CHIEF COMPLAINT: Tracheobronchomalacia

PRESENT ILLNESS: Ms. [**Known lastname 85974**] is a 53-year-old woman who has had multiple
admissions for respiratory trouble. She was found to have
severe, diffuse tracheobronchomalacia. She underwent stent trial
and her dyspnea improved. She had undergone a fundoplication for
GERDwhich she tolerated well; but had no effect on her airway
symptoms.  She is being admitted for trachaelplasty.

MEDICAL HISTORY: right breast cancer s/p lumpectomy (clear margins) and radiation
[**2166**]
fibrocystic breast disease
Irritable bowel syndrome
fybromyalgia
gastroesophageal reflux disease
asthma (on daily Prednisone)
tracheobrochomalacia - as above; triggered by exercise, yelling,
weather changes; had a recent negative exercise stress test (due
to work-up of recent chest discomfort)
anxiety disorder
depression
insomnia
iron deficiency anemia
B12 deficiency anemia
Hysterectomy [**2137**]'s
umbilical hernia repair [**2157**]

MEDICATION ON ADMISSION: Advair 250-50 mcg [**Hospital1 **]
[**Doctor First Name **] 60 mg [**Hospital1 **]
Ambien 10 mg QHS
Clonazepam 0.5 mg [**Hospital1 **]
Calcium carbonate/Vit D 500 mg QD
Singular 10 mg Daily
Tricor 145 mg daily
Venlafaxine XR 300 mg daily
Xopenex NEbs [**3-26**] x day

ALLERGIES: Latex / Penicillins / Codeine / Albuterol Sulfate / Demerol /
Xanax / Monosodium Glutamate / Sulfa (Sulfonamide Antibiotics) /
Dilaudid

PHYSICAL EXAM: VS: T 97.6, BP 136/84, HR 95 reg, O2 sat 98% RA, wt 181.6 lbs,
ht
167 cm
Physical Exam:
Gen: pleasant in NAD
Lungs: clear t/o
CV: fast RRR S1, S2 no MRG or JVD
Abd: soft, NT, ND, incisions healed.
Ext: warm without edema

FAMILY HISTORY: Mother was diagnosed with thyroid cancer
Father was diagnosed with coronary artery disease in his 60's
(s/p 3vCABG), also DM and prostate CA
Brother has HTN

SOCIAL HISTORY: Used to be a medical assistant. Lives with husband and [**Name2 (NI) **]
in [**Name (NI) **]. Has children, all healthy. Denies tobacco, EtOH
or illicits.
Other diseases of trachea and bronchus,Asthma, unspecified type, unspecified,Postprocedural fever,Acute post-thoracotomy pain,Pressure ulcer, hip,Iron deficiency anemia, unspecified,Tachycardia, unspecified,Myalgia and myositis, unspecified,Personal history of irradiation, presenting hazards to health,Personal history of malignant neoplasm of breast,Obstructive sleep apnea (adult)(pediatric),Intestinal bypass or anastomosis status,Other nonspecific findings on examination of blood,Other and unspecified hyperlipidemia,Irritable bowel syndrome
Trachea & bronch dis NEC,Asthma NOS,Postprocedural fever,Acute post-thoracot pain,Pressure ulcer, hip,Iron defic anemia NOS,Tachycardia NOS,Myalgia and myositis NOS,Hx of irradiation,Hx of breast malignancy,Obstructive sleep apnea,Intestinal bypass status,Oth nspcf finding blood,Hyperlipidemia NEC/NOS,Irritable bowel syndrome
Admission Date:  [**2167-12-18**]              Discharge Date:   [**2167-12-24**]

Date of Birth:  [**2114-10-12**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Latex / Penicillins / Codeine / Albuterol Sulfate / Demerol /
Xanax / Monosodium Glutamate / Sulfa (Sulfonamide Antibiotics) /
Dilaudid

Attending:[**First Name3 (LF) 5790**]
Chief Complaint:
Tracheobronchomalacia


Major Surgical or Invasive Procedure:
[**2167-12-18**]:  Right thoracotomy and tracheoplasty with mesh,
right main stem bronchus/bronchus intermedius bronchoplasty
with mesh, left main stem bronchus bronchoplasty with mesh.


