CHIEF COMPLAINT: hypoxia

PRESENT ILLNESS: 81 y/o M w/ Lung Ca, recent MI, emphysema with home O2 2L, over
past 1-week has had increasing dyspnea.  No f/c/ns/chest pain.
Saw PCP [**Name Initial (PRE) 7790**].  Sat was low 80's on 2L.  On Chemo currently.
 Baseline WBC count elevation with chemotherapy with alimta.

MEDICAL HISTORY: 1) CAD s/p MI in [**2140**] by EKG diagnosis, no admission, no
symptoms, ETT/MIBI [**2159**] showing partially reversible defect in
RCA distribution. No interventions performed.
2) HTN
3) Hyperlipidemia
4) COPD
5) DJD
6) Thoracic artery aneursym, stable
7) Nonsmall cell lung cancer (see below)

MEDICATION ON ADMISSION: 1. Citalopram 10 mg Tablet Sig: One (1) Tablet PO once a day.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Tmax: 36.8 ??????C (98.2 ??????F)

FAMILY HISTORY: Father died at age 43 of unknown causes.
Mother died of breast cancer complications at age 53.
Sister had breast cancer and lung cancer and died at age 80

SOCIAL HISTORY: He lives in [**Location 3146**]. He is married and has a daughter and a son.
[**Name (NI) **] has two grandchildren. He is here today with his wife & son.
[**Name (NI) **] smoked for at least 50 years, stopped smoking 3-4 years ago.
He drinks occasional alcohol. He used to work as a carpenter, it
is unclear if he has had asbestos exposure.
Obstructive chronic bronchitis with (acute) exacerbation,Malignant neoplasm of bronchus and lung, unspecified,Malignant neoplasm of liver, secondary,Other pulmonary insufficiency, not elsewhere classified,Leukocytosis, unspecified,Retention of urine, unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Hyperpotassemia,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Thoracic aneurysm without mention of rupture,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Acute upper respiratory infections of unspecified site
Obs chr bronc w(ac) exac,Mal neo bronch/lung NOS,Second malig neo liver,Other pulmonary insuff,Leukocytosis NOS,Retention urine NOS,Adv eff corticosteroids,Hyperpotassemia,Old myocardial infarct,Hypertension NOS,Hyperlipidemia NEC/NOS,Osteoarthros NOS-unspec,Thoracic aortic aneurysm,BPH w urinary obs/LUTS,Acute uri NOS
Admission Date:  [**2164-1-13**]              Discharge Date:   [**2164-1-19**]

Date of Birth:  [**2082-4-5**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Known firstname 5552**]
Chief Complaint:
hypoxia

Major Surgical or Invasive Procedure:
none

History of Present Illness:
81 y/o M w/ Lung Ca, recent MI, emphysema with home O2 2L, over
past 1-week has had increasing dyspnea.  No f/c/ns/chest pain.
Saw PCP [**Name Initial (PRE) 7790**].  Sat was low 80's on 2L.  On Chemo currently.
 Baseline WBC count elevation with chemotherapy with alimta.

.

In the ED, initial vs were: 98.3, 104, 151/78, RR30-35, O2 Sat
99% NRB.  Exam was notable for mild wheeze.  CXR was read as
negative.  Patient got CTA for question PE -> negative.  Was
treated as COPD flare.

.

On arrival, patient was tachypneic to 28-30 with O2 sat of 97%
on NRB.  T98.2, Bp 151/78, HR 96


Past Medical History:
1) CAD s/p MI in [**2140**] by EKG diagnosis, no admission, no
symptoms, ETT/MIBI [**2159**] showing partially reversible defect in
RCA distribution. No interventions performed.
2) HTN
3) Hyperlipidemia
4) COPD
5) DJD
6) Thoracic artery aneursym, stable
7) Nonsmall cell lung cancer (see below)

