CHIEF COMPLAINT: Urosepsis

PRESENT ILLNESS: [**Age over 90 **]F from nursing home ([**Hospital1 **]) recently dc'd from [**Hospital1 18**] after
being admitted for weakness, abd pain, taken to [**Hospital1 **] ed for
periods of unresponsiveness and delta ms. Somnolent and
arousable to pain in the ED. Bp was 90/50 at NH, down to 83/43;
satting 92% ra. Upon arrival from to the ED, HR was 55; BP was
78/55 and RR 20, 100% on 2L. Got 1L NS, BP increased from 80s to
110s. Pt received vanc/levo/flagyl in the ED along with ASA and
Narcan (for pinpoint pupils). Pt has chronic abd pain and
tonight was also c/o tenderness over the bladder.
.
On arrival to the floor, patient was initially agitated and
speaking loudly/groaning. Pt denied any pain. Became
progressively less arousable with HR down to 40s, BP down to
70s/80s systolic when patient sleeping. Given atropine 0.5 mg X
1 with HR to 60s/70s. Normal saline bolus completed; oxygen sats
decreased to high 80s/low 90s on nasal cannula so patient placed
on nonrebreather with sats up to 100%. Repeat CXR and portable
abdomen performed. ABG sent.
.
MICU COURSE:
[**2-17**]: Levo/Flagyl changed to Zosyn. Vanc dosed q48h. Fluid
boluses to keep SBP up

MEDICAL HISTORY: PAST MEDICAL HISTORY:
1. Diverticulosis [**2180**].
2. Irritable bowel syndrome.
3. Spinal stenosis.
4. Memory loss - CT c/w old small vascular disease
#. Lacunar infarct left caudate lobe and right thalamus
5. Hearing loss.
6. Vitamin B12 deficiency.
7. Retinal detachment [**2170**].
8. Chronic abdominal pain
PAST SURGICAL HISTORY: Status post tonsillectomy

MEDICATION ON ADMISSION: tylenol prn
mom
dulcolax
[**Name2 (NI) 109927**] 10 qhs
asa 81 qd
celexa 10 qd
lipitor 10 qd
psyllium
vit b12 100mcg qd
vit d
zyprexa 2.5 po qhs
prilosec 20 qd
atenolol 12.5 qd
lisinopril 5mg qd
detrol 2mg qhs

ALLERGIES: Zosyn

PHYSICAL EXAM: temp 97.4, hr 76/min, rr 18/min, sats 97% on RA, bp 146/76
neck supple, no jvd, no bruit
rrr, nl s1+s2, PSM in apex to axilla
chest with reduced air entry bilaterally, but no wheeze or
crackles
[**Last Name (un) 103**] soft, non tender, nl bs
no o/c/c

FAMILY HISTORY: nc

SOCIAL HISTORY: She was an English professor for many years. She now lives with
her husband, [**Name (NI) **], who is her primary caregiver. She has two
sons, one in [**Name (NI) 531**] and the other one in [**Location (un) 86**].
Unspecified septicemia,Urinary tract infection, site not specified,Retention of urine, unspecified,Acute kidney failure, unspecified,Dehydration,Severe sepsis,Other alteration of consciousness
Septicemia NOS,Urin tract infection NOS,Retention urine NOS,Acute kidney failure NOS,Dehydration,Severe sepsis,Other alter consciousnes
Admission Date:  [**2188-2-17**]              Discharge Date:   [**2188-2-25**]


Service: MEDICINE

Allergies:
Zosyn

Attending:[**First Name3 (LF) 3507**]
Chief Complaint:
Urosepsis

Major Surgical or Invasive Procedure:
None

History of Present Illness:
[**Age over 90 **]F from nursing home ([**Hospital1 **]) recently dc'd from [**Hospital1 18**] after
being admitted for weakness, abd pain, taken to [**Hospital1 **] ed for
periods of unresponsiveness and delta ms. Somnolent and
arousable to pain in the ED. Bp was 90/50 at NH, down to 83/43;
satting 92% ra. Upon arrival from to the ED, HR was 55; BP was
78/55 and RR 20, 100% on 2L. Got 1L NS, BP increased from 80s to
110s. Pt received vanc/levo/flagyl in the ED along with ASA and
Narcan (for pinpoint pupils). Pt has chronic abd pain and
tonight was also c/o tenderness over the bladder.
.
On arrival to the floor, patient was initially agitated and
speaking loudly/groaning. Pt denied any pain. Became
progressively less arousable with HR down to 40s, BP down to
70s/80s systolic when patient sleeping. Given atropine 0.5 mg X
1 with HR to 60s/70s. Normal saline bolus completed; oxygen sats
decreased to high 80s/low 90s on nasal cannula so patient placed
on nonrebreather with sats up to 100%. Repeat CXR and portable
abdomen performed. ABG sent.
.
MICU COURSE:
[**2-17**]: Levo/Flagyl changed to Zosyn. Vanc dosed q48h. Fluid
boluses to keep SBP up


