CHIEF COMPLAINT: Altered mental status, hypoxia

PRESENT ILLNESS: Mr. [**Known lastname 95403**] is an 87 yo man with a recent stroke with
persistent R near-hemiplegia s/p PEG placement, DM2, CKD
(baseline Cr 1.6-2) who presented from his nursing home today
minimally repsonsive.
.
Upon arrival to the ED, he remained minimally responsive and was
intubated for airway protection. His initial VSs were 98.1, 84,
96/53, 80, 94%. A CXR demonstrated a questionable new opacity at
the right base. A U/A was suggestive of UTI, and he was covered
broadly for both UTI and PNA with vancomycin, ceftazadime and
levofloxacin. A central line was placed.
.
No further history was available. Among the pt's outside records
were lab reports indicating that his Cr was 2.1 on [**12-9**] and had
risen to 4.2 on [**12-11**].

MEDICAL HISTORY: - Diabetes mellitus
- Chronic kidney disease, Cr 1.6-2
- Hypertension
- dyslipidemia
- Aortic insufficiency
- Thoracic aortic aneurysm
- Osteoarthritis.
- First degree A-V delay
- GERD
- BPH
- Nephrolithiasis
- Cataracts
- Ventral hernia
- History of malaria
- Baseline chronic anemia
- s/p PEG tube placement [**10/2154**]

MEDICATION ON ADMISSION: Aranesp
Amlodipine 10 daily
Atorvastatin 40 daily
Clopidogrel 75 daily
Vitamin D 1000 daily
Ferrous sulfate 325 daily
Glipizide 10 daily
Lisinopril 7.5 mg daily
Metoprolol 50 [**Hospital1 **]
Acetaminophen prn
Omeprazole 20 [**Hospital1 **]
Senna 2 tabs [**Hospital1 **]
Insulin
.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: Temp: 96.9 BP: 109/47 HR: 100 RR: 16 O2sat 100%
GEN: sedated, intubated
HEENT: PERRL, L eye cloudy, anicteric, MM dry
NECK: supple, no jvd
RESP: CTA b/l anteriorly with good air movement throughout
CV: tachycardic, S1 and S2 wnl, no m/r/g
ABD: G-tube without surrounding erythema, ND, NABS, soft, no
masses or hepatosplenomegaly
EXT: no c/c/e, warm, good pulses
SKIN: no rashes/no jaundice

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: No smoking, occasional alcohol, no drug use.
Acute respiratory failure,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Acute kidney failure with lesion of tubular necrosis,Hyperosmolality and/or hypernatremia,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Intestinal infection due to Clostridium difficile,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Attention to other artificial opening of digestive tract,Edema,Other and unspecified hyperlipidemia,Aortic valve disorders,Esophageal reflux,Anemia in chronic kidney disease,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Thoracic aneurysm without mention of rupture,Ventral, unspecified, hernia without mention of obstruction or gangrene,Other left bundle branch block,Other and unspecified special symptoms or syndromes, not elsewhere classified,Unspecified cataract,Profound impairment, one eye, impairment level not further specified,Other diuretics causing adverse effects in therapeutic use
Acute respiratry failure,Pneumonia, organism NOS,Urin tract infection NOS,Ac kidny fail, tubr necr,Hyperosmolality,Late ef-hemplga side NOS,Int inf clstrdium dfcile,DMII renl nt st uncntrld,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Other staphylococcus,Atten to enterostomy NEC,Edema,Hyperlipidemia NEC/NOS,Aortic valve disorder,Esophageal reflux,Anemia in chr kidney dis,BPH w/o urinary obs/LUTS,Thoracic aortic aneurysm,Ventral hernia NOS,Left bb block NEC,Special symptom NEC/NOS,Cataract NOS,Blindness, one eye,Adv eff diuretics NEC
Admission Date:  [**2154-12-11**]              Discharge Date:   [**2154-12-26**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3326**]
Chief Complaint:
Altered mental status, hypoxia

