CHIEF COMPLAINT: Respiratory failure

PRESENT ILLNESS: Ms. [**Known lastname 3659**] is a [**Age over 90 **] year old female with CAD, CHF (EF 40%
[**2165-3-11**]), COPD who is admitted for respiratory failure. She had a
recent admission to OSH on [**4-3**] for CHF and pneumonia. She was
treated here from [**3-9**] - [**3-18**] for NSTEMI and underwent cardiac
cath with stent placement. Per her daughter, her breathing was
labored yesterday afternoon, but was at baseline last night.
There is no report of cough or fevers from her daughter.
.
Patient was noted to be in respiratory distress at her nursing
home. She had an O2 Sat of 72% on 2LNC, which improved to 100%
on NRB. She was dypsneic, tachypneic and cyanotic. She intubated
by EMT at the nursing home and was given duonebs x 4, lasix 40 x
1, solumedrol 125 x 1 and morphine 1 mg x 1. She was noted to be
wheezing at [**Hospital 8**] Hospital and was given lasix 80 and
ertapenem. She was given ertapenem for concern for PNA.
.
Upon arrival to [**Hospital1 18**], her vitals were T 97, HR 78, BP 151/58,
RR 18, 100% intubated. She was given vanco/levo for treatment of
pneumonia. She remained hemodynamically stable.
.
On the floor, review of sytems unable to obtain due to sedation,
intubation.

MEDICAL HISTORY: # Coronary Disease - s/p NSTEMI [**2164-9-8**], declined cath,
medically managed. Normal stress test [**2163**]
# Chronic renal failure, stage III CKD - Dr [**Last Name (STitle) **]
# Chronic systolic/diastolic congestive heart failure, most
recent EF>60%
# Hypertension
# Hyperlipidemia, intolerant of statins
# Type 2 diabetes, diet-controlled
# GERD
# Breast Cancer - diagnosed in [**2145**], s/p lumpectomy in [**State 108**]
# s/p total abdominal hysterectomy [**2094**] for fibroids
# Cataracts
.
Cardiac Risk Factors: Diabetes, Dyslipidemia, Hypertension

MEDICATION ON ADMISSION: Albuterol nebs prn
Aspirin 81 mg daily
calcitrol 0.25 q Mon/Wed/Fri
Carvedilol 12.5 mg [**Hospital1 **]
[**Hospital1 **] 75 mg daily
Coenzyme q 10 100 mg [**Hospital1 **]
Colace 100 mg daily
Felodipine 10 mg ER daily
Lasix 20 mg [**Hospital1 **]
Isosorbide monnitrate 30 TID
MVI daily
Ranitidine 150 mg daily
Tiotriopium 18 mg inhaled daily
Hydralazine 10 mg QID

ALLERGIES: Atorvastatin / Tylenol / Ibuprofen / Rosuvastatin

PHYSICAL EXAM: Admission:
Vitals: HR 64, BP 132/56, 100% on 400x16, 40%, PEEP 5
General: intubated, sedated
HEENT: Sclera anicteric, ET tube present
Neck: supple, JVP not elevated
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: foley present
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death. Her father had hypertension. Her sister is
alive and healthy at 93.

SOCIAL HISTORY: She lives at home alone, but has family in the area. Social
history is significant for the absence of current tobacco use.
There is no history of alcohol abuse. Has home [**Year (4 digits) 269**] w tele
reports daily and PT. due to multiple admissions, had been at
rehab most recently, but would prefer to go home.
Acute respiratory failure,Acute on chronic combined systolic and diastolic heart failure,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, Stage III (moderate),Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Adrenal cortical steroids causing adverse effects in therapeutic use,Anemia in chronic kidney disease,Esophageal reflux,Personal history of malignant neoplasm of breast,Other postprocedural status
Acute respiratry failure,Ac/chr syst/dia hrt fail,Pneumonia, organism NOS,Acute kidney failure NOS,Chr airway obstruct NEC,Chr kidney dis stage III,Hy kid NOS w cr kid I-IV,Crnry athrscl natve vssl,Old myocardial infarct,DMII wo cmp nt st uncntr,Adv eff corticosteroids,Anemia in chr kidney dis,Esophageal reflux,Hx of breast malignancy,Post-proc states NEC
Admission Date:  [**2165-4-15**]              Discharge Date:   [**2165-4-24**]


