CHIEF COMPLAINT: hypoxia, cough

PRESENT ILLNESS: The patient is a 50 yo paraplegic female (T2 injury following
MVC [**1-5**]) who has a history of recurrent UTIs and pneumonias
who presents with a productive cough and hypoxia x a few hours.
The patient is currently intubated and sedated so the husband
provides the history.  He states that over the past 14 days she
has been treated for a UTI by her PCP with keflex and macrobid.
The day prior to her admission [**2147-10-7**] her abx course had
finished and in the a.m. of [**10-8**] she had a productive cough,
productive of brown sputum.  Her husband stated that her face
would turn red while coughing and he checked her O2 sat and it
was 82%.  He started her on 5L of nasal cannula oxygen and
brought her to the ER.  She was stable for the 45 minute car
ride in without coughing.  She did not complain of any other
symptoms to her husband.  [**Name (NI) **] symptoms of UTI are usually of
color change of her urine, a change in the odor of her urine and
sometimes delerium, none of which she had during this episode.
She had no fevers or chills that the husband is aware of.

MEDICAL HISTORY: 1. T1-T2 paraplegia following MVC [**1-5**]
2. Recurrent UTIs
3. HCV, viral load suppressed after 3 months of therapy
4. H/o recurrent PNAs
5. Anxiety
6. DVT in [**2142**] -IVC filter placed in [**2142**]
7. Pulmonary nodules
8. Hypothyroidism
9. Chronic pain
10. Chronic gastritis
11. H/o obstructive lung disease
12. Anemia of chronic disease

MEDICATION ON ADMISSION: Baclofen 10 mg po tid
Citalopram 40 mg po daily
Methadone 5 mg po tid
Levothyroxine 75 mcg po daily
Omeprazole 20 mg po bid
Pregabalin 75 mg po bid
Pregabalin 75 mg po daily
Calcium Carbonate 500 mg po tid
Senna 8.6 mg [**Hospital1 **] prn constipation
Docusate Sodium 100 mg po bid
Clonazepam 2 mg Tablet po qhs
Polyethylene Glycol po daily prn constipation
Oxycodone-Acetaminophen 5-325 mg q8hrs prn pain
Trazodone 50 mg po qhs

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 98.0  BP: 122/65  P: 98
CVP 8
AC 380 x 28  PEEP 10 FiO2 50%
General: intubated, sedated, responds appropriately to verbal
stimuli
HEENT: Sclera anicteric, MMM
Neck: supple, JVP not elevated, no LAD
Lungs: Crackles heard R>L with decreased breath sounds on RLL.
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen:  soft, non-tender, moderately-distended, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
GU: foley in place
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: The patient currently lives at home wiht her husband and 2
children, ages 15 and 22. Former 35 packyear smoker. Denies
current tobacco or alcohol use.
Pneumonia due to Klebsiella pneumoniae,Cardiac arrest,Unspecified septicemia,Severe sepsis,Acute and chronic respiratory failure,Alkalosis,Other ascites,Paraplegia,Foreign body in larynx,Chronic hepatitis C without mention of hepatic coma,Foreign body accidentally entering other orifice,Late effect of spinal cord injury,Late effects of motor vehicle accident,Unspecified acquired hypothyroidism,Anemia of other chronic disease,Nonspecific abnormal electrocardiogram [ECG] [EKG],Atrophic gastritis, without mention of hemorrhage,Other chronic pain,Dysthymic disorder,Personal history of venous thrombosis and embolism,Personal history, urinary (tract) infection
K. pneumoniae pneumonia,Cardiac arrest,Septicemia NOS,Severe sepsis,Acute & chronc resp fail,Alkalosis,Ascites NEC,Paraplegia NOS,Foreign body in larynx,Chrnc hpt C wo hpat coma,FB entering oth orifice,Late eff spinal cord inj,Late eff motor vehic acc,Hypothyroidism NOS,Anemia-other chronic dis,Abnorm electrocardiogram,Atrph gastrtis w/o hmrhg,Chronic pain NEC,Dysthymic disorder,Hx-ven thrombosis/embols,Personal history UTI
Admission Date:  [**2147-10-8**]              Discharge Date:   [**2147-10-25**]

