CHIEF COMPLAINT: CC: fatigue, dyspnea

PRESENT ILLNESS: .
HPI: 81M with h/o large cell lymphoma (completed 3 week course
of R-CVP on [**2195-1-31**]), HTN, CAD, AS, s/p recent aortic
valvuloplasty [**12-5**], who presented on the [**2195-2-9**] with a 1-week
history of fatigue and dyspnea. The patient reported "not
feeling well". He denied weakness, but does say that his legs
felt tired. His family concurs that he has been quite fatigued
for the last week, and his breathing has appeared labored to
them for the last 48+ hours. They also report that he has not
been himself - they describe that he is "slow" to do things,
mildly forgetful, and give examples of where he says he will do
something then never moves.
.
The patient was admitted to medicine. He had some improvement in
his shortness of breath with aggressive diuresis. The patient's
course was complicated by a fever to 103. The patient became
tachypneic(HR 130s-140sand and hypotensive to the 80's. He also
had delta MS.
.
The patient was tx to the unit for sepsis. He was intubated for
hypotension and resp. failure. In the unit that patient was
treated for urosepsis (Klebsiella ESBL:Zosyn). The patient
received aggressive fluid hydration without evidence of volume
overload. The patient was later extubated and transferred to the
[**Hospital Ward Name 121**] 3 for further mgmt of his cardiac issues.

MEDICAL HISTORY: 1. Diffuse large B cell lymphoma:  involving liver, lung, kidney
2. s/p limited right thoracotomy w/ open lung biopsy [**2194-11-17**]
3. CAD:  h/o MI [**2181**], s/p CABG x 3 [**2181**], cath [**6-3**] w/ 3VD,
patent grafts
4. aortic stenosis
5. CHF:  cath [**6-3**] w/ LVEF 22%, akinetic inferior wall and apex
with some apical dyskinesis, mild mitral regurgitation
6. HTN
7. Hyperlipidemia
8. Glaucoma
9. BPH
10. s/p B/L THR
11. Peptic ulcer disease

MEDICATION ON ADMISSION: asa 81 mg daily
lipitor 10 mg daily
tamsulosin 0.4 mg qhs
allopurinol 200 mg daily
lamivudine 100 mg qhs
latanoprost 0.005 % 1 drop qhs
bumex 3 mg daily
temaz 15 mg qhs
ranitidine 150 mg daily
KCL 40 mEq [**Hospital1 **]

ALLERGIES: Percocet

PHYSICAL EXAM: T97.4 BP 108/64 HR87 R 32 O2sat 98%RA
Gen: NAD, speaking in full sentences
HEENT: JVD to ears, MMM, OP clear
Heart: nl rate, S1S2, II/VISEM
Lungs: faint crackles at bases
Abd: benign
Ext: trace pedal edema
Neuro: A & O X3.

FAMILY HISTORY: 1. CAD:  father died of MI in 40s
2. ALS:  brother

SOCIAL HISTORY: married for 60 years, has 3 children; lives w/ his wife; smoked
30 pack-years but quit this year; no alcohol or IVDU
Congestive heart failure, unspecified,Unspecified septicemia,Urinary tract infection, site not specified,Severe sepsis,Acute respiratory failure,Other malignant lymphomas, lymph nodes of multiple sites,Septic shock,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Anemia, unspecified,Unspecified glaucoma
CHF NOS,Septicemia NOS,Urin tract infection NOS,Severe sepsis,Acute respiratry failure,Lymphomas NEC mult,Septic shock,Klebsiella pneumoniae,Hypertension NOS,Crnry athrscl natve vssl,Anemia NOS,Glaucoma NOS
Admission Date:  [**2195-2-9**]              Discharge Date:   [**2195-2-20**]

