CHIEF COMPLAINT: BPH, Hematuria

PRESENT ILLNESS: Mr. [**Known lastname **] is known to Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] with a history of previous laser
photo vaporization of the prostate many years ago who has had
regrowth of the prostate. He presented with gross hematuria and
and for transurethral
resection.

MEDICAL HISTORY: Elevaed PSA s/p muliple negative biopsies
h/o HG dysplasia on c-scopy polypectomy
BPH s/p TURP
Recent admission for hematuria
HTN
onychomycosis
Hyperglycemia
CKD stage II

MEDICATION ON ADMISSION: Atenolol
Proscar
HCTZ
Lisinopril
Flomax
ASA

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: (per [**Name2 (NI) **]): His mother and father both had high
blood pressure, both deceased. No family history of any coronary

SOCIAL HISTORY: Married and lives with wife.  [**Name (NI) **] [**Name2 (NI) **], does not smoke, use
alcohol, or other drug use.
Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Hyposmolality and/or hyponatremia,Acute posthemorrhagic anemia,Hematuria, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage II (mild)
BPH w/o urinary obs/LUTS,Hyposmolality,Ac posthemorrhag anemia,Hematuria NOS,Hy kid NOS w cr kid I-IV,Chro kidney dis stage II
Admission Date:  [**2139-8-25**]              Discharge Date:   [**2139-8-28**]

Date of Birth:  [**2069-12-11**]             Sex:   M

Service: UROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 6736**]
Chief Complaint:
BPH, Hematuria

Major Surgical or Invasive Procedure:
PROCEDURE:  Transurethral recess resection of the prostate.


History of Present Illness:
Mr. [**Known lastname **] is known to Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] with a history of previous laser
photo vaporization of the prostate many years ago who has had
regrowth of the prostate. He presented with gross hematuria and
and for transurethral
resection.

Past Medical History:
Elevaed PSA s/p muliple negative biopsies
h/o HG dysplasia on c-scopy polypectomy
BPH s/p TURP
Recent admission for hematuria
HTN
onychomycosis
Hyperglycemia
CKD stage II

Social History:
Married and lives with wife.  [**Name (NI) **] [**Name2 (NI) **], does not smoke, use
alcohol, or other drug use.


Family History:
(per [**Name2 (NI) **]): His mother and father both had high
blood pressure, both deceased. No family history of any coronary

artery disease or strokes, diabetes, bleeding disorder.

Pertinent Results:
[**2139-8-28**] 06:52AM BLOOD WBC-9.1 RBC-4.05* Hgb-11.8* Hct-34.4*
MCV-85 MCH-29.1 MCHC-34.3 RDW-15.0 Plt Ct-199
[**2139-8-26**] 04:33AM BLOOD WBC-11.3* RBC-3.69* Hgb-10.9* Hct-31.3*
MCV-85 MCH-29.6 MCHC-35.0 RDW-14.2 Plt Ct-163
[**2139-8-25**] 05:04PM BLOOD WBC-15.2*# RBC-4.00* Hgb-11.6* Hct-33.7*
MCV-84 MCH-29.1 MCHC-34.4 RDW-13.7 Plt Ct-193
[**2139-8-28**] 06:52AM BLOOD Glucose-99 UreaN-16 Creat-1.2 Na-138
K-4.3 Cl-104 HCO3-23 AnGap-15
[**2139-8-27**] 08:01AM BLOOD Glucose-98 UreaN-19 Creat-1.3* Na-139
K-4.0 Cl-107 HCO3-26 AnGap-10
[**2139-8-26**] 12:49PM BLOOD Glucose-124* UreaN-24* Creat-1.2 Na-137
K-4.2 Cl-105 HCO3-25 AnGap-11
[**2139-8-28**] 06:52AM BLOOD Calcium-9.3 Mg-2.0
[**2139-8-27**] 08:01AM BLOOD Calcium-8.5 Mg-2.1

Brief Hospital Course:
69 y/o with HTN, CKD Stage II, Hyperglycemia, BPH present
[**2139-8-25**] a TURP. Mr. [**Known lastname **] was admitted to Dr[**Last Name (STitle) **] Urology
service after TURP of the prostate. No concerning intraoperative
events occurred; please see dictated operative note for details.
The patient received peri-operative antibiotic prophylaxis with
gentamycin and kefzol. Patient's postoperative course was
complicated by TUR syndrome due to the bladder irrigation. He
remained afebrile throughout his hospital stay. While in the
PACU Mr. [**Known lastname **] developed a dysrythmia, remained confused confusion
and experienced some visual acuity changes and vertical
nystagmus. He described mild dizziness and nausea. He developed
bradycardia believed to be sinus arrest with junction escape
rhythm which has since resolved.  HTN up to SBP 200 also occured
in the PACU. Electrolytes were obtained demonstrating
hyperkalemia and hyponatremia and given the questions of mental
status changes and visual changes/vertical nystagmus "stat"
cardiology, ICU, nephrology and opthalmology consults were
obtained. Mr. [**Known lastname **] was managed for TUR syndrome with electrolyte
correction and monitored with serial labs, EKGs and was also
sent for imaging to rule out brain infarct, bleed, increased
pressure.  Final results:  1. No acute intracranial pathology.
Note, limited sensitivity of CT towards central pontine
myelinolysis for which MR is a better modality.
2. Mild sinus disease with air-fluid level in the right
maxillary sinus, in
the correct clinical setting could represent an acute sinusitis.

