CHIEF COMPLAINT: worsening shortness of breath

PRESENT ILLNESS: 67 /o F w/ PMHx of COPD on home O2, Lung cancer s/p resection
presented with worsening SOB. Initially admitted for SOB worse
than baseline occuring at rest and limiting activity for [**5-1**]
days. She had low grade fevers associated with this SOB and a
mild episodic cough with production of yellowish sputum. She
also complained of substernal chest pain on admission.
.
She was admitted for evaluation, she was ruled out for MI. A
chest CT was performed to rule out PE which showed chronic
emphysema.
.
Overnight prior to transfer she had episodes of shortness of
breath with desaturations into the 80s. She was given multiple
nebulizers with some minor improvement. She was noted to be
choking and some food was found in her mouth. She was suctioned
and her secretions were noted to be thick. On the floor she had
increased shortness of breath and was in severe respiratory
distress. An ABG was sent and was 7.33/79/84, the quantity of
FIO2 was decreased and a repeat ABG was 7.29/88/80. Based upon
this it was felt she was tiring so she was transfered to the ICU
and intubated for respiratory distress.

MEDICAL HISTORY: 1. Lung cancer, s/p partial resection of left lung (?left upper

MEDICATION ON ADMISSION: 

ALLERGIES: Hydrocodone

PHYSICAL EXAM: Temp 98, Pulse 93, BP 136/80, Sats 95% on 100% face mask
Post extubation P 97, BP 91/50 RR 16 O2 sat 100%
Gen: cachectic female in clear respiratory distress unable to
complete full sentences.
HEENT: MM dry, OP clear
Heart: RRR, nl S1S2, no m/r/g
Lungs: distant sounds, decreased air movement bilaterally, no
wheezing
abd: s/NT/ND
Ext: no edema

FAMILY HISTORY: Doesn't know any other family history because "I never see
them."

SOCIAL HISTORY: Divorced woman, currently living at [**Hospital3 2558**]. Has brother
in [**Name (NI) 3146**] and son in [**State **]. Used to work as private nurse's
aide. Reports 2 ppd since age 7 (~60 years) and now down to 1
cigarette per day x7 months (since moving in to [**Hospital3 2558**]).
Says she takes off oxygen when she smokes. Used to drink alcohol
3-4 times per
week, and would have [**6-7**] cans of beer at one time. No alcohol
for 3 years. Denies any other recreational drugs.
Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Acute kidney failure, unspecified,Acidosis,Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Unspecified acquired hypothyroidism,Personal history of malignant neoplasm of bronchus and lung,Foreign body in respiratory tree, unspecified
Obs chr bronc w(ac) exac,Acute respiratry failure,Acute kidney failure NOS,Acidosis,Food/vomit pneumonitis,Urin tract infection NOS,Hypothyroidism NOS,Hx-bronchogenic malignan,FB respiratory tree NOS
Admission Date:  [**2139-10-5**]              Discharge Date:   [**2139-10-14**]

Date of Birth:  [**2071-10-20**]             Sex:   F

Service: MEDICINE

Allergies:
Hydrocodone

Attending:[**First Name3 (LF) 330**]
Chief Complaint:
worsening shortness of breath

Major Surgical or Invasive Procedure:
Intubation and Mechanical Ventilation


History of Present Illness:
67 /o F w/ PMHx of COPD on home O2, Lung cancer s/p resection
presented with worsening SOB. Initially admitted for SOB worse
than baseline occuring at rest and limiting activity for [**5-1**]
days. She had low grade fevers associated with this SOB and a
mild episodic cough with production of yellowish sputum. She
also complained of substernal chest pain on admission.
.
She was admitted for evaluation, she was ruled out for MI. A
chest CT was performed to rule out PE which showed chronic
emphysema.
.
Overnight prior to transfer she had episodes of shortness of
breath with desaturations into the 80s. She was given multiple
nebulizers with some minor improvement. She was noted to be
choking and some food was found in her mouth. She was suctioned
and her secretions were noted to be thick. On the floor she had
increased shortness of breath and was in severe respiratory
distress. An ABG was sent and was 7.33/79/84, the quantity of
FIO2 was decreased and a repeat ABG was 7.29/88/80. Based upon
this it was felt she was tiring so she was transfered to the ICU
and intubated for respiratory distress.

