CHIEF COMPLAINT: dyspnea

PRESENT ILLNESS: Ms. [**Known lastname 108328**] is an 81 year old [**Known lastname 595**] speaking female with a
history of anemia and thrombocytopenia, Crohn's disease on
chronic steroids, PE, returned from rehabilitation for
somnolence. Found to be hypoxic and somnolent in the emergency
room (VS T 98, BP 132/53, HR 92, RR 24, 95% on NRB). New
infiltrate on CXR in the left upper lobe, and ABG showed
hypercarbia. She was admitted to the ICU and started on
meropenem and vancomycin. She was given IV fluids for
hypotension and responded appropriately. She was started on
bipap in the ICU which improved her somnolence, and mental
status returned to baseline.

MEDICAL HISTORY: PAST MEDICAL HISTORY:
-Anemia [**3-3**] CRI, chronic disease
-MDS dx 3 yrs ago
-Crohn's disease
-CAD s/p NSTEMI '[**89**]
-CRI w baseline Cr 1.5-1.8
-BL DVTs and saddle embolus in [**2190**], previously on warfarin now
on Lovenox
-Chronic BL LE edema
-Breast cancer s/p lumpectomy & XRT
-GERD
-Intracranial bleed and fx after pedestrian vs car 20 yrs ago
-Cataracts
-Venous stasis dermatitis
-Tinea pedis
-?Arrhythmia unspecified which daughter says is tx with
metoprolol
-dHF with EF 60-70%
.
PAST SURGICAL HISTORY:
-CCY 10 yrs ago
-Lumpectomy 13 yrs ago

MEDICATION ON ADMISSION: Acetaminophen prn pain
Vitamin D 800 U q day
Mesalamine 1200 [**Hospital1 **]
Camphor-Menthol lotion prn
Miconazole powder prn
Atrovent q 6 hours
Albuterol q2 prn
Ciprofloxacin 250 mg [**Hospital1 **]
Loperamide 2 mg PO QID
Calcium Carbonate 1000 mg TID
Timolol Maleate 0.5 drops daily
Polyvinyl alochol-Povidone drops prn
Predinosone 60 mg [**Hospital1 15123**]
Lasix 10 mg daily

ALLERGIES: Belladonna Alkaloids

PHYSICAL EXAM: VS: T HR 84 BP 112/41 RR 15 O2 86% on 4L NC
General: NAD, pleasant and interactive, NC in place
[**Last Name (Titles) 4459**]: NCAT MMM anicteric pink conjunctiva
Neck: no JVD appreciated, supple
Lungs: crackles at LLL
CV: RRR 2/6 SEM at LUSB, PMI nondisplaced
Abd: soft, NT, ND, bowel sounds present, palpable non-moveable
mass c/w ventral hernia
Ext: + anasarca, LLE cellulitis - warm, erythematous, tender
Skin: numerous ecchymoses and sites of skin breakdown over torso
and extremities

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Married; lives with her husband who is demented, her daughter
[**Name (NI) 108329**], [**Name2 (NI) 108330**] husband and 6 [**Name2 (NI) **] granddaughter. Presently in
temporary housing while awaiting renovations on their [**Last Name (un) **]
which was damaged during a fire last winter. [**Last Name (un) 108329**] is the
caretaker for both of her parents. [**Last Name (un) 108329**] very stressed and
overwhelmed. Her mother-in-law in [**Name (NI) 4565**] died this past
month which required her husband to leave for [**Name (NI) 4565**]. She is
in the midst of trying to place her father in nursing care
facility and is quite guilty about this decision. Ms. [**Known lastname 108328**] [**Last Name (Titles) 108331**]y recieves near daily RN visits from Suburban Home Care.
[**Last Name (Titles) 108329**] is reliant on "sitters" to bring her mother to
appointments.
Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Acute kidney failure, unspecified,Chronic diastolic heart failure,Mixed acid-base balance disorder,Cellulitis and abscess of leg, except foot,Other alteration of consciousness,Antiallergic and antiemetic drugs causing adverse effects in therapeutic use,Anemia in chronic kidney disease,Other specified hypotension,Myelodysplastic syndrome, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Other and unspecified noninfectious gastroenteritis and colitis,Coronary atherosclerosis of native coronary artery,Cardiac dysrhythmia, unspecified,Old myocardial infarction,Esophageal reflux,Dermatophytosis of foot,Venous (peripheral) insufficiency, unspecified,Long-term (current) use of steroids,Personal history of venous thrombosis and embolism,Personal history of malignant neoplasm of breast,Personal history of irradiation, presenting hazards to health
Food/vomit pneumonitis,Acute respiratry failure,Acute kidney failure NOS,Chr diastolic hrt fail,Mixed acid-base bal dis,Cellulitis of leg,Other alter consciousnes,Adv eff anallrg/antemet,Anemia in chr kidney dis,Hypotension NEC,Myelodysplastic synd NOS,Hy kid NOS w cr kid I-IV,Chr kidney dis stage III,Noninf gastroenterit NEC,Crnry athrscl natve vssl,Cardiac dysrhythmia NOS,Old myocardial infarct,Esophageal reflux,Dermatophytosis of foot,Venous insufficiency NOS,Long-term use steroids,Hx-ven thrombosis/embols,Hx of breast malignancy,Hx of irradiation
Admission Date:  [**2194-4-9**]              Discharge Date:   [**2194-4-19**]

