CHIEF COMPLAINT: Respiratory distress

PRESENT ILLNESS: 80 yo female w/ hx of COPD, PMHx as below sent by chronic care
facility for fever ( T 101), hypoxia (83% 3L MC per ED), and
agitation. Patient was found to have UTI at chronic care
facility and wsa given levaquin x 5 days then macrobid after,
but continued to spike 101.  Patient then began to be dyspnic
and hypoxic, and pt was transferred to [**Hospital1 18**] ED.  In [**Name (NI) **] pt was
given solumedrol and neb en route for COPD exacerbation and went
to 97% on 4L. On arrival, T 99.8, BP 97-157, 90-93% 3L with
initial ABG: 7.21/PO2 77/PCO2 107/ HCO3 45; last ABG on NIMV (Vt
350/35/0/0.35): 7.27/80/91/44.   Patient was then placed on
BIPAP and transferred to [**Hospital Unit Name 153**].

MEDICAL HISTORY: 1. Catatonic schizophrenia.
2. COPD (on home 02 for COPD, baseline 98% 2L)
3. History of PPD positive.
4. Kyphosis.
5. Osteoporosis with history of humeral fracture.
6. Hypothyroidism.
7. Question history of aspiration pneumonia.

MEDICATION ON ADMISSION: Synthroid
Depakote
Zyprexa
ASA
Vitamin C
Ativan
Ranitidine
Macrobid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 98.8 BP 116/48 P 70 RR 24 O2 sat 93%
Gen: agitated
HEENT: Rhytmic movement of lips and tongue, slightly tremulous
Lungs: CTA bilaterally
Cor: RRR, nl S1, S2, no M/R/G
Abd: +BS, soft, NTND, tender LLQ, no rebound/guarding
Ext warm, no clubbing/cyanosis/edema
Neuro: Resting tremor, stiff, cogwheel rigidity.  Pt nonverbal.

FAMILY HISTORY: 

SOCIAL HISTORY: DNR/DNI
Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Urinary tract infection, site not specified,Hyperosmolality and/or hypernatremia,Unspecified schizophrenia, unspecified,Unspecified acquired hypothyroidism
Acute respiratry failure,Obs chr bronc w(ac) exac,Urin tract infection NOS,Hyperosmolality,Schizophrenia NOS-unspec,Hypothyroidism NOS
Admission Date:  [**2140-7-21**]              Discharge Date:   [**2140-7-25**]


Service: MED

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 6029**]
Chief Complaint:
Respiratory distress

Major Surgical or Invasive Procedure:
None


History of Present Illness:
80 yo female w/ hx of COPD, PMHx as below sent by chronic care
facility for fever ( T 101), hypoxia (83% 3L MC per ED), and
agitation. Patient was found to have UTI at chronic care
facility and wsa given levaquin x 5 days then macrobid after,
but continued to spike 101.  Patient then began to be dyspnic
and hypoxic, and pt was transferred to [**Hospital1 18**] ED.  In [**Name (NI) **] pt was
given solumedrol and neb en route for COPD exacerbation and went
to 97% on 4L. On arrival, T 99.8, BP 97-157, 90-93% 3L with
initial ABG: 7.21/PO2 77/PCO2 107/ HCO3 45; last ABG on NIMV (Vt
350/35/0/0.35): 7.27/80/91/44.   Patient was then placed on
BIPAP and transferred to [**Hospital Unit Name 153**].

Past Medical History:
1. Catatonic schizophrenia.
2. COPD (on home 02 for COPD, baseline 98% 2L)
3. History of PPD positive.
4. Kyphosis.
5. Osteoporosis with history of humeral fracture.
6. Hypothyroidism.
7. Question history of aspiration pneumonia.


Social History:
DNR/DNI

Physical Exam:
T 98.8 BP 116/48 P 70 RR 24 O2 sat 93%
Gen: agitated
HEENT: Rhytmic movement of lips and tongue, slightly tremulous
Lungs: CTA bilaterally
Cor: RRR, nl S1, S2, no M/R/G
Abd: +BS, soft, NTND, tender LLQ, no rebound/guarding
Ext warm, no clubbing/cyanosis/edema
Neuro: Resting tremor, stiff, cogwheel rigidity.  Pt nonverbal.

