CHIEF COMPLAINT: fever

PRESENT ILLNESS: 50M s/p anal squamous ca treated w/ chemoradiation w. subsequent
 anal stricture requiring sigmoid colectomy, end colostomy,
mucous fistula. s/p colostomy resite, parastomal hernia repair
w/ biomesh, component separation, completion sigmoidectomy c/b
perforated ostomy and dehisc/fistula. Now is admitted via the ED
with complaints of fever 103F.

MEDICAL HISTORY: PMH: anal SCC, anal stricture, large abdominal hernia, chronic
abdominal pain, CAD, PVD, ?OSA, HTN, hypercholesterolemia
vitamin D deficiency
PSH: sigmoid colectomy and dilatation, 2 LLE stents,

MEDICATION ON ADMISSION: Cilostazol 100'', Plavix 75', VitD2 50,000 uqwk, Nexium 40',
Mehadone 20''prn, lopressor 100'', Roxicet 5mgq6h, colace, MVI

ALLERGIES: Cymbalta / Morphine / Nortriptyline

PHYSICAL EXAM: VS:
GA: alert and oriented, no acute distress
CVS: normal S1, S2, no murmurs
Resp: CTAB
[**Last Name (un) **]: soft, tender at ostomy site and skin bridge between
midline incision and ostomy site, wound vac in place
Ext: warm, minimal edema

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: originally from [**Country 3400**]
lives with wife, no children
quit tobacco 2 months ago, previously 1 ppd x 2 years
no EtOH in 14 years
Other postoperative infection,Acute kidney failure with lesion of tubular necrosis,Pneumonia, organism unspecified,Other colostomy and enterostomy complication,Cellulitis and abscess of trunk,Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus,Other chronic postoperative pain,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Unspecified vitamin D deficiency,Peripheral vascular disease, unspecified,Obstructive sleep apnea (adult)(pediatric),Anemia, unspecified
Other postop infection,Ac kidny fail, tubr necr,Pneumonia, organism NOS,Colstmy/enteros comp NEC,Cellulitis of trunk,Abn react-external stoma,Hx-rectal & anal malign,Chronic postop pain NEC,DMII wo cmp nt st uncntr,Hypertension NOS,Vitamin D deficiency NOS,Periph vascular dis NOS,Obstructive sleep apnea,Anemia NOS
Admission Date:  [**2128-6-24**]              Discharge Date:   [**2128-7-10**]

Date of Birth:  [**2078-2-19**]             Sex:   M

Service: SURGERY

Allergies:
Cymbalta / Morphine / Nortriptyline

Attending:[**First Name3 (LF) 3376**]
Chief Complaint:
fever

Major Surgical or Invasive Procedure:
Placement of a 34-French Malecot catheter via the stoma to
facilitate drainage of stool.
Placement of VAC.


History of Present Illness:
50M s/p anal squamous ca treated w/ chemoradiation w. subsequent
 anal stricture requiring sigmoid colectomy, end colostomy,
mucous fistula. s/p colostomy resite, parastomal hernia repair
w/ biomesh, component separation, completion sigmoidectomy c/b
perforated ostomy and dehisc/fistula. Now is admitted via the ED
with complaints of fever 103F.


Past Medical History:
PMH: anal SCC, anal stricture, large abdominal hernia, chronic
abdominal pain, CAD, PVD, ?OSA, HTN, hypercholesterolemia
vitamin D deficiency
PSH: sigmoid colectomy and dilatation, 2 LLE stents,

Social History:
originally from [**Country 3400**]
lives with wife, no children
quit tobacco 2 months ago, previously 1 ppd x 2 years
no EtOH in 14 years


Family History:
noncontributory

Physical Exam:
VS:
GA: alert and oriented, no acute distress
CVS: normal S1, S2, no murmurs
Resp: CTAB
[**Last Name (un) **]: soft, tender at ostomy site and skin bridge between
midline incision and ostomy site, wound vac in place
Ext: warm, minimal edema

