CHIEF COMPLAINT: Hypoxia and decreased mental status.

PRESENT ILLNESS: Patinet is an 86 year old woman with COPD on 2L at baseline,
congestive heart failure, and a resident at [**Hospital1 10151**] facility who was transferred due to concern for
decreased mental status and hypoxia. On day of admission, she
developed hypoxia, requiring a 100% NRB to maintain good
saturation. Vitals on transfer were BP 100/60, T 102, and she
was given morphine 8 mg SL. EMS was called and per verbal
report, during transfer SBP dropped to 60s but this responded to
2L NS. According to personnel at rehab center, patient has had
increased difficulty breathing over past week.  Treatment was
started with Lasix, albuterol, levofloxacin, and prednisone
taper.
.
In the ED, patient was obtunded and febrile to 101.3 F axillary.
 RR was in the 30s, HR was 161, and blood pressure was in the
70-90s.  On presentation, a central line was placed under
standard sterile conditions. ED staff noted patient has had
significant diarrhea while there, also witnessed an aspiration
event. She was treated with solumedrol for possible COPD flare,
blood gas obtained which showed ph 7.32, co2 72. Labs in ED
otherwise notable for leukocytosis, bicarbonate 41, creatinine
1.5, and sodium 152.
ED staff discussed with pt's son, her HCP. Confirmed that she is
DNR but would want intubation. She was treated with vancomycin,
ceftriaxone, and metronidazole. 1.4 mg Narcan was given with
some response.

MEDICAL HISTORY: -[**Hospital1 5595**] has a [**Location (un) 27292**] epidemic-symptom free for 10 days
-Influenza vaccine [**2151-12-7**]
-COPD/emphysema with CO2 retention:  admitted in [**2152-2-14**] to
NEBH with fever, hypoxia and respiratory distress with
improvement with bipap, nebulizers, levoquin and steroids. ABG
on admission in [**2-20**] was 7.38/64/70-per d/c summary report. In
[**2152-2-14**], found to have bilateral lower lobe PNA and
presented with hypotension with BP 83/50 requiring ICU
admission.
-Schizophrenia
-Cataracts, status post iridectomy ROS
-Congestive heart failure: EF 55% and mild pulmonary
hypertension ([**2152-4-13**])
-Vitamin B12 deficiency, with macrocytic anemia
-Dementia
-Bladder spasm
-Urinary incontinece
-Partial lung collapse in [**2149**]
-Diabetes Type II, with creatinine in [**2152-2-14**] of 0.8

MEDICATION ON ADMISSION: -albuterol
-Vitamin C
-Aricept
-Lasix 40 mg po qd
-Levofloxacin ([**2152-4-26**]->[**2152-5-3**])
-Morphine oral q4
-Magnexium oxide
-Ditropan
-Prednisone 40 mg as part of taper started at prednisone 60 mg
po qd on [**2152-4-26**]
-Risperdal 1 mg [**Hospital1 **]
-Depakote 500 qam
-Depakote 250 q pm
-Trazadone 50 mg po qhs

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: (on admission to MICU):
Vitals: Tm = 97.0 on the floor and 103.8 in the ED, Tc = 95.5,
83/31, CVP= 10, HR 71-82,
AC 30%, PEEP = 10, VT = 400s, 7.28/64/48
GEN: Elderly female who appears younger than her stated age
NECK: No LAD
HEENT: PEERLA
CARD: nml S1, S2, distant heart sounds.
CHEST: Coarse breaths sounds with upper airway sounds
ABD:nabs, soft nt.
EXT: no edema.
NEURO: obeys simple commands
SKIN: No obvious wounds or rashes.

