CHIEF COMPLAINT: Right shoulder pain, fever

PRESENT ILLNESS: Pt is an 81 yo priest w/ h/o CAD s/p MI, HTN, DM2, who p/w
altered mental status, R shoulder pain x 5d and fever spike to
99.9 at home. He had apparently had worsening shoulder pain for
five days, wincing when the shoulder was touched.  Pt initially
treating shoulder pain at [**Hospital3 **] w/ ASA, heat pack per
his PCP. [**Name10 (NameIs) 2772**], noted to have altered MS changes by his [**Last Name (LF) **], [**First Name3 (LF) **]
he was brought to [**Hospital1 18**] ED.
In [**Name (NI) **], pt noted to be febrile to 101.9, other VSS. Labs notable
for WBC 14.2, lactate 2.4. LP normal. While in the ED, he became
increasingly hypertensive, up to the 230's systolic, difficult
to control with a NTG-gtt and eventually became increasingly
hypoxic.  There was questionable seizure activity, and the
patient was intubated for acute respiratory failure.  At this
point, he underwent CTA showing no PE, dissection, or pulmonary
abnormality, as well as no soft tissue or osseous abnormalities
that could explain his shoulder pain.  He also received
ceftriaxone, metronidazole, vancomycin, and furosemide 40mg IV x
1.
.

MEDICAL HISTORY: -HTN
-DM2
-Hypercholesterolemia
-CAD with 4 prior MIs, prior PTCA, s/p CABG in [**2136**] with LIMA to
LAD, SVG to D2/Om3, SVG to RCA; cath [**11/2152**] with stent to
SVG-RCA, 40%LMCA lesion, patent LIMA-LAD, diffusely disease LCX.

MEDICATION ON ADMISSION: Lisinopril 20 mg PO DAILY (Daily).
Finasteride 5 mg PO DAILY (Daily).
Folic Acid 1 mg PO DAILY (Daily).
Glyburide 5 mg PO DAILY (Daily).
Clopidogrel 75 mg Tablet PO DAILY
Hydrochlorothiazide 25 mg PO DAILY
Furosemide 40 mg PO BID
Aspirin 325 mg PO DAILY (Daily).
Atorvastatin 10 mg PO DAILY
Isosorbide Mononitrate 240 mg PO HS
Trazodone 50 mg PO HS
Metoprolol Tartrate 25 mg PO TID
Nitroglycerin 0.3 mg Sublingual PRN
Bisacodyl 10 mg Tablet, PO DAILY (Daily) as needed.
Ferrous Sulfate 325 (PO DAILY (Daily).
Multivitamin PO DAILY
Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: 1-2 Drops
TID
Docusate Sodium 100 mg PO BID
Lorazepam 0.5 mg PO Q4-6H (every 4 to 6 hours) as needed.
Clonazepam 0.5 mg PO BID
Fluvoxamine 50 mg PO TID
Mirtazapine 15 mg PO HS
Pantoprazole 40 mg PO Q24H

ALLERGIES: Sulfa (Sulfonamides) / Bactrim

PHYSICAL EXAM: t 100.0 (rectal), bp 135/72, hr 87, rr 17, spo2 98%
Vent- A/C 600/5/14/1.00 peak 25/plateau 14
gen- sedated, intubated; non-acutely-ill appearing
heent- anicteric, op with mmm
cv- rrr, s1s2, no m/r/g; cabg scar
pulm- moves air well, no w/r/r
abd- soft, nt, nd, nabs
extrm- no cyanosis/edema, warm dry, full dp pulses bilat
nails- no clubbing, no pitting/color changes/indentations
neuro- sedated, not following commands, perrl, mae
.

FAMILY HISTORY: Non-contributory.
.

