CHIEF COMPLAINT: Dyspnea after elective intubation for Port placement

PRESENT ILLNESS: Mr. [**Known lastname 47716**] is a 74 year-old male with hx of metastatic lung
cancer on 3L home O2 with a recent admission for RUL obstructive
PNA, who presented to [**Known lastname **] for port placement, and could
not lie flat without dyspnea.  He was intubated for his
procedure, and subsequently extubated with acute dyspnea and
agitation with an O2 sat of 79%.  A CXR demonstrated complete
conslidation of the R lung field.  He was intially placed on
BiPAP and admitted to the [**Hospital Unit Name 153**] for respiratory distress.
.
In the PACU, initial vs were: T 97.8 P 110-120 R 15-21 100% O2
sat.  After NC the patient was placed on BiPaP and transfered to
the [**Hospital Unit Name 153**]
.
In the [**Hospital Unit Name 153**], he was breathing comfortably on BiPAP with settings
at 8/5 with an FiO2 of 30% 94% sat, and a minute ventilation of
9.3.  he was immediately transitioned to NC at 5L and sating at
100%.  Per the patient he has had a productive cough, but denies
any hemoptysis, fevers, chills, nausea, emesis, or change in
bowel or bladder habbits.  He reported being thirsty, and was in
no pain.

MEDICAL HISTORY: NSLC [**11/2128**] - diagnosed after antibiotics failed for a presumed
PNA.  CT staging demonstrated invasion of thoracic structures (L
atrium, SVC, and pericardium, right upper lobe bronchus), and a
biopsy from bronchoscopy confirmed the diagnosis.
Chemotherapy was started on [**2129-1-5**].
THERAPY: Cisplatin (50mg/m2, D1 and D8) and etoposide
(50mg/m2,D1-5)with concurrent radiation therapy.
[**2129-1-5**] Cycle 1 D1
[**2129-1-25**] Completion of 3500 cGy radiation therapy
[**2129-1-31**] Cycle 2 D1
[**2129-2-8**] Completion second cycle Cisplatinum and Etoposide
[**2129-3-8**] C1D1 Pemetrexed. Cycle #6 was on [**2129-7-5**]

MEDICATION ON ADMISSION: 1. Folic Acid 1 mg Tablet Sig: One Tab daily.
2. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO

ALLERGIES: Penicillins / Latex

PHYSICAL EXAM: Vitals: T:  BP:129/85 P:116 R:21 O2:100
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MM dry, oropharynx clear. EMOI
Neck: supple, no cervical LAD appreciated
Lungs: (Did not allow movment with exam to listen to R) No R
lung sounds anteriorly.  Inspiratory crackles on the left.
CV: Tachycardic rate, with normal S1 + S2, No S3 or S4
appreciated.
Abdomen: Soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, 1+ edema on the R, greater
than the left.
Neuro: Motor and sensation grossly intact.  Patient is oriented
to self, hospital, and time, but process information logically.

FAMILY HISTORY: Mother: Leukemia
Father: Peritonitis
Sister Breast CA

SOCIAL HISTORY: Married, wife [**Name (NI) 4333**]. [**Name2 (NI) **] children.
-Smoking Hx: History of 50 yrs smoking, has continued until
recently
-Alcohol: Social
-Drugs: None
Pneumonia, organism unspecified,Malignant neoplasm of other parts of bronchus or lung,Secondary malignant neoplasm of bone and bone marrow,Neoplasm related pain (acute) (chronic),Hypovolemia,Chronic airway obstruction, not elsewhere classified,Knee joint replacement,Other dependence on machines, supplemental oxygen,Anemia in neoplastic disease,Lumbago,Tachycardia, unspecified
Pneumonia, organism NOS,Mal neo bronch/lung NEC,Secondary malig neo bone,Neoplasm related pain,Hypovolemia,Chr airway obstruct NEC,Joint replaced knee,Depend-supplement oxygen,Anemia in neoplastic dis,Lumbago,Tachycardia NOS
Admission Date:  [**2129-9-6**]              Discharge Date:   [**2129-9-15**]

Date of Birth:  [**2054-9-10**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins / Latex

Attending:[**First Name3 (LF) 1990**]
Chief Complaint:
Dyspnea after elective intubation for Port placement

