CHIEF COMPLAINT: lightheadedness, fatigue

PRESENT ILLNESS: Ms. [**Known lastname 22951**] is an 84 year old woman with a hx of CAD, HTN,
arthritis who presents with symptomatic bradycardia. The patient
awoke this morning feeling at 4am feeling unwell with nausea,
dizziness and lightheadedness. She denies chest pain,
palpitations, shortness of braeth, chest pressure/tightness. She
called EMS.
.
Per EMS, BP was 60/p with HR of 38 on arrival. She was given
Atropine 0.5mg IV X 2 with improvement of HR to the 40s and BP
to 80s-100s systolic.
.
In the ED, initial vitals were HR50 BP100/60 RR18 100% on RA.
She was given 1mg Atropine x 1 in the ED. ECG showed junctional
rhythm with retrograde p waves. External pacing was done for 1
minute as BP was low (90s) and rhythm spontaneously converted to
sinus. The patient was also given Glucagon 1mg and Calcium
Gluconate. She was given Fentanyl 25mcg while being externally
paced. On rectal exam she was noted to have dark guaiac positive
stool. She was given 40mg IV protonix and GI was consulted. She
was typed and crossed for 2 units.
.
On arrival to the floor, she denies any symptoms of dizziness,
lightheadedness, chest pain, palpitations, abdominal pain. She
had an episode of diarrhea a few days ago. She occasionally has
red/brown stools, the last time was a few weeks ago and she
denies any currently. She does not know why she is on Cipro or
Cephalexin. She is somewhat confused due to Fentanyl given to
her in the ED. She states that she may occasionally make
mistakes regarding her medications. She does not use a pill box.
Per her son, she has been more foregetful lately. The patient
lives alone.
.
Per conversations with her PCP, [**Name10 (NameIs) **] has a history of
gastritis/colitis and was due to have a colonoscopy [**10-31**] which
she did not show for.
.
On review of systems, she denies recent fevers, chills or
rigors. Cardiac review of systems as per HPI. Positive for rash
on the legs and arms which was puritic in nature. All of the
other review of systems were negative.
.

MEDICAL HISTORY: TIAs
- [**2131**] TIA
- [**8-1**] TIA after being off plavix for 4 days; MRA head/neck
showed short segment of R PCA stenosis
CAD
- q waves seen on past ECGs
- echo [**2131**] HK in inferolateral wall
- echo [**2135**] AK in basal posterior wall; worsening HK in
inferolateral wall; EF 65%
- [**2136-10-23**] - stress test ischemic ST changes in inferior and
lateral walls
Hyperlipidemia
HTN
total knee replacement
depression
arthritis
iron deficiency anemia; baseline HCT 34 for past 7 months
gastritis s/p gastric ulcers on EGD
? ischemic colitis; was due for colonoscopy [**10-31**] but pt [**Name (NI) 107125**]

MEDICATION ON ADMISSION: Benicar 20 mg Tab Oral
Ciprofloxacin 250 mg Tab Oral, [**Hospital1 **] - PCP and patient do not know
indication, pt states she has been taking for years
Prednisone 10 mg Tab Oral - pt states she has been taking for 2
weeks for rash
Cephalexin 500 mg Cap Oral, 1 Capsule(s) Three times daily - pt
does not know indication
Atenolol 12.5 mg Tab Oral
Paroxetine 20 mg Tab Oral
Plavix 75 mg Tab Oral
Pravastatin 40 mg Tab Oral
Verapamil SR 180 mg Tab Oral
Zantac 150mg PO BID
Flonase PRN
Glaucoma eye drop

ALLERGIES: Penicillins / Raloxifene / Morphine / Fosamax / Donepezil Hcl /
Ace Inhibitors

PHYSICAL EXAM: VS: T=97.4 BP 124/43 HR 60 RR 23 99% on 2L NC
GENERAL: Elderly woman, NAD. Oriented X 1 (knew hospital but not
name, thought date was [**2137-2-6**]).
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Mother died of congestive heart failure. Father had bladder
cancer. There is no family history of colon cancer.