Pertinent Results:
[**2128-6-24**] 04:42PM   GLUCOSE-107* UREA N-5* CREAT-0.7 SODIUM-135
POTASSIUM-4.5 CHLORIDE-99 TOTAL CO2-26 ANION GAP-15
[**2128-6-24**] 04:42PM   WBC-12.0* RBC-3.77* HGB-9.4* HCT-29.4*
MCV-78* MCH-24.9* MCHC-32.0 RDW-15.2
[**2128-6-24**] 04:42PM   NEUTS-76.1* LYMPHS-16.3* MONOS-5.6 EOS-1.9
BASOS-0.2
[**2128-6-24**] 04:42PM   PLT COUNT-480*
[**2128-6-24**] 04:42PM   PT-13.9* PTT-21.3* INR(PT)-1.2*
[**2128-6-25**] 09:53PM BLOOD WBC-13.3* RBC-3.83* Hgb-9.4* Hct-30.3*
MCV-79* MCH-24.6* MCHC-31.1 RDW-14.9 Plt Ct-442*
[**2128-7-1**] 05:13AM BLOOD WBC-11.1* RBC-3.34* Hgb-8.4* Hct-26.4*#
MCV-79* MCH-25.0* MCHC-31.7 RDW-15.0 Plt Ct-410
[**2128-7-2**] 05:45AM BLOOD WBC-9.6 RBC-3.32* Hgb-8.5* Hct-26.4*
MCV-80* MCH-25.7* MCHC-32.2 RDW-15.3 Plt Ct-452*

Brief Hospital Course:
Mr. [**Known lastname 73917**] was admitted [**2128-6-25**] for fever of 103F. On admission
blood cultures and urine cultures were taken.  WBC was mildly
elevated to 12.0.  His home wound vac was removed as it was
dysfunctional.  On [**2128-6-25**] Mr. [**Known lastname 73917**] was triggered for rigors
and shaking.  It was noted that his ostomy was leaking into a
pocket within his superficial abdominal soft tissues. He was
promptly taken to the OR for washout of his abdominal wall,
placement of a malencot drain to prevent stricture of his
ostomy, and vac placement (@50mmHg).  Immediately
post-operatively patient was transferred to the ICU for
monitoring and pain control.  His Creatinine was elevated to
2.2. Renal US was normal and revealed no hydronephrosis.
Patient was transferred to the floor on [**2128-6-27**]. Pain service
was consulted for management of his pain and weaning of his
methadone therapy.  Patient returned to OR on [**2128-6-29**] for
washout of his abdominal wound. Post-operatively he desaturated
to 83% in PACU. This resolved with BIPAP and he spontaneously
recovered.  On [**2128-7-1**] patient was transfused 2 units for a hct
of 20.8.  Post-transfusion hct was 26.4.  Mr. [**Known lastname 73918**] diet was
advanced to full liquids which he tolerated well.  He was
started on a methadone taper per pain service which involved
decreasing his methadone dose by 5mg per day every 5 days
divided over 3 doses.  At discharge he was tolerating a soft
diet and his pain was managed with methadone to be tapered per
chronic pain service plan listed above.

Medications on Admission:
Cilostazol 100'', Plavix 75', VitD2 50,000 uqwk, Nexium 40',
Mehadone 20''prn, lopressor 100'', Roxicet 5mgq6h, colace, MVI

Discharge Medications:
1. Cilostazol 100 mg Tablet Sig: One (1) Tablet PO bid ().
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed for insomnia.
6. Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO QID (4
times a day).
7. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO every eight
(8) hours as needed for pain.
8. Clonidine 0.1 mg/24 hr Patch Weekly Sig: One (1) Patch Weekly
Transdermal QSAT (every Saturday).
Disp:*2 Patch Weekly(s)* Refills:*0*
9. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q 8H (Every 8 Hours) as needed for constipation.
10. Methadone 10 mg Tablet Sig: Three (3) Tablet PO TID (3 times
a day) for 7 days.
Disp:*63 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Perforated Ostomy and Wound Dehisence


