CHIEF COMPLAINT: SOB

PRESENT ILLNESS: 86 F with PMH of HTN, dCHF, functional MS who presented to the
ED with respirtory distress and HTN.  Of note, she recently
presented with similar symptoms of hypertensive urgency c/b
pulmonary edema requiring a brief intubation from
[**Date range (3) 96701**].  Her home nifedipine was discontinued and she
was started on a BP regimen of carvedilol/ lasix/ lisinopril.
.
Since her discharge from the hospital, the patient reports that
she had been feeling well and was able to do her ADLs without
dyspnea.  However, per VNA vital sign monitoring, her BP was
"poorly controlled" and on Wednesday, her PCP increased her
lisinopril to 20mg daily and lasix to 40mg daily.  Although she
thinks that her weight had been stable, does admit to increased
lower extremity edema and orthopnea requiring her to sleep in an
upright recliner (also helps back pain).  Overall, she has been
compliant with her low salt diet but yesterday went to a
barmitzvah where she had lox, potatoe latkas, i.e. high sodium
content.
.
This morning, patient was cleaning up a spill when she became
acutely short of breath and diaphoretic.  Denied any chest pain,
palpitations, dizziness, headache or other complaints.  +
Productive cough since onset of symptoms.  No fevers, chills, or
other systemic symptoms.
.
VS on arrival to ER were 97.4 94 220/120 38 99% 10L NRB. Quickly
desated to 70s with RR in 40s. Pt was placed on BiPAP. EKG with
no acute changes with an old LBB and CXR with pulm edema. Pt was
given SLN 0.4mg x 1 and started on a nitro gtt, lasix 100mg x 1,
Morphine 4mg x 1, Levoflox IV, ordered for Cefepime x 1, and
Vancomycin x 1. Foley was placed and so far 250ml of UO. Vital
signs at transfer were improved to HR 96 BP 153/84 RR 28 O2 99%
on CPAP [**9-21**] 50% fio2, and 0.5 mcg/ml/hr nitro gtt.
.
On review of systems, s/he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. S/he denies recent fevers, chills or
rigors. S/he denies exertional buttock or calf pain. All of the
other review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

MEDICAL HISTORY: per OMR review
1. CARDIAC RISK
FACTORS:(-)Diabetes,(-)Dyslipidemia,(+)Hypertension
2. CARDIAC HISTORY:
-CABG: None
-PERCUTANEOUS CORONARY INTERVENTIONS: None
-PACING/ICD: None
3. OTHER PAST MEDICAL HISTORY:
- Breast Cancer with mets to lung and bone, including skull
bone, stable on anti-estrogen therapy, primary oncologist (Dr.
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 96699**]) at [**Company 2860**]. Has lumpectomy and left-sided LN
dissection.
- H/o DVT on Fragmin (has h/o allergy to Lovenox), currently
dosed via [**Company 2860**] as part of a study protocol
- Hypertension
- [**Company **] cancer leading to a sigmoid resection in [**2109**]/[**2110**]
- OA - severe glenohumeral osteoarthritis plus other joints
- LUMBAR SPONDYLOSIS/SPINAL STENOSIS
- GERD
- Mild [**Doctor First Name **] Pos (1:40 titer) - clinically insignificant
- Past Cdiff Pos ([**2139**])

MEDICATION ON ADMISSION: - Aspirin 81 mg DAILY
- Omeprazole 20 mg Capsule qday
- Fluoxymesterone 10 mg PO BID
- Carvedilol 6.25 mg Tablet PO BID
- Lisinopril 10 mg Tablet PO HS
- Furosemide 20 mg Tablet PO once a day.
- Scopolamine base 1.5 mg Patch Q 72 hours
- Roxicet 5-325 mg Tablet PO four times a prn pain

ALLERGIES: Augmentin / Tetanus / Biaxin / Clindamycin / Zometa / Enoxaparin
/ hydrochlorothiazide

PHYSICAL EXAM: On admission:

FAMILY HISTORY: Mother had [**Name2 (NI) 499**] cancer, died at age [**Age over 90 **].
Father died at 49 from coronary thrombosis.
Sister with [**Name2 (NI) 499**] cancer.
Another sister with pancreatic cancer.
Niece and nephew (in same family) both with [**Name (NI) 4278**].
She is last surviving relative.