Major Surgical or Invasive Procedure:
Tracheostomy and trach tube placement [**12-24**]


History of Present Illness:
Mr. [**Known lastname 95403**] is an 87 yo man with a recent stroke with
persistent R near-hemiplegia s/p PEG placement, DM2, CKD
(baseline Cr 1.6-2) who presented from his nursing home today
minimally repsonsive.
.
Upon arrival to the ED, he remained minimally responsive and was
intubated for airway protection. His initial VSs were 98.1, 84,
96/53, 80, 94%. A CXR demonstrated a questionable new opacity at
the right base. A U/A was suggestive of UTI, and he was covered
broadly for both UTI and PNA with vancomycin, ceftazadime and
levofloxacin. A central line was placed.
.
No further history was available. Among the pt's outside records
were lab reports indicating that his Cr was 2.1 on [**12-9**] and had
risen to 4.2 on [**12-11**].


Past Medical History:
- Diabetes mellitus
- Chronic kidney disease, Cr 1.6-2
- Hypertension
- dyslipidemia
- Aortic insufficiency
- Thoracic aortic aneurysm
- Osteoarthritis.
- First degree A-V delay
- GERD
- BPH
- Nephrolithiasis
- Cataracts
- Ventral hernia
- History of malaria
- Baseline chronic anemia
- s/p PEG tube placement [**10/2154**]

Social History:
No smoking, occasional alcohol, no drug use.

Family History:
non-contributory

Physical Exam:
VS: Temp: 96.9 BP: 109/47 HR: 100 RR: 16 O2sat 100%
GEN: sedated, intubated
HEENT: PERRL, L eye cloudy, anicteric, MM dry
NECK: supple, no jvd
RESP: CTA b/l anteriorly with good air movement throughout
CV: tachycardic, S1 and S2 wnl, no m/r/g
ABD: G-tube without surrounding erythema, ND, NABS, soft, no
masses or hepatosplenomegaly
EXT: no c/c/e, warm, good pulses
SKIN: no rashes/no jaundice

Pertinent Results:
[**2154-12-11**] 06:00PM   WBC-13.5* RBC-3.65* HGB-10.8* HCT-32.1*
MCV-88# MCH-29.6 MCHC-33.7 RDW-14.8
[**2154-12-11**] 06:00PM   NEUTS-70.0 LYMPHS-25.1 MONOS-3.6 EOS-1.3
BASOS-0.2
[**2154-12-11**] 06:00PM   PT-15.2* PTT-26.9 INR(PT)-1.3*
[**2154-12-11**] 06:00PM   PLT COUNT-192
.
[**2154-12-11**] 06:00PM   GLUCOSE-147* UREA N-120* CREAT-4.3*#
SODIUM-156* POTASSIUM-4.7 CHLORIDE-116* TOTAL CO2-32 ANION
GAP-13
[**2154-12-11**] 06:00PM   ALT(SGPT)-17 AST(SGOT)-16 LD(LDH)-177
CK(CPK)-160 ALK PHOS-93 AMYLASE-160* TOT BILI-0.2 LIPASE-29
.
[**2154-12-11**] 06:17PM   LACTATE-1.3
.
[**2154-12-11**] 06:50PM URINE  RBC-[**2-5**]* WBC-21-50* BACTERIA-MOD
YEAST-NONE EPI-<1
[**2154-12-11**] 06:50PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-TR BILIRUBIN-SM UROBILNGN-NEG PH-5.0 LEUK-SM
[**2154-12-11**] 06:50PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.015
[**2154-12-11**] 06:50PM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
.
Cardiology Report ECG Study Date of [**2154-12-13**]  6:44:40 PM
Sinus rhythm with borderline sinus tachycardia. Brief pause -
probably due to non-conducted atrial premature beat. Borderline
first degree A-V delay. Left atrial abnormality. Left anterior
fascicular block. Since the previous tracing of [**2154-12-11**] atrial
ectopy is present.
.
Intervals Axes
Rate PR QRS QT/QTc P QRS T
99 0 100 350/418 0 -59 56
==========================
On discharge:
.
RECENT STUDIES
[**12-26**] Chest x-ray
FINDINGS:  In comparison with the study of [**12-24**], the patient has
taken a much better inspiration.  The opacification at the right
base almost completely cleared and the hemidiaphragm is sharply
seen.  Mild increased opacification persists at the left base.
The cardiac silhouette remains somewhat enlarged and there is
indistinctness of pulmonary vessels that could be a
manifestation of vascular congestion.
.
Tracheostomy tube and PICC line remain in place.
.
RECENT LAB VALUES:
[**2154-12-26**] 03:47AM BLOOD WBC-11.5* RBC-3.03* Hgb-8.8* Hct-26.3*
MCV-87 MCH-28.9 MCHC-33.2 RDW-14.7 Plt Ct-240
.
[**2154-12-26**] 03:47AM BLOOD PT-14.5* PTT-39.6* INR(PT)-1.3*
[**2154-12-26**] 01:55PM BLOOD Glucose-188* UreaN-46* Creat-2.4* Na-137
K-3.8 Cl-106 HCO3-27 AnGap-8
[**2154-12-26**] 01:55PM BLOOD Calcium-7.7* Phos-3.6 Mg-2.1
.
[**2154-12-25**] 04:43PM URINE Blood-TR Nitrite-NEG Protein-TR
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
[**2154-12-25**] 04:43PM URINE RBC-1 WBC-1 Bacteri-FEW Yeast-NONE Epi-0
.
MICROBIOLOGY: C diff toxin +

