CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: Patient is a 72 y/o F with a history of COPD on home oxygen who
presented to the ER with shortness of breath and subjective
fevers. Patient was a poor historian and unable to tell much of
her medical history. Briefly, patient was admitted for
pneumonia, acute renal failure, and hyponatremia. In the ER,
patient was febrile to 102F. VS were 99.6, 110/60, 112, 26, 93%
on 4L NC. Patient received 2L NS, levaquin 750mg, tylenol 1g,
combivent nebs, morphine 8mg IV, zofran 4mg IV. Lactate was 2.4
on admission.
.
On admission to the [**Hospital Ward Name **], patient was found to be
hypotensive to the 70s, but was mentating well and was found to
have oxygen saturation to 88% on 5L NC. Patient recieved another
2L NS. Patient was tough to measure blood pressure on and thus
was transferred to the [**Hospital Unit Name 153**] for closer monitoring.
.
On arrival to the [**Hospital Unit Name 153**], patient was belligerent and
uncooperative. Patient's inital SBP by doppler was 56, but was
mentating well. After several attempts with different blood
pressure cuffs, patient was found to have SBP in 170-180s.
Patient denied any nausea, vomiting, diarrhea, chest pain,
shortness of breath. All other ROS negative.

MEDICAL HISTORY: # HTN
# Emphysema
# Bleeding Ulcers
# Hepatitis B (tx related)
# Bleeding ulcers
# Carotid stent when 22 y/o
# L Lymph node removal
# Hyperparathyroidism s/p removal
# Chronic back pain
# Hx neurosyphilis
# C. Difficile colitis

MEDICATION ON ADMISSION: Confirmed with [**Location (un) **] Pharmacy at [**Telephone/Fax (1) 105731**]:
plavix 75'
Gabapentin 300 mg [**Hospital1 **] and 600 mg qHS
combivent 2 puffs q6:PRN
Pantoprazole 40'
colace
percocet PRN
Hydrochlorothiazide 25 mg QD
Toprol XL 100mg daily

ALLERGIES: Penicillins / Sulfa (Sulfonamides) / Ibuprofen / Niacin /
Tetanus / Aspirin / Erythromycin Base / Iodine; Iodine
Containing

PHYSICAL EXAM: VS: Temp: 98.9/98.3 BP: 116/67 HR: 88 RR: 20 O2sat: 97% 2L
GENERAL: resting in bed, alert, NAD
HEENT: EOMI. MMM
CARDIAC: RRR, no m/r/g
LUNGS: Coarse breath sounds throughout, no resp distress
ABDOMEN: NABS. Soft, NT, ND. No HSM
EXTREMITIES: trace edema in lower extremities
SKIN: No rashes/lesions, ecchymoses.
NEURO: A&Ox3.

FAMILY HISTORY: Mother [**Name (NI) **] CA - died around age 80, heart disease

SOCIAL HISTORY: She lives alone and gets help from son and [**Name2 (NI) 9259**]; she has
smoked 2PPD for approximately 40 years and note of quiting as of
this past 9/08 per pt. She denies Etoh/drugs, used to take
opioids and benzos when she had a doctor, states opiates not
helping recently her pain.  Per patient and son, she is
competent in most ADLs and IADLs, but due to worsening vision
(from cataracts) she has becoming increasingly dependent on
support from family.
Acute kidney failure, unspecified,Pneumonia, organism unspecified,Hyposmolality and/or hyponatremia,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Other emphysema,Unspecified essential hypertension,Atrial fibrillation,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Anemia, unspecified
Acute kidney failure NOS,Pneumonia, organism NOS,Hyposmolality,Hpt B chrn wo cm wo dlta,Emphysema NEC,Hypertension NOS,Atrial fibrillation,Ocl crtd art wo infrct,Anemia NOS
Admission Date:  [**2166-2-26**]              Discharge Date:   [**2166-3-4**]

Date of Birth:  [**2093-9-19**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Sulfa (Sulfonamides) / Ibuprofen / Niacin /
Tetanus / Aspirin / Erythromycin Base / Iodine; Iodine
Containing

Attending:[**First Name3 (LF) 9853**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
none


