CHIEF COMPLAINT: Respiratory distress

PRESENT ILLNESS: 32 year old female with a history of asthma presented [**2114-8-31**]
with status asthmaticus. She normally has good symptom control
on advair and albuterol and has been hospitalized for
respiratory distress, but has never been intubated. She
developed a URI 1 week prior to admission, which is the likely
trigger. She went to an OSH initially and was given
ceftriaxone/azithromycin and solumedrol. CTA of the chest was
negative for PE or infiltrate. Her ABG (unclear on how much
oxygen) was slightly acidotic, but showed good oxygenation and
no evidence of CO2 retention. She was transferred here on
continuous nebulizer treatments, received magnesium and
continued solumedrol.

MEDICAL HISTORY: Asthma--well controlled on advair and prn albuterol, no
intubations, infrequent steroid tapers
Pancreatitis x1 (medication-related)
Crohn's s/p colonic resection >10 years ago
s/p lap ventral hernia
s/p c-section x 2
Anxiety: on chronic benzodiazepines

MEDICATION ON ADMISSION: Celexa 80 qd
Diazepam 10-15 mg qid prn anxiety (confirmed with pt's pharmacy)
HCTZ 25 qd
Prilosec 40 qd
Adavir 250 [**Hospital1 **]
Albuterol MDI prn

ALLERGIES: Metronidazole / Sulfa (Sulfonamides)

PHYSICAL EXAM: VS: T 96.5, BP 126/62, HR 97, RR 20, Sat 94% on neb
Gen: Speaking full sentences, no retractions
HEENT: MMM, PERRL, no photophobia
Neck: Supple, no meningismus or rigidity
CV: s1s2 RRR
Pulm: Diffuse exp wheezes bilaterally, moving air moderately
well
Abd: Obese, soft, NT/ND
Back: No CVAT, no vertebral TTP
Ext: No edema, warm/dry
Skin: No rashes
Neuro: A&O x 3, speaking in fluent full sentences, MAE, nonfocal

FAMILY HISTORY: Paternal GM with breast ca, HD
Mat GM: HD
Father: HTN

SOCIAL HISTORY: The patient lives at home with her husband.  She is a former
smoker, quit a few weeks ago. DEnies ETOH or recreational drug
use.  Homemaker. Married, 2 kids; one cat at home
Asthma, unspecified type, with status asthmaticus,Bacteremia,Regional enteritis of unspecified site,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Unspecified essential hypertension
Asthma w status asthmat,Bacteremia,Regional enteritis NOS,Enterococcus group d,Hypertension NOS
Admission Date:  [**2114-8-31**]              Discharge Date:   [**2114-9-10**]

Date of Birth:  [**2081-12-5**]             Sex:   F

Service: MEDICINE

Allergies:
Metronidazole / Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 5119**]
Chief Complaint:
Respiratory distress

Major Surgical or Invasive Procedure:
Arterial line placement


History of Present Illness:
32 year old female with a history of asthma presented [**2114-8-31**]
with status asthmaticus. She normally has good symptom control
on advair and albuterol and has been hospitalized for
respiratory distress, but has never been intubated. She
developed a URI 1 week prior to admission, which is the likely
trigger. She went to an OSH initially and was given
ceftriaxone/azithromycin and solumedrol. CTA of the chest was
negative for PE or infiltrate. Her ABG (unclear on how much
oxygen) was slightly acidotic, but showed good oxygenation and
no evidence of CO2 retention. She was transferred here on
continuous nebulizer treatments, received magnesium and
continued solumedrol.

ROS: Neg for chest pain, rash, abd pain, diarrhea. Yesterday had
one episode of post-tussive emesis.

In ED here, received magnesium, continuous neb; currently 94% on
continuous albuterol neb and feeling improved. Complaining of HA
which she has had since last night, gradual onset, hx HA in the
past, has used Fioricet previously.