Past Medical History:
1. Lung cancer, s/p partial resection of left lung (?left upper

lobe) and radiation therapy. No chemotherapy. Treatment was at
[**Hospital1 336**].
2. Emphysema, on home O2
3. Chronic hoarseness secondary to radiation therapy
4. Hypothyroidism
5. s/p tonsillectomy and adenoidectomy
6. Early menopause (age 28), never on hormones
7. On diltiazem, unknown why. Patient denies hypertension,
irregular heart rate.

Social History:
Divorced woman, currently living at [**Hospital3 2558**]. Has brother
in [**Name (NI) 3146**] and son in [**State **]. Used to work as private nurse's
aide. Reports 2 ppd since age 7 (~60 years) and now down to 1
cigarette per day x7 months (since moving in to [**Hospital3 2558**]).
Says she takes off oxygen when she smokes. Used to drink alcohol
3-4 times per
week, and would have [**6-7**] cans of beer at one time. No alcohol
for 3 years. Denies any other recreational drugs.

Family History:
Doesn't know any other family history because "I never see
them."

Physical Exam:
Temp 98, Pulse 93, BP 136/80, Sats 95% on 100% face mask
Post extubation P 97, BP 91/50 RR 16 O2 sat 100%
Gen: cachectic female in clear respiratory distress unable to
complete full sentences.
HEENT: MM dry, OP clear
Heart: RRR, nl S1S2, no m/r/g
Lungs: distant sounds, decreased air movement bilaterally, no
wheezing
abd: s/NT/ND
Ext: no edema

Pertinent Results:
Lung VQ Scan
Diffuse airway disease. With this degree of disease manifest by
clumping it is likely that a perfusion scan would be
nondiagnostic.
CTA Chest
1. No acute pulmonary embolus.
2. Moderate mainly centrilobular emphysema throughout.
3. A least 2 small(sub 6mm) areas of nodularity m nonspecfic,
and unlikely to be clinically significant, but interval follow
up in 6 months should be considered to ensure stability.
Chest Xray [**10-13**]
Interval collapse of the left lung, most likely from an
obstructing mucus plug given the acuity.
Chest Xray [**10-14**]
Expansion of left upper lobe

[**2139-10-13**] 12:40PM BLOOD WBC-14.9* RBC-3.26* Hgb-9.6* Hct-29.7*
MCV-91 MCH-29.5 MCHC-32.3 RDW-16.0* Plt Ct-332
[**2139-10-13**] 12:40PM BLOOD Neuts-91* Bands-0 Lymphs-1* Monos-6 Eos-1
Baso-1 Atyps-0 Metas-0 Myelos-0
[**2139-10-13**] 12:40PM BLOOD Plt Ct-332
[**2139-10-8**] 03:44PM BLOOD PT-12.8 PTT-36.3* INR(PT)-1.1
[**2139-10-5**] 04:15PM BLOOD D-Dimer-1078*
[**2139-10-13**] 12:40PM BLOOD Ret Aut-0.4*
[**2139-10-13**] 04:46AM BLOOD Glucose-89 UreaN-21* Creat-0.8 Na-141
K-4.4 Cl-99 HCO3-38* AnGap-8
[**2139-10-13**] 12:40PM BLOOD LD(LDH)-222
[**2139-10-8**] 11:55PM BLOOD CK(CPK)-41
[**2139-10-8**] 03:44PM BLOOD CK(CPK)-69
[**2139-10-6**] 06:00AM BLOOD CK(CPK)-264*
[**2139-10-6**] 12:53AM BLOOD CK(CPK)-300*
[**2139-10-5**] 04:15PM BLOOD CK(CPK)-422*
[**2139-10-8**] 11:55PM BLOOD CK-MB-NotDone cTropnT-0.08*
[**2139-10-8**] 03:44PM BLOOD CK-MB-NotDone cTropnT-0.07*
[**2139-10-6**] 06:00AM BLOOD CK-MB-7 cTropnT-0.01
[**2139-10-6**] 12:53AM BLOOD CK-MB-8 cTropnT-0.03*
[**2139-10-5**] 04:15PM BLOOD CK-MB-7 cTropnT-0.02*
[**2139-10-13**] 12:40PM BLOOD Iron-77
[**2139-10-13**] 12:40PM BLOOD calTIBC-198* VitB12-991* Folate-9.3
Hapto-329* Ferritn-332* TRF-152*
[**2139-10-6**] 06:00AM BLOOD TSH-0.86
[**2139-10-11**] 03:35AM BLOOD Theophy-3.9*
[**2139-10-9**] 05:38AM BLOOD Theophy-4.3*
[**2139-10-12**] 06:12AM BLOOD Type-ART pO2-134* pCO2-63* pH-7.40
calHCO3-40* Base XS-11

