CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: The patient is a 48-year-old woman with COPD and significant
tracheobronchomalacia.  She underwent a stent trial and despite
running into
complications and side effects with the stent, she reported
marked improvement in her overall dyspnea and quality of life
with the stent in place.  Therefore, we recommended a
tracheobronchoplasty to stabilize the airway.

MEDICAL HISTORY: cholecystectomy,
hysterectomy;
DM- poorly controlled especially with steroids
reflux dx'ed 15 years ago on zantac

MEDICATION ON ADMISSION: omeprazole, prednisone, advair, spiriva, budesonide, diovan,
lantus and humalog, demasex, burporion, zantac, simavstatin,
amiloride, zyrtec, requip

ALLERGIES: Levaquin / Augmentin / Pamelor / adhesive tape / Shellfish
Derived

PHYSICAL EXAM: Discharge Vital Signs:
BP:126/60mmHg
HR:95/min
RR:22/min
SPO2:95% on 3 L/min O2
TEMP:98.0F

FAMILY HISTORY: Mother- thyroid (?cancer)
Father- heart attack

SOCIAL HISTORY: Married, lives with family
Other diseases of trachea and bronchus,Urinary tract infection, site not specified,Chronic airway obstruction, not elsewhere classified,Other iatrogenic hypotension,Other fluid overload,Morbid obesity,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Insulin pump status
Trachea & bronch dis NEC,Urin tract infection NOS,Chr airway obstruct NEC,Iatrogenc hypotnsion NEC,Fluid overload NEC,Morbid obesity,Esophageal reflux,DMII wo cmp nt st uncntr,Long-term use of insulin,Insulin pump status
Admission Date:  [**2183-1-3**]              Discharge Date:   [**2183-1-11**]

Date of Birth:  [**2134-12-22**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Levaquin / Augmentin / Pamelor / adhesive tape / Shellfish
Derived

Attending:[**First Name3 (LF) 5790**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
[**2183-1-3**]
Right thoracotomy, thoracic tracheoplasty with
mesh, right mainstem bronchus/bronchus intermedius
bronchoplasty with mesh, left mainstem bronchus bronchoplasty
with mesh.


History of Present Illness:
The patient is a 48-year-old woman with COPD and significant
tracheobronchomalacia.  She underwent a stent trial and despite
running into
complications and side effects with the stent, she reported
marked improvement in her overall dyspnea and quality of life
with the stent in place.  Therefore, we recommended a
tracheobronchoplasty to stabilize the airway.


Past Medical History:
cholecystectomy,
hysterectomy;
DM- poorly controlled especially with steroids
reflux dx'ed 15 years ago on zantac


Social History:
Married, lives with family

Family History:
Mother- thyroid (?cancer)
Father- heart attack


Physical Exam:
Discharge Vital Signs:
BP:126/60mmHg
HR:95/min
RR:22/min
SPO2:95% on 3 L/min O2
TEMP:98.0F

Discharge Physical Exam:
GEN: alert & oriented x 3
CVS:S1S2+
RS:b/l lungs clear
ABD: soft, non tender, non distended


Pertinent Results:
[**2183-1-10**] 05:18AM BLOOD WBC-14.3* RBC-3.19* Hgb-9.2* Hct-28.4*
MCV-89 MCH-28.7 MCHC-32.2 RDW-17.8* Plt Ct-313
[**2183-1-10**] 05:18AM BLOOD Glucose-172* UreaN-13 Creat-0.9 Na-133
K-4.0 Cl-95* HCO3-28 AnGap-14
[**2183-1-10**] 05:18AM BLOOD Albumin-3.0* Calcium-8.4 Phos-3.7 Mg-2.2

CXR:[**2183-1-11**]-
No relevant change as compared to the previous examination.
Moderate vascular distention indicative of mild-to-moderate
pulmonary edema.
No evidence of interval appearance of focal parenchymal opacity
suggesting
pneumonia. Moderate cardiomegaly with tortuosity of the thoracic
aorta. No
larger pleural effusions. Unchanged position of right-sided
central venous
access line.


