CHIEF COMPLAINT: right upper lobe lung nodule

PRESENT ILLNESS: The patient is a 63-year-old woman with a 4-cm lung cancer
arising from the right upper lobe. Preoperative imaging
suggested that the lesion crossed the
major fissure into the right lower lobe.  Given this and the
tumor size, we elected to perform the lobectomy through a right
thoracotomy.

MEDICAL HISTORY: Metastatic Breast Cancer
Hypertension
Hyperlipidemia
Gout
Pancreatitis
Parotitis
Diverticulitis
Lumbar disc disease
Anxiety
Stress fracture of fibula

MEDICATION ON ADMISSION: Aspirin 325 mg daily
Clonazepam 0.5 1/2-1 tablet daily
Potassium daily
Zometa IV
Prilosec 20 mg daily
Lasix 40 mg prn leg swelling
Cyclobenzaprine 10 mg tid prn
Metformin 1000mg [**Hospital1 **]
Oxycodone 5 mg q3-4 hrs prn pain
Nadolol 40mg [**Hospital1 **]

ALLERGIES: Gabapentin / Phenobarbital / adhesive tape

PHYSICAL EXAM: Discharge vital signs:
T 98.2, HR 67, BP 114/64 RR 20 O2 sats 94% RA

FAMILY HISTORY: FAMILY HISTORY: BRCA [**1-28**] negative
Mother: Died of stomach CA at age 73
Father: Died of renal CA at age 39 (possible related to
radiation
exposure in WWII)
Siblings
Offspring
Other: Niece with breast CA in 40's

SOCIAL HISTORY: former smoker (20+pk yrs, quit x20yrs). Occ EtOH. Had a
significant other.
Malignant neoplasm of upper lobe, bronchus or lung,Diverticulitis of colon (without mention of hemorrhage),Iatrogenic pneumothorax,Cardiac complications, not elsewhere classified,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Body Mass Index 45.0-49.9, adult,Secondary malignant neoplasm of skin,Personal history of antineoplastic chemotherapy,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Gout, unspecified,Sialoadenitis,Displacement of lumbar intervertebral disc without myelopathy,Anxiety state, unspecified,Other iatrogenic hypotension,Personal history of tobacco use,Stress fracture of tibia or fibula,Other specified complications of procedures not elsewhere classified,Other specified misadventures during medical care,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Atrial fibrillation,Retention of urine, unspecified,Other fluid overload,Abnormal coagulation profile,Morbid obesity,Other specified disorders of liver,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Personal history of malignant neoplasm of breast
Mal neo upper lobe lung,Dvrtcli colon w/o hmrhg,Iatrogenic pneumothorax,Surg compl-heart,Acute kidney failure NOS,Urin tract infection NOS,Esoph varice oth dis NOS,BMI 45.0-49.9, adult,Secondary malig neo skin,Hx antineoplastic chemo,Hypertension NOS,Hyperlipidemia NEC/NOS,Gout NOS,Sialoadenitis,Lumbar disc displacement,Anxiety state NOS,Iatrogenc hypotnsion NEC,History of tobacco use,Stress fx tibia/fibula,Oth spcf cmplc procd NEC,Medical misadventure NEC,Abn reac-organ rem NEC,Atrial fibrillation,Retention urine NOS,Fluid overload NEC,Abnrml coagultion prfile,Morbid obesity,Liver disorders NEC,DMII wo cmp nt st uncntr,Long-term use of insulin,Hx of breast malignancy
Admission Date:  [**2103-2-19**]              Discharge Date:   [**2103-3-6**]

Date of Birth:  [**2039-10-29**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Gabapentin / Phenobarbital / adhesive tape

Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
right upper lobe lung nodule

Major Surgical or Invasive Procedure:
[**2103-2-20**]:
1. Right thoracotomy, right upper lobectomy.
2. Wedge resection of superior segment of right lower lobe.
3. Mediastinal lymph node dissection.


History of Present Illness:
The patient is a 63-year-old woman with a 4-cm lung cancer
arising from the right upper lobe. Preoperative imaging
suggested that the lesion crossed the
major fissure into the right lower lobe.  Given this and the
tumor size, we elected to perform the lobectomy through a right
thoracotomy.

Past Medical History:
Metastatic Breast Cancer
Hypertension
Hyperlipidemia
Gout
Pancreatitis
Parotitis
Diverticulitis
Lumbar disc disease
Anxiety
Stress fracture of fibula

Past Surgical History:
Vaginal hysterectomy
multiple D&Cs
left foot surgery


Social History:
former smoker (20+pk yrs, quit x20yrs). Occ EtOH. Had a
significant other.


