CHIEF COMPLAINT: 6.6cm aneurysm

PRESENT ILLNESS: This 77-year-old gentleman has a 6.4 cm aneurysm of the
infrarenal abdominal aorta extending nearly to the renals with a
3-1/2 cm right common iliac aneurysm and a smaller left common
iliac artery aneurysm. Here for surgery.

MEDICAL HISTORY: PMH: afib, GERD; echo [**10-8**] EF 55%, biatrial enlargement; stress
[**10-8**] inf wall reversible defect, EtOH abuse

MEDICATION ON ADMISSION: celebrex 200qd; coumadin; omeprazole 20qd; toprol XL 25qd

ALLERGIES: Lorazepam

PHYSICAL EXAM: T 97, BP 140/60 HR 84, O2 Sat 99%RA
GEN: NAD
CV: irreg/irreg
Abd: obese, soft, open wound/surgical incision- VAC in place. No
drainage. Granualting tissue
Lungs: CTA
Ext: +LE edema, dopplerable PT/DP pulses

FAMILY HISTORY: N/C
Wife and children RN

SOCIAL HISTORY: Remote smoker, quit 10 years ago
ETOH daily.
Quit ETOH 2 weeks prior to surgery.
Abdominal aneurysm without mention of rupture,Bacteremia,Other postoperative infection,Aneurysm of iliac artery,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other anaerobes,Atrial fibrillation,Morbid obesity
Abdom aortic aneurysm,Bacteremia,Other postop infection,Iliac artery aneurysm,Other anaerobes,Atrial fibrillation,Morbid obesity
Admission Date:  [**2172-2-18**]              Discharge Date:   [**2172-3-4**]

Date of Birth:  [**2094-6-12**]             Sex:   M

Service: SURGERY

Allergies:
Lorazepam

Attending:[**First Name3 (LF) 2597**]
Chief Complaint:
6.6cm aneurysm

Major Surgical or Invasive Procedure:
[**2172-2-18**] infrarenal AAA (aortobifem)  for 6.6cm aneurysm


History of Present Illness:
This 77-year-old gentleman has a 6.4 cm aneurysm of the
infrarenal abdominal aorta extending nearly to the renals with a
3-1/2 cm right common iliac aneurysm and a smaller left common
iliac artery aneurysm. Here for surgery.

Past Medical History:
PMH: afib, GERD; echo [**10-8**] EF 55%, biatrial enlargement; stress
[**10-8**] inf wall reversible defect, EtOH abuse

Social History:
Remote smoker, quit 10 years ago
ETOH daily.
Quit ETOH 2 weeks prior to surgery.

Family History:
N/C
Wife and children RN

Physical Exam:
T 97, BP 140/60 HR 84, O2 Sat 99%RA
GEN: NAD
CV: irreg/irreg
Abd: obese, soft, open wound/surgical incision- VAC in place. No
drainage. Granualting tissue
Lungs: CTA
Ext: +LE edema, dopplerable PT/DP pulses

Pertinent Results:
[**2172-3-4**] 06:05AM BLOOD

WBC-11.2* RBC-3.64* Hgb-12.1* Hct-34.6* MCV-95 MCH-33.1*
MCHC-34.9 RDW-14.1 Plt Ct-648*

[**2172-3-4**] 06:05AM BLOOD

Plt Ct-648*

[**2172-3-4**] 06:05AM BLOOD

Glucose-137* UreaN-13 Creat-0.8 Na-138 K-3.9 Cl-99 HCO3-29
AnGap-14

[**2172-2-29**] 07:15AM BLOOD

ALT-40 AST-28 AlkPhos-115 Amylase-34 TotBili-0.5

[**2172-3-4**] 06:05AM BLOOD Calcium-8.3* Phos-3.0 Mg-2.1

[**2172-2-21**] 8:41 pm BLOOD CULTURE

AEROBIC BOTTLE (Final [**2172-2-27**]):    NO GROWTH.

ANAEROBIC BOTTLE (Final [**2172-2-26**]):
REPORTED BY PHONE TO [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] @ 1743 ON [**2-24**] - FA11.
PRESUMPTIVE PEPTOSTREPTOCOCCUS SPECIES. ISOLATED FROM ONE SET
ONLY.

[**2172-3-1**] 8:00 am SWAB     Site: ABDOMEN      Source: abdominal
wound.

