CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: This is a 68 year old female with extensive past medical history
of chronic multifactorial lung disease on 2L home O2, congenital
heart disease with large ASD s/p repair, obstructive/restrictive
lung disease, chronic pulmonary emboli, severe pulmonary
hypertension on sildenifil, presenting with progressive dyspnea.
She first noted increased SOB about one week ago, associated
with increased cough and wheezing. She was initially producing
increased [**Doctor Last Name 352**] sputum (her sputum is this color at baseline),
but over the past 2 days she has had a fairly non-productive
cough. She has been using her nebulizer machine twice a day over
the past week. She was given a prescription by her PCP for
Augmentin on [**12-17**] over the phone as the pt refused to come in to
be seen. This morning the pt felt more acutely short of breath.
She states that she is currently short of breath at rest,
whereas she normally can walk from her car into a store before
she becomes short of breath. She denies any f/c/s. She c/o
pressure at her ventral hernia site, but no chest pain. She
denies any increased leg swelling, and she is still sleeping on
only 1 pillow. She denies any blood in her sputum, sore throat,
diarrhea, or constipation. She admits to nausea today without
emesis and poor appetite for months. The pt states she has lost
15-20 lbs over the past several years.
.
She originally presented to [**Hospital6 3105**] where she
was found to have on O2 sat of 75% on 2 L NC and 86% on 6 L NC.
Her digoxin level was WNL at 0.9. She was started on BIPAP. She
received Levofloxacin 750 mg IV x1 and Solumedrol 125 mg IV x1.
She was transferred to [**Hospital1 18**] ED for further care.
.
In the ED, the pts vitals were: Tm 97.9 HR 95 BP 108-117/54-75 R
26 Sat 89% 4LNC. She received Levofloxacin 500 mg IV x1 and
Solumedrol 125 mg IV x1 at OSH. CXR was clear of new infiltrate.

MEDICAL HISTORY: 1. History of oat cell lung cancer status post radiation and
chemotherapy (cisplatinum), with recent stable pulmonary nodules
on CT.
2. COPD, on 2L NC home oxygen.
3. History of atrial fibrillation. Maintained on sotalol,
Coumadin, followed by Dr. [**Last Name (STitle) 1911**].
4. History of perforated diverticulum status post colostomy.
5. History of peptic ulcer disease.
6. Hypertension.
7. Severe pulmonary hypertension on Viagra.
8. Status post ASD repair.
9. Status post ventral hernia repair.
10. Status post appendectomy.

MEDICATION ON ADMISSION: aldactone 25 mg twice daily
lasix 40 mg daily?
sildenafil 50 mg [**Hospital1 **]
sotalol 40 mg each morning and 80 mg each night
digoxin 125 mcg daily
Vit D3 400 U daily
Calcium
Fluticasone nasal spray [**Hospital1 **]
Combivent
Paroxetine 10 mg daily
Protonix 40 mg daily
Coumadin 4 mg qhs
Xanax 0.5 mg qhs
Albuterol prn nebs
Atorvent prn nebs
Prednisone 10 mg qhs
singulair 10 mg daily
serevent
Astelin nasal spray

ALLERGIES: Bactrim Ds

PHYSICAL EXAM: S: T 98.4 BP 112/62 P 94 R 34 Sat 93% 4 L NC; ABG 7.39/60/130
GEN: pleasant, tachypneic, fatigued
HEENT: PERRL, EOMI, sclerae injected bilaterally, dry MM
NECK: no supraclavicular or cervical lymphadenopathy, no jvd
RESP: dry crackles at RUL, otherwise diffuse expiratory wheezing
CV: RRR, S1 and S2 wnl, no m/r/g
ABD: NTND, +b/s, soft, stoma clean with light brown stool in
ostomy bag
EXT: no c/c/e, warm, good pulses
SKIN: no rashes/no jaundice
NEURO: AAOx3. Cn II-XII intact.