Date of Birth:  [**2112-2-19**]             Sex:   F

Service: MEDICINE

Allergies:
Belladonna Alkaloids

Attending:[**First Name3 (LF) 800**]
Chief Complaint:
dyspnea

Major Surgical or Invasive Procedure:
none


History of Present Illness:
Ms. [**Known lastname 108328**] is an 81 year old [**Known lastname 595**] speaking female with a
history of anemia and thrombocytopenia, Crohn's disease on
chronic steroids, PE, returned from rehabilitation for
somnolence. Found to be hypoxic and somnolent in the emergency
room (VS T 98, BP 132/53, HR 92, RR 24, 95% on NRB). New
infiltrate on CXR in the left upper lobe, and ABG showed
hypercarbia. She was admitted to the ICU and started on
meropenem and vancomycin. She was given IV fluids for
hypotension and responded appropriately. She was started on
bipap in the ICU which improved her somnolence, and mental
status returned to baseline.

Past Medical History:
PAST MEDICAL HISTORY:
-Anemia [**3-3**] CRI, chronic disease
-MDS dx 3 yrs ago
-Crohn's disease
-CAD s/p NSTEMI '[**89**]
-CRI w baseline Cr 1.5-1.8
-BL DVTs and saddle embolus in [**2190**], previously on warfarin now
on Lovenox
-Chronic BL LE edema
-Breast cancer s/p lumpectomy & XRT
-GERD
-Intracranial bleed and fx after pedestrian vs car 20 yrs ago
-Cataracts
-Venous stasis dermatitis
-Tinea pedis
-?Arrhythmia unspecified which daughter says is tx with
metoprolol
-dHF with EF 60-70%
.
PAST SURGICAL HISTORY:
-CCY 10 yrs ago
-Lumpectomy 13 yrs ago


Social History:
Married; lives with her husband who is demented, her daughter
[**Name (NI) 108329**], [**Name2 (NI) 108330**] husband and 6 [**Name2 (NI) **] granddaughter. Presently in
temporary housing while awaiting renovations on their [**Last Name (un) **]
which was damaged during a fire last winter. [**Last Name (un) 108329**] is the
caretaker for both of her parents. [**Last Name (un) 108329**] very stressed and
overwhelmed. Her mother-in-law in [**Name (NI) 4565**] died this past
month which required her husband to leave for [**Name (NI) 4565**]. She is
in the midst of trying to place her father in nursing care
facility and is quite guilty about this decision. Ms. [**Known lastname 108328**] [**Last Name (Titles) 108331**]y recieves near daily RN visits from Suburban Home Care.
[**Last Name (Titles) 108329**] is reliant on "sitters" to bring her mother to
appointments.