Major Surgical or Invasive Procedure:
Chest Port placement

History of Present Illness:
Mr. [**Known lastname 47716**] is a 74 year-old male with hx of metastatic lung
cancer on 3L home O2 with a recent admission for RUL obstructive
PNA, who presented to [**Known lastname **] for port placement, and could
not lie flat without dyspnea.  He was intubated for his
procedure, and subsequently extubated with acute dyspnea and
agitation with an O2 sat of 79%.  A CXR demonstrated complete
conslidation of the R lung field.  He was intially placed on
BiPAP and admitted to the [**Hospital Unit Name 153**] for respiratory distress.
.
In the PACU, initial vs were: T 97.8 P 110-120 R 15-21 100% O2
sat.  After NC the patient was placed on BiPaP and transfered to
the [**Hospital Unit Name 153**]
.
In the [**Hospital Unit Name 153**], he was breathing comfortably on BiPAP with settings
at 8/5 with an FiO2 of 30% 94% sat, and a minute ventilation of
9.3.  he was immediately transitioned to NC at 5L and sating at
100%.  Per the patient he has had a productive cough, but denies
any hemoptysis, fevers, chills, nausea, emesis, or change in
bowel or bladder habbits.  He reported being thirsty, and was in
no pain.

He is DNR/DNI.  He explicity expressed not to be treated with
antibiotic therapy for his possible post-obstructive PNA, until
a discussion with his wife took place.

Past Medical History:
NSLC [**11/2128**] - diagnosed after antibiotics failed for a presumed
PNA.  CT staging demonstrated invasion of thoracic structures (L
atrium, SVC, and pericardium, right upper lobe bronchus), and a
biopsy from bronchoscopy confirmed the diagnosis.
Chemotherapy was started on [**2129-1-5**].
THERAPY: Cisplatin (50mg/m2, D1 and D8) and etoposide
(50mg/m2,D1-5)with concurrent radiation therapy.
[**2129-1-5**] Cycle 1 D1
[**2129-1-25**] Completion of 3500 cGy radiation therapy
[**2129-1-31**] Cycle 2 D1
[**2129-2-8**] Completion second cycle Cisplatinum and Etoposide
[**2129-3-8**] C1D1 Pemetrexed. Cycle #6 was on [**2129-7-5**]

Other Medical History:
- Moderate celiac artery stenosis
- Erectile dysfunction
- Primary right total knee replacement
- Left knee arthroscopic meniscectomy


Social History:
Married, wife [**Name (NI) 4333**]. [**Name2 (NI) **] children.
-Smoking Hx: History of 50 yrs smoking, has continued until
recently
-Alcohol: Social
-Drugs: None


Family History:
Mother: Leukemia
Father: Peritonitis
Sister Breast CA


Physical Exam:
Vitals: T:  BP:129/85 P:116 R:21 O2:100
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MM dry, oropharynx clear. EMOI
Neck: supple, no cervical LAD appreciated
Lungs: (Did not allow movment with exam to listen to R) No R
lung sounds anteriorly.  Inspiratory crackles on the left.
CV: Tachycardic rate, with normal S1 + S2, No S3 or S4
appreciated.
Abdomen: Soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, 1+ edema on the R, greater
than the left.
Neuro: Motor and sensation grossly intact.  Patient is oriented
to self, hospital, and time, but process information logically.


Pertinent Results:
Labs on Admission:

[**2129-9-6**] 11:06PM   GLUCOSE-90 UREA N-13 CREAT-0.9 SODIUM-138
POTASSIUM-4.3 CHLORIDE-99 TOTAL CO2-30 ANION GAP-13
[**2129-9-6**] 11:06PM   CALCIUM-9.2 PHOSPHATE-4.0 MAGNESIUM-1.8
IRON-9*
[**2129-9-6**] 11:06PM   calTIBC-208* FERRITIN-583* TRF-160*
[**2129-9-6**] 11:06PM   WBC-8.2 RBC-4.49* HGB-8.8* HCT-30.2* MCV-67*
MCH-19.7* MCHC-29.3* RDW-17.6*
[**2129-9-6**] 11:06PM   NEUTS-87.4* LYMPHS-4.7* MONOS-6.3 EOS-1.5
BASOS-0.1
[**2129-9-6**] 11:06PM   PLT COUNT-444*
[**2129-9-6**] 11:06PM   PT-13.8* PTT-27.1 INR(PT)-1.2*
[**2129-9-6**] 06:39PM   TYPE-ART PO2-77* PCO2-51* PH-7.37 TOTAL
CO2-31* BASE XS-2 INTUBATED-NOT INTUBA
.
Labs on Transfer:

[**2129-9-7**] 03:40AM BLOOD WBC-7.9 RBC-4.32* Hgb-8.6* Hct-28.9*
MCV-67* MCH-20.0* MCHC-29.8* RDW-17.6* Plt Ct-439
[**2129-9-7**] 03:40AM BLOOD Plt Ct-439
[**2129-9-7**] 03:40AM BLOOD Glucose-83 UreaN-13 Creat-0.8 Na-137
K-4.2 Cl-99 HCO3-30 AnGap-12
[**2129-9-7**] 03:40AM BLOOD Calcium-9.0 Phos-3.7 Mg-1.7
.
Blood cx: NGTD
.
Imaging:
CXR [**2129-9-6**] post Port Placement: FINDINGS: AP single view of the
chest has been obtained with patient in
supine position. Comparison is made with the next preceding
similar study of
[**2129-9-1**]. On the present examination, a complete white
out of the
right hemithorax has now developed. A new right central venous
line has been
placed apparently using the internal jugular approach on the
right side. The
line terminates overlying the lower mediastinum and most likely
has entered
the right atrium. Withdrawal of the line by approximately 5 cm
is
recommended. There is no evidence of pneumothorax in the
right-sided
completely dense hemithorax. Also on the left side no evidence
of
pneumothorax.


Brief Hospital Course:
# Goals of care: Palliative care saw the patient in the [**Hospital Unit Name 153**];
the patient decided to be made CMO; all medications other than
Vicodin and pain regimen were discontinued.
.
# Acute respiratory failure, in setting of metastatic non-small
cell lung cancer: He was admitted with acute respiratory
failure, and finding of right lung consolidation that is likely
secondary to obstructive PNA.   Thoracentesis was considered for
a possible effusion radiographically confounded by infilitrate
on CXR but deferred, and overall after discussion with primary
oncology and family, decision was made to pursue comfort
measures, and stop antibiotics.  He was transferred out of the
ICU, and enrolled in inpatient hospice.  He was seen by
palliative care as well.  He was ultimately sent to the [**Hospital **] for ongoing palliative care/hospice.  At the time of
discharge, he was feeling well, no dyspnea or pain, and was
tolerating po intake with assistance.
.
#. NSLC with Metastasis: Possible chemotherapy for palliation
according to primary Hem/Onc team considered, then deferred.
Palliative care consulted.  Patient remained comfortable during
the remainder of his admission.
.
#. Malignant shoulder Pain: Known metastasis. Continued on home
regimen of Vicodin PRN in conjunction with a bowel regimen.
.
#. Anemia: Stable, but low relative to recent baseline.
Microcytic - raises question of underlying thalessemia.
Continued home Folic Acid.


Medications on Admission:
1. Folic Acid 1 mg Tablet Sig: One Tab daily.
2. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO

every 4-6 hours

Discharge Medications:
1. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for Constipation.
2. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
3. Polyethylene Glycol 3350 17 gram/dose Powder Sig: One (1)
packet PO DAILY (Daily) as needed for constipation.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 **] SKILLED NURSING CENTER

Discharge Diagnosis:
Acute hypoxic respiratory failure
Non small cell lung cancer, metastatic
Chronic anemia
Malignant pain


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
You were admitted for placement of a port for chemotherapy, but
then developed trouble breathing.  Ultimately you and your
doctors decided not to pursue further treatment, and you were
transitioned to a hospice facility.