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: History of tobacco; quit 12 years ago. Drinks a glass of wine a
day. Emmigrated from [**Location (un) 311**] in [**2120**].
Chronic obstructive asthma with (acute) exacerbation,Pneumonia, organism unspecified,Malignant neoplasm of bronchus and lung, unspecified,Hyposmolality and/or hyponatremia,Chronic diastolic heart failure,Hypoxemia,Other chronic pulmonary heart diseases,Atrial fibrillation,Long-term (current) use of anticoagulants,Chronic kidney disease, unspecified,Colostomy status,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other dependence on machines, supplemental oxygen
Ch obst asth w (ac) exac,Pneumonia, organism NOS,Mal neo bronch/lung NOS,Hyposmolality,Chr diastolic hrt fail,Hypoxemia,Chr pulmon heart dis NEC,Atrial fibrillation,Long-term use anticoagul,Chronic kidney dis NOS,Colostomy status,Hy kid NOS w cr kid I-IV,Depend-supplement oxygen
Admission Date:  [**2166-12-23**]              Discharge Date:   [**2166-12-27**]

Date of Birth:  [**2097-12-31**]             Sex:   F

Service: MEDICINE

Allergies:
Bactrim Ds

Attending:[**First Name3 (LF) 603**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
none

History of Present Illness:
This is a 68 year old female with extensive past medical history
of chronic multifactorial lung disease on 2L home O2, congenital
heart disease with large ASD s/p repair, obstructive/restrictive
lung disease, chronic pulmonary emboli, severe pulmonary
hypertension on sildenifil, presenting with progressive dyspnea.
She first noted increased SOB about one week ago, associated
with increased cough and wheezing. She was initially producing
increased [**Doctor Last Name 352**] sputum (her sputum is this color at baseline),
but over the past 2 days she has had a fairly non-productive
cough. She has been using her nebulizer machine twice a day over
the past week. She was given a prescription by her PCP for
Augmentin on [**12-17**] over the phone as the pt refused to come in to
be seen. This morning the pt felt more acutely short of breath.
She states that she is currently short of breath at rest,
whereas she normally can walk from her car into a store before
she becomes short of breath. She denies any f/c/s. She c/o
pressure at her ventral hernia site, but no chest pain. She
denies any increased leg swelling, and she is still sleeping on
only 1 pillow. She denies any blood in her sputum, sore throat,
diarrhea, or constipation. She admits to nausea today without
emesis and poor appetite for months. The pt states she has lost
15-20 lbs over the past several years.
.
She originally presented to [**Hospital6 3105**] where she
was found to have on O2 sat of 75% on 2 L NC and 86% on 6 L NC.
Her digoxin level was WNL at 0.9. She was started on BIPAP. She
received Levofloxacin 750 mg IV x1 and Solumedrol 125 mg IV x1.
She was transferred to [**Hospital1 18**] ED for further care.
.
In the ED, the pts vitals were: Tm 97.9 HR 95 BP 108-117/54-75 R
26 Sat 89% 4LNC. She received Levofloxacin 500 mg IV x1 and
Solumedrol 125 mg IV x1 at OSH. CXR was clear of new infiltrate.

Past Medical History:
1. History of oat cell lung cancer status post radiation and
chemotherapy (cisplatinum), with recent stable pulmonary nodules
on CT.
2. COPD, on 2L NC home oxygen.
3. History of atrial fibrillation. Maintained on sotalol,
Coumadin, followed by Dr. [**Last Name (STitle) 1911**].
4. History of perforated diverticulum status post colostomy.
5. History of peptic ulcer disease.
6. Hypertension.
7. Severe pulmonary hypertension on Viagra.
8. Status post ASD repair.
9. Status post ventral hernia repair.
10. Status post appendectomy.


Social History:
History of tobacco; quit 12 years ago. Drinks a glass of wine a
day. Emmigrated from [**Location (un) 311**] in [**2120**].


Family History:
Non-contributory.

Physical Exam:
S: T 98.4 BP 112/62 P 94 R 34 Sat 93% 4 L NC; ABG 7.39/60/130
GEN: pleasant, tachypneic, fatigued
HEENT: PERRL, EOMI, sclerae injected bilaterally, dry MM
NECK: no supraclavicular or cervical lymphadenopathy, no jvd
RESP: dry crackles at RUL, otherwise diffuse expiratory wheezing
CV: RRR, S1 and S2 wnl, no m/r/g
ABD: NTND, +b/s, soft, stoma clean with light brown stool in
ostomy bag
EXT: no c/c/e, warm, good pulses
SKIN: no rashes/no jaundice
NEURO: AAOx3. Cn II-XII intact.

