CHIEF COMPLAINT: Fever and hypoxia.

PRESENT ILLNESS: The patient is an 85-year-old
female, [**Hospital3 **] resident, with a history of
hypothyroidism, peripheral neuropathy, and a remote history
of endometrial cancer who presents with one day of fever with
a temperature of 102 degrees Fahrenheit and hypoxia to 60% on
room air with an increase to 96% on 4 liters.

MEDICAL HISTORY: 1.  Endometrial cancer; status post total abdominal
hysterectomy, and bilateral salpingo-oophorectomy,
chemotherapy, and radiation therapy.  Complicated by
radiation enteritis (23 years ago).
 2.  Hypothyroidism.
 3.  Peripheral neuropathy.
 4.  Hiatal hernia.
 5.  Status post partial small-bowel resection.
 6.  Status post cholecystectomy.
 7.  Status post appendectomy.
 8.  Urinary incontinence and fecal incontinence.
 9.  Right nasolacrimal duct obstruction.
10.  Anemia.
11.  Hypocalcemia.
12.  Coronary artery disease (with stable angina).
13.  Status post right open reduction/internal fixation.

MEDICATION ON ADMISSION: (The patient's medications
included)
 1.  Levofloxacin times one day.
 2.  Amantadine times one day.
 3.  Synthroid 200 mcg by mouth every day.
 4.  Fentanyl patch 50 mcg per hour every three days.
 5.  Neurontin 800 mg by mouth three times per day.
 6.  Lopressor 25 mg by mouth twice per day.
 7.  Ativan 0.5 mg by mouth once per day.
 8.  Prevacid 30 mg by mouth once per day.
 9.  Maprotiline 150 mg by mouth at hour of sleep.
10.  B12 1000 mcg intramuscularly.
11.  Tylenol 650 mg by mouth three times per day.
12.  Multivitamin one tablet by mouth once per day.
13.  Calcium carbonate.
14.  Vitamin D.

ALLERGIES: SOCIAL HISTORY:  The patient lives at [**Hospital3 **].
Her niece is her health care proxy; name [**First Name9 (NamePattern2) 99851**] [**Doctor Last Name **].  No
tobacco.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history is significant for liver
cancer.

SOCIAL HISTORY: The patient lives at [**Hospital3 **].
Her niece is her health care proxy; name [**First Name9 (NamePattern2) 99851**] [**Doctor Last Name **].  No
tobacco.
Influenza with pneumonia,Acute respiratory failure,Unspecified septicemia,Iatrogenic pneumothorax,Unspecified essential hypertension,Encounter for palliative care,Unspecified acquired hypothyroidism
Influenza with pneumonia,Acute respiratry failure,Septicemia NOS,Iatrogenic pneumothorax,Hypertension NOS,Encountr palliative care,Hypothyroidism NOS
Admission Date:  [**2116-12-2**]       Discharge Date:


Service:  Medicine

CHIEF COMPLAINT:  Fever and hypoxia.

HISTORY OF PRESENT ILLNESS:  The patient is an 85-year-old
female, [**Hospital3 **] resident, with a history of
hypothyroidism, peripheral neuropathy, and a remote history
of endometrial cancer who presents with one day of fever with
a temperature of 102 degrees Fahrenheit and hypoxia to 60% on
room air with an increase to 96% on 4 liters.

One day prior to admission, nasopharyngeal aspirate was
positive for influenza A, and the patient was started on
amantadine and empiric Levaquin therapy.

The patient states her symptoms started a couple of days ago
with a cough productive of green sputum and a runny nose.  No
myalgias.  No dysuria.  No nausea, vomiting, or diarrhea.
She refused her flu shot this year.

In the Emergency Department, the patient's temperature was
100 degrees Fahrenheit, her heart rate was 87, her blood
pressure was 154/80, her respiratory rate was 18, and her
oxygen saturation was 72% on room air and 100% on
nonrebreather.  She appeared comfortable but unable to wean
the oxygen to nasal cannula at this time.  The patient was
lethargic but easily arousable.  The patient was
pan-cultured.  A chest x-ray revealed left lower lobe
pneumonia.  The patient denied any pain.  She was breathing
more comfortably.

