CHIEF COMPLAINT: Mental status changes.

PRESENT ILLNESS: The patient is a 74 year old
female with metastatic ovarian carcinoma status post total
abdominal hysterectomy/bilateral salpingo-oophorectomy,
omentectomy, ileus cecectomy on [**2131-10-18**], by Dr. [**Last Name (STitle) 2093**],
complicated by perforation of anastomosis on [**2132-1-19**],
requiring an exploratory laparotomy, lysis of adhesions,
resection of anastomosis, ileostomy and mucous fistula.  Her
hospital course during that time had been complicated by
prolonged intubation, acute renal failure, hypotension.  She
had been discharged to rehabilitation on [**2132-2-4**].

MEDICAL HISTORY: 1.  Status post cholecystectomy.
2.  Status post total abdominal hysterectomy/bilateral
    salpingo-oophorectomy/omentectomy/ileus cecectomy
    [**2131-10-18**].
3.  Status post exploratory laparotomy, lysis of adhesions,
    resection of anastomosis and ileostomy and mucous fistula
    by Dr. [**Last Name (STitle) **], [**2132-1-19**].
4.  Metastatic ovarian carcinoma.
5.  Status post dilatation and curettage.
6.  Status post cesarean section.
7.  Diabetes mellitus.
8.  Paranoid schizophrenia.
9.  Depression.

MEDICATION ON ADMISSION: 1.  Epogen 40,000 units subcutaneously twice a week, Mondays
    and Thursdays.
2.  Heparin subcutaneously 5,000 twice a day.
3.  Lacrilube to eyes.
4.  Lopressor 100 mg via G-tube twice a day.
5.  Hydralazine 10 mg via G-tube q. six hours.
6.  Sliding scale insulin.
7.  Glyburide 10 units q. a.m.
8.  Risperdal 0.5 mg q. a.m. per G-tube, 1.5 mg q. p.m. per
    G-tube.
9.  Tube feeds, ProMod with fiber at 60 cc an hour, free
    water boluses 250 cc q. four hours.

ALLERGIES: Penicillin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Abscess of liver,Abscess of anal and rectal regions,Acute kidney failure, unspecified,Other drugs and medicinal substances causing adverse effects in therapeutic use,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Paranoid type schizophrenia, unspecified,Personal history of malignant neoplasm of ovary,Ileostomy status
Abscess of liver,Anal & rectal abscess,Acute kidney failure NOS,Adv eff medicinal NEC,DMII wo cmp uncntrld,Paranoid schizo-unspec,Hx of ovarian malignancy,Ileostomy status
Admission Date:  [**2132-2-9**]       Discharge Date:  [**2132-2-13**]

Date of Birth:   [**2057-5-9**]       Sex:  F

Service:  GEN [**Doctor First Name 147**]

CHIEF COMPLAINT:  Mental status changes.

HISTORY OF PRESENT ILLNESS:  The patient is a 74 year old
female with metastatic ovarian carcinoma status post total
abdominal hysterectomy/bilateral salpingo-oophorectomy,
omentectomy, ileus cecectomy on [**2131-10-18**], by Dr. [**Last Name (STitle) 2093**],
complicated by perforation of anastomosis on [**2132-1-19**],
requiring an exploratory laparotomy, lysis of adhesions,
resection of anastomosis, ileostomy and mucous fistula.  Her
hospital course during that time had been complicated by
prolonged intubation, acute renal failure, hypotension.  She
had been discharged to rehabilitation on [**2132-2-4**].

She returns now with mental status changes.  No fever.  She
is still tolerating her tube feeds.

PAST MEDICAL HISTORY:
1.  Status post cholecystectomy.
2.  Status post total abdominal hysterectomy/bilateral
    salpingo-oophorectomy/omentectomy/ileus cecectomy
    [**2131-10-18**].
3.  Status post exploratory laparotomy, lysis of adhesions,
    resection of anastomosis and ileostomy and mucous fistula
    by Dr. [**Last Name (STitle) **], [**2132-1-19**].
4.  Metastatic ovarian carcinoma.
5.  Status post dilatation and curettage.
6.  Status post cesarean section.
7.  Diabetes mellitus.
8.  Paranoid schizophrenia.
9.  Depression.

ALLERGIES:  Penicillin.

