CHIEF COMPLAINT: transfer for bronchoscopy, hypoxia

PRESENT ILLNESS: 81-year-old female with colon cancer (follwowed by dr [**Last Name (STitle) **])
with liver metastasis s/p liver resection (by Dr. [**Last Name (STitle) **] and
questionable lung mets (followed by Dr. [**Last Name (STitle) **], new ? right
diaphramatic hemiparalysis, right pleural effusion, dementia,
hypertension, pulmonary embolism s/p IVC filter and SDH, COPD on
BiPAP at night, EtOH abuse that presented to [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 30746**]
with dyspnea and RLL collapse with pleural effusion. She is
being transferred from [**Hospital3 **] to [**Hospital1 18**] for bronchoscopy
for right lower lobe collapse to look for endobronchial tumor
and pleurocentesis.
Patient was recently discharged from rehab hospital after
sustaining fracture of her obturator ring on right. After only
one day at home she started to have sob and leg swelling. She
presented to [**Hospital3 **] where they originally treated her
for CHF exacerbation with diuresis but BNP was wnl and TTE
showed normal LV systolic function, mild aortic stenosis, and
PAH at 60mmHg. CTA was negative for PEs and for metastati
disease. She was also treated for PNA with rocephin and
zithromax after developing a fever to 100.2 and a new
right-sided haziness on CXR. Did not drain effusion as was not
sizeable enough to tap. Oncology did not feel this was new
metastatic disease because she had just undergone 9 cycles of
chemotherapy.
Had persistent hypoxemia (95 % on 8 L) without oxygen 85 %.
Eventually found to have RLL collapse and right
hemidiaphragmatic paralysis. Was maintained on the medical floor
stable requiering 6 liters O2 nasal cannula and nocturnal Bipap.
(BiPAP setings [**11-11**]). refused daytime bipap. Pulmonology
suggested chest pt and nebulizers but the patient did not
improve so they then recommended bronchoscopy to remove mucous
plugging. As per family request they would like her to be
transferred to [**Hospital1 18**] for bronch (+/- endobronchial intervention)
and pleural drainage tomorrow.

MEDICAL HISTORY: - Stage IIIB colon cancer who completed adjuvant therapy with
eight cycles of capecitabine.
Medical course complicated by recurrent right-sided pleural
effusion, right upper quadrant intra-abdominal abscess, and E.
coli bacteremia.
In addition, s/p liver resection fro metastatic disease
- SDH s/p craniotomy
- PE s/pIVC filter
- COPD
- ETOH abuse
- HTN
- AAOx3 but baseline dementia per OSH records
- hysterectomy
- Colectomy
- BSO
- loculated pleural effusion s/p thoracentesis and chest tube
placement in [**2122**] with cytology on pleural fluid negative for
malignancy

MEDICATION ON ADMISSION: Alendronate 70 mg po weekly
Amlodipine 10 mg po daily
Atenolol 50 mg po daily
Calcium + Vitamin D 600 mg tablet po daily
Docusate 100 mg po daily
Folic Acid 1 mg po daily
Furosemide 40 mg po daily
Lisinopril 10 mg po daily
Lorazepam 0.25 mg po q8h prn
Oxycodone-acetaminophen 3/325 mg po q4-6 hrs prn pain

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Vitals: T: 98 BP:96/59 P:68 R: 18 18 O2: 96% on 50% FM and 4L NC

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: - Tobacco: Quit smoking 12 years ago
- Alcohol: Previous heavy ETOH use not currently sober
- Independent in her ADLs previously, recently discharged from
rehab after a fracture.
Disorders of diaphragm,Acute on chronic diastolic heart failure,Unspecified pleural effusion,Pulmonary collapse,Chronic airway obstruction, not elsewhere classified,Personal history of venous thrombosis and embolism,Other persistent mental disorders due to conditions classified elsewhere,Hypoxemia,Personal history of malignant neoplasm of large intestine,Benign essential hypertension
Disorders of diaphragm,Ac on chr diast hrt fail,Pleural effusion NOS,Pulmonary collapse,Chr airway obstruct NEC,Hx-ven thrombosis/embols,Mental disor NEC oth dis,Hypoxemia,Hx of colonic malignancy,Benign hypertension
Admission Date:  [**2125-11-14**]              Discharge Date:   [**2125-11-20**]

