CHIEF COMPLAINT: respiratory failure

PRESENT ILLNESS: Reason for MICU Admission: Sepsis and respiratory failure
.
HPI: This is an 86 year old man with chronic dementia and
recurrent pneumonia recently hospitalized at [**Hospital1 18**] for failure
to thrive in [**Month (only) 958**] who presents with fever and hypoxia. Of note,
he had a G-tube placed on [**4-25**] at [**Hospital3 **]. He
comes from [**Location **] Soldier's nursing home where he was
discharged a month ago, with one day history of fever and
decreased O2 sats.
.
In the ED, he was febrile to 102.4 and hypoxic to 88% with 4L NC
so he was put on a nonrebreather. His code status was discussed
with his family and it was decided that he was DNR but not DNI.
His systolic blood pressure transiently fell and a femoral line
was placed emergently. He received fluids (4L) total and tylenol
for a temp of 102.4, as well as vancomycin, ceftriaxone, and
azithromycin. He was put on levophedrine for persistenly low
SBP's as low as 80/40 after the third liter of fluid. He was
admitted to the ICU for close monitoring.

MEDICAL HISTORY: -Recurrent pneumonia
-[**Last Name (un) 309**]-body dementia
-Prostate cancer status post XRT in [**2170**]
-Uretheral stricture
-TURP [**2156**]
-Kidney stones
-Hypertension
-Diabetes Type II
-Hypercholesterolemia
-Prostate adenoma in [**2169**]
-Esophagitis
-Radiation colitis

MEDICATION ON ADMISSION: Ipratropium Bromide Inhalation Q6H (every 6 hours) as needed.
Albuterol Sulfate 0.083 % Q6H (every 6 hours) as needed
Docusate Sodium 100 mg PO BID
Senna 8.6 mg PO twice a day prn
MOM prn
Insulin Regular sliding scale
ASA 81 PO qd

ALLERGIES: Cardizem / Vasotec

PHYSICAL EXAM: V: T    BP 148/57   HR  85   RR  14   O sats  100   on NRB
Gen: Lying in bed, good color, comfortable appearing.
HEENT: Pupils 1 mm B and not reactive to light or accommodation.
Resp: Bronchial sounds B. Dullness to percussion B.
CV: RRR, S1 S2 S4, no murmurs rubs or gallops. No JVD. Capillary
refill 4 secs.
Abd: G tube in place c/d/i. Tender to palpation, diffusely. BS +
Ext: No edema. Pulses 1 + bilaterally.

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: 
Pneumonitis due to inhalation of food or vomitus,Unspecified septicemia,Severe sepsis,Acute respiratory failure,Septic shock,Injury to bladder and urethra, without mention of open wound into cavity,Hyperosmolality and/or hypernatremia,Acute kidney failure, unspecified,Unspecified protein-calorie malnutrition,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Dementia with lewy bodies,Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified essential hypertension,Unspecified accident,Hypotension, unspecified,Disorders of phosphorus metabolism,Anemia of other chronic disease,Gastrostomy status
Food/vomit pneumonitis,Septicemia NOS,Severe sepsis,Acute respiratry failure,Septic shock,Bladder/urethra inj-clos,Hyperosmolality,Acute kidney failure NOS,Protein-cal malnutr NOS,DMII wo cmp uncntrld,Dementia w Lewy bodies,Dementia w/o behav dist,Hypertension NOS,Accident NOS,Hypotension NOS,Dis phosphorus metabol,Anemia-other chronic dis,Gastrostomy status
Admission Date:  [**2180-4-29**]              Discharge Date:   [**2180-5-9**]


Service: MEDICINE

Allergies:
Cardizem / Vasotec

Attending:[**First Name3 (LF) 9240**]
Chief Complaint:
respiratory failure

Major Surgical or Invasive Procedure:
PICC placement

History of Present Illness:
Reason for MICU Admission: Sepsis and respiratory failure
.
HPI: This is an 86 year old man with chronic dementia and
recurrent pneumonia recently hospitalized at [**Hospital1 18**] for failure
to thrive in [**Month (only) 958**] who presents with fever and hypoxia. Of note,
he had a G-tube placed on [**4-25**] at [**Hospital3 **]. He
comes from [**Location **] Soldier's nursing home where he was
discharged a month ago, with one day history of fever and
decreased O2 sats.
.
In the ED, he was febrile to 102.4 and hypoxic to 88% with 4L NC
so he was put on a nonrebreather. His code status was discussed
with his family and it was decided that he was DNR but not DNI.
His systolic blood pressure transiently fell and a femoral line
was placed emergently. He received fluids (4L) total and tylenol
for a temp of 102.4, as well as vancomycin, ceftriaxone, and
azithromycin. He was put on levophedrine for persistenly low
SBP's as low as 80/40 after the third liter of fluid. He was
admitted to the ICU for close monitoring.


