CHIEF COMPLAINT: Respiratory Distress.

PRESENT ILLNESS: Ms. [**Known lastname **] is a 71-year-old female with a complicated past
medical history including asthma and OSA who presents with acute
onset shortness of breath since approximately 2 am on the
morning of admission. Per the patient, she noted some mild
shortness of breath before going to bed on the night prior to
admisssion and required an albuterol neb. Her condition did not
improve following this and she was noted to have an O2 sat of
44% and [**Doctor Last Name 352**] complexion. She was given 3 more nebs and brought
in by EMS. In the ED here, her initial O2 sat was 80% on NC,
improved to 100% on NRB. She was initially placed on BiPAP which
was eventually turned off and she was tried on NC. She
subsequently desaturated but came up to 100% on 12L NRB. 3
duonebs were also given after being off BiPAP.
.
She was subsequently transferred to the ICU, where her vitals
were: afebrile, 132/77 80 14 100% 12L NRB. She was given SL
Nitro x2 given for "a little bit of CP", which resolved after
nitro. Also received SoluMedrol 125mg IV x1, Levofloxacin 750mg
IV x1.
.
She denies h/o COPD, CHF, but is on home lasix 40 [**Hospital1 **]. No
f/c/n/v/LE swelling. BNP was negative, CXR read in the ED as
volume overload and 40mg IV furosemide was given with 800cc
output via Foley that was placed in ED. Troponin neg, d-dimer
neg. WBC noted to be 12.
.
She has a history of asthma requiring daily albuterol and prior
hospitalizations but no intubation, on 2L home O2.
.
On the floor, she reports continued mild shortness of breath,
which she notes is near her baseline. She has a chronic
nonproductive cough, but reports mild sinus congestion for the
past two days and her cough has worsened and become productive
of small amounts of yellowish sputum.

MEDICAL HISTORY: - Type 2 diabetes mellitus
- Hypertension
- Dyslipidemia
- Obesity
- s/p GI bleed
- Peptic ulcer disease/GERD/hiatus hernia
- Diverticulosis
- Osteoarthritis
- OSA on CPAP at home
- Sinusitis
- recurrent (4 severe episodes) of Group B strep
cellulitis/bacteremia
- TIA in [**12-24**] presented with facial droop and weakness for 2
hours; had her aspirin increased to 325mg.
- Panic disorder/Depression (3 prior suicide attempts by drug
overdose)
- Personality disorder, NOS
- Borderline personality

MEDICATION ON ADMISSION: (from [**2183-6-15**] discharge summary)
1. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
One (1) puff Inhalation q2hrs.
2. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1) neb Inhalation every four (4) hours as

ALLERGIES: Penicillins / Erythromycin Base / Compazine / Benadryl / Sulfa
(Sulfonamide Antibiotics) / Zinc / Phenothiazines / Oxycodone /
aspirin

PHYSICAL EXAM: ON ADMISSION:
Vitals: T:97 BP:145/78 P:89 R:10 O2: 100% on 6L NC
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Decreased breath sounds, diffuse early inspiratory
wheezes with course breath sounds throughout
CV: Regular rate and rhythm, normal S1 + S2
Abdomen: obese, soft, non-tender, non-distended, bowel sounds
present
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema, no rashes

FAMILY HISTORY: Mother died of renal failure. Father died of an MI at age 58.
She has a brother with skin cancer. She has another sister w
HTN.

SOCIAL HISTORY: Currently lives at [**Hospital3 **]. She is able to ambulate with
assistance of a walker but is basically wheelchair dependant.
She does not smoke, or drink alcohol. Tried marijuana for a year
in the [**2142**].
Asthma, unspecified type, with (acute) exacerbation,Acute upper respiratory infections of unspecified site,Obstructive sleep apnea (adult)(pediatric),Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux
Asthma NOS w (ac) exac,Acute uri NOS,Obstructive sleep apnea,DMII wo cmp nt st uncntr,Hypertension NOS,Hyperlipidemia NEC/NOS,Esophageal reflux
Admission Date:  [**2183-8-23**]              Discharge Date:   [**2183-8-25**]

Date of Birth:  [**2111-12-2**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Erythromycin Base / Compazine / Benadryl / Sulfa
(Sulfonamide Antibiotics) / Zinc / Phenothiazines / Oxycodone /
aspirin

Attending:[**First Name3 (LF) 1973**]
Chief Complaint:
Respiratory Distress.


