CHIEF COMPLAINT: Transfer given power failure.

PRESENT ILLNESS: Ms. [**Known lastname 26495**] is an 82 year-old female initially admitted to an
OSH on [**9-3**] with mental status change in the setting of
hyponatremia and hypertension who is now being transferred to
[**Hospital1 18**] given a power failure at the OSH.
.
NOTE:  The following history was obtained via discussions with
the transferring attending.
.
Initially presented to an OSH on [**9-3**] with mental status
change.  Found to be hypertensive (220/60) with a sodium of 118.
 Also noted to have an INR of 7.0.  Course was complicated by
respiratory failrue requiring intubation on [**9-8**].  Subsequently
extubated on [**9-16**].  Now on BiPAP at night (15/5 with FiO2
0.40).  Also noted to be c.diff positive and was started on PO
vancomycin.  Covering attending at OSH also reports that the
patient was on IV vancomycin but she is unsure for what reason.
.
Given a power failure at the OSH, patient was transferred for
further care.
.
At the time of discharge patient's weight was 158.5 lbs, her dry
weight.
.
In speaking with the husband, he reports that two days prior to
admission to the OSH the patient fell.  It does not appear that
she hit her head.  The following day she had problesm getting to
the bathroom and would loose her stool while urinating.  Two
days after falling her she was disoriented; this prompted the
husband [**Name (NI) 33606**] to [**Hospital1 18**].
.

MEDICAL HISTORY: 1. Coronary artery disease
- Status post stent in [**2167**]
- Status post CABG x5 ([**2173-3-15**]): LIMA->LAD; SVG->PDA;
sequential->PL; SVG->OM and diag
2. Hyperlipidemia
3. Diabetes mellitus
4. Chronic kidney dissease:  baseline SCr 2.0
5. Atrial fibrillation
6. History of deep vein thrombosis times two in the right lower
extremity, status post venous ligation with veins left in situ
by report.
7. Status post cholecystectomy.
8. Arthritis in both knees, status post steroid injections.
9. Hard of hearing
.

MEDICATION ON ADMISSION: (OSH):
1. Labetolol 300mg [**Hospital1 **]
2. Norvasc 10mg daily
3. Aldactone 100mg TID
4. Diamox 250mg TID
5. Bumex 5mg IV PRN for weight (last given on [**9-22**])
6. Lipitor 40mg daily
7. Imdur 60mg daily
8. Coumadin 5mg
9. Lantus 100 units QAM + RISS
10. Januvia 100mg daily
11. Iron IV 62.5mg daily
12. Procrit 20,000 units weekly (last time [**9-23**])
13. Mag Oxide 400mg daily
14. Rocaltrol 0.5mcg daily
15. Protonix 40mg daily
16. Lovenox 1mg/kg [**Hospital1 **]
17. Vancomycin 125mg PO QID
18. Vancomycin 1gram IV Q36 hours

ALLERGIES: Codeine / Morphine

PHYSICAL EXAM: vitals - T 99.6, BP 166/46, HR 87, RR 30, O2 99% on NRB then 98%
on hi-flow FM with FiO2 of 0.6.  Weight 75.6kg
gen - Sleeping but arousable.  Not very interactive, but
responds to name.
heent - JVP elevated at 8-9cm while sitting 45 degrees.  Large
neck.  NG in place.
cv - Regular.  No murmurs.
pulm - Rales noted 3/4 up bilaterally.
abd - Soft and mildly distended.  Non-tender.
ext - Warm with boots on.  Mild edema.
neuro - Sleepy but arousable.  Not cooperative with exam.
.

FAMILY HISTORY: NC.

SOCIAL HISTORY: 
Other encephalopathy,Acute on chronic diastolic heart failure,Pneumonia, organism unspecified,Intestinal infection due to Clostridium difficile,Chronic respiratory failure,Alkalosis,Unspecified pleural effusion,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Long-term (current) use of anticoagulants,Chronic kidney disease, unspecified,Other and unspecified hyperlipidemia,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled
Encephalopathy NEC,Ac on chr diast hrt fail,Pneumonia, organism NOS,Int inf clstrdium dfcile,Chronic respiratory fail,Alkalosis,Pleural effusion NOS,Crnry athrscl natve vssl,Status-post ptca,Long-term use anticoagul,Chronic kidney dis NOS,Hyperlipidemia NEC/NOS,Atrial fibrillation,DMII wo cmp uncntrld
Admission Date:  [**2179-9-25**]              Discharge Date:   [**2179-10-4**]

Date of Birth:  [**2097-5-3**]             Sex:   F

Service: MEDICINE

Allergies:
Codeine / Morphine

Attending:[**First Name3 (LF) 1674**]
Chief Complaint:
Transfer given power failure.