Past Medical History:
-Recurrent pneumonia
-[**Last Name (un) 309**]-body dementia
-Prostate cancer status post XRT in [**2170**]
-Uretheral stricture
-TURP [**2156**]
-Kidney stones
-Hypertension
-Diabetes Type II
-Hypercholesterolemia
-Prostate adenoma in [**2169**]
-Esophagitis
-Radiation colitis


Family History:
Noncontributory.

Physical Exam:
V: T    BP 148/57   HR  85   RR  14   O sats  100   on NRB
Gen: Lying in bed, good color, comfortable appearing.
HEENT: Pupils 1 mm B and not reactive to light or accommodation.
Resp: Bronchial sounds B. Dullness to percussion B.
CV: RRR, S1 S2 S4, no murmurs rubs or gallops. No JVD. Capillary
refill 4 secs.
Abd: G tube in place c/d/i. Tender to palpation, diffusely. BS +
Ext: No edema. Pulses 1 + bilaterally.

Pertinent Results:
EKG:Sinus tach at 114, nl axis, TWI III and diffuse TW
flattening (new from [**2-/2174**]), no Q waves.
.
Imaging:
CXR: (my read) - bibasilar infiltrates consistent with
aspiration pneumonia, RUL obscured by head

[**2180-4-29**] 08:51PM   PT-13.0 PTT-26.7 INR(PT)-1.1
[**2180-4-29**] 08:51PM   WBC-11.9* RBC-4.64 HGB-13.7* HCT-40.3 MCV-87
MCH-29.4 MCHC-33.9 RDW-14.1
[**2180-4-29**] 08:51PM   NEUTS-59 BANDS-16* LYMPHS-13* MONOS-12* EOS-0
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2180-4-29**] 08:51PM   GLUCOSE-362* UREA N-42* CREAT-1.6* SODIUM-144
POTASSIUM-3.4 CHLORIDE-101 TOTAL CO2-26 ANION GAP-20
[**2180-4-29**] 08:51PM   CALCIUM-9.2 PHOSPHATE-3.0 MAGNESIUM-2.4
[**2180-4-29**] 08:51PM   CK-MB-NotDone
[**2180-4-29**] 08:51PM   cTropnT-0.03*
[**2180-4-29**] 08:51PM   CK(CPK)-43
[**2180-4-29**] 09:39PM   GLUCOSE-331* LACTATE-7.5*
[**2180-4-29**] 09:56PM   TYPE-ART RATES-/26 O2-100 PO2-133* PCO2-35
PH-7.46* TOTAL CO2-26 BASE XS-2 AADO2-557 REQ O2-91
[**2180-4-29**] 11:35PM   LACTATE-4.6*

Brief Hospital Course:
86M with end stage dementia presents with respiratory distress,
likely from recurrent aspiration pneumonia/pneumonitis.
.
#) Hypoxic respiratory failure: The patient had a G tube placed
recently due to dysphagia. Developed recurrent aspiration PNA,
treated with 10 days of vanco/zosyn via PICC. Tube feeds have
only been able to be advanced to 20 c/h, family does not want
more aggressive measures. Do not rehospitalize. If he does not
tolerate TF or reaspirates family wants comfort care only.
[**Hospital 18436**] hospice care.
.
#) Septic shock with elevated lactate
Initially treated in ICU with levophed and vasopressin. Sepsis
resolved with vanco/zosyn for aspiration PNA. Family does not
want any more hospital care for this.
.
#) ARF: Cr 1.6 from baseline 0.7, now down to 0.8 s/p fluids
- Likely pre-renal from dehydration.
Do not give IVF, if does not tolerate TF will continue comfort
care only
.
#) Dementia, [**Last Name (un) 309**] body type
- At baseline

#) type II diabetes - hyperglycemic on admission
Continue glargine and sliding scale insulin for now, this may be
d/c'd as patient begins hospice care

#) Code status: DNR/DNI/Comfort oriented care, to initiate
hospice at Soldiers Home, DO NOT HOSPITALIZE

Medications on Admission:
Ipratropium Bromide Inhalation Q6H (every 6 hours) as needed.
Albuterol Sulfate 0.083 % Q6H (every 6 hours) as needed
Docusate Sodium 100 mg PO BID
Senna 8.6 mg PO twice a day prn
MOM prn
Insulin Regular sliding scale
ASA 81 PO qd

Discharge Medications:
1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
2. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
3. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
4. Docusate Sodium 50 mg/5 mL Liquid Sig: One Hundred (100) mg
PO BID (2 times a day).
5. Ipratropium Bromide 0.02 % Solution Sig: One (1) neb
Inhalation Q6H (every 6 hours).
6. Albuterol Sulfate 0.083 % Solution Sig: One (1) neb
Inhalation Q6H (every 6 hours) as needed for hypoxia, short of
breath.
7. Morphine Concentrate 20 mg/mL Solution Sig: 5-20 mg PO q2h as
needed for pain.
8. Insulin Glargine 100 unit/mL Solution Sig: Five (5) units
Subcutaneous at bedtime.
9. Humalog 100 unit/mL Solution Sig: sliding scale sliding scale
Subcutaneous four times a day.


