CHIEF COMPLAINT: SOB

PRESENT ILLNESS: 107 russian only speaking felmale with diastolic congestive
heart failure, hypertension who presents with acute onset
shortness of breath (SOB). She resides at [**Hospital **] rehab. she had
an episode of SOB at 4 pm today and was sent to the ER. her VS
at that time were 128/42 70 30 94/ra.  She had no fevers.  Per
further history the patient reports some trouble with
swallowing.
.
In ER VS 90/40 70 32 100/ra.cxr showed persistent retrocard
opacity. she recd CTX and azithro x 1. she c/o resp distress in
ER and said she felt like she was dying. hence she was put on
CPAP for some time. she felt better w/ it. she was weaned to 40%
venti mask.

MEDICAL HISTORY: #. Diastolic CHF
- EF 70-80% Echo [**2182**]
#. HTN
#. Osteoarthritis
s/p displaced femoral neck fracture
s/p left [**Doctor Last Name 17113**] hemiarthroplasty
#. Cholelithiasis
#. Vertigo
#. Macular degeneration
#. Large left frontal meningioma

MEDICATION ON ADMISSION: 1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6

ALLERGIES: Cephalosporins

PHYSICAL EXAM: VS: afebrile, satting well on room air.
GEN: NAD, awake, alert
HEENT: EOMI, PERRL, sclera anicteric, conjunctivae clear, OP
moist and without lesion
NECK: Supple, no JVD
CV: Reg rate, normal S1, S2. No m/r/g.
CHEST: Resp were unlabored, no accessory muscle use. mild
crackles bibasilar
ABD: Soft, NT, ND, no HSM
EXT: No edema
SKIN: No rash

FAMILY HISTORY: NC

SOCIAL HISTORY: The patient is currently a resident at [**Hospital **] Rehab. At baseline
she is able to walk with 2 person assist. She feeds herself if
her meals are prepared, ground solids. She is generally
dependent on others for most ADL.
Tobacco: None
ETOH: None
Illicits: None
Shortness of breath,Chronic diastolic heart failure,Acute kidney failure, unspecified,Dehydration,Other diuretics causing adverse effects in therapeutic use,Iron deficiency anemia secondary to blood loss (chronic),Benign neoplasm of cerebral meninges,Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere,Dizziness and giddiness,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Macular degeneration (senile), unspecified,Other postprocedural status
Shortness of breath,Chr diastolic hrt fail,Acute kidney failure NOS,Dehydration,Adv eff diuretics NEC,Chr blood loss anemia,Ben neo cerebr meninges,Hypertension NOS,Mental disor NEC oth dis,Dizziness and giddiness,Osteoarthros NOS-unspec,Macular degeneration NOS,Post-proc states NEC
Admission Date:  [**2188-12-26**]              Discharge Date:   [**2188-12-28**]


Service: MEDICINE

Allergies:
Cephalosporins

Attending:[**First Name3 (LF) 2279**]
Chief Complaint:
SOB

Major Surgical or Invasive Procedure:
None


History of Present Illness:
107 russian only speaking felmale with diastolic congestive
heart failure, hypertension who presents with acute onset
shortness of breath (SOB). She resides at [**Hospital **] rehab. she had
an episode of SOB at 4 pm today and was sent to the ER. her VS
at that time were 128/42 70 30 94/ra.  She had no fevers.  Per
further history the patient reports some trouble with
swallowing.
.
In ER VS 90/40 70 32 100/ra.cxr showed persistent retrocard
opacity. she recd CTX and azithro x 1. she c/o resp distress in
ER and said she felt like she was dying. hence she was put on
CPAP for some time. she felt better w/ it. she was weaned to 40%
venti mask.


