CHIEF COMPLAINT: Shortness of Breath

PRESENT ILLNESS: 87yo M with hx of DM, HTN, diverticulosis,s/p partial colectomy,
depression, CKD, parkinson's vascular dementia, s/p pacemaker,
who has been experiencing night desaturation for the past few
days, worse this evening.  At [**Hospital 100**] Rehab, he had awoken with
SOB, satting 89% on 3L NC, improved to 95% on mask at 5L.  Pt
was given Lasix 40 mg po and 81 mg ASA.  Pt had a second episode
of SOB overnight, satting 70-80% on mask at 8L and was
transferred to [**Hospital1 18**].  RR was 28, BP 150/80, HR 64, T 98 ax.
Patient was non-communicative at time of exam and history was
obtained from medical record and from family report.
.
On arrival to [**Hospital1 18**] ED, SpO2 76% on NRB, ABG of 7.34/66/53.  He
was started on BiPap (FiO2 60%, PEEP 5, PS 10) with improvement
of O2 sat to 90-100%.  He received a nitro gtt, Lasix 60 mg IV,
levofloxacin 750 mg IV, and albuterol nebulizer.
.
On review of symptoms, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, hemoptysis, black stools
or red stools. He denies recent fevers, chills or rigors. He has
a chronic raspy cough per the daughter. [**Name (NI) **] of the other review
of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
palpitations.  Daughter is not aware of any dyspnea on exertion,
orthopnea.  She has noted that he had ankle edema ("elephant
legs") in the late winter and early spring and had asked [**Hospital1 100**]
Senior Life to start the patient on Lasix.  Daughter denies any
syncope or presyncope.  He has poor functional capacity at
baseline.

MEDICAL HISTORY: PAST MEDICAL HISTORY:
1. Type 2 DM
2. Thoracic pseudoaneursym of aorta, 4.3 cm in diameter
3. HTN
4. Diverticulosis, s/p partial colectomy
5. Depression
6. CRI (baseline Cr 1.3-1.7)
7. Parkinson's disease
8. Vascular dementia
9. Pacemaker c/b lead thrombus. Previously followed by Dr [**Last Name (STitle) **]
for "episodic unreponsiveness." This resolved with pacemaker
adjustment.  Recently seen by Dr. [**Last Name (STitle) **]/[**Doctor Last Name **] for
the thrombus, anticoagulation deferred for h/o falls, unsteady
gait, and confusion.
11. s/p hip fracture requiring ORIF in [**3-/2172**] with a
complicated medical course including hypoxic respiratory
failure.
12. Chronic diastolic dysfunction.

MEDICATION ON ADMISSION: CURRENT MEDICATIONS:
Furosemide 60 mg daily, started in [**4-22**]
Metoprolol XL 12.5 mg daily
KCl 10 meq MWF
Glipizide 5 mg daily
Acetaminophen 975 mg q 6 hrs
Bupropion Hcl 75 mg [**Hospital1 **]
Celexa 20 mg daily
Donepezil 10 mg daily
Mirapex 0.25 mg TID
Trazodone 12.5 mg qhs
Keflex 500 mg daily for chronic suppressive therapy
Ferrous sulfate 325 mg daily
Vitamin D 1000 units daily
Calcium carbonated 650 mg [**Hospital1 **]
Vitamin C
Vitamin B12 1000 mcg IM monthly
Melatonin 4 mg qhs

ALLERGIES: Bactrim / Procardia

PHYSICAL EXAM: VS: T 95.7 ax, BP 130/85, HR 79, RR 16, O2 95% on BiPap
Gen: Fatigued older male in NAD. Oriented to self only, "[**2138**]",
"[**Hospital1 100**]."  Per daughter, mental status at baseline.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. MMM.
Neck: Supple with JVP of 7 cm.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. ?S3.  No murmurs noted.
Chest:  No accessory muscle use.  Decreased breath sounds
throughout, diffuse rhonchi.  No crackles, wheezes.
Abd: Normoactive, soft, NT/ND, No HSM. No abdominial bruits.
Ext: No femoral bruits.  Trace pedal edema bilaterally.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Neuro:  PERRL, EOMI.  Resting tremor.
.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+
DP/PT
[**Name (NI) 2325**]: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+
DP/PT

