CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: Ms.[**Known lastname **] is a 69 yo female with MMP including [**Known lastname 2182**], ESRD on HD
3X/week, CAD, CHF, HIV, eosinophilic pna, and recently diagnosed
right popliteal DVT without PE on coumadin, who presents from
home with a 1-day history of worsening shortness of breath
following missed hemodialysis yesterday [**2-20**] clotted AV graft.

MEDICAL HISTORY: Past Medical History:
1. CAD s/p NSTEMI [**5-19**], s/p PTCA/stent LCX [**2113**]. Latest
catheterization in [**10-21**] with 2-vessel disease. Persantine MIBI
[**4-22**] without symptoms or EKG changes. MIBI images significant
for severe fixed inferior defect, EF 58%.
2. DM type 2, on NPH.
3. HIV, last CD4 count 940 in [**7-/2115**]
4. ESRD on HD since '[**10**] (M, W, F)
5. CHF, with mixed systolic (EF 45-50%) and diastolic
dysfunction.
6. Severe mitral regurgitation [**2115-6-20**]
7. History of RUL segmental PE in [**11/2114**], on coumadin
([**2114-12-5**]) D/C'd in 06/[**2115**].
8. Recently diagnosed right popliteal DVT [**7-/2115**], restarted on
Coumadin
9. H/o multiple AVF clots, s/p thrombectomies, last in [**2115-1-8**]
9. H/o GIB in the setting of coagulopathy and NSAIDs
10. Eosinophilic pneumonia diagnosed [**4-22**], on chronic
prednisone therapy.
11. Anemia [**2-20**] CRF
12. Vulvar intraepithelial neoplasia diagnosed in [**2113-4-18**].
13. [**Year (4 digits) 2182**] with PFTs with FVC 0.69 (27%), FEV1 0.46 (24%),
FEV1/FVC 92%.
14. History of positive Galactomannan antigen
15. RUL nodules on CT, not FDG avid on PET on [**8-20**]. Etiology
unclear.
16. Vulvar squamous cell carcinoma in situ.

MEDICATION ON ADMISSION: ASA 325 mg PO QD
Coumadin 7.5 mg PO QD
Bactrim SS 1 tab PO QD 3X/week
Prednisone
Metoprolol 25 mg PO BID
Lisinopril 2.5 mg PO QD
Isordil 10 mg PO BID
Combivent 1 inhalation q 6 hours
Nephrocaps 1 tab PO QD
Protonix 40 mg PO QD
Zidovudine 200 mg PO BID
Nevirapine 200 mg PO BID
Lamivudine 50 mg PO QD
Colace 100 mg PO BID
NPH 25 units QAM
Lispro SS

ALLERGIES: Motrin / Lipitor

PHYSICAL EXAM: PHYSICAL EXAMINATION on admission:
VITALS: BP 142/75, HR 99, RR 28, Sat 100% on BiPAP 5/5 FiO2 0.1
GEN: Tachypneic, unable to speak with full sentences.
HEENT: BiPAP in place. Right EJ in place.
NECK: Unable to assess JVP.
RESP: Poor air entry. Bibasilar crackles. Minimal wheezing. No
bronchial breathing.
CV: S1, S2. Loud SEM at apex radiating to axilla.
GI: BS NA. Abdomen soft and non-tender.
EXT: No pedal edema. Palpable left DP. Unable to palpate right
DP/PT, but warm extremity.
NEURO: Oriented X3.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives in [**Location 686**] with her daughter . [**Name (NI) **] EtOH. Ex-smoker (60
pack-year smoking history)
Other pulmonary insufficiency, not elsewhere classified,Acute combined systolic and diastolic heart failure,Other complications due to renal dialysis device, implant, and graft,Cardiac arrest,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Other and unspecified coagulation defects,Hyperpotassemia,Obstructive chronic bronchitis with acute bronchitis,Acute and subacute necrosis of liver,Asymptomatic human immunodeficiency virus [HIV] infection status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin
Other pulmonary insuff,Ac syst/diastol hrt fail,Comp-ren dialys dev/grft,Cardiac arrest,Hyp kid NOS w cr kid V,Ac DVT/emb prox low ext,Coagulat defect NEC/NOS,Hyperpotassemia,Obs chr bronc w ac bronc,Acute necrosis of liver,Asymp hiv infectn status,DMII wo cmp nt st uncntr,Long-term use of insulin
Admission Date:  [**2115-8-27**]              Discharge Date:   [**2115-9-4**]

