CHIEF COMPLAINT: Dyspnea
Reason for MICU Admission: Hypoxia

PRESENT ILLNESS: Ms. [**Known lastname 59386**] is a [**Age over 90 **] yo F with history of HTN, SVT, hx
cholangitis/E.coli bacteremia ([**2-10**]), freq UTIs, who presents
from her nursing home with acute dyspnea, hypoxia to low 80's on
RA, and fever to 102. She was recently hospitalized for LLL PNA
and D/C'd on [**12-1**] on a course of levofloxacin and flagyl. She
was changed at the nursing home from levofloxacin to cefpodoxime
for better facility acquired coverage, but has no sputum cx data
to date. She also had a urine cx sent on [**12-3**] at the NH which
is no growth to date. Per nursing home staff, she had been doing
well for the last 2 days (no O2 requirement) until 9am this
morning when she was found to be confused and lethargic and an
O2 sat was in the low 80s and did not respond to nasal cannula.
She was also found at that time to have a fever to 102.
On interviewing the patient, she denies chest pain, shortness of
breath, abdominal pain or urinary sx. She reports R ear pain.
.
In the ED, her VS were T 99.8 BP 155/96 HR 160 (sinus) O2 84% on
4L. CXR showed a worsening LLL PNA compared to [**11-30**], U/A showed
> WBC. She received CTX, azithro, and vanco as well as 2L IVFs
which brought her HR to 115. On transfer she was satting 98% on
NRB. After discussions w/ family members - she remains DNR/DNI -
plan for abx, supplemental O2, no pressors, no line, and if
worsens or in increased distress plan to switch focus to
comfort.
.
ROS: Other than above, pt unable to provide further hx.
.

MEDICAL HISTORY: --History of SVT
--hyperthyroidism
--htn
--b12 deficiency
--h/o cholangitis s/p ERCP
--Macular degeneration
--s/p TAH BSO
--s/p nephrectomy
--s/p appendectomy
--s/p hip hemiarthroplasty

MEDICATION ON ADMISSION: 1. Metoprolol Tartrate 12.5 mg po bid
2. Docusate Sodium 200mg po bid
3. Acetaminophen 1g q8hr
4. Prilosec 20mg po q24hr
5. Cefpodoxime 100mg po bid
6. Metronidazole 500 mg po bid
7. MVI with iron
8. Remeron 15mg po qhs
9. [**Last Name (un) 7139**]-128 5% eye gtt 4x daily to each eye
.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 98.0  BP: 141/71  HR:  115  RR: 35  O2Sat: 99% on NRB

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Pt lives at [**Hospital1 **] at [**Location (un) 55**]. Denies tobacco, etoh.
Reportedly a retired math teacher (7th and 8th).  Played the
organ in church for years.  Originally from upstate
[**State 5887**], married in [**2070**] and moved to [**Location (un) 86**] at that time.
Widowed since [**2126**].  She is a non-smoker, no EtOH, no illicit
drugs.
Son = HCP = [**Name (NI) **] [**Name (NI) 59386**] [**Telephone/Fax (1) 59387**].  Daughter ([**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 59388**] -[**Telephone/Fax (1) 59389**]) lives in [**Location **] and is ill with COPD
and home oxygen.  Patient has close friend who identifies
herself as her "daughter" though admits that she is not related,
her name is [**Name (NI) 32400**] [**Name (NI) 7756**] [**Telephone/Fax (1) 59390**].  Son [**Name (NI) **] gives
permission to speak with [**Location (un) 32400**] but says that he should be the
first contact.   [**Name (NI) **] family and friend [**Name (NI) 32400**], patient normally
alert, fully oriented and coherent.
Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Unspecified pleural effusion,Encephalopathy, unspecified,Atrial fibrillation,Other diseases of trachea and bronchus,Osteoarthrosis, localized, not specified whether primary or secondary, shoulder region,Unspecified essential hypertension,Hip joint replacement,Macular degeneration (senile), unspecified,Pressure ulcer, heel
Food/vomit pneumonitis,Acute respiratry failure,Pleural effusion NOS,Encephalopathy NOS,Atrial fibrillation,Trachea & bronch dis NEC,Loc osteoarth NOS-shlder,Hypertension NOS,Joint replaced hip,Macular degeneration NOS,Pressure ulcer, heel
Admission Date:  [**2150-12-5**]              Discharge Date:   [**2150-12-14**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2009**]
Chief Complaint:
Dyspnea
Reason for MICU Admission: Hypoxia

