CHIEF COMPLAINT: The patient presented for surgical management of a mesothelioma

PRESENT ILLNESS: 65 year old female with history of pleural effusion presented to
an outside hospital with a 3 week hx of increasing shortness of
breath and dyspnea with exertion.  She was found to have a L
pleural effusion and underwent thoracentesis on [**5-19**] with 1.2L
of pleural fluid removed.  Prelim reports on pleural fluid
showed no malignant cells, pH 7.52, LDH 570 and a negative gram
stain.  She reports that her dyspnea has improved since the
thoracentesis.  SHe also c/o mild back and rib pain secondary to
coughing.  She reports chronic cough since [**12-28**].  She had a CT
done at the OSH which showed a L pleural effusion and a possible
mass in the posterior space of the costophrenic angle.  She was
transferred to [**Hospital1 18**] on [**2183-5-26**] for further evaluation, including
a left VATs, decortication and talc pleurodesis.  Pathology at
the time revealed mesothelioma

MEDICAL HISTORY: Hypertension
GERD
s/p R breast lumpectomy and radiation for phyllodes tumor, CCY

MEDICATION ON ADMISSION: Verapamil 240 mg daily, omeprazole 20 mg PO qd, MVI, Calcium,
Vit D, Vit C
Nasonex

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T: 98.4       HR: 90 SR     BP: 110/60-70   Sats: 99% RA
General: 65 year-old female in no apparent distress
HEENT: normocephalic, mucus membranes moist
Card: RRR normal S1,S2
Resp: right clear to auscultation, left absent breath sounds
GI: bowel sounds positive, abdomen soft non-tender/non-distended
Extr: warm no edema
Incision: left thoracotomy site clean/dry/intact
Neuro: non-focal

FAMILY HISTORY: sister-died from melanoma
father-brain tumor, CAD

SOCIAL HISTORY: married, retired human resources manager, reports occasional
social EtOH use, hx of tobacco use, 1ppd x ?years, quit 20 years
ago, no history of asbestos exposure
Malignant neoplasm of other parts of bronchus or lung,Acute kidney failure, unspecified,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Dehydration,Unspecified essential hypertension,Esophageal reflux
Mal neo bronch/lung NEC,Acute kidney failure NOS,Mal neo lymph-intrathor,Dehydration,Hypertension NOS,Esophageal reflux
Admission Date:  [**2183-7-28**]              Discharge Date:   [**2183-8-5**]

Date of Birth:  [**2117-8-13**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5790**]
Chief Complaint:
The patient presented for surgical management of a mesothelioma

Major Surgical or Invasive Procedure:
[**2183-7-28**] - Left extrapleural pneumonectomy


History of Present Illness:
65 year old female with history of pleural effusion presented to
an outside hospital with a 3 week hx of increasing shortness of
breath and dyspnea with exertion.  She was found to have a L
pleural effusion and underwent thoracentesis on [**5-19**] with 1.2L
of pleural fluid removed.  Prelim reports on pleural fluid
showed no malignant cells, pH 7.52, LDH 570 and a negative gram
stain.  She reports that her dyspnea has improved since the
thoracentesis.  SHe also c/o mild back and rib pain secondary to
coughing.  She reports chronic cough since [**12-28**].  She had a CT
done at the OSH which showed a L pleural effusion and a possible
mass in the posterior space of the costophrenic angle.  She was
transferred to [**Hospital1 18**] on [**2183-5-26**] for further evaluation, including
a left VATs, decortication and talc pleurodesis.  Pathology at
the time revealed mesothelioma

Past Medical History:
Hypertension
GERD
s/p R breast lumpectomy and radiation for phyllodes tumor, CCY

Social History:
married, retired human resources manager, reports occasional
social EtOH use, hx of tobacco use, 1ppd x ?years, quit 20 years
ago, no history of asbestos exposure


Family History:
sister-died from melanoma
father-brain tumor, CAD

Physical Exam:
VS: T: 98.4       HR: 90 SR     BP: 110/60-70   Sats: 99% RA
General: 65 year-old female in no apparent distress
HEENT: normocephalic, mucus membranes moist
Card: RRR normal S1,S2
Resp: right clear to auscultation, left absent breath sounds
GI: bowel sounds positive, abdomen soft non-tender/non-distended
Extr: warm no edema
Incision: left thoracotomy site clean/dry/intact
Neuro: non-focal

Pertinent Results:
[**2183-8-5**] WBC-13.7* RBC-4.10* Hgb-11.1* Hct-34.4*  Plt Ct-414
[**2183-8-4**] WBC-18.4* RBC-4.17* Hgb-11.5* Hct-35.4* Plt Ct-412
[**2183-7-28**] WBC-15.0*# RBC-4.04* Hgb-10.5* Hct-32.5* Plt Ct-257
[**2183-8-5**] Glucose-128* UreaN-17 Creat-0.8 Na-135 K-4.7 Cl-102
HCO3-24
[**2183-7-28**] Glucose-205* UreaN-24* Creat-0.9 Na-137 K-4.4 Cl-105
HCO3-21

CXR: [**2183-8-3**]
There is again noted opacification of the left lung.
Subcutaneous gas within the left chest wall is also seen. The
right lung is well aerated. There has been no interval change.