MEDICATIONS ON ADMISSION:
1.  Epogen 40,000 units subcutaneously twice a week, Mondays
    and Thursdays.
2.  Heparin subcutaneously 5,000 twice a day.
3.  Lacrilube to eyes.
4.  Lopressor 100 mg via G-tube twice a day.
5.  Hydralazine 10 mg via G-tube q. six hours.
6.  Sliding scale insulin.
7.  Glyburide 10 units q. a.m.
8.  Risperdal 0.5 mg q. a.m. per G-tube, 1.5 mg q. p.m. per
    G-tube.
9.  Tube feeds, ProMod with fiber at 60 cc an hour, free
    water boluses 250 cc q. four hours.

PHYSICAL EXAMINATION:  On admission, temperature 98.0 F.;
pulse 109; blood pressure 162/61; respiratory rate 27;
saturation 100% on room air.  She was catatonic, following
simple commands.  Lungs decreased breath sounds both bases.
Heart regular.  Abdomen soft, nontender, nondistended, and
ileostomy plus mucous fistula pink and patent.  Incisions
clean, dry and intact.  Extremities warm.  Rectal examination
revealed a 5 cm left perirectal collection with minimum
erythema.  On rectal examination no mass, no stool.

LABORATORY:  On admission, white count 10.6, hematocrit 33,
platelets 306,000.  Chem-7, sodium 139, potassium 5.3,
chloride 101, CO2 26, BUN 46, creatinine 1.6.  Glucose 208,
magnesium 1.5.

Urinalysis negative.  Chest x-ray negative.  ALT 19, AST 27,
alkaline phosphatase 224, amylase 129, lipase 415, total
bilirubin 0.3, INR 1.1, PT 12.3, PTT 22.2.

Abdominal CT scan revealed a 5 by 6 cm left perirectal
collection, and a 6 by 3 cm perihepatic fluid collection.

HOSPITAL COURSE:  The patient was admitted under the General
Surgery service.  Her perirectal abscess was drained in the
Emergency Department and 200 cc of pus was aspirated.  She
was started on intravenous Levo and Flagyl.  Her tube feeds
were held.  On [**2132-2-9**], the day of admission, she
underwent a CT guided drain placement of a #8 French catheter
into the inferior hepatic fluid collection; 10 cc of
serosanguinous fluid were withdrawn and sent for culture.
She tolerated this well.

Over the next few days, her mental status improved and she
was alert and oriented times three.  On [**2-11**], she underwent
a repeat CT scan and readjustment of the drain.  She also
underwent a swallow study which she failed as she aspirated
the thick and thin liquid.  She was started on Vancomycin
after culture results from the drain.

She continues to do well and is being discharged to
rehabilitation with plans to leave the drain in for a week
and re-scan.  She will also be evaluated for a swallow study
in three weeks' time.

MEDICATIONS ON DISCHARGE:
1.  Vancomycin 500 mg intravenously q. 24 hours times three
    weeks.
2.  Epogen 40,000 units subcutaneously two times a week,
    Mondays and Thursdays.
3.  Glyburide 10 mg q. day per NG tube.
4.  Heparin 5000 units subcutaneously twice a day.
5.  Hydralazine 10 mg q. six hours per NG tube.
6.  Regular insulin sliding scale.
7.  Lacrilube Ointment four times a day.
8.  Metoprolol 100 mg twice a day per NG tube.
9.  Zantac 150 mg per NG tube q. day.
10. Risperidone 0.5 mg q. a.m. and 1.5 mg q. p.m. per NG
    tube.

DISCHARGE INSTRUCTIONS:
1.  Treatment twice a day wet-to-dry dressing changes to the
    perirectal abscess.
2.  Flush drain as recommended.
3.  Re-scan in one week.
4.  Repeat swallow study in three weeks.
5.  Fingerstick q. six hours.
6.  Diet is ProMod with fiber, 60 cc an hour via NG tube, 250
    cc free water q. six hours via NG tube.

CONDITION AT DISCHARGE:  Stable.

FOLLOW-UP INSTRUCTIONS:  Follow-up with Dr. [**Last Name (STitle) **].