Date of Birth:  [**2044-2-14**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 783**]
Chief Complaint:
transfer for bronchoscopy, hypoxia

Major Surgical or Invasive Procedure:
None

History of Present Illness:
81-year-old female with colon cancer (follwowed by dr [**Last Name (STitle) **])
with liver metastasis s/p liver resection (by Dr. [**Last Name (STitle) **] and
questionable lung mets (followed by Dr. [**Last Name (STitle) **], new ? right
diaphramatic hemiparalysis, right pleural effusion, dementia,
hypertension, pulmonary embolism s/p IVC filter and SDH, COPD on
BiPAP at night, EtOH abuse that presented to [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 30746**]
with dyspnea and RLL collapse with pleural effusion. She is
being transferred from [**Hospital3 **] to [**Hospital1 18**] for bronchoscopy
for right lower lobe collapse to look for endobronchial tumor
and pleurocentesis.
Patient was recently discharged from rehab hospital after
sustaining fracture of her obturator ring on right. After only
one day at home she started to have sob and leg swelling. She
presented to [**Hospital3 **] where they originally treated her
for CHF exacerbation with diuresis but BNP was wnl and TTE
showed normal LV systolic function, mild aortic stenosis, and
PAH at 60mmHg. CTA was negative for PEs and for metastati
disease. She was also treated for PNA with rocephin and
zithromax after developing a fever to 100.2 and a new
right-sided haziness on CXR. Did not drain effusion as was not
sizeable enough to tap. Oncology did not feel this was new
metastatic disease because she had just undergone 9 cycles of
chemotherapy.
Had persistent hypoxemia (95 % on 8 L) without oxygen 85 %.
Eventually found to have RLL collapse and right
hemidiaphragmatic paralysis. Was maintained on the medical floor
stable requiering 6 liters O2 nasal cannula and nocturnal Bipap.
(BiPAP setings [**11-11**]). refused daytime bipap. Pulmonology
suggested chest pt and nebulizers but the patient did not
improve so they then recommended bronchoscopy to remove mucous
plugging. As per family request they would like her to be
transferred to [**Hospital1 18**] for bronch (+/- endobronchial intervention)
and pleural drainage tomorrow.

Past Medical History:
- Stage IIIB colon cancer who completed adjuvant therapy with
eight cycles of capecitabine.
Medical course complicated by recurrent right-sided pleural
effusion, right upper quadrant intra-abdominal abscess, and E.
coli bacteremia.
In addition, s/p liver resection fro metastatic disease
- SDH s/p craniotomy
- PE s/pIVC filter
- COPD
- ETOH abuse
- HTN
- AAOx3 but baseline dementia per OSH records
- hysterectomy
- Colectomy
- BSO
- loculated pleural effusion s/p thoracentesis and chest tube
placement in [**2122**] with cytology on pleural fluid negative for
malignancy


Social History:
- Tobacco: Quit smoking 12 years ago
- Alcohol: Previous heavy ETOH use not currently sober
- Independent in her ADLs previously, recently discharged from
rehab after a fracture.

Family History:
Non-contributory

Physical Exam:
Vitals: T: 98 BP:96/59 P:68 R: 18 18 O2: 96% on 50% FM and 4L NC

General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: decreased BS on right. crackles at base on left
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: tr edema bilaterally

Discharge:
VS: T: 95.6, BP: 140/82, P: 68, RR: 24, 94% 6L
GA: seen in bed, laughing, AAOx3 (person, [**Location (un) **] hospital,
year, month)
Cards: RRR S1/S2 heard. no murmurs/gallops/rubs.
Pulm: decreased breath sounds on the right, dullness to
percussion on right. mild crackles at right mid lung and left
lower lung
Abd: soft, NT, +BS. no g/rt.
Extremities: wwp, 1+ ankle edema


