CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 78 year old
woman initially transferred from [**Hospital6 4620**] to
the Emergency Department at [**Hospital1 188**] for management of pneumonia and respiratory failure.
The patient has multiple medical problems to include
schizophrenia, dementia, Parkinson's Disease, and atrial
fibrillation.  The patient was status post right above the
knee amputation on [**2-17**], at [**First Name8 (NamePattern2) 1495**] [**Hospital **]
Hospital.  Following this procedure, she was transferred to
[**Hospital 110826**] Health and Rehabilitation Center.

MEDICAL HISTORY: 1.  Schizophrenia.
2.  Parkinson's Disease.
3.  Atrial fibrillation.
4.  PEG tube placed [**2197-2-8**], at [**First Name8 (NamePattern2) 1495**] [**Hospital **]
Hospital.
5.  Status post cerebrovascular accident.
6.  Status post right above the knee amputation for dry
gangrene.  The procedure was done on [**2-17**], at [**First Name8 (NamePattern2) 1495**]
[**Hospital **] Hospital.
7.  Status post cerebrovascular accident.
8.  Status post right above the knee amputation for dry
gangrene.  The procedure was done on [**2-17**], at [**First Name8 (NamePattern2) 1495**]
[**Hospital **] Hospital.
9.  Status post third degree burns sustained in the [**2153**]
during an accident.
10. Status post pacer placement.
11. Gastroesophageal reflux disease.
12. Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Not known.

SOCIAL HISTORY: The patient resides in a rehabilitation.
Per son, the patient has an extensive smoking history.  The
patient's family contact is her son, [**Name (NI) 1193**] [**Name (NI) 1557**],
[**Telephone/Fax (1) 110827**].
Methicillin susceptible pneumonia due to Staphylococcus aureus,Acute respiratory failure,Urinary tract infection, site not specified,Infection (chronic) of amputation stump,Ulcer of heel and midfoot,Hyperosmolality and/or hypernatremia,Atrial fibrillation,Unspecified schizophrenia, unspecified,Infection with microorganisms resistant to penicillins
Meth sus pneum d/t Staph,Acute respiratry failure,Urin tract infection NOS,Infection amputat stump,Ulcer of heel & midfoot,Hyperosmolality,Atrial fibrillation,Schizophrenia NOS-unspec,Inf mcrg rstn pncllins
Admission Date:  [**2197-3-8**]       Discharge Date:  [**2197-3-9**]

Date of Birth:   [**2118-11-7**]       Sex:  F

Service:  [**Location (un) 259**]

HISTORY OF PRESENT ILLNESS:  The patient is a 78 year old
woman initially transferred from [**Hospital6 4620**] to
the Emergency Department at [**Hospital1 188**] for management of pneumonia and respiratory failure.
The patient has multiple medical problems to include
schizophrenia, dementia, Parkinson's Disease, and atrial
fibrillation.  The patient was status post right above the
knee amputation on [**2-17**], at [**First Name8 (NamePattern2) 1495**] [**Hospital **]
Hospital.  Following this procedure, she was transferred to
[**Hospital 110826**] Health and Rehabilitation Center.

While at the rehabilitation center, the patient was noted to
be febrile to 103.2 F.,  diaphoretic and short of breath.
She was then transferred to [**Hospital6 4620**] for
further work-up.  At that hospital, she was noted to be
hypertensive, tachycardic, tachypneic, with a decreased
oxygen saturation.  Chest x-ray disclosed evidence for right
upper lobe, left lower lobe infiltrates.  Therefore, the
patient was intubated and pan cultured; given a dose of
Zosyn.  Her labs were notable for an elevated white blood
cell count at 23.8.  Chemistries were notable for
hypernatremia with a sodium of 155, an elevated BUN and
creatinine 48, 1.0.

The patient was transferred to [**Hospital1 188**] for further management of her respiratory failure.  On
presentation to the Emergency Department at [**Hospital1 346**], the patient's temperature was 101.2
F.

PAST MEDICAL HISTORY:
1.  Schizophrenia.
2.  Parkinson's Disease.
3.  Atrial fibrillation.
4.  PEG tube placed [**2197-2-8**], at [**First Name8 (NamePattern2) 1495**] [**Hospital **]
Hospital.
5.  Status post cerebrovascular accident.
6.  Status post right above the knee amputation for dry
gangrene.  The procedure was done on [**2-17**], at [**First Name8 (NamePattern2) 1495**]
[**Hospital **] Hospital.
7.  Status post cerebrovascular accident.
8.  Status post right above the knee amputation for dry
gangrene.  The procedure was done on [**2-17**], at [**First Name8 (NamePattern2) 1495**]
[**Hospital **] Hospital.
9.  Status post third degree burns sustained in the [**2153**]
during an accident.
10. Status post pacer placement.
11. Gastroesophageal reflux disease.
12. Hypertension.