SOCIAL HISTORY: She is married; her husband lives in a nursing home and the
patient lives alone. She has 1 son who lives in [**Location **] and she
has 1 daughter. She does not smoke cigarettes and drinks a glass
of wine every so often.
Poisoning by other and unspecified agents primarily affecting the cardiovascular system,Acute kidney failure, unspecified,Encephalopathy, unspecified,Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Accidental poisoning by agents primarily affecting cardiovascular system,Other specified cardiac dysrhythmias,Hypovolemia,Other persistent mental disorders due to conditions classified elsewhere,Duodenitis, without mention of hemorrhage,Diaphragmatic hernia without mention of obstruction or gangrene,Knee joint replacement,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Rash and other nonspecific skin eruption,Diverticulosis of colon (without mention of hemorrhage),Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Coronary atherosclerosis of native coronary artery,Arthropathy, unspecified, site unspecified,Depressive disorder, not elsewhere classified
Pois-cardiovasc agt NEC,Acute kidney failure NOS,Encephalopathy NOS,Gastrointest hemorr NOS,Ac posthemorrhag anemia,Acc poisn-cardiovasc agt,Cardiac dysrhythmias NEC,Hypovolemia,Mental disor NEC oth dis,Duodenitis w/o hmrhg,Diaphragmatic hernia,Joint replaced knee,Hyperlipidemia NEC/NOS,Hypertension NOS,Nonspecif skin erupt NEC,Dvrtclo colon w/o hmrhg,Hx TIA/stroke w/o resid,Crnry athrscl natve vssl,Arthropathy NOS-unspec,Depressive disorder NEC
Admission Date:  [**2136-12-10**]              Discharge Date:   [**2136-12-17**]

Date of Birth:  [**2052-10-4**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Raloxifene / Morphine / Fosamax / Donepezil Hcl /
Ace Inhibitors

Attending:[**First Name3 (LF) 2009**]
Chief Complaint:
lightheadedness, fatigue

Major Surgical or Invasive Procedure:
EGD
Colonoscopy

History of Present Illness:
Ms. [**Known lastname 22951**] is an 84 year old woman with a hx of CAD, HTN,
arthritis who presents with symptomatic bradycardia. The patient
awoke this morning feeling at 4am feeling unwell with nausea,
dizziness and lightheadedness. She denies chest pain,
palpitations, shortness of braeth, chest pressure/tightness. She
called EMS.
.
Per EMS, BP was 60/p with HR of 38 on arrival. She was given
Atropine 0.5mg IV X 2 with improvement of HR to the 40s and BP
to 80s-100s systolic.
.
In the ED, initial vitals were HR50 BP100/60 RR18 100% on RA.
She was given 1mg Atropine x 1 in the ED. ECG showed junctional
rhythm with retrograde p waves. External pacing was done for 1
minute as BP was low (90s) and rhythm spontaneously converted to
sinus. The patient was also given Glucagon 1mg and Calcium
Gluconate. She was given Fentanyl 25mcg while being externally
paced. On rectal exam she was noted to have dark guaiac positive
stool. She was given 40mg IV protonix and GI was consulted. She
was typed and crossed for 2 units.
.
On arrival to the floor, she denies any symptoms of dizziness,
lightheadedness, chest pain, palpitations, abdominal pain. She
had an episode of diarrhea a few days ago. She occasionally has
red/brown stools, the last time was a few weeks ago and she
denies any currently. She does not know why she is on Cipro or
Cephalexin. She is somewhat confused due to Fentanyl given to
her in the ED. She states that she may occasionally make
mistakes regarding her medications. She does not use a pill box.
Per her son, she has been more foregetful lately. The patient
lives alone.
.
Per conversations with her PCP, [**Name10 (NameIs) **] has a history of
gastritis/colitis and was due to have a colonoscopy [**10-31**] which
she did not show for.
.
On review of systems, she denies recent fevers, chills or
rigors. Cardiac review of systems as per HPI. Positive for rash
on the legs and arms which was puritic in nature. All of the
other review of systems were negative.
.