Brief Hospital Course:
# Respiratory distress - Patient with known baseline emphysema
and lung resection p/w with worsening shortness of breath. CTA
showed no evidence of PE, also has been ruled out for MI. Most
likely this is COPD exacerbation with possible aspiration
pnemonia vs. viral illness. She had fever, cough, sputum w/
elevated white counts with no infiltrate on CXR.  During the
hospital stay, developed aspiration PNA and was intubated and
ventilated. She had a favorable recovery post-intubation. She
was continued on Combivent nebs, Prednisone, Theophylline
(levels were monitored). She was also started on Levofloxacin
for presumed PNA (to be continued for 5 days after discharge).
Pt to benefit from Chest PT.
.
# Speech and Swallow eval: done and S&S suugested pureed solids
and thin liquids and to advance diet cautiously.
.
# Lung Collapse: She developed total left lung collapse on [**10-13**]
most likely secondary to mucus plugs. Respiratory suctioned her
and repeat Xray the next day showed interval expansion of left
lung.
.
# ARF: Creatinine elevated to 1.6 on admission which eventually
trended down.
.
# UTI: intial UA showed RBC [**11-15**], WBC >50, Epi [**2-28**]; likely
contaminated. A repeat Cx negative.
.
# Hypothryoidism: TSH levels normal, was continued on
levothyroxine
.
# Dispo planning: the patient will benefit from chest PT as she
is prone to mucus plugging. PT was involved w/ patient while in
hospital. Also continue Levofloxacin for 5 days post-discharge.
.
# Code Status: was discussed w/ patient and she wanted to be
DNR/DNI after she came out of the intubation in intensive care
unit.

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H
(every 4 to 6 hours) as needed.
2. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
3. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO Q8H (every
8 hours) as needed.
4. Levothyroxine Sodium 100 mcg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
5. Aluminum-Magnesium Hydroxide 225-200 mg/5 mL Suspension Sig:
15-30 MLs PO QID (4 times a day) as needed.
6. Insulin injection
Please continue insulin regimen as before
7. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q2H (every 2 hours) as needed.
8. Ipratropium Bromide 18 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation Q2H (every 2 hours) as needed.
9. Albuterol 90 mcg/Actuation Aerosol Sig: 4-8 Puffs Inhalation
Q6H (every 6 hours).
10. Ipratropium Bromide 18 mcg/Actuation Aerosol Sig: Four (4)
Puff Inhalation QID (4 times a day).
11. Theophylline 100 mg Tablet Sustained Release 12HR Sig: One
(1) Tablet Sustained Release 12HR PO QAM (once a day (in the
morning)).
12. Theophylline 200 mg Tablet Sustained Release 12HR Sig: One
(1) Tablet Sustained Release 12HR PO QPM (once a day (in the
evening)).
13. Olanzapine 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for aggitation.
14. Diltiazem HCl 60 mg Tablet Sig: One (1) Tablet PO QID (4
times a day).
15. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
16. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
17. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
18. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
19. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 5 days.
20. Bupropion 150 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO QAM (once a day (in the morning)).
21. Trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as
needed.
22. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed.
23. Methyl Salicylate-Menthol 15-15 % Ointment Sig: One (1) Appl
Topical  TID (3 times a day) as needed.


