CHIEF COMPLAINT: ventral hernia

PRESENT ILLNESS: NOTE: Info obtained from various parts of the medical record due
to intubation/sedation.
51 y/o M with PMH notable for HTN, obesity and
hypercholesterolemia presents s/p massive ventral hernia repair
with difficulty weaning from the ventilator.  Apparently, pt
required fio2 of 100% during the procedure and failed "t-piece"
in PACU.  Patient was thus sent to ICU for further monitoring
and slow wean from vent.

MEDICAL HISTORY: HTN
Hypercholesterolemia
Depression
Obesity
Hx Bell's Palsy
Hx Left knee injury

MEDICATION ON ADMISSION: per OMR:
ASPIRIN 325 mg--one tablet(s) by mouth once a day
ATENOLOL 50 mg--one tablet(s) by mouth once a day
LIPITOR 10 mg--one tablet(s) by mouth once a day
TRAZODONE HCL 50 mg--one tablet(s) by mouth at bedtime as needed
for insomnia
WELLBUTRIN XL 300 mg--one tablet(s) by mouth once a day
ZOLOFT 100 mg--two tablet(s) by mouth once a day

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: t99.4/ hr 69/ bp 133/74// O2 sat 98% on 50% FiO2,10/5 cpap//
rr 15
General: Obese man, intubated and sedated but awakens to voice,
moving around in bed.
HEENT: PERRL, skin tags on eyelids,
Neck: Plethoric, no LAD
Heart: RR, no m/g/r
Lungs: Diffusely rhonchorous anterolaterally
Abd: Distended, NABS, not deeply palpated due to recent
Ext: 2+ dps, obese, 1+ pitting edema

FAMILY HISTORY: father and paternal uncle both had CAD.  Both his brother and
sister had [**Name2 (NI) **] in their mid 50s. Mother with pancreatic cancer.
Father with diabetes and alcoholism.

SOCIAL HISTORY: Mr. [**Known lastname **] is a teamster.  He works for DHL.  He
also delivers newspapers.  He spends time with his family and
transports his children to and from school and school
activities.
He is married, with a son age 15 and a daughter age 14.  His
wife
has [**Name (NI) 4522**] disease.  Tobacco:  None.  Alcohol:  I had drunk
heavily in the past.  He cut down to three to five glasses of
wine per day in [**2171**].  He quit drinking about six weeks ago.
Drugs:  Marijuana.  Mr. [**Known lastname **] is sexually active in a monogamous
relationship.  No known history of sexually transmitted disease.
Ventral, unspecified, hernia without mention of obstruction or gangrene,Acute respiratory failure,Acidosis,Paralytic ileus,Pneumonia, organism unspecified,Bacteremia,Morbid obesity,Pure hypercholesterolemia,Unspecified essential hypertension
Ventral hernia NOS,Acute respiratry failure,Acidosis,Paralytic ileus,Pneumonia, organism NOS,Bacteremia,Morbid obesity,Pure hypercholesterolem,Hypertension NOS
Admission Date:  [**2177-9-29**]              Discharge Date:   [**2177-10-7**]

Date of Birth:  [**2126-2-6**]             Sex:   M

Service: PLASTIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 10416**]
Chief Complaint:
ventral hernia

Major Surgical or Invasive Procedure:
[**2177-9-29**]
1.  Ventral hernia repair.
2.  Reconstruction of abdominal wall with component
    separation muscle flap.
3.  Reconstruction of abdominal wall with placement of mesh.

History of Present Illness:
NOTE: Info obtained from various parts of the medical record due
to intubation/sedation.
51 y/o M with PMH notable for HTN, obesity and
hypercholesterolemia presents s/p massive ventral hernia repair
with difficulty weaning from the ventilator.  Apparently, pt
required fio2 of 100% during the procedure and failed "t-piece"
in PACU.  Patient was thus sent to ICU for further monitoring
and slow wean from vent.

Past Medical History:
HTN
Hypercholesterolemia
Depression
Obesity
Hx Bell's Palsy
Hx Left knee injury

Social History:
Mr. [**Known lastname **] is a teamster.  He works for DHL.  He
also delivers newspapers.  He spends time with his family and
transports his children to and from school and school
activities.
He is married, with a son age 15 and a daughter age 14.  His
wife
has [**Name (NI) 4522**] disease.  Tobacco:  None.  Alcohol:  I had drunk
heavily in the past.  He cut down to three to five glasses of
wine per day in [**2171**].  He quit drinking about six weeks ago.
Drugs:  Marijuana.  Mr. [**Known lastname **] is sexually active in a monogamous
relationship.  No known history of sexually transmitted disease.

