CHIEF COMPLAINT: Morbid obesity

PRESENT ILLNESS: Mrs. [**Known lastname 82153**] is a 63 year old female status post laparoscopic
adjustable band in [**2179**], subsequently removed in [**2185**] in
anticipation of a gastric bypass at [**Hospital3 1196**].
The patient had lost 50 pounds at that time but then
was diagnosed with Parkinson's disease and gastric bypass was
not performed.  The patient has subsequently had weight gain,
and she comes to us today in hopes of proceeding with gastric
sleeve procedure.  Gastric bypass was not performed at
[**Hospital1 **] because of concern of poor drug absorption for
necessary medications for her Parkinson's.

MEDICAL HISTORY: Past Medical History:  Hypertension, sleep apnea,
hyperlipidemia,
asthma, osteoarthritis, fatty liver, Parkinson's disease, renal
stones.

MEDICATION ON ADMISSION: Mirapex 0.50 mg "', simvastatin 10', furosemide 20', flovent
2puff "prn, fluticasone 50 one spray each nostril"prn,
fluoxetine 20', zolpidem 10qhsprn, armodafinal 150', vitamin D
2000U

ALLERGIES: Penicillins / Cephalosporins / Sulfa (Sulfonamide Antibiotics) /
Biaxin / Reglan

PHYSICAL EXAM: Physical Exam on Discharge:

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Works at [**Company 2475**] as a clinical researcher. Quit tobacco in [**2152**].
 Denies alcohol or drug use.
Morbid obesity,Incisional ventral hernia with obstruction,Paralysis agitans,Other fluid overload,Other chronic nonalcoholic liver disease,Accidental puncture or laceration during a procedure, not elsewhere classified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Asthma, unspecified type, unspecified,Reaction to spinal or lumbar puncture,Unspecified pruritic disorder,Body Mass Index 50.0-59.9, adult,Peritoneal adhesions (postoperative) (postinfection),Accidental cut, puncture, perforation or hemorrhage during surgical operation
Morbid obesity,Obstr incisional hernia,Paralysis agitans,Fluid overload NEC,Chronic liver dis NEC,Accidental op laceration,Hypertension NOS,Hyperlipidemia NEC/NOS,Asthma NOS,Lumbar puncture reaction,Pruritic disorder NOS,BMI 50.0-59.9, adult,Peritoneal adhesions,Acc cut/hem in surgery
Admission Date:  [**2186-12-18**]              Discharge Date:   [**2186-12-29**]

Date of Birth:  [**2123-9-10**]             Sex:   F

Service: SURGERY

Allergies:
Penicillins / Cephalosporins / Sulfa (Sulfonamide Antibiotics) /
Biaxin / Reglan

Attending:[**First Name3 (LF) 301**]
Chief Complaint:
Morbid obesity

Major Surgical or Invasive Procedure:
[**2186-12-18**]:
1. Open sleeve gastrectomy.
2. Splenectomy.


History of Present Illness:
Mrs. [**Known lastname 82153**] is a 63 year old female status post laparoscopic
adjustable band in [**2179**], subsequently removed in [**2185**] in
anticipation of a gastric bypass at [**Hospital3 1196**].
The patient had lost 50 pounds at that time but then
was diagnosed with Parkinson's disease and gastric bypass was
not performed.  The patient has subsequently had weight gain,
and she comes to us today in hopes of proceeding with gastric
sleeve procedure.  Gastric bypass was not performed at
[**Hospital1 **] because of concern of poor drug absorption for
necessary medications for her Parkinson's.


Past Medical History:
Past Medical History:  Hypertension, sleep apnea,
hyperlipidemia,
asthma, osteoarthritis, fatty liver, Parkinson's disease, renal
stones.

Past Surgical History:  Status post band at [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
Hospital, status post band removal at [**Hospital3 **], status
post rotator cuff, status post hand surgery, status post
lithotripsy, status post C-section, status post T&A.


Social History:
Works at [**Company 2475**] as a clinical researcher. Quit tobacco in [**2152**].
 Denies alcohol or drug use.

Family History:
Non-contributory

Physical Exam:
Physical Exam on Discharge:

VSS, afebrile
Gen: NAD, AAOx3
HEENT: Neck supple, mucous membranes moist
CV: RRR, no murmurs/rubs/gallops
Pulm: CTAB
Abd: soft, non-tender, non-distended, incision sites c/w
procedure. Clean, dry, intact dressings. JP drain pulled prior
to discharge.
Derm:  b/l upper thighs, groin, lower abdominal pannus diffuse
macular erythema with pruritis, decreasing in size since recent
cortisone creams started. Also, erythema extends to back,
flanks, axilla and lower extremities.
Ext: warm, well perfused, diffuse pitting edema to b/l lower
extremities, distal pulses palpable.