Past Medical History:
PAST MEDICAL HISTORY:
1. Diverticulosis [**2180**].
2. Irritable bowel syndrome.
3. Spinal stenosis.
4. Memory loss - CT c/w old small vascular disease
#. Lacunar infarct left caudate lobe and right thalamus
5. Hearing loss.
6. Vitamin B12 deficiency.
7. Retinal detachment [**2170**].
8. Chronic abdominal pain
PAST SURGICAL HISTORY: Status post tonsillectomy


Social History:
She was an English professor for many years. She now lives with
her husband, [**Name (NI) **], who is her primary caregiver. She has two
sons, one in [**Name (NI) 531**] and the other one in [**Location (un) 86**].

Family History:
nc

Physical Exam:
temp 97.4, hr 76/min, rr 18/min, sats 97% on RA, bp 146/76
neck supple, no jvd, no bruit
rrr, nl s1+s2, PSM in apex to axilla
chest with reduced air entry bilaterally, but no wheeze or
crackles
[**Last Name (un) 103**] soft, non tender, nl bs
no o/c/c


Pertinent Results:
pCXR: Left basilar atelectasis. No evidence of pneumonia or CHF.
.
TTE: Symmetric left ventricular hypertrophy with preserved
global and
regional biventricular systolic function. Aortic valve stenosis.
Pulmonary  artery systolic hypertension.
.

[**2188-2-16**] 11:00PM BLOOD CK-MB-NotDone cTropnT-0.04*
[**2188-2-17**] 07:00AM BLOOD CK-MB-5 cTropnT-0.03*
[**2188-2-16**] 11:00PM BLOOD ALT-24 AST-22 CK(CPK)-17* AlkPhos-49
Amylase-32 TotBili-0.5
[**2188-2-17**] 07:00AM BLOOD CK(CPK)-22*
[**2188-2-16**] 11:00PM BLOOD Glucose-132* UreaN-30* Creat-1.7* Na-136
K-3.8 Cl-102 HCO3-25 AnGap-13
[**2188-2-25**] 05:19AM BLOOD Glucose-103 UreaN-11 Creat-1.1 Na-138
K-4.3 Cl-104 HCO3-27 AnGap-11
[**2188-2-16**] 11:00PM BLOOD WBC-12.4*# RBC-4.34 Hgb-12.1 Hct-37.1
MCV-86 MCH-27.8 MCHC-32.5 RDW-14.8 Plt Ct-240
[**2188-2-25**] 05:19AM BLOOD WBC-6.1 RBC-3.68* Hgb-10.1* Hct-32.5*
MCV-88 MCH-27.6 MCHC-31.2 RDW-16.0* Plt Ct-297
.
Urine Cx: Pan-S E coli

Brief Hospital Course:
# Urosepsis: foley placed during last admission and was supposed
to be dc'd after 2 days in rehab ([**2-16**]) after the patient passed
a voiding trial. Pt was started on vanco and zosyn, eventually
transitioned to PO Cipro as Ucx grew Pan-S E Coli.  Will
complete a total of a 14 day course.  Pt with urinary retention
that improved with scheduled voidings and holding of Detrol.
Detrol to be held on d/c.
.
# MS changes: likely [**1-18**] UTI. and ARF. Resolved during
hospitalization.  Per Geriatric consultants, Celexa, Aricept,
and Zyprexa held upon d/c.
.
# Bradycardia: Likely combination of taking usual atenolol plus
acute renal failure.  BB held on d/c (see below).
.
# HTN:  meds (BB/ACE) were stopped in the setting of urosepsis.
BP remained well controlled off these agents, and they were held
on d/c.  To f/u with PCP for BP check within 1-2 weeks.
.
# ARF: baseline Cr 1.2-1.5; 1.7 on admission but improved to 1.1
after fluid.


