CHIEF COMPLAINT: Per daughter - pt. w/ respiratory distress

PRESENT ILLNESS: HPI per daughter
77 y.o. Italian speaking woman with multiple medical problem who
was discharged from [**Hospital 100**] rehab 1 day PTA, and presented from
home with respiratory distress.  She apparently had multiple
failed swallow tests but was reportedly had been advanced to
pureed diet at rehab. She returned to home after a pureed diet
meal and reportedly did not have anything else after arriving
home. She is minimally communicative at baseline.  She was only
home for several hours before she developed shortness of breath
and had to go to the hospital.
In ED, her initial vitals were P142 BP191/101 R27 76% NRB. She
was started on vanco/levo/flagyl.  Her CXR was clear.  Due to
persistent hypoxia on the NRB, the trachea was intubated.  Pt
was continued on levaquin and flagyl but vanco was d/c'd.  She
had a low grade fever of 99.9 on initial presentation.  She was
extubated on [**11-17**], and respiratory status has been stable all
day.  In addition, she became agitated that evening, which per
the family is her usual pattern.

MEDICAL HISTORY: Ascending Aortic Aneurysm
Polymyalgia Rheumatica
Recurrent UTI's on Macrodantin ppx. chronically
HTN
CVA (multiple?) with residual Lt. hemiparesis and expressive
aphasia
? of a seizure d/o
Pacemaker for sick sinus syndrome and PAF (overdrive pacing)
GERD
PAF on coumadin
Anxiety
PTSD (initial trauma WWII)
Depression
Multinodular goiter
Diabetes (type 2)

MEDICATION ON ADMISSION: CURRENT MEDS:
Flagyl 500mg IV q8h (day 2)
Levaquin 500mg IV daily (day 2)
Lansoprazole
Lactulose 30ml tid (held)
Insulin SS
Coumadin (held for INR 3.9)
Verapamil 160mg PO q8h
Lopressor 50mg tid
Lisinopril 20mg daily

ALLERGIES: Penicillins / Codeine / Latex

PHYSICAL EXAM: PE:
VS  Tm 98.1 HR 75 BP 118/60 75 RR 20 99% RA (93-99)
Gen- elderly, cachectic, sedated but responsive to voice and
touch.
HEENT- Pupils equal, min reactive b/l, anicteric, conj
noninjected.  OP clear but dry MM (pt's mouth open).
Neck:  no JVD appreciated.
Lungs:  rhonchi b/l with decreased BS at right base and minimal
bibasilar crackles.
CV: heart sounds masked by breath sounds; irregular, no murmurs
appreciated.
Abdomen: PEG in place, + BS, site C/D/I
Ext: no edema, DP 1+b/l, warm.
Neuro:  exam limited by sedation, but moving all 4 extremities,
responds to voice.

FAMILY HISTORY: Maternal fatal MI

SOCIAL HISTORY: Was at rehab and had recently been taken to live w/ daughter, is
italian and has "reverted to her native language" since her CVA.
 She worked as a laundress.  Unknown tobhx/etho hx
Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Nontoxic multinodular goiter,Iron deficiency anemia, unspecified,Unspecified essential hypertension,Polymyalgia rheumatica,Esophageal reflux,Long-term (current) use of anticoagulants,Posttraumatic stress disorder,Thoracic aneurysm without mention of rupture,Anticoagulants causing adverse effects in therapeutic use
Acute respiratry failure,Food/vomit pneumonitis,CHF NOS,Urin tract infection NOS,Atrial fibrillation,DMII wo cmp nt st uncntr,Nontox multinodul goiter,Iron defic anemia NOS,Hypertension NOS,Polymyalgia rheumatica,Esophageal reflux,Long-term use anticoagul,Posttraumatic stress dis,Thoracic aortic aneurysm,Adv eff anticoagulants
Admission Date:  [**2141-11-16**]              Discharge Date:   [**2141-11-30**]

Date of Birth:  [**2063-12-13**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Codeine / Latex

Attending:[**First Name3 (LF) 2641**]
Chief Complaint:
Per daughter - pt. w/ respiratory distress