ONCOLOGIC HISTORY:
Mr. [**Known lastname 14194**] was in his USOH until [**2163-7-25**] when he
presented with hemoptysis and weight loss of 10 pounds over
previous 1-2 months. He had a CT scan of the chest on [**8-21**] and
it showed a 4.1 x 4.0 right hilar mass with subcarinal
lymphadenopathy, 19 mm right axillary lymph node as well as
multiple right lower lobe and left lower lobe nodules concerning
for lung cancer. On [**2163-8-28**], he was admitted to [**Hospital1 771**] with chest pain and ruled out for a
non-ST elevation MI. He was seen by the hematology-oncology
consult service while in the hospital and underwent FNA of the
right axillary lymph node, the pathology of which showed
nonsmall cell cancer, squamous cell type. He was discharged on
the third of [**Month (only) 359**] and then on [**2163-8-30**], he had a
bronchoscopy done for evaluation of his hemoptysis as well as
bronchial biopsy and the cytology confirmed metastatic nonsmall
cell lung cancer. He has subsequently completed 2 cycles of
Navelbine.

Social History:
He lives in [**Location 3146**]. He is married and has a daughter and a son.
[**Name (NI) **] has two grandchildren. He is here today with his wife & son.
[**Name (NI) **] smoked for at least 50 years, stopped smoking 3-4 years ago.
He drinks occasional alcohol. He used to work as a carpenter, it
is unclear if he has had asbestos exposure.


Family History:
Father died at age 43 of unknown causes.
Mother died of breast cancer complications at age 53.
Sister had breast cancer and lung cancer and died at age 80

Physical Exam:
Tmax: 36.8 ??????C (98.2 ??????F)

Tcurrent: 36.8 ??????C (98.2 ??????F)

HR: 91 (91 - 99) bpm

BP: 162/85(104) {151/70(97) - 163/85(108)} mmHg

RR: 25 (24 - 29) insp/min

SpO2: 96%

 O2 Delivery Device: Medium conc mask

SpO2: 96%
 ABG: 7.45/31/140//0

Physical Examination

General Appearance: Well nourished, No(t) Overweight / Obese,
Diaphoretic

Eyes / Conjunctiva: PERRL

Head, Ears, Nose, Throat: Normocephalic

Cardiovascular: (S1: Normal), (S2: Normal), No(t) S3, No(t) S4,
No(t) Rub

Peripheral Vascular: (Right radial pulse: Present), (Left radial
pulse: Present), (Right DP pulse: Not assessed), (Left DP pulse:
Not assessed)

Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds:
Diminished: occasional wheezes, rare)

Abdominal: Soft, Non-tender, Bowel sounds present, No(t)
Distended

Extremities: Right: Absent, Left: Absent

Musculoskeletal: No(t) Muscle wasting

Skin:  Not assessed

Neurologic: Attentive, Follows simple commands


Pertinent Results:
Labs on Admission:
[**2164-1-13**] 03:45PM BLOOD WBC-63.7*# RBC-3.50* Hgb-10.6* Hct-30.5*
MCV-87 MCH-30.4 MCHC-34.8 RDW-17.7* Plt Ct-329
[**2164-1-13**] 03:45PM BLOOD Glucose-107* UreaN-23* Creat-0.9 Na-132*
K-4.7 Cl-98 HCO3-22 AnGap-17
[**2164-1-14**] 03:14AM BLOOD Calcium-8.9 Phos-5.0* Mg-2.2
[**2164-1-13**] 07:23PM BLOOD Type-ART pO2-140* pCO2-31* pH-7.45
calTCO2-22 Base XS-0
Lactic Acid:2.0 mmol/L
.
Imaging:
CTA [**2164-1-14**]:
1. No pulmonary embolism or secondary signs of embolism.
2. While the right hilar mass, multiple parenchymal lung masses,
and thoracic lymphadenopthy have deacreased in size,
intra-abdominal metastases, including hepatic metastases, have
increased in size. L1 lucent lesion, worrisome for metastasis,
is more conspicuous today.
3. Emphysema with upper lobe predominant ground- glass opacity
which may
represent respiratory bronchiolitis-associated interstitial lung
disease.
4. Decreased right pleural effusion.
.
CXR on Admission:  No appreciable change compared to torso
[**2163-10-27**]. Known right hilar and right lower lobe masses
re-demonstrated with persistent interstitial abnormality of the
right lung concerning for possible lymphangitic carcinomatosis.
No evident new superimposed acute abnormality.
.
CXR [**2164-1-17**]: In comparison with the study of [**1-14**], there is
persistent
enlargement of the right hilum consistent with the mass seen on
CT.
Increasing opacification in the right upper lobe just above the
minor fissure consistent with developing pneumonia. Suggestion
of a similar area of opacification in the left upper zone. Mild
atelectatic changes are seen at the left base.


