CHIEF COMPLAINT: weakness, hypotension

PRESENT ILLNESS: Ms [**Name13 (STitle) 43791**] is a 64-year-old female with metastatic breast
cancer, history of DVT, s/p recent ureteral stent placement
([**2162-1-12**])for left sided hydroureteronephrosis, who was
transferred to the [**Hospital1 18**] with weakness, hypotension. The patient
was initially brought to [**Hospital3 417**] hospital after being
found on her bathroom floor, without loss of consciousness,
apparently following a fall in which she injured her right knee.
.
Upon arrival to the ED, the patient was found to be hypotensive
with a BP of 94/37. She received 2.5 L of NS with minimal
improvement in her BP, and was started on Levophed for her
hypotension. CT scan of the abdomen and pelvis revealed possible
mild diverticulitis, and her U/A was suggestive of UTI. She
subsequently was transferred to the [**Hospital Unit Name 153**] for presumed urosepsis.
.
In the [**Hospital Unit Name 153**], she was initially treated with cipro/flagyl. She
was persistently hypotensive requiring IVF and levophed.
Ceftriaxone was added to regimen. Vancomycin was also added
given persistent hypotension. She underwent a percutaneous
nephrostomy tube placement on [**2162-1-18**]. She has been off
vasopressors since pm [**1-18**]. She was transfused 1 unit PRBCs on
[**1-19**] for Hct 24->22. She has had no evidence of active bleeding.
She has been maintained on dilaudid PCA for back pain and plan
was to wean off 12 hrs after placement of fentanyl patch (she
was found to have 2 patches on by nursing, both of which were
removed and new patch placed at 8 pm [**1-19**]. She has only minimal
PCA requirements at this time.
.
Currently, patient is feeling well. Niece is at bedside to
interpret. Patient currently notes back pain, which has been
improving. She also notes R knee pain with movement. She denies
fevers, chills, chest pain, SOB, abdominal pain, nausea,
vomiting.

MEDICAL HISTORY: # metastatic breast cancer s/p chemo, XRT, 5 years tamoxifen,
arimidex, Cyberknife, Xeloda, Zometa
# Left-sided hydroureteronephrosis with a question of mass at
the left ureter s/p ureteral stent placement [**2162-1-12**]
# DVT treated with lovenox [**2161-2-19**]
# Right total knee replacement
# HTN
# s/p Thyroidectomy
# s/p Cholecystectomy
.
Onc History:
She was diagnosed with left-sided breast cancer with lumpectomy
and axillary lymph node dissection 12 years ago.  She had stage
II disease and was treated with adjuvant radiation therapy and
chemotherapy and five years of tamoxifen.  She later had a
mastectomy, which had no evidence of residual disease.  In
[**8-/2159**], she presented with bone metastases and diffuse
lymphadenopathy.  A lymph node biopsy of a left supraclavicular
node confirmed metastatic disease on [**2159-10-1**].  The tumor was
ER/PR positive and HER-2/neu negative. Currently on Arimidex
and Zometa beginning in 11/[**2158**]. Received 10 treatments XRT for
lesion growing on C2 bone, completed [**2160-9-17**].

