CHIEF COMPLAINT: Pneumonia, pancreatic pseudocyst

PRESENT ILLNESS: Pt is a 60 yo F transferred from [**Hospital3 **] for
management of complicated pancreatitis as well as possible
pnuemonia. Transferred for worsening respiratory status as well
as failure to progress w/ pancreatitis/pseudocyst tx. Pt was
originally admitted on [**2198-6-8**] for gallstone pancreatitis,
complicated by infected pseudocyst, pneumonia, ARDS and
persistent fevers. She has failed multiple ERCP stent
palacements. Per OSH records, she developed fever to 101.8 and
white count of 16.8 today prior to transfer to [**Hospital1 **]. Her
amylase/lipase have normalized. The patient underwent
tracheostomy on [**2198-7-12**] and was weaned from the vent on [**2198-7-24**],
and has been stable on trach mask w/ 10L O2.  Of note, pt has
been treated for VRE and CDiff during her extended
hospitalization.

MEDICAL HISTORY: -Prior left foot surgery for a heel spur
-no other PMH prior to gallstone pancreatitis
-as above: ARDS, PNA, gallstones, pancreatitis, pseudocyst,
tachy-brady syndrome

MEDICATION ON ADMISSION: -Albuterol/Ipratropium -4 puffs TID
-Ferrous Sulfate 325mg daily
-Lovenox 40mg SC daily
same medications on transfer:
-Guaifenesin 200mg q4hrs PRN
-Tylenol 650mg q6hrs PRN
-Albuterol INH, 4 puffs qhour PRN
-Lactobacillus Acidophilis/lactinex -1 tablet daily
-Miconazole 2% ointment PRN
-Octreotide acetate 100 mcg SC TID
-olanzapine 10mg PO qhs
-Protonix 40mg IV BID
-Vitamin A&D external cream PRN
-Zinc oxide ointment PRN

ALLERGIES: Codeine

PHYSICAL EXAM: VS 96.4 92 104/60 20 100%TM
Gen: A&O, NAD, Trached
Neuro: CN II-XII grossly intact
HEENT: NCAT, Anicteric
Card: RRR -mgr
Pulm: + Ronchi bilat, Diffuse crackles
Abd: Soft, NTND, 3 drains in place draining brown fluid, GJ
clamped
Ext: No cyanosis, clubbing, or edema
Skin: No ulcers

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Patient is engaged and her fiancee is her health care proxy.
She denies tobacco, EtOH, or IVDU.
Cyst and pseudocyst of pancreas,Mechanical complication of tracheostomy,Urinary tract infection, site not specified,Chronic respiratory failure,Pneumonia due to Pseudomonas,Encephalopathy, unspecified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in other specified places,Cardiac pacemaker in situ,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Surgical or other procedure not carried out because of patient's decision,Depressive disorder, not elsewhere classified,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Feeding difficulties and mismanagement
Pancreat cyst/pseudocyst,Tracheostomy - mech comp,Urin tract infection NOS,Chronic respiratory fail,Pseudomonal pneumonia,Encephalopathy NOS,Abn react-procedure NEC,Accident in place NEC,Status cardiac pacemaker,Enterococcus group d,No proc/patient decision,Depressive disorder NEC,Cholelithiasis NOS,Feeding problem
Admission Date:  [**2198-8-31**]              Discharge Date:   [**2198-10-15**]

Date of Birth:  [**2137-9-5**]             Sex:   F

Service: SURGERY

Allergies:
Codeine

Attending:[**First Name3 (LF) 2836**]
Chief Complaint:
Pneumonia, pancreatic pseudocyst

Major Surgical or Invasive Procedure:
[**2198-9-4**]- Aborted PEG placement
[**2198-9-5**]- GJ tube placement
8/10,14,28,25/09- Laparoscopic pancreatic necrosectomy and
drainage tube placement




History of Present Illness:
Pt is a 60 yo F transferred from [**Hospital3 **] for
management of complicated pancreatitis as well as possible
pnuemonia. Transferred for worsening respiratory status as well
as failure to progress w/ pancreatitis/pseudocyst tx. Pt was
originally admitted on [**2198-6-8**] for gallstone pancreatitis,
complicated by infected pseudocyst, pneumonia, ARDS and
persistent fevers. She has failed multiple ERCP stent
palacements. Per OSH records, she developed fever to 101.8 and
white count of 16.8 today prior to transfer to [**Hospital1 **]. Her
amylase/lipase have normalized. The patient underwent
tracheostomy on [**2198-7-12**] and was weaned from the vent on [**2198-7-24**],
and has been stable on trach mask w/ 10L O2.  Of note, pt has
been treated for VRE and CDiff during her extended
hospitalization.