Pertinent Results:
ADMISSION LABS

[**2166-12-23**] 01:38PM BLOOD WBC-16.7* RBC-4.25 Hgb-12.5 Hct-38.8
MCV-91# MCH-29.3 MCHC-32.2 RDW-14.5 Plt Ct-293
[**2166-12-23**] 01:38PM BLOOD Neuts-97.6* Bands-0 Lymphs-1.3*
Monos-1.0* Eos-0.2 Baso-0
[**2166-12-23**] 01:38PM BLOOD PT-35.3* PTT-30.1 INR(PT)-3.7*
[**2166-12-23**] 01:38PM BLOOD Plt Smr-NORMAL Plt Ct-293
[**2166-12-23**] 01:38PM BLOOD Glucose-144* UreaN-26* Creat-1.0 Na-134
K-4.7 Cl-92* HCO3-34* AnGap-13
[**2166-12-23**] 09:30PM BLOOD Glucose-139* UreaN-24* Creat-1.1 Na-131*
K-4.6 Cl-91* HCO3-32 AnGap-13
[**2166-12-23**] 01:38PM BLOOD CK(CPK)-41
[**2166-12-23**] 09:30PM BLOOD CK(CPK)-41
[**2166-12-23**] 01:38PM BLOOD cTropnT-0.02*
[**2166-12-23**] 09:30PM BLOOD cTropnT-<0.01
[**2166-12-23**] 01:38PM BLOOD Calcium-9.4 Phos-2.4* Mg-2.3
[**2166-12-23**] 01:26PM BLOOD pO2-130* pCO2-60* pH-7.39 calTCO2-38*
Base XS-9
IMAGING
LENI
No DVT in the bilateral lower extremities.
.
CXR
No acute cardiopulmonary process. Stable appearance of fibrosis
and atelectasis at the right lung base, right lung volume loss,
and cardiomegaly.
.
ECHO
The left atrium is elongated. The right atrium is moderately
dilated. No atrial septal defect is seen by 2D or color Doppler.
Left ventricular wall thickness, cavity size and regional/global
systolic function are normal (LVEF >55%) There is no ventricular
septal defect. The right ventricular cavity is markedly dilated
with severe global free wall hypokinesis. There is abnormal
septal motion/position consistent with right ventricular
pressure/volume overload. The aortic valve leaflets (3) appear
structurally normal with good leaflet excursion and no aortic
regurgitation. The mitral valve leaflets are mildly thickened.
There is no mitral valve prolapse. Mild to moderate ([**11-26**]+)
mitral regurgitation is seen. The tricuspid valve leaflets are
moderately thickened. Moderate to severe [3+] tricuspid
regurgitation is seen. There is severe pulmonary artery systolic
hypertension. There is a trivial/physiologic pericardial
effusion.

Compared with the prior study (images reviewed) of [**2164-9-20**],
the RV has further dilated and systolic function has
deteriorated. The estimated PASP has increased. The LVEF remains
normal.


Brief Hospital Course:
68F h/o 2L home O2, congenital ASD s/p repair,
obstructive/restrictive lung disease, chronic pulmonary emboli,
severe pulmonary hypertension on sildenifil, presenting with
progressive dyspnea most c/w COPD flare with a question of PNA.

.
# Respiratory status: The pt has had worsening symptoms over 2
weeks. She was initially admitted to the MICU, however was
called out to the floor quickly thereafter.  She had no need for
bipap or intubation this admission.  Her worsening respiratory
status was felt to be most likely secondary to a COPD flare w/
possible RLL pneumonia.  While in the hospital she had LENI's
neg for DVT bilaterally, CTA chest showed New RUL and LLL
spiculated nodules.  Primary oncologist is aware of these
findings and at this time, is holding on any further workup.  Pt
remains unaware of results.  The patient was negative for flu
and sputum, blood and urine cultures were pending at discharge.

The patient was seen by Pulmonary while in house who recommended
increasing home oxygen and restarting Combivent at home.  The
patient was continued on her inhalers with an increase in
standing albuterol and ipratropium nebs.  She was continued on
fluticasone, salmeterol, and montelukast.  She was also started
on a prednisone taper and Levofloxacin 750 mg PO Q48H (impaired
GFR) x5 days for COPD flare

For her pulmonary HTN: sildenafil TID, *** NOT [**Hospital1 **] *** (pt had
decreased frequency but should be on TID per pulmonary).  She
was continued on her PCP [**Name Initial (PRE) 1102**]: Atovaquone and continued
on anticoagulation for her chronic pulmonary emboli.

# Supratheraputic INR: Admitted with INR >3, but quickly
decreasing INR
-Neg LENI, no new PE per CTA PE protocol
-Warfarin restarted at 3mg daily x 3 days per [**Hospital 197**] Clinic
RN.
.
# Chronic renal insufficiency: Cr 1.1, GFR near 50, stable
during this admission.
.
# Hyponatremia: On presentation the patient had mild
hyponatremia which resolved during her stay.

