CHIEF COMPLAINT: Incisional hernia, gallstones, severe obesity

PRESENT ILLNESS: Patient is a 55 year old woman with a complicated medical
history including abdominal crush injury ([**10-26**]), bilateral PE
([**2133**]), cardiac arrest x3 (from CVL placement), gallstone
pancreatitis, seizure dz, asthma, mild COPD, HTN, and
severe obesity. She presents for repair of her hernia, gastric
bypass, and cholecystectomy.

MEDICAL HISTORY: 1. Morbid obesity.
2. Chronic back pain.
3. Asthma.
4. Gallstones.
5. Incisional hernia.
6. Pulmonary embolus

MEDICATION ON ADMISSION: klor
lasix
coumadin (held pre-op)
ultram
gabapentin
lidoderm
toprol

ALLERGIES: Demerol / Ativan / Petroleum

PHYSICAL EXAM: Temperature 98.8 heart rate 58  blood pressure 102/70
respiratons 18 O2 aturation  98% on room air.
Alert and oriented. No acute distress.
Sclerae anicteric. PERRL.
Neck supple, no lymphadenopathy
Regular rate and rhythm. S1 S2 normal. No rubs, gallops
Clear to auscultation bilaterally. No wheezing
Abdomen soft, appropriately tender, non-distended. Bowel sounds
present. Incision intact. No erythema, drainage. Drains in
place.
No clubbing, cyanosis, edema.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Patient is a nurse who is now disabled. She denies smoking, drug
use. Uses alcohol occasionally.
Morbid obesity,Calculus of gallbladder with other cholecystitis, without mention of obstruction,Chronic obstructive asthma, unspecified,Other convulsions,Accidental puncture or laceration during a procedure, not elsewhere classified,Peritoneal adhesions (postoperative) (postinfection),Ventral, unspecified, hernia without mention of obstruction or gangrene,Unspecified essential hypertension
Morbid obesity,Cholelith w cholecys NEC,Chronic obst asthma NOS,Convulsions NEC,Accidental op laceration,Peritoneal adhesions,Ventral hernia NOS,Hypertension NOS
Admission Date:  [**2137-10-15**]              Discharge Date:   [**2137-10-22**]

Date of Birth:  [**2082-4-9**]             Sex:   F

Service: SURGERY

Allergies:
Demerol / Ativan / Petroleum

Attending:[**First Name3 (LF) 4111**]
Chief Complaint:
Incisional hernia, gallstones, severe obesity

Major Surgical or Invasive Procedure:
Exploratory laparotomy, lysis of adhesions, cholecystectomy,
choledochiotomy, cholangiogram, Gortex repair of ventral hernia


History of Present Illness:
Patient is a 55 year old woman with a complicated medical
history including abdominal crush injury ([**10-26**]), bilateral PE
([**2133**]), cardiac arrest x3 (from CVL placement), gallstone
pancreatitis, seizure dz, asthma, mild COPD, HTN, and
severe obesity. She presents for repair of her hernia, gastric
bypass, and cholecystectomy.

Past Medical History:
1. Morbid obesity.
2. Chronic back pain.
3. Asthma.
4. Gallstones.
5. Incisional hernia.
6. Pulmonary embolus

Social History:
Patient is a nurse who is now disabled. She denies smoking, drug
use. Uses alcohol occasionally.

Family History:
Non-contributory

Physical Exam:
Temperature 98.8 heart rate 58  blood pressure 102/70
respiratons 18 O2 aturation  98% on room air.
Alert and oriented. No acute distress.
Sclerae anicteric. PERRL.
Neck supple, no lymphadenopathy
Regular rate and rhythm. S1 S2 normal. No rubs, gallops
Clear to auscultation bilaterally. No wheezing
Abdomen soft, appropriately tender, non-distended. Bowel sounds
present. Incision intact. No erythema, drainage. Drains in
place.
No clubbing, cyanosis, edema.