SOCIAL HISTORY: Reverend. Lives in [**Hospital3 **] facility at JP. History of
tobacco in the past. No alcohol or IVDU history. His niece is
his HCP.
.
Acute respiratory failure,Methicillin susceptible Staphylococcus aureus septicemia,Congestive heart failure, unspecified,Methicillin susceptible pneumonia due to Staphylococcus aureus,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Disorders of bursae and tendons in shoulder region, unspecified,Knee joint replacement,Osteoarthrosis, unspecified whether generalized or localized, shoulder region,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Old myocardial infarction,Unspecified essential hypertension,Aortocoronary bypass status
Acute respiratry failure,Meth susc Staph aur sept,CHF NOS,Meth sus pneum d/t Staph,BPH w urinary obs/LUTS,Rotator cuff synd NOS,Joint replaced knee,Osteoarthros NOS-shlder,DMII wo cmp nt st uncntr,Old myocardial infarct,Hypertension NOS,Aortocoronary bypass
Admission Date:  [**2153-8-12**]              Discharge Date:   [**2153-8-29**]

Date of Birth:  [**2072-6-16**]             Sex:   M

Service: MEDICINE

Allergies:
Sulfa (Sulfonamides) / Bactrim

Attending:[**First Name3 (LF) 2972**]
Chief Complaint:
Right shoulder pain, fever

Major Surgical or Invasive Procedure:
Intubation
.
Urethral dilatation for foley placement
.
[**8-27**]: Right shoulder MRI
IMPRESSION:
1)  Tendinosis in the distal supraspinatus and infraspinatus
tendons without evidence of tearing.
2) Edema in the medial aspects of the supraspinatus and
infraspinatus muscles without associated atrophy, which is
nonspecific.
3)  Mild acromioclavicular osteoarthritis.
.
[**8-28**]: Thoracic spine MRI
IMPRESSION:  Multilevel degenerative disease with at least
moderate spinal canal narrowing as above.  No abnormal signal
within the cord.  Study is severely limited due to patient
motion artifact.  However, given the absence of abnormal T2
signal in the disc spaces or within the vertebral bodies,
osteomyelitis is considered unlikely.
.
[**8-23**] Abd US
IMPRESSION:  Unremarkable abdominal ultrasound.  No evidence of
cholecystitis, cholangitis, or focal mass lesion identified.  No
fluid collection or source of MRSA identified.
.
TEE [**8-23**]
Conclusions:
1. The left atrium is moderately dilated.
2. 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
low normal (LVEF 50-55%).
3. The ascending aorta is mildly dilated.
4. The aortic valve leaflets are mildly thickened. Trace aortic
regurgitation  is seen.
5. The mitral valve leaflets are mildly thickened. Mild (1+)
mitral
regurgitation is seen.
6. No obvious vegetations are seen.
7. Compared with the prior study (images reviewed) of [**2153-8-13**],
LV function  may have improved.
.
Video speech and swallow ([**8-21**])
FINDINGS:  Oropharyngeal swallowing evaluation was performed
today in
collaboration with speech and swallow pathologist.  The thin
liquid, nectar thick, pureed, and [**12-27**] of cookie were
administered.  There were moderate defects with decreased bolus
control and premature spillover of thin and thick liquids to the
valleculae and piriform sinuses.  There was a decreased high
laryngeal excursion, laryngeal valve closure, and only partial
epiglottic deflection.  There was mild-to-moderate deep
penetration that occurred during the swallow with both thin and
nectar thick liquids.  However, though barium was seen on the
vocal cords, no aspiration below the vocal cords was
definitively demonstrated.

IMPRESSION:  A moderate dysphasia with deep penetration to thin
and nectar thick liquids.
.
Shoulder XRAY [**8-16**]
No fracture or dislocation is detected. No bony destructive
changes are seen. No obvious soft tissue abnormalities are
appreciated.  Minimal degenerative changes of the
acromioclavicular joints are present.
.
CTA [**8-13**]
IMPRESSION:
1.  No aortic dissection or pulmonary embolism.
2.  Coronary artery bypass graft.  Severe coronary artery
calcifications.
3.  Unchanged cardiomegaly.  Trace bilateral pleural effusions,
decreased from the prior study.
4.  Unchanged compression deformities of the thoracic spine
.
CT Head [**8-13**]
IMPRESSION:  No acute intracranial hemorrhage.  No change
compared to the prior study.