Pertinent Results:
[**2140-7-20**] 03:30PM BLOOD WBC-9.3 RBC-3.89* Hgb-11.8* Hct-37.2
MCV-96 MCH-30.3 MCHC-31.6 RDW-13.9 Plt Ct-199
[**2140-7-20**] 03:30PM BLOOD Neuts-46.8* Lymphs-45.0* Monos-4.2
Eos-3.8 Baso-0.3
[**2140-7-21**] 01:00AM BLOOD Glucose-159* UreaN-28* Creat-0.6 Na-147*
K-4.9 Cl-105 HCO3-38* AnGap-9
[**2140-7-23**] 07:23AM BLOOD Type-ART Temp-36.4 Rates-/35 O2 Flow-36
pO2-141* pCO2-59* pH-7.39 calHCO3-37* Base XS-8
[**2140-7-22**] 02:54AM BLOOD Type-ART PEEP-10 O2-35 pO2-85 pCO2-71*
pH-7.33* calHCO3-39* Base XS-7 Intubat-NOT INTUBA
[**2140-7-20**] 09:47PM BLOOD Type-ART pO2-65* pCO2-100* pH-7.24*
calHCO3-45* Base XS-10
[**2140-7-23**] 07:23AM BLOOD Glucose-113* Lactate-1.4 Na-144 K-5.0
Cl-108
[**2140-7-20**] 10:15PM URINE  HOURS-RANDOM SODIUM-17 CALCIUM-11.4
[**2140-7-20**] 10:15PM URINE  OSMOLAL-590
[**2140-7-20**] 06:00PM URINE  BLOOD-TR NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2140-7-20**] 06:00PM URINE  RBC-0 WBC-<1 BACTERIA-NONE YEAST-NONE
EPI-<1

CXR ([**2140-7-20**])
FINDINGS: The heart is top normal in size and the mediastinal
contours are unremarkable. There is atelectasis at the left lung
base. There is no evidence of CHF or pneumonia. There is no
pneumothorax. A healed right humeral neck fracture is noted. The
bones are demineralized.

IMPRESSION: Left base atelectasis. No failure or pneumonia.


Brief Hospital Course:
1) Respiratory failure: Patient was transferred to ICU for NIMV
for hypoxia and hypercapnea for presumable COPD exacerbation.
Patient was given Solu-medrol and nebulizer which showed
improvement.  BIPAP was weaned off, however, patient became
intermittently somnolent on nasal cannula and had to be put back
on BIPAP.  Patient continued to have day time somnolence with
desaturations on nasal canula requiring BIPAP.  There was a
question of obstructive sleep pnea vs restrictive/obstructive
lung dz scondarty to kyphosis. Patient's oxygen saturation was
generally maintatined >90% but <95% since pt has COPD and needs
hypoxic respiratory drive.  Solu-medrol was taper to prednisone
po and patient will be discharged with prednisone taper.
Doxycycline was initially started for possible infectious cause
as a trigger.  Since CXR was unlikely for pneumonia, doxycycline
was discontinued in 2 days.  Patient did well with nasal canula
the last 36 hrs but there is a possibility that patient may
become somnolent and hypoxic again.  This was discussed with her
PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] who agrees that patient will no be put back on
BIPAP if she were to get hypoxic at the rehab.  Patient may
benefit from sleep studies to evluate for obstructive sleep
apnea.

2) UTI: Patient came in with UTI, finished [**7-20**] day course of
macrobid.  Repeat urine culture was negative.

3) Schizophrenia: Patient with history of catatonic
schizophrenia.  Patient remained on Zyprexa, Ativan, Depakote
throughout admission.  Per PCP [**Name9 (PRE) 7027**], [**Name9 (PRE) 7130**] was
changed to 5 mg qAM and 2.5 mg qPM.

4) Hypothyroid:  TSH normal.  Patient was on levothyroxine.


Medications on Admission:
Synthroid
Depakote
Zyprexa
ASA
Vitamin C
Ativan
Ranitidine
Macrobid

Discharge Medications:
1. Multivitamin     Capsule Sig: One (1) Cap PO QD (once a day).