Major Surgical or Invasive Procedure:
None.

History of Present Illness:
Ms. [**Known lastname **] is a 71-year-old female with a complicated past
medical history including asthma and OSA who presents with acute
onset shortness of breath since approximately 2 am on the
morning of admission. Per the patient, she noted some mild
shortness of breath before going to bed on the night prior to
admisssion and required an albuterol neb. Her condition did not
improve following this and she was noted to have an O2 sat of
44% and [**Doctor Last Name 352**] complexion. She was given 3 more nebs and brought
in by EMS. In the ED here, her initial O2 sat was 80% on NC,
improved to 100% on NRB. She was initially placed on BiPAP which
was eventually turned off and she was tried on NC. She
subsequently desaturated but came up to 100% on 12L NRB. 3
duonebs were also given after being off BiPAP.
.
She was subsequently transferred to the ICU, where her vitals
were: afebrile, 132/77 80 14 100% 12L NRB. She was given SL
Nitro x2 given for "a little bit of CP", which resolved after
nitro. Also received SoluMedrol 125mg IV x1, Levofloxacin 750mg
IV x1.
.
She denies h/o COPD, CHF, but is on home lasix 40 [**Hospital1 **]. No
f/c/n/v/LE swelling. BNP was negative, CXR read in the ED as
volume overload and 40mg IV furosemide was given with 800cc
output via Foley that was placed in ED. Troponin neg, d-dimer
neg. WBC noted to be 12.
.
She has a history of asthma requiring daily albuterol and prior
hospitalizations but no intubation, on 2L home O2.
.
On the floor, she reports continued mild shortness of breath,
which she notes is near her baseline. She has a chronic
nonproductive cough, but reports mild sinus congestion for the
past two days and her cough has worsened and become productive
of small amounts of yellowish sputum.

Past Medical History:
- Type 2 diabetes mellitus
- Hypertension
- Dyslipidemia
- Obesity
- s/p GI bleed
- Peptic ulcer disease/GERD/hiatus hernia
- Diverticulosis
- Osteoarthritis
- OSA on CPAP at home
- Sinusitis
- recurrent (4 severe episodes) of Group B strep
cellulitis/bacteremia
- TIA in [**12-24**] presented with facial droop and weakness for 2
hours; had her aspirin increased to 325mg.
- Panic disorder/Depression (3 prior suicide attempts by drug
overdose)
- Personality disorder, NOS
- Borderline personality

PSxH:
- Total abdominal hysterectomy-for Ovarian CA in [**2158**]
- She mentioned that she had a recent lung biopsy which was
suggestive of sarcoidosis according to the patient, in her CTA
chest carried out in [**2182-3-18**], there is a mention of possible
BAL
lung ca.
- Bilateral Breast reduction complicated by Left breast
cellulitis/abscess
- s/p R knee replacement [**2176**]
- cholecystectomy

Social History:
Currently lives at [**Hospital3 **]. She is able to ambulate with
assistance of a walker but is basically wheelchair dependant.
She does not smoke, or drink alcohol. Tried marijuana for a year
in the [**2142**].


Family History:
Mother died of renal failure. Father died of an MI at age 58.
She has a brother with skin cancer. She has another sister w
HTN.


Physical Exam:
ON ADMISSION:
Vitals: T:97 BP:145/78 P:89 R:10 O2: 100% on 6L NC
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Decreased breath sounds, diffuse early inspiratory
wheezes with course breath sounds throughout
CV: Regular rate and rhythm, normal S1 + S2
Abdomen: obese, soft, non-tender, non-distended, bowel sounds
present
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema, no rashes

ON DISCHARGE:
Vitals: T: 96.8 BP: 118/51 P: 70 R: 22 O2: 983L
General: Morbidly obese elderly woman who is alert, oriented,
and in no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, very poor
dentition
Neck: supple, nontender
Lungs: Diffuse early inspiratory wheezes with course breath
sounds throughout
CV: Normal rate and regular rhythm, normal S1 + S2, no murmurs,
rubs, gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, no clubbing, cyanosis.


