CHIEF COMPLAINT: transferred from OSH for altered mental status and bilateral
pleural effusions with right-sided loculated hydropneumothorax

PRESENT ILLNESS: 73M with history of ESRD, PEG tube, CVA, DMII, CAD s/p CABG,
initially admitted to an OSH for altered mental status. There,
he had a chest X-ray showing bilateral pleural effusions. The
effusions were tapped and he developed a pneumothorax.
Subsequently, he developed abdominal pain, had a KUB showed free
air under the diaphragm, and CT scan was consistent with air
around the G-tube. At this time, he was transferred to [**Hospital1 18**].

MEDICAL HISTORY: -CABG [**1-19**] after MI (at [**Hospital1 2177**]: LIMA to LAD, SVG to OM1, SVG to
PDA)
-Post-operative R.MCA CVA ~1wk after CABG-Pt with resultant
hemiplegia, aphasia, dsyphagia.
-Post-op large RUE DVT
-Status-post respiratory failure from CVA, now weaned of vent.
-Hypertension
-Peripheral vascular disease, status-post left
popliteal-dorsalis pedis bypass with saphenous vein graft
-Status-post sepsis at [**Hospital1 **] in [**Month (only) 958**]
-Diabetes mellitus, Type II. Diagnosed 40 years ago,
complicated by nephropathy, neuropathy (sensory and autonomic
leading to urinary retention) and retinopathy (s/p bilat
vitrectomies, L eye blindness).
-ESRD secondary to diabetic nephropathy + chronic allograft
insufficiency s/p R cadaveric kidney transplant, complicated by

MEDICATION ON ADMISSION: Zocor 10mg QHS
Prednisone 10 mg QD
Aspirin 81 mg PO DAILY
Metoclopramide 5 mg/5 mL Five (5) ml PO TID via g-tube.
Therapeutic Multivitamin DAILY via g-tube
Simethicone 40 mg/0.6 mL Drops via g-tube.
Robitussin 200mg Q6H PRN
Vicodin 5mg Q4H PRN
Prevacid 30mg [**Hospital1 **]
Regular Insulin SS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T: 95.0 BP: 131/79 HR:79 RR:20 O2Sat: 100(3L)
GENERAL: NAD, talking to daughter
[**Name (NI) 4459**]: L cataract, poor vision, poor dentition, no cervical LAD,
no JVD
CARDIAC: RRR, nl S1S2, 2/6 systolic murmur at left sternal
border
PULM: left CTA, unable to auscultate right lung
ABD: firm, NT/ND, G-tube in place, BS+
EXT: warm, stumps C/D/I, no C/C/E
NEURO: left hemiparesis
SKIN: sacral decub ulcer, stage 2

FAMILY HISTORY: Mother and brother with DM Type 2.

SOCIAL HISTORY: Immigrated from [**Country **] in [**2141**].  Retired civil engineer.
Retired at age 47 because of health issues.  Currently lives at
home with his wife and 38 year old daughter.  Daughter, [**Name2 (NI) 4457**],
provides most of his care.  Denies alcohol, tobacco, drug use.
Hemorrhage complicating a procedure,Pneumonia due to Pseudomonas,Other specified forms of effusion, except tuberculous,End stage renal disease,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Complications of transplanted kidney,Glucocorticoid deficiency,Peripheral autonomic neuropathy in disorders classified elsewhere,Hyperosmolality and/or hypernatremia,Blood in stool,Foreign body in other specified parts bronchus and lung,Foreign body accidentally entering other orifice,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Aspiration of fluid as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Abdominal pain, unspecified site,Old myocardial infarction,Dysphagia, unspecified,Polyneuropathy in diabetes,Retention of urine, unspecified,Diabetes with renal manifestations, type II or unspecified type, uncontrolled,Background diabetic retinopathy,Pressure ulcer, lower back,Neurogenic bladder NOS,Anemia in chronic kidney disease,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other alteration of consciousness,Aromatic analgesics, not elsewhere classified, causing adverse effects in therapeutic use,Disorders of phosphorus metabolism,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction
Hemorrhage complic proc,Pseudomonal pneumonia,Effusion NEC exc tb,End stage renal disease,Late ef-hemplga side NOS,Hyp kid NOS w cr kid V,Compl kidney transplant,Glucocorticoid deficient,Aut neuropthy in oth dis,Hyperosmolality,Blood in stool,FB trach/bronch/lung NEC,FB entering oth orifice,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Abn react-fluid aspirat,Abdmnal pain unspcf site,Old myocardial infarct,Dysphagia NOS,Neuropathy in diabetes,Retention urine NOS,DMII renal uncntrld,Diabetic retinopathy NOS,Pressure ulcer, low back,Neurogenic bladder NOS,Anemia in chr kidney dis,Abn react-org transplant,Other alter consciousnes,Adv eff arom analgsc NEC,Dis phosphorus metabol,Peptic ulcer NOS
Admission Date:  [**2162-10-8**]              Discharge Date:   [**2162-10-26**]