Major Surgical or Invasive Procedure:
Intubation

History of Present Illness:
HPI per daughter
77 y.o. Italian speaking woman with multiple medical problem who
was discharged from [**Hospital 100**] rehab 1 day PTA, and presented from
home with respiratory distress.  She apparently had multiple
failed swallow tests but was reportedly had been advanced to
pureed diet at rehab. She returned to home after a pureed diet
meal and reportedly did not have anything else after arriving
home. She is minimally communicative at baseline.  She was only
home for several hours before she developed shortness of breath
and had to go to the hospital.
In ED, her initial vitals were P142 BP191/101 R27 76% NRB. She
was started on vanco/levo/flagyl.  Her CXR was clear.  Due to
persistent hypoxia on the NRB, the trachea was intubated.  Pt
was continued on levaquin and flagyl but vanco was d/c'd.  She
had a low grade fever of 99.9 on initial presentation.  She was
extubated on [**11-17**], and respiratory status has been stable all
day.  In addition, she became agitated that evening, which per
the family is her usual pattern.

She was admitted in [**8-22**] with altered MS with a negative workup
that included CT head, EEG, LP.  At the time she had a failed
swallow eval and a PEG was placed for nutrition.


Past Medical History:
Ascending Aortic Aneurysm
Polymyalgia Rheumatica
Recurrent UTI's on Macrodantin ppx. chronically
HTN
CVA (multiple?) with residual Lt. hemiparesis and expressive
aphasia
? of a seizure d/o
Pacemaker for sick sinus syndrome and PAF (overdrive pacing)
GERD
PAF on coumadin
Anxiety
PTSD (initial trauma WWII)
Depression
Multinodular goiter
Diabetes (type 2)

Social History:
Was at rehab and had recently been taken to live w/ daughter, is
italian and has "reverted to her native language" since her CVA.
 She worked as a laundress.  Unknown tobhx/etho hx

Family History:
Maternal fatal MI

Physical Exam:
PE:
VS  Tm 98.1 HR 75 BP 118/60 75 RR 20 99% RA (93-99)
Gen- elderly, cachectic, sedated but responsive to voice and
touch.
HEENT- Pupils equal, min reactive b/l, anicteric, conj
noninjected.  OP clear but dry MM (pt's mouth open).
Neck:  no JVD appreciated.
Lungs:  rhonchi b/l with decreased BS at right base and minimal
bibasilar crackles.
CV: heart sounds masked by breath sounds; irregular, no murmurs
appreciated.
Abdomen: PEG in place, + BS, site C/D/I
Ext: no edema, DP 1+b/l, warm.
Neuro:  exam limited by sedation, but moving all 4 extremities,
responds to voice.

Pertinent Results:
[**2141-11-20**] 06:30AM BLOOD WBC-4.9 RBC-3.69* Hgb-9.5* Hct-28.9*
MCV-78* MCH-25.8* MCHC-32.9 RDW-15.1 Plt Ct-160
[**2141-11-19**] 06:25AM BLOOD WBC-6.0 RBC-3.82* Hgb-10.0* Hct-30.1*
MCV-79* MCH-26.3* MCHC-33.4 RDW-15.1 Plt Ct-189
[**2141-11-18**] 06:15AM BLOOD WBC-8.0 RBC-4.08* Hgb-10.8* Hct-32.3*
MCV-79* MCH-26.5* MCHC-33.5 RDW-14.9 Plt Ct-194
[**2141-11-17**] 04:21AM BLOOD WBC-5.4# RBC-3.70* Hgb-9.6* Hct-29.2*
MCV-79* MCH-26.0* MCHC-32.8 RDW-14.8 Plt Ct-134*
[**2141-11-16**] 04:36PM BLOOD Hct-32.7*
[**2141-11-16**] 06:27AM BLOOD WBC-11.9* RBC-4.03* Hgb-10.2* Hct-31.2*
MCV-77* MCH-25.4* MCHC-32.8 RDW-14.8 Plt Ct-186
[**2141-11-16**] 03:26AM BLOOD WBC-19.3*# RBC-5.11 Hgb-12.7 Hct-39.9
MCV-78* MCH-24.9* MCHC-31.9 RDW-14.8 Plt Ct-278
[**2141-11-16**] 03:26AM BLOOD Neuts-82.9* Bands-0 Lymphs-13.6*
Monos-3.1 Eos-0.2 Baso-0.2
[**2141-11-16**] 03:26AM BLOOD Hypochr-1+ Anisocy-1+ Poiklo-1+
Macrocy-NORMAL Microcy-1+ Polychr-OCCASIONAL Ovalocy-1+
[**2141-11-20**] 11:15AM BLOOD PT-18.2* PTT-29.6 INR(PT)-2.3
[**2141-11-20**] 06:30AM BLOOD Plt Ct-160
[**2141-11-19**] 06:25AM BLOOD PT-20.9* PTT-32.8 INR(PT)-3.1
[**2141-11-18**] 06:15AM BLOOD PT-22.6* PTT-36.4* INR(PT)-3.7
[**2141-11-17**] 07:34AM BLOOD PT-23.2* PTT-37.1* INR(PT)-3.9
[**2141-11-16**] 06:27AM BLOOD PT-21.6* PTT-34.3 INR(PT)-3.3
[**2141-11-20**] 06:30AM BLOOD Glucose-78 UreaN-11 Creat-0.6 Na-144
K-3.3 Cl-109* HCO3-25 AnGap-13
[**2141-11-19**] 06:25AM BLOOD Glucose-121* UreaN-15 Creat-0.6 Na-142
K-4.4 Cl-114* HCO3-18* AnGap-14
[**2141-11-18**] 06:15AM BLOOD Glucose-79 UreaN-12 Creat-0.5 Na-143
K-3.6 Cl-110* HCO3-20* AnGap-17
[**2141-11-17**] 04:21AM BLOOD Glucose-75 UreaN-13 Creat-0.6 Na-144
K-3.4 Cl-114* HCO3-23 AnGap-10
[**2141-11-16**] 06:27AM BLOOD Glucose-130* UreaN-15 Creat-0.7 Na-138
K-3.9 Cl-103 HCO3-22 AnGap-17
[**2141-11-16**] 03:26AM BLOOD Glucose-134* UreaN-15 Creat-0.7 Na-139
K-4.4 Cl-100 HCO3-25 AnGap-18
[**2141-11-16**] 06:27AM BLOOD CK(CPK)-27