Date of Birth:  [**2096-10-22**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2485**]
Chief Complaint:
hypoxia, cough

Major Surgical or Invasive Procedure:
Percutaneous tracheostomy under direct bronchoscopic
visualization.
Intubation
R IJ
R radial arterial line

History of Present Illness:
The patient is a 50 yo paraplegic female (T2 injury following
MVC [**1-5**]) who has a history of recurrent UTIs and pneumonias
who presents with a productive cough and hypoxia x a few hours.
The patient is currently intubated and sedated so the husband
provides the history.  He states that over the past 14 days she
has been treated for a UTI by her PCP with keflex and macrobid.
The day prior to her admission [**2147-10-7**] her abx course had
finished and in the a.m. of [**10-8**] she had a productive cough,
productive of brown sputum.  Her husband stated that her face
would turn red while coughing and he checked her O2 sat and it
was 82%.  He started her on 5L of nasal cannula oxygen and
brought her to the ER.  She was stable for the 45 minute car
ride in without coughing.  She did not complain of any other
symptoms to her husband.  [**Name (NI) **] symptoms of UTI are usually of
color change of her urine, a change in the odor of her urine and
sometimes delerium, none of which she had during this episode.
She had no fevers or chills that the husband is aware of.

In the ER she was 83% on 5L.   She improved to 96% on a non
rebreather.  She has 2 PIV 20g in hand and a R IJ in place.  She
has had a persistent low BP of 80s and she was started on
levophed and her BPs improved.  She had rec'd 4 L of IVF in the
ER.  Her Tmax was 101.8 rectally.

She rec'd vanc, zosyn, and tylenol in the ER for likely
pneumonia.

Past Medical History:
1. T1-T2 paraplegia following MVC [**1-5**]
2. Recurrent UTIs
3. HCV, viral load suppressed after 3 months of therapy
4. H/o recurrent PNAs
5. Anxiety
6. DVT in [**2142**] -IVC filter placed in [**2142**]
7. Pulmonary nodules
8. Hypothyroidism
9. Chronic pain
10. Chronic gastritis
11. H/o obstructive lung disease
12. Anemia of chronic disease


Social History:
The patient currently lives at home wiht her husband and 2
children, ages 15 and 22. Former 35 packyear smoker. Denies
current tobacco or alcohol use.


Family History:
Non-contributory.

Physical Exam:
Vitals: T: 98.0  BP: 122/65  P: 98
CVP 8
AC 380 x 28  PEEP 10 FiO2 50%
General: intubated, sedated, responds appropriately to verbal
stimuli
HEENT: Sclera anicteric, MMM
Neck: supple, JVP not elevated, no LAD
Lungs: Crackles heard R>L with decreased breath sounds on RLL.
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen:  soft, non-tender, moderately-distended, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
GU: foley in place
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

Pertinent Results:
Imaging:
CXR ([**10-8**]): FINDINGS: The right IJ line has been slightly
retracted and is now at the SVC just above the right atrium.
Again seen is moderate right pleural effusion.  There is
bilateral alveolar infiltrates, left greater than right. This
appears to have progressed slightly; however, there is improved
aeration at the left base.

CXR ([**10-24**]): FINDINGS: The tracheostomy and right IJ line both
appear unchanged from previous study. An endogastric tube
courses inferiorly below the GE junction The tip of an IVC
filter is seen at the edge of the field of view. There has been
interval placement of a left PICC whose tip rests in the lower
SVC. The heart size is at the large end of normal but unchanged
from previous study. The mediastinal contours are also
unchanged. Overall the lungs are clear with no focal or lobar
consolidation. There is no pleural effusion or pneumothorax.

