CHIEF COMPLAINT: fever

PRESENT ILLNESS: Ms. [**Known lastname 6995**] is a 36 yo F w/end-stage [**Location (un) 6988**] disease who
was recently dc'd from the MICU on [**2189-2-2**] after tx for PNA and
SVT (requiring cardioversion) who was brought in by family after
she was noted to be febrile to 102F. Her sister and caregivers
noted a productive cough, congestion, but deny witnessing
diarrhea/vomiting. She was also noted to have depressed mental
status and decreased po intake over the past few days. Family
denies noticing respiratory distress. Per the family, her
baseline SBPs in 80's-90's.
.
In the ED, the pt was noted to be febrile to 103.2 and
tachycardic to 104. Her BP was 107/63 with a respiratory rate of
20 and a room air O2 saturation of 97%. She had poor air
movement on lung exam and cool extremities. Of note, the patient
is nonverbal at baseline and does not follow commands.
.
A CXR in the ED did not show any new focal infiltrates or
effusions. There was no evidence for active CHF. It appeared
improved vs. [**2189-2-2**].
An EKG revealed old, nonspecific ST/TW changes laterally and
diffuse low-voltage. Blood cultures and urine culture were sent
from the ED. She was started on levofloxacin/flagyl.

MEDICAL HISTORY: [**Location (un) 6988**] Disease
Anemia
CHF: EF 10%
Nonverbal at baseline

MEDICATION ON ADMISSION: -lasix
-asa
-amiodarone
-amoxicillin

ALLERGIES: Haldol

PHYSICAL EXAM: 97.7, 67, 84/51, 16,
GEN: Awake, occasional tracks to voice, nonverbal. Appears in
NAD.
HEENT: PERRL bilat., MM moist, no LAD.
CV: RRR, difficult exam secondary to pt motion
RESP: diffusely diminished breath sounds at bases, coarse upper
airway sounds bilaterally at apices.
ABD: soft, NT/ND. +bs
EXT: wdwp.
NEURO: ++choreoathetoid movements. unable to test.

FAMILY HISTORY: father who passed away of [**Name (NI) **] dz

SOCIAL HISTORY: MEDS:
Tylenol
Ensure
.
SocHX: Patient lives at home with sister and brother.  She also
goes to daycare.  She is non-verbal at baseline.
.
Pneumonia, organism unspecified,Congestive heart failure, unspecified,Huntington's chorea
Pneumonia, organism NOS,CHF NOS,Huntington's chorea
Admission Date:  [**2189-2-21**]              Discharge Date:   [**2189-2-25**]

Date of Birth:  [**2153-9-26**]             Sex:   F

Service: MEDICINE

Allergies:
Haldol

Attending:[**First Name3 (LF) 6994**]
Chief Complaint:
fever

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Ms. [**Known lastname 6995**] is a 36 yo F w/end-stage [**Location (un) 6988**] disease who
was recently dc'd from the MICU on [**2189-2-2**] after tx for PNA and
SVT (requiring cardioversion) who was brought in by family after
she was noted to be febrile to 102F. Her sister and caregivers
noted a productive cough, congestion, but deny witnessing
diarrhea/vomiting. She was also noted to have depressed mental
status and decreased po intake over the past few days. Family
denies noticing respiratory distress. Per the family, her
baseline SBPs in 80's-90's.
.
In the ED, the pt was noted to be febrile to 103.2 and
tachycardic to 104. Her BP was 107/63 with a respiratory rate of
20 and a room air O2 saturation of 97%. She had poor air
movement on lung exam and cool extremities. Of note, the patient
is nonverbal at baseline and does not follow commands.
.
A CXR in the ED did not show any new focal infiltrates or
effusions. There was no evidence for active CHF. It appeared
improved vs. [**2189-2-2**].
An EKG revealed old, nonspecific ST/TW changes laterally and
diffuse low-voltage. Blood cultures and urine culture were sent
from the ED. She was started on levofloxacin/flagyl.


Past Medical History:
[**Location (un) 6988**] Disease
Anemia
CHF: EF 10%
Nonverbal at baseline


Social History:
MEDS:
Tylenol
Ensure
.
SocHX: Patient lives at home with sister and brother.  She also
goes to daycare.  She is non-verbal at baseline.
.


Family History:
father who passed away of [**Name (NI) **] dz

Physical Exam:
97.7, 67, 84/51, 16,
GEN: Awake, occasional tracks to voice, nonverbal. Appears in
NAD.
HEENT: PERRL bilat., MM moist, no LAD.
CV: RRR, difficult exam secondary to pt motion
RESP: diffusely diminished breath sounds at bases, coarse upper
airway sounds bilaterally at apices.
ABD: soft, NT/ND. +bs
EXT: wdwp.
NEURO: ++choreoathetoid movements. unable to test.


