CHIEF COMPLAINT: cough and shortness of breath

PRESENT ILLNESS: This is a 73 yo F with h/o poorly-controlled HTN, ESRD, and DM
p/w cough and SOB. The cough was initially dry for 2 weeks, but
is now productive of white sputum. Over the weekend it worsened
in frequency and severity. She has cough-associated chest and
b/t shoulder pain. She reports dyspnea over the past 3 days and
worsened leg and abdominal swelling. She denies F/C/S. She is on
HD MWF and has not missed a session.
.
On presentation to the ED her BP was 231/84 with HR = 67, SaO2
92% RA. She was unable to complete sentences and had rales
half-way up her chest. She was started on a nitro gtt which was
titrated up to 100 mcg/min with BP = 183/67. Renal was consulted
for urgent dialysis but felt that the patient could wait until
the morning. She was evaluated by the MICU attending who felt
that she could be managed on the floor with a nitro gtt. She
also received lasix 100 mg IV (no urine output response),
morphine 2 mg IV, and regular insulin 10 units.
.
ROS: Of note, patient presented in Decemeber with similar cough;
additionally, she had been seen in [**Month (only) **] by Pulmonary for
cough. She also reports a hypoglycemic episode on Friday
evening.

MEDICAL HISTORY: 1) Type 2 diabetes mellitus: Started insulin in [**2157**].
2) Hypertension: Poorly controlled with many admissions to
MICU/CCU for hypertensive urgency.
3) Renal artery stenosis: Last MRA [**1-6**] revealed 3 left renal
arteries, superior with question of stenosis and middle with
stenosis.
4) Hypercholesterolemia
5) ESRD on HD Q M, W, F. Followed by Dr. [**First Name (STitle) **]
6) Diastolic CHF
7) Osteoarthritis
8) Depression
9) Anxiety
10) Sickle cell trait
11) Hiatal hernia
12) Gastroesophageal reflux disease
13) Chronic constipation
14) History of mechanical falls.
15) Chronic anemia: Presumed secondary to renal failure.
16) Status post hysterectomy in [**2132**].

MEDICATION ON ADMISSION: 1. Labetalol 200 mg PO BID
2. Lisinopril 40 mg PO QD
3. Nifedipine 180 mg QD
4. Hydralazine 50 mg PO BID
5. Clonidine 0.3 mg PO BID
6. Isosorbide Mononitrate 60 mg Sustained Release PO DAILY (has
not been taking)
7. Atorvastatin 10 mg PO DAILY
8. Pantoprazole 40 mg PO once a day.
9. Ferrous Sulfate 325 PO DAILY
10. Clonazepam 1 mg PO BID
11. Folic acid 1 mg daily
12. Insulin Lantus 45 units QAM, 5 units Qpm
13. glyburide 2 mg [**Hospital1 **]
14. MVI 1 tablet daily
15. B12 50 mcg po daily
16. Tylenol prn arthritis
17. Sevelemer 400 mg TID
18. ASA 325 mg daily
19. Rhinocort Acqua

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T 97.3 BP 196/90 P 68 RR 22 O2 100% 4LNC
GEN: A&O x 3, pleasant, thin F sitting up in bed in NAD. no use
of accessory muscles, talking in complete sentences.
HEENT: EOMI, OP clear with MMM.
Neck: JVD to level of jaw at 90 degrees.
CV: RRR, nl S1/S2, no m/r/g
LUNGS: crackles half-way up bilaterally
ABD: soft, moderately distended, NT, +BS
EXT: 1+ pitting edema b/t, warm. L AVF with palpable thrill.