Date of Birth:  [**2046-6-27**]             Sex:   F

Service: MEDICINE

Allergies:
Motrin / Lipitor

Attending:[**First Name3 (LF) 562**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
Endotracheal intubation [**2115-8-27**]
Central line placement [**2115-8-27**]
Temporary dialysis catheter placement left groin [**2115-8-27**]
Hemodialysis


History of Present Illness:
Ms.[**Known lastname **] is a 69 yo female with MMP including [**Known lastname 2182**], ESRD on HD
3X/week, CAD, CHF, HIV, eosinophilic pna, and recently diagnosed
right popliteal DVT without PE on coumadin, who presents from
home with a 1-day history of worsening shortness of breath
following missed hemodialysis yesterday [**2-20**] clotted AV graft.

She describes that she woke up last night with SOB, with some
relief with sitting upright. She describes transient chest
tightness in AM relieved with SLNG X1. No N/V. No pleuritic
discomfort. No diaphoresis. Chronic non-productive cough,
without change. No fever or chills. Some wheezing, not
significantly worse versus usual. No lower extremity edema. She
has been compliant with her medications and low salt diet. Her
last hemodialysis was on [**8-23**]. HD was attempted yesterday
without success [**2-20**] clotted AV graft. She was scheduled for left
UE AV graft thrombectomy today, but presented to the ED with
SOB.

In the ED, initial vitals were T 98.6, HR 102, BP 140/100, RR
32, Sat 93% on room air. Labs remarkable for INR 6.8 (was 5.2
yesterday, Coumadin held last night). Right EJ line placed.
Given elevated INR, transfusion of FFP as initiated, with
subsequent increasing oxygen requirement and eventual sat 91 %
on NRB. She was placed on BiPAP 5/5 with FiO2 0.1, with sat 95%.
MICU admission requested.

Review of labs indicates supratherapeutic INR on multiple
occasions.

Past Medical History:
Past Medical History:
1. CAD s/p NSTEMI [**5-19**], s/p PTCA/stent LCX [**2113**]. Latest
catheterization in [**10-21**] with 2-vessel disease. Persantine MIBI
[**4-22**] without symptoms or EKG changes. MIBI images significant
for severe fixed inferior defect, EF 58%.
2. DM type 2, on NPH.
3. HIV, last CD4 count 940 in [**7-/2115**]
4. ESRD on HD since '[**10**] (M, W, F)
5. CHF, with mixed systolic (EF 45-50%) and diastolic
dysfunction.
6. Severe mitral regurgitation [**2115-6-20**]
7. History of RUL segmental PE in [**11/2114**], on coumadin
([**2114-12-5**]) D/C'd in 06/[**2115**].
8. Recently diagnosed right popliteal DVT [**7-/2115**], restarted on
Coumadin
9. H/o multiple AVF clots, s/p thrombectomies, last in [**2115-1-8**]
9. H/o GIB in the setting of coagulopathy and NSAIDs
10. Eosinophilic pneumonia diagnosed [**4-22**], on chronic
prednisone therapy.
11. Anemia [**2-20**] CRF
12. Vulvar intraepithelial neoplasia diagnosed in [**2113-4-18**].
13. [**Year (4 digits) 2182**] with PFTs with FVC 0.69 (27%), FEV1 0.46 (24%),
FEV1/FVC 92%.
14. History of positive Galactomannan antigen
15. RUL nodules on CT, not FDG avid on PET on [**8-20**]. Etiology
unclear.
16. Vulvar squamous cell carcinoma in situ.

Social History:
Lives in [**Location 686**] with her daughter . [**Name (NI) **] EtOH. Ex-smoker (60
pack-year smoking history)


Family History:
Non-contributory

Physical Exam:
PHYSICAL EXAMINATION on admission:
VITALS: BP 142/75, HR 99, RR 28, Sat 100% on BiPAP 5/5 FiO2 0.1
GEN: Tachypneic, unable to speak with full sentences.
HEENT: BiPAP in place. Right EJ in place.
NECK: Unable to assess JVP.
RESP: Poor air entry. Bibasilar crackles. Minimal wheezing. No
bronchial breathing.
CV: S1, S2. Loud SEM at apex radiating to axilla.
GI: BS NA. Abdomen soft and non-tender.
EXT: No pedal edema. Palpable left DP. Unable to palpate right
DP/PT, but warm extremity.
NEURO: Oriented X3.

