CHIEF COMPLAINT: "Needs BiPAP."

PRESENT ILLNESS: The patient is a 67 year-old
woman with very severe chronic obstructive pulmonary disease,
FEV1 of 0.59, continues tobacco abuse on home O2 of 2 liters,
bipolar disorder who now presents with increased dyspnea
times one week requiring BiPAP.  She is followed by Dr.
[**Last Name (STitle) 29658**] for lung disease, last admitted from [**2-6**] to [**2-18**]
with respiratory failure secondary to influenza infection.
She has been steroid dependent for several years.  The
patient represents now with complaints of dyspnea at rest
times one week, increased rhinorrhea, sore throat and cough,
scant production of clear sputum with subjective fevers and
chills, lower substernal chest tightness.

MEDICAL HISTORY: Chronic obstructive pulmonary disease,
FEV1 0.59, PPD positive, multiple sputum negative for
tuberculosis, bipolar, hypertension, hypercholesterolemia,
osteoporosis, appendectomy, hiatal hernia repair,
polycythemia.  Echocardiogram in [**2172-2-7**]
demonstrated left atrium of 4.4 cm, EF greater then 50%, mild
left ventricular hypertrophy, decreased right ventricular
function.

MEDICATION ON ADMISSION: 

ALLERGIES: Codeine, phenobarbital and Lithium.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Married with three children.  Husband cares
for the patient at home.  Tobacco use greater then two packs
per day.  The patient with bipolar disorder well controlled.
She uses wheel chair at home.
Obstructive chronic bronchitis with (acute) exacerbation,Acute and chronic respiratory failure,Unspecified protein-calorie malnutrition,Polycythemia, secondary,Bipolar I disorder, most recent episode (or current) unspecified,Anxiety state, unspecified,Herpes zoster without mention of complication,Tobacco use disorder
Obs chr bronc w(ac) exac,Acute & chronc resp fail,Protein-cal malnutr NOS,Secondary polycythemia,Bipolor I current NOS,Anxiety state NOS,Herpes zoster NOS,Tobacco use disorder
Name:  [**Known lastname 1223**], [**Known firstname **] K                       Unit No:  [**Numeric Identifier 5179**]

Admission Date:  [**2172-8-8**]     Discharge Date:  [**2172-8-18**]

Date of Birth:   [**2104-12-24**]     Sex:  F

Service:

Continuation at hospital course:  The patient was started on
levofloxacin 500 mg q day.  On [**8-10**], the patient was
transferred to the floor for further management of her
respiratory care.  At that time the patient refused further
treatment with BiPAP and maintained her DNR/DNI status.

The patient was continued under treatment for one pulmonary
nebulizer treatments q2 hours, levofloxacin, Solu-Medrol,
Volmax, oral medication was added q hs.  For anxiety,
respiratory distress was also alleviated with Morphine 1-2 mg
q2 hours prn.  Anxiety helped controlled with Ativan 1-2 mg
IV q4 hours prn.

Patient's respiratory status slowly improved.  When she
arrived to the floor, she was maintained on rebreather face
mask with frequent desaturations.  At the time of discharge,
she was able to maintain saturations in the low 90s on 3
liters nasal cannula.

2. Psych.  The patient was continued on her outpatient
medications including Tegretol, Norvasc, Serax, and Ativan.

3. Endocrine.  Continued the outpatient Premarin dose.

4. GI.  Prophylaxis with Protonix.

5. Code status.  Discussions were initiated RE:  Patient
goals of care.  The patient definite wishes to remain
DNR/DNI.  Discussion about hospice home services were
initiated, however, patient liked to continue with VNA
services at this time.

6. ID.  Patient with the appearance of herpes zoster across
the lumbar region.  Treatment was initiated with acyclovir
and Capsaicin cream as well as pain control with Morphine.

CONDITION ON DISCHARGE:  Good.

Discharged to home with VNA services.

DISCHARGE MEDICATIONS:
1. Combivent inhaler 3-4 puffs 4x a day.
2. Albuterol and Atrovent nebulizer treatments prn.
3. Flovent inhaler four puffs [**Hospital1 **].
4. Volmax 4 mg q am.
5. Tegretol 200 mg tid.
6. Narvane 4 mg q hs.
7. Serax 10 mg one po qid.
8. Protonix 40 mg q day.
9. Colace 100 mg [**Hospital1 **].
10. Tylenol 650 mg one q4 hours prn.
11. Aspirin 325 mg q day.
12. Multivitamins q day.
13. Premarin 0.625 mg q day.
14. Prednisone 30 mg q day x7 days and then 20 mg q day x7
days and then permanent dose is 15 mg q day.
15. Levofloxacin 500 mg q day x3 days.
16. Acyclovir 800 mg 5x a day x7 days.
17. Capsaicin cream applied to effected area 4x a day as
needed.
18. Morphine IR 10 mg/5 cc every six hours as needed for pain
x7 days with instructions not to take at the same time as
Serax.  If she becomes sleepy or confused, she may decrease
the dose to 5 mg.
19. Senna one po q hs.

Follow-up appointment arranged with Dr. [**Last Name (STitle) 5180**] in one
week.






                          [**Name6 (MD) 116**] [**Name8 (MD) 117**], M.D.  [**MD Number(1) 118**]

Dictated By:[**Last Name (NamePattern1) 2168**]

MEDQUIST36

D:  [**2172-9-22**]  15:05
T:  [**2172-9-22**]  15:14
JOB#:  [**Job Number **]


Admission Date:  [**2172-8-8**]     Discharge Date:  [**2172-8-18**]

Date of Birth:   [**2104-12-24**]     Sex:  F

Service:

CHIEF COMPLAINT:  "Needs BiPAP."