.
# Pain at ventral hernia/hiatal hernia site: This pain resolved
over course of admission.  Ventral hernia remains reducible.
The patient was treated with GI cocktail PRN (pt c/o
indigestion) and Simethicone PRN (pt c/o gas).
.
# h/o atrial fibrillation: Warfarin initially restarted at lower
than home dose  and the patient was continued on sotalol and
digoxin.
.
# Diastolic dysfunction: The patient was restarted on her home
regimen of Furosemide.  Her spironolactone was held.  The
patient was advised to discuss restarting this medication with
her Cardiologist after discharge.
.
# Elevated TropT: STABLE.  Pt has ranged up to 0.02 in the past.
Near baseline.  Pt is asymptomatic.
.
# Psych: The patient was continued on Xanax and Paxil for
anxiety.
.
# Code Status: Full Code confirmed by MICU team [**2166-12-23**]
.
# Communication:
Health Care Proxy
[**Name (NI) 4906**] [**Name (NI) **] (aka [**Doctor Last Name **])
home [**Telephone/Fax (1) 20715**], cell-[**Telephone/Fax (1) 20716**]
[**Doctor Last Name **], Son Cell: [**Telephone/Fax (1) 20717**]


Medications on Admission:
aldactone 25 mg twice daily
lasix 40 mg daily?
sildenafil 50 mg [**Hospital1 **]
sotalol 40 mg each morning and 80 mg each night
digoxin 125 mcg daily
Vit D3 400 U daily
Calcium
Fluticasone nasal spray [**Hospital1 **]
Combivent
Paroxetine 10 mg daily
Protonix 40 mg daily
Coumadin 4 mg qhs
Xanax 0.5 mg qhs
Albuterol prn nebs
Atorvent prn nebs
Prednisone 10 mg qhs
singulair 10 mg daily
serevent
Astelin nasal spray

Discharge Medications:
1. 4L continuous oxygen
4L continuous home oxygen therapy.
2. Atovaquone 750 mg/5 mL Suspension Sig: Seven [**Age over 90 1230**]y
(750) mg PO BID (2 times a day).
Disp:*[**Numeric Identifier 17451**] mg* Refills:*2*
3. Levofloxacin 250 mg Tablet Sig: Three (3) Tablet PO Q48H
(every 48 hours) for 2 doses: Take three tablets on Saturday, [**12-27**], and then another three tablets on Sunday, [**12-29**].
Disp:*6 Tablet(s)* Refills:*0*
4. Prednisone 20 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily) for 1 days: Take on [**12-27**].
Disp:*3 Tablet(s)* Refills:*0*
5. Prednisone 20 mg Tablet Sig: Two (2) Tablet PO once a day for
3 days: Take on [**2-15**], and [**12-30**].
Disp:*6 Tablet(s)* Refills:*0*
6. Prednisone 20 mg Tablet Sig: One (1) Tablet PO once a day for
3 days: Take on [**2-17**], [**1-2**].
Disp:*3 Tablet(s)* Refills:*0*
7. Prednisone 10 mg Tablet Sig: One (1) Tablet PO at bedtime:
Start taking on [**1-3**].
Disp:*30 Tablet(s)* Refills:*2*
8. Sildenafil 50 mg Tablet Sig: One (1) Tablet PO three times a
day.
Disp:*90 Tablet(s)* Refills:*2*
9. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
10. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day)
as needed for constipation.
11. Docusate Sodium 50 mg/5 mL Liquid Sig: [**4-4**] mL PO BID (2
times a day) as needed for constipation.
12. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

13. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
14. Paroxetine HCl 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
15. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
16. Combivent 18-103 mcg/Actuation Aerosol Sig: [**11-26**] sprays each
nostril Inhalation three times a day.
17. Warfarin 1 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily)
for 3 days.
Disp:*9 Tablet(s)* Refills:*0*
18. Fluticasone 50 mcg/Actuation Spray, Suspension Sig: One (1)
Spray Nasal DAILY (Daily).
19. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
20. Salmeterol 50 mcg/Dose Disk with Device Sig: Fifty (50) mcg
Inhalation Q12H (every 12 hours).
21. Alprazolam 0.25 mg Tablet Sig: Two (2) Tablet PO QHS (once a
day (at bedtime)).
22. Sotalol 80 mg Tablet Sig: 0.5 Tablet PO QAM (once a day (in
the morning)).
23. Sotalol 80 mg Tablet Sig: One (1) Tablet PO QPM (once a day
(in the evening)).
24. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
25. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO DAILY (Daily).
26. Sildenafil 50 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
Disp:*90 Tablet(s)* Refills:*2*
27. Furosemide 80 mg Tablet Sig: One (1) Tablet PO once a day.
28. Outpatient Lab Work
Potassium check, please have results sent to Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 3029**] at
([**Telephone/Fax (1) 20718**]. phone ([**Telephone/Fax (1) 1300**]