Family History:
father and paternal uncle both had CAD.  Both his brother and
sister had [**Name2 (NI) **] in their mid 50s. Mother with pancreatic cancer.
Father with diabetes and alcoholism.

Physical Exam:
PE: t99.4/ hr 69/ bp 133/74// O2 sat 98% on 50% FiO2,10/5 cpap//
rr 15
General: Obese man, intubated and sedated but awakens to voice,
moving around in bed.
HEENT: PERRL, skin tags on eyelids,
Neck: Plethoric, no LAD
Heart: RR, no m/g/r
Lungs: Diffusely rhonchorous anterolaterally
Abd: Distended, NABS, not deeply palpated due to recent
Ext: 2+ dps, obese, 1+ pitting edema

Pertinent Results:
[**2177-9-29**] CXR: Abnormally dense and widened mediastinum. Per
report, there has been no intervention in this area, thus making
the possibility of hematoma unlikely in the absence of
coagulopathy. This appearance could be caused by lymphadenopathy
or mediastinal lipomatosis. Dedicated PA and lateral chest
radiographs are recommended for initial further evaluation when
this is possible. Alternatively, CT could be obtained.
.
[**10-1**] CXR: AP chest compared to [**9-30**] and [**10-1**] at 2:00
a.m.:
Endotracheal tube tip is at the thoracic inlet, cuff is
overinflated and should be evaluated clinically for appropriate
settings. Lung volumes remain low with less differential
elevation of the right hemidiaphragm following intubation.
Pulmonary edema is new. Mild cardiomegaly is stable. Nasogastric
tube passes into the stomach and out of view. No pneumothorax or
substantial pleural effusion.
.
[**2177-10-1**] Right upper extremity u/s: No evidence of DVT.
.
[**2177-9-29**] 02:59PM   TYPE-ART TEMP-37.1 RATES-/18 TIDAL VOL-700
PEEP-5 O2-50 PO2-125* PCO2-48* PH-7.33* TOTAL CO2-26 BASE XS--1
INTUBATED-INTUBATED VENT-SPONTANEOU
[**2177-9-29**] 04:47PM   TYPE-ART TEMP-37.4 PO2-109* PCO2-44 PH-7.33*
TOTAL CO2-24 BASE XS--2 INTUBATED-INTUBATED
[**2177-9-29**] 10:22PM   PLT COUNT-353
[**2177-9-29**] 10:22PM   WBC-14.6*# RBC-4.27* HGB-12.7* HCT-35.7*
MCV-84 MCH-29.8 MCHC-35.7* RDW-15.0
[**2177-9-29**] 10:22PM   CALCIUM-9.0 PHOSPHATE-4.4 MAGNESIUM-1.8
[**2177-9-29**] 10:22PM   GLUCOSE-131* UREA N-15 CREAT-0.8 SODIUM-140
POTASSIUM-4.3 CHLORIDE-106 TOTAL CO2-25 ANION GAP-13
[**2177-9-29**] 11:48PM   TYPE-ART TEMP-37.6 PO2-116* PCO2-49* PH-7.33*
TOTAL CO2-27 BASE XS-0

Brief Hospital Course:
[**Date range (3) 106999**]
The pt was admitted and taken to the OR for the above noted
procedures. Per the operative report, "the patient was not able
to be extubated at the conclusion of the procedure but was
breathing spontaneously on a T-piece to the recovery room, awake
with stable vital signs." The pt was taken to the [**Hospital Ward Name 332**] ICU.
The pt was maintained intubated and sedated. He was unable to be
extubated to high FiO2 requirements and PEEP requirement due to
assumed increase in intraabdominal pressure translating to
increased intrathoracic pressure. He was extubated but then
re-intubated due to CO2=100 and pH=7.12 per Anesthesia. The pt's
temperature rose to 101.2 with a WBC=27 on [**2177-10-1**]. Sputum,
urine and blood cultures were taken which were negative except
for one blood culture.  This culture was felt to be contaminated
as all others were negative. He was started on Vancomycin and
Zosyn empirically but this was later d'ced upon resolution of
fevers, WBC and negative cultures.  Once FiO2 and PEEP
requirements stabilized he was extubated without complications.
He was therefore transferred to floor status without incident.
He was maintained on antibiotics and fevers and WBC declined.
He continued to remain stable on the floor with good JP output.
His JP drains were therefore kept in place and he was discharged
to rehab with po keflex while JP drains are present, dressing
changes prn and will f/u with Dr. [**Last Name (STitle) **] in one week.