Pertinent Results:
Relevant laboratory data on admission:
[**2115-8-27**] 10:15AM:
WBC-12.3* RBC-2.53* HGB-10.7* HCT-31.9* MCV-126* MCH-42.5*
RDW-18.6*
NEUTS-87.2* LYMPHS-10.0* MONOS-2.4 EOS-0.4 BASOS-0.1
GLUCOSE-97 UREA N-106* CREAT-11.0*# SODIUM-139 POTASSIUM-5.0
CHLORIDE-86* TOTAL CO2-25 ANION GAP-33*
ALBUMIN-4.0 CALCIUM-8.0* PHOSPHATE-8.2* MAGNESIUM-2.3
ALT(SGPT)-21 AST(SGOT)-25 ALK PHOS-96 AMYLASE-169* TOT BILI-0.2
PT-32.1* PTT-37.5* INR(PT)-6.8

Cardiac enzymes:
[**2115-8-27**] 10:15AM   CK-MB-5 cTropnT-0.20*
[**2115-8-27**] 06:19PM   CK-MB-6 cTropnT-0.18*
[**2115-8-27**] 09:14PM   CK-MB-5 cTropnT-0.13*

IMAGING:
[**2115-8-27**] CXR: Mild CHF. Blunting of right CPA.
[**2115-8-27**] CXR: INDICATIONS: Hypoxia, increasing shortness of
breath.
PORTABLE AP CHEST AT 1610: Comparison is made to the study from
six hours earlier. Heart size remains at the upper limits of
normal. There is minimal pulmonary, vascular engorgement, but
overall, the appearance is improved since the study from six
hours earlier. There are no focal consolidations.
[**2115-8-31**] CXR: Triangular opacity in the right suprahilar lung is
probably atelectasis. Lungs are clear otherwise. Small bilateral
pleural effusions layer posteriorly. Mild cardiomegaly,
unchanged. There is no pneumothorax. There is no retrosternal
hematoma or displaced rib fracture. Configuration of the chest
suggests [**Month/Day/Year 2182**].
EKG on admission: Rate 96 [**Doctor First Name **], regular. Normal axis, normal
intervals. LAA. LVH by voltage criteria. Q in III (old),
non-specific ST changes in anterior leads (old versus
[**2115-7-24**])
EKG on discharge: Sinus rhythm
Lateral ST changes are nonspecific
Since previous tracing of [**2115-8-30**], no significant change

********************

Relevant studies in hospital:
[**2115-8-29**] ECHO: LVEF low normal (LVEF 50%) secondary to
hypokinesis of the inferior and posterior walls. No masses or
thrombi are seen in the left ventricle. Right ventricular
chamber size and free wall
motion are normal. No AR, no AS. (2+) MR, (2+) TR. Moderate
pulmonary
artery systolic hypertension. There is no pericardial effusion.


Brief Hospital Course:
69 yo female with MMP including ESRD on HD, CAD, CHF, severe MR,
and [**Month/Day/Year 2182**], admitted with SOB in setting of missed HD [**2-20**] clotted
AV graft, as well as supratherapeutic INR.

Transfusion of FFP was initiated in the ED to reverse her
coagulopathy and plan for temporary hemodialysis catheter
placement. Unfortunately, she developed worsening hypoxemia with
volume administration, and was placed on BiPAP and admitted to
the ICU for volume overload and respiratory distress. In the
ICU, she developed worsening respiratory distress, and was
intubated emergently on [**2115-8-27**] at 20:10, with succinylcholine
administration for induction. Shortly after intubation, she went
into PEA arrest.