Past Medical History:
TIAs
- [**2131**] TIA
- [**8-1**] TIA after being off plavix for 4 days; MRA head/neck
showed short segment of R PCA stenosis
CAD
- q waves seen on past ECGs
- echo [**2131**] HK in inferolateral wall
- echo [**2135**] AK in basal posterior wall; worsening HK in
inferolateral wall; EF 65%
- [**2136-10-23**] - stress test ischemic ST changes in inferior and
lateral walls
Hyperlipidemia
HTN
total knee replacement
depression
arthritis
iron deficiency anemia; baseline HCT 34 for past 7 months
gastritis s/p gastric ulcers on EGD
? ischemic colitis; was due for colonoscopy [**10-31**] but pt [**Name (NI) 107125**]


Social History:
She is married; her husband lives in a nursing home and the
patient lives alone. She has 1 son who lives in [**Location **] and she
has 1 daughter. She does not smoke cigarettes and drinks a glass
of wine every so often.

Family History:
Mother died of congestive heart failure. Father had bladder
cancer. There is no family history of colon cancer.

Physical Exam:
VS: T=97.4 BP 124/43 HR 60 RR 23 99% on 2L NC
GENERAL: Elderly woman, NAD. Oriented X 1 (knew hospital but not
name, thought date was [**2137-2-6**]).
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP of 5 cm.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+


Pertinent Results:
CXR [**2136-12-10**]:
1. Large hiatal hernia.
2. No acute cardiopulmonary abnormality.

ADMISSION LABS
[**2136-12-10**] 03:00PM BLOOD WBC-8.2# RBC-4.36 Hgb-9.5* Hct-32.9*
MCV-75* MCH-21.7* MCHC-28.8* RDW-17.4* Plt Ct-290
[**2136-12-11**] 02:30AM BLOOD WBC-6.7 RBC-3.38* Hgb-7.5* Hct-25.4*
MCV-75* MCH-22.1* MCHC-29.5* RDW-17.0* Plt Ct-215
[**2136-12-10**] 03:00PM BLOOD PT-11.7 PTT-22.5 INR(PT)-1.0
[**2136-12-11**] 02:30AM BLOOD Glucose-81 UreaN-19 Creat-0.6 Na-142
K-4.0 Cl-111* HCO3-26 AnGap-9
[**2136-12-10**] 03:00PM BLOOD CK(CPK)-144
[**2136-12-10**] 09:02PM BLOOD CK(CPK)-97
[**2136-12-11**] 02:15AM BLOOD CK(CPK)-99
[**2136-12-11**] 02:30AM BLOOD CK(CPK)-89
[**2136-12-10**] 03:00PM BLOOD cTropnT-<0.01
[**2136-12-10**] 09:02PM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2136-12-11**] 02:15AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2136-12-11**] 02:30AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2136-12-10**] 03:00PM BLOOD Calcium-9.1 Phos-4.4 Mg-2.4
[**2136-12-10**] 03:00PM BLOOD TSH-3.9

EGD [**12-13**]
Large hiatal hernia
Erythema in the antrum
Multiple erosions in the duodenal bulb compatible with
duodenitis
Normal mucosa in the second part of the duodenum (biopsy)
Otherwise normal EGD to third part of the duodenum

Colonscopy [**12-13**]
Diverticulosis of the throughout the colon
Otherwise normal colonoscopy to cecum