Admission labs:
[**2147-10-8**] 05:35PM   GLUCOSE-126* UREA N-13 CREAT-0.5 SODIUM-134
POTASSIUM-5.8* CHLORIDE-103 TOTAL CO2-20* ANION GAP-17
[**2147-10-8**] 05:35PM   CALCIUM-9.4 PHOSPHATE-3.1 MAGNESIUM-1.9
[**2147-10-8**] 05:35PM   WBC-10.8# RBC-4.01*# HGB-11.1* HCT-34.5*
MCV-86 MCH-27.6 MCHC-32.0 RDW-15.6*
[**2147-10-8**] 05:35PM   NEUTS-81.8* BANDS-0 LYMPHS-12.5* MONOS-4.5
EOS-0.7 BASOS-0.6
[**2147-10-8**] 05:35PM   HYPOCHROM-1+ ANISOCYT-1+ POIKILOCY-NORMAL
MACROCYT-NORMAL MICROCYT-NORMAL POLYCHROM-NORMAL
[**2147-10-8**] 05:35PM   PLT SMR-NORMAL PLT COUNT-177
[**2147-10-8**] 05:35PM URINE  COLOR-Yellow APPEAR-Hazy SP [**Last Name (un) 155**]-1.024
[**2147-10-8**] 05:35PM URINE  BLOOD-TR NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-TR BILIRUBIN-NEG UROBILNGN-1 PH-5.0 LEUK-MOD
[**2147-10-8**] 05:35PM URINE  RBC-[**4-6**]* WBC-21-50* BACTERIA-MOD
YEAST-NONE EPI-[**4-6**] TRANS EPI-0-2
[**2147-10-8**] 04:44PM   LACTATE-1.9
[**2147-10-8**] 07:25PM   TYPE-ART PO2-99 PCO2-53* PH-7.34* TOTAL
CO2-30 BASE XS-0
[**2147-10-8**] 11:48PM   TYPE-ART PO2-195* PCO2-75* PH-7.14* TOTAL
CO2-27 BASE XS--5
[**2147-10-8**] 08:22PM   POTASSIUM-3.6

Labs at time of discharge:
COMPLETE BLOOD COUNT    WBC RBC    Hgb   Hct  MCV  MCH   MCHC
RDW  Plt Ct
[**2147-10-24**] 06:15AM    6.9  2.88*  7.9* 24.8*  86  27.4  31.8
16.7* 254

  BASIC COAGULATION    PT     PTT     INR(PT)
[**2147-10-24**] 06:15AM    12.4   27.3     1.0

 RENAL & GLUCOSE    Glucose UreaN Creat  Na    K   Cl  HCO3
[**2147-10-24**] 06:15AM    89     7    0.2*  138  4.1  102  29

CHEMISTRY                  Calcium  Phos   Mg
[**2147-10-24**] 06:15AM          8.7    3.6#   1.9

Microbiology:
[**2147-10-19**]  BLOOD CULTURE -PENDING
[**2147-10-19**]  BLOOD CULTURE -PENDING
[**2147-10-19**]  BLOOD CULTURE -PENDING
[**2147-10-19**]  BLOOD CULTURE -PENDING
[**2147-10-19**]  URINE CULTURE - No growth
[**2147-10-18**]  BRONCHOALVEOLAR LAVAGE GRAM STAIN-FINAL; RESPIRATORY
CULTURE-FINAL; LEGIONELLA CULTURE-PRELIMINARY; FUNGAL
CULTURE-PRELIMINARY {YEAST}
[**2147-10-18**]  SPUTUM GRAM STAIN-FINAL; RESPIRATORY CULTURE-FINAL;
LEGIONELLA CULTURE-PRELIMINARY; FUNGAL CULTURE-PRELIMINARY
[**2147-10-17**]  MRSA SCREEN MRSA SCREEN- Negative
[**2147-10-13**]  STOOL CLOSTRIDIUM DIFFICILE TOXIN A & B TEST-
Negative
[**2147-10-13**]  SPUTUM GRAM STAIN-FINAL; RESPIRATORY CULTURE-FINAL
{YEAST}
[**2147-10-10**]  Influenza A/B by DFA DIRECT INFLUENZA A ANTIGEN
TEST- negative; DIRECT INFLUENZA B ANTIGEN TEST- Negative
[**2147-10-9**]  SPUTUM GRAM STAIN-FINAL; RESPIRATORY CULTURE-FINAL
{KLEBSIELLA PNEUMONIAE}; FUNGAL CULTURE-FINAL {YEAST}
[**2147-10-9**]  BLOOD CULTURE - No growth
[**2147-10-9**]  BLOOD CULTURE - No growth
[**2147-10-9**]  URINE CULTURE - No growth
[**2147-10-9**]  URINE CULTURE - No growth
[**2147-10-8**]  SPUTUM GRAM STAIN-FINAL; RESPIRATORY CULTURE-FINAL
{KLEBSIELLA PNEUMONIAE, STAPH AUREUS COAG +}
[**2147-10-8**]  BLOOD CULTURE - No growth
[**2147-10-8**]  BLOOD CULTURE - No growth


