CHIEF COMPLAINT: prostate cancer

PRESENT ILLNESS: 57 y/o male with T2DM, HTN, OSA, and prostate cancer (recent PSA
4.2, Gl 6+7 disease comprising up to 90% of the cores on the
right, [**4-29**]; h/o colovesical fistula/repair.  Got 10.0L EBL:
1.5L.  Difficult intubation requiring fiber optic scope - took
15 minutes.  Per anesthesia, would like monitoring overnight in
unit before attempting extubation.

MEDICAL HISTORY: Diverticulitis s/p exploratory laparotomy, sigmoid and left
colectomy with mobilization of the splenic flexure, repair of
bladder, and
primary anastomosis
s/p repair of his bladder from a fistula [**2099**]
Anti-platelet antibodies with chronic thrombocytopenia
OSA s/p palatal surgery
T2DM
HTN
Hypothyroidism

MEDICATION ON ADMISSION: Diovan
Verapamil SR 240 mg PO daily
Metformin 500 mg PO BID
Levothyroxine 0.225mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T 101 BP: 100/65 HR: 107
GEN: No acute distress, intubated
HEENT: Intubated, pupils small but reactive
NECK: No JVD
COR: RRR, no M/G/R, normal S1 S2, radial pulses +2
PULM: rhonchorous throughout
ABD: Soft, NT, JP drain in place draiing serosanguinous fluid
EXT: no [**Location (un) **], 2+ DP pulses bilaterally
NEURO: sedated
SKIN: no rashes

FAMILY HISTORY: 

SOCIAL HISTORY: 
Malignant neoplasm of prostate,Acute posthemorrhagic anemia,Acute kidney failure, unspecified,Urinary complications, not elsewhere classified,Oliguria and anuria,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Obstructive sleep apnea (adult)(pediatric)
Malign neopl prostate,Ac posthemorrhag anemia,Acute kidney failure NOS,Surg compl-urinary tract,Oliguria & anuria,DMII wo cmp nt st uncntr,Hypertension NOS,Hypothyroidism NOS,Obstructive sleep apnea
Admission Date:  [**2109-2-1**]              Discharge Date:   [**2109-2-6**]

Date of Birth:  [**2051-5-25**]             Sex:   M

Service: UROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name8 (NamePattern2) 19908**]
Chief Complaint:
prostate cancer

Major Surgical or Invasive Procedure:
radical prostatectomy

History of Present Illness:
57 y/o male with T2DM, HTN, OSA, and prostate cancer (recent PSA
4.2, Gl 6+7 disease comprising up to 90% of the cores on the
right, [**4-29**]; h/o colovesical fistula/repair.  Got 10.0L EBL:
1.5L.  Difficult intubation requiring fiber optic scope - took
15 minutes.  Per anesthesia, would like monitoring overnight in
unit before attempting extubation.

ROS: Unable to obtain as patient is intubated and sedated

Past Medical History:
Diverticulitis s/p exploratory laparotomy, sigmoid and left
colectomy with mobilization of the splenic flexure, repair of
bladder, and
primary anastomosis
s/p repair of his bladder from a fistula [**2099**]
Anti-platelet antibodies with chronic thrombocytopenia
OSA s/p palatal surgery
T2DM
HTN
Hypothyroidism

Physical Exam:
Vitals: T 101 BP: 100/65 HR: 107
GEN: No acute distress, intubated
HEENT: Intubated, pupils small but reactive
NECK: No JVD
COR: RRR, no M/G/R, normal S1 S2, radial pulses +2
PULM: rhonchorous throughout
ABD: Soft, NT, JP drain in place draiing serosanguinous fluid
EXT: no [**Location (un) **], 2+ DP pulses bilaterally
NEURO: sedated
SKIN: no rashes