History of Present Illness:
Pt is an 81 yo priest w/ h/o CAD s/p MI, HTN, DM2, who p/w
altered mental status, R shoulder pain x 5d and fever spike to
99.9 at home. He had apparently had worsening shoulder pain for
five days, wincing when the shoulder was touched.  Pt initially
treating shoulder pain at [**Hospital3 **] w/ ASA, heat pack per
his PCP. [**Name10 (NameIs) 2772**], noted to have altered MS changes by his [**Last Name (LF) **], [**First Name3 (LF) **]
he was brought to [**Hospital1 18**] ED.
In [**Name (NI) **], pt noted to be febrile to 101.9, other VSS. Labs notable
for WBC 14.2, lactate 2.4. LP normal. While in the ED, he became
increasingly hypertensive, up to the 230's systolic, difficult
to control with a NTG-gtt and eventually became increasingly
hypoxic.  There was questionable seizure activity, and the
patient was intubated for acute respiratory failure.  At this
point, he underwent CTA showing no PE, dissection, or pulmonary
abnormality, as well as no soft tissue or osseous abnormalities
that could explain his shoulder pain.  He also received
ceftriaxone, metronidazole, vancomycin, and furosemide 40mg IV x
1.
.

Past Medical History:
-HTN
-DM2
-Hypercholesterolemia
-CAD with 4 prior MIs, prior PTCA, s/p CABG in [**2136**] with LIMA to
LAD, SVG to D2/Om3, SVG to RCA; cath [**11/2152**] with stent to
SVG-RCA, 40%LMCA lesion, patent LIMA-LAD, diffusely disease LCX.

-Bladder outlet obstruction and BPH
-Multiple prior UTIs
-Depression
-Tardive dyskinesia
-Anxiety
-status post TKR [**9-23**]
.

Social History:
Reverend. Lives in [**Hospital3 **] facility at JP. History of
tobacco in the past. No alcohol or IVDU history. His niece is
his HCP.
.

Family History:
Non-contributory.
.

Physical Exam:
t 100.0 (rectal), bp 135/72, hr 87, rr 17, spo2 98%
Vent- A/C 600/5/14/1.00 peak 25/plateau 14
gen- sedated, intubated; non-acutely-ill appearing
heent- anicteric, op with mmm
cv- rrr, s1s2, no m/r/g; cabg scar
pulm- moves air well, no w/r/r
abd- soft, nt, nd, nabs
extrm- no cyanosis/edema, warm dry, full dp pulses bilat
nails- no clubbing, no pitting/color changes/indentations
neuro- sedated, not following commands, perrl, mae
.

Pertinent Results:
[**2153-8-12**] 03:20PM BLOOD WBC-14.2*# RBC-5.40 Hgb-16.8 Hct-46.3
MCV-86 MCH-31.1 MCHC-36.2* RDW-14.8 Plt Ct-166
[**2153-8-13**] 03:21AM BLOOD WBC-17.6* RBC-5.59 Hgb-17.0 Hct-47.7
MCV-85 MCH-30.4 MCHC-35.7* RDW-14.6 Plt Ct-164
[**2153-8-15**] 05:34AM BLOOD WBC-9.3 RBC-5.14 Hgb-15.3 Hct-44.9 MCV-87
MCH-29.8 MCHC-34.1 RDW-14.6 Plt Ct-199
.
[**2153-8-12**] 03:20PM BLOOD Glucose-261* UreaN-14 Creat-0.9 Na-131*
K-3.5 Cl-92* HCO3-27 AnGap-16
[**2153-8-13**] 12:20PM BLOOD Glucose-153* UreaN-21* Creat-1.0 Na-135
K-3.6 Cl-96 HCO3-27 AnGap-16
[**2153-8-15**] 05:34AM BLOOD Glucose-142* UreaN-33* Creat-0.8 Na-140
K-4.0 Cl-101 HCO3-30 AnGap-13
.
[**2153-8-12**] 03:20PM BLOOD CK(CPK)-69
[**2153-8-12**] 03:20PM BLOOD cTropnT-<0.01
[**2153-8-12**] 11:55PM BLOOD CK(CPK)-261*
[**2153-8-12**] 11:55PM BLOOD CK-MB-3 cTropnT-<0.01
[**2153-8-13**] 03:21AM BLOOD CK(CPK)-102
[**2153-8-13**] 03:21AM BLOOD CK-MB-4 cTropnT-0.06*
[**2153-8-13**] 12:20PM BLOOD CK(CPK)-109
[**2153-8-13**] 12:20PM BLOOD CK-MB-4 cTropnT-0.02*
.


