CHIEF COMPLAINT: Chief Complaint: conjunctivitis
Reason for MICU admission: tachypnea

PRESENT ILLNESS: 77M with CAD, systolic CHF, brought to ED with bilateral
conjunctivitis and O2 requirement. Patient is a poor historian,
but per notes he was noted to have bilateral conjunctivitis with
painless erythema two days ago and started on cipro eye gtts
plus warm compresses. Then noted to have increased drainage,
particularly from left eye. Last night he was also noted to
desat to 76% which improved to 96% on 2L and also reported
dyspnea on exertion. Sent to ED for further evaluation.
.
In the ED, initial vs were: T98.8 69 131/82 32 100 on NRB. RR
has remained in the 28-34 range with some accessory muscle use.
90% RA and 99% on 3L. Patient with bilateral conjunctivitis but
EOMs full and painless and eyes in general without pain; per ED
no concern for orbital cellulitis. CXR with R sided effusion
which looked somewhat worse than prior, ?pneumonia or failure.
Patient was given vanco and levofloxacin and ceftriaxone.
Received 250 cc NS.
.
In the MICU, patient confused about reasons for coming to the
hospital but does note that his eyes have been "stiff". No
visual difficulties or pain in the eyes. Denies shortness of
breath, cough, chest pain. + orthopnea. Unsure about edema or
weight gain.
.
Review of systems:
(+) Per HPI. Also recently completed ampicillin course for UTI.

MEDICAL HISTORY: - CAD
- CHF, EF 20% in [**8-/2163**]; also with mod PA HTN
- paroxysmal Afib without anticoagulation
- HTN
- Hyperlipidemia
- h/o bladder CA
- h/o prostate CA
- h/o colon polyps
- Dementia, reported as Alzheimer type; recent cognitive decline

MEDICATION ON ADMISSION: enalapril 20 mg daily
furosemide 80 mg daily
isosorbide 30 mg daily
potassium 20 meq daily
multivitamin daily
B12 500 mcg daily
vitamin D3 800 units daily
chlorhexidine rinse swish and spit [**Hospital1 **]
namenda 5 mg [**Hospital1 **]
cipro eye gtts 2 gtts QID x 7 days (started [**10-9**])
metoprolol 50 mg [**Hospital1 **]
calcium carbonate 500 mg TID
citalopram 20 mg daily
aricept 10 mg HS
flomax 0.4 mg daily
claritin 10 mg daily
lidoderm patch to R knee
plavix - stopped [**10-5**]
ASA 81 mg - stopped [**10-3**]
ampicillin 500 mg QID [**Date range (1) 111620**]
bisacodyl prn
MOM prn
[**Name2 (NI) **] prn
guiafenesin prn
fleet enema prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General: Alert, pleasant, moderately tachypneic when awake with
pursed lip breathing.
HEENT: Marked bilateral bulbar and tarsal conjunctival erythema
with L>R yellow purulent exudate. Denies facial tenderness. Not
much periorbital edema. EOMI intact and painless. Bilateral
erythema over superior maxillae (at site of nasal cannula). MM
quite dry, no clear OP lesions.
Neck: supple, JVD to at least 5-6 cm ASA. No adenopathy.
Lungs: Diminished anteriorly and posteriorly; R lung fields with
more diminished breath sounds particularly at base. Few crackles
at L base. Pursed lip breathing.
CV: Diminished, regular rate and rhythm, normal S1 + S2, no
murmurs, rubs, gallops appreciated
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: warm, well perfused, no clubbing, cyanosis. 2+ bilateral
pedal edema. Bilateral lower legs wrapped. Chronic venous stasis
changes.
Neuro: Alert, oriented to self and [**Location (un) 86**]. CN II-XII intact.
Easily able to read at close and far distances.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Resident at [**Location (un) **] Hourse. Worked in pharmacy when young; now
retired. Sister also lives in [**Name (NI) **] (is health care proxy)
and helps with his care; niece in close proximity. Stopped
smoking in [**2144**]; smoked for 40 years.
Other conjunctivitis,Acute on chronic systolic heart failure,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Hypoxemia,Hematuria, unspecified,Hypopotassemia,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Abnormal coagulation profile,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)
Conjunctivitis NEC,Ac on chr syst hrt fail,Atrial fibrillation,Crnry athrscl natve vssl,Hypertension NOS,Hypoxemia,Hematuria NOS,Hypopotassemia,Alzheimer's disease,Dementia w/o behav dist,Abnrml coagultion prfile,BPH w/o urinary obs/LUTS
Admission Date:  [**2164-10-10**]              Discharge Date:   [**2164-10-15**]

