CHIEF COMPLAINT: Initially presented with Dyspnea to [**Hospital **] hospital from
nursing home. Transfered to [**Hospital1 18**] ICU because of respiratory
failure requiring intubation and hypotension requiring pressors.

PRESENT ILLNESS: 55 y/o female with breast cancer presented with SOB to [**Hospital **]
Hospital because of dyspnea, fever, tachypnea, and tachycardia.
At [**Hospital **] Hospital, found to have fever to 101.5, tachycardia
to 112, tachypnea of 22, O2 sat of 93% on RA, and transiently
was hypotensive to 70 systolic. She was intubated, given 4L NS,
treated with zosyn, and started on dopamine.
.
At [**Hospital1 18**], a RIJ was placed, norepinepherine started in place of
dopamine, and given vancomycin and 3L NS. Paralysed with
vecuronium for CTA done for back pain to rule out disection.
.
Per her sister, she had a cold for the last few weeks but was
otherwise feeling well until the day before admission.

MEDICAL HISTORY: Breast Cancer- Diagnosed 8/[**2114**]. T3 N0, Infiltrating lobular
carcinoma; ER positive, PR positive, and her2neu negative;
status post a left modified radical mastectomy with axillary
lymph node disection on [**2114-12-7**], started [**2115-2-1**] on adjuvant
chemotherapy (cyclophosphamide and adriamycin as well as
dexamethasone) by Dr. [**Last Name (STitle) **].
Hypotension NOS
Schizoaffective Doisorder
Chronic Liver disease with Cirrhosis
History of Seizures
Tobacco Abuse
Mood d/o NOS
h/o alcohol dependence along with drug abuse.

MEDICATION ON ADMISSION: Zelnorm 6 mg Oral [**Hospital1 **]
Lyrica 150 mg Oral [**Hospital1 **]
Miralax 17 gm daily
Lithium Carbonate 300 mg PO QAM and 600 mg PO QHS
Prilosec 20 mg daily
Melatonin 3 mg QHS
Multivitamin daily
Aromasin 25 mg daily
Cogentin 0.5 mg [**Hospital1 **]
Stelazine 10 mg [**Hospital1 **]
Seroquel 400 mg QHS
Buspar 15 mg [**Hospital1 **]

ALLERGIES: Morphine Sulfate

PHYSICAL EXAM: Intubated, sedated, Caucasian female.
T 97.6 HR 93 BP 148/119 (cuff on levo) RR 18 SAT 100%
Vent AC 500x12 FiO2 100% PEEP 5
SKIN: no rashes, cool extremities
HEENT: PERRL. Sclera anicteric. Intubated. OG tube in place.
NECK: R IJ in place. Good carotid pulses. No LAD.
CHEST: Left mastectomy. Bronchial breath sounds over right
posterior lung fields. Left lung fields clear.
HEART: Regular rhythm. No murmurs.
ABD: soft, NT, ND, faint bowel sounds.
EXT: Good femoral pulses, good DP pulses.
NEURO: Repsonds to noxious stimuli. Reflexes 2+ and equal
bilaterally. Toes downgoing.

FAMILY HISTORY: One sister with breast cancer at 54. 4 other siblings are
healthy.

SOCIAL HISTORY: Sister [**Name (NI) 2048**] [**Name (NI) 110914**] [**Telephone/Fax (1) 110915**] (health care proxy). Lives
in [**Hospital3 **] facility because of psychiatric history.
Coming in from [**Location (un) 169**] nursing home in [**Location (un) **] after
recent hospitalization four weeks ago. Ambulates with a cane
with supervision because of unsteady gait. Declared incompetent
at nursing home.
Unspecified septicemia,Pneumonia, organism unspecified,Acute respiratory failure,Schizoaffective disorder, unspecified,Cirrhosis of liver without mention of alcohol,Severe sepsis,Constipation, unspecified,Anemia, unspecified,Personal history of malignant neoplasm of breast
Septicemia NOS,Pneumonia, organism NOS,Acute respiratry failure,Schizoaffective dis NOS,Cirrhosis of liver NOS,Severe sepsis,Constipation NOS,Anemia NOS,Hx of breast malignancy
Admission Date:  [**2115-3-31**]              Discharge Date:   [**2115-4-5**]