Date of Birth:  [**2114-1-22**]             Sex:   M

Service: MEDICINE

Allergies:
Percocet

Attending:[**First Name3 (LF) 613**]
Chief Complaint:
CC: fatigue, dyspnea


Major Surgical or Invasive Procedure:
Intubation


History of Present Illness:
.
HPI: 81M with h/o large cell lymphoma (completed 3 week course
of R-CVP on [**2195-1-31**]), HTN, CAD, AS, s/p recent aortic
valvuloplasty [**12-5**], who presented on the [**2195-2-9**] with a 1-week
history of fatigue and dyspnea. The patient reported "not
feeling well". He denied weakness, but does say that his legs
felt tired. His family concurs that he has been quite fatigued
for the last week, and his breathing has appeared labored to
them for the last 48+ hours. They also report that he has not
been himself - they describe that he is "slow" to do things,
mildly forgetful, and give examples of where he says he will do
something then never moves.
.
The patient was admitted to medicine. He had some improvement in
his shortness of breath with aggressive diuresis. The patient's
course was complicated by a fever to 103. The patient became
tachypneic(HR 130s-140sand and hypotensive to the 80's. He also
had delta MS.
.
The patient was tx to the unit for sepsis. He was intubated for
hypotension and resp. failure. In the unit that patient was
treated for urosepsis (Klebsiella ESBL:Zosyn). The patient
received aggressive fluid hydration without evidence of volume
overload. The patient was later extubated and transferred to the
[**Hospital Ward Name 121**] 3 for further mgmt of his cardiac issues.


Past Medical History:
1. Diffuse large B cell lymphoma:  involving liver, lung, kidney
2. s/p limited right thoracotomy w/ open lung biopsy [**2194-11-17**]
3. CAD:  h/o MI [**2181**], s/p CABG x 3 [**2181**], cath [**6-3**] w/ 3VD,
patent grafts
4. aortic stenosis
5. CHF:  cath [**6-3**] w/ LVEF 22%, akinetic inferior wall and apex
with some apical dyskinesis, mild mitral regurgitation
6. HTN
7. Hyperlipidemia
8. Glaucoma
9. BPH
10. s/p B/L THR
11. Peptic ulcer disease

Social History:
married for 60 years, has 3 children; lives w/ his wife; smoked
30 pack-years but quit this year; no alcohol or IVDU


Family History:
1. CAD:  father died of MI in 40s
2. ALS:  brother

Physical Exam:
T97.4 BP 108/64 HR87 R 32 O2sat 98%RA
Gen: NAD, speaking in full sentences
HEENT: JVD to ears, MMM, OP clear
Heart: nl rate, S1S2, II/VISEM
Lungs: faint crackles at bases
Abd: benign
Ext: trace pedal edema
Neuro: A & O X3.


Pertinent Results:
[**2195-2-9**] 11:43PM   ALT(SGPT)-47* AST(SGOT)-44* LD(LDH)-220
CK(CPK)-32* ALK PHOS-275*
[**2195-2-9**] 11:43PM   CK-MB-NotDone cTropnT-0.02*
[**2195-2-9**] 11:43PM   AMMONIA-21
[**2195-2-9**] 11:43PM   OSMOLAL-280
[**2195-2-9**] 03:40PM   CK(CPK)-45
[**2195-2-9**] 03:40PM   CK-MB-NotDone cTropnT-0.03*
[**2195-2-9**] 03:40PM   cTropnT-0.02*
[**2195-2-9**] 03:40PM URINE  HOURS-RANDOM
[**2195-2-9**] 03:40PM URINE  HOURS-RANDOM
[**2195-2-9**] 03:40PM URINE  UHOLD-HOLD
[**2195-2-9**] 03:40PM URINE  GR HOLD-HOLD
[**2195-2-9**] 03:40PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.010
[**2195-2-9**] 03:40PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG
[**2195-2-9**] 01:05PM   GLUCOSE-122* UREA N-25* CREAT-0.9 SODIUM-129*
POTASSIUM-4.2 CHLORIDE-88* TOTAL CO2-31 ANION GAP-14
[**2195-2-9**] 01:05PM   ALT(SGPT)-54* AST(SGOT)-57* LD(LDH)-259* ALK
PHOS-299* TOT BILI-1.3 DIR BILI-0.6* INDIR BIL-0.7
[**2195-2-9**] 01:05PM   TOT PROT-6.0* ALBUMIN-4.3 GLOBULIN-1.7*
CALCIUM-9.0 PHOSPHATE-3.3 MAGNESIUM-1.8 URIC ACID-4.8
[**2195-2-9**] 01:05PM   WBC-3.8* RBC-3.31* HGB-10.9* HCT-30.5* MCV-92
MCH-33.0* MCHC-35.9* RDW-17.3*
[**2195-2-9**] 01:05PM   NEUTS-65 BANDS-0 LYMPHS-14* MONOS-19* EOS-1
BASOS-1 ATYPS-0 METAS-0 MYELOS-0
[**2195-2-9**] 01:05PM   HYPOCHROM-NORMAL ANISOCYT-1+ POIKILOCY-1+
MACROCYT-1+ MICROCYT-NORMAL POLYCHROM-NORMAL OVALOCYT-1+
[**2195-2-9**] 01:05PM   PLT SMR-NORMAL PLT COUNT-223
[**2195-2-9**] 01:05PM   GRAN CT-2510

