CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: [**Age over 90 **] y/o F with PMHx of mult-infarct dementia and diverticulosis
who had a witnessed aspiration event at home and was brought
into the ED with cough and shortness of breath. On arrival to
the [**Name (NI) **], pt was
tachypneic to 40s with audible secretions. Per HCP, pt was in
her usual state of health prior to the witnessed aspiration
event. She has not have any fevers, sick contacts, upper
respiratory congestion, sore throat, shortness of breath or DOE,
though she is bedridden at baseline.
.
In the ED, initial vs were: T 97.1 P 83 BP 147/110 R 35 Sats
100% on NRB. Pt was notably rhoncherous and having difficulty
clearing secretions. Attempts were made at NG suction which pt
was unable to tolerate. Pt was placed on BiPAP with some
improvement in resp status. Blood Cx were obtained, she was
given 1LNS, Clindamycin and Ceftriaxone for presumed aspiration
pneumonia though portable CXR did not show any acute infiltrate.
Pt was noted to have intermittent respiratory distress with
audible rhonchi during attempts to wean from non-invasive
ventilation.
.
On arrival to the ICU, pt was mildly tachypneic though sating
well on NRB and in no acute respiratory distress. She was
coughing spontaneously but did not respond to questions due to
underlying dementia and husband provided additional ROS.

MEDICAL HISTORY: - Diverticulosis
- Multi-infarct dementia
- Hearing loss
- Retinal detachment
- B12 deficiency
- Chronic abdominal pain
- Irritable bowel syndrome
- Spinal Stenosis

MEDICATION ON ADMISSION: Aspirin 81mg daily
Aricept 10mg daily
Vitamin B-12 1000mcg daily
Vitamin 800units daily
Simvastatin 10mg daily

ALLERGIES: Zosyn

PHYSICAL EXAM: General: NAD
HEENT: Sclera anicteric, MMM
Neck: supple
Lungs: Diffuse wheezes and rhonchi, audible airway secretions
CV: RRR, normal S1/S2, no apprec m/r/g
Abdomen: soft, NT/ND, bowel sounds present, no rebound or
guarding
Ext: Cool, no edema, + pulses

FAMILY HISTORY: Not contributory

SOCIAL HISTORY: She was an English professor for many years. She now lives with
Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Chronic kidney disease, Stage III (moderate),Vascular dementia, uncomplicated,Cerebral atherosclerosis,Other B-complex deficiencies,Diverticulosis of colon (without mention of hemorrhage)
Food/vomit pneumonitis,Acute respiratry failure,Chr kidney dis stage III,Vascular dementia,uncomp,Cerebral atherosclerosis,B-complex defic NEC,Dvrtclo colon w/o hmrhg
Admission Date:  [**2190-7-10**]              Discharge Date:   [**2190-7-14**]


Service: MEDICINE

Allergies:
Zosyn

Attending:[**First Name3 (LF) 1257**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
none

History of Present Illness:
[**Age over 90 **] y/o F with PMHx of mult-infarct dementia and diverticulosis
who had a witnessed aspiration event at home and was brought
into the ED with cough and shortness of breath. On arrival to
the [**Name (NI) **], pt was
tachypneic to 40s with audible secretions. Per HCP, pt was in
her usual state of health prior to the witnessed aspiration
event. She has not have any fevers, sick contacts, upper
respiratory congestion, sore throat, shortness of breath or DOE,
though she is bedridden at baseline.
.
In the ED, initial vs were: T 97.1 P 83 BP 147/110 R 35 Sats
100% on NRB. Pt was notably rhoncherous and having difficulty
clearing secretions. Attempts were made at NG suction which pt
was unable to tolerate. Pt was placed on BiPAP with some
improvement in resp status. Blood Cx were obtained, she was
given 1LNS, Clindamycin and Ceftriaxone for presumed aspiration
pneumonia though portable CXR did not show any acute infiltrate.
Pt was noted to have intermittent respiratory distress with
audible rhonchi during attempts to wean from non-invasive
ventilation.
.
On arrival to the ICU, pt was mildly tachypneic though sating
well on NRB and in no acute respiratory distress. She was
coughing spontaneously but did not respond to questions due to
underlying dementia and husband provided additional ROS.