Past Medical History:
Asthma--well controlled on advair and prn albuterol, no
intubations, infrequent steroid tapers
Pancreatitis x1 (medication-related)
Crohn's s/p colonic resection >10 years ago
s/p lap ventral hernia
s/p c-section x 2
Anxiety: on chronic benzodiazepines


Social History:
The patient lives at home with her husband.  She is a former
smoker, quit a few weeks ago. DEnies ETOH or recreational drug
use.  Homemaker. Married, 2 kids; one cat at home


Family History:
Paternal GM with breast ca, HD
Mat GM: HD
Father: HTN

Physical Exam:
VS: T 96.5, BP 126/62, HR 97, RR 20, Sat 94% on neb
Gen: Speaking full sentences, no retractions
HEENT: MMM, PERRL, no photophobia
Neck: Supple, no meningismus or rigidity
CV: s1s2 RRR
Pulm: Diffuse exp wheezes bilaterally, moving air moderately
well
Abd: Obese, soft, NT/ND
Back: No CVAT, no vertebral TTP
Ext: No edema, warm/dry
Skin: No rashes
Neuro: A&O x 3, speaking in fluent full sentences, MAE, nonfocal


Pertinent Results:
CBC:
[**2114-8-31**] 06:48AM BLOOD WBC-11.0 RBC-5.33# Hgb-14.4# Hct-45.3#
MCV-85 MCH-27.1 MCHC-31.9 RDW-15.2 Plt Ct-289
[**2114-9-1**] 03:27AM BLOOD WBC-21.3*# RBC-4.86 Hgb-13.2 Hct-41.0
MCV-84 MCH-27.2 MCHC-32.3 RDW-15.4 Plt Ct-303
[**2114-9-10**] 06:30AM BLOOD WBC-15.4* RBC-4.54 Hgb-13.0 Hct-38.3
MCV-84 MCH-28.6 MCHC-33.9 RDW-15.0 Plt Ct-260
[**2114-8-31**] 06:48AM BLOOD Neuts-91.5* Lymphs-7.4* Monos-0.8*
Eos-0.2 Baso-0.1

Chem-10:
[**2114-8-31**] 06:48AM BLOOD Glucose-243* UreaN-10 Creat-0.9 Na-132*
K-6.4* Cl-99 HCO3-22 AnGap-17
[**2114-8-31**] 12:30PM BLOOD Glucose-205* UreaN-10 Creat-0.8 Na-135
K-4.7 Cl-102 HCO3-26 AnGap-12
[**2114-9-9**] 07:05AM BLOOD Glucose-108* UreaN-19 Creat-0.6 Na-135
K-3.9 Cl-96 HCO3-30 AnGap-13
[**2114-9-10**] 06:30AM BLOOD Glucose-102 UreaN-17 Creat-0.7 Na-138
K-4.0 Cl-97 HCO3-30 AnGap-15
[**2114-8-31**] 12:30PM BLOOD Calcium-8.9 Phos-3.6 Mg-2.8*
[**2114-9-10**] 06:30AM BLOOD Calcium-9.1 Phos-4.8* Mg-2.1

Cardiac enzymes:
[**2114-9-1**] 03:27AM BLOOD CK(CPK)-75
[**2114-9-1**] 11:05AM BLOOD CK(CPK)-87
[**2114-9-1**] 05:42PM BLOOD CK(CPK)-77
[**2114-9-1**] 03:27AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2114-9-1**] 11:05AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2114-9-1**] 05:42PM BLOOD CK-MB-NotDone cTropnT-<0.01

ABGs:
[**2114-8-31**] 10:31AM BLOOD Type-ART pO2-70* pCO2-51* pH-7.33*
calTCO2-28 Base XS-0
[**2114-8-31**] 12:42PM BLOOD Type-ART pO2-91 pCO2-53* pH-7.33*
calTCO2-29 Base XS-0
[**2114-9-1**] 08:00PM BLOOD Type-ART pO2-73* pCO2-40 pH-7.42
calTCO2-27 Base XS-0