GRAM STAIN (Final [**2172-3-1**]):
NO POLYMORPHONUCLEAR LEUKOCYTES SEEN.
NO MICROORGANISMS SEEN.

WOUND CULTURE (Final [**2172-3-3**]):    NO GROWTH.

ANAEROBIC CULTURE (Preliminary):    NO GROWTH.

Repeat BC X2 negative
CDiff X 2 negative


Brief Hospital Course:
Mr. [**Known lastname **],[**Known firstname **] was admitted on [**2171-2-18**] for an elective
Resection and repair of abdominal aortic aneurysm with 16 x 8
aortobifemoral graft. Pre-operatively, he was consented,
prepped, and brought down to the operating room for surgery.
Intra-operatively, he was closely monitored and remained
hemodynamically stable. He tolerated the procedure well without
any difficulty or complication.

Post-operatively, he was extubated and transferred to the [**Date Range 13042**]
for further stabilization and monitoring. After stabalization in
the [**Date Range 13042**]. He was transfered to the [**Date Range **] in stable condition.

Pt had NG tube, when bowel sounds improved. NGT was DC'd Diet
was advanced. At this time foley was DC'd / aline, swan DC'd.

While in the [**Name (NI) **] pt had continuos drainage from his wound,
persistant white count and fevers. An ID consult was obtained.
They recommended a CT scan. This was essentiallly negative. It
did show some straining of the pancrease. Pancreatic / hepatic
enzymes were obtained. The pancreatic enzymes were borderline
high, After a complete ID work-up,, which was negative, It was
thought that the persistant high WBC anf fevers were from
pancreatitis. To note pt did not have any overt signs of
pancreatitis. On DC pt is afebrile. WBC is at 11, down from 26.

Because of the drainage in the wound and given the pt body
habitus. Staples were removed. The wound was allowed to drain.
To note the fascia was intact. This was thought to be due to a
seroma. The wound was managed with a VAC dressing. Pt to go home
with  VAC dressing. this wound was also cx.

Site: ABDOMEN      Source: abdominal wound.

GRAM STAIN (Final [**2172-3-1**]):

NO POLYMORPHONUCLEAR LEUKOCYTES SEEN.
NO MICROORGANISMS SEEN.

WOUND CULTURE (Final [**2172-3-3**]):    NO GROWTH.

ANAEROBIC CULTURE (Preliminary):    NO GROWTH.

To note Pt had one positve blood cx.  PEPTOSTREPTOCOCCUS. ID
thought this was a contaminant. But given  that the patient had
abdominal wound open. They thought the patient would benefit
from treatment for two weeks. Pt to go home on PO AB.

Also while in the [**Name (NI) 13042**] pt did have post opertive confusion. Pt
placed on  CIWA scale. treated with ativan and haldol.

Pt was vigorously diuresed, during this hospital stay for fluid
overload from intra-op fluid resusitation. Pt will also recieve
7 day course of lasix and potassium.

Pt also had diarrhea. C-Diff negative x 3.

He was then transferred to the floor for further recovery.

On the floor, he remained hemodynamically stable with his pain
controlled. He progressed with physical therapy to improve his
strength and mobility. He continues to make steady progress
without any incidents. He was discharged home with services in
stable condition.

Medications on Admission:
celebrex 200qd; coumadin; omeprazole 20qd; toprol XL 25qd

Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. Warfarin 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily):
Continue routine following of Coumadin with primary care MD .
3. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO TID
(3 times a day): Metoprolol 75mg 3x per day.
Disp:*270 Tablet(s)* Refills:*2*
4. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual PRN (as needed) as needed for chest pain.

5. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 7
days.
Disp:*14 Tablet(s)* Refills:*0*
6. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
Two (2) Tab Sust.Rel. Particle/Crystal PO once a day for 7 days.
Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours):
resume home dose of Prilosec.
8. Levaquin 500 mg Tablet Sig: One (1) Tablet PO once a day for
7 days.
Disp:*7 Tablet(s)* Refills:*0*
9. Outpatient Lab Work
Please draw INR 2x per week and prn as directed patient primary
care MD Dr. [**Name (NI) 7047**] (pt has been on Coumadin)


Discharge Disposition:
Home With Service

Facility:
[**Hospital 2255**] [**Name (NI) 2256**]

