CHIEF COMPLAINT: 

PRESENT ILLNESS: This is an 81 year old woman
with a history of cerebrovascular accident, hypertension,
diabetes mellitus, and end-stage renal disease who presented
to the Emergency Room at 5 a.m. on [**10-22**] complaining of
worsening right sided weakness.  The weakness has been
present for a while but had been worsening for about two
weeks.  She has some baseline right-sided weakness from her
cerebrovascular accident five to seven years ago and requires
either a wheelchair or a assistance with ambulation.  The
initial neurological evaluation in the Emergency Department
revealed the patient alert and oriented times three with
fluent speech, mind, cranial nerves intact, positive tremor
of the whole body, right leg two to three out of five
strength, intact sensory system, bilateral plantar reflexes
upward.   A CT scan of the head was negative for bleed.

MEDICAL HISTORY: 1.  Left sided cerebrovascular accident.
2.  Diabetes mellitus type 2.
3.  Hypertension.
4.  End-stage renal disease with hemodialysis on Monday,
Wednesday and Friday.
5.  Scoliosis.
6.  Legally blind, both eyes.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives alone with her nephew in a
building.  She has no spouse and no children, but has the
support from extended family.  Does not smoke; does not drink
alcohol.
Hypertensive encephalopathy,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere
Hypertens encephalopathy,Hyp kid NOS w cr kid V,DMII renl nt st uncntrld,Nephritis NOS in oth dis
Admission Date:  [**2184-10-22**]       Discharge Date:  [**2184-10-30**]


Service:  [**Hospital1 **]

HISTORY OF PRESENT ILLNESS:   This is an 81 year old woman
with a history of cerebrovascular accident, hypertension,
diabetes mellitus, and end-stage renal disease who presented
to the Emergency Room at 5 a.m. on [**10-22**] complaining of
worsening right sided weakness.  The weakness has been
present for a while but had been worsening for about two
weeks.  She has some baseline right-sided weakness from her
cerebrovascular accident five to seven years ago and requires
either a wheelchair or a assistance with ambulation.  The
initial neurological evaluation in the Emergency Department
revealed the patient alert and oriented times three with
fluent speech, mind, cranial nerves intact, positive tremor
of the whole body, right leg two to three out of five
strength, intact sensory system, bilateral plantar reflexes
upward.   A CT scan of the head was negative for bleed.

Vital signs on admission to the Emergency Department were
significant for a blood pressure of 248/97.  She was started
on Nitroglycerin with a small decrease in blood pressure.  At
MRI she would not tolerate the test and on removal she had
full-body rigoring.  She said she felt that she had to gather
her bearings and was miserable, but remained afebrile.

On return to the Emergency Department, she stopped shaking,
face contorted and stopped moving.  Question of whether she
stopped breathing.  The patient was rapidly intubated for
airway protection and given ativan 2 mg, Vecuronium 1 mg,
succinylcholine 100, calcium and D50.  Post-intubation
arterial blood gas was 7.33/40/159.  The patient was
transferred to the Medical Intensive Care Unit with blood
pressure at 66/42.  The blood pressure continued to be
extraordinarily low.

PAST MEDICAL HISTORY:
1.  Left sided cerebrovascular accident.
2.  Diabetes mellitus type 2.
3.  Hypertension.
4.  End-stage renal disease with hemodialysis on Monday,
Wednesday and Friday.
5.  Scoliosis.
6.  Legally blind, both eyes.

MEDICATIONS PRIOR TO ARRIVAL TO THE HOSPITAL:
1.  Levoxyl 150 q. day.
2.  Norvasc 10 q. day.
3.  Celebrex 100 q. day.
4.  Roxicet twice a day.
5.  Nephrocaps.
6.  Remegel 800 three times a day Monday and Wednesday only.
7.  Aspirin 81 once a day.
8.  Tylenol 325 at bedtime.
9.  Ultram 50 twice a day.
10. Colace 100 twice a day.
11. Timoptic 0.5% twice a day.
12. Lactulose 30 q. day.

SOCIAL HISTORY:   She lives alone with her nephew in a
building.  She has no spouse and no children, but has the
support from extended family.  Does not smoke; does not drink
alcohol.

PHYSICAL EXAMINATION:   Vital signs 96.9 F., blood pressure
ranged from 66 to 224 over 24 to 169; heart rate 73;
respiratory rate was 16.  At the time of examination, the
patient was sedated and unresponsive.  In general, the
patient was intubated and sedated.  The Head, Eyes, Ears,
Nose and Throat revealed pupils equal, round and reactive to
light and accommodation.  Extraocular muscles were not able
to be assessed.  Lungs were clear to auscultation, no rales
or rhonchi.  Cardiac had regular rate and rhythm, II/VI
systolic murmur.  Abdomen was soft, nontender, nondistended.
Extremities were warm with no edema.  Distal pulses were not
palpable in the lower extremities.  Neurologic examination
showed her moving all four limbs.

LABORATORY:  White blood cell count 5.11, hematocrit 45.2,
platelets 168.  Sodium 168, potassium 3.6, chloride 101,
bicarbonate 22, glucose 164, lactate was 5.7.

Chest x-ray in the Emergency Department post intubation
revealed nothing consistent with congestive heart failure.

CT scan examination revealed no acute abnormalities.