Date of Birth:  [**2059-11-4**]             Sex:   F

Service: MEDICINE

Allergies:
Morphine Sulfate

Attending:[**First Name3 (LF) 1148**]
Chief Complaint:
Initially presented with Dyspnea to [**Hospital **] hospital from
nursing home. Transfered to [**Hospital1 18**] ICU because of respiratory
failure requiring intubation and hypotension requiring pressors.

Major Surgical or Invasive Procedure:
Intubation with mechanical ventilation


History of Present Illness:
55 y/o female with breast cancer presented with SOB to [**Hospital **]
Hospital because of dyspnea, fever, tachypnea, and tachycardia.
At [**Hospital **] Hospital, found to have fever to 101.5, tachycardia
to 112, tachypnea of 22, O2 sat of 93% on RA, and transiently
was hypotensive to 70 systolic. She was intubated, given 4L NS,
treated with zosyn, and started on dopamine.
.
At [**Hospital1 18**], a RIJ was placed, norepinepherine started in place of
dopamine, and given vancomycin and 3L NS. Paralysed with
vecuronium for CTA done for back pain to rule out disection.
.
Per her sister, she had a cold for the last few weeks but was
otherwise feeling well until the day before admission.


Past Medical History:
Breast Cancer- Diagnosed 8/[**2114**]. T3 N0, Infiltrating lobular
carcinoma; ER positive, PR positive, and her2neu negative;
status post a left modified radical mastectomy with axillary
lymph node disection on [**2114-12-7**], started [**2115-2-1**] on adjuvant
chemotherapy (cyclophosphamide and adriamycin as well as
dexamethasone) by Dr. [**Last Name (STitle) **].
Hypotension NOS
Schizoaffective Doisorder
Chronic Liver disease with Cirrhosis
History of Seizures
Tobacco Abuse
Mood d/o NOS
h/o alcohol dependence along with drug abuse.


Social History:
Sister [**Name (NI) 2048**] [**Name (NI) 110914**] [**Telephone/Fax (1) 110915**] (health care proxy). Lives
in [**Hospital3 **] facility because of psychiatric history.
Coming in from [**Location (un) 169**] nursing home in [**Location (un) **] after
recent hospitalization four weeks ago. Ambulates with a cane
with supervision because of unsteady gait. Declared incompetent
at nursing home.

Family History:
One sister with breast cancer at 54. 4 other siblings are
healthy.

Physical Exam:
Intubated, sedated, Caucasian female.
T 97.6 HR 93 BP 148/119 (cuff on levo) RR 18 SAT 100%
Vent AC 500x12 FiO2 100% PEEP 5
SKIN: no rashes, cool extremities
HEENT: PERRL. Sclera anicteric. Intubated. OG tube in place.
NECK: R IJ in place. Good carotid pulses. No LAD.
CHEST: Left mastectomy. Bronchial breath sounds over right
posterior lung fields. Left lung fields clear.
HEART: Regular rhythm. No murmurs.
ABD: soft, NT, ND, faint bowel sounds.
EXT: Good femoral pulses, good DP pulses.
NEURO: Repsonds to noxious stimuli. Reflexes 2+ and equal
bilaterally. Toes downgoing.


