CHIEF COMPLAINT: Fevers

PRESENT ILLNESS: This is a 52 y.o. female with PMH sig for C2 quadriplegia
suffered after an epidural abcess on [**2148**] causing pt to be vent
dependent, pacer dependent and s/p diaphram pacer who presents
to [**Hospital1 18**] from OSH for persisent fevers. The pt was transfered to
have an LP with neurosurg backup. Pt was in USOH when she a
migraine requiring narcotics and went to ED with altered MS [**First Name (Titles) **] [**Last Name (Titles) 17267**]s. Found to have R ureteral stone/obstruction. Pt had stent
placed and was treated for E. coli sepsis with Levo and cefepime
x 2 weeks. 4 days after abx ended she agian had a fever and grew
C. albicans from urine and have a ? LLL infintrate on CXR with
sputm + for MRSA. PICC line grew coag neg staph. Pt initially
treated with Imipenem, Levofloxa and eventually vanco and
fluconazole. % days after she finished this treatment she again
returned to the ED with fevers and MS changes. Blood cx neg. TEE
neg. Vanco d/c'd as thought to be possible cause of MS changes.
Pt transfered to [**Hospital1 18**] for difficult LP.

MEDICAL HISTORY: C2 quadriplegia
Migraines
DM2
Nephrolithiasis- s/p stent
s/p colostomy for severe decub
chronic indwelling foley

MEDICATION ON ADMISSION: Heparin SC
MVI
Colace 100 PO QD
Lasix 80 QD
Flovent 220
Neurontin 300 TID
Metformin 1g
Baclofen 20 QID
Elavil 75 QD
Spironolactone 25 QD
Prevacid
Guanifesin 1200 [**Hospital1 **]
Kcl 20
Ferrous sulfate 325 QD
Flonase
Cefepime
Zinc
Ativan
Zofran

ALLERGIES: Augmentin

PHYSICAL EXAM: Vitals: T-101.1, BP: 106/45, P 90, RR: 12, O2: 100% on home vent
Gen: morbidly obese quadriplegic female, NAD, A&O x1 (person)
HEENT: MMM, PERRL, OP clear
CV: RRR, nl S1S2, no mrg
Resp: CTA anteriorly
Abd: morbidly obese, NT, + BS, soft
Ext: 2+ peripheral edema
Neuro: quadriplegic, CNII-XII intact, confused, follows
commands, 0/5 strength all ext, + clonus.

FAMILY HISTORY: None

SOCIAL HISTORY: Lives at home with husband and 24 hour nursing.
No tob
No Etoh
Quadriplegia, C1-C4, complete,Chronic respiratory failure,Mechanical complication of other vascular device, implant, and graft,Pneumonia, organism unspecified,Carrier or suspected carrier of other specified bacterial diseases,Infection with microorganisms resistant to penicillins
Quadrplg c1-c4, complete,Chronic respiratory fail,Malfunc vasc device/graf,Pneumonia, organism NOS,Bacteria dis carrier NEC,Inf mcrg rstn pncllins
Admission Date:  [**2152-9-19**]              Discharge Date:   [**2152-9-22**]

