CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: Mr. [**Known lastname 92234**] is a 80 yo greek M with h/o chronic bilateral
pleural effusions (exudative, uremic pleurisy) s/p bilat
thoracentesis and pleural bx with pleurex cath placement on
[**3-6**], CAD s/p MI, CHB s/p pacer, diabetes, HTN, ESRD on HD who
presents with shortness of breath over the last 24hrs.  He noted
the increase gradually over the course of the day,
symptomatically improved with home 02.  He endorses a mild
non-productive cough, but denies hemoptysis.  He denies CP, n/v,
f/c, or change in BMs.  Furthermore, he denies any
lightheadedness or dizziness.  His pleurex cath was drained
today without output (drained every other day, no output over
the last 5 drainages).  Patient reports good adherence to
medications and has not missed a dialysis session.
.
In the ED, VS T 99.2, HR 64, BP 153/42, RR 32, 87% on RA ->
97%4L.  EKG non-ischemic.  CXR with large L pleural effusion.
IP consulted and performed thoracentesis.  Given CTX 1g and
levaquin 750mg for ? PNA.  Cont to show labored breathing so was
admitted to the MICU for further monitoring.
.
Allergies: Sulfa, Haldol, [**Last Name (LF) 7130**], [**First Name3 (LF) **]

MEDICAL HISTORY: -h/o recent chronic lymphocytic exudative pleural effusions
secondary to chronic uremic pleurisy:
s/p thoracentesis [**4-21**] (transudative), [**2169-2-10**] (right, 1700 ml,
exudative, symptomatic relief, poor lung expansion"trapped"),
[**2169-2-13**] (left, 300ml, exudate, no symptomatic releif, poor lung
expansion).
Right sided pleuroscopy with drainage of 1200 ml of serious
fluid and parietal pleural biopsy and pleurex catheter placement
on [**3-6**]
.
-Colonic adenoma with high grade dysplasia / intramucosal
carcinoma; no mucosal invasion, all LN negative, s/p right
colectomy [**3-22**]
-CAD: NSTEMI in [**2150**], no perfusion defects [**3-/2168**] MIBI.
-Mod Pulm HTN, EF >70% 3/09 Echo
-Complete Heart Block S/P [**Company 1543**] Sigma DR [**Last Name (STitle) 26019**] PPM
in [**6-/2167**]
-Left internal carotid artery stenosis: (Carotid US in [**3-19**]
showed a L ICA 70-79% stenosis with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3098**]/LCCA index of 3.6, no
right ICA stenosis with a [**Country **]/RCCA index of 1. in [**2164**]) on
clopidogrel.
-ESRD: [**1-16**] HTN and diabetes, on HD, Receives hemodialysis on
Tuesday, Thrusday and Saturday via a left AV fistula at [**Location (un) 1468**]
Dialysis Center.
-Type 2 DM: (last A1c 6% in [**7-22**]) on oral agents
-Hypertension
-Chronic anemia (baseline hct ~ 35)
-Hyperlipidemia
-Secondary hyperparathyroidism
-Bilateral cataracts s/p surgical intervention
-s/p ERCP for bile duct stenosis
-Mild dementia
-h/o urinary retention requiring discharge home with
Foley/leg bag

MEDICATION ON ADMISSION: RENAL CAPS 1 cap daily
CLOPIDOGREL 75mg daily
GLIPIZIDE 5mg daily
METOPROLOL TARTRATE 25mg [**Hospital1 **]
NIFEDIPINE 30 mg SR [**Hospital1 **]
Darvocet 50mg-325 [**Hospital1 **] prn
SIMVASTATIN 20mg daily
TERAZOSIN 2mg daily

ALLERGIES: Sulfa (Sulfonamides) / [**Year (4 digits) 7130**] / Haldol / Aspirin

PHYSICAL EXAM: On Transfer from MICU:
Vital signs: T 97.6 BP 177/51 76 SaO2100% on 2L
Gen: lying flat in bed, pleasant, talking without labored
breathing
HEENT: EOMI, pinpoint pupils, symmetric, anicteric sclera
NECK: supple, no LAD
Heart: Regularly irregular, 2/6 SEM at base
Lung: decreased BS bilaterally, L>R with crackles
Abd: thin, soft, NT/ND + BS no rebound or guarding
Ext: warm, no rash, 2+ DP pulses
Skin: no bruising
Neuro: alert and oriented, no focal deficits

