CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 89-year-old
female, with a history of atrial fibrillation, coronary
artery disease, who underwent colonoscopy on [**2163-5-10**]
which showed a large cecal mass.  Biopsies revealed well-
differentiated adenocarcinoma for which she was admitted on
[**2163-7-20**] for right hemicolectomy.

MEDICAL HISTORY: Sick sinus syndrome.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient has never smoked cigarettes.
She lives in the [**Hospital3 **] Center secondary to an
inability to take care of herself.  She is retired.  She has
a large family.  She is Russian speaking.
Malignant neoplasm of cecum,Streptococcal septicemia,Severe sepsis,Acute respiratory failure,Acute posthemorrhagic anemia,Pneumonia, organism unspecified,Atrial fibrillation,Congestive heart failure, unspecified
Malignant neoplasm cecum,Streptococcal septicemia,Severe sepsis,Acute respiratry failure,Ac posthemorrhag anemia,Pneumonia, organism NOS,Atrial fibrillation,CHF NOS
Admission Date: [**2163-7-20**]        Discharge Date: [**2163-8-9**]


Service:  [**Last Name (un) **]


HISTORY OF PRESENT ILLNESS:  The patient is a 89-year-old
female, with a history of atrial fibrillation, coronary
artery disease, who underwent colonoscopy on [**2163-5-10**]
which showed a large cecal mass.  Biopsies revealed well-
differentiated adenocarcinoma for which she was admitted on
[**2163-7-20**] for right hemicolectomy.

PAST MEDICAL HISTORY:  Sick sinus syndrome.

Coronary artery disease.

Atrial fibrillation.

Hypertension.

Osteoporosis.

PREADMISSION MEDICATIONS:
1. Fosamax.
2. Lasix.
3. Lisinopril.
4. Lopressor.
5. Digoxin.
6. Prozac.
7. Amiodarone.


ALLERGIES:  The patient has no known drug allergies.

SOCIAL HISTORY:  The patient has never smoked cigarettes.
She lives in the [**Hospital3 **] Center secondary to an
inability to take care of herself.  She is retired.  She has
a large family.  She is Russian speaking.

HOSPITAL COURSE:  The patient was admitted on [**2163-7-20**].
She was taken directly to the operating room where an
epidural was placed in an attempt to avoid general
anesthesia, secondary to the patient's high respiratory and
cardiac risk.  The patient tolerated the procedure with
minimal blood loss.

Postoperatively, the patient was eventually mildly
hypotensive secondary to hypovolemia and was bolused fluid.
She was also given a unit of packed red blood cells due to
postoperative anemia complicating preexisting anemia.  She
was also treated for hypokalemia.  She received serial Crit's
to insure that the patient was not bleeding significantly.
The patient was monitored cautiously during the resuscitative
period, and evaluated for congestive heart failure, despite
the fact that her EF was greater than 55 percent,
particularly because of O2 saturations in the low-90's,
although this was not an initial finding on chest x-ray.  The
patient received aggressive chest physical therapy, as well
as received a rule out for myocardial infarction, which was
confirmed negative by enzymes.

On the night of postoperative day 4, the patient experienced
a decrease in O2 saturation, satting only in the 70 percent
range on a nonrebreather after nebulizer treatments.  The
patient received a chest x-ray which showed bilateral
pulmonary edema.  She had bilateral wheezes and rales, right
side greater than left.  Her ABG showed both a respiratory,
as well as metabolic acidosis.

The patient was transferred to the ICU for closer monitoring
and treatment.  The patient had a triple-lumen subclavian
catheter inserted while in the unit.  The patient was
intubated and placed on a ventilation system, was given Lasix
as needed, and received serial ABG's.  She was made NPO, and
a G-tube was placed.  A right A-line was also placed for
closer monitoring.  The patient spiked a temperature to
103.8, which prompted a fever work-up including UA, urine
culture, sputum culture, and blood culture.  The patient was
placed on Zosyn for a question of pneumonia.  While in the
unit, despite the fact that the patient had pulmonary edema,
as well as a question of pneumonia, it was also decided that
the patient had a component of acute respiratory distress
syndrome.