REVIEW OF SYSTEMS:  Review of systems revealed right lower
extremity tenderness after recent trauma.

PAST MEDICAL HISTORY:
 1.  Endometrial cancer; status post total abdominal
hysterectomy, and bilateral salpingo-oophorectomy,
chemotherapy, and radiation therapy.  Complicated by
radiation enteritis (23 years ago).
 2.  Hypothyroidism.
 3.  Peripheral neuropathy.
 4.  Hiatal hernia.
 5.  Status post partial small-bowel resection.
 6.  Status post cholecystectomy.
 7.  Status post appendectomy.
 8.  Urinary incontinence and fecal incontinence.
 9.  Right nasolacrimal duct obstruction.
10.  Anemia.
11.  Hypocalcemia.
12.  Coronary artery disease (with stable angina).
13.  Status post right open reduction/internal fixation.

MEDICATIONS ON ADMISSION:  (The patient's medications
included)
 1.  Levofloxacin times one day.
 2.  Amantadine times one day.
 3.  Synthroid 200 mcg by mouth every day.
 4.  Fentanyl patch 50 mcg per hour every three days.
 5.  Neurontin 800 mg by mouth three times per day.
 6.  Lopressor 25 mg by mouth twice per day.
 7.  Ativan 0.5 mg by mouth once per day.
 8.  Prevacid 30 mg by mouth once per day.
 9.  Maprotiline 150 mg by mouth at hour of sleep.
10.  B12 1000 mcg intramuscularly.
11.  Tylenol 650 mg by mouth three times per day.
12.  Multivitamin one tablet by mouth once per day.
13.  Calcium carbonate.
14.  Vitamin D.

ALLERGIES:

SOCIAL HISTORY:  The patient lives at [**Hospital3 **].
Her niece is her health care proxy; name [**First Name9 (NamePattern2) 99851**] [**Doctor Last Name **].  No
tobacco.

FAMILY HISTORY:  Family history is significant for liver
cancer.

PHYSICAL EXAMINATION ON PRESENTATION:   Physical examination
revealed the patient's temperature was 97.5 degrees
Fahrenheit, her blood pressure was 121/41, her heart rate was
in the 80s, and her oxygen saturation was 100% on a 100%
nonrebreather, and her respiratory rate was 19.  In general,
the patient was resting but easily arousable and able to hold
a conversation.  The patient was in no acute distress.  The
mucous membranes were dry.  There were coarse breath sounds
with no wheezes.  Cardiovascular examination revealed a
regular rate.  The abdomen was soft and nontender.  There
were positive bowel sounds.  Extremity examination revealed
the right lower extremity with erythema, and focal
ecchymosis, and mild tenderness.   There was bilateral edema
of 1 to 2+.

PERTINENT LABORATORY VALUES ON PRESENTATION:   The patient's
white blood cell count was 7.2 (with 88 neutrophils, 0 bands,
8 lymphocytes, 3 monocytes, 0.4 eosinophils, and 0.5
basophils), her hematocrit was 37, and her platelets were
282.  Her INR was 2.1.  The patient's sodium was 135,
potassium was 3.9, chloride was 92, bicarbonate was 31, blood
urea nitrogen was 13, creatinine was 0.6, and her blood
glucose was 83.  Urinalysis revealed slightly hazy with a
specific gravity of 1.03, pH was 5, moderate blood, negative
leukocytes, negative nitrites, 30 protein, and 15 ketones.  A
nasopharyngeal swab was positive for influenza A and negative
for influenza B.  The culture was pending.  Blood cultures
and urine cultures were pending.

PERTINENT RADIOLOGY/IMAGING:  A chest x-ray revealed probable
left lower lobe pneumonia with pleural thickening at the left
costophrenic angle.  Could not rule out fluid.  No
pneumothorax.  No congestive heart failure.