FAMILY HISTORY: Mother-DM, CAD

SOCIAL HISTORY: Lives with wife and son. [**Name (NI) **] another son who lives in downstairs
apartment. He worked as a bricklayer for many years. Reports a
45 pk/yr h/o tobacco but quit over 20 yrs ago. Has glass of wine
with lunch and dinner. Occasional beer on a hot day.
Unspecified pleural effusion,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia in chronic kidney disease,Other chronic pulmonary heart diseases,Cardiac pacemaker in situ,Occlusion and stenosis of carotid artery without mention of cerebral infarction
Pleural effusion NOS,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,DMII wo cmp nt st uncntr,Anemia in chr kidney dis,Chr pulmon heart dis NEC,Status cardiac pacemaker,Ocl crtd art wo infrct
Admission Date:  [**2169-4-3**]              Discharge Date:   [**2169-4-6**]

Date of Birth:  [**2088-10-27**]             Sex:   M

Service: MEDICINE

Allergies:
Sulfa (Sulfonamides) / [**Year (4 digits) 7130**] / Haldol / Aspirin

Attending:[**First Name3 (LF) 800**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
Left thoracentesis


History of Present Illness:
Mr. [**Known lastname 92234**] is a 80 yo greek M with h/o chronic bilateral
pleural effusions (exudative, uremic pleurisy) s/p bilat
thoracentesis and pleural bx with pleurex cath placement on
[**3-6**], CAD s/p MI, CHB s/p pacer, diabetes, HTN, ESRD on HD who
presents with shortness of breath over the last 24hrs.  He noted
the increase gradually over the course of the day,
symptomatically improved with home 02.  He endorses a mild
non-productive cough, but denies hemoptysis.  He denies CP, n/v,
f/c, or change in BMs.  Furthermore, he denies any
lightheadedness or dizziness.  His pleurex cath was drained
today without output (drained every other day, no output over
the last 5 drainages).  Patient reports good adherence to
medications and has not missed a dialysis session.
.
In the ED, VS T 99.2, HR 64, BP 153/42, RR 32, 87% on RA ->
97%4L.  EKG non-ischemic.  CXR with large L pleural effusion.
IP consulted and performed thoracentesis.  Given CTX 1g and
levaquin 750mg for ? PNA.  Cont to show labored breathing so was
admitted to the MICU for further monitoring.
.
Allergies: Sulfa, Haldol, [**Last Name (LF) 7130**], [**First Name3 (LF) **]


Past Medical History:
-h/o recent chronic lymphocytic exudative pleural effusions
secondary to chronic uremic pleurisy:
s/p thoracentesis [**4-21**] (transudative), [**2169-2-10**] (right, 1700 ml,
exudative, symptomatic relief, poor lung expansion"trapped"),
[**2169-2-13**] (left, 300ml, exudate, no symptomatic releif, poor lung
expansion).
Right sided pleuroscopy with drainage of 1200 ml of serious
fluid and parietal pleural biopsy and pleurex catheter placement
on [**3-6**]
.
-Colonic adenoma with high grade dysplasia / intramucosal
carcinoma; no mucosal invasion, all LN negative, s/p right
colectomy [**3-22**]
-CAD: NSTEMI in [**2150**], no perfusion defects [**3-/2168**] MIBI.
-Mod Pulm HTN, EF >70% 3/09 Echo
-Complete Heart Block S/P [**Company 1543**] Sigma DR [**Last Name (STitle) 26019**] PPM
in [**6-/2167**]
-Left internal carotid artery stenosis: (Carotid US in [**3-19**]
showed a L ICA 70-79% stenosis with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3098**]/LCCA index of 3.6, no
right ICA stenosis with a [**Country **]/RCCA index of 1. in [**2164**]) on
clopidogrel.
-ESRD: [**1-16**] HTN and diabetes, on HD, Receives hemodialysis on
Tuesday, Thrusday and Saturday via a left AV fistula at [**Location (un) 1468**]
Dialysis Center.
-Type 2 DM: (last A1c 6% in [**7-22**]) on oral agents
-Hypertension
-Chronic anemia (baseline hct ~ 35)
-Hyperlipidemia
-Secondary hyperparathyroidism
-Bilateral cataracts s/p surgical intervention
-s/p ERCP for bile duct stenosis
-Mild dementia
-h/o urinary retention requiring discharge home with
Foley/leg bag

Social History:
Lives with wife and son. [**Name (NI) **] another son who lives in downstairs
apartment. He worked as a bricklayer for many years. Reports a
45 pk/yr h/o tobacco but quit over 20 yrs ago. Has glass of wine
with lunch and dinner. Occasional beer on a hot day.