Family History:
FAMILY HISTORY: BRCA [**1-28**] negative
Mother: Died of stomach CA at age 73
Father: Died of renal CA at age 39 (possible related to
radiation
exposure in WWII)
Siblings
Offspring
Other: Niece with breast CA in 40's


Physical Exam:
Discharge vital signs:
T 98.2, HR 67, BP 114/64 RR 20 O2 sats 94% RA

Discharge Physical exam:
General: pleasant in NAD
Lungs: clear t/o
chest: right thoracotomy healed. right chest tube site with
suture intact.
CV: RRR S1, S2, no MRG or JVD
Abd: soft, NT, ND
Ext: warm without edema


Pertinent Results:
[**2103-3-1**] 07:30AM BLOOD WBC-13.9* RBC-3.86* Hgb-12.3 Hct-35.0*
MCV-91 MCH-31.9 MCHC-35.2* RDW-16.7* Plt Ct-298
[**2103-2-28**] 07:10AM BLOOD WBC-16.7* RBC-3.91* Hgb-12.1 Hct-35.5*
MCV-91 MCH-30.9 MCHC-34.1 RDW-17.2* Plt Ct-256
[**2103-2-22**] 01:43AM BLOOD PT-17.8* PTT-33.6 INR(PT)-1.6*
[**2103-3-2**] 07:15AM BLOOD Glucose-135* UreaN-15 Creat-0.6 Na-136
K-4.1 Cl-102 HCO3-26 AnGap-12
[**2103-3-1**] 07:30AM BLOOD Glucose-148* UreaN-21* Creat-0.7 Na-135
K-4.0 Cl-102 HCO3-24 AnGap-13
[**2103-2-28**] 07:10AM BLOOD Glucose-104* UreaN-44* Creat-1.4* Na-137
K-4.9 Cl-102 HCO3-24 AnGap-16
[**2103-2-27**] 11:10AM BLOOD Glucose-120* UreaN-36* Creat-2.2* Na-138
K-4.5 Cl-101 HCO3-25 AnGap-17
[**2103-2-24**] 08:10AM BLOOD ALT-26 AST-37 LD(LDH)-377* AlkPhos-86
TotBili-2.0*
[**2103-3-2**] 07:15AM BLOOD Calcium-8.4 Phos-2.0* Mg-1.8

CXR on discharge [**2103-3-6**]:
Stable right apical pneumothorax.

[**2103-2-27**] Renal US
Normal renal ultrasound.

[**2103-2-26**]
IMPRESSION: Suboptimal image quality. Grossly normal cavity
sizes and biventricular systolic function. No definite
pathologic valvular flow identified.

Brief Hospital Course:
Ms. [**Known lastname 96189**] was taken to the operating room by Dr. [**First Name (STitle) **] on
[**2103-2-19**] where she underwent a right open thoractomy with right
upper lobectomy and lymph node dissection (see operative report
for full details). She remained intubated postoperatively and
transfered to the ICU. Below is a systems review of her hospital
stay.

Neuro: The patient remained neurologically intact throughout her
stay. Dilaudid IV was used in the immediate postoperative
period, then switched to ibuprofen, tylenol, lidocaine patch and
oxycodone, with prn cyclobenzaprine which was effective in pain
relief.

Pulmonary: The patient was keep intubated postoperatively, and
extubated POD 1. Aggressive pulmonary toilet was continued to
incentive spirometry, ambulation, nebulizers and mucolytics.
Home lasix was continued with spot dosing of IV lasix to
diurese. She had a right chest tube which was discontinued
initially on [**2103-2-24**], however developed increasing pneumothorax,
and subcutaneous air necesitating right pigtail placement with
Dr. [**Last Name (STitle) **] of interventional pulmonology on [**2103-2-26**]. Leak
continued, therefore a talc 5gram pleurodiesis was done on
[**2103-3-2**]. The chesttube was kept for 48hours on suction. It was
eventually removed on [**2103-3-6**] after successful clamp trial, with
stable right small pneumothorax on postpull film.