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse.  Patient resides at
[**Hospital 100**] Rehab.
Acute respiratory failure,Hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified,Diastolic heart failure, unspecified,Paralysis agitans,Cardiac pacemaker in situ,Vascular dementia, uncomplicated,Cerebral atherosclerosis,Depressive disorder, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Thoracoabdominal aneurysm, without mention of rupture,Diverticulosis of colon (without mention of hemorrhage),Chronic kidney disease, unspecified
Acute respiratry failure,Hyp ht/kd NOS I-IV w hf,Diastolc hrt failure NOS,Paralysis agitans,Status cardiac pacemaker,Vascular dementia,uncomp,Cerebral atherosclerosis,Depressive disorder NEC,DMII wo cmp nt st uncntr,Thracabd anurysm wo rupt,Dvrtclo colon w/o hmrhg,Chronic kidney dis NOS
Admission Date:  [**2173-8-12**]              Discharge Date:   [**2173-8-15**]


Service: MEDICINE

Allergies:
Bactrim / Procardia

Attending:[**First Name3 (LF) 458**]
Chief Complaint:
Shortness of Breath

Major Surgical or Invasive Procedure:
None

History of Present Illness:
87yo M with hx of DM, HTN, diverticulosis,s/p partial colectomy,
depression, CKD, parkinson's vascular dementia, s/p pacemaker,
who has been experiencing night desaturation for the past few
days, worse this evening.  At [**Hospital 100**] Rehab, he had awoken with
SOB, satting 89% on 3L NC, improved to 95% on mask at 5L.  Pt
was given Lasix 40 mg po and 81 mg ASA.  Pt had a second episode
of SOB overnight, satting 70-80% on mask at 8L and was
transferred to [**Hospital1 18**].  RR was 28, BP 150/80, HR 64, T 98 ax.
Patient was non-communicative at time of exam and history was
obtained from medical record and from family report.
.
On arrival to [**Hospital1 18**] ED, SpO2 76% on NRB, ABG of 7.34/66/53.  He
was started on BiPap (FiO2 60%, PEEP 5, PS 10) with improvement
of O2 sat to 90-100%.  He received a nitro gtt, Lasix 60 mg IV,
levofloxacin 750 mg IV, and albuterol nebulizer.
.
On review of symptoms, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, hemoptysis, black stools
or red stools. He denies recent fevers, chills or rigors. He has
a chronic raspy cough per the daughter. [**Name (NI) **] of the other review
of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
palpitations.  Daughter is not aware of any dyspnea on exertion,
orthopnea.  She has noted that he had ankle edema ("elephant
legs") in the late winter and early spring and had asked [**Hospital1 100**]
Senior Life to start the patient on Lasix.  Daughter denies any
syncope or presyncope.  He has poor functional capacity at
baseline.




Past Medical History:
PAST MEDICAL HISTORY:
1. Type 2 DM
2. Thoracic pseudoaneursym of aorta, 4.3 cm in diameter
3. HTN
4. Diverticulosis, s/p partial colectomy
5. Depression
6. CRI (baseline Cr 1.3-1.7)
7. Parkinson's disease
8. Vascular dementia
9. Pacemaker c/b lead thrombus. Previously followed by Dr [**Last Name (STitle) **]
for "episodic unreponsiveness." This resolved with pacemaker
adjustment.  Recently seen by Dr. [**Last Name (STitle) **]/[**Doctor Last Name **] for
the thrombus, anticoagulation deferred for h/o falls, unsteady
gait, and confusion.
11. s/p hip fracture requiring ORIF in [**3-/2172**] with a
complicated medical course including hypoxic respiratory
failure.
12. Chronic diastolic dysfunction.


Social History:
Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse.  Patient resides at
[**Hospital 100**] Rehab.

Family History:
There is no family history of premature coronary artery disease
or sudden death.

