CHIEF COMPLAINT: altered mental status, fevers

PRESENT ILLNESS: Ms. [**Known lastname **] is an 85 year old nursing home resident, chinese
speaking, s/p hospitalization [**Date range (1) 17569**] at [**Hospital1 2025**] for influenza a,
has been on O2 since with baseline RA sats 88% and 92% on 2l NC.
 She presented to the [**Hospital1 18**] with altered mental status and
fevers.  She is very demented at baseline but is verbal.  On the
morning of admission, she had a small amount of her usual
breakfast but was very lethargic and according to her nurses,
may have aspirated some of her meal.  VS there were T 103.8. BP
141/94 HR 99 O2 Sat 87% on 2LNC.  When EMS arrived, her VS were
92/68 HR 95 (irregular) RR 42 Sat 94% on BVM 100%.
.
In the ED, she was noted to also be febrile so code sepsis was
initiated.  Her code status was confirmed to be full code.  A
left subclavian line was placed, and IV normal saline were
administered.  Intravenous ceftriaxone, vancomycin, levaquin and
clindamycin were administered.  Levophed was also started.
Prior to transfer to the floor her SVO2 was 71%.
.
In the MICU, the levophed was weaned.  The patient was
maintained on vanco and zosyn.  CXR showed a flourishing RUL
PNA.  Her mental status improved on time of transfer.

MEDICAL HISTORY: Alzheimer's
Depression
Hypernatremia
Paroxymal Afib
h/o Urinary tract infections
Cholelithiasis
h/o Influenza A/b

MEDICATION ON ADMISSION: Aricept 10mg daily
Vitamin E 80u qPM
Zyprexa 5mg qPM
Namenda 5mg qPM
Tylenol 650 supp q6:prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: Tm 103.9 Tc BP 117/49 (88-121/34-49) HR 84 RR 30 Sat 100% NC
GEN: Elderly asian woman in bed sedate and difficult to arouse,
breathing comfortably.  Daughters at bedside.
HEENT: Dry MM, eyes closed, no scleral icterus.
NECK: Supple, no masses
CV: Irregular, normal s1/s2
PUL: Coarse upper airway sounds
ABD: Diffuse ttp, +BS, no rebound or guarding.
EXT: No edema
NEURO: Sedated, arousable, but non-verbal with eyes closed.

FAMILY HISTORY: N/A

SOCIAL HISTORY: Permanent resident of [**Hospital3 **] Manor. Chinese speaking only,
Son and daughter active in her life and visit daily
Methicillin susceptible Staphylococcus aureus septicemia,Pneumonitis due to inhalation of food or vomitus,Hyperosmolality and/or hypernatremia,Septic shock,Atrial fibrillation,Acute kidney failure, unspecified,Severe sepsis,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Depressive disorder, not elsewhere classified
Meth susc Staph aur sept,Food/vomit pneumonitis,Hyperosmolality,Septic shock,Atrial fibrillation,Acute kidney failure NOS,Severe sepsis,Alzheimer's disease,Dementia w/o behav dist,Depressive disorder NEC
Admission Date:  [**2195-4-5**]              Discharge Date:   [**2195-4-8**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1055**]
Chief Complaint:
altered mental status, fevers

Major Surgical or Invasive Procedure:
central line placement

History of Present Illness:
Ms. [**Known lastname **] is an 85 year old nursing home resident, chinese
speaking, s/p hospitalization [**Date range (1) 17569**] at [**Hospital1 2025**] for influenza a,
has been on O2 since with baseline RA sats 88% and 92% on 2l NC.
 She presented to the [**Hospital1 18**] with altered mental status and
fevers.  She is very demented at baseline but is verbal.  On the
morning of admission, she had a small amount of her usual
breakfast but was very lethargic and according to her nurses,
may have aspirated some of her meal.  VS there were T 103.8. BP
141/94 HR 99 O2 Sat 87% on 2LNC.  When EMS arrived, her VS were
92/68 HR 95 (irregular) RR 42 Sat 94% on BVM 100%.
.
In the ED, she was noted to also be febrile so code sepsis was
initiated.  Her code status was confirmed to be full code.  A
left subclavian line was placed, and IV normal saline were
administered.  Intravenous ceftriaxone, vancomycin, levaquin and
clindamycin were administered.  Levophed was also started.
Prior to transfer to the floor her SVO2 was 71%.
.
In the MICU, the levophed was weaned.  The patient was
maintained on vanco and zosyn.  CXR showed a flourishing RUL
PNA.  Her mental status improved on time of transfer.