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: At baseline, she is able to hold a superficial conversation. Her
memory is quite poor. Dependent for all ADL. She could feed
herself after the tray was set up. Spoke to [**First Name8 (NamePattern2) 47532**] [**Last Name (NamePattern1) 4894**] at
[**Hospital 100**] Rehab who notes that patient is dependent in all ADLS
except feeding. Total care. Been at [**Hospital1 5595**] for 2 weeks.
Unspecified septicemia,Acute and chronic respiratory failure,Chronic diastolic heart failure,Septic shock,Obstructive chronic bronchitis with (acute) exacerbation,Hyperosmolality and/or hypernatremia,Unspecified schizophrenia, unspecified,Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction,Unspecified disorder of kidney and ureter,Other chronic pulmonary heart diseases,Other vitamin B12 deficiency anemia,Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Septicemia NOS,Acute & chronc resp fail,Chr diastolic hrt fail,Septic shock,Obs chr bronc w(ac) exac,Hyperosmolality,Schizophrenia NOS-unspec,SIRS-noninf w ac org dys,Renal & ureteral dis NOS,Chr pulmon heart dis NEC,B12 defic anemia NEC,Hypertension NOS,Mental disor NEC oth dis,DMII wo cmp nt st uncntr
Admission Date:  [**2152-4-28**]              Discharge Date:   [**2152-5-2**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 7455**]
Chief Complaint:
Hypoxia and decreased mental status.

Major Surgical or Invasive Procedure:
Right central line placed.  Removed on [**2152-4-30**].


History of Present Illness:
Patinet is an 86 year old woman with COPD on 2L at baseline,
congestive heart failure, and a resident at [**Hospital1 10151**] facility who was transferred due to concern for
decreased mental status and hypoxia. On day of admission, she
developed hypoxia, requiring a 100% NRB to maintain good
saturation. Vitals on transfer were BP 100/60, T 102, and she
was given morphine 8 mg SL. EMS was called and per verbal
report, during transfer SBP dropped to 60s but this responded to
2L NS. According to personnel at rehab center, patient has had
increased difficulty breathing over past week.  Treatment was
started with Lasix, albuterol, levofloxacin, and prednisone
taper.
.
In the ED, patient was obtunded and febrile to 101.3 F axillary.
 RR was in the 30s, HR was 161, and blood pressure was in the
70-90s.  On presentation, a central line was placed under
standard sterile conditions. ED staff noted patient has had
significant diarrhea while there, also witnessed an aspiration
event. She was treated with solumedrol for possible COPD flare,
blood gas obtained which showed ph 7.32, co2 72. Labs in ED
otherwise notable for leukocytosis, bicarbonate 41, creatinine
1.5, and sodium 152.
ED staff discussed with pt's son, her HCP. Confirmed that she is
DNR but would want intubation. She was treated with vancomycin,
ceftriaxone, and metronidazole. 1.4 mg Narcan was given with
some response.


Past Medical History:
-[**Hospital1 5595**] has a [**Location (un) 27292**] epidemic-symptom free for 10 days
-Influenza vaccine [**2151-12-7**]
-COPD/emphysema with CO2 retention:  admitted in [**2152-2-14**] to
NEBH with fever, hypoxia and respiratory distress with
improvement with bipap, nebulizers, levoquin and steroids. ABG
on admission in [**2-20**] was 7.38/64/70-per d/c summary report. In
[**2152-2-14**], found to have bilateral lower lobe PNA and
presented with hypotension with BP 83/50 requiring ICU
admission.
-Schizophrenia
-Cataracts, status post iridectomy ROS
-Congestive heart failure: EF 55% and mild pulmonary
hypertension ([**2152-4-13**])
-Vitamin B12 deficiency, with macrocytic anemia
-Dementia
-Bladder spasm
-Urinary incontinece
-Partial lung collapse in [**2149**]
-Diabetes Type II, with creatinine in [**2152-2-14**] of 0.8

Social History:
At baseline, she is able to hold a superficial conversation. Her
memory is quite poor. Dependent for all ADL. She could feed
herself after the tray was set up. Spoke to [**First Name8 (NamePattern2) 47532**] [**Last Name (NamePattern1) 4894**] at
[**Hospital 100**] Rehab who notes that patient is dependent in all ADLS
except feeding. Total care. Been at [**Hospital1 5595**] for 2 weeks.

Family History:
Noncontributory.


Physical Exam:
(on admission to MICU):
Vitals: Tm = 97.0 on the floor and 103.8 in the ED, Tc = 95.5,
83/31, CVP= 10, HR 71-82,
AC 30%, PEEP = 10, VT = 400s, 7.28/64/48
GEN: Elderly female who appears younger than her stated age
NECK: No LAD
HEENT: PEERLA
CARD: nml S1, S2, distant heart sounds.
CHEST: Coarse breaths sounds with upper airway sounds
ABD:nabs, soft nt.
EXT: no edema.
NEURO: obeys simple commands
SKIN: No obvious wounds or rashes.