Pertinent Results:
[**2115-3-31**] 10:32AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG
[**2115-3-31**] 10:32AM   PT-11.6 PTT-24.9 INR(PT)-1.0
[**2115-3-31**] 10:32AM   PLT SMR-NORMAL PLT COUNT-274
[**2115-3-31**] 10:32AM   HYPOCHROM-NORMAL ANISOCYT-NORMAL
POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL
POLYCHROM-NORMAL
[**2115-3-31**] 10:32AM   NEUTS-61 BANDS-28* LYMPHS-7* MONOS-3 EOS-1
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2115-3-31**] 10:32AM   WBC-12.4* RBC-3.91* HGB-11.4* HCT-35.2*
MCV-90 MCH-29.1 MCHC-32.3 RDW-15.1
[**2115-3-31**] 10:32AM   LITHIUM-0.9
[**2115-3-31**] 10:32AM   CRP-56.9*
[**2115-3-31**] 10:32AM   AMMONIA-23
[**2115-3-31**] 10:32AM   CALCIUM-8.3* PHOSPHATE-4.8* MAGNESIUM-1.5*
[**2115-3-31**] 10:32AM   ALT(SGPT)-20 AST(SGOT)-20 CK(CPK)-46 ALK
PHOS-74 AMYLASE-151* TOT BILI-0.3
Urine culture no growth
Blood cultures no growth to date
.
CTA: IMPRESSION:
1. No evidence of pulmonary embolism or aortic dissection.
2. Right upper and right lower lobe pneumonia.
3. Consolidation in the left lower lobe.
4. Sideports of the NG tube located at the level of GE junction.
.
TTE: Conclusions:
The left atrium is normal in size. Left ventricular wall
thicknesses are
normal. The left ventricular cavity size is normal. Overall left
ventricular systolic function is normal (LVEF>55%). Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets (3) appear structurally normal with good
leaflet excursion. Trace aortic regurgitation is seen. The
mitral valve appears structurally normal with trivial mitral
regurgitation. The estimated pulmonary artery systolic pressure
is normal. There is a trivial/physiologic pericardial effusion.

.
Abd xray: FINDINGS: One vew of the abdomen on spine position
demonstrates no evidence of bowel loop dilatation. No evidence
of obstruction. Unremarkable bowel gas pattern.
.
PORTABLE CHEST: Endotracheal and NG tube have been removed. A
right internal jugular line is unchanged in position. Previously
noted asymmetric increased interstitial opacity diffusely
throughout the right lung may be slightly any improved compared
to three days prior. Left lung appears grossly clear. There is
no evidence of effusion. Cardiomediastinal silhouette is
unchanged.

Brief Hospital Course:
A/P: 55 y/o female with breast cancer and new right middle and
lower lobe PNA.
.
#. Hypoxia/Right Lower Lobe PNA: Patient admitted to MICU and
intubated, required pressors briefly.  Was extubated on [**4-1**] and
did well.  No PE on CTA.  No evidence post obstructive disease.
Treated with vancomycin and zosyn with azithromycin on admission
and received 6 days here (3 days azithro).  On room air at time
of discharge.  Intubated. Hypoxia likely due to airspace disease
(PNA) on top of poor lungs (smoking history). No PE on CTA.
Negative cardiac enzymes. TTE repeated and unchanged from
previous (normal).  At time of discharge plan to change to
levofloxacin for 14 day course total.  Patient should get repeat
CXR to see resolution of infiltrates in [**3-10**] weeks.  Seen by
swallow specialists here and no abnormality found; can continue
regular diet.  Still unclear why two recent episodes of
pneumonia, although in different locations by report.  Can
continue to investigate as outpatient.
.
#. Hypotension: Combination sepsis and hypovolemia.  Had [**Last Name (un) 104**]
stim test with appropriate bump and appropriate am cortisol.
This can be repeated in outpatient setting if desired.  TFTs
also normal and normal TTE.
.
#. Breast Cancer: No evidence of lung metastasis.  D/w patient's
oncologist and will get outpatient follow up.  Continued on
aromasin while here.  Patient did complain of lower back pain
but appears to be chronic issue with negative bone scan last
fall.
.
#. Schizoaffective Disorder and Mood Disorder:  Followed by
psychiatry here and medications adjusted as outlined.  Initially
in ICU patient very agitated when extubated but became calm and
redirectable (with bouts of yelling) after transfer to floor.
No prolonged QTc on EKG on haldol.  Lithium level 0.9.  Also on
depakote so LFTs should be followed as outpatient.
.
#. h/o Liver disease: Labs show preserved synthetic function and
LFT's not elevated.
.
# h/o chronic constipation:  Continued zelnorm and miralax.
.
#. CODE: Full
.
#. CONTACT: Sister [**Name (NI) 2048**] [**Name (NI) 110914**] [**Telephone/Fax (1) 110915**] (health care
proxy)
Discharge back to [**Hospital 169**] Center/[**Location (un) **].