Brief Hospital Course:
Mrs. [**Known firstname **] [**Known lastname 14837**] was taken to the operating room on [**2183-1-3**]
where she underwent right thoractomy and tracheoplasty by Dr.
[**Last Name (STitle) **] for tracheobronchomalacia. She was kept intubated
and went to the ICU following surgery due to airway edema. She
was diuresed with lasix and on neosynephrine drip for
hypotension. She was given a dose of stress dose steroids
intraoperatively. The patient was extubated on [**2183-1-5**], and
remained on neosynephrine drip in the ICU, which was titrated
off on [**2183-1-7**].
The patient was transferred to the floor on the evening of
[**2183-1-7**], with acceptable blood pressures, in normal sinus
rhythm. The following is a systems review of the [**Hospital 228**]
hospital course.

Neuro/Pain:
The patient was kept on bupivicaine with dilaudid epidural which
was removed on [**2183-1-7**], and started on oxycodone with tylenol
which was effective.

Pulmonary:
Aggressive pulmonary toilet was maintained throughout admission
with around the clock nebulizers, mucolytics and chest
physiotherapy. Serial chest xrays were taken daily. The patient
exhibited signs of increased volume overload on [**2183-1-8**],
therefore was aggressively diuresed with IV lasix. Subsequent
films improved. She was unable to wean completely off oxygen.
She was discharged with 2Liters NC, with TID mucomyst and
albuterol nebulizers.

CV: The patient remained in normal sinus rhythm with blood
pressures in the 100-120 range systolic, on the floor.

Abd: The patient advanced her diet to regular diabetic diet. She
was kept on stool softeners, passing gas.

Renal: Her foley was kept initially during epidural but then for
urine output monitoring. It was discontinued [**2183-1-9**]. A UA was
checked due to bump in white count which was positive. Bactrim
was started [**2183-1-10**].
She was aggressively diuresed for volume overload with IV lasix.
Her electrolytes were repleted.

Endocrine: Her insulin pump was discontinued preoperatively.
Postoperatively she remained on insulin drip then SQ long
acting, managed by [**Last Name (un) **] endocrinology. On [**2183-1-8**] the
patient's insulin pump was restarted with normal blood sugars.

Prophylactic: SCD's, TEDS and heparin SQ were given for VTE
prophylaxis.

The patient was seen by physical therapy who deemed her safe for
discharge home with home PT. The patient was discharged home on
[**2183-1-11**].


Medications on Admission:
omeprazole, prednisone, advair, spiriva, budesonide, diovan,
lantus and humalog, demasex, burporion, zantac, simavstatin,
amiloride, zyrtec, requip


Discharge Medications:
1. brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic Q12H
(every 12 hours).
2. paroxetine HCl 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
4. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. tiotropium bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
6. bupropion HCl 150 mg Tablet Sustained Release Sig: Two (2)
Tablet Sustained Release PO QAM (once a day (in the morning)).
7. prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. calcium carbonate 200 mg (500 mg) Tablet, Chewable Sig: One
(1) Tablet, Chewable PO DAILY (Daily): as you were taking prior
to surgery.
9. oxycodone 5 mg Tablet Sig: 1-3 Tablets PO Q4H (every 4 hours)
as needed for pain.
Disp:*120 Tablet(s)* Refills:*0*
10. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day): while on narcotics to prevent constipation.
11. insulin regular hum U-500 conc 500 unit/mL Solution Sig: 0.5
unit Injection continuous: take as directed by endocrinologist.

12. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed for constipation: available
over the counter .
13. valsartan 80 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
14. torsemide 20 mg Tablet Sig: Two (2) Tablet PO once a day.
15. potassium chloride 20 mEq Packet Sig: One (1) packet PO once
a day: or as you were taking.
16. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q 8H
(Every 8 Hours).
17. Symbicort 160-4.5 mcg/Actuation HFA Aerosol Inhaler Sig: Two
(2) puffs Inhalation [**Hospital1 **] ().
18. amiloride-hydrochlorothiazide 5-50 mg Tablet Sig: One (1)
Tablet PO once a day.
19. Prevacid 30 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.
20. ropinirole 1 mg Tablet Sig: Three (3) Tablet PO QPM (once a
day (in the evening)).
21. ranitidine HCl 150 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
22. cholecalciferol (vitamin D3) 400 unit Tablet Sig: 2.5
Tablets PO DAILY (Daily): or as your were taking prior to
surgery.
23. Home oxygen
2Liter Nasal cannula continuous, pulse dose for portablitity
for tracheobronchomalacia s/p tracheoplasty, to keep RA
saturations >92%