Brief Hospital Course:
A/P: 35 yo F w/end stage [**Location (un) 6988**], recent dc from MICU for
PNA/SVT, who presented with fever, cough, and altered mental
status. Despite improved CXR, concern for PNA.
.
1. Fever: Pt with fever at home to 103, recent hospitalization
and tx for PNA. Despite improved cxr, lungs are most likely
source of infection. UA was negative. Blood cultures from prev
hospitalization NGTD. Cultures from ED were also neagitve. The
patient was started on broad spectrum antibiotics initially but
then converted to oral levaquin and flagyl.  The patient was
afebrile while hospitalized.

.
2. [**Location (un) 6988**]: Pt has end-stage [**Location (un) 6988**] disease. Dr
[**Last Name (STitle) **] was aware that the patient was hospitalized and spoke
with the family about goals of care.
.
3. SVT: Hx of recent SVT requiring cardioversion. Started on
amiodarone at d/c from hospital on last admission.  The patient
had no issues with tachycardia this admission.
.
4. CHF: Pt has CHF w/EF 10% by report. No clinical evidence of
failure. Pt did not have any fluid overload issues while
hospitalized.

Medications on Admission:
-lasix
-asa
-amiodarone
-amoxicillin

Discharge Medications:
1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 4 days.
Disp:*qs Tablet(s)* Refills:*0*
5. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 4 days.
Disp:*4 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] [**Location (un) 269**]

Discharge Diagnosis:
Fever
--------
Secondary
Hunnington's Disease
Congestive Heart Failure


Discharge Condition:
Stable, afebrile


Discharge Instructions:
You were treated in the hospital for fever.  We did not find a
source of infection.  You were treated in the ICU because your
initial blood pressure was low but then transferred to the
floor.  You were treated with antibiotics for a presumed
pneumonia given the symptoms that you came in with.  You should
finish the course of antibiotics when at home.

Call your primary care provider or return to the emergency
department for any of the following:
fever, chills, chest pain, shortness of breath, nausea,
vomiting, diarrhea, constipation, or other concerning symptoms

Other than the new prescription for antibiotics, we did not make
any changes to your home medications.  Please resume your home
medications upon discharge

Followup Instructions:
Follow up with Dr [**Last Name (STitle) **] in one week.  Please call [**Telephone/Fax (1) **]
to schedule an appointment.

Follow up with Dr [**Last Name (STitle) **] for further care.
{"Pneumonia, organism unspecified,Congestive heart failure, unspecified,Huntington's chorea"}


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

PRESENT ILLNESS: Ms. [**Known lastname 6995**] is a 36 yo F w/end-stage [**Location (un) 6988**] disease who
was recently dc'd from the MICU on [**2189-2-2**] after tx for PNA and
SVT (requiring cardioversion) who was brought in by family after
she was noted to be febrile to 102F. Her sister and caregivers
noted a productive cough, congestion, but deny witnessing
diarrhea/vomiting. She was also noted to have depressed mental
status and decreased po intake over the past few days. Family
denies noticing respiratory distress. Per the family, her
baseline SBPs in 80's-90's.
.
In the ED, the pt was noted to be febrile to 103.2 and
tachycardic to 104. Her BP was 107/63 with a respiratory rate of
20 and a room air O2 saturation of 97%. She had poor air
movement on lung exam and cool extremities. Of note, the patient
is nonverbal at baseline and does not follow commands.
.
A CXR in the ED did not show any new focal infiltrates or
effusions. There was no evidence for active CHF. It appeared
improved vs. [**2189-2-2**].
An EKG revealed old, nonspecific ST/TW changes laterally and
diffuse low-voltage. Blood cultures and urine culture were sent
from the ED. She was started on levofloxacin/flagyl.

MEDICAL HISTORY: [**Location (un) 6988**] Disease
Anemia
CHF: EF 10%
Nonverbal at baseline

MEDICATION ON ADMISSION: -lasix
-asa
-amiodarone
-amoxicillin

ALLERGIES: Haldol

PHYSICAL EXAM: 97.7, 67, 84/51, 16,
GEN: Awake, occasional tracks to voice, nonverbal. Appears in
NAD.
HEENT: PERRL bilat., MM moist, no LAD.
CV: RRR, difficult exam secondary to pt motion
RESP: diffusely diminished breath sounds at bases, coarse upper
airway sounds bilaterally at apices.
ABD: soft, NT/ND. +bs
EXT: wdwp.
NEURO: ++choreoathetoid movements. unable to test.

FAMILY HISTORY: father who passed away of [**Name (NI) **] dz

SOCIAL HISTORY: MEDS:
Tylenol
Ensure
.
SocHX: Patient lives at home with sister and brother.  She also
goes to daycare.  She is non-verbal at baseline.
. 

### Response:
{"Pneumonia, organism unspecified,Congestive heart failure, unspecified,Huntington's chorea"}