MEDICATION ON ADMISSION: CAPECITABINE [XELODA] - 1500 mg in am, 1000mg in pm
ENOXAPARIN [LOVENOX] - 120 mg/0.8 mL Syringe qd
FENTANYL [DURAGESIC] - 75 mcg/hour Patch 72 hr - 1 patch TD q 72
hours
LOVASTATIN - (Prescribed by Other Provider) - 40 mg qhs
NYSTATIN - 100,000 unit/mL Suspension - 5 mL Suspension(s) by
mouth four times a day Swish
OMEPRAZOLE [PRILOSEC] - 20 mg [**Hospital1 **]
OXYCODONE - 5 mg q 3-4 hours prn pain
PROCHLORPERAZINE EDISYLATE [COMPAZINE] - 10 mg q8hrs prn nausea
VALSARTAN [DIOVAN] - 160 mg qd
ZOLEDRONIC ACID [ZOMETA] - (infusion in clinic) - 4 mg/5 mL
Solution - monthly
ACETAMINOPHEN [TYLENOL] - 325 mg by mouth daily
MULTIVITAMINS-MINERALS-LUTEIN [CENTRUM SILVER]
SENNOSIDES-DOCUSATE SODIUM [PERI-COLACE] - 8.6 mg-50 mg [**Hospital1 **]
.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T: 96.1 BP: 102/57 HR: 80 RR: 20 O2 97% RA
Gen: Pleasant, well appearing female in NAD
HEENT: No conjunctival pallor. No icterus. MMM. OP clear.
NECK: Supple, No LAD, JVP low.
CV: RRR. nl S1, S2. II/VI sys murmur. L portocath CDI.
LUNGS: Bibasilar crackles.
ABD: Obese. NABS. Soft, NT, ND. No HSM. L sided nephrostomy tube
dressed, CDI.
EXT: WWP, NO CCE. 2+ DP pulses BL
MSK: + R knee effusion with pain on active and passive ROM
SKIN: No rashes/lesions, ecchymoses.
NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Moving all
extremities.

FAMILY HISTORY: NC

SOCIAL HISTORY: Patient lives at home with her husband. [**Name (NI) **] [**Name2 (NI) **], etoh, drugs.
Hydronephrosis,Secondary malignant neoplasm of bone and bone marrow,Urinary tract infection, site not specified,Pain in joint, lower leg,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Personal history of malignant neoplasm of breast,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health,History of fall,Personal history of venous thrombosis and embolism,Knee joint replacement,Iron deficiency anemia secondary to blood loss (chronic)
Hydronephrosis,Secondary malig neo bone,Urin tract infection NOS,Joint pain-l/leg,Hyperlipidemia NEC/NOS,Hypertension NOS,Hx of breast malignancy,Hx antineoplastic chemo,Hx of irradiation,Personal history of fall,Hx-ven thrombosis/embols,Joint replaced knee,Chr blood loss anemia
Admission Date:  [**2162-1-17**]              Discharge Date:   [**2162-1-23**]

Date of Birth:  [**2097-1-8**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 6021**]
Chief Complaint:
weakness, hypotension

Major Surgical or Invasive Procedure:
IR percutaneous nephrostomy tube placement [**2162-1-18**]


History of Present Illness:
Ms [**Name13 (STitle) 43791**] is a 64-year-old female with metastatic breast
cancer, history of DVT, s/p recent ureteral stent placement
([**2162-1-12**])for left sided hydroureteronephrosis, who was
transferred to the [**Hospital1 18**] with weakness, hypotension. The patient
was initially brought to [**Hospital3 417**] hospital after being
found on her bathroom floor, without loss of consciousness,
apparently following a fall in which she injured her right knee.
.
Upon arrival to the ED, the patient was found to be hypotensive
with a BP of 94/37. She received 2.5 L of NS with minimal
improvement in her BP, and was started on Levophed for her
hypotension. CT scan of the abdomen and pelvis revealed possible
mild diverticulitis, and her U/A was suggestive of UTI. She
subsequently was transferred to the [**Hospital Unit Name 153**] for presumed urosepsis.
.
In the [**Hospital Unit Name 153**], she was initially treated with cipro/flagyl. She
was persistently hypotensive requiring IVF and levophed.
Ceftriaxone was added to regimen. Vancomycin was also added
given persistent hypotension. She underwent a percutaneous
nephrostomy tube placement on [**2162-1-18**]. She has been off
vasopressors since pm [**1-18**]. She was transfused 1 unit PRBCs on
[**1-19**] for Hct 24->22. She has had no evidence of active bleeding.
She has been maintained on dilaudid PCA for back pain and plan
was to wean off 12 hrs after placement of fentanyl patch (she
was found to have 2 patches on by nursing, both of which were
removed and new patch placed at 8 pm [**1-19**]. She has only minimal
PCA requirements at this time.
.
Currently, patient is feeling well. Niece is at bedside to
interpret. Patient currently notes back pain, which has been
improving. She also notes R knee pain with movement. She denies
fevers, chills, chest pain, SOB, abdominal pain, nausea,
vomiting.

