CHIEF COMPLAINT: hypoxemia

PRESENT ILLNESS: 52F with history of likely COPD (on 2L O2 at home), T1-T2 spinal
injury and subsequent paraplegia c/b recurrent UTI's ([**First Name3 (LF) 40097**]
klebsiella) with multiple recent admissions for
hypoxia/pneumonia presented to the ED with complaint of dyspnea
and hypoxia 48 hours after discharge from [**Hospital1 18**] for similar
complaint. During previous admission, patient came in with
hypoxia and chest x-ray concerning for multi-focal pneumonia.
She was started on empiric antibiotics, CT was negative for PE.
Due to absence of other infectious symptoms - no fever or
leukocytsosis - antibiotics were discontinued and she was
treated with nebulizers as needed. She was discharged on home
O2. Since discharge, she has had gradually worsening secretions
- green, per husband. Despite aggressive chest PT by husband and
PCA, she was found to be hypoxic in mid-80's today on pulse
oximeter and unable to increase with additional oxygen. Poor Po
intake, talking to herself for past 24 hours. She was brought to
the ER for further evaluation. Of note, previous admission on
[**4-17**] for RLL pna, dc'd on linezolid, cipro) with 3 days of
levaquin, meropenem and 4 days of concomitant vancomycin before
dc'ing due to improved clinical status.
In the ER, initial vitals were afebrile, 78% on 4L with systolic
blood pressure 110. On exam, she had diffuse expiratory wheezes
bilaterally and 1+ non-pitting edema in bilateral lower
extremities (baseline). Also, notable for leukocytosis. She
recieved combivents with minimal improvement in oxygenation. She
was placed on NRB then 50% venturi mask. ABG prior to transfer
was 7.32/70/150 - on 6L NC. She recieved Vancomycin.

MEDICAL HISTORY: 1. T1-T2 paraplegia following MVC [**1-4**]
2. Recurrent UTIs: [**Month/Year (2) 40097**] klebsiella
3. HCV, viral load suppressed
4. H/o recurrent PNAs: MRSA, Klebs, followed by Dr. [**Last Name (STitle) **]
5. Anxiety
6. DVT in [**2142**] - IVC filter placed in [**2142**]
7. Pulmonary nodules
8. Hypothyroidism
9. Chronic pain
10. Chronic gastritis
11. H/o obstructive lung disease
12. Anemia of chronic disease
13. s/p PEA arrest during hospitalization in [**2147-10-3**]

MEDICATION ON ADMISSION: (per DC summary [**2149-5-14**])
- albuterol sulfate 2.5 mg /3 mL (0.083 %) Q6h prn
- ipratropium bromide 0.02 % Q6h prn
- baclofen 20mg Qam, QHS
- baclofen 10mg Q1600
- citalopram 20 mg QD
- levothyroxine 88 mcg QD
- methadone 5mg TID
- omeprazole 20 mg EC [**Hospital1 **]
- oxybutynin chloride 10mg Qam, Qhs
- oxybutynin chloride 5 mg Q1600
- pregabalin 100 mg TID
- calcium carbonate 200 mg [**Hospital1 **]
- oxycodone 5 mg Q8 prn pain
- nicotine 7 mg/24 hr Patch
- polyethylene glycol 3350 17 gram qd
- lidocaine 5 %(700 mg/patch) 4 patches/day
- clonazepam 2mg qhs prn insomnia
- bisacodyl 5 mg Tablet, Delayed Release QD

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: Temp: 97.0 BP: 90/57 HR: 89 RR: 19 O2sat: 92% venturi 50%
GEN: awake, but appears tired.
HEENT: PERRL, EOMI. Dry mucous membranes. no JVD. left side of
neck with some pain to palpation over trapezius.
RESP: decreased BS at right base with inspiratory wheeze and
associated thonchi, bronchial BS over upper anterior lung
fields, rhonchi at left lung base.
CV: RRR, no m/g/r
ABD: soft, NT/ND, +BS, no ascites
EXT: non-pitting edema of feet bilaterally, no clubbing or
cyanosis/
SKIN: no rashes/no jaundice/no splinters
NEURO: alert, oriented x 3, but falls asleep easily,
inattentive. no cranial nerve deficits. no facial droop. moves
bilateral upper extremities against gravity, paralyzed below
T1-T2.

