CHIEF COMPLAINT: Altered Mental Status

PRESENT ILLNESS: Mr. [**Known lastname 90598**] is an 83yo man wiht a PMHx significant for
known aortic stenosis s/p valve replacement on [**2103-9-25**], CAD
s/p CABG x4, significant pulmonary disease including pulmonary
HTN in the setting of restrictive lung dz (pulmonary asbestosis)
as well as obstructive lung dz (on home O2), right cerebellar
CVA, s/p right CEA, HTN, HL and RCC s/p left nephrectomy who was
admitted overnight for altered mental status.
     He was admitted here between [**9-24**] and 11/3 [**1-3**] increasing
SOB in the setting of severe AS.  He had a valve replacement on
[**9-25**] and improved over the next several days.  Upon discharge
to
rehab, he was noted to be at neurological baseline and is
described as being alert and oriented.  However, upon arrival to
rehab ([**Hospital 4470**] Health Care Center Rehab in [**Location (un) 38**]) he was
noted to be very confused and combative with the staff.  He did
not sleep much overnight, but finally settled down by the next
morning ([**10-5**]-- the morning of admission).  Mr. [**Known lastname 90598**]
himself
notes that he wasn't feeling "right".  However, when he awoke,
he
again was noted to be confused, stating that he was in a school
in [**State 108**] filming a movie when asked where he was.  He was
evaluated by [**Name Initial (MD) **] psychiatric RN who recommended that he be
evaluated in an ED for further investigation of these changes.
Apparently was given LZP at the rehab by ED report.  However, he
then began to c/o chest pain and became unresponsive.  He then
went to an OSH ED where an evaluation revealed a negative NCHCT
and a CXR with concern for mild CHF per ED notes.  He as then
transferred to the [**Hospital1 18**] ED for further management.
     In the ED, he received a NCHCT, which showed no acute
process and a urinalysis which was significant for 75 WBCs and
he
was started on cipro due to concern for a UTI.

MEDICAL HISTORY: Aortic Stenosis
s/p CoreValve Aortic Valve Replacement
PMH:
CABG x 4 ([**Hospital3 **] - early [**2081**]'s)
Severe aortic stenosis
Pulmonary hypertension
Restrictive and Obstructive Lung disease (home O2)
Pulmonary asbestosis
Extensive pleural plaques
right cerebellar infarct
peripheral vascular disease
hypertension
dyslipidemia
left nephrectomy secondary to renal carcinoma
gastritis
herpes zoster
depression
right carotid endartectomy ([**2091**])
cholecystectomy ([**2090**])

MEDICATION ON ADMISSION: metoprolol tartrate 50 mg TID, citalopram 20 mg DAILY, trazodone
75 mg HS, albuterol sulfate 2.5 mg /3 mL (0.083 %) Neb Q6H,
ipratropium bromide 0.02 % Solution Q6H, clopidogrel 75 mg
DAILY, heparin (porcine) 5,000 unit/mL TID, simvastatin 40 mg
DAILY, cyanocobalamin (vitamin B-12) 100 mcg DAILY, fluticasone
110 mcg/Actuation Aerosol 2 Puff Inhalation [**Hospital1 **], aspirin 81 mg
DAILY, magnesium hydroxide 400 mg/5 mL Thirty ML HS, docusate
sodium 100 mg [**Hospital1 **], acetaminophen 325 mg Q4H PRN, lansoprazole 30
mg DAILY, lisinopril 10 mg DAILY, hydralazine 25 mg Q6H,
furosemide 80 mg [**Hospital1 **] for one week, potassium chloride 10 mEq
Q12H for one week

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Physical Examination:
VS: T: 97.6 HR: 90 BP: 94/60 RR: 26 O2: 93% on 2L NC
Genl: Awake, alert, NAD
HEENT: Sclerae anicteric, no conjunctival injection, oropharynx
clear
CV: nml S1, S2, rrr, no m/r/g
Chest: CTA b/l though with diminished aeration at bases
Abd: soft, NT, ND but full, NABS, no H/S/M
Ext: no edema, slightly cool