[**2141-11-18**] 06:15AM BLOOD calTIBC-306 Ferritn-108 TRF-235

[**2141-11-19**] 05:52PM BLOOD Type-ART pO2-158* pCO2-36 pH-7.43
calHCO3-25 Base XS-0
[**2141-11-16**] 03:40PM BLOOD Type-ART Temp-37.1 PEEP-5 FiO2-50
pO2-196* pCO2-40 pH-7.39 calHCO3-25 Base XS-0 Intubat-INTUBATED
[**2141-11-16**] 06:27AM BLOOD Type-ART Tidal V-400 FiO2-100 pO2-513*
pCO2-36 pH-7.45 calHCO3-26 Base XS-2 AADO2-180 REQ O2-38
[**2141-11-16**] 04:50AM BLOOD Type-ART pO2-555* pCO2-35 pH-7.44
calHCO3-25 Base XS-0
[**2141-11-16**] 03:26AM BLOOD Comment-GREEN TOP
[**2141-11-19**] 05:52PM BLOOD Lactate-1.0 K-3.5
[**2141-11-16**] 03:26AM BLOOD Lactate-2.9*
[**2141-11-16**] 04:04AM URINE Color-Yellow Appear-Cloudy Sp [**Last Name (un) **]-1.019
[**2141-11-16**] 04:04AM URINE Blood-SM Nitrite-NEG Protein-500
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-MOD
[**2141-11-16**] 04:04AM URINE RBC-[**4-22**]* WBC->50 Bacteri-MANY Yeast-NONE
Epi-0-2

EKG: EKG ([**11-16**]): Atrial fibrillation with normal vent rate; nml
int; TWI in III, no ST changes.

IMAGING:
CXR [**11-28**]: new line placement -IMPRESSION:
 1.  Termination of PICC catheter at cavoatrial junction.
 2.  Improved aeration of the left lower lobe.
CXR: [**11-23**]: Resolving congestive heart failure. No definite
pneumonia.
CXR: [**11-19**]: 1. Persistent patchy right lower lobe consolidation,
which may be due to focal pneumonia. 2. Early/mild congestive
heart failure
CXR ([**11-17**]): developing RLL infiltrate
.
CT ([**11-26**]): Stable appearance of the brain.
CT ([**11-19**]) No evidence of new stroke or bleed
.
KUB ([**11-26**]): No intestinal obstruction or pneumoperitoneum
Sputum culture ([**11-16**]): [**2141-11-16**] 8:17 am SPUTUM      Source:
Endotracheal.