Brief Hospital Course:
# Hypoxia and respiratory failure: Patient presented with
respiratory distress, and was found to have recurrent RLL
pneumonia. Sputum culture grew out klebsiella.  Patient was
intubated on arrival to the ICU floor as respiratory status
worsened and arterial gas concerning. Patient was put on
levofloxacin and her pneumonia and respiratory status improved.
She was extubated on [**10-15**], and was doing well despite copious
amount of secretions. However, 2 hours after the extubation,
patient complained of acute pleuritic RUQ. Stat CXR showed
worsening right pleural effusion, and RLL and RML collapse. The
team discussed the necessity of re-intubation given new right
lung collapse/plugging and inability to cough, and plan of
tracheostomy in a couple of days, pt refused. Her oxygen
saturation remained good for the rest of the night. Repeat CXR
the next morning showed worsened right lung collapse to the
point of complete right lung collapse, but patient continued to
do well with intermittent CPAP supports despite the completely
collapsed right lung. On [**10-18**], pt requested that she be
re-intubated in the afternoon as she was more dyspneic on
non-rebreather. Anesthesiology came and intubated her. Soon
afterwards, patient had bradycardia and went into PEA, and pt
was coded. Patient was resuscitated with CPR, 3 epi and 2
atropine, 1 amp bicarb, 5u insulin and 1amp dextrose. During the
code, it was difficult to bag patient, indicating central airway
was plugged. After about 4min, her pulse returned, patient was
intially hypertensive with SBP in 170s, tachycardic at 150s with
SVT, possibly AVNRT. she became hypotensive with SBP in the
80-90s as well. Patient was bronch'd immediately, copious
secretions were suctioned, and post-bronch cxr showed part of
the right lung re-opened up. Following bronch, BP and HR
improved. Vancomycin and cefepime were started together with
levofloxacin, which were discontinued after 72 hours of no
growth in culture. Patient continued to improve since
re-intubation. Tracheostomy was placed on [**10-20**], and patient
tolerated the procedure well. On discharge to rehab on [**10-24**],
patient was doing well on trach mask with minimal ventilator
support.
.
# Sepsis: Patient met the criteria for sepsis. The source of
infection was most likely pulmonary with evidence of pneumonia.
She required pressors on and off in the initial part of her
admission, and was off pressor during the later part of her stay
in ICU. Early goal-directed therapy was employed and her MAP was
maintained above 65, CVP above [**9-13**], UOP > 30cc/hr and ScvO2 >
70%.
.
# Anemia: Patient has chronic normocytic anemia, with baseline
hct in the 25-30 range.  During her stay in ICU, she was
hemodynamically stable with no obvious sources of bleeding.
B12, iron, folate studies were within normal limits.  Patient's
hematocrit was stable throughout her stay here in ICU and did
not require an blood product transfusion.
.
# Mild metabolic alkalosis: Patient presented with mild
metabolic alkalosis which was most likely due to contraction
alkalosis. It resolved with IVF.
.
# T2 Paraplegia: Home pain regimen with baclofen, methadone and
lyrica were continued.
.
# Depression: Outpatient management with Celexa 40mg was
continued.
.
# Prophylaxis: Patient was put on subutaneous heparin for DVT
prophylaxis. She received IV PPI for stress ulcer prevention.
.
# Code:  Full (discussed with patient)
.
# Communication: Patient and husband [**Name (NI) **] were updated daily on
patient progress.


