CHIEF COMPLAINT: Hypotension

PRESENT ILLNESS: [**Age over 90 **]F AF on warfarin (goal INR 3 as previous atrial emboli), s/p
MVR with tissue valve, history of DVT, PE (DVT [**11-19**], PE '[**57**]),
CHF/cardiomyopathy EF 15-20 %, HTN, previous strokes presenting
from rehabilitation where she is for a recent mechanical fall
complicated by lower back pain, recurrent UTI, A. fib on
Coumadin presenting with hypotension and leukocytosis from rehab
in the context of a long term indwelling foley. EMS was called
for asymptomatic hypotension at rehab (76/54) with initial EMS
VS BP 81/46 with repeat 82/49 and HR in 60s. The impression of
the rehab per note was no constitutional symptoms such as fever,
chills, or major change in clinical appearance. She was not
started empirically on antibiotics. It was favored to be an UTI
in setting of indwelling foley for urinary retention. Her WBC on
[**8-11**] was 8.4 with WBC 18.4 on [**2175-8-16**] with 91.5 % neutrophils.

MEDICAL HISTORY: Afib on coumadin (goal INR 3)
hx of DVT, PE (DVT [**11-19**], PE '[**57**])
CHF/cardiomyopathy EF 20-25%, last echo [**3-23**]
Moderate Tricuspid Regurgitation
s/p MVR w/porcine tissue '[**61**]
HTN (SBP 120's at baseline)
hypothyroidism
atrial emboli- INR should be 3
DJD
h/o CVA p/w slurred speech and facial droop
CKD baseline Cr 1.4-1.6

MEDICATION ON ADMISSION: - acetaminophen 975 mg PO TID
- ASA 81 mg PO qD
- calcium carbonate 650 mg PO BID
- cholecalciferol 1000 unit PO qD
- levothyroxine 88 mcg PO qD
- lidocaine patch PO qD
- losartan 25 mg PO qD
- metoprolol succinate 12.5 mg PO qD
- torsemide 30 mg PO TID
- warfarin 5 mg PO qPM
- oxycodone 5 mg PO BID
- oxycodone IR 5 mg PO q 4 hr prn pain

ALLERGIES: Ace Inhibitors

PHYSICAL EXAM: Admission:

FAMILY HISTORY: SSA trait
No hx of stroke, DM, HTN or heart disease

SOCIAL HISTORY: Pt normally lives alone when not in rehab, does some of cooking,
has cleaning and shopping aid, has three daughters who are very
supportive. Walks very short distances, slowly, with walker but
primarily in wheel chair. Denies EtOH, tobacco and illicits.
Infection and inflammatory reaction due to indwelling urinary catheter,Acute kidney failure, unspecified,Other primary cardiomyopathies,Hyposmolality and/or hyponatremia,Chronic systolic heart failure,Atrial fibrillation,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Delirium due to conditions classified elsewhere,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Urinary tract infection, site not specified,Other iatrogenic hypotension,Other diuretics causing adverse effects in therapeutic use,Heart valve replaced by transplant,Abnormal coagulation profile,Anticoagulants causing adverse effects in therapeutic use,Sciatica,Chronic kidney disease, unspecified,Unspecified acquired hypothyroidism,Personal history of venous thrombosis and embolism,Constipation, unspecified,Coronary atherosclerosis of native coronary artery
React-indwell urin cath,Acute kidney failure NOS,Prim cardiomyopathy NEC,Hyposmolality,Chr systolic hrt failure,Atrial fibrillation,Enterococcus group d,Delirium d/t other cond,Hy kid NOS w cr kid I-IV,Abn react-urinary cath,Urin tract infection NOS,Iatrogenc hypotnsion NEC,Adv eff diuretics NEC,Heart valve transplant,Abnrml coagultion prfile,Adv eff anticoagulants,Sciatica,Chronic kidney dis NOS,Hypothyroidism NOS,Hx-ven thrombosis/embols,Constipation NOS,Crnry athrscl natve vssl
Name:  [**Known lastname 15495**],[**Known firstname 9854**]                    Unit No:   [**Numeric Identifier 16126**]

Admission Date:  [**2175-8-16**]              Discharge Date:   [**2175-8-21**]

Date of Birth:  [**2081-10-22**]             Sex:   F

Service: MEDICINE

Allergies:
Ace Inhibitors

Attending:[**First Name3 (LF) 11279**]
Addendum:
With regards to the patient's atrial fibrillation.  Patient's
INR was supratherapeutic during hospitalization and warfarin was
held from [**8-17**] to [**8-20**].  On [**8-21**] the INR was 2.5 and previous dose
of warfarin was resumed at 5mg daily.  Patient's goal INR is 2.5
to 3.5 in light of mitral valve replacement and atrial
fibrillation.