Pertinent Results:
[**2137-10-20**] 07:20AM BLOOD WBC-5.2 RBC-2.73* Hgb-8.7* Hct-26.1*
MCV-96 MCH-32.0 MCHC-33.5 RDW-13.6 Plt Ct-228
[**2137-10-15**] 04:56PM BLOOD Neuts-93.6* Bands-0 Lymphs-4.2* Monos-2.1
Eos-0.1 Baso-0.1
[**2137-10-15**] 04:56PM BLOOD WBC-11.6*# RBC-3.68*# Hgb-11.8*#
Hct-34.5*# MCV-94 MCH-32.1* MCHC-34.3 RDW-13.1 Plt Ct-206
[**2137-10-22**] 07:05AM BLOOD PT-24.2* PTT-33.3 INR(PT)-4.2
[**2137-10-21**] 06:25AM BLOOD PT-19.4* PTT-30.6 INR(PT)-2.7
[**2137-10-20**] 07:20AM BLOOD Glucose-77 UreaN-7 Creat-0.6 Na-140 K-4.1
Cl-107 HCO3-26 AnGap-11
[**2137-10-15**] 04:56PM BLOOD Glucose-144* UreaN-10 Creat-0.9 Na-141
K-4.3 Cl-110* HCO3-22 AnGap-13
[**2137-10-16**] 02:19AM BLOOD ALT-61* AST-54* AlkPhos-46 Amylase-251*
TotBili-0.4
[**2137-10-15**] 04:56PM BLOOD ALT-76* AST-90* AlkPhos-49 Amylase-149*
TotBili-0.5
[**2137-10-20**] 07:20AM BLOOD Calcium-7.5* Phos-3.6 Mg-2.1
[**2137-10-15**] 04:56PM BLOOD Phos-3.5 Mg-1.7
[**2137-10-17**] 02:43AM BLOOD Lactate-1.6

Brief Hospital Course:
Patient underwent an exploratory laparotomy, lysis of adhesions,
cholecystectomy, choledochotomy, cholangiogram, and Gortex
incisional hernia repair on [**2137-10-15**] (for operative details
please see dictated operative report from same date). Patient
did well and was transferred to surgical intensive care unit
intubated for post-operative observation given her complicated
surgical past.
She did well overnight and was weaned and extubated on
post-operative day one.
She was transferred to the floor on post operative day 2.
Patient did well and diet was advanced without complications per
gastric bypass nutrition protocol. Patient was weaned off of PCA
pain control and started on PO pain medication with good pain
control.
On post operative day 3 patient developed wheezing and
difficulty breathing. This was treated with an albuterol
nebulizer and Lasix with good effect.
Patient continued to do well. Anticoagulation was closely
monitored given [**Hospital 228**] medical history, and Coumadin dosing
was adjusted accordingly until patient became therapeutic.
Patient remained hemodynamically stable throughout
hospitalization and was discharged home on post operative day 6
in good condition, with strict instructions for follow-up.

Medications on Admission:
klor
lasix
coumadin (held pre-op)
ultram
gabapentin
lidoderm
toprol

Discharge Medications:
1. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q4-6H (every 4 to 6 hours) as needed.
2. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO Q4-6H (every 4 to 6 hours) as needed for pain.
Disp:*250 ML(s)* Refills:*0*
3. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: One
(1)  PO DAILY (Daily).
Disp:*30 * Refills:*2*
4. Furosemide 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Gabapentin 250 mg/5 mL Solution Sig: Three (3)  PO TID (3
times a day).
6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day): Please crush prior to taking.
Disp:*60 Tablet(s)* Refills:*2*
7. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical  QD PRN ().
8. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
[**1-27**] Disk with Devices Inhalation [**Hospital1 **] (2 times a day).
9. Warfarin 5 mg Tablet Sig: One (1) Tablet PO QMWF ().
10. Warfarin 2.5 mg Tablet Sig: One (1) Tablet PO QTTHSASU ().
11. Tramadol 50 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
12. K-Dur 20 mEq Tab Sust.Rel. Particle/Crystal Sig: Two (2) Tab
Sust.Rel. Particle/Crystal PO once a day.
Disp:*60 Tab Sust.Rel. Particle/Crystal(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
newfound area nsg

