CHIEF COMPLAINT: SOB

PRESENT ILLNESS: 82 yo F w/ reported CHF, CAD, and reported COPD/obstructive lung
disease p/w increasing SOB & decreased exercise tolerance x's 2
weeks. At recent checkup ([**2120-7-9**]) was noted to have crackles on
exam and started on lasix 40mg. On follow-up 2 days later, she
noted symptomatic improvement but no increase in UOP, and lasix
was increased to 60 mg. Home nurse noted O2 sat of 87% today at
rest and 79% with exertion, with O2 sats settling persistently
in the 70's at rest, which prompted the pt to come into the ED.

MEDICAL HISTORY: #. CHF (mibi performed at [**Hospital1 112**] in [**2114**] per pt)
#. COPD, h/o childhood asthma
#. h/o MRSA PNA ([**Hospital1 882**] Hospial, [**2116**])
#. Anemia
#. CAD, s/p MI, s/p 3X stents ([**2114**]), EF baseline unknown
#. Valvular disease: mild MR, LVEF 50%, LVH (per Echo @ [**Hospital1 112**]
[**10-23**])
#. HTN (baseline SBPs in 150s)
#. Hyperlipidemia
#. Anxiety
#. Macular degeneration
#. GERD
#. h/o SBO
#. Constipation
#. h/o recurrent UTIs
#. LBP
#. s/p Left rotator cuff tear
#. DJD bilat shoulders (severe)
#. Osteoarthritis
#. Cervical Spondylosis
#. h/o Choledocholithiasis
#. h/o Cholangitis ([**Hospital 882**] Hospital, [**2116**])
#. h/o fx right elbow, s/p falls

MEDICATION ON ADMISSION: Lasix 60 mg po qd (started 3 days prior to admission)
ECASA 81 mg qd
Zocor 20 mg qhs
Flonase 0.05mg/inh [**Hospital1 **]
Claritin 10 mg po qd
Albuterol 90 mcg inh 2 puffs qid (takes only 1 - 2 x's/ day)
Nexium 40 mg po qd
Xanax 0.5 mg tid PRN (takes only qhs)
Lexapro 10 mg qd
Tylenol 500 mg X2 qhs
Lactulose 15 ml [**Hospital1 **] PRN
Eye drops o.s.
Bactroban 2% [**Last Name (un) 94018**] to RUE x3 /wk
.
** Compounded med for arthritis pain: Lidocaine 5%/Ketoprofen
15%/Dexamethasone 2%, apply [**Hospital1 **] (per pharmaacist @ [**Location (un) 1226**]
Pharmacy); 1st rx was [**2120-1-20**].
.
OTC - "Cranberry pills"
Vitamins/Supplements - Visi-Vites one tab PO QD

ALLERGIES: Ambien / Motrin / Lisinopril

PHYSICAL EXAM: Gen: Obese female in NAD.
HEENT: O/P clear. MMM. EOMI, PERRLA.
CV: Soft heart sounds, Tachycardic. No M/R/G. JVP at 9-10cm.
Pulm: fine crackles half way up the lung fields bilaterally,
harsh breath sounds.
Abd: soft NT, ND. +BS. Healed midline scars X2.
Ext: trace edema bilaterally. WWP. 1+ pedal pulses.
Neuro: AOx3. CNs intact grossly. moves all extremities.

FAMILY HISTORY: Mother- one kidney, died of PNA. Father - DM, CVA.