Brief Hospital Course:
A/P: 87 yo man with recent stroke with persistent
near-hemiplegia and PEG placement, DM2, CKD presents from NH
with delirium, acute renal failure, ? PNA and ? UTI.
.
# Hypoxemic respiratory failure: Mr [**Known lastname 95403**] was intubated for
airway protection and hypoxemia on arrival. His x-ray was read
as a possible right lower lobe pneumonia, and then evolved with
perihilar opacities. He was started on levofloxacin, ceftazidime
and vancomycin to treat a healthcare-associated pneumonia (given
recent nursing home residence) and possible UTI. By the 12th
(day [**2-4**]) his x-ray was no longer showing a clear opacity, but
he remained ventilator dependent with copious oral and pulmonary
secretions. He was titrated down to FiO2 of 0.40, pressure
support of 10 and PEEP of 5 by the 14th, and has been on these
settings since then.
.
Despite multiple spontaneous breathing trials, his RSBI never
declined to a level in which extubation appeared reasonable.
Accordingly, after discussion with his family, he had a bedside
tracheostomy on [**12-24**] and was on a trach tube thereafter; still,
his vent settings remained the same and he remained unable to
tolerate spontaneous breathing trials. In the last two days of
his admission we started 4x/daily trach mask trials for 20-30
minutes as tolerated in order to see whether this would help his
pulmonary condition. We also began to more aggressively diurese
him (see below) which appeared to help resolve edema seen on his
x-ray although his clinical condition did not change
substantially in the short term. Hopefully with further diuresis
he can wean from the vent as there is no clear other reason he
should not be able to.
.
# C. difficile infection. On the night before discharge, Mr
[**Name13 (STitle) 95404**] was noted to have foul-smelling mucoid stool, and C.
diff was sent. This returned positive, and flagyl was started.
This was likely caught very early in the infection, which was
most likely secondary to C. diff regrowth soon after the
discontinuation of his 14 day course of levo/ceftaz/vanco for
pneumonia, which had likely depleted much of his normal flora.
[**12-26**] is day 1 of 14 for treatment of this.
.
# Altered mental status: He was lethargic and unresponsive on
arrival. We considered several possible etiologies including
toxic/metabolic encephalopathy, uremia, hypernatremia, PNA, UTI,
and meningitis. His BUN was remarkably high (baseline at last
d/c was 20), though he had no pericardial rub on exam.
Hypernatremia likely [**1-4**] volume depletion. His neck was supple
on exam. A CT head was negative for new processes although it
did show an old pontine infarct. A clear etiology was not
identified since his infection and hypernatremia were both
treated in the first days of his admission; his mental status
appeared to clear somewhat although it was difficult to tell
(particularly in the setting of requiring mechanical
ventilation) what his baseline was and whether he had returned
to it. He had some clearly lucid periods in which he was able to
shake his head or nod in response to questions and even
occasionally to attempt to mouth words, though on the day of
discharge he was arousable and tracked and registered his
examiners but did not clearly answer questions. (He had received
a one-time dose of ativan in the night prior.) Whether he might
continue to have improvement as other aspects of his health
improve is not clear. We would suggest low-dose Haldol if his