Family History:
Mother-DM, CAD

Physical Exam:
On Transfer from MICU:
Vital signs: T 97.6 BP 177/51 76 SaO2100% on 2L
Gen: lying flat in bed, pleasant, talking without labored
breathing
HEENT: EOMI, pinpoint pupils, symmetric, anicteric sclera
NECK: supple, no LAD
Heart: Regularly irregular, 2/6 SEM at base
Lung: decreased BS bilaterally, L>R with crackles
Abd: thin, soft, NT/ND + BS no rebound or guarding
Ext: warm, no rash, 2+ DP pulses
Skin: no bruising
Neuro: alert and oriented, no focal deficits

Pertinent Results:
[**2169-4-3**] 06:40PM BLOOD WBC-7.2 RBC-4.02* Hgb-11.0* Hct-34.9*
MCV-87 MCH-27.4 MCHC-31.6 RDW-16.1* Plt Ct-487*
[**2169-4-4**] 03:05AM BLOOD WBC-6.9 RBC-3.27* Hgb-9.2* Hct-28.6*
MCV-88 MCH-28.1 MCHC-32.1 RDW-16.5* Plt Ct-428
[**2169-4-4**] 08:59AM BLOOD Hct-29.9*
[**2169-4-3**] 06:40PM BLOOD Neuts-76.3* Lymphs-15.8* Monos-5.7
Eos-2.1 Baso-0.2
[**2169-4-3**] 06:40PM BLOOD PT-12.6 PTT-26.5 INR(PT)-1.1
[**2169-4-4**] 04:00AM BLOOD PT-13.7* PTT-27.8 INR(PT)-1.2*
[**2169-4-3**] 06:40PM BLOOD Glucose-228* UreaN-37* Creat-4.4*# Na-139
K-4.2 Cl-95* HCO3-29 AnGap-19
[**2169-4-4**] 03:05AM BLOOD Glucose-153* UreaN-41* Creat-4.6* Na-137
K-4.1 Cl-98 HCO3-28 AnGap-15
[**2169-4-3**] 06:40PM BLOOD cTropnT-0.14*
[**2169-4-4**] 03:05AM BLOOD CK-MB-NotDone cTropnT-0.15*
[**2169-4-3**] 06:40PM BLOOD TotProt-7.0 Albumin-3.7 Globuln-3.3
Calcium-9.0 Phos-3.6# Mg-2.2
[**2169-4-4**] 03:05AM BLOOD Calcium-8.1* Phos-4.1 Mg-2.2
[**2169-4-3**] 06:47PM BLOOD Lactate-2.3*
.
CXR [**2169-4-3**]:
1. Interval increase in the left basal effusion with progressive
left lower
lobe collapse when compared to the chest radiograph of [**2169-3-13**].

2. Stable right basal effusion with areas of added density in
the right lower
lobe suggestive of superimposed infection.


Brief Hospital Course:
In the ED, the patient had a left thoracentesis, one liter
removed and was symptomatically imprved. He was admitted to the
ICU for tachypnea with RR 40, but then improved to RR 20's.
Initially, he had a high O2 requirement - 87% RA in the ED, 92%
on 4L, 98% on 5L. He received dialysis in the ICU and his oxygen
levels improved to 100% on 3LNC. The interventional pulmonary
service consulted on this patient - as he is followed by them
closely as an outpt- and recommended removal of right pleurex
and placement on a new left pleurex after plavix wash out. The
patient was tranfered to the floor in stable condition. While on
the floor, he remained stable, with his O2 saturation 95-97% on
2-3L NC. He had no tachypnea or pleuritic chest pain while on
the floor. He had dialysis x1 on the floor. He is being d/c home
with home VNA for daily vital signs/lung exam to be sure
effusion not returning while patient at home.