Past Medical History:
Alzheimer's
Depression
Hypernatremia
Paroxymal Afib
h/o Urinary tract infections
Cholelithiasis
h/o Influenza A/b

Social History:
Permanent resident of [**Hospital3 **] Manor. Chinese speaking only,
Son and daughter active in her life and visit daily


Family History:
N/A

Physical Exam:
VS: Tm 103.9 Tc BP 117/49 (88-121/34-49) HR 84 RR 30 Sat 100% NC
GEN: Elderly asian woman in bed sedate and difficult to arouse,
breathing comfortably.  Daughters at bedside.
HEENT: Dry MM, eyes closed, no scleral icterus.
NECK: Supple, no masses
CV: Irregular, normal s1/s2
PUL: Coarse upper airway sounds
ABD: Diffuse ttp, +BS, no rebound or guarding.
EXT: No edema
NEURO: Sedated, arousable, but non-verbal with eyes closed.


Pertinent Results:
EKG: normal axis, 1st degree a-v block, LVH, qV1-2, lateral
j-point depression
.
Initial CBC:
[**2195-4-5**] 11:38AM   WBC-13.1*# RBC-4.56 HGB-14.7 HCT-45.4
MCV-100* MCH-32.1* MCHC-32.3 RDW-15.3
[**2195-4-5**] 11:38AM   NEUTS-80.7* LYMPHS-9.9* MONOS-6.4 EOS-0.5
BASOS-2.5*
[**2195-4-5**] 11:38AM   PLT COUNT-402#
.
Lactate: 4.8 ([**2195-4-5**])
.
UA negative.
.
CXR [**2195-4-5**]:  Again seen is mild cardiomegaly, unchanged from
prior study.  Mediastinal and hilar contours appear unchanged
with calcification again seen within the aorta.  Pulmonary
vasculature appears within normal limits.  There is no evidence
of focal consolidations.  Diffuse opacity over the right upper
lobe could be consistent with aspiration.  Again noted are
healed rib fractures on the right side. IMPRESSION:  Diffuse
increased opacity over the right upper lobe which could be
consistent with aspiration.  No focal consolidations seen.
.
Micro
[**2195-4-7**] BLOOD CULTURE x 2 sets: NGTD
[**2195-4-5**] URINE URINE CULTURE-FINAL {YEAST}
[**2195-4-5**] BLOOD CULTURE AEROBIC BOTTLE & ANAEROBIC
BOTTLE-PRELIMINARY {STAPHYLOCOCCUS, COAGULASE NEGATIVE)
[**2195-4-5**] BLOOD CULTURE AEROBIC BOTTLE-PENDING; ANAEROBIC
BOTTLE: NGTD


Brief Hospital Course:
86F with history of severe dementia, presents with fever and
altered mental status, code sepsis in ED.  The patient was
resuscitated and admitted to the MICU.  She was diagnosed with
pneumonia and treated with Zosyn and Vancomycin for broad
coverage.  After she was stabilized and weaned off of pressors,
she was transferred to the regular medical floor where she
remained stable.  She was discharged back to her NH in stable
condition.
.
# AMS/infection: The patient is severely demented at baseline.
A head CT completed in the ED was negative, and she did not have
any focal neurological deficits on exam (although it was limited
by the language barrier).  On admission to the ICU, she had a
clean UA but a RUL consolidation consistent with aspiration
pneumonia.  She was also hypernatremic which would also account
for AMS.  She was repleted with free water to correct her
sodium, and she was continued on both Vanc and Zosyn for
antibiotics.  Given that she was recently hospitalized for
influenza earlier in the month, it was thought she was at high
risk for a nosocomial pneumonia, (also staph a. pneumonia post
influenza).  She had a repeat CXR the following day, which
showed a more definitive infiltrate to suggest pneumonia.  [**2-7**]
bottles from her blood cultures grew coag negative staph.  On
the morning following admission, she became much more alert and
talkative, demonstrating echolalia.  Her family confirmed that
her mental status was close to baseline on discharge.  A PICC
line was placed by IR on [**4-8**] without complication.  She was
discharged on 10 days of vancomycin and zosyn therapy.  Her home
medications for Alzheimer's were intially held while she was NPO
but were restarted on transfer to the floor.
.
# F/E/N: She was initially kept NPO out of concern for sepsis
and altered mental status.  She had recently undergone a speech
and swallow eval at [**Hospital1 2025**]; these results were obtained, which
recommended the patient be kept on a pureed diet with honey
thickened liquids.  She was fed under aspiration precautions.