CV: The patient went into atrial fibrillation on POD 1 after
extubation. This resolved initially on home dose of nadolol and
IV diltiazem. After transfer to the floor on [**2103-2-22**] she
developed atrial fibrillation [**2103-2-23**]. At this time IV lopressor
was unsuccessfull, therefore she received IV amiodarone 10g load
with oral amio plus nadolol as recommended by cardiology
thereafter. We did consult cardiology who recommended echo and
the above described antiarrhythmic agents. The patient had afib
on [**2-26**], but converted midday and has maintained SR since with
occasional tachycardia with ECG evidence of SR with PAC's. It
was felt she did not need coumadin, but a full strength aspirin
was started. The patient remained hemodynamically stable
throughout. Her nadolol was cut in half on [**2-27**] after acute renal
insufficiency as described below. Echo was done on [**2103-2-26**] and
essentially normal with normal LVEF. She was set up with Dr.
[**First Name (STitle) **] in a month for followup and weaning off amiodarone.

Abd: Her diet was advanced and tolerated. Stool softeners were
given to prevent constipation.

Renal: Foley was removed POD 1, but replaced for retention, and
dc'd on [**2-24**], with minimal but adequate urine output. She
required IV lasix for volume overload. Daily weights were
followed. Electrolytes were watched and replaced.
On [**2-27**] the patient's creatinine acutely rose to 2.0 then later
2.2. Renal US was performed and normal. NSAIDS were dc'd and
metformin held. Amiodarone was decreased to [**Hospital1 **] and nadolol home
dosing halved to increase renal perfusion pressures. Urine lytes
were done. She was felt to be dry, therefore a liter of fluid
was given. The patient's creatinine was closely watched and two
days later normalized, with auto diuresing.

Endo: Sliding scale insulin was initially given for
hyperglycemia. Her home metformin was restarted with improved
blood sugars in the low 100's. This was held during her renal
insufficiency, and resumed [**2103-3-1**] with improved glucose. Insulin
sliding scale was utilized as well.

ID: The patient remained afebrile, and CBC trends watched. On
[**2-27**] she spiked w WBC count 23, UA was sent and positive, cipro
was started and continued x 3 days. Urine culture was sent and
final was mixed bacteria consistent with fecal contaminant.
After the cipro started her WBC trended downward. The patient
noted that during past colon infections she has never mounted a
fever.

Proph: SCD's and SQ heparin were given for VTE prophylaxis.

Dispo: Physical therapy evaluation was made. The patient was
deemed appropriate for home with PT. She left with a walker for
stabilization. On [**2103-3-6**] the patient was ambulating with
adequate pain control, with room air saturations of 92-94%. The
patient will see Dr. [**First Name (STitle) **] on [**3-13**] with a chest xray in clinic.

Medications on Admission:
Aspirin 325 mg daily
Clonazepam 0.5 1/2-1 tablet daily
Potassium daily
Zometa IV
Prilosec 20 mg daily
Lasix 40 mg prn leg swelling
Cyclobenzaprine 10 mg tid prn
Metformin 1000mg [**Hospital1 **]
Oxycodone 5 mg q3-4 hrs prn pain
Nadolol 40mg [**Hospital1 **]


Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO once a
day.
2. cyclobenzaprine 10 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) as needed for muscle spasm.
Disp:*90 Tablet(s)* Refills:*0*
3. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO every
eight (8) hours.
4. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily): 12
hours on during day, 12 hours off at night.
Disp:*30 Adhesive Patch, Medicated(s)* Refills:*1*
5. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3 hours)
as needed for pain.
Disp:*120 Tablet(s)* Refills:*0*
6. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
7. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
8. metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day.

9. nadolol 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for HTN: note that this is half the dose you were
taking at home.
10. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): x 2 weeks until [**2103-3-18**] then take 1 tabs by mouth daily
x a month and followup with your cardiologist about future
dosing.
Disp:*75 Tablet(s)* Refills:*0*
11. exemestane 25 mg Tablet Sig: One (1) Tablet PO daily ().


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Right upper lobe mass s/p right upper lobectomy positive for
adenocarcinoma
Postoperative atrial fibrillation
Postoperative acute kidney injury, resolved
Postoperative urinary tract infection, resolved
Metastatic Breast Cancer
Hypertension
Hyperlipidemia
Gout
Pancreatitis
Parotitis
Diverticulitis
Lumbar disc disease
Anxiety
Stress fracture of fibula


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


Discharge Instructions:
Call Dr.[**Name (NI) 5067**] office [**Telephone/Fax (1) 2348**] if you experience:
-Fevers > 101 or chills
-Increased shortness of breath, cough, or chest pain (It is
normal to cough up small amounts of blood tinge sputum)
-Incision develops drainage
-Chest tube site: remove dressing on Wednesday evening and cover
site with a bandaid until healed
-Should site have drainage cover with a clean, dry dressing,
change as needed to keep site clean and dry.
-Shower daily starting Wednesday night. Wash incisions with mild
soap and water, rinse, pat dry
-No tub bathing, swimming or hot tubs
-No driving while taking narcotics. Take stool softners with
narcotics
-Walk 4-5 times a day day for 10-15 minutes increase to a Goal
of 30 minutes daily