Past Medical History:
# metastatic breast cancer s/p chemo, XRT, 5 years tamoxifen,
arimidex, Cyberknife, Xeloda, Zometa
# Left-sided hydroureteronephrosis with a question of mass at
the left ureter s/p ureteral stent placement [**2162-1-12**]
# DVT treated with lovenox [**2161-2-19**]
# Right total knee replacement
# HTN
# s/p Thyroidectomy
# s/p Cholecystectomy
.
Onc History:
She was diagnosed with left-sided breast cancer with lumpectomy
and axillary lymph node dissection 12 years ago.  She had stage
II disease and was treated with adjuvant radiation therapy and
chemotherapy and five years of tamoxifen.  She later had a
mastectomy, which had no evidence of residual disease.  In
[**8-/2159**], she presented with bone metastases and diffuse
lymphadenopathy.  A lymph node biopsy of a left supraclavicular
node confirmed metastatic disease on [**2159-10-1**].  The tumor was
ER/PR positive and HER-2/neu negative. Currently on Arimidex
and Zometa beginning in 11/[**2158**]. Received 10 treatments XRT for
lesion growing on C2 bone, completed [**2160-9-17**].


Social History:
Patient lives at home with her husband. [**Name (NI) **] [**Name2 (NI) **], etoh, drugs.


Family History:
NC

Physical Exam:
T: 96.1 BP: 102/57 HR: 80 RR: 20 O2 97% RA
Gen: Pleasant, well appearing female in NAD
HEENT: No conjunctival pallor. No icterus. MMM. OP clear.
NECK: Supple, No LAD, JVP low.
CV: RRR. nl S1, S2. II/VI sys murmur. L portocath CDI.
LUNGS: Bibasilar crackles.
ABD: Obese. NABS. Soft, NT, ND. No HSM. L sided nephrostomy tube
dressed, CDI.
EXT: WWP, NO CCE. 2+ DP pulses BL
MSK: + R knee effusion with pain on active and passive ROM
SKIN: No rashes/lesions, ecchymoses.
NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Moving all
extremities.

Pertinent Results:
On Admission:
[**2162-1-17**] 03:15PM BLOOD WBC-9.8 RBC-2.79* Hgb-10.3* Hct-30.3*
MCV-109* MCH-37.1* MCHC-34.1 RDW-16.4* Plt Ct-234
[**2162-1-17**] 03:15PM BLOOD Neuts-84.0* Lymphs-12.4* Monos-2.5
Eos-0.8 Baso-0.2
[**2162-1-17**] 03:15PM BLOOD PT-14.5* PTT-33.4 INR(PT)-1.3*
[**2162-1-17**] 03:15PM BLOOD Glucose-161* UreaN-28* Creat-1.7* Na-142
K-4.5 Cl-113* HCO3-21* AnGap-13
[**2162-1-18**] 03:59AM BLOOD ALT-14 AST-17 LD(LDH)-219 AlkPhos-47
TotBili-0.3
[**2162-1-18**] 03:59AM BLOOD Albumin-3.4 Calcium-8.2* Phos-1.3* Mg-1.9
.
Imaging:
CT Abdomen/Pelvis:
1. Colonic diverticulosis with minimal perisigmoid inflammatory
fat strand to
suggest uncomplicated diverticulitis.

2. Persistent left hydroureteronephrosis with indwelling
internal nephrostomy
stent. There is high attenuation layering in the dilated left
collecting
system, this may represent debris, infection or hemorrhage.

