CHIEF COMPLAINT: Asthma Exacerbation

PRESENT ILLNESS: 53 yo F non-smoker w/poorly controlled asthma requiring several
admissions in past few months, GERD, allergic rhinitis admitted
with Asthma exacerbation. Pt was sent to the ED [**Location 29938**]Clinic on Friday when she presented to clinic with acute
SOB.  She awoke at 4 o'clock in the morning feeling very short
of breath.  Between 4 and 8 she used three nebulizer treatments
without much improvement, she decided go to [**Hospital **] clinic to be
seen. However, per pt she has been having difficulty breathing
for 1 week with a non-productive cough, sore throat and N/V x4
days. She was recently placed on a steroid taper x5 days on [**7-19**]
per her PCP. [**Name10 (NameIs) **] breathing improved on the steroids and once
again noticed difficulty breathing and excessive coughing once
off the steroids. She does not know what her triggers are per
se, has had no sick contacts and no recent travelling. She has
not been on abx recently. Her most recent Asthma decompensation
was in [**2167-5-3**] requiring ICU monitoring but no intubation. In
clinic she was tachypneic, RR 22 O2 Sat at 100%, she was having
difficulty speaking in full sentences and therefore sent to ED
for further care.

MEDICAL HISTORY: - Asthma-has had multiple asthma exacerbations requiring 3
hospitalizations, steroids; no intubations
- h/o Polio requiring her to use crutches when walking
- Benign hypertension
- allergic rhinitis
- hyperlipidemia

MEDICATION ON ADMISSION: ACETAMINOPHEN 325 mg--2 tabs QID prn pain
ADVAIR DISKUS 500 mcg-50 mcg/Dose--1 puff po BID
ALBUTEROL 90MCG--2 puffs TID prn
ALBUTEROL SULFATE 0.83 mg/mL--1 unit dose inhaled QID prn
CROLOM 4 %--1 gtt each eye Q6HR prn
DOCUSATE SODIUM 100 mg [**2-3**] tab HS prn
FLONASE 50MCG daily each nostril
FLUOXETINE 20 mg dialy
HYDROCHLOROTHIAZIDE 25 mg dialy
IPRATROPIUM BROMIDE 0.2 mg/mL (0.02 %)--1 unit dose inhaled tid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 97.1, 140/90, 75, 20, 99%  PEF 375
GEN: Comfortable sitting in bed in NAD
HEENT: MMM, OP clear-no exudates, no cervical LAD
RESP: no stridor, no accessory muscle use, no paradoxical
breathing, no wheezing or crackles throughout lung fields
CV: RRR, S1, S2, no M/R/G
ABD: Soft, obese, ND/NT, +BS
EXT: No peripheral edema, R leg with atrophied muscle/paralysis
NEURO: A&O x3, no focal deficits

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Lives with sister.  Vietnamese-speaking (speaks english).  Goes
to senior day care 3x/week with parents.  No tob/ETOH.
Extrinsic asthma with (acute) exacerbation,Late effects of acute poliomyelitis,Other and unspecified hyperlipidemia,Benign essential hypertension,Esophageal reflux
Ext asthma w(acute) exac,Late effect acute polio,Hyperlipidemia NEC/NOS,Benign hypertension,Esophageal reflux
Admission Date:  [**2167-8-8**]              Discharge Date:   [**2167-8-11**]

Date of Birth:  [**2113-8-21**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1973**]
Chief Complaint:
Asthma Exacerbation

Major Surgical or Invasive Procedure:
None

History of Present Illness:
53 yo F non-smoker w/poorly controlled asthma requiring several
admissions in past few months, GERD, allergic rhinitis admitted
with Asthma exacerbation. Pt was sent to the ED [**Location 29938**]Clinic on Friday when she presented to clinic with acute
SOB.  She awoke at 4 o'clock in the morning feeling very short
of breath.  Between 4 and 8 she used three nebulizer treatments
without much improvement, she decided go to [**Hospital **] clinic to be
seen. However, per pt she has been having difficulty breathing
for 1 week with a non-productive cough, sore throat and N/V x4
days. She was recently placed on a steroid taper x5 days on [**7-19**]
per her PCP. [**Name10 (NameIs) **] breathing improved on the steroids and once
again noticed difficulty breathing and excessive coughing once
off the steroids. She does not know what her triggers are per
se, has had no sick contacts and no recent travelling. She has
not been on abx recently. Her most recent Asthma decompensation
was in [**2167-5-3**] requiring ICU monitoring but no intubation. In
clinic she was tachypneic, RR 22 O2 Sat at 100%, she was having
difficulty speaking in full sentences and therefore sent to ED
for further care.

