CHIEF COMPLAINT: Hypotension

PRESENT ILLNESS: Mrs. [**Known lastname 19672**] is an 82 year old woman with a past medical history
significant for dementia, DM 2, CAD s/p CABG, systolic CHF
hypothyroid, known UTI, and two recent admissions for UGIB/CoNS
bacteremia and AMS/ARF now admitted with hypotension from
presumed urosepsis. The patient's daughter states that last week
she has had intermitent vomiting described as NBNB emesis every
3-4 days and lethargy. She had a urinalysis and urine culture
drawn last Friday, and was called by her PCPs office yesterday
and was prescribed nitrofurantoin.  Of note, the patient has had
a chronic indwelling foley catheter since [**3-7**], with a voiding
cystogram done on [**4-2**] that was unremarkable. Over the past week,
her daughter reports that she has had decreased PO intake, and
this afternoon was found to be lethargic. At that point, she was
brought into the [**Hospital1 18**] ED for further evaluation.
.
Of note, the patient presented to the ED on [**3-4**] for abdominal
pain. At that time, she was evaluated by Surgery and felt to not
have an acute process and was found to have pyuria on UA treated
with 3 days of cipro 250 mg daily with no urine culture sent.
She was also admitted to [**Hospital1 18**] from [**Date range (1) 19675**] for AMS felt to be
secondary to ARF. During that admission, she failed a voiding
trial and has since had a chronic indwelling foley cathter. In
addition, she was admitted for [**Hospital1 18**] from [**Date range (1) 19676**] for a
duodenal ulcer bleed requiring 6 units PRBC transfusion with
hospital course complicated by CoNS bacteremia treated with 7
days of vancomycin.
.
In the [**Hospital1 18**] ED, initial VS 98.8 75 69/34 14 99%RA.  Labs
notable for a lactate of 3.3 down trending to 3 and a UA with
>100 WBC with <1 epithelial. The patient received vanco,
levofloxacin, flagyl, 100 mg hydrocortisone, and 6L IVF, and was
then admitted to the MICU for further management.
.
Currently, the patient is resting comfortably. On ROS, she
endorses pain with palpation of her chest, shoulders, back, and
abdomen.

MEDICAL HISTORY: -Dementia
-Diabetes mellitus type II
-Coronary artery disease s/p CABG x 3 in 7/92
-Vasculopathy
-Status post laminectomy at L4-L5 for spinal stenosis on
[**2166-6-7**]
-Ventral hernia since [**2159**] s/p repair in 6/93
-Hashimoto's hypothyroidism
-HTN
-s/p appendectomy
-s/p cholecystectomy via paramedial incision
-s/p total abdominal hysterectomy via the same paramedial
incision
-s/p bilateral salpingo-oophorectomy via midline incision
-osteoarthritis
-irritable bowel syndrome
-esophageal stricture s/p dilation
-s/p benign polypectomy
-nephrolithiasis.

MEDICATION ON ADMISSION: Carvedilol 3.125 mg po bid
Sucralfate 1 gram QID
Esomeprazole daily
Donepezil 10 mg daily
Lisinopril 20 mg daily
Furosemide 20 mg daily
Pravastatin 40 mg daily
Memantine 10 mg po bid (on hold)
Glipizide ER 2.5 mg daily
Metformin 500 mg po bid
Levothyroxine 100 mcg daily
Ezetimibe 10 mg daily (on hold)
Allopurinol 100 mg daily (on hold)
Omeprazole 20 mg daily

ALLERGIES: Penicillins / Sulfa (Sulfonamide Antibiotics) / Cephalexin /
Cefazolin / Opioids-Morphine & Related

PHYSICAL EXAM: ADMISSION
VS: 96 (ax) 84 89/34 16 98%RA
Gen: Elderly woman, comfortable appearing.
HEENT: MM dry
CV: Nl S1+S2. Harsh II/VI systolic murmur loudest at the base
radiating to the carotids.  JVP<10 cm.
Pulm: Scattered crackles b/l
Abd: S/ND +bs. Mild TTP throughout, no rebound or guarding.
Ext: No c/c/.e
Neuro: Oriented to person. CN II-XII intact.
At discharge:
same as above except:
Abd: non-tender
Psych: agitated at times, easily redirected by family

FAMILY HISTORY: Her mother died of CAD at 74.  Four siblings (three brothers and
a sister) with MI prior to age 60.