SOCIAL HISTORY: Roles/Relationships: Retired ([**2097**]) 1st-grade school teacher,
lives alone in own house (steps 4 in w/ railing, no steps in
house). Only family are cousins (in [**Name (NI) 2973**], MA & [**State 108**]);
supports identified are [**Name (NI) 1158**] [**Name (NI) 94017**] (Friend & HCP) & [**Initials (NamePattern4) **] [**Name (NI) **]
[**Name (NI) 3647**] (POA), her attorney. No etoh or smoking.
.
Functional Status: ADLs - independent except bathing (sponge
bath only); IADLs - independent with phone, finances; assist
with meal prep (self & MOWs), dependent on HM & friends for all
others.
.
Value-Belief: Religous affiliation - [**First Name4 (NamePattern1) 4186**] [**Last Name (NamePattern1) **]; Hobbies -
praying; social - only goes out to church.
.
Mobility: Walks with cane/RW; last fall - "slipped" [**1-27**],
positive unsteady gait
.
Assistive Devices: Uses cane & RW; Lifeline; has "grabber" to
pick-up dropped/out-of-reach items; no glasses, dentures,
hearing aids.
.
Health Maintaince: [**Hospital3 4262**] [**Name8 (MD) **] NP; HM x's 2/wk; lifeline;
MOWs; also [**Location (un) 620**] VNA
Postinflammatory pulmonary fibrosis,Acute on chronic systolic heart failure,Acute kidney failure, unspecified,Pneumonia, organism unspecified,Unspecified disorder of liver,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status
Postinflam pulm fibrosis,Ac on chr syst hrt fail,Acute kidney failure NOS,Pneumonia, organism NOS,Liver disorder NOS,Hypertension NOS,Crnry athrscl natve vssl,Status-post ptca
Admission Date:  [**2120-7-12**]              Discharge Date:   [**2120-7-23**]


Service: MEDICINE

Allergies:
Ambien / Motrin / Lisinopril

Attending:[**First Name3 (LF) 2167**]
Chief Complaint:
SOB

Major Surgical or Invasive Procedure:
none

History of Present Illness:
82 yo F w/ reported CHF, CAD, and reported COPD/obstructive lung
disease p/w increasing SOB & decreased exercise tolerance x's 2
weeks. At recent checkup ([**2120-7-9**]) was noted to have crackles on
exam and started on lasix 40mg. On follow-up 2 days later, she
noted symptomatic improvement but no increase in UOP, and lasix
was increased to 60 mg. Home nurse noted O2 sat of 87% today at
rest and 79% with exertion, with O2 sats settling persistently
in the 70's at rest, which prompted the pt to come into the ED.

Of note ROS is remarkable for: stable 2 pillow orthopnea,
diminished exercise tolerance (one room length), chronic
productive nonbloody cough X 3 years and dysuria after
completing a 7 day course of ciprofloxacin recently. She also
endorses lightheadedness on the morning of admission, hx of
falls (last in [**2120-1-20**]), and increasing unsteadiness
recently that she attributes to recent hip replacement.
.
In the ED her vitals were 97.8 111 155/67 24, o2 sat 97% on
Non-rebreather. She received albuterol and ipratropium nebs,
levofloxacin 750mg and furosemide 60mg IV and ASA 81 mg. She
recovered and was saturating 99% on NRB on trnasfer to [**Hospital Unit Name 153**].
.

Past Medical History:
#. CHF (mibi performed at [**Hospital1 112**] in [**2114**] per pt)
#. COPD, h/o childhood asthma
#. h/o MRSA PNA ([**Hospital1 882**] Hospial, [**2116**])
#. Anemia
#. CAD, s/p MI, s/p 3X stents ([**2114**]), EF baseline unknown
#. Valvular disease: mild MR, LVEF 50%, LVH (per Echo @ [**Hospital1 112**]
[**10-23**])
#. HTN (baseline SBPs in 150s)
#. Hyperlipidemia
#. Anxiety
#. Macular degeneration
#. GERD
#. h/o SBO
#. Constipation
#. h/o recurrent UTIs
#. LBP
#. s/p Left rotator cuff tear
#. DJD bilat shoulders (severe)
#. Osteoarthritis
#. Cervical Spondylosis
#. h/o Choledocholithiasis
#. h/o Cholangitis ([**Hospital 882**] Hospital, [**2116**])
#. h/o fx right elbow, s/p falls