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives at home with her husband. Moved to the US in [**2124**].
Originally from Barbados, but lived in [**Location **] for 20 years as
well. She used to work as a medic in the PACU at [**Hospital1 18**], then
later as a recreational assistant at another facility. Denies
any alcohol use, no history of smoking, no IVDU.
Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,Chronic diastolic heart failure,End stage renal disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Dysthymic disorder,Esophageal reflux,Anemia in chronic kidney disease,Constipation, unspecified,Acute upper respiratory infections of unspecified site
Mal hyp kid w cr kid V,Chr diastolic hrt fail,End stage renal disease,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Dysthymic disorder,Esophageal reflux,Anemia in chr kidney dis,Constipation NOS,Acute uri NOS
Admission Date:  [**2159-3-4**]              Discharge Date:   [**2159-3-9**]

Date of Birth:  [**2085-6-27**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 783**]
Chief Complaint:
cough and shortness of breath


Major Surgical or Invasive Procedure:
Dialysis


History of Present Illness:
This is a 73 yo F with h/o poorly-controlled HTN, ESRD, and DM
p/w cough and SOB. The cough was initially dry for 2 weeks, but
is now productive of white sputum. Over the weekend it worsened
in frequency and severity. She has cough-associated chest and
b/t shoulder pain. She reports dyspnea over the past 3 days and
worsened leg and abdominal swelling. She denies F/C/S. She is on
HD MWF and has not missed a session.
.
On presentation to the ED her BP was 231/84 with HR = 67, SaO2
92% RA. She was unable to complete sentences and had rales
half-way up her chest. She was started on a nitro gtt which was
titrated up to 100 mcg/min with BP = 183/67. Renal was consulted
for urgent dialysis but felt that the patient could wait until
the morning. She was evaluated by the MICU attending who felt
that she could be managed on the floor with a nitro gtt. She
also received lasix 100 mg IV (no urine output response),
morphine 2 mg IV, and regular insulin 10 units.
.
ROS: Of note, patient presented in Decemeber with similar cough;
additionally, she had been seen in [**Month (only) **] by Pulmonary for
cough. She also reports a hypoglycemic episode on Friday
evening.

Past Medical History:
1) Type 2 diabetes mellitus: Started insulin in [**2157**].
2) Hypertension: Poorly controlled with many admissions to
MICU/CCU for hypertensive urgency.
3) Renal artery stenosis: Last MRA [**1-6**] revealed 3 left renal
arteries, superior with question of stenosis and middle with
stenosis.
4) Hypercholesterolemia
5) ESRD on HD Q M, W, F. Followed by Dr. [**First Name (STitle) **]
6) Diastolic CHF
7) Osteoarthritis
8) Depression
9) Anxiety
10) Sickle cell trait
11) Hiatal hernia
12) Gastroesophageal reflux disease
13) Chronic constipation
14) History of mechanical falls.
15) Chronic anemia: Presumed secondary to renal failure.
16) Status post hysterectomy in [**2132**].

Social History:
Lives at home with her husband. Moved to the US in [**2124**].
Originally from Barbados, but lived in [**Location **] for 20 years as
well. She used to work as a medic in the PACU at [**Hospital1 18**], then
later as a recreational assistant at another facility. Denies
any alcohol use, no history of smoking, no IVDU.

Family History:
NC

Physical Exam:
Vitals: T 97.3 BP 196/90 P 68 RR 22 O2 100% 4LNC
GEN: A&O x 3, pleasant, thin F sitting up in bed in NAD. no use
of accessory muscles, talking in complete sentences.
HEENT: EOMI, OP clear with MMM.
Neck: JVD to level of jaw at 90 degrees.
CV: RRR, nl S1/S2, no m/r/g
LUNGS: crackles half-way up bilaterally
ABD: soft, moderately distended, NT, +BS
EXT: 1+ pitting edema b/t, warm. L AVF with palpable thrill.