Pertinent Results:
Admission:
[**2125-11-14**] 09:41PM   GLUCOSE-112* UREA N-34* CREAT-0.9 SODIUM-138
POTASSIUM-4.7 CHLORIDE-100 TOTAL CO2-31 ANION GAP-12
[**2125-11-14**] 09:41PM   CALCIUM-9.4 PHOSPHATE-3.9 MAGNESIUM-2.0
[**2125-11-14**] 09:41PM   WBC-6.8 RBC-4.44 HGB-12.4 HCT-37.7 MCV-85
MCH-27.9 MCHC-32.9 RDW-14.5
[**2125-11-14**] 09:41PM   PT-13.5* PTT-23.7 INR(PT)-1.2*

Discharge:
[**2125-11-18**] 05:55AM BLOOD WBC-5.4 RBC-4.12* Hgb-11.8* Hct-36.1
MCV-87 MCH-28.6 MCHC-32.8 RDW-14.6 Plt Ct-226
[**2125-11-18**] 05:55AM BLOOD PT-12.8 PTT-25.3 INR(PT)-1.1
[**2125-11-18**] 05:55AM BLOOD Glucose-96 UreaN-25* Creat-0.9 Na-139
K-4.3 Cl-100 HCO3-32 AnGap-11
[**2125-11-18**] 05:55AM BLOOD ALT-11 AST-15 LD(LDH)-184 AlkPhos-105
TotBili-0.3
[**2125-11-18**] 05:55AM BLOOD Albumin-3.5 Calcium-9.4 Phos-3.8 Mg-1.9
[**2125-11-18**] 05:55AM BLOOD CEA-1.5

[**2125-11-15**] Echo:
The left atrium is mildly dilated. No atrial septal defect is
seen by 2D or color Doppler. There is mild 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 65%). The right ventricular
cavity is mildly dilated with normal free wall contractility.
The aortic root is mildly dilated at the sinus level. The aortic
valve leaflets (3) are mildly thickened but aortic stenosis is
not present. The mitral valve leaflets are mildly thickened.
There is no mitral valve prolapse. Mild to moderate ([**12-9**]+)
mitral regurgitation is seen. The tricuspid valve leaflets are
mildly thickened. There is no pericardial effusion.

Compared with the findings of the prior study (images reviewed)
of [**2123-4-29**], the findings are similar.

[**2125-11-15**] CXR:
As compared to the previous radiograph, there is no relevant
change. Moderate cardiomegaly, small bilateral pleural
effusions. Tortuosity of the thoracic aorta. Partial right and
left lung base atelectasis. No evidence of focal parenchymal
opacity suggesting pneumonia.

[**2125-11-19**]: CT Chest Wetread
chest: small bilateral effusions and associated atelectasis
obscure some of the known pulmonary nodules. at least one
pulmonary nodule in the right upper lobe is unchagned in size
compared to [**2125-1-15**]. others are not seen due to atelectasis.
hyperdense pleural material on the right suggests prior
pleurodesis. septal thickening and ground glass opacities
suggest an element of volume overload.

abd/pelvis: stable appearance of the liver s/p partial right
hepatectomy.
no new liver lesions. spleen, pancreas, adrenal and kidneys
unchanged. no
new RP or mesenteric adenopathy. bowel-containing ventral hernia
is
uncomplicated. no free fluid or free air or other acute
intraabdominal
process identified.

bones: right pubic rami fractures are new from [**Month (only) **] but do
not appear
acute. bones are otherwise unchanged. no acute fractures.


Brief Hospital Course:
81 yo female with PMH of colon cancer stage IIIb with liver mets
s/p resection, questionable lung mets, new right diaphragmatic
hemiparalysis, right pleural effusion, dementia, pulmonary
embolism s/p IVC filter, COPD admitted to OSH with SOB found to
have R lobe collapse and transferred to [**Hospital1 18**] MICU for hypoxia
then transferred to the medicine team stable on 6 L NC.

