CHIEF COMPLAINT: Fever and shortness of breath

PRESENT ILLNESS: 75M w/ hx arthritis, HTN, gout s/p hernia repair [**8-21**], presented
with 4 day history of intermittent dyspnea and one day of fever
and chills. The patient underwent a right direct inguinal,
epigastric, and umbilical hernia repair, w/o immediate
complication.  Post-op course was complicated by urinary
retention for which a foley catheter was placed requiring
overnight obs.  he was discharged with foley catheter in place,
which was removed [**8-26**] at his PCPs office. At discharge on [**8-22**]
pt's vitals were 98.7, 83, 140/83, 16, 92% RA.

MEDICAL HISTORY: Past medical history is significant for:
1.  Arthritis.
2.  Hypertension.
3.  Gout.

MEDICATION ON ADMISSION: Discharge medications: ([**8-22**])
1. Tamsulosin 0.4 mg PO HS
RX *tamsulosin 0.4 mg 1 capsule(s) by mouth once a day Disp #*40

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: UPON ADMISSION:
Vitals: 103 90 110/67 30 92% ra
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, slightly distended. Well healing
surgical incisions.
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: grossly intact aox3

FAMILY HISTORY: Family history significant for breast cancer.

SOCIAL HISTORY: From central america. Lives at home with wife/ family and 6
daughters + rest of family.
- Tobacco: 14 pack years - quit 40 years ago
- Alcohol: used to drink 4 beers/day, stopped 40 years ago
- Illicits: no
Infection and inflammatory reaction due to indwelling urinary catheter,Septicemia due to escherichia coli [E. coli],Acute kidney failure, unspecified,Acute pyelonephritis without lesion of renal medullary necrosis,Hyposmolality and/or hyponatremia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other disorders of plasma protein metabolism,Severe sepsis,Septic shock,Urinary complications, not elsewhere classified,Other specified disorders of kidney and ureter,Retention of urine, unspecified,Hypoxemia,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Chronic kidney disease, unspecified,Nausea with vomiting,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Gout, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Other postprocedural status,Personal history of tobacco use,Family history of malignant neoplasm of breast
React-indwell urin cath,E coli septicemia,Acute kidney failure NOS,Ac pyelonephritis NOS,Hyposmolality,Hy kid NOS w cr kid I-IV,Dis plas protein met NEC,Severe sepsis,Septic shock,Surg compl-urinary tract,Renal & ureteral dis NEC,Retention urine NOS,Hypoxemia,Abn react-urinary cath,Chronic kidney dis NOS,Nausea with vomiting,Elev transaminase/ldh,Gout NOS,Osteoarthros NOS-unspec,Post-proc states NEC,History of tobacco use,Family hx-breast malig
Admission Date:  [**2144-8-31**]              Discharge Date:   [**2144-9-4**]

Date of Birth:  [**2069-6-6**]             Sex:   M

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 3200**]
Chief Complaint:
Fever and shortness of breath

Major Surgical or Invasive Procedure:
None


History of Present Illness:
75M w/ hx arthritis, HTN, gout s/p hernia repair [**8-21**], presented
with 4 day history of intermittent dyspnea and one day of fever
and chills. The patient underwent a right direct inguinal,
epigastric, and umbilical hernia repair, w/o immediate
complication.  Post-op course was complicated by urinary
retention for which a foley catheter was placed requiring
overnight obs.  he was discharged with foley catheter in place,
which was removed [**8-26**] at his PCPs office. At discharge on [**8-22**]
pt's vitals were 98.7, 83, 140/83, 16, 92% RA.

[**Name (NI) **] pt presented to rheumatologist [**8-28**] with 3 days of left
knee pain.  An arthrocentesis was attempted by OP
rheumatologist, but there was no fluid to aspirate.  He was
referred to the ED for r/o DVT.  In the ED, LLE doppler was
negative for DVT.  At this time, his leukocytosis had improved
to 18K and his cr was 1.8. He was discharged home from the ED.