Pertinent Results:
[**2159-3-4**] 06:30PM   LACTATE-1.7
[**2159-3-4**] 05:45PM   GLUCOSE-269* UREA N-60* CREAT-4.3* SODIUM-138
POTASSIUM-4.1 CHLORIDE-94* TOTAL CO2-30 ANION GAP-18
[**2159-3-4**] 05:45PM   estGFR-Using this
[**2159-3-4**] 05:45PM   CK(CPK)-83
[**2159-3-4**] 05:45PM   cTropnT-0.13*
[**2159-3-4**] 05:45PM   CK-MB-NotDone
[**2159-3-4**] 05:45PM   WBC-9.2 RBC-5.35# HGB-13.1# HCT-39.5# MCV-74*
MCH-24.6* MCHC-33.3 RDW-20.0*
[**2159-3-4**] 05:45PM   NEUTS-78.0* LYMPHS-9.8* MONOS-4.6 EOS-5.3*
BASOS-2.4*
[**2159-3-4**] 05:45PM   HYPOCHROM-1+ ANISOCYT-2+ MICROCYT-3+
[**2159-3-4**] 05:45PM   PLT COUNT-114*#
[**2159-3-4**] 05:45PM   PT-15.3* PTT-30.4 INR(PT)-1.4*

EKG: NSR @ 76, nl axis/intervals, TWI in III, aVF.
.
Studies:
CXR ([**3-4**]): The cardiac silhouette is slightly decreased in size
from [**2158-12-28**], where a pericardial effusion was
suspected. The cardiac silhouette remains enlarged, however. The
aorta is calcified. There is no pneumonia or congestive failure.
No pleural effusion or pneumothorax.
.
Echo ([**2158-12-29**]): The LA is moderately dilated. The RA is
moderately dilated. The estimated RA pressure is 11-15mmHg.
There is mild symmetric LVH. The LV cavity size is normal.
Overall left ventricular systolic function is normal (LVEF>55%).
Tissue Doppler imaging suggests an increased left ventricular
filling pressure (PCWP>18mmHg). The RV cavity is mildly dilated.
RV systolic function is normal. The aortic valve leaflets (3)
are mildly thickened. There is no aortic valve stenosis. No AR
is seen. The mitral valve leaflets are mildly thickened. Mild
(1+) mitral regurgitation is seen. The tricuspid valve leaflets
are mildly thickened. Moderate [2+] TR is seen. The tricuspid
regurgitation jet is eccentric and may be underestimated. There
is moderate pulmonary artery systolic hypertension. Significant
pulmonic regurgitation is seen. There is a very small
pericardial effusion. There are no echocardiographic signs of
tamponade.
Compared with the prior study (images reviewed) of [**2158-9-5**],
tricuspid regurgitation is now more prominent.

Brief Hospital Course:
* Hypertensive Urgency: The patient was compliant with all
medications except Imdur.  She was restarted on her home
medications labetolol, lisinopril, nifedipine, hydralazine,
clonidine, and imdur.  We titrated up her labetalol and changed
to TID while hospitalized.  The patient was also likely fluid
overloaded and underwent daily dialysis to remove extra fluid.
Upon discharge the pt's SBP was between 120-160.  The patient
agreed to follow up with her pcp for further management of her
medications and medications.
.
* ESRD on HD: The patient underwent hemodialysis daily while
hospitalized without complications to remove excess fluid as the
likely cause of her hypertension.
.
* DM: While in the hospital the patient had multiple episodes of
hypoglycemia.  [**Last Name (un) **] was consulted, and the patients lantus
dose was decreased.  The patient is to follow up with [**Last Name (un) **] as
an outpatient
.


Medications on Admission:
1. Labetalol 200 mg PO BID
2. Lisinopril 40 mg PO QD
3. Nifedipine 180 mg QD
4. Hydralazine 50 mg PO BID
5. Clonidine 0.3 mg PO BID
6. Isosorbide Mononitrate 60 mg Sustained Release PO DAILY (has
not been taking)
7. Atorvastatin 10 mg PO DAILY
8. Pantoprazole 40 mg PO once a day.
9. Ferrous Sulfate 325 PO DAILY
10. Clonazepam 1 mg PO BID
11. Folic acid 1 mg daily
12. Insulin Lantus 45 units QAM, 5 units Qpm
13. glyburide 2 mg [**Hospital1 **]
14. MVI 1 tablet daily
15. B12 50 mcg po daily
16. Tylenol prn arthritis
17. Sevelemer 400 mg TID
18. ASA 325 mg daily
19. Rhinocort Acqua