Service: MEDICINE

Allergies:
Atorvastatin / Tylenol / Ibuprofen / Rosuvastatin

Attending:[**First Name3 (LF) 1253**]
Chief Complaint:
Respiratory failure

Major Surgical or Invasive Procedure:
Endotracheal Intubation

History of Present Illness:
Ms. [**Known lastname 3659**] is a [**Age over 90 **] year old female with CAD, CHF (EF 40%
[**2165-3-11**]), COPD who is admitted for respiratory failure. She had a
recent admission to OSH on [**4-3**] for CHF and pneumonia. She was
treated here from [**3-9**] - [**3-18**] for NSTEMI and underwent cardiac
cath with stent placement. Per her daughter, her breathing was
labored yesterday afternoon, but was at baseline last night.
There is no report of cough or fevers from her daughter.
.
Patient was noted to be in respiratory distress at her nursing
home. She had an O2 Sat of 72% on 2LNC, which improved to 100%
on NRB. She was dypsneic, tachypneic and cyanotic. She intubated
by EMT at the nursing home and was given duonebs x 4, lasix 40 x
1, solumedrol 125 x 1 and morphine 1 mg x 1. She was noted to be
wheezing at [**Hospital 8**] Hospital and was given lasix 80 and
ertapenem. She was given ertapenem for concern for PNA.
.
Upon arrival to [**Hospital1 18**], her vitals were T 97, HR 78, BP 151/58,
RR 18, 100% intubated. She was given vanco/levo for treatment of
pneumonia. She remained hemodynamically stable.
.
On the floor, review of sytems unable to obtain due to sedation,
intubation.


Past Medical History:
# Coronary Disease - s/p NSTEMI [**2164-9-8**], declined cath,
medically managed. Normal stress test [**2163**]
# Chronic renal failure, stage III CKD - Dr [**Last Name (STitle) **]
# Chronic systolic/diastolic congestive heart failure, most
recent EF>60%
# Hypertension
# Hyperlipidemia, intolerant of statins
# Type 2 diabetes, diet-controlled
# GERD
# Breast Cancer - diagnosed in [**2145**], s/p lumpectomy in [**State 108**]
# s/p total abdominal hysterectomy [**2094**] for fibroids
# Cataracts
.
Cardiac Risk Factors: Diabetes, Dyslipidemia, Hypertension


Social History:
She lives at home alone, but has family in the area. Social
history is significant for the absence of current tobacco use.
There is no history of alcohol abuse. Has home [**Year (4 digits) 269**] w tele
reports daily and PT. due to multiple admissions, had been at
rehab most recently, but would prefer to go home.


Family History:
There is no family history of premature coronary artery disease
or sudden death. Her father had hypertension. Her sister is
alive and healthy at 93.

Physical Exam:
Admission:
Vitals: HR 64, BP 132/56, 100% on 400x16, 40%, PEEP 5
General: intubated, sedated
HEENT: Sclera anicteric, ET tube present
Neck: supple, JVP not elevated
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: foley present
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

Discharge:
afebrile  148/51  p67  18  97%RA
Breathing comfortably, talking full sentences without
difficulty. Lungs CTA B.
JVP WNL
RRR.
No edema lower extremities bilaterally.

