CHIEF COMPLAINT: s/p T tube placement

PRESENT ILLNESS: Ms. [**Known lastname **] is a 70F with DM2, asthma, with a history of chronic
respiratory failure [**1-19**] PNA/asthma (with chronic trach x3
months, previously vented at night only, now off vent) CVA, CAD,
s/p recent tracheal bleed and trach change [**2106-7-4**] who was
admitted after an elective IP procedure to debride granulation
tissue around her stoma and distal trach site, and place a T
tube.

MEDICAL HISTORY: IDDM2
Asthma
Chronic resp failure ([**1-19**] asthma and PNA) s/p trach and PEG ? 3
months ago
s/p bronch [**7-8**], [**7-6**], cuffless trach replacement to cuffed
catheter in ED [**7-4**]
CVA (L weakness)
CAD
HTN
DJD
GERD
h/o AFB in sputum felt to be colonizer
Polypoid lesion trachea
Hypothyroidism
Hyperlipidemia

MEDICATION ON ADMISSION: 1. Bisacodyl 10mg po daily PRN constipation
2. Docusate 100mg po liquid [**Hospital1 **]
3. Senna 8.6 mg po bid PRN constipation
4. Acetaminophen 650 mg po q6h PRN pain
5. Escitalopram 20 mg po daily
6. Hydrochlorothiazide 12.5 mg po daily
7. Levothyroxine 100 mcg po daily
8. Lorazepam 0.5 mg po q6h PRN anxiety
9. Oxycodone 5 mg/5 mL po q4h PRN pain
10. Quetiapine 25 mg po bid
11. Ropinirole 2 mg po qPM
12. Simvastatin 20 mg po daily
13. Gabapentin 300 mg po tid
14. Albuterol inh 2 puffs q2h PRN
15. Chlorhexidine Mouthwash 1mL [**Hospital1 **]
16. Omeprazole 40 mg po bid
17. Ranitidine 300 mg po qhs
18. Nystatin 100,000 unit/mL Suspension -5mL po qid PRN thrush
19. Levemir 25 units sc bid
20. Novolog sliding scale
21. Aspirin 325 mg po daily

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: Temp: 98.2 BP: 155/62 HR:57 RR:14 O2sat 100% on 10L trach
mask
GEN: pleasant, comfortable, trach mask in place
HEENT: PERRL, EOMI, anicteric, MMM, op without lesions, no
supraclavicular or cervical lymphadenopathy, no jvd, no carotid
bruits, no thyromegaly or thyroid nodules
RESP: Mild expiratory wheezes bilaterally with good air movement
throughout
CV: RR, S1 and S2 wnl, no m/r/g
ABD: Obese. ND, +b/s, soft, nt, no masses or hepatosplenomegaly.
PEG tube in place.
EXT: no c/c/e
SKIN: no rashes/no jaundice/no splinters
NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout.
1+DTR's-patellar and biceps

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Resident at [**Hospital1 **] Commons. Has 3 sons. previously worked as
manager of group home.
- Tobacco:  Denies
- Alcohol:  rare
- Illicits:  None
Other tracheostomy complications,Acute and chronic respiratory failure,Other late effects of cerebrovascular disease,Muscle weakness (generalized),Leukocytosis, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Esophageal reflux,Other chronic pain,Dysthymic disorder,Long-term (current) use of insulin,Gastrostomy status
Tracheostomy comp NEC,Acute & chronc resp fail,Late effect CV dis NEC,Muscle weakness-general,Leukocytosis NOS,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Hypothyroidism NOS,Osteoarthros NOS-unspec,Esophageal reflux,Chronic pain NEC,Dysthymic disorder,Long-term use of insulin,Gastrostomy status
Admission Date:  [**2106-9-16**]              Discharge Date:   [**2106-9-19**]

Date of Birth:  [**2035-11-14**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 2712**]
Chief Complaint:
s/p T tube placement

Major Surgical or Invasive Procedure:
Flexible and Rigid bronchscopy with debridement of granulation
tissue and T tube placement


History of Present Illness:
Ms. [**Known lastname **] is a 70F with DM2, asthma, with a history of chronic
respiratory failure [**1-19**] PNA/asthma (with chronic trach x3
months, previously vented at night only, now off vent) CVA, CAD,
s/p recent tracheal bleed and trach change [**2106-7-4**] who was
admitted after an elective IP procedure to debride granulation
tissue around her stoma and distal trach site, and place a T
tube.