1) PEA arrest: Etiology of PEA arrest attributed to
hyperkalemia, with exacerbation following succinylcholine
administration. She was resuscitated according to the ACLS
algorithms for PEA/asystole/pulseless VT, shocked twice (200
joules and 360 joules)and concomitantly repeatedly treated for
hyperkalemia. Potassium during code 6.9, after therapy. She
recovered a perfusing normal sinus rhythm after about 30 minutes
of resuscitation. EKG post code unchanged. She was started on a
dopamine drip for hypotension, which was slowly weaned off on
[**8-29**]. An echo was obtained on [**8-29**], which revealed a stable EF
at 50%, 2+ MR (improved versus [**6-/2115**]) and moderate PA HTN
(old). She was transferred from the ICU to the floor and
remained hemodynamically stable with no neurologic deficits.
Significant pain in chest from chest compressions, but chest
x-ray after code showed no evidence of PNX, hemothorax, rib
fracture.  Supportive management with Dilaudid PO and oxycontin.
Of note, previous bleeding with Ibuprofen (history of acquired
factor VII deficiency, s/p Rx). Avoided Tylenol [**2-20**]
transaminitis.  Electrolytes were monitored and she received HD
QOD.
2) Respiratory failure: Attributed to fluid overload in the
setting of missed hemodialysis [**2-20**] clotted AV graft and fluid
administration +/- [**Month/Day (2) 2182**]. She was 4 kg above dry weight at the
time of admission to the ICU. She was initially placed on BiPAP,
then emergently intubated given worsening respiratory distress.
Renal was called emergently following PEA arrest, and she was
emergently dialyzed on [**8-27**].
She was further dialyzed on [**8-28**] with removal of 3 additional
kg, and was succesfully extubated on [**8-28**]. She has been stable
from a respiratory standpoint since then. She was continued on
her chronic out-patient dose of Prednisone 20 mg PO QD and MDIs.
Post-arrest, she was empirically started on Levofloxacin and
Clindamycin (started on [**8-29**]) for coverage of ? aspiration
pneumonia or tracheobronchitis given new sputum production. CXR,
however, negative for infiltrate. Sputum grew GPC, GNR,
pseudomonas, but patient has had psuedomonas in past and is
likely colonized.  She completed a 7 day course of antibiotics
but remained afebrile, WBC count at baseline, with no evidence
of PNA on any CXR's.
3) ESRD on HD: As above. Initial placement of dialysis access
deferred given supratherapeutic INR, but eventually placed
emergently following arrest (cordis line placed during code
changed over wire and dialysis cath placed). She was emergently
dialyzed on [**8-27**] at night, then again on [**7-7**], [**9-1**],
[**9-3**]. LUE AV graft thrombectomy on [**8-30**] in PM, at which time
she was transferred to the floor.  Her potassium remained stable
and she was given EPO and paricalcitol at dialysis.  Her
phosphate was chronically elevated, but once TUMS were changed
to be given with meals, the phosphate fell to 4-5 range.
4) CAD: She was ruled out for MI on admission with serial
cardiac enzymes. EKG pre and post arrest unchanged. Cardiac
enzymes not trended post chest compresssions. ASA, isordil, BB,
and Lisinopril held throughout admission.  WILL RESTART BB, ASA,
ISORDIL, AND ACE I ON DAY OF DISCHARGE, AS PATIENT WAS ON ALL OF
THESE MEDICATIONS AT ADMISSION TIME.  Pulse and BP stable, but
please monitor at rehab.
5) Coagulopathy: INR 6.8 on admission. She was given 1 [**1-20**] units
of FFP, stopped in the setting of respiratory failure. Vitamin K
given on [**8-29**], and INR down to 2.3 on [**8-30**]. Heparin IV
restarted after thrombectomy for RLE DVT.  Coumadin restarted at
same time, initially at 7.5 mg.  She reached therapeutic level
quickly so dose was decreased to 5 mg and then 2.5 mg.  INR on
discharge 2.1, with goal [**2-21**].
6) DM type 2: Kept on [**1-20**] NPH (12 units QAM) and RISS. Once
patient started eating again, sugars increased.  Will DC on 18
units in a.m. and ask rehabilitation facility to monitor
closely.  Patient was on ISS while inpatient.
7) HIV: On HAART. Last CD4 well above 200.
8) FEN: Initially NPO, advanced to [**Doctor First Name **]/heart healthy diet/renal
diet.  Patient initially had some difficulty eating as she felt
nauseated and vomited up food.  Thought to be due to pain meds.
By the time of discharge the patient was keeping most foods
down.  Patient was seen by nutrition and it was determine that
she was at nutrition risk.  Patient was drinking one can of
Nepro per day and was encouraged to increase to two on the day
of discharge.
9) Transaminitis: LFT's transiently rose in setting of shock
liver, but returned to baseline by discharge with no
intervention needed.
10) Ppx: Maintained on heparin and coumadin. Elevate HOB. PPI.
Bowel regimen.
11) Access: Initially right EJ and RUE 20-gauge peripheral IV.
Left femoral cordis placed during arrest, changed over wire for
temporary dialysis catheter, removed on [**8-30**]). Given 1 dose of
Vancomycin prophylactically on [**8-29**] given dirty line still in
place, but d/c'd on [**8-30**]. Of note, attempt to place right groin
femoral line during code resulted in arterial puncture. Small
hematoma noted, no bruit. U/S done on wrong side, not repeated.
Thrombectomy performed and original AV graft used thereafter for
HD.
12) Code: Full. Has been Discussed with patient.