Pertinent Results:
Images:
-Chest Xray ([**2152-4-28**]):  Evidence of congestive heart failure.
There may be superimposed pneumonia versus atelectasis of the
right middle lobe.
.
-Cardiac ECHO ([**2152-4-29**]):  EF >55%.  Right atrial pressure
11-15mmHg.  Dilated RV cavity with RVH suggestive of chronic
pulmonary
hypertension. Normal RV systolic function suggests no acute (on
chronic) RV strain.
.
-Head CT ([**2152-4-28**]):  1.  No hemorrhage or mass effect.   2.
Chronic microvascular infarction.
.
EKG ([**2152-4-28**]):  SVT at 161 bpm.
.
.
MICRO:
Blood culture ([**4-28**], [**4-30**]):  Negative to date.
.
Urine ([**2152-4-28**] and [**2152-4-30**]):  Negative.
.
Stool ([**2152-4-28**]):  NO CAMPYLOBACTER FOUND.  NO E.COLI 0157:H7
FOUND.  FECES NEGATIVE FOR C. DIFFICILE TOXIN BY EIA.
.
.
LABS:
[**2152-5-2**] 07:00AM BLOOD WBC-11.5* RBC-3.01* Hgb-10.0* Hct-29.8*
MCV-99* MCH-33.1* MCHC-33.4 RDW-16.0* Plt Ct-289
[**2152-5-1**] 10:01AM BLOOD WBC-11.1* RBC-2.83* Hgb-9.4* Hct-28.0*
MCV-99* MCH-33.3* MCHC-33.6 RDW-16.1* Plt Ct-268
[**2152-4-28**] 10:30AM BLOOD WBC-14.1* RBC-3.20* Hgb-10.4* Hct-33.5*
MCV-105* MCH-32.6* MCHC-31.1 RDW-15.9* Plt Ct-317
[**2152-4-29**] 02:51AM BLOOD Neuts-88.6* Lymphs-9.8* Monos-1.5*
Eos-0.1 Baso-0
[**2152-4-28**] 10:30AM BLOOD Neuts-76.7* Lymphs-17.2* Monos-5.5
Eos-0.5 Baso-0.2
[**2152-5-2**] 07:00AM BLOOD Plt Ct-289
[**2152-5-2**] 07:00AM BLOOD PT-12.2 PTT-38.0* INR(PT)-1.0
[**2152-4-28**] 10:30AM BLOOD PT-12.4 PTT-25.8 INR(PT)-1.1
[**2152-5-2**] 07:00AM BLOOD Glucose-154* UreaN-18 Creat-0.7 Na-147*
K-4.4 Cl-108 HCO3-31 AnGap-12
[**2152-4-28**] 10:30AM BLOOD Glucose-87 UreaN-60* Creat-1.4* Na-154*
K-4.4 Cl-108 HCO3-37* AnGap-13
[**2152-4-28**] 05:20PM BLOOD ALT-22 AST-36 LD(LDH)-250 CK(CPK)-158*
AlkPhos-44 TotBili-0.2
[**2152-4-28**] 05:20PM BLOOD CK-MB-8 cTropnT-<0.01 proBNP-5066*
[**2152-4-28**] 10:30AM BLOOD CK-MB-4 cTropnT-0.05*
[**2152-5-2**] 07:00AM BLOOD Calcium-8.8 Phos-2.5* Mg-2.3
[**2152-4-28**] 10:30AM BLOOD Calcium-9.4 Phos-4.7* Mg-2.7*
[**2152-5-1**] 04:24PM BLOOD Type-ART pO2-71* pCO2-53* pH-7.47*
calTCO2-40* Base XS-12
[**2152-4-28**] 10:41AM BLOOD Type-ART pO2-167* pCO2-73* pH-7.34*
calTCO2-41* Base XS-10
[**2152-5-1**] 10:15AM BLOOD Type-ART pO2-67* pCO2-58* pH-7.46*
calTCO2-42* Base XS-14 Intubat-NOT INTUBA
[**2152-4-30**] 08:23AM BLOOD Type-ART Temp-37.6 pO2-80* pCO2-58*
pH-7.42 calTCO2-39* Base XS-10 Intubat-NOT INTUBA
[**2152-4-30**] 04:15AM BLOOD Type-MIX pO2-33* pCO2-56* pH-7.39
calTCO2-35* Base XS-6
[**2152-4-28**] 02:16PM BLOOD Type-ART pO2-96 pCO2-71* pH-7.31*
calTCO2-37* Base XS-5
[**2152-5-1**] 04:24PM BLOOD Glucose-152* Lactate-1.72 Na-141 K-4.1
Cl-99* calHCO3-38*
[**2152-5-1**] 04:24PM BLOOD freeCa-1.19
[**2152-5-1**] 10:15AM BLOOD freeCa-1.21