                            **FINAL REPORT [**2141-11-18**]**

   GRAM STAIN (Final [**2141-11-16**]):
      >25 PMNs and <10 epithelial cells/100X field.
      2+   (1-5 per 1000X FIELD):   MULTIPLE ORGANISMS
CONSISTENT WITH
                                    OROPHARYNGEAL FLORA.

   RESPIRATORY CULTURE (Final [**2141-11-18**]):
      SPARSE GROWTH OROPHARYNGEAL FLORA.

Blood Cx([**11-16**]): NGTD
.
Urine Ctx:
     URINE     Site: CATHETER

                            **FINAL REPORT [**2141-11-20**]**

   URINE CULTURE (Final [**2141-11-20**]):
      THIS IS A CORRECTED REPORT ([**2141-11-18**]).
      ESCHERICHIA COLI.    >100,000 ORGANISMS/ML..
         PRESUMPTIVE IDENTIFICATION.
         Trimethoprim/sulfa sensitivity confirmed by
[**Doctor Last Name 3077**]-[**Doctor Last Name 3060**].
         AZTREONAM SENSITIVITY REQUESTED PER DR [**Last Name (STitle) **] ([**Numeric Identifier 96800**]).
         AZTREONAM SENSITIVE <=1 MCU/ML BY MIC.
      PSEUDOMONAS AERUGINOSA.    >100,000 ORGANISMS/ML..
         AZTREONAM sensitivity performed by [**First Name8 (NamePattern2) 3077**] [**Last Name (NamePattern1) 3060**].
         AZTREONAM SENSITIVITY REQUESTED BY [**Doctor Last Name **] [**Last Name (un) **] ([**Numeric Identifier 96800**]).
         SENSITIVE TO AZTREONAM.  PREVIOUSLY REPORTED AS
([**2141-11-17**]).
         GRAM POSITIVE BACTERIA.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             ESCHERICHIA COLI
                             |          PSEUDOMONAS AERUGINOSA
                             |          |
AMPICILLIN------------     4 S
AMPICILLIN/SULBACTAM--     4 S
CEFAZOLIN-------------   <=4 S
CEFEPIME--------------   <=1 S        8 S
CEFTAZIDIME-----------   <=1 S        4 S
CEFTRIAXONE-----------   <=1 S
CEFUROXIME------------     4 S
CIPROFLOXACIN---------   =>4 R      =>4 R
GENTAMICIN------------   <=1 S     =>16 R
IMIPENEM--------------   <=1 S        4 S
LEVOFLOXACIN----------   =>8 R
MEROPENEM-------------<=0.25 S   <=0.25 S
NITROFURANTOIN--------  <=16 S
PIPERACILLIN----------   <=4 S        8 S
PIPERACILLIN/TAZO-----   <=4 S        8 S
TOBRAMYCIN------------   <=1 S     =>16 R
TRIMETHOPRIM/SULFA----  =>16 R