ALLERGIES:   No known drug allergies.

MEDICATIONS:
1.  Hydrochlorothiazide 12.5 mg p.o. q. day.
2.  Digoxin 0.125 mg p.o. q. day.
3.  Catapres 0.1 microgram patch q. week.
4.  Colace 100 twice a day.
5.  Senna two q. day.
6.  Restoril 15 q. h.s.
7.  Ativan 0.25 q. h.s.
8.  Metoprolol 150 twice a day.
9.  Lisinopril 40 q. day.
10. Norvasc 10 q. day.
11. Albuterol and Atrovent nebulizers p.r.n.
12. Prazosin 4 q. day.
13. Jevity tube feeds, 60 cc per hour.
14. Multivitamin, one q. day.
15. Artificial tears.
16. Zyprexa 20 q. h.s.
17. Abilify 10 q. h.s.

SOCIAL HISTORY:  The patient resides in a rehabilitation.
Per son, the patient has an extensive smoking history.  The
patient's family contact is her son, [**Name (NI) 1193**] [**Name (NI) 1557**],
[**Telephone/Fax (1) 110827**].

FAMILY HISTORY:  Not known.

PHYSICAL EXAMINATION:  In general, a chronically ill
appearing female lying in bed, intubated.  Vital signs were
temperature of 101.0 F.; blood pressure 140/80; heart rate
92; respiratory status - the patient on assist control
ventilation, total volume 400, respiratory rate 12, FIO2
100%, PEEP 5, O2 saturation 96%.  HEENT:  The pupils are
sluggish,  Periorbital burn scar.  Endotracheal tube in
place.  Mucous membranes were dry.  Neck with left IJ line in
place.  Heart is irregularly irregular, S1, S2, no murmurs,
rubs or gallops.  Lungs with coarse breath sounds anteriorly.
Abdomen is soft, nontender, nondistended, positive bowel
sounds.  G-tube in place.  Extremities with right stump,
black ulceration, left heel; left pretibial ulcer.
Contractures of upper extremities.  Neurologic:  The patient
is intubated and sedated, unable to cooperate with
neurological examination.  Skin with burn scars present on
face, torso and upper extremities.

LABORATORY:  On presentation, white blood cell count 24.9,
hemoglobin 8.7, hematocrit 29.6.  Differential 84%
neutrophils, 12% bands, 3% lymphs, platelet count 610.  PT
13.8, PTT 19.9, INR 1.3.

Chemistries with sodium 154, potassium 3.0, chloride 115,
bicarbonate 27, BUN 43, creatinine 0.9 with a glucose of 106.
Initial CK MB 2, troponin T 0.07, magnesium 1.7, digoxin
level 1.0.  Initial blood gas 7.40, pCO2 44, pO2 68, lactate
2.7.

EKG:  Atrial fibrillation at 80 beats per minute, QT 362, QT
corrected 391, downsloping ST segments in II, III, AVF, V3
through V6.  Normal axis.  Consider anteroseptal infarction.

RADIOLOGY:  Chest x-ray with aspiration versus multifocal
pneumonia with consolidations in the left lower lobe and
right lower lobe, endotracheal tube in place.  Left internal
jugular venous catheter tip within the left brachiocephalic
vein.

IMPRESSION:  This is a 78 year old woman with multiple
medical problems including atrial fibrillation, dementia, and
schizophrenia, transferred from [**Hospital3 1196**] to
[**Hospital1 69**] for management of
respiratory failure.  Chest x-ray notable for right lower
lobe and left lower lobe infiltrates.

Labs significant for hypernatremia and elevated white count.

PLAN:
1.  RESPIRATORY FAILURE:  The patient initially was admitted
to the Medical Intensive Care Unit for management of her
respiratory failure thought to be secondary to aspiration
pneumonia.  The patient remained on assist control mechanical
ventilation.  Sputum culture was obtained.  She was continued
on Zosyn for broad spectrum coverage.  She continued on
Albuterol, Atrovent nebulizer treatments.  Her sputum culture
grew Methicillin resistant Staphylococcus aureus; therefore,
on the subsequent day, Vancomycin was added to the patient's
regimen.

The patient was also noted to have a Klebsiella urinary tract
infection.  The Klebsiella was initially thought to be beta
lactamase resistant, so the patient was changed to meropenem
and Vancomycin.  The patient self extubated on [**3-4**],
her respiratory status improved.  She was weaned off
supplemental oxygen.  The patient was transferred to the
Medical Floor on [**3-4**].