Discharge Disposition:
Extended Care

Facility:
Soldiers Home in [**State 350**] - [**Location (un) **]

Discharge Diagnosis:
Recurrent Aspiration Pneumonia
Sepsis
[**Last Name (un) 309**] Body Dementia
Parkinson's Disease
Acute Renal Failure
Hypernatremia


Discharge Condition:
stable, non-responsive


Discharge Instructions:
Continue medications as listed. Patient to initiate hospice care
at [**Location (un) 18437**]. DO NOT HOSPITALIZE per family and health care
proxy, his wife [**Name (NI) 17**]. [**Name2 (NI) **] continue to try to advance tube
feeds, but if residuals remain high, family has decided not to
persue feeding further. NO IVF, NO AGGRESSIVE CARE. HOSPICE
CARE.

Followup Instructions:
Can follow up with PCP as needed per family. DO NOT HOSPITALIZE
per family wishes.
{'Pneumonitis due to inhalation of food or vomitus,Unspecified septicemia,Severe sepsis,Acute respiratory failure,Septic shock,Injury to bladder and urethra, without mention of open wound into cavity,Hyperosmolality and/or hypernatremia,Acute kidney failure, unspecified,Unspecified protein-calorie malnutrition,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Dementia with lewy bodies,Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified essential hypertension,Unspecified accident,Hypotension, unspecified,Disorders of phosphorus metabolism,Anemia of other chronic disease,Gastrostomy status'}


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: respiratory failure

PRESENT ILLNESS: Reason for MICU Admission: Sepsis and respiratory failure
.
HPI: This is an 86 year old man with chronic dementia and
recurrent pneumonia recently hospitalized at [**Hospital1 18**] for failure
to thrive in [**Month (only) 958**] who presents with fever and hypoxia. Of note,
he had a G-tube placed on [**4-25**] at [**Hospital3 **]. He
comes from [**Location **] Soldier's nursing home where he was
discharged a month ago, with one day history of fever and
decreased O2 sats.
.
In the ED, he was febrile to 102.4 and hypoxic to 88% with 4L NC
so he was put on a nonrebreather. His code status was discussed
with his family and it was decided that he was DNR but not DNI.
His systolic blood pressure transiently fell and a femoral line
was placed emergently. He received fluids (4L) total and tylenol
for a temp of 102.4, as well as vancomycin, ceftriaxone, and
azithromycin. He was put on levophedrine for persistenly low
SBP's as low as 80/40 after the third liter of fluid. He was
admitted to the ICU for close monitoring.

MEDICAL HISTORY: -Recurrent pneumonia
-[**Last Name (un) 309**]-body dementia
-Prostate cancer status post XRT in [**2170**]
-Uretheral stricture
-TURP [**2156**]
-Kidney stones
-Hypertension
-Diabetes Type II
-Hypercholesterolemia
-Prostate adenoma in [**2169**]
-Esophagitis
-Radiation colitis

MEDICATION ON ADMISSION: Ipratropium Bromide Inhalation Q6H (every 6 hours) as needed.
Albuterol Sulfate 0.083 % Q6H (every 6 hours) as needed
Docusate Sodium 100 mg PO BID
Senna 8.6 mg PO twice a day prn
MOM prn
Insulin Regular sliding scale
ASA 81 PO qd

ALLERGIES: Cardizem / Vasotec

PHYSICAL EXAM: V: T    BP 148/57   HR  85   RR  14   O sats  100   on NRB
Gen: Lying in bed, good color, comfortable appearing.
HEENT: Pupils 1 mm B and not reactive to light or accommodation.
Resp: Bronchial sounds B. Dullness to percussion B.
CV: RRR, S1 S2 S4, no murmurs rubs or gallops. No JVD. Capillary
refill 4 secs.
Abd: G tube in place c/d/i. Tender to palpation, diffusely. BS +
Ext: No edema. Pulses 1 + bilaterally.

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY:  

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Unspecified septicemia,Severe sepsis,Acute respiratory failure,Septic shock,Injury to bladder and urethra, without mention of open wound into cavity,Hyperosmolality and/or hypernatremia,Acute kidney failure, unspecified,Unspecified protein-calorie malnutrition,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Dementia with lewy bodies,Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified essential hypertension,Unspecified accident,Hypotension, unspecified,Disorders of phosphorus metabolism,Anemia of other chronic disease,Gastrostomy status'}
