CHIEF COMPLAINT: cough, chills, confusion

PRESENT ILLNESS: 81 year old male status post CABG, COPD, HTN, and recurrent UTIs
was found by his daughter seeming somewhat confused and having
rigors.  Over the past few days he had developed nonproductive
cough, difficulty breathing, and had felt weak.  He was admitted
to the MICU where he was treated for sepsis and pneumonia.

MEDICAL HISTORY: CAD s/p CABG, DM2 w/neuropathy (wheelchair bound), anxiety, HTN,
hyperchol, COPD, insonmia, CHF, constipation, recurrent UTIs,
h/o lymphoma s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3454**], [**First Name3 (LF) **] mass (etiology unknown), childhood
polio.

MEDICATION ON ADMISSION: Prednisone 10 mg po qd
Aspirin 325 mg ad
Simvastatin 40 mg po qd
3. Cyanocobalamin 500 mcg Two (2) Tablet PO qd
4. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H x10
days.
Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID
6. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO QD (once a
day).
7. Prednisone 10 mg Tablet Sig: One (1) Tablet PO once a day.

ALLERGIES: Bactrim

PHYSICAL EXAM: T 96.8 BP 118/60 HR 93 RR 20, 96% RA
Gen: NAD
PERRLA, EOMI, MMM
No jvd
RRR, nl s1s2 no m/r/g
Lungs with rhonchi b/l, occasional exp wheeze
Abd soft nt nd normal bs
Extremities without c/c/e, + onchymycosis, 1+ peripheral pulses
Neuro cn II-XII intact, decreased sensation at soles of feet
b/l, strength 5/5 throughout

FAMILY HISTORY: non contributory

SOCIAL HISTORY: 40 pack year tobacco history, rare alcohol, lives downstairs
from daughter.
Unspecified septicemia,Pneumonia, organism unspecified,Pneumonitis due to inhalation of food or vomitus,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Congestive heart failure, unspecified,Retention of urine, unspecified,Sepsis
Septicemia NOS,Pneumonia, organism NOS,Food/vomit pneumonitis,Chr airway obstruct NEC,Atrial fibrillation,CHF NOS,Retention urine NOS,Sepsis
Admission Date:  [**2165-8-1**]              Discharge Date:   [**2165-8-8**]


Service: MED

Allergies:
Bactrim

Attending:[**First Name3 (LF) 6114**]
Chief Complaint:
cough, chills, confusion

Major Surgical or Invasive Procedure:
none

History of Present Illness:
81 year old male status post CABG, COPD, HTN, and recurrent UTIs
was found by his daughter seeming somewhat confused and having
rigors.  Over the past few days he had developed nonproductive
cough, difficulty breathing, and had felt weak.  He was admitted
to the MICU where he was treated for sepsis and pneumonia.


Past Medical History:
CAD s/p CABG, DM2 w/neuropathy (wheelchair bound), anxiety, HTN,
hyperchol, COPD, insonmia, CHF, constipation, recurrent UTIs,
h/o lymphoma s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3454**], [**First Name3 (LF) **] mass (etiology unknown), childhood
polio.


Social History:
40 pack year tobacco history, rare alcohol, lives downstairs
from daughter.

Family History:
non contributory

Physical Exam:
T 96.8 BP 118/60 HR 93 RR 20, 96% RA
Gen: NAD
PERRLA, EOMI, MMM
No jvd
RRR, nl s1s2 no m/r/g
Lungs with rhonchi b/l, occasional exp wheeze
Abd soft nt nd normal bs
Extremities without c/c/e, + onchymycosis, 1+ peripheral pulses
Neuro cn II-XII intact, decreased sensation at soles of feet
b/l, strength 5/5 throughout


Pertinent Results:
CXR-The vascular catheter remains in satisfactory position. The
cardiac silhouette is enlarged but stable. There is extensive
blurring of the strs likely due to motion artifact. This limits
overall assessment. There are patchy some confluent opacities at
the lung bases, left greater than right. The left lower lobe
opacity is unchanged but the right lower lobe opacity appears
new.
IMPRESSION:
1. Persistent left lower lobe opacity and new patchy right lower
lobe opacity. This could be due to aspiration given the clinical
suspicion.
2. Limited assessment for congestive heart failure due to
respiratory motion.