Of note patient was recently admitted to the MICU from [**Date range (1) 87240**]
for tracheal bleed, and difficulty talking. She had a rigid
bronchoscopy by IP which showed diffuse granulation tissue
around her stoma and her trach, as well as subglottic stenosis.
This was debrided and a larger size (#7 non-fenestrated) trach
tube was inserted.

IP performed an elective rigid and flexible bronch and placed a
T tube today (12mm) without complications. Granulation tissue
from the stoma was debrided. After the procedure, patient was
hypoventilating on pressure support, requiring CMV.  She was
reportedly hypercarbic and somnolent.  She was slowly
transitioned to PS, CPAP, and trach mask. She was admitted to
the MICU for close respiratory monitoring given concerns for
airway edema.

Patient denies any change in respiratory status since here
recent discharge on [**8-31**]. She denies hemoptysis. She hasn't been
able to speak at all. Denies fevers or chills, chest pain,
shortness of breath, orthopnea or LE edema.

Past Medical History:
IDDM2
Asthma
Chronic resp failure ([**1-19**] asthma and PNA) s/p trach and PEG ? 3
months ago
s/p bronch [**7-8**], [**7-6**], cuffless trach replacement to cuffed
catheter in ED [**7-4**]
CVA (L weakness)
CAD
HTN
DJD
GERD
h/o AFB in sputum felt to be colonizer
Polypoid lesion trachea
Hypothyroidism
Hyperlipidemia

Social History:
Resident at [**Hospital1 **] Commons. Has 3 sons. previously worked as
manager of group home.
- Tobacco:  Denies
- Alcohol:  rare
- Illicits:  None

Family History:
Non-contributory

Physical Exam:
VS: Temp: 98.2 BP: 155/62 HR:57 RR:14 O2sat 100% on 10L trach
mask
GEN: pleasant, comfortable, trach mask in place
HEENT: PERRL, EOMI, anicteric, MMM, op without lesions, no
supraclavicular or cervical lymphadenopathy, no jvd, no carotid
bruits, no thyromegaly or thyroid nodules
RESP: Mild expiratory wheezes bilaterally with good air movement
throughout
CV: RR, S1 and S2 wnl, no m/r/g
ABD: Obese. ND, +b/s, soft, nt, no masses or hepatosplenomegaly.
PEG tube in place.
EXT: no c/c/e
SKIN: no rashes/no jaundice/no splinters
NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout.
1+DTR's-patellar and biceps

Pertinent Results:
Admission Labs:
[**2106-9-16**] 05:53PM   WBC-12.8* RBC-3.87* HGB-10.6*# HCT-32.3*
MCV-83 MCH-27.3 MCHC-32.7 RDW-15.5
[**2106-9-16**] 05:53PM   PLT COUNT-379
[**2106-9-16**] 05:53PM   PT-12.1 PTT-25.1 INR(PT)-1.0
[**2106-9-16**] 05:53PM   CALCIUM-9.4 PHOSPHATE-4.4 MAGNESIUM-2.0
[**2106-9-16**] 05:53PM   ALT(SGPT)-16 AST(SGOT)-28 LD(LDH)-260* ALK
PHOS-77 TOT BILI-0.3
[**2106-9-16**] 05:53PM   GLUCOSE-185* UREA N-35* CREAT-0.8 SODIUM-133
POTASSIUM-5.0 CHLORIDE-93* TOTAL CO2-31 ANION GAP-14

Imaging:

CXR [**2106-9-18**]:
As compared to the previous radiograph, there is no relevant
change. Minimal increase in extent of the retrocardiac
atelectasis. Minimal
increase in extent of the right basal atelectasis. Unchanged
course and
position of the PICC line, a tracheostomy tube in situ.