Brief Hospital Course:
Ms. [**Known lastname 22951**] is an 84 year old woman with a hx of TIAs, CAD, HTN,
iron-deficiency anemia who presents with symptomatic
bradycardia.
.
#. BRADYCARDIA:  Patient was found to be in a junctional rhythm
on arrival to ED. Her bradycardia was thought to be secondary to
improper dosing of her beta-blocker and Verapamil in the setting
of acute renal failure (hypovolemia, GI bleed). These
medications were held with resulting improvement in her heart
rate, though there may be a component of sinus node dysfuction.
ECG did not show ST segment changes and cardiac enzymes were
negative ruling out an ischemic cause of her symptoms. While in
the CCU, she did not require Atropine or Dopamine. The patients
symptoms resolved and she remained in sinus rhythm at a normal
rate. She was transfered to the floor and started on a low dose
of metoproplol tartate.
.
#. GI BLEED: Patient was guaiac positive on exam and iron
studies c/w severe iron deficiency. She required 2u pRBC's in
the CCU for a Hct of 25.4 in the context of lower blood
pressures. She was continued on Protonix 40mg IV BID and
remained NPO. GI recommended NG lavage, but very worried about
vagal stimulation. The patient received EGD/Colonoscopy that
showed duodenitis and diverticulosis. She will need to be
maintained on protonix [**Hospital1 **] outpatient.
.
# Acute Renal Insufficiency: Patient with Cr of 1.0 on
admission, clinical exam supported poor intravascular status
(poor PO and GI bleed). She was given IVF's with improvement in
her clinical appearance and a repeat Cr of 0.6.
.
#. CORONARY ARTERY DISEASE: Unclear history. Per PCP, [**Name10 (NameIs) **]
has q waves on ECG but no prior caths or stents. She has been on
Plavix as an outpatient for h/o TIAs, but has not been on
Aspirin. In the context of bradycardia, her beta-blocker was
initially held. She was restarted on metoprolol prior to
discharge.
.
#. History of multiple TIAs: Patient to continue on plavix.
.
# ?Dementia: Patient with waxing & [**Doctor Last Name 688**] agitation/confusion
during CCU stay. Patient lives alone and reports being able to
manage her medications and ADL's independently. She has fired
VNA on multiple occasions in the past per PCP. [**Name10 (NameIs) **] saw patient
and recommended rehab that patient refused. OT reccommended 24
hour supervision but recognized that if the patient refuses that
there is a middle ground. Her mental status waxed and waned,
however by HD#3, she was mentating very well. In the ED, she had
received large doses of atropine and fentanyl which could
precipitate delirium. There was a family meeting involving the
patient's daughter and social work for placement for rehab.
.
#. Rash: Patient reportedly placed on PO Prednisone by
Dermatologist for rash after failing topical therapy, but
etiology of rash is unclear and plan for taper unknown. Admitted
on 10mg PO Prednisone, but this was held in the setting of
possible GI bleed. She was started on sarna lotion with good
effect.
.

Medications on Admission:
Benicar 20 mg Tab Oral
Ciprofloxacin 250 mg Tab Oral, [**Hospital1 **] - PCP and patient do not know
indication, pt states she has been taking for years
Prednisone 10 mg Tab Oral - pt states she has been taking for 2
weeks for rash
Cephalexin 500 mg Cap Oral, 1 Capsule(s) Three times daily - pt
does not know indication
Atenolol 12.5 mg Tab Oral
Paroxetine 20 mg Tab Oral
Plavix 75 mg Tab Oral
Pravastatin 40 mg Tab Oral
Verapamil SR 180 mg Tab Oral
Zantac 150mg PO BID
Flonase PRN
Glaucoma eye drop


Discharge Medications:
1. Losartan 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
[**Hospital1 **]:*30 Tablet(s)* Refills:*0*
2. Pravastatin 40 mg Tablet Sig: One (1) Tablet PO at bedtime.
3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Paroxetine HCl 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Flonase 50 mcg/Actuation Spray, Suspension Sig: One (1)
Nasal twice a day as needed for allergy symptoms.
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours):
please discuss with primary care physician.
[**Name Initial (NameIs) **]:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
7. Ferrous Sulfate 300  mg (60 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
[**Name Initial (NameIs) **]:*30 Tablet(s)* Refills:*0*
8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
[**Name Initial (NameIs) **]:*60 Capsule(s)* Refills:*0*
9. Timolol Maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **]
(2 times a day).
10. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
[**Hospital1 **] (2 times a day) as needed for itching.
11. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO once a day.
12. Benicar 20 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Last Name (un) 1687**] - [**Location (un) 745**]