#Hypoxia: Patient has underlying lung pathology including COPD
and prior pulmonary embolism. She was found to have RLL collapse
at the OSH with right hemidiaphragmatic paralysis. The RLL
collapse was thought to be the most likely cause of her new
oxygen requirement. She was evaluated by interventional
pulmonology who felt that she was not a candidate for
bronchscopy as she would be difficult to extubate. She was
evaluated by oncology who felt that pulmonary involvement of her
cancer was less likely based on review on imaging and normal
CEA.  Incentive spirometry was encouraged. On discharge, she was
requiring 6 L supplemental O2 via nasal cannula with O2 sats in
the mid to low 90s.

#Hx of Colon Cancer: There was initial concern that
endobronchial tumor may have been cause of RLL collapse. CEA was
elevated when liver mets were found, now within normal limits,
making metastasis less likely. LFTs were also within normal
limits. CT Chest/abdomen/ pelvis did not show any evidence of
new metastasis. Patient was discharged with oncology follow-up
in 1 month.

#Hypertension: BP was low-normal on admission. Her amlodipine
was stopped and furosemide was decreased from 40 mg po daily to
20 mg po daily. She was continued on lisinopril and atenolol.

#Chronic Diastolic CHF: Patient had signs of acute on chronic
CHF at OSH including bilateral pleural effusions, vascular
congestion which improved with diuretics. On discharge, patient
had mild tibial edema and bibasilar crackles on lung exam. She
was discharged on lasix 20 mg po daily which can be increased to
40 mg po daily if her blood pressure allows.

#COPD: Likely contributing to new O2 requirement. There were mo
signs of acute COPD exacerbation on this admission.

#Hx of PE: patient had IVC placed as she was unable to receive
anticoagulation at the time secondary to subdural hematoma. CTA
was negative for PE at OSH. She was given heparin subq tid for
DVT prophylaxis.

#Pending: final read of CT chest/abdomen/ pelvis pending.

#CODE: Full Code (confirmed with son)

Medications on Admission:
Alendronate 70 mg po weekly
Amlodipine 10 mg po daily
Atenolol 50 mg po daily
Calcium + Vitamin D 600 mg tablet po daily
Docusate 100 mg po daily
Folic Acid 1 mg po daily
Furosemide 40 mg po daily
Lisinopril 10 mg po daily
Lorazepam 0.25 mg po q8h prn
Oxycodone-acetaminophen 3/325 mg po q4-6 hrs prn pain

Discharge Medications:
1. atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. Calcium 600 + D(3) 600-400 mg-unit Tablet Sig: One (1) Tablet
PO once a day.
3. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. folic acid 1 mg Tablet Sig: One (1) Tablet PO once a day.
6. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. alendronate 70 mg Tablet Sig: One (1) Tablet PO once a week.

8. Outpatient Lab Work
Please check Chem 7 (Na, K, Cl, HCO3, BUN, creatinine, glucose)
on [**2125-11-21**].


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 701**]

Discharge Diagnosis:
Primary: Right hemidiaphragmatic paralysis


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


Discharge Instructions:
You were transferred to [**Hospital1 69**] on
[**2125-11-14**] with shortness of breath. You were found to have
collapse of part of your right lung and impaired diaphragm
function. You were evaluated by the interventional pulmonary
service who felt there was a considerable risk to performing a
bronchscopy. You were evaluated by the oncology service who felt
that this was less likely to be due to cancer. Part of your
shortness of breath is likely due to heart failure and you were
continued on lasix to remove the extra fluid. You were given
oxygen to help your breathing.

The following changes were made to your medications:
-STOPPED Amlodipine
-STOPPED Percocet (oxycodone-acetominophen)
-STOPPED Lorazepam
-DECREASED furosemide from 40 mg to 20 mg by mouth once a day

Followup Instructions:
Department: HEMATOLOGY/ONCOLOGY
When: WEDNESDAY [**2125-12-19**] at 11:00 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 6050**], MD [**Telephone/Fax (1) 8770**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 24**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage


                             [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**] MD, [**MD Number(3) 799**]
{'Disorders of diaphragm,Acute on chronic diastolic heart failure,Unspecified pleural effusion,Pulmonary collapse,Chronic airway obstruction, not elsewhere classified,Personal history of venous thrombosis and embolism,Other persistent mental disorders due to conditions classified elsewhere,Hypoxemia,Personal history of malignant neoplasm of large intestine,Benign essential hypertension'}