Physical Exam:
VS: T 95.7 ax, BP 130/85, HR 79, RR 16, O2 95% on BiPap
Gen: Fatigued older male in NAD. Oriented to self only, "[**2138**]",
"[**Hospital1 100**]."  Per daughter, mental status at baseline.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. MMM.
Neck: Supple with JVP of 7 cm.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. ?S3.  No murmurs noted.
Chest:  No accessory muscle use.  Decreased breath sounds
throughout, diffuse rhonchi.  No crackles, wheezes.
Abd: Normoactive, soft, NT/ND, No HSM. No abdominial bruits.
Ext: No femoral bruits.  Trace pedal edema bilaterally.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Neuro:  PERRL, EOMI.  Resting tremor.
.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+
DP/PT
[**Name (NI) 2325**]: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+
DP/PT


Pertinent Results:
ADMISSION LABS:

[**2173-8-12**] 04:05AM BLOOD
WBC-10.8 RBC-4.64# Hgb-13.5*# Hct-41.4# MCV-89 MCH-29.1
MCHC-32.6 RDW-14.3 Plt Ct-146*
Neuts-84.1* Lymphs-10.8* Monos-2.3 Eos-2.6 Baso-0.2
PT-14.0* PTT-27.7 INR(PT)-1.2*
Glucose-208* UreaN-22* Creat-1.5* Na-145 K-3.5 Cl-101 HCO3-37*
AnGap-11

[**2173-8-12**] 04:05AM BLOOD
ALT-16 AST-19 LD(LDH)-200 CK(CPK)-85 AlkPhos-70 TotBili-0.4
CK-MB-NotDone proBNP-1203*
Albumin-4.2 Mg-2.0
.
[**2173-8-12**] 04:20AM BLOOD
Type-ART pO2-53* pCO2-66* pH-7.34* calTCO2-37* Base XS-6
Intubat-NOT INTUBA
.
[**2173-8-12**] 05:37AM   TYPE-ART PO2-70* PCO2-68* PH-7.32* TOTAL
CO2-37* BASE XS-5 INTUBATED-NOT INTUBA
.
[**2173-8-12**] 10:51AM   TYPE-ART PEEP-5 O2-60 PO2-130* PCO2-66*
PH-7.35 TOTAL CO2-38* BASE XS-8 INTUBATED-NOT INTUBA
.
[**2173-8-12**] 01:44PM   CK-MB-NotDone cTropnT-0.02*
[**2173-8-12**] 01:44PM   CK(CPK)-67
.
[**2173-8-13**] 04:28AM
Triglyc-163* HDL-34 CHOL/HD-4.1 LDLcalc-72
.
[**Hospital1 18**] [**Numeric Identifier 96306**]Portable TTE (Complete)
Done [**2173-8-12**] at 2:12:50 PM      FINAL
The left atrium is dilated. There is moderate symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. Due to suboptimal technical quality, a focal wall motion
abnormality cannot be fully excluded. Overall left ventricular
systolic function is normal (LVEF>55%). Right ventricular
chamber size and free wall motion are normal. The aortic root is
moderately dilated at the sinus level. The ascending aorta is
moderately dilated. Trace aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. There is no mitral
valve prolapse. Trivial mitral regurgitation is seen. The left
ventricular inflow pattern suggests impaired relaxation. The
pulmonary artery systolic pressure could not be determined.
There is an anterior space which most likely represents a fat
pad.
.
Compared with the prior study (images reviewed) of [**2173-5-25**],
the previously suspected thrombus on the pacing wire is not
apparent on the current study. However, the suboptimal image
quality precludes close examination of the pacing wrie. The
other findings are similar.
.
Radiology Report CHEST (PORTABLE AP) Study Date of [**2173-8-12**] 4:03
AM
UPRIGHT PORABLE CHEST
Streaky linear atelectasis is noted extending from the region of
the right
hila and at the left base in this patient with persistent low
lung volumes. No evidence of interstitial pulmonary edema,
pneumothorax, or consolidation to suggest pneumonia. The
cardiomediastinal silhouette is unchanged with stable appearance
to abnormal contour projecting above the aortic knob consistent
with the patient's known pseudoaneurysm. Positioning of
pacemaker leads is unchanged.
.
Radiology Report CHEST (PA & LAT) Study Date of [**2173-8-14**] 1:55 PM

Lateral views are not well penetrated. The right hemidiaphragm
is elevated, as before. The lungs appear clear except for
streaky density in the retrocardiac area, which is suboptimally
evaluated. The cardiac silhouette appears large but may be
exaggerated by AP technique. A 4.5 cm round density projected
adjacent to the aortic knob, consistent with a known aortic
pseudoaneurysm is unchanged. Mediastinal structures are
unchanged in appearance, and the bony thorax is grossly intact.
A bipolar transvenous pacemaker remains in place.
IMPRESSION: Streaky density in the retrocardiac area that may
represent
partial atelectasis or consolidation. Elevation of the right
hemidiaphragm. No definite interval change.