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis
# COPD exacerbation
# Pulmonary artery hypertension
# Diastolic congestive heart failure
.
Secondary diagnosis
# Atrial fibrillation


Discharge Condition:
Stable


Discharge Instructions:
You were admitted to the hospital because of extreme shortness
of breath.  We treated you for a COPD (chronic obstructive
pulmonary disease) flare, and started you on a steroid taper as
well as levofloxacin (an antibiotic).  We also continued you on
your inhalers.
.
WE HAVE MADE SEVERAL MEDICATION CHANGES, AS OUTLINED BELOW:
# Your  spironolactone has been temporarily stopped while you
were inpatient because of dehydration.  Please discuss with your
cardiologist and primary care physician about restarting this as
an outpatient.
You should have your potassium checked on monday and have the
results faxed to Dr. [**Last Name (STitle) 3029**].

.
*** For your COPD, you should take the following medications:
# Levofloxacin 750mg: You should take two more doses (on [**12-27**] and
on [**12-29**]).
# Prednisone: You should take one more dose of prednisone 60mg
on [**12-27**], and then take 40mg on [**2-15**], and [**12-30**].  Then take
prednisone 20mg on [**2-17**], [**1-2**].  Then, return to your regular
prednisone dose of 10mg every night.
.
*** We have increased your oxygen to 4 L daily.
.
*** We have also added another new medication, which will help
prevent you from getting a lung infection:
# Atovaquone 750mg [**Hospital1 **] (two times daily)
.
*** Please note that your sildenafil 50mg should be taken THREE
TIMES DAILY for your pulmonary artery hypertension!  Do not
reduce this medication!
.
*** Because you are taking levofloxacin, we have lowered your
dose of warfarin to 3mg daily.  Please return to the [**Hospital 197**]
Clinic on Monday, [**12-29**], to follow your INR and adjust your
warfarin.
.
We also found that your right heart function has become more
impaired.  Please continue taking your diuretics and follow up
with your cardiologist Dr. [**Last Name (STitle) 1911**] as below.
.
Otherwise, we have not made any changes to your medications.
.
If you are experiencing worrisome symptoms, please call your
doctor and go immediately to the emergency room.

Followup Instructions:
Please call [**Telephone/Fax (1) 612**] to schedule a follow-up appointment in
pulmonary clinic within 2 weeks with either Dr. [**Last Name (STitle) **] or Dr.
[**Last Name (STitle) 575**].  If you are unable to get an appointment within 2
weeks, please contact your primary care physician, [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 3029**],
in order to facilitate getting this appointment.

You should go to the [**Hospital 197**] Clinic on Monday, [**12-29**].  The
[**Hospital 197**] Clinic will be expecting you.

You also have the following appointments:
Provider: [**Name10 (NameIs) 1918**] [**Name11 (NameIs) **] Phone:[**Telephone/Fax (1) 16827**]
Date/Time:[**2167-1-26**] 9:00
Provider: [**Name10 (NameIs) 13368**] [**Last Name (NamePattern4) 13369**], MD Phone:[**Telephone/Fax (1) 1091**]
Date/Time:[**2167-2-4**] 11:00
Provider: [**First Name11 (Name Pattern1) 674**] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **], M.D. Date/Time:[**2167-3-6**] 11:10
{'Chronic obstructive asthma with (acute) exacerbation,Pneumonia, organism unspecified,Malignant neoplasm of bronchus and lung, unspecified,Hyposmolality and/or hyponatremia,Chronic diastolic heart failure,Hypoxemia,Other chronic pulmonary heart diseases,Atrial fibrillation,Long-term (current) use of anticoagulants,Chronic kidney disease, unspecified,Colostomy status,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other dependence on machines, supplemental oxygen'}