Pertinent Results:
[**2165-4-15**] 10:30AM BLOOD WBC-10.6 RBC-4.05* Hgb-11.5* Hct-35.3*
MCV-87 MCH-28.3 MCHC-32.5 RDW-15.3 Plt Ct-304
[**2165-4-24**] 06:45AM BLOOD WBC-7.3 RBC-3.72* Hgb-11.2* Hct-33.6*
MCV-90 MCH-30.0 MCHC-33.3 RDW-14.9 Plt Ct-272
[**2165-4-20**] 06:20AM BLOOD PT-13.8* INR(PT)-1.2*
[**2165-4-15**] 10:30AM BLOOD Glucose-221* UreaN-57* Creat-2.4* Na-142
K-3.5 Cl-99 HCO3-29 AnGap-18
[**2165-4-21**] 06:30AM BLOOD Glucose-175* UreaN-94* Creat-3.0* Na-141
K-3.1* Cl-94* HCO3-30 AnGap-20
[**2165-4-22**] 06:10AM BLOOD Glucose-133* UreaN-95* Creat-2.9* Na-139
K-3.6 Cl-95* HCO3-31 AnGap-17
[**2165-4-24**] 06:45AM BLOOD Glucose-119* UreaN-91* Creat-2.9* Na-139
K-3.3 Cl-95* HCO3-31 AnGap-16
[**2165-4-15**] 10:30AM BLOOD CK-MB-NotDone proBNP-[**Numeric Identifier **]*
[**2165-4-15**] 10:30AM BLOOD cTropnT-0.04*
[**2165-4-15**] 07:04PM BLOOD CK-MB-3 cTropnT-0.04*
[**2165-4-24**] 06:45AM BLOOD Phos-5.1* Mg-2.2

[**2165-4-17**] SPUTUM GRAM STAIN-FINAL; RESPIRATORY CULTURE-FINAL
INPATIENT:
   GRAM STAIN (Final [**2165-4-17**]):
      [**12-2**] PMNs and <10 epithelial cells/100X field.
      2+   (1-5 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS AND CLUSTERS.
   RESPIRATORY CULTURE (Final [**2165-4-19**]):
      SPARSE GROWTH Commensal Respiratory Flora.

[**2165-4-15**] MRSA SCREEN MRSA SCREEN-Negative
[**2165-4-15**] BLOOD CULTURE Blood Culture, Routine-Negative

Initial CXR:
CHEST, AP: The vascular markings are slightly prominent, may be
consistent
with mild central CHF. There is ground-glass opacification in
the superior
segment of the left lower lobe. Small bilateral pleural
effusions, left
greater than right, noted.
An endotracheal tube is seen with tip 4 cm from the carina. The
osseous
structures are demineralized. The soft tissues are unremarkable.


IMPRESSION: Mild CHF. Ground-glass consolidation in superior
segment of left lower lobe may represent aspiration or
pneumonia.


Brief Hospital Course:
Ms. [**Known lastname 3659**] is a [**Age over 90 **] year old female with CAD, CHF, COPD, HTN,
admitted with respiratory failure requiring intubation likely
secondary to flash pulmonary edema.
.
1. Respiratory failure; required mechanical ventilation: Likely
secondary to CHF exacerbation given elevated BNP and history of
CHF. Most recent echo in [**3-20**] showed EF of 40% following NSTEMI.
The patient was diuresed in the ICU with IV lasix 80mg [**Hospital1 **].
Fluid balance was -4.5L on ICU Day 3. She received her home
doses of hydralazine for afterload reduction and carvedilol for
beta blockade. She was sedated initially with propofol but
apneic on high doses and agitated on low doses, with several
failed SBTs. Sediation was switched to Precedex on ICU Day 2.
Patient was extubated without difficulty on ICU Day 3 with RA O2
sat 98-100%. She was changed to 80mg lasix PO BID for continued
diuresis. This was changed to 40 mg po bid on [**4-21**] due to
worsening azotemia. PNA was not suspected given her lack of
leukocytosis and lack of evidence of consolidation on CXR,
therefore empiric antibiotics that had been started on admission
were discontinued by ICU Day 1.
She is not on an ace-inhibitor due ot her renal disease. She is
not followed routinely by a cardiologist, she should likely be
seen in [**Hospital 1902**] clinic, appointment scheduled through care
connections.
Pt currently appears euvolemic, with appropriate JVP. Fluid
balance currently appears about even, but pt did not collect all
of urine.
.
2. HTN.
Contin home carvedilol, felodipine, isosorbide monoitrate,
hydralazine
.
3. Renal failure. Baseline Cr likely approx 2.4.
Pt's Cr not currently back to baseline, but pt appears
euvolemic. Suspect pt's renal function may have suffered an
insult with recent events, and it may take time to see what
amount of function she may recover. As pt currently appears
euvolemic, and is clinically doing very well, maintaining
current doses of lasix.
.
4. Anemia, CKD. Stable, at baseline.  Resume iron at discharge.
.
5. CAD. EKG with LBBB. Cardiac enzymes negative. Recent stent
placement last month. The patient ruled out for myocardial
infarction with negative cardiac enzymes and EKG. Her [**Hospital **] and
Clopidogrel were continued but her statin was held as it was not
on formulary and pt with history of multiple allergies to
statins.  Her fluvastatin will be resumed at time of discharge
with CoQ-10, as previously prescribed. Please monitor for side
effects, including myalgias on this medication.
.
7. Type 2 diabetes. Patient is diet controlled. HgA1C was 6.1 in
[**5-17**].
- treated with sliding scale insulin while inpatient; diet
controlled as an outpatient.
.
8. Hyperlipidemia. History of intolerance to many statins.
Patient's statin is not on formulary and therefore was held.
See "CAD" above for details.
.
CODE: Full, confirmed with HCP, daughter.
[**Name2 (NI) **]: Daughter, patient, PCP [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 3029**]
[**Name9 (PRE) **]: [**Hospital 100**] Rehab today