Brief Hospital Course:
The patient is an 87yo man with a history of Diabetes,
Hypertension, diastolic CHF, s/p pacemaker, CKD, Parkinson's,
and vascular dementia who presented for SOB/hypoxia and found to
be in hypercarbic/hypoxic respiratory failure requiring BiPap.
.
# Hypercarbic/hypoxic respiratory failure:  The patient was
hypoxic on admission with  SpO2 76% on NRB and an arterial blood
gas of 7.34/66/53.  He was started on BiPap (FiO2 60%, PEEP 5,
PS 10) with improvement of O2 sat to 90-100% which was weaned
over several hours.  The patient had no history of COPD or
asthma.  His acute hypoxia was felt to be due to diastolic heart
failure, although CXR appeared to have mild pulmonary edema
without significant change from [**4-22**].  The patient was afebrile,
without cough, fever or leukocytosis.  PE was considered given a
previously noted thrombus in the RA and the patient's poor
functional capacity at baseline. However, repeat ECHO was
without evidence of thrombus and there was no evidence of DVT on
physical exam.  The patient received Lasix boluses for diuresis
and was slowly switched back to his home dose of PO Lasix.  Over
the course of hospitalization the patient had marked improvement
in his supplemental oxygen requirements and at the time of
discharge he was sating well on 4L of oxygen.
.
# Diastolic CHF:  The patient had an Echocardiogram in [**Month (only) **] with
evidence of mild pulmonary artery systolic hypertension and
diastolic dysfunction.  On presentation this admission, the
patient lacked overt volume overload on arrival and chest xray
was not remarkably changed from previous exams.  However, BNP
was elevated at 1203. Blood pressure was noted to be 150/80 and
the patient was given IV Lasix boluses and started on a Nitro
gtt for blood pressure control.  Repeat ECHO showed little
change since previous exam.  We would encourage daily weights
and a low sodium diet in this patient.  Should his weight
increase greater than 3 pounds, he should be given an extra PM
dose of Lasix.
.
# HTN:  The patient was noted to be hypertensive during
admission, with systolic blood pressures to the 160's/170's.  He
was initially started on a Nitro drip for immediate blood
pressure control.  He was then transitioned to oral medications.
 His home dose of metoprolol was increased from 12.5mg daily to
100mg and he was started on Imdur 30mg daily with a good
response in BP.  At the time of discharge, his blood pressure
was in an acceptable range of 110's systolic.
.
# CAD/Ischemia: The patient had an episode of chest pain.
Cardiac enzymes were unremarkable with troponin was slightly
elevated in setting of chronic renal failure, possible demand
ischemia from diastolic CHF. The patient had no known history of
CAD and no evidence of acute ischemic changes on EKG.
.
# DM: The patient was maintained in glipizide and an insulin
sliding scale for extra coverage.
.
# CRI (baseline Cr 1.3-1.7):  The patient had a history of
chronic renal insufficiency and on arrival, his creatinine was
at baseline.  Following Lasix diuresis, the patient's creatinine
increased to a peak of 1.9 but was trending down at the time of
discharge.  The patient was discharged on his home dose of Lasix
(60mg).  His renal function should be carefully monitored and
his Lasix dosing adjusted accordingly.
.
# Parkinson's disease/Vascular Dementia/Depression:  The patient
was maintained on his normal regiment of donepezil, Mirapex,
bupropion HCl, and Celexa 20 mg.  His nightly trazodone dose was
increased to 25mg QHS.
.
# Code status: Full code, confirmed with daughter.
.