Followup Instructions:
As needed with your [**Hospital3 3390**]:
[**Name Initial (NameIs) 3390**]: [**Last Name (LF) 7476**],[**First Name3 (LF) **] [**Telephone/Fax (1) 7477**]

Department: ORTHOPEDICS
When: THURSDAY [**2129-11-3**] at 8:00 AM
With: ORTHO XRAY (SCC 2) [**Telephone/Fax (1) 1228**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 551**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: ORTHOPEDICS
When: THURSDAY [**2129-11-3**] at 8:20 AM
With: [**Name6 (MD) 251**] [**Last Name (NamePattern4) 14200**], MD [**Telephone/Fax (1) 1228**]
Building: [**Hospital6 29**] [**Location (un) 551**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Pneumonia, organism unspecified,Malignant neoplasm of other parts of bronchus or lung,Secondary malignant neoplasm of bone and bone marrow,Neoplasm related pain (acute) (chronic),Hypovolemia,Chronic airway obstruction, not elsewhere classified,Knee joint replacement,Other dependence on machines, supplemental oxygen,Anemia in neoplastic disease,Lumbago,Tachycardia, unspecified'}


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: Dyspnea after elective intubation for Port placement

PRESENT ILLNESS: Mr. [**Known lastname 47716**] is a 74 year-old male with hx of metastatic lung
cancer on 3L home O2 with a recent admission for RUL obstructive
PNA, who presented to [**Known lastname **] for port placement, and could
not lie flat without dyspnea.  He was intubated for his
procedure, and subsequently extubated with acute dyspnea and
agitation with an O2 sat of 79%.  A CXR demonstrated complete
conslidation of the R lung field.  He was intially placed on
BiPAP and admitted to the [**Hospital Unit Name 153**] for respiratory distress.
.
In the PACU, initial vs were: T 97.8 P 110-120 R 15-21 100% O2
sat.  After NC the patient was placed on BiPaP and transfered to
the [**Hospital Unit Name 153**]
.
In the [**Hospital Unit Name 153**], he was breathing comfortably on BiPAP with settings
at 8/5 with an FiO2 of 30% 94% sat, and a minute ventilation of
9.3.  he was immediately transitioned to NC at 5L and sating at
100%.  Per the patient he has had a productive cough, but denies
any hemoptysis, fevers, chills, nausea, emesis, or change in
bowel or bladder habbits.  He reported being thirsty, and was in
no pain.

MEDICAL HISTORY: NSLC [**11/2128**] - diagnosed after antibiotics failed for a presumed
PNA.  CT staging demonstrated invasion of thoracic structures (L
atrium, SVC, and pericardium, right upper lobe bronchus), and a
biopsy from bronchoscopy confirmed the diagnosis.
Chemotherapy was started on [**2129-1-5**].
THERAPY: Cisplatin (50mg/m2, D1 and D8) and etoposide
(50mg/m2,D1-5)with concurrent radiation therapy.
[**2129-1-5**] Cycle 1 D1
[**2129-1-25**] Completion of 3500 cGy radiation therapy
[**2129-1-31**] Cycle 2 D1
[**2129-2-8**] Completion second cycle Cisplatinum and Etoposide
[**2129-3-8**] C1D1 Pemetrexed. Cycle #6 was on [**2129-7-5**]

MEDICATION ON ADMISSION: 1. Folic Acid 1 mg Tablet Sig: One Tab daily.
2. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO

ALLERGIES: Penicillins / Latex

PHYSICAL EXAM: Vitals: T:  BP:129/85 P:116 R:21 O2:100
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MM dry, oropharynx clear. EMOI
Neck: supple, no cervical LAD appreciated
Lungs: (Did not allow movment with exam to listen to R) No R
lung sounds anteriorly.  Inspiratory crackles on the left.
CV: Tachycardic rate, with normal S1 + S2, No S3 or S4
appreciated.
Abdomen: Soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, 1+ edema on the R, greater
than the left.
Neuro: Motor and sensation grossly intact.  Patient is oriented
to self, hospital, and time, but process information logically.

FAMILY HISTORY: Mother: Leukemia
Father: Peritonitis
Sister Breast CA

SOCIAL HISTORY: Married, wife [**Name (NI) 4333**]. [**Name2 (NI) **] children.
-Smoking Hx: History of 50 yrs smoking, has continued until
recently
-Alcohol: Social
-Drugs: None 

### Response:
{'Pneumonia, organism unspecified,Malignant neoplasm of other parts of bronchus or lung,Secondary malignant neoplasm of bone and bone marrow,Neoplasm related pain (acute) (chronic),Hypovolemia,Chronic airway obstruction, not elsewhere classified,Knee joint replacement,Other dependence on machines, supplemental oxygen,Anemia in neoplastic disease,Lumbago,Tachycardia, unspecified'}