SOCIAL HISTORY: Lives with 84yo husband and daughter [**Name (NI) 717**] at home, husband is
her primary caretaker, daughters and sons as well as friends
take turn at home to care for her.  Remote tobacco, no alcohol
or drugs.
Unspecified septicemia,Septic shock,Urinary tract infection, site not specified,Chronic systolic heart failure,Delirium due to conditions classified elsewhere,Acute kidney failure, unspecified,Hyposmolality and/or hyponatremia,Severe sepsis,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Infection with microorganisms with resistance to multiple drugs,Anemia, unspecified,Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation, without mention of obstruction,Other persistent mental disorders due to conditions classified elsewhere,Unspecified acquired hypothyroidism,Retention of urine, unspecified,Do not resuscitate status,Aortocoronary bypass status,Other acquired absence of organ,Acquired absence of both cervix and uterus,Personal history of urinary calculi
Septicemia NOS,Septic shock,Urin tract infection NOS,Chr systolic hrt failure,Delirium d/t other cond,Acute kidney failure NOS,Hyposmolality,Severe sepsis,Enterococcus group d,DMII wo cmp nt st uncntr,Inf mcrg rstn oth drg ml,Anemia NOS,Duodenal ulcer NOS,Mental disor NEC oth dis,Hypothyroidism NOS,Retention urine NOS,Do not resusctate status,Aortocoronary bypass,Acq absence of organ NEC,Acq absnce cervix/uterus,Prsnl hst urnr dsrd calc
Admission Date:  [**2177-4-10**]              Discharge Date:   [**2177-4-12**]

Date of Birth:  [**2095-1-5**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Sulfa (Sulfonamide Antibiotics) / Cephalexin /
Cefazolin / Opioids-Morphine & Related

Attending:[**First Name3 (LF) 10552**]
Chief Complaint:
Hypotension

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Mrs. [**Known lastname 19672**] is an 82 year old woman with a past medical history
significant for dementia, DM 2, CAD s/p CABG, systolic CHF
hypothyroid, known UTI, and two recent admissions for UGIB/CoNS
bacteremia and AMS/ARF now admitted with hypotension from
presumed urosepsis. The patient's daughter states that last week
she has had intermitent vomiting described as NBNB emesis every
3-4 days and lethargy. She had a urinalysis and urine culture
drawn last Friday, and was called by her PCPs office yesterday
and was prescribed nitrofurantoin.  Of note, the patient has had
a chronic indwelling foley catheter since [**3-7**], with a voiding
cystogram done on [**4-2**] that was unremarkable. Over the past week,
her daughter reports that she has had decreased PO intake, and
this afternoon was found to be lethargic. At that point, she was
brought into the [**Hospital1 18**] ED for further evaluation.
.
Of note, the patient presented to the ED on [**3-4**] for abdominal
pain. At that time, she was evaluated by Surgery and felt to not
have an acute process and was found to have pyuria on UA treated
with 3 days of cipro 250 mg daily with no urine culture sent.
She was also admitted to [**Hospital1 18**] from [**Date range (1) 19675**] for AMS felt to be
secondary to ARF. During that admission, she failed a voiding
trial and has since had a chronic indwelling foley cathter. In
addition, she was admitted for [**Hospital1 18**] from [**Date range (1) 19676**] for a
duodenal ulcer bleed requiring 6 units PRBC transfusion with
hospital course complicated by CoNS bacteremia treated with 7
days of vancomycin.
.
In the [**Hospital1 18**] ED, initial VS 98.8 75 69/34 14 99%RA.  Labs
notable for a lactate of 3.3 down trending to 3 and a UA with
>100 WBC with <1 epithelial. The patient received vanco,
levofloxacin, flagyl, 100 mg hydrocortisone, and 6L IVF, and was
then admitted to the MICU for further management.
.
Currently, the patient is resting comfortably. On ROS, she
endorses pain with palpation of her chest, shoulders, back, and
abdomen.

Past Medical History:
-Dementia
-Diabetes mellitus type II
-Coronary artery disease s/p CABG x 3 in 7/92
-Vasculopathy
-Status post laminectomy at L4-L5 for spinal stenosis on
[**2166-6-7**]
-Ventral hernia since [**2159**] s/p repair in 6/93
-Hashimoto's hypothyroidism
-HTN
-s/p appendectomy
-s/p cholecystectomy via paramedial incision
-s/p total abdominal hysterectomy via the same paramedial
incision
-s/p bilateral salpingo-oophorectomy via midline incision
-osteoarthritis
-irritable bowel syndrome
-esophageal stricture s/p dilation
-s/p benign polypectomy
-nephrolithiasis.