2.  INFECTIOUS DISEASE:  As noted above, the patient was
noted to have a Methicillin resistant Staphylococcus aureus
pneumonia and a klebsiella urinary tract infection.  There
was also concern about possible postoperative infection of
the patient's right stump.

The Infectious Disease Service was involved in managing the
patient's antibiotic regimen.  As noted above, the patient
remained on Vancomycin for her Methicillin resistant
Staphylococcus aureus pneumonia.  The patient is to complete
a three week course of treatment for this pneumonia.

Regarding the patient's Klebsiella urinary tract infection,
initially it was thought that the Klebsiella was beta
lactamase resistant; however, further sensitivities revealed
that this organism was sensitive to Ceftriaxone.

On [**3-4**], however, the patient developed a peripheral
eosinophilia.  The Infectious Disease Service thought that
this reaction might be due to beta lactin antibiotics;
therefore, the patient was changed from ceftriaxone to
Aztreonam.  The patient to complete a two week course of
Aztreonam for her Klebsiella urinary tract infection.

Given persistently elevated white count, the patient
underwent a CT scan of her right stump to rule out the
presence of a fluid collection.  No focal fluid collection
was identified within the right lower extremity.

Finally, on [**3-5**], the patient was noted to have
Candiduria.  The patient's Foley catheter was changed.  She
was started on a seven day course of fluconazole.

3.  FLUIDS, ELECTROLYTES AND NUTRITION:   On admission, the
patient was noted to be hypernatremic with a sodium of 155.
The patient was thought to be volume depleted.  She was
hydrated and given free water boluses for her PEG tube.  The
patient was also maintained on her tube feeds and a nutrition
consultation was obtained for assistance with tube feeds.
The patient started Probalan, 50 cc per hour.  The patient
was maintained on aspiration precautions during her hospital
stay.

4.  CARDIOVASCULAR:  Pump - On admission the patient's
anti-hypertensive medications were initially held; then they
were reintroduced and then required further titration during
her hospital stay.  The patient is currently on Metoprolol
100 three times a day, Lisinopril 40 twice a day,
Hydrochlorothiazide 25 q. day; Norvasc 10 q. day; and
Clonidine patch 0.2 mg patch weekly.  The patient also
remains on her digoxin 125 micrograms q. day.  Digoxin level
was within normal limits during this hospital admission.

Coronary artery disease:  The patient was noted to have
elevated troponin on admission.  CK remained flat.  It was
thought that this elevated troponin was secondary to demand
ischemia.

Rhythm:  The patient has a history of atrial fibrillation
with pacer.  The patient's heart rate was stable during this
admission.  She remains on her digoxin and beta blocker.

The patient is not on anti-coagulation given history of
cerebrovascular hemorrhage.

5.  VASCULAR:  As noted above, there was concern for a
possible postoperative wound infection in the patient's right
stump.  Vascular Surgery was consulted for evaluation of this
area as well as a left pretibial ulcer.  Vascular surgery
recommended multi-Podis boots to decrease skin breakdown.
They also provided recommendations regarding dressing
changes.  On [**3-7**], Vascular Surgery took the patient
to the Operating Room for revision of the right above the
knee amputation stump.  The area was debrided and revised.

6.  GASTROINTESTINAL:  The patient was maintained on a proton
pump inhibitor and bowel regimen during her hospital stay.
At one point, she was noted to have elevated liver function
tests including alkaline phosphatase.  These elevated liver
enzymes were thought to be secondary to medication or sepsis.
 Liver function tests have trended down during her hospital
stay.

7.  PSYCHIATRIC:  The patient has a history of schizophrenia.
She was maintained on her psychiatric medications during her
hospital stay to include Zyprexa, Abilify and Ativan as
needed.

8.  HEMATOLOGIC:  The patient was noted to be anemic during
her hospital stay.  Iron studies were sent off and it was
felt that it was an anemia secondary to chronic disease.  Of
note, the patient underwent an esophagogastroduodenoscopy at
the outside hospital recently.  Esophagogastroduodenoscopy
disclosed erosive gastritis.

9.  PROPHYLAXIS:  The patient was maintained on subcutaneous
heparin during her hospital stay.  She was also maintained on
proton pump inhibitor and bowel regimen.

10. ACCESS:  The patient had a left internal jugular vein
catheter during her hospital stay.  A PICC line was placed in
the right basilic vein on [**3-8**].

11. CODE STATUS:  The patient remains full code.

CONDITION AT DISCHARGE:   Stable.