Pertinent Results:
[**2186-12-18**] 09:32PM BLOOD WBC-13.3*# RBC-3.72* Hgb-11.3* Hct-32.1*
MCV-86 MCH-30.2 MCHC-35.0 RDW-13.9 Plt Ct-117*
[**2186-12-19**] 03:03AM BLOOD WBC-17.7* RBC-3.95* Hgb-11.9* Hct-33.3*
MCV-84 MCH-30.3 MCHC-35.8* RDW-14.1 Plt Ct-139*
[**2186-12-20**] 02:20AM BLOOD WBC-16.4* RBC-2.84*# Hgb-8.6*# Hct-25.0*
MCV-88 MCH-30.3 MCHC-34.4 RDW-14.5 Plt Ct-137*
[**2186-12-25**] 11:00AM BLOOD WBC-10.5 RBC-3.14* Hgb-9.6* Hct-29.3*
MCV-93 MCH-30.4 MCHC-32.6 RDW-15.1 Plt Ct-304#
[**2186-12-25**] 11:00AM BLOOD Neuts-79.6* Lymphs-8.9* Monos-3.9
Eos-7.4* Baso-0.2
[**2186-12-18**] 09:32PM BLOOD PT-14.1* PTT-25.9 INR(PT)-1.3*
[**2186-12-20**] 02:20AM BLOOD PT-13.7* PTT-24.9* INR(PT)-1.3*
[**2186-12-25**] 11:00AM BLOOD Plt Ct-304#
[**2186-12-18**] 09:32PM BLOOD Glucose-193* UreaN-14 Creat-0.6 Na-140
K-3.6 Cl-107 HCO3-25 AnGap-12
[**2186-12-22**] 06:15AM BLOOD Glucose-104* UreaN-26* Creat-0.9 Na-145
K-4.3 Cl-108 HCO3-30 AnGap-11
[**2186-12-19**] 03:03AM BLOOD ALT-162* AST-213* AlkPhos-71 TotBili-0.9
[**2186-12-21**] 02:15AM BLOOD ALT-76* AST-59* AlkPhos-61 TotBili-0.5
[**2186-12-18**] 09:32PM BLOOD Calcium-8.1* Phos-3.7 Mg-1.5*
[**2186-12-22**] 06:15AM BLOOD Calcium-8.1* Phos-2.2* Mg-2.4
[**2186-12-18**] 06:35PM BLOOD Type-ART pO2-304* pCO2-41 pH-7.39
calTCO2-26 Base XS-0 Intubat-INTUBATED Vent-CONTROLLED
[**2186-12-18**] 06:35PM BLOOD Hgb-10.9* calcHCT-33
[**2186-12-19**] 05:43AM BLOOD Hgb-10.5* calcHCT-32
[**2186-12-18**] 06:35PM BLOOD Glucose-177* Lactate-3.0* Na-134 K-4.0
Cl-104
[**2186-12-18**] 07:25PM BLOOD Glucose-236* Lactate-3.2* Na-135 K-3.8
Cl-105
[**2186-12-18**] 09:43PM BLOOD Glucose-187* Lactate-2.0
[**2186-12-18**] 06:35PM BLOOD freeCa-1.64*
[**2186-12-18**] 09:43PM BLOOD freeCa-1.14

CXR: [**2186-12-18**]: Low lung volumes. Extensive areas of atelectasis
and mild overhydration. No pleural effusions. Borderline size of
the cardiac silhouette.

CXR: [**2186-12-19**]: No newly occurred focal parenchymal opacities.
Possible left pleural effusion with retrocardiac atelectasis. No
pneumothorax.

CXR: [**2186-12-20**]: There are no new lung opacities of concern.
Top normal heart size, mediastinal and hilar contours are
unchanged. There is no pleural effusion or pneumothorax.