Lactate:
[**2114-8-31**] 10:31AM BLOOD Lactate-1.5 Na-136 K-4.5 Cl-98*
[**2114-8-31**] 06:38PM BLOOD Lactate-1.9
[**2114-8-31**] 12:30PM BLOOD PERTUSSIS SEROLOGY-PND

Microbiology:
Blood cx's: E. faecalis, sensitive to ampicillin
Urine legionella antigen: negative
Surveillence cx's: negative

Imaging Studies:
CXRs from admission:IMPRESSION: Ill-defined density of the right
lower lobe and left retrocardiac region. The latter findings
might represent pneumonia in correct clinical setting.

Subsequent CXRs demonstrate increased and improved aeration of
her lungs.

Head CT:
IMPRESSION: Tiny left frontal subcutaneous hematoma without
underlying
fracture or intracranial hemorrhage.


Brief Hospital Course:
A/P: 32 y.o. F with asthma presenting with status asthmaticus,
much improved with room air/ambulatory sats in the 95%. Also
with E. faecalis bacteremia. Called out of MICU on [**9-1**].

#Asthma exacerbation: Patient was initially admitted to the MICU
for monitoring and treatment of her asthma exacerbation. She
received continuous albuterol nebs, as well as additional
magnesium, Atrovent, Advair, and IV Solumedrol. Given her
persistent hypoxia on ICU day 2, Azithromycin was added for
atypical coverage and she completed a 5 day course while in the
hospital.  An arterial line was placed for monitoring. She
clinically improved and oxygen was able to be weaned to room air
(93%), but the patient was sypmtomatically more comfortable on a
35% humidified face tent. She was transferred to the floor on
[**2114-9-2**], and transitioned to oral prednisone. Her ambulatory
saturations improved to 95%. Her peak flows were acceptable per
respiratory. She was continued on a 2 week prednisone taper as
follows: 60 mg x3 days ([**Date range (1) 29491**],completed), 50 mg x3 days
([**Date range (1) 22564**], completed), 40 mg x3 days ([**Date range (1) 29492**]), 30 mg x3 days
([**Date range (1) 8967**]), 20 mg x3 days ([**Date range (1) 29493**]), then off.) She was
tapered off of standing albuterol nebs and discharged on q6H PRN
with a machine at home (SW instrumental in helping her get this
at no cost). She was continued on Advair, Singulair on
discharge. She was attempted on CPAP but did not tolerate the
machine (had panic attack and claustrophobia). She may have a
sleep study to evaluate for OSA as an outpatient. She has
pertussis serology still pending at the time of discharge.

#Bacteremia: Pt had pansensitive E. faecalis from [**8-31**] blood
cultures. Her surveillance cultures negative. She received 10
days of IV ampicillin while in house. Afebrile and
hemodynamically stable on discharge.

#Fall: Pt reports a fall in ICU, and being unsteady on her feet
(not at her baseline, as reports being very active.) She also
had a fall overnight on [**9-6**] after receiving sleeping
medication, and she hit her head and her R knee. Her neurologic
exam and MS exams were stable, and her hematocrit remained
stable at 38. She had a Head CT w/o contrast that showed a
subcutaneous hematoma, but no evidence of intracranial bleed,
midline shift, or structural malformation. She received
Ibuprofen/Tylenol for soft tissue trauma/pain to her frontal
head, R knee. She was kept on fall precautions and was not given
sleeping medication at night thereafter. PT was consulted, and
deemed her safe to go home with physical therapy treatments.

#Anxiety: She takes high doses of valium daily as outpatient,
and was tolerating ativan here. Benzodiazapines were held
initially during her hospitalization, as there was concern on
admission for respitory compromise. While on the floor, her
respirations were stable. She was continued on celexa and a
lower dose of her outpatient valium (TID instead of QID.) Her
outpt psychiatrist has referred her to outpt therapist to deal
w/ multiple psychosocial stressors at home.  SW has provided pt
with resources to help w/ therapist co-pay from MassHealth.