Date of Birth:  [**2089-8-16**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5129**]
Chief Complaint:
transferred from OSH for altered mental status and bilateral
pleural effusions with right-sided loculated hydropneumothorax

Major Surgical or Invasive Procedure:
3 chest tubes placed in left, right anterior, and right
posterior chest.
Bronchoscopy x 2.


History of Present Illness:
73M with history of ESRD, PEG tube, CVA, DMII, CAD s/p CABG,
initially admitted to an OSH for altered mental status. There,
he had a chest X-ray showing bilateral pleural effusions. The
effusions were tapped and he developed a pneumothorax.
Subsequently, he developed abdominal pain, had a KUB showed free
air under the diaphragm, and CT scan was consistent with air
around the G-tube. At this time, he was transferred to [**Hospital1 18**].

Past Medical History:
-CABG [**1-19**] after MI (at [**Hospital1 2177**]: LIMA to LAD, SVG to OM1, SVG to
PDA)
-Post-operative R.MCA CVA ~1wk after CABG-Pt with resultant
hemiplegia, aphasia, dsyphagia.
-Post-op large RUE DVT
-Status-post respiratory failure from CVA, now weaned of vent.
-Hypertension
-Peripheral vascular disease, status-post left
popliteal-dorsalis pedis bypass with saphenous vein graft
-Status-post sepsis at [**Hospital1 **] in [**Month (only) 958**]
-Diabetes mellitus, Type II. Diagnosed 40 years ago,
complicated by nephropathy, neuropathy (sensory and autonomic
leading to urinary retention) and retinopathy (s/p bilat
vitrectomies, L eye blindness).
-ESRD secondary to diabetic nephropathy + chronic allograft
insufficiency s/p R cadaveric kidney transplant, complicated by

postinfectious GN (negative [**Doctor First Name **], ANCA, low complemt), signs of
chronic rejection (sclerotic glomeruli, interstitial fibrosis
3/[**2158**]). On dialysis starting [**2148**]. Tu/Th/sat
-Anemia
-Neurogenic bladder
-BPH status-post TURP [**2157**].
-Chronic osteomyelitis of C-spine and bilateral feet, s/p
bilateral transmetatarsal amputations (R foot [**2145**], L foot
[**2157**]).
-HSV stomatitis/genital
-Recurrent UTI
-blindness in R.eye
- Adrenal insufficiently diagnosed this year.
- ICD for mobitz type II

Social History:
Immigrated from [**Country **] in [**2141**].  Retired civil engineer.
Retired at age 47 because of health issues.  Currently lives at
home with his wife and 38 year old daughter.  Daughter, [**Name2 (NI) 4457**],
provides most of his care.  Denies alcohol, tobacco, drug use.


Family History:
Mother and brother with DM Type 2.

Physical Exam:
T: 95.0 BP: 131/79 HR:79 RR:20 O2Sat: 100(3L)
GENERAL: NAD, talking to daughter
[**Name (NI) 4459**]: L cataract, poor vision, poor dentition, no cervical LAD,
no JVD
CARDIAC: RRR, nl S1S2, 2/6 systolic murmur at left sternal
border
PULM: left CTA, unable to auscultate right lung
ABD: firm, NT/ND, G-tube in place, BS+
EXT: warm, stumps C/D/I, no C/C/E
NEURO: left hemiparesis
SKIN: sacral decub ulcer, stage 2

....

On discharge, exam was unchanged except for the following:
PULM: Improvement of breath sounds in the right lung, though
still diminshed compared to left.  No crackles/wheezes/rhonchi.