Brief Hospital Course:
The patient presented to pre-op on [**2186-12-18**]. Pt was
evaluated by anesthesia and taken to the operating room for open
gastric sleeve procedure. A splenic injury occured while in the
operating room and a splenectomy was also preformed. The patient
was transferred to the ICU intubated given history of
Parkinson's and sleep
apnea and extended operative time.  The patient was thought to
be stable having received 4.5 liters of crystalloid, 2 units of
FFP, 4 units of packed red blood cells with a urine output of
635 cc. Please see the operative note for details.
Pt was extubated early on the morning of [**2186-12-19**] while in the
ICU. She was on a neo drip for hypotension. Her pain was well
controlled and she was tightly controlled while in the ICU. On
[**2186-12-20**], patient was taken off of the neo drip, and she
recieved an IVF bolus and albumin for low urine output. On
[**2186-12-21**], pt was stable and transferred to the [**Hospital1 **] for
observation. While on the floor, she was transfused 2 units on
[**2186-12-21**] and her hematocrit went from 23.7->28.7. On [**2186-12-22**],
patient was advanced to stage II diet and lasix x1 was given
with improvement in respiratory status. Patient OOB to chair and
ambulating well that day. On [**2186-12-23**], patient developed
headache, presumablely related to removal of her epidural,
stayed on stage 2 due to abdominal pain. On [**2186-12-24**],
dermatology was consulted for continuing rash and pruritis. On
[**2186-12-25**],  nausea improved, headache subsided with fluids, and
patient was advanced to stage 3 diet. WBC was within normal
limits. c.diff x2 was ordered because of loose stools and came
back negative. On [**2186-12-27**] continued rash, derm makes
recommendations suspecting medication reaction - Sarna liberally
for cooling effect, miconazole [**Hospital1 **] to intertriginous rash,
clobetazole to everywhere else except groin, betamethasone to
groin, hydroxyzine for pruritis, if no improvement may consider
skin biopsy. On [**2186-12-28**], rash improving, topical steroids ok up
to 1 week, Aquaphor to back, jp D/C'D.

At the time of discharge, the patient was doing well, afebrile
with stable vital signs.  The patient was tolerating a stage 3
diet, ambulating, voiding without assistance, and pain was well
controlled.  The patient received discharge teaching and
follow-up instructions with understanding verbalized and
agreement with the discharge plan.


Medications on Admission:
Mirapex 0.50 mg "', simvastatin 10', furosemide 20', flovent
2puff "prn, fluticasone 50 one spray each nostril"prn,
fluoxetine 20', zolpidem 10qhsprn, armodafinal 150', vitamin D
2000U

Discharge Medications:
1. modafinil 100 mg Tablet Sig: Two (2) Tablet PO QAM (once a
day (in the morning)).
Disp:*30 Tablet(s)* Refills:*2*
2. pramipexole 0.5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
Disp:*30 Tablet(s)* Refills:*2*
3. fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
Disp:*1 inhaler* Refills:*2*
4. fluoxetine 10 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
Disp:*30 Capsule(s)* Refills:*2*
5. fluticasone 50 mcg/Actuation Spray, Suspension Sig: One (1)
Spray Nasal Q6H (every 6 hours) as needed for congestion.
6. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q4H (every 4 hours) as
needed for wheeze.
9. insulin regular human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED).
10. miconazole nitrate 2 % Powder Sig: One (1) Appl Topical [**Hospital1 **]
(2 times a day): Apply to intertriginous areas ONLY.
Disp:*1 tube* Refills:*2*
11. camphor-menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
QID (4 times a day) as needed for erythema: Apply liberally for
cooling effect.
Disp:*1 tube* Refills:*2*
12. clobetasol 0.05 % Cream Sig: One (1) Appl Topical [**Hospital1 **] (2
times a day) for 5 days: Apply to legs, back, arms, chest where
rash present DO NOT APPLY TO PERI-INCISIONAL AREA OR GROIN
.
Disp:*1 tube* Refills:*0*
13. betamethasone valerate 0.1 % Cream Sig: One (1) Appl Topical
[**Hospital1 **] (2 times a day) for 5 days: APPLY TO GROIN .
Disp:*1 tube* Refills:*0*
14. hydroxyzine HCl 25 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours) as needed for pruritis.
Disp:*20 Tablet(s)* Refills:*0*
15. petrolatum     Ointment Sig: One (1) Appl Topical TID (3
times a day).


Discharge Disposition:
Extended Care

Facility:
Willow Manor - [**Hospital1 189**]

Discharge Diagnosis:
1. Splenic injury.
2. Obesity.
3. Sleep apnea.
4. Fatty liver.
5. Hypertension.

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).

Discharge Instructions:
Please call your surgeon or return to the emergency department
if you develop a fever greater than 101.5, chest pain, shortness
of breath, severe abdominal pain, pain unrelieved by your pain
medication, severe nausea or vomiting, severe abdominal
bloating, inability to eat or drink, foul smelling or colorful
drainage from your incisions, redness or swelling around your
incisions, or any other symptoms which are concerning to you.