Medications on Admission:
ASA 325 mg PO QD
Coumadin 7.5 mg PO QD
Bactrim SS 1 tab PO QD 3X/week
Prednisone
Metoprolol 25 mg PO BID
Lisinopril 2.5 mg PO QD
Isordil 10 mg PO BID
Combivent 1 inhalation q 6 hours
Nephrocaps 1 tab PO QD
Protonix 40 mg PO QD
Zidovudine 200 mg PO BID
Nevirapine 200 mg PO BID
Lamivudine 50 mg PO QD
Colace 100 mg PO BID
NPH 25 units QAM
Lispro SS

Discharge Medications:
1. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1)
Tablet PO 3X/WEEK (MO,WE,FR).
2. Prednisone 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily):
This is to be tapered slowly.
3. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
4. Zidovudine 100 mg Capsule Sig: Two (2) Capsule PO BID (2
times a day).
5. Nevirapine 200 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
6. Lamivudine 100 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
8. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

9. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q4H (every 4 hours) as needed.
10. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: One
(1) Puff Inhalation Q6H (every 6 hours).
11. Hydromorphone 4 mg Tablet Sig: One (1) Tablet PO Q3-4H
(Every 3 to 4 Hours) as needed for Pain.
12. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID W/MEALS (3 TIMES A DAY WITH MEALS).
13. Oxycodone 10 mg Tablet Sustained Release 12HR Sig: One (1)
Tablet Sustained Release 12HR PO Q12H (every 12 hours).
14. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
15. Epoetin Alfa 10,000 unit/mL Solution Sig: Per protocol
Injection ASDIR (AS DIRECTED).
16. Warfarin Sodium 2.5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
17. Paricalcitol 5 mcg/mL Solution Sig: As decided at dialysis
Intravenous  3X/WEEK (MO,WE,FR).


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2558**] - [**Location (un) **]

Discharge Diagnosis:
1) Thrombosis of AV graft used for dialysis
2) S/P PEA arrest d/t hyperkalemia
3) ESRD


Discharge Condition:
Stable.  Patient continues to receive HD TID.  Breathing has
returned to baseline.  Ready for rehabilitation.


Discharge Instructions:
1) Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
2) Adhere to 2 gm sodium diet
3) Please take all of your medications as prescribed
4) Please call your PCP or return to the ED if you have
worsening SOB, chest pain LE edema, nausea, vomiting, fevers,
weight gain.

Followup Instructions:
1) Please follow-up with Dr. [**Last Name (STitle) **] at [**Telephone/Fax (1) 2393**] in [**1-20**]
weeks after discharge from rehabilitation center.
2) [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1330**], MD Where: LM [**Hospital Unit Name 5628**]
CENTER Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2115-9-9**] 2:40
3) [**Name6 (MD) 251**] [**Last Name (NamePattern4) 252**], M.D. Where: [**Hospital6 29**] [**Hospital1 37213**] CENTER Phone:[**Telephone/Fax (1) 253**] Date/Time:[**2115-9-17**] 11:00
4) [**First Name8 (NamePattern2) **] [**Name8 (MD) 4174**], MD Where: [**Hospital6 29**] OBSTETRICS AND
GYNECOLOGY Phone:[**Telephone/Fax (1) 2664**] Date/Time:[**2115-9-18**] 1:00
{'Other pulmonary insufficiency, not elsewhere classified,Acute combined systolic and diastolic heart failure,Other complications due to renal dialysis device, implant, and graft,Cardiac arrest,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Other and unspecified coagulation defects,Hyperpotassemia,Obstructive chronic bronchitis with acute bronchitis,Acute and subacute necrosis of liver,Asymptomatic human immunodeficiency virus [HIV] infection status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin'}