3. No significant change in appearance of known osseous
metastases.


Brief Hospital Course:
[**Hospital Unit Name 13533**]:
Patient was admitted to the [**Hospital Unit Name 153**] with hypotension. It was felt
to be urosepsis from pyelonephritis. A CT scan demonstrated
stranding and possible infection in the collecting system of her
recently stented kidney. She was given fluids and levophed. She
did not improve during the first 24 hours of her admission, and
was unable to wean from levophed. Thus, she was taken for a
percutaneous nephrostomy tube. During the next 12 hours, she was
able to wean from levophed. She was continued on vancomycin,
ceftriaxone and cipro, double coverage for possible gram
negatives and pseudomonas. She was called out to Oncology
service for continued management of metastatic breast cancer
with bony mets.
.
Oncology Course: According to problems.
.
# Urosepsis ?: Felt to be etiology of hypotension, however
unclear. [**Name2 (NI) **] positive cultures. However, CT does demonstrate high
attenuation focus which could be infection - consequently
continued Cipro for 10 day course.
.
# L hydronephrosis: CT Abdomen [**10-17**] new L hydronephrosis with
transition point mid ureter -> concerning for metastasis left
ureter. Stent placed [**2162-1-12**]. CT abdomen [**1-18**] persistent L
hydroureteronephrosis indwelling internal nephrostimy stent.
High attenuation dilated L collecting - diff includes debris,
infection, hemorrhage.
- Patient to follow-up with urology (Dr. [**Last Name (STitle) 770**] as outpatient
in [**1-13**] weeks
- To be discharged with draining PTC drain - will need to follow
up with Interventional Radiology
.
# Anemia: Most likely secondary to hematuria, serosangiunous
draining from PTC. Patient to follow-up with urology as
outpatient.
.
# Knee Pain: Chronic plus recent trauma. Resolved with lidocaine
patch. Continue outpatient pain medications.
.
# Breast Cancer: s/p multiple rounds of chemo, hormonal therapy,
XRT, and Cyberknife.
- Per primary oncologist
.
# h/o DVT: Diagnosed [**2161-2-19**]. Had been on lovenox. Was initially
transitioned to heparin gtt, stopped [**1-18**] prior to percutaneous
nephrostomy tube placement.
- Prior to discharge re-started patient on prophylactic Lovenox
dose
.
# HTN: Valsartan was discontinued. Patient's BP < 120. [**Month (only) 116**] be
re-started as outpatient is blood pressure increases.
.
# Hyperlididemia: Continued statin


Medications on Admission:
CAPECITABINE [XELODA] - 1500 mg in am, 1000mg in pm
ENOXAPARIN [LOVENOX] - 120 mg/0.8 mL Syringe qd
FENTANYL [DURAGESIC] - 75 mcg/hour Patch 72 hr - 1 patch TD q 72
hours
LOVASTATIN - (Prescribed by Other Provider) - 40 mg qhs
NYSTATIN - 100,000 unit/mL Suspension - 5 mL Suspension(s) by
mouth four times a day Swish
OMEPRAZOLE [PRILOSEC] - 20 mg [**Hospital1 **]
OXYCODONE - 5 mg q 3-4 hours prn pain
PROCHLORPERAZINE EDISYLATE [COMPAZINE] - 10 mg q8hrs prn nausea
VALSARTAN [DIOVAN] - 160 mg qd
ZOLEDRONIC ACID [ZOMETA] - (infusion in clinic) - 4 mg/5 mL
Solution - monthly
ACETAMINOPHEN [TYLENOL] - 325 mg by mouth daily
MULTIVITAMINS-MINERALS-LUTEIN [CENTRUM SILVER]
SENNOSIDES-DOCUSATE SODIUM [PERI-COLACE] - 8.6 mg-50 mg [**Hospital1 **]
.

