitals: T:98.1 BP 118/61  P:72  R:18  97% on 3L
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Crackles at bases, scattered rhonchi, no wheezes
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Right leg is tender to palpation in calf
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, 2+ reflexes bilaterally, gait
deferred, finger-to-nose intact


Pertinent Results:
[**2113-7-10**] 03:36PM   GLUCOSE-87 UREA N-40* CREAT-1.1 SODIUM-139
POTASSIUM-4.6 CHLORIDE-101 TOTAL CO2-22 ANION GAP-21*
[**2113-7-10**] 03:36PM   cTropnT-0.03*
[**2113-7-10**] 03:36PM   CALCIUM-8.9 PHOSPHATE-4.7* MAGNESIUM-1.7
[**2113-7-10**] 04:13AM   LACTATE-1.5
[**2113-7-10**] 02:55AM   GLUCOSE-123* UREA N-42* CREAT-1.0 SODIUM-139
POTASSIUM-4.2 CHLORIDE-106 TOTAL CO2-20* ANION GAP-17
[**2113-7-10**] 02:55AM   cTropnT-0.06*
[**2113-7-10**] 02:55AM   CALCIUM-8.3* PHOSPHATE-4.1# MAGNESIUM-1.7
[**2113-7-10**] 02:55AM   WBC-13.1* RBC-3.99* HGB-11.5* HCT-35.6*
MCV-89 MCH-28.8 MCHC-32.2 RDW-15.3
[**2113-7-10**] 02:55AM   PLT COUNT-396
[**2113-7-10**] 12:20AM   TYPE-[**Last Name (un) **] PO2-81* PCO2-34* PH-7.40 TOTAL
CO2-22 BASE XS--2 COMMENTS-GREEN TOP
[**2113-7-10**] 12:20AM   LACTATE-2.1* K+-4.5
[**2113-7-9**] 11:04PM   TYPE-ART TEMP-37.9 PO2-130* PCO2-30* PH-7.42
TOTAL CO2-20* BASE XS--3 INTUBATED-NOT INTUBA COMMENTS-O2
DELIVER
[**2113-7-9**] 11:04PM   K+-4.5
[**2113-7-9**] 10:50PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.018
[**2113-7-9**] 10:50PM URINE  BLOOD-TR NITRITE-NEG PROTEIN-100
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-4* PH-5.5
LEUK-NEG
[**2113-7-9**] 10:50PM URINE  RBC-5* WBC-2 BACTERIA-FEW YEAST-NONE
EPI-2
[**2113-7-9**] 10:50PM URINE  HYALINE-17*
[**2113-7-9**] 10:50PM URINE  MUCOUS-RARE
[**2113-7-9**] 09:40PM   GLUCOSE-152* UREA N-36* CREAT-1.0 SODIUM-138
POTASSIUM-6.4* CHLORIDE-103 TOTAL CO2-13* ANION GAP-28*
[**2113-7-9**] 09:40PM   estGFR-Using this
[**2113-7-9**] 09:40PM   ALT(SGPT)-143* AST(SGOT)-272* ALK PHOS-209*
TOT BILI-0.8
[**2113-7-9**] 09:40PM   cTropnT-0.02*
[**2113-7-9**] 09:40PM   proBNP-[**Numeric Identifier **]*
[**2113-7-9**] 09:40PM   CALCIUM-9.0 PHOSPHATE-6.0*# MAGNESIUM-2.1
[**2113-7-9**] 09:40PM   WBC-17.4*# RBC-4.46 HGB-13.2 HCT-42.4 MCV-95
MCH-29.7 MCHC-31.2 RDW-15.2
[**2113-7-9**] 09:40PM   NEUTS-82.7* LYMPHS-13.1* MONOS-3.3 EOS-0.3
BASOS-0.5
[**2113-7-9**] 09:40PM   PLT COUNT-500*
[**2113-7-9**] 09:40PM   [**Name (NI) 8255**] TO  PTT-UNABLE TO  INR(PT)-UNABLE
TO
[**2113-7-9**] 09:23PM   LACTATE-7.0* K+-5.2*
.
Discharge Labs:
[**2113-7-14**] 07:05AM BLOOD WBC-7.7 RBC-4.15* Hgb-11.9* Hct-37.4
MCV-90 MCH-28.6 MCHC-31.7 RDW-15.4 Plt Ct-350
[**2113-7-14**] 07:05AM BLOOD Glucose-102* UreaN-36* Creat-1.0 Na-140
K-3.8 Cl-97 HCO3-33* AnGap-14
[**2113-7-14**] 07:05AM BLOOD ALT-137* AST-48* LD(LDH)-228 AlkPhos-96
TotBili-0.5
[**2113-7-14**] 07:05AM BLOOD Calcium-8.7 Phos-4.1 Mg-1.9