3. Mild prominence of R>L prefrontal extraxial spaces could
represent atrophy
related changes or small subdural collections.

Mr. [**Known lastname **] was kept in ICU overnight and on POD2 was transferred to
the general surgical urology floor. His electrolytes corrected
as did his EKG and his clarity returned. On POD2 he passed his
trial of voiding and began physical therapy. He endorsed feeling
well and voiding without difficulty despite PVRs x 2 around
300cc. By POD3, [**2139-8-28**] Mr.[**Known lastname **] was doing very well, tolerating
a regular diet and PO pain medications and denying any new
complaints. He endorsed being ready for discharge home and his
wife will be retrieving him later this evening. After formal
evaluation with PT and their recommendations, Mr. [**Known lastname **] was
discharged home with services for physical therapy.

He was discharged with explicit instructions to follow-up with
his own opthalmologist and to follow up with nephrology,
urology, cardiology and his Primary care clinician. All his
questions were answered.

Medications on Admission:
Atenolol
Proscar
HCTZ
Lisinopril
Flomax
ASA

NKDA

Discharge Medications:
1. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime): PLEASE CONTINUE
UNTIL YOUR F/U WITH DR. [**Last Name (STitle) 163**].
2. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily):
Please continue until your f/u with Dr. [**Last Name (STitle) **].
3. Timolol Maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **]
(2 times a day).
4. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
6. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO every six (6)
hours as needed for pain: DO NOT drive, consume ETOH or operate
machinery/dangerous equipment if using. .
Disp:*25 Tablet(s)* Refills:*0*
7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*1*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
PREOPERATIVE DIAGNOSES:  Benign prostatic hypertrophy,
hematuria.
POSTOPERATIVE DIAGNOSES:  Benign prostatic hypertrophy,
hematuria.


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
No vigorous physical activity for 2 weeks.

-Expect to see occasional blood in your urine and to experience
urgency and frequecy over the next month.

-You may shower and bathe normally.

-Tylenol should be your first line pain medication, a narcotic
pain medication has been prescribed for breakthough pain >4.
Replace Tylenol with narcotic pain medication.  Max daily
Tylenol dose is 4gm, note that narcotic pain medication also
contains Tylenol (acetaminophen)

-Do not drive or drink alcohol while taking narcotics. Do not
operate heavy machinery/dangerous equipment while taking
narcotics

-Colace has been prescribed to avoid post surgical constipation
and constipation related to narcotic pain medication,
discontinue if loose stool or diarrhea develops.

-Resume your home medications, except hold NSAID (aspirin,  and
ibuprofen containing products such as advil & motrin,) until you
see your urologist in follow-up

DO NOT RESUME LISINOPRIL OR HYDROCHLOROTHIAZIDE until advised by
cardiology or nephrology in follow-up.

-Call Dr.[**Name (NI) 10529**] office ([**Telephone/Fax (1) 921**]) for follow-up AND if you
have any questions (page Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] [**Telephone/Fax (1) 2756**]).

The operation you have experienced is a "scraping" operation.
Bleeding was controlled with electrocautery which has produced a
"scab" in the channel through which the urine passes (the
urethra). About 1-2 weeks after the operation, pieces of the
scab will fall off and come out with the urine. As this occurs,
bleeding may be noted which is normal. You should not worry
about this. Simply lie down and increase your fluid intake for a
few hours. In most cases, the urine will clear. If bleeding
occurs or persists for more than 12 hours or if clots appear
impairing your stream, call your surgeon. Because of the
potential for bleeding, aspirin (or Advil) should be avoided for
the first 3 weeks after surgery. You will be given a
prescription for antibiotics to be taken for a few days after
surgery. This is to help prevent infection. If you develop a
fever over 101??????, chills, or pain in the testicles, call your
surgeon. Although not common, this may indicate infection that
has developed beyond the control of the antibiotics that you
have taken. It will take 6 weeks from the date of surgery to
fully recovery from your operation. This can be divided into two
parts -- the first 2 weeks and the last 4 weeks. During the
first 2 weeks from the date of your surgery, it is important to
be "a person of leisure". You should avoid lifting and
straining, which also means that you should avoid constipation.
This can be done by any of 3 ways: 1) modify your diet, 2) use
stool softeners which have been prescribed for you, and 3) use
gentle laxatives such as Milk of Magnesia which can be purchased
at your local drug store.