Brief Hospital Course:
A/P: 81 yo man with h/o Diffuse large B cell lymphoma, ischemic
acardiomyopathy, CAD, AS s/p recent aortic valvuloplasty [**12-5**],
hypertension initially presented with fatigue, sob course
complicated by [**Hospital Unit Name 153**] stay for urosepsis, now clinically stable.
.
#)Dyspnea/urosepsis:

The patient was initially admitted to medicine. He had some
improvement in his shortness of breath with aggressive diuresis.
However, the patient's course was complicated by a fever to 103.
The patient became tachypneic(HR 130s-140sand and hypotensive to
the 80's. He also had changes in mental status.
.
He was subsequently transferred to the unit on [**2195-2-10**] for
sepsis. He was intubated for hypotension and respiratory
failure. In the unit he was treated for urosepsis: given
Klebsiella ESBL that grew out in his urine, he was started on a
14 day course of Zosyn. The patient received aggressive fluid
hydration without evidence of volume overload. The patient was
later extubated and transferred to the [**Hospital Ward Name 121**] 3 on [**2195-2-15**] for
further management.
.
While on the floor he remained hemodynamically stable.  He was
continued on zosyn and was on day [**10-13**] on discharge.
.
#) volume status--While on [**Hospital Ward Name 121**] 3 following his time in the
unit, the patient's fluid status was evaluated daily giving
consideration to both his heaart failure and aortic stenosis. On
discharge he was breathing comfortably and satting well. He is
to be discharged on bumex 1.5 mg daily.
.
#) CHF:  A repeat Echo on [**2-11**] confirmed severe valvular and
systolic CHF, EF 20% [**Location (un) 109**] 0.8. His bumex was balanced as above.
Per cardiology he was also placed on low low dose toprol.
.
#. CAD s/ CABG: The pt is s/p CABG in '[**81**] and a cath in [**6-3**]
with 3 patent grafts. The pt experienced no active angina during
admission.  He was continued on asa, statin, throughout his
admission. Per cardiology he was started on a bb during this
admission.
.
# lymphoma:  The pt has large cell lymphoma. He completed 3 week
cycle of R-CVP [**2195-1-31**]. He is followed by Dr. [**Last Name (STitle) 12375**], who was
aware of his course during this admission.
.
#. glaucoma:  The pt was continued on Latanoprost throughout the
admission.
.
#. Anemia: His anemia was a stable issue throughout the
admission.
.
#. Prophylaxis: For hep b reactivation the pt was continued on
lamivudine. He was placed on [**Last Name (un) 12376**] regimen, protonix and SC
heparin.
.
#FEN: While extubated the pt was maintained on a low sodium
heart healthy regular diet.
.
# Code: Full.  This was discussed/confirmed on multiple
occasions with the pt's family.
.
Dispo: The pt is to be discharged to [**Hospital 100**] Rehab for further
management of the patient following this acute hospitalization.

Medications on Admission:
asa 81 mg daily
lipitor 10 mg daily
tamsulosin 0.4 mg qhs
allopurinol 200 mg daily
lamivudine 100 mg qhs
latanoprost 0.005 % 1 drop qhs
bumex 3 mg daily
temaz 15 mg qhs
ranitidine 150 mg daily
KCL 40 mEq [**Hospital1 **]

Discharge Medications:
1. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
3. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic  HS
(at bedtime).
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
5. Lamivudine 100 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)).
6. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
8. Bumetanide 0.5 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
9. Piperacillin-Tazobactam 4.5 g Recon Soln Sig: One (1) Recon
Soln Intravenous  Q8H (every 8 hours) for 4 days.
10. Potassium Chloride 20 mEq Packet Sig: Two (2)  PO twice a
day.
11. Temazepam 15 mg Capsule Sig: One (1) Capsule PO at bedtime
as needed for insomnia. Capsule(s)
12. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO at bedtime.
13. Magnesium Oxide 400 mg Tablet Sig: Two (2) Tablet PO once a
day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - Acute Rehab

Discharge Diagnosis:
Primary: urospesis

Secondary: congestive heart failure
Coronary srtery disease
lymphoma
glaucoma
anemia


Discharge Condition:
Good. Pt is hemodynamically stable and is breathing comfortably.