Pertinent Results:
ON ADMISSION:

[**2183-8-23**] 08:50AM BLOOD WBC-12.0*# RBC-3.82* Hgb-11.4* Hct-34.4*
MCV-90 MCH-29.8 MCHC-33.1 RDW-15.4 Plt Ct-222
[**2183-8-23**] 08:50AM BLOOD Neuts-82.4* Lymphs-8.6* Monos-2.4
Eos-5.8* Baso-0.7
[**2183-8-23**] 08:50AM BLOOD Glucose-127* UreaN-18 Creat-0.8 Na-145
K-4.5 Cl-101 HCO3-36* AnGap-13
[**2183-8-24**] 08:55AM BLOOD Calcium-8.9 Phos-2.5* Mg-2.0
[**2183-8-23**] 08:50AM BLOOD cTropnT-<0.01
[**2183-8-23**] 08:50AM BLOOD proBNP-30
[**2183-8-23**] 08:50AM BLOOD D-Dimer-271

Imaging:
[**8-23**] CXR: No acute intrathoracic process. No evidence of fluid
overload.

ON DISCHARGE:
[**2183-8-24**] 08:55AM BLOOD WBC-7.0 RBC-3.80* Hgb-10.9* Hct-32.9*
MCV-87 MCH-28.7 MCHC-33.1 RDW-15.0 Plt Ct-200
[**2183-8-24**] 08:55AM BLOOD Glucose-153* UreaN-19 Creat-0.7 Na-139
K-4.4 Cl-97 HCO3-35* AnGap-11


Brief Hospital Course:
Ms. [**Known lastname **] is a 71-year-old female with a complicated past
medical history including asthma and OSA who presents with acute
onset shortness of breath since approximately 2 am on the
morning of admission. She was briefly admitted to the ICU on a
BiPap then NRB. She swiftly transitioned to nasal cannula on
asthma exacerbation therapy.
.
ACTIVE ISSUES:
#Chronic Asthma with Acute Exacerbation: Given her history of
asthma, wheezing on exam, and improvement over several hours
with nebs, this was likely another asthma exacerbation. Despite
her decreased mobility, we doubted PE, as she had a low D-dimer
of 271, and she has no calf tenderness. Given her elevated white
count with slight left shift, she could have early pna, but she
was afebrile and had no other sx and CXR and her exam was not
consistent with infection. Given her risk factors of DM2, HTN,
HLD she is also at risk of ACS. She denied any CP upon
development of her SOB, her first trop was negative, and her
recent cath was unremarkable. The inspiratory nature of her
wheezing is also concerning for vocal cord dysfunction. Also,
her recent URI is likely a contributing factor to the
exacerbation. COPD, Pickwikian, bronchitis, and vocal cord
dysfunction are also possible and her acute decompensation is
likely multifactorial. She was treated with IV steroids (125 mg
solumedrol), albuterol nebs, and a 100% non-rebreather and was
brought to the ICU. By the time she reached the ICU, her sats
had improved and she was stable on 4L by nasal cannula. She was
brought up to the floor where she was continued on Q4 albuterol
nebs and 30 mg PO prednisone and her O2 was weaned. She noted
significant improvement in her breathing and felt that she was
near her baseline by the morning following her admission. She
was discharge on albuterol nebs, which she has at baseline, as
well as a 3 day prednisone taper and flovent inhaler
.
INACTIVE ISSUES:
#Type 2 DM Uncontrolled with complications- We held her hold
home metformin and glipizide and kept her on ISS.
.
#Benign Hypertension- Home meds were continued: valsartan,
furosemide.
.
#Hyperlipidemia- continued home statin
.
#GERD- continued omeprazole
.
#Osteoarthritis- continued home pain treatment regimen with
vicodin and motrin
.
#Panic disorder- continued home quetiapine QHS
.
#depression- continued mirtazapine and citalopram
.
TRANSITIONAL ISSUES:
1. She will go back to the [**Hospital3 2558**] for continued care.
2. She has a follow-up appointment with a pulmonologist to
[**Hospital3 4656**] her respiratory issues. An [**Month (only) **] appointment was being
discussed at discharge and may be arranged pending appointment
availability.
3. She has a follow-up appointment with ENT to [**Month (only) 4656**] for
possible vocal cord dysfunction.

Medications on Admission:
(from [**2183-6-15**] discharge summary)
1. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
One (1) puff Inhalation q2hrs.
2. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1) neb Inhalation every four (4) hours as

needed for shortness of breath or wheezing.
3. alum-mag hydroxide-simeth 200-200-20 mg/5 mL Suspension Sig:
15-30 MLs PO every six (6) hours as needed for heartburn.
4. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO at bedtime.

5. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
Sundays and Fridays as needed for constipation.
6. calcium carbonate-vit D3-min 600-400 mg-unit Tablet Sig: One
(1) Tablet PO twice a day.
7. cholecalciferol (vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO twice a day.
8. citalopram 40 mg Tablet Sig: 1.5 Tablets PO once a day.
9. clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)).
10. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
11. fluticasone 50 mcg/Actuation Spray, Suspension Sig: One (1)
nasal Nasal at bedtime.
12. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. glipizide 10 mg Tablet Sig: One (1) Tablet PO once a day.
14. hydrocodone-acetaminophen 5-500 mg Tablet Sig: One (1)
Tablet PO Q4H (every 4 hours) as needed for pain.
15. insulin lispro 100 unit/mL Solution Sig: One (1) injection
Subcutaneous four times a day: Per sliding scale as instructed
by your doctor.
16. ipratropium bromide 17 mcg/Actuation HFA Aerosol Inhaler
Sig: Two (2) puffs Inhalation four times a day.
17. lactase 3,000 unit Tablet Sig: One (1) Tablet PO three times

a day.
18. lactobacillus acidophilus     Capsule Sig: One (1) Capsule
PO three times a day.
19. lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO TID (3
times a day).
20. lamotrigine 200 mg Tablet Sig: One (1) Tablet PO once a day.

21. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily): 12
hours on, 12 hours off.
22. loratadine 10 mg Tablet Sig: One (1) Tablet PO once a day.
23. metformin 500 mg Tablet Sig: One (1) Tablet PO once a day.
24. mirtazapine 45 mg Tablet Sig: One (1) Tablet PO at bedtime.

25. omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)

Capsule, Delayed Release(E.C.) PO twice a day.
26. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1)
PO DAILY (Daily).
27. quetiapine 400 mg Tablet Extended Release 24 hr Sig: One (1)

Tablet Extended Release 24 hr PO once a day.
28. sennosides 8.6 mg Tablet Sig: Two (2) Tablet PO twice a day
as needed for constipation.
29. valsartan 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

30. ibuprofen 200 mg Tablet Sig: One (1) Tablet PO three times a

day as needed for pain.
31. gabapentin 100 mg Capsule Sig: Two (2) Capsule PO Q12H
(every 12 hours).
32. gabapentin 100 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily) as needed for at 2pm.
33. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO twice a
day.
34. cepacol  Sig: Fifteen (15) mg  prn as needed for cough.
35. Tussin 100 mg/5 mL Syrup Sig: Ten (10) mg PO every four (4)
hours as needed for cough.
36. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO DAILY (Daily).
37. nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) tablet
Sublingual prn as needed for chest pain.
38. sodium chloride 0.65 % Aerosol, Spray Sig: [**2-16**] Sprays Nasal
[**Hospital1 **] (2 times a day).

Discharge Medications:
1. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
One (1) Puff Inhalation Q2H.
2. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q4H (every 4 hours) as
needed for wheezing.
3. alum-mag hydroxide-simeth 200-200-20 mg/5 mL Suspension Sig:
One (1)  PO every six (6) hours as needed for heartburn.
4. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO at bedtime.

5. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
ONCE (Once) as needed for constipation: Sundays and Fridays as
needed for constipation.
6. Calcium 600 + D(3) 600 mg(1,500mg) -400 unit Tablet Sig: One
(1) Tablet PO twice a day.
7. cholecalciferol (vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO twice a day.
8. citalopram 20 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
9. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. hydrocodone-acetaminophen 5-500 mg Tablet Sig: One (1)
Tablet PO Q6H (every 6 hours) as needed for pain.
11. lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO three
times a day.
12. lamotrigine 100 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
13. mirtazapine 15 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime).
14. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO BID (2 times a day).
15. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1)
PO DAILY (Daily).
16. quetiapine 200 mg Tablet Extended Release 24 hr Sig: Two (2)
Tablet Extended Release 24 hr PO QHS (once a day (at bedtime))
as needed for depression.
17. senna 8.6 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
18. valsartan 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