CTA Chest [**7-10**]
1.  No pulmonary embolus.
2.  Bilateral pleural effusions with centrilobular emphysema and
ground glass opacities, the appearance may be due to fluid
overload.  Focal punctate areas of consolidation are noted in
the right upper lobe only.
3.  Multivessel coronary artery calcifications and progression
of extensive ulcerating plaques in the aortic arch.
.
EKG [**7-10**]: HR 96, PR 104, QTc 390, nl axis, a in III, flat T in
III

Shoulder Films:
Three views of the right humerus show a comminuted fracture of
the neck of the
proximal humerus with displaced associated fractures of the
tuberosities of
the humeral head.  No dislocation and the visualized right lung
is grossly
normal. Little position change from previous exam [**2113-7-1**].

RUQ ultrasound [**7-11**]:
IMPRESSION:
1.  No liver pathology and no biliary dilatation seen.
2.  Cholelithiasis with no sign of cholecystitis.
3.  Bilateral pleural effusions.
4.  Small non-obstructing stone in the right kidney and small
simple right
renal cyst.

Echo [**7-12**]
The left atrium is moderately dilated. No atrial septal defect
is seen by 2D or color Doppler. There is mild symmetric left
ventricular hypertrophy with normal cavity size and
regional/global systolic function (LVEF>55%). There is no
ventricular septal defect. The right ventricular free wall is
hypertrophied. Right ventricular chamber size is normal. with
normal free wall contractility. The diameters of aorta at the
sinus, ascending and arch levels are normal. The aortic valve
leaflets (3) are mildly thickened but aortic stenosis is not
present. Mild (1+) aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. There is no mitral valve
prolapse. Trivial mitral regurgitation is seen. The tricuspid
valve leaflets are mildly thickened. There is moderate pulmonary
artery systolic hypertension. There is no pericardial effusion

CXR [**7-13**] FINDINGS:  In comparison with the study of [**7-11**], there
is some continued enlargement of the cardiac silhouette with
little change in the degree of pulmonary vascular congestion.
Continued opacification of the right hemidiaphragm, consistent
with pleural effusion and atelectasis at the left base.  Again
supervening pneumonia would be difficult to exclude in the
appropriate clinical setting.


Brief Hospital Course:
82F with history of neurofibromatosis, PVD, [**Date Range **], recent
admission for humeral fracture in setting of mechanical fall
treated conservatively (discharged 5 days prior to this
admission) who presented with acute SOB.
.
# Shortness of breath: Pt met 2 SIRS criteria on presentation:
leukocytosis (WBC 17), tachypnea, possible sources include
pulmonary (?LLL opacity) or GI (diarrhea). Given 750cc IVF in
the ED and started on zosyn and levofloxacin empirically for
possible infectious process. Differential for SOB also includes:
PE (considered in pt with recent humeral fracture) and recent
immobility and right calf tenderness. ACS (trop 0.02, but no
chest pain or EKG changes), acute heart failure (BNP 17,500 (no
prior), pulmonary edema on CXR).  Aa gradient of 590 assuming
100% FiO2 on non-rebreather.  Heparin drip was started
empirically, but was discontinued when the pt's CT chest showed
no PE.  The patient was but on empiric PNA coverage with
vanc/Zosyn/levo. Blood cultures were sent (NG at discharge). The
patient was transferred to the MICU for close monitoring.  The
patient had a foley placed and was diuresed with good response.
She remained afebrile and abx were stopped. She was downgraded
to NC and transferred to the floor. She continued to have
difficulty acheiving O2 sat >90% on room air and required O2 NC.
A repeat CXR showed persistent pleural effusions and the patient
was diuresed with moderate improvement She was started on 20mg
PO lasix daily. Additionally, she received chest PT and was
started on inhaled steroids in setting of emphysema and
persistent cough with sputum production. She remained afebrile
following transfer to floor. At discharge, she is saturating
88-90% on RA, 97% on 3L, and 94-95% on 3L with ambulation.
.
# [**Date Range **]: Hypertensive to 200s in the ED. Pt has history of BP in
200s on prior admissions in setting of med non compliance. She
states she missed several doses prior to this admission.
Patient without evidence of end organ dysfunction, no chest
pain. BP was controlled with hydralazine and amlodipine in the
unit. In the MICU, the patient's BP was controlled with
hydralazine. Her dose of lisinopril was increased from 20mg to
40mg daily. A beta-blocker was held in the setting of possible
bacterial etiology to SOB and elevated lactate. Upon transfer to
the floor, the patient was started on home atenalol for SBP of
180. Atenolol failed to successfully control BP so pt was
transitioned to labetalol [**Hospital1 **]. BP is now well controlled. She
has also been started on lasix 20mg daily.

