CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: Mrs. [**Known lastname 103181**] had been at rehab
following her surgery, per patient progressing well.  She states
that she was at her sisters for a picnic yesterday and felt OK.
Last evening her blood sugar dropped to 38 and she was minimally
responsive to treatment.  EMS was called, she was pale and
diaphoretic, vomited during transport to OSH.  At OSH, she
continued to vomit, was hypoxic on RA, and tachypnic.  Per rehab
report, patient has been more tachypnic over last day, patient
states her breathing has been OK and denies increased SOB or
sputum production.  She was also noted to have an area of
erythema and separation of her sternal incision at the distal
portion, which is about the same at discharge.  Upon arrival to
[**Hospital1 18**] pt temp was 102.9.

MEDICAL HISTORY: CAD s/p cabg x4 [**2145-8-17**]
Diabetes mellitus type 2
Lower Extremity Neuropathy
Hypertension
Hyperlipidemia
Obesity
Osteoporosis
Arthritis
Hypothyroidism
Hard of Hearing

MEDICATION ON ADMISSION: Simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.
Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Levothyroxine 200 mcg Tablet Sig: One (1) Tablet PO daily
Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day): will evaluate lasix at wound check follow up 9/8.
Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours): call [**Month/Year (2) 5059**] for fevers, change in wound [**Telephone/Fax (1) 170**].

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse:84 Resp:28  O2 sat:97 on 3L NC
B/P  Right:137/76    Left:

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Occupation: Retired from BJ Wholesalers
Lives with: daughter; pt is divorced and has 3 grown daughters
[**Name (NI) 1139**]: quit [**11-30**], 1ppd x >30yrs
ETOH: Rare
Other respiratory complications,Pneumonia, organism unspecified,Diabetes with other specified manifestations, type II or unspecified type, uncontrolled,Polyneuropathy in diabetes,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Unspecified acquired hypothyroidism
Respiratory comp NEC,Pneumonia, organism NOS,DMII oth uncntrld,Neuropathy in diabetes,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Hypertension NOS,Hyperlipidemia NEC/NOS,Osteoporosis NOS,Hypothyroidism NOS
Admission Date:  [**2145-8-31**]              Discharge Date:   [**2145-9-4**]

Date of Birth:  [**2078-1-1**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Mrs. [**Known lastname 103181**] had been at rehab
following her surgery, per patient progressing well.  She states
that she was at her sisters for a picnic yesterday and felt OK.
Last evening her blood sugar dropped to 38 and she was minimally
responsive to treatment.  EMS was called, she was pale and
diaphoretic, vomited during transport to OSH.  At OSH, she
continued to vomit, was hypoxic on RA, and tachypnic.  Per rehab
report, patient has been more tachypnic over last day, patient
states her breathing has been OK and denies increased SOB or
sputum production.  She was also noted to have an area of
erythema and separation of her sternal incision at the distal
portion, which is about the same at discharge.  Upon arrival to
[**Hospital1 18**] pt temp was 102.9.


Past Medical History:
CAD s/p cabg x4 [**2145-8-17**]
Diabetes mellitus type 2
Lower Extremity Neuropathy
Hypertension
Hyperlipidemia
Obesity
Osteoporosis
Arthritis
Hypothyroidism
Hard of Hearing

Social History:
Occupation: Retired from BJ Wholesalers
Lives with: daughter; pt is divorced and has 3 grown daughters
[**Name (NI) 1139**]: quit [**11-30**], 1ppd x >30yrs
ETOH: Rare


Family History:
Non-contributory

Physical Exam:
Pulse:84 Resp:28  O2 sat:97 on 3L NC
B/P  Right:137/76    Left:

General:
Skin: Dry [x]
HEENT: PERRLA [x]
Neck:  Supple [x]
Chest: decreased BS bilat, faint crackles at bases
Heart: RRR [x]
Abdomen: Soft [x] mildly distended [x] non-tender [x]  bowel
sounds + [x]
Extremities: Warm [x], well-perfused [x]  Edema1-2+
Varicosities:
None [x]
Neuro: Grossly intact[x]
Sternal incision w/distal portion separation of skin edges
w/yellow fibrinous on edges, mild erythema between breasts,
small
amout of serous drainage expressed, sternum stable.  Chest tube
sites w/fibrinous exudate, no drainage.
LLE vein harvest site minimal erythema, no drainage
Pulses:
DP           Right: 1+  Left:1+
PT           [**Name (NI) 167**]: 1+  Left:1+
Radial       Right: 2+  Left: 2+


Pertinent Results:
[**2145-8-31**] 07:40PM   WBC-14.6* RBC-3.12* HGB-7.7* HCT-24.8*
MCV-80* MCH-24.6* MCHC-30.9* RDW-15.5

[**2145-8-31**] CTA
1. No pulmonary embolus. No aortic dissection.
2. Bibasilar atelectasis with small left pleural effusion.
Pneumonia cannot be excluded especially in the context of
enlarged mediastinal lymph nodes, which may be reactive in
etiology.
3. Pulmonary nodules at the left base. Recommend dedicated chest
CT after
termination of antibiotic treatment, especially in the context
of mediastinal lymphadenopathy.
4. Emphysema.
5. Hepatic granulomata.
6. Small renal hypodensities, too small to characterize,
statistically likely to be benign cysts.
7. Vascular including, coronary artery calcifications in this
status post
CABG patient.
8. Small fluid collection in the anterior mediastinum is likely
a
postoperative seroma.
9. Cholelithiasis.

[**2145-9-4**] 02:39AM BLOOD WBC-7.4 RBC-3.95* Hgb-9.9*# Hct-31.9*
MCV-81* MCH-25.1* MCHC-31.2 RDW-15.1 Plt Ct-672*
[**2145-9-4**] 02:39AM BLOOD Glucose-144* UreaN-10 Creat-0.6 Na-140
K-4.4 Cl-103 HCO3-29 AnGap-12


Brief Hospital Course:
Mrs. [**Known lastname 103181**] was admitted to the [**Hospital1 18**] on [**2145-8-31**] for further
management of her fever and shortness of breath. A chest CT
showed a left lower lobe consolidation. She was thus placed on
vancomycin, ciprofloxacin and cefepime. She was transferred to
the step down unit on [**2145-9-1**] for further management. A PICC line
was placed for intravenous access. She was brought back to the
intensive care unit on [**9-2**] for blood sugar management with an
insulin drip.[**Last Name (un) **] consult done. Hematology consult also done
for thrombocytosis. Transferred back to the floor on [**9-3**] and
PICC removed on [**9-4**]. Cleared for discharge on [**9-4**]. Pt. is to
make all follow-up appts. as per discharge instructions.

Medications on Admission:
Simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.
Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Levothyroxine 200 mcg Tablet Sig: One (1) Tablet PO daily
Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day): will evaluate lasix at wound check follow up 9/8.
Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours): call [**Month/Year (2) 5059**] for fevers, change in wound [**Telephone/Fax (1) 170**].

Lantus 100 unit/mL Solution Sig: Twelve (12) units
Subcutaneous twice a day.
humalog sliding scale


Discharge Medications:
1. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
2. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily):
take 2 pills (40mg) daily for one week, then decrease to 1 pill
(20mg) daily.
Disp:*30 Tablet(s)* Refills:*2*
3. Levothyroxine 100 mcg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
4. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
6. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Keflex 500 mg Capsule Sig: One (1) Capsule PO four times a
day for 10 days.
Disp:*40 Capsule(s)* Refills:*2*
8. Insulin Glargine 100 unit/mL Cartridge Sig: Ten (10) units
Subcutaneous QAM.
Disp:*qs * Refills:*2*
9. Insulin Glargine 100 unit/mL Cartridge Sig: Twenty (20) units
Subcutaneous at bedtime.
Disp:*qs * Refills:*2*
10. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
11. Insulin Lispro 100 unit/mL Solution Sig: per sliding scale
Subcutaneous four times a day.
Disp:*qs * Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Fever/Hypoglycemia/Dyspnea
Pneumonia
Past Medical History:
Diabetes mellitus type 2
Lower Extremity Neuropathy
Hypertension
Hyperlipidemia
Obesity
Osteoporosis
Arthritis
Hypothyroidism
Hard of Hearing
Past Surgical History:
s/p CABGx4 [**8-17**]
s/p left knee replacement
s/p Tonsillectomy
s/p C-section x 3
s/p TAHBSO
S/P bilateral shoulder surgery


