CHIEF COMPLAINT: left-lower quadrant hernia, symptomatic

PRESENT ILLNESS: 67yo F reports undergoing multiple repairs of ventral hernias
throughout her abdomen over the past ten years, including
left-upper quadrant, umbilical, and midline.  She has had
symptoms from the left lower quadrant, where a hernia was
appreciated during an outpatient referral measuring ~10x15cm on
exam.  She presents for elective repair of these symptomatic
hernias.

MEDICAL HISTORY: COPD/emphysema from smoking
IDDM
depression
s/p ventral hernia repair, open, with mesh, multiple.
s/p appendectomy
s/p TAH/BSO

MEDICATION ON ADMISSION: Paxil 30'
Avapro 150'
Humulin 34units qam, 34units qpm
Novalog sliding scale

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: In clinic:
A&Ox3, NAD.
VSS
supple neck
coarse BS decreased at bases BL
RRR, no M/G.
soft, NT, no R/G. large reducible hernias in LLQ, largest
10x15cm.
FROM x4 extremities, nl gait and station.

FAMILY HISTORY: 

SOCIAL HISTORY: + tobacco, 1ppd
Other ventral hernia with obstruction,Chronic airway obstruction, not elsewhere classified,Urinary tract infection, site not specified,Pneumonia due to Hemophilus influenzae [H. influenzae],Acute posthemorrhagic anemia,Laparoscopic surgical procedure converted to open procedure,Peritoneal adhesions (postoperative) (postinfection),Hyperosmolality and/or hypernatremia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Foreign body in larynx,Tobacco use disorder,Unspecified essential hypertension,Unspecified adjustment reaction,Delirium due to conditions classified elsewhere,Other iatrogenic hypotension,Scar conditions and fibrosis of skin
Obstr ventral hernia NEC,Chr airway obstruct NEC,Urin tract infection NOS,H.influenzae pneumonia,Ac posthemorrhag anemia,Lap surg convert to open,Peritoneal adhesions,Hyperosmolality,DMII wo cmp nt st uncntr,Foreign body in larynx,Tobacco use disorder,Hypertension NOS,Adjustment reaction NOS,Delirium d/t other cond,Iatrogenc hypotnsion NEC,Scar & fibrosis of skin
Admission Date:  [**2175-8-15**]              Discharge Date:   [**2175-9-6**]

Date of Birth:  [**2108-8-31**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 301**]
Chief Complaint:
left-lower quadrant hernia, symptomatic

Major Surgical or Invasive Procedure:
laparoscopic converted to open ventral hernia repair, small
bowel resection for incarcerated ischemic small bowel with
primary anastamosis, and component release of anterior abdominal
wall, [**2175-8-15**].
percutaneous tracheostomy [**2175-8-21**]
broncheoalveolar lavage [**2175-8-25**]


History of Present Illness:
67yo F reports undergoing multiple repairs of ventral hernias
throughout her abdomen over the past ten years, including
left-upper quadrant, umbilical, and midline.  She has had
symptoms from the left lower quadrant, where a hernia was
appreciated during an outpatient referral measuring ~10x15cm on
exam.  She presents for elective repair of these symptomatic
hernias.

Past Medical History:
COPD/emphysema from smoking
IDDM
depression
s/p ventral hernia repair, open, with mesh, multiple.
s/p appendectomy
s/p TAH/BSO

Social History:
+ tobacco, 1ppd

Physical Exam:
In clinic:
A&Ox3, NAD.
VSS
supple neck
coarse BS decreased at bases BL
RRR, no M/G.
soft, NT, no R/G. large reducible hernias in LLQ, largest
10x15cm.
FROM x4 extremities, nl gait and station.

