CHIEF COMPLAINT: Lower Lip melanoma

PRESENT ILLNESS: 69 y/o man with lower lip melanoma. Patient underwent excision
and repair of
right lower lip mass during previous admission of [**2169-10-9**]. He
was readmitted due to positive margins for re-excision and
reconstruction.

MEDICAL HISTORY: Essential Tremor
AAA, repaired
CRI s/p nephrectomy on hemodialysis
CAD s/p 4 vessel stenting
Lower lip melanoma

MEDICATION ON ADMISSION: toprol xl 25 po qd
atorvastatin 40mg po qd
furosemide 40mg po qd
nephrocaps
sevalamar 400mg po tid
aspirin
plavix

ALLERGIES: Morphine Sulfate / Tegretol

PHYSICAL EXAM: T 98.0, BP 98/33, P 79, RR 16, SpO2 97% on RA.
A+O x3
PERRLA, no focal sensorimotor deficit.
JVP could not be appreciated.
Regular S1, S2. II/VI SEM @ RUSB.
LCA anteriorly.
+BS. soft abdomen, multiple abdominal scars, large R sided
hernia w/ extrusion bowel contents into R side of abdomen.
+L femoral bruit.
+R cephalic fistula bruit and thrill.
1+ dp pulses b/l.

FAMILY HISTORY: Father died at age 62 with coronary artery
disease.  Mother died at 50 years old with breast cancer.  He
has one brother with a heart attack history.  Two brothers
with coronary artery bypass grafting history.  Sister died at
67 from cancer.

SOCIAL HISTORY: The patient has a significant smoking history of two packs per
day times 55 years, with occasional alcohol use.  He has an
occupational history as a retired
brick layer.  Currently lives alone w/ daughter, who helps w/
his care.
Malignant melanoma of skin of lip,Hemorrhage complicating a procedure,Congestive heart failure, unspecified,Acute respiratory failure,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Malig melanoma lip,Hemorrhage complic proc,CHF NOS,Acute respiratry failure,Abn react-surg proc NEC
Admission Date:  [**2169-10-30**]              Discharge Date:   [**2169-11-4**]

Date of Birth:  [**2100-2-18**]             Sex:   M

Service: OTOLARYNGOLOGY

Allergies:
Morphine Sulfate / Tegretol

Attending:[**First Name3 (LF) 7729**]
Chief Complaint:
Lower Lip melanoma

Major Surgical or Invasive Procedure:
1) Re-excision of lower lip melanoma
2) Rt mental nerve biopsy
3) Lt Estlander flap to lower lip


History of Present Illness:
69 y/o man with lower lip melanoma. Patient underwent excision
and repair of
right lower lip mass during previous admission of [**2169-10-9**]. He
was readmitted due to positive margins for re-excision and
reconstruction.

Past Medical History:
Essential Tremor
AAA, repaired
CRI s/p nephrectomy on hemodialysis
CAD s/p 4 vessel stenting
Lower lip melanoma


Social History:
The patient has a significant smoking history of two packs per
day times 55 years, with occasional alcohol use.  He has an
occupational history as a retired
brick layer.  Currently lives alone w/ daughter, who helps w/
his care.

Family History:
Father died at age 62 with coronary artery
disease.  Mother died at 50 years old with breast cancer.  He
has one brother with a heart attack history.  Two brothers
with coronary artery bypass grafting history.  Sister died at
67 from cancer.


Physical Exam:
T 98.0, BP 98/33, P 79, RR 16, SpO2 97% on RA.
A+O x3
PERRLA, no focal sensorimotor deficit.
JVP could not be appreciated.
Regular S1, S2. II/VI SEM @ RUSB.
LCA anteriorly.
+BS. soft abdomen, multiple abdominal scars, large R sided
hernia w/ extrusion bowel contents into R side of abdomen.
+L femoral bruit.
+R cephalic fistula bruit and thrill.
1+ dp pulses b/l.

Pertinent Results:
[**2169-10-30**] 08:47PM   GLUCOSE-81 UREA N-47* CREAT-5.8* SODIUM-138
POTASSIUM-6.0* CHLORIDE-100 TOTAL CO2-29 ANION GAP-15
[**2169-10-30**] 08:47PM   CALCIUM-8.8 PHOSPHATE-4.9* MAGNESIUM-2.1
[**2169-10-30**] 08:47PM   WBC-9.5# RBC-3.25* HGB-11.2* HCT-32.8*
MCV-101* MCH-34.4* MCHC-34.0 RDW-13.4
[**2169-10-30**] 08:47PM   PLT COUNT-208
[**2169-10-30**] 08:47PM   PT-13.2 PTT-28.0 INR(PT)-1.1