FAMILY HISTORY: Mother passed away with lung disease.

SOCIAL HISTORY: She lives at home with her husband and 2 adolescent children.
Her PCA and best friend, [**Name (NI) **], is with her much of the time and
helps to take care of her.
- Tobacco: 35 pack years, quit smoking 1-2 months ago
- EtOH: Denies
- Illicits: Denies
Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia due to Pseudomonas,Acute and chronic respiratory failure,Paraplegia,Other dependence on machines, supplemental oxygen,Late effect of spinal cord injury,Late effects of motor vehicle accident,Anxiety state, unspecified,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Other chronic pain,Iron deficiency anemia, unspecified
Obs chr bronc w(ac) exac,Pseudomonal pneumonia,Acute & chronc resp fail,Paraplegia NOS,Depend-supplement oxygen,Late eff spinal cord inj,Late eff motor vehic acc,Anxiety state NOS,Hypothyroidism NOS,Depressive disorder NEC,Chronic pain NEC,Iron defic anemia NOS
Admission Date:  [**2149-5-17**]              Discharge Date:   [**2149-5-21**]

Date of Birth:  [**2096-10-22**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 3151**]
Chief Complaint:
hypoxemia

Major Surgical or Invasive Procedure:
PICC placement


History of Present Illness:
52F with history of likely COPD (on 2L O2 at home), T1-T2 spinal
injury and subsequent paraplegia c/b recurrent UTI's ([**First Name3 (LF) 40097**]
klebsiella) with multiple recent admissions for
hypoxia/pneumonia presented to the ED with complaint of dyspnea
and hypoxia 48 hours after discharge from [**Hospital1 18**] for similar
complaint. During previous admission, patient came in with
hypoxia and chest x-ray concerning for multi-focal pneumonia.
She was started on empiric antibiotics, CT was negative for PE.
Due to absence of other infectious symptoms - no fever or
leukocytsosis - antibiotics were discontinued and she was
treated with nebulizers as needed. She was discharged on home
O2. Since discharge, she has had gradually worsening secretions
- green, per husband. Despite aggressive chest PT by husband and
PCA, she was found to be hypoxic in mid-80's today on pulse
oximeter and unable to increase with additional oxygen. Poor Po
intake, talking to herself for past 24 hours. She was brought to
the ER for further evaluation. Of note, previous admission on
[**4-17**] for RLL pna, dc'd on linezolid, cipro) with 3 days of
levaquin, meropenem and 4 days of concomitant vancomycin before
dc'ing due to improved clinical status.
In the ER, initial vitals were afebrile, 78% on 4L with systolic
blood pressure 110. On exam, she had diffuse expiratory wheezes
bilaterally and 1+ non-pitting edema in bilateral lower
extremities (baseline). Also, notable for leukocytosis. She
recieved combivents with minimal improvement in oxygenation. She
was placed on NRB then 50% venturi mask. ABG prior to transfer
was 7.32/70/150 - on 6L NC. She recieved Vancomycin.


Past Medical History:
1. T1-T2 paraplegia following MVC [**1-4**]
2. Recurrent UTIs: [**Month/Year (2) 40097**] klebsiella
3. HCV, viral load suppressed
4. H/o recurrent PNAs: MRSA, Klebs, followed by Dr. [**Last Name (STitle) **]
5. Anxiety
6. DVT in [**2142**] - IVC filter placed in [**2142**]
7. Pulmonary nodules
8. Hypothyroidism
9. Chronic pain
10. Chronic gastritis
11. H/o obstructive lung disease
12. Anemia of chronic disease
13. s/p PEA arrest during hospitalization in [**2147-10-3**]


Social History:
She lives at home with her husband and 2 adolescent children.
Her PCA and best friend, [**Name (NI) **], is with her much of the time and
helps to take care of her.
- Tobacco: 35 pack years, quit smoking 1-2 months ago
- EtOH: Denies
- Illicits: Denies


Family History:
Mother passed away with lung disease.