Past Medical History:
- Diverticulosis
- Multi-infarct dementia
- Hearing loss
- Retinal detachment
- B12 deficiency
- Chronic abdominal pain
- Irritable bowel syndrome
- Spinal Stenosis


Social History:
She was an English professor for many years. She now lives with

her husband, [**Name (NI) **], who is her primary caregiver. She has two
sons, one in [**Name (NI) 531**] and the other one in [**Location (un) 86**]. She has
profound vascular dementia, is dependant with all ADLs and is
non verbal at baseline.


Family History:
Not contributory

Physical Exam:
General: NAD
HEENT: Sclera anicteric, MMM
Neck: supple
Lungs: Diffuse wheezes and rhonchi, audible airway secretions
CV: RRR, normal S1/S2, no apprec m/r/g
Abdomen: soft, NT/ND, bowel sounds present, no rebound or
guarding
Ext: Cool, no edema, + pulses


Pertinent Results:
[**2190-7-10**] 09:52PM BLOOD WBC-14.3*# RBC-4.83# Hgb-14.6# Hct-42.3#
MCV-88 MCH-30.2 MCHC-34.5 RDW-14.6 Plt Ct-356
[**2190-7-10**] 09:52PM BLOOD Neuts-85.2* Lymphs-10.0* Monos-3.9
Eos-0.6 Baso-0.4
[**2190-7-10**] 09:52PM BLOOD PT-12.2 PTT-27.4 INR(PT)-1.0
[**2190-7-10**] 11:19PM BLOOD Glucose-220* UreaN-31* Creat-1.4* Na-137
K-4.3 Cl-102 HCO3-22 AnGap-17
[**2190-7-11**] 02:02AM BLOOD Type-ART Temp-36.7 pO2-70* pCO2-36
pH-7.34* calTCO2-20* Base XS--5
[**2190-7-11**] 02:02AM BLOOD Lactate-2.8*
[**2190-7-10**] 11:28PM BLOOD Lactate-2.8*
[**2190-7-10**] 11:35PM URINE Blood-SM Nitrite-NEG Protein-500
Glucose-100 Ketone-50 Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
[**2190-7-10**] 11:35PM URINE RBC-0-2 WBC-0-2 Bacteri-OCC Yeast-NONE
Epi-<1

Brief Hospital Course:
This is a [**Age over 90 **] year old woman who was admitted for acute shortness
of breath related to aspiration pneumonitis. Initially, there
was no clear infiltrate on the CXR but on repeat it showed a new
left infiltrate. A third subsequent CXR showed improvement in
the left lung infiltrate. She was weaned off oxygen quickly and
was on RA on the day of discharge. She had no fever, or
leukocytosis to suggest aspiration pneumonia. The acute event
and the rapid resolution suggested pneumonitis. However, she was
treated with antibiotics by the ED AND THE ICU TEAMS. She had
severe dementia and difficulty clearing secretions. She was on
special aspiration precaution diet and this was reinforced
during this admission. She had audible rhonchi with wheezes and
mild tachypnea initially but this has resolved. She remained
afebrile and responded well to nebs and humidified O2. Although
the patient should be DNR/DNI (on papers by her request and
wish), the HCP is her elderly husband who exhibited poor
cognitive function. The son agreed to DNR and DNI status. The
husband requested to be informed in case of cardiopulmonary
arrest as he will make descision then (case by case). I
recommended to the son to override the HCP and make a clear
DNR/DNI status to avoid confusion. The [**Last Name (LF) 109934**], [**First Name3 (LF) **], and case
manager agreed to hospice services at home. She was discharged
on hospice care. She remained in the hospital for an extra day
as the husband refused to take her home because of some
construction work on the roof.  Total discharge time 35 minutes.


