CHIEF COMPLAINT: Fever, hypoxia

PRESENT ILLNESS: Mr. [**Known lastname 63077**] is a 77 yo male nursing home resident with
dementia, h/o aspiration pneumonia, COPD, HTN, DM2,
schizophrenia, bipolar disorder, GERD, angina and a h/o prostate
cancer who presents from his nurisng home with fever, shortness
of breath and increased sputum production.

MEDICAL HISTORY: Dementia
Paranoid Schizophrenia
DM2
Prostate Ca
Hypertension
GERD
Angina
Bipolar d/o
COPD
Hearing impaired

MEDICATION ON ADMISSION: Aspirin 81 mg PO qd
Atenolol 12.5 mg PO qd
Rosiglitazone 2 mg PO qd
Amlodipine 5 mg PO qd
Clopidogrel 75 mg PO qd
Haloperidol decanoate 25 mg IM qoWed
Olanzapine 5 mg PO qd
Docusate 100 mg PO bid
Ranitidine 150 mg PO qd
Benztropine 1 mg PO tid
Haloperidol 5 mg IV bid prn
Regular insulin SS
Albuterol neb q6 hrs prn
Ipatropium neb q6hrs prn
Bisacodyl PR prn
Fleet's enema PR prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:  Temp: 97.2   BP: 121/54   HR: 84   RR: 22   94%50% facemask
general: Difficult to rouse, does not open eyes, except to
sternal rub
HEENT: PERRL, anicteric, MMM, no significant JVD
Lungs: pt noncompliant with exam, diffuse ronchi, mild
expiratory wheeze, worse in lower lung fields
Heart: RR, S1 and S2 wnl, no appreciable murmurs, rubs or
gallops
Abdomen: G tube in place, no surrounding erythema or induration,
normoactive bowel sounds
Extremities: No edema
neuro: A&Ox1. Moving all extremeties well

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Patient lives in [**Location **] Manor nursing [**Last Name (un) **], wheelchair bound. He
has one son who lives in the area. He smokes 10 cigarettes/day.
Baseline ADL/IADLs unknown.
Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Volume depletion, unspecified,Chronic airway obstruction, not elsewhere classified,Paranoid type schizophrenia, unspecified,Bipolar disorder, unspecified,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Esophageal reflux,Other persistent mental disorders due to conditions classified elsewhere
Acute respiratry failure,Food/vomit pneumonitis,Acute kidney failure NOS,Volume depletion NOS,Chr airway obstruct NEC,Paranoid schizo-unspec,Bipolar disorder NOS,Hypertension NOS,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Anemia NOS,Esophageal reflux,Mental disor NEC oth dis
Admission Date:  [**2173-12-24**]              Discharge Date:   [**2173-12-29**]

Date of Birth:  [**2096-8-7**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2932**]
Chief Complaint:
Fever, hypoxia

Major Surgical or Invasive Procedure:
PICC line placement


History of Present Illness:
Mr. [**Known lastname 63077**] is a 77 yo male nursing home resident with
dementia, h/o aspiration pneumonia, COPD, HTN, DM2,
schizophrenia, bipolar disorder, GERD, angina and a h/o prostate
cancer who presents from his nurisng home with fever, shortness
of breath and increased sputum production.

In the ED, his vitals were 101.8, 90, 138/60, 40, 100% NRB. He
was ronchorous diffusely. He was placed on BIPAP.

He received vancomycin 1g, levofloxacin 500 mg, metronidazole
500 mg, albuterol/ipratropium nebs x2, albuterol neb x1,
acetaminophen PR x1, lorazepam 1 mg x1 and was transferred to
the ICU.


Past Medical History:
Dementia
Paranoid Schizophrenia
DM2
Prostate Ca
Hypertension
GERD
Angina
Bipolar d/o
COPD
Hearing impaired


Social History:
Patient lives in [**Location **] Manor nursing [**Last Name (un) **], wheelchair bound. He
has one son who lives in the area. He smokes 10 cigarettes/day.
Baseline ADL/IADLs unknown.