24. nebulizer kits
please give pt a nebulizer kits for home nebulizer.

s/p tracheoplasty
25. albuterol sulfate 1.25 mg/3 mL Solution for Nebulization
Sig: One (1) neb Inhalation every eight (8) hours for 2 weeks.
Disp:*42 nebs* Refills:*1*
26. acetylcysteine 20 % (200 mg/mL) Solution Sig: Three (3) ml
Miscellaneous every eight (8) hours.
Disp:*50 ml* Refills:*1*
27. Zyrtec 10 mg Tablet Sig: One (1) Tablet PO once a day.
28. Singulair 10 mg Tablet Sig: One (1) Tablet PO at bedtime.
29. potassium chloride 10 % Liquid Sig: Two (2) tsp PO once a
day: as directec by PCP.
30. sulfamethoxazole-trimethoprim 800-160 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily) for 2 doses.
Disp:*2 Tablet(s)* Refills:*0*
31. fexofenadine 60 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 **] VNA & Hospice Services

Discharge Diagnosis:
Tracheobronchomalacia
Diabetes Mellitus
GERD


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Call Dr.[**Name (NI) 2347**] office at [**Telephone/Fax (1) 2348**] if you have:
-fevers greater than 101.5, chills or shakes
-worsening cough or shortness of breath
-drainage, swelling or redness from right incisions
-uncontrolled surgical pain

Walk several times a day and use your incentive spirometer.

While on narcotics for pain do not drive, and talk stool
softeners to avoid constipation.

No tub bathing or submerging in water until incisions fully
healed (usually 4 weeks)

You should change your chest tube site with a bandaid, changing
daily. You may shower Tuesday.

Check your weight daily and if greater than 2 pounds in a day or
more than 3 pounds in a week call Dr. [**Last Name (STitle) 85693**] to change
torsemide and potassium dosing.

Use mucomyst and albuterol nebulizers three times a day.

Use oxygen to keep oxygen saturation >92%.




Followup Instructions:
Provider: [**Name10 (NameIs) 1532**] [**Last Name (NamePattern4) 8786**], MD Phone:[**Telephone/Fax (1) 3020**]
Date/Time:[**2183-1-28**] 11:00am [**Hospital1 **] 116 [**Hospital Ward Name 517**].

Get a chest xray 30 minutes prior to you appointment in Clinical
Center [**Location (un) 470**] radiology

Followup with Dr. [**Last Name (STitle) 85693**] for followup on fluid status, and
labs, and adjustment of diuretics and potassium on
[**2183-1-17**] at 10:45 am. Call the office if you get leg
cramps or severe weakness prior to check your electrolytes.

Followup with your endocrinologist regarding insulin pump.



Completed by:[**2183-1-13**]
{'Other diseases of trachea and bronchus,Urinary tract infection, site not specified,Chronic airway obstruction, not elsewhere classified,Other iatrogenic hypotension,Other fluid overload,Morbid obesity,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Insulin pump status'}


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: The patient is a 48-year-old woman with COPD and significant
tracheobronchomalacia.  She underwent a stent trial and despite
running into
complications and side effects with the stent, she reported
marked improvement in her overall dyspnea and quality of life
with the stent in place.  Therefore, we recommended a
tracheobronchoplasty to stabilize the airway.

MEDICAL HISTORY: cholecystectomy,
hysterectomy;
DM- poorly controlled especially with steroids
reflux dx'ed 15 years ago on zantac

MEDICATION ON ADMISSION: omeprazole, prednisone, advair, spiriva, budesonide, diovan,
lantus and humalog, demasex, burporion, zantac, simavstatin,
amiloride, zyrtec, requip

ALLERGIES: Levaquin / Augmentin / Pamelor / adhesive tape / Shellfish
Derived

PHYSICAL EXAM: Discharge Vital Signs:
BP:126/60mmHg
HR:95/min
RR:22/min
SPO2:95% on 3 L/min O2
TEMP:98.0F

FAMILY HISTORY: Mother- thyroid (?cancer)
Father- heart attack

SOCIAL HISTORY: Married, lives with family 

### Response:
{'Other diseases of trachea and bronchus,Urinary tract infection, site not specified,Chronic airway obstruction, not elsewhere classified,Other iatrogenic hypotension,Other fluid overload,Morbid obesity,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Insulin pump status'}