Pertinent Results:
Admission labs:
[**2162-10-9**] 02:50PM BLOOD WBC-6.2 RBC-3.46* Hgb-9.9* Hct-30.6*
MCV-89 MCH-28.7 MCHC-32.4 RDW-19.0* Plt Ct-185
[**2162-10-9**] 02:50PM BLOOD PT-14.0* PTT-37.2* INR(PT)-1.2*
[**2162-10-9**] 02:50PM BLOOD Fibrino-664*#
[**2162-10-9**] 02:50PM BLOOD FDP-10-40*
[**2162-10-9**] 02:50PM BLOOD Glucose-113* UreaN-25* Creat-4.1* Na-141
K-4.1 Cl-98 HCO3-34* AnGap-13
[**2162-10-9**] 02:50PM BLOOD ALT-19 AST-22 CK(CPK)-19* AlkPhos-111
TotBili-0.5
[**2162-10-9**] 02:50PM BLOOD Lipase-10
[**2162-10-9**] 02:50PM BLOOD CK-MB-NotDone cTropnT-0.33*
[**2162-10-9**] 02:50PM BLOOD Calcium-9.8 Phos-3.4 Mg-2.4 Iron-29*
[**2162-10-9**] 02:50PM BLOOD calTIBC-140* VitB12-GREATER TH
Folate-17.7 Ferritn-743* TRF-108*

Labs prior to transfer to MICU:
[**2162-10-14**] 12:18PM BLOOD WBC-18.4* RBC-3.22* Hgb-9.6* Hct-29.1*
MCV-91 MCH-29.7 MCHC-32.8 RDW-19.7* Plt Ct-272
[**2162-10-14**] 12:18PM BLOOD Glucose-197* UreaN-37* Creat-4.4* Na-139
K-4.2 Cl-100 HCO3-29 AnGap-14
[**2162-10-14**] 12:18PM BLOOD ALT-11 AST-17 AlkPhos-108 Amylase-209*
TotBili-0.5
[**2162-10-14**] 12:18PM BLOOD Calcium-9.5 Phos-3.2 Mg-2.1
[**2162-10-14**] 09:07PM BLOOD Glucose-253* Lactate-1.8 Na-141 K-3.4*
Cl-98*
[**2162-10-14**] 09:07PM BLOOD Type-ART pO2-80* pCO2-46* pH-7.46*
calTCO2-34* Base XS-7

Repeat Blood Gas MICU day 1:
[**2162-10-15**] 08:22AM BLOOD Type-ART pO2-102 pCO2-42 pH-7.48*
calTCO2-32* Base XS-6

Discharge labs:
[**2162-10-26**] 08:10AM BLOOD WBC-12.3 Hgb-9.1 Hct-27.4 MCV-91 Plt
Ct-333
[**2162-10-26**] 08:10AM BLOOD Glucose-202 UreaN-63 Creat-4.7 Na-139
K-3.4 Cl-103 HCO3-27 Ca 9.3 Mg 2.0 P 3.5

Radiology:
CXR [**10-9**]:
1. Interval development of large right hydropneumothorax.
2. Malpositioned right PICC tip projects over the subclavian
vein at the
upper lateral right chest. Repositioning is recommended.

CT [**10-9**]:
1. Large right hydropneumothorax. Predominantly loculated
posteriorly, with
smaller anterior component with layering fluid. Right lung
mostly collapsed,
except for a small portion of the right upper lobe.
2. Moderate left pleural effusion, with related compressive
atelectasis.
3. No free air in the abdomen.

G-tube study [**10-9**]:
G-tube in appropriate position within the stomach, without
evidence of contrast extravasation.

Cytology on [**10-11**] and [**10-17**]:
NEGATIVE FOR MALIGNANT CELLS

Head CT [**10-14**]:
IMPRESSION:
1. No evidence of hemorrhage or recent infarction.
2. Chronic right MCA territory infarction.
3. Periventricular white matter disease and findings consistent
with age-
related atrophy.
4. Sinus mucosal disease.
5. No significant change from [**2162-10-6**].

CXR [**10-14**] prior to MICU transfer:
1. Bilateral hydropneumothoraces, not significantly changed from
previous
radiograph.

LENI [**10-16**]:
IMPRESSION:
1. No lower extremity DVT.
2. Small amount of subcutaneous edema bilaterally.

CTA [**10-16**]:
IMPRESSION:
1. No evidence of pulmonary embolism.
2. Bilateral hydropneumothorax, with hemothorax on the right.
The size of
the pneumothorax component on the left has slightly decreased.
3. Bibasilar atelectasis, unchanged. The possibility of
superimposed
consolidation is difficult to exclude.

CXR [**10-21**]:
IMPRESSION: No significant change in moderate right-sided
hydropneumothorax
and small left apical pneumothorax.

