CHIEF COMPLAINT: Persistent shortness of breath.

PRESENT ILLNESS: The patient returned to the
hospital 12 hours after discharge on [**2140-4-21**].  He states
that he felt short of breath upon returning home and had to
increase his oxygen delivery by nasal cannula without
improvement, and called 911 to return to the Emergency
Department.  He stated that the right-sided chest pain was
unchanged; however, he felt more tired and has slept
throughout his Emergency Department stay.

MEDICAL HISTORY: Cholecystitis, status post
laparoscopic cholecystectomy with persisting bile leak as
described in the previous discharge summary.

MEDICATION ON ADMISSION: 

ALLERGIES: Vicodin causes hallucinations.

PHYSICAL EXAM: 

FAMILY HISTORY: There is no interval change.

SOCIAL HISTORY: No change since his previous admission.
Methicillin susceptible pneumonia due to Staphylococcus aureus,Acidosis,Infection with microorganisms resistant to penicillins,Asthma, unspecified type, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified essential hypertension,Unspecified glaucoma
Meth sus pneum d/t Staph,Acidosis,Inf mcrg rstn pncllins,Asthma NOS,DMII neuro nt st uncntrl,Neuropathy in diabetes,Hypertension NOS,Glaucoma NOS
Admission Date: [**2140-4-22**]        Discharge Date: [**2140-4-29**]

Date of Birth:  [**2078-1-6**]        Sex:  M

Service:  MED


CHIEF COMPLAINT:  Persistent shortness of breath.

HISTORY OF PRESENT ILLNESS:  The patient returned to the
hospital 12 hours after discharge on [**2140-4-21**].  He states
that he felt short of breath upon returning home and had to
increase his oxygen delivery by nasal cannula without
improvement, and called 911 to return to the Emergency
Department.  He stated that the right-sided chest pain was
unchanged; however, he felt more tired and has slept
throughout his Emergency Department stay.

REVIEW OF SYSTEMS:  Please see the discharge summary dated
[**2140-4-21**] for a detailed review of systems that is unchanged.

PAST MEDICAL HISTORY:  Cholecystitis, status post
laparoscopic cholecystectomy with persisting bile leak as
described in the previous discharge summary.

Restrictive lung disease, as described in the previous
discharge summary.  PFT's were not repeated upon this
admission.

Type 2 diabetes complicated by neuropathy.  Note:  The
patient is being transitioned from oral hypoglycemic agents
to subcutaneous insulin administration.

Benign prostatic hyperplasia.

Appendicitis, status post appendectomy.

Coronary artery disease, status post non-ST segment elevation
myocardial infarction, [**2140-3-3**].

Glaucoma.

ALLERGIES:  Vicodin causes hallucinations.


MEDICATIONS ON PRESENTATION:
1. Levofloxacin 500 mg q 24 h.  The patient had taken 1 dose
   since discharge and was to complete a 10-day course.
2. Aspirin 235 mg qd.
3. Albuterol/ipratropium inhaler 2 puffs q 6 h.
4. Metoprolol 50 mg [**Hospital1 **].
5. Oxycodone/acetaminophen 5 mg tablets [**12-4**] q 4-6 h prn.
6. Transdermal fentanyl 25 mcg q h.
7. Dorzolamide/timolol drops prn.
8. Fosamax 0.4 mg capsules [**Hospital1 **].
9. Ranitidine 150 mg [**Hospital1 **].
10.Ibuprofen 400 mg po q 8 h.
11.Pioglitazone 30 mg po qd.
12.Glucotrol 10 mg po bid.

FAMILY HISTORY:  There is no interval change.

SOCIAL HISTORY:  No change since his previous admission.

PHYSICAL EXAMINATION:  Temperature 97.6, heart rate 78, blood
pressure 127/57, oxygen saturation 100 percent on 3 liters
and 99 percent and 1 liter.
Generally, he was a tired appearing, pleasant, articulate man
who is sitting comfortably in a chair.
HEENT:  Normocephalic, atraumatic, anicteric sclerae, pale
conjunctivae.  Pupils equal, round and reactive to light and
accommodation.  Extraocular movements are intact without
nystagmus.  The oropharynx is clear.
NECK:  The jugulovenous pressure is inestimable.  The trachea
is midline.  There is no carotid bruit.  The thyroid gland is
not palpable.
HEART:  Regular, normal S1 and S2.  There is no S3, S4,
murmur, rubs, or gallops.
LUNGS:  There is a decreased excursion bilaterally and
crackles at the right base that are unchanged from his
previous evaluation.
ABDOMEN:  Scaphoid, soft, not tender or distended.  There are
normal bowel sounds present.
EXTREMITIES:  There is no rash, clubbing, cyanosis, or edema.

LABORATORY EVALUATION:  White blood cell count 8,200,
hematocrit 31.6 percent, platelets 170,000, sodium 142,
potassium 5.5, chloride 106, bicarbonate 29, blood urea
nitrogen 33, creatinine 1.4, glucose 194.  Serial assessment
of CK, CK-MB, troponin-T did not show evidence of myocardial
infarction.
CHEST X-RAY:  Showed slight cephalization of the pulmonary
vasculature and a persisting right lower lobe opacity and
small bilateral pleural effusions.  There were unchanged from
his previous evaluation.