Pertinent Results:
[**2109-2-1**] 07:06PM   GLUCOSE-143* UREA N-13 CREAT-1.0 SODIUM-139
POTASSIUM-4.3 CHLORIDE-108 TOTAL CO2-22 ANION GAP-13
[**2109-2-1**] 07:06PM   CALCIUM-7.9* MAGNESIUM-1.5*
[**2109-2-1**] 07:06PM   WBC-13.7* RBC-3.67* HGB-11.4* HCT-32.5*
MCV-89 MCH-31.1 MCHC-35.1* RDW-13.4
[**2109-2-1**] 10:57PM   LACTATE-3.7*
[**2109-2-1**] 02:34PM   TYPE-ART TIDAL VOL-800 O2-100 PO2-227*
PCO2-46* PH-7.30* TOTAL CO2-24 BASE XS--3 AADO2-440 REQ O2-76
INTUBATED-INTUBATED VENT-CONTROLLED
[**2109-2-1**] 05:10PM   TYPE-ART TEMP-35.3 RATES-10/ TIDAL VOL-1100
PEEP-5 O2-60 PO2-95 PCO2-43 PH-7.34* TOTAL CO2-24 BASE XS--2
INTUBATED-INTUBATED VENT-CONTROLLED
[**2109-2-1**] 10:57PM   TYPE-ART TEMP-37.6 RATES-/18 TIDAL VOL-865
PEEP-5 O2-100 PO2-153* PCO2-44 PH-7.32* TOTAL CO2-24 BASE XS--3
AADO2-516 REQ O2-86 INTUBATED-INTUBATED VENT-SPONTANEOU

Imaging:
CXR: No evidence of consolidation, ? blunting on CP angles
bilaterally


Brief Hospital Course:
57 yo M with prostate CA 2/p radical prostatectomy with
difficult intubation requiring fiber optic scope.  Admitted to
ICU for monitoring now s/p extubation.

# Difficult Intubation: Patient with fiber optic intubation, per
anesthesia, needed monitoring overnight.  Required increased
fentanyl for sedation.  Was sucessfully extubated [**11-1**] and was
on CPAP overnight for OSA.  This morning was satting well on RA.

# Oliguria:  The patient postoperatively had oliguria and was
given LR boluses.  This resolved with IVF.

# Anemia:  Hct decreased from 29.9 to 26.6 this am, on recheck
was 26.3, likely secondary to dilution from IVF and
intraoperative blood loss, EBL 1.5L. Recheck pm Hct, if
continues to decrease would have a low threshold to scan his
abdomen/pelvis with a CT to rule out RP bleed.

# Lower extremity numbness:  Patient had new onset numbness in
her lower extremities b/l overnight which was improving this am.
 No motor deficits.  Unclear cause, possible related to how he
was laying for the operation (possible nerve compression?).

# Positive UA: Patient had trace LE, pos nit, but >1000 RBC's.
Has colovesicular fistula in past.  Difficult to interpret UA in
this setting.  Was on cefazolin post surgically, wihch has some
urine pathogen coverage. Per urology, expected to have dirty UA,
no tx indicated at this time.

# Fever: The patient spiked a fever to 101 on [**2-1**] and was
cultured.  Unclear source, could be post-op vs infectious,
slighly tachy to 100's with the fever.  WBC elevated at 14.9,
but decreased to 11.9 today.  Cx have been NGTD except for the
dirty UA as above.  No fever for the last day.

# Tachycardia: Patient has been in the 90??????s to 100??????s; was on
verapamil as an outpatient and this was held, so may be reflex
tachycardia from this.  Received IVF yesterday without much
response.  His home verapamil was added back and ****.

# Prostate CA: T3N0M0, s/p radical prostatecomy. His JP tube
continued to put out a large amount of serosanguinous fluid.

# HTN: Patient is on verapamil and diovan as an outpatient.  His
pressures have been well-controlled, but he??????s been tachycardic.
These medications were initally held perioperatively, however
verapamil was restarted the day he left the MICU.

#Hypothyroidism: The patient was continued on his home
levthyroxine.