.
<b>PSHx:</b>
#. s/p knee replacements bilaterally
#. s/p L hip replacement
#. abdominal hernias s/p repair X2
#. s/p ERCP w/ stent ([**2117-9-6**] @ [**Hospital1 882**]; Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1968**])
#. s/p ERCP w/ sphincterotomy, stone removal & stent removal
([**2117-9-17**] @ [**Hospital1 882**], Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1968**])
#. s/p Cataracts o.u.#

Social History:
Roles/Relationships: Retired ([**2097**]) 1st-grade school teacher,
lives alone in own house (steps 4 in w/ railing, no steps in
house). Only family are cousins (in [**Name (NI) 2973**], MA & [**State 108**]);
supports identified are [**Name (NI) 1158**] [**Name (NI) 94017**] (Friend & HCP) & [**Initials (NamePattern4) **] [**Name (NI) **]
[**Name (NI) 3647**] (POA), her attorney. No etoh or smoking.
.
Functional Status: ADLs - independent except bathing (sponge
bath only); IADLs - independent with phone, finances; assist
with meal prep (self & MOWs), dependent on HM & friends for all
others.
.
Value-Belief: Religous affiliation - [**First Name4 (NamePattern1) 4186**] [**Last Name (NamePattern1) **]; Hobbies -
praying; social - only goes out to church.
.
Mobility: Walks with cane/RW; last fall - "slipped" [**1-27**],
positive unsteady gait
.
Assistive Devices: Uses cane & RW; Lifeline; has "grabber" to
pick-up dropped/out-of-reach items; no glasses, dentures,
hearing aids.
.
Health Maintaince: [**Hospital3 4262**] [**Name8 (MD) **] NP; HM x's 2/wk; lifeline;
MOWs; also [**Location (un) 620**] VNA

Family History:
Mother- one kidney, died of PNA. Father - DM, CVA.

Physical Exam:
Gen: Obese female in NAD.
HEENT: O/P clear. MMM. EOMI, PERRLA.
CV: Soft heart sounds, Tachycardic. No M/R/G. JVP at 9-10cm.
Pulm: fine crackles half way up the lung fields bilaterally,
harsh breath sounds.
Abd: soft NT, ND. +BS. Healed midline scars X2.
Ext: trace edema bilaterally. WWP. 1+ pedal pulses.
Neuro: AOx3. CNs intact grossly. moves all extremities.

Pertinent Results:
ADMISSION LABS:
==============
[**2120-7-12**]  URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.012
BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG
BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG
CK(CPK)-24*CK-MB-3 cTropnT-0.01
LACTATE-3.2* K+-3.8
139 95 43
----------< 180
4.6 29 1.3
WBC-17.3* / HCT-34.3* /PLT COUNT-591*  MCV-87 MCH-29.2 MCHC-33.6
RDW-12.6
NEUTS-85.9* LYMPHS-9.9* MONOS-3.3 EOS-0.8 BASOS-0.2
PT-14.4* PTT-28.0 INR(PT)-1.3*

Lfts: ALT-24 AST- 38 CK(CPK)-48 ALK PHOS-67 AMYLASE-44 TOT
BILI-0.2
LIPASE-33
cTropnT-<0.01 CK-MB-NotDone proBNP-[**2115**]*
IRON-27* calTIBC-255* VIT B12-141* FOLATE-GREATER TH
FERRITIN-354* TRF-196*
TSH-0.76