ED COURSE: Initial VS 98.4 BP 122/90 HR 80 RR 20 100% _?_RA/NC,
Pt was having difficulty speaking in full sentences due to SOB,
wheezing. Some stridor noted, which resolved post nebs. Her RR
was as high as 33, maintaining O2 sats 100% w/continous nebs.
Her initial PEFR 350, 400, 320. She received Solumedrol 125mg IV
x1, Atrovent nebs, combivent neb x3, albuterol nebs continuous,
Levofloxacin 750mg x1, guaifenesin 10ml PO x1, 1LNS. Peek flow
at 5am 400. Admitted to [**Hospital Unit Name 153**] for further monitoring.


Past Medical History:
- Asthma-has had multiple asthma exacerbations requiring 3
hospitalizations, steroids; no intubations
- h/o Polio requiring her to use crutches when walking
- Benign hypertension
- allergic rhinitis
- hyperlipidemia

Social History:
Lives with sister.  Vietnamese-speaking (speaks english).  Goes
to senior day care 3x/week with parents.  No tob/ETOH.


Family History:
Non contributory

Physical Exam:
VS: 97.1, 140/90, 75, 20, 99%  PEF 375
GEN: Comfortable sitting in bed in NAD
HEENT: MMM, OP clear-no exudates, no cervical LAD
RESP: no stridor, no accessory muscle use, no paradoxical
breathing, no wheezing or crackles throughout lung fields
CV: RRR, S1, S2, no M/R/G
ABD: Soft, obese, ND/NT, +BS
EXT: No peripheral edema, R leg with atrophied muscle/paralysis
NEURO: A&O x3, no focal deficits

Pertinent Results:
[**2167-8-11**] 05:00AM BLOOD WBC-9.9 RBC-4.10* Hgb-12.8 Hct-37.4
MCV-91 MCH-31.3 MCHC-34.4 RDW-14.5 Plt Ct-294
[**2167-8-11**] 05:00AM BLOOD Glucose-83 UreaN-16 Creat-0.8 Na-139
K-3.6 Cl-98 HCO3-34* AnGap-11
[**2167-8-11**] 05:00AM BLOOD Calcium-9.9 Phos-5.0* Mg-2.4
[**2167-8-7**] 11:39AM BLOOD Lactate-2.6*

TECHNIQUE: Semi-upright portable chest x-ray.
FINDINGS: The lungs are well aerated, and there is no evidence
of acute airspace consolidation, pleural effusion, or
pneumothorax. The cardiomediastinal contour is within normal
limits. Pulmonary vasculature is unremarkable. Mild
dextroscoliosis of the thoracis spine is noted. Otherwise, the
osseous structures are unremarkable.
IMPRESSION: Unremarkable chest.


Brief Hospital Course:
Admitted to [**Hospital Unit Name 153**] then Transferred to [**Hospital Ward Name 516**] Hospitalist
Service

1. Asthma Exacerbation
- Patient able to articulate full understanding of medication
use
- Prednisone Taper (starting at 60mg)
- PEF 375, no baseline, but getting [**Hospital Ward Name 1570**]'s soon
- Given peak-flow meter to take home
- Continue advair, atrovent, albuterol and monoleukast
- Improved clinically
- Cough suppressant

2. Benign Hypertension
- Nifedipine
- HCTZ
- Pt states she was not on lisinopril

3. Hyperlipidemia
- Continue atorvastatin

4. GERD
- PPI

Medications on Admission:
ACETAMINOPHEN 325 mg--2 tabs QID prn pain
ADVAIR DISKUS 500 mcg-50 mcg/Dose--1 puff po BID
ALBUTEROL 90MCG--2 puffs TID prn
ALBUTEROL SULFATE 0.83 mg/mL--1 unit dose inhaled QID prn
CROLOM 4 %--1 gtt each eye Q6HR prn
DOCUSATE SODIUM 100 mg [**2-3**] tab HS prn
FLONASE 50MCG daily each nostril
FLUOXETINE 20 mg dialy
HYDROCHLOROTHIAZIDE 25 mg dialy
IPRATROPIUM BROMIDE 0.2 mg/mL (0.02 %)--1 unit dose inhaled tid

with nebulizer
LIPITOR 20 mg daily
LISINOPRIL 10 mg daily
NAPROSYN 375MG [**Hospital1 **] prn
NIFEDIPINE 30 mg daily
Nebulizer & Compressor For Neb
PRILOSEC OTC 20 mg daily
SINGULAIR 10 mg daily


Discharge Medications:
1. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 puffs Inhalation
every four (4) hours as needed for shortness of breath or
wheezing.
2. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Prednisone 10 mg Tablet Sig: Six (6) Tablet PO once a day for
6 days: Taper: 60-10: 10mg/day.
Disp:*21 Tablet(s)* Refills:*0*
5. Dextromethorphan-Guaifenesin 10-100 mg/5 mL Syrup Sig: [**6-11**]
MLs PO Q6H (every 6 hours) as needed for cough for 7 days.
Disp:*120 ML(s)* Refills:*0*
6. Atrovent HFA 17 mcg/Actuation Aerosol Sig: Two (2) puffs
Inhalation every six (6) hours.
7. Fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
8. Docusate Sodium 100 mg Capsule Sig: Two (2) Capsule PO DAILY
(Daily).
9. Fluticasone-Salmeterol 500-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
10. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
11. Nifedipine 30 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO DAILY (Daily).
12. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).