Remember that the prostate is near the rectum, and therefore, it
is important for you to be mindful of the way you sit. For
example, sitting directly upright on a hard surface, such as an
exercise bicycle [**Last Name (LF) 10530**], [**First Name3 (LF) **] cause bleeding. Reclining on a soft
sea, or sitting on a "donut", is best. Walking (not jogging) is
okay. You should avoid sexual activity during this time. Also,
avoid driving an automobile. This is important, not because you
are physically incapable of driving, but rather if you have an
urge to urinate, it is important that you void and not let your
bladder "stretch" too much, otherwise bleeding may occur.
Therefore, it is OK for you to be a passenger in an automobile
(or even to drive for very short distances).  During the second
[**2-13**] week period of your recovery, you may begin regular
activity, but only on a graduated basis. For example, you may
feel well enough to return to work, but you may find it easier
to begin on a half-day basis. It is common to become quite tired
in the afternoon, and if such occurs, it is best to take a nap!
If you are a golfer, you may begin to swing a golf club at this
time. Sexual activity may be resumed during the second 3 week
period, but only on a limited basis. Remember that the ejaculate
may be directed back into the bladder (rather than out),
producing a "dry" orgasm which is a normal consequence of the
operation. This should not change the quality of sex.

In general, your overall activity may be escalated to normal as
you progress through this second time period, such that by [**5-19**]
weeks following the date of surgery, you should be back to
normal activity. Remember that your operation was a "scraping"
operation and not all of the prostate was removed. Therefore,
you should still be monitored for prostate cancer (assuming age
and general medical conditions dictate such).

Followup Instructions:
Please follow up with Urology, Cardiology, Nephrology and
Opthalmolgy.

[**2139-9-10**]  03:00p   Dr. [**Last Name (STitle) **],[**First Name3 (LF) **]
  DE [**Hospital1 **] BUILDING ([**Hospital Ward Name **] COMPLEX), [**Location (un) **]
  RENAL DIV-WSC (SB)

[**2139-9-7**]  10:30a   [**Last Name (LF) 163**],[**First Name3 (LF) 161**] K.
  [**Hospital6 29**], [**Location (un) **]
  UROLOGY CC3 (NHB)

Name: [**Name8 (MD) **], MD, FACS, [**Doctor First Name **] K. Pager: [**Numeric Identifier 55344**] Office Phone: ([**Telephone/Fax (1) 14702**] Office Location: [**Location (un) **];Rabb440: [**Hospital Ward Name 23**]
3:[**Location (un) 86**] [**Numeric Identifier **] Division: Urology

Name: [**Last Name (LF) 4090**], [**First Name3 (LF) 4102**] Pager: [**Numeric Identifier 55345**] Office Phone: ([**Telephone/Fax (1) 817**]
Office Location: One [**Last Name (un) **] Place [**Location (un) 86**] [**Numeric Identifier **] Division:
Nephrology

PLEASE CALL BY MONDAY, [**8-31**], TO SCHEDULE AN APPOINTMENT WITHIN
[**6-11**]- DAYS OF DISCHARGE.
[**Last Name (LF) 73**], [**First Name7 (NamePattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] Division:Cardiology
Office Location:[**Street Address(2) **]. - W/ [**Hospital Ward Name **] 4
Phone:([**Telephone/Fax (1) 2037**] Fax:([**Telephone/Fax (1) 16763**] Pager:[**Numeric Identifier 55346**]



Completed by:[**2139-8-28**]
{'Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Hyposmolality and/or hyponatremia,Acute posthemorrhagic anemia,Hematuria, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage II (mild)'}


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: BPH, Hematuria

PRESENT ILLNESS: Mr. [**Known lastname **] is known to Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] with a history of previous laser
photo vaporization of the prostate many years ago who has had
regrowth of the prostate. He presented with gross hematuria and
and for transurethral
resection.

MEDICAL HISTORY: Elevaed PSA s/p muliple negative biopsies
h/o HG dysplasia on c-scopy polypectomy
BPH s/p TURP
Recent admission for hematuria
HTN
onychomycosis
Hyperglycemia
CKD stage II

MEDICATION ON ADMISSION: Atenolol
Proscar
HCTZ
Lisinopril
Flomax
ASA

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: (per [**Name2 (NI) **]): His mother and father both had high
blood pressure, both deceased. No family history of any coronary

SOCIAL HISTORY: Married and lives with wife.  [**Name (NI) **] [**Name2 (NI) **], does not smoke, use
alcohol, or other drug use. 

### Response:
{'Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Hyposmolality and/or hyponatremia,Acute posthemorrhagic anemia,Hematuria, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage II (mild)'}