Physical Exam:
VS: Temp: 97.0 BP: 90/57 HR: 89 RR: 19 O2sat: 92% venturi 50%
GEN: awake, but appears tired.
HEENT: PERRL, EOMI. Dry mucous membranes. no JVD. left side of
neck with some pain to palpation over trapezius.
RESP: decreased BS at right base with inspiratory wheeze and
associated thonchi, bronchial BS over upper anterior lung
fields, rhonchi at left lung base.
CV: RRR, no m/g/r
ABD: soft, NT/ND, +BS, no ascites
EXT: non-pitting edema of feet bilaterally, no clubbing or
cyanosis/
SKIN: no rashes/no jaundice/no splinters
NEURO: alert, oriented x 3, but falls asleep easily,
inattentive. no cranial nerve deficits. no facial droop. moves
bilateral upper extremities against gravity, paralyzed below
T1-T2.


Pertinent Results:
[**2149-5-17**] 10:10PM BLOOD WBC-16.0*# RBC-3.32* Hgb-10.1* Hct-29.9*
MCV-90 MCH-30.5 MCHC-33.8 RDW-15.2 Plt Ct-198
[**2149-5-18**] 03:38AM BLOOD WBC-12.0* RBC-2.97* Hgb-9.0* Hct-27.0*
MCV-91 MCH-30.2 MCHC-33.3 RDW-15.1 Plt Ct-170
[**2149-5-17**] 10:48PM   TYPE-ART PO2-159* PCO2-70* PH-7.32* TOTAL
CO2-38* BASE XS-7
[**2149-5-17**] 10:20PM   LACTATE-1.0
[**2149-5-17**] 10:10PM   GLUCOSE-122* UREA N-6 CREAT-0.3* SODIUM-138
POTASSIUM-4.1 CHLORIDE-96 TOTAL CO2-34* ANION GAP-12
[**2149-5-17**] 10:10PM   CK-MB-2 cTropnT-<0.01 proBNP-757*

Chest X-ray [**2149-5-17**] - Findings suggestive of moderate
pulmonary edema. Bibasilar opacities, could represent a
combination of atelectasis and small effusions, however,
superimpsed infection cannot be excluded.
PFT's [**2148-9-30**] - FVC 25%, FEV1 31%, FEV1/FVC 125% (% expected)

Chest CTA [**2149-5-12**] - No evidence of pulonary embolism. 2. Left
upper lobe and lingular ground-glass opacities with smooth
septal thickening. Differential diagnosis includes atypical
infection, hemorrhage, or an unusual distribution of pulmonary
edema. 3. Bibasilar atelectasis with possible coexistent
aspiriation given plugging of the lower lobe bronchi and
fluid-filled upper esophagus.
4. Stable appearance of soft tissue mass in the azygoesophageal
recess since [**2148-2-24**]. Further evaluation with MRI may
be helpful to distinguish duplication cyst from solid mass such
as lymphadenopathy. 5. Right hilar lymphadenopathy, increased
since the prior study, and likely reactive. Attention to this
area at the time of MRI (if performed) would be helpful to
ensure return to baseline size. If MRI is not performed to
evaluate the azygoesophageal recess mass, then follow up
contrast-enhanced CT would be recommended in 3 months. 6. Small
right-sided pleural effusion.

Microbiology:
[**2149-5-18**] 3:52 am SPUTUM      Source: Expectorated.

                            **FINAL REPORT [**2149-5-20**]**

   GRAM STAIN (Final [**2149-5-19**]):
      THIS IS A CORRECTED REPORT ([**2149-5-19**]).
      Reported to and read back by DR. [**Last Name (STitle) 65353**], N ([**Numeric Identifier 104919**])
ON [**2149-5-19**]
      AT 12:30 PM.
      >25 PMNs and <10 epithelial cells/100X field.
      1+    (<1 per 1000X FIELD):   GRAM NEGATIVE ROD(S).
      PREVIOUSLY REPORTED ([**2149-5-18**]) AS:.
      <10 PMNs and >10 epithelial cells/100X field.
      1+    (<1 per 1000X FIELD):   GRAM NEGATIVE ROD(S).

   RESPIRATORY CULTURE (Final [**2149-5-20**]):
      Commensal Respiratory Flora Absent.
      PSEUDOMONAS AERUGINOSA.    SPARSE GROWTH.
         Piperacillin/Tazobactam sensitivity testing confirmed
by [**First Name8 (NamePattern2) 3077**]
         [**Last Name (NamePattern1) 3060**].