Discharge Diagnosis:
Primary Diagnosis:
1. Symptomatic bradycardia
2. Duodenitis

Secondary Diagnosis:
1. Hypertension
2. Hyperlipidemia
3. Iron deficiency anemia
4. Coronary artery disease
5. History of TIA
6. Depression


Discharge Condition:
Mental Status:Confused - sometimes
Level of Consciousness:Alert and interactive
Activity Status:Ambulatory - Independent


Discharge Instructions:
You were admitted for a slow heart rate. You were given
medications to help speed up your heart and had to be externally
paced. It is likely that this happened because you took to many
of your high blood pressure medications at once. Be careful to
take you medications as directed in the future. You were also
found to have some blood in your stool. You had a endoscopy and
colonoscopy to evaluate the site of bleeding. It was found that
you had some irritation of your duodenum. A biopsy was taken but
the results are pending. This will need to be followed by your
primary care physician. [**Name10 (NameIs) **] are being discharged to a rehab
facility.

The following changes were made in your medications:
1. Stop Atenolol
2. Stop Verapamil
3. Stop ciprofloxacin
4. Stop cephalexin
5. START Metoprolol Succinate 25mg by mouth daily
6. START Pantoprazole 40mg by mouth twice a day
7. STOP Zantac 150mg by mouth twice a day
8. START sarna lotion apply as needed for your itch


Followup Instructions:
MD: Dr. [**First Name4 (NamePattern1) 402**] [**Last Name (NamePattern1) **]
Specialty: PCP
[**Name Initial (PRE) 2897**]/ Time: Wednesday, [**1-2**] at 11:15am
Location: [**Hospital1 93015**], ROUTE 9, [**University/College **],[**Numeric Identifier 3471**]
Phone number: [**Telephone/Fax (1) 18377**]

MD: Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1940**]
Specialty: Gastroenterology
Date/ Time: Thursday, [**1-3**] at 9:15am
Location: [**Last Name (NamePattern1) 439**], [**Hospital Ward Name **] Bldg [**Location (un) 858**], [**Location (un) 86**] MA
Phone number: [**Telephone/Fax (1) 463**]
{'Poisoning by other and unspecified agents primarily affecting the cardiovascular system,Acute kidney failure, unspecified,Encephalopathy, unspecified,Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Accidental poisoning by agents primarily affecting cardiovascular system,Other specified cardiac dysrhythmias,Hypovolemia,Other persistent mental disorders due to conditions classified elsewhere,Duodenitis, without mention of hemorrhage,Diaphragmatic hernia without mention of obstruction or gangrene,Knee joint replacement,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Rash and other nonspecific skin eruption,Diverticulosis of colon (without mention of hemorrhage),Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Coronary atherosclerosis of native coronary artery,Arthropathy, unspecified, site unspecified,Depressive disorder, not elsewhere classified'}