Medications on Admission:
Zelnorm 6 mg Oral [**Hospital1 **]
Lyrica 150 mg Oral [**Hospital1 **]
Miralax 17 gm daily
Lithium Carbonate 300 mg PO QAM and 600 mg PO QHS
Prilosec 20 mg daily
Melatonin 3 mg QHS
Multivitamin daily
Aromasin 25 mg daily
Cogentin 0.5 mg [**Hospital1 **]
Stelazine 10 mg [**Hospital1 **]
Seroquel 400 mg QHS
Buspar 15 mg [**Hospital1 **]


Discharge Medications:
1. Tegaserod Hydrogen Maleate 6 mg Tablet Sig: One (1) Tablet PO
BID (2 times a day) as needed for constipation.
2. Pregabalin 75 mg Capsule Sig: Two (2) Capsule PO BID (2 times
a day) as needed for Seizure Disorder.
3. Polyethylene Glycol 3350 17 g (100%) Powder in Packet Sig:
One (1) Powder in Packet PO DAILY (Daily) as needed for
COnstipation.
4. Lithium Carbonate 300 mg Capsule Sig: One (1) Capsule PO QAM
(once a day (in the morning)).
5. Lithium Carbonate 300 mg Capsule Sig: Two (2) Capsule PO QHS
(once a day (at bedtime)).
6. Exemestane 25 mg Tablet Sig: One (1) Tablet PO Daily () as
needed for Breast Cancer.
7. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
8. Simethicone 80 mg Tablet, Chewable Sig: One (1) Tablet,
Chewable PO QID (4 times a day) as needed.
9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
10. Divalproex 250 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO BID (2 times a day).
11. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed for shortness of breath or
wheezing.
12. Haloperidol 5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
13. Guaifenesin 100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H (every 6
hours) as needed.
14. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO ONCE (Once) for
1 doses.
15. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO once a day
for 8 days.
16. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO three times a
day as needed for pain.


Discharge Disposition:
Extended Care

Facility:
[**Hospital 169**] Center/ [**Location (un) **]

Discharge Diagnosis:
Community acquired pneumonia, multilobar pneumonia
Severe sepsis
Schizoaffective disorder


Discharge Condition:
Good


Discharge Instructions:
You had a very severe pneumonia requiring intensive care unit
care.  This has improved.  If you develop worsening cough,
fevers, difficulty breathing please see your doctor.
.
You have now had two hospitalizations with serious pneumonias.
We did not find a clear reason that you are at higher risk for
these but will recommend to your physicians to continue this
work up as an outpatient.
.
We also have made some adjustments to your psychiatric
medications.  We recommend close follow up with your
psychiatrist to continue to make adjustments as needed.

Followup Instructions:
1. Provider: [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Name12 (NameIs) **], MD Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2115-4-30**] 10:00
.
2. You have an appointment with your PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 31446**] [**Name (STitle) 8521**], on
Wednesday [**2115-4-10**] at 11:00.  [**Telephone/Fax (1) 54268**]
.
3. Please follow up with your psychiatrist for continued
management of your schizoaffective disorder.
{'Unspecified septicemia,Pneumonia, organism unspecified,Acute respiratory failure,Schizoaffective disorder, unspecified,Cirrhosis of liver without mention of alcohol,Severe sepsis,Constipation, unspecified,Anemia, unspecified,Personal history of malignant neoplasm of breast'}


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: Initially presented with Dyspnea to [**Hospital **] hospital from
nursing home. Transfered to [**Hospital1 18**] ICU because of respiratory
failure requiring intubation and hypotension requiring pressors.

