CHIEF COMPLAINT: AAA

PRESENT ILLNESS: This 73-year-old gentleman was recently found
to have an abdominal aortic aneurysm with a left external
iliac artery occlusion. The maximum diameter of the aneurysm
was about 7.4 cm and he had about a 3-cm right common iliac
aneurysm. Because of the size, he was advised to have repair.
His CT angiogram showed juxtarenal aneurysm which was not
suitable for endovascular repair

MEDICAL HISTORY: PMH: hypercholesterolemia, degenerative arthritis, Afib, CAD,
CHF (EF 30-40%)
.
PSH: hip replacement surgery, atrial ablation

MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: amlodipoine 10', cilostazol 100', plavix 75', digoxin
250mcg', simvastatin 20', asa

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: afvss
a/o nad
supple farom
no jvd
cta
rrr
pos bc / flatus
palp pulses

FAMILY HISTORY: n/c

SOCIAL HISTORY: He is a former heavy drinker and smoker
but does neither currently
Abdominal aneurysm without mention of rupture,Accidental puncture or laceration during a procedure, not elsewhere classified,Other primary cardiomyopathies,Accidental cut, puncture, perforation or hemorrhage during surgical operation,Congestive heart failure, unspecified,Atrial fibrillation,Pure hypercholesterolemia,Aortic valve disorders,Chronic airway obstruction, not elsewhere classified,Long-term (current) use of aspirin,Other chronic pulmonary heart diseases,Knee joint replacement,Atherosclerosis of other specified arteries
Abdom aortic aneurysm,Accidental op laceration,Prim cardiomyopathy NEC,Acc cut/hem in surgery,CHF NOS,Atrial fibrillation,Pure hypercholesterolem,Aortic valve disorder,Chr airway obstruct NEC,Long-term use of aspirin,Chr pulmon heart dis NEC,Joint replaced knee,Atherosclerosis NEC
Admission Date:  [**2167-6-19**]              Discharge Date:   [**2167-6-25**]

Date of Birth:  [**2093-11-8**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2597**]
Chief Complaint:
AAA

Major Surgical or Invasive Procedure:
Resection and repair of abdominal aortic
aneurysm with aorto right iliac and left common femoral
bifurcated Dacron graft.


History of Present Illness:
This 73-year-old gentleman was recently found
to have an abdominal aortic aneurysm with a left external
iliac artery occlusion. The maximum diameter of the aneurysm
was about 7.4 cm and he had about a 3-cm right common iliac
aneurysm. Because of the size, he was advised to have repair.
His CT angiogram showed juxtarenal aneurysm which was not
suitable for endovascular repair

Past Medical History:
PMH: hypercholesterolemia, degenerative arthritis, Afib, CAD,
CHF (EF 30-40%)
.
PSH: hip replacement surgery, atrial ablation


Social History:
He is a former heavy drinker and smoker
but does neither currently

Family History:
n/c

Physical Exam:
afvss
a/o nad
supple farom
no jvd
cta
rrr
pos bc / flatus
palp pulses

Pertinent Results:
[**2167-6-25**] 05:45AM BLOOD

WBC-11.4* RBC-4.17* Hgb-11.7* Hct-36.7* MCV-88 MCH-28.0
MCHC-31.8 RDW-15.4 Plt Ct-209

[**2167-6-25**] 05:45AM BLOOD

Glucose-120* UreaN-10 Creat-0.7 Na-140 K-3.6 Cl-101 HCO3-29
AnGap-14

[**2167-6-25**] 05:45AM BLOOD

Calcium-7.9* Phos-2.5* Mg-2.0

[**2167-6-22**] 10:36AM

URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.017
URINE Blood-MOD Nitrite-NEG Protein-NEG Glucose-NEG Ketone-10
Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-NEG
URINE RBC-40* WBC-<1 Bacteri-NONE Yeast-RARE Epi-0

ECHO:

The left atrium is markedly dilated. Moderate to severe
spontaneous echo contrast is seen in the body of the left
atrium. Moderate to severe spontaneous echo contrast is present
in the left atrial appendage. The left atrial appendage emptying
velocity is depressed (<0.2m/s). The right atrium is moderately
dilated. No atrial septal defect is seen by 2D or color Doppler.
Overall left ventricular systolic function is moderately
depressed (LVEF= 30-40%). The right ventricular cavity is mildly
dilated with mild global free wall hypokinesis. The ascending
aorta is markedly dilated The descending thoracic aorta is
moderately dilated. There are complex (>4mm) atheroma in the
descending thoracic aorta. There are three aortic valve
leaflets. The aortic valve leaflets (3) are mildly thickened but
aortic stenosis is not present. There is a minimally increased
gradient consistent with minimal aortic valve stenosis. Trace
aortic regurgitation is seen. The mitral valve leaflets are
moderately thickened. Mild to moderate ([**2-14**]+) mitral
regurgitation is seen.