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: This is a 68 year old female with extensive past medical history
of chronic multifactorial lung disease on 2L home O2, congenital
heart disease with large ASD s/p repair, obstructive/restrictive
lung disease, chronic pulmonary emboli, severe pulmonary
hypertension on sildenifil, presenting with progressive dyspnea.
She first noted increased SOB about one week ago, associated
with increased cough and wheezing. She was initially producing
increased [**Doctor Last Name 352**] sputum (her sputum is this color at baseline),
but over the past 2 days she has had a fairly non-productive
cough. She has been using her nebulizer machine twice a day over
the past week. She was given a prescription by her PCP for
Augmentin on [**12-17**] over the phone as the pt refused to come in to
be seen. This morning the pt felt more acutely short of breath.
She states that she is currently short of breath at rest,
whereas she normally can walk from her car into a store before
she becomes short of breath. She denies any f/c/s. She c/o
pressure at her ventral hernia site, but no chest pain. She
denies any increased leg swelling, and she is still sleeping on
only 1 pillow. She denies any blood in her sputum, sore throat,
diarrhea, or constipation. She admits to nausea today without
emesis and poor appetite for months. The pt states she has lost
15-20 lbs over the past several years.
.
She originally presented to [**Hospital6 3105**] where she
was found to have on O2 sat of 75% on 2 L NC and 86% on 6 L NC.
Her digoxin level was WNL at 0.9. She was started on BIPAP. She
received Levofloxacin 750 mg IV x1 and Solumedrol 125 mg IV x1.
She was transferred to [**Hospital1 18**] ED for further care.
.
In the ED, the pts vitals were: Tm 97.9 HR 95 BP 108-117/54-75 R
26 Sat 89% 4LNC. She received Levofloxacin 500 mg IV x1 and
Solumedrol 125 mg IV x1 at OSH. CXR was clear of new infiltrate.

MEDICAL HISTORY: 1. History of oat cell lung cancer status post radiation and
chemotherapy (cisplatinum), with recent stable pulmonary nodules
on CT.
2. COPD, on 2L NC home oxygen.
3. History of atrial fibrillation. Maintained on sotalol,
Coumadin, followed by Dr. [**Last Name (STitle) 1911**].
4. History of perforated diverticulum status post colostomy.
5. History of peptic ulcer disease.
6. Hypertension.
7. Severe pulmonary hypertension on Viagra.
8. Status post ASD repair.
9. Status post ventral hernia repair.
10. Status post appendectomy.

MEDICATION ON ADMISSION: aldactone 25 mg twice daily
lasix 40 mg daily?
sildenafil 50 mg [**Hospital1 **]
sotalol 40 mg each morning and 80 mg each night
digoxin 125 mcg daily
Vit D3 400 U daily
Calcium
Fluticasone nasal spray [**Hospital1 **]
Combivent
Paroxetine 10 mg daily
Protonix 40 mg daily
Coumadin 4 mg qhs
Xanax 0.5 mg qhs
Albuterol prn nebs
Atorvent prn nebs
Prednisone 10 mg qhs
singulair 10 mg daily
serevent
Astelin nasal spray

ALLERGIES: Bactrim Ds

PHYSICAL EXAM: S: T 98.4 BP 112/62 P 94 R 34 Sat 93% 4 L NC; ABG 7.39/60/130
GEN: pleasant, tachypneic, fatigued
HEENT: PERRL, EOMI, sclerae injected bilaterally, dry MM
NECK: no supraclavicular or cervical lymphadenopathy, no jvd
RESP: dry crackles at RUL, otherwise diffuse expiratory wheezing
CV: RRR, S1 and S2 wnl, no m/r/g
ABD: NTND, +b/s, soft, stoma clean with light brown stool in
ostomy bag
EXT: no c/c/e, warm, good pulses
SKIN: no rashes/no jaundice
NEURO: AAOx3. Cn II-XII intact.

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: History of tobacco; quit 12 years ago. Drinks a glass of wine a
day. Emmigrated from [**Location (un) 311**] in [**2120**]. 

### Response:
{'Chronic obstructive asthma with (acute) exacerbation,Pneumonia, organism unspecified,Malignant neoplasm of bronchus and lung, unspecified,Hyposmolality and/or hyponatremia,Chronic diastolic heart failure,Hypoxemia,Other chronic pulmonary heart diseases,Atrial fibrillation,Long-term (current) use of anticoagulants,Chronic kidney disease, unspecified,Colostomy status,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other dependence on machines, supplemental oxygen'}