Brief Hospital Course:
Hospital Course/Assessment/Plan:
Patient is an 86 year old woman with COPD, CHF, who was
transferred for an acute respiratory hypercarbic hypoxemic
failure thought to be due to COPD exacerbation.  Patient with
pronounced diarrhea, with cultures negative.  Hypernatremic and
resolving renal failure.  Cultures to date negative.
.
.
1)Infectious Process:
On admission to the MICU, patient thought to have sepsis and
severe hypovolemia in the setting of diarrhea.  Concern for
aspiration pneumonia or infectious diarrhea. Reccurent episodes
of pneumonia and COPD exacerbation concerning for potential
aspiration.
-In MICU, required IV fluids and neosynephrine.  CVP 10-14.
Received solumedrol in ED.  Initially, started broad spectrum
vancomycin, ceftriaxone, and flagyl.  Urine, blood, and stool
cultures negative.  Patient came from nursing home where large
outbreak of [**Location (un) **] virus.
-Speech and swallow performed video swallowing study, as concern
for aspiration pneumonia.  Patient will need to continue on
pureed solids and thick liquids to prevent aspiration.
-Will be discharged on levofloxacin for four more days for COPD
exacerbation.
.
2)Respiratory Distress:
Hypercarbic and hypoxemic repsiratory failure most likely
secondary to COPD flare. Previous ABGs revealed carbon dioxide
retention. Cardiac ECHO on [**4-29**] revealed elevated right atrial
pressure and dilated right ventricle, consistent with pulmonary
hypertension.  Placed on bi-pap initially, but on discharge
tolerating 2L nasal canula.  At baseline, patient requires
supplemental oxygen.
-Patient to continue on levofloxacin and prednisone, as
respiratory distress most consistent with COPD exacerbation.
Will continue prednisone for four more days.  40mg for the next
two days and then 20mg for the following two days.  Patient will
also complete four more days of levofloxacin.
-Patient will be discharged on lasix 40mg daily, PRN for
pulmonary congestion.
.
3)Hypernatremia:
On admission, appeared hypovolemic, in setting of diarrhea.
Patient with dementia, so difficult to maintain adequate
hydration.  Initially, calculated free water deficit of 3.9
liters.  Continued to gently hydrate with IV fluids and follow
serum sodium levels.  By discharge, sodium corrected at 147.
Continue to encourage PO liquid supplementation.
.
4)Diarrhea:
Patient from nursing home where previous norovirus outbreak.
Sent stool cultures for C. dificile and cultures.  Initially
started metronidazole for empiric coverage.
-Patient's diarrhea resolved on discharge.  Stool cultures
negative to date.
.
5) Altered Mental Status:
Underlying schizophrenia and dementia.  Improved mental status
with improved ventilation.  Head CT negative for intracranial
hemorrhage.  Vitamin B12 864.  Depakote level 16.  Initially
held all psychotropic medications for schizophrenia, but
restarted on [**4-29**].
.
6) Acute renal insufficiency:
On presentation, creatinine 1.4, with baseline creatinin
0.8-1.0.  With IV fluids, creatinine improved to 0.7.
.
7) Anemia:
Patient with history of macrocytic anemia on B12
supplementation. Iron studies on [**2152-4-4**] demonstrated ferritin
127, TIBC 246, iron 53.
.
8) Diabetes:
Placed on insulin sliding scale.  Switched to glargine 10 and
humalong sliding scale.
-On discharge, will need to continue to monitor blood sugars, as
patient receiving prednisone.
.
9) Prophylaxis:
Placed on PPI and heparin subcutaneously.  Previously colonized
with MRSA, so placed on precautions.
.
10) Code:
HCP: [**Name (NI) 25812**] [**Name (NI) **] [**Telephone/Fax (1) 61335**].
DNR, but can intubate for short periods of time.


