CHIEF COMPLAINT: SOB, cough

PRESENT ILLNESS: Ms. [**Known lastname **] is a [**Age over 90 **]yo female with PMH of severe diastolic heart
failure and atrial fibrillation who presents with 3 days of
shortness of breath, cough, and decreased PO intake. Per her
daughter, she has been decompensating since her last hospital
admission for CHF, 1 month ago and has been living at [**Hospital 100**]
Rehab since discharge. For the past 3 days, she has been
increasingly short of breath. She has been holding her food in
her mouth and not swallowing and her daughter noticed swelling
to her right jaw which is causing her pain. She was given lasix
at rehab and had little urine output in the past day. Her CXR at
rehab showed pneumonia so she was given vanc and zosyn at 21:45
[**3-28**] and sent to the ED on a non-rebreather. ABG was 7.54/28/68.
Her daughter states she has not had any documented fevers.
.
In the ED, initial VS were:  98.7 110 130/86 38 99%. Exam was
notable for crackles on right greater than left. She does not
have good pleth, and was placed on [**6-11**] in ED. Pt has not had a
lot of secretions. Right parotid also enlarged on examination.
Labs showed lactate 3.8, WBC 11.1 with 90% PMN's, Hct 35, INR
3.7, BNP 15,000, trop 0.04, Na 146, Cr 1.8 (baseline 1.1-1.2),
AG 15. Blood cultures were sent. ECG showed AF @ 94, ST dep +
TWF laterally, which is unchanged per report. CXR showed left
upper lobe opacity, right basilar infiltrates and likely some
pulmonary edema. She was given 500cc NS in the ED for elevated
lactate.
VS prior to transfer 92 128/81 94% 20 [**6-11**]. She has 18g right
arm, 24g right hand for acccess.
.
On arrival to the MICU, patient appears  uncomfortable and is
accompanied by her daughters. A foley was placed a put out 250cc
concentrated urine.
.
Review of systems:
(+) Per HPI, unable to obtain additional information at time of
admission.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes (non-insulin dependent),
Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
-  Paroxysmal atrial fibrillation
-  Severe diastolic congestive heart failure.
-  Pulmonary hypertension.
-  Moderate-to-severe mitral regurgitation.
-  Moderate tricuspid regurgitation.
-  Question of restrictive cardiomyopathy.
-PACING/ICD:
3. OTHER PAST MEDICAL HISTORY:
-  Osteoporosis.
-  Glaucoma.
-  Gout.
-  Appendicitis with septic shock.

MEDICATION ON ADMISSION: 1. amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day.
3. metformin 500 mg Tablet Sig: 0.5 Tablet PO once a day.
4. warfarin 1 mg Tablet Sig: One (1) Tablet PO Once Daily at 4
PM: Take 1 tablet Sun, Mon, Tues, Thurs, Fri; take 1.5 tab Wed,
Sat.
5. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1)
packet PO DAILY (Daily).
6. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
7. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Physical:
Vitals: T:97.5 BP: 105/65 P:92 R:13 O2:  96% NRB
General: appears uncomfortable, moaning
HEENT: mucous membranes dry, right submandibular mass
nonerythematous and tender on palpation
Neck: supple, JVP not elevated
CV: a fib, S1, S2
Lungs: very faint crackles at right base, exam limited [**3-10**]
moaning
Abdomen: soft, non-tender, non-distended
GU: foley  in place
Ext: warm, well perfused, no edema
Neuro: unable to cooperate with neuro exam

