CHIEF COMPLAINT: Shortness of breath.

PRESENT ILLNESS: The patient is a [**Age over 90 **] year old
female who is a resident of [**Hospital3 **], who
presented to the Emergency Department with increasing
shortness of breath.  At [**Hospital3 **], O2
saturations were recorded to be at 62% with a temperature
maximum of 99.7 F., rectally.  The patient had been having
increasing shortness of breath with desaturations throughout
the day at [**Hospital3 **] on the day prior to
admission and was treated there with Lasix and nebulizer
treatments.  In the Emergency Room, the patient was treated
with Levofloxacin, Vancomycin and Flagyl for a pneumonia on
chest x-ray.  O2 saturations were stable in the low 90s on
100% non-rebreather.

MEDICAL HISTORY: 1.  Hypertension.
2.  Degenerative joint disease.
3.  Questionable dementia.
4.  Third degree AV block status post pacemaker placement.
5.  Constipation.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a resident of [**Hospital3 1761**].  She has a history of 50 pack years tobacco.
The patient is "DO NOT RESUSCITATE", "DO NOT INTUBATE".
Pneumonia, organism unspecified,Congestive heart failure, unspecified,Unspecified essential hypertension,Cardiac pacemaker in situ,Unspecified disorder of kidney and ureter,Cardiomegaly
Pneumonia, organism NOS,CHF NOS,Hypertension NOS,Status cardiac pacemaker,Renal & ureteral dis NOS,Cardiomegaly
Admission Date:  [**2181-4-4**]     Discharge Date:  [**2181-4-5**]


Service:  ICU MED

CHIEF COMPLAINT:  Shortness of breath.

HISTORY OF PRESENT ILLNESS:  The patient is a [**Age over 90 **] year old
female who is a resident of [**Hospital3 **], who
presented to the Emergency Department with increasing
shortness of breath.  At [**Hospital3 **], O2
saturations were recorded to be at 62% with a temperature
maximum of 99.7 F., rectally.  The patient had been having
increasing shortness of breath with desaturations throughout
the day at [**Hospital3 **] on the day prior to
admission and was treated there with Lasix and nebulizer
treatments.  In the Emergency Room, the patient was treated
with Levofloxacin, Vancomycin and Flagyl for a pneumonia on
chest x-ray.  O2 saturations were stable in the low 90s on
100% non-rebreather.

REVIEW OF SYSTEMS:   Negative for fever or chills, negative
for cough, negative for headache, negative for visual changes
or diarrhea.  Per family, the patient is slightly confused
which is not unusual in the setting of acute infection.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Degenerative joint disease.
3.  Questionable dementia.
4.  Third degree AV block status post pacemaker placement.
5.  Constipation.

MEDICATIONS:  On admission.
1.  Atenolol 100 mg p.o. q. day.
2.  Diltiazem 360 mg p.o. q. day.
3.  Lisinopril 20 mg p.o. q. day.
4.  Imdur 90 mg p.o. q. day.
5.  Calcium.

SOCIAL HISTORY:  The patient is a resident of [**Hospital3 1761**].  She has a history of 50 pack years tobacco.
The patient is "DO NOT RESUSCITATE", "DO NOT INTUBATE".

PHYSICAL EXAMINATION:  On physical examination, temperature
98.4 F.; blood pressure 135/52; heart rate 54; respiratory
rate 20; O2 saturation 100% on non-rebreather.  In general,
the patient is sitting up comfortably and talking profusely.
The patient is Russian speaking only.  Oropharynx clear.
Right eye closed.  Neck was supple.  No jugular venous
distention, no lymphadenopathy.  Lungs:  Fair air movement,
crackles bilaterally.  Egophony at right base.
Cardiovascular:  Regular, no audible murmur.  Abdomen soft,
nontender, nondistended.  Positive bowel sounds.  Extremities
warm and well perfused, no edema.  Good pulses bilaterally.
Neurologic:  Right eye closed.  Left eye with reactive
pupils.  Five out of five strength throughout all
extremities.

LABORATORY DATA:  Significant for a creatinine of 2.0 from a
baseline of 1.5.  White blood cell count of 9.5, 81%
neutrophils, hematocrit of 33, PT and PTT, INR within normal
limits.

Urinalysis was negative.

Chest x-ray with left lower lobe infiltrate and right middle
lobe infiltrate.

