CHIEF COMPLAINT: SOB

PRESENT ILLNESS: 88 y.o woman with metastatic [**First Name3 (LF) 499**] cancer to the liver, possible
primary pancreatic cancer, recent dx of UTI on cipro, who
presented to the hospital after developing acute shortness of
breath at home. The patient was at home at her [**Hospital3 **]
when her aide noticed her to be in acute respiratory distress.
The aid called her son in law, who is a physician, [**Name10 (NameIs) **] because
the hospice agency was unable to come to evaluate, he decided to
bring her to the hospital.
.
Of note, the patient had recently been admitted to the hospital
on [**4-7**] for tachycardia, cough, found to have a bandemia and was
treated for pneumonia. During that admission, after extensive
consultations with palliative care and given the patient's
underlying oncologic disease, she was discharged with PO
antibiotics and was placed in hospice care the day after.
According to his chart in OMR, the family has been actively
involved in the decision to place her in hospice as the patient
herself has not wanted to know anything about her diagnosis.
.
In the ED, initial vs were: T 97.9 P 113 BP 170/90 R 23 O2 sat
99% on NRB. Patient was given Vancomycin 1 gram IV x1 and Ativan
2 mg IV x1. Zosyn was ordered but not given in the ED. She was
also given 40mg IV lasix enroute by EMS. The patient was
hypoxic, and was placed on Bipap 40%, [**9-15**], drawing a tidal
volume of 400cc with minute ventilation of 16. Vitals on
transfer were HR 110, BP 135/87, RR 40 O2 sat of 100%.

MEDICAL HISTORY: - Biopsy proven [**Month/Day (1) 499**] ca, possible pancreatic cancer, and
possible liver mets (not Bx proven). The family knows, however,
the patient does not and apparently the PCP has been in
discussion with the family, and the patient has told the PCP she
does not want to know her diagnosis. They feel she will be
anxious and depressed and do not want her to know.
-HTN
-glaucoma
-OA
-?Rheum dx
-LBP
-gait disorder
-stage I pressure ulcer on kyphotic area of spine, noted [**2-18**]
-GERD
-Depression
-Extensive bilateral DVT's seen on u/s [**2-18**] with IVC filter in
place
-pulmonary artery hypertension

MEDICATION ON ADMISSION: Acetaminophen 500 mg Tablet Two (2) Tablet by mouth three times
a day.
Calcitonin (Salmon) 200 unit/Actuation Aerosol, Spray One (1)
spray Nasal DAILY (Daily).
Calcium Carbonate 500 mg Tablet, Chewable One (1) Tablet,
Chewable by mouth four times a day.
Ciprofloxacin 500mg [**Hospital1 **]
Cholecalciferol (Vitamin D3)400 unit Tablet Two (2) Tablet by
mouth DAILY (Daily).
Docusate Sodium 100 mg Capsule One (1) Capsule by mouth twice a
day
Duloxetine 20 mg Capsule, Delayed Release(E.C.) Two (2) Capsule,
Delayed Release(E.C.) by mouth DAILY (Daily).
Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated [**12-14**]
Adhesive Patch, Medicateds Topical DAILY (Daily) as needed for
pain.
Lorazepam 0.5 mg Tablet One (1) Tablet by mouth every four (4)
hours as needed for anxiety.
Magnesium Hydroxide 400 mg/5 mL Suspension Thirty (30) ML by
mouth every six (6) hours as needed for constipation.
Metoprolol XL 50 mg Tablet One (1) Tablet by mouth once a day.
Mirtazapine 30 mg Tablet One (1) Tablet by mouth HS (at
bedtime).
Oxycodone 10 mg Tablet Sustained Release 12 hr One (1) Tablet
Sustained Release 12 hr by mouth every twelve (12) hours.
Oxycodone 5 mg Tablet One (1) Tablet by mouth every four (4)
hours as needed for pain.
Polysaccharide Iron Complex 150 mg Capsule One (1) Capsule by
mouth DAILY (Daily).
Prednisone 5 mg Tablet One (1) Tablet by mouth DAILY (Daily).
Sennosides [Senna] 8.6 mg Tablet Two (2) Tablet by mouth HS (at
bedtime).

