CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 67-year-old female
with a history of chronic obstructive pulmonary disease,
emphysema (forced expiratory volume 0.59) on home oxygen 2
liters nasal cannula and smokes two packs per day who
infection symptoms for three days including a cough at
baseline and sputum eight days prior Emergency Room admission
on [**2172-2-6**] PEEP.  The patient was lethargic,
somnolent, and had increased work of breathing with an oxygen
saturation in the 60s and wheezing bilaterally.  Her arterial
blood gas demonstrated a respiratory acidosis and hypocarbia.
She was placed on nasal BiPAP, albuterol and Atrovent
Emergency Room, and her oxygen saturation increased to 90% to
91%, and her arterial blood gas revealed a pH of 7.42, PCO2
of 74, and PO2 of 120.  She also complained of
nonexertional/nonradiating chest pain with no ischemic
changes on electrocardiogram.  Additionally, her code status
was discussed in the Emergency Room, and the patient was made
do not intubate, but she still desired to defibrillated.

MEDICAL HISTORY: 1.  Chronic obstructive pulmonary disease/emphysema; on home
oxygen, smokes two packs per day, forced expiratory
volume 0.59.
2.  Polycythemia.
3.  Bipolar disorder.
4.  Anxiety.
5.  Hypercholesterolemia.
6.  History of tuberculosis; childhood, has had no
reactivation, plus purified protein derivative, status post
treatment at age of five years old, multiple sputum negative
for acid-fast bacillus.
7.  Hiatal hernia.
8.  Irritable bowel syndrome.

MEDICATION ON ADMISSION: 

ALLERGIES: CODEINE (stomatitis), PHENOBARBITAL (temperature
variations), LITHIUM (increase in creatinine).

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Smokes two pack per day.  No ethanol.  No
intravenous drug use.  Lives at home with a very supportive
husband.  Married for 42 years.
Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Influenza with other respiratory manifestations,Polycythemia vera,Bipolar I disorder, most recent episode (or current) unspecified,Tobacco use disorder,Pure hypercholesterolemia,Personal history of tuberculosis,Diaphragmatic hernia without mention of obstruction or gangrene
Acute respiratry failure,Obs chr bronc w(ac) exac,Flu w resp manifest NEC,Polycythemia vera,Bipolor I current NOS,Tobacco use disorder,Pure hypercholesterolem,Prsnl hst tuberculosis,Diaphragmatic hernia
Admission Date:  [**2172-2-6**]     Discharge Date:  [**2172-2-18**]

Date of Birth:   [**2104-12-24**]     Sex:  F


HISTORY OF PRESENT ILLNESS:  This is a 67-year-old female
with a history of chronic obstructive pulmonary disease,
emphysema (forced expiratory volume 0.59) on home oxygen 2
liters nasal cannula and smokes two packs per day who
infection symptoms for three days including a cough at
baseline and sputum eight days prior Emergency Room admission
on [**2172-2-6**] PEEP.  The patient was lethargic,
somnolent, and had increased work of breathing with an oxygen
saturation in the 60s and wheezing bilaterally.  Her arterial
blood gas demonstrated a respiratory acidosis and hypocarbia.
She was placed on nasal BiPAP, albuterol and Atrovent
Emergency Room, and her oxygen saturation increased to 90% to
91%, and her arterial blood gas revealed a pH of 7.42, PCO2
of 74, and PO2 of 120.  She also complained of
nonexertional/nonradiating chest pain with no ischemic
changes on electrocardiogram.  Additionally, her code status
was discussed in the Emergency Room, and the patient was made
do not intubate, but she still desired to defibrillated.

She was transferred to the Medical Intensive Care Unit where
she was febrile with a temperature of 102.5, and 85% on
BiPAP.  Her chest x-ray was clear, hyperinflated lungs, no
signs of congestive heart failure but a nasal swab that was
positive for influenza.  She was treated with amantadine and
levofloxacin.  She was weaned from BiPAP to 2 liters nasal
cannula with an oxygen saturation of 90% to 91% at rest, but
had decreasing oxygen saturations to 70% with activity.  She
was continued on her Flomax, albuterol, and Atrovent
nebulizers, and prednisone 20 mg q.d. to improve her
respiratory condition.  She ruled out for myocardial
infarction with negative creatine kinases, CK/MB, and C
troponin.