19. ibuprofen 200 mg Tablet Sig: One (1) Tablet PO three times a
day as needed for pain.
20. prednisone 10 mg Tablet Sig: Three (3) Tablet PO once a day
for 3 days: Take 3 tablets on [**8-26**], take 2 tablets on [**8-27**], take
1 tablet on [**8-28**].
Disp:*6 Tablet(s)* Refills:*0*
21. insulin lispro 100 unit/mL Solution Sig: One (1)
Subcutaneous four times a day: Per sliding scale as instructed
by your doctor.
22. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO twice
a day.
23. glipizide 10 mg Tablet Sig: One (1) Tablet PO once a day.
24. ipratropium bromide 17 mcg/Actuation HFA Aerosol Inhaler
Sig: Two (2)  Inhalation four times a day.
25. lactase 3,000 unit Tablet Sig: One (1) Tablet PO three times
a day.
26. lactobacillus acidophilus     Capsule Sig: One (1) Capsule
PO three times a day.
27. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1)  Topical once a day: 12 hours on, 12 hours off.
28. loratadine 10 mg Tablet Sig: One (1) Tablet PO once a day.
29. metformin 500 mg Tablet Sig: One (1) Tablet PO once a day.
30. gabapentin 100 mg Capsule Sig: Two (2) Capsule PO every
twelve (12) hours.
31. gabapentin 100 mg Capsule Sig: One (1) Capsule PO once a day
as needed for pain.
32. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO twice a
day.
33. cepacol  Sig: One (1) 15 mg  four times a day as needed for
cough.
34. Tussin 100 mg/5 mL Syrup Sig: One (1)  PO every four (4)
hours.
35. magnesium hydroxide 400 mg/5 mL Suspension Sig: 30 mL  PO
once a day.
36. nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1)
Sublingual once a day as needed for chest pain.
37. sodium chloride 0.65 % Aerosol, Spray Sig: [**2-16**]  Nasal twice
a day.
38. Flonase 50 mcg/Actuation Spray, Suspension Sig: One (1)
nasal spray Nasal at bedtime.
39. Flovent HFA 110 mcg/Actuation Aerosol Sig: One (1) puff
Inhalation twice a day.
Disp:*1 inhaler* Refills:*2*
40. Misc
Please arrange a Nasal CPAP for nighttime CPAP
PLease ensure [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] BM
Please provide q4 nebs and steroids as ordered


Discharge Disposition:
Extended Care

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

Discharge Diagnosis:
Primary diagnosis:
Asthma exacerbation, secondary to upper respiratory tract
infection
Vocal Cord Dysfunction


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
Dear [**Known firstname **] [**Known lastname **], It was a pleasure participating in your care
while you were an inpatient at the [**Hospital1 18**]. You were admitted to
the hospital because you had an acute episode of shortness of
breath at night that made your oxygen saturation very low. You
were given oxygen therapy and IV steroids in the emergency
department, which helped your breathing a great deal. It is
likely that this episode was the result of an asthma
exacerbation and may have been triggered by your recent cold and
the congestion and sputum you mentioned. There may also be some
involvement from a dysfunction of your vocal cords. You were
continued on oxygen by nasal cannula, with a higher rate than at
your nursing home and you were given a low dose of oral steroids
on your second day in the hospital. You will go back to your
nursing home with continued albuterol nebs and oxygen therapy as
you were on before admission. You should follow up with your PCP
and the [**Name9 (PRE) **], Nose and Throat doctor [**First Name (Titles) **] [**Last Name (Titles) 4656**] your vocal cords
and you should continue taking oral steroids for a few more
days.
.
We have made the following changes to your medications:
START Prednisone 30 mg. You will decrease the dose to 10 mg over
3 days.

Followup Instructions:
Name: [**Last Name (LF) **], [**First Name7 (NamePattern1) 122**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
Location: [**Hospital1 **]
PULMONARY, CRITICAL CARE & SLEEP MEDICINE
Address: [**Location (un) **], E/KS-B23, [**Location (un) **],[**Numeric Identifier 718**]
Phone: [**Telephone/Fax (1) 612**]
*You should see Dr. [**Last Name (STitle) **] within one month.  His office will
contact you to schedule an appointment.