Medications on Admission:
CURRENT MEDICATIONS:
Furosemide 60 mg daily, started in [**4-22**]
Metoprolol XL 12.5 mg daily
KCl 10 meq MWF
Glipizide 5 mg daily
Acetaminophen 975 mg q 6 hrs
Bupropion Hcl 75 mg [**Hospital1 **]
Celexa 20 mg daily
Donepezil 10 mg daily
Mirapex 0.25 mg TID
Trazodone 12.5 mg qhs
Keflex 500 mg daily for chronic suppressive therapy
Ferrous sulfate 325 mg daily
Vitamin D 1000 units daily
Calcium carbonated 650 mg [**Hospital1 **]
Vitamin C
Vitamin B12 1000 mcg IM monthly
Melatonin 4 mg qhs

Discharge Medications:
1. Bupropion 75 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
2. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO BID (2 times a day).
3. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
4. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Donepezil 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

6. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
7. Pramipexole 0.25 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed.
9. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
10. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
11. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
12. Glipizide 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

13. Trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as
needed.
14. Isosorbide Mononitrate 10 mg Tablet Sig: One (1) Tablet PO
BID (2 times a day).
15. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
16. Potassium Chloride 10 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO MWF.
17. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q24H
(every 24 hours).
18. Iron (Ferrous Sulfate) 325 mg (65 mg Iron) Tablet Sig: One
(1) Tablet PO once a day.
19. Vitamin C 100 mg Tablet Sig: One (1) Tablet PO once a day.
20. Vitamin B-12 1,000 mcg/mL Solution Sig: One (1)  Injection
once a month.
21. Melatonin 1 mg Tablet Sig: Four (4) Tablet PO qHS.
22. Lasix 20 mg Tablet Sig: Three (3) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - LTC

Discharge Diagnosis:
Primary:
diastolic Heart Failure
HTN
Type 2 DM
CRI (1.3-1.7)

Secondary:
Diverticulosis, s/p partial colectomy
Depression
Parkinson's disease
Dementia-vascular on MRI [**2162**]
Pacemaker

Discharge Condition:
The patient was hemodynamically stable, afebrile and without
pain.  He was sating 96% on 3L NC oxygen.


Discharge Instructions:
You were admitted for evaluation of shortness of breath.  It was
felt that your symptoms were realated to poor heart function.
You were treated with diuretics and oxygen with a significant
improvement in your symptoms.

During your hospitalization, it was noted that your blood
pressure was elevated.  We have increased your dose of
metoprolol to 100mg daily and we have also added an additional
medication (Imdur).  You should take both medications as
prescribed.

We have also increased your dose of trazadone from 12.5 to 25mg
every evening.

Please take all medications as prescribed.

You should follow-up with your primary care doctor with regards
to your kidney function.

You should be weighed daily.  If you have a weight gain > 3lbs,
you should take an EXTRA dose of Lasix (40 mg) in the evening.

Please call your doctor or return to the hospital if you develop
chest pain, increased shortness of breath, numbness or tingling
in your arm, nausea, vomiting, fevers, chills or any other
symptoms of concern.

Followup Instructions:
Appointments scheduled prior to admission:
.
Provider: [**Name10 (NameIs) **] SCAN
Phone:[**Telephone/Fax (1) 327**]
Date/Time:[**2173-12-2**] 1:00
.
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3469**], MD
Phone:[**Telephone/Fax (1) 1237**]
Date/Time:[**2173-12-2**] 1:45