Family History:
non-contributory


Physical Exam:
VS: T HR 84 BP 112/41 RR 15 O2 86% on 4L NC
General: NAD, pleasant and interactive, NC in place
[**Last Name (Titles) 4459**]: NCAT MMM anicteric pink conjunctiva
Neck: no JVD appreciated, supple
Lungs: crackles at LLL
CV: RRR 2/6 SEM at LUSB, PMI nondisplaced
Abd: soft, NT, ND, bowel sounds present, palpable non-moveable
mass c/w ventral hernia
Ext: + anasarca, LLE cellulitis - warm, erythematous, tender
Skin: numerous ecchymoses and sites of skin breakdown over torso
and extremities


Pertinent Results:
[**2194-4-8**] 05:56AM   PT-13.2 PTT-25.0 INR(PT)-1.1
[**2194-4-8**] 05:56AM   PLT SMR-LOW PLT COUNT-82*
[**2194-4-8**] 05:56AM   WBC-11.8* RBC-2.86* HGB-9.6* HCT-29.5*
MCV-103* MCH-33.7* MCHC-32.6 RDW-18.8*
[**2194-4-8**] 05:56AM   CALCIUM-7.9* PHOSPHATE-3.9 MAGNESIUM-1.6
[**2194-4-8**] 05:56AM   estGFR-Using this
[**2194-4-8**] 05:56AM   GLUCOSE-110* UREA N-67* CREAT-2.5* SODIUM-143
POTASSIUM-5.2* CHLORIDE-109* TOTAL CO2-27 ANION GAP-12
[**2194-4-8**] 10:11AM URINE  MUCOUS-RARE
[**2194-4-8**] 10:11AM URINE  RBC-4* WBC-3 BACTERIA-NONE YEAST-NONE
EPI-0
[**2194-4-8**] 10:11AM URINE  BLOOD-TR NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.5
LEUK-NEG
[**2194-4-8**] 10:11AM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.012
[**2194-4-9**] 03:00PM URINE  RBC-[**4-3**]* WBC-[**4-3**] BACTERIA-FEW YEAST-NONE
EPI-0-2
[**2194-4-9**] 03:00PM URINE  BLOOD-LG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-TR
[**2194-4-9**] 03:00PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.010
[**2194-4-9**] 03:00PM URINE  GR HOLD-HOLD
[**2194-4-9**] 03:00PM URINE  UHOLD-HOLD
[**2194-4-9**] 03:00PM URINE  HOURS-RANDOM
[**2194-4-9**] 03:00PM URINE  HOURS-RANDOM
[**2194-4-9**] 03:45PM   PT-14.2* PTT-29.3 INR(PT)-1.2*
[**2194-4-9**] 03:45PM   PLT SMR-LOW PLT COUNT-104*
[**2194-4-9**] 03:45PM   HYPOCHROM-NORMAL ANISOCYT-1+ POIKILOCY-NORMAL
MACROCYT-1+ MICROCYT-OCCASIONAL POLYCHROM-OCCASIONAL STIPPLED-1+
[**2194-4-9**] 03:45PM   NEUTS-74* BANDS-12* LYMPHS-6* MONOS-7 EOS-0
BASOS-0 ATYPS-0 METAS-0 MYELOS-1*
[**2194-4-9**] 03:45PM   WBC-15.9* RBC-3.19* HGB-11.0* HCT-33.8*
MCV-106* MCH-34.4* MCHC-32.5 RDW-19.2*
[**2194-4-9**] 03:45PM   CK-MB-NotDone cTropnT-0.07*
[**2194-4-9**] 03:45PM   CK(CPK)-18*
[**2194-4-9**] 03:45PM   GLUCOSE-107* UREA N-58* CREAT-2.3* SODIUM-144
POTASSIUM-5.3* CHLORIDE-110* TOTAL CO2-25 ANION GAP-14
[**2194-4-9**] 05:27PM   freeCa-1.15
[**2194-4-9**] 05:27PM   HGB-10.9* calcHCT-33 O2 SAT-92 CARBOXYHB-1
[**2194-4-9**] 05:27PM   GLUCOSE-137* LACTATE-1.0 NA+-143 K+-5.4*
CL--107
[**2194-4-9**] 05:27PM   TYPE-ART PO2-69* PCO2-73* PH-7.18* TOTAL
CO2-29 BASE XS--2