Social History:
Lives with 84yo husband and daughter [**Name (NI) 717**] at home, husband is
her primary caretaker, daughters and sons as well as friends
take turn at home to care for her.  Remote tobacco, no alcohol
or drugs.


Family History:
Her mother died of CAD at 74.  Four siblings (three brothers and
a sister) with MI prior to age 60.

Physical Exam:
ADMISSION
VS: 96 (ax) 84 89/34 16 98%RA
Gen: Elderly woman, comfortable appearing.
HEENT: MM dry
CV: Nl S1+S2. Harsh II/VI systolic murmur loudest at the base
radiating to the carotids.  JVP<10 cm.
Pulm: Scattered crackles b/l
Abd: S/ND +bs. Mild TTP throughout, no rebound or guarding.
Ext: No c/c/.e
Neuro: Oriented to person. CN II-XII intact.
At discharge:
same as above except:
Abd: non-tender
Psych: agitated at times, easily redirected by family

Pertinent Results:
ADMISSION LABS:
[**2177-4-10**] 04:00PM [**Month/Day/Year 3143**] WBC-9.7 RBC-3.72* Hgb-10.9* Hct-31.9*
MCV-86 MCH-29.4 MCHC-34.3 RDW-15.3 Plt Ct-276
[**2177-4-10**] 04:00PM [**Month/Day/Year 3143**] Neuts-94.9* Lymphs-3.2* Monos-1.3*
Eos-0.4 Baso-0.2
[**2177-4-10**] 05:29PM [**Month/Day/Year 3143**] PT-11.4 PTT-23.6 INR(PT)-0.9
[**2177-4-10**] 04:00PM [**Month/Day/Year 3143**] Glucose-86 UreaN-29* Creat-1.3* Na-128*
K-4.6 Cl-92* HCO3-24 AnGap-17
[**2177-4-10**] 04:00PM [**Month/Day/Year 3143**] ALT-19 AST-66* AlkPhos-74 TotBili-0.5
[**2177-4-10**] 04:00PM [**Month/Day/Year 3143**] Lipase-29
[**2177-4-10**] 04:00PM [**Month/Day/Year 3143**] cTropnT-<0.01
[**2177-4-10**] 04:00PM [**Month/Day/Year 3143**] Albumin-3.9
[**2177-4-10**] 09:51PM [**Month/Day/Year 3143**] TSH-4.3*
[**2177-4-10**] 09:51PM [**Month/Day/Year 3143**] Free T4-1.2
[**2177-4-10**] 04:17PM [**Month/Day/Year 3143**] Lactate-3.3*
[**2177-4-11**] 05:21AM [**Month/Day/Year 3143**] Lactate-2.0
.
DISCHARGE LABS:
[**2177-4-12**] 08:10AM [**Month/Day/Year 3143**] WBC-6.2 RBC-3.21* Hgb-9.4* Hct-28.2*
MCV-88 MCH-29.3 MCHC-33.3 RDW-15.1 Plt Ct-236
[**2177-4-12**] 08:10AM [**Month/Day/Year 3143**] Glucose-87 UreaN-24* Creat-1.0 Na-134
K-3.6 Cl-106 HCO3-18* AnGap-14
[**2177-4-12**] 08:10AM [**Month/Day/Year 3143**] Albumin-3.0* Calcium-8.8 Phos-1.6* Mg-2.1
.
URINE:
[**2177-4-10**] 04:30PM URINE Color-Yellow Appear-Hazy Sp [**Last Name (un) **]-1.003
[**2177-4-10**] 04:30PM URINE [**Month/Day/Year **]-NEG Nitrite-NEG Protein-TR
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-LG
[**2177-4-10**] 04:30PM URINE RBC-2 WBC-116* Bacteri-FEW Yeast-MOD
Epi-<1
[**2177-4-10**] 04:30PM URINE CastHy-3*
[**2177-4-10**] 04:30PM URINE Hours-RANDOM Creat-60 Na-47 K-42 Cl-52
[**2177-4-10**] 04:30PM URINE Osmolal-301
   URINE CULTURE (Preliminary):
      YEAST.    >100,000 ORGANISMS/ML..
      ENTEROCOCCUS SP..    >100,000 ORGANISMS/ML.
.
PCP Urine Culture results obtained, E. faecium >100K organisms,
sensitive to linezolid.
.
[**Month/Day/Year **] cultures no growth to date at time of discharge
.
.
IMAGING:
PCXR: FINDINGS: Single AP upright portable view of the chest was
obtained. The patient is status post median sternotomy and CABG.
No focal consolidation, pleural effusion, or pneumothorax is
seen. The cardiac and mediastinal silhouette, and the hilar
contours are stable.
IMPRESSION: No significant interval change. No focal
consolidation seen.