ALLERGIES: Amoxicillin / Sulfonamides / Penicillins

PHYSICAL EXAM: Vitals: T: 98.5 BP: 102/47 P: 100 R: 22 O2: 97% on Bipap
General: responsive to voice, in moderate distress
HEENT: BiPAP mask on
Neck: supple, JVP not elevated, no LAD
Lungs: Bilateral crackles and rhonchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, palpable cords, 2+
bilateral LE edema
Skin: diffuse ecchymoses

FAMILY HISTORY: No history of [**Location (un) 499**] cancer, IBD, breast cancer, CAD, diabetes,
rheumatic diseases, asthma.

SOCIAL HISTORY: "The patient lives in [**Hospital3 **] with a home health aide to
whom she is dearly attatched. She has two daughters, one lives
in [**Name (NI) 531**] and one in [**Location (un) 86**]. The patient went to teachers
college and worked in an engineering office. Her social supports
include her family. She does do physical therapy, but she says
that she does not do much of the activities because she gets
tired. Denies alcohol, smoking. Says that she sometimes eats 50%
of the meals; she tries to drink Boost in between. She has been
doing physical therapy, which is continuing, and apparently, she
has made progress. In terms of sleep, she says that some nights
are good and some nights are not, but she denies any pain while
sleeping or that wakes her up from sleep. She feels otherwise
safe at home."
Pneumonia, organism unspecified,Acute respiratory failure,Malignant neoplasm of colon, unspecified site,Malignant neoplasm of liver, secondary,Malignant neoplasm of pancreas, part unspecified,Encounter for palliative care,Unspecified essential hypertension,Pressure ulcer, other site,Unspecified glaucoma,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Esophageal reflux,Other chronic pulmonary heart diseases,Personal history of venous thrombosis and embolism
Pneumonia, organism NOS,Acute respiratry failure,Malignant neo colon NOS,Second malig neo liver,Malig neo pancreas NOS,Encountr palliative care,Hypertension NOS,Pressure ulcer, site NEC,Glaucoma NOS,Osteoarthros NOS-unspec,Esophageal reflux,Chr pulmon heart dis NEC,Hx-ven thrombosis/embols
Admission Date:  [**2195-5-14**]              Discharge Date:   [**2195-5-16**]


Service: MEDICINE

Allergies:
Amoxicillin / Sulfonamides / Penicillins

Attending:[**First Name3 (LF) 710**]
Chief Complaint:
SOB

Major Surgical or Invasive Procedure:
none

History of Present Illness:
88 y.o woman with metastatic [**First Name3 (LF) 499**] cancer to the liver, possible
primary pancreatic cancer, recent dx of UTI on cipro, who
presented to the hospital after developing acute shortness of
breath at home. The patient was at home at her [**Hospital3 **]
when her aide noticed her to be in acute respiratory distress.
The aid called her son in law, who is a physician, [**Name10 (NameIs) **] because
the hospice agency was unable to come to evaluate, he decided to
bring her to the hospital.
.
Of note, the patient had recently been admitted to the hospital
on [**4-7**] for tachycardia, cough, found to have a bandemia and was
treated for pneumonia. During that admission, after extensive
consultations with palliative care and given the patient's
underlying oncologic disease, she was discharged with PO
antibiotics and was placed in hospice care the day after.
According to his chart in OMR, the family has been actively
involved in the decision to place her in hospice as the patient
herself has not wanted to know anything about her diagnosis.
.
In the ED, initial vs were: T 97.9 P 113 BP 170/90 R 23 O2 sat
99% on NRB. Patient was given Vancomycin 1 gram IV x1 and Ativan
2 mg IV x1. Zosyn was ordered but not given in the ED. She was
also given 40mg IV lasix enroute by EMS. The patient was
hypoxic, and was placed on Bipap 40%, [**9-15**], drawing a tidal
volume of 400cc with minute ventilation of 16. Vitals on
transfer were HR 110, BP 135/87, RR 40 O2 sat of 100%.