-Daily weight. If up 2 # or more in a day, or 3# or more in a
week take lasix 40mg and followup with your PCP.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3000**], MD Phone:[**0-0-**]
Date/Time:[**2103-3-13**] 9:00 on the [**Hospital Ward Name 516**] [**Hospital Ward Name 23**] Clinical
Center [**Location (un) 24**]

Chest X-Ray 30 minutes before your appointment [**Location (un) 861**]
Radiology

Followup with your primary care doctor Dr. [**First Name (STitle) 1022**]
on [**2102-3-14**] at 2:40pm [**Telephone/Fax (1) 17794**]

Follow up with Dr. [**First Name (STitle) **] (Cardiologist) on [**Telephone/Fax (1) 2258**]
on [**4-4**] at 1050am
[**Location (un) 4363**] [**Location (un) **] Office, [**Location (un) 86**] [**Numeric Identifier 6425**]
fax [**Telephone/Fax (1) 79385**]



Completed by:[**2103-3-6**]
{'Malignant neoplasm of upper lobe, bronchus or lung,Diverticulitis of colon (without mention of hemorrhage),Iatrogenic pneumothorax,Cardiac complications, not elsewhere classified,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Body Mass Index 45.0-49.9, adult,Secondary malignant neoplasm of skin,Personal history of antineoplastic chemotherapy,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Gout, unspecified,Sialoadenitis,Displacement of lumbar intervertebral disc without myelopathy,Anxiety state, unspecified,Other iatrogenic hypotension,Personal history of tobacco use,Stress fracture of tibia or fibula,Other specified complications of procedures not elsewhere classified,Other specified misadventures during medical care,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Atrial fibrillation,Retention of urine, unspecified,Other fluid overload,Abnormal coagulation profile,Morbid obesity,Other specified disorders of liver,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Personal history of malignant neoplasm of breast'}


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: right upper lobe lung nodule

PRESENT ILLNESS: The patient is a 63-year-old woman with a 4-cm lung cancer
arising from the right upper lobe. Preoperative imaging
suggested that the lesion crossed the
major fissure into the right lower lobe.  Given this and the
tumor size, we elected to perform the lobectomy through a right
thoracotomy.

MEDICAL HISTORY: Metastatic Breast Cancer
Hypertension
Hyperlipidemia
Gout
Pancreatitis
Parotitis
Diverticulitis
Lumbar disc disease
Anxiety
Stress fracture of fibula

MEDICATION ON ADMISSION: Aspirin 325 mg daily
Clonazepam 0.5 1/2-1 tablet daily
Potassium daily
Zometa IV
Prilosec 20 mg daily
Lasix 40 mg prn leg swelling
Cyclobenzaprine 10 mg tid prn
Metformin 1000mg [**Hospital1 **]
Oxycodone 5 mg q3-4 hrs prn pain
Nadolol 40mg [**Hospital1 **]

ALLERGIES: Gabapentin / Phenobarbital / adhesive tape

PHYSICAL EXAM: Discharge vital signs:
T 98.2, HR 67, BP 114/64 RR 20 O2 sats 94% RA

FAMILY HISTORY: FAMILY HISTORY: BRCA [**1-28**] negative
Mother: Died of stomach CA at age 73
Father: Died of renal CA at age 39 (possible related to
radiation
exposure in WWII)
Siblings
Offspring
Other: Niece with breast CA in 40's

SOCIAL HISTORY: former smoker (20+pk yrs, quit x20yrs). Occ EtOH. Had a
significant other. 

### Response:
{'Malignant neoplasm of upper lobe, bronchus or lung,Diverticulitis of colon (without mention of hemorrhage),Iatrogenic pneumothorax,Cardiac complications, not elsewhere classified,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Body Mass Index 45.0-49.9, adult,Secondary malignant neoplasm of skin,Personal history of antineoplastic chemotherapy,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Gout, unspecified,Sialoadenitis,Displacement of lumbar intervertebral disc without myelopathy,Anxiety state, unspecified,Other iatrogenic hypotension,Personal history of tobacco use,Stress fracture of tibia or fibula,Other specified complications of procedures not elsewhere classified,Other specified misadventures during medical care,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Atrial fibrillation,Retention of urine, unspecified,Other fluid overload,Abnormal coagulation profile,Morbid obesity,Other specified disorders of liver,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Personal history of malignant neoplasm of breast'}