Discharge Medications:
1. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical QD (): 12 hours on, 12
hours off. Apply to knee.  .
2. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
4. Prochlorperazine Maleate 10 mg Tablet Sig: One (1) Tablet PO
Q8H (every 8 hours) as needed for nausea.
5. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day).
6. Fentanyl 75 mcg/hr Patch 72 hr Sig: One (1) Patch 72 hr
Transdermal Q72H (every 72 hours).
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
9. Polyethylene Glycol 3350 100 % Powder Sig: One (1)  PO DAILY
(Daily) as needed for constipation.
10. Morphine 15 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
11. Enoxaparin 40 mg/0.4 mL Syringe Sig: One (1)  Subcutaneous
Q24H (every 24 hours).
12. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 6 days: For 10 day total. .


Discharge Disposition:
Extended Care

Facility:
Bay [**Hospital **] Rehab

Discharge Diagnosis:
Breast Cancer
L hydronephrosis
Anemia, hematuria
Possible urosepsis


Discharge Condition:
Good, ambulating, stable BP.


Discharge Instructions:
You were admitted for low blood pressure and weakness. You were
monitored in the ICU, started on antibiotics and a tube was
placed to drain your kidney.
.
Attend all your follow-up appointments.
.
Follow your discharge medication list closely.
.
Return to the ER if you experience fever, chills, abdominal
pain, difficulty breathing, passing out or other concerning
symptoms.

Followup Instructions:
You need to follow-up with urology, Dr. [**Last Name (STitle) 770**], in [**1-13**] weeks.
We were unable to schedule you the appointment, please call
([**Telephone/Fax (1) 7707**] to make an appointment. It is very important you
follow-up with Urology regarding your stent.
.
Schedule an appointment with your primary care doctor,
[**Doctor Last Name 43792**],TALIN [**Telephone/Fax (1) 3183**], in [**12-11**] weeks.



Completed by:[**2162-1-24**]
{'Hydronephrosis,Secondary malignant neoplasm of bone and bone marrow,Urinary tract infection, site not specified,Pain in joint, lower leg,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Personal history of malignant neoplasm of breast,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health,History of fall,Personal history of venous thrombosis and embolism,Knee joint replacement,Iron deficiency anemia secondary to blood loss (chronic)'}


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: weakness, hypotension

PRESENT ILLNESS: Ms [**Name13 (STitle) 43791**] is a 64-year-old female with metastatic breast
cancer, history of DVT, s/p recent ureteral stent placement
([**2162-1-12**])for left sided hydroureteronephrosis, who was
transferred to the [**Hospital1 18**] with weakness, hypotension. The patient
was initially brought to [**Hospital3 417**] hospital after being
found on her bathroom floor, without loss of consciousness,
apparently following a fall in which she injured her right knee.
.
Upon arrival to the ED, the patient was found to be hypotensive
with a BP of 94/37. She received 2.5 L of NS with minimal
improvement in her BP, and was started on Levophed for her
hypotension. CT scan of the abdomen and pelvis revealed possible
mild diverticulitis, and her U/A was suggestive of UTI. She
subsequently was transferred to the [**Hospital Unit Name 153**] for presumed urosepsis.
.
In the [**Hospital Unit Name 153**], she was initially treated with cipro/flagyl. She
was persistently hypotensive requiring IVF and levophed.
Ceftriaxone was added to regimen. Vancomycin was also added
given persistent hypotension. She underwent a percutaneous
nephrostomy tube placement on [**2162-1-18**]. She has been off
vasopressors since pm [**1-18**]. She was transfused 1 unit PRBCs on
[**1-19**] for Hct 24->22. She has had no evidence of active bleeding.
She has been maintained on dilaudid PCA for back pain and plan
was to wean off 12 hrs after placement of fentanyl patch (she
was found to have 2 patches on by nursing, both of which were
removed and new patch placed at 8 pm [**1-19**]. She has only minimal
PCA requirements at this time.
.
Currently, patient is feeling well. Niece is at bedside to
interpret. Patient currently notes back pain, which has been
improving. She also notes R knee pain with movement. She denies
fevers, chills, chest pain, SOB, abdominal pain, nausea,
vomiting.