Brief Hospital Course:
81 y/o M w/ long smoking history, emphysema, metastatic
non-small cell lung cancer, CAD, who p/w respiratory distress
from COPD flare. Initially admitted to MICU,  improved on
steroids & azithromycin and transferred to OMED. [**Hospital 2035**] hospital
course according to active problem list.
.
#Respiratory distress: Secondary to COPD exacerbation. Initially
treated in ICU requiring 50% face mask. Transferred to OMED once
oxygen requirement stable on NC. Stable on 4 L NC (patient's
baseline is 2 L NC). Patient was discharged on prednisone taper
and inhalers. Patient was treated with Azithromycin for total of
7 days.
.
#Leukocytosis: Stable at WBC 40K. Was as high as 63K on
admission. Discussed with Heme/Onc to evaluate his leukocytosis
and eosinophilia, which was thought likely [**12-26**] underlying cancer
and unlikely related to tx with Alimta.
.
# Lung Ca: Hepatic metastases. Care per primary oncologist Dr.
[**Last Name (STitle) **].
.
# Hyperkalemia: Resolved following kayexylate. Captopril was
discontinued (started during admission for elevated blood
pressure).
.
#Hypertension: Atenolol held during acute exacerbation,
re-started prior to discharge.
.
# Urinary retention: Patient demonstrated urinary retention in
ICU. Refused foley and discharge on BPH medication. Improved
prior to discharge.
.
#CAD: Not active during admission. Discharged on statin and
Atenolol. Patient did not tolerate captopril due to hyperK.
- Patient should discuss ASA use with primary care doctor


Medications on Admission:
1. Citalopram 10 mg Tablet Sig: One (1) Tablet PO once a day.

2. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)

Capsule, Delayed Release(E.C.) PO BID (2 times a day).

3. Atenolol 50 mg Tablet Sig: One (1) Tablet PO once a day.

4. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily).

Tablet(s)

5. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)

Tablet, Chewable PO BID (2 times a day).

6. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day.


7. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) puffs

Inhalation every four (4) hours as needed for shortness of

breath or wheezing.

8. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at


bedtime).

9. Salmeterol 50 mcg/Dose Disk with Device Sig: One (1) puff

Inhalation Q12H (every 12 hours).

10. Prochlorperazine Maleate 10 mg Tablet Sig: One (1) Tablet PO


Q6H (every 6 hours) as needed for nausea.


Discharge Medications:
1. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO BID (2 times a day).
2. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO BID (2 times a day).
4. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
6. Prednisone 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 7 days: Take 2 tablets daily for 3 days then take 1 tab
daily for 7 days.
Disp:*13 Tablet(s)* Refills:*0*
7. Azithromycin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 3 days: Take for 3 more days for total 7 days. .
Disp:*3 Tablet(s)* Refills:*0*
8. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) puffs
Inhalation every four (4) hours as needed for shortness of
breath or wheezing.
9. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
[**11-25**]  Inhalation twice a day.
Disp:*1 inhaler* Refills:*3*
10. Citalopram 10 mg Tablet Sig: One (1) Tablet PO once a day.
11. Atenolol 50 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Non-small cell lung cancer
COPD
Coronary artery disease


Discharge Condition:
Good, ambulating, on 3 L NC.


Discharge Instructions:
You were admitted for difficulty breathing due to a COPD flare.
You will be discharged on antibiotics, new inhalers, and
steroids.