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Ms. [**Known lastname 59386**] is a [**Age over 90 **] yo F with history of HTN, SVT, hx
cholangitis/E.coli bacteremia ([**2-10**]), freq UTIs, who presents
from her nursing home with acute dyspnea, hypoxia to low 80's on
RA, and fever to 102. She was recently hospitalized for LLL PNA
and D/C'd on [**12-1**] on a course of levofloxacin and flagyl. She
was changed at the nursing home from levofloxacin to cefpodoxime
for better facility acquired coverage, but has no sputum cx data
to date. She also had a urine cx sent on [**12-3**] at the NH which
is no growth to date. Per nursing home staff, she had been doing
well for the last 2 days (no O2 requirement) until 9am this
morning when she was found to be confused and lethargic and an
O2 sat was in the low 80s and did not respond to nasal cannula.
She was also found at that time to have a fever to 102.
On interviewing the patient, she denies chest pain, shortness of
breath, abdominal pain or urinary sx. She reports R ear pain.
.
In the ED, her VS were T 99.8 BP 155/96 HR 160 (sinus) O2 84% on
4L. CXR showed a worsening LLL PNA compared to [**11-30**], U/A showed
> WBC. She received CTX, azithro, and vanco as well as 2L IVFs
which brought her HR to 115. On transfer she was satting 98% on
NRB. After discussions w/ family members - she remains DNR/DNI -
plan for abx, supplemental O2, no pressors, no line, and if
worsens or in increased distress plan to switch focus to
comfort.
.
ROS: Other than above, pt unable to provide further hx.
.


Past Medical History:
--History of SVT
--hyperthyroidism
--htn
--b12 deficiency
--h/o cholangitis s/p ERCP
--Macular degeneration
--s/p TAH BSO
--s/p nephrectomy
--s/p appendectomy
--s/p hip hemiarthroplasty


Social History:
Pt lives at [**Hospital1 **] at [**Location (un) 55**]. Denies tobacco, etoh.
Reportedly a retired math teacher (7th and 8th).  Played the
organ in church for years.  Originally from upstate
[**State 5887**], married in [**2070**] and moved to [**Location (un) 86**] at that time.
Widowed since [**2126**].  She is a non-smoker, no EtOH, no illicit
drugs.
Son = HCP = [**Name (NI) **] [**Name (NI) 59386**] [**Telephone/Fax (1) 59387**].  Daughter ([**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 59388**] -[**Telephone/Fax (1) 59389**]) lives in [**Location **] and is ill with COPD
and home oxygen.  Patient has close friend who identifies
herself as her "daughter" though admits that she is not related,
her name is [**Name (NI) 32400**] [**Name (NI) 7756**] [**Telephone/Fax (1) 59390**].  Son [**Name (NI) **] gives
permission to speak with [**Location (un) 32400**] but says that he should be the
first contact.   [**Name (NI) **] family and friend [**Name (NI) 32400**], patient normally
alert, fully oriented and coherent.


Family History:
Non-contributory.

Physical Exam:
Vitals: T: 98.0  BP: 141/71  HR:  115  RR: 35  O2Sat: 99% on NRB

GEN: Respiratory distress with use of accessory muscles
HEENT: surgical pupils b/l, MM dry, OP Clear
NECK: No JVD, carotid pulses brisk, no bruits, no cervical
lymphadenopathy, trachea midline
COR: Tachycardic, no M/G/R, normal S1 S2, radial pulses +2
PULM: Lungs decreased BS at bases, L > R. No crackles, wheezes
or rhonchi.
ABD: Soft, NT, ND, +BS, no HSM, no masses
EXT: No C/C/E, no palpable cords
NEURO: Awake, answers simple questions. moving all extremities.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.

.


Pertinent Results:
Other labs/interpretation:
Resp cx: GRAM STAIN (Final [**2150-12-7**]):  >25 PMNs and <10
epithelial cells/100X field ? OROPHARYNGEAL FLORA. YEAST, SPARSE
GROWTH.
STAPH AUREUS COAG +.    SPARSE GROWTH. MRSA
 .
.
UA [**12-5**] >50wbc, mod bact, UCx [**12-5**] >100K yeast
UA [**12-7**] 6wbc, no bacteria, UCx [**12-7**]: >100K yeast
.
.
Imaging/results:
[**2150-12-5**] CXR: Increasing left lower lobe infiltrate and pleural
effusion is concerning for progression of pneumonia. The
remainder of the study is relatively unchanged.
.
[**2150-12-7**]
Unchanged area of worsening right basilar area of consolidation
and
stable appearance of left basilar consolidation.
Unchanged slight volume overload and bronchial wall thickening.
.
[**12-10**]: Increased right pleural effusions, bilateral basilar
consolidations unchanged. Pulm vasc congeston.