Brief Hospital Course:
Pt is a 81 yo man with PMH CAD s/p MI, HTN, DM2, who p/w altered
mental status, R shoulder pain x 5d and fever.
.
#Respiratory failure -- Given overall story, normal initial CXR,
lack of presenting respiratory complaints, pre- and
post-intubation CXR's, and post-intubation CTA, it seems the
most likely diagnosis was acute pulmonary edema secondary to a
hypertensive emergency.  He has known depressed systolic
function and MR and likely could not tolerate the elevated
afterload, causing sudden fluid back-up into the pulmonary tree.
 This scenario is further supported by his rapid improvement (in
terms of o2 sats, abg, and post-intubation cxr) as the
positive-pressure ventilation likely dropped both his preload
and afterload.  There was probably a modest contribution from
his RUL pneumonia, seen on the next day's CXR as well.  Other
possibilities, such as aspiration and PE were excluded his
post-intubation CTA.  No known history of obstructive lung
disease and was moving air well on exam.
On the second day of admission, he was easily reduced to minimal
ventilatory settings and then extubated with the use of a
nitroglycerin drip to control both preload and afterload.  A
moderate diuresis was He did quite well afterwards, quickly
being weaned down from a 70% face-mask to 4L NC with good o2
saturations.  On the floor he was satting in the mid 90s on room
air and did not have any further respiratory difficulties.  He
was found to have a RUL pneumonia (likely MRSA).  Will continue
furosemide 40mg PO.  WBC stable and afebrile.
.
#CHF -- Pt seems to have experienced acute pulmonary edema as
above.  Has baseline systolic dysfunction, last EF [**12/2152**] was
30-40%, and current EF on [**2153-8-23**] after acute exacerbation was
50-55%. Continued on lisinopril, metoprolol for afterload
reduction and isosorbide dinitrate for afterload/preload
reduction.  Arrempted to keep balance -500cc per day.
.
#. HTN -- Unclear cause of sudden elevation in ED, possibly [**1-25**]
to pain, confusion, anxiety.  Better controlled on the floor
with no issues in terms of hypertension.  Continued home meds.
.
#. Fever/leukocytosis -- Although it's of unclear etiology,
clinically the only presenting symptom was his right shoulder
pain. ID work-up in ED included: CSF negative, CXR with RUL
pneumonia, blood cxs positive for MRSA (last +bcx was on [**8-12**]),
3/4 bottles with MRSA, urine culture negative.  C. Diff was
negative.  ID consulted while in house. Shoulder MRI did not
show any evidence of osteo, and neither did thoracic MRI.  RUQ
ultrasound and repeat echo did not show a source.  The plan is
to treat him for four weeks (started [**8-13**] should end vancomycin
course on [**9-11**]).  He will need weekly CBC, LFT, BUN/Cr, Vanc
trough, which should be faxed to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] (ID fellow)
at ([**Telephone/Fax (1) 1353**].
.
#Right shoulder pain -- As above, main clinical sx.
.
#MS changes -- Likely [**1-25**] underlying infectious process,
possibly pain. LP negative for infection.  He was mentating well
on the floor.  Haldol was given as needed for agitation.
.
#CAD -- No evidence of active ischemia on ECG or by cardiac
enzymes.  Pt on numerous cardiac meds. MI was ruled out with
enzymes.  Con't asa, clopidogrel, atorvastatin, metoprolol.  He
had multiple episodes of chest pain while in house with negative
ECGs.  The pain was reproducible on palpation and likely
secondary to sternotomy scar.
.
# DM: Pt on glyburide as outpt.  He was kept on an insulin
sliding scale while in house and his glyburide should be
restared once at the rehab facility.  (He was taking glyburide 5
mg po qd).
.
# Anxiety/OCD: Pt on numerous anxiolytics. Continue home meds.
.
# BPH: Patient had urethral dilatation by GU and foley was left
in place for duration of his hospital stay.  He should have his
Foley in place on discharge to the rehab facility.  He has an
outpatient follow up with Dr. [**Last Name (STitle) 4229**] on [**9-4**] (from
URology) for a voiding trial.  He was started on Flomax and
continued his Proscar while in house.
.
# FEN: Video speech and swallow done in house.  Recommended
nectar prethickened liquids Please crush PO meds, assist patient
with feeding. Cue patient to swallow every [**1-26**] bites/sips, and
cute patient to clear cough and swallow every [**1-26**] bites.
.
# PPX: SC heparin, ppi
.
# Code status: Presumed full
.
# Dispo: To rehab facility.
.
# PCP (Gershegorn [**2153**])

