CHIEF COMPLAINT: Right mainstem bronchus mass

PRESENT ILLNESS: Ms. [**Known lastname 1005**] is a 50 year old female with a large right hilar
mass.  She underwent a bronchoscopy on [**2107-6-8**] with pathology
revealing a squamous cell carcinoma and negative level 7 and 10R
lymph nodes.  She subsequently underwent a cervical
mediastinoscopy on [**6-28**] with pathology negative for malignancy
at
levels 2R & L, 4R & L, and 7.  She presented in clinic for
follow up
after her [**Hospital Unit Name **] and for further operative planning.  Since the
operation she reports doing well with minimal pain and no
drainage from the wound.  She is still taking percocet 1-2 times
per day.

MEDICAL HISTORY: Squamous Cell Carcinoma of the lung
Bronchitis
Asthma
Oral surgery in [**2107**]

MEDICATION ON ADMISSION: Ativan
Percocet

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: T: 98.3  HR: 84 SR  BP: 98/60  Sats: 96% RA
Gen: No acute distress
CV: RRR, nl S1 and S2
Resp: CTAB
GI: abd soft, NT, ND
Incision: R thoracotomy site clean dry intact, margins well
approximated, no erythema
Neuro: awake, alert oriented. walking in halls independently

FAMILY HISTORY: Sister with breast cancer at age 38, father with diabetes
milletus

SOCIAL HISTORY: Tobacco history 37 years at 1.5 packs per day, he quit in
2/[**2107**]. She drinks alcohol 2-3x/month and uses cocaine
occasionally. Lives with her mother.
Malignant neoplasm of main bronchus,Asthma, unspecified type, unspecified,Other acute postoperative pain,Personal history of tobacco use
Malig neo main bronchus,Asthma NOS,Acute postop pain NEC,History of tobacco use
Admission Date:  [**2107-7-15**]              Discharge Date:   [**2107-7-19**]

Date of Birth:  [**2056-12-27**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 5790**]
Chief Complaint:
Right mainstem bronchus mass

Major Surgical or Invasive Procedure:
Right pneumonectomy


History of Present Illness:
Ms. [**Known lastname 1005**] is a 50 year old female with a large right hilar
mass.  She underwent a bronchoscopy on [**2107-6-8**] with pathology
revealing a squamous cell carcinoma and negative level 7 and 10R
lymph nodes.  She subsequently underwent a cervical
mediastinoscopy on [**6-28**] with pathology negative for malignancy
at
levels 2R & L, 4R & L, and 7.  She presented in clinic for
follow up
after her [**Hospital Unit Name **] and for further operative planning.  Since the
operation she reports doing well with minimal pain and no
drainage from the wound.  She is still taking percocet 1-2 times
per day.

She elected to undergo operative resection of this mass.


Past Medical History:
Squamous Cell Carcinoma of the lung
Bronchitis
Asthma
Oral surgery in [**2107**]

Social History:
Tobacco history 37 years at 1.5 packs per day, he quit in
2/[**2107**]. She drinks alcohol 2-3x/month and uses cocaine
occasionally. Lives with her mother.

Family History:
Sister with breast cancer at age 38, father with diabetes
milletus

Physical Exam:
VS: T: 98.3  HR: 84 SR  BP: 98/60  Sats: 96% RA
Gen: No acute distress
CV: RRR, nl S1 and S2
Resp: CTAB
GI: abd soft, NT, ND
Incision: R thoracotomy site clean dry intact, margins well
approximated, no erythema
Neuro: awake, alert oriented. walking in halls independently

Pertinent Results:
[**2107-7-15**] WBC-19.7*# RBC-4.19* HGB-10.8* HCT-32.9* MCV-79*
MCH-25.8* MCHC-32.8 RDW-14.7
[**2107-7-15**] GLUCOSE-158* UREA N-13 CREAT-0.7 SODIUM-139
POTASSIUM-4.5 CHLORIDE-105 TOTAL CO2-23 ANION GAP-16
[**2107-7-17**] WBC-10.5 RBC-3.58* Hgb-8.9* Hct-27.7* MCV-77* MCH-24.9*
MCHC-32.1 RDW-14.5 Plt Ct-570*
[**2107-7-17**] Glucose-135* UreaN-12 Creat-0.6 Na-137 K-4.5 Cl-100
HCO3-28

CXR:
[**2107-7-18**]: Right hydropneumothorax shows an air-fluid level that
is gradually increasing in height compared with prior
examinations after accounting for difference in techniques.
Subcutaneous emphysema unchanged from prior exam. The
mediastinum is displaced to the right status post pneumonectomy.
Lung in the left side is clear with no signs of pleural effusion
or pneumothorax.

Brief Hospital Course:
Ms. [**Known lastname 1005**] presented for pneumonectomy to remove the mass in
her right hilar region.

Neuro: She was transferred directly to ICU from the OR. An
epidural was placed for pain control. She was given Ativan for
sleep. She was extubated on POD 0.