Medications on Admission:
-albuterol
-Vitamin C
-Aricept
-Lasix 40 mg po qd
-Levofloxacin ([**2152-4-26**]->[**2152-5-3**])
-Morphine oral q4
-Magnexium oxide
-Ditropan
-Prednisone 40 mg as part of taper started at prednisone 60 mg
po qd on [**2152-4-26**]
-Risperdal 1 mg [**Hospital1 **]
-Depakote 500 qam
-Depakote 250 q pm
-Trazadone 50 mg po qhs

Discharge Medications:
1. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
2. Divalproex 500 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO QAM (once a day (in the
morning)).
3. Divalproex 250 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO QPM (once a day (in the
evening)).
4. Risperidone 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
5. Donepezil 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

6. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 4 days.
7. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
q6hr PRN as needed for shortness of breath or wheezing.
8. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
q6hr PRN as needed for shortness of breath or wheezing.
9. Multi-Vitamin     Tablet Sig: One (1) Tablet PO once a day.
10. Ditropan 5 mg Tablet Sig: One (1) Tablet PO once a day.
11. Trazodone 50 mg Tablet Sig: One (1) Tablet PO at bedtime.
12. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day as
needed for shortness of breath or wheezing.
13. MEDICATION
Continue on insulin sliding scale (see attached)
14. Prednisone 20 mg Tablet Sig: Two (2) Tablet PO once a day
for 2 days: Give 40 mg on [**5-3**] and [**5-4**].
15. Prednisone 20 mg Tablet Sig: One (1) Tablet PO once a day
for 2 days: Give 20mg on [**5-5**] and [**2152-5-6**].  No
further prednisone after [**5-6**] required.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - MACU

Discharge Diagnosis:
Primary:
-COPD exacerbation
.
Secondary:
-Schizophrenia
-Cataracts, status post iridectomy
-Congestive heart failure: EF 55% and mild pulmonary
hypertension ([**2152-4-13**])
-Vitamin B12 deficiency, with macrocytic anemia
-Dementia
-Bladder spasm
-Urinary incontinece
-Partial lung collapse in [**2149**]
-Diabetes Type II
-Influenza vaccine [**2151-12-7**]


Discharge Condition:
Stable.


Discharge Instructions:
-You were admitted for hypoxia and decreased mental status.  You
were started on a bi-pap machine.  Most likely, you had an
exacerbation of your underlying COPD.  Antibiotics were started
and you will continue on levofloxacin for four more days.
Prednisone will be continued for four more days (40mg per day on
[**5-3**] and [**5-4**], followed by 20mg per day on [**5-5**] and [**5-6**]).
-Continue on all medications prescribed on discharge.  Lasix can
be used for increased edema or pulmonary congestion.
-You should continue to be followed by an attending physician at
your facility.
-If you experience any chest pain, shortness of breath, or any
other concerning symptoms, call your PCP or come to the ED
immediately.


Followup Instructions:
-You should continue to be followed by an attending physician at
your facility.
{'Unspecified septicemia,Acute and chronic respiratory failure,Chronic diastolic heart failure,Septic shock,Obstructive chronic bronchitis with (acute) exacerbation,Hyperosmolality and/or hypernatremia,Unspecified schizophrenia, unspecified,Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction,Unspecified disorder of kidney and ureter,Other chronic pulmonary heart diseases,Other vitamin B12 deficiency anemia,Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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 and decreased mental status.