Medications on Admission:
Albuterol nebs prn
Aspirin 81 mg daily
calcitrol 0.25 q Mon/Wed/Fri
Carvedilol 12.5 mg [**Hospital1 **]
[**Hospital1 **] 75 mg daily
Coenzyme q 10 100 mg [**Hospital1 **]
Colace 100 mg daily
Felodipine 10 mg ER daily
Lasix 20 mg [**Hospital1 **]
Isosorbide monnitrate 30 TID
MVI daily
Ranitidine 150 mg daily
Tiotriopium 18 mg inhaled daily
Hydralazine 10 mg QID

Discharge Medications:
1. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for Constipation.
2. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q24H (every 24
hours).
3. Calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO QMOWEFR
(Monday -Wednesday-Friday).
4. Aspirin 81 mg Tablet, Chewable Sig: Two (2) Tablet, Chewable
PO DAILY (Daily).
5. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Cyanocobalamin 500 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Hydralazine 10 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours).
8. Isosorbide Mononitrate 20 mg Tablet Sig: One (1) Tablet PO
BID (2 times a day).
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
10. Felodipine 10 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
11. Carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
12. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
13. Iron (Ferrous Sulfate) 325 mg (65 mg Iron) Tablet Sig: One
(1) Tablet PO once a day.
14. Nitrostat 0.4 mg Tablet, Sublingual Sig: One (1) tab
Sublingual as directed: Q 5min as needed for chest pain. Seek
immediate medical attention if not relieved after 3rd dose.
15. Fluvastatin 80 mg Tablet Sustained Release 24 hr Sig: One
(1) Tablet Sustained Release 24 hr PO once a day: (per previous
admission. Pt has failed multiple other statins. Please monitor
for side effects, including myalgias, and notify MD if present).

16. Coenzyme Q10 100 mg Capsule Sig: One (1) Capsule PO twice a
day: (to help prevent myalgias on statin, per previous
admission).


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - [**Location (un) 550**]

Discharge Diagnosis:
Respiratory failure
Congestive Heart Failure, systolic, acute
Acute on chronic Renal Failure


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 were admitted with respiratory failure due to congestive
heart failure. This caused fluid to build up on your lungs. You
will need to take your medications daily and watch your weight
closely.
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more
than 3 lbs.

