CHIEF COMPLAINT: asthma exacerbation

PRESENT ILLNESS: 53F h/o HTN, asthma, with several recent asthma flares p/w acute
dyspnea 4d ago. She was admitted to MICU but never intubated.
She was started on high dose steroids and frequent nebs with
slow improvement. No evidence of pneumonia. Her O2 requirement
has decreased steadily.  Currenlty, she states breathing is
little better. Has been c/o dizziness since admit.

MEDICAL HISTORY: 1. Asthma-has had multiple asthma exacerbations requiring 3
hospitalizations, steroids; no intubations
2. HTN
3. Hyperlipidemia
4. polio- uses crutches at baseline

MEDICATION ON ADMISSION: 1. Acetaminophen 650 mg QID prn fever/pain
2. Albuterol 90 mcg IH, 2 puffs tid prn
3. Albuterol sulfate 0.83 mg/ml IH, 1 unit qid prn SOB/cough
4. Clonazepam 0.5 mg po bid prn for sleep
5. Crolom 4% 1 gtt each eye q 6 hr prn
6. Docusate sodium 100 mg, [**2-3**] capsules po @hs prn constipation
7. Flonase 50 mcg NS, qd each nostril
8. HCTZ 25 mg po daily
9. Lipitor 20 mg po daily
10. Lisinopril 10 mg po daily
11. Loratidine 10 mg po  daily
12. Naprosyn 375 mg po bid prn pain
13. Predisone taper finished
14. Prilosec OTC 20 mg po daily
15. Pulmicort 0.5 mg/2 m IH, one unit [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals are 96.9---123/74---90----22---99% 2lNC
PE: NAD
OP clear and dry, no thrush
Lungs: mod air flow, faint exp wheeze anteriorly
CV: RRR, nml S1S2
Abd benign

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Lives with sister.  Vietnamese-speaking.  Goes to senior day
care 3x/week with parents.  No tob/ETOH.
Asthma, unspecified type, with (acute) exacerbation,Late effects of acute poliomyelitis,Unspecified essential hypertension,Esophageal reflux,Other and unspecified hyperlipidemia,Dysthymic disorder,Leukocytosis, unspecified
Asthma NOS w (ac) exac,Late effect acute polio,Hypertension NOS,Esophageal reflux,Hyperlipidemia NEC/NOS,Dysthymic disorder,Leukocytosis NOS
Admission Date:  [**2167-4-14**]              Discharge Date:   [**2167-4-22**]

Date of Birth:  [**2113-8-21**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1974**]
Chief Complaint:
asthma exacerbation

Major Surgical or Invasive Procedure:
None.


History of Present Illness:
53F h/o HTN, asthma, with several recent asthma flares p/w acute
dyspnea 4d ago. She was admitted to MICU but never intubated.
She was started on high dose steroids and frequent nebs with
slow improvement. No evidence of pneumonia. Her O2 requirement
has decreased steadily.  Currenlty, she states breathing is
little better. Has been c/o dizziness since admit.

Past Medical History:
1. Asthma-has had multiple asthma exacerbations requiring 3
hospitalizations, steroids; no intubations
2. HTN
3. Hyperlipidemia
4. polio- uses crutches at baseline


Social History:
Lives with sister.  Vietnamese-speaking.  Goes to senior day
care 3x/week with parents.  No tob/ETOH.

Family History:
Non contributory

Physical Exam:
Vitals are 96.9---123/74---90----22---99% 2lNC
PE: NAD
OP clear and dry, no thrush
Lungs: mod air flow, faint exp wheeze anteriorly
CV: RRR, nml S1S2
Abd benign


Pertinent Results:
[**2167-4-14**] CHEST (PORTABLE AP): Heart is at the upper limit of
normal.  Lung fields are clear and symmetric.  No focal
consolidation or infiltrate is seen.  There is no pneumothorax
or pleural effusion.  No evidence of congestive heart failure.
Stable examination as compared to 3 days ago.  Cardiac size at
upper limit of normal.
.
[**2167-4-15**] ECG: Sinus tachycardia
Nonspecific T wave changes in lead V3
Since previous tracing of [**2167-4-14**], ventricular rate faster, and
further T waves
changes present
.
[**2167-4-20**] ECHO: The left atrium is normal in size. Left
ventricular wall thickness, cavity
size, and systolic function are normal (LVEF>55%). Regional left
ventricular
wall motion is normal. Tissue Doppler imaging suggests a normal
left
ventricular filling pressure (PCWP<12mmHg). Right ventricular
chamber size and  free wall motion are normal. The aortic valve
leaflets (3) are mildly  thickened but aortic stenosis is not
present. No aortic regurgitation is seen.  The mitral valve
appears structurally normal with trivial mitral  regurgitation.
There is no mitral valve prolapse. The estimated pulmonary
artery systolic pressure is normal. There is no pericardial
effusion.  Compared with the report of the prior study (images
unavailable for review) of  [**2163-8-4**], the findings are similar.

.
[**2167-4-20**] CHEST (PORTABLE AP): There is no evidence of pneumonia.
There are low lung volumes, which result in pulmonary vascular
crowding, though mild superimposed vascular congestion is
difficult to exclude.
.

Brief Hospital Course:
1) ASTHMA FLARE:
Pt's presentation was consistent with asthma flare.  There was
no evidence of underlying or superimposed infection.  While in
the MICU, she was started on steroids, nebulizers, and singulair
and advair were added to her long-term regimen given her poor
asthma control.  On the floor, these were continued and her
steroids were tapered gradually.  Her oxygenation improved and
she was on room air.  Her breathing was also much better and
close to baseline by discharge.