Medications on Admission:
Lisinopril 20 mg PO DAILY (Daily).
Finasteride 5 mg PO DAILY (Daily).
Folic Acid 1 mg PO DAILY (Daily).
Glyburide 5 mg PO DAILY (Daily).
Clopidogrel 75 mg Tablet PO DAILY
Hydrochlorothiazide 25 mg PO DAILY
Furosemide 40 mg PO BID
Aspirin 325 mg PO DAILY (Daily).
Atorvastatin 10 mg PO DAILY
Isosorbide Mononitrate 240 mg PO HS
Trazodone 50 mg PO HS
Metoprolol Tartrate 25 mg PO TID
Nitroglycerin 0.3 mg Sublingual PRN
Bisacodyl 10 mg Tablet, PO DAILY (Daily) as needed.
Ferrous Sulfate 325 (PO DAILY (Daily).
Multivitamin PO DAILY
Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: 1-2 Drops
TID
Docusate Sodium 100 mg PO BID
Lorazepam 0.5 mg PO Q4-6H (every 4 to 6 hours) as needed.
Clonazepam 0.5 mg PO BID
Fluvoxamine 50 mg PO TID
Mirtazapine 15 mg PO HS
Pantoprazole 40 mg PO Q24H


Discharge Medications:
1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Fluvoxamine 50 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
4. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
5. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
7. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO HS (at bedtime).
10. Risperidone 1 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
11. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
12. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
13. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
14. Morphine 2 mg/mL Syringe Sig: One (1)  Injection Q4H (every
4 hours) as needed for chest pain.
15. Isosorbide Dinitrate 20 mg Tablet Sig: Two (2) Tablet PO TID
(3 times a day).
16. Phenol-Phenolate Sodium 1.4 % Mouthwash Sig: One (1) Spray
Mucous membrane  Q4H (every 4 hours) as needed.
17. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO
TID (3 times a day).
18. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical  [**Hospital1 **]
(2 times a day) as needed.
19. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
20. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
21. Vancomycin in Dextrose 1 g/200 mL Piggyback Sig: One (1)
Intravenous  Q 12H (Every 12 Hours): Continue through [**2153-9-13**].
22. Glyburide 5 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 103373**]

Discharge Diagnosis:
.
MRSA bacteremia:
You have a bloodstream infection with MRSA (a resistant
bacteria).  You need treatment with Vancomycin intravenously for
at least four weeks (Started on [**8-13**], need to continue through
[**9-13**]).
.
Flash pulmonary edema:
You had a sudden increase in fluid in your lungs because of your
high blood pressure.  You need to keep your blood pressure under
control.


Discharge Condition:
Good


Discharge Instructions:
Please call your PCP if you have high fevers, chills, chest pain
uncontrolled with nitro.


Followup Instructions:
Dr. [**Last Name (STitle) 4229**], urologist, as an outpatient for a voiding trial.  You
will be discharged with a Foley in place.
- [**Telephone/Fax (1) 10941**]; Tuesday, [**9-4**] @ 8:15, [**Hospital Ward Name 23**], [**Location (un) **], surgery specialty
.
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], ID specialist will follow up on Mr.
[**Known lastname 103374**] labs, to be drawn by Rehab facility.  They should
include a weekly CBC, LFTs, BUN/Cr and Vanc trough.  They should
be faxed to ([**Telephone/Fax (1) 1353**]
.
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] of ID will follow up with him in clinic prior
to antibiotic completion on [**9-4**] @ 10am.   [**Last Name (NamePattern1) **], [**Hospital Unit Name **], [**Hospital **] medical building.  ([**Telephone/Fax (1) 4170**]
{'Acute respiratory failure,Methicillin susceptible Staphylococcus aureus septicemia,Congestive heart failure, unspecified,Methicillin susceptible pneumonia due to Staphylococcus aureus,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Disorders of bursae and tendons in shoulder region, unspecified,Knee joint replacement,Osteoarthrosis, unspecified whether generalized or localized, shoulder region,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Old myocardial infarction,Unspecified essential hypertension,Aortocoronary bypass status'}


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: Right shoulder pain, fever