#Hyperglycemia: in setting of acute illness and steroids.
Continued on regular insulin sliding scale while in house.
.
#Back pain: Likely osteoarthritis, muscular pain,
deconditioning. Pt was treated w/ ibuprofen (pre-treated w/
compazine for nausea) and lidocaine patches.
.
#Crohn's Disease: currently with diarrhea--likely antibiotic
associated, given high dose steroids recently. Otherwise,
disease has been in remission.
.
#Hypertension:  Stable on HCTZ
.
#FEN: Regular diet, repleted electrolytes as necessary.
#Ppx: Heparin SQ, PPI, bowel regimen.
#Code full
#Dispo: home with physical therapy.

Medications on Admission:
Celexa 80 qd
Diazepam 10-15 mg qid prn anxiety (confirmed with pt's pharmacy)
HCTZ 25 qd
Prilosec 40 qd
Adavir 250 [**Hospital1 **]
Albuterol MDI prn


Discharge Medications:
1. Hydrochlorothiazide 12.5 mg Capsule Sig: Two (2) Capsule PO
DAILY (Daily).
2. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

3. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
4. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
[**12-6**] Disk with Devices Inhalation [**Hospital1 **] (2 times a day).
5. Miconazole Nitrate 2 % Cream Sig: One (1) Appl Topical [**Hospital1 **] (2
times a day).
6. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily) as
needed.
Disp:*10 Adhesive Patch, Medicated(s)* Refills:*0*
8. Prednisone 10 mg Tablet Sig: 1-4 Tablets PO once a day: Take
3 tablets (30 mg) [**Date range (1) 8967**]; then take 2 tablets (20 mg)
[**Date range (1) 29493**]; then take 1 tablet (10 mg) [**Date range (1) 16066**], then stop.
Disp:*18 Tablet(s)* Refills:*0*
9. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 puffs Inhalation
four times a day.
10. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for back pain.
11. Diazepam 10 mg Tablet Sig: One (1) Tablet PO four times a
day as needed: for anxiety.
12. Equipment
Nebulizer
13. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: 1-2 puffs Inhalation four times a day as
needed for shortness of breath or wheezing.
Disp:*30 nebs* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
VNA of Southeastern Mass.

Discharge Diagnosis:
Asthma exacerbation

Discharge Condition:
Off oxygen, ambulating with PT


Discharge Instructions:
You were admitted with a diagnosis of a bad flare of your asthma
known as status asthmaticus. You also were diagnosed with
bacteria in your blood stream.

The status asthmaticus required that you stay in the ICU for 2
days. Your vital signs and oxygen saturations were monitered
closely, and you were treated with oxygen therapy, oral
prednisone, and an antibiotic known as azithromycin to cover for
bacteria in the lung that might have been causing an infection.
You completed the azithromycin while in the hospital. Your
prednisone will need to be taken over two weeks according to the
taper listed below.

The bacteria in the blood was treated with the antibiotic
ampicillin. It proved to have cleared from your blood stream on
repeat blood cultures after the ampicillin was started. You
received 10 days total of this medication while in the hospital.

You were discharged on the following new medications:
-Prednisone taper: (2 week taper plan:)
60 mg x3 days (completed),
50 mg x3 days ([**Date range (1) 22564**], completed),
40 mg x3 days ([**Date range (1) 29492**], completed),
30 mg x3 days ([**Date range (1) 8967**], to start day after discharge),
20 mg x3 days ([**Date range (1) 29493**]),
then off.

-Lidocaine patches: can use as needed for back pain
-Singulair: a medication for asthma control
-You can take Acetaminophen (up to 4 grams per day) or Ibuprofen
over the counter as needed for headache and back pain.
-You can continue to take the celexa, diazepam,
hydrochlorothiazide, advair, prilosec and albuterol as you were
prior to admission. You were discharged on a celexa dose of 40
mg, even though your admission information states you were on 80
mg daily, because this exceeds the maximum dosage limit advised
in adults. No prescriptions for your outpatient medications will
be provided. Please contact your PCP or prescribing physician if
refills are needed and to discuss the dose of your celexa.