Brief Hospital Course:
77 yo F with h/o CVA, HTN, PAF, dementia, and DM2 presented 2d
ago with hypoxic respiratory failure thought to be secondary to
aspiration pneumonia and now w/ mild CHF after fluid
resuscitation, along w/ levo resistant UTI.
.
Hypoxic respiratory failure/Pneumonia: Pt. came to ED and was
intubated for resp. distress.  Most likely etiology is
aspiration pneumonitis/pneumonia given high risk (pt. has failed
swallow studies in the past and had recently gone home and
allowed to eat pureed foods)and CXR that indicated RLL
pneumonia.  Unlikely PE given that pt. was anticoagulated. Pt.
was extubated 12 hrs later and called out to the floor.  On the
floor patient was not in respiratory distress and had good O2
sats.  Pt. treated with levo/flagyl given risk of aspiration
pneumonia and received a total of 10 days.  Pt. had been
receiving fluids and began to have crackles on [**11-19**].  CXR showed
mild CHF.  Fluids were stopped and pt. was given 10mg IV lasix
and responded.  Repeat CXRs showed resolving pneumonia and no
CHF. Pt. continued to have good sats throughout the hospital
stay.  Pt. continued to have a lot of secretions, as she cannot
clear them.  Pt. did not appear to be fluid overloaded.  It is
very likely that pt. will continue to re-aspirate.
.
Nutrition - Pt. had been cleared at nursing home w/ swallow
study? and was taken home, allowed to eat and then aspirated.
During this hospitalization, pt. with possible aspiration with
tube feeds, increased secretions and cough.  Held TF for a night
and pt. improved.  Discussed this with daughter (proxy) who
wants pt. to be fed through G-tube anyway.  Pt. failed swallow
study, so will be d/c w/ G-tube.  Family aware of aspiration
risk.
.
Mental Status changes - per daughter, pt. was walking around w/
walker week prior to admission w/ minimal talking, but was
responsive and even had foley out for a while.  During
admission, pt. very sedated at times, possibly secondary to
ativan as pt. was sundowning and requiring chemcial restraint.
Did an infectious and metabolic work-up.  Got a CT with no
evidence of new stroke or bleed, repeat lactate was 1.0, no
evidence of hypoxia/hypercarbia on ABG.  Ativan was d/c and pt.
was less sedated most of the time.  Likely pt is at her baseline
after stroke and has episodes where she is more sedated.  Pt.
had 2 head CTs while in the hospital b/c of these episodes and
both of these CTs showed no hemorrhage or stroke.  Pt's family
understands risk of anticoagulation and bleeding, but wants the
pt. to be anticoagulated for her afib.
.
Recurrent UTI - Pt. w/ E.coli UTI that is resistant to levo and
pt. w/ allergy to penicillin.  Pt. was macrodentin chronically
for recurrent UTIs.  Pt. received 7 days total of gentamicin for
this infection.  Pt. eventually grew psuedomonas in her urine
that was sensitive to aztreonam.  Pt. received 7 days of IV
aztreonam.  Pt. had a PICC line placed and will receive a total
of 14 days of aztreonam.
. - last doses to be given on [**12-7**].
.
Thrombocytopenia:  Pt. had thrombocytopenia soon after receing
heparin, so heparin was d/c and HIT antibody sent which was
negative.  Once heparin was d/c, pt's thrombocytopenia began to
resolve. Pt. remained on coumadin throughout hospitalization.
.
Anemia:  Pt. had a slow hct drop.  Iron studies indicated that
pt. was likely iron deficient so pt. was given iron.  Pt's
baseline is in low 30s.  No indication of bleeding.  Stools were
guiac negative
.
A-fib: Pt. w/ h/o afib who was supratherapeutic on coumadin when
she came to ED so coumadin was held for a few days.  Restarted
pt. on coumadin and INR will be monitored at NH with goal INR of
[**3-23**].  Pt. seemed stable w/ 2.5 mg coumadin.  Pt. was rate
controlled with verapamil and lopressor.  Patient has Pacemaker
for sick sinus syndrome and PAF (overdrive pacing.) Battery was
recently replaced by EP [**8-22**].
.
Hypertension: Pt's hypertension was well controlled during
hospitalization with lisinopril, verapamil, and lopressor.
.
Palliative care consult was called and daughter continues to
want a full-code and to continue feeding, despite the risk of
aspiration pneumonia. Family understands that pt. is very
debilitated and will likely return with another aspiration
pneumonia.  There are 8 siblings and they do not agree about
further care.  At this time, pt. is to remain full code.  If
they change their mind they will inform both the nursing home
and PCP.

Medications on Admission:
CURRENT MEDS:
Flagyl 500mg IV q8h (day 2)
Levaquin 500mg IV daily (day 2)
Lansoprazole
Lactulose 30ml tid (held)
Insulin SS
Coumadin (held for INR 3.9)
Verapamil 160mg PO q8h
Lopressor 50mg tid
Lisinopril 20mg daily


Discharge Medications:
1. Verapamil 80 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8
hours).
2. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Docusate sodium - 100mg liquid NG [**Hospital1 **]   Sig: One (1)   twice
a day.
4. Ferrous Sulfate 300 mg/5 mL Liquid Sig: One (1)  PO BID (2
times a day).
5. Haloperidol 1 mg Tablet Sig: One (1) Tablet PO twice a day as
needed for agitation.
Disp:*60 Tablet(s)* Refills:*0*
6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
7. Warfarin 2.5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime): Titrate this as needed for goal INR of [**3-23**].
8. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical  PRN
(as needed).
9. Aztreonam 1 g Recon Soln Sig: One (1) Recon Soln Injection
Q8H (every 8 hours).
10. Acetaminophen 160 mg/5 mL Solution Sig: Two (2)  PO Q4-6H
(every 4 to 6 hours) as needed for fever/pain.
11. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED).
12. Lansoprazole 30 mg Capsule, Delayed Release(E.C.) Sig: One
(1) Capsule, Delayed Release(E.C.) PO once a day: Put in NG
tube.