agitation continues. We have been attempting to avoid sedation
in order to try to work further towards weaning from the vent.
.
# Acute renal failure: Mr [**Last Name (Titles) 95405**] creatinine was quite
elevated from baseline on arrival at 4.3, with a BUN of 120; we
hydrated him aggressively and saw a progressive improvement in
his creatinine over the next several days. His urine from his
inital presentation grew out coag-negative staph, resistant to
oxacillin and levofloxacin but sensitive to the vancomycin we
had started by that time. We judged the initial presentation of
renal failure to be most likely secondary to volume depletion
given BUN/Cr ratio and the strong possibility of falling behind
on intake at the nursing home in the setting of an acute
illness. We held his lisinopril and other antihypertensives, and
dosed medicines renally as appropriate.
.
His creatinine rose again in the last three days of admission
(to 2.4 on [**12-26**]) in the setting of gentle efforts at diuresis,
with the hope of getting his pulmonary and peripheral edema to
resolve. We consulted the renal team which agreed with further
efforts at diuresis, and we increased our doses of lasix, which
we titrated to a fluid balance of even to -500 cc/day, although
we only actually achieved a negative fluid balance on the last
day of admission. He will likely need further increasingly
aggressive diuresis if he does not begin to autodiurese more
vigorously, and will likely need furosemide plus another [**Doctor Last Name 360**].
.
# Hypernatremia: He was hypernatremic on arrival; this corrected
with consistent hydration and free water boluses in his tube
feeds.
.
# s/p CVA: Per neuro d/c summary, "at the time of discharge he
could withdraw his right leg slightly, with plegia in the right
arm and a right facial droop, as well as dysarthria. AS now is
sedated, unable to perform adequate neuro exam.
- continue clopidogrel, atorvastatin
.
# Leukocytosis: Likely [**1-4**].
.
# DM: We held his PO hypoglycemics. We kept him on an insulin
sliding scale, and also added glargine for baseline level.
.
# Anemia: He has most recently been written for an outpatient
dose of 40 mcg of Aranesp every other week, likely [**1-4**] CKD. We
held this during this admission but this could be restarted. He
received a unit of packed red blood cells on [**12-14**] for a
hematocrit of 21.4 which was dropping in the setting of
aggressive hydration (a source of bleeding was not identified
then or in retrospect). He also received a unit of packed red
blood cells on [**12-25**] for a hematocrit of 21.9, with the
expectation that this would continue to drop, he would be
leaving the ICU soon, and evaluation of his post-transfusion
stability would be helpful before transfer. Otherwise his
hematocrit transfusion criteria could be <21.
.
# GERD: lansoprazole 30 daily
.
# F/E/N: IVF. Repleted lytes PRN. Tube feeds; we changed this
during the last two days of his admission to reduce his total
fluid volume, and on discharge he was on Replete w/fiber, full
strength; with a goal rate of 65 ml/hr. His albumin did decline
during this admission although the contribution of nutrition vs
acute illness was difficult to know, and should be followed
after discharge.
.
# PPx: Bowel regimen (should hold with diarrhea), sq Heparin
.
# Access: Right subclavian central line, PIVs
.
# Dispo: To a rehabilitation facility with ventilator capacity
.
# Code Status: full (confirmed with daughter, [**Name (NI) 2431**])
.