Discharge Disposition:
Extended Care

Facility:
[**Hospital **] rehab

                             [**First Name11 (Name Pattern1) 3344**] [**Last Name (NamePattern4) 11280**] MD [**MD Number(2) 11281**]

Completed by:[**2175-8-21**]

Name:  [**Known lastname 15495**],[**Known firstname 9854**]                    Unit No:   [**Numeric Identifier 16126**]

Admission Date:  [**2175-8-16**]              Discharge Date:   [**2175-8-21**]

Date of Birth:  [**2081-10-22**]             Sex:   F

Service: MEDICINE

Allergies:
Ace Inhibitors

Attending:[**First Name3 (LF) 11279**]
Addendum:
Blood Cultures negative x2 from [**2175-8-16**].

Discharge Disposition:
Extended Care

Facility:
[**Hospital **] rehab

                             [**First Name11 (Name Pattern1) 3344**] [**Last Name (NamePattern4) 11280**] MD [**MD Number(2) 11281**]

Completed by:[**2175-8-22**]

Admission Date:  [**2175-8-16**]              Discharge Date:   [**2175-8-21**]


Service: MEDICINE

Allergies:
Ace Inhibitors

Attending:[**First Name3 (LF) 3705**]
Chief Complaint:
Hypotension

Major Surgical or Invasive Procedure:
None

History of Present Illness:
[**Age over 90 **]F AF on warfarin (goal INR 3 as previous atrial emboli), s/p
MVR with tissue valve, history of DVT, PE (DVT [**11-19**], PE '[**57**]),
CHF/cardiomyopathy EF 15-20 %, HTN, previous strokes presenting
from rehabilitation where she is for a recent mechanical fall
complicated by lower back pain, recurrent UTI, A. fib on
Coumadin presenting with hypotension and leukocytosis from rehab
in the context of a long term indwelling foley. EMS was called
for asymptomatic hypotension at rehab (76/54) with initial EMS
VS BP 81/46 with repeat 82/49 and HR in 60s. The impression of
the rehab per note was no constitutional symptoms such as fever,
chills, or major change in clinical appearance. She was not
started empirically on antibiotics. It was favored to be an UTI
in setting of indwelling foley for urinary retention. Her WBC on
[**8-11**] was 8.4 with WBC 18.4 on [**2175-8-16**] with 91.5 % neutrophils.


Of note, she was recently hospitalized from [**2175-8-5**] to [**2175-8-10**]
with trouble coordinating her left arm and dysarthria in setting
of a fall at rehab. An extensive neurological work-up revealed
evidence of subacute infarction in right anterior parietal lobe
favored to be embolic. She was discharged to rehab.
.
In the ED, initial vs were: 10 96.6 62 73/50 1 98% RA. Exam with
no focal findings except for cloudy urine in Foley catheter.
Labs significant for WBC 17, stable Hct although MCV 81, Diff N
85.1 L 9.8, lactate 2.2, Na 132, Cl 94, BUN 41, Cr 1.8 (baseline
1.3 - 1.6), Glc 108. UA significant for large LE, Bld, RBC 13,
WBC 35, Few Bacteria, CastHy 9. She was given linezolid 600 mg
IV x 1. CXR performed showing LLL opacification consistent with
atelectasis vs. early pneumonia cannot be excluded. Blood and
urine cultures were drawn. EKG showing atrial fibrillation, LBBB
similar compared to prior. She received 1 L of NS.

She was admitted for hypotension and presumed urosepsis. Sepsis
pathway not utilized secondary to improved blood pressure with
IVF resuscitation in setting of low EF.