Brief Hospital Course:
This is a 73M with history of ESRD, COPD, CAD, CVA transferred
from an outside hospital with bilateral pleural effusions and
right loculated hemopneumothorax.

Question of perforated G-tube:
On admission to the [**Hospital1 **], a G-tube check indicated proper
placement of the G-tube with no extravasation of contrast,
indicating that a perforation was not present.  Repeat CT
indicated no free air in the abdomen.

Hemopneumothorax:
A CXR for PICC placement on admission showed worsening
hemopneumothorax. CT scan showed large right hydropneumothorax,
which is predominantly loculated posteriorly, with smaller
anterior component with layering fluid. Right lung was mostly
collapsed, except for a small portion of the right upper lobe.
There was also moderate left pleural effusion, with related
compressive atelectasis. Large, round perihilar lymph nodes were
also noted.  IP and thoracics were consulted the patient had 3
chest tubes placed on HD2: left, right anterior, and right
posterior. The chest tubes drained serosanguinous fluid that was
exudative by Light's criteria.  No malignant cells were noted on
cytology. On HD3, the patient received a bronchoscopy that ruled
out endotrachial tumors and cleared secretions. Two chest tubes
were taken out on HD9 and HD10, but the left posterior tube was
left in place. Repeat chest CTA on HD11 showed the size of right
hemopneumothorax had decreased, but was still loculated, the L
lung had re-expanded, although there was still a persistent
apical pneumothorax. Patient was further evaluated by thoracic
surgery and interventional pulmonology, and both teams decided
that chest tubes would be of no further benefit to the patient.
A surgical operation would be necessary to re-expand the
patient's right lung, but the patient was not a surgical
candidate due to his multiple co-morbidities.  On HD13, the last
chest tube was also taken out.  On HD15, patient received
another therapeutic bronchoscopy that was only signficant for
secretions.

Pneumonia:
The patient developed a pseudomonas pneumonia on HD7 and was
initially treated with Zosyn.  The pseudomonas was eventually
found to be pan-sensitive and the patient was started on
Ceftazidime 1g IV qHD, which is the dose for ESRD on HD.  He was
continued on this regimen until discharge.  He will receive one
more dose of Ceftazidime at HD after discharge, after which he
will have completed a 14 day course.

Mental status:
The patient was alert and oriented x 3 upon transfer to the [**Hospital1 **].
However, his mental status began to wax and wane.  On HD5, he
became somnolent, but was still arousable. His mental status
deteriorated over the next day, and on HD7, when his white blood
cell count climbed to 18.5, he became difficult to arouse. He
triggered for tachypnea and nursing concern for somnolence.
Head CT was negative for bleed/ischemia.  He was transferred to
the MICU with a blood gas of 7.46/46/80.  In the MICU, CTA was
negative for PE. Lumbar puncture showed no PMN or
micro-organisms on gram stain and no growth was noted on
culture.  His respiratory culture speciated while in the MICU,
and he began Ceftazidime for pseudomonas pneumonia at this time.
 HD11, his oxygenation had improved and his WBC count had
decreased to 11.2, and the patient was transferred back to
floor.  On the floor, his mental status continued to improve
with intermittent periods of somnolence.  On the day of
discharge, his mental status was back to his baseline.  He was
alert and oriented x 3 (aware of his name, that he was at [**Hospital1 18**],
and that it was [**Month (only) 359**]).

Diarrhea/Rectal Bleeding:
On HD15, the patient developed loose stools and diarrhea and a
rectal tube was inserted.  Bloody diarrhea was then noticed in
the rectal tube, and it was discontinued.  The patient was
started on PO vancomycin to cover for C. diff.  He was found to
be C. diff negative x 2, and stool culture, ova and parasite
were negative as well. PO vancomycin was discontinued. On HD18,
the day of discharge, the patient's abdominal pain and
distension had resolved, and he was no longer having diarrhea.

DMII:
The patient's DMII was managed with a Humalog sliding scale.  He
was also started back on Lantus, which he was on at home.  At
time of discharge, the patient was receiving 9U of Lantus at
noon as well as the sliding scale.

ESRD:
He received dialysis every Tuesday, Thursday, Saturday, and also
received Epo and antibiotics at HD.  He was always diuresed to
his dry weight, or as much as possible while still maintaining
his SBP above 90mmHg.

Coronary Artery Disease (s/p MI and CABG in [**1-19**]) and
Hypertension were stable throughout the hospital course.  He was
managed on his home medications.

