CHIEF COMPLAINT: Community acquired pneumonia

PRESENT ILLNESS: Mr. [**Known firstname 4580**] [**Known lastname 109123**] is a 62 year old Caucasian male in his usual
state of well health when he awoke to right back pain last
Saturday. He had this similar back pain 2 years ago relieved by
mattress change. He also fell playing tennis which he thought
might have exacerbated this. His pain progressed until evaluated
by his PCP Wednesday and admitted to [**Hospital6 **]. He
developed fevers, leukocytosis, and CT chest [**2195-6-24**] revealed
right small pleural effusion. He was started on levaquin. He
also had CTA [**2195-6-25**] for ongoing right sided back and chest
pain, which ruled out pulmonary embolus, but revealed increasing
right
pleural effusion and right basilar atelectasis since [**2195-6-24**].
The patient also developed chest congestion, cough and
diaphoresis.

MEDICAL HISTORY: Hypertension

MEDICATION ON ADMISSION: Home Meds:  Aspirin 325 mg daily, Zestril 10 mg daily, MVI. fish
oil

ALLERGIES: Demerol

PHYSICAL EXAM: VS: T: 97.2  HR: 68 SR  BP: 142/74  Sats: 93% RA
General: 62 year-old male no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple
Card: RRR normal S1,S2
Resp: diminshed breath sounds on right > left no crackles
GI: bowel sounds positive, abdomen soft non-tender/non-distended
Extre: warm no edema
Incision: Right VATs site clean dry intact, 2 chest tube remain
Neuro: non-focal

FAMILY HISTORY: Mother- colon and liver CA.
Father- died suddenly in hospital of "some cardiac issue"
Siblings- healthy
Offspring- healthy

SOCIAL HISTORY: Single, has one son. [**Name (NI) 1403**] as a lawyer. 60 pk yr smoking hx-
current. No cigarrettes since Wednesday. 4 glasses of
wine/month.
No illicit drugs.
Pneumonia, organism unspecified,Unspecified pleural effusion,Tobacco use disorder,Unspecified essential hypertension
Pneumonia, organism NOS,Pleural effusion NOS,Tobacco use disorder,Hypertension NOS
Admission Date:  [**2195-6-26**]              Discharge Date:   [**2195-7-2**]

Date of Birth:  [**2132-9-1**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Demerol

Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Community acquired pneumonia

Major Surgical or Invasive Procedure:
[**2195-6-29**]: Thoracoscopy and decortication of lung. Therapeutic
bronchoscopy.


History of Present Illness:
Mr. [**Known firstname 4580**] [**Known lastname 109123**] is a 62 year old Caucasian male in his usual
state of well health when he awoke to right back pain last
Saturday. He had this similar back pain 2 years ago relieved by
mattress change. He also fell playing tennis which he thought
might have exacerbated this. His pain progressed until evaluated
by his PCP Wednesday and admitted to [**Hospital6 **]. He
developed fevers, leukocytosis, and CT chest [**2195-6-24**] revealed
right small pleural effusion. He was started on levaquin. He
also had CTA [**2195-6-25**] for ongoing right sided back and chest
pain, which ruled out pulmonary embolus, but revealed increasing
right
pleural effusion and right basilar atelectasis since [**2195-6-24**].
The patient also developed chest congestion, cough and
diaphoresis.

He denies any prior URI's, major flu's, fevers, chills,
nightsweats. He now has cough with congestion, and overall does
not feel well. He was referred to Dr. [**First Name (STitle) **] for possible surgery.


Past Medical History:
Hypertension

PSH: Rotator cuff and knee surgeries.


Social History:
Single, has one son. [**Name (NI) 1403**] as a lawyer. 60 pk yr smoking hx-
current. No cigarrettes since Wednesday. 4 glasses of
wine/month.
No illicit drugs.