Admission VS: 108/68, 62, 14, 100% RA; Access: 2x20G

Past Medical History:
Afib on coumadin (goal INR 3)
hx of DVT, PE (DVT [**11-19**], PE '[**57**])
CHF/cardiomyopathy EF 20-25%, last echo [**3-23**]
Moderate Tricuspid Regurgitation
s/p MVR w/porcine tissue '[**61**]
HTN (SBP 120's at baseline)
hypothyroidism
atrial emboli- INR should be 3
DJD
h/o CVA p/w slurred speech and facial droop
CKD baseline Cr 1.4-1.6

Social History:
Pt normally lives alone when not in rehab, does some of cooking,
has cleaning and shopping aid, has three daughters who are very
supportive. Walks very short distances, slowly, with walker but
primarily in wheel chair. Denies EtOH, tobacco and illicits.


Family History:
SSA trait
No hx of stroke, DM, HTN or heart disease


Physical Exam:
Admission:

General Appearance: Well nourished, No acute distress, No(t)
Overweight / Obese, No(t) Anxious, No(t) Diaphoretic

Eyes / Conjunctiva: No(t) Pupils dilated, No(t) Conjunctiva
pale, No(t) Sclera edema

Head, Ears, Nose, Throat: Normocephalic, No(t) Poor dentition,
No(t) Endotracheal tube, No(t) NG tube, No(t) OG tube

Lymphatic: Cervical WNL, Supraclavicular WNL, No(t) Cervical
adenopathy

Cardiovascular: (PMI Normal), (S1: Normal, No(t) Absent), (S2:
Normal), No(t) S3, No(t) S4, No(t) Rub, (Murmur: No(t) Systolic,
No(t) Diastolic)

Peripheral Vascular: (Right radial pulse: Diminished), (Left
radial pulse: Diminished), (Right DP pulse: Diminished), (Left
DP pulse: Diminished)

Respiratory / Chest: (Expansion: Symmetric, No(t) Paradoxical),
(Breath Sounds: Clear : , Crackles : fine at right lung base,
No(t) Wheezes : )

Abdominal: Soft, Non-tender, No(t) Bowel sounds present, No(t)
Distended, No(t) Tender: , No suprapubic tenderness

Extremities: Right lower extremity edema: Absent, Left lower
extremity edema: Absent, No(t) Cyanosis, No(t) Clubbing, distal
extremities cool to touch bilateral UE and LE

Musculoskeletal: Muscle wasting, Unable to stand

Skin:  Not assessed, No(t) Rash: , No(t) Jaundice

Neurologic: Attentive, Follows simple commands, Responds to:
Verbal stimuli, Oriented (to): , Movement: Purposeful, No(t)
Sedated, No(t) Paralyzed, Tone: Not assessed

Discharge:
Vitals: 96.3-98.3, 101-130/60-79, 56-73, 18-20, 94-100% RA
General: NAD, AOx3; able to roll herself over in bed.
HEENT: OP clear, MMM, sclera anicteric.
Neck: L-side bandage removed; JVP flat; no LAD, no carotid
bruits
Cardiac: RRR, no m/r/g appreciated
Lungs: CTAB
Abdomen: positive bowel sounds, soft, non-tender, non-distended
Ext: no C/C/E; 2 radial pulses, DP pulses b/l
Skin: no rashes, jaundice or eccymoses noted
Neuro: AOx3, CN2-12 intact; no decreased sensation to touch
throughout; proprioception in both large toes b/l.  L hand
weakness persists.


Pertinent Results:
[**2175-8-16**] 07:15PM   WBC-17.0* RBC-4.59 HGB-13.2 HCT-37.1 MCV-81*
MCH-28.8 MCHC-35.6* RDW-17.9*
[**2175-8-16**] 07:15PM   NEUTS-85.1* LYMPHS-9.8* MONOS-3.4 EOS-1.3
BASOS-0.3
[**2175-8-16**] 07:15PM   PLT COUNT-412
[**2175-8-16**] 06:42PM   LACTATE-2.2*
[**2175-8-16**] 06:25PM   GLUCOSE-108* UREA N-41* CREAT-1.8*
SODIUM-132* POTASSIUM-4.0 CHLORIDE-94* TOTAL CO2-29 ANION GAP-13
[**2175-8-16**] 03:45PM URINE  BLOOD-LG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-LG
[**2175-8-18**] 08:35AM BLOOD TSH-4.2
[**2175-8-18**] 08:35AM BLOOD Cortsol-17.2