History of Present Illness:
Patient is a 72 y/o F with a history of COPD on home oxygen who
presented to the ER with shortness of breath and subjective
fevers. Patient was a poor historian and unable to tell much of
her medical history. Briefly, patient was admitted for
pneumonia, acute renal failure, and hyponatremia. In the ER,
patient was febrile to 102F. VS were 99.6, 110/60, 112, 26, 93%
on 4L NC. Patient received 2L NS, levaquin 750mg, tylenol 1g,
combivent nebs, morphine 8mg IV, zofran 4mg IV. Lactate was 2.4
on admission.
.
On admission to the [**Hospital Ward Name **], patient was found to be
hypotensive to the 70s, but was mentating well and was found to
have oxygen saturation to 88% on 5L NC. Patient recieved another
2L NS. Patient was tough to measure blood pressure on and thus
was transferred to the [**Hospital Unit Name 153**] for closer monitoring.
.
On arrival to the [**Hospital Unit Name 153**], patient was belligerent and
uncooperative. Patient's inital SBP by doppler was 56, but was
mentating well. After several attempts with different blood
pressure cuffs, patient was found to have SBP in 170-180s.
Patient denied any nausea, vomiting, diarrhea, chest pain,
shortness of breath. All other ROS negative.


Past Medical History:
# HTN
# Emphysema
# Bleeding Ulcers
# Hepatitis B (tx related)
# Bleeding ulcers
# Carotid stent when 22 y/o
# L Lymph node removal
# Hyperparathyroidism s/p removal
# Chronic back pain
# Hx neurosyphilis
# C. Difficile colitis

Social History:
She lives alone and gets help from son and [**Name2 (NI) 9259**]; she has
smoked 2PPD for approximately 40 years and note of quiting as of
this past 9/08 per pt. She denies Etoh/drugs, used to take
opioids and benzos when she had a doctor, states opiates not
helping recently her pain.  Per patient and son, she is
competent in most ADLs and IADLs, but due to worsening vision
(from cataracts) she has becoming increasingly dependent on
support from family.


Family History:
Mother [**Name (NI) **] CA - died around age 80, heart disease

Physical Exam:
VS: Temp: 98.9/98.3 BP: 116/67 HR: 88 RR: 20 O2sat: 97% 2L
GENERAL: resting in bed, alert, NAD
HEENT: EOMI. MMM
CARDIAC: RRR, no m/r/g
LUNGS: Coarse breath sounds throughout, no resp distress
ABDOMEN: NABS. Soft, NT, ND. No HSM
EXTREMITIES: trace edema in lower extremities
SKIN: No rashes/lesions, ecchymoses.
NEURO: A&Ox3.


Pertinent Results:
[**2166-2-26**] 04:20PM   GLUCOSE-115* UREA N-38* CREAT-2.4*#
SODIUM-129* POTASSIUM-4.0 CHLORIDE-89* TOTAL CO2-29 ANION GAP-15
[**2166-2-26**] 04:20PM   ALT(SGPT)-22 AST(SGOT)-20 LD(LDH)-198 ALK
PHOS-102 TOT BILI-0.2
[**2166-2-26**] 04:20PM   WBC-17.8*# RBC-3.31* HGB-9.8* HCT-29.6*
MCV-90 MCH-29.5 MCHC-32.9 RDW-15.9*
[**2166-2-26**] 04:20PM   NEUTS-87.5* LYMPHS-8.1* MONOS-2.8 EOS-1.3
BASOS-0.4
[**2166-2-26**] 04:20PM   PLT COUNT-525*#
[**2166-2-26**] 05:55PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.023
[**2166-2-26**] 05:55PM URINE  BLOOD-TR NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-SM UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2166-2-26**] 05:55PM URINE  RBC-[**1-23**]* WBC-[**1-23**] BACTERIA-MANY
YEAST-NONE EPI-[**4-30**]
[**2166-2-26**] 04:45PM   LACTATE-2.4*

CT head [**2166-2-26**]
1. No acute intracranial process.
2. Marked chronic microvascular ischemic changes

Left LENI [**2166-2-28**]: No left lower extremity DVT.

Chest CT [**2166-3-1**]:
1. Near-complete resolution of previously described pulmonary
nodules, likely represented foci of infection.
2. New bilateral septal thickening and bilateral pleural
effusions worse on the right likely reflecting volume overload.
3. Atherosclerotic calcification of the thoracic aorta and
coronary vasculature.


Brief Hospital Course:
72 yo F with severe COPD, HTN, and recent admission for lingular
PNA with workup concerning for multiple pulmonary nodules and
possible malignancy presents as a transfer from the medical [**Hospital1 **]
immediately after ED admission with hypotension and hypoxia.