Date of Birth:  [**2100-5-8**]             Sex:   F

Service: MED

Allergies:
Augmentin

Attending:[**First Name3 (LF) 3326**]
Chief Complaint:
Fevers

Major Surgical or Invasive Procedure:
Bronchoscopy x2


History of Present Illness:
This is a 52 y.o. female with PMH sig for C2 quadriplegia
suffered after an epidural abcess on [**2148**] causing pt to be vent
dependent, pacer dependent and s/p diaphram pacer who presents
to [**Hospital1 18**] from OSH for persisent fevers. The pt was transfered to
have an LP with neurosurg backup. Pt was in USOH when she a
migraine requiring narcotics and went to ED with altered MS [**First Name (Titles) **] [**Last Name (Titles) 17267**]s. Found to have R ureteral stone/obstruction. Pt had stent
placed and was treated for E. coli sepsis with Levo and cefepime
x 2 weeks. 4 days after abx ended she agian had a fever and grew
C. albicans from urine and have a ? LLL infintrate on CXR with
sputm + for MRSA. PICC line grew coag neg staph. Pt initially
treated with Imipenem, Levofloxa and eventually vanco and
fluconazole. % days after she finished this treatment she again
returned to the ED with fevers and MS changes. Blood cx neg. TEE
neg. Vanco d/c'd as thought to be possible cause of MS changes.
Pt transfered to [**Hospital1 18**] for difficult LP.

Past Medical History:
C2 quadriplegia
Migraines
DM2
Nephrolithiasis- s/p stent
s/p colostomy for severe decub
chronic indwelling foley


Social History:
Lives at home with husband and 24 hour nursing.
No tob
No Etoh


Family History:
None

Physical Exam:
Vitals: T-101.1, BP: 106/45, P 90, RR: 12, O2: 100% on home vent
Gen: morbidly obese quadriplegic female, NAD, A&O x1 (person)
HEENT: MMM, PERRL, OP clear
CV: RRR, nl S1S2, no mrg
Resp: CTA anteriorly
Abd: morbidly obese, NT, + BS, soft
Ext: 2+ peripheral edema
Neuro: quadriplegic, CNII-XII intact, confused, follows
commands, 0/5 strength all ext, + clonus.


Pertinent Results:
[**2152-9-19**] 11:43PM   GLUCOSE-110* UREA N-13 CREAT-0.5 SODIUM-134
POTASSIUM-3.4 CHLORIDE-101 TOTAL CO2-22 ANION GAP-14
[**2152-9-19**] 11:43PM   ALT(SGPT)-32 AST(SGOT)-20 LD(LDH)-315* ALK
PHOS-231* AMYLASE-17 TOT BILI-0.6
[**2152-9-19**] 11:43PM   LIPASE-22
[**2152-9-19**] 11:43PM   ALBUMIN-3.6 CALCIUM-9.0 PHOSPHATE-1.8*
MAGNESIUM-1.0*
[**2152-9-19**] 11:43PM   TSH-3.8
[**2152-9-19**] 11:43PM   WBC-4.1 RBC-2.73* HGB-7.3* HCT-21.3* MCV-78*
MCH-26.7* MCHC-34.1 RDW-17.2*
[**2152-9-19**] 11:43PM   NEUTS-71* BANDS-1 LYMPHS-18 MONOS-4 EOS-0
BASOS-0 ATYPS-6* METAS-0 MYELOS-0 NUC RBCS-1*
[**2152-9-19**] 11:43PM   HYPOCHROM-2+ ANISOCYT-1+ POIKILOCY-1+
MACROCYT-NORMAL MICROCYT-2+ POLYCHROM-OCCASIONAL OVALOCYT-1+
STIPPLED-OCCASIONAL TEARDROP-OCCASIONAL
[**2152-9-19**] 11:43PM   PLT COUNT-166
[**2152-9-19**] 11:43PM   PT-14.1* PTT-23.2 INR(PT)-1.3
[**2152-9-19**] 11:43PM   SED RATE-83*
[**2152-9-19**] 11:43PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.019
[**2152-9-19**] 11:43PM URINE  BLOOD-SM NITRITE-NEG PROTEIN-30
GLUCOSE-NEG KETONE-15 BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 LEUK-SM
[**2152-9-19**] 11:43PM URINE  RBC-0-2 WBC-[**7-20**]* BACTERIA-FEW YEAST-OCC
EPI-[**4-14**]

CT ABD: IMPRESSION:
1. Left lung base consolidation consistent with pneumonia.
2. Vague low-attenuation lesion in the left hepatic lobe may
represent a focus of fatty infiltration. Confirmation by MR is
recommended.
3. 1.5 cm right suprarenal nodule likely represents a right
adrenal adenoma. Confirmation by MR is recommended.