Family History:
Mother- colon and liver CA.
Father- died suddenly in hospital of "some cardiac issue"
Siblings- healthy
Offspring- healthy


Physical Exam:
VS: T: 97.2  HR: 68 SR  BP: 142/74  Sats: 93% RA
General: 62 year-old male no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple
Card: RRR normal S1,S2
Resp: diminshed breath sounds on right > left no crackles
GI: bowel sounds positive, abdomen soft non-tender/non-distended
Extre: warm no edema
Incision: Right VATs site clean dry intact, 2 chest tube remain
Neuro: non-focal

Pertinent Results:
[**2195-7-1**] WBC-10.5 RBC-3.80* Hgb-12.6* Hct-38.0 Plt Ct-465*
[**2195-6-30**] WBC-14.6* RBC-3.68*# Hgb-12.0* Hct-36.6 Plt Ct-337
[**2195-6-29**] WBC-9.9 RBC-3.83* Hgb-12.7* Hct-38.1 Plt Ct-339
[**2195-6-27**] WBC-12.7* RBC-3.99* Hgb-13.2* Hct-39.1 Plt Ct-297
[**2195-6-30**] Glucose-185* UreaN-13 Creat-0.7 Na-141 K-4.1 Cl-105
HCO3-29
[**2195-6-29**] Glucose-148* UreaN-11 Creat-0.8 Na-130* K-4.0 Cl-95*
HCO3-27
[**2195-6-29**] Glucose-144* UreaN-11 Creat-0.8 Na-139 K-3.7 Cl-100
HCO3-29
[**2195-6-27**] Glucose-162* UreaN-16 Creat-1.0 Na-137 K-4.2 Cl-101
HCO3-26
[**2195-6-30**] Calcium-8.2* Phos-3.3 Mg-2.1

[**2195-6-29**] PLEURAL Tissue No Growth TO Date
[**2195-6-29**] Pleural Fluid No Growth To Date

CXR: [**2195-7-1**]: The three right-sided chest tubes are in
unchanged position.  There is no evidence of pneumothorax. The
right lung base is minimally better ventilated than on the
previous exam. The pre-existing left basal atelectasis shows
unchanged extent, but slightly different distribution.
[**2195-6-29**]: There is interval placement of chest tubes within the
right chest. There are two tips with the tips in the apex and
one at the base. There has been interval decrease in the size of
the right peripheral opacity compatible with adjacent empyema.
There is a small left-sided pleural effusion. No pneumothoraces
are seen. There is a left retrocardiac opacity which has
developed in the interim.
[**2195-6-27**] Two views of the chest are obtained without comparison
studies. There is peripheral opacity in the right lung
consistent with empyema. There is also a right-sided moderate
effusion. There is fluid tracking along the major fissure. There
is a small left-sided pleural effusion. The upper lung zones are
relatively clear. Heart and mediastinum are within normal
limits.

Pathology: Pleural Tissue Granulation tissue, fibrin, and acute
and chronic inflammation.




Brief Hospital Course:
Mr. [**Known lastname 109123**] was transferred from [**Hospital6 **]
for further management of his right pleural effusion.  His IV
Levofloxacin was continued.  He was taken to the operating room
on [**2195-6-29**] for successful Thoracoscopy and decortication of
right lung and Therapeutic bronchoscopy.  He was transferred to
the SICU intubated/sedated overnight with CPAP 10/5/50%. He was
suctioned for moderate amounts of thick secretions. He was
extubated on [**2195-6-30**] and transfer to the floor.

Respiratory: Aggressive pulmonary toilet and nebs were
administered.  He extubated on POD1 to 4L NC with oxygen
saturations 95%.  Over the course of his hospital stay his
oxygen requirement were titrated off with continue aggressive
pulmonary therapy and ambulation.  On discharge his oxygen
saturations at rest 93% with ambulation 92% after obtaining good
pain control.

Chest-Tubes (3):anterior tube was a 28-French right-angle over
the diaphragm, the middle tube was a 24-French directed to the
apex of the right chest and the posterior tube at the skin level
was a posterior chest tube.  The remained to low-wall suction
until [**2195-7-1**] with minimal serosanguinous discharge.  On [**2195-7-1**]
they were converted to Pneumostats.  On [**2195-7-2**] the Middle Apex
tube was removed.  He was discharged with the remaining 2 chest
tube to pneumostats until culture data final.

Chest-Ray: he was followed by serial chest films: see above
reports.

Cardiac: he was started on  prophylactic low dose beta-blocker.
He remained in sinus rhythm 60-70.  He was continued on his ACE
with SBP 130-140.

GI: PPI were continue.  His bowel function returned to [**Location 213**].

Nutrition: He was maintained on IV fluids until he tolerated a
regular diet.

Renal: Foley was removed on [**2195-6-30**] he voided with good urine
output.  His renal function remained normal.

ID: He remained afebrile. He will continue a 14 day course of
Levofloxacin.  Pleural cultures are still pending with no growth
to date.

Pain: Dilaudid PCA converted to PO pain medication with moderate
control.  NSAIDS were started on [**2195-7-2**] with optimal pain
management.