DISCHARGE DIAGNOSES:
1.  Klebsiella urinary tract infection.
2.  Methicillin resistant Staphylococcus aureus pneumonia.
3.  Candiduria.
4.  Possible beta lactate allergy.
5.  Hypertension.
6.  Atrial fibrillation.
7.  Peripheral vascular disease, status post revision of
right above the knee amputation stump.
8.  Hypertension.
9.  Schizophrenia.
10. Dementia.

DISCHARGE MEDICATIONS:
1.  Albuterol one to two puffs inhaled q. six hours as
needed.
2.  Atrovent two puffs four times a day.
3.  Multivitamin one tablet p.o. q. day.
4.  Albuterol one nebulizer q. six hours.
5.  Lopressor 100 mg three times a day.
6.  Atrovent nebulizer q. six hours p.r.n.
7.  Lisinopril 40 twice a day.
8.  Hydrochlorothiazide 25 q. day.
9.  Norvasc 10 q. day.
10. Clonidine 0.2 patch weekly.
11. Digoxin 0.125 micrograms q. day.
12. Aspirin 325 q. day.
13. Colace 15 ml twice a day.
14. Senna one twice a day.
15. Abilify 10 q. day.
16. Olanzapine 20 q. day.
17. Ativan 0.5 to 1 mg q. four hours p.r.n.
18. Vancomycin 1 gram q. 18 hours times eleven days.
19. Aztreonam 1 gram q. eight hours times four days.
20. Fluconazole 100 mg p.o. times five days.
21. Lansoprazole 30 q. day.
22. Subcutaneous heparin 5000 units twice a day while
hospitalized.

DISCHARGE INSTRUCTIONS:
1.  The patient's son will arrange follow-up with a physician
within one week after discharge.
2.  Dressings changes right above the knee amputation, gauze
dry dressings should be changed daily.
3.  For patient's left tibial ulcer, wet-to-dry dressing
changes q. day.
4.  Tube feeds, Probalan full strength, 50 cc per hour.




                            [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**], M.D.  [**MD Number(1) 736**]

Dictated By:[**Last Name (NamePattern1) 5092**]
MEDQUIST36

D:  [**2197-3-8**]  16:47
T:  [**2197-3-8**]  17:03
JOB#:  [**Job Number 110828**]
{'Methicillin susceptible pneumonia due to Staphylococcus aureus,Acute respiratory failure,Urinary tract infection, site not specified,Infection (chronic) of amputation stump,Ulcer of heel and midfoot,Hyperosmolality and/or hypernatremia,Atrial fibrillation,Unspecified schizophrenia, unspecified,Infection with microorganisms resistant to penicillins'}


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: 

PRESENT ILLNESS: The patient is a 78 year old
woman initially transferred from [**Hospital6 4620**] to
the Emergency Department at [**Hospital1 188**] for management of pneumonia and respiratory failure.
The patient has multiple medical problems to include
schizophrenia, dementia, Parkinson's Disease, and atrial
fibrillation.  The patient was status post right above the
knee amputation on [**2-17**], at [**First Name8 (NamePattern2) 1495**] [**Hospital **]
Hospital.  Following this procedure, she was transferred to
[**Hospital 110826**] Health and Rehabilitation Center.

MEDICAL HISTORY: 1.  Schizophrenia.
2.  Parkinson's Disease.
3.  Atrial fibrillation.
4.  PEG tube placed [**2197-2-8**], at [**First Name8 (NamePattern2) 1495**] [**Hospital **]
Hospital.
5.  Status post cerebrovascular accident.
6.  Status post right above the knee amputation for dry
gangrene.  The procedure was done on [**2-17**], at [**First Name8 (NamePattern2) 1495**]
[**Hospital **] Hospital.
7.  Status post cerebrovascular accident.
8.  Status post right above the knee amputation for dry
gangrene.  The procedure was done on [**2-17**], at [**First Name8 (NamePattern2) 1495**]
[**Hospital **] Hospital.
9.  Status post third degree burns sustained in the [**2153**]
during an accident.
10. Status post pacer placement.
11. Gastroesophageal reflux disease.
12. Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Not known.

SOCIAL HISTORY: The patient resides in a rehabilitation.
Per son, the patient has an extensive smoking history.  The
patient's family contact is her son, [**Name (NI) 1193**] [**Name (NI) 1557**],
[**Telephone/Fax (1) 110827**]. 

### Response:
{'Methicillin susceptible pneumonia due to Staphylococcus aureus,Acute respiratory failure,Urinary tract infection, site not specified,Infection (chronic) of amputation stump,Ulcer of heel and midfoot,Hyperosmolality and/or hypernatremia,Atrial fibrillation,Unspecified schizophrenia, unspecified,Infection with microorganisms resistant to penicillins'}
