CHIEF COMPLAINT: dyspnea

PRESENT ILLNESS: HPI: This is a 66 year old woman with unknown PMH who is
admitted to the MICU for respiratory distress, altered mental
status, and hyponatremia.  History is obtained from the medical
record, as the patient is unable to give history and no other
sources of history are currently available.  The patient lives
in a group home and the manager of the group home apparently
called EMS because the patient was "not acting herself."  EMS
found the patient to be SOB and with O2sat 88% on RA with RR 30.
did complain of cough for 2-3 days, but no F/C, CP, or N/V/D.
.
In the ED, VS: 96.3, HR 103, BP 154/89, O2sat 99% while on nebs.
 Initially she was apparently wheezing and in some distress.
She was given prednisone 60mg, azithromycin 500mg, ceftriaxone
1g IV, and continuous nebs. She was then placed on CPAP.  When
her CXR showed CHF, she was given aspirin 325 and lasix 40mg IV,
and a ntg gtt was started. She put out 3.5L of urine to the
lasix.
.
The patient was about to be transferred to the ICU, when she was
noted to be more somnolent and difficult to arouse.  It was
decided to intubate her for airway protection.  Just prior to
intubation, ABG was 7.32/67/79.  She was given versed for
sedation and started on a propofol gtt.  She was then taken for
head CT and chest CT prior to coming up to the ICU.

MEDICAL HISTORY: COPD

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 97.7, HR 87, BP 118/54, RR 12, O2 sat 100%
Vent: AC 700x12, PEEP 5, FiO2 40%
Gen: intubated, sedated
HEENT: PERRL, MMM, ETT in place
Neck: supple, unable to appreciate JVD
Lungs: coarse breath sounds b/l, no wheezes or rales
Heart: RRR, distant heart sounds, no murmurs
Abd: +BS, soft, obese, NT/ND
Extrem: warm, no edema, 2+ DP pulses
Neuro: sedated, occasionally coughs/gags on ETT, does not open
eyes to voice or sternal rub

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives in Pine street, Denies alcohol. Started smoking at age 12.
 Son lives in [**State 4260**]
Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia, organism unspecified,Hyposmolality and/or hyponatremia
Acute respiratry failure,Obs chr bronc w(ac) exac,Pneumonia, organism NOS,Hyposmolality
Admission Date:  [**2137-2-27**]              Discharge Date:   [**2137-3-4**]

Date of Birth:  [**2070-11-18**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2160**]
Chief Complaint:
dyspnea

Major Surgical or Invasive Procedure:
Intubation, extubation


History of Present Illness:
HPI: This is a 66 year old woman with unknown PMH who is
admitted to the MICU for respiratory distress, altered mental
status, and hyponatremia.  History is obtained from the medical
record, as the patient is unable to give history and no other
sources of history are currently available.  The patient lives
in a group home and the manager of the group home apparently
called EMS because the patient was "not acting herself."  EMS
found the patient to be SOB and with O2sat 88% on RA with RR 30.
did complain of cough for 2-3 days, but no F/C, CP, or N/V/D.
.
In the ED, VS: 96.3, HR 103, BP 154/89, O2sat 99% while on nebs.
 Initially she was apparently wheezing and in some distress.
She was given prednisone 60mg, azithromycin 500mg, ceftriaxone
1g IV, and continuous nebs. She was then placed on CPAP.  When
her CXR showed CHF, she was given aspirin 325 and lasix 40mg IV,
and a ntg gtt was started. She put out 3.5L of urine to the
lasix.
.
The patient was about to be transferred to the ICU, when she was
noted to be more somnolent and difficult to arouse.  It was
decided to intubate her for airway protection.  Just prior to
intubation, ABG was 7.32/67/79.  She was given versed for
sedation and started on a propofol gtt.  She was then taken for
head CT and chest CT prior to coming up to the ICU.


Past Medical History:
COPD

Social History:
Lives in Pine street, Denies alcohol. Started smoking at age 12.
 Son lives in [**State 4260**]

Family History:
NC


Physical Exam:
VS: T 97.7, HR 87, BP 118/54, RR 12, O2 sat 100%
Vent: AC 700x12, PEEP 5, FiO2 40%
Gen: intubated, sedated
HEENT: PERRL, MMM, ETT in place
Neck: supple, unable to appreciate JVD
Lungs: coarse breath sounds b/l, no wheezes or rales
Heart: RRR, distant heart sounds, no murmurs
Abd: +BS, soft, obese, NT/ND
Extrem: warm, no edema, 2+ DP pulses
Neuro: sedated, occasionally coughs/gags on ETT, does not open
eyes to voice or sternal rub


