CHIEF COMPLAINT: Right flank pain

PRESENT ILLNESS: 89 year old female with extensive
medical history who presented with right flank pain since last
night. The patient reports being in her usual state of health
until yesterday around 8pm. The pain was of incidious onset,
localized to right flank and chest wall, no inciting event. It
is
now [**4-18**], non-radiating, improved with positioning, worse with
deep inspiration and cough, unrelated to food intake. The
patient
reports a cough productive of clear sputum, rhinnorhea, and sore
throat since last night. Currently with mild SOB secondary to
pain. Denies fevers, chills, nausea, hematuria, back pain,
abdominal pain. + constipation, lightheadedness.

MEDICAL HISTORY: patient unable to give history, per last discharge summary.
Frequent Falls
CAD - s/p MI [**00**] years ago
CHF - ? last ECHO [**7-12**] EF 70%
Atrial fibrillation, no longer on antiarrhythmic or
anticoagulation
Chronic venous stasis with b/l lower extremity edema
Constipation
Hernia repair
s/p appy
Degenerative disc disease followed by ortho

MEDICATION ON ADMISSION: Lipitor 10 mg Tab
Calan 40 mg Tab
Lasix 20 mg Tab
Rythmol 150 mg Tab
Coumadin 1 mg Tab
Folic Acid 400 mcg Tab
Prevacid 15 mg Cap

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives in [**Location **] with husband. Previous husband died 10 [**Name2 (NI) 1686**]
ago. Has two children, both of whom live in [**State 531**], and three
grandchildren. She used to smoke a PPD for 40 [**State 1686**] stopped
roughly 20 [**State 1686**] ago after her MI. Limited alcohol use (one glass
wine/week). No other drugs.
Empyema without mention of fistula,Pneumonia, organism unspecified,Chronic systolic heart failure,Delirium due to conditions classified elsewhere,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Atrial fibrillation,Venous (peripheral) insufficiency, unspecified,Hypotension, unspecified
Empyema w/o fistula,Pneumonia, organism NOS,Chr systolic hrt failure,Delirium d/t other cond,Crnry athrscl natve vssl,Old myocardial infarct,Atrial fibrillation,Venous insufficiency NOS,Hypotension NOS
Admission Date:  [**2190-6-29**]              Discharge Date:   [**2190-7-8**]


Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Right flank pain


Major Surgical or Invasive Procedure:
[**2190-6-29**] ultrasound guided pigtail right posterior collection


History of Present Illness:
89 year old female with extensive
medical history who presented with right flank pain since last
night. The patient reports being in her usual state of health
until yesterday around 8pm. The pain was of incidious onset,
localized to right flank and chest wall, no inciting event. It
is
now [**4-18**], non-radiating, improved with positioning, worse with
deep inspiration and cough, unrelated to food intake. The
patient
reports a cough productive of clear sputum, rhinnorhea, and sore
throat since last night. Currently with mild SOB secondary to
pain. Denies fevers, chills, nausea, hematuria, back pain,
abdominal pain. + constipation, lightheadedness.


Past Medical History:
patient unable to give history, per last discharge summary.
Frequent Falls
CAD - s/p MI [**00**] years ago
CHF - ? last ECHO [**7-12**] EF 70%
Atrial fibrillation, no longer on antiarrhythmic or
anticoagulation
Chronic venous stasis with b/l lower extremity edema
Constipation
Hernia repair
s/p appy
Degenerative disc disease followed by ortho


Social History:
Lives in [**Location **] with husband. Previous husband died 10 [**Name2 (NI) 1686**]
ago. Has two children, both of whom live in [**State 531**], and three
grandchildren. She used to smoke a PPD for 40 [**State 1686**] stopped
roughly 20 [**State 1686**] ago after her MI. Limited alcohol use (one glass
wine/week). No other drugs.