History of Present Illness:
Ms. [**Known lastname 85974**] is a 53-year-old woman who has had multiple
admissions for respiratory trouble. She was found to have
severe, diffuse tracheobronchomalacia. She underwent stent trial
and her dyspnea improved. She had undergone a fundoplication for
GERDwhich she tolerated well; but had no effect on her airway
symptoms.  She is being admitted for trachaelplasty.


Past Medical History:
right breast cancer s/p lumpectomy (clear margins) and radiation
[**2166**]
fibrocystic breast disease
Irritable bowel syndrome
fybromyalgia
gastroesophageal reflux disease
asthma (on daily Prednisone)
tracheobrochomalacia - as above; triggered by exercise, yelling,
weather changes; had a recent negative exercise stress test (due
to work-up of recent chest discomfort)
anxiety disorder
depression
insomnia
iron deficiency anemia
B12 deficiency anemia
Hysterectomy [**2137**]'s
umbilical hernia repair [**2157**]


Social History:
Used to be a medical assistant. Lives with husband and [**Name2 (NI) **]
in [**Name (NI) **]. Has children, all healthy. Denies tobacco, EtOH
or illicits.


Family History:
Mother was diagnosed with thyroid cancer
Father was diagnosed with coronary artery disease in his 60's
(s/p 3vCABG), also DM and prostate CA
Brother has HTN

Physical Exam:
VS: T 97.6, BP 136/84, HR 95 reg, O2 sat 98% RA, wt 181.6 lbs,
ht
167 cm
Physical Exam:
Gen: pleasant in NAD
Lungs: clear t/o
CV: fast RRR S1, S2 no MRG or JVD
Abd: soft, NT, ND, incisions healed.
Ext: warm without edema

Pertinent Results:
[**2167-12-23**] WBC-3.6* RBC-3.13* Hgb-8.5* Hct-25.0* MCV-80* MCH-27.3
MCHC-34.1 RDW-15.0 Plt Ct-283#
[**2167-12-21**] WBC-3.8* RBC-3.25* Hgb-8.8* Hct-25.6* MCV-79* MCH-26.9*
MCHC-34.2 RDW-14.5 Plt Ct-175
[**2167-12-18**] WBC-5.1 RBC-3.86* Hgb-10.2* Hct-30.5* MCV-79* MCH-26.4*
MCHC-33.4 RDW-14.9 Plt Ct-203
[**2167-12-23**] Glucose-88 UreaN-8 Creat-0.6 Na-140 K-4.1 Cl-106
HCO3-26
[**2167-12-22**] Glucose-84 UreaN-8 Creat-0.6 Na-137 K-3.9 Cl-102
HCO3-28
[**2167-12-18**] Glucose-148* UreaN-13 Creat-0.7 Na-140 K-3.7 Cl-107
HCO3-26
[**2167-12-23**] Calcium-8.4 Phos-3.8# Mg-2.0
[**2167-12-23**] CK(CPK)-528*
[**2167-12-19**] CK(CPK)-2454*
[**2167-12-18**] CK(CPK)-925*

Micro:
[**2167-12-20**] BLOOD CULTURE      Source: Venipuncture.
   Blood Culture, Routine (Preliminary):
      STAPHYLOCOCCUS, COAGULASE NEGATIVE.    ISOLATED FROM ONE
SET ONLY.
         SENSITIVITIES PERFORMED ON REQUEST..
   Aerobic Bottle Gram Stain (Final [**2167-12-20**]):
      GRAM POSITIVE COCCI IN CLUSTERS.
[**2167-12-20**] BLOOD CULTURE      Source: Catheter.
   Blood Culture, Routine (Pending):
[**2167-12-20**] Urine Culture negative