Brief Hospital Course:
Mr. [**Known lastname 8923**],[**Known firstname **] was admitted on [**6-19**] with AAA. He agreed to
have an elective surgery. Pre-operatively, he was consented. A
CXR, EKG, UA, CBC, Electrolytes, T/S - were obtained,  all other
preperations were made.

It was decided that she would undergo a:

PROCEDURES:  Resection and repair of abdominal aortic aneurysm
with aorto right iliac and left common femoral bifurcated Dacron
graft.

He was 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 sent to the CVICU he was then
extubated and transferred to the VICU for further stabilization
and monitoring.

While in the VICU he received monitored care. When stable he was
delined. His diet was advanced. A PT consult was obtained. When
he was stabilized from the acute setting of post operative care,
he was transferred to floor status

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

To note he did have Lasix post operatively.

Medications on Admission:
[**Last Name (un) 1724**]: amlodipoine 10', cilostazol 100', plavix 75', digoxin
250mcg', simvastatin 20', asa

Discharge Medications:
1. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).
5. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
6. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
7. Digoxin 250 mcg Tablet Sig: One (1) Tablet PO once a day.
8. Pletal 100 mg Tablet Sig: One (1) Tablet PO twice a day.
9. Plavix 75 mg Tablet Sig: One (1) Tablet PO once a day.
10. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours): prn.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] Senior Healthcare - [**Location (un) 1887**]

Discharge Diagnosis:
AAA

Discharge Condition:
Mental Status: Confused - sometimes.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).

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 [**7-21**]
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 [**3-18**]
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:
Provider: [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2604**], MD Phone:[**Telephone/Fax (1) 1237**]
Date/Time:[**2167-7-6**] 1:00


Completed by:[**2167-6-25**]
{'Abdominal aneurysm without mention of rupture,Accidental puncture or laceration during a procedure, not elsewhere classified,Other primary cardiomyopathies,Accidental cut, puncture, perforation or hemorrhage during surgical operation,Congestive heart failure, unspecified,Atrial fibrillation,Pure hypercholesterolemia,Aortic valve disorders,Chronic airway obstruction, not elsewhere classified,Long-term (current) use of aspirin,Other chronic pulmonary heart diseases,Knee joint replacement,Atherosclerosis of other specified arteries'}


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: AAA

PRESENT ILLNESS: This 73-year-old gentleman was recently found
to have an abdominal aortic aneurysm with a left external
iliac artery occlusion. The maximum diameter of the aneurysm
was about 7.4 cm and he had about a 3-cm right common iliac
aneurysm. Because of the size, he was advised to have repair.
His CT angiogram showed juxtarenal aneurysm which was not
suitable for endovascular repair

MEDICAL HISTORY: PMH: hypercholesterolemia, degenerative arthritis, Afib, CAD,
CHF (EF 30-40%)
.
PSH: hip replacement surgery, atrial ablation

MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: amlodipoine 10', cilostazol 100', plavix 75', digoxin
250mcg', simvastatin 20', asa

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: afvss
a/o nad
supple farom
no jvd
cta
rrr
pos bc / flatus
palp pulses

FAMILY HISTORY: n/c

SOCIAL HISTORY: He is a former heavy drinker and smoker
but does neither currently 

### Response:
{'Abdominal aneurysm without mention of rupture,Accidental puncture or laceration during a procedure, not elsewhere classified,Other primary cardiomyopathies,Accidental cut, puncture, perforation or hemorrhage during surgical operation,Congestive heart failure, unspecified,Atrial fibrillation,Pure hypercholesterolemia,Aortic valve disorders,Chronic airway obstruction, not elsewhere classified,Long-term (current) use of aspirin,Other chronic pulmonary heart diseases,Knee joint replacement,Atherosclerosis of other specified arteries'}