Date of Birth:  [**2087-5-11**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name8 (NamePattern2) 812**]
Chief Complaint:
Chief Complaint: conjunctivitis
Reason for MICU admission: tachypnea


Major Surgical or Invasive Procedure:
None


History of Present Illness:
77M with CAD, systolic CHF, brought to ED with bilateral
conjunctivitis and O2 requirement. Patient is a poor historian,
but per notes he was noted to have bilateral conjunctivitis with
painless erythema two days ago and started on cipro eye gtts
plus warm compresses. Then noted to have increased drainage,
particularly from left eye. Last night he was also noted to
desat to 76% which improved to 96% on 2L and also reported
dyspnea on exertion. Sent to ED for further evaluation.
.
In the ED, initial vs were: T98.8 69 131/82 32 100 on NRB. RR
has remained in the 28-34 range with some accessory muscle use.
90% RA and 99% on 3L. Patient with bilateral conjunctivitis but
EOMs full and painless and eyes in general without pain; per ED
no concern for orbital cellulitis. CXR with R sided effusion
which looked somewhat worse than prior, ?pneumonia or failure.
Patient was given vanco and levofloxacin and ceftriaxone.
Received 250 cc NS.
.
In the MICU, patient confused about reasons for coming to the
hospital but does note that his eyes have been "stiff". No
visual difficulties or pain in the eyes. Denies shortness of
breath, cough, chest pain. + orthopnea. Unsure about edema or
weight gain.
.
Review of systems:
(+) Per HPI. Also recently completed ampicillin course for UTI.

(-) Denies headache, cough, shortness of breath. Denied chest
pain or tightness, palpitations. Denied nausea, vomiting,
diarrhea, abdominal pain. No recent change in bowel or bladder
habits. No dysuria.
.


Past Medical History:
- CAD
- CHF, EF 20% in [**8-/2163**]; also with mod PA HTN
- paroxysmal Afib without anticoagulation
- HTN
- Hyperlipidemia
- h/o bladder CA
- h/o prostate CA
- h/o colon polyps
- Dementia, reported as Alzheimer type; recent cognitive decline



Social History:
Resident at [**Location (un) **] Hourse. Worked in pharmacy when young; now
retired. Sister also lives in [**Name (NI) **] (is health care proxy)
and helps with his care; niece in close proximity. Stopped
smoking in [**2144**]; smoked for 40 years.

Family History:
Noncontributory

Physical Exam:
General: Alert, pleasant, moderately tachypneic when awake with
pursed lip breathing.
HEENT: Marked bilateral bulbar and tarsal conjunctival erythema
with L>R yellow purulent exudate. Denies facial tenderness. Not
much periorbital edema. EOMI intact and painless. Bilateral
erythema over superior maxillae (at site of nasal cannula). MM
quite dry, no clear OP lesions.
Neck: supple, JVD to at least 5-6 cm ASA. No adenopathy.
Lungs: Diminished anteriorly and posteriorly; R lung fields with
more diminished breath sounds particularly at base. Few crackles
at L base. Pursed lip breathing.
CV: Diminished, regular rate and rhythm, normal S1 + S2, no
murmurs, rubs, gallops appreciated
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: warm, well perfused, no clubbing, cyanosis. 2+ bilateral
pedal edema. Bilateral lower legs wrapped. Chronic venous stasis
changes.
Neuro: Alert, oriented to self and [**Location (un) 86**]. CN II-XII intact.
Easily able to read at close and far distances.