[**2175-8-21**] 05:35AM BLOOD WBC-5.7 RBC-4.66 Hgb-13.0 Hct-39.2 MCV-84
MCH-27.9 MCHC-33.1 RDW-18.0* Plt Ct-334
[**2175-8-21**] 05:35AM BLOOD Glucose-89 UreaN-16 Creat-1.1 Na-133
K-5.2* Cl-102 HCO3-24 AnGap-12
[**2175-8-21**] 05:35AM BLOOD Calcium-8.6 Phos-2.8 Mg-2.6
[**2175-8-20**] 07:45AM BLOOD PT-37.7* PTT-40.6* INR(PT)-3.8*

   URINE CULTURE (Final [**2175-8-19**]):
      ENTEROCOCCUS SP..    >100,000 ORGANISMS/ML..

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             ENTEROCOCCUS SP.
                             |
AMPICILLIN------------   <=2 S
NITROFURANTOIN--------  <=16 S
TETRACYCLINE----------  =>16 R
VANCOMYCIN------------     1 S

Blood Cultures X2 Pending:
XXXXXXX

CXR [**2175-8-16**]:
IMPRESSION: Left lower lobe opacification, likely atelectasis,
though early
pneumonia is not excluded.

EKG [**2175-8-16**]:
Atrial fibrillation with controlled ventricular response. Left
bundle-branch block with secondary ST-T wave abnormalities.
Compared to the previous tracing of [**2175-8-6**] no diagnostic
change.

INR Pending from [**2175-8-21**]:
XXXXX

Blood cultures from [**2175-8-16**] Pending

Brief Hospital Course:
[**Age over 90 **]-year-old woman with a past medical history of atrial
fibrillation with previous stroke, CHF with EF 15-20%, HTN, and
previous MVR and a chronic indwelling foley found to be
hypotensive, a result of UTI and medications.

# Complicated Enterococcus UTI.  Urinary tract infection is
complicated given chronic foley placed and WBC 17 in setting of
hypotension.   Given her history of [**Age over 90 **] UTI, she was started
empirically on linezolid ([**2175-8-16**]), as well as
piperacillin/tazobactam for possible pneumonia.  Her white count
fell by the following morning and her lactate normalized and
piperacillin/tazobactam was stopped.  Patient was then
transitioned to linezolid and cefepime.  When sensitivities of
the infection returned as enterococcus, patient was transitioned
to ampicillin.  Her white count decreased and she was afebrile.
Her foley was removed and patient was able to void without
difficulty into diapers which were changed appropriately.
Patient is to finish PO course of PO ampicillin on [**8-27**].

# Hypotension.  Differential diagnosis for hypotension is quite
broad and includes cardiac versus metabolic versus
medication-related including large dose of home torsemide (30mg
TID), oxycodone which the patient is on secondary to hip pain.
Initial hypotension was responsive to 500cc NS, and patient was
hemodynamically stable throughout admission without fluid or
pressor support.  We had the patient discharged on a reduced
dose of her torsemide and losartan, with the possibility to
increase as an outpatient.

# Atrial fibrillation.  Patient has history of atrial
fibrillation and tissue MVR with goal 2.5 to 3.5 due to previous
atrial emboli.  INR was elevated and warfarin was held, with
discharge INR at 2.5 and most recent dose of coumadin 5mg daily
started with follow up on Friday with PCP.

# Back pain/ pain along right thigh.  Likely sciatica given
positive straight leg raise test versus piriformis syndrome.
Patient was initially treated with oxycodone, however was
altered during the course of the hospitalization briefly, which
resolved when oxycodone was stopped and tramadol was started.
Patient was intermittently given tramadol with good control of
her pain.  By time of discharge, patient was able to get out of
bed with assist to chair and without pain.