Discharge Diagnosis:
s/p infrarenal AAA (aortobifem) for 6.6cm aneurysm
History of afib, GERD; echo [**10-8**] EF 55%, biatrial enlargement;
stress [**10-8**] inf wall reversible defect,


Discharge Condition:
Good. Cr 0.8, INR 2.2
Abdominal suture line opened, VAC wound care system initiated


Discharge Instructions:
Division of Vascular and Endovascular Surgery
Abdominal Aortic Aneurysm (AAA) Surgery Discharge Instructions

What to expect when you go home:
1. It is normal to feel weak and tired, this will last for [**7-10**]
weeks
??????	You should get up out of bed every day and gradually increase
your activity each day
??????	You may walk and you may go up and down stairs
??????	Increase your activities as you can tolerate- do not do too
much right away!

2. It is normal to have incisional and leg swelling:
??????	Wear loose fitting pants/clothing (this will be less
irritating to incision)
??????	Elevate your legs above the level of your heart (use [**3-7**]
pillows or a recliner) every 2-3 hours throughout the day and at
night
??????	Avoid prolonged periods of standing or sitting without your
legs elevated

3. It is normal to have a decreased appetite, your appetite will
return with time
??????	You will probably lose your taste for food and lose some
weight
??????	Eat small frequent meals
??????	It is important to eat nutritious food options (high fiber,
lean meats, vegetables/fruits, low fat, low cholesterol) to
maintain your strength and assist in wound healing
??????	To avoid constipation: eat a high fiber diet and use stool
softener while taking pain medication

What activities you can and cannot do:
??????	No driving until post-op visit and you are no longer taking
pain medications
??????	You should get up every day, get dressed and walk, gradually
increasing your activity
??????	You may up and down stairs, go outside and/or ride in a car
??????	Increase your activities as you can tolerate- do not do too
much right away!
??????	No heavy lifting, pushing or pulling (greater than 5 pounds)
until your post op visit
??????	You may shower (let the soapy water run over incision, rinse
and pat dry)
??????	Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing
over the area that is draining, as needed
??????	Take all the medications you were taking before surgery,
unless otherwise directed
??????	Take one full strength (325mg) enteric coated aspirin daily,
unless otherwise directed
??????	Call and schedule an appointment to be seen in 2 weeks for
staple/suture removal

What to report to office:
??????	Redness that extends away from your incision
??????	A sudden increase in pain that is not controlled with pain
medication
??????	A sudden change in the ability to move or use your leg or the
ability to feel your leg
??????	Temperature greater than 101.5F for 24 hours
??????	Bleeding from incision
??????	New or increased drainage from incision or white, yellow or
green drainage from incisions

Followup Instructions:
Call Dr.[**Name (NI) 5695**] office at [**Telephone/Fax (1) 3121**] to schedule post op
visit to be seen in 1 week.



Completed by:[**2172-3-4**]
{'Abdominal aneurysm without mention of rupture,Bacteremia,Other postoperative infection,Aneurysm of iliac artery,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other anaerobes,Atrial fibrillation,Morbid obesity'}


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: 6.6cm aneurysm

PRESENT ILLNESS: This 77-year-old gentleman has a 6.4 cm aneurysm of the
infrarenal abdominal aorta extending nearly to the renals with a
3-1/2 cm right common iliac aneurysm and a smaller left common
iliac artery aneurysm. Here for surgery.

MEDICAL HISTORY: PMH: afib, GERD; echo [**10-8**] EF 55%, biatrial enlargement; stress
[**10-8**] inf wall reversible defect, EtOH abuse

MEDICATION ON ADMISSION: celebrex 200qd; coumadin; omeprazole 20qd; toprol XL 25qd

ALLERGIES: Lorazepam

PHYSICAL EXAM: T 97, BP 140/60 HR 84, O2 Sat 99%RA
GEN: NAD
CV: irreg/irreg
Abd: obese, soft, open wound/surgical incision- VAC in place. No
drainage. Granualting tissue
Lungs: CTA
Ext: +LE edema, dopplerable PT/DP pulses

FAMILY HISTORY: N/C
Wife and children RN

SOCIAL HISTORY: Remote smoker, quit 10 years ago
ETOH daily.
Quit ETOH 2 weeks prior to surgery. 

### Response:
{'Abdominal aneurysm without mention of rupture,Bacteremia,Other postoperative infection,Aneurysm of iliac artery,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other anaerobes,Atrial fibrillation,Morbid obesity'}