Brief Hospital Course:
The patient underwent a left extrapleural pneumonectomy on
[**2183-7-28**].  An epidural was in place for pain relief, foley
catheter in place, she remained NPO, IVF for hydration, left
chest tube in place.  She tolerated the procedure well and was
transferred to the ICU for close monitoring.  Dehydrated with
hypotension during her postoperative period resulted in acute
renal failure.  Pt was given crystalloids, albumin, and blood
products and was placed on a phenylephrine drip. Pt was weaned
off pressors on [**2183-7-29**].  Cardiac enzymes, EKG, and an ECHO were
performed due to increase in cardiac enzymes.  Enzyme elevation
was believed to have resulted from ARF.  ECHO was suboptimal.

Pt improved with fluids and was transferred to the floor on
[**2183-7-31**].  The epidural catheter and the foley catheter were
removed.  Her pain was controlled with a Dilaudid PCA then
converted to PO pain meds with good control. She was seen by
physical therapy and deemed safe for home.  Her white count was
elevated and her UA was found to be positive.  She was started
on a 5 day course of Ciprofloxacin.  She continued to make
steady progress and was discharged to home.  She will follow-up
with Dr. [**Last Name (STitle) **] as an outpatient.

Medications on Admission:
Verapamil 240 mg daily, omeprazole 20 mg PO qd, MVI, Calcium,
Vit D, Vit C
Nasonex


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Senna 8.6 mg Tablet Sig: One (1) Tablet PO every twelve (12)
hours as needed for constipation for 4 weeks: as needed.
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed.
Disp:*70 Tablet(s)* Refills:*0*
4. Nasonex 50 mcg/Actuation Spray, Non-Aerosol Sig: Two (2)
Nasal once a day.
5. Vitamin D 1,000 unit Tablet Sig: One (1) Tablet PO once a
day.
6. Vitamin C 100 mg Tablet Sig: One (1) Tablet PO once a day.
7. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 5 days.
Disp:*10 Tablet(s)* Refills:*0*
8. Omeprazole 20 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
9. Verapamil 240 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO once a day.


Discharge Disposition:
Home

Discharge Diagnosis:
Mesothelioma


Discharge Condition:
good


Discharge Instructions:
Call Dr. [**Last Name (STitle) **] office([**Telephone/Fax (1) 1504**] if you experience:
-Fever greater than 101.5, chills,
-Increasing shortness of breath, chest pain, increased cough
-Incision develops drainage, or redness
-Increased ankle swelling
You may shower: No tub bathing or swimming for 6 weeks
No driving on pain medication: Take stool softeners with
narcotics.

Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) **] on [**8-19**] at 10:00am in the [**Hospital Ward Name 121**]
Building, [**Hospital1 **] I Chest Disease Center.
Report to the [**Hospital Ward Name 517**] Clinical Center [**Location (un) **] Radiology
Department for a Chest X-Ray 45 minutes before your appointment.
Follow-up with your PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 36502**]



Completed by:[**2183-8-5**]
{'Malignant neoplasm of other parts of bronchus or lung,Acute kidney failure, unspecified,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Dehydration,Unspecified essential hypertension,Esophageal reflux'}


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: The patient presented for surgical management of a mesothelioma

PRESENT ILLNESS: 65 year old female with history of pleural effusion presented to
an outside hospital with a 3 week hx of increasing shortness of
breath and dyspnea with exertion.  She was found to have a L
pleural effusion and underwent thoracentesis on [**5-19**] with 1.2L
of pleural fluid removed.  Prelim reports on pleural fluid
showed no malignant cells, pH 7.52, LDH 570 and a negative gram
stain.  She reports that her dyspnea has improved since the
thoracentesis.  SHe also c/o mild back and rib pain secondary to
coughing.  She reports chronic cough since [**12-28**].  She had a CT
done at the OSH which showed a L pleural effusion and a possible
mass in the posterior space of the costophrenic angle.  She was
transferred to [**Hospital1 18**] on [**2183-5-26**] for further evaluation, including
a left VATs, decortication and talc pleurodesis.  Pathology at
the time revealed mesothelioma

MEDICAL HISTORY: Hypertension
GERD
s/p R breast lumpectomy and radiation for phyllodes tumor, CCY

MEDICATION ON ADMISSION: Verapamil 240 mg daily, omeprazole 20 mg PO qd, MVI, Calcium,
Vit D, Vit C
Nasonex

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T: 98.4       HR: 90 SR     BP: 110/60-70   Sats: 99% RA
General: 65 year-old female in no apparent distress
HEENT: normocephalic, mucus membranes moist
Card: RRR normal S1,S2
Resp: right clear to auscultation, left absent breath sounds
GI: bowel sounds positive, abdomen soft non-tender/non-distended
Extr: warm no edema
Incision: left thoracotomy site clean/dry/intact
Neuro: non-focal

FAMILY HISTORY: sister-died from melanoma
father-brain tumor, CAD

SOCIAL HISTORY: married, retired human resources manager, reports occasional
social EtOH use, hx of tobacco use, 1ppd x ?years, quit 20 years
ago, no history of asbestos exposure 

### Response:
{'Malignant neoplasm of other parts of bronchus or lung,Acute kidney failure, unspecified,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Dehydration,Unspecified essential hypertension,Esophageal reflux'}