Pertinent Results:
[**2175-9-6**] 06:05AM BLOOD WBC-6.4 RBC-3.41* Hgb-9.7* Hct-31.0*
MCV-91 MCH-28.4 MCHC-31.2 RDW-15.0 Plt Ct-454*
[**2175-9-6**] 06:05AM BLOOD Glucose-43* UreaN-16 Creat-0.6 Na-142
K-4.1 Cl-102 HCO3-32 AnGap-12
[**2175-9-6**] 06:05AM BLOOD Calcium-9.1 Phos-4.4 Mg-2.4
[**2175-9-5**] 05:33AM BLOOD Type-ART pO2-94 pCO2-54* pH-7.41
calHCO3-35* Base XS-7

Brief Hospital Course:
     67yo female was admitted to the Minimally Invasive Surgiery
(MIS) service post-operatively on [**2175-8-15**].  Please see operative
report for details. In brief, laparoscopic hernia repair was
attempted but converted to open repair due to incarcerate small
bowel in the hernia.  After dissection of the incarcerated bowel
off the mesh, an area of ischemic bowel was appreciated,
resected, and anastamosed primarily.  Plastic surgery consult
was obtained intra-operatively for assistance with closure and a
component release procedure was performed.  2 JP bulbs were left
in as drains.
     Neuro: initially on propofol while intubated, subsequently
treated with morphine and later roxicet.  Occassional agitation
was treated with haldol.
     Cardiovascular: HTN treated with lopressor and hydralazine.
 After a desaturation episode, an EKG was suspicious for ST
changes but cardiac enzymes were cycled and negative.
     Respiratory: Post-operatively the pt remained in the PACU
and intubated.  She was successfully extubated on POD 1 but
subsequently developed respiratory distress on POD 2 and was
re-intubated.  She was then transferred to the SICU and followed
with the ICU team.  She proved very difficult to wean off the
ventilator, probably due to her smoking history and
COPD/emphysema, and ultimately underwent a percutaneous
tracheostomy on [**2175-8-21**], POD 6.  Ultimately she was able to
tolerate a vent wean bu POD 18, remained on trach collar x48h,
and was transferred to the floor.  There an episode of
respiratory distress, tachypnea, and desaturation was relieved
with suctioning, presumably due to mucous plug, and she was
returned to the ICU.  Vent supported overnight and returned to
trach collar by the next day.  A pulmonary consult was also
obtained.  She continued to receive chest pt, inhalers and
nebulizers.  A speech/swallow consult provided a Passy-Muir
valve and she successfully passed a bedside swallow evaluation.
     GI/FEN: initially kept NPO but diet was later begun with
promote with fiber, advanced easily to goal, via a dobhoff
nasogastric tube.  After passing swallow exam, begun on PO
diabetic diet.
     GU: Foley d/c'd on POD 20 and pt voided successfully.  UTI
treated with levaquin.
     Heme: Progressive hematocrit fall down to 24, treated with
transfusion to maintain Hct > 30.  No evidence for any bleeding
was found.  Hematology consult was obtained although hemolysis
work-up was negative and deemed possibly secondary to chronic
disease and phlebotomy.
     ID:  A fever spike on POD 9 prompted a pan-culture, which
revealed a UTI, and broncheoalveolar lavage, which demostrated
HFlu pneumonia.  Levaquin was started for 14days beginning POD
11.  Although she continued to have secretions, no further
fevers or elevated WBCs were observed.
     Wound: Plastic surgery continued to follow the patient
post-operatively.  JP drains were maintained with plan to remove
once the output was zero; drain #1 was removed on POD 22 while
drain #2 remains in place with scant daily output.  Wound
necrosis between the paramedian incision and her prior midline
occurred and was treated with wet-to-drys and later with
silvadene cream.
     Endo: RISS well controlled and added NPH upon initiation of
TF and diet.
     Rehab: Underwent evaluation by PT/OT services and received
care throughout her hospital stay.
     Prophylaxis: received pneumoboots, sq heparin, and GI
prophylaxis throughout the hospital stay.
     On POD 21 the patient was transferred from the ICU to the
floor after remaining on trach collar successfully for 24 hours.
 She did well overnight and was planned for discharge to vent
rehab on POD 22.

Medications on Admission:
Paxil 30'
Avapro 150'
Humulin 34units qam, 34units qpm
Novalog sliding scale