He returned on [**8-31**] with fever and shortness of breath. As per
daughter (documented in [**Name (NI) **] signout) pt was c/o vague dysuria,
and occsional difficulty voiding. He denied cough, DOE, PND,
pleuritic CP.  No N/V, diarrhea, constipation, dysuria, urinary
retention, night sweats, sore throat, headache, vision changes,
increased redness or drainage from surgical site.

Past Medical History:
Past medical history is significant for:
1.  Arthritis.
2.  Hypertension.
3.  Gout.

Past Surgical History: R inguinal hernia, epigastric and
umbilical hernia repair ([**2144-8-21**])

Social History:
From central america. Lives at home with wife/ family and 6
daughters + rest of family.
- Tobacco: 14 pack years - quit 40 years ago
- Alcohol: used to drink 4 beers/day, stopped 40 years ago
- Illicits: no


Family History:
Family history significant for breast cancer.

Physical Exam:
UPON ADMISSION:
Vitals: 103 90 110/67 30 92% ra
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, slightly distended. Well healing
surgical incisions.
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: grossly intact aox3

UPON DISCHARGE:
Vitals: 99.1  98.0  63  136/76  20  98%RA
Gen: AAOx3, NAD
HEENT: anicteric sclera, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, no LAD, no JVD
CV: RRR, +S1/S2, no m/r/g
Resp: CTAB, no w/c/r
Abd: soft, NT, ND, well-healing surgical incisions, +BS, no
r/r/g
Inc: c/d/i, no erythema/drainage/induration
Ext: warm, well-perfused, no c/c/e
Neuro: CN2-12 grossly intact, [**5-2**] motor exam throughout, normal
sensory exam throughout

Pertinent Results:
ADMISSION LABS:

[**2144-8-31**] 02:40PM   WBC-40.0*# RBC-4.25* HGB-13.3* HCT-39.2*
MCV-92 MCH-31.3 MCHC-33.9 RDW-14.2
[**2144-8-31**] 02:40PM   NEUTS-94.7* LYMPHS-2.8* MONOS-2.3 EOS-0
BASOS-0.2
[**2144-8-31**] 02:40PM   PT-13.9* PTT-33.3 INR(PT)-1.3*
[**2144-8-31**] 10:30AM   TYPE-[**Last Name (un) **] TEMP-38.9 PO2-41* PCO2-37 PH-7.35
TOTAL CO2-21 BASE XS--4 INTUBATED-NOT INTUBA
[**2144-8-31**] 10:30AM   LACTATE-2.4*
[**2144-8-31**] 07:56AM   ALT(SGPT)-76* AST(SGOT)-65* LD(LDH)-248
CK(CPK)-56 ALK PHOS-101 TOT BILI-1.6*
[**2144-8-31**] 02:55AM URINE  BLOOD-SM  NITRITE-POS PROTEIN-30
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-4* PH-5.5 LEUK-LG
[**2144-8-31**] 02:55AM URINE  RBC-8* WBC->182* BACTERIA-MANY
YEAST-NONE EPI-0 TRANS EPI-<1
[**2144-8-31**] 02:55AM URINE  WBCCLUMP-FEW MUCOUS-RARE
[**2144-8-31**] 02:30AM   cTropnT-<0.01

CXR ([**8-31**]): Basilar atelectasis, although in the appropriate
clinical
setting, an underlying pneumonia cannot be excluded.

CT ABDOMEN PELVIS ([**8-31**]):
1.  Heterogeneous enhancement of the right kidney with right
periureteric
stranding, compatible with right pyelonephritis and ureteritis,
given history of known UTI.
2.  Status post right inguinal and umbilical hernia repairs.  No
intra-abdominal fluid collection or pneumoperitoneum.
3.  Small bilateral pleural effusions.