Pertinent Results:
WBC 5.9
Hct 38.1 MCV 93
Plts 173
INR 1.7

Na 144   K3.2   Cl 103  HCO 33  BUN 20  Cr 0.9
Ca 8.7  Mg 2.1  Phos 3.0
CK 17
CE negative x1
ABG 7.43/48/127/33
Lact 1.7

Micro:
Blood culture x 2 pending
Urine culture pending
.
Images:
CXR: AP upright portable chest radiograph is obtained.
Evaluation is limited due to low lung volumes and the patient's
chin overlying the lung apices as well as patient's rotation to
the right. There is persistent large right pleural effusion with
right basilar consolidation. The left lung appears grossly
clear. There is mild pulmonary vascular congestion more apparent
in the right upper lung. Heart size cannot be assessed. Aorta
appears unfolded. No definite pneumothorax is seen. Bones are
demineralized. IMPRESSION: Persistent right-sided pleural
effusion with right basilar consolidation, likely atelectasis.
Increasing congestion notable in the right lung. Evaluation
quite limited due to patient's position.
.
EKG: NSR at 69, incomplete LBBB, normal axis, low limb lead
voltage, diffuse TWF; all grossly unchanged from prior.


Brief Hospital Course:
77M with CAD, CHF EF 20%, dementia; presenting with
conjunctivitis and hypoxemia yesterday, admitted to MICU for
sCHF exacerbation.
.
# Acute on chronic systolic heart failure: EF 20%. Patient
demonstrated evidence of volume overload with tachypnea,
hypoxia, LE edema, decreased breath sounds, and elevated JVD.
Pneumonia was initially considered and he was covered with 24
hrs of Levofloxacin, Vancomycin, and Ceftriaxone, but he had no
evidence of leukocytosis or fever and little change in a CXR, so
the antibiotics were stopped. A serum BNP was markedly elevated
on admission and clinical exam were more consistent with CHF
exacerbation. CXR demonstrated a large, simple right pleural
effusion. He was treated with supplemental O2, Albuterol nebs,
diuresed with IV Lasix, and continued his home dose Metoprolol
and Enalapril. His symptoms improved on with this regimen and
his effusion demonstrated improvement with serial CXR's. While
the cause of his CHF exacerbation is unknown, the patient
reports medication compliance and cardiac enzymes were negative
x 3 without EKG changes. Despite the absence of clear ischemic
event, he was maintained on telemetry throughout this
hospitalization without incident. He was discharged on an
increased dose of Lasix.
.
# Bilateral Conjunctivitis: Patient with marked erythema and
exudate on admission, most likely bacterial. He received 1.5
days of Ciprofloxacin eye drops and changed to Erythromycin
drops QID on admission with subsequent improvement in his
symptoms. He completed 7 days of treatment & the patient was
without eye pain or significant periorbital edema throughout
this admission and his extraocular movements were intact
throughout his stay.
.
# CAD: Patient with negative CE's x 3. Patient continued on his
home Metoprolol and a an ASA was restarted, but he was not on a
statin on admission and it was not started as an inpatient. He
remained on telemetry throughout this hospitalization without
incident.
.
# Hematuria: Patient with an episode of hematuria, thought to be
[**1-2**] traumatic Foley placement. Hematuria improved without
intervention.
.
# Dementia. Patient continued on his home Aricept, but Namenda
was not given because it was non-formulary. It was restarted at
discharge.
.
# Paroxysmal Atrial fibrillation: Patient remained in sinus
rhythm throughout this admission. He was continued on his home
Metoprolol 50mg [**Hospital1 **] with adequate rate control. He was started
on ASA 325mg in lieu of Coumadin given his history of GI bleed.
.
# Hypertension: Patient normotensive as an inpatient, but
continued on his home Metoprolol 50mg [**Hospital1 **], Enalapril 20mg daily,
& Lasix 80mg IV PRN.