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             PSEUDOMONAS AERUGINOSA
                             |
CEFEPIME--------------     2 S
CEFTAZIDIME-----------     4 S
CIPROFLOXACIN---------<=0.25 S
GENTAMICIN------------     2 S
MEROPENEM-------------<=0.25 S
PIPERACILLIN/TAZO-----    16 S
TOBRAMYCIN------------   <=1 S


Brief Hospital Course:
Ms. [**Known firstname **] [**Known lastname **] is a 52 female with a history of obstructive lung
disease, paraplegia c/b recurrent UTI's and recent admissions
for pneumonia admitted with hypoxia 48 hours after recent
discharge.

# Community Acquired Pneumonia and COPD Exacerbation: She
required frequent nebulizers and suction in the medical
intensive care unit but was transferred to the floor on hospital
day three. Due to her history of [**Known lastname 40097**] in her lungs, she was
maintained on vancomycin and meropenem while in house. Her
sputum culture grew pseudomonas. The vancomycine was
discontinued. The meropenem was switched to ertapenem for daily
dosing. She was discharged home with services with a total two
week course of antibiotics. She was also treated with frequent
nebulizer treatments, which she also uses at home. Due to her
history of COPD, a five day course of prednisone 60m daily was
added.

# Hypotension: In the MICU, she required fluid resuscitation and
brief pressors for treatment of sepsis. She stabilized and was
transferred to the regular medicine floor.

# Chronic Pain: She was continued on her home regimen below.
- continue methadone 5 mg TID
- continue pregabalin
- continue oxycodone 5 mg q8h prn pain
- continue lidocaine patches

# Anemia: Her hematocrit was stable. She has known anemia of
chronic disease.

# Gastritis - continued omeprazole, continue calcium carbonate
# Hypothyroidism - continued levothyroxine
# Depression - continued citalopram
# Smoking cessation - continued nicotine patch
.
FEN: regular, IVF prn
Access: right femoral central line
PPx: heparin sc tid, omeprazole (home med)
Comm: patient, husband [**Name (NI) **] [**Telephone/Fax (1) 104920**]
[**Name2 (NI) **]ct: husband
[**Name (NI) 7092**]: FULL


Medications on Admission:
(per DC summary [**2149-5-14**])
- albuterol sulfate 2.5 mg /3 mL (0.083 %) Q6h prn
- ipratropium bromide 0.02 % Q6h prn
- baclofen 20mg Qam, QHS
- baclofen 10mg Q1600
- citalopram 20 mg QD
- levothyroxine 88 mcg QD
- methadone 5mg TID
- omeprazole 20 mg EC [**Hospital1 **]
- oxybutynin chloride 10mg Qam, Qhs
- oxybutynin chloride 5 mg Q1600
- pregabalin 100 mg TID
- calcium carbonate 200 mg [**Hospital1 **]
- oxycodone 5 mg Q8 prn pain
- nicotine 7 mg/24 hr Patch
- polyethylene glycol 3350 17 gram qd
- lidocaine 5 %(700 mg/patch) 4 patches/day
- clonazepam 2mg qhs prn insomnia
- bisacodyl 5 mg Tablet, Delayed Release QD


Discharge Medications:
1. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization [**Hospital1 **]: One (1)  Inhalation every six (6) hours as
needed for shortness of breath or wheezing.
2. ipratropium bromide 0.02 % Solution [**Hospital1 **]: One (1)  Inhalation
Q6H (every 6 hours) as needed for shortness of breath or
wheezing.
3. baclofen 10 mg Tablet [**Hospital1 **]: Two (2) Tablet PO BID (2 times a
day).
4. baclofen 10 mg Tablet [**Hospital1 **]: One (1) Tablet PO Once Daily at 4
PM.
5. citalopram 20 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).

