CHIEF COMPLAINT: malfunctioning hemodialysis fistula

PRESENT ILLNESS: 69 y/o F w/Right arm fistula placed 9 years ago was transferred
from referring hospital because of inability to undergo
hemodialysis on [**2173-9-13**].  Pt. also had K of 6.1 but denied any
palpitations, confusion, disoritentation, nausea/vomitting,
chest pain, shortness of breath.  Pt. did c/o some lower
abdominal pain that resolved prior to arriving at this
institution.

MEDICAL HISTORY: multiple drug allergies, ACEI-cough, ativan, confusion w/ ambien
hx delirium in the hospital
hx Dm2
Hx ESRD on HD MWF
hx CAD, CHF, EF 40%
hx CVA
hx DVT
hx hyperhomocystenemia
hx microcytic anemia
hx refractory HTN requiring Hd
hx cervical spondylosis s/p C4-7 fusion

MEDICATION ON ADMISSION: - ASA qday
- plavix 75 qday
- amlodipine 10 qday
- isosorbide mononitrate 30 qday
- lipitor 40 qday
- metoprolol 100 [**Hospital1 **]
- protonix 40 qday
- renagel 800 tid
- sertraline 50 qday
- diovan 160 [**Hospital1 **]
- pyridoxine 50 qday

ALLERGIES: A.C.E Inhibitors / Ativan / Ambien

PHYSICAL EXAM: Vitals: T 98.8  P 88  BP 106/88  R 20  O2 100ra
Gen: Well developed, well nourished female in no acute distress
CV: RRR, no m/r/g appreciated
Chest: CTAB, no w/c/r appreciated
Abd: soft, non-tender, non-distended, normal active bowel sounds
Ext: wound clean/dry/intact and appropriately tender, +thrill,
no cyanosos/clubbing/edema

FAMILY HISTORY: CAD/MI

SOCIAL HISTORY: She is widowed, lives with her son and daughter.
She ambulates with a cane.
She denies alcohol or tobacco use.
Other complications due to renal dialysis device, implant, and graft,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hypotension of hemodialysis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery
Comp-ren dialys dev/grft,CHF NOS,Hyp kid NOS w cr kid V,Hemododialysis hypotensn,DMII wo cmp nt st uncntr,Crnry athrscl natve vssl
Admission Date:  [**2173-9-14**]              Discharge Date:   [**2173-9-17**]

Date of Birth:  [**2103-11-27**]             Sex:   F

Service: SURGERY

Allergies:
A.C.E Inhibitors / Ativan / Ambien

Attending:[**First Name3 (LF) 1384**]
Chief Complaint:
malfunctioning hemodialysis fistula

Major Surgical or Invasive Procedure:
- attempted venoplasty and declotting of existing AV fistula
- placement of new left upper extremity AV graft
- placement of new tunneled perm cath for dialysis


History of Present Illness:
69 y/o F w/Right arm fistula placed 9 years ago was transferred
from referring hospital because of inability to undergo
hemodialysis on [**2173-9-13**].  Pt. also had K of 6.1 but denied any
palpitations, confusion, disoritentation, nausea/vomitting,
chest pain, shortness of breath.  Pt. did c/o some lower
abdominal pain that resolved prior to arriving at this
institution.

Past Medical History:
multiple drug allergies, ACEI-cough, ativan, confusion w/ ambien
hx delirium in the hospital
hx Dm2
Hx ESRD on HD MWF
hx CAD, CHF, EF 40%
hx CVA
hx DVT
hx hyperhomocystenemia
hx microcytic anemia
hx refractory HTN requiring Hd
hx cervical spondylosis s/p C4-7 fusion

Social History:
She is widowed, lives with her son and daughter.
She ambulates with a cane.
She denies alcohol or tobacco use.


Family History:
CAD/MI

Physical Exam:
Vitals: T 98.8  P 88  BP 106/88  R 20  O2 100ra
Gen: Well developed, well nourished female in no acute distress
CV: RRR, no m/r/g appreciated
Chest: CTAB, no w/c/r appreciated
Abd: soft, non-tender, non-distended, normal active bowel sounds
Ext: wound clean/dry/intact and appropriately tender, +thrill,
no cyanosos/clubbing/edema

Pertinent Results:
[**2173-9-16**] 08:35AM BLOOD WBC-7.1# RBC-3.58* Hgb-11.7* Hct-35.8*
MCV-100* MCH-32.6* MCHC-32.6 RDW-17.5* Plt Ct-229
[**2173-9-14**] 10:00AM BLOOD Neuts-56.4 Lymphs-32.4 Monos-4.3 Eos-5.9*
Baso-0.9
[**2173-9-14**] 10:00AM BLOOD Hypochr-2+ Anisocy-2+ Poiklo-1+
Macrocy-2+
[**2173-9-16**] 08:35AM BLOOD Plt Ct-229
[**2173-9-16**] 08:35AM BLOOD Glucose-107* UreaN-37* Creat-8.5*# Na-142
K-4.6 Cl-101 HCO3-24 AnGap-22*
[**2173-9-14**] 10:00AM BLOOD ALT-11 AST-15 AlkPhos-67 Amylase-135*
TotBili-0.4
[**2173-9-14**] 10:00AM BLOOD Lipase-121*
[**2173-9-16**] 08:35AM BLOOD Calcium-9.7 Phos-4.9* Mg-2.0
[**2173-9-14**] 05:28PM BLOOD K-5.5*

Brief Hospital Course:
69 y/o F was admitted to [**Hospital1 18**] on [**2173-9-14**] for revision vs.
thrombectomy of right arm AV fistula.  During the operation the
fistula was not able to be salvaged and a new graft was placed
in the left upper extremitiy.  Please see the operative report
for further details.  POD 1 Pt. had a tunneled perm cath placed
by interventional radiology so she could continue with dialysis.
 This procedure went without difficulty.  Pt. successfully
underwent HD later that day.  Evening of [**2173-9-15**] pt. blood
pressure dropped to 80/60 and was given a small bolus of 250cc
ns.  This blood pressure drop was believed to be secondary to
having 2.5L of fluid taken off during dialysis earlier in the
day.  POD [**3-2**] pt. underwent another treatment of hemodialysis -
per renal b/c it had been quite and extended amount of time
between her prior treatments.  Pt. tolerated hemodialysis well.
Pt. was afebrile during her stay, pain was controlled on oral
pain medications, and pt was tolerating a regular diet by POD 2
and pt. ready for discharge.