Brief Hospital Course:
# Pneumonia: The patient was admitted to the medicine service
for new left upper lobe pneumonia thought to be consistent with
aspiration. She was started on vancomycin and meropenem. Given
she was afebrile, no leukocytosis and was hemodynamically stable
vancomycin was discontinued two days into admission meropenem
was continued for a 10 day course. On day 10 of admission she
was found to be somnolent in the morning. Per her daughter she
received valerian root overnight for insomnia and anxiety. ABG
indicated respiratory acidosis, with PCO2 at 81 (baseline high
50s to 60). She was transferred to the ICU for further
management.
She was started on BiPAP until her blood gas improved.  She was
able to come off to eat her dinner.  She was put back on BiPAP
overnight to get some rest.  In the morning, she again came off
and continued to do well.  Patient did receive one 250cc bolus
for hypotension and an appropriate increase in her blood
pressure. She completed her 10 days of meropenem. Prior to
discharge she was scheduled for a sleep study to further
evaluate for home bipap.

.
# Diastolic Heart Failure: Echo done on previous discharge
showed mild LVH, hyperdynamic systolic function (EF>75%), right
ventricular pressure/volume overload, 2+TR, and moderate
pulmonary artery hypertension. Her lasix was continued at 10mg
daily and intake/output was monitored as well. She continued to
do well without need for further intervention. Prior to
discharge she was restarted on her home beta blocker (metoprolol
succinate 12.5mg PO bid) with good BP control.
.

# CKD: Admitted with Cr of 2.3, which was near her baseline.
With conservative treatment creatinine improved to 1.4.
Nephrotoxins were avoided.

.
# Crohn's Disease: She did not experience frequent bouts of
diarrhea on this admission. Prednisone [**Year/Month/Day 15123**] was initially
continued, but changed to a slower [**Year/Month/Day 15123**] per daughters request.
Ciprofloxacin and mesalamine was continued.

.
# MDS and Related Anemia: She was given 1U PRBC for hct 24, and
weekly epogen was restarted on this admission. She will need
further follow-up with hematology.

.
# DVT/PE: Patient had chronic DVT/PE in the past for which she
was on lovenox. The patient's daughter refused heparin (previous
history of worsening thrombocytopenia w/use although HIT Ab
negative) and pneumoboot to arm given patients poor skin
condition. Given her anemia and thrombocytopenia, her previous
bloody stools, it was felt the risk of bleeding with
anticoagulation was highter than her risk for worsening DVT or
PE at this time. This should be re-evaluated by her PCP in the
future.

.
# Wound care: the patients skin looked much improved since her
last admission, with decreased extremity edema. Nursing wound
care was continued per previous recommendations.

.
# GERD: omeprazole 20mg twice daily was continued
.

# Prophylaxis: Calcium and vitamin D were continued, bactrim was
added for PCP [**Name Initial (PRE) 1102**]
.

# Social/psych: During this admission, social work and ethics
were called to assist in determining what was the appropriate
level of care for the patient (rehabilitation or home with
services). A family meeting was held, and the medical team and
family were in agreement that the patient can be cared for at
home with 24h care to assist her daughter. She did not want to
consider rehabilitation, although this would have been the ideal
setting for the patient at this time.
.
# Code: DNR/DNI


Medications on Admission:
Acetaminophen prn pain
Vitamin D 800 U q day
Mesalamine 1200 [**Hospital1 **]
Camphor-Menthol lotion prn
Miconazole powder prn
Atrovent q 6 hours
Albuterol q2 prn
Ciprofloxacin 250 mg [**Hospital1 **]
Loperamide 2 mg PO QID
Calcium Carbonate 1000 mg TID
Timolol Maleate 0.5 drops daily
Polyvinyl alochol-Povidone drops prn
Predinosone 60 mg [**Hospital1 15123**]
Lasix 10 mg daily