Discharge Disposition:
Extended Care

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

Discharge Diagnosis:
COPD excerbation
Aspiration Pneumonia
Collapse of left lung secondary to mucus plug


Discharge Condition:
all vitals are stable


Discharge Instructions:
Please take all your medications and follow up with your
appointments. Please report to the ED or to your physician if
you have any concerns at all.
.
Please continue with Chest physical therapy

Followup Instructions:
Please make an appointment to see your primary care physician [**Last Name (NamePattern4) **]
[**7-5**] days.



Completed by:[**2139-10-14**]
{'Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Acute kidney failure, unspecified,Acidosis,Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Unspecified acquired hypothyroidism,Personal history of malignant neoplasm of bronchus and lung,Foreign body in respiratory tree, 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: worsening shortness of breath

PRESENT ILLNESS: 67 /o F w/ PMHx of COPD on home O2, Lung cancer s/p resection
presented with worsening SOB. Initially admitted for SOB worse
than baseline occuring at rest and limiting activity for [**5-1**]
days. She had low grade fevers associated with this SOB and a
mild episodic cough with production of yellowish sputum. She
also complained of substernal chest pain on admission.
.
She was admitted for evaluation, she was ruled out for MI. A
chest CT was performed to rule out PE which showed chronic
emphysema.
.
Overnight prior to transfer she had episodes of shortness of
breath with desaturations into the 80s. She was given multiple
nebulizers with some minor improvement. She was noted to be
choking and some food was found in her mouth. She was suctioned
and her secretions were noted to be thick. On the floor she had
increased shortness of breath and was in severe respiratory
distress. An ABG was sent and was 7.33/79/84, the quantity of
FIO2 was decreased and a repeat ABG was 7.29/88/80. Based upon
this it was felt she was tiring so she was transfered to the ICU
and intubated for respiratory distress.

MEDICAL HISTORY: 1. Lung cancer, s/p partial resection of left lung (?left upper

MEDICATION ON ADMISSION: 

ALLERGIES: Hydrocodone

PHYSICAL EXAM: Temp 98, Pulse 93, BP 136/80, Sats 95% on 100% face mask
Post extubation P 97, BP 91/50 RR 16 O2 sat 100%
Gen: cachectic female in clear respiratory distress unable to
complete full sentences.
HEENT: MM dry, OP clear
Heart: RRR, nl S1S2, no m/r/g
Lungs: distant sounds, decreased air movement bilaterally, no
wheezing
abd: s/NT/ND
Ext: no edema

FAMILY HISTORY: Doesn't know any other family history because "I never see
them."

SOCIAL HISTORY: Divorced woman, currently living at [**Hospital3 2558**]. Has brother
in [**Name (NI) 3146**] and son in [**State **]. Used to work as private nurse's
aide. Reports 2 ppd since age 7 (~60 years) and now down to 1
cigarette per day x7 months (since moving in to [**Hospital3 2558**]).
Says she takes off oxygen when she smokes. Used to drink alcohol
3-4 times per
week, and would have [**6-7**] cans of beer at one time. No alcohol
for 3 years. Denies any other recreational drugs. 

### Response:
{'Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Acute kidney failure, unspecified,Acidosis,Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Unspecified acquired hypothyroidism,Personal history of malignant neoplasm of bronchus and lung,Foreign body in respiratory tree, unspecified'}