PRESENT ILLNESS: Pt is an 81 yo priest w/ h/o CAD s/p MI, HTN, DM2, who p/w
altered mental status, R shoulder pain x 5d and fever spike to
99.9 at home. He had apparently had worsening shoulder pain for
five days, wincing when the shoulder was touched.  Pt initially
treating shoulder pain at [**Hospital3 **] w/ ASA, heat pack per
his PCP. [**Name10 (NameIs) 2772**], noted to have altered MS changes by his [**Last Name (LF) **], [**First Name3 (LF) **]
he was brought to [**Hospital1 18**] ED.
In [**Name (NI) **], pt noted to be febrile to 101.9, other VSS. Labs notable
for WBC 14.2, lactate 2.4. LP normal. While in the ED, he became
increasingly hypertensive, up to the 230's systolic, difficult
to control with a NTG-gtt and eventually became increasingly
hypoxic.  There was questionable seizure activity, and the
patient was intubated for acute respiratory failure.  At this
point, he underwent CTA showing no PE, dissection, or pulmonary
abnormality, as well as no soft tissue or osseous abnormalities
that could explain his shoulder pain.  He also received
ceftriaxone, metronidazole, vancomycin, and furosemide 40mg IV x
1.
.

MEDICAL HISTORY: -HTN
-DM2
-Hypercholesterolemia
-CAD with 4 prior MIs, prior PTCA, s/p CABG in [**2136**] with LIMA to
LAD, SVG to D2/Om3, SVG to RCA; cath [**11/2152**] with stent to
SVG-RCA, 40%LMCA lesion, patent LIMA-LAD, diffusely disease LCX.

MEDICATION ON ADMISSION: Lisinopril 20 mg PO DAILY (Daily).
Finasteride 5 mg PO DAILY (Daily).
Folic Acid 1 mg PO DAILY (Daily).
Glyburide 5 mg PO DAILY (Daily).
Clopidogrel 75 mg Tablet PO DAILY
Hydrochlorothiazide 25 mg PO DAILY
Furosemide 40 mg PO BID
Aspirin 325 mg PO DAILY (Daily).
Atorvastatin 10 mg PO DAILY
Isosorbide Mononitrate 240 mg PO HS
Trazodone 50 mg PO HS
Metoprolol Tartrate 25 mg PO TID
Nitroglycerin 0.3 mg Sublingual PRN
Bisacodyl 10 mg Tablet, PO DAILY (Daily) as needed.
Ferrous Sulfate 325 (PO DAILY (Daily).
Multivitamin PO DAILY
Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: 1-2 Drops
TID
Docusate Sodium 100 mg PO BID
Lorazepam 0.5 mg PO Q4-6H (every 4 to 6 hours) as needed.
Clonazepam 0.5 mg PO BID
Fluvoxamine 50 mg PO TID
Mirtazapine 15 mg PO HS
Pantoprazole 40 mg PO Q24H

ALLERGIES: Sulfa (Sulfonamides) / Bactrim

PHYSICAL EXAM: t 100.0 (rectal), bp 135/72, hr 87, rr 17, spo2 98%
Vent- A/C 600/5/14/1.00 peak 25/plateau 14
gen- sedated, intubated; non-acutely-ill appearing
heent- anicteric, op with mmm
cv- rrr, s1s2, no m/r/g; cabg scar
pulm- moves air well, no w/r/r
abd- soft, nt, nd, nabs
extrm- no cyanosis/edema, warm dry, full dp pulses bilat
nails- no clubbing, no pitting/color changes/indentations
neuro- sedated, not following commands, perrl, mae
.

FAMILY HISTORY: Non-contributory.
.

SOCIAL HISTORY: Reverend. Lives in [**Hospital3 **] facility at JP. History of
tobacco in the past. No alcohol or IVDU history. His niece is
his HCP.
. 

### Response:
{'Acute respiratory failure,Methicillin susceptible Staphylococcus aureus septicemia,Congestive heart failure, unspecified,Methicillin susceptible pneumonia due to Staphylococcus aureus,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Disorders of bursae and tendons in shoulder region, unspecified,Knee joint replacement,Osteoarthrosis, unspecified whether generalized or localized, shoulder region,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Old myocardial infarction,Unspecified essential hypertension,Aortocoronary bypass status'}