On admission, her hematocrit was 55.4 and was 55.4 secondary
to her history of polycythemia, and was due for a blood
removal the day after admission.  Due to various blood draws,
her hematocrit decreased to 44.1 by the time the patient was
transferred from the Medical Intensive Care Unit to the
floor.  When the patient was transferred to the floor, the
patient continued to have shortness of breath but was
improving and became less dyspneic with activity such as
moving in the bed and having bowel movements.  Her cough had
decreased, but she was having difficulty coughing up her
sputum.  When able to expectorate her sputum, it was tan in
color without bright red blood.  The night before transfer to
the floor, she had nonexertional chest pain for a couple of
hours located to the right of the midline and also in the
midline of her back.  The pain did not radiate, was constant,
was relieved by Zantac.  Serax helped alleviate some of the
pain.  Additionally, she reported abdominal pain the night
before admission that was relieved by having a bowel
movement, and she currently has a baseline intermittent
constipation and diarrhea due to irritable bowel syndrome.
She was nauseated and wanted to vomit but has been unable to
do so since her hernia repair.  Her strength is slowing
progressing.  There was a re-discussion of her code status,
and the patient desired to be do not resuscitate/do not
intubate.

REVIEW OF SYSTEMS:   Dizziness when having a bowel movement,
no visual changes, no headaches.  Denies tingling and
numbness.

PAST MEDICAL HISTORY:
1.  Chronic obstructive pulmonary disease/emphysema; on home
oxygen, smokes two packs per day, forced expiratory
volume 0.59.
2.  Polycythemia.
3.  Bipolar disorder.
4.  Anxiety.
5.  Hypercholesterolemia.
6.  History of tuberculosis; childhood, has had no
reactivation, plus purified protein derivative, status post
treatment at age of five years old, multiple sputum negative
for acid-fast bacillus.
7.  Hiatal hernia.
8.  Irritable bowel syndrome.

PAST SURGICAL HISTORY:
1.  Cholecystectomy.
2.  Appendectomy.
3.  Hysterectomy.
4.  Hernia repair.
5.  Glomectomy.
6.  Treatment for asthma in [**2141**].
7.  Arterial repair of left arm laceration.
8.  Disk operations.

MEDICATIONS ON TRANSFER:  Levofloxacin 250 mg p.o. q.d.,
Navane 2 mg p.o. q.h.s., Volmax 4 mg p.o. q.h.s.,
enteric-coated aspirin 325 mg p.o. q.d., Zantac 150 mg p.o.
b.i.d., Serax 10 mg p.o. t.i.d., Atrovent meter-dosed inhaler
1 nebulizer q.4h., albuterol 1 nebulizer q.4h.,
prednisone 40 mg p.o. q.d., Atrovent nebulizers one treatment
q.1-2h. for dyspnea, albuterol 2 puffs inhaler q.3-4h.,
Tegretol 200 mg p.o. q.i.d.

ALLERGIES:  CODEINE (stomatitis), PHENOBARBITAL (temperature
variations), LITHIUM (increase in creatinine).

SOCIAL HISTORY:  Smokes two pack per day.  No ethanol.  No
intravenous drug use.  Lives at home with a very supportive
husband.  Married for 42 years.

PHYSICAL EXAMINATION ON PRESENTATION:  Vital signs were
temperature maximum of 98.1, temperature current 98.1, blood
pressure 100/60, pulse 100, respiratory rate 32, 80% on 3
liters with activity, 93% on 3 liters at rest.  The patient
was alert and oriented times three with labored breathing,
and had difficulty in talking due to shortness of breath.
Normocephalic.  Pupils were equal, round, and reactive (3 mm
to 2 mm).  Normal extraocular movements.  Anicteric.
Oropharynx was nonerythematous without exudate.  Mucous
membranes were dry with a small amount of thrush.  No
lymphadenopathy.  Heart was regular in rate and rhythm with
distant first heart sound and second heart sound.  No third
heart sound or fourth heart sound, with a question of a
systolic ejection murmur at the left upper sternal border.
No gallops or rubs.  Pulmonary examination demonstrated
coarse breath sounds with diffuse expiratory wheezes resonant
on percussion extended bilaterally.  Abdomen had positive
bowel sounds, was soft and nondistended, with mild tenderness
in the epigastrium and right upper quadrant.  The patient was
unable to lay flat for palpation of liver and spleen.
Extremities had no edema, 2+ dorsalis pedis pulses
bilaterally and warm.  Cranial nerves II to VII, IX, and X
were intact with 2+ reflexes bilaterally in the upper and
lower extremities.  Strength was not tested due to dyspnea.