PRESENT ILLNESS: 55 y/o female with breast cancer presented with SOB to [**Hospital **]
Hospital because of dyspnea, fever, tachypnea, and tachycardia.
At [**Hospital **] Hospital, found to have fever to 101.5, tachycardia
to 112, tachypnea of 22, O2 sat of 93% on RA, and transiently
was hypotensive to 70 systolic. She was intubated, given 4L NS,
treated with zosyn, and started on dopamine.
.
At [**Hospital1 18**], a RIJ was placed, norepinepherine started in place of
dopamine, and given vancomycin and 3L NS. Paralysed with
vecuronium for CTA done for back pain to rule out disection.
.
Per her sister, she had a cold for the last few weeks but was
otherwise feeling well until the day before admission.

MEDICAL HISTORY: Breast Cancer- Diagnosed 8/[**2114**]. T3 N0, Infiltrating lobular
carcinoma; ER positive, PR positive, and her2neu negative;
status post a left modified radical mastectomy with axillary
lymph node disection on [**2114-12-7**], started [**2115-2-1**] on adjuvant
chemotherapy (cyclophosphamide and adriamycin as well as
dexamethasone) by Dr. [**Last Name (STitle) **].
Hypotension NOS
Schizoaffective Doisorder
Chronic Liver disease with Cirrhosis
History of Seizures
Tobacco Abuse
Mood d/o NOS
h/o alcohol dependence along with drug abuse.

MEDICATION ON ADMISSION: Zelnorm 6 mg Oral [**Hospital1 **]
Lyrica 150 mg Oral [**Hospital1 **]
Miralax 17 gm daily
Lithium Carbonate 300 mg PO QAM and 600 mg PO QHS
Prilosec 20 mg daily
Melatonin 3 mg QHS
Multivitamin daily
Aromasin 25 mg daily
Cogentin 0.5 mg [**Hospital1 **]
Stelazine 10 mg [**Hospital1 **]
Seroquel 400 mg QHS
Buspar 15 mg [**Hospital1 **]

ALLERGIES: Morphine Sulfate

PHYSICAL EXAM: Intubated, sedated, Caucasian female.
T 97.6 HR 93 BP 148/119 (cuff on levo) RR 18 SAT 100%
Vent AC 500x12 FiO2 100% PEEP 5
SKIN: no rashes, cool extremities
HEENT: PERRL. Sclera anicteric. Intubated. OG tube in place.
NECK: R IJ in place. Good carotid pulses. No LAD.
CHEST: Left mastectomy. Bronchial breath sounds over right
posterior lung fields. Left lung fields clear.
HEART: Regular rhythm. No murmurs.
ABD: soft, NT, ND, faint bowel sounds.
EXT: Good femoral pulses, good DP pulses.
NEURO: Repsonds to noxious stimuli. Reflexes 2+ and equal
bilaterally. Toes downgoing.

FAMILY HISTORY: One sister with breast cancer at 54. 4 other siblings are
healthy.

SOCIAL HISTORY: Sister [**Name (NI) 2048**] [**Name (NI) 110914**] [**Telephone/Fax (1) 110915**] (health care proxy). Lives
in [**Hospital3 **] facility because of psychiatric history.
Coming in from [**Location (un) 169**] nursing home in [**Location (un) **] after
recent hospitalization four weeks ago. Ambulates with a cane
with supervision because of unsteady gait. Declared incompetent
at nursing home. 

### Response:
{'Unspecified septicemia,Pneumonia, organism unspecified,Acute respiratory failure,Schizoaffective disorder, unspecified,Cirrhosis of liver without mention of alcohol,Severe sepsis,Constipation, unspecified,Anemia, unspecified,Personal history of malignant neoplasm of breast'}