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Mrs. [**Known lastname **] lives at [**Hospital 100**] Rehab in the last month, previously
lived at home and was independent before [**2157-2-6**]. She is
Mandarin speaking only, but understands some english.
Supportive daughters very involved in her care.
Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Atrial fibrillation,Cerebral atherosclerosis,Hyperosmolality and/or hypernatremia,Tricuspid valve disorders, specified as nonrheumatic,Hypocalcemia,Other chronic pulmonary heart diseases,Other and unspecified Escherichia coli [E. coli],Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of anticoagulants,Swelling, mass, or lump in head and neck,Vascular dementia, uncomplicated,Chronic kidney disease, unspecified,Other and unspecified hyperlipidemia,Abnormal coagulation profile,Gout, unspecified,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Do not resuscitate status,Encounter for palliative care,Osteoporosis, unspecified,Unspecified glaucoma,Pneumonia, organism unspecified,Unspecified septicemia,Acute kidney failure, unspecified,Acute respiratory failure,Toxic encephalopathy,Sepsis,Acute on chronic diastolic heart failure
Hy kid NOS w cr kid I-IV,Atrial fibrillation,Cerebral atherosclerosis,Hyperosmolality,Nonrheum tricusp val dis,Hypocalcemia,Chr pulmon heart dis NEC,E.coli infection NEC/NOS,DMII wo cmp nt st uncntr,Long-term use anticoagul,Swelling in head & neck,Vascular dementia,uncomp,Chronic kidney dis NOS,Hyperlipidemia NEC/NOS,Abnrml coagultion prfile,Gout NOS,Alzheimer's disease,Dementia w/o behav dist,Do not resusctate status,Encountr palliative care,Osteoporosis NOS,Glaucoma NOS,Pneumonia, organism NOS,Septicemia NOS,Acute kidney failure NOS,Acute respiratry failure,Toxic encephalopathy,Sepsis,Ac on chr diast hrt fail
Admission Date:  [**2157-3-29**]              Discharge Date:   [**2157-4-8**]


Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 613**]
Chief Complaint:
SOB, cough


Major Surgical or Invasive Procedure:
none

History of Present Illness:
Ms. [**Known lastname **] is a [**Age over 90 **]yo female with PMH of severe diastolic heart
failure and atrial fibrillation who presents with 3 days of
shortness of breath, cough, and decreased PO intake. Per her
daughter, she has been decompensating since her last hospital
admission for CHF, 1 month ago and has been living at [**Hospital 100**]
Rehab since discharge. For the past 3 days, she has been
increasingly short of breath. She has been holding her food in
her mouth and not swallowing and her daughter noticed swelling
to her right jaw which is causing her pain. She was given lasix
at rehab and had little urine output in the past day. Her CXR at
rehab showed pneumonia so she was given vanc and zosyn at 21:45
[**3-28**] and sent to the ED on a non-rebreather. ABG was 7.54/28/68.
Her daughter states she has not had any documented fevers.
.
In the ED, initial VS were:  98.7 110 130/86 38 99%. Exam was
notable for crackles on right greater than left. She does not
have good pleth, and was placed on [**6-11**] in ED. Pt has not had a
lot of secretions. Right parotid also enlarged on examination.
Labs showed lactate 3.8, WBC 11.1 with 90% PMN's, Hct 35, INR
3.7, BNP 15,000, trop 0.04, Na 146, Cr 1.8 (baseline 1.1-1.2),
AG 15. Blood cultures were sent. ECG showed AF @ 94, ST dep +
TWF laterally, which is unchanged per report. CXR showed left
upper lobe opacity, right basilar infiltrates and likely some
pulmonary edema. She was given 500cc NS in the ED for elevated
lactate.
VS prior to transfer 92 128/81 94% 20 [**6-11**]. She has 18g right
arm, 24g right hand for acccess.
.
On arrival to the MICU, patient appears  uncomfortable and is
accompanied by her daughters. A foley was placed a put out 250cc
concentrated urine.
.
Review of systems:
(+) Per HPI, unable to obtain additional information at time of
admission.


Past Medical History:
1. CARDIAC RISK FACTORS: Diabetes (non-insulin dependent),
Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
-  Paroxysmal atrial fibrillation
-  Severe diastolic congestive heart failure.
-  Pulmonary hypertension.
-  Moderate-to-severe mitral regurgitation.
-  Moderate tricuspid regurgitation.
-  Question of restrictive cardiomyopathy.
-PACING/ICD:
3. OTHER PAST MEDICAL HISTORY:
-  Osteoporosis.
-  Glaucoma.
-  Gout.
-  Appendicitis with septic shock.

Social History:
Mrs. [**Known lastname **] lives at [**Hospital 100**] Rehab in the last month, previously
lived at home and was independent before [**2157-2-6**]. She is
Mandarin speaking only, but understands some english.
Supportive daughters very involved in her care.