                            [**Name6 (MD) 843**] [**Name8 (MD) 844**], M.D.  [**MD Number(1) 845**]

Dictated By:[**Last Name (NamePattern1) 2209**]
MEDQUIST36

D:  [**2132-2-13**]  11:09
T:  [**2132-2-13**]  11:35
JOB#:  [**Job Number 35754**]


Name:  [**Known lastname 5171**], [**Known firstname 6374**]                    Unit No:  [**Numeric Identifier 6375**]

Admission Date:  [**2132-2-9**]     Discharge Date:  [**2132-2-13**]

Date of Birth:   [**2057-5-9**]     Sex:  F

Service:  GEN [**Doctor First Name 1379**]

HOSPITAL COURSE:
While awaiting the ambulating for discharge to
rehabilitation, Mrs. [**Known lastname **] was found sitting on the floor
beside her bed apparently having fallen out of bed.  She had
no apparent injuries, although her nasogastric tube was found
pulled back about 8 inches.

She had x-rays of the head and chest which showed no
injuries.

Over the course of that night and the next day, she became
oliguric and also had some mental status changes.  A CT scan
of the head was negative.  She was transferred to Intensive
Care for placement of catheter for rest of fluid management.
Her ostomy output was high and there was replaced.

Renal and Medicine consult was obtained.  They concurred that
her oliguria was most likely due to contrast
nephropathy/renal hypoperfusion.  Her renal function and
mental status improved after hydration, and she was
transferred back to the [**Hospital1 **] where she continued to do well,
and she is now ready for discharge to rehabilitation.

ADDITIONAL DISCHARGE INSTRUCTIONS:
Ostomy outputs to be measured and if high, need to be
repleted.





                          [**Last Name (LF) **],[**Name8 (MD) **] M.D.02-333


Dictated By:[**Last Name (NamePattern1) 5028**]

MEDQUIST36

D:  [**2132-2-19**]  10:22
T:  [**2132-2-20**]  05:13
JOB#:  [**Job Number 6376**]
{'Abscess of liver,Abscess of anal and rectal regions,Acute kidney failure, unspecified,Other drugs and medicinal substances causing adverse effects in therapeutic use,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Paranoid type schizophrenia, unspecified,Personal history of malignant neoplasm of ovary,Ileostomy status'}


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: Mental status changes.

PRESENT ILLNESS: The patient is a 74 year old
female with metastatic ovarian carcinoma status post total
abdominal hysterectomy/bilateral salpingo-oophorectomy,
omentectomy, ileus cecectomy on [**2131-10-18**], by Dr. [**Last Name (STitle) 2093**],
complicated by perforation of anastomosis on [**2132-1-19**],
requiring an exploratory laparotomy, lysis of adhesions,
resection of anastomosis, ileostomy and mucous fistula.  Her
hospital course during that time had been complicated by
prolonged intubation, acute renal failure, hypotension.  She
had been discharged to rehabilitation on [**2132-2-4**].

MEDICAL HISTORY: 1.  Status post cholecystectomy.
2.  Status post total abdominal hysterectomy/bilateral
    salpingo-oophorectomy/omentectomy/ileus cecectomy
    [**2131-10-18**].
3.  Status post exploratory laparotomy, lysis of adhesions,
    resection of anastomosis and ileostomy and mucous fistula
    by Dr. [**Last Name (STitle) **], [**2132-1-19**].
4.  Metastatic ovarian carcinoma.
5.  Status post dilatation and curettage.
6.  Status post cesarean section.
7.  Diabetes mellitus.
8.  Paranoid schizophrenia.
9.  Depression.

MEDICATION ON ADMISSION: 1.  Epogen 40,000 units subcutaneously twice a week, Mondays
    and Thursdays.
2.  Heparin subcutaneously 5,000 twice a day.
3.  Lacrilube to eyes.
4.  Lopressor 100 mg via G-tube twice a day.
5.  Hydralazine 10 mg via G-tube q. six hours.
6.  Sliding scale insulin.
7.  Glyburide 10 units q. a.m.
8.  Risperdal 0.5 mg q. a.m. per G-tube, 1.5 mg q. p.m. per
    G-tube.
9.  Tube feeds, ProMod with fiber at 60 cc an hour, free
    water boluses 250 cc q. four hours.

ALLERGIES: Penicillin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Abscess of liver,Abscess of anal and rectal regions,Acute kidney failure, unspecified,Other drugs and medicinal substances causing adverse effects in therapeutic use,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Paranoid type schizophrenia, unspecified,Personal history of malignant neoplasm of ovary,Ileostomy status'}