Medications on Admission:
Zocor 10mg QHS
Prednisone 10 mg QD
Aspirin 81 mg PO DAILY
Metoclopramide 5 mg/5 mL Five (5) ml PO TID via g-tube.
Therapeutic Multivitamin DAILY via g-tube
Simethicone 40 mg/0.6 mL Drops via g-tube.
Robitussin 200mg Q6H PRN
Vicodin 5mg Q4H PRN
Prevacid 30mg [**Hospital1 **]
Regular Insulin SS

Discharge Medications:
1. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Ceftazidime 1 gram Recon Soln Sig: One (1) Recon Soln
Intravenous QHD (each hemodialysis) for 1 doses: At dialysis on
[**2162-10-28**].
Disp:*1 gram* Refills:*0*
4. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO once a day.
5. Metoclopramide 5 mg/5 mL Solution Sig: One (1)  PO three
times a day.
6. Simethicone 40 mg/0.6 mL Drops, Suspension Sig: One (1)  PO
once a day.
7. Prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Lantus 100 unit/mL Cartridge Sig: Nine (9) Units Subcutaneous
once a day: Please give at 12:00pm.
Disp:*1 cartridge* Refills:*2*
9. Insulin Sliding Scale
Resume previous home sliding scale.
10. Prevacid 30 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
Primary Diagnoses:
Bilateraly hemopneumothorax
Pseudomonas pneumonia

Secondary Diagnoses:
Coronary artery disease
Right-sided Cerebral Vascular Accident
Hypertension
Peripheral Vascular Disease
Diabetes Mellitus Type II with diabetic nephropathy and diabetic
neuropathy and diabetic retinopathy
Post-infectious glomerulonephropathy
Anemia
Neurogenic bladder
Benign Prostatic Hypertrophy
Mobitz II with pacemaker/ICD
Adrenal Insufficiency
End Stage Renal Disease on Hemodialysis


Discharge Condition:
stable, good oxygenation on room air


Discharge Instructions:
You were admitted because you had difficulty with breathing due
to large, bilateral hemopneumothoraces (blood and air around
your lungs).  You had three chest tubes placed in your chest to
help drain the fluid.
You also developed a pneumonia while in the hospital that you
are being treated for with antibiotics.
Please continue to take the medications provided to you at the
time of this discharge.  We have made the following changes to
your medications.
1. Antibiotics: You should receive one more dose of Ceftazipime
1mg IV at hemodialysis on Thursday [**2162-10-28**].
2. Insulin: Please take Lantus 9 units once daily; continue your
insulin sliding scale.
3. Your prednisone has been decreased to 5 mg daily.
.
Please follow up with your Primary Care Physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **], after discharge as listed below. You should have a
colonoscopy as an outpatient; Dr [**Last Name (STitle) **] will help you arrange
this.
Please follow up with Pulmonology for continued work up of your
lung issues, including the hemopneumothoraces and enlarged hilar
lymph nodes.
.
Please come back to the Emergency Room if you experience nausea,
vomiting, diarrhea, bleeding from your rectum, shortness of
breath, chest pain, change in mental status, difficulty or
intolerance of tube feeds, or fever to 101F.

Followup Instructions:
Please follow up on these appointments, which are already
scheduled:

PULMONOLOGY (DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1112**]/Dr [**Last Name (STitle) **]): [**2162-11-3**] 1:00 PM
([**Hospital Ward Name 23**] 7). Call [**Telephone/Fax (1) 612**] with questions.

PRIMARY CARE (DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **])
[**2162-11-26**]. 3:30pm.  [**Hospital6 733**] - [**Location (un) 8661**]
Atrium at [**Hospital1 69**] [**Hospital Ward Name 516**].  You
will need a colonoscopy in the near future; Dr [**Last Name (STitle) **] will help
you arrange this.