=====
EKG:Q waves inferiorly iii, avl. LAD. Sinus tachycardia.
=====
MICRO:
Blood culture ([**2120-7-12**]): Pending.
Urine cx ([**2120-7-12**]):
======
IMAGING:
[**2120-7-12**] CXR - Pulmonary edema, bilateral effusions. Cannot
exclude retrocardiac opacity.
[**2120-7-15**] CARDIAC ECHO (TTE) - LA & RA are normal in cavity
size. Mild symmetric LVH with normal cavity size. Mild to
moderate regional LV systolic dysfunction with focal hypokinesis
of the inferolateral and anterolatreral walls. The remaining
segments contract normally (LVEF = 40 %). The estimated cardiac
index is normal (>=2.5L/min/m2). RV chamber size and free wall
motion are normal. The ascending aorta is mildly dilated. The
aortic valve leaflets (3) are mildly thickened. No AS, mild to
moderate ([**11-22**]+) AR, mild (1+) MR, mild [1+] TR . The pulmonary
artery systolic pressure could not be quantified. There is no
pericardial effusion. IMPRESSION: Mild symmetric left
ventricular hypertrophy with regional systolic dysfunction c/w
CAD (LCX terrigory). Mild-moderate aortic regurgitation. Dilated
ascending aorta.
[**2120-7-15**] CHEST (PA & LAT) - Since [**2120-7-12**] and
yesterday, lung volumes remain low. Bilateral subpleural
interstitial markings are still very prominent suggesting severe
interstitial lung disease. Cardiomegaly is unchanged. Bilateral
pleural effusions are small and unchanged, probably related to
residual prior CHF. Incidentally, severe degenerative changes
and deformity of both gleno-humeral joints are unchanged, mostly
prominent on the right. Thoracic deformity with S- shaped
scoliosis is unchanged. Baseline HRCT is recommended for further
characterization of underlying ILD.
[**2120-7-16**] High Resolution Chest CT: IMPRESSION:
1. The pattern of pulmonary fibrosis that favors fibrotic NSIP
over UIP.
2. Signs of cardiomegaly and pulmonary hypertension.
3. Two highly suspicious hypodense liver lesions.
4. Extensive degeneration and destruction at the level of the
shoulder
joints.
================
DISCHARGE LABS:
141  94  48  133   AGap=15
-----------<
4.3  36  1.0
Ca: 10.0 Mg: 2.2 P: 3.6
22.3 / 32.9 / 677
PT: 14.0  PTT: 30.6  INR: 1.2
CK: 10  MB: 2  Trop-T: <0.01
CK: 10  MB: 2  Trop-T: <0.01
CK: 18  MB: 3  Trop-T: <0.01
LFTs ALT: 16 AP: 63 Tbili: 0.2 Alb: 3.1  AST: 21 LDH: 253
ESR- 111

MICRO:
Blood culture ([**2120-7-12**]): NTD
Sputum cx (8/.27/8/28) - contaminated
Urine cx ([**2120-7-12**]): negative
==============

Brief Hospital Course:
82 y.o. F w/ CAD, CHF and reported COPD, who p/w hypoxia and
leukocytosis.

Hypoxia: The patient was admitted to the ICU for her hypoxia.
The hypoxia was multifactorial, due in large part to diastolic
CHF exacerbation (BNP [**2111**] on admission); with contributions
from underlying severe interstitial lung disease and possible
CAP given leukocytosis and infiltrate seen on admission CXR. She
ruled out for MI with Cardiac enzymes negative x 3. An echo
showed diminished systolic function EF 40% and inferior
hypokinesis. She was also started on IV diuresis for net
negative goal, with high dose lasix. A course of empiric
antibiotics to cover CAP and MRSA with azithromycin,
ceftriaxone, and vancomycin were started. Nebulizers and
Supplemental oxygen was provided with successful transition from
non-rebreather to nasal cannula 3-4 L on transfer. While on the
floor, pulmonary was consulted to evaluate the nature of her
underlying lung disease (as she was on nebulizers on admission
without documentation of COPD and no hx of smoking). A chest CT
revealed extensive fibrotic lung disease consistent with either
UIP or NSIP, and PFTs revealed a severe restrictive defect
consistent with an interstitial lung disease. Pulmonary was
consulted and recommended to start a [**2-25**] week course of
prednisone 0.5mg/kg on [**2120-7-18**], to follow up with Pulmonary in
[**11-22**] months and follow up CT chest without contrast and PFTs. She
completed a 5 day course of azithro and ceftriaxone, and was
stable on 5L O2 by NC by day of expected discharge, but was
retransfered to the ICU for what appeared to be worsening
hypoxia on the floor. This may have been due to a titration of
her O2 down to 2L overnight in combination with transder to
commode. However O2 sats were persistently at 90 on full fask
mask with 10%O2.  In the ICU she remained stable on 4L. She was
transferred back to the floor to await rehab placement. She was
stable on 4-5L oxygen. This will need to be adjusted, and likely
uptitrated with ambulation to maintain oxygen saturations >90%.