EKG paced at 60.

HOSPITAL COURSE:
1.  The patient is a [**Age over 90 **] year old female with shortness of
breath and hypoxia with infiltrates on chest x-ray, who
presents with likely pneumonia.  The patient was continued on
Levofloxacin and Flagyl for a full seven day course.  Blood
cultures were sent which were negative.  The patient was also
gently diuresed.

The patient seemed to rapidly improve from her admission and
was thought that it might have been secondary to diuresis.  A
chest CT scan was proposed but was not done at this time,
considering that the patient did not want any invasive
procedures if anything were to be found on chest CT scan.

The patient's hypoxia improved and she was saturating 93 to
97% on five liters nasal cannula.

2.  In terms of the patient's hypertension, the patient was
continued on her beta blocker, ACE inhibitor, aspirin, Imdur
and her blood pressure remained stable.

The patient's renal functioning showed worsening creatinine
to 2.0 baseline, however, the day after admission, it
improved to 1.8 despite diuresis.  FEna was 6.8.  P.o.'s were
encouraged and the patient's creatinine was continued to be
monitored.  No interventions were taken.

3.  Possible dementia/psychosis:  The patient appeared
confused on admission, however, improved with Haldol p.r.n.
The patient's mental status also improved with treatment of
her infection.

4.  Fluids, Electrolytes and Nutrition:  The patient was
maintained on a regular diet and had Protonix prophylaxis
while in the Intensive Care Unit.

DISCHARGE DIAGNOSES:
1.  Multifocal pneumonia of unclear etiology.
2.  Possible congestive heart failure component.
3.  Hypoxia.
4.  Mental status changes.

DISCHARGE MEDICATIONS:
1.  Atenolol 100 mg p.o. q. day.
2.  Diltiazem 250 mg p.o. q. day.
3.  Lisinopril 20 mg p.o. q. day.
4.  Imdur 90 mg p.o. q. day.
5.  Calcium.
6.  Lasix 20 mg p.o. q. day; this dose will be changed at
[**Hospital3 **] as needed.
7.  Levofloxacin 250 mg p.o. q. day.
8.  Flagyl 500 mg q. eight hours p.o.

CONDITION AT DISCHARGE:   The patient was discharged back to
[**Hospital3 **] on hospital day number two.

DISCHARGE INSTRUCTIONS:
1.  The patient's O2 saturations will continue to be
monitored.
2.  The patient will complete her course of Levofloxacin and
Flagyl.
3.  The patient will follow-up with her physician at [**Hospital3 1761**] as needed.


                          [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 292**]

Dictated By:[**Last Name (NamePattern1) 218**]

MEDQUIST36

D:  [**2181-5-20**]  15:31
T:  [**2181-5-22**]  08:48
JOB#:  [**Job Number 22179**]
{'Pneumonia, organism unspecified,Congestive heart failure, unspecified,Unspecified essential hypertension,Cardiac pacemaker in situ,Unspecified disorder of kidney and ureter,Cardiomegaly'}


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: Shortness of breath.

PRESENT ILLNESS: The patient is a [**Age over 90 **] year old
female who is a resident of [**Hospital3 **], who
presented to the Emergency Department with increasing
shortness of breath.  At [**Hospital3 **], O2
saturations were recorded to be at 62% with a temperature
maximum of 99.7 F., rectally.  The patient had been having
increasing shortness of breath with desaturations throughout
the day at [**Hospital3 **] on the day prior to
admission and was treated there with Lasix and nebulizer
treatments.  In the Emergency Room, the patient was treated
with Levofloxacin, Vancomycin and Flagyl for a pneumonia on
chest x-ray.  O2 saturations were stable in the low 90s on
100% non-rebreather.

MEDICAL HISTORY: 1.  Hypertension.
2.  Degenerative joint disease.
3.  Questionable dementia.
4.  Third degree AV block status post pacemaker placement.
5.  Constipation.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a resident of [**Hospital3 1761**].  She has a history of 50 pack years tobacco.
The patient is "DO NOT RESUSCITATE", "DO NOT INTUBATE". 

### Response:
{'Pneumonia, organism unspecified,Congestive heart failure, unspecified,Unspecified essential hypertension,Cardiac pacemaker in situ,Unspecified disorder of kidney and ureter,Cardiomegaly'}
