CHIEF COMPLAINT: AAA

PRESENT ILLNESS: This is a 71 year old gentleman from the US [**State 21008**] who
noticed an abdominal mass approximately 1 month ago. He states
that he presented to a primary care physician in the [**Name9 (PRE) **]
Islands who recommended a CT scan out of concern for recurrence
of lymphoma, which he had 13 years ago. He underwent a
CT scan on [**12-26**] which demonstrated a large AAA. He met with a
surgeon in the Virgin Island but elected to come to [**Hospital1 18**] for
further care. He arrived in [**Location (un) 86**] this afternoon on a flight
and now presents for further care.

MEDICAL HISTORY: Non-hodgkin's lymphoma s/p chemotx and radiation now
currently in remission, HTN

MEDICATION ON ADMISSION: lisinopril 10'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:
T:98.8  P:80   BP: 130/69    RR: 26   Sp02: 97%
Gen: NAD
Cards: RRR
Lungs: CTAB
Abd: soft, ND, appropriately tender
Palpable pulses through out

FAMILY HISTORY: N/C

SOCIAL HISTORY: Patient reports 50 pack-year h/o smoking, quit 12 years ago, [**1-15**]
drinks/day, no illicit drug use
Abdominal aneurysm without mention of rupture,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Alcohol abuse, continuous,Unspecified essential hypertension,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health,Personal history of tobacco use
Abdom aortic aneurysm,Oth lymp unsp xtrndl org,Alcohol abuse-continuous,Hypertension NOS,Hx antineoplastic chemo,Hx of irradiation,History of tobacco use
Admission Date:  [**2114-12-27**]              Discharge Date:   [**2115-1-1**]

Date of Birth:  [**2043-6-18**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2597**]
Chief Complaint:
AAA

Major Surgical or Invasive Procedure:
s/p EVAR [**2114-12-29**]


History of Present Illness:
This is a 71 year old gentleman from the US [**State 21008**] who
noticed an abdominal mass approximately 1 month ago. He states
that he presented to a primary care physician in the [**Name9 (PRE) **]
Islands who recommended a CT scan out of concern for recurrence
of lymphoma, which he had 13 years ago. He underwent a
CT scan on [**12-26**] which demonstrated a large AAA. He met with a
surgeon in the Virgin Island but elected to come to [**Hospital1 18**] for
further care. He arrived in [**Location (un) 86**] this afternoon on a flight
and now presents for further care.


Past Medical History:
Non-hodgkin's lymphoma s/p chemotx and radiation now
currently in remission, HTN

PSH: left neck mass biopsy, right knee surgery


Social History:
Patient reports 50 pack-year h/o smoking, quit 12 years ago, [**1-15**]
drinks/day, no illicit drug use


Family History:
N/C

Physical Exam:
VS:
T:98.8  P:80   BP: 130/69    RR: 26   Sp02: 97%
Gen: NAD
Cards: RRR
Lungs: CTAB
Abd: soft, ND, appropriately tender
Palpable pulses through out

Pertinent Results:
[**2114-12-31**] 08:40AM BLOOD WBC-9.5 RBC-3.32* Hgb-10.9* Hct-29.8*
MCV-90 MCH-32.7* MCHC-36.5* RDW-13.2 Plt Ct-228
[**2114-12-31**] 06:40AM BLOOD WBC-9.5 RBC-3.29* Hgb-10.7* Hct-29.5*
MCV-90 MCH-32.4* MCHC-36.1* RDW-13.2 Plt Ct-232
[**2114-12-31**] 08:40AM BLOOD Plt Ct-228
[**2114-12-31**] 08:40AM BLOOD Glucose-101 UreaN-9 Creat-0.8 Na-138
K-4.0 Cl-101 HCO3-27 AnGap-14

[**Known lastname **],[**Known firstname **] [**Medical Record Number 81614**] M  71  [**2043-6-18**]

Radiology Report CHEST (PA & LAT) Study Date of [**2114-12-31**] 11:45
AM


[**Last Name (LF) 1111**],[**First Name11 (Name Pattern1) 1112**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 147**] VICU [**2114-12-31**] SCHED
CHEST (PA & LAT)   Clip # [**Clip Number (Radiology) 81615**]
Reason: ? atelectasis



[**Hospital 93**] MEDICAL CONDITION:
   71 year old man with fevers s/p evar
REASON FOR THIS EXAMINATION:
   ? atelectasis



Final Report
TWO VIEW CHEST

INDICATION: Fevers.

FINDINGS: The heart size is normal. The aorta is mildly
tortuous. New small
right pleural effusion and minor right lower lobe linear
atelectasis as
compared to recent CT of [**2114-12-27**]. Bilateral
peridiaphragmatic
pleural plaques are seen to better detail on the recent CT.

IMPRESSION: Small right pleural effusion and adjacent linear
atelectasis.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5785**]
Approved: MON [**2114-12-31**] 5:41 PM


Brief Hospital Course:
[**2114-12-27**]
Direct admit to Vascular Surgery from ED for AAA. Started on a
esmolol drip for pressure control. Cardiology consulted. CT scan
obtained for assessment of AAA. Patient pre-op and consented for
an EVAR repair in the am.