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Usually stays with his girlfriend. [**Name (NI) **] has three
children (daughter, 2 sons). [**Name2 (NI) **] is a retired shoe repairman
where
he worked in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 20181**] environment with glues and solvents. He
also
had some asbestos exposure when working in a shipyard for a
year.
He never smoked. He rarely drinks alcohol.
Toxic encephalopathy,Intestinal infection due to Clostridium difficile,Other chronic pulmonary heart diseases,Urinary tract infection, site not specified,Other dependence on machines, supplemental oxygen,Chronic airway obstruction, not elsewhere classified,Hypotension, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Asbestosis,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of kidney,Heart valve replaced by transplant,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits
Toxic encephalopathy,Int inf clstrdium dfcile,Chr pulmon heart dis NEC,Urin tract infection NOS,Depend-supplement oxygen,Chr airway obstruct NEC,Hypotension NOS,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Asbestosis,Hypertension NOS,Hyperlipidemia NEC/NOS,Hx of kidney malignancy,Heart valve transplant,DMII wo cmp nt st uncntr,Hx TIA/stroke w/o resid
Admission Date:  [**2103-10-5**]              Discharge Date:   [**2103-10-9**]

Date of Birth:  [**2019-8-27**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Altered Mental Status

Major Surgical or Invasive Procedure:
none


History of Present Illness:
Mr. [**Known lastname 90598**] is an 83yo man wiht a PMHx significant for
known aortic stenosis s/p valve replacement on [**2103-9-25**], CAD
s/p CABG x4, significant pulmonary disease including pulmonary
HTN in the setting of restrictive lung dz (pulmonary asbestosis)
as well as obstructive lung dz (on home O2), right cerebellar
CVA, s/p right CEA, HTN, HL and RCC s/p left nephrectomy who was
admitted overnight for altered mental status.
     He was admitted here between [**9-24**] and 11/3 [**1-3**] increasing
SOB in the setting of severe AS.  He had a valve replacement on
[**9-25**] and improved over the next several days.  Upon discharge
to
rehab, he was noted to be at neurological baseline and is
described as being alert and oriented.  However, upon arrival to
rehab ([**Hospital 4470**] Health Care Center Rehab in [**Location (un) 38**]) he was
noted to be very confused and combative with the staff.  He did
not sleep much overnight, but finally settled down by the next
morning ([**10-5**]-- the morning of admission).  Mr. [**Known lastname 90598**]
himself
notes that he wasn't feeling "right".  However, when he awoke,
he
again was noted to be confused, stating that he was in a school
in [**State 108**] filming a movie when asked where he was.  He was
evaluated by [**Name Initial (MD) **] psychiatric RN who recommended that he be
evaluated in an ED for further investigation of these changes.
Apparently was given LZP at the rehab by ED report.  However, he
then began to c/o chest pain and became unresponsive.  He then
went to an OSH ED where an evaluation revealed a negative NCHCT
and a CXR with concern for mild CHF per ED notes.  He as then
transferred to the [**Hospital1 18**] ED for further management.
     In the ED, he received a NCHCT, which showed no acute
process and a urinalysis which was significant for 75 WBCs and
he
was started on cipro due to concern for a UTI.


Past Medical History:
Aortic Stenosis
s/p CoreValve Aortic Valve Replacement
PMH:
CABG x 4 ([**Hospital3 **] - early [**2081**]'s)
Severe aortic stenosis
Pulmonary hypertension
Restrictive and Obstructive Lung disease (home O2)
Pulmonary asbestosis
Extensive pleural plaques
right cerebellar infarct
peripheral vascular disease
hypertension
dyslipidemia
left nephrectomy secondary to renal carcinoma
gastritis
herpes zoster
depression
right carotid endartectomy ([**2091**])
cholecystectomy ([**2090**])


Social History:
Usually stays with his girlfriend. [**Name (NI) **] has three
children (daughter, 2 sons). [**Name2 (NI) **] is a retired shoe repairman
where
he worked in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 20181**] environment with glues and solvents. He
also
had some asbestos exposure when working in a shipyard for a
year.
He never smoked. He rarely drinks alcohol.