Brief Hospital Course:
Mrs. [**Known lastname 19672**] is an 82 year old woman with a past medical history
significant for dementia, DM 2, CAD s/p CABG, systolic CHF,
hypothyroid, known UTI, and two recent admissions for UGIB/CoNS
bacteremia and AMS/ARF now admitted with hypotension.

1. Hypotension: Given pyuria on UA consistent with UTI,
hypotension likely in part caused by urosepsis, although lack of
>WBC/<WBC, tachycardia, or tachypnea is inconsistent with SIRS
physiology for UTI.  In addition, intravascular volume depletion
in setting of decreased PO intake likely contributing a great
deal, as the hemodynamics and lactate improved after 8L IVF.
Patient was was treated broadly with linezolid and meropenem
given history of VRE and prolonged use of ciprofloxacin for
recurrent UTIs. Antihypertensives and furosemide held at
admission and only furosemide and lisinopril restarted at
discharge. Carvedilol should be reintroduced as soon as BP and
HR tolerates, hopefully at PCP visit [**Name9 (PRE) 766**] or Tuesday. SBPs
ranged 110-140 on day of discharge without tachycardia. BP check
to be done by VNA on day after discharge.

2. UTI: Patient was was treated broadly with linezolid and
meropenem given history of VRE and prolonged use of
ciprofloxacin for recurrent UTIs. Antibiotic coverage was
narrowed to PO linezolid 600mg [**Hospital1 **] x total 7 days at time of
discharge. This decision was based on urine culture report
obtained from Quest lab, ordered by PCP prior to admission which
showed E. faecium >100K organisms, sensitive to linezolid. Foley
replaced at admission.

3. Hyponatremia: Likely in setting of intravascular hypovolemia.
Resolved with IVF.

4. Renal failure: Cr improved to baseline 0.9-1 after IVF. ACEI
and furosemide held during admission.

5. Anemia: Hct at baseline and stable this admission.

6. Goals of care: Discussed at length with daughter/HCP.
Confirmed DNR/DNI status. Family is in agreement that patient
would not want extensive life support, but would be amenable to
CVL and arterial line.

7. CAD/CHF: Patient with known LVEF 25-30%. Carvediilol,
lisinopril,furosemide held at admission and carvedilol held at
discharge (see above). No need for supplemental O2 despite poor
EF and aggressive IVF resuscitation.

8. DM 2: Held orals, accuchecks with HISS with good control.

9. Hypothyroid: Continued levothyroxine.

10. Duodenal ulcer: Continued PPI, Hct stable.
.
11. Delirium/Dementia: Continued home donepizil, held
mirtazapine per report from home that being held. Patient
developed significant delirium upon transfer to the floor,
requiring sitting at nurses station and eventual 2 point
restraints for pulling on Foley. No response to low dose
quetiapine or Zydis.
.
12. Urinary retention: Foley placed last admission given failed
void trial. Changed when admitted to the MICU. Discharged with
Foley in place. Patient should have voiding trial as outpatient
and Foley should be removed ASAP to avoid further risk of
recurrent UTI.
.
.
TRANSITIONAL ISSUES:
- restart Carvedilol once BP and HR tolerates
- continue linezolid for total 7 day course
- f/u volume status and encourage PO fluid intake
- ensure family has adequate support to take care of patient
24/7
- void trial and D/C Foley once spontaneously voiding
- attempt to minimize admissions and lengths of stay given
significant delirium in hospital repeatedly

Medications on Admission:
Carvedilol 3.125 mg po bid
Sucralfate 1 gram QID
Esomeprazole daily
Donepezil 10 mg daily
Lisinopril 20 mg daily
Furosemide 20 mg daily
Pravastatin 40 mg daily
Memantine 10 mg po bid (on hold)
Glipizide ER 2.5 mg daily
Metformin 500 mg po bid
Levothyroxine 100 mcg daily
Ezetimibe 10 mg daily (on hold)
Allopurinol 100 mg daily (on hold)
Omeprazole 20 mg daily