CXR:
[**2167-12-23**]: There are bilateral small pleural effusions with
postoperative
changes again seen in the right upper zone. No definite vascular
congestion or acute focal pneumonia. Atelectatic changes are
seen at the left base.
[**2167-12-21**]: New small-to-moderate right pleural effusion, some of
which is fissural, could be blood, pus, or [**Last Name (LF) 85975**], [**First Name3 (LF) **] indicate
new bronchopleural connection. Stable small left pleural
effusion.
[**2167-12-19**]: There is no evidence of abnormality of the
hemidiaphragm that is seen throughout the entire length on the
lateral view. There is right and left pleural effusion. No
appreciable pneumothorax is demonstrated.
[**2167-12-18**]; 1. Minor interstitial lines in the left base
consistent with mild edema. Right hilar prominence may represent
a small postoperative hematoma or perihilar atelectasis. No
evidence of effusion or pneumothorax.




Brief Hospital Course:
Mrs. [**Known lastname 85974**] is a 53 year-old female admitted following Right
thoracotomy and tracheoplasty with mesh, right main stem
bronchus/bronchus intermedius bronchoplasty
with mesh, left main stem bronchus bronchoplasty with mesh.  She
was extubated in the operating room  and transferred to the ICU
for close respiratory monitoring.

Respiratory: aggressive pulmonary toilets, nebs, incentive
spirometer and good pain control her respiratory status improved
with oxygen saturations of 97% RA.

Chest tube: right chest tube was removed [**2167-12-19**].

Chest films: serial chest films showed bibasilar atelectasis

Cardiac: sinus rhythm 80-100's stable on Lopressor 25 mg [**Hospital1 **]

GI: PPI, bowel regime and tolerated a regular diet

Renal: Cycled CK Pk 2450 trended down. Renal function normal
with good urine output.
Electrolytes replete as needed.

Pain: difficult pain management. Titrated MSO4 IV then converted
to PO MSO4.  Toradol was given with moderate pain control.  She
transitioned to Motrin, Oxycodone, muscle relaxant and lidoderm
patch with good control.

ID: spiked a fever 101 on [**2167-12-21**]. Pan-cultured.  BC x 2 1
bottle w/GPC Vancomycin was started empirically in a patient
with mesh, once final culture grew COAG neg staph likely
contaminate the Vanco was discontinued.

Neuro: antidepressant medications were continued.

Disposition: Home with husband on [**Name2 (NI) **] 6.  She will follow-up
with Dr. [**Last Name (STitle) **] as an outpatient


Medications on Admission:
Advair 250-50 mcg [**Hospital1 **]
[**Doctor First Name **] 60 mg [**Hospital1 **]
Ambien 10 mg QHS
Clonazepam 0.5 mg [**Hospital1 **]
Calcium carbonate/Vit D 500 mg QD
Singular 10 mg Daily
Tricor 145 mg daily
Venlafaxine XR 300 mg daily
Xopenex NEbs [**3-26**] x day


Discharge Medications:
1. clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
2. fexofenadine 60 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
3. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain.
4. venlafaxine 150 mg Tablet Extended Rel 24 hr Sig: Two (2)
Tablet Extended Rel 24 hr PO once a day.
5. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. senna 8.6 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).
7. zolpidem 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime)
as needed for sleep.
8. ferrous sulfate 300  mg (60 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
9. oxycodone 10 mg Tablet Sig: One (1) Tablet PO every four (4)
hours as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
10. ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours).
Disp:*120 Tablet(s)* Refills:*2*
11. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q8H
(every 8 hours) as needed for pain.
Disp:*180 Tablet(s)* Refills:*0*
12. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily): Cut
patch in half and place on each side of your incision.
Disp:*30 Adhesive Patch, Medicated(s)* Refills:*2*
13. tizanidine 2 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for pain.
Disp:*20 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Tracheobronchomalacia.
Depression


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.
-Shower daily. Wash incisions with mild soap and water, rinse,
pat dry
-No tub bathing, swimming or hot tubs until incision healed
-No lifting greater than 10 pounds until seen
-No driving while taking narcotics. Take stool softners with
narcotics
-Walk 4-5 times a day for 10-15 minutes increase to a Goal of 30
minutes daily


Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 3020**] Date/Time:[**2167-12-30**]
2:00 in the [**Last Name (un) 2577**] Building [**Last Name (NamePattern1) **] [**Location (un) **] Neurology
3A
Chest X-Ray [**Location (un) **] Radiology [**Hospital Ward Name 517**] Clinical Center



Completed by:[**2167-12-24**]
{'Other diseases of trachea and bronchus,Asthma, unspecified type, unspecified,Postprocedural fever,Acute post-thoracotomy pain,Pressure ulcer, hip,Iron deficiency anemia, unspecified,Tachycardia, unspecified,Myalgia and myositis, unspecified,Personal history of irradiation, presenting hazards to health,Personal history of malignant neoplasm of breast,Obstructive sleep apnea (adult)(pediatric),Intestinal bypass or anastomosis status,Other nonspecific findings on examination of blood,Other and unspecified hyperlipidemia,Irritable bowel syndrome'}


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: Tracheobronchomalacia

PRESENT ILLNESS: Ms. [**Known lastname 85974**] is a 53-year-old woman who has had multiple
admissions for respiratory trouble. She was found to have
severe, diffuse tracheobronchomalacia. She underwent stent trial
and her dyspnea improved. She had undergone a fundoplication for
GERDwhich she tolerated well; but had no effect on her airway
symptoms.  She is being admitted for trachaelplasty.

MEDICAL HISTORY: right breast cancer s/p lumpectomy (clear margins) and radiation
[**2166**]
fibrocystic breast disease
Irritable bowel syndrome
fybromyalgia
gastroesophageal reflux disease
asthma (on daily Prednisone)
tracheobrochomalacia - as above; triggered by exercise, yelling,
weather changes; had a recent negative exercise stress test (due
to work-up of recent chest discomfort)
anxiety disorder
depression
insomnia
iron deficiency anemia
B12 deficiency anemia
Hysterectomy [**2137**]'s
umbilical hernia repair [**2157**]

MEDICATION ON ADMISSION: Advair 250-50 mcg [**Hospital1 **]
[**Doctor First Name **] 60 mg [**Hospital1 **]
Ambien 10 mg QHS
Clonazepam 0.5 mg [**Hospital1 **]
Calcium carbonate/Vit D 500 mg QD
Singular 10 mg Daily
Tricor 145 mg daily
Venlafaxine XR 300 mg daily
Xopenex NEbs [**3-26**] x day

ALLERGIES: Latex / Penicillins / Codeine / Albuterol Sulfate / Demerol /
Xanax / Monosodium Glutamate / Sulfa (Sulfonamide Antibiotics) /
Dilaudid

PHYSICAL EXAM: VS: T 97.6, BP 136/84, HR 95 reg, O2 sat 98% RA, wt 181.6 lbs,
ht
167 cm
Physical Exam:
Gen: pleasant in NAD
Lungs: clear t/o
CV: fast RRR S1, S2 no MRG or JVD
Abd: soft, NT, ND, incisions healed.
Ext: warm without edema

FAMILY HISTORY: Mother was diagnosed with thyroid cancer
Father was diagnosed with coronary artery disease in his 60's
(s/p 3vCABG), also DM and prostate CA
Brother has HTN

SOCIAL HISTORY: Used to be a medical assistant. Lives with husband and [**Name2 (NI) **]
in [**Name (NI) **]. Has children, all healthy. Denies tobacco, EtOH
or illicits. 

### Response:
{'Other diseases of trachea and bronchus,Asthma, unspecified type, unspecified,Postprocedural fever,Acute post-thoracotomy pain,Pressure ulcer, hip,Iron deficiency anemia, unspecified,Tachycardia, unspecified,Myalgia and myositis, unspecified,Personal history of irradiation, presenting hazards to health,Personal history of malignant neoplasm of breast,Obstructive sleep apnea (adult)(pediatric),Intestinal bypass or anastomosis status,Other nonspecific findings on examination of blood,Other and unspecified hyperlipidemia,Irritable bowel syndrome'}