SOCIAL HISTORY: She lives alone in [**Location (un) 96700**] and is very active at
baseline.  Ambulates independently.  Spends Mon/Fri at the
cultural center, Tues playing trumpet in a band, and Weds/Thurs
running erands.  Has 3 cars at home and drives.  Retired
teacher.  Never married and without children.  Smoked 2ppd x
10-15 years until [**2094**], glass of wine <1x/week.  No other drug
use.
-Tobacco history: Past use, stopped [**2094**]
-ETOH: <1 glass/wk
-Illicit drugs: None
Acute on chronic diastolic heart failure,Pneumonia, organism unspecified,Secondary malignant neoplasm of bone and bone marrow,Secondary malignant neoplasm of lung,Malignant neoplasm of other specified sites of female breast,Unspecified essential hypertension,Mitral stenosis,Personal history of malignant neoplasm of large intestine,Hip joint replacement
Ac on chr diast hrt fail,Pneumonia, organism NOS,Secondary malig neo bone,Secondary malig neo lung,Malign neopl breast NEC,Hypertension NOS,Mitral stenosis,Hx of colonic malignancy,Joint replaced hip
Admission Date:  [**2143-3-17**]              Discharge Date:   [**2143-3-19**]


Service: MEDICINE

Allergies:
Augmentin / Tetanus / Biaxin / Clindamycin / Zometa / Enoxaparin
/ hydrochlorothiazide

Attending:[**Last Name (NamePattern1) 1167**]
Chief Complaint:
SOB

Major Surgical or Invasive Procedure:
none

History of Present Illness:
86 F with PMH of HTN, dCHF, functional MS who presented to the
ED with respirtory distress and HTN.  Of note, she recently
presented with similar symptoms of hypertensive urgency c/b
pulmonary edema requiring a brief intubation from
[**Date range (3) 96701**].  Her home nifedipine was discontinued and she
was started on a BP regimen of carvedilol/ lasix/ lisinopril.
.
Since her discharge from the hospital, the patient reports that
she had been feeling well and was able to do her ADLs without
dyspnea.  However, per VNA vital sign monitoring, her BP was
"poorly controlled" and on Wednesday, her PCP increased her
lisinopril to 20mg daily and lasix to 40mg daily.  Although she
thinks that her weight had been stable, does admit to increased
lower extremity edema and orthopnea requiring her to sleep in an
upright recliner (also helps back pain).  Overall, she has been
compliant with her low salt diet but yesterday went to a
barmitzvah where she had lox, potatoe latkas, i.e. high sodium
content.
.
This morning, patient was cleaning up a spill when she became
acutely short of breath and diaphoretic.  Denied any chest pain,
palpitations, dizziness, headache or other complaints.  +
Productive cough since onset of symptoms.  No fevers, chills, or
other systemic symptoms.
.
VS on arrival to ER were 97.4 94 220/120 38 99% 10L NRB. Quickly
desated to 70s with RR in 40s. Pt was placed on BiPAP. EKG with
no acute changes with an old LBB and CXR with pulm edema. Pt was
given SLN 0.4mg x 1 and started on a nitro gtt, lasix 100mg x 1,
Morphine 4mg x 1, Levoflox IV, ordered for Cefepime x 1, and
Vancomycin x 1. Foley was placed and so far 250ml of UO. Vital
signs at transfer were improved to HR 96 BP 153/84 RR 28 O2 99%
on CPAP [**9-21**] 50% fio2, and 0.5 mcg/ml/hr nitro gtt.
.
On review of systems, s/he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. S/he denies recent fevers, chills or
rigors. S/he denies exertional buttock or calf pain. All of the
other review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