Discharge Diagnosis:
obesity, ventral hernia
massive abdominal adhesions
cholecystitis, cholelithiasis


Discharge Condition:
Good to home wit VNA services


Discharge Instructions:
having worsening pains, fevers, chills, nausea, vomiting,
shortness of breath, chest pain, redness or drainage about the
wounds, or if there are any questions or concerns.  Patient to
take antibiotics and other medications as directed.  Patient not
to drive or operate heavy machinery while on any narcotic pain
medication such as percocet as it can be sedating.  Patient to
take colace to soften the stool as needed for constipation as
narcotic pain medication can cause this issue.
Patient will have visiting nurse help with recording JP outputs
and drain care. Patient to keep sites clean and dry.
Patient to wear abdominal binder until otherwise directed by
surgeon.
Patient is to avoid strenuous activity or [**Last Name (un) 37604**] of heavy
objects for 4-6 weeks unless otherwise instructed by surgeon.

Patient is to measure INR daily and call Dr.[**Name (NI) 37605**] office to
get coumadin dosing.


Followup Instructions:
Please call Dr. [**First Name4 (NamePattern1) 122**] [**Last Name (NamePattern1) 957**] at [**Telephone/Fax (1) 17478**] to schedule your
follow up appointment. Your appointment should be in [**1-27**] weeks.
Please call to confirm the following appointments:
Provider: [**Name10 (NameIs) **] [**Doctor Last Name 28352**], LDN Where: [**Hospital6 29**] BARIATRIC
SURGERY Phone:[**Telephone/Fax (1) 28351**] Date/Time:[**2137-11-6**] 1:00

Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 304**], MD Where: [**Hospital6 29**] BARIATRIC
SURGERY Phone:[**Telephone/Fax (1) 28351**] Date/Time:[**2137-11-6**] 1:30



Completed by:[**2137-10-25**]
{'Morbid obesity,Calculus of gallbladder with other cholecystitis, without mention of obstruction,Chronic obstructive asthma, unspecified,Other convulsions,Accidental puncture or laceration during a procedure, not elsewhere classified,Peritoneal adhesions (postoperative) (postinfection),Ventral, unspecified, hernia without mention of obstruction or gangrene,Unspecified essential hypertension'}


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: Incisional hernia, gallstones, severe obesity

PRESENT ILLNESS: Patient is a 55 year old woman with a complicated medical
history including abdominal crush injury ([**10-26**]), bilateral PE
([**2133**]), cardiac arrest x3 (from CVL placement), gallstone
pancreatitis, seizure dz, asthma, mild COPD, HTN, and
severe obesity. She presents for repair of her hernia, gastric
bypass, and cholecystectomy.

MEDICAL HISTORY: 1. Morbid obesity.
2. Chronic back pain.
3. Asthma.
4. Gallstones.
5. Incisional hernia.
6. Pulmonary embolus

MEDICATION ON ADMISSION: klor
lasix
coumadin (held pre-op)
ultram
gabapentin
lidoderm
toprol

ALLERGIES: Demerol / Ativan / Petroleum

PHYSICAL EXAM: Temperature 98.8 heart rate 58  blood pressure 102/70
respiratons 18 O2 aturation  98% on room air.
Alert and oriented. No acute distress.
Sclerae anicteric. PERRL.
Neck supple, no lymphadenopathy
Regular rate and rhythm. S1 S2 normal. No rubs, gallops
Clear to auscultation bilaterally. No wheezing
Abdomen soft, appropriately tender, non-distended. Bowel sounds
present. Incision intact. No erythema, drainage. Drains in
place.
No clubbing, cyanosis, edema.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Patient is a nurse who is now disabled. She denies smoking, drug
use. Uses alcohol occasionally. 

### Response:
{'Morbid obesity,Calculus of gallbladder with other cholecystitis, without mention of obstruction,Chronic obstructive asthma, unspecified,Other convulsions,Accidental puncture or laceration during a procedure, not elsewhere classified,Peritoneal adhesions (postoperative) (postinfection),Ventral, unspecified, hernia without mention of obstruction or gangrene,Unspecified essential hypertension'}
