CHIEF COMPLAINT: malignant pleural effusion

PRESENT ILLNESS: The patient is a delightful 93- year-old woman who was recently
diagnosed with stage 3A lung cancer. This was diagnosed and
treated with a vats wedge node
dissection. We elected not to treat her with postoperative
adjuvant therapy. She has recently developed dyspnea and was
found to have a left pleural effusion which on aspiration
demonstrated malignancy. She subsequently recurred with dyspnea
and therefore we admitted her for talc pleurodesis.

MEDICAL HISTORY: PMHX:
1) CAD s/p anterior wall MI - stent in OM1 in '[**78**]
2) Ischemic cardiomyopathy with EF 35%
3) Pacemaker for sick sinus syndrome
4) HTN
5) TIAs
6) DVTs
7) osteoporosis; thoracic compression fracture.
8) small cell lung ca (dx [**4-14**]; wide resection; decision against
chemo)

MEDICATION ON ADMISSION: Lipitor 20mg po daily
Fosamax 35mg qweek
Flonase
Lisinopril 10mg po daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: NAD
RRR
decreased lung sounds on left, CTA-R
s/nt/nd
no c/c/e

FAMILY HISTORY: .
FMH: sister with breast cancer. + CAD

SOCIAL HISTORY: .
SOCIAL HISTORY:  She had been a one to one and a half pack a day
smoker for 15 years, but she quit 50 years ago.  Denies ETOH.
She has been quite active and continued to swim at least up
through the recent
problem.
Secondary malignant neoplasm of pleura,Acute kidney failure, unspecified,Mitral valve disorders,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status,Coronary atherosclerosis of native coronary artery,Cardiac pacemaker in situ,Personal history of malignant neoplasm of bronchus and lung,Osteoporosis, unspecified
Second malig neo pleura,Acute kidney failure NOS,Mitral valve disorder,Hypertension NOS,Status-post ptca,Crnry athrscl natve vssl,Status cardiac pacemaker,Hx-bronchogenic malignan,Osteoporosis NOS
Admission Date:  [**2185-7-29**]              Discharge Date:   [**2185-8-8**]


Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern1) 1561**]
Chief Complaint:
malignant pleural effusion

Major Surgical or Invasive Procedure:
L video-assisted thoracoscopy and talc pleurodesis


History of Present Illness:
The patient is a delightful 93- year-old woman who was recently
diagnosed with stage 3A lung cancer. This was diagnosed and
treated with a vats wedge node
dissection. We elected not to treat her with postoperative
adjuvant therapy. She has recently developed dyspnea and was
found to have a left pleural effusion which on aspiration
demonstrated malignancy. She subsequently recurred with dyspnea
and therefore we admitted her for talc pleurodesis.


Past Medical History:
PMHX:
1) CAD s/p anterior wall MI - stent in OM1 in '[**78**]
2) Ischemic cardiomyopathy with EF 35%
3) Pacemaker for sick sinus syndrome
4) HTN
5) TIAs
6) DVTs
7) osteoporosis; thoracic compression fracture.
8) small cell lung ca (dx [**4-14**]; wide resection; decision against
chemo)

Social History:
.
SOCIAL HISTORY:  She had been a one to one and a half pack a day
smoker for 15 years, but she quit 50 years ago.  Denies ETOH.
She has been quite active and continued to swim at least up
through the recent
problem.


Family History:
.
FMH: sister with breast cancer. + CAD

Physical Exam:
NAD
RRR
decreased lung sounds on left, CTA-R
s/nt/nd
no c/c/e

Pertinent Results:
[**2185-7-29**] 06:10PM BLOOD Glucose-95 UreaN-21* Creat-0.9 Na-135
K-4.9 Cl-93* HCO3-35* AnGap-12
[**2185-8-2**] 12:50PM BLOOD Glucose-106* UreaN-38* Creat-2.2* Na-133
K-5.2* Cl-101 HCO3-26 AnGap-11
[**2185-8-6**] 05:15AM BLOOD Glucose-85 UreaN-28* Creat-0.9 Na-141
K-4.7 Cl-107 HCO3-26 AnGap-13

Brief Hospital Course:
Ms. [**Known lastname 12163**] went to the OR under the care of Dr. [**Last Name (STitle) 952**].
Please see his operative note for detail.  On POD #1, it was
noted that Ms. [**Known lastname 12163**] had low urine output.  She had lost IV
access and was unable to receive IV fluids.  A left subclavian
central line was placed.  Her creatinine was 1.6, indicating
that she was in acute renal failure, likely secondary to a
pre-renal state given a FeNa of <1%.  She was given IV hydration
but continued to fail to produce any urine.  By POD #2, she was
averaging only 0-5cc/hour overnight.  She was transferred to the
ICU for placement of a Swan-Ganz to assess fluid status and
closer monitoring.  Finally, Ms. [**Known lastname 12163**] received and responded
to Lasix to increase her urine output.  Her anterior left chest
tube was pulled on POD #3.