Diet: Stay on Stage III diet until your follow up appointment.
Do not self advance
diet, do not drink out of a straw or chew gum.

Medication Instructions:
Resume your home medications, CRUSH ALL PILLS.
You will be starting some new medications:
1.  You are being discharged on medications to treat the pain
from your operation. These medications will make you drowsy and
impair your ability to drive a motor vehicle or operate
machinery safely. You MUST refrain from such activities while
taking these medications.
2. You should begin taking a chewable complete multivitamin with
minerals. No gummy vitamins.
3. You should take a stool softener, Colace, twice daily for
constipation as needed, or until you resume a normal bowel
pattern.
4. You must not use NSAIDS (non-steroidal anti-inflammatory
drugs) Examples are Ibuprofen, Motrin, Aleve, Nuprin and
Naproxen. These agents will cause bleeding and ulcers in your
digestive system.

Activity:
No heavy lifting of items [**10-21**] pounds for 6 weeks. You may
resume moderate
exercise at your discretion, no abdominal exercises.

Wound Care:
You may shower, no tub baths or swimming.
If there is clear drainage from your incisions, cover with
clean, dry gauze.
Your steri-strips will fall off on their own. Please remove any
remaining strips 7-10 days after surgery.
Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites.


Followup Instructions:
Provider: [**First Name8 (NamePattern2) **] [**Doctor Last Name **], RD,LDN Phone:[**Telephone/Fax (1) 305**]
Date/Time:[**2187-1-10**] 2:00
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 304**], MD Phone:[**Telephone/Fax (1) 305**]
Date/Time:[**2187-1-10**] 2:45
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1941**], [**Name Initial (NameIs) **].D. Phone:[**Telephone/Fax (1) 1942**]
Date/Time:[**2187-1-11**] 10:30


Completed by:[**2186-12-29**]
{'Morbid obesity,Incisional ventral hernia with obstruction,Paralysis agitans,Other fluid overload,Other chronic nonalcoholic liver disease,Accidental puncture or laceration during a procedure, not elsewhere classified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Asthma, unspecified type, unspecified,Reaction to spinal or lumbar puncture,Unspecified pruritic disorder,Body Mass Index 50.0-59.9, adult,Peritoneal adhesions (postoperative) (postinfection),Accidental cut, puncture, perforation or hemorrhage during surgical 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: Morbid obesity

PRESENT ILLNESS: Mrs. [**Known lastname 82153**] is a 63 year old female status post laparoscopic
adjustable band in [**2179**], subsequently removed in [**2185**] in
anticipation of a gastric bypass at [**Hospital3 1196**].
The patient had lost 50 pounds at that time but then
was diagnosed with Parkinson's disease and gastric bypass was
not performed.  The patient has subsequently had weight gain,
and she comes to us today in hopes of proceeding with gastric
sleeve procedure.  Gastric bypass was not performed at
[**Hospital1 **] because of concern of poor drug absorption for
necessary medications for her Parkinson's.

MEDICAL HISTORY: Past Medical History:  Hypertension, sleep apnea,
hyperlipidemia,
asthma, osteoarthritis, fatty liver, Parkinson's disease, renal
stones.

MEDICATION ON ADMISSION: Mirapex 0.50 mg "', simvastatin 10', furosemide 20', flovent
2puff "prn, fluticasone 50 one spray each nostril"prn,
fluoxetine 20', zolpidem 10qhsprn, armodafinal 150', vitamin D
2000U

ALLERGIES: Penicillins / Cephalosporins / Sulfa (Sulfonamide Antibiotics) /
Biaxin / Reglan

PHYSICAL EXAM: Physical Exam on Discharge:

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Works at [**Company 2475**] as a clinical researcher. Quit tobacco in [**2152**].
 Denies alcohol or drug use. 

### Response:
{'Morbid obesity,Incisional ventral hernia with obstruction,Paralysis agitans,Other fluid overload,Other chronic nonalcoholic liver disease,Accidental puncture or laceration during a procedure, not elsewhere classified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Asthma, unspecified type, unspecified,Reaction to spinal or lumbar puncture,Unspecified pruritic disorder,Body Mass Index 50.0-59.9, adult,Peritoneal adhesions (postoperative) (postinfection),Accidental cut, puncture, perforation or hemorrhage during surgical operation'}