Discharge Medications:
1. Insulin Glargine 100 unit/mL Cartridge Sig: One (1) injection
Subcutaneous BREAKFAST (Breakfast): 30 units in morning
0 units at night.
Disp:*qs one month* Refills:*2*
2. Aspirin 325 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*
3. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
4. Nifedipine 90 mg Tablet Sustained Release Sig: Two (2) Tablet
Sustained Release PO DAILY (Daily).
Disp:*60 Tablet Sustained Release(s)* Refills:*2*
5. Hydralazine 25 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
Disp:*120 Tablet(s)* Refills:*2*
6. Clonidine 0.1 mg Tablet Sig: Three (3) Tablet PO BID (2 times
a day).
Disp:*180 Tablet(s)* Refills:*2*
7. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
9. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Clonazepam 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
11. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
12. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
Disp:*30 Cap(s)* Refills:*2*
13. Cyanocobalamin 100 mcg Tablet Sig: 0.5 Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
14. Sevelamer 400 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
Disp:*90 Tablet(s)* Refills:*2*
15. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24 hr
Sig: Three (3) Tablet Sustained Release 24 hr PO QHS (once a day
(at bedtime)).
Disp:*90 Tablet Sustained Release 24 hr(s)* Refills:*2*
16. Labetalol 200 mg Tablet Sig: 1.5 Tablets PO TID (3 times a
day).
Disp:*135 Tablet(s)* Refills:*2*
17. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
Disp:*60 Capsule(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Hypertension
----
Secondary
End stage renal disease
Diabetes


Discharge Condition:
Stable, normal blood pressure, pain free


Discharge Instructions:
HIGH BLOOD PRESSURE

You were treated in the hospital for your high blood pressure.
You underwent dialysis and your medications were adjusted in
order to control your hypertension (high blood pressure).  High
blood pressure can lead to strokes, kidney problems and heart
problems.

Please follow these instructions carefully:
    * See your doctor soon to recheck your blood pressure.
    * In addition to seeing your doctor, you should also:
         1. Not add salt to food and avoid salty food.
         2. Relax and avoid stress as much as possible.

Return to the Emergency Department or see your own doctor right
away if any problems develop, including the following:
    * Blurry vision or any changes in your eyesight.
    * Bad headache or a headache that is getting worse.
    * Trouble speaking.
    * Trouble breathing or shortness of breath.
    * Chest pain or chest discomfort.
    * Confusion, drowsiness or any change in alertness.
    * Dizziness or fainting.
    * Any weakness or numbness in your arms or legs.
    * Anything else that worries you.

We adjusted your medications.  We added Imdur and increased your
dosage of labetalol.  We also decreased your Lantus dose **30
units and morning and none at night**.  Please review the new
medication dosages with Dr [**Last Name (STitle) 16258**].

Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet
Fluid Restriction:

Followup Instructions:
Follow up with Dr [**Last Name (STitle) 16258**], your primary care provider on [**3-13**] at 10:15AM.

Please discuss with Dr [**Last Name (STitle) 16258**] about obtaining a CT of the abdomen
to work up your weightloss.

Resume your regular dialysis schedule upon discharge.

Provider: [**First Name11 (Name Pattern1) 5445**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5446**], DPM Phone:[**Telephone/Fax (1) 543**]
Date/Time:[**2159-3-28**] 10:30


                             [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**] MD, [**MD Number(3) 799**]
{'Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,Chronic diastolic heart failure,End stage renal disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Dysthymic disorder,Esophageal reflux,Anemia in chronic kidney disease,Constipation, unspecified,Acute upper respiratory infections of unspecified site'}


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: cough and shortness of breath