Medications on Admission:
Aranesp
Amlodipine 10 daily
Atorvastatin 40 daily
Clopidogrel 75 daily
Vitamin D 1000 daily
Ferrous sulfate 325 daily
Glipizide 10 daily
Lisinopril 7.5 mg daily
Metoprolol 50 [**Hospital1 **]
Acetaminophen prn
Omeprazole 20 [**Hospital1 **]
Senna 2 tabs [**Hospital1 **]
Insulin
.


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

2. Atorvastatin 80 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY
(Daily).
3. Docusate Sodium 50 mg/5 mL Liquid [**Hospital1 **]: One Hundred (100) mg
PO BID (2 times a day): hold for diarrhea.
4. Senna 8.6 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
5. Cholecalciferol (Vitamin D3) 400 unit Tablet [**Hospital1 **]: One (1)
Tablet PO DAILY (Daily).
6. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
7. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) [**Last Name (STitle) **]: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily): hold for
diarrhea.
8. Metoclopramide 10 mg Tablet [**Last Name (STitle) **]: 0.5 Tablet PO QIDACHS (4
times a day (before meals and at bedtime)) as needed for for
regurgitation/high residuals.
9. Albuterol 90 mcg/Actuation Aerosol [**Last Name (STitle) **]: 1-2 Puffs Inhalation
Q6H (every 6 hours).
10. Ipratropium Bromide 17 mcg/Actuation Aerosol [**Last Name (STitle) **]: Two (2)
Puff Inhalation QID (4 times a day).
11. Heparin (Porcine) 5,000 unit/mL Solution [**Last Name (STitle) **]: One (1)
Injection TID (3 times a day).
12. Acetaminophen 325 mg Tablet [**Last Name (STitle) **]: Two (2) Tablet PO Q6H
(every 6 hours) as needed for fever or pain: notify physician if
patient has fever.
13. Metronidazole 500 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO TID (3
times a day).
14. Clopidogrel 75 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY
(Daily).
15. Ferrous Sulfate 300 mg/5 mL Liquid [**Last Name (STitle) **]: One (1)  PO DAILY
(Daily).
16. Sodium Chloride 0.9%  Flush 3 mL IV DAILY:PRN
Peripheral IV - Inspect site every shift
17. Heparin Flush PICC (100 units/ml) 2 mL IV DAILY:PRN
10 ml NS followed by 2 mL of 100 Units/mL heparin (200 units
heparin) each lumen Daily and PRN.  Inspect site every shift.
18. Haloperidol Lactate 5 mg/mL Solution [**Last Name (STitle) **]: 0.25 mg Injection
Q4H (every 4 hours) as needed for agitation.
19. plan for diuresis
Consider continuing diuresis with furosemide 100-160 up to [**Hospital1 **]
to reach fluid balance goal of -500 cc/day
20. Aranesp (Polysorbate) 40 mcg/0.4 mL Syringe [**Hospital1 **]: One (1)
injection Injection every other week.


Discharge Disposition:
Extended Care

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

Discharge Diagnosis:
Pneumonia, pulmonary edema, C. diff infection


Discharge Condition:
Stable


Discharge Instructions:
You are being discharged to the [**Hospital3 95406**], where your care can continue.

See below for instructions to providers.