Family History:
non-contributory

Physical Exam:
Admission Physical:
Vitals: T:97.5 BP: 105/65 P:92 R:13 O2:  96% NRB
General: appears uncomfortable, moaning
HEENT: mucous membranes dry, right submandibular mass
nonerythematous and tender on palpation
Neck: supple, JVP not elevated
CV: a fib, S1, S2
Lungs: very faint crackles at right base, exam limited [**3-10**]
moaning
Abdomen: soft, non-tender, non-distended
GU: foley  in place
Ext: warm, well perfused, no edema
Neuro: unable to cooperate with neuro exam

Discharge Physical:


Pertinent Results:

Imaging:
CXR [**3-29**]:
IMPRESSION: Multifocal pneumonia. Under appropriate clinical
circumstances
peripheral consolidation can be seen with chronic eosinophilic
pneumonia.

TTE [**3-29**]:
Conclusions
The left atrium is elongated. No left atrial mass/thrombus seen
(best excluded by transesophageal echocardiography). The right
atrium is moderately dilated. No atrial septal defect is seen by
2D or color Doppler. There is mild symmetric left ventricular
hypertrophy with normal cavity size. There is mild to moderate
regional left ventricular systolic dysfunction with hypokinesis
of the distal half of the anterior septum and dyskinesis of the
distal half of the anterior wall. The remaining segments
contract normally (LVEF = 45 %). Right ventricular chamber size
and free wall motion are normal. The aortic valve leaflets (3)
are mildly thickened but aortic stenosis is not present. Mild
(1+) aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. Severe (4+) mitral regurgitation is seen.
Moderate to severe [3+] tricuspid regurgitation is seen. There
is moderate pulmonary artery systolic hypertension. The main
pulmonary artery is dilated. There is a very small pericardial
effusion.

IMPRESSION:Mild symmetric left ventricular hypertrophy with
regional systolic dysfunction c/w CAD (mid-LAD distribution).
Severe mitral regurgitation. Pulmonary artery hypertension.
Moderate to severe tricuspid regurgitation. Biatrial
enlargement.
Compared with the prior study (images reviewed) of [**2154-7-26**],
regional left ventricular systolic dysfunction is now
identified.


CT head w/o [**3-29**]:
IMPRESSION:
1. No acute intracranial process. If ischemia is of concern, MRI
is more
sensitive if not contraindicated.
2. Small vessel ischemic disease and age-related involution.

Microbiology:

[**2157-3-29**] 01:36AM BLOOD WBC-11.1* RBC-3.32* Hgb-11.4* Hct-35.3*
MCV-106* MCH-34.3* MCHC-32.3 RDW-15.6* Plt Ct-294
[**2157-3-29**] 02:25PM BLOOD WBC-13.1* RBC-3.48* Hgb-11.6* Hct-36.0
MCV-103* MCH-33.2* MCHC-32.1 RDW-15.6* Plt Ct-227
[**2157-3-30**] 01:34AM BLOOD WBC-13.3* RBC-3.37* Hgb-11.0* Hct-34.7*
MCV-103* MCH-32.7* MCHC-31.7 RDW-15.6* Plt Ct-227
[**2157-3-31**] 10:00AM BLOOD WBC-9.9 RBC-3.76* Hgb-12.5 Hct-40.6
MCV-108* MCH-33.2* MCHC-30.8* RDW-15.4 Plt Ct-303
[**2157-4-1**] 07:05AM BLOOD WBC-7.9 RBC-3.34* Hgb-11.2* Hct-34.8*
MCV-104* MCH-33.6* MCHC-32.2 RDW-15.9* Plt Ct-263
[**2157-4-1**] 09:45AM BLOOD WBC-6.4 RBC-3.36* Hgb-11.2* Hct-35.6*
MCV-106* MCH-33.2* MCHC-31.4 RDW-15.6* Plt Ct-279
[**2157-4-2**] 10:15AM BLOOD WBC-8.1 RBC-3.33* Hgb-11.1* Hct-35.0*
MCV-105* MCH-33.3* MCHC-31.7 RDW-15.6* Plt Ct-230
[**2157-3-29**] 02:25PM BLOOD Neuts-94.3* Lymphs-4.2* Monos-0.8*
Eos-0.5 Baso-0.2
[**2157-3-29**] 01:36AM BLOOD PT-37.4* PTT-38.2* INR(PT)-3.7*
[**2157-3-29**] 06:04AM BLOOD PT-34.2* PTT-44.6* INR(PT)-3.3*
[**2157-3-30**] 01:34AM BLOOD PT-47.1* PTT-48.8* INR(PT)-4.7*
[**2157-3-31**] 10:00AM BLOOD PT-42.4* PTT-47.9* INR(PT)-4.2*
[**2157-4-1**] 06:55PM BLOOD PT-69.4* INR(PT)-7.0*
[**2157-4-2**] 10:15AM BLOOD PT-81.5* PTT-55.1* INR(PT)-8.3*
[**2157-3-29**] 01:36AM BLOOD Glucose-78 UreaN-55* Creat-1.8* Na-146*
K-4.4 Cl-106 HCO3-25 AnGap-19
[**2157-3-29**] 06:04AM BLOOD Glucose-83 UreaN-52* Creat-1.6* Na-147*
K-4.0 Cl-106 HCO3-24 AnGap-21*
[**2157-3-29**] 02:29PM BLOOD Glucose-397* UreaN-44* Creat-1.5* Na-142
K-3.6 Cl-105 HCO3-25 AnGap-16
[**2157-3-30**] 01:34AM BLOOD Glucose-120* UreaN-40* Creat-1.2* Na-144
K-3.5 Cl-109* HCO3-27 AnGap-12
[**2157-3-31**] 10:00AM BLOOD Glucose-253* UreaN-43* Creat-1.3* Na-143
K-3.5 Cl-106 HCO3-20* AnGap-21*
[**2157-4-1**] 07:05AM BLOOD Glucose-124* UreaN-41* Creat-1.2* Na-152*
K-3.2* Cl-118* HCO3-20* AnGap-17
[**2157-4-1**] 09:45AM BLOOD Glucose-129* UreaN-38* Creat-1.2* Na-152*
K-3.1* Cl-118* HCO3-21* AnGap-16
[**2157-4-1**] 12:48PM BLOOD Glucose-192* UreaN-39* Creat-1.3* Na-150*
K-3.3 Cl-115* HCO3-19* AnGap-19
[**2157-4-1**] 06:55PM BLOOD Glucose-193* UreaN-42* Creat-1.5* Na-148*
K-3.9 Cl-114* HCO3-16* AnGap-22*
[**2157-4-2**] 02:22AM BLOOD Glucose-126* UreaN-41* Creat-1.4* Na-148*
K-3.1* Cl-114* HCO3-21* AnGap-16
[**2157-4-2**] 10:15AM BLOOD Glucose-190* UreaN-40* Creat-1.4* Na-147*
K-4.1 Cl-112* HCO3-21* AnGap-18
[**2157-3-29**] 01:36AM BLOOD proBNP-[**Numeric Identifier 23731**]*
[**2157-3-29**] 01:36AM BLOOD cTropnT-0.04*
[**2157-3-29**] 02:29PM BLOOD CK-MB-3 cTropnT-0.03*
[**2157-3-31**] 10:00AM BLOOD Vanco-79.4*
[**2157-4-1**] 07:05AM BLOOD Vanco-15.9
[**2157-3-29**] 05:52PM BLOOD Type-ART Temp-36.7 pO2-120* pCO2-30*
pH-7.51* calTCO2-25 Base XS-2 Intubat-NOT INTUBA Comment-NASAL
[**Last Name (un) 154**]
[**2157-3-29**] 01:43AM BLOOD Lactate-3.8*
[**2157-3-29**] 01:39PM BLOOD Lactate-2.1*
[**2157-3-31**] 10:50AM BLOOD Lactate-3.8*
[**2157-4-3**] 03:30PM BLOOD Lactate-4.0*

Brief Hospital Course:
Brief Course:
Ms. [**Known lastname **] is a [**Age over 90 **]yo female with PMH of severe diastolic heart
failure and atrial fibrillation who presents with 3 days of
shortness of breath, cough, and decreased PO intake, who was
admitted to the MICU given concern for respiratory distress. She
was hypoxic at rehab, and placed on CPAP briefly in the ED. On
arrival to the MICU, she was improved, and bipap was weaned off.
She was initially continued on antibiotics for concern for
pneumonia, with cultures pending. However, her mental status
declined.  After discussion with her family, given her goals of
care, she was made DNR/DNI. Her multifocal pneumonia and
diastolic heart failure did not improve. The patient went into
respiratory distress on the floor and had a persistently
altered-non responsive mental state. At this point, the family
opted for inpatient hospice and comfort focused care. The
patient passed away at the age of 91 on [**2157-4-8**] at 810am,
peacefully with her family at the bedside.