Past Medical History:
per OMR review
1. CARDIAC RISK
FACTORS:(-)Diabetes,(-)Dyslipidemia,(+)Hypertension
2. CARDIAC HISTORY:
-CABG: None
-PERCUTANEOUS CORONARY INTERVENTIONS: None
-PACING/ICD: None
3. OTHER PAST MEDICAL HISTORY:
- Breast Cancer with mets to lung and bone, including skull
bone, stable on anti-estrogen therapy, primary oncologist (Dr.
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 96699**]) at [**Company 2860**]. Has lumpectomy and left-sided LN
dissection.
- H/o DVT on Fragmin (has h/o allergy to Lovenox), currently
dosed via [**Company 2860**] as part of a study protocol
- Hypertension
- [**Company **] cancer leading to a sigmoid resection in [**2109**]/[**2110**]
- OA - severe glenohumeral osteoarthritis plus other joints
- LUMBAR SPONDYLOSIS/SPINAL STENOSIS
- GERD
- Mild [**Doctor First Name **] Pos (1:40 titer) - clinically insignificant
- Past Cdiff Pos ([**2139**])

PAST SURGICAL HISTORY - per OMR
- s/p bilateral TKA
- L hip replacement, pins in right hip, most recent surgery [**1-17**]
yr ago
- S/p TAH in [**2098**]

Social History:
She lives alone in [**Location (un) 96700**] and is very active at
baseline.  Ambulates independently.  Spends Mon/Fri at the
cultural center, Tues playing trumpet in a band, and Weds/Thurs
running erands.  Has 3 cars at home and drives.  Retired
teacher.  Never married and without children.  Smoked 2ppd x
10-15 years until [**2094**], glass of wine <1x/week.  No other drug
use.
-Tobacco history: Past use, stopped [**2094**]
-ETOH: <1 glass/wk
-Illicit drugs: None


Family History:
Mother had [**Name2 (NI) 499**] cancer, died at age [**Age over 90 **].
Father died at 49 from coronary thrombosis.
Sister with [**Name2 (NI) 499**] cancer.
Another sister with pancreatic cancer.
Niece and nephew (in same family) both with [**Name (NI) 4278**].
She is last surviving relative.


Physical Exam:
On admission:

VS: T=Afebrile.BP=146/73 HR=80 RR=20 O2 sat= 99% (BIPAP 10/8)
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP of 10 cm.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. systolic murmur [**2-17**]. No thrills, lifts.
No S3 or S4.
LUNGS: No chest wall deformities, scoliosis, mild kyphosis. Resp
were unlabored, no accessory muscle use. Crackles to mid field
posteriorly on right and at base on left, no wheezes or rhonchi.

ABDOMEN: Soft, ND. No HSM but slight tenderness to palpation in
upper right quadrant. Abd aorta not enlarged by palpation. No
abdominial bruits.
EXTREMITIES: Warm, well perfused, 2+ pitting edema to knees
bilaterally. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+

On discharge:

VS: T=Afebrile.BP=146/73 HR=80 RR=20 O2 sat= 99% (BIPAP 10/8)

GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP of 5-7cm.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. systolic murmur [**2-17**]. No thrills, lifts.
No S3 or S4.
LUNGS: No chest wall deformities, scoliosis, mild kyphosis. Resp
were unlabored, no accessory muscle use. Crackles at bases
bilaterally. No wheezes, or rhonchi.
ABDOMEN: Soft, ND. No HSM but slight tenderness to palpation in
upper right quadrant. Abd aorta not enlarged by palpation. No
abdominial bruits.
EXTREMITIES: Warm, well perfused, 1+ pitting edema to mid shin
bilaterally. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+


Pertinent Results:
Labs on admission:

[**2143-3-17**] 08:48AM   PO2-392* PCO2-49* PH-7.35 TOTAL CO2-28 BASE
XS-0
[**2143-3-17**] 08:35AM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.008
[**2143-3-17**] 08:35AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-30
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG
[**2143-3-17**] 08:35AM URINE  RBC-<1 WBC-<1 BACTERIA-FEW YEAST-NONE
EPI-<1
[**2143-3-17**] 08:35AM URINE  MUCOUS-RARE
[**2143-3-17**] 08:29AM   COMMENTS-GREEN TOP
[**2143-3-17**] 08:29AM   LACTATE-2.8*
[**2143-3-17**] 08:24AM   GLUCOSE-254* UREA N-21* CREAT-1.2* SODIUM-140
POTASSIUM-4.8 CHLORIDE-100 TOTAL CO2-28 ANION GAP-17
[**2143-3-17**] 08:24AM   ALT(SGPT)-46* AST(SGOT)-33 CK(CPK)-183 ALK
PHOS-91 TOT BILI-0.2
[**2143-3-17**] 08:24AM   cTropnT-0.02*
[**2143-3-17**] 08:24AM   CK-MB-6 proBNP-2307*
[**2143-3-17**] 08:24AM   CALCIUM-9.1 PHOSPHATE-5.3*# MAGNESIUM-2.5
[**2143-3-17**] 08:24AM   WBC-7.8 RBC-5.10 HGB-13.7 HCT-44.6 MCV-88
MCH-26.9* MCHC-30.7* RDW-15.8*
[**2143-3-17**] 08:24AM   NEUTS-67.7 LYMPHS-25.6 MONOS-4.8 EOS-1.0
BASOS-0.9
[**2143-3-17**] 08:24AM   PLT COUNT-721*#
[**2143-3-17**] 08:24AM   PT-11.8 PTT-22.6 INR(PT)-1.0
[**2143-3-17**] 08:24AM   PT-11.8 PTT-22.6 INR(PT)-1.0
[**2143-3-17**] 08:24AM   PT-11.8 PTT-22.6 INR(PT)-1.0
[**2143-3-17**] 08:24AM   PT-11.8 PTT-22.6 INR(PT)-1.0

ON Discharge:
[**2143-3-19**] 05:48AM BLOOD WBC-4.9 RBC-3.72* Hgb-10.0* Hct-31.6*
MCV-85 MCH-27.0 MCHC-31.8 RDW-15.4 Plt Ct-446*
[**2143-3-19**] 05:48AM BLOOD Glucose-91 UreaN-26* Creat-1.1 Na-139
K-4.3 Cl-100 HCO3-33* AnGap-10
[**2143-3-19**] 05:48AM BLOOD Calcium-8.6 Phos-3.4 Mg-2.2

CXR [**2143-3-17**]:
IMPRESSION: Diffuse bilateral opacities as described above. The
patient has demonstrated a propensity for developing confluent
opacities in a very similar distribution reference to series of
chest x-rays on [**3-6**] and 24th of this year. These
opacities have relative similar distribution; however, the last
x-ray of [**3-7**] demonstrated a relative improvement.
Therefore, this is most likely representing the patient's unique
distribution of pulmonary edema in the setting of decompensated
heart failure. However, the appearance, in and of itself, is
nonspecific and multifocal pneumonia or massive aspiration
remain diagnostic considerations. In the clinical context, CHF
is favored.

##########################################################
Microbiology:
[**2143-3-17**]: URINE CULTURE (Final [**2143-3-18**]):    NO GROWTH.
[**2143-3-17**]: Blood Culture: PENDING


Brief Hospital Course:
86 yo f with hx of HTN, mitral stenosis and diastolic
dysfunction presenting with repeat HTN urgency and likely flash
pulm edema in setting of dietary discretion
.
# Pulm Edema:  likely a combination of volume overload from
dietary indiscretion and hypertensive urgency leading to
pulmonary edema. This is supported by crackles to mid field on
exam, increased peripheral pitting edema, increased JVD,
increased BNP. BIPAP was started, as well as a nitro gtt. She
was given lasix with a goal diuresis of -2L. Her carvedilol was
restarted at 12.5mg [**Hospital1 **]. She achieved her goal diuresis on the
first night and was weaned to RA. Her SBP remained 120-140. She
received another dose of lasix 20mg PO on the evening prior to
discharge (given euvolemia on morning exam). On the night prior
to discharge, her carvedilol was increased to 25mg [**Hospital1 **]. She
underwent physical therapy and had a nutrition consult explain
the require diet. Her lisinopril was not restarted given that
her SBP was 120 on day of discharge. She was instructed to limit
her sodium intake and to weight herself every day, her Wt on the
day of discharge was 58.9 Kg

# HTN: presented with hypertensive urgency that likely reflected
her high sympathetic tone in setting of dyspnea and which
contributed to her acute pulmonary edema. A nitro gtt was
started and her home carvedilol was continued. Her BP quickly
normalized, she remained SBP 120-150s in the 24 hrs prior to
discharge.
.
# CAD:  no Chest pain currently, CE flat, no symptoms of ACS on
this admission