ARF: On admission, she had acute renal failure of 1.3 likely
hypovolemic and improving to 1.1 the next day and remaining
stable through diuresis throughout her course. She is currently
euvolemic, receiving lasix prn.

.
CAD s/p stents/acute on chronic systolic CHF (EF 40%): she was
continued on ASA and Zocor and started on metoprolol.  She
reported intolerance to beta-blocker and ACE-I but currently is
tolerating a low dose BB. She should have her weight taken daily
and receive lasix prn.
.
Leukocytosis: Elevated WBC at admission, initially thought to be
[**12-23**] PNA and received 7 day course of antibiotic with some
decrease. However CT scan negative for infiltrate, and
leukocytosis increased prior to initiation of steroids.
Infectius w/up remains negative. Suspect may be due to possible
malignancy but will defer w/up at this time given patients focus
more on comfort.
.
Thrombocytosis: she exhibited rising platelets over her course,
most likely reactive in setting of recent PNA, elevated ESR, or
malignancy given lesion on liver seen on  recent CTscan.
 .
For chronic pain in shoulders and legs, and new complaint of
hyperesthesia, she was started on gabapentin and lidocaine patch
with relief.
.
LUE skin tear: A skin tear was identified and dressed with
bactroban + gauze.
.
Anxiety, she was continued on Xanax prn initially per home
regimen.
.
For Macular degeneration, her steriod eye drops were continued.
.
Heaptic Lesions: Two hypodense liver lesions concerning for
malignancy were documented incidentally on CT [**2120-7-18**], and the
patient expressed no desire to have follow up. She confirms that
she would not want chemo/radiation/surgery so therefore would
not want biopsy.
.
She had a bedside swallow eval on [**2120-7-15**], that concluded she
had funcional oral and pharyngeal swallow but is at increased
risk for aspiration due to impulsivity. She was recommended to
have a regular diet and thin liquids with encouragement to slow
rate of intake. Recommended adaptive equipment to assist with
self feeding.
.
She was started on a PPI, MVI and Ca and Vit D while on
steriods.

Advance Directives: Patient is clear her wishes are DNR/DNI with
focus on symptom management. She agrees to any non-invasive
work-up but does not want anything invasive, i.e. biopsies.

Medications on Admission:
Lasix 60 mg po qd (started 3 days prior to admission)
ECASA 81 mg qd
Zocor 20 mg qhs
Flonase 0.05mg/inh [**Hospital1 **]
Claritin 10 mg po qd
Albuterol 90 mcg inh 2 puffs qid (takes only 1 - 2 x's/ day)
Nexium 40 mg po qd
Xanax 0.5 mg tid PRN (takes only qhs)
Lexapro 10 mg qd
Tylenol 500 mg X2 qhs
Lactulose 15 ml [**Hospital1 **] PRN
Eye drops o.s.
Bactroban 2% [**Last Name (un) 94018**] to RUE x3 /wk
.
** Compounded med for arthritis pain: Lidocaine 5%/Ketoprofen
15%/Dexamethasone 2%, apply [**Hospital1 **] (per pharmaacist @ [**Location (un) 1226**]
Pharmacy); 1st rx was [**2120-1-20**].
.
OTC - "Cranberry pills"
Vitamins/Supplements - Visi-Vites one tab PO QD