PERTINENT LABORATORY DATA ON PRESENTATION:  White blood cell
count of 9.4 (with a differential of 84.4 neutrophils,
4.9 lymphocytes, 7.8 monocytes on [**2-6**]).  White blood
cell count had decreased to 6.8 on the day of transfer
([**2-7**]), hematocrit 55.4 on admission (decreased to 44.1
on [**2-11**]), platelets of 174 on admission (decreased
to 139 on transfer).  Sodium of 145, potassium 4.2, chloride
of 102, bicarbonate of 33, blood urea nitrogen of 22,
creatinine of 1.3, glucose of 82.  Calcium 7.7, magnesium 2,
phosphorous 6.  PT of 13.3, PTT of 28.6, INR of 1.2.
Creatine kinases were 100, 250, 259.  CK/MB of 2, C troponin
of less than 0.3.  Urinalysis and urine sedimentation were
negative for infection.  Sputum on [**2172-2-7**]
demonstrated sparse growth or oropharyngeal flora.  Blood
cultures from [**2172-2-7**] demonstrated no growth.  Urine
cultures from [**2172-2-8**] demonstrated no growth.

RADIOLOGY/IMAGING:  Chest x-ray on [**2172-2-12**]
demonstrated no pneumonia, no congestive heart failure, and
no pneumothorax.

HOSPITAL COURSE:  The patient is a 76-year-old female with
severe chronic obstructive pulmonary disease, emphysema, who
smokes two packs per day, and is on home oxygen, who was
admitted to the Medical Intensive Care Unit for respiratory
failure due to a chronic obstructive pulmonary disease flare
secondary to influenza infection and is now transferred to
the Medicine Service after being weaned from BiPAP for
continued management of her chronic obstructive pulmonary
disease flare.

1.  PULMONARY:  The patient apparently on levofloxacin to
prevent secondary bacterial pneumonia, status post influenza
infection, and is on prednisone for treatment of chronic
obstructive pulmonary disease flare.  The levofloxacin was
discontinued on hospital day two, and the patient continued
to have baseline cough with baseline slight tan sputum.  The
patient was continued on her Atrovent and albuterol
nebulizers p.r.n., albuterol inhaler, and prednisone taper.
The patient continued to have decreased oxygen saturations
with activity, in which she varied between approximately 90%
to 93% on 2 liters and 3 liters at rest, and decreased to 80%
on 3 liters with movement.

By the time the patient was discharged she was 92% on 3
liters at rest and 80% on 3 liters with activity.  Her
arterial blood gas on discharge demonstrated a pH of 7.35, a
PCO2 of 58, a PO2 of 66, a CO2 of 33, and a base excess of 3
on 3 liters of oxygen.

Although she continued to be dyspneic on activity, she was
able to ambulate and use the bathroom on her own.  A Physical
Therapy evaluation thought it was safe for the patient to be
discharged home with her husband's assistance and to have
home physical therapy.

2.  CARDIOVASCULAR:  The patient had cardiomegaly on chest
x-ray.  An echocardiogram was obtained to assess pulmonary
arterial pressures as well as to determine if there was a
right or left ventricular hypertrophy.  Echocardiogram
demonstrated mild dilatation of the left atrium, mild
symmetric left ventricular hypertrophy, with an ejection
fraction of greater than 55%, a mildly dilated right
ventricle with depressed systolic function, a mildly dilated
abdominal aorta, and questionable impaired relaxation of the
left ventricle.  Pulmonary artery pressures could not be
assessed on this echocardiogram.

3.  HEMATOLOGY:  The patient's hematocrit increased from 55.4
to 47.2.  Withdraw of blood was not considered necessary
unless her hematocrit increased to 50.

4.  GENITOURINARY:  The patient was at her baseline
creatinine of approximately 1.1 to 1.3.  She was continued on
her Premarin.

5.  GASTROINTESTINAL:  The patient had constipation and
alternating diarrhea due to her irritable bowel syndrome.

6.  PSYCHIATRY:  The patient was continued on her psychiatric
medications for her bipolar disorder.  Additionally, she was
placed on Serax t.i.d. p.r.n. for anxiety.  The patient
tended to become anxious when she had difficulty breathing,
and Serax helped improve her symptoms of dyspnea.

CONDITION AT DISCHARGE:  Condition on discharge was stable.