Past Medical History:
#. Diastolic CHF
- EF 70-80% Echo [**2182**]
#. HTN
#. Osteoarthritis
s/p displaced femoral neck fracture
s/p left [**Doctor Last Name 17113**] hemiarthroplasty
#. Cholelithiasis
#. Vertigo
#. Macular degeneration
#. Large left frontal meningioma


Social History:
The patient is currently a resident at [**Hospital **] Rehab. At baseline
she is able to walk with 2 person assist. She feeds herself if
her meals are prepared, ground solids. She is generally
dependent on others for most ADL.
Tobacco: None
ETOH: None
Illicits: None


Family History:
NC

Physical Exam:
VS: afebrile, satting well on room air.
GEN: NAD, awake, alert
HEENT: EOMI, PERRL, sclera anicteric, conjunctivae clear, OP
moist and without lesion
NECK: Supple, no JVD
CV: Reg rate, normal S1, S2. No m/r/g.
CHEST: Resp were unlabored, no accessory muscle use. mild
crackles bibasilar
ABD: Soft, NT, ND, no HSM
EXT: No edema
SKIN: No rash


Pertinent Results:
CBC:
[**2188-12-26**] 10:45PM BLOOD WBC-3.6* RBC-2.43* Hgb-8.5* Hct-22.5*
MCV-92 MCH-35.0* MCHC-37.9* RDW-15.8* Plt Ct-194
[**2188-12-28**] 09:45AM BLOOD WBC-3.2* RBC-2.87* Hgb-9.8* Hct-26.4*
MCV-92 MCH-34.2* MCHC-37.3* RDW-16.9* Plt Ct-185

Chemistry:
[**2188-12-26**] 03:36PM BLOOD Glucose-102 UreaN-57* Creat-1.2* Na-140
K-3.7 Cl-96 HCO3-30 AnGap-18
[**2188-12-28**] 09:45AM BLOOD Glucose-187* UreaN-49* Creat-1.3* Na-139
K-3.1* Cl-98 HCO3-29 AnGap-15
[**2188-12-28**] 09:45AM BLOOD Calcium-8.8 Phos-4.0 Mg-2.3

Cardiac Enzymes:
[**2188-12-26**] 03:36PM BLOOD CK(CPK)-25*
[**2188-12-26**] 10:45PM BLOOD CK(CPK)-22*
[**2188-12-26**] 03:36PM BLOOD cTropnT-0.01
[**2188-12-26**] 10:45PM BLOOD cTropnT-<0.01

BNP:
[**2188-12-26**] 03:36PM BLOOD CK-MB-NotDone proBNP-4240*

CXR:  IMPRESSION: Persistent retrocardiac opacity, which could
represent atelectasis, although pneumonia is not excluded.
Cardiomegaly with prominance of the pulmonary vascularity, but
no overt congestive heart failure.


Brief Hospital Course:
107 russian only speaking F w/ dCHF, HTN p/w acute onset SOB.
.
#SOB: Patient minimally desatted and was placed on CPAP
overnight initially.  She was initially given antibiotics, but
the lack of fever, white count and [**Male First Name (un) **] CXR fiondings made
pneumonia unlikely and the antibiotics were continued.  The next
day she was weaned to room air.  She remained satting well on
room air.  She did desat overnight once and responded to 2L NC.
In the morning again she was weaned to room air.  Current
thinking is small aspiration event or mucous plugging.  She was
placed on aspiration precautions.
.
# Persistent retrocardiac opacity: Unlikely to represent
pneumonia as unchanged over time.  More likely atelectasis.
Small pleural effusion.
.
#h/o Meningioma: cont home dialntin
.
# anemia: per previous notes, egd and colon deffered.  She was
given one unit of blood slowly and her hematocrit responded
appropriatly.
.
# dCHF: She was continued on her home dose of lasix.  She was
given one extra dose of lasix 20mg with her transfusion.  As the
patient did not appear clinically volume overloaded and her labs
were trending towards being dry (Cr. up from 0.8 on previous
admission to 1.2).  The decision was made to hold her lasix.
Would check her labs in [**1-20**] days to see if Creatinine trending
down.  If not she may benefit from some IV fluids.  If she
starts to appear volume overloaded would restart her lasix at
20mg daily and uptitrate as needed.
.
# FEN: reg diet.
.
# Access: PIV
.
# PPx: heparin SC
.
# Code: DNR/DNI
.
# Medication changes: Stopped lasix.

Medications on Admission:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6

hours) as needed.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2

times a day).
3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
4. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO BID (2 times a day).
5. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
6. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).