Medications on Admission:
1. Acetaminophen 650 mg QID prn fever/pain
2. Albuterol 90 mcg IH, 2 puffs tid prn
3. Albuterol sulfate 0.83 mg/ml IH, 1 unit qid prn SOB/cough
4. Clonazepam 0.5 mg po bid prn for sleep
5. Crolom 4% 1 gtt each eye q 6 hr prn
6. Docusate sodium 100 mg, [**2-3**] capsules po @hs prn constipation
7. Flonase 50 mcg NS, qd each nostril
8. HCTZ 25 mg po daily
9. Lipitor 20 mg po daily
10. Lisinopril 10 mg po daily
11. Loratidine 10 mg po  daily
12. Naprosyn 375 mg po bid prn pain
13. Predisone taper finished
14. Prilosec OTC 20 mg po daily
15. Pulmicort 0.5 mg/2 m IH, one unit [**Hospital1 **]

Discharge Medications:
1. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
2. Fluticasone-Salmeterol 500-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
Disp:*1 disk* Refills:*0*
3. Albuterol 90 mcg/Actuation Aerosol Sig: One (1) puff
Inhalation every four (4) hours as needed for shortness of
breath or wheezing.
Disp:*1 aerosol* Refills:*0*
4. Hydrochlorothiazide 25 mg Tablet Sig: 0.5 Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Pseudoephedrine HCl 30 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours) as needed for 5 days.
Disp:*30 Tablet(s)* Refills:*0*
8. Fluticasone 50 mcg/Actuation Aerosol, Spray Sig: One (1)
Spray Nasal [**Hospital1 **] (2 times a day) for 7 days.
Disp:*1 bottle* Refills:*0*
9. Prednisone 10 mg Tablet Sig: taper as directed Tablet PO once
a day for 10 days: 2 tabs (20mg) on [**4-29**].  1 tab (10mg) on
[**5-2**].  Half-tab (5mg) on [**5-5**].
Disp:*10 Tablet(s)* Refills:*0*
10. Prilosec  Oral
11. Claritin  Oral
12. Naprosyn  Oral


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
PRIMARY:
Asthma with exacerbation


Discharge Condition:
Good--oxygenating well.


Discharge Instructions:
1.  Take medications as prescribed.  Your dose of HCTZ was
reduced as your BP was slightly low.
2.  Follow up as below.
3.  Please call Dr. [**Last Name (STitle) 8499**] if you have any fevers, chills,
worsening breathing.

Followup Instructions:
You have an appointment with Dr. [**Last Name (STitle) 8499**] on [**5-14**] at
2:30pm (his phone number is [**Telephone/Fax (1) 7976**] if you need to
reschedule).

You also have the following appointments with the lung doctor:
Provider: [**Name10 (NameIs) 1571**] BREATHING TESTS Phone:[**Telephone/Fax (1) 612**]
Date/Time:[**2167-5-14**] 8:40
Provider: [**Name10 (NameIs) 1570**],[**Name11 (NameIs) 2162**] [**Name12 (NameIs) 1570**] INTEPRETATION BILLING
Date/Time:[**2167-5-14**] 8:40
Provider: [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] Phone:[**Telephone/Fax (1) 612**]
Date/Time:[**2167-5-14**] 9:00
{'Asthma, unspecified type, with (acute) exacerbation,Late effects of acute poliomyelitis,Unspecified essential hypertension,Esophageal reflux,Other and unspecified hyperlipidemia,Dysthymic disorder,Leukocytosis, unspecified'}


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: asthma exacerbation

PRESENT ILLNESS: 53F h/o HTN, asthma, with several recent asthma flares p/w acute
dyspnea 4d ago. She was admitted to MICU but never intubated.
She was started on high dose steroids and frequent nebs with
slow improvement. No evidence of pneumonia. Her O2 requirement
has decreased steadily.  Currenlty, she states breathing is
little better. Has been c/o dizziness since admit.

MEDICAL HISTORY: 1. Asthma-has had multiple asthma exacerbations requiring 3
hospitalizations, steroids; no intubations
2. HTN
3. Hyperlipidemia
4. polio- uses crutches at baseline

MEDICATION ON ADMISSION: 1. Acetaminophen 650 mg QID prn fever/pain
2. Albuterol 90 mcg IH, 2 puffs tid prn
3. Albuterol sulfate 0.83 mg/ml IH, 1 unit qid prn SOB/cough
4. Clonazepam 0.5 mg po bid prn for sleep
5. Crolom 4% 1 gtt each eye q 6 hr prn
6. Docusate sodium 100 mg, [**2-3**] capsules po @hs prn constipation
7. Flonase 50 mcg NS, qd each nostril
8. HCTZ 25 mg po daily
9. Lipitor 20 mg po daily
10. Lisinopril 10 mg po daily
11. Loratidine 10 mg po  daily
12. Naprosyn 375 mg po bid prn pain
13. Predisone taper finished
14. Prilosec OTC 20 mg po daily
15. Pulmicort 0.5 mg/2 m IH, one unit [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals are 96.9---123/74---90----22---99% 2lNC
PE: NAD
OP clear and dry, no thrush
Lungs: mod air flow, faint exp wheeze anteriorly
CV: RRR, nml S1S2
Abd benign

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Lives with sister.  Vietnamese-speaking.  Goes to senior day
care 3x/week with parents.  No tob/ETOH. 

### Response:
{'Asthma, unspecified type, with (acute) exacerbation,Late effects of acute poliomyelitis,Unspecified essential hypertension,Esophageal reflux,Other and unspecified hyperlipidemia,Dysthymic disorder,Leukocytosis, unspecified'}