Past Medical History:
-Prior left foot surgery for a heel spur
-no other PMH prior to gallstone pancreatitis
-as above: ARDS, PNA, gallstones, pancreatitis, pseudocyst,
tachy-brady syndrome


Social History:
Patient is engaged and her fiancee is her health care proxy.
She denies tobacco, EtOH, or IVDU.

Family History:
Noncontributory.

Physical Exam:
VS 96.4 92 104/60 20 100%TM
Gen: A&O, NAD, Trached
Neuro: CN II-XII grossly intact
HEENT: NCAT, Anicteric
Card: RRR -mgr
Pulm: + Ronchi bilat, Diffuse crackles
Abd: Soft, NTND, 3 drains in place draining brown fluid, GJ
clamped
Ext: No cyanosis, clubbing, or edema
Skin: No ulcers


Pertinent Results:
[**2198-8-31**] 10:51PM   ALT(SGPT)-18 AST(SGOT)-19 LD(LDH)-270* ALK
PHOS-170* AMYLASE-31
[**2198-8-31**] 10:51PM   LIPASE-27
[**2198-8-31**] 10:51PM   ALBUMIN-2.0* CALCIUM-8.8 PHOSPHATE-3.5
MAGNESIUM-2.2 IRON-37
[**2198-8-31**] 10:51PM   calTIBC-117* FERRITIN-GREATER TH TRF-90*
[**2198-8-31**] 10:51PM   TRIGLYCER-78
[**2198-8-31**] 10:51PM   WBC-13.5* RBC-2.82* HGB-8.3* HCT-27.7* MCV-98
MCH-29.4 MCHC-29.9* RDW-15.7*
[**2198-8-31**] 10:51PM   PLT COUNT-530*
[**2198-8-31**] 10:51PM   PT-13.4 PTT-24.3 INR(PT)-1.1
[**2198-8-31**] 11:24PM URINE  HYALINE-[**4-5**]*
[**2198-8-31**] 11:24PM URINE  RBC-0-2 WBC-0-2 BACTERIA-FEW YEAST-NONE
EPI-0-2

Brief Hospital Course:
Briefly, this is a 60F with gallstone pancreatitis [**6-9**] with
unsuccessful ERCP
complicated by ARDS (now s/p trach) and severe pancreatitis
resulting in multiple pseudocysts with prolonged, intermittent
fevers. Was at [**Hospital 8**] Hospital/[**Hospital1 **] for extended period
with VRE from pseudocysts, pseudomonas PNA and UTI (treated with
amikacin, details unclear), and c diff treated with oral vanco.
Was transferred to [**Hospital1 **] for futher management and possible cyst
gastrectomy.

The patient was admitted from OSH at the beginning of [**Month (only) 216**],
expressing suicidal ideation, refusing ventilator, refusing
surgery. Per psychiatry evaluation, patient having delirium,
currently denying suicidal ideation and expressing desire to go
ahead with further medical/surgical interventions.

Over the ensuing days, her affect improved, the suicidal
ideation ceased, and she agreed to treatment of her
pancreatitis. Upon transfer, was thought to be poor candidate
for cyst gastrostomy, and has been managed with multiple
pseudocyst
debridements - OR on [**9-10**] (placement of two drainage and
irrigation systems), [**9-14**] (necrosectomy), [**9-18**] (necrosectomy),
[**9-25**] (laparoscopic necrosectomy, 2 L flank drains placed, others
not changed, of note there was a concern for a possible enteric
fistula based on the nature of the drainge). She was found to
have stool leakage and then then underwent a CT scan which
revealed a pancreaticocolonic fistula. No small bowel fistula
was ever identified on Small Bowel Follow Through study. Based
on this finding, she was made NPO and put on TPN, which she
needs to continue on until surgical follow up.

She also underwent GJ tube placement on [**2198-9-5**]. The GJ is not
currently being used and should be clamped until after her
follow up visit.