6. levothyroxine 88 mcg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY
(Daily).
7. methadone 5 mg Tablet [**Hospital1 **]: One (1) Tablet PO TID (3 times a
day).
8. omeprazole 20 mg Capsule, Delayed Release(E.C.) [**Hospital1 **]: One (1)
Capsule, Delayed Release(E.C.) PO BID (2 times a day).
9. oxybutynin chloride 5 mg Tablet [**Hospital1 **]: Two (2) Tablet PO BID (2
times a day).
10. oxybutynin chloride 5 mg Tablet [**Hospital1 **]: One (1) Tablet PO Once
Daily at 4 PM.
11. pregabalin 100 mg Capsule [**Hospital1 **]: One (1) Capsule PO TID (3
times a day).
12. calcium carbonate 200 mg (500 mg) Tablet, Chewable [**Hospital1 **]: One
(1) Tablet, Chewable PO BID (2 times a day).
13. prednisone 20 mg Tablet [**Hospital1 **]: Three (3) Tablet PO DAILY
(Daily) for 1 days.
Disp:*3 Tablet(s)* Refills:*0*
14. nicotine 7 mg/24 hr Patch 24 hr [**Hospital1 **]: One (1) Patch 24 hr
Transdermal DAILY (Daily).
15. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated [**Hospital1 **]:
Four (4) Adhesive Patch, Medicated Topical DAILY (Daily).
16. sucralfate 1 gram Tablet [**Hospital1 **]: One (1) Tablet PO QID (4 times
a day).
17. oxycodone 5 mg Tablet [**Hospital1 **]: One (1) Tablet PO Q8H (every 8
hours) as needed for pain.
18. trazodone 100 mg Tablet [**Hospital1 **]: One (1) Tablet PO HS (at
bedtime) as needed for insomnia.
19. estradiol 0.01 % (0.1 mg/g) Cream [**Hospital1 **]: One (1)  Vaginal
Twice daily ().
20. ertapenem 1 gram Recon Soln [**Hospital1 **]: One (1) gram Intravenous
daily () for 10 days.
Disp:*10 gram* Refills:*0*
21. Outpatient Lab Work
[**2149-5-29**]: CBC with differential, BUN, Creatinin, AST, ALT,
alkaline phophatase, total bilirubin. Have these labs drawn at
your [**Company 191**] appointment for Dr. [**Last Name (STitle) 665**] to see.
22. clonazepam 1 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO three times a
day as needed for anxiety.


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
Hospital Acquired Pneumonia
COPD Exacerbation


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
Dear Ms. [**Known lastname **]:
It was a pleasure taking care of you at [**Hospital1 18**]. You were treated
for hospital acquired pneumonia and for an exacerbation of COPD.
Your respiratory status had deteriorated, and for this reason
you had to be transferred to the medical intensive care unit.
Upon returning to the hospital floor, your respiratory status
improved. Your infection is caused by a bacteria called
pseudomonas. You were treated with antibiotics, steroids,
nebulizers, and lasix. You will have to continue intravenous
antibiotics at home (see below). You have an appointment with
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2425**] at [**Company 191**] on [**2149-5-29**] (see below), where you
will have to get labs drawn. Please take the prescription for
the lab draws necessary.

Please make the following changes to your home medication
regimen:
1) Take prednisone 60mg for one more day (on [**2149-5-22**])
2) Take ertapenem 1 gram intravenously through your PICC for 10
days starting on [**2149-5-18**]

Followup Instructions:
You have the following appointments:

Department: [**Hospital3 249**]
When: THURSDAY [**2149-5-29**] at 10:20 AM
With: [**First Name8 (NamePattern2) 1409**] [**Last Name (NamePattern1) **], NP [**Telephone/Fax (1) 250**]
Building: [**Hospital6 29**] [**Location (un) 895**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: SURGICAL SPECIALTIES
When: [**Hospital Ward Name **] [**2149-9-8**] at 11:45 AM
With: [**First Name8 (NamePattern2) 161**] [**Name6 (MD) 162**] [**Name8 (MD) 163**], MD [**Telephone/Fax (1) 921**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage



Completed by:[**2149-6-1**]
{'Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia due to Pseudomonas,Acute and chronic respiratory failure,Paraplegia,Other dependence on machines, supplemental oxygen,Late effect of spinal cord injury,Late effects of motor vehicle accident,Anxiety state, unspecified,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Other chronic pain,Iron deficiency anemia, unspecified'}