Brief Hospital Course:
After the operation he was admitted to the ICU for observation.
During the night following admission, the patient continued to
bleed out of the unclosed openings of his mouth.  Eventually
required surgicell packing of oral cavity to stave off continued
bleeding.  Unclear [**Name2 (NI) **] loss quantity but hematocrit remained
stable.  Secondary to the ongoing bleeding and significant
drainage of dark red contents from NGT it was felt that the
patient should remain  intubated until HD 2.  Given inability to
intubate through the oropharynx, pt was extubated over
bronchoscope by ENT, w/o complication.  Secondary to the ongoing
bleeding, Plavix and ASA were held Pt has been continued on
cefazolin 1g renally dosed w/ plan to continue for 7 day course
for propylaxis.
On HD2, pt developed low grade temperature to 100.4, and sputum
and urine were sent.  Sputum grew out 4+ GNR and 4+ GPC in
clusters, chains, pairs.  There was no indication for treatment
as pt was w/o s/sx of PNA and developed no further temperature.
He was maintained on IV Lopressor and transitioned to orals on
HD 3.
His fluid status was largely determined by HD.  Only 1.3L taken
off on HD1 and pt remains w/ some residual UE edema.  Daily CXRs
were followed and O2 requirements were closely monitored.
He underwent another session of HD and 3L were taken off. His
breathing improved (95-97% on RA) and he voided after his Foley
catheter was discontinued.
On day af his dicharge he was able to ambulate, void and breathe
w/o difficulty. His surgical sites were d/c/i.


Medications on Admission:
toprol xl 25 po qd
atorvastatin 40mg po qd
furosemide 40mg po qd
nephrocaps
sevalamar 400mg po tid
aspirin
plavix

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
2. Acetaminophen 160 mg/5 mL Elixir Sig: Four (4)  PO Q6H (every
6 hours) as needed for pain.
3. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO Q6H (every 6 hours) as needed: Avoid Tylenol when taking
Percocet/Roxicet.
Disp:*500 ML(s)* Refills:*0*
4. Calcium Acetate 667 mg Tablet Sig: One (1) Tablet PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
5. Atorvastatin Calcium 40 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
6. Bacitracin Zinc 500 unit/g Ointment Sig: One (1) Appl Topical
 [**Hospital1 **] (2 times a day).
7. Tamsulosin HCl 0.4 mg Capsule, Sust. Release 24HR Sig: One
(1) Capsule, Sust. Release 24HR PO HS (at bedtime).
Disp:*10 Capsule, Sust. Release 24HR(s)* Refills:*0*
8. Sevelamer HCl 800 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
9. Keflex 500 mg Capsule Sig: One (1) Capsule PO twice a day for
7 days.
Disp:*28 Capsule(s)* Refills:*0*
10. Nexium 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
Disp:*50 Capsule, Delayed Release(E.C.)(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Right lower lip melanoma


Discharge Condition:
Stable

Discharge Instructions:
Keep wounds clean and dry. Contact ENT if you experience fever
>101, shaking chills, difficulty in breathing or swallowing, lip
swelling or discharge (possible infection), wound dehiscence.
Mobilize at least three to four times daily.

Followup Instructions:
with Dr [**Last Name (STitle) 1837**] in one week. Please call [**Telephone/Fax (1) 7732**] to
schedule an appointment.



Completed by:[**2169-11-4**]
{'Malignant melanoma of skin of lip,Hemorrhage complicating a procedure,Congestive heart failure, unspecified,Acute respiratory failure,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: Lower Lip melanoma

PRESENT ILLNESS: 69 y/o man with lower lip melanoma. Patient underwent excision
and repair of
right lower lip mass during previous admission of [**2169-10-9**]. He
was readmitted due to positive margins for re-excision and
reconstruction.

MEDICAL HISTORY: Essential Tremor
AAA, repaired
CRI s/p nephrectomy on hemodialysis
CAD s/p 4 vessel stenting
Lower lip melanoma

MEDICATION ON ADMISSION: toprol xl 25 po qd
atorvastatin 40mg po qd
furosemide 40mg po qd
nephrocaps
sevalamar 400mg po tid
aspirin
plavix

ALLERGIES: Morphine Sulfate / Tegretol

PHYSICAL EXAM: T 98.0, BP 98/33, P 79, RR 16, SpO2 97% on RA.
A+O x3
PERRLA, no focal sensorimotor deficit.
JVP could not be appreciated.
Regular S1, S2. II/VI SEM @ RUSB.
LCA anteriorly.
+BS. soft abdomen, multiple abdominal scars, large R sided
hernia w/ extrusion bowel contents into R side of abdomen.
+L femoral bruit.
+R cephalic fistula bruit and thrill.
1+ dp pulses b/l.

FAMILY HISTORY: Father died at age 62 with coronary artery
disease.  Mother died at 50 years old with breast cancer.  He
has one brother with a heart attack history.  Two brothers
with coronary artery bypass grafting history.  Sister died at
67 from cancer.

SOCIAL HISTORY: The patient has a significant smoking history of two packs per
day times 55 years, with occasional alcohol use.  He has an
occupational history as a retired
brick layer.  Currently lives alone w/ daughter, who helps w/
his care. 

### Response:
{'Malignant melanoma of skin of lip,Hemorrhage complicating a procedure,Congestive heart failure, unspecified,Acute respiratory failure,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
