CHIEF COMPLAINT: weakness and lethargy

PRESENT ILLNESS: Ms. [**Known lastname **] is a 79F with h/o dementia who comes in with
anorexia, fatigue for 1-2 weeks. Patient without any localized
complaints, felt that "something was not right" and that she
"wasn't herself." She had generalized weakness. Review of
systems negative in detail for fevers, nausea, vomiting,
abdominal or back discomfort, dysuria, urinary frequency, chest
discomfort, dyspnea, cough, diarrhea.

MEDICAL HISTORY: Dementia
Stroke
HTN
Hyperlipidemia
s/p TAHBSO
h/o vaginal prolapse and vaginal pessary
h/o R central retinal vein occlusion

MEDICATION ON ADMISSION: Donepezil 10mg daily
Simvastatin 40mg daily
nifedipine 90mg daily
aspirin 325 daily
omeprazole 20mg daily
terazosin 2mg daily
irbesartan 300mg daily
bumetanide 2mg daily
nadolol 40mg TID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam
T 96.8 P 76 Bp 100/70 RR 20 O2 94% RA
General Breathing comfortably on room air in no acute distress
Pulm Lungs with few crackles at L base, no egophony
Back no CVA tenderness
CV Regular rate S1 S1 no m/r/g
Abd Soft, nontender
Extrem warm, well perfused 1+ bilateral lower extremity edema

FAMILY HISTORY: NC

SOCIAL HISTORY: Retired, lives with her husband and son.  [**Name (NI) **] smoking, EtoH,
ilicits
Acute kidney failure, unspecified,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Unspecified essential hypertension,Senile dementia, uncomplicated,Coronary atherosclerosis of native coronary artery,Personal history of other diseases of circulatory system,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Hypopotassemia
Acute kidney failure NOS,Urin tract infection NOS,CHF NOS,Hypertension NOS,Senile dementia uncomp,Crnry athrscl natve vssl,Hx-circulatory dis NEC,Pure hypercholesterolem,Hypothyroidism NOS,Hypopotassemia
Admission Date:  [**2141-6-19**]              Discharge Date:   [**2141-6-25**]

Date of Birth:  [**2062-6-11**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4963**]
Chief Complaint:
weakness and lethargy

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Ms. [**Known lastname **] is a 79F with h/o dementia who comes in with
anorexia, fatigue for 1-2 weeks. Patient without any localized
complaints, felt that "something was not right" and that she
"wasn't herself." She had generalized weakness. Review of
systems negative in detail for fevers, nausea, vomiting,
abdominal or back discomfort, dysuria, urinary frequency, chest
discomfort, dyspnea, cough, diarrhea.

In the ED, vitals were T 96.6 P 75 BP 95/57 O2 95% RA. Her
admission labs were remarkable for WBC of 28.3, and urinalysis
showing >50 WBC. Her pessary was reportedly removed, and she
received vancomycin and ceftriaxone empirically.

Past Medical History:
Dementia
Stroke
HTN
Hyperlipidemia
s/p TAHBSO
h/o vaginal prolapse and vaginal pessary
h/o R central retinal vein occlusion

Social History:
Retired, lives with her husband and son.  [**Name (NI) **] smoking, EtoH,
ilicits

Family History:
NC

Physical Exam:
Physical Exam
T 96.8 P 76 Bp 100/70 RR 20 O2 94% RA
General Breathing comfortably on room air in no acute distress
Pulm Lungs with few crackles at L base, no egophony
Back no CVA tenderness
CV Regular rate S1 S1 no m/r/g
Abd Soft, nontender
Extrem warm, well perfused 1+ bilateral lower extremity edema

Pertinent Results:
RENAL ULTRASOUND:  The right kidney measures 11.3 cm.  The left
kidney
measures 9.7 cm.  There are no stones or hydronephrosis.  Mild
lobulation of the right renal cortex is unchanged compared to
the prior study.
IMPRESSION:
1.  No stones or hydronephrosis
.
CT HEAD W/O CONTRAST:
IMPRESSION:
1.  No hemorrhage or mass effect.
2.  Chronic microvascular ischemia.
.
CHEST (PA & LAT):
IMPRESSION:
1)  Mild cardiomegaly without congestive heart failure.