Disposition: he was seen by physical therapy who felt he may
initially require home PT but his ambulation improved and was
discharged home with VNA.  He will follow-up
with Dr. [**First Name (STitle) **] in 2 weeks for CCT w/contrast.

Medications on Admission:
Home Meds:  Aspirin 325 mg daily, Zestril 10 mg daily, MVI. fish
oil

Transfer Meds: lisinopril 10 mg daily, levofloxacin IV 500mg
daily, lactobacillus tab tid, ambien hs, raitidine 150 mg daily,
MVI, lidoderm patch,
Heparin 5000 units SQ, morphine prn, percocet prn.

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): while taking narcotics.
2. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
Disp:*70 Tablet(s)* Refills:*0*
5. Levofloxacin 750 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 10 days.
Disp:*10 Tablet(s)* Refills:*0*
6. Multiple Vitamin     Tablet Sig: One (1) Tablet PO once a
day.
7. Fish Oil 1,000 mg Capsule Sig: One (1) Capsule PO once a day.

8. Toprol XL 25 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
9. Motrin 600 mg Tablet Sig: One (1) Tablet PO every eight (8)
hours as needed for pain: take with food and water.
Disp:*90 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
Community-acquired pneumonia
Hypertension


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Call Dr.[**Name (NI) 5067**] office [**Telephone/Fax (1) 2348**] if you experience:
-Fevers > 101 or chills
-Increased shortness of breath, cough or sputum production
-Incision develops drainage
-Chest tube sites: 2 pneumostats.  Empty daily keep a log.
Change dressing daily.
-Call immediately if a chest tube falls out.  Cover site with
gauze then call.
-You may shower.  Wash incisions with mild soap pat dry. No tub
bathing or swimming.
-No driving while taking narcotics.
-Take motrin with food and water


Followup Instructions:
Follow-up with Dr. [**First Name (STitle) **] [**0-0-**] Date/Time:[**2195-7-16**] 3:00 on
the [**Hospital Ward Name 516**] [**Hospital Ward Name 23**] Clinical Center, [**Location (un) 24**]
Chest CT [**2195-7-16**] at 12:45 [**Location (un) 861**] Radiology department.
Nothing to Eat or Drink 1 hour before the procedure.



Completed by:[**2195-7-2**]
{'Pneumonia, organism unspecified,Unspecified pleural effusion,Tobacco use disorder,Unspecified essential hypertension'}


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: Community acquired pneumonia

PRESENT ILLNESS: Mr. [**Known firstname 4580**] [**Known lastname 109123**] is a 62 year old Caucasian male in his usual
state of well health when he awoke to right back pain last
Saturday. He had this similar back pain 2 years ago relieved by
mattress change. He also fell playing tennis which he thought
might have exacerbated this. His pain progressed until evaluated
by his PCP Wednesday and admitted to [**Hospital6 **]. He
developed fevers, leukocytosis, and CT chest [**2195-6-24**] revealed
right small pleural effusion. He was started on levaquin. He
also had CTA [**2195-6-25**] for ongoing right sided back and chest
pain, which ruled out pulmonary embolus, but revealed increasing
right
pleural effusion and right basilar atelectasis since [**2195-6-24**].
The patient also developed chest congestion, cough and
diaphoresis.

MEDICAL HISTORY: Hypertension

MEDICATION ON ADMISSION: Home Meds:  Aspirin 325 mg daily, Zestril 10 mg daily, MVI. fish
oil

ALLERGIES: Demerol

PHYSICAL EXAM: VS: T: 97.2  HR: 68 SR  BP: 142/74  Sats: 93% RA
General: 62 year-old male no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple
Card: RRR normal S1,S2
Resp: diminshed breath sounds on right > left no crackles
GI: bowel sounds positive, abdomen soft non-tender/non-distended
Extre: warm no edema
Incision: Right VATs site clean dry intact, 2 chest tube remain
Neuro: non-focal

FAMILY HISTORY: Mother- colon and liver CA.
Father- died suddenly in hospital of "some cardiac issue"
Siblings- healthy
Offspring- healthy

SOCIAL HISTORY: Single, has one son. [**Name (NI) 1403**] as a lawyer. 60 pk yr smoking hx-
current. No cigarrettes since Wednesday. 4 glasses of
wine/month.
No illicit drugs. 

### Response:
{'Pneumonia, organism unspecified,Unspecified pleural effusion,Tobacco use disorder,Unspecified essential hypertension'}