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: Ms.[**Known lastname **] is a 69 yo female with MMP including [**Known lastname 2182**], ESRD on HD
3X/week, CAD, CHF, HIV, eosinophilic pna, and recently diagnosed
right popliteal DVT without PE on coumadin, who presents from
home with a 1-day history of worsening shortness of breath
following missed hemodialysis yesterday [**2-20**] clotted AV graft.

MEDICAL HISTORY: Past Medical History:
1. CAD s/p NSTEMI [**5-19**], s/p PTCA/stent LCX [**2113**]. Latest
catheterization in [**10-21**] with 2-vessel disease. Persantine MIBI
[**4-22**] without symptoms or EKG changes. MIBI images significant
for severe fixed inferior defect, EF 58%.
2. DM type 2, on NPH.
3. HIV, last CD4 count 940 in [**7-/2115**]
4. ESRD on HD since '[**10**] (M, W, F)
5. CHF, with mixed systolic (EF 45-50%) and diastolic
dysfunction.
6. Severe mitral regurgitation [**2115-6-20**]
7. History of RUL segmental PE in [**11/2114**], on coumadin
([**2114-12-5**]) D/C'd in 06/[**2115**].
8. Recently diagnosed right popliteal DVT [**7-/2115**], restarted on
Coumadin
9. H/o multiple AVF clots, s/p thrombectomies, last in [**2115-1-8**]
9. H/o GIB in the setting of coagulopathy and NSAIDs
10. Eosinophilic pneumonia diagnosed [**4-22**], on chronic
prednisone therapy.
11. Anemia [**2-20**] CRF
12. Vulvar intraepithelial neoplasia diagnosed in [**2113-4-18**].
13. [**Year (4 digits) 2182**] with PFTs with FVC 0.69 (27%), FEV1 0.46 (24%),
FEV1/FVC 92%.
14. History of positive Galactomannan antigen
15. RUL nodules on CT, not FDG avid on PET on [**8-20**]. Etiology
unclear.
16. Vulvar squamous cell carcinoma in situ.

MEDICATION ON ADMISSION: ASA 325 mg PO QD
Coumadin 7.5 mg PO QD
Bactrim SS 1 tab PO QD 3X/week
Prednisone
Metoprolol 25 mg PO BID
Lisinopril 2.5 mg PO QD
Isordil 10 mg PO BID
Combivent 1 inhalation q 6 hours
Nephrocaps 1 tab PO QD
Protonix 40 mg PO QD
Zidovudine 200 mg PO BID
Nevirapine 200 mg PO BID
Lamivudine 50 mg PO QD
Colace 100 mg PO BID
NPH 25 units QAM
Lispro SS

ALLERGIES: Motrin / Lipitor

PHYSICAL EXAM: PHYSICAL EXAMINATION on admission:
VITALS: BP 142/75, HR 99, RR 28, Sat 100% on BiPAP 5/5 FiO2 0.1
GEN: Tachypneic, unable to speak with full sentences.
HEENT: BiPAP in place. Right EJ in place.
NECK: Unable to assess JVP.
RESP: Poor air entry. Bibasilar crackles. Minimal wheezing. No
bronchial breathing.
CV: S1, S2. Loud SEM at apex radiating to axilla.
GI: BS NA. Abdomen soft and non-tender.
EXT: No pedal edema. Palpable left DP. Unable to palpate right
DP/PT, but warm extremity.
NEURO: Oriented X3.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives in [**Location 686**] with her daughter . [**Name (NI) **] EtOH. Ex-smoker (60
pack-year smoking history) 

### Response:
{'Other pulmonary insufficiency, not elsewhere classified,Acute combined systolic and diastolic heart failure,Other complications due to renal dialysis device, implant, and graft,Cardiac arrest,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Other and unspecified coagulation defects,Hyperpotassemia,Obstructive chronic bronchitis with acute bronchitis,Acute and subacute necrosis of liver,Asymptomatic human immunodeficiency virus [HIV] infection status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin'}