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: lightheadedness, fatigue

PRESENT ILLNESS: Ms. [**Known lastname 22951**] is an 84 year old woman with a hx of CAD, HTN,
arthritis who presents with symptomatic bradycardia. The patient
awoke this morning feeling at 4am feeling unwell with nausea,
dizziness and lightheadedness. She denies chest pain,
palpitations, shortness of braeth, chest pressure/tightness. She
called EMS.
.
Per EMS, BP was 60/p with HR of 38 on arrival. She was given
Atropine 0.5mg IV X 2 with improvement of HR to the 40s and BP
to 80s-100s systolic.
.
In the ED, initial vitals were HR50 BP100/60 RR18 100% on RA.
She was given 1mg Atropine x 1 in the ED. ECG showed junctional
rhythm with retrograde p waves. External pacing was done for 1
minute as BP was low (90s) and rhythm spontaneously converted to
sinus. The patient was also given Glucagon 1mg and Calcium
Gluconate. She was given Fentanyl 25mcg while being externally
paced. On rectal exam she was noted to have dark guaiac positive
stool. She was given 40mg IV protonix and GI was consulted. She
was typed and crossed for 2 units.
.
On arrival to the floor, she denies any symptoms of dizziness,
lightheadedness, chest pain, palpitations, abdominal pain. She
had an episode of diarrhea a few days ago. She occasionally has
red/brown stools, the last time was a few weeks ago and she
denies any currently. She does not know why she is on Cipro or
Cephalexin. She is somewhat confused due to Fentanyl given to
her in the ED. She states that she may occasionally make
mistakes regarding her medications. She does not use a pill box.
Per her son, she has been more foregetful lately. The patient
lives alone.
.
Per conversations with her PCP, [**Name10 (NameIs) **] has a history of
gastritis/colitis and was due to have a colonoscopy [**10-31**] which
she did not show for.
.
On review of systems, she denies recent fevers, chills or
rigors. Cardiac review of systems as per HPI. Positive for rash
on the legs and arms which was puritic in nature. All of the
other review of systems were negative.
.

MEDICAL HISTORY: TIAs
- [**2131**] TIA
- [**8-1**] TIA after being off plavix for 4 days; MRA head/neck
showed short segment of R PCA stenosis
CAD
- q waves seen on past ECGs
- echo [**2131**] HK in inferolateral wall
- echo [**2135**] AK in basal posterior wall; worsening HK in
inferolateral wall; EF 65%
- [**2136-10-23**] - stress test ischemic ST changes in inferior and
lateral walls
Hyperlipidemia
HTN
total knee replacement
depression
arthritis
iron deficiency anemia; baseline HCT 34 for past 7 months
gastritis s/p gastric ulcers on EGD
? ischemic colitis; was due for colonoscopy [**10-31**] but pt [**Name (NI) 107125**]

MEDICATION ON ADMISSION: Benicar 20 mg Tab Oral
Ciprofloxacin 250 mg Tab Oral, [**Hospital1 **] - PCP and patient do not know
indication, pt states she has been taking for years
Prednisone 10 mg Tab Oral - pt states she has been taking for 2
weeks for rash
Cephalexin 500 mg Cap Oral, 1 Capsule(s) Three times daily - pt
does not know indication
Atenolol 12.5 mg Tab Oral
Paroxetine 20 mg Tab Oral
Plavix 75 mg Tab Oral
Pravastatin 40 mg Tab Oral
Verapamil SR 180 mg Tab Oral
Zantac 150mg PO BID
Flonase PRN
Glaucoma eye drop

ALLERGIES: Penicillins / Raloxifene / Morphine / Fosamax / Donepezil Hcl /
Ace Inhibitors

PHYSICAL EXAM: VS: T=97.4 BP 124/43 HR 60 RR 23 99% on 2L NC
GENERAL: Elderly woman, NAD. Oriented X 1 (knew hospital but not
name, thought date was [**2137-2-6**]).
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Mother died of congestive heart failure. Father had bladder
cancer. There is no family history of colon cancer.

SOCIAL HISTORY: She is married; her husband lives in a nursing home and the
patient lives alone. She has 1 son who lives in [**Location **] and she
has 1 daughter. She does not smoke cigarettes and drinks a glass
of wine every so often. 

### Response:
{'Poisoning by other and unspecified agents primarily affecting the cardiovascular system,Acute kidney failure, unspecified,Encephalopathy, unspecified,Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Accidental poisoning by agents primarily affecting cardiovascular system,Other specified cardiac dysrhythmias,Hypovolemia,Other persistent mental disorders due to conditions classified elsewhere,Duodenitis, without mention of hemorrhage,Diaphragmatic hernia without mention of obstruction or gangrene,Knee joint replacement,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Rash and other nonspecific skin eruption,Diverticulosis of colon (without mention of hemorrhage),Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Coronary atherosclerosis of native coronary artery,Arthropathy, unspecified, site unspecified,Depressive disorder, not elsewhere classified'}