Brief Hospital Course:
[**Age over 90 **] year old female with h/o SVT, HTN, recent admission with LLL
PNA (discharged [**12-1**] on levo/flagyl), admitted from [**Hospital1 1501**] with
acute onset hypoxia/dyspnea/fevers 102, CXR with worsening LLL
PNA, which has now progressed to b/l PNA, clinical evidence of
aspirartion. Afebrile and mostly stable, but episodes of
clinical deterioration.
.
.
Pneumonia, admitted with acute hypoxic resp failure, much
improved. CXR with progressive infiltrates, LLL->now bilateral
(infection vs fluid).  Acuity suggests component of aspiration
pneumonitis. Has resp and oral secretions, aspirating oral
secretions, but has trouble bringing up tracheal secretions
(weak cough) and requires deep suctioning. No fevers. White
count finally coming down. She will be treated to complete a 14
day course of vanc/zosyn.
.
Given likely aspiration risk, she had multiple swallow
evaluations, with evidence of aspiration.  Based on family
discussion, there is a goal of primarily comfort for patient,
with thin liquids, despite risk of aspiration.  If there is
evidence of significant coughing, further evaluation or
discussions regarding goals of care should continue with her
family.
.
.
Pleural effusions: developing over 3days, likely due to
tachycardia and fluid.  Diuresis for the most part was deferred
further, given minimal oral intake.
.
.
Leukocytosis: She had a leukocytosis that worsened, likely due
to pneumonia.  This had resolved by [**2150-12-12**].
.
Atrial fibrillation, with intermittent tachycardia: While in the
ICU, she had evidence of tachycardia, possibly atrial
fibrillation, which broke with IV metoprolol.  She continued to
have intermittent episodes of tachycardia throughout her stay,
likely sinus tachycardia in the setting of mucous plugging and
anxiety.  She was maintained on IV lopressor, and transitioned
on d/c to oral lopressor.
.
Contaminated UA: UA/UCx on admission wtih >100K yeast, foley
removed, 1 dose diflucan in MICU, but repeat UCx again >100K
yeast, though UA less WBC 50->6.
No treatment pursued.
.
.
Encephalopathy:  She had evidence of intermittent confusion,
consistent with delirium, due to ICU stay, pneumonia.  She
gradually improved, though remains off her baseline.
.
.
HTN: Well controlled on metoprolol
.
.
PUD. cont PPI
.
.
OA/shoulder pain: lidocaine patch, no narcotics, esp given
aspiration risk
.
.
FEN/proph: HLIV, monitor lytes, soft diet with honey thick
liquids per speech only when awake, otw NPO, strict aspiration
precautions, TEDs/SCDs, heparin [**Hospital1 **], PPI
.
.
Dispo/Code status: DNR/DNI. Goals of care defined with goal
toward comfort, based on family meeting between geriatrics
service and her family (son, daughter, daughter in law).  They
would like her to return to her nursing home.  A
do-not-rehospitalize order will likely need to be discussed on
return to [**Hospital1 599**].
.
[**First Name8 (NamePattern2) **] [**Known lastname 59386**] is HCP(wife [**Doctor First Name **] [**Telephone/Fax (1) 59387**], c [**Telephone/Fax (1) 59391**].
 Daughter ([**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 59388**] - [**Telephone/Fax (1) 59389**]) lives in [**Location **]
(but is ill).


Medications on Admission:
1. Metoprolol Tartrate 12.5 mg po bid
2. Docusate Sodium 200mg po bid
3. Acetaminophen 1g q8hr
4. Prilosec 20mg po q24hr
5. Cefpodoxime 100mg po bid
6. Metronidazole 500 mg po bid
7. MVI with iron
8. Remeron 15mg po qhs
9. [**Last Name (un) 7139**]-128 5% eye gtt 4x daily to each eye
.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 599**] of [**Location (un) 55**]

Discharge Diagnosis:
Pneumonia, bilateral
Aspiration, chronic
Pleural effusions
Atrial fibrillatoin
Encephalopathy


Discharge Condition:
Stable.  Prognosis is poor.


Discharge Instructions:
You were admitted secondary to pneumonia that is likley
secondary to aspiration.  You were treated for pneumonia with
antibiotics.
.
We had extensive discussion with you and your family regarding
the risk of aspiration depending on what type of food/liquids
you
consume but you will be allowed to eat food with aspiration
precautions.
.
Your doctor will discuss future plans for rehospitalization with
your family.