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted to the hospital with fever as a result of an
infection that was in your blood. You were treated with
antibiotics during your admission which has treated this fever.
You have not had a fever for many days and you are now ready to
return home. It is important that when you return home you work
closely with the visiting nursing team and follow their
instruction. The VAC sponge dressing will be changed every 3
days as previously ordered. There is a small area that drains a
small amount of stool that stains the white sponge only a small
amount, the VNA will know about this, it is our hope that this
will stop over time and this connection will close. If you note
that the stool has increased or you have increasing pain call
the office or if severe got ot the emergency room. Watch for
signs and symptoms of worsening infection such as fever,
increased pain, fast heart rate, or green/white drainage in the
surgical wound. The ostomy appliance should be changed with
these dressing changes. Monitor the output in the ostomy
appliance, it should be thin stool and should not be more than
1500ml daily, if the output is above this amount or below 500cc
please call Dr.[**Name (NI) 3377**] office. You will take a medication to
make your stool thin three times daily. Please adhere to the
soft diet taught to you by nutrition services and the surgical
NP. It is very important that the stool is thin so it will pass
through the drain in your stoma and not tract through into the
wound. Please keep yourself well hydrated. Your diet should
include soft foods, full liquids, and ensure. Soft foods such
as: scrambled eggs, couscous, mashed potato, nothing very high
in fiber. If you notice that the stool is to thick, or output
from the ostomy decreases call Dr. [**Last Name (STitle) 4488**] office, if you have
increased pain, develop a fever, are nauseated, or begin to
vomit please come to the emergency room. As you improve your
diet will be advanced by Dr. [**Last Name (STitle) 4488**] team.

You have a follow up appointment currently with the Chronic Pain
Clinic as described below. Please keep this appointment. The
goal is that you will continue to decrease the amount of
methadone you are taking daily. Your medications will continue
as given in the hospital. Please make a follow-up appointment
with your primary care provider to remove your medications. Take
these medications as precribed.


Followup Instructions:
Please make an appointment to be seen with Dr. [**Last Name (STitle) 1120**] to be seen
in [**1-24**] weeks. Call ([**Telephone/Fax (1) 3378**] to make an appointment.
Provider: [**Name10 (NameIs) 1089**] [**Name11 (NameIs) 1090**], MD Phone:[**Telephone/Fax (1) 1652**] Date/Time:[**2128-7-14**]
2:20



Completed by:[**2128-7-10**]
{'Other postoperative infection,Acute kidney failure with lesion of tubular necrosis,Pneumonia, organism unspecified,Other colostomy and enterostomy complication,Cellulitis and abscess of trunk,Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus,Other chronic postoperative pain,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Unspecified vitamin D deficiency,Peripheral vascular disease, unspecified,Obstructive sleep apnea (adult)(pediatric),Anemia, 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: fever

PRESENT ILLNESS: 50M s/p anal squamous ca treated w/ chemoradiation w. subsequent
 anal stricture requiring sigmoid colectomy, end colostomy,
mucous fistula. s/p colostomy resite, parastomal hernia repair
w/ biomesh, component separation, completion sigmoidectomy c/b
perforated ostomy and dehisc/fistula. Now is admitted via the ED
with complaints of fever 103F.

MEDICAL HISTORY: PMH: anal SCC, anal stricture, large abdominal hernia, chronic
abdominal pain, CAD, PVD, ?OSA, HTN, hypercholesterolemia
vitamin D deficiency
PSH: sigmoid colectomy and dilatation, 2 LLE stents,

MEDICATION ON ADMISSION: Cilostazol 100'', Plavix 75', VitD2 50,000 uqwk, Nexium 40',
Mehadone 20''prn, lopressor 100'', Roxicet 5mgq6h, colace, MVI

ALLERGIES: Cymbalta / Morphine / Nortriptyline

PHYSICAL EXAM: VS:
GA: alert and oriented, no acute distress
CVS: normal S1, S2, no murmurs
Resp: CTAB
[**Last Name (un) **]: soft, tender at ostomy site and skin bridge between
midline incision and ostomy site, wound vac in place
Ext: warm, minimal edema

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: originally from [**Country 3400**]
lives with wife, no children
quit tobacco 2 months ago, previously 1 ppd x 2 years
no EtOH in 14 years 

### Response:
{'Other postoperative infection,Acute kidney failure with lesion of tubular necrosis,Pneumonia, organism unspecified,Other colostomy and enterostomy complication,Cellulitis and abscess of trunk,Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus,Other chronic postoperative pain,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Unspecified vitamin D deficiency,Peripheral vascular disease, unspecified,Obstructive sleep apnea (adult)(pediatric),Anemia, unspecified'}