Discharge Disposition:
Extended Care

Facility:
Life Care Center of the [**Location (un) 1121**] - [**Location (un) **]

Discharge Diagnosis:
Aspiration Pneumonia


Discharge Condition:
Stable


Discharge Instructions:
There were some changes made in your medication.  Please see the
attached list for medication and doses.  You need to have IV
antibiotics for 7 more days.  The patient's daughter should call
the doctor or return to the emergency room if she experiencs
chest pain/tightness, nausea, vomiting, fevers, chills,
difficulty breathing, signs of aspiration.

Followup Instructions:
You should follow up with Dr. [**Last Name (STitle) 3029**] in the next week.  Her office
number is
[**Telephone/Fax (1) 1300**].
{'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Nontoxic multinodular goiter,Iron deficiency anemia, unspecified,Unspecified essential hypertension,Polymyalgia rheumatica,Esophageal reflux,Long-term (current) use of anticoagulants,Posttraumatic stress disorder,Thoracic aneurysm without mention of rupture,Anticoagulants 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: Per daughter - pt. w/ respiratory distress

PRESENT ILLNESS: HPI per daughter
77 y.o. Italian speaking woman with multiple medical problem who
was discharged from [**Hospital 100**] rehab 1 day PTA, and presented from
home with respiratory distress.  She apparently had multiple
failed swallow tests but was reportedly had been advanced to
pureed diet at rehab. She returned to home after a pureed diet
meal and reportedly did not have anything else after arriving
home. She is minimally communicative at baseline.  She was only
home for several hours before she developed shortness of breath
and had to go to the hospital.
In ED, her initial vitals were P142 BP191/101 R27 76% NRB. She
was started on vanco/levo/flagyl.  Her CXR was clear.  Due to
persistent hypoxia on the NRB, the trachea was intubated.  Pt
was continued on levaquin and flagyl but vanco was d/c'd.  She
had a low grade fever of 99.9 on initial presentation.  She was
extubated on [**11-17**], and respiratory status has been stable all
day.  In addition, she became agitated that evening, which per
the family is her usual pattern.

MEDICAL HISTORY: Ascending Aortic Aneurysm
Polymyalgia Rheumatica
Recurrent UTI's on Macrodantin ppx. chronically
HTN
CVA (multiple?) with residual Lt. hemiparesis and expressive
aphasia
? of a seizure d/o
Pacemaker for sick sinus syndrome and PAF (overdrive pacing)
GERD
PAF on coumadin
Anxiety
PTSD (initial trauma WWII)
Depression
Multinodular goiter
Diabetes (type 2)

MEDICATION ON ADMISSION: CURRENT MEDS:
Flagyl 500mg IV q8h (day 2)
Levaquin 500mg IV daily (day 2)
Lansoprazole
Lactulose 30ml tid (held)
Insulin SS
Coumadin (held for INR 3.9)
Verapamil 160mg PO q8h
Lopressor 50mg tid
Lisinopril 20mg daily

ALLERGIES: Penicillins / Codeine / Latex

PHYSICAL EXAM: PE:
VS  Tm 98.1 HR 75 BP 118/60 75 RR 20 99% RA (93-99)
Gen- elderly, cachectic, sedated but responsive to voice and
touch.
HEENT- Pupils equal, min reactive b/l, anicteric, conj
noninjected.  OP clear but dry MM (pt's mouth open).
Neck:  no JVD appreciated.
Lungs:  rhonchi b/l with decreased BS at right base and minimal
bibasilar crackles.
CV: heart sounds masked by breath sounds; irregular, no murmurs
appreciated.
Abdomen: PEG in place, + BS, site C/D/I
Ext: no edema, DP 1+b/l, warm.
Neuro:  exam limited by sedation, but moving all 4 extremities,
responds to voice.

FAMILY HISTORY: Maternal fatal MI

SOCIAL HISTORY: Was at rehab and had recently been taken to live w/ daughter, is
italian and has "reverted to her native language" since her CVA.
 She worked as a laundress.  Unknown tobhx/etho hx 

### Response:
{'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Nontoxic multinodular goiter,Iron deficiency anemia, unspecified,Unspecified essential hypertension,Polymyalgia rheumatica,Esophageal reflux,Long-term (current) use of anticoagulants,Posttraumatic stress disorder,Thoracic aneurysm without mention of rupture,Anticoagulants causing adverse effects in therapeutic use'}