Discharge Condition:
Good


Discharge Instructions:
1)  Monitor wounds for signs of infection. These include
redness, drainage or increased pain. In the event that you have
drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at
([**Telephone/Fax (1) 1504**].
2)  Report any fever greater then 100.5.
3)  Report any weight gain of 2 pounds in 24 hours or 5 pounds
in 1 week.
4)  No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. Gently pat the wound
dry.  Please shower daily.  No bathing or swimming for 1 month.
Use sunscreen on incision if exposed to sun.
5) No lifting greater then 10 pounds for 10 weeks from date of
surgery.
6) No driving for 1 month or while taking narcotics for pain.
7) Call with any questions or concerns.


Followup Instructions:
Please follow-up with Dr. [**Last Name (STitle) **] (cardiac surgery) at 1 month
postop. ([**Telephone/Fax (1) 1504**]
Please follow-up with Dr. [**Last Name (STitle) 5314**] (PCP) in 2 weeks.
([**Telephone/Fax (1) 103182**]
Please follow-up with Dr. [**Last Name (STitle) 5686**] (cardiology) in [**1-26**] weeks.

Wound check on [**Hospital Ward Name 121**] 6 in 1 week.



Completed by:[**2145-9-8**]
{'Other respiratory complications,Pneumonia, organism unspecified,Diabetes with other specified manifestations, type II or unspecified type, uncontrolled,Polyneuropathy in diabetes,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Osteoporosis, 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: Shortness of breath

PRESENT ILLNESS: Mrs. [**Known lastname 103181**] had been at rehab
following her surgery, per patient progressing well.  She states
that she was at her sisters for a picnic yesterday and felt OK.
Last evening her blood sugar dropped to 38 and she was minimally
responsive to treatment.  EMS was called, she was pale and
diaphoretic, vomited during transport to OSH.  At OSH, she
continued to vomit, was hypoxic on RA, and tachypnic.  Per rehab
report, patient has been more tachypnic over last day, patient
states her breathing has been OK and denies increased SOB or
sputum production.  She was also noted to have an area of
erythema and separation of her sternal incision at the distal
portion, which is about the same at discharge.  Upon arrival to
[**Hospital1 18**] pt temp was 102.9.

MEDICAL HISTORY: CAD s/p cabg x4 [**2145-8-17**]
Diabetes mellitus type 2
Lower Extremity Neuropathy
Hypertension
Hyperlipidemia
Obesity
Osteoporosis
Arthritis
Hypothyroidism
Hard of Hearing

MEDICATION ON ADMISSION: Simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.
Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Levothyroxine 200 mcg Tablet Sig: One (1) Tablet PO daily
Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day): will evaluate lasix at wound check follow up 9/8.
Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours): call [**Month/Year (2) 5059**] for fevers, change in wound [**Telephone/Fax (1) 170**].

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse:84 Resp:28  O2 sat:97 on 3L NC
B/P  Right:137/76    Left:

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Occupation: Retired from BJ Wholesalers
Lives with: daughter; pt is divorced and has 3 grown daughters
[**Name (NI) 1139**]: quit [**11-30**], 1ppd x >30yrs
ETOH: Rare 

### Response:
{'Other respiratory complications,Pneumonia, organism unspecified,Diabetes with other specified manifestations, type II or unspecified type, uncontrolled,Polyneuropathy in diabetes,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Unspecified acquired hypothyroidism'}