# Elevated INR: Patient with elevated INR, thought to be
nutritional deficiency. Given 1mg Vitamin K with subsequent
improvement in his INR from 1.7 to 1.3.
.
# Code: Patient remained FULL CODE throughout this
hospitalization



Medications on Admission:
enalapril 20 mg daily
furosemide 80 mg daily
isosorbide 30 mg daily
potassium 20 meq daily
multivitamin daily
B12 500 mcg daily
vitamin D3 800 units daily
chlorhexidine rinse swish and spit [**Hospital1 **]
namenda 5 mg [**Hospital1 **]
cipro eye gtts 2 gtts QID x 7 days (started [**10-9**])
metoprolol 50 mg [**Hospital1 **]
calcium carbonate 500 mg TID
citalopram 20 mg daily
aricept 10 mg HS
flomax 0.4 mg daily
claritin 10 mg daily
lidoderm patch to R knee
plavix - stopped [**10-5**]
ASA 81 mg - stopped [**10-3**]
ampicillin 500 mg QID [**Date range (1) 111620**]
bisacodyl prn
MOM prn
[**Name2 (NI) **] prn
guiafenesin prn
fleet enema prn


Discharge Disposition:
Extended Care

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

Discharge Diagnosis:
Primary: Hypoxia & pulmonary edema secondary to congestive heart
failure
Bacterial Conjunctivitis
Secondary: Coronary artery disease
Paroxysmal Atrial Fibrillation
Dementia
Hypertension
Hyperlipidemia
Benign Prostatic Hypertrophy


Discharge Condition:
Breathing comfortably on room air. Vital signs stable.


Discharge Instructions:
You were admitted to the hospital due to shortness of breath and
an infection in your eyes. In the hospital, you were found to
have an exacerbation of your congestive heart failure and some
excess fluid in your chest. You were treated with oxygen and
medication to remove the excess fluid and your breathing
improved. You also had a conjunctivitis in your eyes that was
treated with an antibiotic.
.
Medications:
Lasix - This medication was INCREASED from 80mg a day to 80mg
twice a day by mouth
Aspirin - This medication was RESTARTED at 325mg daily.
Plavix - This medication CONTINUED TO BE HELD given your history
of bleeding while taking this medication.
.
Please weigh yourself every day. If your weight changes by more
than 3 pounds, please call your primary care physician. [**Name10 (NameIs) **],
please adhere to a low-salt diet and limit the amount of fluid
you drink to less than 1.5 liters a day. If you experience any
new shortness of breath, cough, increased swelling in your legs,
pain or discharge from your eyes, impaired vision, or pain with
moving your eyes, please call your doctor or go the emergency
room.


Followup Instructions:
Please follow-up with your primary care physician, [**Last Name (NamePattern4) **].
[**Name (NI) 111621**], in [**12-2**] weeks. You can schedule an appointment by
calling [**Telephone/Fax (1) 608**].


                             [**First Name8 (NamePattern2) **] [**Name6 (MD) **] [**Name8 (MD) **] MD, DMD [**MD Number(2) 821**]
{"Other conjunctivitis,Acute on chronic systolic heart failure,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Hypoxemia,Hematuria, unspecified,Hypopotassemia,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Abnormal coagulation profile,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)"}


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: Chief Complaint: conjunctivitis
Reason for MICU admission: tachypnea