# Abdominal pain: intermittent, chronic and mild and disappeared
quickly after admissioin. Her LFTs were nl range,
.
# Breast CA:  patient on oupatient regimen of Fluoxymesterone
which she brought. We continued home fluoxymesterone
.
# RHYTHM: pt in sinus tach likely [**1-16**] reflexive tachycardia.
Quickly reverted to sinus in setting of diuresis and decreased
afterload. She had no significant arrythmias on tele.
.
TRANSITIONAL ISSUES:
Blood Cultures need to be followed up on

Medications on Admission:
- Aspirin 81 mg DAILY
- Omeprazole 20 mg Capsule qday
- Fluoxymesterone 10 mg PO BID
- Carvedilol 6.25 mg Tablet PO BID
- Lisinopril 10 mg Tablet PO HS
- Furosemide 20 mg Tablet PO once a day.
- Scopolamine base 1.5 mg Patch Q 72 hours
- Roxicet 5-325 mg Tablet PO four times a prn pain

Discharge Medications:
1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
3. fluoxymesterone 10 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
4. carvedilol 25 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*0*
5. furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day.
6. scopolamine base 1.5 mg Patch 72 hr Sig: One (1)  Transdermal
every seventy-two (72) hours.
7. Roxicet 5-325 mg Tablet Sig: One (1) Tablet PO every six (6)
hours as needed for pain.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Primary Diagnosis:
Acute on Chronic diastolic CHF exacerbation
.
Secondary Diagnosis:
-Hypertension
-functional mitral stenosis


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 are being discharged from [**Hospital1 1170**].  It was a pleasure taking care of you.  You were
admitted because your blood pressure was very high, you had too
much fluid on your body and som eof it went into your lungs and
you were having difficulty breathing.  You were given
medications to help remove the fluid from your body as well as
lower your blood pressure.  You quickly had lots of fluid
removed and were feeling better and walking around.  You were
seen by a dietician who made recommendations regarding your
diet.  It is important to AVOID salt as well as limiting how
much fluid you drink.
.
The followin medications were CHANGED:
Carvedilol 6.25mg by mouth twice a day --> 25mg by mouth twice a
day
.
The following medication was STOPPED:
lisinopril 10mg by mouth at bedtime
.
Please take your other medications as prescribed
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more
than 3 lbs.

Followup Instructions:
please follow up with your the following physicians:

Department: [**State **]When: WEDNESDAY [**2143-3-27**] at 10:00 AM
With: [**First Name11 (Name Pattern1) 2946**] [**Last Name (NamePattern4) 6564**], MD [**Telephone/Fax (1) 2205**]
Building: [**State **] ([**Location (un) **], MA) [**Location (un) **]
Campus: OFF CAMPUS     Best Parking: On Street Parking

Department: CARDIAC SERVICES
When: WEDNESDAY [**2143-4-24**] at 3:00 PM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D. [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Acute on chronic diastolic heart failure,Pneumonia, organism unspecified,Secondary malignant neoplasm of bone and bone marrow,Secondary malignant neoplasm of lung,Malignant neoplasm of other specified sites of female breast,Unspecified essential hypertension,Mitral stenosis,Personal history of malignant neoplasm of large intestine,Hip joint replacement'}