HOSPITAL COURSE BY SYSTEMS:
1. PULMONARY:  The patient's sputum culture dated [**2140-4-20**]
   grew 2 organisms, specifically Methicillin resistant
   Staphylococcus aureus was identified, along with
   Pseudomonas aeruginosa.  Due to his previous ciprofloxacin
   resistant islet of Pseudomonas, levofloxacin was
   discontinued.  Cefepime 1 gm q 8 h was substituted.  Also,
   vancomycin 1 gm q 12 h was added to the patient's regimen.
   Of note, the patient has been afebrile despite the
   presence of right lower lobe pneumonia and has had normal
   white blood cell count throughout.

The patient expressed concern that he experienced anxiety and
acute shortness of breath upon exerting himself, and asked to
have his oxygen delivery increased to 4 L/min.  Given his
previous hospital stays marked by delirium in the setting of
hypercarbia, he was instructed not to increase his oxygen
requirement above that recommended by the treating
physicians.  The patient was evaluated by the physical
therapy service and found to have a desaturation of his pulse
oxygen to approximately 85 percent on room air while
ambulating, with prompt restoration of the normal pulse
oxygen saturation on 1 liter of oxygen supplemented by nasal
cannula.

1. GASTROINTESTINAL:  The patient had his percutaneous
   gastrostomy tube removed on this admission.  He was slated
   to have it removed by Dr. [**First Name (STitle) 679**] as described previously on
   the medical record.

1. CORONARY ARTERY DISEASE AND HYPERTENSION:  No changes were
   made to the patient's regimen of aspirin and beta blocker.
   His blood pressure at a low-normal range, and an ACE
   inhibitor was not added, although this would be an
   excellent medication for this patient in the future.  The
   patient required 1 dose of intravenous furosemide on
   admission with prompt diuresis.

1. TYPE 2 DIABETES:  The patient was placed on a regimen of
   insulin NPH [**Hospital1 **] along with regular insulin sliding scale.
   The patient had excellent glycemic control for the
   duration of his hospital stay.

1. BENIGN PROSTATIC HYPERPLASIA:  No changes were made to his
   alpha blocker.

1. DEPRESSION AND ANXIETY:  The patient and his wife met with
   a social worker while in the hospital.  Outpatient
   arrangements for psychiatric evaluation were made.  His
   antidepressant which was started on the previous discharge
   was restarted here.  Specifically, the patient received 20
   mg of escitalopram qd.


DISCHARGE DIAGNOSES:  Complicated hospital acquired
pneumonia.

Restrictive lung disease.

Cholecystitis, status post laparoscopic cholecystectomy with
persisting bile leak as described in the previous discharge
summary.


Type 2 diabetes complicated by neuropathy.  Note:  The
patient is being transitioned from oral hypoglycemic agents
to subcutaneous insulin administration.

Benign prostatic hyperplasia.

Appendicitis, status post appendectomy.

Coronary artery disease, status post non-ST segment elevation
myocardial infarction, [**2140-3-3**].

Glaucoma.

DISCHARGE MEDICATIONS:
1. Ceftazidime 1 gm q 8 h x 14 days (Note:  This medication
   was started on [**2140-4-26**].).
2. Vancomycin 1 gm q 12 h, started on [**2140-4-26**].  The patient
   should have a trough level checked on [**2140-5-3**].
3. Heparin 5,000 U q 12 h subcutaneously.
4. Aspirin 325 mg qd.
5. Metoprolol 50 mg [**Hospital1 **].
6. Albuterol/ipratropium inhaler 1-2 puffs q 6 h prn.
7. Ambien 5-10 mg at night immediately.
8. Flomax 0.4 mg [**Hospital1 **].
9. Ranitidine 150 mg [**Hospital1 **].
10.Transdermal fentanyl 25 mcg, change q 72 h.
11.Dorzolamide/timolol 1 drop OU [**Hospital1 **].
12.Insulin NPH 6 U in the morning and 2 U in the evening with
a regular insulin sliding scale as attached separately.
13.Senna 1 tablet [**Hospital1 **].
14.Colace 10 mg PO or PR prn.
15.Escitalopram 20 mg qd.

DISCHARGE CONDITION:  Stable.

DISPOSITION:  The patient was sent to acute rehabilitation
for further pulmonary rehabilitation.