Medications on Admission:
Baclofen 10 mg po tid
Citalopram 40 mg po daily
Methadone 5 mg po tid
Levothyroxine 75 mcg po daily
Omeprazole 20 mg po bid
Pregabalin 75 mg po bid
Pregabalin 75 mg po daily
Calcium Carbonate 500 mg po tid
Senna 8.6 mg [**Hospital1 **] prn constipation
Docusate Sodium 100 mg po bid
Clonazepam 2 mg Tablet po qhs
Polyethylene Glycol po daily prn constipation
Oxycodone-Acetaminophen 5-325 mg q8hrs prn pain
Trazodone 50 mg po qhs


Discharge Medications:
1. Heparin (Porcine) 5,000 unit/mL Solution [**Hospital1 **]: One (1)
Injection TID (3 times a day).
2. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette [**Hospital1 **]: [**2-3**]
Drops Ophthalmic PRN (as needed) as needed for dry eyes.
3. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) [**Month/Day (2) **]: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
Constipation.
4. Bismuth Subsalicylate 262 mg/15 mL Suspension [**Month/Day (2) **]: Fifteen
(15) ML PO TID (3 times a day) as needed for dyspepsia.
5. Citalopram 20 mg Tablet [**Month/Day (2) **]: Two (2) Tablet PO DAILY (Daily).

6. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
7. Docusate Sodium 50 mg/5 mL Liquid [**Last Name (STitle) **]: Two (2)  PO BID (2
times a day).
8. Senna 8.6 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
9. Methadone 5 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO TID (3 times a
day).
10. Cholecalciferol (Vitamin D3) 400 unit Tablet [**Last Name (STitle) **]: Two (2)
Tablet PO DAILY (Daily).
11. Oxycodone 5 mg/5 mL Solution [**Last Name (STitle) **]: One (1)  PO Q4H (every 4
hours) as needed for pain.
12. Tramadol 50 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
13. Polyethylene Glycol 3350 17 gram/dose Powder [**Last Name (STitle) **]: One (1)
PO DAILY (Daily) as needed for constipation.
14. Pregabalin 75 mg Capsule [**Last Name (STitle) **]: One (1) Capsule PO BID (2
times a day).
15. Baclofen 10 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO TID (3 times a
day).
16. Acetaminophen 160 mg/5 mL Solution [**Last Name (STitle) **]: [**3-7**]  PO Q6H (every 6
hours) as needed for fever, pain.
17. Clonazepam 1 mg Tablet [**Month/Day (3) **]: One (1) Tablet PO QHS (once a
day (at bedtime)) as needed for anxiety/insomnia.
18. Acetylcysteine 20 % (200 mg/mL) Solution [**Month/Day (3) **]: 1-10 MLs
Miscellaneous Q6H (every 6 hours) as needed for thick
secretions.
19. Trazodone 50 mg Tablet [**Month/Day (3) **]: 0.5 Tablet PO HS (at bedtime) as
needed for insomnia.
20. Clonazepam 1 mg Tablet [**Month/Day (3) **]: One (1) Tablet PO QID (4 times a
day).
21. Chlorhexidine Gluconate 0.12 % Mouthwash [**Month/Day (3) **]: Fifteen (15)
ML Mucous membrane [**Hospital1 **] (2 times a day).


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 701**]

Discharge Diagnosis:
Primary -
Klebsiella pneumonia
Pulseless electrial activity (PEA) arrest
Sepsis

Secondary -
Paraplegia
Hypothyroidism
Anemia of chronic disease
Hepatitis C


Discharge Condition:
On trach with vent support. Failed speech and swallow so with
dobhoff tube. Awake, alert, oriented, continued anxiety.


Discharge Instructions:
You were admitted to the hospital due to severe pneumonia.  You
had a prolonged hospital course complicated by respiratory
failure and right lung collapse requiring a tracheostomy to be
placed.

Your medications have been changed.

Please call you doctor or present to the Emergency Department if
you develop worsening respiratory distress, shortness of breath,
chest pain or any other symptom that concerns you.