Family History:
Noncontributory

Physical Exam:
VS:  Temp: 97.2   BP: 121/54   HR: 84   RR: 22   94%50% facemask
general: Difficult to rouse, does not open eyes, except to
sternal rub
HEENT: PERRL, anicteric, MMM, no significant JVD
Lungs: pt noncompliant with exam, diffuse ronchi, mild
expiratory wheeze, worse in lower lung fields
Heart: RR, S1 and S2 wnl, no appreciable murmurs, rubs or
gallops
Abdomen: G tube in place, no surrounding erythema or induration,
normoactive bowel sounds
Extremities: No edema
neuro: A&Ox1. Moving all extremeties well


Pertinent Results:
Laboratory studies on admission:
[**2173-12-24**]
WBC-16.5 HGB-10.5 HCT-30.0 MCV-91 RDW-13.8 PLT COUNT-417
PT-12.6 PTT-25.4 INR(PT)-1.1
NEUTS-93.9 BANDS-0 LYMPHS-3.1* MONOS-2.7 EOS-0.1 BASOS-0.1
CALCIUM-9.1 PHOSPHATE-1.5*# MAGNESIUM-3.1*
ALT(SGPT)-17 AST(SGOT)-17 ALK PHOS-89 TOT BILI-0.2
LIPASE-25
GLUCOSE-173* UREA N-43* CREAT-1.5* SODIUM-137 POTASSIUM-4.7
CHLORIDE-100 TOTAL CO2-27 ANION GAP-15
[**2173-12-24**] 06:50PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-1 PH-7.0 LEUK-NEG

Laboratory studies on discharge:
[**2173-12-29**]
WBC-11.8 Hgb-9.6 Hct-29.0 MCV-92 RDW-14.5 Plt Ct-311
[**2173-12-29**] 06:55AM BLOOD Glucose-163* UreaN-25* Creat-1.3* Na-137
K-4.8 Cl-102 HCO3-25

Radiology
[**12-24**] CXR: Limited examination secondary to patient motion.
However, multiple airspace opacities seen bilaterally are
concerning for acute infection

[**12-27**] CXR: Mild pulmonary edema has developed since [**12-24**]
superimposed on residual consolidation in the right lower and
left mid lung zones, which may represent pneumonia. Small right
pleural effusion is new, and mild cardiomegaly has developed.
Lateral aspect of the left lower costal pleural surface is
excluded from the examination. Remaining pleural margins show no
indication of pneumothorax.

[**12-29**] PICC placement: Ultrasound-guided puncture of the left
basilic vein, (this is with hard copy documentation of the
ultrasound) with fluoroscopic placement of a 40 cm 4 French PICC
line in the superior vena cava.


Brief Hospital Course:
77 yo male nursing home resident with dementia, h/o aspiration
pneumonia, COPD, HTN, DM2, schizophrenia, bipolar disorder,
GERD, angina and a h/o prostate cancer who presents from his
nurisng home with fever, shortness of breath and increased
sputum production, found to have an aspiration pneumonia

1) Aspiration pneumonia: The patient was treated with
Zosyn/Vancomycin, of which he will complete a 14 day course, in
addition to 5 day course of azithromycin. Influenza DFA A/B was
negative. He was briefly on BIPAP in the ICU, but was
transferred to the general floor [**2173-12-27**]. His oxygen was weaned
to 2L NC (98% on 2L NC at discharge). He should continue chest
physical therapy and maintain strict aspiration precautions.

2) Acute renal failure: Likely secondary to volume depletion in
setting of fever. Received IVF to maintain urine output
initially. His creatinine trended down to 1.3 over the course of
his hospital stay.

3) COPD: On prn nebs at NH, which were continued.

4) CAD: The patient was continued on ASA, beta-blocker, and
Plavix

5) Type II diabetes: While in the ICU, the patient's
rosiglitazone was held. This was restarting following transfer
to the general floor. He was continued on a regular insulin
sliding scale.

6) Schizophrenia/Bipolar disorder: The patient was continued on
his home regimen of haldol and Zyprexa

7) Anemia: The patient's hematocrit was stable on discharge (29;
baseline high 20s/low 30s). Iron studies were not consistent
with deficiency. Vitamin B12 was elevated and folate level was
normal. His hematocrit will need to continue to be monitored.

Medications on Admission:
Aspirin 81 mg PO qd
Atenolol 12.5 mg PO qd
Rosiglitazone 2 mg PO qd
Amlodipine 5 mg PO qd
Clopidogrel 75 mg PO qd
Haloperidol decanoate 25 mg IM qoWed
Olanzapine 5 mg PO qd
Docusate 100 mg PO bid
Ranitidine 150 mg PO qd
Benztropine 1 mg PO tid
Haloperidol 5 mg IV bid prn
Regular insulin SS
Albuterol neb q6 hrs prn
Ipatropium neb q6hrs prn
Bisacodyl PR prn
Fleet's enema PR prn


Discharge Medications:
1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. Atenolol 25 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
3. Rosiglitazone 2 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Ferrous Sulfate 220 mg/5mL Elixir Sig: 7.5 ml PO once a day.

5. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Haloperidol Decanoate 100 mg/mL Solution Sig: Twenty Five
(25) mg Intramuscular every other Wednesday.
8. Olanzapine 2.5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
9. Zantac 15 mg/mL Syrup Sig: Ten (10) ml PO twice a day.
10. Benztropine 1 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
11. Haloperidol 1 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) as needed for agitation.
12. Ipratropium Bromide 0.02 % Solution Sig: One (1) neb
Inhalation Q6H (every 6 hours) as needed.
13. Albuterol Sulfate 0.083 % Solution Sig: One (1) neb
Inhalation Q6H (every 6 hours) as needed.
14. Vancomycin 1,000 mg Recon Soln Sig: Seven [**Age over 90 1230**]y
(750) mg Intravenous Q 24H (Every 24 Hours) for 9 days.
15. Piperacillin-Tazobactam 4.5 g Recon Soln Sig: One (1) Recon
Soln Intravenous Q8H (every 8 hours) for 9 days.
16. Heparin Flush PICC (100 units/ml) 2 ml IV DAILY:PRN
10 ml NS followed by 2 ml of 100 Units/ml heparin (200 units
heparin) each lumen Daily and PRN.  Inspect site every shift.
17. Insulin Regular Human 100 unit/mL Solution Sig: sliding
scale  Injection before each meal and at bedtime: If FS <150
give 0 units, if 151-200 give 2 units, if 201-250 give 4 units,
if 251-300 give 6 units, if 301-350 give 8 units, if 351-400
give 10 units, if >400 [**Name8 (MD) 138**] MD.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) **] Manor

Discharge Diagnosis:
Primary: aspiration pneumonia
Secondary: acute renal failure, chronic obstructive pulmonary
disease, coronary artery disease, type II diabetes
well-controlled without complications, Schizophrenia,
hypertension, anemia


Discharge Condition:
Stable 99% 2L NC


Discharge Instructions:
Please see your PCP or come to the emergency room if you develop
shortness of breath, fever, or other symptoms that concern you.

Followup Instructions:
Please follow-up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5762**] ([**Telephone/Fax (1) 608**]) within [**12-21**]
weeks following discharge.


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 2937**]

Completed by:[**2173-12-29**]
{'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Volume depletion, unspecified,Chronic airway obstruction, not elsewhere classified,Paranoid type schizophrenia, unspecified,Bipolar disorder, unspecified,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Esophageal reflux,Other persistent mental disorders due to conditions classified elsewhere'}


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, hypoxia

PRESENT ILLNESS: Mr. [**Known lastname 63077**] is a 77 yo male nursing home resident with
dementia, h/o aspiration pneumonia, COPD, HTN, DM2,
schizophrenia, bipolar disorder, GERD, angina and a h/o prostate
cancer who presents from his nurisng home with fever, shortness
of breath and increased sputum production.

MEDICAL HISTORY: Dementia
Paranoid Schizophrenia
DM2
Prostate Ca
Hypertension
GERD
Angina
Bipolar d/o
COPD
Hearing impaired

MEDICATION ON ADMISSION: Aspirin 81 mg PO qd
Atenolol 12.5 mg PO qd
Rosiglitazone 2 mg PO qd
Amlodipine 5 mg PO qd
Clopidogrel 75 mg PO qd
Haloperidol decanoate 25 mg IM qoWed
Olanzapine 5 mg PO qd
Docusate 100 mg PO bid
Ranitidine 150 mg PO qd
Benztropine 1 mg PO tid
Haloperidol 5 mg IV bid prn
Regular insulin SS
Albuterol neb q6 hrs prn
Ipatropium neb q6hrs prn
Bisacodyl PR prn
Fleet's enema PR prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:  Temp: 97.2   BP: 121/54   HR: 84   RR: 22   94%50% facemask
general: Difficult to rouse, does not open eyes, except to
sternal rub
HEENT: PERRL, anicteric, MMM, no significant JVD
Lungs: pt noncompliant with exam, diffuse ronchi, mild
expiratory wheeze, worse in lower lung fields
Heart: RR, S1 and S2 wnl, no appreciable murmurs, rubs or
gallops
Abdomen: G tube in place, no surrounding erythema or induration,
normoactive bowel sounds
Extremities: No edema
neuro: A&Ox1. Moving all extremeties well

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Patient lives in [**Location **] Manor nursing [**Last Name (un) **], wheelchair bound. He
has one son who lives in the area. He smokes 10 cigarettes/day.
Baseline ADL/IADLs unknown. 

### Response:
{'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Volume depletion, unspecified,Chronic airway obstruction, not elsewhere classified,Paranoid type schizophrenia, unspecified,Bipolar disorder, unspecified,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Esophageal reflux,Other persistent mental disorders due to conditions classified elsewhere'}