# Hypoxia: Resolved on transfer to the [**Hospital Unit Name 153**]
[**12-23**] Recurrent Lingular Pneumonia - Recent CT chest from [**12-30**]
showing multiple b/l pulm nodules concerning for mets without
found primary lesion raising suspicion for post-obstructive PNA
vs. infiltrate from malginancy. She did have fever and elevated
WBC on presentation to the ED supporting active infection.
continued coverage with vancomycin(added on floor prior to
transfer to [**Hospital Unit Name 153**]) and levofloxacin given recent hospitalization.
As she quickly clinically improved her vancomycin was stopped
and chest CT showed almost complete resolution of multiple
pulmonary nodules seen in [**12-30**], which indicated a likely
infectious etiology. This was discussed with her outpatient
pulmonologist, and no further followup is needed at this time.
There was evidence of volume overload, and she was diuresed with
further improvement of her respiratory status. She completed a
five day course of levaquin in-house, and her respiratory status
was stable for her hospital course on the general medical floor.

# A Fib: Pt went into A fib with RVR while in the unit.  Her PCP
was called and she has a history of A fib.  She was given
diltiazem 5 IV x2 and then diltiazem 10 IV x2.  She was then
started on standing diltiazem which was titrated up to the max
dose with good effect. After she was called out to the floor,
her pharmacy was contact[**Name (NI) **] to verify her med list and they
reported she was on Toprol XL 100mg daily. Since she had been
stabilized on diltiazem, she was discharged on this medication
instead. CHADS score 2; however, given h/o bleeding ulcers and
possible poor compliance with meds/followup, would not advise
anticoagulating for now.

# COPD, severe - 40 pack year smoking history, quit [**7-29**], with
severe centrilobular emphysematous changes on most recent CT.
Was not started on steroids given concern for acute PNA, and
repeat chest CT showed resolution of previously seen nodules as
well as mild volume overload, treated as above.

# Hypotension: Floor team unable to obtain SBP >60/palp in the
absence of obtundation despite 4L NS. Concern given lactate,
WBC, and PNA that patient was becoming septic. On arrival to the
[**Hospital Unit Name 105730**] 170s.  Her UOP remained good, she continued to mentate
well and unit team was unable to place arterial line, but given
above likely that cuff readings were inaccurate. Her blood
pressure remained stable thereafter, and repeat lactate was
decreased to 1.8. Home BP meds were initially held but restarted
for afib with RVR as above, and her pressures remained stable
afterwards.

# Hyponatremia - Likely [**12-23**] hypovolemia and HCTZ use, this
resolved after IVF resuscitation and holding HCTZ.

# Acute Renal Failure - Likely prerenal in setting of acute
infection. Patient appeared volume depleted on exam on
admission. Baseline 0.8, admitted w/ Cr 2.4.  Improved back to
baseline with IVF.

# Chronic Anemia, normocytic - Dates back to [**9-28**] with baseline
around 30. At baseline on admission. Iron studies from [**12-30**]
consistent with anemia of chronic inflammation.

# HTN: started on diltiazem as above, BP remained stable with
this medication. HCTZ was held as above.

# Carotid Stent: continued with Plavix

# Dispo: PT initially recommended rehab, but the patient
adamantly refused. She showed improvement on subsequent sessions
and so was cleared to be discharged home with home PT.


Medications on Admission:
Confirmed with [**Location (un) **] Pharmacy at [**Telephone/Fax (1) 105731**]:
plavix 75'
Gabapentin 300 mg [**Hospital1 **] and 600 mg qHS
combivent 2 puffs q6:PRN
Pantoprazole 40'
colace
percocet PRN
Hydrochlorothiazide 25 mg QD
Toprol XL 100mg daily

Discharge Medications:
1. Diltiazem HCl 360 mg Tablet Sustained Release 24 hr Sig: One
(1) Tablet Sustained Release 24 hr PO once a day.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO three times
a day.
4. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO at bedtime:
take with pm dose to make total of 600 mg.
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO once a day.
6. Colace 100 mg Capsule Sig: One (1) Capsule PO once a day as
needed for constipation.
7. Combivent 18-103 mcg/Actuation Aerosol Sig: Two (2) puffs
Inhalation every six (6) hours as needed for shortness of breath
or wheezing.