Medications on Admission:
RENAL CAPS 1 cap daily
CLOPIDOGREL 75mg daily
GLIPIZIDE 5mg daily
METOPROLOL TARTRATE 25mg [**Hospital1 **]
NIFEDIPINE 30 mg SR [**Hospital1 **]
Darvocet 50mg-325 [**Hospital1 **] prn
SIMVASTATIN 20mg daily
TERAZOSIN 2mg daily

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed.
2. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
PRN as needed for constipation.
4. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual PRN (as needed).
5. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
6. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
7. Nifedipine 30 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO BID (2 times a day).
8. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
9. Terazosin 1 mg Capsule Sig: Two (2) Capsule PO HS (at
bedtime).
10. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1) nebulizer Inhalation Q6H (every 6
hours) as needed.
11. Glipizide 5 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
recurrent left pleural effusion


Discharge Condition:
stable. vital signs normal. patient is s/p hemodyalisis today
([**4-6**])


Discharge Instructions:
You were admitted for shortness of breath that was associated
with a recurrent pleural effusion (fluid on your lungs) on the
left side. This effusion was drained and your shortness of
breath improved over the following two days. You will need an
additional drainage of this fluid and a placment of a temporary
catheter next week and this will be done be interventional
pulmonology. Until that time, you will have the visiting nurse
come by and check on you daily to be sure that this fluid does
not rapidly accumulate and cause you trouble again.
.
Please stop taking your Plavix and aspirin at home to prepare
for this procedure. You can likely re-start these medicines
after you see Dr [**Last Name (STitle) **] - be sure to clarify this with him at
your next visit (next [**Last Name (STitle) 766**]).
.
You can use your home oxygen if you feel that you need it but if
you start to need larger and larger amounts or have a lot of
difficulty breathing, please return to the hospital.
.
The catheter on your right side does not appear to be
functioning at this time but the interventional pulmonology
physicians do not feel that it needs to be removed during this
visit (they may remove it at your follow up appointment). You do
not need to try and drain this catheter while you are at home.
.
Please return to the Emergency Department or call your primary
care physician if you develop any of the following:
* fever, chills, redness or tenderness over the catheter site
* increasing shortness of breath, chest pain, pain when you take
a deep breath
* any other symptoms that are concerning to you

Followup Instructions:
Please call Dr[**Name (NI) 5070**] office (inteventional pulmonology) today
at [**Telephone/Fax (1) 3020**] to schedule an appointment for [**Last Name (LF) 766**], [**4-10**].
.
Please also keep the following appointments that are already
scheduled for you:
Provider:  [**Name10 (NameIs) 676**] CLINIC Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2169-5-1**]
8:30
Provider: [**Name10 (NameIs) 900**] [**Name8 (MD) 901**], M.D. Phone:[**Telephone/Fax (1) 62**]
Date/Time:[**2169-5-1**] 10:20
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4853**], M.D. Phone:[**Telephone/Fax (1) 253**]
Date/Time:[**2169-5-10**] 10:00


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 810**] MD, [**MD Number(3) 811**]
{'Unspecified pleural effusion,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia in chronic kidney disease,Other chronic pulmonary heart diseases,Cardiac pacemaker in situ,Occlusion and stenosis of carotid artery without mention of cerebral infarction'}


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: Mr. [**Known lastname 92234**] is a 80 yo greek M with h/o chronic bilateral
pleural effusions (exudative, uremic pleurisy) s/p bilat
thoracentesis and pleural bx with pleurex cath placement on
[**3-6**], CAD s/p MI, CHB s/p pacer, diabetes, HTN, ESRD on HD who
presents with shortness of breath over the last 24hrs.  He noted
the increase gradually over the course of the day,
symptomatically improved with home 02.  He endorses a mild
non-productive cough, but denies hemoptysis.  He denies CP, n/v,
f/c, or change in BMs.  Furthermore, he denies any
lightheadedness or dizziness.  His pleurex cath was drained
today without output (drained every other day, no output over
the last 5 drainages).  Patient reports good adherence to
medications and has not missed a dialysis session.
.
In the ED, VS T 99.2, HR 64, BP 153/42, RR 32, 87% on RA ->
97%4L.  EKG non-ischemic.  CXR with large L pleural effusion.
IP consulted and performed thoracentesis.  Given CTX 1g and
levaquin 750mg for ? PNA.  Cont to show labored breathing so was
admitted to the MICU for further monitoring.
.
Allergies: Sulfa, Haldol, [**Last Name (LF) 7130**], [**First Name3 (LF) **]