Pertinent Results:
[**2137-2-27**] 09:44PM   PO2-79* PCO2-67* PH-7.32* TOTAL CO2-36* BASE
XS-5
[**2137-2-27**] 08:43PM URINE  HOURS-RANDOM
[**2137-2-27**] 08:43PM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2137-2-27**] 08:08PM   NA+-119*
[**2137-2-27**] 08:00PM   SODIUM-115*
[**2137-2-27**] 08:00PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2137-2-27**] 06:16PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.012
[**2137-2-27**] 06:16PM URINE  BLOOD-TR NITRITE-NEG PROTEIN-30
GLUCOSE-NEG KETONE-50 BILIRUBIN-NEG UROBILNGN-1 PH-6.5 LEUK-NEG
[**2137-2-27**] 06:16PM URINE  RBC-0-2 WBC-0-2 BACTERIA-RARE YEAST-NONE
EPI-0-2
[**2137-2-27**] 05:03PM   TYPE-ART PO2-184* PCO2-57* PH-7.37 TOTAL
CO2-34* BASE XS-6
[**2137-2-27**] 05:03PM   LACTATE-0.8
[**2137-2-27**] 05:00PM   GLUCOSE-134* UREA N-10 CREAT-0.7 SODIUM-116*
POTASSIUM-3.7 CHLORIDE-74* TOTAL CO2-26 ANION GAP-20
[**2137-2-27**] 05:00PM   estGFR-Using this
[**2137-2-27**] 05:00PM   ALT(SGPT)-36 AST(SGOT)-39 CK(CPK)-294* ALK
PHOS-158* TOT BILI-0.5
[**2137-2-27**] 05:00PM   LIPASE-45
[**2137-2-27**] 05:00PM   cTropnT-<0.01
[**2137-2-27**] 05:00PM   CK-MB-12* MB INDX-4.1 proBNP-239
[**2137-2-27**] 05:00PM   PHOSPHATE-2.8
[**2137-2-27**] 05:00PM   OSMOLAL-244*
[**2137-2-27**] 05:00PM   WBC-18.2*# RBC-5.31 HGB-15.5 HCT-41.8
MCV-79*# MCH-29.2 MCHC-37.1* RDW-14.6
[**2137-2-27**] 05:00PM   NEUTS-82.4* BANDS-0 LYMPHS-10.1* MONOS-6.5
EOS-0.8 BASOS-0.3
[**2137-2-27**] 05:00PM   HYPOCHROM-NORMAL ANISOCYT-1+ POIKILOCY-NORMAL
MACROCYT-NORMAL MICROCYT-1+ POLYCHROM-NORMAL
SPHEROCYT-OCCASIONAL
[**2137-2-27**] 05:00PM   PLT SMR-NORMAL PLT COUNT-276
[**2137-2-27**] 05:00PM   PT-12.4 PTT-29.3 INR(PT)-1.1

Brief Hospital Course:
# Dyspnea: The patient was intubated for airway protection and
was then extubated on [**2-28**], and continued doing well
post-extubation.  The patient was thought to have pneumonia
given her elevated the CTA chest read describing tree in [**Male First Name (un) 239**]
opacities, elevated WBC, and cough.  The patient was not thought
to be in failure as her BNP was 239.  Given the patient's long
history of smoking and emphysema on CTA, she was treated with
steroids.  Her cardiac enzymes were negative for two sets.  She
was treated while hospitalized with steriods, broad spectrum
antibiotics (vanc, zosyn, flagyl) and nebulizers while
hospitalized.  The patient was then converted to augmentin to
finish a 10 day course of antibiotics for her pneumonia.  The
patient was also discharged with a steroid taper.  She had
increased oxygen requirements when transferred to the floor but
was eventaully weaned off of oxygen supplementation.  Blood and
sputum cultures were negative at time of discharge.  The patient
requested assistance with smoking cessation.  She will be
discharged with zyban and instructed to use the nicotine patch.
.
# Hyponatremia - Slowly correcting since admission (Na 116 on
[**2-27**], upon transfer to floor 125). Etiology has been difficult
to determine. Had brisk diuresis in ED and MICU, and sodium
trended up. Urine sodium was subsequently less than 10,
suggesting that she may have crossed over from hypervolemia to
hypovolemia.  She also did not appear volume overloaded (no JVD,
no peripheral edema, MM slightly dry). She was started on
normal saline and her repeat sodium was normal and was stable
upon discharge.
.
# Leukocytosis -The patient's leukocytosis was attributed to the
pneumonia initially then to the steroids that she began during
her hospital course.  The patient was treated with broad
spectrum antibiotics and did not spike during her hospital stay.
.
# Hyperglycemia - denies history of diabetes, is now on
corticosteroid therapy, which is likely causing high serum
glucose levels. She did not require SSI while on the floor.