Average Daily Living:
Live independently            Yes [x]   No [ ]
Bathing                [x] Independent  [ ] Dependent
Dressing               [x] Independent  [ ] Dependent
Toileting              [x] Independent  [ ] Dependent
Transferring           [x] Independent  [ ] Dependent
Continence             [x] Independent  [ ] Dependent
Feeding                [x] Independent  [ ] Dependent


Family History:
non-contributory

Physical Exam:
Physical Examination:
VS: T: 97.6 HR: 90 BP: 94/60 RR: 26 O2: 93% on 2L NC
Genl: Awake, alert, NAD
HEENT: Sclerae anicteric, no conjunctival injection, oropharynx
clear
CV: nml S1, S2, rrr, no m/r/g
Chest: CTA b/l though with diminished aeration at bases
Abd: soft, NT, ND but full, NABS, no H/S/M
Ext: no edema, slightly cool

Neurologic examination:
Mental status: Awake and alert, cooperative with exam, normal
affect. Oriented to person, place ("[**Hospital **] Hospital, [**Location (un) 86**],
MA"), but not to date ([**2099-10-25**]).  Aware of why he is in the
hospital  ("I'm confused"), but is very tangential with his
thoughts. Able to [**Doctor Last Name 1841**] backwards quickly but ends with "winter"
instead of "[**Month (only) 404**]". Speech is fluent with normal comprehension
and repetition; naming intact, but with some errors (bracelets =
rings). No dysarthria. [**Location (un) **] intact. Registers [**2-1**], but
recalls
[**12-4**] in 5 minutes (but [**1-4**] with prompting). No right-left
confusion. No evidence of neglect.

Cranial Nerves: Pupils equally round and reactive to light, 3 to
2 mm bilaterally. Unable to visualize fundi [**1-3**] cooperation.
Visual fields are full to confrontation. Extraocular movements
intact bilaterally with some right beating end-gaze nystagmus.
Sensation intact V1-V3. Facial movement symmetric. Hearing
intact
to finger rub bilaterally. Palate elevation symmetric.
Sternocleidomastoid and trapezius full strength bilaterally.
Tongue midline, movements intact.

Motor: Normal bulk and tone bilaterally. Unable to assess drift
[**1-3**] restraints.
  [**Doctor First Name **] Tri [**Hospital1 **]  WE FE FF  IP  H  Q DF PF TE
R  5   5   5  5  5  5   5   5  5  5  5  5
L  5   5   5  5  5  5   5   5  5  5  5  5

Sensation: Intact to light touch, vibration, and cold sensation
throughout.

Reflexes: 2+ and symmetric throughout. Toes downgoing
bilaterally.

Coordination: heel-knee-shin and [**Doctor First Name **] normal.  Unable to do FNF
[**1-3**] restraints

Gait: deferred


Pertinent Results:
Admission LAbs:
[**2103-10-4**] 08:40AM   PLT COUNT-313
[**2103-10-4**] 08:40AM   WBC-10.6 RBC-4.40* HGB-13.5* HCT-41.2 MCV-94
MCH-30.7 MCHC-32.7 RDW-14.0
[**2103-10-4**] 08:40AM   MAGNESIUM-2.4
[**2103-10-4**] 08:40AM   UREA N-32* CREAT-1.5* SODIUM-138
POTASSIUM-4.3 CHLORIDE-98
[**2103-10-5**] 08:05PM URINE Blood-SM  Nitrite-NEG Protein-TR
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.5 Leuks-LG
[**2103-10-5**] 08:05PM URINE RBC-7* WBC-75* Bacteri-FEW Yeast-NONE
Epi-0
[**2103-10-5**] 8:05 pm URINE     Site: CATHETER
URINE CULTURE (Final [**2103-10-6**]): GRAM NEGATIVE ROD(S).
~9000/ML.
CLOSTRIDIUM DIFFICILE TOXIN A & B TEST (Final [**2103-10-8**]):
      FECES POSITIVE FOR C. DIFFICILE TOXIN BY EIA.

Discharge Labs:
[**2103-10-9**] 03:26AM BLOOD WBC-8.1 RBC-3.13* Hgb-9.4* Hct-29.5*
MCV-95 MCH-29.9 MCHC-31.7 RDW-14.1 Plt Ct-352
[**2103-10-9**] 03:26AM BLOOD Plt Ct-352
[**2103-10-9**] 03:26AM BLOOD PT-13.0 PTT-27.5 INR(PT)-1.1
[**2103-10-9**] 03:26AM BLOOD Glucose-172* UreaN-30* Creat-1.4* Na-139
K-3.5 Cl-102 HCO3-27 AnGap-14