9. Phenytoin Sodium Extended 100 mg Capsule Sig: Three (3)
Capsule PO DAILY (Daily).
10. Cyanocobalamin 500 mcg Tablet Sig: One (1) Tablet PO once a

day.


Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed.
2. Docusate Sodium 100 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
4. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO BID (2 times a day).
5. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
6. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
8. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule
PO TID (3 times a day).
9. Cyanocobalamin 500 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).


Discharge Disposition:
Extended Care

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

Discharge Diagnosis:
Shortness of breath


Discharge Condition:
Stable on room air


Discharge Instructions:
You were admitted because of shortness of breath.  You were
placed on posative airway pressure.  The next morning you were
able to breath well on room air again.  We think that you
aspirated some food into your lungs.  Please be very careful
when you are eating.  Always sit up and take small bites.
Remember to chew frequently.  Have people help you eat.

You lasix was stopped for concern that you may be getting a
little dehydrated.  Please continue to eat and drink.  Your
doctor may decide to restart your lasix if it looks like you are
holding on to more water.

No other medication changes were made.

Please return to the hospital or call your doctor if you have
temperature greater than 101, shortness of breath, worsening
difficulty with swallowing, chest pain, abdominal pain,
diarrhea, or any other symptoms that you are concerned about.


Followup Instructions:
PCP


                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 2285**]
{'Shortness of breath,Chronic diastolic heart failure,Acute kidney failure, unspecified,Dehydration,Other diuretics causing adverse effects in therapeutic use,Iron deficiency anemia secondary to blood loss (chronic),Benign neoplasm of cerebral meninges,Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere,Dizziness and giddiness,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Macular degeneration (senile), unspecified,Other postprocedural 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: SOB

PRESENT ILLNESS: 107 russian only speaking felmale with diastolic congestive
heart failure, hypertension who presents with acute onset
shortness of breath (SOB). She resides at [**Hospital **] rehab. she had
an episode of SOB at 4 pm today and was sent to the ER. her VS
at that time were 128/42 70 30 94/ra.  She had no fevers.  Per
further history the patient reports some trouble with
swallowing.
.
In ER VS 90/40 70 32 100/ra.cxr showed persistent retrocard
opacity. she recd CTX and azithro x 1. she c/o resp distress in
ER and said she felt like she was dying. hence she was put on
CPAP for some time. she felt better w/ it. she was weaned to 40%
venti mask.

MEDICAL HISTORY: #. Diastolic CHF
- EF 70-80% Echo [**2182**]
#. HTN
#. Osteoarthritis
s/p displaced femoral neck fracture
s/p left [**Doctor Last Name 17113**] hemiarthroplasty
#. Cholelithiasis
#. Vertigo
#. Macular degeneration
#. Large left frontal meningioma

MEDICATION ON ADMISSION: 1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6

ALLERGIES: Cephalosporins

PHYSICAL EXAM: VS: afebrile, satting well on room air.
GEN: NAD, awake, alert
HEENT: EOMI, PERRL, sclera anicteric, conjunctivae clear, OP
moist and without lesion
NECK: Supple, no JVD
CV: Reg rate, normal S1, S2. No m/r/g.
CHEST: Resp were unlabored, no accessory muscle use. mild
crackles bibasilar
ABD: Soft, NT, ND, no HSM
EXT: No edema
SKIN: No rash

FAMILY HISTORY: NC

SOCIAL HISTORY: The patient is currently a resident at [**Hospital **] Rehab. At baseline
she is able to walk with 2 person assist. She feeds herself if
her meals are prepared, ground solids. She is generally
dependent on others for most ADL.
Tobacco: None
ETOH: None
Illicits: None 

### Response:
{'Shortness of breath,Chronic diastolic heart failure,Acute kidney failure, unspecified,Dehydration,Other diuretics causing adverse effects in therapeutic use,Iron deficiency anemia secondary to blood loss (chronic),Benign neoplasm of cerebral meninges,Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere,Dizziness and giddiness,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Macular degeneration (senile), unspecified,Other postprocedural status'}