# Hypoxic respiratory distress: Pt had an ABG at her
rehabilitation facility with low PaO2 (unclear what level of
oxygen she was on at that time). She was initially placed on
broad-spectrum antibiotics for HCAP. Her CXR showed multilobar
pneumonia. In the ICU, she was weaned to nasal cannula and
symptomatically improved. Her TTE showed mildly depressed EF and
severe MR. Diuresis was held given pt was clinically dry with
acute renal failure (see below). Cultures showed no growth Her
antibiotics were changed to vanc zosyn.

# Acute on chronic renal failure: Patient's creatine was found
to be 1.8 (baseline 1.2) and calculated GFR is 26. The etiology
was determined to be pre-renal, and she improved with gentle
fluid resuscitation. .


# Acute on chronic diastolic heart failure:  Patient has a
history of severe diastolic heart failure.  Last EF > 55%.
Repeat TTE showed EF 45% and severe MR. As above, lasix
initially held. BNP on admission was [**Numeric Identifier 3301**].

# Atrial fibrillation/RHYTHM:  Patient is in atrial
fibrillation, on coumadin and amiodarone. Cardioversion has been
 unsuccessful in the past. Her INR was supratherapeutic on
admission, and this was held on admission.

# Cognitive decline:  Per daughter, patient with slow cognitive
decline over 6 months and has worsened since last admission 1
week ago. At baseline for the past month, she has been sleeping
throughout the day, has been more lethargic, has decreased PO
intake, and periods of irregular bleeding. It is unclear whether
or not this started acutely. A fib does put her at risk for
embolic stroke. She had a CT head which showed no acute process.
Likely toxic metabolic encephalopathy contributing to overall
picture. Her mental status declined during her admission to the
point of non-responsiveness.


Medications on Admission:
1. amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day.
3. metformin 500 mg Tablet Sig: 0.5 Tablet PO once a day.
4. warfarin 1 mg Tablet Sig: One (1) Tablet PO Once Daily at 4
PM: Take 1 tablet Sun, Mon, Tues, Thurs, Fri; take 1.5 tab Wed,
Sat.
5. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1)
packet PO DAILY (Daily).
6. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
7. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Calcium 500 + D (D3) 500-125 mg-unit Tablet Sig: One (1)
Tablet PO once a day.
9. Humalog ss sq 2 u
10. clotrimazole


Discharge Disposition:
Expired

Discharge Diagnosis:
hospital acquired pneumonia
acute on chronic diastolic heart failure
sepsis
atrial fibrillation

Discharge Condition:
expired

Discharge Instructions:
n/a

Followup Instructions:
n/a

                             [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]
{"Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Atrial fibrillation,Cerebral atherosclerosis,Hyperosmolality and/or hypernatremia,Tricuspid valve disorders, specified as nonrheumatic,Hypocalcemia,Other chronic pulmonary heart diseases,Other and unspecified Escherichia coli [E. coli],Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of anticoagulants,Swelling, mass, or lump in head and neck,Vascular dementia, uncomplicated,Chronic kidney disease, unspecified,Other and unspecified hyperlipidemia,Abnormal coagulation profile,Gout, unspecified,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Do not resuscitate status,Encounter for palliative care,Osteoporosis, unspecified,Unspecified glaucoma,Pneumonia, organism unspecified,Unspecified septicemia,Acute kidney failure, unspecified,Acute respiratory failure,Toxic encephalopathy,Sepsis,Acute on chronic diastolic heart failure"}