Past Medical History:
- Biopsy proven [**Month/Day (1) 499**] ca, possible pancreatic cancer, and
possible liver mets (not Bx proven). The family knows, however,
the patient does not and apparently the PCP has been in
discussion with the family, and the patient has told the PCP she
does not want to know her diagnosis. They feel she will be
anxious and depressed and do not want her to know.
-HTN
-glaucoma
-OA
-?Rheum dx
-LBP
-gait disorder
-stage I pressure ulcer on kyphotic area of spine, noted [**2-18**]
-GERD
-Depression
-Extensive bilateral DVT's seen on u/s [**2-18**] with IVC filter in
place
-pulmonary artery hypertension

Social History:
"The patient lives in [**Hospital3 **] with a home health aide to
whom she is dearly attatched. She has two daughters, one lives
in [**Name (NI) 531**] and one in [**Location (un) 86**]. The patient went to teachers
college and worked in an engineering office. Her social supports
include her family. She does do physical therapy, but she says
that she does not do much of the activities because she gets
tired. Denies alcohol, smoking. Says that she sometimes eats 50%
of the meals; she tries to drink Boost in between. She has been
doing physical therapy, which is continuing, and apparently, she
has made progress. In terms of sleep, she says that some nights
are good and some nights are not, but she denies any pain while
sleeping or that wakes her up from sleep. She feels otherwise
safe at home."

Family History:
No history of [**Location (un) 499**] cancer, IBD, breast cancer, CAD, diabetes,
rheumatic diseases, asthma.

Physical Exam:
Vitals: T: 98.5 BP: 102/47 P: 100 R: 22 O2: 97% on Bipap
General: responsive to voice, in moderate distress
HEENT: BiPAP mask on
Neck: supple, JVP not elevated, no LAD
Lungs: Bilateral crackles and rhonchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, palpable cords, 2+
bilateral LE edema
Skin: diffuse ecchymoses

Pertinent Results:
CXR:
IMPRESSION: Extensive opacification in the right middle lobe
with air bronchograms. Although the significant rotation
severely limits evaluation of this region, there is a likely
underlying infiltrate.

Brief Hospital Course:
Patient admitted to the MICU service with respiratory distress.
Thought to most likely be secondary to her known pneumonia.  She
received vancomycin in the ED and was started on cefepime and
ciprofloxacin IV as empiric coverage for HAP.  She was placed on
BiPAP overnight and then a facemask in the morning.  She seemed
comfortable.  Family meeting held on [**5-15**] regarding goals of
care.  At this point, family preferred CMO with morphine gtt.
Patient called out to floor on [**2195-5-15**] and expired [**2195-5-16**].