PRESENT ILLNESS: Patinet is an 86 year old woman with COPD on 2L at baseline,
congestive heart failure, and a resident at [**Hospital1 10151**] facility who was transferred due to concern for
decreased mental status and hypoxia. On day of admission, she
developed hypoxia, requiring a 100% NRB to maintain good
saturation. Vitals on transfer were BP 100/60, T 102, and she
was given morphine 8 mg SL. EMS was called and per verbal
report, during transfer SBP dropped to 60s but this responded to
2L NS. According to personnel at rehab center, patient has had
increased difficulty breathing over past week.  Treatment was
started with Lasix, albuterol, levofloxacin, and prednisone
taper.
.
In the ED, patient was obtunded and febrile to 101.3 F axillary.
 RR was in the 30s, HR was 161, and blood pressure was in the
70-90s.  On presentation, a central line was placed under
standard sterile conditions. ED staff noted patient has had
significant diarrhea while there, also witnessed an aspiration
event. She was treated with solumedrol for possible COPD flare,
blood gas obtained which showed ph 7.32, co2 72. Labs in ED
otherwise notable for leukocytosis, bicarbonate 41, creatinine
1.5, and sodium 152.
ED staff discussed with pt's son, her HCP. Confirmed that she is
DNR but would want intubation. She was treated with vancomycin,
ceftriaxone, and metronidazole. 1.4 mg Narcan was given with
some response.

MEDICAL HISTORY: -[**Hospital1 5595**] has a [**Location (un) 27292**] epidemic-symptom free for 10 days
-Influenza vaccine [**2151-12-7**]
-COPD/emphysema with CO2 retention:  admitted in [**2152-2-14**] to
NEBH with fever, hypoxia and respiratory distress with
improvement with bipap, nebulizers, levoquin and steroids. ABG
on admission in [**2-20**] was 7.38/64/70-per d/c summary report. In
[**2152-2-14**], found to have bilateral lower lobe PNA and
presented with hypotension with BP 83/50 requiring ICU
admission.
-Schizophrenia
-Cataracts, status post iridectomy ROS
-Congestive heart failure: EF 55% and mild pulmonary
hypertension ([**2152-4-13**])
-Vitamin B12 deficiency, with macrocytic anemia
-Dementia
-Bladder spasm
-Urinary incontinece
-Partial lung collapse in [**2149**]
-Diabetes Type II, with creatinine in [**2152-2-14**] of 0.8

MEDICATION ON ADMISSION: -albuterol
-Vitamin C
-Aricept
-Lasix 40 mg po qd
-Levofloxacin ([**2152-4-26**]->[**2152-5-3**])
-Morphine oral q4
-Magnexium oxide
-Ditropan
-Prednisone 40 mg as part of taper started at prednisone 60 mg
po qd on [**2152-4-26**]
-Risperdal 1 mg [**Hospital1 **]
-Depakote 500 qam
-Depakote 250 q pm
-Trazadone 50 mg po qhs

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: (on admission to MICU):
Vitals: Tm = 97.0 on the floor and 103.8 in the ED, Tc = 95.5,
83/31, CVP= 10, HR 71-82,
AC 30%, PEEP = 10, VT = 400s, 7.28/64/48
GEN: Elderly female who appears younger than her stated age
NECK: No LAD
HEENT: PEERLA
CARD: nml S1, S2, distant heart sounds.
CHEST: Coarse breaths sounds with upper airway sounds
ABD:nabs, soft nt.
EXT: no edema.
NEURO: obeys simple commands
SKIN: No obvious wounds or rashes.

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: At baseline, she is able to hold a superficial conversation. Her
memory is quite poor. Dependent for all ADL. She could feed
herself after the tray was set up. Spoke to [**First Name8 (NamePattern2) 47532**] [**Last Name (NamePattern1) 4894**] at
[**Hospital 100**] Rehab who notes that patient is dependent in all ADLS
except feeding. Total care. Been at [**Hospital1 5595**] for 2 weeks. 

### Response:
{'Unspecified septicemia,Acute and chronic respiratory failure,Chronic diastolic heart failure,Septic shock,Obstructive chronic bronchitis with (acute) exacerbation,Hyperosmolality and/or hypernatremia,Unspecified schizophrenia, unspecified,Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction,Unspecified disorder of kidney and ureter,Other chronic pulmonary heart diseases,Other vitamin B12 deficiency anemia,Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