Followup Instructions:
Key issues for discharge:
* Attempt to further diurese patient who gained considerable
fluid weight during his ICU admission; this may also improve
respiratory status.
* Weaning from vent as tolerated
* Treatment of C. diff infection; day 1 of 14 day course of
metronidazole is [**12-26**]
* Ongoing evaluation of mental status; not clear what new
baseline will be at this point.
.
He has the following appointments:
RENAL FOLLOW-UP: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 435**]
Date/Time:[**2155-1-6**] 4:00



Completed by:[**2154-12-26**]
{'Acute respiratory failure,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Acute kidney failure with lesion of tubular necrosis,Hyperosmolality and/or hypernatremia,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Intestinal infection due to Clostridium difficile,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Attention to other artificial opening of digestive tract,Edema,Other and unspecified hyperlipidemia,Aortic valve disorders,Esophageal reflux,Anemia in chronic kidney disease,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Thoracic aneurysm without mention of rupture,Ventral, unspecified, hernia without mention of obstruction or gangrene,Other left bundle branch block,Other and unspecified special symptoms or syndromes, not elsewhere classified,Unspecified cataract,Profound impairment, one eye, impairment level not further specified,Other diuretics causing adverse effects in therapeutic use'}


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, hypoxia

PRESENT ILLNESS: Mr. [**Known lastname 95403**] is an 87 yo man with a recent stroke with
persistent R near-hemiplegia s/p PEG placement, DM2, CKD
(baseline Cr 1.6-2) who presented from his nursing home today
minimally repsonsive.
.
Upon arrival to the ED, he remained minimally responsive and was
intubated for airway protection. His initial VSs were 98.1, 84,
96/53, 80, 94%. A CXR demonstrated a questionable new opacity at
the right base. A U/A was suggestive of UTI, and he was covered
broadly for both UTI and PNA with vancomycin, ceftazadime and
levofloxacin. A central line was placed.
.
No further history was available. Among the pt's outside records
were lab reports indicating that his Cr was 2.1 on [**12-9**] and had
risen to 4.2 on [**12-11**].

MEDICAL HISTORY: - Diabetes mellitus
- Chronic kidney disease, Cr 1.6-2
- Hypertension
- dyslipidemia
- Aortic insufficiency
- Thoracic aortic aneurysm
- Osteoarthritis.
- First degree A-V delay
- GERD
- BPH
- Nephrolithiasis
- Cataracts
- Ventral hernia
- History of malaria
- Baseline chronic anemia
- s/p PEG tube placement [**10/2154**]

MEDICATION ON ADMISSION: Aranesp
Amlodipine 10 daily
Atorvastatin 40 daily
Clopidogrel 75 daily
Vitamin D 1000 daily
Ferrous sulfate 325 daily
Glipizide 10 daily
Lisinopril 7.5 mg daily
Metoprolol 50 [**Hospital1 **]
Acetaminophen prn
Omeprazole 20 [**Hospital1 **]
Senna 2 tabs [**Hospital1 **]
Insulin
.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: Temp: 96.9 BP: 109/47 HR: 100 RR: 16 O2sat 100%
GEN: sedated, intubated
HEENT: PERRL, L eye cloudy, anicteric, MM dry
NECK: supple, no jvd
RESP: CTA b/l anteriorly with good air movement throughout
CV: tachycardic, S1 and S2 wnl, no m/r/g
ABD: G-tube without surrounding erythema, ND, NABS, soft, no
masses or hepatosplenomegaly
EXT: no c/c/e, warm, good pulses
SKIN: no rashes/no jaundice

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: No smoking, occasional alcohol, no drug use. 

### Response:
{'Acute respiratory failure,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Acute kidney failure with lesion of tubular necrosis,Hyperosmolality and/or hypernatremia,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Intestinal infection due to Clostridium difficile,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Attention to other artificial opening of digestive tract,Edema,Other and unspecified hyperlipidemia,Aortic valve disorders,Esophageal reflux,Anemia in chronic kidney disease,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Thoracic aneurysm without mention of rupture,Ventral, unspecified, hernia without mention of obstruction or gangrene,Other left bundle branch block,Other and unspecified special symptoms or syndromes, not elsewhere classified,Unspecified cataract,Profound impairment, one eye, impairment level not further specified,Other diuretics causing adverse effects in therapeutic use'}