Discharge Medications:
1. semi-electric bed
[**Hospital 485**] hospital bed for diagnosis of respiratory failure
and congestive heart failure
2. bipap
bipap machine: ST pressures [**11-3**], with backup RR of 10
3. PICC flushes
PICC heparin flushes: per NEHT protocol
4. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed.
5. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Mesalamine 400 mg Tablet, Delayed Release (E.C.) Sig: Three
(3) Tablet, Delayed Release (E.C.) PO BID (2 times a day).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
7. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical QID
(4 times a day) as needed: apply up to 4 times daily to affected
area.
Disp:*qs 1* Refills:*2*
8. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO BID (2 times a day).
Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
9. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Ciprofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours).
Disp:*60 Tablet(s)* Refills:*2*
11. Furosemide 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
12. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
13. Prednisone 10 mg Tablet Sig: 3.5 Tablets PO DAILY (Daily):
35mg daily until [**4-22**]; [**Date range (1) 85977**] take 30mg daily then follow
your outpatient doctors orders for [**Name5 (PTitle) 15123**].
Disp:*10 Tablet(s)* Refills:*0*
14. Epoetin Alfa 10,000 unit/mL Solution Sig: One (1)  Injection
once a week.
15. Cyanocobalamin 1,000 mcg/mL Solution Sig: One (1)  Injection
once a month.
16. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
17. Triamcinolone Acetonide 0.025 % Cream Sig: One (1)  Topical
twice a day: for venous stasis.
18. Saline Flush 0.9 % Syringe Sig: Ten (10) ml  Injection once
a day: On going daily flush for PICC line and PRN.
Disp:*30 syringes* Refills:*2*
19. Calcium 500 mg Tablet Sig: Two (2) Tablet PO three times a
day.
20. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: 0.5 Tablet Sustained Release 24 hr PO once a day.


Discharge Disposition:
Home With Service

Facility:
[**Hospital6 1952**], [**Location (un) 86**]

Discharge Diagnosis:
hypercarbic respiratory failure
diastolic heart failure


Discharge Condition:
hemodynamically stable and afebrile


Discharge Instructions:
You were admitted to the hospital for increasing shortness of
breath and somnolence. You were treated for high bicarbonate
levels with bipap and oxygen supplementation. You were also
found to have a new pneumonia with was treated with meropenem
for 10 days and vancomycin for 2 days.
You will need to make an appointment with Dr.[**Last Name (STitle) 3357**] at your
convenience to follow your anemia and other symptoms.
Please make sure that you use your bipap machine at home and
continue your medications as ordered.

If you experience increasing shortness of breath, chest pains,
fevers, chills or any other concerning symptoms please call your
doctor or return to the emergency room.

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

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 7290**], MD Phone:[**Telephone/Fax (1) 463**] Date/Time:[**2194-4-24**]
10:20
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 647**], MD Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2194-4-29**] 3:30
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3014**], RN Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2194-4-29**]
3:30
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], MD Phone:[**Telephone/Fax (1) 4606**] Date/Time:
[**2194-5-6**] 2:45

Please make sure to attend your sleep study on [**5-2**] at
12:45pm in the [**Hospital Ward Name 1950**] building. Please call [**Telephone/Fax (1) 6856**] for
questions on directions or if  you need to reschedule.


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 810**] MD, [**MD Number(3) 811**]
{'Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Acute kidney failure, unspecified,Chronic diastolic heart failure,Mixed acid-base balance disorder,Cellulitis and abscess of leg, except foot,Other alteration of consciousness,Antiallergic and antiemetic drugs causing adverse effects in therapeutic use,Anemia in chronic kidney disease,Other specified hypotension,Myelodysplastic syndrome, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Other and unspecified noninfectious gastroenteritis and colitis,Coronary atherosclerosis of native coronary artery,Cardiac dysrhythmia, unspecified,Old myocardial infarction,Esophageal reflux,Dermatophytosis of foot,Venous (peripheral) insufficiency, unspecified,Long-term (current) use of steroids,Personal history of venous thrombosis and embolism,Personal history of malignant neoplasm of breast,Personal history of irradiation, presenting hazards to health'}


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: dyspnea

PRESENT ILLNESS: Ms. [**Known lastname 108328**] is an 81 year old [**Known lastname 595**] speaking female with a
history of anemia and thrombocytopenia, Crohn's disease on
chronic steroids, PE, returned from rehabilitation for
somnolence. Found to be hypoxic and somnolent in the emergency
room (VS T 98, BP 132/53, HR 92, RR 24, 95% on NRB). New
infiltrate on CXR in the left upper lobe, and ABG showed
hypercarbia. She was admitted to the ICU and started on
meropenem and vancomycin. She was given IV fluids for
hypotension and responded appropriately. She was started on
bipap in the ICU which improved her somnolence, and mental
status returned to baseline.