Major Surgical or Invasive Procedure:
Lumbar puncture on [**2179-10-1**], tolerated the procedure well.

History of Present Illness:
Ms. [**Known lastname 26495**] is an 82 year-old female initially admitted to an
OSH on [**9-3**] with mental status change in the setting of
hyponatremia and hypertension who is now being transferred to
[**Hospital1 18**] given a power failure at the OSH.
.
NOTE:  The following history was obtained via discussions with
the transferring attending.
.
Initially presented to an OSH on [**9-3**] with mental status
change.  Found to be hypertensive (220/60) with a sodium of 118.
 Also noted to have an INR of 7.0.  Course was complicated by
respiratory failrue requiring intubation on [**9-8**].  Subsequently
extubated on [**9-16**].  Now on BiPAP at night (15/5 with FiO2
0.40).  Also noted to be c.diff positive and was started on PO
vancomycin.  Covering attending at OSH also reports that the
patient was on IV vancomycin but she is unsure for what reason.
.
Given a power failure at the OSH, patient was transferred for
further care.
.
At the time of discharge patient's weight was 158.5 lbs, her dry
weight.
.
In speaking with the husband, he reports that two days prior to
admission to the OSH the patient fell.  It does not appear that
she hit her head.  The following day she had problesm getting to
the bathroom and would loose her stool while urinating.  Two
days after falling her she was disoriented; this prompted the
husband [**Name (NI) 33606**] to [**Hospital1 18**].
.

Past Medical History:
1. Coronary artery disease
- Status post stent in [**2167**]
- Status post CABG x5 ([**2173-3-15**]): LIMA->LAD; SVG->PDA;
sequential->PL; SVG->OM and diag
2. Hyperlipidemia
3. Diabetes mellitus
4. Chronic kidney dissease:  baseline SCr 2.0
5. Atrial fibrillation
6. History of deep vein thrombosis times two in the right lower
extremity, status post venous ligation with veins left in situ
by report.
7. Status post cholecystectomy.
8. Arthritis in both knees, status post steroid injections.
9. Hard of hearing
.

Family History:
NC.

Physical Exam:
vitals - T 99.6, BP 166/46, HR 87, RR 30, O2 99% on NRB then 98%
on hi-flow FM with FiO2 of 0.6.  Weight 75.6kg
gen - Sleeping but arousable.  Not very interactive, but
responds to name.
heent - JVP elevated at 8-9cm while sitting 45 degrees.  Large
neck.  NG in place.
cv - Regular.  No murmurs.
pulm - Rales noted 3/4 up bilaterally.
abd - Soft and mildly distended.  Non-tender.
ext - Warm with boots on.  Mild edema.
neuro - Sleepy but arousable.  Not cooperative with exam.
.


Pertinent Results:
---OSH---
.
138  91  59
----------- 206
4.6  37  2.0
.
Ca 9.0
.
WBC: 18.6
HCT: 29.7;  MCV 83
PLT: 606
.
INR: 1.8
.
---ADMISSION---
.
140  92  58
------------ 249
4.5  35  1.8
.
Ca: 9.5 Mg: 2.4 P: 4.0
.
WBC: 19.5
HCT: 34.4
PLT: 709
N:85.2 L:6.9 M:4.7 E:2.9 Bas:0.4
PT: 18.8  PTT: 28.8  INR: 1.8
.
CXR [**9-25**]:Cardiac size is top normal. Bilateral pleural effusions
are small on the left and moderate on the right. There is no
pneumothorax. There is mild interstitial pulmonary edema.
Patient is post median sternotomy. NG tube tip is out of view
below the diafragm.
.
[**9-26**] CT head w/o contrast: No intracranial hemorrhage. Paranasal
sinus and left mastoid abnormalities seen as described above, in
part post-surgical in origin.
.
[**9-27**] TTE: The left atrium is elongated. No atrial septal defect
is seen by 2D or color Doppler. The estimated right atrial
pressure is 11-15mmHg. There is mild symmetric left ventricular
hypertrophy with normal cavity size and regional/global systolic
function (LVEF>55%). There is no ventricular septal defect. The
aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. No aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. There is no mitral
valve prolapse. Trivial mitral regurgitation is seen. The
tricuspid valve leaflets are mildly thickened. There is a
trivial/physiologic pericardial effusion.
IMPRESSION: Normal LV systolic funciton.
.
MRI/MRA head [**9-28**]:
1. No acute infarcts or signal abnormalities suggestive of
osmotic demyelination.
2. Mild generalized atrophy.
3. Short segment stenoses of the A1 segment of the left ACA and
the right MCA bifurcation, which likely represent
atherosclerotic changes.
.
EEG [**9-29**]: Abnormal portable EEG due to the slow and disorganized

background and bursts of generalized slowing. These findings
indicate a
widespread encephalopathy affecting both cortical and
subcortical
structures. Medications, metabolic disturbances, and infection
are
among the most common causes. There were no areas of prominent
focal
slowing, but encephalopathies may obscure focal findings. There
were no
clearly epileptiform features