[**2152-9-21**] 3:30 pm BRONCHOALVEOLAR LAVAG

   GRAM STAIN (Final [**2152-9-21**]):
      2+   (1-5 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      2+   (1-5 per 1000X FIELD):   GRAM NEGATIVE ROD(S).
      1+    (<1 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS AND CLUSTERS.

   RESPIRATORY CULTURE (Final [**2152-9-23**]):
      OROPHARYNGEAL FLORA ABSENT.
      Due to mixed bacterial types ( >= 3 colony types) an
abbreviated
      workup will be performed appropriate to the isolates
recovered from
      this site.
      GRAM NEGATIVE ROD(S).    SPARSE GROWTH.
         OF THREE COLONIAL MORPHOLOGIES.
      STAPH AUREUS COAG +.    SPARSE GROWTH.


Brief Hospital Course:
BY PROBLEM:

1) Fever: Mult potential sources identified. Pt was
re-pancultured on admission and started on broad coverage due to
mental status changes with ceftriaxone, vanco and PO flagyl for
possible c.diff infection. Ct head showed no evidence of a mass
lesion. CT chest showed evidence of consolidation in LLL
suggestive of infiltrate. Bronchoscopy was performed and there
was no evidence of post-obstructive pna. It was felt that pt may
be due to constant aspiration. Pt was not inflating cuff for
eating as she did not like inability to speak. Pt was then seen
by our speech and swallow service for evaluation for Passy-Muir
valve. Recommended pt wear valve for parts of day to allow for
better cough and clearance of secreations. Pt can also use with
eating.
After hospital day #1 and all cx's neg, pt taken off all abx and
any meds that can potentially cause fevers. Pt was afebrile for
remainder of admission. Fevers thought to be [**3-13**] drug reactions.
After fevers resolved pts mental status returned to [**Month/Day (2) 5348**].
- No vent changes were made other than valve change
- Bronch revealed aspiration.
- No fevers after d/c'd unnecessary meds, abx and valve changed.


2) MS changes: as mentioned above, thought to be [**3-13**] fevers.
When fevers resolved, MS returned to [**Month/Day (2) 5348**].

3) Sacral decub: stage 2-3. Applied wet to dry dressing [**Hospital1 **] and
rotated frequently to avoid complression.

4) DM2: while in hosptial d/c'd metformin as possible drug
reaction. Covered with insulin slidine scale.

5) FEN: diabetic diet. Repleted lytes as needed.

6) Dispo: Pt returned home after afebrile for over 72 hours and
MS [**First Name (Titles) **] [**Last Name (Titles) 5348**].

7) Code: FULL


Medications on Admission:
Heparin SC
MVI
Colace 100 PO QD
Lasix 80 QD
Flovent 220
Neurontin 300 TID
Metformin 1g
Baclofen 20 QID
Elavil 75 QD
Spironolactone 25 QD
Prevacid
Guanifesin 1200 [**Hospital1 **]
Kcl 20
Ferrous sulfate 325 QD
Flonase
Cefepime
Zinc
Ativan
Zofran


Discharge Medications:
1. Heparin Sodium (Porcine) 5,000 unit/mL Solution Sig: 5000
(5000) units Injection TID (3 times a day).
2. Furosemide 80 mg Tablet Sig: One (1) Tablet PO QD (once a
day).
3. Fluticasone Propionate 110 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation [**Hospital1 **] (2 times a day).
4. Venlafaxine HCl 75 mg Tablet Sig: One (1) Tablet PO QAM (once
a day (in the morning)).
5. Venlafaxine HCl 75 mg Tablet Sig: Two (2) Tablet PO QPM (once
a day (in the evening)).
6. Neutra-Phos  Oral
7. Potassimin  Oral
8. Lansoprazole 30 mg Capsule, Delayed Release(E.C.) Sig: One
(1) Capsule, Delayed Release(E.C.) PO QD (once a day).
9. Baclofen 10 mg Tablet Sig: Two (2) Tablet PO QID (4 times a
day).
10. Metformin HCl 1,000 mg Tab,Sust Rel Osmotic Push 24HR Sig:
One (1) Tab,Sust Rel Osmotic Push 24HR PO once a day.
11. Colace  Oral


Discharge Disposition:
Home

Discharge Diagnosis:
Fever.