Radiology [**2103-10-8**]
UPRIGHT AP VIEW OF THE CHEST: Compared to the prior film, there
is reduction in the diffuse bilateral opacities seen on the
prior film. There is also stable widening of the cardiac and
mediastinal silhouettes. Again noted are extensive
asbestos-related pleural plaques. There is no pneumothorax,
hemothorax, or pleural effusion. The sternal cerclage wires are
intact and unchanged. The large wire stent projecting over the
mediastinum is also unchanged in position.
IMPRESSION:
1. No evidence of intrathoracic hemorrhage.
2. Interval improvement in pulmonary edema.
3. Stable asbestos-related pleural plaques.
4. Stable postoperative changes to the mediastinal structures.
The study and the report were reviewed by the staff radiologist.


[**2103-10-5**]: Head CT
No acute intracranial hemorrhage, large vascular territory
infarct, shift of midline structures or mass effect is present.
The ventricles and sulci are mildly prominent consistent with
age-related atrophy. There is mild periventricular and
subcortical white matter hypoattenuation consistent with
sequelae of small vessel ischemic disease. The visible paranasal
sinuses and mastoid air cells show a mucus-retention cyst in the
right maxillary sinus.
IMPRESSION:
No acute intracranial process.


Brief Hospital Course:
84yoM s/p AVR-Corevalve via right thoracotomy on [**9-25**].
Discharged to rehabilitation on [**10-4**]. Readmitted with mental
status changes and UTI(Gram neg rods) started on antibiotics.
Additionally he was found to be positive for C difficille and
was started on Flagyl which should continue for 2 weeks.
Neurology was consulted because of his mental status changes: a
head CT revealed: No acute intracranial process. Neurology
thought it was consistant with encephalopathy without evidence
for intercurrent cerebrovascular event/stroke.
Per neurology: His mental status contains features of
reduplicative paramnesia which would suggest bifrontal (or Rt.
frontal) brain dysfunction.  This deficit can be a direct effect
of beta-blockers in the elderly (his beta blocker dose was
minimized).
The mental status changes resolved over the hospital course.
Hemodynamically the p[atient was given volume on admission which
he responded to appropriately, He had an [**Month/Day (4) 461**] that
showed:
Mild symmetric left ventricular hypertrophy with normal cavity
size and global systolic function (LVEF>55%). An aortic
CoreValve prosthesis is present. Mild aortic regurgitation is
seen. Mitral regurgitation is present but cannot be quantified.
There is moderate pulmonary artery systolic hypertension. There
is no pericardial effusion.
IMPRESSION: No pericardial effusion identified. Pulmonary artery
hypertension. Mild symmetric left ventricular hypertrophy with
preserved global biventricular systolic function. Well seated
CoreValve prosthesis with mild aortic regurgitation.

On DC pt is hemodynamically stable. Neurologically he is anxious
but alert and oriented x3. His wounds are healing well. He has
ambulated with assistance, and is tolerating a heart healthy
diet.

Medications on Admission:
metoprolol tartrate 50 mg TID, citalopram 20 mg DAILY, trazodone
75 mg HS, albuterol sulfate 2.5 mg /3 mL (0.083 %) Neb Q6H,
ipratropium bromide 0.02 % Solution Q6H, clopidogrel 75 mg
DAILY, heparin (porcine) 5,000 unit/mL TID, simvastatin 40 mg
DAILY, cyanocobalamin (vitamin B-12) 100 mcg DAILY, fluticasone
110 mcg/Actuation Aerosol 2 Puff Inhalation [**Hospital1 **], aspirin 81 mg
DAILY, magnesium hydroxide 400 mg/5 mL Thirty ML HS, docusate
sodium 100 mg [**Hospital1 **], acetaminophen 325 mg Q4H PRN, lansoprazole 30
mg DAILY, lisinopril 10 mg DAILY, hydralazine 25 mg Q6H,
furosemide 80 mg [**Hospital1 **] for one week, potassium chloride 10 mEq
Q12H for one week

Discharge Medications:
1. citalopram 20 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).