He was admitted to Urology after undergoing radical
prostatectomy. No concerning intraoperative events occurred;
please see dictated operative note for details. He received
ancef for perioperative prophylaxis. He was transferred to the
ICU from the PACU in stable condition.  On POD0 he remained
intubated with large urine output from his JP. He was extubated
on POD 1 and transferred to the floor on POD 2. His pain was
well controlled on PCA , hydrated for urine output >30cc/hour,
provided with pneumoboots and incentive spirometry for
prophylaxis. A physical therapy consult was obtained who
recommended home with VNA. On POD3, he was restarted on his home
medications, basic metabolic panel and complete blood count were
checked, pain control was transitioned from PCA to oral
analgesics, diet was advanced to a regular diet with start of
colace. JP removed POD5 without difficulty after drainage was
<10 for the past 2 days. The remainder of the hospital course
was relatively unremarkable. He was discharged in stable
condition on POD1, ambulating independently, eating well, and
with pain control on oral analgesics. On exam, his incision was
clean, dry, and intact, with no evidence of hematoma collection
or infection. He was given explicit instructions to follow-up in
clinic with Dr. [**Last Name (STitle) 9125**] in 1 week, and that the urethral catheter
(foley) would be removed during the follow-up appointment.  He
was instructed to start 3 day course of Ciprofloxacin on day
prior to Foley removal.


Medications on Admission:
Diovan
Verapamil SR 240 mg PO daily
Metformin 500 mg PO BID
Levothyroxine 0.225mg daily

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
2. Verapamil 240 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO Q24H (every 24 hours).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): use while taking narcotics.
Disp:*60 Capsule(s)* Refills:*0*
4. Levothyroxine 200 mcg Tablet Oral
5. Cipro 500 mg Tablet Sig: One (1) Tablet PO twice a day for 3
days: Start day before appointment.
Disp:*6 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
prostate cancer

Discharge Condition:
stable

Discharge Instructions:
-You may take motrin and narcotic together for pain control

-You may shower 2 days after surgery, but do not tub bathe,
swim, soak, or scrub incision for 2 weeks.

-Allow bandage strips to fall off over time, remove all
remaining dressings in 2 days

-No heavy lifting for 4 weeks (no more than 10 pounds)

[**Hospital 16237**] medical attention for fevers (temp>101.5), worsening pain,
drainage or excessive bleeding from incision, chest pain or
shortness of breath.

-Follow up in 1 week for wound check/foley removal

-Please do not drive or consume alcohol while taking pain
medications.

-Take first dose of Ciprofloxacin 1 day prior to foley catheter
removal and for subsequent 2 days.

- Wear Large foley bag for majority of time, leg bag is only for
short-term when leaving house.


Followup Instructions:
1-2 weeks


Completed by:[**2109-2-6**]
{'Malignant neoplasm of prostate,Acute posthemorrhagic anemia,Acute kidney failure, unspecified,Urinary complications, not elsewhere classified,Oliguria and anuria,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Obstructive sleep apnea (adult)(pediatric)'}


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: prostate cancer

PRESENT ILLNESS: 57 y/o male with T2DM, HTN, OSA, and prostate cancer (recent PSA
4.2, Gl 6+7 disease comprising up to 90% of the cores on the
right, [**4-29**]; h/o colovesical fistula/repair.  Got 10.0L EBL:
1.5L.  Difficult intubation requiring fiber optic scope - took
15 minutes.  Per anesthesia, would like monitoring overnight in
unit before attempting extubation.

MEDICAL HISTORY: Diverticulitis s/p exploratory laparotomy, sigmoid and left
colectomy with mobilization of the splenic flexure, repair of
bladder, and
primary anastomosis
s/p repair of his bladder from a fistula [**2099**]
Anti-platelet antibodies with chronic thrombocytopenia
OSA s/p palatal surgery
T2DM
HTN
Hypothyroidism

MEDICATION ON ADMISSION: Diovan
Verapamil SR 240 mg PO daily
Metformin 500 mg PO BID
Levothyroxine 0.225mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T 101 BP: 100/65 HR: 107
GEN: No acute distress, intubated
HEENT: Intubated, pupils small but reactive
NECK: No JVD
COR: RRR, no M/G/R, normal S1 S2, radial pulses +2
PULM: rhonchorous throughout
ABD: Soft, NT, JP drain in place draiing serosanguinous fluid
EXT: no [**Location (un) **], 2+ DP pulses bilaterally
NEURO: sedated
SKIN: no rashes

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Malignant neoplasm of prostate,Acute posthemorrhagic anemia,Acute kidney failure, unspecified,Urinary complications, not elsewhere classified,Oliguria and anuria,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Obstructive sleep apnea (adult)(pediatric)'}