HISTORY OF PRESENT ILLNESS:  The patient is a 67 year-old
woman with very severe chronic obstructive pulmonary disease,
FEV1 of 0.59, continues tobacco abuse on home O2 of 2 liters,
bipolar disorder who now presents with increased dyspnea
times one week requiring BiPAP.  She is followed by Dr.
[**Last Name (STitle) 29658**] for lung disease, last admitted from [**2-6**] to [**2-18**]
with respiratory failure secondary to influenza infection.
She has been steroid dependent for several years.  The
patient represents now with complaints of dyspnea at rest
times one week, increased rhinorrhea, sore throat and cough,
scant production of clear sputum with subjective fevers and
chills, lower substernal chest tightness.

PAST MEDICAL HISTORY:  Chronic obstructive pulmonary disease,
FEV1 0.59, PPD positive, multiple sputum negative for
tuberculosis, bipolar, hypertension, hypercholesterolemia,
osteoporosis, appendectomy, hiatal hernia repair,
polycythemia.  Echocardiogram in [**2172-2-7**]
demonstrated left atrium of 4.4 cm, EF greater then 50%, mild
left ventricular hypertrophy, decreased right ventricular
function.

ALLERGIES:  Codeine, phenobarbital and Lithium.

SOCIAL HISTORY:  Married with three children.  Husband cares
for the patient at home.  Tobacco use greater then two packs
per day.  The patient with bipolar disorder well controlled.
She uses wheel chair at home.

PHYSICAL EXAMINATION:  Temperature 100.  Heart rate 99.
Blood pressure 122/65.  97% on 30% FIO2.  HEENT extraocular
movements intact.  Pupils are equal, round and reactive to
light and accommodation.  Oropharynx dry.  Pulmonary diffuse
rhonchi, fine crackles at bases bilaterally.  Decreased
breath sounds throughout.  Cardiovascular distant heart
sounds, normal S1 and S2.  Abdomen soft, nontender,
nondistended.  Extremities no clubbing, cyanosis or edema.
Neurological alert and oriented times two.

LABORATORY:  White blood cell count 10.8, neutrophils 87,
bands 3, lymphocytes 3, monocytes 6, atypicals 1.  Hematocrit
49, platelets 297, sodium 142, potassium 3.9, chloride 103,
bicarb 25, BUN 8, creatinine 1.3 at baseline, glucose 116, CK
54, troponin less then 0.3.  Arterial blood gas 7.34, 52, 58,
29 on 2 liters nasal cannula.  Chest x-ray slight upper zone
redistribution.  No infiltrate, blunting of the angles
bilaterally.  Electrocardiogram sinus tachycardia, left
atrium enlargement, low limb lead voltages, wavy baseline,
slight ST depression in V3 through V6.

HOSPITAL COURSE:  Ms. [**Known lastname **] was admitted to the [**Hospital Ward Name 332**]
Intensive Care Unit for further management of her respiratory
distress.  She is maintained on BiPAP, although the patient
had difficulty tolerating the machine.  She was started on
Solu-Medrol and continued on nebulizer treatments q 2 prn.
She ruled out for myocardial infarction.  The patient was
started on Levofloxacin 500 mg q day.






                          [**Name6 (MD) 251**] [**Name8 (MD) **], M.D.  [**MD Number(1) 1197**]

Dictated By:[**Last Name (NamePattern1) 29659**]

MEDQUIST36

D:  [**2172-8-27**]  10:56
T:  [**2172-9-2**]  07:17
JOB#:  [**Job Number 29660**]
{'Obstructive chronic bronchitis with (acute) exacerbation,Acute and chronic respiratory failure,Unspecified protein-calorie malnutrition,Polycythemia, secondary,Bipolar I disorder, most recent episode (or current) unspecified,Anxiety state, unspecified,Herpes zoster without mention of complication,Tobacco use disorder'}


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: "Needs BiPAP."

PRESENT ILLNESS: The patient is a 67 year-old
woman with very severe chronic obstructive pulmonary disease,
FEV1 of 0.59, continues tobacco abuse on home O2 of 2 liters,
bipolar disorder who now presents with increased dyspnea
times one week requiring BiPAP.  She is followed by Dr.
[**Last Name (STitle) 29658**] for lung disease, last admitted from [**2-6**] to [**2-18**]
with respiratory failure secondary to influenza infection.
She has been steroid dependent for several years.  The
patient represents now with complaints of dyspnea at rest
times one week, increased rhinorrhea, sore throat and cough,
scant production of clear sputum with subjective fevers and
chills, lower substernal chest tightness.

MEDICAL HISTORY: Chronic obstructive pulmonary disease,
FEV1 0.59, PPD positive, multiple sputum negative for
tuberculosis, bipolar, hypertension, hypercholesterolemia,
osteoporosis, appendectomy, hiatal hernia repair,
polycythemia.  Echocardiogram in [**2172-2-7**]
demonstrated left atrium of 4.4 cm, EF greater then 50%, mild
left ventricular hypertrophy, decreased right ventricular
function.

MEDICATION ON ADMISSION: 

ALLERGIES: Codeine, phenobarbital and Lithium.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Married with three children.  Husband cares
for the patient at home.  Tobacco use greater then two packs
per day.  The patient with bipolar disorder well controlled.
She uses wheel chair at home. 

### Response:
{'Obstructive chronic bronchitis with (acute) exacerbation,Acute and chronic respiratory failure,Unspecified protein-calorie malnutrition,Polycythemia, secondary,Bipolar I disorder, most recent episode (or current) unspecified,Anxiety state, unspecified,Herpes zoster without mention of complication,Tobacco use disorder'}