As far as her infectious disease course during this
hospitalization, pseudocyst cultures have grown heavy
pseudomonas and sparse enterococcus. She had a BAL with 10-100K
oral flora and >100k pseudomonas ([**Last Name (un) 36**] to pip-tazo, tobra, but
intermed to meropenem and R to cipro). C diff was negative x 3
but was sent here on oral vancomycin and finished a 14 day
course.

She was on linezolid/meropenem/oral vanco then changed to
linezolid/pip-tazo/tobra (conventional dosing)/oral vanco. Based
on sensitivities of the pseudomonas and the enterococcus, was
then on a course of dapto, zosyn, tobramycin. At that time,
adequate drainage was in place after drains placed in OR, and
remaining positive cultures of drain fluid most likely
represented colonization rather than infection, and so once
completed over 14 days of antibiotics, they were discontinued on
[**9-20**].

Had a possible VAP with RLL infiltrate/collapse, BAL [**9-1**] done
and with 2+polys, grew pseudomonas, treated with zosyn and
inhaled tobra initially, and then iv tobra, and completed a
treatment course on [**9-13**] in case of a VAP or aspiration pna.
Antibiotics were then resumed when there was evidence of colonic
fistula formation. At the time of discharge, she was on IV
Ciprofloxacin and IV Tobramycin, which she should continue for 2
weeks until surgical follow up.


Medications on Admission:
-Albuterol/Ipratropium -4 puffs TID
-Ferrous Sulfate 325mg daily
-Lovenox 40mg SC daily
same medications on transfer:
-Guaifenesin 200mg q4hrs PRN
-Tylenol 650mg q6hrs PRN
-Albuterol INH, 4 puffs qhour PRN
-Lactobacillus Acidophilis/lactinex -1 tablet daily
-Miconazole 2% ointment PRN
-Octreotide acetate 100 mcg SC TID
-olanzapine 10mg PO qhs
-Protonix 40mg IV BID
-Vitamin A&D external cream PRN
-Zinc oxide ointment PRN

Discharge Medications:
1. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Four (4) Puff Inhalation Q4H (every 4 hours) as needed for For
wheezes.
2. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day) as needed for thrush.
3. Ciprofloxacin in D5W 400 mg/200 mL Piggyback Sig: One (1)
Intravenous Q12H (every 12 hours) for 2 weeks.
4. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED).
5. Acetylcysteine 20 % (200 mg/mL) Solution Sig: One (1) ML
Miscellaneous Q6H (every 6 hours) as needed for secretions.
6. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q6H (every 6 hours) as
needed for wheezing.
7. Nystatin 100,000 unit/g Cream Sig: One (1) Appl Topical [**Hospital1 **]
(2 times a day).
8. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical TID
(3 times a day) as needed for rash.
9. Hydromorphone (PF) 1 mg/mL Syringe Sig: [**2-2**]  Injection Q4H
(every 4 hours) as needed for pain.
10. Phenol 1.4 % Aerosol, Spray Sig: One (1) Spray Mucous
membrane Q4H (every 4 hours) as needed for pain.
11. Acetaminophen 650 mg Suppository Sig: One (1) Suppository
Rectal Q6H (every 6 hours) as needed for pain .
12. Heparin, Porcine (PF) 10 unit/mL Syringe Sig: One (1) ML
Intravenous PRN (as needed) as needed for line flush.
13. Ondansetron 8 mg IV Q8H:PRN nausea
14. Tobramycin Sulfate 80 mg/8mL Solution Sig: 90 mg
Intravenous every eight (8) hours for 2 weeks.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 672**] Hospital

Discharge Diagnosis:
Gallstone pancreatitis, pseudocysts percutaneously, and
pneumonia s/p tracheostomy as well as waxing mental status,
perc/lap necrosectomy x 4


Discharge Condition:
Good, meeting discharge criteria, stable respiratory status with
trach mask, NPO and chronically on TPN at baseline.