Discharge Medications:
1. Nicotine 21 mg/24 hr Patch 24HR Sig: One (1) Patch 24HR
Transdermal DAILY (Daily).
2. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q4H (every 4 hours).
3. Ipratropium Bromide 18 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation Q4H (every 4 hours).
4. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
5. Silver Sulfadiazine 1 % Cream Sig: One (1) Appl Topical  TID
(3 times a day): apply to necrotic wound.
6. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO Q4-6H (every 4 to 6 hours) as needed for pain.
7. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
8. Levofloxacin 750 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 4 days: final dose on [**2175-09-08**].
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
10. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
once a day as needed.
11. Guaifenesin 100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H (every 6
hours) as needed.
12. Acetylcysteine 20 % (200 mg/mL) Solution Sig: One (1) ML
Miscell.  Q4-6H (every 4 to 6 hours) as needed.
13. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
14. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day): hold for SBP < 100 or HR < 60.
15. Diphenhydramine HCl 25 mg Capsule Sig: One (1) Capsule PO HS
(at bedtime) as needed.
16. Haloperidol Lactate 5 mg/mL Solution Sig: One (1)  Injection
HS (at bedtime) as needed.
17. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Twenty
Eight (28) units Subcutaneous twice a day: can titrate dose as
transition to bolus tube/po feedings.
18. Insulin Regular Human 100 unit/mL Solution Sig: qs units
Injection four times a day: as directed by accompanying sliding
scale.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 701**]

Discharge Diagnosis:
s/p open ventral hernia repair [**2175-8-15**] for incarcerated ventral
hernia with concurrent small bowel resection, component release
by plastic surgery.
respiratory distress, reintubation.
respiratory failure, ventilator dependence, percutaneous
tracheostomy [**8-21**]
COPD, smoker
IDDM
depression
PNA with H.Flu
UTI, morganella


Discharge Condition:
stable, on trach collar.


Discharge Instructions:
continue trachostomy site care.
continue tracheal suction as needed.  continue medications as
directed.
continue vent wean.
strip and record JP drains qshift.
continue dressing changes with silvadene to necrotic area of
wound

Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) **], General Surgery, 1 week from
discharge.  Call [**Telephone/Fax (1) 2723**] for an appointment time.
Follow-up with Dr. [**First Name (STitle) 3228**], Plastic surgery, 1 week from
discharge.  Please call [**Telephone/Fax (1) 5343**] for appointment.
{'Other ventral hernia with obstruction,Chronic airway obstruction, not elsewhere classified,Urinary tract infection, site not specified,Pneumonia due to Hemophilus influenzae [H. influenzae],Acute posthemorrhagic anemia,Laparoscopic surgical procedure converted to open procedure,Peritoneal adhesions (postoperative) (postinfection),Hyperosmolality and/or hypernatremia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Foreign body in larynx,Tobacco use disorder,Unspecified essential hypertension,Unspecified adjustment reaction,Delirium due to conditions classified elsewhere,Other iatrogenic hypotension,Scar conditions and fibrosis of skin'}


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: left-lower quadrant hernia, symptomatic

PRESENT ILLNESS: 67yo F reports undergoing multiple repairs of ventral hernias
throughout her abdomen over the past ten years, including
left-upper quadrant, umbilical, and midline.  She has had
symptoms from the left lower quadrant, where a hernia was
appreciated during an outpatient referral measuring ~10x15cm on
exam.  She presents for elective repair of these symptomatic
hernias.

MEDICAL HISTORY: COPD/emphysema from smoking
IDDM
depression
s/p ventral hernia repair, open, with mesh, multiple.
s/p appendectomy
s/p TAH/BSO

MEDICATION ON ADMISSION: Paxil 30'
Avapro 150'
Humulin 34units qam, 34units qpm
Novalog sliding scale

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: In clinic:
A&Ox3, NAD.
VSS
supple neck
coarse BS decreased at bases BL
RRR, no M/G.
soft, NT, no R/G. large reducible hernias in LLQ, largest
10x15cm.
FROM x4 extremities, nl gait and station.

FAMILY HISTORY: 

SOCIAL HISTORY: + tobacco, 1ppd 

### Response:
{'Other ventral hernia with obstruction,Chronic airway obstruction, not elsewhere classified,Urinary tract infection, site not specified,Pneumonia due to Hemophilus influenzae [H. influenzae],Acute posthemorrhagic anemia,Laparoscopic surgical procedure converted to open procedure,Peritoneal adhesions (postoperative) (postinfection),Hyperosmolality and/or hypernatremia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Foreign body in larynx,Tobacco use disorder,Unspecified essential hypertension,Unspecified adjustment reaction,Delirium due to conditions classified elsewhere,Other iatrogenic hypotension,Scar conditions and fibrosis of skin'}