PRESENT ILLNESS: This is a 73 yo F with h/o poorly-controlled HTN, ESRD, and DM
p/w cough and SOB. The cough was initially dry for 2 weeks, but
is now productive of white sputum. Over the weekend it worsened
in frequency and severity. She has cough-associated chest and
b/t shoulder pain. She reports dyspnea over the past 3 days and
worsened leg and abdominal swelling. She denies F/C/S. She is on
HD MWF and has not missed a session.
.
On presentation to the ED her BP was 231/84 with HR = 67, SaO2
92% RA. She was unable to complete sentences and had rales
half-way up her chest. She was started on a nitro gtt which was
titrated up to 100 mcg/min with BP = 183/67. Renal was consulted
for urgent dialysis but felt that the patient could wait until
the morning. She was evaluated by the MICU attending who felt
that she could be managed on the floor with a nitro gtt. She
also received lasix 100 mg IV (no urine output response),
morphine 2 mg IV, and regular insulin 10 units.
.
ROS: Of note, patient presented in Decemeber with similar cough;
additionally, she had been seen in [**Month (only) **] by Pulmonary for
cough. She also reports a hypoglycemic episode on Friday
evening.

MEDICAL HISTORY: 1) Type 2 diabetes mellitus: Started insulin in [**2157**].
2) Hypertension: Poorly controlled with many admissions to
MICU/CCU for hypertensive urgency.
3) Renal artery stenosis: Last MRA [**1-6**] revealed 3 left renal
arteries, superior with question of stenosis and middle with
stenosis.
4) Hypercholesterolemia
5) ESRD on HD Q M, W, F. Followed by Dr. [**First Name (STitle) **]
6) Diastolic CHF
7) Osteoarthritis
8) Depression
9) Anxiety
10) Sickle cell trait
11) Hiatal hernia
12) Gastroesophageal reflux disease
13) Chronic constipation
14) History of mechanical falls.
15) Chronic anemia: Presumed secondary to renal failure.
16) Status post hysterectomy in [**2132**].

MEDICATION ON ADMISSION: 1. Labetalol 200 mg PO BID
2. Lisinopril 40 mg PO QD
3. Nifedipine 180 mg QD
4. Hydralazine 50 mg PO BID
5. Clonidine 0.3 mg PO BID
6. Isosorbide Mononitrate 60 mg Sustained Release PO DAILY (has
not been taking)
7. Atorvastatin 10 mg PO DAILY
8. Pantoprazole 40 mg PO once a day.
9. Ferrous Sulfate 325 PO DAILY
10. Clonazepam 1 mg PO BID
11. Folic acid 1 mg daily
12. Insulin Lantus 45 units QAM, 5 units Qpm
13. glyburide 2 mg [**Hospital1 **]
14. MVI 1 tablet daily
15. B12 50 mcg po daily
16. Tylenol prn arthritis
17. Sevelemer 400 mg TID
18. ASA 325 mg daily
19. Rhinocort Acqua

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T 97.3 BP 196/90 P 68 RR 22 O2 100% 4LNC
GEN: A&O x 3, pleasant, thin F sitting up in bed in NAD. no use
of accessory muscles, talking in complete sentences.
HEENT: EOMI, OP clear with MMM.
Neck: JVD to level of jaw at 90 degrees.
CV: RRR, nl S1/S2, no m/r/g
LUNGS: crackles half-way up bilaterally
ABD: soft, moderately distended, NT, +BS
EXT: 1+ pitting edema b/t, warm. L AVF with palpable thrill.

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives at home with her husband. Moved to the US in [**2124**].
Originally from Barbados, but lived in [**Location **] for 20 years as
well. She used to work as a medic in the PACU at [**Hospital1 18**], then
later as a recreational assistant at another facility. Denies
any alcohol use, no history of smoking, no IVDU. 

### Response:
{'Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,Chronic diastolic heart failure,End stage renal disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Dysthymic disorder,Esophageal reflux,Anemia in chronic kidney disease,Constipation, unspecified,Acute upper respiratory infections of unspecified site'}