[**2165-7-31**] 11:00PM BLOOD WBC-13.5* RBC-4.60 Hgb-14.0 Hct-38.9*
MCV-85 MCH-30.5 MCHC-36.0* RDW-15.1 Plt Ct-136*
[**2165-7-31**] 11:00PM BLOOD Glucose-213* UreaN-23* Creat-0.9 Na-139
K-4.6 Cl-98 HCO3-31* AnGap-15
[**2165-7-31**] 11:18PM BLOOD Lactate-5.0*
[**2165-8-8**] 03:00AM BLOOD WBC-12.2* RBC-3.81* Hgb-11.3* Hct-33.3*
MCV-87 MCH-29.7 MCHC-34.1 RDW-15.5 Plt Ct-164
[**2165-8-8**] 03:00AM BLOOD Glucose-74 UreaN-16 Creat-0.9 Na-139
K-3.5 Cl-102 HCO3-28 AnGap-13
[**2165-7-31**] 11:00PM BLOOD TSH-0.76

[**8-2**] Swallow Eval SUMMARY / IMPRESSION:
Functional oral and pharyngeal swallowing ability with no signs
of aspiration on bedside swallowing evaluation. Pt. was able to
swallow [**Last Name (LF) 58300**], [**First Name3 (LF) **] cracker and water without difficulty.
He
denied food sticking in his throat or going down the wrong way.
RECOMMENDATIONS:
1.  Diet of soft solids and thin liquids
2.  He should take small bites of solids
    Eat only one bite at a time
    Chew well
    Alternate between one bite and one sip
3.  Keep him seated upright for 30 minutes after eating.
4.  Medications broken or crushed in puree
5.  If further swallowing difficulties are noted w/solids
    suggest GI consult, as pt. has a history of esophageal
    stricture


Brief Hospital Course:
The patient was admitted to the unit and reaponded quickly on
the MUST protocol.  Early after admission patient had elevated
troponins in the setting of tachycardia, which was thought to be
due to a demand ischemia.  He was diagnosed with pneumonia, and
blood cultures remained negative.  On the second day in the MICU
the patient was witnessed to cough while eating.  A repeat CXR
confirmed new aspiration pneumonia.

RESPIRATORY: On trasfer to the floor [**2165-8-2**], the patient was
stable with good oxygenation but clinically his pneumonia was
slow to improve.  He was treated with Levoquin and Vancomycin,
which was discontinued [**8-2**] since the patient did not have MRSA,
and given nebulizer albuterol/atrovent therapy.  The patient has
COPD and is on standing dose of 10mg prednisone daily and
albuterol MDI.  He received a steroid taper and was discharged
using his home dose of prednisone and off nebs.  Throughout the
hospital course, the patient was afebrile and maintained good
oxygen saturation.  He occasionally developed shortness of
breath when anxious that was relieved by oxygen saturation.
Blood cultures remained negative.  At discharge, the patient had
gotten 7 days of levoquin and a prescription for 7 more days was
provided for a full 14 day course for pneumonia.

CARDIOVASCULAR: The patient has CAD s/p CABG, HTN, CHF with EF
30-35%, and diabetes. Troponin revealed slight elevations
consistent with demand ischemia, and the trend was stable. He
takes aspirin, a beta blocker, statin and ACE inhibitor which
were continued. His chronic atrial fibrillation was rate
controlled on lopressor. Anticoagulation is contraindicated due
to the patients fall risk. Blood pressure was well controlled on
lopressor and lisinopril.

URINARY RETENTION: The patient is s/p TURP with a history of
recurrent urinary tract infections and had continued urinary
retention with difficulty voiding this admission.  He required
Foley placement [**8-6**] for urinary retention at which time a
bladder scan revealed one-half liter retained urine.  The
patient was able to spontaneously urinate the next day and
developed gross hematuria.  After passage of blood clots, the
patient voided additional clear urine.  He was started on flomax
[**8-6**] for long term therapy and recommended to visit urology
clinic as an outpatient.

ANXIETY: The patient easily became anxious and dyspneic with
discussions about disposition or with procedures.  His home
regimen was continued and sertraline was increased to 30mg po
daily on [**8-7**].

DIABETES: The patient followed a diabetic cardiac healthy diet
and glucose levels were managed by application of regular
insulin per sliding scale with fingerstick glucose checks every
four hours.

PHYSICAL THERAPY: The patient was weak and lacking strength to
transfer himself from bed to chair or just to stand from sitting
position.  He was treated intensely with physical therapy and
was much improved by discharge where he was able to complete
transfers with the assistance of a walker.  Every day at
mutliple times of enquiry, the patient adamantly refused to
attend a short time in a rehab facility before returning home
even after a family meeting including his daughter.