ECHOCARDIOGRAM ([**9-1**]):
The left atrium is mildly dilated. Left ventricular wall
thicknesses are normal. The left ventricular cavity size is
normal. There is probable mild regional left ventricular
systolic dysfunction with mid to distal inferior hypokinesis
(see clip [**Clip Number (Radiology) **]) although views of regional wall motion are
technically suboptimal. Right ventricular chamber size and free
wall motion are probably normal (not fully visualized). The
ascending aorta is mildly dilated. The aortic valve leaflets (3)
are mildly thickened. Trace aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen. The tricuspid valve leaflets are mildly
thickened. There is mild pulmonary artery systolic hypertension.
There is a trivial/physiologic pericardial effusion.

DISCHARGE LABS:

[**2144-9-4**] 03:49AM BLOOD WBC-13.3* RBC-4.83 Hgb-14.8 Hct-44.0
MCV-91 MCH-30.7 MCHC-33.7 RDW-14.5 Plt Ct-338
[**2144-9-2**] 05:17AM BLOOD Glucose-96 UreaN-21* Creat-1.4* Na-138
K-3.6 Cl-107 HCO3-23 AnGap-12

Brief Hospital Course:
The patient was admitted to the hospital for evaluation and
treatment of his fever and shortness of breath.

In the ED, initial vital signs were 103 90 110/67 30 92% ra.
Labs were notable for WBC 15.9, lactate 2.3, Cr. 1.9, trop
negative x1, ddimer was 1014 and urinalysis with many bacteria,
nitrite positive and >185WBC. CXR showed low lung volumes/
bibasilar atelectasis. Blood cultures were sent x 2. Patient
received 3L NS, 1g tylenol, vancomycin 1g and
ampicillin/sulbactam 3g, albuterol and ipratropium nebs.  He was
initially admitted to medicine floor, but around 6am he began
rigoring and became tachycardic to 130s in the setting of
receiving nebulizers.  Due to persistent tachycardia he was
admitted to MICU.

Shortly after arrival to the ICU, his care was transferred to
the Surgical ICU (SICU) team. His workup was continued with a CT
abdomen/pelvis, serial laboratory studies, and followup of the
microbiology sent earlier (reader referred to 'Pertinent
Results' section for details). He was aggressively hydrated,
kept NPO for diet, and given IV antibiotics. He transiently
required pressor support for his blood pressure, and was
successfully weaned off pressor support on [**8-31**] itself. His urine
output was closely monitored.

On [**9-1**], his care was continued in this manner. His diet was
slowly advanced to clear liquids and then a regular diet. His
antibiotics were continued, and catered to his blood and urine
cultures (GNRs, ultimately growing out zosyn-susceptible and
ciprofloxacin-susceptible E.coli). IVF rehydration was
continued. On the evening of this day, given his significantly
improved clinical presentation, he was transferred to the
general surgical floor.

On [**8-14**], and [**9-4**], his IV fluids were discontinued upn
achievement of sufficient oral intake of food and liquids.
Antibiotic treatment was continued. He was encouraged to
ambulate. His WBC count was noted to improve every day, and he
remained afebrile since and including the day of [**9-1**]. He
expressed feeling significantly improved and prepared to
continue his recovery at home. He was explained the neccessity
of completing a full course of his prescribed antibiotics
(ciprofloxacin 500 mg Q12H for 11 days after discharge, to make
for a complete 2 week course of antibiotics). He was also
explained the importance of eating a healthy diet, and
ambulating regularly. Finally, he was clearly explained the link
between his urinary health and his recent illness; he was
scheduled for a 1-week appointment with Urology to discuss and
evaluate this further.

Throuhgout his hospital stay, vital signs were routinely
monitored. Good pulmonary toilet, early ambulation and incentive
spirometry were encouraged throughout hospitalization.
Electrolytes were routinely followed, and repleted when
necessary. The patient's white blood count and fever curves were
closely watched for signs of infection. Wound care was performed
regularly and thoroughly. The patient's blood sugar was
monitored throughout his stay; insulin dosing was adjusted
accordingly. The patient received subcutaneous heparin and
venodyne boots were used during this stay; was encouraged to get
up and ambulate as early as possible.