Brief Hospital Course:
MICU COURSE:
82 year-old female with a history of CAD, CKD, DM, Afib who
presented to an OSH with mental status change in the setting of
hyponatremia and hypertension who is now transferred to the [**Hospital Unit Name 153**]
after a power failure at the OSH.
.
1. Mental status change:
LP, MRI without causation.  Pt is responsive, answering name and
answering "in hospital" when asked orienting questions.  EEG
with diffuse encephalopathy.  Neurology team at [**Hospital1 18**] felt that
the decreased mental status is likely due to hypoxic damage in
the septic, peri-intubation period.

2. Respiratory failure:
Currently saturating well at 95% on face tent receiving Fio2
35%.  Per sign-out from OSH, patient was intubated from [**9-8**] -
[**9-16**] with respiratory failure.  Appeared volume overloaded on
admission. At [**Hospital1 18**] pt has been diuresed about 500cc per day
requiring Lasix 120 mg IV bid.  At most recent CXR [**2179-10-3**],
pleural effusions resolved, pt still has mild interstitial
edema.  Wt today is 171 lbs. Pt has also been responding to
blood pressure control and aldactone.

3. C.Difficile colitis:  Completed course of oral/pr vancomycin
at [**Hospital3 **] and through [**Hospital1 18**].  C. difficile negative x 3
here at [**Hospital1 18**].

4. Atrial Fibrillation:  Pt currently in sinus rhythm.  Continue
beta blocker and coumadin.  She is currently on coumadin 2 mg po
daily for past 2 day (previously held)  needs at least qod INRs

5. Aspiration risk: Due to decreased mental status.  Will need
re-eval and feeding by NG tube until then.

6. Chronic kidney disease:
Baseline creatinine 1.8.  Currenly at this baseline.

7. Diabetes:
On extremely high dose of lantus with Januvia.  Please start
Januvia if available at rehab and if so be sure to titrate
lantus dose - will likely need less.

8.  Heel wounds:  Please see attached wound care recs.

CODE STATUS IS DNR/DNI PER FAMILY.

Medications on Admission:
(OSH):
1. Labetolol 300mg [**Hospital1 **]
2. Norvasc 10mg daily
3. Aldactone 100mg TID
4. Diamox 250mg TID
5. Bumex 5mg IV PRN for weight (last given on [**9-22**])
6. Lipitor 40mg daily
7. Imdur 60mg daily
8. Coumadin 5mg
9. Lantus 100 units QAM + RISS
10. Januvia 100mg daily
11. Iron IV 62.5mg daily
12. Procrit 20,000 units weekly (last time [**9-23**])
13. Mag Oxide 400mg daily
14. Rocaltrol 0.5mcg daily
15. Protonix 40mg daily
16. Lovenox 1mg/kg [**Hospital1 **]
17. Vancomycin 125mg PO QID
18. Vancomycin 1gram IV Q36 hours


Discharge Medications:
1. Labetalol 300 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2 times a
day).
2. Atorvastatin 40 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY
(Daily).
3. Warfarin 2 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY16 (Once
Daily at 16).
4. Ipratropium Bromide 0.02 % Solution [**Hospital1 **]: One (1) treatment
Inhalation Q6H (every 6 hours) as needed for shortness of breath
or wheezing.
5. Aspirin 81 mg Tablet, Chewable [**Hospital1 **]: One (1) Tablet, Chewable
PO DAILY (Daily).
6. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
7. Aldactone 100 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO once a day.
8. Hydralazine 25 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO three times a
day.
9. Thiamine HCl 100 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY
(Daily).
10. Furosemide 120 mg IV BID
11. Calcitriol 0.25 mcg Capsule [**Last Name (STitle) **]: One (1) Capsule PO DAILY
(Daily).
12. Insulin
Please see attached list: pt will receive insulin Lantus in am
and sliding scale throughout day.
13. JANUVIA 100 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO once a day:
qpm.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **]@ [**Hospital 1263**] Hospital

Discharge Diagnosis:
pneumonia
c diff colitis (treated)
acute on chronic diastolic heart failure
hypoxic brain damage


Discharge Condition:
Requires 35%FiO2 by face mask to maintain O2 sat > 92%.  On tube
feeds.  When asked name answers correctly '[**Known firstname 1494**].'  Otherwise
little communication.


Discharge Instructions:
Return to ER with shortnes of breath, increased oxygen
saturation requirements, or other concerning symptoms.