Department: [**Hospital3 1935**] CENTER
When: THURSDAY [**2183-8-28**] at 2:45 PM
With: [**Doctor Last Name **] OPTOMETRY [**Telephone/Fax (1) 253**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: OTOLARYNGOLOGY (ENT)
When: WEDNESDAY [**2183-9-10**] at 12:00 PM
With: [**Hospital **] CLINIC [**Telephone/Fax (1) 41**]
Building: LM [**Hospital Unit Name **] [**Location (un) 895**]
Campus: WEST     Best Parking: [**Doctor First Name **]. GARAGE

Department: MEDICAL SPECIALTIES
When: THURSDAY [**2183-9-11**] at 2:00 PM
With: [**Name6 (MD) **] [**Name8 (MD) 611**], M.D. [**Telephone/Fax (1) 612**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage


Completed by:[**2183-8-25**]
{'Asthma, unspecified type, with (acute) exacerbation,Acute upper respiratory infections of unspecified site,Obstructive sleep apnea (adult)(pediatric),Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux'}


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: Respiratory Distress.

PRESENT ILLNESS: Ms. [**Known lastname **] is a 71-year-old female with a complicated past
medical history including asthma and OSA who presents with acute
onset shortness of breath since approximately 2 am on the
morning of admission. Per the patient, she noted some mild
shortness of breath before going to bed on the night prior to
admisssion and required an albuterol neb. Her condition did not
improve following this and she was noted to have an O2 sat of
44% and [**Doctor Last Name 352**] complexion. She was given 3 more nebs and brought
in by EMS. In the ED here, her initial O2 sat was 80% on NC,
improved to 100% on NRB. She was initially placed on BiPAP which
was eventually turned off and she was tried on NC. She
subsequently desaturated but came up to 100% on 12L NRB. 3
duonebs were also given after being off BiPAP.
.
She was subsequently transferred to the ICU, where her vitals
were: afebrile, 132/77 80 14 100% 12L NRB. She was given SL
Nitro x2 given for "a little bit of CP", which resolved after
nitro. Also received SoluMedrol 125mg IV x1, Levofloxacin 750mg
IV x1.
.
She denies h/o COPD, CHF, but is on home lasix 40 [**Hospital1 **]. No
f/c/n/v/LE swelling. BNP was negative, CXR read in the ED as
volume overload and 40mg IV furosemide was given with 800cc
output via Foley that was placed in ED. Troponin neg, d-dimer
neg. WBC noted to be 12.
.
She has a history of asthma requiring daily albuterol and prior
hospitalizations but no intubation, on 2L home O2.
.
On the floor, she reports continued mild shortness of breath,
which she notes is near her baseline. She has a chronic
nonproductive cough, but reports mild sinus congestion for the
past two days and her cough has worsened and become productive
of small amounts of yellowish sputum.

MEDICAL HISTORY: - Type 2 diabetes mellitus
- Hypertension
- Dyslipidemia
- Obesity
- s/p GI bleed
- Peptic ulcer disease/GERD/hiatus hernia
- Diverticulosis
- Osteoarthritis
- OSA on CPAP at home
- Sinusitis
- recurrent (4 severe episodes) of Group B strep
cellulitis/bacteremia
- TIA in [**12-24**] presented with facial droop and weakness for 2
hours; had her aspirin increased to 325mg.
- Panic disorder/Depression (3 prior suicide attempts by drug
overdose)
- Personality disorder, NOS
- Borderline personality

MEDICATION ON ADMISSION: (from [**2183-6-15**] discharge summary)
1. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
One (1) puff Inhalation q2hrs.
2. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1) neb Inhalation every four (4) hours as

ALLERGIES: Penicillins / Erythromycin Base / Compazine / Benadryl / Sulfa
(Sulfonamide Antibiotics) / Zinc / Phenothiazines / Oxycodone /
aspirin

PHYSICAL EXAM: ON ADMISSION:
Vitals: T:97 BP:145/78 P:89 R:10 O2: 100% on 6L NC
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Decreased breath sounds, diffuse early inspiratory
wheezes with course breath sounds throughout
CV: Regular rate and rhythm, normal S1 + S2
Abdomen: obese, soft, non-tender, non-distended, bowel sounds
present
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema, no rashes

FAMILY HISTORY: Mother died of renal failure. Father died of an MI at age 58.
She has a brother with skin cancer. She has another sister w
HTN.

SOCIAL HISTORY: Currently lives at [**Hospital3 **]. She is able to ambulate with
assistance of a walker but is basically wheelchair dependant.
She does not smoke, or drink alcohol. Tried marijuana for a year
in the [**2142**]. 

### Response:
{'Asthma, unspecified type, with (acute) exacerbation,Acute upper respiratory infections of unspecified site,Obstructive sleep apnea (adult)(pediatric),Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux'}