The patient's son was very involved during the hospital stay. HE
lives in [**State 4260**] and he was going to take the patient with him to
live with hinm in [**State 4260**] on the week of discharge. He was advised
to make a PCP appointment for the patient as soon as he reached
[**State 4260**] and to inform the PCP of this hospitalization. He was given
the business card and contact information for Dr [**First Name (STitle) **]
[**Name (NI) 21386**] (med attending) prior to discharge to give to the new
provider in case the doctor had any questions about this
hospitalization. It was also suggested to them that in case the
patient ended up not going to [**State 4260**] and living alone in MA, he
should arrange to more care eg VNA etc via the patient's
PCP/hospital.

Medications on Admission:
none

Discharge Medications:
1. Prednisone 10 mg Tablet Sig: Five (5) Tablet PO once a day:
Taper as follows: 5 tablets for 5 days, then 4 tablets for 5
days, then 3 tablets for 5 days, then 2 tablets for 5 days, then
1 tablet for 5 days.
Disp:*75 Tablet(s)* Refills:*0*
2. Augmentin 875-125 mg Tablet Sig: One (1) Tablet PO twice a
day for 4 days.
Disp:*8 Tablet(s)* Refills:*0*
3. Zyban 150 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO twice a day for 4 weeks: 1 tablet 150 mg
once daily for 3 days; then increase to 150 mg twice daily; .
Disp:*56 Tablet Sustained Release(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Pneumonia
COPD exacerbation


Discharge Condition:
Stable, afebrile, O2 sat at or above 88% on room air while
ambulating.


Discharge Instructions:
* Rest: You should restrict your activities until you are
completely better.

* Drink plenty of liquids (unless your doctor has told you not
to.)  Do not consume alcohol until you are completely better.

* Many lung conditions are related to smoking.  Quitting now can
help some problems, and prevent others from getting worse.  You
can purchase the nicotine patch at any pharmacy.  Do not wear
the patch while smoking as it may cause a nicotine overdose.

* Be sure to take any prescribed medications as you were
instructed.

Warning Signs:

Call your doctor or return to the Emergency Department right
away if any of the following problems develop:

* You are not getting better in 24 hours, or you are getting
worse in any way.
* You experience new chest pain, pressure, squeezing or
tightness.
* You have shaking chills, or a fever greater than 102 degrees
(F)
* New or worsening cough or wheezing.
* Abdominal (belly) pain, vomiting, severe headache.
* Dizziness, confusion or change in behavior.
* Any serious change in your symptoms, or any new symptoms that
concern you.


Followup Instructions:
Follow up with your primary care provider in two weeks.

You should have a repeat chest x-ray done in one month as well
as have pulmonary function tests done.

Your PCP should follow up on the nodularity seen in the right
lobe of the thyroid on your CT scan.
A thyroid nodule was identified on CT, you should have an
ultrasound and close follow up with your primary care provider
for this issue.

You should also follow up with a psychiatrist within the next
month.
{'Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia, organism unspecified,Hyposmolality and/or hyponatremia'}


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: dyspnea

PRESENT ILLNESS: HPI: This is a 66 year old woman with unknown PMH who is
admitted to the MICU for respiratory distress, altered mental
status, and hyponatremia.  History is obtained from the medical
record, as the patient is unable to give history and no other
sources of history are currently available.  The patient lives
in a group home and the manager of the group home apparently
called EMS because the patient was "not acting herself."  EMS
found the patient to be SOB and with O2sat 88% on RA with RR 30.
did complain of cough for 2-3 days, but no F/C, CP, or N/V/D.
.
In the ED, VS: 96.3, HR 103, BP 154/89, O2sat 99% while on nebs.
 Initially she was apparently wheezing and in some distress.
She was given prednisone 60mg, azithromycin 500mg, ceftriaxone
1g IV, and continuous nebs. She was then placed on CPAP.  When
her CXR showed CHF, she was given aspirin 325 and lasix 40mg IV,
and a ntg gtt was started. She put out 3.5L of urine to the
lasix.
.
The patient was about to be transferred to the ICU, when she was
noted to be more somnolent and difficult to arouse.  It was
decided to intubate her for airway protection.  Just prior to
intubation, ABG was 7.32/67/79.  She was given versed for
sedation and started on a propofol gtt.  She was then taken for
head CT and chest CT prior to coming up to the ICU.

MEDICAL HISTORY: COPD

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 97.7, HR 87, BP 118/54, RR 12, O2 sat 100%
Vent: AC 700x12, PEEP 5, FiO2 40%
Gen: intubated, sedated
HEENT: PERRL, MMM, ETT in place
Neck: supple, unable to appreciate JVD
Lungs: coarse breath sounds b/l, no wheezes or rales
Heart: RRR, distant heart sounds, no murmurs
Abd: +BS, soft, obese, NT/ND
Extrem: warm, no edema, 2+ DP pulses
Neuro: sedated, occasionally coughs/gags on ETT, does not open
eyes to voice or sternal rub

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives in Pine street, Denies alcohol. Started smoking at age 12.
 Son lives in [**State 4260**] 

### Response:
{'Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia, organism unspecified,Hyposmolality and/or hyponatremia'}