Medications on Admission:
Aricept 10mg daily
Vitamin E 80u qPM
Zyprexa 5mg qPM
Namenda 5mg qPM
Tylenol 650 supp q6:prn


Discharge Medications:
1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
2. Donepezil 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

3. Memantine 5 mg Tablet Sig: One (1) Tablet PO Qpm ().
4. Albuterol Sulfate 0.083 % Solution Sig: One (1) neb
Inhalation Q6H (every 6 hours) as needed.
5. Vancomycin 1,000 mg Recon Soln Sig: 1000 (1000) mg
Intravenous  twice a day for 10 days.
6. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO once a day
for 10 days.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 **] Manor - [**Location (un) 86**]

Discharge Diagnosis:
pneumonia
hypernatremia
sepsis
bacteremia
severe dementia
paroxysmal AFib


Discharge Condition:
stable, back to baseline mental status.  afebrile and
normotensive.


Discharge Instructions:
Please return if you experience shortness of breath, fever
>101.5, loow blood pressure, chest pain, lethargy, or any other
worrisome symptoms.

Please take all medications as directed.  You have been
prescribed 2 antibiotics to take for your pneumonia.

Followup Instructions:
Please follow-up with Dr [**Last Name (STitle) 10145**] within 1-2 weeks at
[**Telephone/Fax (1) **].
{"Methicillin susceptible Staphylococcus aureus septicemia,Pneumonitis due to inhalation of food or vomitus,Hyperosmolality and/or hypernatremia,Septic shock,Atrial fibrillation,Acute kidney failure, unspecified,Severe sepsis,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Depressive disorder, not elsewhere classified"}


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, fevers

PRESENT ILLNESS: Ms. [**Known lastname **] is an 85 year old nursing home resident, chinese
speaking, s/p hospitalization [**Date range (1) 17569**] at [**Hospital1 2025**] for influenza a,
has been on O2 since with baseline RA sats 88% and 92% on 2l NC.
 She presented to the [**Hospital1 18**] with altered mental status and
fevers.  She is very demented at baseline but is verbal.  On the
morning of admission, she had a small amount of her usual
breakfast but was very lethargic and according to her nurses,
may have aspirated some of her meal.  VS there were T 103.8. BP
141/94 HR 99 O2 Sat 87% on 2LNC.  When EMS arrived, her VS were
92/68 HR 95 (irregular) RR 42 Sat 94% on BVM 100%.
.
In the ED, she was noted to also be febrile so code sepsis was
initiated.  Her code status was confirmed to be full code.  A
left subclavian line was placed, and IV normal saline were
administered.  Intravenous ceftriaxone, vancomycin, levaquin and
clindamycin were administered.  Levophed was also started.
Prior to transfer to the floor her SVO2 was 71%.
.
In the MICU, the levophed was weaned.  The patient was
maintained on vanco and zosyn.  CXR showed a flourishing RUL
PNA.  Her mental status improved on time of transfer.

MEDICAL HISTORY: Alzheimer's
Depression
Hypernatremia
Paroxymal Afib
h/o Urinary tract infections
Cholelithiasis
h/o Influenza A/b

MEDICATION ON ADMISSION: Aricept 10mg daily
Vitamin E 80u qPM
Zyprexa 5mg qPM
Namenda 5mg qPM
Tylenol 650 supp q6:prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: Tm 103.9 Tc BP 117/49 (88-121/34-49) HR 84 RR 30 Sat 100% NC
GEN: Elderly asian woman in bed sedate and difficult to arouse,
breathing comfortably.  Daughters at bedside.
HEENT: Dry MM, eyes closed, no scleral icterus.
NECK: Supple, no masses
CV: Irregular, normal s1/s2
PUL: Coarse upper airway sounds
ABD: Diffuse ttp, +BS, no rebound or guarding.
EXT: No edema
NEURO: Sedated, arousable, but non-verbal with eyes closed.

FAMILY HISTORY: N/A

SOCIAL HISTORY: Permanent resident of [**Hospital3 **] Manor. Chinese speaking only,
Son and daughter active in her life and visit daily 

### Response:
{"Methicillin susceptible Staphylococcus aureus septicemia,Pneumonitis due to inhalation of food or vomitus,Hyperosmolality and/or hypernatremia,Septic shock,Atrial fibrillation,Acute kidney failure, unspecified,Severe sepsis,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Depressive disorder, not elsewhere classified"}