Medications on Admission:
Acetaminophen 500 mg Tablet Two (2) Tablet by mouth three times
a day.
Calcitonin (Salmon) 200 unit/Actuation Aerosol, Spray One (1)
spray Nasal DAILY (Daily).
Calcium Carbonate 500 mg Tablet, Chewable One (1) Tablet,
Chewable by mouth four times a day.
Ciprofloxacin 500mg [**Hospital1 **]
Cholecalciferol (Vitamin D3)400 unit Tablet Two (2) Tablet by
mouth DAILY (Daily).
Docusate Sodium 100 mg Capsule One (1) Capsule by mouth twice a
day
Duloxetine 20 mg Capsule, Delayed Release(E.C.) Two (2) Capsule,
Delayed Release(E.C.) by mouth DAILY (Daily).
Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated [**12-14**]
Adhesive Patch, Medicateds Topical DAILY (Daily) as needed for
pain.
Lorazepam 0.5 mg Tablet One (1) Tablet by mouth every four (4)
hours as needed for anxiety.
Magnesium Hydroxide 400 mg/5 mL Suspension Thirty (30) ML by
mouth every six (6) hours as needed for constipation.
Metoprolol XL 50 mg Tablet One (1) Tablet by mouth once a day.
Mirtazapine 30 mg Tablet One (1) Tablet by mouth HS (at
bedtime).
Oxycodone 10 mg Tablet Sustained Release 12 hr One (1) Tablet
Sustained Release 12 hr by mouth every twelve (12) hours.
Oxycodone 5 mg Tablet One (1) Tablet by mouth every four (4)
hours as needed for pain.
Polysaccharide Iron Complex 150 mg Capsule One (1) Capsule by
mouth DAILY (Daily).
Prednisone 5 mg Tablet One (1) Tablet by mouth DAILY (Daily).
Sennosides [Senna] 8.6 mg Tablet Two (2) Tablet by mouth HS (at
bedtime).

Discharge Medications:
N/A

Discharge Disposition:
Expired

Discharge Diagnosis:
N/A

Discharge Condition:
expired

Discharge Instructions:
N/A

Followup Instructions:
N/A


Completed by:[**2195-5-18**]
{'Pneumonia, organism unspecified,Acute respiratory failure,Malignant neoplasm of colon, unspecified site,Malignant neoplasm of liver, secondary,Malignant neoplasm of pancreas, part unspecified,Encounter for palliative care,Unspecified essential hypertension,Pressure ulcer, other site,Unspecified glaucoma,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Esophageal reflux,Other chronic pulmonary heart diseases,Personal history of venous thrombosis and embolism'}


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: SOB

PRESENT ILLNESS: 88 y.o woman with metastatic [**First Name3 (LF) 499**] cancer to the liver, possible
primary pancreatic cancer, recent dx of UTI on cipro, who
presented to the hospital after developing acute shortness of
breath at home. The patient was at home at her [**Hospital3 **]
when her aide noticed her to be in acute respiratory distress.
The aid called her son in law, who is a physician, [**Name10 (NameIs) **] because
the hospice agency was unable to come to evaluate, he decided to
bring her to the hospital.
.
Of note, the patient had recently been admitted to the hospital
on [**4-7**] for tachycardia, cough, found to have a bandemia and was
treated for pneumonia. During that admission, after extensive
consultations with palliative care and given the patient's
underlying oncologic disease, she was discharged with PO
antibiotics and was placed in hospice care the day after.
According to his chart in OMR, the family has been actively
involved in the decision to place her in hospice as the patient
herself has not wanted to know anything about her diagnosis.
.
In the ED, initial vs were: T 97.9 P 113 BP 170/90 R 23 O2 sat
99% on NRB. Patient was given Vancomycin 1 gram IV x1 and Ativan
2 mg IV x1. Zosyn was ordered but not given in the ED. She was
also given 40mg IV lasix enroute by EMS. The patient was
hypoxic, and was placed on Bipap 40%, [**9-15**], drawing a tidal
volume of 400cc with minute ventilation of 16. Vitals on
transfer were HR 110, BP 135/87, RR 40 O2 sat of 100%.