Medications on Admission:
per OMR:
ASPIRIN 325 mg--one tablet(s) by mouth once a day
ATENOLOL 50 mg--one tablet(s) by mouth once a day
LIPITOR 10 mg--one tablet(s) by mouth once a day
TRAZODONE HCL 50 mg--one tablet(s) by mouth at bedtime as needed
for insomnia
WELLBUTRIN XL 300 mg--one tablet(s) by mouth once a day
ZOLOFT 100 mg--two tablet(s) by mouth once a day

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
2. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Sertraline 100 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. Bupropion 100 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
5. Atenolol 50 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).
6. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day) as needed.
7. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Keflex 500 mg Capsule Sig: One (1) Capsule PO four times a
day for 10 days.
Disp:*40 Capsule(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**Hospital 66**] Rehab & Nursing Center - [**Hospital1 392**]

Discharge Diagnosis:
Ventral Hernia
status post:
1.  Ventral hernia repair.
2.  Reconstruction of abdominal wall with component
    separation muscle flap.
3.  Reconstruction of abdominal wall with placement of mesh.

Discharge Condition:
stable


Discharge Instructions:
Make and keep all follow up appointments.
Take all medication as prescribed.
Continue to perform drain care as previously instructed.

Go to the emergency room if you develop fevers, chills, nausea,
vomiting, chest pain, shortness of breath

Followup Instructions:
1. Call Dr.[**Name (NI) 26831**] office at [**Telephone/Fax (1) 28541**] as soon as you get
home for a follow up appointment in one week.

2. Provider [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2477**], M.D. Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2177-11-26**] 7:40



Completed by:[**2177-10-7**]
{'Ventral, unspecified, hernia without mention of obstruction or gangrene,Acute respiratory failure,Acidosis,Paralytic ileus,Pneumonia, organism unspecified,Bacteremia,Morbid obesity,Pure hypercholesterolemia,Unspecified essential hypertension'}


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: ventral hernia

PRESENT ILLNESS: NOTE: Info obtained from various parts of the medical record due
to intubation/sedation.
51 y/o M with PMH notable for HTN, obesity and
hypercholesterolemia presents s/p massive ventral hernia repair
with difficulty weaning from the ventilator.  Apparently, pt
required fio2 of 100% during the procedure and failed "t-piece"
in PACU.  Patient was thus sent to ICU for further monitoring
and slow wean from vent.

MEDICAL HISTORY: HTN
Hypercholesterolemia
Depression
Obesity
Hx Bell's Palsy
Hx Left knee injury

MEDICATION ON ADMISSION: per OMR:
ASPIRIN 325 mg--one tablet(s) by mouth once a day
ATENOLOL 50 mg--one tablet(s) by mouth once a day
LIPITOR 10 mg--one tablet(s) by mouth once a day
TRAZODONE HCL 50 mg--one tablet(s) by mouth at bedtime as needed
for insomnia
WELLBUTRIN XL 300 mg--one tablet(s) by mouth once a day
ZOLOFT 100 mg--two tablet(s) by mouth once a day

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: t99.4/ hr 69/ bp 133/74// O2 sat 98% on 50% FiO2,10/5 cpap//
rr 15
General: Obese man, intubated and sedated but awakens to voice,
moving around in bed.
HEENT: PERRL, skin tags on eyelids,
Neck: Plethoric, no LAD
Heart: RR, no m/g/r
Lungs: Diffusely rhonchorous anterolaterally
Abd: Distended, NABS, not deeply palpated due to recent
Ext: 2+ dps, obese, 1+ pitting edema

FAMILY HISTORY: father and paternal uncle both had CAD.  Both his brother and
sister had [**Name2 (NI) **] in their mid 50s. Mother with pancreatic cancer.
Father with diabetes and alcoholism.

SOCIAL HISTORY: Mr. [**Known lastname **] is a teamster.  He works for DHL.  He
also delivers newspapers.  He spends time with his family and
transports his children to and from school and school
activities.
He is married, with a son age 15 and a daughter age 14.  His
wife
has [**Name (NI) 4522**] disease.  Tobacco:  None.  Alcohol:  I had drunk
heavily in the past.  He cut down to three to five glasses of
wine per day in [**2171**].  He quit drinking about six weeks ago.
Drugs:  Marijuana.  Mr. [**Known lastname **] is sexually active in a monogamous
relationship.  No known history of sexually transmitted disease. 

### Response:
{'Ventral, unspecified, hernia without mention of obstruction or gangrene,Acute respiratory failure,Acidosis,Paralytic ileus,Pneumonia, organism unspecified,Bacteremia,Morbid obesity,Pure hypercholesterolemia,Unspecified essential hypertension'}