Family History:
NC

Pertinent Results:
[**2190-7-6**] 05:26AM BLOOD WBC-20.9* RBC-2.88* Hgb-8.4* Hct-26.9*
MCV-93 MCH-29.1 MCHC-31.2 RDW-14.9 Plt Ct-758*
[**2190-7-5**] 02:04AM BLOOD WBC-19.4* RBC-2.87* Hgb-8.3* Hct-26.7*
MCV-93 MCH-29.0 MCHC-31.2 RDW-14.5 Plt Ct-712*
[**2190-6-30**] 01:13AM BLOOD WBC-35.8* RBC-3.40* Hgb-10.3* Hct-30.8*
MCV-91 MCH-30.4 MCHC-33.6 RDW-14.7 Plt Ct-634*
[**2190-6-29**] 06:21PM BLOOD WBC-48.3* RBC-3.94* Hgb-12.1 Hct-36.0
MCV-91 MCH-30.7 MCHC-33.7 RDW-14.7 Plt Ct-821*
[**2190-6-29**] 03:46AM BLOOD WBC-36.4*# RBC-4.57 Hgb-13.7 Hct-42.8
MCV-94 MCH-29.9 MCHC-32.0 RDW-13.7 Plt Ct-790*#
[**2190-7-4**] 02:05AM BLOOD Neuts-81* Bands-1 Lymphs-8* Monos-5 Eos-3
Baso-0 Atyps-1* Metas-1* Myelos-0
[**2190-7-4**] 02:05AM BLOOD Hypochr-2+ Anisocy-NORMAL Poiklo-NORMAL
Macrocy-NORMAL Microcy-NORMAL Polychr-OCCASIONAL
[**2190-7-5**] 02:04AM BLOOD PT-14.0* PTT-50.2* INR(PT)-1.2*
[**2190-7-7**] 04:58AM BLOOD Glucose-78 UreaN-15 Creat-0.5 Na-140
K-4.1 Cl-106 HCO3-29 AnGap-9
[**2190-7-5**] 02:04AM BLOOD Glucose-94 UreaN-17 Creat-0.5 Na-141
K-3.8 Cl-109* HCO3-27 AnGap-9
[**2190-6-29**] 03:46AM BLOOD Glucose-98 UreaN-16 Creat-0.6 Na-140
K-3.7 Cl-105 HCO3-22 AnGap-17
[**2190-6-29**] 03:46AM BLOOD ALT-7 AST-16 CK(CPK)-18* AlkPhos-129*
TotBili-0.5
[**2190-7-7**] 04:58AM BLOOD Albumin-1.8* Calcium-7.9* Phos-2.7 Mg-2.1
[**2190-7-4**] 02:05AM BLOOD Calcium-7.8* Phos-2.9 Mg-2.0
[**2190-6-30**] 07:39AM BLOOD Albumin-2.0* Calcium-8.2* Phos-2.9 Mg-2.3

[**2190-7-5**] Chest x/ray: IMPRESSION: Stable appearances of the right
bibasilar small pleural effusions. No new consolidation. The
right-sided pigtail catheter has been withdrawn and the tip is
unfolded. No pneumothorax.
[**2190-7-1**] CT of head:IMPRESSION: No acute intracranial process,
Mild small vessel ischemic disease, Age-appropriate atrophy

[**2190-6-30**] CT of the Chest: IMPRESSION:
Decrease in size of dominant loculated component of right
pleural fluid
collection following placement of pigtail pleural catheter, and
development of small collection of air within the pleural space
consistent with the recent procedure. Otherwise little change in
the appearance of the chest since the recent study of one day
earlier except for development of small dependent left effusion.
Abdominal findings unchanged since study of one day earlier
including marked distention of the gallbladder measuring nearly
10 cm in diameter but incompletely imaged. Cholecystis cannot be
excluded although no secondary signs are identified by CT.


[**2190-6-29**] 06:21PM BLOOD Calcium-7.5* Phos-2.7 Mg-1.5*
[**2190-7-5**] 11:30AM BLOOD Osmolal-298
[**2190-6-29**] 06:21PM BLOOD TSH-3.3
[**2190-6-30**] 07:53AM BLOOD Type-ART pO2-90 pCO2-30* pH-7.43
calTCO2-21 Base XS--2
[**2190-6-30**] 06:13AM BLOOD Type-ART Temp-36.7 pO2-96 pCO2-27*
pH-7.40 calTCO2-17* Base XS--5 Intubat-NOT INTUBA
[**2190-6-30**] 03:46AM BLOOD Type-ART pO2-103 pCO2-30* pH-7.39
calTCO2-19* Base XS--5
[**2190-6-30**] 03:46AM BLOOD Glucose-80 Lactate-0.7
[**2190-6-29**] 04:57AM BLOOD Lactate-4.0*

Brief Hospital Course:
89 year old woman with extensive medical history who presented
with right flank pain, with CT showing right sided loculated
pleural effusion, likely empyema. The patient reports being in
good health without fever and with no cough until last
night, but now patient febrile to 101 with WBCs 36.4, lactate
2.1, and chest CT suggestive of an empyema. On [**2190-6-29**] admitted
to the ICU Pigtail placed right pl effussion, afib, right
subclavian central line in place. Meds Lasix amiodarone and
lopressore for Afib.  ID consulted vanco and zosyn started.
Geriatrics consult for agitation-haldol given with good effect.
On [**2190-7-1**] TPA administer to her pigtail drain to help break up
loculated fluid.  After respiratory treatment patient developed
left dilated pupil -Neuro consult obtained and head CT obtained
and negative. Self resolving believe related to neb treatment to
that eye.
[**2190-7-4**] Pleural fluid growing strep-vancomycin D/c'd.
Amiodarone D/c'd Patient now in NSR. [**2190-7-5**] transfered to F9
pigtail drain converted from pleural vac to bag drainage.  [**7-6**]
PICC line placed for rehab w/ zosyn, Nutrition consult for alb
of 1.8 continue with ensure 3 cans per day.  Pigtail secured.

D/c to rehab; Follow up appointment on [**2190-7-22**]  NPO 3 hours
prior to her appointment.