MEDICAL HISTORY: - Biopsy proven [**Month/Day (1) 499**] ca, possible pancreatic cancer, and
possible liver mets (not Bx proven). The family knows, however,
the patient does not and apparently the PCP has been in
discussion with the family, and the patient has told the PCP she
does not want to know her diagnosis. They feel she will be
anxious and depressed and do not want her to know.
-HTN
-glaucoma
-OA
-?Rheum dx
-LBP
-gait disorder
-stage I pressure ulcer on kyphotic area of spine, noted [**2-18**]
-GERD
-Depression
-Extensive bilateral DVT's seen on u/s [**2-18**] with IVC filter in
place
-pulmonary artery hypertension

MEDICATION ON ADMISSION: Acetaminophen 500 mg Tablet Two (2) Tablet by mouth three times
a day.
Calcitonin (Salmon) 200 unit/Actuation Aerosol, Spray One (1)
spray Nasal DAILY (Daily).
Calcium Carbonate 500 mg Tablet, Chewable One (1) Tablet,
Chewable by mouth four times a day.
Ciprofloxacin 500mg [**Hospital1 **]
Cholecalciferol (Vitamin D3)400 unit Tablet Two (2) Tablet by
mouth DAILY (Daily).
Docusate Sodium 100 mg Capsule One (1) Capsule by mouth twice a
day
Duloxetine 20 mg Capsule, Delayed Release(E.C.) Two (2) Capsule,
Delayed Release(E.C.) by mouth DAILY (Daily).
Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated [**12-14**]
Adhesive Patch, Medicateds Topical DAILY (Daily) as needed for
pain.
Lorazepam 0.5 mg Tablet One (1) Tablet by mouth every four (4)
hours as needed for anxiety.
Magnesium Hydroxide 400 mg/5 mL Suspension Thirty (30) ML by
mouth every six (6) hours as needed for constipation.
Metoprolol XL 50 mg Tablet One (1) Tablet by mouth once a day.
Mirtazapine 30 mg Tablet One (1) Tablet by mouth HS (at
bedtime).
Oxycodone 10 mg Tablet Sustained Release 12 hr One (1) Tablet
Sustained Release 12 hr by mouth every twelve (12) hours.
Oxycodone 5 mg Tablet One (1) Tablet by mouth every four (4)
hours as needed for pain.
Polysaccharide Iron Complex 150 mg Capsule One (1) Capsule by
mouth DAILY (Daily).
Prednisone 5 mg Tablet One (1) Tablet by mouth DAILY (Daily).
Sennosides [Senna] 8.6 mg Tablet Two (2) Tablet by mouth HS (at
bedtime).

ALLERGIES: Amoxicillin / Sulfonamides / Penicillins

PHYSICAL EXAM: Vitals: T: 98.5 BP: 102/47 P: 100 R: 22 O2: 97% on Bipap
General: responsive to voice, in moderate distress
HEENT: BiPAP mask on
Neck: supple, JVP not elevated, no LAD
Lungs: Bilateral crackles and rhonchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, palpable cords, 2+
bilateral LE edema
Skin: diffuse ecchymoses

FAMILY HISTORY: No history of [**Location (un) 499**] cancer, IBD, breast cancer, CAD, diabetes,
rheumatic diseases, asthma.

SOCIAL HISTORY: "The patient lives in [**Hospital3 **] with a home health aide to
whom she is dearly attatched. She has two daughters, one lives
in [**Name (NI) 531**] and one in [**Location (un) 86**]. The patient went to teachers
college and worked in an engineering office. Her social supports
include her family. She does do physical therapy, but she says
that she does not do much of the activities because she gets
tired. Denies alcohol, smoking. Says that she sometimes eats 50%
of the meals; she tries to drink Boost in between. She has been
doing physical therapy, which is continuing, and apparently, she
has made progress. In terms of sleep, she says that some nights
are good and some nights are not, but she denies any pain while
sleeping or that wakes her up from sleep. She feels otherwise
safe at home." 

### Response:
{'Pneumonia, organism unspecified,Acute respiratory failure,Malignant neoplasm of colon, unspecified site,Malignant neoplasm of liver, secondary,Malignant neoplasm of pancreas, part unspecified,Encounter for palliative care,Unspecified essential hypertension,Pressure ulcer, other site,Unspecified glaucoma,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Esophageal reflux,Other chronic pulmonary heart diseases,Personal history of venous thrombosis and embolism'}