MEDICAL HISTORY: # metastatic breast cancer s/p chemo, XRT, 5 years tamoxifen,
arimidex, Cyberknife, Xeloda, Zometa
# Left-sided hydroureteronephrosis with a question of mass at
the left ureter s/p ureteral stent placement [**2162-1-12**]
# DVT treated with lovenox [**2161-2-19**]
# Right total knee replacement
# HTN
# s/p Thyroidectomy
# s/p Cholecystectomy
.
Onc History:
She was diagnosed with left-sided breast cancer with lumpectomy
and axillary lymph node dissection 12 years ago.  She had stage
II disease and was treated with adjuvant radiation therapy and
chemotherapy and five years of tamoxifen.  She later had a
mastectomy, which had no evidence of residual disease.  In
[**8-/2159**], she presented with bone metastases and diffuse
lymphadenopathy.  A lymph node biopsy of a left supraclavicular
node confirmed metastatic disease on [**2159-10-1**].  The tumor was
ER/PR positive and HER-2/neu negative. Currently on Arimidex
and Zometa beginning in 11/[**2158**]. Received 10 treatments XRT for
lesion growing on C2 bone, completed [**2160-9-17**].

MEDICATION ON ADMISSION: CAPECITABINE [XELODA] - 1500 mg in am, 1000mg in pm
ENOXAPARIN [LOVENOX] - 120 mg/0.8 mL Syringe qd
FENTANYL [DURAGESIC] - 75 mcg/hour Patch 72 hr - 1 patch TD q 72
hours
LOVASTATIN - (Prescribed by Other Provider) - 40 mg qhs
NYSTATIN - 100,000 unit/mL Suspension - 5 mL Suspension(s) by
mouth four times a day Swish
OMEPRAZOLE [PRILOSEC] - 20 mg [**Hospital1 **]
OXYCODONE - 5 mg q 3-4 hours prn pain
PROCHLORPERAZINE EDISYLATE [COMPAZINE] - 10 mg q8hrs prn nausea
VALSARTAN [DIOVAN] - 160 mg qd
ZOLEDRONIC ACID [ZOMETA] - (infusion in clinic) - 4 mg/5 mL
Solution - monthly
ACETAMINOPHEN [TYLENOL] - 325 mg by mouth daily
MULTIVITAMINS-MINERALS-LUTEIN [CENTRUM SILVER]
SENNOSIDES-DOCUSATE SODIUM [PERI-COLACE] - 8.6 mg-50 mg [**Hospital1 **]
.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T: 96.1 BP: 102/57 HR: 80 RR: 20 O2 97% RA
Gen: Pleasant, well appearing female in NAD
HEENT: No conjunctival pallor. No icterus. MMM. OP clear.
NECK: Supple, No LAD, JVP low.
CV: RRR. nl S1, S2. II/VI sys murmur. L portocath CDI.
LUNGS: Bibasilar crackles.
ABD: Obese. NABS. Soft, NT, ND. No HSM. L sided nephrostomy tube
dressed, CDI.
EXT: WWP, NO CCE. 2+ DP pulses BL
MSK: + R knee effusion with pain on active and passive ROM
SKIN: No rashes/lesions, ecchymoses.
NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Moving all
extremities.

FAMILY HISTORY: NC

SOCIAL HISTORY: Patient lives at home with her husband. [**Name (NI) **] [**Name2 (NI) **], etoh, drugs. 

### Response:
{'Hydronephrosis,Secondary malignant neoplasm of bone and bone marrow,Urinary tract infection, site not specified,Pain in joint, lower leg,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Personal history of malignant neoplasm of breast,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health,History of fall,Personal history of venous thrombosis and embolism,Knee joint replacement,Iron deficiency anemia secondary to blood loss (chronic)'}