An EEG examination showed no changes consistent with recent
event.

HOSPITAL COURSE:   Respiratory status included extubation on
Saturday, [**2184-10-23**], with no subsequent difficulties.  Her
hypertension was managed initially with nitrates and was
changed to a regimen to include Norvasc 5 mg, Atenolol 25 mg,
and Lisinopril 5 mg once a day.  This resulted in a reduction
of her blood pressure to approximately 110/70, at which point
the Norvasc was discontinued.  The Atenolol was continued at
25 mg once a day and the Lisinopril was changed to 2.5 mg per
day, which seems to be an acceptable regimen producing a
blood pressure of 130/80.

Her mental status has been disoriented and confused
throughout most of the hospital stay with periods of
improvement followed by a return to the baseline of
confusion.  She has said that the date is [**2105**], her location
was at home.  There does not seem to be any correlation
between mental status and blood pressure.

Neurologic examination in follow-up did not provide any
follow-up any organic cause for her confusion.

Her renal issues were followed with hemodialysis for
end-stage renal disease followed by Dr. [**First Name (STitle) 805**] on Monday,
Wednesday and Friday.  There were no issues.

Her disposition for hospital discharge resulted in
discussions with the family, Case Management, physicians and
Physical Therapy.  It was felt by the hospital staff that
given that the patient is unable to follow commands, assist
with her care and is incontinent, that home care would not be
appropriate at this time and transfer to a rehabilitation
facility would be her best option.

This discussion went on for some time with the family, at the
end of which the family agreed at discharge to a
rehabilitation facility such as [**Hospital1 **] would be
appropriate.

DISCHARGE DIAGNOSES:
1.  Hypertension.
2.  End-stage renal disease.
3.  Diabetes mellitus.
4.  Changes in mental status due to delirium overlaid on top
of ongoing dementia.

DISCHARGE STATUS:   Fair given that the patient is unable to
follow commands or participate in her own care.

DISCHARGE MEDICATIONS:
1.  Lisinopril 2.5 mg q. day p.o.
2.  Atenolol 25 mg p.o. q. day.
3.  Regular insulin sliding scale.
4.  Bisacodyl 10 mg p.r. h.s. p.r.n.
5.  Docusate 100 mg p.o. twice a day.
6.  Levothyroxine 150 micrograms p.o. q. day.
7.  Heparin 5000 units subcutaneously q. 12 hours.
8.  Remegel 800 p.o. three times a day, Monday and Wednesday
only.
9.  Aspirin 81 mg q. day.
10. Artificial Tears, one to two drops o.u. twice a day.
11. Atenolol 0.5% ophthalmic solution, one drop o.u. twice a
day.
12. Dorzolamide 2% ophthalmic solution, one drop o.u. three
times a day.


                            [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 4987**]

Dictated By:[**Last Name (NamePattern1) 96751**]
D:  [**2184-10-29**]  18:05
T:  [**2184-10-29**]  19:20
JOB#:  [**Job Number **]


Admission Date:  [**2184-10-22**]       Discharge Date: [**2184-10-31**]


Service:

ADDENDUM:  Ms. [**Known lastname **] hospital course continued along the
same lines as in the prior dictation.  Her mental status
continued to wax and wane.  At her times of maximum
alertness, she was able to hold a conversation regarding her
care and her disposition, whereas at other times she spoke of
people who weren't in the room.  The only change to her
medications since previous dictation is that her atenolol was
discontinued due to a heart rate of 46.  She continues to be
on Lisinopril 2.5 mg once daily with adequate blood pressure
control.

After discussion with Neurology, it was also felt that she
would benefit from a Neurobehavioral assessment at her
rehabilitation facility.




                      DR.[**First Name (STitle) **],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] 11-719

Dictated By:[**Last Name (NamePattern1) 96786**]
MEDQUIST36

D:  [**2184-10-31**]  21:48
T:  [**2184-11-1**]  00:13
JOB#:  [**Job Number 23174**]
{'Hypertensive encephalopathy,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere'}


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: 

PRESENT ILLNESS: This is an 81 year old woman
with a history of cerebrovascular accident, hypertension,
diabetes mellitus, and end-stage renal disease who presented
to the Emergency Room at 5 a.m. on [**10-22**] complaining of
worsening right sided weakness.  The weakness has been
present for a while but had been worsening for about two
weeks.  She has some baseline right-sided weakness from her
cerebrovascular accident five to seven years ago and requires
either a wheelchair or a assistance with ambulation.  The
initial neurological evaluation in the Emergency Department
revealed the patient alert and oriented times three with
fluent speech, mind, cranial nerves intact, positive tremor
of the whole body, right leg two to three out of five
strength, intact sensory system, bilateral plantar reflexes
upward.   A CT scan of the head was negative for bleed.

MEDICAL HISTORY: 1.  Left sided cerebrovascular accident.
2.  Diabetes mellitus type 2.
3.  Hypertension.
4.  End-stage renal disease with hemodialysis on Monday,
Wednesday and Friday.
5.  Scoliosis.
6.  Legally blind, both eyes.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives alone with her nephew in a
building.  She has no spouse and no children, but has the
support from extended family.  Does not smoke; does not drink
alcohol. 

### Response:
{'Hypertensive encephalopathy,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere'}
