CHIEF COMPLAINT: Abdominal aortic aneurysm.

PRESENT ILLNESS: This is a patient with known
abdominal aortic aneurysm with an increase in size. Patient
now is admitted for elective repair.

MEDICAL HISTORY: Known cardiomyopathy with diastolic
dysfunction by echocardiogram, history of dysrhythmia
symptomatic with syncope, AVNRT status post ablation in [**2154**],
history of hypertension, history of negative stress test on
[**2159-1-16**]. Echocardiogram showed EF of greater than 60% with
mildly thickened aortic valve and mitral valve and impaired
relaxation in inflow pattern, normal systolic function,
arthritis of the back and cervical spondylolysis with
foraminal stenosis on C2, type 2 diabetes with peripheral
neuropathy with a history of falls, type 2 diabetes with
nephropathy and chronic renal insufficiency, baseline
creatinine 2.9, history of hepatitis B remote, remote drug
history of IV drug use and cocaine. Has not used drugs since
[**2138**].

MEDICATION ON ADMISSION: Aspirin 325 mg daily. This was
stopped 5 days prior to [**12-15**]. Insulin Lantus 56 units
at bedtime with a Humalog sliding scale, Lipitor 20 mg daily,
lisinopril 5 mg daily, Zyprexa 10 mg daily, Lamictal 25 mg
q.i.d., Desipramine, oxycodone daily, Toprol XL 25 mg daily.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: Blood pressure is 157/90, pulse rate 94,
respirations 16. General appearance is alert white male in no
acute distress, but somewhat vague historian. Heart is a
regular rate and rhythm without carotid bruits. Lungs are
clear to auscultation. Abdomen is protuberant, soft,
nontender with palpable femoral pulses bilaterally.
Extremities are unremarkable. Pedal pulses are 1+ palpable
bilaterally.

FAMILY HISTORY: 

SOCIAL HISTORY: Patient is a current smoker with 1 pack per
day since [**2160-7-18**], previously went to 2 packs for 30
years; had discontinued this smoking pattern in [**2149**]. Denies
alcohol or current drug use.
Abdominal aneurysm without mention of rupture,Other primary cardiomyopathies,Chronic kidney disease, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Tobacco use disorder,Bipolar I disorder, most recent episode (or current) unspecified,Other iatrogenic hypotension,Delirium due to conditions classified elsewhere
Abdom aortic aneurysm,Prim cardiomyopathy NEC,Chronic kidney dis NOS,DMII neuro nt st uncntrl,Neuropathy in diabetes,Hy kid NOS w cr kid I-IV,Tobacco use disorder,Bipolor I current NOS,Iatrogenc hypotnsion NEC,Delirium d/t other cond
Admission Date: [**2160-12-13**]        Discharge Date: [**2160-12-20**]

Date of Birth:  [**2096-3-24**]        Sex:

Service:


CHIEF COMPLAINT:  Abdominal aortic aneurysm.

HISTORY OF PRESENT ILLNESS:  This is a patient with known
abdominal aortic aneurysm with an increase in size. Patient
now is admitted for elective repair.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:  Aspirin 325 mg daily. This was
stopped 5 days prior to [**12-15**]. Insulin Lantus 56 units
at bedtime with a Humalog sliding scale, Lipitor 20 mg daily,
lisinopril 5 mg daily, Zyprexa 10 mg daily, Lamictal 25 mg
q.i.d., Desipramine, oxycodone daily, Toprol XL 25 mg daily.

PAST MEDICAL HISTORY:  Known cardiomyopathy with diastolic
dysfunction by echocardiogram, history of dysrhythmia
symptomatic with syncope, AVNRT status post ablation in [**2154**],
history of hypertension, history of negative stress test on
[**2159-1-16**]. Echocardiogram showed EF of greater than 60% with
mildly thickened aortic valve and mitral valve and impaired
relaxation in inflow pattern, normal systolic function,
arthritis of the back and cervical spondylolysis with
foraminal stenosis on C2, type 2 diabetes with peripheral
neuropathy with a history of falls, type 2 diabetes with
nephropathy and chronic renal insufficiency, baseline
creatinine 2.9, history of hepatitis B remote, remote drug
history of IV drug use and cocaine. Has not used drugs since
[**2138**].

SOCIAL HISTORY:  Patient is a current smoker with 1 pack per
day since [**2160-7-18**], previously went to 2 packs for 30
years; had discontinued this smoking pattern in [**2149**]. Denies
alcohol or current drug use.

PHYSICAL EXAM:  Blood pressure is 157/90, pulse rate 94,
respirations 16. General appearance is alert white male in no
acute distress, but somewhat vague historian. Heart is a
regular rate and rhythm without carotid bruits. Lungs are
clear to auscultation. Abdomen is protuberant, soft,
nontender with palpable femoral pulses bilaterally.
Extremities are unremarkable. Pedal pulses are 1+ palpable
bilaterally.

HOSPITAL COURSE:  Patient was admitted to the preoperative
holding area. On [**2160-12-11**], he underwent abdominal
aortic repair with tube graft, tolerated the procedure well.
Had palpable pedal pulses. He was transferred to the PACU in
stable condition. He continued to have persistent acidosis
with a normal lactate and normal hematocrit.

Patient remained intubated and was transferred to the SICU
for respiratory ventilation support. Epidural was placed
intraoperatively for analgesic control. Pain was moderately
controlled with epidural. Adjustments are made. Psychiatry
was requested to see the patient because of his agitation
postoperatively. They felt his picture was consistent with
acute delirium with multiple contributing factors including
recent anesthesia and sedation, with elevated creatinine and
a predisposed psychiatric history.