[**2141-6-19**] 01:45PM   WBC-28.8*# RBC-3.63* HGB-11.4* HCT-33.3*
MCV-92 MCH-31.5 MCHC-34.3 RDW-13.2
[**2141-6-19**] 01:45PM   NEUTS-86* BANDS-0 LYMPHS-1* MONOS-13* EOS-0
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2141-6-19**] 01:45PM   HYPOCHROM-NORMAL ANISOCYT-NORMAL POIKILOCY-1+
MACROCYT-NORMAL MICROCYT-NORMAL POLYCHROM-NORMAL OVALOCYT-1+
[**2141-6-19**] 01:45PM   PLT SMR-NORMAL PLT COUNT-264
[**2141-6-19**] 09:26AM URINE  HOURS-RANDOM CREAT-182 SODIUM-51
[**2141-6-19**] 09:26AM URINE  OSMOLAL-302
[**2141-6-19**] 01:45PM   GLUCOSE-133* UREA N-92* CREAT-5.5*#
SODIUM-132* POTASSIUM-3.0* CHLORIDE-87* TOTAL CO2-26 ANION
GAP-22*
[**2141-6-19**] 03:05PM   LACTATE-1.9
[**2141-6-19**] 04:00PM URINE  BLOOD-LG NITRITE-NEG PROTEIN-100
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-MOD
[**2141-6-19**] 04:00PM URINE  RBC-21-50* WBC->50 BACTERIA-MANY
YEAST-NONE EPI-[**1-30**]

[**6-19**] blood cultures:
   URINE CULTURE (Final [**2141-6-22**]):
      ESCHERICHIA COLI.    >100,000 ORGANISMS/ML..
      LACTOBACILLUS SPECIES.    10,000-100,000 ORGANISMS/ML..

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             ESCHERICHIA COLI
                             |
AMPICILLIN------------  =>32 R
AMPICILLIN/SULBACTAM--  =>32 R
CEFAZOLIN-------------   <=4 S
CEFEPIME--------------   <=1 S
CEFTAZIDIME-----------   <=1 S
CEFTRIAXONE-----------   <=1 S
CEFUROXIME------------     4 S
CIPROFLOXACIN---------     1 S
GENTAMICIN------------   <=1 S
IMIPENEM--------------   <=1 S
MEROPENEM-------------<=0.25 S
NITROFURANTOIN--------  <=16 S
PIPERACILLIN/TAZO-----   <=4 S
TOBRAMYCIN------------   <=1 S
TRIMETHOPRIM/SULFA----  =>16 R

[**6-19**] blood cultures E. coli, as above
[**Date range (1) 73636**] blood cultures negative
[**6-22**] stool cultures negative, C. diff negative x1

Brief Hospital Course:
1. UTI, urosepsis - The patient was treated empirically with
vancomycin and ceftriaxone in the emergency department. Upon
arrival to the floor, she was hypotensive to the 80's systolic.
She was subsequently transferred to the medical intensive care
unit for close monitoring and did well hemodynamically with
fluid support, without any pressor requirement. Her antibiotics
were changed to Zosyn, and she showed a good clinical response
and improvement in her leukocytosis. On the floor, she was
transistioned to PO ciprofloxacin which she will complete for a
14d course, to end on [**7-2**].
.
2. Acute renal failure - The patient's creatinine improved
follow IVF rehydration. Her renal failure was thought to be
pre-renal in etiology. She will hold off on Avapro until her
follow-up appointment with her PCP, [**Name10 (NameIs) **] repeat Bun/Cr will be
measured the week following discharge.
.
2. CAD - The patient continued aspirin and her statin.
.
4. Dementia - She continued aricept for her dementia.
.
5. Hypertension - Her anti-hypertensives were initially held in
the setting of hypotension. She will resume her home
anti-hypertensive regimen excepting Avapro, for further
adjustment by her PCP at her next appointment.
.
The patient was full code.