# Chronic systolic heart failure.  Patient with EF 15-20% on
ECHO in [**2-24**] with significant dyssynchrony but normally
functioning mitral prosthesis and moderate TR. Patient's CHF was
not active during this hospitalization.

# CKD.  Baseline Cr 1.4-1.7 with admission Cr 1.8. This is
likely prerenal given the patient's apparent hypovolemia, and
her creatinine fell to 1.6 the following morning.  At discharge,
patient's creatinine was at 1.1.

# Mild hyponatremia.  Likely volume depleted given low urine Na
and Cl. TSH and cortisol normal.  Resolved during
hospitalization.

# Hypothyroidism.  She was continued on her home synthroid with
a normal TSH.

# Transitional issues:
-Please check INR, goal 2.5 to 3.5.  Warfarin was held
throughout hospitalization.  was 2.5 upon discharge, with
resumption of most recent warfarin dose.
-Please check blood pressure

Medications on Admission:
- acetaminophen 975 mg PO TID
- ASA 81 mg PO qD
- calcium carbonate 650 mg PO BID
- cholecalciferol 1000 unit PO qD
- levothyroxine 88 mcg PO qD
- lidocaine patch PO qD
- losartan 25 mg PO qD
- metoprolol succinate 12.5 mg PO qD
- torsemide 30 mg PO TID
- warfarin 5 mg PO qPM
- oxycodone 5 mg PO BID
- oxycodone IR 5 mg PO q 4 hr prn pain


Discharge Medications:
1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical Daily PRN as needed
for body pain .
4. torsemide 20 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).
Disp:*0 Tablet(s)* Refills:*0*
5. losartan 25 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*0 Tablet(s)* Refills:*0*
6. ampicillin 250 mg Capsule Sig: Two (2) Capsule PO Q8H (every
8 hours) as needed for UTI for 8 days: [**Date range (1) 100323**].
Disp:*0 Capsule(s)* Refills:*0*
7. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig:
0.5 Tablet Extended Release 24 hr PO DAILY (Daily).
8. docusate sodium 100 mg Tablet Sig: 1-2 Tablets PO twice a day
as needed for constipation.
Disp:*0 Tablet(s)* Refills:*0*
9. tramadol 50 mg Tablet Sig: One (1) Tablet PO twice a day as
needed for pain.
Disp:*0 Tablet(s)* Refills:*0*
10. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO three
times a day.
11. calcium carbonate 650 mg calcium (1,625 mg) Tablet Sig: One
(1) Tablet PO twice a day.
12. Vitamin D 1,000 unit Tablet Sig: One (1) Tablet PO once a
day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] rehab

Discharge Diagnosis:
Primary Diagnosis: Complicated Enterococcal Urinary Tract
Infection, Systolic heart failure, Hypertension, Acute kidney
injury, Back pain


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


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

It was our pleasure to take care of you at [**Hospital1 18**].

You were admitted for low blood pressure likely related to an
infection in your bladder and from taking too much torsemide.

We found that the infection was due to a bacteria called
enterococcus which is sensitive to ampicillin, which we are
being treated with.

For follow up, please continue rehabilitation at your current
rehabilitation center and keep the following appointments below.

We have made the following changes in your medications:
START Ampicillin until [**2175-8-29**]
START Tramadol for pain
START Colace as needed for constipation
STOP Oxycodone as it caused you to be confused
DECREASE Torsemide to 30mg DAILY as this may have also
contributed to your low blood pressures.
DECREASE Losartan to 12.5mg DAILY as this may have also
contributed to your low blood pressures.

Please continue taking all your other home medications.

Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more
than 3 lbs.

Followup Instructions:
Please attend the following appointments:

Department: [**Hospital3 249**]
When: FRIDAY [**2175-8-25**] at 10:40 AM
With: [**Doctor First Name **] FERN, RNC [**Telephone/Fax (1) 250**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: NEUROLOGY
When: FRIDAY [**2175-9-22**] at 10:30 AM
With: [**First Name8 (NamePattern2) **] [**Name8 (MD) 162**], MD [**Telephone/Fax (1) 2574**]
Building: [**Hospital6 29**] [**Location (un) 858**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: CARDIAC SERVICES
When: WEDNESDAY [**2175-10-25**] at 11:00 AM
With: [**First Name8 (NamePattern2) 1903**] [**Last Name (NamePattern1) 1904**], NP [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Infection and inflammatory reaction due to indwelling urinary catheter,Acute kidney failure, unspecified,Other primary cardiomyopathies,Hyposmolality and/or hyponatremia,Chronic systolic heart failure,Atrial fibrillation,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Delirium due to conditions classified elsewhere,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Urinary tract infection, site not specified,Other iatrogenic hypotension,Other diuretics causing adverse effects in therapeutic use,Heart valve replaced by transplant,Abnormal coagulation profile,Anticoagulants causing adverse effects in therapeutic use,Sciatica,Chronic kidney disease, unspecified,Unspecified acquired hypothyroidism,Personal history of venous thrombosis and embolism,Constipation, unspecified,Coronary atherosclerosis of native coronary artery'}


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: Hypotension

PRESENT ILLNESS: [**Age over 90 **]F AF on warfarin (goal INR 3 as previous atrial emboli), s/p
MVR with tissue valve, history of DVT, PE (DVT [**11-19**], PE '[**57**]),
CHF/cardiomyopathy EF 15-20 %, HTN, previous strokes presenting
from rehabilitation where she is for a recent mechanical fall
complicated by lower back pain, recurrent UTI, A. fib on
Coumadin presenting with hypotension and leukocytosis from rehab
in the context of a long term indwelling foley. EMS was called
for asymptomatic hypotension at rehab (76/54) with initial EMS
VS BP 81/46 with repeat 82/49 and HR in 60s. The impression of
the rehab per note was no constitutional symptoms such as fever,
chills, or major change in clinical appearance. She was not
started empirically on antibiotics. It was favored to be an UTI
in setting of indwelling foley for urinary retention. Her WBC on
[**8-11**] was 8.4 with WBC 18.4 on [**2175-8-16**] with 91.5 % neutrophils.

MEDICAL HISTORY: Afib on coumadin (goal INR 3)
hx of DVT, PE (DVT [**11-19**], PE '[**57**])
CHF/cardiomyopathy EF 20-25%, last echo [**3-23**]
Moderate Tricuspid Regurgitation
s/p MVR w/porcine tissue '[**61**]
HTN (SBP 120's at baseline)
hypothyroidism
atrial emboli- INR should be 3
DJD
h/o CVA p/w slurred speech and facial droop
CKD baseline Cr 1.4-1.6

MEDICATION ON ADMISSION: - acetaminophen 975 mg PO TID
- ASA 81 mg PO qD
- calcium carbonate 650 mg PO BID
- cholecalciferol 1000 unit PO qD
- levothyroxine 88 mcg PO qD
- lidocaine patch PO qD
- losartan 25 mg PO qD
- metoprolol succinate 12.5 mg PO qD
- torsemide 30 mg PO TID
- warfarin 5 mg PO qPM
- oxycodone 5 mg PO BID
- oxycodone IR 5 mg PO q 4 hr prn pain

ALLERGIES: Ace Inhibitors

PHYSICAL EXAM: Admission:

FAMILY HISTORY: SSA trait
No hx of stroke, DM, HTN or heart disease

SOCIAL HISTORY: Pt normally lives alone when not in rehab, does some of cooking,
has cleaning and shopping aid, has three daughters who are very
supportive. Walks very short distances, slowly, with walker but
primarily in wheel chair. Denies EtOH, tobacco and illicits. 

### Response:
{'Infection and inflammatory reaction due to indwelling urinary catheter,Acute kidney failure, unspecified,Other primary cardiomyopathies,Hyposmolality and/or hyponatremia,Chronic systolic heart failure,Atrial fibrillation,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Delirium due to conditions classified elsewhere,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Urinary tract infection, site not specified,Other iatrogenic hypotension,Other diuretics causing adverse effects in therapeutic use,Heart valve replaced by transplant,Abnormal coagulation profile,Anticoagulants causing adverse effects in therapeutic use,Sciatica,Chronic kidney disease, unspecified,Unspecified acquired hypothyroidism,Personal history of venous thrombosis and embolism,Constipation, unspecified,Coronary atherosclerosis of native coronary artery'}