2. trazodone 50 mg Tablet [**Hospital1 **]: 1.5 Tablets PO HS (at bedtime) as
needed for insomnia .
3. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization [**Hospital1 **]: One (1) neb Inhalation Q6H (every 6 hours) as
needed for SOB.
4. ipratropium bromide 0.02 % Solution [**Hospital1 **]: One (1) neb
Inhalation Q6H (every 6 hours).
5. clopidogrel 75 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY
(Daily).
6. heparin (porcine) 5,000 unit/mL Solution [**Hospital1 **]: 5000 (5000)
units Injection TID (3 times a day).
7. simvastatin 40 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY
(Daily).
8. cyanocobalamin (vitamin B-12) 100 mcg Tablet [**Hospital1 **]: One (1)
Tablet PO DAILY (Daily).
9. fluticasone 110 mcg/Actuation Aerosol [**Hospital1 **]: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
10. aspirin 81 mg Tablet, Chewable [**Hospital1 **]: One (1) Tablet, Chewable
PO DAILY (Daily).
11. docusate sodium 100 mg Capsule [**Hospital1 **]: One (1) Capsule PO BID
(2 times a day).
12. acetaminophen 325 mg Tablet [**Hospital1 **]: Two (2) Tablet PO Q6H
(every 6 hours) as needed for pain.
13. bisacodyl 5 mg Tablet, Delayed Release (E.C.) [**Hospital1 **]: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
14. metronidazole 500 mg Tablet [**Hospital1 **]: One (1) Tablet PO TID (3
times a day) for 2 weeks.
15. lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
16. furosemide 40 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY
(Daily).
17. sulfamethoxazole-trimethoprim 800-160 mg Tablet [**Last Name (STitle) **]: One (1)
Tablet PO BID (2 times a day) for 3 days.
18. olanzapine 5 mg Tablet, Rapid Dissolve [**Last Name (STitle) **]: 0.25 Tablet,
Rapid Dissolve PO DAILY (Daily) as needed for agitation.
19. potassium chloride 10 mEq Tablet Extended Release [**Last Name (STitle) **]: One
(1) Tablet Extended Release PO once a day.
20. Toprol XL 25 mg Tablet Extended Release 24 hr [**Last Name (STitle) **]: One (1)
Tablet Extended Release 24 hr PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital 4470**] HealthCare Center at [**Location (un) 38**]

Discharge Diagnosis:
Altered mental Status-hypotension
UTI


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, with assistance- wheelchair
Sternal pain managed with tylenol
Right thoracotomy incision - healing well, no erythema or
drainage


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart
No driving for approximately one month or while taking
narcotics. Driving will be discussed at follow up appointment
with surgeon.
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

Followup Instructions:
Provider: [**Name10 (NameIs) **] Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2103-10-29**]
9:00
Surgeon:
[**First Name8 (NamePattern2) 177**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 170**] Date/Time  [**2103-10-29**] 11:00
Cardiologist:
[**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2103-11-16**] 9:20

Please call and schedule an appointmnent for 2 weeks:
PCP: [**Name10 (NameIs) **],[**Name11 (NameIs) **] MD
Location: [**Hospital **] MEDICAL CENTER-CARDIAC ARRHYTHMIA
Address: [**State 50761**], SOUTH 3RD FL, [**Location (un) **],[**Numeric Identifier 4809**]
Phone: [**Telephone/Fax (1) 90599**] Fax: [**Telephone/Fax (1) 90600**]

Primary Care in [**3-6**] weeks:
Name: [**Last Name (LF) **],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
Location: [**Hospital3 **] MEDICAL ASSOCIATES
Address: [**Apartment Address(1) 41731**], [**Location (un) **],[**Numeric Identifier 17464**]
Phone: [**Telephone/Fax (1) 17503**] Fax: [**Telephone/Fax (1) 69267**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**



Completed by:[**2103-10-9**]
{'Toxic encephalopathy,Intestinal infection due to Clostridium difficile,Other chronic pulmonary heart diseases,Urinary tract infection, site not specified,Other dependence on machines, supplemental oxygen,Chronic airway obstruction, not elsewhere classified,Hypotension, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Asbestosis,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of kidney,Heart valve replaced by transplant,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}