Discharge Medications:
1. linezolid 600 mg Tablet [**Hospital1 **]: One (1) Tablet PO twice a day
for 6 days.
Disp:*12 Tablet(s)* Refills:*0*
2. sucralfate 1 gram Tablet [**Hospital1 **]: One (1) Tablet PO QID (4 times
a day).
3. pravastatin 40 mg Tablet [**Hospital1 **]: One (1) Tablet PO once a day.
4. donepezil 10 mg Tablet [**Hospital1 **]: One (1) Tablet PO once a day.
5. lisinopril 20 mg Tablet [**Hospital1 **]: One (1) Tablet PO once a day.
6. furosemide 20 mg Tablet [**Hospital1 **]: One (1) Tablet PO once a day.
7. glipizide 2.5 mg Tablet Extended Rel 24 hr [**Hospital1 **]: One (1)
Tablet Extended Rel 24 hr PO once a day.
8. metformin 500 mg Tablet [**Hospital1 **]: One (1) Tablet PO twice a day.
9. levothyroxine 100 mcg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY
(Daily).
10. omeprazole 40 mg Capsule, Delayed Release(E.C.) [**Hospital1 **]: One (1)
Capsule, Delayed Release(E.C.) PO once a day.


Discharge Disposition:
Home With Service

Facility:
[**Company **] [**Location (un) **]

Discharge Diagnosis:
Primary:
1. Urinary tract infection
2. Hypotension
3. Delirium
4. Acute on Chronic Renal Failure
5. Hyponatremia
Secondary:
1. Hypertension
2. Dementia
3. Diabetes
4. Duodenal ulcer


Discharge Condition:
Mental Status: Confused - always.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
You were admitted to the hospital with low [**Location (un) **] pressure and
vomiting. You were given antibiotics for the infection in your
urine and IN fluids. Your [**Location (un) **] pressure improved to a normal
range. You also developed delirium, or confusion, while in the
hospital. We gave you medicines to help with this but the most
helpful thing is for you to not be in the hospital. Your family
should provide 24 hour care of you. It is important you drink
lots of fluids over the next 48 hours. It is also very important
that you see your PCP on [**Name9 (PRE) 766**] or Tuesday.
.
Some of your medications were changed during this admission:
START linezolid
STOP carvedilol
.
You should continue to take all of your other medications as
prescribed.

Followup Instructions:
It is VERY IMPORTANT you call Dr.[**Name (NI) 11351**] office at
[**Telephone/Fax (1) 1701**] on [**Telephone/Fax (1) 766**] morning to schedule an appointment to be
seen on [**Telephone/Fax (1) 766**] or Tuesday of this week. Please remember to do
this.
.
Your [**Telephone/Fax (1) **] pressure will be checked by a visiting nurse [**First Name (Titles) **] [**Last Name (Titles) **].
{'Unspecified septicemia,Septic shock,Urinary tract infection, site not specified,Chronic systolic heart failure,Delirium due to conditions classified elsewhere,Acute kidney failure, unspecified,Hyposmolality and/or hyponatremia,Severe sepsis,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Infection with microorganisms with resistance to multiple drugs,Anemia, unspecified,Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation, without mention of obstruction,Other persistent mental disorders due to conditions classified elsewhere,Unspecified acquired hypothyroidism,Retention of urine, unspecified,Do not resuscitate status,Aortocoronary bypass status,Other acquired absence of organ,Acquired absence of both cervix and uterus,Personal history of urinary calculi'}