We recommend you follow up with a pulmonary specialist, the
number for the [**Hospital 18**] clinic is provided. If it is difficult for
you to come to [**Location (un) 86**], please discuss finding a pulmonary
specialist closer to your home. We recommend a sleep study for
evaluation of obstructive sleep apnea as an outpatient.

Please return to the ED or call your primary care physician if
you experience any of the following symptoms:
shortness of breath, intense difficulty breathing, chest pain,
abdominal pain, leg or back pain, nausea, vomiting, diarrhea,
temperature greater than 101 F, or any other symptoms not listed
here that are disturbing to you.

Followup Instructions:
Please follow up with your primary care physician after
discharge, Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 9347**].

[**Hospital1 18**] Pulmonary Clinic: ([**Telephone/Fax (1) 513**]. If you would prefer to
see a specialist closer to your house, please discuss referrals
with your PCP.

-We recommend you get a sleep study to be assessed for
obstructive sleep apnea


                             [**First Name7 (NamePattern1) 1569**] [**Initial (NamePattern1) **] [**Name8 (MD) **] MD [**MD Number(2) 5122**]

Completed by:[**2114-9-12**]
{'Asthma, unspecified type, with status asthmaticus,Bacteremia,Regional enteritis of unspecified site,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Unspecified 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: Respiratory distress

PRESENT ILLNESS: 32 year old female with a history of asthma presented [**2114-8-31**]
with status asthmaticus. She normally has good symptom control
on advair and albuterol and has been hospitalized for
respiratory distress, but has never been intubated. She
developed a URI 1 week prior to admission, which is the likely
trigger. She went to an OSH initially and was given
ceftriaxone/azithromycin and solumedrol. CTA of the chest was
negative for PE or infiltrate. Her ABG (unclear on how much
oxygen) was slightly acidotic, but showed good oxygenation and
no evidence of CO2 retention. She was transferred here on
continuous nebulizer treatments, received magnesium and
continued solumedrol.

MEDICAL HISTORY: Asthma--well controlled on advair and prn albuterol, no
intubations, infrequent steroid tapers
Pancreatitis x1 (medication-related)
Crohn's s/p colonic resection >10 years ago
s/p lap ventral hernia
s/p c-section x 2
Anxiety: on chronic benzodiazepines

MEDICATION ON ADMISSION: Celexa 80 qd
Diazepam 10-15 mg qid prn anxiety (confirmed with pt's pharmacy)
HCTZ 25 qd
Prilosec 40 qd
Adavir 250 [**Hospital1 **]
Albuterol MDI prn

ALLERGIES: Metronidazole / Sulfa (Sulfonamides)

PHYSICAL EXAM: VS: T 96.5, BP 126/62, HR 97, RR 20, Sat 94% on neb
Gen: Speaking full sentences, no retractions
HEENT: MMM, PERRL, no photophobia
Neck: Supple, no meningismus or rigidity
CV: s1s2 RRR
Pulm: Diffuse exp wheezes bilaterally, moving air moderately
well
Abd: Obese, soft, NT/ND
Back: No CVAT, no vertebral TTP
Ext: No edema, warm/dry
Skin: No rashes
Neuro: A&O x 3, speaking in fluent full sentences, MAE, nonfocal

FAMILY HISTORY: Paternal GM with breast ca, HD
Mat GM: HD
Father: HTN

SOCIAL HISTORY: The patient lives at home with her husband.  She is a former
smoker, quit a few weeks ago. DEnies ETOH or recreational drug
use.  Homemaker. Married, 2 kids; one cat at home 

### Response:
{'Asthma, unspecified type, with status asthmaticus,Bacteremia,Regional enteritis of unspecified site,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Unspecified essential hypertension'}