MEDICAL HISTORY: PAST MEDICAL HISTORY:
-Anemia [**3-3**] CRI, chronic disease
-MDS dx 3 yrs ago
-Crohn's disease
-CAD s/p NSTEMI '[**89**]
-CRI w baseline Cr 1.5-1.8
-BL DVTs and saddle embolus in [**2190**], previously on warfarin now
on Lovenox
-Chronic BL LE edema
-Breast cancer s/p lumpectomy & XRT
-GERD
-Intracranial bleed and fx after pedestrian vs car 20 yrs ago
-Cataracts
-Venous stasis dermatitis
-Tinea pedis
-?Arrhythmia unspecified which daughter says is tx with
metoprolol
-dHF with EF 60-70%
.
PAST SURGICAL HISTORY:
-CCY 10 yrs ago
-Lumpectomy 13 yrs ago

MEDICATION ON ADMISSION: Acetaminophen prn pain
Vitamin D 800 U q day
Mesalamine 1200 [**Hospital1 **]
Camphor-Menthol lotion prn
Miconazole powder prn
Atrovent q 6 hours
Albuterol q2 prn
Ciprofloxacin 250 mg [**Hospital1 **]
Loperamide 2 mg PO QID
Calcium Carbonate 1000 mg TID
Timolol Maleate 0.5 drops daily
Polyvinyl alochol-Povidone drops prn
Predinosone 60 mg [**Hospital1 15123**]
Lasix 10 mg daily

ALLERGIES: Belladonna Alkaloids

PHYSICAL EXAM: VS: T HR 84 BP 112/41 RR 15 O2 86% on 4L NC
General: NAD, pleasant and interactive, NC in place
[**Last Name (Titles) 4459**]: NCAT MMM anicteric pink conjunctiva
Neck: no JVD appreciated, supple
Lungs: crackles at LLL
CV: RRR 2/6 SEM at LUSB, PMI nondisplaced
Abd: soft, NT, ND, bowel sounds present, palpable non-moveable
mass c/w ventral hernia
Ext: + anasarca, LLE cellulitis - warm, erythematous, tender
Skin: numerous ecchymoses and sites of skin breakdown over torso
and extremities

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Married; lives with her husband who is demented, her daughter
[**Name (NI) 108329**], [**Name2 (NI) 108330**] husband and 6 [**Name2 (NI) **] granddaughter. Presently in
temporary housing while awaiting renovations on their [**Last Name (un) **]
which was damaged during a fire last winter. [**Last Name (un) 108329**] is the
caretaker for both of her parents. [**Last Name (un) 108329**] very stressed and
overwhelmed. Her mother-in-law in [**Name (NI) 4565**] died this past
month which required her husband to leave for [**Name (NI) 4565**]. She is
in the midst of trying to place her father in nursing care
facility and is quite guilty about this decision. Ms. [**Known lastname 108328**] [**Last Name (Titles) 108331**]y recieves near daily RN visits from Suburban Home Care.
[**Last Name (Titles) 108329**] is reliant on "sitters" to bring her mother to
appointments. 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Acute kidney failure, unspecified,Chronic diastolic heart failure,Mixed acid-base balance disorder,Cellulitis and abscess of leg, except foot,Other alteration of consciousness,Antiallergic and antiemetic drugs causing adverse effects in therapeutic use,Anemia in chronic kidney disease,Other specified hypotension,Myelodysplastic syndrome, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Other and unspecified noninfectious gastroenteritis and colitis,Coronary atherosclerosis of native coronary artery,Cardiac dysrhythmia, unspecified,Old myocardial infarction,Esophageal reflux,Dermatophytosis of foot,Venous (peripheral) insufficiency, unspecified,Long-term (current) use of steroids,Personal history of venous thrombosis and embolism,Personal history of malignant neoplasm of breast,Personal history of irradiation, presenting hazards to health'}