The patient was discharged to home with services provided by
visiting nursing.  He was breathing comfortably on room air and
lacked dyspnea on exertion.  He was voiding spontaneously with
ease.  In conclusion, the patient has significantly improved and
will complete a home course of levoquin for pneumonia.
Of note, recommendation for rehab was made, however he firmly
and repeatedly denied and insisted upon discharge home with
services.  He did agree to stay in the hospital for several
additional days for physical therapy and resolution of his
urinary retention (which resolved prior to discharge), and had
made significant gains prior to discharge.  He was discharged
with VNA and home PT.

Medications on Admission:
Prednisone 10 mg po qd
Aspirin 325 mg ad
Simvastatin 40 mg po qd
3. Cyanocobalamin 500 mcg Two (2) Tablet PO qd
4. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H x10
days.
Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID
6. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO QD (once a
day).
7. Prednisone 10 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO QD (once a day).

2. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO QD (once a
day).
3. Cyanocobalamin 500 mcg Tablet Sig: Two (2) Tablet PO QD (once
a day).
4. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
5. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO QD (once a
day).
6. Prednisone 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
7. Digoxin 250 mcg Tablet Sig: One (1) Tablet PO QD (once a
day).
Disp:*30 Tablet(s)* Refills:*2*
8. Albuterol  Inhalation
9. Atrovent 18 mcg/Actuation Aerosol Inhalation
10. Xanax  Oral
11. Calcium + D 600-200 mg-unit Tablet Sig: One (1) Tablet PO
three times a day.
Disp:*90 Tablet(s)* Refills:*2*
12. Tamsulosin HCl 0.4 mg Capsule, Sust. Release 24HR Sig: One
(1) Capsule, Sust. Release 24HR PO HS (at bedtime).
Disp:*30 Capsule, Sust. Release 24HR(s)* Refills:*2*
13. Psyllium 58.6 % Packet Sig: One (1) Packet PO TID (3 times a
day).
Disp:*90 Packet(s)* Refills:*2*
14. Citalopram Hydrobromide 20 mg Tablet Sig: 1.5 Tablets PO QD
(once a day).
Disp:*45 Tablet(s)* Refills:*2*
15. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO once a day
for 7 days.
Disp:*7 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 **] Elder Services: [**First Name4 (NamePattern1) 3825**] [**Last Name (NamePattern1) **]

Discharge Diagnosis:
Pneumonia
Sepsis
COPD


Discharge Condition:
stable and improved

Discharge Instructions:
Please take all medicines as prescribed. Please return to the
emergency room or call your primary doctor if you develop
worsening shortness of breath.


Followup Instructions:
Follow up with your primary doctor within 1 week.
{'Unspecified septicemia,Pneumonia, organism unspecified,Pneumonitis due to inhalation of food or vomitus,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Congestive heart failure, unspecified,Retention of urine, unspecified,Sepsis'}


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: cough, chills, confusion

PRESENT ILLNESS: 81 year old male status post CABG, COPD, HTN, and recurrent UTIs
was found by his daughter seeming somewhat confused and having
rigors.  Over the past few days he had developed nonproductive
cough, difficulty breathing, and had felt weak.  He was admitted
to the MICU where he was treated for sepsis and pneumonia.

MEDICAL HISTORY: CAD s/p CABG, DM2 w/neuropathy (wheelchair bound), anxiety, HTN,
hyperchol, COPD, insonmia, CHF, constipation, recurrent UTIs,
h/o lymphoma s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3454**], [**First Name3 (LF) **] mass (etiology unknown), childhood
polio.

MEDICATION ON ADMISSION: Prednisone 10 mg po qd
Aspirin 325 mg ad
Simvastatin 40 mg po qd
3. Cyanocobalamin 500 mcg Two (2) Tablet PO qd
4. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H x10
days.
Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID
6. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO QD (once a
day).
7. Prednisone 10 mg Tablet Sig: One (1) Tablet PO once a day.

ALLERGIES: Bactrim

PHYSICAL EXAM: T 96.8 BP 118/60 HR 93 RR 20, 96% RA
Gen: NAD
PERRLA, EOMI, MMM
No jvd
RRR, nl s1s2 no m/r/g
Lungs with rhonchi b/l, occasional exp wheeze
Abd soft nt nd normal bs
Extremities without c/c/e, + onchymycosis, 1+ peripheral pulses
Neuro cn II-XII intact, decreased sensation at soles of feet
b/l, strength 5/5 throughout

FAMILY HISTORY: non contributory

SOCIAL HISTORY: 40 pack year tobacco history, rare alcohol, lives downstairs
from daughter. 

### Response:
{'Unspecified septicemia,Pneumonia, organism unspecified,Pneumonitis due to inhalation of food or vomitus,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Congestive heart failure, unspecified,Retention of urine, unspecified,Sepsis'}