Discharge Medications:
1. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
injection Injection TID (3 times a day): while patient is not
ambulating.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
4. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
6. Escitalopram 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily) as
needed for   one on each shoulder: Place on for 12 hours
starting at 8 am, and take off at 8 pm. .
8. Trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as
needed.
9. Prednisone 10 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
10. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Calcium Acetate 667 mg Capsule Sig: Two (2) Capsule PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
12. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
13. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
14. Dexamethasone 0.1 % Drops, Suspension Sig: One (1) Drop
Ophthalmic Q6H (every 6 hours).
15. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
16. Cyanocobalamin 500 mcg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
17. Nystatin 100,000 unit/g Cream Sig: One (1) Appl Topical [**Hospital1 **]
(2 times a day).
18. Lactulose 10 gram/15 mL Syrup Sig: Fifteen (15) ML PO BID (2
times a day) as needed.
19. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
20. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO TID (3
times a day): for pain related to DJD.
21. Insulin Regular Human 100 unit/mL Solution Sig: One (1) dose
Injection ASDIR (AS DIRECTED): Per sliding scale.


Discharge Disposition:
Extended Care

Facility:
[**Doctor First Name 533**] centre for extended care (deutsches Altenheim)

Discharge Diagnosis:
Primary Diagnosis:
=================
Interstitial lung disease
Hypoxemia
Acute on chronic systolic congestive heart failure
Leukocytosis
Thrombocytosis
Hepatic masses
Community acquired pneumonia
.
Secondary:
=========
Degenerative joint disease
Acute renal failure


Discharge Condition:
Stable.


Discharge Instructions:
You were admitted to the hospital after experiencing increasing
shortness of breath. In the emergency room you were felt to have
heart failure, chronic lung disease and pneumonia. You were
initially admitted to the ICU and then transferred to the floor.


If you develop increased shortness of breath, fevers, chills, or
increasing cough, please call your primary care doctor.


Followup Instructions:
Please follow up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] from Pulmonary [**11-22**]
months from time of discharge. Please call [**Telephone/Fax (1) 612**] to make
an appointment. You will need to have another CT scan and
pulmonary function tests done at this time.

Please contact [**Name (NI) 4457**] [**Name (NI) 10686**] primary nurse practitioner [**First Name (Titles) 767**] [**Hospital3 94019**] Group with discharge plan when patient is to be
discharged from rehabilitation. The number to call is
([**Telephone/Fax (1) 30577**], option 4.
{'Postinflammatory pulmonary fibrosis,Acute on chronic systolic heart failure,Acute kidney failure, unspecified,Pneumonia, organism unspecified,Unspecified disorder of liver,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status'}


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: 82 yo F w/ reported CHF, CAD, and reported COPD/obstructive lung
disease p/w increasing SOB & decreased exercise tolerance x's 2
weeks. At recent checkup ([**2120-7-9**]) was noted to have crackles on
exam and started on lasix 40mg. On follow-up 2 days later, she
noted symptomatic improvement but no increase in UOP, and lasix
was increased to 60 mg. Home nurse noted O2 sat of 87% today at
rest and 79% with exertion, with O2 sats settling persistently
in the 70's at rest, which prompted the pt to come into the ED.