                     DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 12-AAE

Dictated By:[**Doctor Last Name 34877**]
MEDQUIST36
D:  [**2140-4-29**] 09:13:46
T:  [**2140-4-29**] 09:55:19
Job#:  [**Job Number 34879**]


Admission Date: [**2140-4-22**]        Discharge Date: [**2140-5-4**]

Date of Birth:  [**2078-1-6**]        Sex:  M

Service:  MED


ADDENDUM:

HOSPITAL COURSE:  On the anticipated date of discharge the
patient had persisting somnolence.  Arterial blood gas
performed to document hypercarbia:  The pH was 7.21, pCO2 87,
pO2 80 on one liter by nasal cannula confirming an acute on
chronic respiratory acidosis.  The patient's narcotics were
discontinued; specifically, the transdermal fentanyl patch
was removed and the oxycodone/acetaminophen tablet frequency
was decreased.  Six hours following the documentation
described above, a repeat arterial blood gas was performed
showing slight improvement; specifically, the pH was 7.32,
pCO2 68, pO2 54.  On all gases the SaO2 was above 95 percent.

In the face of the patient's transient hypercarbia and acute
on chronic respiratory acidosis, he was transfer to the
Medical Intensive Care Unit for initiation of biphasic
positive airway pressure ventilation without oxygen
supplementation.  On the first night in the Medical Intensive
Care Unit the patient required four hours of BiPAP although
by the morning he was breathing comfortably on his own.  A
repeat blood gas showed stable chronic respiratory acidosis
with pH of 7.39, pCO2 58 and pO2 was 79 on the day of
discharge from the Medical Intensive Care Unit.  Of note, he
spent two days in the Intensive Care Unit, the second night
he did not require biphasic positive airway pressure.  After
returning to the Medical [**Hospital1 **], assessment of his vancomycin
trough was found to be elevated at nearly 30 mcg/mL.  This
medication was held for a day and a half until the random
level decreased below 15.  It was restarted at one gram every
36 hours intravenously.  The duration of the treatment is
unchanged from the previous discharge summary; specifically,
this medication should continue for 14 days starting from [**2140-4-26**], along with ceftazidime one gram every eight hours.

Regarding the patient's depression, given that he had a
protracted stay, inpatient psychiatric evaluation was
obtained and stimulating anti-depressant, specifically
bupropion, was added to his regimen.  The patient shall
establish psychiatric care at [**Hospital6 733**] upon
discharge from the rehabilitation hospital.

DISCHARGE MEDICATIONS:
1. Vancomycin 1 gram intravenously q. 36h. to complete a 14
   day course started on [**2140-4-26**].
2. Ceftazidime 1 gram q. 8h. to complete a 14 day course
   started on [**2140-4-26**].
3. Oxycodone/acetaminophen one to two tablets by mouth every
   four to six hours as needed.
4. Prochlorperazine 10 mg IV every six hours as needed.
5. Bupropion 100 mg p.o. q. a.m.
6. Furosemide 20 mg daily.
7. Heparin 5000 units subcutaneously every eight hours.
8. Acetaminophen 650 mg by mouth every four to six hours as
   needed.
9. Albuterol two puffs inhaled every four hours.
10.      Ipratropium two puffs inhaled q.i.d.
11.      Senna one tablet p.o. b.i.d.
12.      Bisacodyl 10 mg p.o. p.r. q. day p.r.n.
13.      Regular insulin sliding scale as listed separately
   (Note:  The patient was on oral hypoglycemics prior to
   discharge from the hospital; however, he has had excellent
   glycemic control with minimal need for subcutaneous
   insulin while here.  Anticipate restarting his oral
   hypoglycemics upon discharge and advancement of his diet.)
14.      Dorzolamide 2 percent/timolol 0.5 percent ophthalmic
   solution one drop OU b.i.d.
15.      Ranitidine 150 mg p.o. b.i.d.
16.      Tamsulosin 0.4 mg p.o. b.i.d.
17.      Aspirin 325 mg p.o. daily.




                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], MD [**MD Number(2) 34876**]

Dictated By:[**Doctor Last Name 34877**]
MEDQUIST36
D:  [**2140-5-4**] 09:15:18
T:  [**2140-5-4**] 09:44:49
Job#:  [**Job Number 34880**]
{'Methicillin susceptible pneumonia due to Staphylococcus aureus,Acidosis,Infection with microorganisms resistant to penicillins,Asthma, unspecified type, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified essential hypertension,Unspecified glaucoma'}


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: Persistent shortness of breath.

PRESENT ILLNESS: The patient returned to the
hospital 12 hours after discharge on [**2140-4-21**].  He states
that he felt short of breath upon returning home and had to
increase his oxygen delivery by nasal cannula without
improvement, and called 911 to return to the Emergency
Department.  He stated that the right-sided chest pain was
unchanged; however, he felt more tired and has slept
throughout his Emergency Department stay.

MEDICAL HISTORY: Cholecystitis, status post
laparoscopic cholecystectomy with persisting bile leak as
described in the previous discharge summary.

MEDICATION ON ADMISSION: 

ALLERGIES: Vicodin causes hallucinations.

PHYSICAL EXAM: 

FAMILY HISTORY: There is no interval change.

SOCIAL HISTORY: No change since his previous admission. 

### Response:
{'Methicillin susceptible pneumonia due to Staphylococcus aureus,Acidosis,Infection with microorganisms resistant to penicillins,Asthma, unspecified type, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified essential hypertension,Unspecified glaucoma'}