[**2106-9-18**] 06:11AM BLOOD WBC-23.3*# RBC-3.52* Hgb-9.7* Hct-29.7*
MCV-84 MCH-27.5 MCHC-32.6 RDW-15.5 Plt Ct-431
[**2106-9-19**] 04:55AM BLOOD WBC-16.0* RBC-3.42* Hgb-9.5* Hct-29.0*
MCV-85 MCH-27.6 MCHC-32.6 RDW-15.6* Plt Ct-398
[**2106-9-19**] 04:55AM BLOOD Glucose-69* UreaN-25* Creat-0.7 Na-137
K-3.8 Cl-97 HCO3-34* AnGap-10

Brief Hospital Course:
70 yo F with DM2, asthma, chronic respiratory failure s/p trach
complicated by hemoptysis secondary to granulation tissue around
stoma site and subglottic stenosis s/p debridement and T tube
placement.

1.  Acute on Chronic respiratory failure: After her debridement,
she briefly required increased ventilator support with CMV that
was felt to be due to oversedation.  She also had a significant
amount of airway edema on bronchoscopy and was admitted to the
MICU for monitoring.  She was kept on Mucinex twice daily and
kept on her home nebulizers.  After T tube placement she was
able to speak. However the following day, she had difficulty
speaking again.  She was taken back to the OR for repeat
debridement of granulation tissue around the T tube, and the T
tube was removed.

2. Leukocytosis was attributed to administration of steroids
while in house.

Her home meds were continued. Other than the mucinex, no other
changes were made to her medications.

Code Status:  Full code, confirmed on admission

Medications on Admission:
1. Bisacodyl 10mg po daily PRN constipation
2. Docusate 100mg po liquid [**Hospital1 **]
3. Senna 8.6 mg po bid PRN constipation
4. Acetaminophen 650 mg po q6h PRN pain
5. Escitalopram 20 mg po daily
6. Hydrochlorothiazide 12.5 mg po daily
7. Levothyroxine 100 mcg po daily
8. Lorazepam 0.5 mg po q6h PRN anxiety
9. Oxycodone 5 mg/5 mL po q4h PRN pain
10. Quetiapine 25 mg po bid
11. Ropinirole 2 mg po qPM
12. Simvastatin 20 mg po daily
13. Gabapentin 300 mg po tid
14. Albuterol inh 2 puffs q2h PRN
15. Chlorhexidine Mouthwash 1mL [**Hospital1 **]
16. Omeprazole 40 mg po bid
17. Ranitidine 300 mg po qhs
18. Nystatin 100,000 unit/mL Suspension -5mL po qid PRN thrush
19. Levemir 25 units sc bid
20. Novolog sliding scale
21. Aspirin 325 mg po daily

Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. Ranitidine HCl 15 mg/mL Syrup Sig: One (1) unit PO DAILY
(Daily).
3. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
4. Chlorhexidine Gluconate 0.12 % Mouthwash Sig: One (1) ML
Mucous membrane [**Hospital1 **] (2 times a day).
5. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1) neb Inhalation Q2H (every 2 hours) as
needed for SOB.
6. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO Q12H (every
12 hours).
7. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
8. Ropinirole 1 mg Tablet Sig: Two (2) Tablet PO QPM (once a day
(in the evening)).
9. Quetiapine 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. Oxycodone 5 mg/5 mL Solution Sig: Five (5) mL PO Q4H (every
4 hours) as needed for pain.
11. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for anxiety.
12. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
14. Escitalopram 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
15. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain, fever.
16. Senna 8.6 mg Capsule Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
17. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
18. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
19. Insulin Detemir 100 unit/mL Solution Sig: Twenty Five (25) u
Subcutaneous twice a day.
20. Humalog 100 unit/mL Solution Sig: asdir units Subcutaneous
qachs: Please resume prior sliding scale.
21. Guaifenesin 600 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO bid ().
Disp:*60 Tablet Sustained Release(s)* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] Commons Nursing & Rehabilitation Center - [**Location (un) 6691**]

Discharge Diagnosis:
Primary diagnosis:
Acute on chronic respiratory failure

Secondary diagnosis:
Chronic respiratory failure s/p tracheostomy
Type 2 Diabetes Mellitus


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Bedbound.