[**2114-12-28**]
Taken to the OR for an EVAR. Tolerated procedure without
complications. Per closure device used on bilateral groins. TX
to ICU for overnight monitoring. CIWA scale post-op for hx: Etoh
[**2-13**] drinks daily. Nitro gtt for pressure control. SQH and
venodynes for DVT prophylaxis. Bilateral groins flat without
hematoma or bleeding.

[**2114-12-29**]
VSS. Transferred to floor. Bedrest overnight. OOB to chair in
am. ADAT diet. Continued nitro gtt for pressure control. Started
on lopressor. CIWA scale.

[**2114-12-30**]
Continue BP control on po meds. CIWA scale for withdrawl
precautions. OOB ambulating with assistance.

[**2114-12-31**]
No acute events. PT following. Tmax 102.2, IS and cough and deep
breathing encouraged. DC planning.

[**2115-1-1**]
Stable. DC home.

Medications on Admission:
lisinopril 10'

Discharge Medications:
1. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1)  PO BID (2
times a day).
2. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed.
Disp:*30 Tablet(s)* Refills:*0*
3. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
6. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
7. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).



Discharge Disposition:
Home

Discharge Diagnosis:
AAA (pre-op)
PMH:
non-hodgkin's lymphoma s/p chemotx and radiation now currently
in remission
Hypertension


Discharge Condition:
Stable


Discharge Instructions:
Division of Vascular and Endovascular Surgery
Endovascular Abdominal Aortic Aneurysm (AAA) Discharge
Instructions

Medications:
??????	Take Aspirin 325mg (enteric coated) once daily
??????	Do not stop Aspirin unless your Vascular Surgeon instructs you
to do so.
??????	Continue all other medications you were taking before surgery,
unless otherwise directed
??????	You make take Tylenol or prescribed pain medications for any
post procedure pain or discomfort

What to expect when you go home:
It is normal to have slight swelling of the legs:
??????	Elevate your leg above the level of your heart (use [**1-15**]
pillows or a recliner) every 2-3 hours throughout the day and at
night
??????	Avoid prolonged periods of standing or sitting without your
legs elevated
It is normal to feel tired and have a decreased appetite, your
appetite will return with time
??????	Drink plenty of fluids and eat small frequent meals
??????	It is important to eat nutritious food options (high fiber,
lean meats, vegetables/fruits, low fat, low cholesterol) to
maintain your strength and assist in wound healing
??????	To avoid constipation: eat a high fiber diet and use stool
softener while taking pain medication

What activities you can and cannot do:
??????	When you go home, you may walk and go up and down stairs
??????	You may shower (let the soapy water run over groin incision,
rinse and pat dry)
??????	Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing or
band aid over the area that is draining, as needed
??????	No heavy lifting, pushing or pulling (greater than 5 lbs) for
1 week (to allow groin puncture to heal)
??????	After 1 week, you may resume sexual activity
??????	After 1 week, gradually increase your activities and distance
walked as you can tolerate
??????	No driving until you are no longer taking pain medications
??????	Call and schedule an appointment to be seen in [**3-18**] weeks for
post procedure check and CTA

What to report to office:
??????	Numbness, coldness or pain in lower extremities
??????	Temperature greater than 101.5F for 24 hours
??????	New or increased drainage from incision or white, yellow or
green drainage from incisions
??????	Bleeding from groin puncture site

SUDDEN, SEVERE BLEEDING OR SWELLING (Groin puncture site or
incision)
??????	Lie down, keep leg straight and have someone apply firm
pressure to area for 10 minutes. If bleeding stops, call
vascular office. If bleeding does not stop, call 911 for
transfer to closest Emergency Room.


Followup Instructions:
Provider: [**Name10 (NameIs) **] SCAN Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2115-1-7**] 2:00
Provider: [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2604**], MD Phone:[**Telephone/Fax (1) 1237**]
Date/Time:[**2115-1-7**] 3:20



Completed by:[**2115-1-1**]
{'Abdominal aneurysm without mention of rupture,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Alcohol abuse, continuous,Unspecified essential hypertension,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health,Personal history of tobacco use'}


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: AAA

PRESENT ILLNESS: This is a 71 year old gentleman from the US [**State 21008**] who
noticed an abdominal mass approximately 1 month ago. He states
that he presented to a primary care physician in the [**Name9 (PRE) **]
Islands who recommended a CT scan out of concern for recurrence
of lymphoma, which he had 13 years ago. He underwent a
CT scan on [**12-26**] which demonstrated a large AAA. He met with a
surgeon in the Virgin Island but elected to come to [**Hospital1 18**] for
further care. He arrived in [**Location (un) 86**] this afternoon on a flight
and now presents for further care.

MEDICAL HISTORY: Non-hodgkin's lymphoma s/p chemotx and radiation now
currently in remission, HTN

MEDICATION ON ADMISSION: lisinopril 10'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:
T:98.8  P:80   BP: 130/69    RR: 26   Sp02: 97%
Gen: NAD
Cards: RRR
Lungs: CTAB
Abd: soft, ND, appropriately tender
Palpable pulses through out

FAMILY HISTORY: N/C

SOCIAL HISTORY: Patient reports 50 pack-year h/o smoking, quit 12 years ago, [**1-15**]
drinks/day, no illicit drug use 

### Response:
{'Abdominal aneurysm without mention of rupture,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Alcohol abuse, continuous,Unspecified essential hypertension,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health,Personal history of tobacco use'}