CV: She tolerated the procedure well and was hemodynamically
stable throughout. On POD 2 she was noted to be mildly
tachycardic and so she was started on metoprolol 25mg TID, which
was effective. She was discharged on toprol 50 mg daily

Pulm: A chest tube was placed and was placed immediately on
water seal. She was transferred to the unit intubated but was
extubated soon after arriving on POD 0 and by POD 1 was on 2lNC
with good oxygen saturation. Her chest tube was pulled on POD 1
after having minimal output. She was weaned to room air without
difficulty and maintained good oxygen saturation throughout. Her
chest x-rays showed minimal mediastinal shift and progressive
filing of her right chest cavity.

GI: She was transitioned from clears to fulls to regualr diet by
POD 3 and tolerated POs well.

GU: A foley was placed in the OR and was kept in until the
epidural was taken out on POD 2. She voided after foley was
removed.

Heme: She had minimal blood loss in the OR and had a stable Hct.

ID: She was afebrile and had an initial leukocytosis thought to
be from the operation that normalized.

FEN: She was quickly transitioned to POs.

Pain: her pain was well controlled with oxycodone and
acetaminophen.

Dispo: She was seen by physical therapy who recommended home.
She will follow-up with Dr. [**Last Name (STitle) 5795**] as an outpatient.

Medications on Admission:
Ativan
Percocet

Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as
needed for pain.
Disp:*70 Tablet(s)* Refills:*0*
3. lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime) as needed for anxiety.
4. metoprolol succinate 50 mg Tablet Extended Release 24 hr Sig:
One (1) Tablet Extended Release 24 hr PO once a day.
Disp:*30 Tablet Extended Release 24 hr(s)* Refills:*2*
5. ibuprofen 600 mg Tablet Sig: One (1) Tablet PO every eight
(8) hours as needed for pain: take with food and water.
Disp:*90 Tablet(s)* Refills:*0*
6. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.


Discharge Disposition:
Home

Discharge Diagnosis:
Large right hilar mass, Stage IIB lung cancer


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


Discharge Instructions:
Call Dr.[**Name (NI) 2347**] office [**Telephone/Fax (1) 2348**] if you experience:
-Fevers > 101 or chills
-Increased shortness of breath, cough or chest pain
-Incision develops drainage

Daily weights:
-Keep a log. Call with 3-4 pound weight gain
-Monitor fluid intake.

Pain:
-Acetaminophen 650 every 6 hours as needed for pain
-Oxycodone 5-10 mg every 4-6 hours as needed for pain
-Ibuprofen 600 mg every 8 hours as needed for pain. Take with
food and water
-No driving while taking narcotics
-Take stool softners with narcotics

Activity
-Shower daily.  Wash incision with mild soap & water, rinse, pat
dry
-No tub bathing, swimming or hot tubs until incision healed
-No lifting greater than 10 pounds until seen
-Walk 4-5 times a day for 5-10 minutes increase to a Goal of 30
minutes daily


Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) **] [**0-0-**] on the [**Hospital Ward Name 516**]
[**Hospital Ward Name 23**] Clinical Center [**Location (un) 24**] on [**2107-8-2**] at 2:00PM

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



Completed by:[**2107-7-19**]
{'Malignant neoplasm of main bronchus,Asthma, unspecified type, unspecified,Other acute postoperative pain,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: Right mainstem bronchus mass

PRESENT ILLNESS: Ms. [**Known lastname 1005**] is a 50 year old female with a large right hilar
mass.  She underwent a bronchoscopy on [**2107-6-8**] with pathology
revealing a squamous cell carcinoma and negative level 7 and 10R
lymph nodes.  She subsequently underwent a cervical
mediastinoscopy on [**6-28**] with pathology negative for malignancy
at
levels 2R & L, 4R & L, and 7.  She presented in clinic for
follow up
after her [**Hospital Unit Name **] and for further operative planning.  Since the
operation she reports doing well with minimal pain and no
drainage from the wound.  She is still taking percocet 1-2 times
per day.

MEDICAL HISTORY: Squamous Cell Carcinoma of the lung
Bronchitis
Asthma
Oral surgery in [**2107**]

MEDICATION ON ADMISSION: Ativan
Percocet

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: T: 98.3  HR: 84 SR  BP: 98/60  Sats: 96% RA
Gen: No acute distress
CV: RRR, nl S1 and S2
Resp: CTAB
GI: abd soft, NT, ND
Incision: R thoracotomy site clean dry intact, margins well
approximated, no erythema
Neuro: awake, alert oriented. walking in halls independently

FAMILY HISTORY: Sister with breast cancer at age 38, father with diabetes
milletus

SOCIAL HISTORY: Tobacco history 37 years at 1.5 packs per day, he quit in
2/[**2107**]. She drinks alcohol 2-3x/month and uses cocaine
occasionally. Lives with her mother. 

### Response:
{'Malignant neoplasm of main bronchus,Asthma, unspecified type, unspecified,Other acute postoperative pain,Personal history of tobacco use'}