THIS IS VERY IMPORTANT - DO NOT TAKE YOUR SCHEDULED
DEXAMETHASONE (as scheduled prior to chemotherapy with Dr.
[**Last Name (STitle) **] [**2164-1-24**]). We are discharging you on another type of
steroids (prednisone) and if you take both Prednisone and
Dexamethasone your blood sugar will elevate to a critical level
which is dangerous to your health.
.
Please contact Dr.[**Name (NI) 8949**] office regarding plans for your
chemotherapy.
.
Attend all your follow-up appointments:
Provider: [**Known firstname **] [**Last Name (NamePattern1) 593**], MD Phone:[**0-0-**]
Date/Time:[**2164-1-24**] 9:30
Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2164-1-24**]
9:30
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10384**], RN Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2164-1-24**] 10:30
.
We have made the following changes to your medication:
# ADDED: New inhalers to treat your COPD: Advair. Continue to
take the Albuterol as needed for shortness of breath.
# ADDED: Prednisone. You will take 20 mg (2 tablets) once a day
for 3 days, then 10 mg for 7 days. DO NOT TAKE YOUR SCHEDULED
DEXAMETHASONE. If you take both Prednisone and Dexamethasone
your blood sugar will elevate to a critical level which is
dangerous to your health.
# ADDED: Antibiotic Azithromycin 250 mg once a day for three
more days
# STOPPED: Salmeterol inhaler - instead you will take Advair
# STOPPED: Captopril because your potassium was too high while
on this.
.
Return to the ER if you experience fever, chills, increased
difficulty breathing, chest pain or other concerning symptoms.

Followup Instructions:
Provider: [**Known firstname **] [**Last Name (NamePattern1) 593**], MD Phone:[**0-0-**]
Date/Time:[**2164-1-24**] 9:30
Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2164-1-24**]
9:30
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10384**], RN Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2164-1-24**] 10:30



Completed by:[**2164-2-1**]
{'Obstructive chronic bronchitis with (acute) exacerbation,Malignant neoplasm of bronchus and lung, unspecified,Malignant neoplasm of liver, secondary,Other pulmonary insufficiency, not elsewhere classified,Leukocytosis, unspecified,Retention of urine, unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Hyperpotassemia,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Thoracic aneurysm without mention of rupture,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Acute upper respiratory infections of unspecified site'}


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: hypoxia

PRESENT ILLNESS: 81 y/o M w/ Lung Ca, recent MI, emphysema with home O2 2L, over
past 1-week has had increasing dyspnea.  No f/c/ns/chest pain.
Saw PCP [**Name Initial (PRE) 7790**].  Sat was low 80's on 2L.  On Chemo currently.
 Baseline WBC count elevation with chemotherapy with alimta.

MEDICAL HISTORY: 1) CAD s/p MI in [**2140**] by EKG diagnosis, no admission, no
symptoms, ETT/MIBI [**2159**] showing partially reversible defect in
RCA distribution. No interventions performed.
2) HTN
3) Hyperlipidemia
4) COPD
5) DJD
6) Thoracic artery aneursym, stable
7) Nonsmall cell lung cancer (see below)

MEDICATION ON ADMISSION: 1. Citalopram 10 mg Tablet Sig: One (1) Tablet PO once a day.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Tmax: 36.8 ??????C (98.2 ??????F)

FAMILY HISTORY: Father died at age 43 of unknown causes.
Mother died of breast cancer complications at age 53.
Sister had breast cancer and lung cancer and died at age 80

SOCIAL HISTORY: He lives in [**Location 3146**]. He is married and has a daughter and a son.
[**Name (NI) **] has two grandchildren. He is here today with his wife & son.
[**Name (NI) **] smoked for at least 50 years, stopped smoking 3-4 years ago.
He drinks occasional alcohol. He used to work as a carpenter, it
is unclear if he has had asbestos exposure. 

### Response:
{'Obstructive chronic bronchitis with (acute) exacerbation,Malignant neoplasm of bronchus and lung, unspecified,Malignant neoplasm of liver, secondary,Other pulmonary insufficiency, not elsewhere classified,Leukocytosis, unspecified,Retention of urine, unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Hyperpotassemia,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Thoracic aneurysm without mention of rupture,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Acute upper respiratory infections of unspecified site'}