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: SOB

PRESENT ILLNESS: 86 F with PMH of HTN, dCHF, functional MS who presented to the
ED with respirtory distress and HTN.  Of note, she recently
presented with similar symptoms of hypertensive urgency c/b
pulmonary edema requiring a brief intubation from
[**Date range (3) 96701**].  Her home nifedipine was discontinued and she
was started on a BP regimen of carvedilol/ lasix/ lisinopril.
.
Since her discharge from the hospital, the patient reports that
she had been feeling well and was able to do her ADLs without
dyspnea.  However, per VNA vital sign monitoring, her BP was
"poorly controlled" and on Wednesday, her PCP increased her
lisinopril to 20mg daily and lasix to 40mg daily.  Although she
thinks that her weight had been stable, does admit to increased
lower extremity edema and orthopnea requiring her to sleep in an
upright recliner (also helps back pain).  Overall, she has been
compliant with her low salt diet but yesterday went to a
barmitzvah where she had lox, potatoe latkas, i.e. high sodium
content.
.
This morning, patient was cleaning up a spill when she became
acutely short of breath and diaphoretic.  Denied any chest pain,
palpitations, dizziness, headache or other complaints.  +
Productive cough since onset of symptoms.  No fevers, chills, or
other systemic symptoms.
.
VS on arrival to ER were 97.4 94 220/120 38 99% 10L NRB. Quickly
desated to 70s with RR in 40s. Pt was placed on BiPAP. EKG with
no acute changes with an old LBB and CXR with pulm edema. Pt was
given SLN 0.4mg x 1 and started on a nitro gtt, lasix 100mg x 1,
Morphine 4mg x 1, Levoflox IV, ordered for Cefepime x 1, and
Vancomycin x 1. Foley was placed and so far 250ml of UO. Vital
signs at transfer were improved to HR 96 BP 153/84 RR 28 O2 99%
on CPAP [**9-21**] 50% fio2, and 0.5 mcg/ml/hr nitro gtt.
.
On review of systems, s/he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. S/he denies recent fevers, chills or
rigors. S/he denies exertional buttock or calf pain. All of the
other review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

MEDICAL HISTORY: per OMR review
1. CARDIAC RISK
FACTORS:(-)Diabetes,(-)Dyslipidemia,(+)Hypertension
2. CARDIAC HISTORY:
-CABG: None
-PERCUTANEOUS CORONARY INTERVENTIONS: None
-PACING/ICD: None
3. OTHER PAST MEDICAL HISTORY:
- Breast Cancer with mets to lung and bone, including skull
bone, stable on anti-estrogen therapy, primary oncologist (Dr.
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 96699**]) at [**Company 2860**]. Has lumpectomy and left-sided LN
dissection.
- H/o DVT on Fragmin (has h/o allergy to Lovenox), currently
dosed via [**Company 2860**] as part of a study protocol
- Hypertension
- [**Company **] cancer leading to a sigmoid resection in [**2109**]/[**2110**]
- OA - severe glenohumeral osteoarthritis plus other joints
- LUMBAR SPONDYLOSIS/SPINAL STENOSIS
- GERD
- Mild [**Doctor First Name **] Pos (1:40 titer) - clinically insignificant
- Past Cdiff Pos ([**2139**])

MEDICATION ON ADMISSION: - Aspirin 81 mg DAILY
- Omeprazole 20 mg Capsule qday
- Fluoxymesterone 10 mg PO BID
- Carvedilol 6.25 mg Tablet PO BID
- Lisinopril 10 mg Tablet PO HS
- Furosemide 20 mg Tablet PO once a day.
- Scopolamine base 1.5 mg Patch Q 72 hours
- Roxicet 5-325 mg Tablet PO four times a prn pain

ALLERGIES: Augmentin / Tetanus / Biaxin / Clindamycin / Zometa / Enoxaparin
/ hydrochlorothiazide

PHYSICAL EXAM: On admission:

FAMILY HISTORY: Mother had [**Name2 (NI) 499**] cancer, died at age [**Age over 90 **].
Father died at 49 from coronary thrombosis.
Sister with [**Name2 (NI) 499**] cancer.
Another sister with pancreatic cancer.
Niece and nephew (in same family) both with [**Name (NI) 4278**].
She is last surviving relative.

SOCIAL HISTORY: She lives alone in [**Location (un) 96700**] and is very active at
baseline.  Ambulates independently.  Spends Mon/Fri at the
cultural center, Tues playing trumpet in a band, and Weds/Thurs
running erands.  Has 3 cars at home and drives.  Retired
teacher.  Never married and without children.  Smoked 2ppd x
10-15 years until [**2094**], glass of wine <1x/week.  No other drug
use.
-Tobacco history: Past use, stopped [**2094**]
-ETOH: <1 glass/wk
-Illicit drugs: None 

### Response:
{'Acute on chronic diastolic heart failure,Pneumonia, organism unspecified,Secondary malignant neoplasm of bone and bone marrow,Secondary malignant neoplasm of lung,Malignant neoplasm of other specified sites of female breast,Unspecified essential hypertension,Mitral stenosis,Personal history of malignant neoplasm of large intestine,Hip joint replacement'}