# Metabolic Acidosis/Lactate: AG 22, Lactate 7.0-->2.1 after
750cc IVF.  AG closed.  Lactate normalized on transfer to the
floor. Still uncertain etiology. Most likely [**1-19**] to hypertensive
emergency

# Tachycardia:  Patient had a run of supraventricular
tachycardia that self-resolves and did not return after
restarting beta-blockers.

# Right humeral fracture s/p fall: s/p comminuted fracture in
setting of mechanical fall.Ortho saw patient and noted fracture
healing well. Shoulder films show proper healing. Follow up in 2
months.
.
Chronic issues:

# HLD.  Continued home simvastatin.
.
# Osteoporosis.  Continued calcium/vitamin D daily.
.
# Neurofibromatosis type II.  Stable no acute issues
.
# Lichen sclerosis.  Continued clobetasol cream.
.
# Carotid stenosis s/p CEA of left ICA in [**2106**].  Right ICA with
80% stenosis as of [**2110**].  No acute issues.
.
# PVD.  Not on any medications, no acute issues.
.
# Cataracts.  Stable no acute issues.

Transition of Care:
# Follow lytes in in [**12-19**] weeks after starting lasix
# Trend blood pressures to ensure goal 110-140/60-80
# Follow up with Ortho in 2 months
# Communication: [**First Name8 (NamePattern2) **] [**Known lastname 83141**], Relationship: husband. Phone
number: [**Telephone/Fax (1) 104461**]
# Code: DNR/DNI confirmed

Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from webOMR.
1. Aspirin 81 mg PO DAILY
2. Atenolol 100 mg PO DAILY
3. Lisinopril 20 mg PO DAILY
4. Simvastatin 20 mg PO DAILY
5. Calcium 600 + D(3) *NF* (calcium carbonate-vitamin D3) 600
mg(1,500mg) -200 unit Oral daily
6. Clobetasol Propionate 0.05% Ointment 1 Appl TP DAILY:PRN
itching
7. Acetaminophen 1000 mg PO Q6H:PRN pain


Discharge Medications:
1. Aspirin 81 mg PO DAILY
2. Lisinopril 40 mg PO DAILY
hold for SBP<100
3. Clobetasol Propionate 0.05% Ointment 1 Appl TP DAILY:PRN
itching
4. Acetaminophen 1000 mg PO Q6H:PRN pain
5. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
6. Furosemide 20 mg PO DAILY
hold for sbp<100
7. Guaifenesin 10 mL PO Q6H
8. Labetalol 200 mg PO BID
hold for SBP <100 and HR <60
9. Calcium 600 + D(3) *NF* (calcium carbonate-vitamin D3) 600
mg(1,500mg) -200 unit Oral daily
10. Docusate Sodium 100 mg PO DAILY:PRN constipation
11. Simvastatin 20 mg PO DAILY


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 9475**] Care Center - [**Location (un) 3146**]

Discharge Diagnosis:
Hypertensive Emergency with Secondary Pulmonary Edema


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
Dear Ms. [**Known lastname 83141**],

It was a pleasure taking care of you during your stay at [**Hospital1 18**].
You came in due to shortness of breath and were found to have
high blood pressure. We believe your high blood pressure caused
your shortness of breath. We controlled your blood pressure and
gave you medicine to decrease fluid in your lungs. Your
shortness of breath is now improving, but you still require some
oxygen.