DISCHARGE STATUS:  The patient was discharged to home with a
nebulizer machine from which she would take Atrovent and
albuterol nebulizers in the a.m. and Atrovent and albuterol
inhalers p.r.n. during the day.  She was also continuing her
prednisone taper.  The patient was referred for home physical
therapy and [**Hospital6 407**].

DISCHARGE FOLLOWUP:   The patient was to follow up with
Dr. [**Last Name (STitle) 575**] in approximately eight weeks.

MEDICATIONS ON DISCHARGE:
 1.  Home oxygen; 3 liters to 4 liters at rest, 4 liters with
exertion.
 2.  Premarin 0.625 mg p.o. q.d.
 3.  Serax 10 mg p.o. t.i.d.
 4.  Atrovent nebulizers and albuterol nebulizers times one
q.a.m., Atrovent meter-dosed inhaler 2 to 4 puffs q.4-6h.
p.r.n. for dyspnea, albuterol meter-dosed inhaler 2 to 4
puffs q.4-6h. p.r.n. for dyspnea.
 5.  Prednisone taper 20 mg p.o. q.d. on [**2172-2-19**];
to 15 mg p.o. q.d. on [**2172-2-20**].
 6.  Navane 2 mg p.o. q.h.s.
 7.  Volmax 4 mg p.o. q.h.s.
 8.  Enteric-coated aspirin 325 mg p.o. q.d.
 9.  Zantac 150 mg p.o. b.i.d.
10.  Tegretol 200 mg p.o. q.i.d.
11.  Flovent 100 mcg meter-dosed inhaler 4 puffs b.i.d.
12.  Colace 100 mg p.o. b.i.d.
13.  Protonix 40 mg p.o. q.i.d.



                          [**First Name11 (Name Pattern1) 1569**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 15074**]

Dictated By:[**Name8 (MD) 29656**]

MEDQUIST36

D:  [**2172-2-18**]  22:56
T:  [**2172-2-20**]  20:05
JOB#:  [**Job Number 29657**]
{'Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Influenza with other respiratory manifestations,Polycythemia vera,Bipolar I disorder, most recent episode (or current) unspecified,Tobacco use disorder,Pure hypercholesterolemia,Personal history of tuberculosis,Diaphragmatic 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: 

PRESENT ILLNESS: This is a 67-year-old female
with a history of chronic obstructive pulmonary disease,
emphysema (forced expiratory volume 0.59) on home oxygen 2
liters nasal cannula and smokes two packs per day who
infection symptoms for three days including a cough at
baseline and sputum eight days prior Emergency Room admission
on [**2172-2-6**] PEEP.  The patient was lethargic,
somnolent, and had increased work of breathing with an oxygen
saturation in the 60s and wheezing bilaterally.  Her arterial
blood gas demonstrated a respiratory acidosis and hypocarbia.
She was placed on nasal BiPAP, albuterol and Atrovent
Emergency Room, and her oxygen saturation increased to 90% to
91%, and her arterial blood gas revealed a pH of 7.42, PCO2
of 74, and PO2 of 120.  She also complained of
nonexertional/nonradiating chest pain with no ischemic
changes on electrocardiogram.  Additionally, her code status
was discussed in the Emergency Room, and the patient was made
do not intubate, but she still desired to defibrillated.

MEDICAL HISTORY: 1.  Chronic obstructive pulmonary disease/emphysema; on home
oxygen, smokes two packs per day, forced expiratory
volume 0.59.
2.  Polycythemia.
3.  Bipolar disorder.
4.  Anxiety.
5.  Hypercholesterolemia.
6.  History of tuberculosis; childhood, has had no
reactivation, plus purified protein derivative, status post
treatment at age of five years old, multiple sputum negative
for acid-fast bacillus.
7.  Hiatal hernia.
8.  Irritable bowel syndrome.

MEDICATION ON ADMISSION: 

ALLERGIES: CODEINE (stomatitis), PHENOBARBITAL (temperature
variations), LITHIUM (increase in creatinine).

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Smokes two pack per day.  No ethanol.  No
intravenous drug use.  Lives at home with a very supportive
husband.  Married for 42 years. 

### Response:
{'Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Influenza with other respiratory manifestations,Polycythemia vera,Bipolar I disorder, most recent episode (or current) unspecified,Tobacco use disorder,Pure hypercholesterolemia,Personal history of tuberculosis,Diaphragmatic hernia without mention of obstruction or gangrene'}