Patient was continued on antipsychotics. Narcotics were
minimalized. Anticholinergic agents were avoided. Urine and
urine C and S was sent which were negative. Attempts were
made to reorient patient and maintain a consistent
environment. Patient was extubated on postoperative day 1. He
had improvement in his mental status exam. His antipsychotics
were reinstituted, and Haldol was utilized on a p.r.n. basis.

Patient remained in the SICU. On postoperative day 4, the
epidural was discontinued. Patient was transferred to the
regular nursing floor for continued postoperative care.
Patient continued to be followed by psychiatric service, and
his antipsychotic medications were adjusted accordingly. Was
continued on the olanzapine 2.5 mg t.i.d. He has noted some
left arm swelling on postoperative day 6. An ultrasound was
done which was negative for DVT.

Patient was transferred to the VICU on [**12-17**] and then
transferred to the regular nursing floor on [**2160-12-18**].
Patient will be evaluated by physical therapy and discharge
plan is to discharge to rehab. His mental status is slowly
improving. He is tolerating his POs. Patient will be
discharged when medically stable and bed available.

DISCHARGE MEDICATIONS:  Atorvastatin 20 mg daily, aspirin 325
mg daily, nicotine patch 21 mg per 24 hours, olanzapine 2.5
mg t.i.d., oxycodone/acetaminophen 5/325 tablets [**11-18**] q.4-6
hours p.r.n. for pain, metoprolol 100 mg b.i.d., Colace 100
mg daily, senna tablets 8.6 mg tablets 1 b.i.d. as needed,
pentamidine 20 mg daily. His insulin is glargine 55 units at
bedtime, Humalog sliding scale before meals and at bedtime.

DISCHARGE DIAGNOSES:  Abdominal aortic aneurysm of increasing
size, history of cardiomyopathy with diastolic dysfunction,
history of cardiac arrhythmias, atrioventricular node reentry
tachycardia status post ablation, history of arthritis,
cervical spondylolysis with foraminal stenosis, history of
type 2 diabetes with neuropathy, renal insufficiency with a
baseline creatinine of 2.9, history of falls, history of
hepatitis C, history of remote intravenous drug use and
cocaine; last episode was in [**2138**], current tobacco use 1 pack
per day since [**2160-9-17**], prior to that was 1-2 packs per
day x30 years which was discontinued in [**2149**], history of
bipolar disorder, depression, postoperative delirium
resolved.

POSTOPERATIVE INSTRUCTIONS:  The patient may shower, but no
tub baths. No driving until seen in followup. He may ambulate
essential distances until seen in followup. Dr.[**Name (NI) 1392**]
office should be called if he develops fever greater than
101.5, whether incision wound has become red, or swollen, or
drain.

MAJOR SURGICAL PROCEDURE:  Abdominal aorta repair with tube
graft on [**2160-12-11**].



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2380**], [**MD Number(1) 2381**]

Dictated By:[**Last Name (NamePattern1) 2382**]
MEDQUIST36
D:  [**2160-12-18**] 10:32:15
T:  [**2160-12-18**] 11:03:56
Job#:  [**Job Number 28788**]
{'Abdominal aneurysm without mention of rupture,Other primary cardiomyopathies,Chronic kidney disease, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Tobacco use disorder,Bipolar I disorder, most recent episode (or current) unspecified,Other iatrogenic hypotension,Delirium due to conditions classified elsewhere'}


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: Abdominal aortic aneurysm.

PRESENT ILLNESS: This is a patient with known
abdominal aortic aneurysm with an increase in size. Patient
now is admitted for elective repair.

MEDICAL HISTORY: Known cardiomyopathy with diastolic
dysfunction by echocardiogram, history of dysrhythmia
symptomatic with syncope, AVNRT status post ablation in [**2154**],
history of hypertension, history of negative stress test on
[**2159-1-16**]. Echocardiogram showed EF of greater than 60% with
mildly thickened aortic valve and mitral valve and impaired
relaxation in inflow pattern, normal systolic function,
arthritis of the back and cervical spondylolysis with
foraminal stenosis on C2, type 2 diabetes with peripheral
neuropathy with a history of falls, type 2 diabetes with
nephropathy and chronic renal insufficiency, baseline
creatinine 2.9, history of hepatitis B remote, remote drug
history of IV drug use and cocaine. Has not used drugs since
[**2138**].

MEDICATION ON ADMISSION: Aspirin 325 mg daily. This was
stopped 5 days prior to [**12-15**]. Insulin Lantus 56 units
at bedtime with a Humalog sliding scale, Lipitor 20 mg daily,
lisinopril 5 mg daily, Zyprexa 10 mg daily, Lamictal 25 mg
q.i.d., Desipramine, oxycodone daily, Toprol XL 25 mg daily.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: Blood pressure is 157/90, pulse rate 94,
respirations 16. General appearance is alert white male in no
acute distress, but somewhat vague historian. Heart is a
regular rate and rhythm without carotid bruits. Lungs are
clear to auscultation. Abdomen is protuberant, soft,
nontender with palpable femoral pulses bilaterally.
Extremities are unremarkable. Pedal pulses are 1+ palpable
bilaterally.

FAMILY HISTORY: 

SOCIAL HISTORY: Patient is a current smoker with 1 pack per
day since [**2160-7-18**], previously went to 2 packs for 30
years; had discontinued this smoking pattern in [**2149**]. Denies
alcohol or current drug use. 

### Response:
{'Abdominal aneurysm without mention of rupture,Other primary cardiomyopathies,Chronic kidney disease, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Tobacco use disorder,Bipolar I disorder, most recent episode (or current) unspecified,Other iatrogenic hypotension,Delirium due to conditions classified elsewhere'}