Medications on Admission:
Aspirin 81mg daily
Aricept 10mg daily
Vitamin B-12 1000mcg daily
Vitamin 800units daily
Simvastatin 10mg daily


Discharge Medications:
1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
Constipation.
2. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed for SOB, wheeze.
3. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q2H (every 2 hours) as
needed for wheeze.
4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. Flagyl 500 mg Tablet Sig: One (1) Tablet PO three times a day
for 4 days.
Disp:*12 Tablet(s)* Refills:*0*
7. Donepezil 10 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,
Rapid Dissolve PO HS (at bedtime).
8. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
9. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Cyanocobalamin 1,000 mcg Lozenge Sig: One (1)  PO DAILY
(Daily).
11. Vitamin D-3 400 unit Tablet, Chewable Sig: Two (2) Tablet,
Chewable PO DAILY (Daily).
12. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) for 4 days.
Disp:*4 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
Season's Hospice

Discharge Diagnosis:
aspiration pneumonitis

Discharge Condition:
Hospice.

Discharge Instructions:
Your wife had aspiration pneumonitis. Please make sure she is
fed slowly with the special aspiration precaution diet. Please
call your PCP if she develops fever or shortness of breath. You
agreed to hospice care.

Followup Instructions:
[**Last Name (LF) **],[**First Name3 (LF) **] E. [**Telephone/Fax (1) 719**]
{'Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Chronic kidney disease, Stage III (moderate),Vascular dementia, uncomplicated,Cerebral atherosclerosis,Other B-complex deficiencies,Diverticulosis of colon (without mention of hemorrhage)'}


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: [**Age over 90 **] y/o F with PMHx of mult-infarct dementia and diverticulosis
who had a witnessed aspiration event at home and was brought
into the ED with cough and shortness of breath. On arrival to
the [**Name (NI) **], pt was
tachypneic to 40s with audible secretions. Per HCP, pt was in
her usual state of health prior to the witnessed aspiration
event. She has not have any fevers, sick contacts, upper
respiratory congestion, sore throat, shortness of breath or DOE,
though she is bedridden at baseline.
.
In the ED, initial vs were: T 97.1 P 83 BP 147/110 R 35 Sats
100% on NRB. Pt was notably rhoncherous and having difficulty
clearing secretions. Attempts were made at NG suction which pt
was unable to tolerate. Pt was placed on BiPAP with some
improvement in resp status. Blood Cx were obtained, she was
given 1LNS, Clindamycin and Ceftriaxone for presumed aspiration
pneumonia though portable CXR did not show any acute infiltrate.
Pt was noted to have intermittent respiratory distress with
audible rhonchi during attempts to wean from non-invasive
ventilation.
.
On arrival to the ICU, pt was mildly tachypneic though sating
well on NRB and in no acute respiratory distress. She was
coughing spontaneously but did not respond to questions due to
underlying dementia and husband provided additional ROS.

MEDICAL HISTORY: - Diverticulosis
- Multi-infarct dementia
- Hearing loss
- Retinal detachment
- B12 deficiency
- Chronic abdominal pain
- Irritable bowel syndrome
- Spinal Stenosis

MEDICATION ON ADMISSION: Aspirin 81mg daily
Aricept 10mg daily
Vitamin B-12 1000mcg daily
Vitamin 800units daily
Simvastatin 10mg daily

ALLERGIES: Zosyn

PHYSICAL EXAM: General: NAD
HEENT: Sclera anicteric, MMM
Neck: supple
Lungs: Diffuse wheezes and rhonchi, audible airway secretions
CV: RRR, normal S1/S2, no apprec m/r/g
Abdomen: soft, NT/ND, bowel sounds present, no rebound or
guarding
Ext: Cool, no edema, + pulses

FAMILY HISTORY: Not contributory

SOCIAL HISTORY: She was an English professor for many years. She now lives with 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Chronic kidney disease, Stage III (moderate),Vascular dementia, uncomplicated,Cerebral atherosclerosis,Other B-complex deficiencies,Diverticulosis of colon (without mention of hemorrhage)'}