Discharge Disposition:
Home

Discharge Diagnosis:
Asthma Exacerbation
Benign Hypertension
Hyperlipidemia
GERD

Discharge Condition:
Good

Discharge Instructions:
Return to the hospital if you experience shortness of breath,
severe wheezing, no improvement in your cough, fever/chills

Finish all your medications as prescribed

Followup Instructions:
Provider: [**Name10 (NameIs) 1571**] BREATHING TESTS Phone:[**Telephone/Fax (1) 612**]
Date/Time:[**2167-8-19**] 9:30
Provider: [**Name10 (NameIs) 1570**],INTERPRET W/LAB NO CHECK-IN [**Name10 (NameIs) 1570**] INTEPRETATION
BILLING Date/Time:[**2167-8-19**] 9:30
Provider: [**Name10 (NameIs) 1571**] BREATHING TESTS Phone:[**Telephone/Fax (1) 612**]
Date/Time:[**2167-8-19**] 9:40
{'Extrinsic asthma with (acute) exacerbation,Late effects of acute poliomyelitis,Other and unspecified hyperlipidemia,Benign essential hypertension,Esophageal reflux'}


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: Asthma Exacerbation

PRESENT ILLNESS: 53 yo F non-smoker w/poorly controlled asthma requiring several
admissions in past few months, GERD, allergic rhinitis admitted
with Asthma exacerbation. Pt was sent to the ED [**Location 29938**]Clinic on Friday when she presented to clinic with acute
SOB.  She awoke at 4 o'clock in the morning feeling very short
of breath.  Between 4 and 8 she used three nebulizer treatments
without much improvement, she decided go to [**Hospital **] clinic to be
seen. However, per pt she has been having difficulty breathing
for 1 week with a non-productive cough, sore throat and N/V x4
days. She was recently placed on a steroid taper x5 days on [**7-19**]
per her PCP. [**Name10 (NameIs) **] breathing improved on the steroids and once
again noticed difficulty breathing and excessive coughing once
off the steroids. She does not know what her triggers are per
se, has had no sick contacts and no recent travelling. She has
not been on abx recently. Her most recent Asthma decompensation
was in [**2167-5-3**] requiring ICU monitoring but no intubation. In
clinic she was tachypneic, RR 22 O2 Sat at 100%, she was having
difficulty speaking in full sentences and therefore sent to ED
for further care.

MEDICAL HISTORY: - Asthma-has had multiple asthma exacerbations requiring 3
hospitalizations, steroids; no intubations
- h/o Polio requiring her to use crutches when walking
- Benign hypertension
- allergic rhinitis
- hyperlipidemia

MEDICATION ON ADMISSION: ACETAMINOPHEN 325 mg--2 tabs QID prn pain
ADVAIR DISKUS 500 mcg-50 mcg/Dose--1 puff po BID
ALBUTEROL 90MCG--2 puffs TID prn
ALBUTEROL SULFATE 0.83 mg/mL--1 unit dose inhaled QID prn
CROLOM 4 %--1 gtt each eye Q6HR prn
DOCUSATE SODIUM 100 mg [**2-3**] tab HS prn
FLONASE 50MCG daily each nostril
FLUOXETINE 20 mg dialy
HYDROCHLOROTHIAZIDE 25 mg dialy
IPRATROPIUM BROMIDE 0.2 mg/mL (0.02 %)--1 unit dose inhaled tid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 97.1, 140/90, 75, 20, 99%  PEF 375
GEN: Comfortable sitting in bed in NAD
HEENT: MMM, OP clear-no exudates, no cervical LAD
RESP: no stridor, no accessory muscle use, no paradoxical
breathing, no wheezing or crackles throughout lung fields
CV: RRR, S1, S2, no M/R/G
ABD: Soft, obese, ND/NT, +BS
EXT: No peripheral edema, R leg with atrophied muscle/paralysis
NEURO: A&O x3, no focal deficits

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Lives with sister.  Vietnamese-speaking (speaks english).  Goes
to senior day care 3x/week with parents.  No tob/ETOH. 

### Response:
{'Extrinsic asthma with (acute) exacerbation,Late effects of acute poliomyelitis,Other and unspecified hyperlipidemia,Benign essential hypertension,Esophageal reflux'}