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 7571**]VNA

Discharge Diagnosis:
Primary: pneumonia
Secondary: hypertension, acute renal failure, COPD, acute renal
failure


Discharge Condition:
good, stable, cleared by PT for dicharge home with PT


Discharge Instructions:
You were evaluated for shortness or breath and found to have low
blood pressure. You improved with IV fluids, antibiotics. Your
heart rate was found to be very high and we started you on a
medication called diltiazem for this. You should not take
metoprolol along with this medication.

If you have lightheadedness, shortness of breath, chest pain,
episodes of loss of consciousness, fevers, chills, or any other
concerning symptoms, call your doctor.

Followup Instructions:
Follow up with your primary care physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) 3403**] [**Last Name (NamePattern1) **];
call his office at [**Telephone/Fax (1) 250**] to make an appointment.
{'Acute kidney failure, unspecified,Pneumonia, organism unspecified,Hyposmolality and/or hyponatremia,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Other emphysema,Unspecified essential hypertension,Atrial fibrillation,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Anemia, 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: shortness of breath

PRESENT ILLNESS: Patient is a 72 y/o F with a history of COPD on home oxygen who
presented to the ER with shortness of breath and subjective
fevers. Patient was a poor historian and unable to tell much of
her medical history. Briefly, patient was admitted for
pneumonia, acute renal failure, and hyponatremia. In the ER,
patient was febrile to 102F. VS were 99.6, 110/60, 112, 26, 93%
on 4L NC. Patient received 2L NS, levaquin 750mg, tylenol 1g,
combivent nebs, morphine 8mg IV, zofran 4mg IV. Lactate was 2.4
on admission.
.
On admission to the [**Hospital Ward Name **], patient was found to be
hypotensive to the 70s, but was mentating well and was found to
have oxygen saturation to 88% on 5L NC. Patient recieved another
2L NS. Patient was tough to measure blood pressure on and thus
was transferred to the [**Hospital Unit Name 153**] for closer monitoring.
.
On arrival to the [**Hospital Unit Name 153**], patient was belligerent and
uncooperative. Patient's inital SBP by doppler was 56, but was
mentating well. After several attempts with different blood
pressure cuffs, patient was found to have SBP in 170-180s.
Patient denied any nausea, vomiting, diarrhea, chest pain,
shortness of breath. All other ROS negative.

MEDICAL HISTORY: # HTN
# Emphysema
# Bleeding Ulcers
# Hepatitis B (tx related)
# Bleeding ulcers
# Carotid stent when 22 y/o
# L Lymph node removal
# Hyperparathyroidism s/p removal
# Chronic back pain
# Hx neurosyphilis
# C. Difficile colitis

MEDICATION ON ADMISSION: Confirmed with [**Location (un) **] Pharmacy at [**Telephone/Fax (1) 105731**]:
plavix 75'
Gabapentin 300 mg [**Hospital1 **] and 600 mg qHS
combivent 2 puffs q6:PRN
Pantoprazole 40'
colace
percocet PRN
Hydrochlorothiazide 25 mg QD
Toprol XL 100mg daily

ALLERGIES: Penicillins / Sulfa (Sulfonamides) / Ibuprofen / Niacin /
Tetanus / Aspirin / Erythromycin Base / Iodine; Iodine
Containing

PHYSICAL EXAM: VS: Temp: 98.9/98.3 BP: 116/67 HR: 88 RR: 20 O2sat: 97% 2L
GENERAL: resting in bed, alert, NAD
HEENT: EOMI. MMM
CARDIAC: RRR, no m/r/g
LUNGS: Coarse breath sounds throughout, no resp distress
ABDOMEN: NABS. Soft, NT, ND. No HSM
EXTREMITIES: trace edema in lower extremities
SKIN: No rashes/lesions, ecchymoses.
NEURO: A&Ox3.

FAMILY HISTORY: Mother [**Name (NI) **] CA - died around age 80, heart disease

SOCIAL HISTORY: She lives alone and gets help from son and [**Name2 (NI) 9259**]; she has
smoked 2PPD for approximately 40 years and note of quiting as of
this past 9/08 per pt. She denies Etoh/drugs, used to take
opioids and benzos when she had a doctor, states opiates not
helping recently her pain.  Per patient and son, she is
competent in most ADLs and IADLs, but due to worsening vision
(from cataracts) she has becoming increasingly dependent on
support from family. 

### Response:
{'Acute kidney failure, unspecified,Pneumonia, organism unspecified,Hyposmolality and/or hyponatremia,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Other emphysema,Unspecified essential hypertension,Atrial fibrillation,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Anemia, unspecified'}