At the time of discharge, the patient was doing well, afebrile
with stable vital signs.  The patient was tolerating a regular
diet, ambulating, voiding without assistance, and pain was well
controlled.  The patient received discharge teaching and
follow-up instructions with understanding verbalized and
agreement with the discharge plan.

Medications on Admission:
Discharge medications: ([**8-22**])
1. Tamsulosin 0.4 mg PO HS
RX *tamsulosin 0.4 mg 1 capsule(s) by mouth once a day Disp #*40

Capsule Refills:*0
2. Oxycodone-Acetaminophen (5mg-325mg) [**12-30**] TAB PO Q4H pain
RX *oxycodone-acetaminophen 5 mg-325 mg [**12-30**] tablet(s) by mouth
every four (4) hours Disp #*45 Tablet Refills:*0
3. Allopurinol 300 mg PO DAILY
4. Colchicine 0.6 mg PO EVERY OTHER DAY
5. Losartan Potassium 25 mg PO DAILY
- of note, was on ASA 81 on admission, but this was held at
discharge

Discharge Medications:
1. Ciprofloxacin HCl 500 mg PO Q12H
RX *ciprofloxacin [Cipro] 500 mg 1 tablet(s) by mouth every
twelve (12) hours Disp #*22 Tablet Refills:*0
2. Finasteride 5 mg PO DAILY
RX *finasteride 5 mg 1 tablet(s) by mouth once a day Disp #*40
Tablet Refills:*1
3. Tamsulosin 0.4 mg PO HS
4. Allopurinol 300 mg PO DAILY
5. Colchicine 0.6 mg PO EVERY OTHER DAY
6. Losartan Potassium 25 mg PO DAILY


Discharge Disposition:
Home

Discharge Diagnosis:
Fever, tachypnea and tachycardia in the setting of a
post-operative Foley cathether, most concerning for urosepsis.


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted to the surgery service at [**Hospital1 18**] for evaluation
and treatment of your fever and shortness of breath. You have
done well in the hospital and are now safe to return home to
complete your recovery with the following instructions:

Please resume all regular home medications, unless specifically
advised not to take a particular medication.  Also, please take
any new medications as prescribed.

Please get plenty of rest, continue to ambulate several times
per day, and drink adequate amounts of fluids.  Avoid lifting
weights greater than [**5-7**] lbs until you follow-up with your
surgeon, who will instruct you further regarding activity
restrictions.

Avoid driving or operating heavy machinery while taking pain
medications.

Please follow-up with your surgeon and Primary Care Provider
(PCP) as advised.

Incision Care:
*Please call your doctor or nurse practitioner if you have
increased pain, swelling, redness, or drainage from the incision
site.
*Avoid swimming and baths until your follow-up appointment.
*You may shower, and wash surgical incisions with a mild soap
and warm water.  Gently pat the area dry.
*If you have staples, they will be removed at your follow-up
appointment.
*If you have steri-strips, they will fall off on their own.
Please remove any remaining strips 7-10 days after surgery.

Please call your doctor or nurse practitioner if you experience
the following:
*You experience new chest pain, pressure, squeezing or
tightness.
*New or worsening cough, shortness of breath, or wheeze.
*If you are vomiting and cannot keep down fluids or your
medications.
*You are getting dehydrated due to continued vomiting, diarrhea,
or other reasons. Signs of dehydration include dry mouth, rapid
heartbeat, or feeling dizzy or faint when standing.
*You see blood or dark/black material when you vomit or have a
bowel movement.
*You experience burning when you urinate, have blood in your
urine, or experience a discharge.
*Your pain is not improving within 8-12 hours or is not gone
within 24 hours. Call or return immediately if your pain is
getting worse or changes location or moving to your chest or
back.
*You have shaking chills, or fever greater than 101.5 degrees
Fahrenheit or 38 degrees Celsius.
*Any change in your symptoms, or any new symptoms that concern
you.


Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4653**], MD
Phone:[**Telephone/Fax (1) 5727**]
Date/Time:[**2144-9-10**] 4:20 PM
Location: [**Hospital Ward Name **] 3, [**Hospital1 18**]

Provider: [**First Name11 (Name Pattern1) 177**] [**Last Name (NamePattern4) 13365**], MD
Phone:[**Telephone/Fax (1) 3201**]
Date/Time:[**2144-9-16**] 9:45 AM
Location: [**Hospital1 18**], [**Hospital Ward Name **] 3 - SURGICAL SPECIALTIES OFFICE

Provider: [**First Name8 (NamePattern2) 11595**] [**Last Name (NamePattern1) 11596**], MD
Phone:[**Telephone/Fax (1) 2226**]
Date/Time:[**2145-1-7**] 9:30 AM



Completed by:[**2144-9-4**]
{'Infection and inflammatory reaction due to indwelling urinary catheter,Septicemia due to escherichia coli [E. coli],Acute kidney failure, unspecified,Acute pyelonephritis without lesion of renal medullary necrosis,Hyposmolality and/or hyponatremia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other disorders of plasma protein metabolism,Severe sepsis,Septic shock,Urinary complications, not elsewhere classified,Other specified disorders of kidney and ureter,Retention of urine, unspecified,Hypoxemia,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Chronic kidney disease, unspecified,Nausea with vomiting,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Gout, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Other postprocedural status,Personal history of tobacco use,Family history of malignant neoplasm of breast'}


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: Fever and shortness of breath

PRESENT ILLNESS: 75M w/ hx arthritis, HTN, gout s/p hernia repair [**8-21**], presented
with 4 day history of intermittent dyspnea and one day of fever
and chills. The patient underwent a right direct inguinal,
epigastric, and umbilical hernia repair, w/o immediate
complication.  Post-op course was complicated by urinary
retention for which a foley catheter was placed requiring
overnight obs.  he was discharged with foley catheter in place,
which was removed [**8-26**] at his PCPs office. At discharge on [**8-22**]
pt's vitals were 98.7, 83, 140/83, 16, 92% RA.

MEDICAL HISTORY: Past medical history is significant for:
1.  Arthritis.
2.  Hypertension.
3.  Gout.

MEDICATION ON ADMISSION: Discharge medications: ([**8-22**])
1. Tamsulosin 0.4 mg PO HS
RX *tamsulosin 0.4 mg 1 capsule(s) by mouth once a day Disp #*40

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: UPON ADMISSION:
Vitals: 103 90 110/67 30 92% ra
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, slightly distended. Well healing
surgical incisions.
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: grossly intact aox3

FAMILY HISTORY: Family history significant for breast cancer.

SOCIAL HISTORY: From central america. Lives at home with wife/ family and 6
daughters + rest of family.
- Tobacco: 14 pack years - quit 40 years ago
- Alcohol: used to drink 4 beers/day, stopped 40 years ago
- Illicits: no 

### Response:
{'Infection and inflammatory reaction due to indwelling urinary catheter,Septicemia due to escherichia coli [E. coli],Acute kidney failure, unspecified,Acute pyelonephritis without lesion of renal medullary necrosis,Hyposmolality and/or hyponatremia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other disorders of plasma protein metabolism,Severe sepsis,Septic shock,Urinary complications, not elsewhere classified,Other specified disorders of kidney and ureter,Retention of urine, unspecified,Hypoxemia,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Chronic kidney disease, unspecified,Nausea with vomiting,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Gout, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Other postprocedural status,Personal history of tobacco use,Family history of malignant neoplasm of breast'}