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, cough

PRESENT ILLNESS: Ms. [**Known lastname **] is a [**Age over 90 **]yo female with PMH of severe diastolic heart
failure and atrial fibrillation who presents with 3 days of
shortness of breath, cough, and decreased PO intake. Per her
daughter, she has been decompensating since her last hospital
admission for CHF, 1 month ago and has been living at [**Hospital 100**]
Rehab since discharge. For the past 3 days, she has been
increasingly short of breath. She has been holding her food in
her mouth and not swallowing and her daughter noticed swelling
to her right jaw which is causing her pain. She was given lasix
at rehab and had little urine output in the past day. Her CXR at
rehab showed pneumonia so she was given vanc and zosyn at 21:45
[**3-28**] and sent to the ED on a non-rebreather. ABG was 7.54/28/68.
Her daughter states she has not had any documented fevers.
.
In the ED, initial VS were:  98.7 110 130/86 38 99%. Exam was
notable for crackles on right greater than left. She does not
have good pleth, and was placed on [**6-11**] in ED. Pt has not had a
lot of secretions. Right parotid also enlarged on examination.
Labs showed lactate 3.8, WBC 11.1 with 90% PMN's, Hct 35, INR
3.7, BNP 15,000, trop 0.04, Na 146, Cr 1.8 (baseline 1.1-1.2),
AG 15. Blood cultures were sent. ECG showed AF @ 94, ST dep +
TWF laterally, which is unchanged per report. CXR showed left
upper lobe opacity, right basilar infiltrates and likely some
pulmonary edema. She was given 500cc NS in the ED for elevated
lactate.
VS prior to transfer 92 128/81 94% 20 [**6-11**]. She has 18g right
arm, 24g right hand for acccess.
.
On arrival to the MICU, patient appears  uncomfortable and is
accompanied by her daughters. A foley was placed a put out 250cc
concentrated urine.
.
Review of systems:
(+) Per HPI, unable to obtain additional information at time of
admission.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes (non-insulin dependent),
Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
-  Paroxysmal atrial fibrillation
-  Severe diastolic congestive heart failure.
-  Pulmonary hypertension.
-  Moderate-to-severe mitral regurgitation.
-  Moderate tricuspid regurgitation.
-  Question of restrictive cardiomyopathy.
-PACING/ICD:
3. OTHER PAST MEDICAL HISTORY:
-  Osteoporosis.
-  Glaucoma.
-  Gout.
-  Appendicitis with septic shock.

MEDICATION ON ADMISSION: 1. amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day.
3. metformin 500 mg Tablet Sig: 0.5 Tablet PO once a day.
4. warfarin 1 mg Tablet Sig: One (1) Tablet PO Once Daily at 4
PM: Take 1 tablet Sun, Mon, Tues, Thurs, Fri; take 1.5 tab Wed,
Sat.
5. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1)
packet PO DAILY (Daily).
6. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
7. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Physical:
Vitals: T:97.5 BP: 105/65 P:92 R:13 O2:  96% NRB
General: appears uncomfortable, moaning
HEENT: mucous membranes dry, right submandibular mass
nonerythematous and tender on palpation
Neck: supple, JVP not elevated
CV: a fib, S1, S2
Lungs: very faint crackles at right base, exam limited [**3-10**]
moaning
Abdomen: soft, non-tender, non-distended
GU: foley  in place
Ext: warm, well perfused, no edema
Neuro: unable to cooperate with neuro exam

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Mrs. [**Known lastname **] lives at [**Hospital 100**] Rehab in the last month, previously
lived at home and was independent before [**2157-2-6**]. She is
Mandarin speaking only, but understands some english.
Supportive daughters very involved in her care. 

### Response:
{"Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Atrial fibrillation,Cerebral atherosclerosis,Hyperosmolality and/or hypernatremia,Tricuspid valve disorders, specified as nonrheumatic,Hypocalcemia,Other chronic pulmonary heart diseases,Other and unspecified Escherichia coli [E. coli],Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of anticoagulants,Swelling, mass, or lump in head and neck,Vascular dementia, uncomplicated,Chronic kidney disease, unspecified,Other and unspecified hyperlipidemia,Abnormal coagulation profile,Gout, unspecified,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Do not resuscitate status,Encounter for palliative care,Osteoporosis, unspecified,Unspecified glaucoma,Pneumonia, organism unspecified,Unspecified septicemia,Acute kidney failure, unspecified,Acute respiratory failure,Toxic encephalopathy,Sepsis,Acute on chronic diastolic heart failure"}