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: hypoxemia

PRESENT ILLNESS: 52F with history of likely COPD (on 2L O2 at home), T1-T2 spinal
injury and subsequent paraplegia c/b recurrent UTI's ([**First Name3 (LF) 40097**]
klebsiella) with multiple recent admissions for
hypoxia/pneumonia presented to the ED with complaint of dyspnea
and hypoxia 48 hours after discharge from [**Hospital1 18**] for similar
complaint. During previous admission, patient came in with
hypoxia and chest x-ray concerning for multi-focal pneumonia.
She was started on empiric antibiotics, CT was negative for PE.
Due to absence of other infectious symptoms - no fever or
leukocytsosis - antibiotics were discontinued and she was
treated with nebulizers as needed. She was discharged on home
O2. Since discharge, she has had gradually worsening secretions
- green, per husband. Despite aggressive chest PT by husband and
PCA, she was found to be hypoxic in mid-80's today on pulse
oximeter and unable to increase with additional oxygen. Poor Po
intake, talking to herself for past 24 hours. She was brought to
the ER for further evaluation. Of note, previous admission on
[**4-17**] for RLL pna, dc'd on linezolid, cipro) with 3 days of
levaquin, meropenem and 4 days of concomitant vancomycin before
dc'ing due to improved clinical status.
In the ER, initial vitals were afebrile, 78% on 4L with systolic
blood pressure 110. On exam, she had diffuse expiratory wheezes
bilaterally and 1+ non-pitting edema in bilateral lower
extremities (baseline). Also, notable for leukocytosis. She
recieved combivents with minimal improvement in oxygenation. She
was placed on NRB then 50% venturi mask. ABG prior to transfer
was 7.32/70/150 - on 6L NC. She recieved Vancomycin.

MEDICAL HISTORY: 1. T1-T2 paraplegia following MVC [**1-4**]
2. Recurrent UTIs: [**Month/Year (2) 40097**] klebsiella
3. HCV, viral load suppressed
4. H/o recurrent PNAs: MRSA, Klebs, followed by Dr. [**Last Name (STitle) **]
5. Anxiety
6. DVT in [**2142**] - IVC filter placed in [**2142**]
7. Pulmonary nodules
8. Hypothyroidism
9. Chronic pain
10. Chronic gastritis
11. H/o obstructive lung disease
12. Anemia of chronic disease
13. s/p PEA arrest during hospitalization in [**2147-10-3**]

MEDICATION ON ADMISSION: (per DC summary [**2149-5-14**])
- albuterol sulfate 2.5 mg /3 mL (0.083 %) Q6h prn
- ipratropium bromide 0.02 % Q6h prn
- baclofen 20mg Qam, QHS
- baclofen 10mg Q1600
- citalopram 20 mg QD
- levothyroxine 88 mcg QD
- methadone 5mg TID
- omeprazole 20 mg EC [**Hospital1 **]
- oxybutynin chloride 10mg Qam, Qhs
- oxybutynin chloride 5 mg Q1600
- pregabalin 100 mg TID
- calcium carbonate 200 mg [**Hospital1 **]
- oxycodone 5 mg Q8 prn pain
- nicotine 7 mg/24 hr Patch
- polyethylene glycol 3350 17 gram qd
- lidocaine 5 %(700 mg/patch) 4 patches/day
- clonazepam 2mg qhs prn insomnia
- bisacodyl 5 mg Tablet, Delayed Release QD

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: Temp: 97.0 BP: 90/57 HR: 89 RR: 19 O2sat: 92% venturi 50%
GEN: awake, but appears tired.
HEENT: PERRL, EOMI. Dry mucous membranes. no JVD. left side of
neck with some pain to palpation over trapezius.
RESP: decreased BS at right base with inspiratory wheeze and
associated thonchi, bronchial BS over upper anterior lung
fields, rhonchi at left lung base.
CV: RRR, no m/g/r
ABD: soft, NT/ND, +BS, no ascites
EXT: non-pitting edema of feet bilaterally, no clubbing or
cyanosis/
SKIN: no rashes/no jaundice/no splinters
NEURO: alert, oriented x 3, but falls asleep easily,
inattentive. no cranial nerve deficits. no facial droop. moves
bilateral upper extremities against gravity, paralyzed below
T1-T2.

FAMILY HISTORY: Mother passed away with lung disease.

SOCIAL HISTORY: She lives at home with her husband and 2 adolescent children.
Her PCA and best friend, [**Name (NI) **], is with her much of the time and
helps to take care of her.
- Tobacco: 35 pack years, quit smoking 1-2 months ago
- EtOH: Denies
- Illicits: Denies 

### Response:
{'Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia due to Pseudomonas,Acute and chronic respiratory failure,Paraplegia,Other dependence on machines, supplemental oxygen,Late effect of spinal cord injury,Late effects of motor vehicle accident,Anxiety state, unspecified,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Other chronic pain,Iron deficiency anemia, unspecified'}