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: Hypotension

PRESENT ILLNESS: Mrs. [**Known lastname 19672**] is an 82 year old woman with a past medical history
significant for dementia, DM 2, CAD s/p CABG, systolic CHF
hypothyroid, known UTI, and two recent admissions for UGIB/CoNS
bacteremia and AMS/ARF now admitted with hypotension from
presumed urosepsis. The patient's daughter states that last week
she has had intermitent vomiting described as NBNB emesis every
3-4 days and lethargy. She had a urinalysis and urine culture
drawn last Friday, and was called by her PCPs office yesterday
and was prescribed nitrofurantoin.  Of note, the patient has had
a chronic indwelling foley catheter since [**3-7**], with a voiding
cystogram done on [**4-2**] that was unremarkable. Over the past week,
her daughter reports that she has had decreased PO intake, and
this afternoon was found to be lethargic. At that point, she was
brought into the [**Hospital1 18**] ED for further evaluation.
.
Of note, the patient presented to the ED on [**3-4**] for abdominal
pain. At that time, she was evaluated by Surgery and felt to not
have an acute process and was found to have pyuria on UA treated
with 3 days of cipro 250 mg daily with no urine culture sent.
She was also admitted to [**Hospital1 18**] from [**Date range (1) 19675**] for AMS felt to be
secondary to ARF. During that admission, she failed a voiding
trial and has since had a chronic indwelling foley cathter. In
addition, she was admitted for [**Hospital1 18**] from [**Date range (1) 19676**] for a
duodenal ulcer bleed requiring 6 units PRBC transfusion with
hospital course complicated by CoNS bacteremia treated with 7
days of vancomycin.
.
In the [**Hospital1 18**] ED, initial VS 98.8 75 69/34 14 99%RA.  Labs
notable for a lactate of 3.3 down trending to 3 and a UA with
>100 WBC with <1 epithelial. The patient received vanco,
levofloxacin, flagyl, 100 mg hydrocortisone, and 6L IVF, and was
then admitted to the MICU for further management.
.
Currently, the patient is resting comfortably. On ROS, she
endorses pain with palpation of her chest, shoulders, back, and
abdomen.

MEDICAL HISTORY: -Dementia
-Diabetes mellitus type II
-Coronary artery disease s/p CABG x 3 in 7/92
-Vasculopathy
-Status post laminectomy at L4-L5 for spinal stenosis on
[**2166-6-7**]
-Ventral hernia since [**2159**] s/p repair in 6/93
-Hashimoto's hypothyroidism
-HTN
-s/p appendectomy
-s/p cholecystectomy via paramedial incision
-s/p total abdominal hysterectomy via the same paramedial
incision
-s/p bilateral salpingo-oophorectomy via midline incision
-osteoarthritis
-irritable bowel syndrome
-esophageal stricture s/p dilation
-s/p benign polypectomy
-nephrolithiasis.

MEDICATION ON ADMISSION: Carvedilol 3.125 mg po bid
Sucralfate 1 gram QID
Esomeprazole daily
Donepezil 10 mg daily
Lisinopril 20 mg daily
Furosemide 20 mg daily
Pravastatin 40 mg daily
Memantine 10 mg po bid (on hold)
Glipizide ER 2.5 mg daily
Metformin 500 mg po bid
Levothyroxine 100 mcg daily
Ezetimibe 10 mg daily (on hold)
Allopurinol 100 mg daily (on hold)
Omeprazole 20 mg daily

ALLERGIES: Penicillins / Sulfa (Sulfonamide Antibiotics) / Cephalexin /
Cefazolin / Opioids-Morphine & Related

PHYSICAL EXAM: ADMISSION
VS: 96 (ax) 84 89/34 16 98%RA
Gen: Elderly woman, comfortable appearing.
HEENT: MM dry
CV: Nl S1+S2. Harsh II/VI systolic murmur loudest at the base
radiating to the carotids.  JVP<10 cm.
Pulm: Scattered crackles b/l
Abd: S/ND +bs. Mild TTP throughout, no rebound or guarding.
Ext: No c/c/.e
Neuro: Oriented to person. CN II-XII intact.
At discharge:
same as above except:
Abd: non-tender
Psych: agitated at times, easily redirected by family

FAMILY HISTORY: Her mother died of CAD at 74.  Four siblings (three brothers and
a sister) with MI prior to age 60.

SOCIAL HISTORY: Lives with 84yo husband and daughter [**Name (NI) 717**] at home, husband is
her primary caretaker, daughters and sons as well as friends
take turn at home to care for her.  Remote tobacco, no alcohol
or drugs. 

### Response:
{'Unspecified septicemia,Septic shock,Urinary tract infection, site not specified,Chronic systolic heart failure,Delirium due to conditions classified elsewhere,Acute kidney failure, unspecified,Hyposmolality and/or hyponatremia,Severe sepsis,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Infection with microorganisms with resistance to multiple drugs,Anemia, unspecified,Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation, without mention of obstruction,Other persistent mental disorders due to conditions classified elsewhere,Unspecified acquired hypothyroidism,Retention of urine, unspecified,Do not resuscitate status,Aortocoronary bypass status,Other acquired absence of organ,Acquired absence of both cervix and uterus,Personal history of urinary calculi'}