Followup Instructions:
Department: CARDIAC SERVICES
When: MONDAY [**2165-4-29**] at 10:00 AM
With: DR. [**First Name8 (NamePattern2) **] [**Doctor Last Name **] [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: CARDIAC SERVICES
When: TUESDAY [**2165-5-14**] at 2:30 PM
With: [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 5250**], 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

Department: MEDICAL SPECIALTIES
When: THURSDAY [**2165-5-16**] at 9:30 AM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2540**], RN [**Telephone/Fax (1) 721**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Acute respiratory failure,Acute on chronic combined systolic and diastolic heart failure,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, Stage III (moderate),Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Adrenal cortical steroids causing adverse effects in therapeutic use,Anemia in chronic kidney disease,Esophageal reflux,Personal history of malignant neoplasm of breast,Other postprocedural 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: Respiratory failure

PRESENT ILLNESS: Ms. [**Known lastname 3659**] is a [**Age over 90 **] year old female with CAD, CHF (EF 40%
[**2165-3-11**]), COPD who is admitted for respiratory failure. She had a
recent admission to OSH on [**4-3**] for CHF and pneumonia. She was
treated here from [**3-9**] - [**3-18**] for NSTEMI and underwent cardiac
cath with stent placement. Per her daughter, her breathing was
labored yesterday afternoon, but was at baseline last night.
There is no report of cough or fevers from her daughter.
.
Patient was noted to be in respiratory distress at her nursing
home. She had an O2 Sat of 72% on 2LNC, which improved to 100%
on NRB. She was dypsneic, tachypneic and cyanotic. She intubated
by EMT at the nursing home and was given duonebs x 4, lasix 40 x
1, solumedrol 125 x 1 and morphine 1 mg x 1. She was noted to be
wheezing at [**Hospital 8**] Hospital and was given lasix 80 and
ertapenem. She was given ertapenem for concern for PNA.
.
Upon arrival to [**Hospital1 18**], her vitals were T 97, HR 78, BP 151/58,
RR 18, 100% intubated. She was given vanco/levo for treatment of
pneumonia. She remained hemodynamically stable.
.
On the floor, review of sytems unable to obtain due to sedation,
intubation.

MEDICAL HISTORY: # Coronary Disease - s/p NSTEMI [**2164-9-8**], declined cath,
medically managed. Normal stress test [**2163**]
# Chronic renal failure, stage III CKD - Dr [**Last Name (STitle) **]
# Chronic systolic/diastolic congestive heart failure, most
recent EF>60%
# Hypertension
# Hyperlipidemia, intolerant of statins
# Type 2 diabetes, diet-controlled
# GERD
# Breast Cancer - diagnosed in [**2145**], s/p lumpectomy in [**State 108**]
# s/p total abdominal hysterectomy [**2094**] for fibroids
# Cataracts
.
Cardiac Risk Factors: Diabetes, Dyslipidemia, Hypertension

MEDICATION ON ADMISSION: Albuterol nebs prn
Aspirin 81 mg daily
calcitrol 0.25 q Mon/Wed/Fri
Carvedilol 12.5 mg [**Hospital1 **]
[**Hospital1 **] 75 mg daily
Coenzyme q 10 100 mg [**Hospital1 **]
Colace 100 mg daily
Felodipine 10 mg ER daily
Lasix 20 mg [**Hospital1 **]
Isosorbide monnitrate 30 TID
MVI daily
Ranitidine 150 mg daily
Tiotriopium 18 mg inhaled daily
Hydralazine 10 mg QID

ALLERGIES: Atorvastatin / Tylenol / Ibuprofen / Rosuvastatin

PHYSICAL EXAM: Admission:
Vitals: HR 64, BP 132/56, 100% on 400x16, 40%, PEEP 5
General: intubated, sedated
HEENT: Sclera anicteric, ET tube present
Neck: supple, JVP not elevated
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: foley present
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death. Her father had hypertension. Her sister is
alive and healthy at 93.

SOCIAL HISTORY: She lives at home alone, but has family in the area. Social
history is significant for the absence of current tobacco use.
There is no history of alcohol abuse. Has home [**Year (4 digits) 269**] w tele
reports daily and PT. due to multiple admissions, had been at
rehab most recently, but would prefer to go home. 

### Response:
{'Acute respiratory failure,Acute on chronic combined systolic and diastolic heart failure,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, Stage III (moderate),Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Adrenal cortical steroids causing adverse effects in therapeutic use,Anemia in chronic kidney disease,Esophageal reflux,Personal history of malignant neoplasm of breast,Other postprocedural status'}