Followup Instructions:
You should follow up with your primary doctor within one week
after discharge from the rehab
{'Pneumonia due to Klebsiella pneumoniae,Cardiac arrest,Unspecified septicemia,Severe sepsis,Acute and chronic respiratory failure,Alkalosis,Other ascites,Paraplegia,Foreign body in larynx,Chronic hepatitis C without mention of hepatic coma,Foreign body accidentally entering other orifice,Late effect of spinal cord injury,Late effects of motor vehicle accident,Unspecified acquired hypothyroidism,Anemia of other chronic disease,Nonspecific abnormal electrocardiogram [ECG] [EKG],Atrophic gastritis, without mention of hemorrhage,Other chronic pain,Dysthymic disorder,Personal history of venous thrombosis and embolism,Personal history, urinary (tract) infection'}


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: hypoxia, cough

PRESENT ILLNESS: The patient is a 50 yo paraplegic female (T2 injury following
MVC [**1-5**]) who has a history of recurrent UTIs and pneumonias
who presents with a productive cough and hypoxia x a few hours.
The patient is currently intubated and sedated so the husband
provides the history.  He states that over the past 14 days she
has been treated for a UTI by her PCP with keflex and macrobid.
The day prior to her admission [**2147-10-7**] her abx course had
finished and in the a.m. of [**10-8**] she had a productive cough,
productive of brown sputum.  Her husband stated that her face
would turn red while coughing and he checked her O2 sat and it
was 82%.  He started her on 5L of nasal cannula oxygen and
brought her to the ER.  She was stable for the 45 minute car
ride in without coughing.  She did not complain of any other
symptoms to her husband.  [**Name (NI) **] symptoms of UTI are usually of
color change of her urine, a change in the odor of her urine and
sometimes delerium, none of which she had during this episode.
She had no fevers or chills that the husband is aware of.

MEDICAL HISTORY: 1. T1-T2 paraplegia following MVC [**1-5**]
2. Recurrent UTIs
3. HCV, viral load suppressed after 3 months of therapy
4. H/o recurrent PNAs
5. Anxiety
6. DVT in [**2142**] -IVC filter placed in [**2142**]
7. Pulmonary nodules
8. Hypothyroidism
9. Chronic pain
10. Chronic gastritis
11. H/o obstructive lung disease
12. Anemia of chronic disease

MEDICATION ON ADMISSION: Baclofen 10 mg po tid
Citalopram 40 mg po daily
Methadone 5 mg po tid
Levothyroxine 75 mcg po daily
Omeprazole 20 mg po bid
Pregabalin 75 mg po bid
Pregabalin 75 mg po daily
Calcium Carbonate 500 mg po tid
Senna 8.6 mg [**Hospital1 **] prn constipation
Docusate Sodium 100 mg po bid
Clonazepam 2 mg Tablet po qhs
Polyethylene Glycol po daily prn constipation
Oxycodone-Acetaminophen 5-325 mg q8hrs prn pain
Trazodone 50 mg po qhs

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 98.0  BP: 122/65  P: 98
CVP 8
AC 380 x 28  PEEP 10 FiO2 50%
General: intubated, sedated, responds appropriately to verbal
stimuli
HEENT: Sclera anicteric, MMM
Neck: supple, JVP not elevated, no LAD
Lungs: Crackles heard R>L with decreased breath sounds on RLL.
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen:  soft, non-tender, moderately-distended, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
GU: foley in place
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: The patient currently lives at home wiht her husband and 2
children, ages 15 and 22. Former 35 packyear smoker. Denies
current tobacco or alcohol use. 

### Response:
{'Pneumonia due to Klebsiella pneumoniae,Cardiac arrest,Unspecified septicemia,Severe sepsis,Acute and chronic respiratory failure,Alkalosis,Other ascites,Paraplegia,Foreign body in larynx,Chronic hepatitis C without mention of hepatic coma,Foreign body accidentally entering other orifice,Late effect of spinal cord injury,Late effects of motor vehicle accident,Unspecified acquired hypothyroidism,Anemia of other chronic disease,Nonspecific abnormal electrocardiogram [ECG] [EKG],Atrophic gastritis, without mention of hemorrhage,Other chronic pain,Dysthymic disorder,Personal history of venous thrombosis and embolism,Personal history, urinary (tract) infection'}