Completed by:[**2173-8-15**]
{'Acute respiratory failure,Hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified,Diastolic heart failure, unspecified,Paralysis agitans,Cardiac pacemaker in situ,Vascular dementia, uncomplicated,Cerebral atherosclerosis,Depressive disorder, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Thoracoabdominal aneurysm, without mention of rupture,Diverticulosis of colon (without mention of hemorrhage),Chronic kidney disease, 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: 87yo M with hx of DM, HTN, diverticulosis,s/p partial colectomy,
depression, CKD, parkinson's vascular dementia, s/p pacemaker,
who has been experiencing night desaturation for the past few
days, worse this evening.  At [**Hospital 100**] Rehab, he had awoken with
SOB, satting 89% on 3L NC, improved to 95% on mask at 5L.  Pt
was given Lasix 40 mg po and 81 mg ASA.  Pt had a second episode
of SOB overnight, satting 70-80% on mask at 8L and was
transferred to [**Hospital1 18**].  RR was 28, BP 150/80, HR 64, T 98 ax.
Patient was non-communicative at time of exam and history was
obtained from medical record and from family report.
.
On arrival to [**Hospital1 18**] ED, SpO2 76% on NRB, ABG of 7.34/66/53.  He
was started on BiPap (FiO2 60%, PEEP 5, PS 10) with improvement
of O2 sat to 90-100%.  He received a nitro gtt, Lasix 60 mg IV,
levofloxacin 750 mg IV, and albuterol nebulizer.
.
On review of symptoms, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, hemoptysis, black stools
or red stools. He denies recent fevers, chills or rigors. He has
a chronic raspy cough per the daughter. [**Name (NI) **] of the other review
of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
palpitations.  Daughter is not aware of any dyspnea on exertion,
orthopnea.  She has noted that he had ankle edema ("elephant
legs") in the late winter and early spring and had asked [**Hospital1 100**]
Senior Life to start the patient on Lasix.  Daughter denies any
syncope or presyncope.  He has poor functional capacity at
baseline.

MEDICAL HISTORY: PAST MEDICAL HISTORY:
1. Type 2 DM
2. Thoracic pseudoaneursym of aorta, 4.3 cm in diameter
3. HTN
4. Diverticulosis, s/p partial colectomy
5. Depression
6. CRI (baseline Cr 1.3-1.7)
7. Parkinson's disease
8. Vascular dementia
9. Pacemaker c/b lead thrombus. Previously followed by Dr [**Last Name (STitle) **]
for "episodic unreponsiveness." This resolved with pacemaker
adjustment.  Recently seen by Dr. [**Last Name (STitle) **]/[**Doctor Last Name **] for
the thrombus, anticoagulation deferred for h/o falls, unsteady
gait, and confusion.
11. s/p hip fracture requiring ORIF in [**3-/2172**] with a
complicated medical course including hypoxic respiratory
failure.
12. Chronic diastolic dysfunction.

MEDICATION ON ADMISSION: CURRENT MEDICATIONS:
Furosemide 60 mg daily, started in [**4-22**]
Metoprolol XL 12.5 mg daily
KCl 10 meq MWF
Glipizide 5 mg daily
Acetaminophen 975 mg q 6 hrs
Bupropion Hcl 75 mg [**Hospital1 **]
Celexa 20 mg daily
Donepezil 10 mg daily
Mirapex 0.25 mg TID
Trazodone 12.5 mg qhs
Keflex 500 mg daily for chronic suppressive therapy
Ferrous sulfate 325 mg daily
Vitamin D 1000 units daily
Calcium carbonated 650 mg [**Hospital1 **]
Vitamin C
Vitamin B12 1000 mcg IM monthly
Melatonin 4 mg qhs

ALLERGIES: Bactrim / Procardia

PHYSICAL EXAM: VS: T 95.7 ax, BP 130/85, HR 79, RR 16, O2 95% on BiPap
Gen: Fatigued older male in NAD. Oriented to self only, "[**2138**]",
"[**Hospital1 100**]."  Per daughter, mental status at baseline.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. MMM.
Neck: Supple with JVP of 7 cm.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. ?S3.  No murmurs noted.
Chest:  No accessory muscle use.  Decreased breath sounds
throughout, diffuse rhonchi.  No crackles, wheezes.
Abd: Normoactive, soft, NT/ND, No HSM. No abdominial bruits.
Ext: No femoral bruits.  Trace pedal edema bilaterally.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Neuro:  PERRL, EOMI.  Resting tremor.
.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+
DP/PT
[**Name (NI) 2325**]: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+
DP/PT

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse.  Patient resides at
[**Hospital 100**] Rehab. 

### Response:
{'Acute respiratory failure,Hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified,Diastolic heart failure, unspecified,Paralysis agitans,Cardiac pacemaker in situ,Vascular dementia, uncomplicated,Cerebral atherosclerosis,Depressive disorder, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Thoracoabdominal aneurysm, without mention of rupture,Diverticulosis of colon (without mention of hemorrhage),Chronic kidney disease, unspecified'}