PRESENT ILLNESS: 77M with CAD, systolic CHF, brought to ED with bilateral
conjunctivitis and O2 requirement. Patient is a poor historian,
but per notes he was noted to have bilateral conjunctivitis with
painless erythema two days ago and started on cipro eye gtts
plus warm compresses. Then noted to have increased drainage,
particularly from left eye. Last night he was also noted to
desat to 76% which improved to 96% on 2L and also reported
dyspnea on exertion. Sent to ED for further evaluation.
.
In the ED, initial vs were: T98.8 69 131/82 32 100 on NRB. RR
has remained in the 28-34 range with some accessory muscle use.
90% RA and 99% on 3L. Patient with bilateral conjunctivitis but
EOMs full and painless and eyes in general without pain; per ED
no concern for orbital cellulitis. CXR with R sided effusion
which looked somewhat worse than prior, ?pneumonia or failure.
Patient was given vanco and levofloxacin and ceftriaxone.
Received 250 cc NS.
.
In the MICU, patient confused about reasons for coming to the
hospital but does note that his eyes have been "stiff". No
visual difficulties or pain in the eyes. Denies shortness of
breath, cough, chest pain. + orthopnea. Unsure about edema or
weight gain.
.
Review of systems:
(+) Per HPI. Also recently completed ampicillin course for UTI.

MEDICAL HISTORY: - CAD
- CHF, EF 20% in [**8-/2163**]; also with mod PA HTN
- paroxysmal Afib without anticoagulation
- HTN
- Hyperlipidemia
- h/o bladder CA
- h/o prostate CA
- h/o colon polyps
- Dementia, reported as Alzheimer type; recent cognitive decline

MEDICATION ON ADMISSION: enalapril 20 mg daily
furosemide 80 mg daily
isosorbide 30 mg daily
potassium 20 meq daily
multivitamin daily
B12 500 mcg daily
vitamin D3 800 units daily
chlorhexidine rinse swish and spit [**Hospital1 **]
namenda 5 mg [**Hospital1 **]
cipro eye gtts 2 gtts QID x 7 days (started [**10-9**])
metoprolol 50 mg [**Hospital1 **]
calcium carbonate 500 mg TID
citalopram 20 mg daily
aricept 10 mg HS
flomax 0.4 mg daily
claritin 10 mg daily
lidoderm patch to R knee
plavix - stopped [**10-5**]
ASA 81 mg - stopped [**10-3**]
ampicillin 500 mg QID [**Date range (1) 111620**]
bisacodyl prn
MOM prn
[**Name2 (NI) **] prn
guiafenesin prn
fleet enema prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General: Alert, pleasant, moderately tachypneic when awake with
pursed lip breathing.
HEENT: Marked bilateral bulbar and tarsal conjunctival erythema
with L>R yellow purulent exudate. Denies facial tenderness. Not
much periorbital edema. EOMI intact and painless. Bilateral
erythema over superior maxillae (at site of nasal cannula). MM
quite dry, no clear OP lesions.
Neck: supple, JVD to at least 5-6 cm ASA. No adenopathy.
Lungs: Diminished anteriorly and posteriorly; R lung fields with
more diminished breath sounds particularly at base. Few crackles
at L base. Pursed lip breathing.
CV: Diminished, regular rate and rhythm, normal S1 + S2, no
murmurs, rubs, gallops appreciated
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: warm, well perfused, no clubbing, cyanosis. 2+ bilateral
pedal edema. Bilateral lower legs wrapped. Chronic venous stasis
changes.
Neuro: Alert, oriented to self and [**Location (un) 86**]. CN II-XII intact.
Easily able to read at close and far distances.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Resident at [**Location (un) **] Hourse. Worked in pharmacy when young; now
retired. Sister also lives in [**Name (NI) **] (is health care proxy)
and helps with his care; niece in close proximity. Stopped
smoking in [**2144**]; smoked for 40 years. 

### Response:
{"Other conjunctivitis,Acute on chronic systolic heart failure,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Hypoxemia,Hematuria, unspecified,Hypopotassemia,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Abnormal coagulation profile,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)"}