Medications on Admission:
Donepezil 10mg daily
Simvastatin 40mg daily
nifedipine 90mg daily
aspirin 325 daily
omeprazole 20mg daily
terazosin 2mg daily
irbesartan 300mg daily
bumetanide 2mg daily
nadolol 40mg TID

Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
primary
1. urinary tract infection
secondary
1. acute renal failure
2. hypertension
3. dementia


Discharge Condition:
good


Discharge Instructions:
Please seek medical attention if you develop fevers, chills,
sweats, shortness of breath, abdominal or back pain, worsened
discomfort with urination, or other symptoms that worry you.
Please take all of your antibiotics (ciprofloxacin) as directed,
even if you are feeling entirely well.
Please have the following blood work done on Tuesday [**6-27**]:
complete blood count, BUN, and Creatinine.
Please do NOT take your Avapro until Dr. [**Last Name (STitle) 172**] says to resume
it.

Followup Instructions:
Please follow up with your primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 172**]
[**Telephone/Fax (1) 133**] on [**7-3**] 1:45





Name:  [**Known lastname 14729**],[**Known firstname 2219**]                  Unit No:   [**Numeric Identifier 14730**]

Admission Date:  [**2141-6-19**]              Discharge Date:   [**2141-6-25**]

Date of Birth:  [**2062-6-11**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2925**]
Addendum:
The patient will be discharged from the hospital to home with
services.

Discharge Disposition:
Home With Service

Facility:
[**Hospital3 413**] VNA

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2927**] MD [**MD Number(2) 2928**]

Completed by:[**2141-6-25**]
{'Acute kidney failure, unspecified,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Unspecified essential hypertension,Senile dementia, uncomplicated,Coronary atherosclerosis of native coronary artery,Personal history of other diseases of circulatory system,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Hypopotassemia'}


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: weakness and lethargy

PRESENT ILLNESS: Ms. [**Known lastname **] is a 79F with h/o dementia who comes in with
anorexia, fatigue for 1-2 weeks. Patient without any localized
complaints, felt that "something was not right" and that she
"wasn't herself." She had generalized weakness. Review of
systems negative in detail for fevers, nausea, vomiting,
abdominal or back discomfort, dysuria, urinary frequency, chest
discomfort, dyspnea, cough, diarrhea.

MEDICAL HISTORY: Dementia
Stroke
HTN
Hyperlipidemia
s/p TAHBSO
h/o vaginal prolapse and vaginal pessary
h/o R central retinal vein occlusion

MEDICATION ON ADMISSION: Donepezil 10mg daily
Simvastatin 40mg daily
nifedipine 90mg daily
aspirin 325 daily
omeprazole 20mg daily
terazosin 2mg daily
irbesartan 300mg daily
bumetanide 2mg daily
nadolol 40mg TID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam
T 96.8 P 76 Bp 100/70 RR 20 O2 94% RA
General Breathing comfortably on room air in no acute distress
Pulm Lungs with few crackles at L base, no egophony
Back no CVA tenderness
CV Regular rate S1 S1 no m/r/g
Abd Soft, nontender
Extrem warm, well perfused 1+ bilateral lower extremity edema

FAMILY HISTORY: NC

SOCIAL HISTORY: Retired, lives with her husband and son.  [**Name (NI) **] smoking, EtoH,
ilicits 

### Response:
{'Acute kidney failure, unspecified,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Unspecified essential hypertension,Senile dementia, uncomplicated,Coronary atherosclerosis of native coronary artery,Personal history of other diseases of circulatory system,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Hypopotassemia'}