Completed by:[**2162-10-27**]
{'Hemorrhage complicating a procedure,Pneumonia due to Pseudomonas,Other specified forms of effusion, except tuberculous,End stage renal disease,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Complications of transplanted kidney,Glucocorticoid deficiency,Peripheral autonomic neuropathy in disorders classified elsewhere,Hyperosmolality and/or hypernatremia,Blood in stool,Foreign body in other specified parts bronchus and lung,Foreign body accidentally entering other orifice,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Aspiration of fluid as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Abdominal pain, unspecified site,Old myocardial infarction,Dysphagia, unspecified,Polyneuropathy in diabetes,Retention of urine, unspecified,Diabetes with renal manifestations, type II or unspecified type, uncontrolled,Background diabetic retinopathy,Pressure ulcer, lower back,Neurogenic bladder NOS,Anemia in chronic kidney disease,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other alteration of consciousness,Aromatic analgesics, not elsewhere classified, causing adverse effects in therapeutic use,Disorders of phosphorus metabolism,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction'}


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: transferred from OSH for altered mental status and bilateral
pleural effusions with right-sided loculated hydropneumothorax

PRESENT ILLNESS: 73M with history of ESRD, PEG tube, CVA, DMII, CAD s/p CABG,
initially admitted to an OSH for altered mental status. There,
he had a chest X-ray showing bilateral pleural effusions. The
effusions were tapped and he developed a pneumothorax.
Subsequently, he developed abdominal pain, had a KUB showed free
air under the diaphragm, and CT scan was consistent with air
around the G-tube. At this time, he was transferred to [**Hospital1 18**].

MEDICAL HISTORY: -CABG [**1-19**] after MI (at [**Hospital1 2177**]: LIMA to LAD, SVG to OM1, SVG to
PDA)
-Post-operative R.MCA CVA ~1wk after CABG-Pt with resultant
hemiplegia, aphasia, dsyphagia.
-Post-op large RUE DVT
-Status-post respiratory failure from CVA, now weaned of vent.
-Hypertension
-Peripheral vascular disease, status-post left
popliteal-dorsalis pedis bypass with saphenous vein graft
-Status-post sepsis at [**Hospital1 **] in [**Month (only) 958**]
-Diabetes mellitus, Type II. Diagnosed 40 years ago,
complicated by nephropathy, neuropathy (sensory and autonomic
leading to urinary retention) and retinopathy (s/p bilat
vitrectomies, L eye blindness).
-ESRD secondary to diabetic nephropathy + chronic allograft
insufficiency s/p R cadaveric kidney transplant, complicated by

MEDICATION ON ADMISSION: Zocor 10mg QHS
Prednisone 10 mg QD
Aspirin 81 mg PO DAILY
Metoclopramide 5 mg/5 mL Five (5) ml PO TID via g-tube.
Therapeutic Multivitamin DAILY via g-tube
Simethicone 40 mg/0.6 mL Drops via g-tube.
Robitussin 200mg Q6H PRN
Vicodin 5mg Q4H PRN
Prevacid 30mg [**Hospital1 **]
Regular Insulin SS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T: 95.0 BP: 131/79 HR:79 RR:20 O2Sat: 100(3L)
GENERAL: NAD, talking to daughter
[**Name (NI) 4459**]: L cataract, poor vision, poor dentition, no cervical LAD,
no JVD
CARDIAC: RRR, nl S1S2, 2/6 systolic murmur at left sternal
border
PULM: left CTA, unable to auscultate right lung
ABD: firm, NT/ND, G-tube in place, BS+
EXT: warm, stumps C/D/I, no C/C/E
NEURO: left hemiparesis
SKIN: sacral decub ulcer, stage 2

FAMILY HISTORY: Mother and brother with DM Type 2.

SOCIAL HISTORY: Immigrated from [**Country **] in [**2141**].  Retired civil engineer.
Retired at age 47 because of health issues.  Currently lives at
home with his wife and 38 year old daughter.  Daughter, [**Name2 (NI) 4457**],
provides most of his care.  Denies alcohol, tobacco, drug use. 

### Response:
{'Hemorrhage complicating a procedure,Pneumonia due to Pseudomonas,Other specified forms of effusion, except tuberculous,End stage renal disease,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Complications of transplanted kidney,Glucocorticoid deficiency,Peripheral autonomic neuropathy in disorders classified elsewhere,Hyperosmolality and/or hypernatremia,Blood in stool,Foreign body in other specified parts bronchus and lung,Foreign body accidentally entering other orifice,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Aspiration of fluid as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Abdominal pain, unspecified site,Old myocardial infarction,Dysphagia, unspecified,Polyneuropathy in diabetes,Retention of urine, unspecified,Diabetes with renal manifestations, type II or unspecified type, uncontrolled,Background diabetic retinopathy,Pressure ulcer, lower back,Neurogenic bladder NOS,Anemia in chronic kidney disease,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other alteration of consciousness,Aromatic analgesics, not elsewhere classified, causing adverse effects in therapeutic use,Disorders of phosphorus metabolism,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction'}