MEDICAL HISTORY: #. CHF (mibi performed at [**Hospital1 112**] in [**2114**] per pt)
#. COPD, h/o childhood asthma
#. h/o MRSA PNA ([**Hospital1 882**] Hospial, [**2116**])
#. Anemia
#. CAD, s/p MI, s/p 3X stents ([**2114**]), EF baseline unknown
#. Valvular disease: mild MR, LVEF 50%, LVH (per Echo @ [**Hospital1 112**]
[**10-23**])
#. HTN (baseline SBPs in 150s)
#. Hyperlipidemia
#. Anxiety
#. Macular degeneration
#. GERD
#. h/o SBO
#. Constipation
#. h/o recurrent UTIs
#. LBP
#. s/p Left rotator cuff tear
#. DJD bilat shoulders (severe)
#. Osteoarthritis
#. Cervical Spondylosis
#. h/o Choledocholithiasis
#. h/o Cholangitis ([**Hospital 882**] Hospital, [**2116**])
#. h/o fx right elbow, s/p falls

MEDICATION ON ADMISSION: Lasix 60 mg po qd (started 3 days prior to admission)
ECASA 81 mg qd
Zocor 20 mg qhs
Flonase 0.05mg/inh [**Hospital1 **]
Claritin 10 mg po qd
Albuterol 90 mcg inh 2 puffs qid (takes only 1 - 2 x's/ day)
Nexium 40 mg po qd
Xanax 0.5 mg tid PRN (takes only qhs)
Lexapro 10 mg qd
Tylenol 500 mg X2 qhs
Lactulose 15 ml [**Hospital1 **] PRN
Eye drops o.s.
Bactroban 2% [**Last Name (un) 94018**] to RUE x3 /wk
.
** Compounded med for arthritis pain: Lidocaine 5%/Ketoprofen
15%/Dexamethasone 2%, apply [**Hospital1 **] (per pharmaacist @ [**Location (un) 1226**]
Pharmacy); 1st rx was [**2120-1-20**].
.
OTC - "Cranberry pills"
Vitamins/Supplements - Visi-Vites one tab PO QD

ALLERGIES: Ambien / Motrin / Lisinopril

PHYSICAL EXAM: Gen: Obese female in NAD.
HEENT: O/P clear. MMM. EOMI, PERRLA.
CV: Soft heart sounds, Tachycardic. No M/R/G. JVP at 9-10cm.
Pulm: fine crackles half way up the lung fields bilaterally,
harsh breath sounds.
Abd: soft NT, ND. +BS. Healed midline scars X2.
Ext: trace edema bilaterally. WWP. 1+ pedal pulses.
Neuro: AOx3. CNs intact grossly. moves all extremities.

FAMILY HISTORY: Mother- one kidney, died of PNA. Father - DM, CVA.

SOCIAL HISTORY: Roles/Relationships: Retired ([**2097**]) 1st-grade school teacher,
lives alone in own house (steps 4 in w/ railing, no steps in
house). Only family are cousins (in [**Name (NI) 2973**], MA & [**State 108**]);
supports identified are [**Name (NI) 1158**] [**Name (NI) 94017**] (Friend & HCP) & [**Initials (NamePattern4) **] [**Name (NI) **]
[**Name (NI) 3647**] (POA), her attorney. No etoh or smoking.
.
Functional Status: ADLs - independent except bathing (sponge
bath only); IADLs - independent with phone, finances; assist
with meal prep (self & MOWs), dependent on HM & friends for all
others.
.
Value-Belief: Religous affiliation - [**First Name4 (NamePattern1) 4186**] [**Last Name (NamePattern1) **]; Hobbies -
praying; social - only goes out to church.
.
Mobility: Walks with cane/RW; last fall - "slipped" [**1-27**],
positive unsteady gait
.
Assistive Devices: Uses cane & RW; Lifeline; has "grabber" to
pick-up dropped/out-of-reach items; no glasses, dentures,
hearing aids.
.
Health Maintaince: [**Hospital3 4262**] [**Name8 (MD) **] NP; HM x's 2/wk; lifeline;
MOWs; also [**Location (un) 620**] VNA 

### Response:
{'Postinflammatory pulmonary fibrosis,Acute on chronic systolic heart failure,Acute kidney failure, unspecified,Pneumonia, organism unspecified,Unspecified disorder of liver,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status'}