Please check potassium and creatinine daily while on IV lasix.
Keep strict account of ins/outs with goal even to negative 500cc
per day for next several days.  Please check INR qod for goal
INR [**12-26**] for atrial fibrillation.

Followup Instructions:
Please follow up with neurology clinic within one month. Call
[**Telephone/Fax (1) 2756**] to make appointment.


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 1677**]

Completed by:[**2179-10-4**]
{'Other encephalopathy,Acute on chronic diastolic heart failure,Pneumonia, organism unspecified,Intestinal infection due to Clostridium difficile,Chronic respiratory failure,Alkalosis,Unspecified pleural effusion,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Long-term (current) use of anticoagulants,Chronic kidney disease, unspecified,Other and unspecified hyperlipidemia,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled'}


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: Transfer given power failure.

PRESENT ILLNESS: Ms. [**Known lastname 26495**] is an 82 year-old female initially admitted to an
OSH on [**9-3**] with mental status change in the setting of
hyponatremia and hypertension who is now being transferred to
[**Hospital1 18**] given a power failure at the OSH.
.
NOTE:  The following history was obtained via discussions with
the transferring attending.
.
Initially presented to an OSH on [**9-3**] with mental status
change.  Found to be hypertensive (220/60) with a sodium of 118.
 Also noted to have an INR of 7.0.  Course was complicated by
respiratory failrue requiring intubation on [**9-8**].  Subsequently
extubated on [**9-16**].  Now on BiPAP at night (15/5 with FiO2
0.40).  Also noted to be c.diff positive and was started on PO
vancomycin.  Covering attending at OSH also reports that the
patient was on IV vancomycin but she is unsure for what reason.
.
Given a power failure at the OSH, patient was transferred for
further care.
.
At the time of discharge patient's weight was 158.5 lbs, her dry
weight.
.
In speaking with the husband, he reports that two days prior to
admission to the OSH the patient fell.  It does not appear that
she hit her head.  The following day she had problesm getting to
the bathroom and would loose her stool while urinating.  Two
days after falling her she was disoriented; this prompted the
husband [**Name (NI) 33606**] to [**Hospital1 18**].
.

MEDICAL HISTORY: 1. Coronary artery disease
- Status post stent in [**2167**]
- Status post CABG x5 ([**2173-3-15**]): LIMA->LAD; SVG->PDA;
sequential->PL; SVG->OM and diag
2. Hyperlipidemia
3. Diabetes mellitus
4. Chronic kidney dissease:  baseline SCr 2.0
5. Atrial fibrillation
6. History of deep vein thrombosis times two in the right lower
extremity, status post venous ligation with veins left in situ
by report.
7. Status post cholecystectomy.
8. Arthritis in both knees, status post steroid injections.
9. Hard of hearing
.

MEDICATION ON ADMISSION: (OSH):
1. Labetolol 300mg [**Hospital1 **]
2. Norvasc 10mg daily
3. Aldactone 100mg TID
4. Diamox 250mg TID
5. Bumex 5mg IV PRN for weight (last given on [**9-22**])
6. Lipitor 40mg daily
7. Imdur 60mg daily
8. Coumadin 5mg
9. Lantus 100 units QAM + RISS
10. Januvia 100mg daily
11. Iron IV 62.5mg daily
12. Procrit 20,000 units weekly (last time [**9-23**])
13. Mag Oxide 400mg daily
14. Rocaltrol 0.5mcg daily
15. Protonix 40mg daily
16. Lovenox 1mg/kg [**Hospital1 **]
17. Vancomycin 125mg PO QID
18. Vancomycin 1gram IV Q36 hours

ALLERGIES: Codeine / Morphine

PHYSICAL EXAM: vitals - T 99.6, BP 166/46, HR 87, RR 30, O2 99% on NRB then 98%
on hi-flow FM with FiO2 of 0.6.  Weight 75.6kg
gen - Sleeping but arousable.  Not very interactive, but
responds to name.
heent - JVP elevated at 8-9cm while sitting 45 degrees.  Large
neck.  NG in place.
cv - Regular.  No murmurs.
pulm - Rales noted 3/4 up bilaterally.
abd - Soft and mildly distended.  Non-tender.
ext - Warm with boots on.  Mild edema.
neuro - Sleepy but arousable.  Not cooperative with exam.
.

FAMILY HISTORY: NC.

SOCIAL HISTORY:  

### Response:
{'Other encephalopathy,Acute on chronic diastolic heart failure,Pneumonia, organism unspecified,Intestinal infection due to Clostridium difficile,Chronic respiratory failure,Alkalosis,Unspecified pleural effusion,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Long-term (current) use of anticoagulants,Chronic kidney disease, unspecified,Other and unspecified hyperlipidemia,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled'}