Discharge Instructions:
In regards to your heart failure, weigh yourself every morning,
[**Name8 (MD) 138**] MD if weight increase > 3 lbs. Also, please adhere to a
strict 2 gm sodium diet.

If you experience chest pain, shortness of breath, fever,
chills, tell the health care providers at your nursing facility
immediately.

Please follow-up with your appointments below

Take all your medications as prescribed.

Followup Instructions:
Cardiology: Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**Name Initial (NameIs) **].D. Phone:[**Telephone/Fax (1) 5003**]
Date/Time:[**2195-2-24**] 4:00

Please follow-up with your primary care provider [**Last Name (NamePattern4) **] [**12-1**] weeks
after discharge.


                             [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]
{"Congestive heart failure, unspecified,Unspecified septicemia,Urinary tract infection, site not specified,Severe sepsis,Acute respiratory failure,Other malignant lymphomas, lymph nodes of multiple sites,Septic shock,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Anemia, unspecified,Unspecified glaucoma"}


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: CC: fatigue, dyspnea

PRESENT ILLNESS: .
HPI: 81M with h/o large cell lymphoma (completed 3 week course
of R-CVP on [**2195-1-31**]), HTN, CAD, AS, s/p recent aortic
valvuloplasty [**12-5**], who presented on the [**2195-2-9**] with a 1-week
history of fatigue and dyspnea. The patient reported "not
feeling well". He denied weakness, but does say that his legs
felt tired. His family concurs that he has been quite fatigued
for the last week, and his breathing has appeared labored to
them for the last 48+ hours. They also report that he has not
been himself - they describe that he is "slow" to do things,
mildly forgetful, and give examples of where he says he will do
something then never moves.
.
The patient was admitted to medicine. He had some improvement in
his shortness of breath with aggressive diuresis. The patient's
course was complicated by a fever to 103. The patient became
tachypneic(HR 130s-140sand and hypotensive to the 80's. He also
had delta MS.
.
The patient was tx to the unit for sepsis. He was intubated for
hypotension and resp. failure. In the unit that patient was
treated for urosepsis (Klebsiella ESBL:Zosyn). The patient
received aggressive fluid hydration without evidence of volume
overload. The patient was later extubated and transferred to the
[**Hospital Ward Name 121**] 3 for further mgmt of his cardiac issues.

MEDICAL HISTORY: 1. Diffuse large B cell lymphoma:  involving liver, lung, kidney
2. s/p limited right thoracotomy w/ open lung biopsy [**2194-11-17**]
3. CAD:  h/o MI [**2181**], s/p CABG x 3 [**2181**], cath [**6-3**] w/ 3VD,
patent grafts
4. aortic stenosis
5. CHF:  cath [**6-3**] w/ LVEF 22%, akinetic inferior wall and apex
with some apical dyskinesis, mild mitral regurgitation
6. HTN
7. Hyperlipidemia
8. Glaucoma
9. BPH
10. s/p B/L THR
11. Peptic ulcer disease

MEDICATION ON ADMISSION: asa 81 mg daily
lipitor 10 mg daily
tamsulosin 0.4 mg qhs
allopurinol 200 mg daily
lamivudine 100 mg qhs
latanoprost 0.005 % 1 drop qhs
bumex 3 mg daily
temaz 15 mg qhs
ranitidine 150 mg daily
KCL 40 mEq [**Hospital1 **]

ALLERGIES: Percocet

PHYSICAL EXAM: T97.4 BP 108/64 HR87 R 32 O2sat 98%RA
Gen: NAD, speaking in full sentences
HEENT: JVD to ears, MMM, OP clear
Heart: nl rate, S1S2, II/VISEM
Lungs: faint crackles at bases
Abd: benign
Ext: trace pedal edema
Neuro: A & O X3.

FAMILY HISTORY: 1. CAD:  father died of MI in 40s
2. ALS:  brother

SOCIAL HISTORY: married for 60 years, has 3 children; lives w/ his wife; smoked
30 pack-years but quit this year; no alcohol or IVDU 

### Response:
{"Congestive heart failure, unspecified,Unspecified septicemia,Urinary tract infection, site not specified,Severe sepsis,Acute respiratory failure,Other malignant lymphomas, lymph nodes of multiple sites,Septic shock,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Anemia, unspecified,Unspecified glaucoma"}