Followup Instructions:
Follow up with Dr. [**Last Name (STitle) **] on return to [**Hospital1 599**].
{'Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Unspecified pleural effusion,Encephalopathy, unspecified,Atrial fibrillation,Other diseases of trachea and bronchus,Osteoarthrosis, localized, not specified whether primary or secondary, shoulder region,Unspecified essential hypertension,Hip joint replacement,Macular degeneration (senile), unspecified,Pressure ulcer, heel'}


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
Reason for MICU Admission: Hypoxia

PRESENT ILLNESS: Ms. [**Known lastname 59386**] is a [**Age over 90 **] yo F with history of HTN, SVT, hx
cholangitis/E.coli bacteremia ([**2-10**]), freq UTIs, who presents
from her nursing home with acute dyspnea, hypoxia to low 80's on
RA, and fever to 102. She was recently hospitalized for LLL PNA
and D/C'd on [**12-1**] on a course of levofloxacin and flagyl. She
was changed at the nursing home from levofloxacin to cefpodoxime
for better facility acquired coverage, but has no sputum cx data
to date. She also had a urine cx sent on [**12-3**] at the NH which
is no growth to date. Per nursing home staff, she had been doing
well for the last 2 days (no O2 requirement) until 9am this
morning when she was found to be confused and lethargic and an
O2 sat was in the low 80s and did not respond to nasal cannula.
She was also found at that time to have a fever to 102.
On interviewing the patient, she denies chest pain, shortness of
breath, abdominal pain or urinary sx. She reports R ear pain.
.
In the ED, her VS were T 99.8 BP 155/96 HR 160 (sinus) O2 84% on
4L. CXR showed a worsening LLL PNA compared to [**11-30**], U/A showed
> WBC. She received CTX, azithro, and vanco as well as 2L IVFs
which brought her HR to 115. On transfer she was satting 98% on
NRB. After discussions w/ family members - she remains DNR/DNI -
plan for abx, supplemental O2, no pressors, no line, and if
worsens or in increased distress plan to switch focus to
comfort.
.
ROS: Other than above, pt unable to provide further hx.
.

MEDICAL HISTORY: --History of SVT
--hyperthyroidism
--htn
--b12 deficiency
--h/o cholangitis s/p ERCP
--Macular degeneration
--s/p TAH BSO
--s/p nephrectomy
--s/p appendectomy
--s/p hip hemiarthroplasty

MEDICATION ON ADMISSION: 1. Metoprolol Tartrate 12.5 mg po bid
2. Docusate Sodium 200mg po bid
3. Acetaminophen 1g q8hr
4. Prilosec 20mg po q24hr
5. Cefpodoxime 100mg po bid
6. Metronidazole 500 mg po bid
7. MVI with iron
8. Remeron 15mg po qhs
9. [**Last Name (un) 7139**]-128 5% eye gtt 4x daily to each eye
.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 98.0  BP: 141/71  HR:  115  RR: 35  O2Sat: 99% on NRB

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Pt lives at [**Hospital1 **] at [**Location (un) 55**]. Denies tobacco, etoh.
Reportedly a retired math teacher (7th and 8th).  Played the
organ in church for years.  Originally from upstate
[**State 5887**], married in [**2070**] and moved to [**Location (un) 86**] at that time.
Widowed since [**2126**].  She is a non-smoker, no EtOH, no illicit
drugs.
Son = HCP = [**Name (NI) **] [**Name (NI) 59386**] [**Telephone/Fax (1) 59387**].  Daughter ([**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 59388**] -[**Telephone/Fax (1) 59389**]) lives in [**Location **] and is ill with COPD
and home oxygen.  Patient has close friend who identifies
herself as her "daughter" though admits that she is not related,
her name is [**Name (NI) 32400**] [**Name (NI) 7756**] [**Telephone/Fax (1) 59390**].  Son [**Name (NI) **] gives
permission to speak with [**Location (un) 32400**] but says that he should be the
first contact.   [**Name (NI) **] family and friend [**Name (NI) 32400**], patient normally
alert, fully oriented and coherent. 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Unspecified pleural effusion,Encephalopathy, unspecified,Atrial fibrillation,Other diseases of trachea and bronchus,Osteoarthrosis, localized, not specified whether primary or secondary, shoulder region,Unspecified essential hypertension,Hip joint replacement,Macular degeneration (senile), unspecified,Pressure ulcer, heel'}