Medications on Admission:
tylenol prn
mom
dulcolax
[**Name2 (NI) 109927**] 10 qhs
asa 81 qd
celexa 10 qd
lipitor 10 qd
psyllium
vit b12 100mcg qd
vit d
zyprexa 2.5 po qhs
prilosec 20 qd
atenolol 12.5 qd
lisinopril 5mg qd
detrol 2mg qhs


Discharge Medications:
1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
2. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed for pain/fever.
3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
4. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO Q8H (every
8 hours) as needed for constipation.
5. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical [**Hospital1 **]
(2 times a day).
6. Docusate Sodium 50 mg/5 mL Liquid Sig: One Hundred (100) mg
PO BID (2 times a day).
7. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 6 days.
Disp:*6 Tablet(s)* Refills:*0*
8. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
[**Hospital1 **] (2 times a day) as needed.
9. Aspir-81 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day. Tablet, Delayed
Release (E.C.)(s)
10. Lipitor 10 mg Tablet Sig: One (1) Tablet PO once a day.
11. Vitamin B-12 100 mcg Tablet Sig: One (1) Tablet PO once a
day.
12. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 **] Family & [**Hospital1 1926**] Services

Discharge Diagnosis:
Sepsis due to Urinary Tract Infection
Delirium, resolving
Urinary Retention, resolving


Discharge Condition:
stable


Discharge Instructions:
Please continue your medications as listed (see medication sheet
for changes). Call your doctor if you experience fever,
abdominal pain, difficulty urinating, or any other concerning
symptoms. Please make sure you follow up with Dr. [**Last Name (STitle) **] in the
next 1-2 weeks.

Do not take Celexa, Aricept, Zyprexa, Atenolol, Lisinopril or
Detrol until you see Dr. [**Last Name (STitle) **].

Followup Instructions:
1. Please make sure you follow up with Dr. [**Last Name (STitle) **] in the next
1-2 weeks.
{'Unspecified septicemia,Urinary tract infection, site not specified,Retention of urine, unspecified,Acute kidney failure, unspecified,Dehydration,Severe sepsis,Other alteration of consciousness'}


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: Urosepsis

PRESENT ILLNESS: [**Age over 90 **]F from nursing home ([**Hospital1 **]) recently dc'd from [**Hospital1 18**] after
being admitted for weakness, abd pain, taken to [**Hospital1 **] ed for
periods of unresponsiveness and delta ms. Somnolent and
arousable to pain in the ED. Bp was 90/50 at NH, down to 83/43;
satting 92% ra. Upon arrival from to the ED, HR was 55; BP was
78/55 and RR 20, 100% on 2L. Got 1L NS, BP increased from 80s to
110s. Pt received vanc/levo/flagyl in the ED along with ASA and
Narcan (for pinpoint pupils). Pt has chronic abd pain and
tonight was also c/o tenderness over the bladder.
.
On arrival to the floor, patient was initially agitated and
speaking loudly/groaning. Pt denied any pain. Became
progressively less arousable with HR down to 40s, BP down to
70s/80s systolic when patient sleeping. Given atropine 0.5 mg X
1 with HR to 60s/70s. Normal saline bolus completed; oxygen sats
decreased to high 80s/low 90s on nasal cannula so patient placed
on nonrebreather with sats up to 100%. Repeat CXR and portable
abdomen performed. ABG sent.
.
MICU COURSE:
[**2-17**]: Levo/Flagyl changed to Zosyn. Vanc dosed q48h. Fluid
boluses to keep SBP up

MEDICAL HISTORY: PAST MEDICAL HISTORY:
1. Diverticulosis [**2180**].
2. Irritable bowel syndrome.
3. Spinal stenosis.
4. Memory loss - CT c/w old small vascular disease
#. Lacunar infarct left caudate lobe and right thalamus
5. Hearing loss.
6. Vitamin B12 deficiency.
7. Retinal detachment [**2170**].
8. Chronic abdominal pain
PAST SURGICAL HISTORY: Status post tonsillectomy

MEDICATION ON ADMISSION: tylenol prn
mom
dulcolax
[**Name2 (NI) 109927**] 10 qhs
asa 81 qd
celexa 10 qd
lipitor 10 qd
psyllium
vit b12 100mcg qd
vit d
zyprexa 2.5 po qhs
prilosec 20 qd
atenolol 12.5 qd
lisinopril 5mg qd
detrol 2mg qhs

ALLERGIES: Zosyn

PHYSICAL EXAM: temp 97.4, hr 76/min, rr 18/min, sats 97% on RA, bp 146/76
neck supple, no jvd, no bruit
rrr, nl s1+s2, PSM in apex to axilla
chest with reduced air entry bilaterally, but no wheeze or
crackles
[**Last Name (un) 103**] soft, non tender, nl bs
no o/c/c

FAMILY HISTORY: nc

SOCIAL HISTORY: She was an English professor for many years. She now lives with
her husband, [**Name (NI) **], who is her primary caregiver. She has two
sons, one in [**Name (NI) 531**] and the other one in [**Location (un) 86**]. 

### Response:
{'Unspecified septicemia,Urinary tract infection, site not specified,Retention of urine, unspecified,Acute kidney failure, unspecified,Dehydration,Severe sepsis,Other alteration of consciousness'}