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: Altered Mental Status

PRESENT ILLNESS: Mr. [**Known lastname 90598**] is an 83yo man wiht a PMHx significant for
known aortic stenosis s/p valve replacement on [**2103-9-25**], CAD
s/p CABG x4, significant pulmonary disease including pulmonary
HTN in the setting of restrictive lung dz (pulmonary asbestosis)
as well as obstructive lung dz (on home O2), right cerebellar
CVA, s/p right CEA, HTN, HL and RCC s/p left nephrectomy who was
admitted overnight for altered mental status.
     He was admitted here between [**9-24**] and 11/3 [**1-3**] increasing
SOB in the setting of severe AS.  He had a valve replacement on
[**9-25**] and improved over the next several days.  Upon discharge
to
rehab, he was noted to be at neurological baseline and is
described as being alert and oriented.  However, upon arrival to
rehab ([**Hospital 4470**] Health Care Center Rehab in [**Location (un) 38**]) he was
noted to be very confused and combative with the staff.  He did
not sleep much overnight, but finally settled down by the next
morning ([**10-5**]-- the morning of admission).  Mr. [**Known lastname 90598**]
himself
notes that he wasn't feeling "right".  However, when he awoke,
he
again was noted to be confused, stating that he was in a school
in [**State 108**] filming a movie when asked where he was.  He was
evaluated by [**Name Initial (MD) **] psychiatric RN who recommended that he be
evaluated in an ED for further investigation of these changes.
Apparently was given LZP at the rehab by ED report.  However, he
then began to c/o chest pain and became unresponsive.  He then
went to an OSH ED where an evaluation revealed a negative NCHCT
and a CXR with concern for mild CHF per ED notes.  He as then
transferred to the [**Hospital1 18**] ED for further management.
     In the ED, he received a NCHCT, which showed no acute
process and a urinalysis which was significant for 75 WBCs and
he
was started on cipro due to concern for a UTI.

MEDICAL HISTORY: Aortic Stenosis
s/p CoreValve Aortic Valve Replacement
PMH:
CABG x 4 ([**Hospital3 **] - early [**2081**]'s)
Severe aortic stenosis
Pulmonary hypertension
Restrictive and Obstructive Lung disease (home O2)
Pulmonary asbestosis
Extensive pleural plaques
right cerebellar infarct
peripheral vascular disease
hypertension
dyslipidemia
left nephrectomy secondary to renal carcinoma
gastritis
herpes zoster
depression
right carotid endartectomy ([**2091**])
cholecystectomy ([**2090**])

MEDICATION ON ADMISSION: metoprolol tartrate 50 mg TID, citalopram 20 mg DAILY, trazodone
75 mg HS, albuterol sulfate 2.5 mg /3 mL (0.083 %) Neb Q6H,
ipratropium bromide 0.02 % Solution Q6H, clopidogrel 75 mg
DAILY, heparin (porcine) 5,000 unit/mL TID, simvastatin 40 mg
DAILY, cyanocobalamin (vitamin B-12) 100 mcg DAILY, fluticasone
110 mcg/Actuation Aerosol 2 Puff Inhalation [**Hospital1 **], aspirin 81 mg
DAILY, magnesium hydroxide 400 mg/5 mL Thirty ML HS, docusate
sodium 100 mg [**Hospital1 **], acetaminophen 325 mg Q4H PRN, lansoprazole 30
mg DAILY, lisinopril 10 mg DAILY, hydralazine 25 mg Q6H,
furosemide 80 mg [**Hospital1 **] for one week, potassium chloride 10 mEq
Q12H for one week

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Physical Examination:
VS: T: 97.6 HR: 90 BP: 94/60 RR: 26 O2: 93% on 2L NC
Genl: Awake, alert, NAD
HEENT: Sclerae anicteric, no conjunctival injection, oropharynx
clear
CV: nml S1, S2, rrr, no m/r/g
Chest: CTA b/l though with diminished aeration at bases
Abd: soft, NT, ND but full, NABS, no H/S/M
Ext: no edema, slightly cool

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Usually stays with his girlfriend. [**Name (NI) **] has three
children (daughter, 2 sons). [**Name2 (NI) **] is a retired shoe repairman
where
he worked in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 20181**] environment with glues and solvents. He
also
had some asbestos exposure when working in a shipyard for a
year.
He never smoked. He rarely drinks alcohol. 

### Response:
{'Toxic encephalopathy,Intestinal infection due to Clostridium difficile,Other chronic pulmonary heart diseases,Urinary tract infection, site not specified,Other dependence on machines, supplemental oxygen,Chronic airway obstruction, not elsewhere classified,Hypotension, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Asbestosis,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of kidney,Heart valve replaced by transplant,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}