Followup Instructions:
Department: [**Hospital1 18**] [**Location (un) 2352**] - ADULT MED
When: WEDNESDAY [**2113-7-19**] at 2:45 PM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 6887**], MD [**Telephone/Fax (1) 1144**]
Building: [**Location (un) 2355**] ([**Location (un) **], MA) [**Location (un) 551**]
Campus: OFF CAMPUS     Best Parking: Free Parking on Site

Department: ORTHOPEDICS
When: THURSDAY [**2113-8-17**] at 5:00 PM
With: [**Name6 (MD) 13978**] [**Name8 (MD) **], MD [**Telephone/Fax (1) 1228**]
Building: [**Hospital6 29**] [**Location (un) 551**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Malignant essential hypertension,Acute edema of lung, unspecified,Acidosis,Paroxysmal ventricular tachycardia,Peripheral vascular disease, unspecified,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Neurofibromatosis, type 2 [acoustic neurofibromatosis],Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Circumscribed scleroderma,Do not resuscitate status,Personal history of tobacco use,Aftercare for healing traumatic fracture of upper arm'}


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: 82 F with history of neurofibromatosis, PVD, [**First Name3 (LF) **], recent
admission for humeral fracture in setting of mechanical fall
treated conservatively (discharged 5 days ago, [**2113-7-4**]) who
presents with acute SOB. Evening of [**2113-7-9**], patient reports dry
cough. 1 hr prior to presentation accutely SOB.
Per EMS, patient was satting mid 80s on non-rebreather. In the
ED, VITALS: T 97.2, HR 94, 220/124, 99% non rebreather. On exam,
negative JVP, no pedal edema, looked dry. Labs notable for:
Bicarb 13, K 6.4 (hemolyzed), AG 22, Phos 6, BNP 17,500, PLT
500, WBC 17, HCT 42, Hb 13, trop 0.02, Lactate 7.0. ABG: 7.42,
CO2 30, O2 130, Bicarb 20. CXR: LLL pna and some pulmonary
edema. For lactate 7, gave 750cc IVF, lactate improved to 2.1, K
4.5. As pt was given fluids, breathing improved.
ABG on non rebreather: pH 7.40, CO2 34, O2 81, HCO3 22,
Temp 100.2 rectally.
Pt was given: zosyn and levofloxacin 750mg.
Vitals on transfer: RR 24, 98.2 axillary, HR 75, 185/93
(150-160s SBP), 100% on non rebreather.
On arrival to the MICU, patient is comfortable on a
non-rebreather at 70%. She denies any chest pressure or
pleuritic component chest pain. She also denies any headache.
She is 79% on Room Air when checked.

MEDICAL HISTORY: - [**Date Range **]
- HLD
- DCIS s/p excision/XRT, on tamoxifen in past but d/c'd due to
side effects
- Osteoporosis
- Neurofibromatosis type II
- Lichen sclerosis
- Left hip fracture s/p hemiarthroplasty
- Carotid stenosis s/p CEA of left ICA in [**2106**].  Right ICA with
80% stenosis as of [**2110**]
- PVD
- Cataracts s/p removal ([**2109**])

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from webOMR.
1. Aspirin 81 mg PO DAILY
2. Atenolol 100 mg PO DAILY
3. Lisinopril 20 mg PO DAILY
4. Simvastatin 20 mg PO DAILY
5. Calcium 600 + D(3) *NF* (calcium carbonate-vitamin D3) 600
mg(1,500mg) -200 unit Oral daily
6. Clobetasol Propionate 0.05% Ointment 1 Appl TP DAILY:PRN
itching
7. Acetaminophen 1000 mg PO Q6H:PRN pain

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Exam:
79% on room air.
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Crackles at bases, otherwise, no wheezes, rales, ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Right leg is tender to palpation in calf
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, 2+ reflexes bilaterally, gait
deferred, finger-to-nose intact

FAMILY HISTORY: Mother:  Deceased, unknown reason.
Father:  Deceased, TB.
Cancer History:  Sister with breast cancer in her 70s.
Coronary Artery Disease History:  None.
Diabetes Mellitus History:  None.

SOCIAL HISTORY: Occupation:  Former homemaker.
Marital:  Married.
Home Situation:  Lives with husband in [**Name (NI) 3146**].
Religion:  Catholic.
Tobacco:  50 years of one-half pack a day. Quit circa [**2100**].
Alcohol:  Occasional.  No prior difficulty.
Other Drugs:  None. 

### Response:
{'Malignant essential hypertension,Acute edema of lung, unspecified,Acidosis,Paroxysmal ventricular tachycardia,Peripheral vascular disease, unspecified,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Neurofibromatosis, type 2 [acoustic neurofibromatosis],Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Circumscribed scleroderma,Do not resuscitate status,Personal history of tobacco use,Aftercare for healing traumatic fracture of upper arm'}