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: transfer for bronchoscopy, hypoxia

PRESENT ILLNESS: 81-year-old female with colon cancer (follwowed by dr [**Last Name (STitle) **])
with liver metastasis s/p liver resection (by Dr. [**Last Name (STitle) **] and
questionable lung mets (followed by Dr. [**Last Name (STitle) **], new ? right
diaphramatic hemiparalysis, right pleural effusion, dementia,
hypertension, pulmonary embolism s/p IVC filter and SDH, COPD on
BiPAP at night, EtOH abuse that presented to [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 30746**]
with dyspnea and RLL collapse with pleural effusion. She is
being transferred from [**Hospital3 **] to [**Hospital1 18**] for bronchoscopy
for right lower lobe collapse to look for endobronchial tumor
and pleurocentesis.
Patient was recently discharged from rehab hospital after
sustaining fracture of her obturator ring on right. After only
one day at home she started to have sob and leg swelling. She
presented to [**Hospital3 **] where they originally treated her
for CHF exacerbation with diuresis but BNP was wnl and TTE
showed normal LV systolic function, mild aortic stenosis, and
PAH at 60mmHg. CTA was negative for PEs and for metastati
disease. She was also treated for PNA with rocephin and
zithromax after developing a fever to 100.2 and a new
right-sided haziness on CXR. Did not drain effusion as was not
sizeable enough to tap. Oncology did not feel this was new
metastatic disease because she had just undergone 9 cycles of
chemotherapy.
Had persistent hypoxemia (95 % on 8 L) without oxygen 85 %.
Eventually found to have RLL collapse and right
hemidiaphragmatic paralysis. Was maintained on the medical floor
stable requiering 6 liters O2 nasal cannula and nocturnal Bipap.
(BiPAP setings [**11-11**]). refused daytime bipap. Pulmonology
suggested chest pt and nebulizers but the patient did not
improve so they then recommended bronchoscopy to remove mucous
plugging. As per family request they would like her to be
transferred to [**Hospital1 18**] for bronch (+/- endobronchial intervention)
and pleural drainage tomorrow.

MEDICAL HISTORY: - Stage IIIB colon cancer who completed adjuvant therapy with
eight cycles of capecitabine.
Medical course complicated by recurrent right-sided pleural
effusion, right upper quadrant intra-abdominal abscess, and E.
coli bacteremia.
In addition, s/p liver resection fro metastatic disease
- SDH s/p craniotomy
- PE s/pIVC filter
- COPD
- ETOH abuse
- HTN
- AAOx3 but baseline dementia per OSH records
- hysterectomy
- Colectomy
- BSO
- loculated pleural effusion s/p thoracentesis and chest tube
placement in [**2122**] with cytology on pleural fluid negative for
malignancy

MEDICATION ON ADMISSION: Alendronate 70 mg po weekly
Amlodipine 10 mg po daily
Atenolol 50 mg po daily
Calcium + Vitamin D 600 mg tablet po daily
Docusate 100 mg po daily
Folic Acid 1 mg po daily
Furosemide 40 mg po daily
Lisinopril 10 mg po daily
Lorazepam 0.25 mg po q8h prn
Oxycodone-acetaminophen 3/325 mg po q4-6 hrs prn pain

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Vitals: T: 98 BP:96/59 P:68 R: 18 18 O2: 96% on 50% FM and 4L NC

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: - Tobacco: Quit smoking 12 years ago
- Alcohol: Previous heavy ETOH use not currently sober
- Independent in her ADLs previously, recently discharged from
rehab after a fracture. 

### Response:
{'Disorders of diaphragm,Acute on chronic diastolic heart failure,Unspecified pleural effusion,Pulmonary collapse,Chronic airway obstruction, not elsewhere classified,Personal history of venous thrombosis and embolism,Other persistent mental disorders due to conditions classified elsewhere,Hypoxemia,Personal history of malignant neoplasm of large intestine,Benign essential hypertension'}