2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Levothyroxine Sodium 112 mcg Tablet Sig: One (1) Tablet PO QD
(once a day).
4. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO QD (once a day).
5. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
7. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

8. Divalproex Sodium 125 mg Capsule, Sprinkle Sig: Two (2)
Capsule, Sprinkle PO QAM (once a day (in the morning)).
9. Divalproex Sodium 125 mg Capsule, Sprinkle Sig: One (1)
Capsule, Sprinkle PO QHS (once a day (at bedtime)).
10. Heparin Sodium (Porcine) 5,000 unit/mL Solution Sig: 5000
(5000) units Injection Q12H (every 12 hours).
11. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**1-15**]
Puffs Inhalation Q6H (every 6 hours).
12. Zyprexa 5 mg Tablet Sig: One (1) Tablet PO qAM.
13. Zyprexa 2.5 mg Tablet Sig: One (1) Tablet PO qPM.
14. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed.
15. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID W/MEALS (3 TIMES A DAY WITH MEALS).
16. Prednisone 10 mg Tablet Sig: Five (5) Tablet PO qd () for 2
doses.
17. Prednisone 20 mg Tablet Sig: Two (2) Tablet PO qd () for 2
doses.
18. Prednisone 10 mg Tablet Sig: Three (3) Tablet PO qd () for 2
doses.
19. Prednisone 20 mg Tablet Sig: One (1) Tablet PO qd () for 2
doses.
20. Prednisone 10 mg Tablet Sig: One (1) Tablet PO qd () for 2
doses.
21. Prednisone 5 mg Tablet Sig: One (1) Tablet PO qd () for 2
doses.
22. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day) as needed.
23. Albuterol Sulfate 0.083 % Solution Sig: [**1-15**]  Inhalation Q6H
(every 6 hours).
24. Ipratropium Bromide 0.02 % Solution Sig: [**1-15**]  Inhalation Q6H
(every 6 hours).


Discharge Disposition:
Extended Care

Facility:
[**Doctor First Name 391**] Bay - [**Hospital1 392**]

Discharge Diagnosis:
1. COPD
2. Hypernatremia
3. Catatonic schizophrenia
4. Hypothyroidism
5. +PPD
5. Kyphosis
6. UTI


Discharge Condition:
Patient's condition is fair and stable.  Patient was breathing
comfortably without mask ventilation at the time of discharge.

Discharge Instructions:
Patient may need to have oxygen via nasal canula if she becomes
hypoxic but no further intervention (BIPAP) is needed.  Patient
needs to be seen by her PCP or [**Name9 (PRE) **], if she develops fever/chills,
worsening SOB, cyanosis, palpitation, or diaphoresis.

Followup Instructions:
Patient needs to be seen by her PCP as soon as possible.


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 6035**]

Completed by:[**2140-7-25**]
{'Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Urinary tract infection, site not specified,Hyperosmolality and/or hypernatremia,Unspecified schizophrenia, unspecified,Unspecified acquired hypothyroidism'}


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: Respiratory distress

PRESENT ILLNESS: 80 yo female w/ hx of COPD, PMHx as below sent by chronic care
facility for fever ( T 101), hypoxia (83% 3L MC per ED), and
agitation. Patient was found to have UTI at chronic care
facility and wsa given levaquin x 5 days then macrobid after,
but continued to spike 101.  Patient then began to be dyspnic
and hypoxic, and pt was transferred to [**Hospital1 18**] ED.  In [**Name (NI) **] pt was
given solumedrol and neb en route for COPD exacerbation and went
to 97% on 4L. On arrival, T 99.8, BP 97-157, 90-93% 3L with
initial ABG: 7.21/PO2 77/PCO2 107/ HCO3 45; last ABG on NIMV (Vt
350/35/0/0.35): 7.27/80/91/44.   Patient was then placed on
BIPAP and transferred to [**Hospital Unit Name 153**].

MEDICAL HISTORY: 1. Catatonic schizophrenia.
2. COPD (on home 02 for COPD, baseline 98% 2L)
3. History of PPD positive.
4. Kyphosis.
5. Osteoporosis with history of humeral fracture.
6. Hypothyroidism.
7. Question history of aspiration pneumonia.

MEDICATION ON ADMISSION: Synthroid
Depakote
Zyprexa
ASA
Vitamin C
Ativan
Ranitidine
Macrobid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 98.8 BP 116/48 P 70 RR 24 O2 sat 93%
Gen: agitated
HEENT: Rhytmic movement of lips and tongue, slightly tremulous
Lungs: CTA bilaterally
Cor: RRR, nl S1, S2, no M/R/G
Abd: +BS, soft, NTND, tender LLQ, no rebound/guarding
Ext warm, no clubbing/cyanosis/edema
Neuro: Resting tremor, stiff, cogwheel rigidity.  Pt nonverbal.

FAMILY HISTORY: 

SOCIAL HISTORY: DNR/DNI 

### Response:
{'Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Urinary tract infection, site not specified,Hyperosmolality and/or hypernatremia,Unspecified schizophrenia, unspecified,Unspecified acquired hypothyroidism'}