A renal consult was also obtained and followed Ms. [**Known lastname 12163**]
closely.

Her posterior left chest tube was pulled on POD #4 and she was
transferred to the floor in stable condition.  The remainder of
her hospital course was uneventful.  Her central line was pulled
on POD#7/  By the time of discharge on on POD #8, she was
tolerating a regular diet, had good urine output with a normal
creatinine, and had good pain control.

She was discharged to rehab in good condition.

Medications on Admission:
Lipitor 20mg po daily
Fosamax 35mg qweek
Flonase
Lisinopril 10mg po daily

Discharge Medications:
1. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day).
Disp:*90 Tablet, Chewable(s)* Refills:*2*
3. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
5. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
6. Vicodin 5-500 mg Tablet Sig: One (1) Tablet PO every [**3-16**]
hours.
Disp:*30 Tablet(s)* Refills:*2*
7. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
Disp:*60 Tablet(s)* Refills:*0*
8. Alendronate 35 mg Tablet Sig: One (1) Tablet PO QFRI (every
Friday).
Disp:*4 Tablet(s)* Refills:*2*
9. Heparin Sodium (Porcine) 5,000 unit/mL Solution Sig: One (1)
mL Injection TID (3 times a day).
Disp:*90 mL(s)* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 30191**] - [**Location (un) 22287**]

Discharge Diagnosis:
acute renal failure
recurrent malignant pleural effusion
s/p L VATS/talc pleurodesis [**7-15**]
small cell lung CA
s/p LLL wedge resection [**4-14**]
CAD s/p MI (EF 35%)
osteoporosis
HTN
TIAs


Discharge Condition:
Stable


Discharge Instructions:
If you have difficulty breathing, chest pain, persistent
nausea/vomiting, fevers/chills, or redness/oozing at incision
sites, Call Dr.[**Name (NI) 1816**] office [**Telephone/Fax (1) 170**].

Followup Instructions:
Provider: [**Name10 (NameIs) 251**] [**Last Name (NamePattern4) 15108**], MD Where: [**Hospital6 29**]
HEMATOLOGY/ONCOLOGY Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2185-8-30**] 11:00

Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD Where: CLINICAL CTR. - 9TH FL.
THORACIC SURGERY Date/Time:[**2185-8-30**] 11:30



Completed by:[**2185-8-8**]
{'Secondary malignant neoplasm of pleura,Acute kidney failure, unspecified,Mitral valve disorders,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status,Coronary atherosclerosis of native coronary artery,Cardiac pacemaker in situ,Personal history of malignant neoplasm of bronchus and lung,Osteoporosis, 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: malignant pleural effusion

PRESENT ILLNESS: The patient is a delightful 93- year-old woman who was recently
diagnosed with stage 3A lung cancer. This was diagnosed and
treated with a vats wedge node
dissection. We elected not to treat her with postoperative
adjuvant therapy. She has recently developed dyspnea and was
found to have a left pleural effusion which on aspiration
demonstrated malignancy. She subsequently recurred with dyspnea
and therefore we admitted her for talc pleurodesis.

MEDICAL HISTORY: PMHX:
1) CAD s/p anterior wall MI - stent in OM1 in '[**78**]
2) Ischemic cardiomyopathy with EF 35%
3) Pacemaker for sick sinus syndrome
4) HTN
5) TIAs
6) DVTs
7) osteoporosis; thoracic compression fracture.
8) small cell lung ca (dx [**4-14**]; wide resection; decision against
chemo)

MEDICATION ON ADMISSION: Lipitor 20mg po daily
Fosamax 35mg qweek
Flonase
Lisinopril 10mg po daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: NAD
RRR
decreased lung sounds on left, CTA-R
s/nt/nd
no c/c/e

FAMILY HISTORY: .
FMH: sister with breast cancer. + CAD

SOCIAL HISTORY: .
SOCIAL HISTORY:  She had been a one to one and a half pack a day
smoker for 15 years, but she quit 50 years ago.  Denies ETOH.
She has been quite active and continued to swim at least up
through the recent
problem. 

### Response:
{'Secondary malignant neoplasm of pleura,Acute kidney failure, unspecified,Mitral valve disorders,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status,Coronary atherosclerosis of native coronary artery,Cardiac pacemaker in situ,Personal history of malignant neoplasm of bronchus and lung,Osteoporosis, unspecified'}