Discharge Instructions:
Dear Ms. [**Known lastname **],

It was a pleasure caring for you. You were admitted after an
elective procedure to place a T tube, and remove some
unnecessary tissue near  your trach. The following day you were
still having difficulty speaking. You were taken back to the OR
for removal of granulation tissue, and the T tube was removed.


Followup Instructions:
Please follow up with your PCP in the next 2 weeks.



Completed by:[**2106-9-19**]
{'Other tracheostomy complications,Acute and chronic respiratory failure,Other late effects of cerebrovascular disease,Muscle weakness (generalized),Leukocytosis, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Esophageal reflux,Other chronic pain,Dysthymic disorder,Long-term (current) use of insulin,Gastrostomy 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: s/p T tube placement

PRESENT ILLNESS: Ms. [**Known lastname **] is a 70F with DM2, asthma, with a history of chronic
respiratory failure [**1-19**] PNA/asthma (with chronic trach x3
months, previously vented at night only, now off vent) CVA, CAD,
s/p recent tracheal bleed and trach change [**2106-7-4**] who was
admitted after an elective IP procedure to debride granulation
tissue around her stoma and distal trach site, and place a T
tube.

MEDICAL HISTORY: IDDM2
Asthma
Chronic resp failure ([**1-19**] asthma and PNA) s/p trach and PEG ? 3
months ago
s/p bronch [**7-8**], [**7-6**], cuffless trach replacement to cuffed
catheter in ED [**7-4**]
CVA (L weakness)
CAD
HTN
DJD
GERD
h/o AFB in sputum felt to be colonizer
Polypoid lesion trachea
Hypothyroidism
Hyperlipidemia

MEDICATION ON ADMISSION: 1. Bisacodyl 10mg po daily PRN constipation
2. Docusate 100mg po liquid [**Hospital1 **]
3. Senna 8.6 mg po bid PRN constipation
4. Acetaminophen 650 mg po q6h PRN pain
5. Escitalopram 20 mg po daily
6. Hydrochlorothiazide 12.5 mg po daily
7. Levothyroxine 100 mcg po daily
8. Lorazepam 0.5 mg po q6h PRN anxiety
9. Oxycodone 5 mg/5 mL po q4h PRN pain
10. Quetiapine 25 mg po bid
11. Ropinirole 2 mg po qPM
12. Simvastatin 20 mg po daily
13. Gabapentin 300 mg po tid
14. Albuterol inh 2 puffs q2h PRN
15. Chlorhexidine Mouthwash 1mL [**Hospital1 **]
16. Omeprazole 40 mg po bid
17. Ranitidine 300 mg po qhs
18. Nystatin 100,000 unit/mL Suspension -5mL po qid PRN thrush
19. Levemir 25 units sc bid
20. Novolog sliding scale
21. Aspirin 325 mg po daily

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: Temp: 98.2 BP: 155/62 HR:57 RR:14 O2sat 100% on 10L trach
mask
GEN: pleasant, comfortable, trach mask in place
HEENT: PERRL, EOMI, anicteric, MMM, op without lesions, no
supraclavicular or cervical lymphadenopathy, no jvd, no carotid
bruits, no thyromegaly or thyroid nodules
RESP: Mild expiratory wheezes bilaterally with good air movement
throughout
CV: RR, S1 and S2 wnl, no m/r/g
ABD: Obese. ND, +b/s, soft, nt, no masses or hepatosplenomegaly.
PEG tube in place.
EXT: no c/c/e
SKIN: no rashes/no jaundice/no splinters
NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout.
1+DTR's-patellar and biceps

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Resident at [**Hospital1 **] Commons. Has 3 sons. previously worked as
manager of group home.
- Tobacco:  Denies
- Alcohol:  rare
- Illicits:  None 

### Response:
{'Other tracheostomy complications,Acute and chronic respiratory failure,Other late effects of cerebrovascular disease,Muscle weakness (generalized),Leukocytosis, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Esophageal reflux,Other chronic pain,Dysthymic disorder,Long-term (current) use of insulin,Gastrostomy status'}