MEDICAL HISTORY: -h/o recent chronic lymphocytic exudative pleural effusions
secondary to chronic uremic pleurisy:
s/p thoracentesis [**4-21**] (transudative), [**2169-2-10**] (right, 1700 ml,
exudative, symptomatic relief, poor lung expansion"trapped"),
[**2169-2-13**] (left, 300ml, exudate, no symptomatic releif, poor lung
expansion).
Right sided pleuroscopy with drainage of 1200 ml of serious
fluid and parietal pleural biopsy and pleurex catheter placement
on [**3-6**]
.
-Colonic adenoma with high grade dysplasia / intramucosal
carcinoma; no mucosal invasion, all LN negative, s/p right
colectomy [**3-22**]
-CAD: NSTEMI in [**2150**], no perfusion defects [**3-/2168**] MIBI.
-Mod Pulm HTN, EF >70% 3/09 Echo
-Complete Heart Block S/P [**Company 1543**] Sigma DR [**Last Name (STitle) 26019**] PPM
in [**6-/2167**]
-Left internal carotid artery stenosis: (Carotid US in [**3-19**]
showed a L ICA 70-79% stenosis with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3098**]/LCCA index of 3.6, no
right ICA stenosis with a [**Country **]/RCCA index of 1. in [**2164**]) on
clopidogrel.
-ESRD: [**1-16**] HTN and diabetes, on HD, Receives hemodialysis on
Tuesday, Thrusday and Saturday via a left AV fistula at [**Location (un) 1468**]
Dialysis Center.
-Type 2 DM: (last A1c 6% in [**7-22**]) on oral agents
-Hypertension
-Chronic anemia (baseline hct ~ 35)
-Hyperlipidemia
-Secondary hyperparathyroidism
-Bilateral cataracts s/p surgical intervention
-s/p ERCP for bile duct stenosis
-Mild dementia
-h/o urinary retention requiring discharge home with
Foley/leg bag

MEDICATION ON ADMISSION: RENAL CAPS 1 cap daily
CLOPIDOGREL 75mg daily
GLIPIZIDE 5mg daily
METOPROLOL TARTRATE 25mg [**Hospital1 **]
NIFEDIPINE 30 mg SR [**Hospital1 **]
Darvocet 50mg-325 [**Hospital1 **] prn
SIMVASTATIN 20mg daily
TERAZOSIN 2mg daily

ALLERGIES: Sulfa (Sulfonamides) / [**Year (4 digits) 7130**] / Haldol / Aspirin

PHYSICAL EXAM: On Transfer from MICU:
Vital signs: T 97.6 BP 177/51 76 SaO2100% on 2L
Gen: lying flat in bed, pleasant, talking without labored
breathing
HEENT: EOMI, pinpoint pupils, symmetric, anicteric sclera
NECK: supple, no LAD
Heart: Regularly irregular, 2/6 SEM at base
Lung: decreased BS bilaterally, L>R with crackles
Abd: thin, soft, NT/ND + BS no rebound or guarding
Ext: warm, no rash, 2+ DP pulses
Skin: no bruising
Neuro: alert and oriented, no focal deficits

FAMILY HISTORY: Mother-DM, CAD

SOCIAL HISTORY: Lives with wife and son. [**Name (NI) **] another son who lives in downstairs
apartment. He worked as a bricklayer for many years. Reports a
45 pk/yr h/o tobacco but quit over 20 yrs ago. Has glass of wine
with lunch and dinner. Occasional beer on a hot day. 

### Response:
{'Unspecified pleural effusion,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia in chronic kidney disease,Other chronic pulmonary heart diseases,Cardiac pacemaker in situ,Occlusion and stenosis of carotid artery without mention of cerebral infarction'}