Discharge Condition:
Stable

Discharge Instructions:
Please follow-up with your regular physician regarding
[**Name9 (PRE) 58319**] of permanent intravenous access.
Call your physican for fevers or new symptoms

Followup Instructions:
Follow-up with your regular physician [**Last Name (NamePattern4) **] [**2-11**] weeks.  Contact
your physician if you develop any fevers or other new
complaints.
{'Quadriplegia, C1-C4, complete,Chronic respiratory failure,Mechanical complication of other vascular device, implant, and graft,Pneumonia, organism unspecified,Carrier or suspected carrier of other specified bacterial diseases,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: Fevers

PRESENT ILLNESS: This is a 52 y.o. female with PMH sig for C2 quadriplegia
suffered after an epidural abcess on [**2148**] causing pt to be vent
dependent, pacer dependent and s/p diaphram pacer who presents
to [**Hospital1 18**] from OSH for persisent fevers. The pt was transfered to
have an LP with neurosurg backup. Pt was in USOH when she a
migraine requiring narcotics and went to ED with altered MS [**First Name (Titles) **] [**Last Name (Titles) 17267**]s. Found to have R ureteral stone/obstruction. Pt had stent
placed and was treated for E. coli sepsis with Levo and cefepime
x 2 weeks. 4 days after abx ended she agian had a fever and grew
C. albicans from urine and have a ? LLL infintrate on CXR with
sputm + for MRSA. PICC line grew coag neg staph. Pt initially
treated with Imipenem, Levofloxa and eventually vanco and
fluconazole. % days after she finished this treatment she again
returned to the ED with fevers and MS changes. Blood cx neg. TEE
neg. Vanco d/c'd as thought to be possible cause of MS changes.
Pt transfered to [**Hospital1 18**] for difficult LP.

MEDICAL HISTORY: C2 quadriplegia
Migraines
DM2
Nephrolithiasis- s/p stent
s/p colostomy for severe decub
chronic indwelling foley

MEDICATION ON ADMISSION: Heparin SC
MVI
Colace 100 PO QD
Lasix 80 QD
Flovent 220
Neurontin 300 TID
Metformin 1g
Baclofen 20 QID
Elavil 75 QD
Spironolactone 25 QD
Prevacid
Guanifesin 1200 [**Hospital1 **]
Kcl 20
Ferrous sulfate 325 QD
Flonase
Cefepime
Zinc
Ativan
Zofran

ALLERGIES: Augmentin

PHYSICAL EXAM: Vitals: T-101.1, BP: 106/45, P 90, RR: 12, O2: 100% on home vent
Gen: morbidly obese quadriplegic female, NAD, A&O x1 (person)
HEENT: MMM, PERRL, OP clear
CV: RRR, nl S1S2, no mrg
Resp: CTA anteriorly
Abd: morbidly obese, NT, + BS, soft
Ext: 2+ peripheral edema
Neuro: quadriplegic, CNII-XII intact, confused, follows
commands, 0/5 strength all ext, + clonus.

FAMILY HISTORY: None

SOCIAL HISTORY: Lives at home with husband and 24 hour nursing.
No tob
No Etoh 

### Response:
{'Quadriplegia, C1-C4, complete,Chronic respiratory failure,Mechanical complication of other vascular device, implant, and graft,Pneumonia, organism unspecified,Carrier or suspected carrier of other specified bacterial diseases,Infection with microorganisms resistant to penicillins'}