CONCISE SUMMARY OF HOSPITAL COURSE BY ISSUE/SYSTEM:  The
patient was admitted to the Medicine Service for fever,
hypoxia, and respiratory distress.  The patient was found to
have influenza and a left lower lobe infiltrate.  Her
hospital course by issue/system was as follows:

 1.  INFLUENZA/PNEUMONIA ISSUES:  The patient was placed on
droplet precautions.  She was started on amantadine 100 per
day for a total of a 5-day course.  She was continued on
Levaquin.  She was initially able to be weaned off the
nonrebreather to nasal cannula with continued attempts to wean
her oxygen further.

 2.  FEVER ISSUES:  The patient was pan-cultured, and the
culture data was pending at the time of this dictation.  It
was also felt that perhaps her right lower extremity erythema
could be contributing as well to her fevers from cellulitis.
However, this improved on Levaquin.  She was given Tylenol
around the clock.

 3.  LETHARGY ISSUES:  The patient's lethargy was found to
improve with continued intravenous fluid hydration.
Initially, she was only placed on a half dose of her usual
Fentanyl and Ativan, but this was eventually brought back to
her baseline level.

 4.  CORONARY ARTERY DISEASE ISSUES:  The patient was placed
on Lopressor, and her blood pressures were well controlled.

 5.  HYPOTHYROIDISM ISSUES:  The patient was maintained on
her Synthroid.

 6.  HYPOCALCEMIA ISSUES:  The patient was maintained on her
calcium carbonate and vitamin d.

 7.  HISTORY OF ANEMIA:  The patient's hematocrit was stable.

 8.  PERSONALITY DISORDER ISSUES:  The patient was maintained
on maprotiline.

 9.  FLUIDS/ELECTROLYTES/NUTRITION ISSUES:  The patient's
oral intake was poor initially secondary to desaturation with
removal of the nonrebreather and lethargy.  However, she was
restarted on oral intake the following morning.  She was
maintained on supplemental intravenous fluids until she was
able to take in full oral intake.  She complained of mouth
dryness and throat soreness with swallowing.  The patient was
given a humidified tent in order to help improve her mouth
discomfort.

10.  CODE STATUS ISSUES:  The patient is do not resuscitate/do
not intubate; however, during her hospitalization she was
switched to full code given her respiratory distress in the
setting of an acute illness that was being treated.  However, the
expectation was that once this resolved that the patient will go
back to do not resuscitate/do not intubate (to be determined by
her current primary care physician).

This dictation was current only through [**2116-12-3**].  The remainder
of the dictation will be completed by the next house officer to
care for the patient.


DISCHARGE DIAGNOSES:
1.  Influenza A.
2.  Left lower lobe pneumonia.

CONDITION AT DISCHARGE:  Patient died in the hospital.



                      DR.[**Last Name (STitle) **],[**First Name3 (LF) 1037**] 12-ACL

Dictated By:[**Last Name (NamePattern1) 4988**]
MEDQUIST36

D:  [**2116-12-3**]  13:58
T:  [**2116-12-3**]  14:40
JOB#:  [**Job Number **]



Name:  [**Known lastname 7208**], [**Known firstname 2219**]                     Unit No:  [**Numeric Identifier 15988**]

Admission Date:  [**2116-12-2**]     Discharge Date:  [**2116-12-18**]

Date of Birth:   [**2031-5-21**]     Sex:  F

Service:

ADDENDUM TO HOSPITAL COURSE:  On [**2116-12-3**] the patient had
decreased mental status and was hypoxic to 50 to 70% on 50%
face mask with a chest x-ray consistent with diffuse
pneumonia.  The patient was intubated on the floor and
transferred to the Intensive Care Unit.  On [**2116-12-4**] a right
subclavian attempt led to a right tension pneumothorax
requiring decompression.  The patient also suffered
hypotension likely secondary to sepsis, treated with a
boluses and a Levophed drip, which was weaned off on [**2116-12-5**].
Tube feeds were started for nutritional support.  Access
remained difficult and the patient received an ............
PICC placement on [**2116-12-9**].  Given persistently elevated RISBI
a tracheostomy was discussed with the patient who declined.
On [**2116-12-17**] her health care proxy decided to withdraw
ventilatory support and make the patient CMO.  The patient
was extubated and tube feeds, antibiotics and cardiac
medications were discontinued.  The patient was continued on
a Fentanyl drip with a Scopolamine patch and Ativan prn.  The
patient was transferred back to the floor on [**2116-12-17**].  She
was kept comfortable with a Fentanyl drip, Lorazepam
intravenously prn and Scopolamine.  The patient passed away
[**2116-12-18**] at 10:53 p.m.  Health care proxy was notified who
declined a postmortem examination.



                                   [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 15989**], M.D.

Dictated By:[**Last Name (NamePattern1) 834**]

MEDQUIST36

D:  [**2117-2-8**]  05:27
T:  [**2117-2-10**]  09:45
JOB#:  [**Job Number 15990**]
{'Influenza with pneumonia,Acute respiratory failure,Unspecified septicemia,Iatrogenic pneumothorax,Unspecified essential hypertension,Encounter for palliative care,Unspecified acquired hypothyroidism'}


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: Fever and hypoxia.

PRESENT ILLNESS: The patient is an 85-year-old
female, [**Hospital3 **] resident, with a history of
hypothyroidism, peripheral neuropathy, and a remote history
of endometrial cancer who presents with one day of fever with
a temperature of 102 degrees Fahrenheit and hypoxia to 60% on
room air with an increase to 96% on 4 liters.

MEDICAL HISTORY: 1.  Endometrial cancer; status post total abdominal
hysterectomy, and bilateral salpingo-oophorectomy,
chemotherapy, and radiation therapy.  Complicated by
radiation enteritis (23 years ago).
 2.  Hypothyroidism.
 3.  Peripheral neuropathy.
 4.  Hiatal hernia.
 5.  Status post partial small-bowel resection.
 6.  Status post cholecystectomy.
 7.  Status post appendectomy.
 8.  Urinary incontinence and fecal incontinence.
 9.  Right nasolacrimal duct obstruction.
10.  Anemia.
11.  Hypocalcemia.
12.  Coronary artery disease (with stable angina).
13.  Status post right open reduction/internal fixation.

MEDICATION ON ADMISSION: (The patient's medications
included)
 1.  Levofloxacin times one day.
 2.  Amantadine times one day.
 3.  Synthroid 200 mcg by mouth every day.
 4.  Fentanyl patch 50 mcg per hour every three days.
 5.  Neurontin 800 mg by mouth three times per day.
 6.  Lopressor 25 mg by mouth twice per day.
 7.  Ativan 0.5 mg by mouth once per day.
 8.  Prevacid 30 mg by mouth once per day.
 9.  Maprotiline 150 mg by mouth at hour of sleep.
10.  B12 1000 mcg intramuscularly.
11.  Tylenol 650 mg by mouth three times per day.
12.  Multivitamin one tablet by mouth once per day.
13.  Calcium carbonate.
14.  Vitamin D.

ALLERGIES: SOCIAL HISTORY:  The patient lives at [**Hospital3 **].
Her niece is her health care proxy; name [**First Name9 (NamePattern2) 99851**] [**Doctor Last Name **].  No
tobacco.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history is significant for liver
cancer.

SOCIAL HISTORY: The patient lives at [**Hospital3 **].
Her niece is her health care proxy; name [**First Name9 (NamePattern2) 99851**] [**Doctor Last Name **].  No
tobacco. 

### Response:
{'Influenza with pneumonia,Acute respiratory failure,Unspecified septicemia,Iatrogenic pneumothorax,Unspecified essential hypertension,Encounter for palliative care,Unspecified acquired hypothyroidism'}