Discharge Instructions:
Please call your doctor or return to the ER for any of the
following:
* You experience new chest pain, pressure, squeezing or
tightness.
* New or worsening cough or wheezing.
* If you are vomiting and cannot keep in 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.
* Your skin, or the whites of your eyes become yellow.
* Your pain is not improving within 8-12 hours or not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or
back.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.
.
* Take all new meds as ordered.
* Do not drive or operate heavy machinery while taking any
narcotic pain medication. You may have constipation when taking
narcotic pain medications (oxycodone, percocet, vicodin,
hydrocodone, dilaudid, etc.); you should continue drinking
fluids, you may take stool softeners, and should eat foods that
are high in fiber.
* Continue to increase activity daily
* No heavy lifting (>[**11-15**] lbs) for 6 weeks.
* You may shower and wash. No tub baths or swimming.
* Monitor your incision for signs of infections

JP Drain Care:
-Please look at the site every day for signs of infection
(increased redness, swelling, odor, yellow or bloody discharge,
fever).
-Maintain the bulb deflated to provide adequate suction.
-Note color, consistency, and amount of fluid in drain. Call
doctor if amount increases significantly or changes in
character.
-Be sure to empty the drain frequently.
-You may shower, wash area gently with warm, soapy water.
-Maintain the site clean, dry, and intact.
-Avoid swimming, baths, hot tubs-do not submerge yourself in
water.
-Keep drain attached safely to body to prevent pulling


Followup Instructions:
Call Dr.[**Name (NI) 5067**] office at ([**Telephone/Fax (1) 6347**] to schedule a follow up
appointment in 2 weeks.
{"Cyst and pseudocyst of pancreas,Mechanical complication of tracheostomy,Urinary tract infection, site not specified,Chronic respiratory failure,Pneumonia due to Pseudomonas,Encephalopathy, unspecified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in other specified places,Cardiac pacemaker in situ,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Surgical or other procedure not carried out because of patient's decision,Depressive disorder, not elsewhere classified,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Feeding difficulties and mismanagement"}


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: Pneumonia, pancreatic pseudocyst

PRESENT ILLNESS: Pt is a 60 yo F transferred from [**Hospital3 **] for
management of complicated pancreatitis as well as possible
pnuemonia. Transferred for worsening respiratory status as well
as failure to progress w/ pancreatitis/pseudocyst tx. Pt was
originally admitted on [**2198-6-8**] for gallstone pancreatitis,
complicated by infected pseudocyst, pneumonia, ARDS and
persistent fevers. She has failed multiple ERCP stent
palacements. Per OSH records, she developed fever to 101.8 and
white count of 16.8 today prior to transfer to [**Hospital1 **]. Her
amylase/lipase have normalized. The patient underwent
tracheostomy on [**2198-7-12**] and was weaned from the vent on [**2198-7-24**],
and has been stable on trach mask w/ 10L O2.  Of note, pt has
been treated for VRE and CDiff during her extended
hospitalization.

MEDICAL HISTORY: -Prior left foot surgery for a heel spur
-no other PMH prior to gallstone pancreatitis
-as above: ARDS, PNA, gallstones, pancreatitis, pseudocyst,
tachy-brady syndrome

MEDICATION ON ADMISSION: -Albuterol/Ipratropium -4 puffs TID
-Ferrous Sulfate 325mg daily
-Lovenox 40mg SC daily
same medications on transfer:
-Guaifenesin 200mg q4hrs PRN
-Tylenol 650mg q6hrs PRN
-Albuterol INH, 4 puffs qhour PRN
-Lactobacillus Acidophilis/lactinex -1 tablet daily
-Miconazole 2% ointment PRN
-Octreotide acetate 100 mcg SC TID
-olanzapine 10mg PO qhs
-Protonix 40mg IV BID
-Vitamin A&D external cream PRN
-Zinc oxide ointment PRN

ALLERGIES: Codeine

PHYSICAL EXAM: VS 96.4 92 104/60 20 100%TM
Gen: A&O, NAD, Trached
Neuro: CN II-XII grossly intact
HEENT: NCAT, Anicteric
Card: RRR -mgr
Pulm: + Ronchi bilat, Diffuse crackles
Abd: Soft, NTND, 3 drains in place draining brown fluid, GJ
clamped
Ext: No cyanosis, clubbing, or edema
Skin: No ulcers

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Patient is engaged and her fiancee is her health care proxy.
She denies tobacco, EtOH, or IVDU. 

### Response:
{"Cyst and pseudocyst of pancreas,Mechanical complication of tracheostomy,Urinary tract infection, site not specified,Chronic respiratory failure,Pneumonia due to Pseudomonas,Encephalopathy, unspecified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in other specified places,Cardiac pacemaker in situ,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Surgical or other procedure not carried out because of patient's decision,Depressive disorder, not elsewhere classified,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Feeding difficulties and mismanagement"}