The patient also experienced issues with atrial fibrillation
which required an increase in Lopressor treatment.  She
eventually had a feeding tube placed to initiate tube feeds.
Over time, cultures came back with coag-negative staph in 1
blood culture, and E. coli in the urine.  The patient was
continued on Zosyn, but also placed on vancomycin.

The patient was finally successfully extubated on the [**7-31**].  Her diuresis was continued aggressively to pull
fluid off.  After extensive treatment with Lasix, the patient
developed a metabolic alkalosis, and for that reason was
placed on Diamox, both to aid with diuresis and with
correction of her metabolic alkalosis.

On the 3, the patient underwent a speech and swallow study
which she failed, and for that reason was left NPO, and left
on aggressive tube feed treatment.  On the 3, it was
confirmed that one of the patient's blood cultures was
confirmed with Enterococcus, and the patient was started on
linezolid.  She had experienced another decrease in oxygen
saturation, requiring nonrebreather mask and increased
pulmonary toilet.  The patient also experienced increase in
confusion at that time.  She received Haldol, as well as
continued persistence with fever/infection work-up.

On the 5, the patient had a beside swallow reattempted which
she failed.  On the night of the 8, the patient was
transferred to the Vascular ICU to continue a closer eye on
her, but because she did not need the super close attention
of the regular ICU.  While in the VICU, the patient continued
to flourish, and her respiratory status improving.  She
reached her baseline preoperative weight, and her Lasix was
stopped.  She did not require persistent replacement of
potassium and magnesium for hypokalemia and hypomagnesemia.
The patient continued to tolerate her tube feeds well.  It is
now [**2163-8-9**], and the patient will be discharged as soon as
a bed is available at [**Hospital 100**] Rehab.  The patient is in good
condition.  She will be discharged with a Dobbhoff in place
and on tube feeds at 40 cc/h, and in 1 week will require a
swallow study.  If, at that time, she is able to swallow, the
tube feeds can be DC'd, and the patient placed on a diet.
She does require physical therapy, for which the patient was
started on in house, but will need continued therapy as the
days go on.

DISCHARGE MEDICATIONS:
1. All the patient's antibiotics are being DC'd with the
   exception of linezolid which she will be required to
   complete a 10-day course of.
2. She will be discharged on Tylenol prn for pain.
3. Albuterol nebs 1 neb q 4 h.
4. Amiodarone 400 mg po bid.
5. Heparin 5,000 U subcu tid.
6. Insulin sliding scale.
7. Atrovent 1 neb q 6 h.
8. Lopressor 50 mg po tid.
9. Miconazole powder 1 application tid prn.
10.Nystatin oral suspension 5 ml po qid prn.
11.Prevacid 30 mg per Dobbhoff qd.

FOLLOW UP:  She is to follow-up with Dr. [**Last Name (STitle) **] in [**12-31**]
weeks.  She is to have her speech and swallow in
approximately 1 week.  She should follow-up with her primary
care physician in approximately 2 weeks.




                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5732**], [**MD Number(1) 5733**]

Dictated By:[**Last Name (NamePattern1) 3956**]
MEDQUIST36
D:  [**2163-8-9**] 10:24:38
T:  [**2163-8-9**] 11:11:26
Job#:  [**Job Number 94628**]
{'Malignant neoplasm of cecum,Streptococcal septicemia,Severe sepsis,Acute respiratory failure,Acute posthemorrhagic anemia,Pneumonia, organism unspecified,Atrial fibrillation,Congestive heart failure, unspecified'}


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: 

PRESENT ILLNESS: The patient is a 89-year-old
female, with a history of atrial fibrillation, coronary
artery disease, who underwent colonoscopy on [**2163-5-10**]
which showed a large cecal mass.  Biopsies revealed well-
differentiated adenocarcinoma for which she was admitted on
[**2163-7-20**] for right hemicolectomy.

MEDICAL HISTORY: Sick sinus syndrome.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient has never smoked cigarettes.
She lives in the [**Hospital3 **] Center secondary to an
inability to take care of herself.  She is retired.  She has
a large family.  She is Russian speaking. 

### Response:
{'Malignant neoplasm of cecum,Streptococcal septicemia,Severe sepsis,Acute respiratory failure,Acute posthemorrhagic anemia,Pneumonia, organism unspecified,Atrial fibrillation,Congestive heart failure, unspecified'}