Medications on Admission:
Lipitor 10 mg Tab
Calan 40 mg Tab
Lasix 20 mg Tab
Rythmol 150 mg Tab
Coumadin 1 mg Tab
Folic Acid 400 mcg Tab
Prevacid 15 mg Cap

Discharge Medications:
1. Gabapentin 100 mg Capsule [**Date Range **]: Two (2) Capsule PO Q8H (every
8 hours).
2. Heparin (Porcine) 5,000 unit/mL Solution [**Date Range **]: One (1)
Injection [**Hospital1 **] (2 times a day).
3. Metoprolol Tartrate 25 mg Tablet [**Hospital1 **]: 0.5 Tablet PO BID (2
times a day).
4. Furosemide 20 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).

5. Quetiapine 25 mg Tablet [**Hospital1 **]: 0.5 Tablet PO ONCE (Once) as
needed for agitation, insomnia.
6. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device [**Hospital1 **]:
One (1) Cap Inhalation DAILY (Daily).
7. Venlafaxine 37.5 mg Tablet [**Hospital1 **]: Two (2) Tablet PO BID (2
times a day).
8. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization [**Hospital1 **]: One (1)  Inhalation Q6H (every 6 hours) as
needed for wheeze.
9. Senna 8.6 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
10. Atorvastatin 10 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY
(Daily).
11. Acetaminophen 500 mg Tablet [**Hospital1 **]: Two (2) Tablet PO Q 8H
(Every 8 Hours) as needed for pain.
12. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
13. Docusate Sodium 100 mg Capsule [**Last Name (STitle) **]: One (1) Capsule PO BID
(2 times a day).
14. Insulin sliding scale
Insulin SC Sliding Scale
  Q6H
Regular
Glucose Insulin Dose
0-80   mg/dL [**12-11**] amp D50
81-120   mg/dL 0   Units
121-160   mg/dL 2   Units
161-200   mg/dL 4   Units
201-240   mg/dL 6   Units
241-280   mg/dL 8   Units
281-320   mg/dL 10   Units
> 320   mg/dL Notify M.D.

15. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated [**Month/Day (2) **]:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily).
16. Piperacillin-Tazobactam 2.25 g IV Q6H


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 599**] of [**Location (un) 55**]

Discharge Diagnosis:
EMPYEMA


Discharge Condition:
Good


Discharge Instructions:
Please call Dr. [**First Name (STitle) **] with any questins or concerns [**Telephone/Fax (1) 2348**].

Call with fevers greater than 101.5
call with increased cough secretions or shortness of breath.
Call if problems with her chest drain.
Flush drain with 10 cc of normal saline Q 8 hours
Antibiotics continue until follow up appointment with Dr. [**First Name (STitle) **]

Followup Instructions:
Follow up appointment is on [**2190-7-22**] [**Hospital Ward Name **] [**Hospital Ward Name **] building
on the [**Location (un) **] radiology for a CAT scan at 8:30 am.  Then to
follow you need to report to the [**Location (un) **] of the same building
for your appointment with Dr. [**First Name (STitle) **] at 11:30 am.  You need to be
NPO 3 hours prior to your CAT scan.



Completed by:[**2190-7-7**]
{'Empyema without mention of fistula,Pneumonia, organism unspecified,Chronic systolic heart failure,Delirium due to conditions classified elsewhere,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Atrial fibrillation,Venous (peripheral) insufficiency, unspecified,Hypotension, unspecified'}


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: Right flank pain

PRESENT ILLNESS: 89 year old female with extensive
medical history who presented with right flank pain since last
night. The patient reports being in her usual state of health
until yesterday around 8pm. The pain was of incidious onset,
localized to right flank and chest wall, no inciting event. It
is
now [**4-18**], non-radiating, improved with positioning, worse with
deep inspiration and cough, unrelated to food intake. The
patient
reports a cough productive of clear sputum, rhinnorhea, and sore
throat since last night. Currently with mild SOB secondary to
pain. Denies fevers, chills, nausea, hematuria, back pain,
abdominal pain. + constipation, lightheadedness.

MEDICAL HISTORY: patient unable to give history, per last discharge summary.
Frequent Falls
CAD - s/p MI [**00**] years ago
CHF - ? last ECHO [**7-12**] EF 70%
Atrial fibrillation, no longer on antiarrhythmic or
anticoagulation
Chronic venous stasis with b/l lower extremity edema
Constipation
Hernia repair
s/p appy
Degenerative disc disease followed by ortho

MEDICATION ON ADMISSION: Lipitor 10 mg Tab
Calan 40 mg Tab
Lasix 20 mg Tab
Rythmol 150 mg Tab
Coumadin 1 mg Tab
Folic Acid 400 mcg Tab
Prevacid 15 mg Cap

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives in [**Location **] with husband. Previous husband died 10 [**Name2 (NI) 1686**]
ago. Has two children, both of whom live in [**State 531**], and three
grandchildren. She used to smoke a PPD for 40 [**State 1686**] stopped
roughly 20 [**State 1686**] ago after her MI. Limited alcohol use (one glass
wine/week). No other drugs. 

### Response:
{'Empyema without mention of fistula,Pneumonia, organism unspecified,Chronic systolic heart failure,Delirium due to conditions classified elsewhere,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Atrial fibrillation,Venous (peripheral) insufficiency, unspecified,Hypotension, unspecified'}