Medications on Admission:
- ASA qday
- plavix 75 qday
- amlodipine 10 qday
- isosorbide mononitrate 30 qday
- lipitor 40 qday
- metoprolol 100 [**Hospital1 **]
- protonix 40 qday
- renagel 800 tid
- sertraline 50 qday
- diovan 160 [**Hospital1 **]
- pyridoxine 50 qday

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6 hours prn as needed for for pain: Do not drive while taking
this medication.
Disp:*30 Tablet(s)* Refills:*0*
2. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day: -
please take while taking pain medications
- hold for diarrhea.
Disp:*20 Capsule(s)* Refills:*0*
3. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

4. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
5. Valsartan 160 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
6. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

7. Sertraline 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
8. Atorvastatin Calcium 40 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
9. Calcium Acetate 667 mg Tablet Sig: One (1) Tablet PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
10. Sevelamer 800 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
- s/p attempted thrombectomy of existing AV fistula and
placement of new Left upper extrem AV graft
- chronic renal insufficiency
- diabetes mellitis
- s/p myocardial infarction (six years ago)
- peripheral vascular disease
- hypertension
- h/o deep venous thrombosis
- s/p right fem-pedal bipass ([**2173-8-10**])
- congestive heart failure w/EF 40%
- h/o ceberal vascular accident


Discharge Condition:
good


Discharge Instructions:
- Please resume all home medications
vomitting, pain in arm, erythema or purulent drainage from
wound, numbness or tingling in hand/arm, loss of strength in
hand/arm, signigicant swelling, loss of thrill, difficulty with
dialysis, or any other concern.

Followup Instructions:
Please follow-up with Dr. [**First Name (STitle) **] at the [**Hospital 1326**] clinic.
Please call [**First Name8 (NamePattern2) 5969**] [**Last Name (NamePattern1) 15170**] at [**Telephone/Fax (1) 7207**] for an appointment.





Name:  [**Known lastname **],[**Known firstname 2**] S                 Unit No:   [**Numeric Identifier 15789**]

Admission Date:  [**2173-9-14**]              Discharge Date:   [**2173-9-17**]

Date of Birth:  [**2103-11-27**]             Sex:   F

Service: SURGERY

Allergies:
A.C.E Inhibitors / Ativan / Ambien

Attending:[**First Name3 (LF) 2648**]
Addendum:
this is an addendum from the prior summary because the pt. will
no longer be discharged to home but rather a long term care
facility.

POD 2 after dialysis the pt. had an episode of hyoptension to
80s/50s and she responded to a 250cc bolus with her pressures
raising to 90s/60s.  The pt. was also very weak after her second
dialysis treament in two days.  The decision was made to keep
the patient in house over night and to have PT evaluate her in
the morning to assess her safety and fall risk.  POD3 PT came to
evaluate the patient and strongly recommended that the pt. go to
a rehab facility secondary to her deconditioning(unable to walk
only 20 feet) and instability on her feet.  The felt some of her
instability was be related to her recent dialysis treatment,
however, she would greatly benefit from daily physical therapy
treatments and 24 hour care.  During the day the patient
remained medically stable, afebrile, and willing to work with
rehab.

Please see previous summary for all other information.

Discharge Disposition:
Extended Care

Facility:
[**Hospital3 14**] & Rehab Center - [**Hospital1 15**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2649**] MD [**MD Number(2) 2650**]

Completed by:[**2173-9-17**]
{'Other complications due to renal dialysis device, implant, and graft,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hypotension of hemodialysis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery'}


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: malfunctioning hemodialysis fistula

PRESENT ILLNESS: 69 y/o F w/Right arm fistula placed 9 years ago was transferred
from referring hospital because of inability to undergo
hemodialysis on [**2173-9-13**].  Pt. also had K of 6.1 but denied any
palpitations, confusion, disoritentation, nausea/vomitting,
chest pain, shortness of breath.  Pt. did c/o some lower
abdominal pain that resolved prior to arriving at this
institution.

MEDICAL HISTORY: multiple drug allergies, ACEI-cough, ativan, confusion w/ ambien
hx delirium in the hospital
hx Dm2
Hx ESRD on HD MWF
hx CAD, CHF, EF 40%
hx CVA
hx DVT
hx hyperhomocystenemia
hx microcytic anemia
hx refractory HTN requiring Hd
hx cervical spondylosis s/p C4-7 fusion

MEDICATION ON ADMISSION: - ASA qday
- plavix 75 qday
- amlodipine 10 qday
- isosorbide mononitrate 30 qday
- lipitor 40 qday
- metoprolol 100 [**Hospital1 **]
- protonix 40 qday
- renagel 800 tid
- sertraline 50 qday
- diovan 160 [**Hospital1 **]
- pyridoxine 50 qday

ALLERGIES: A.C.E Inhibitors / Ativan / Ambien

PHYSICAL EXAM: Vitals: T 98.8  P 88  BP 106/88  R 20  O2 100ra
Gen: Well developed, well nourished female in no acute distress
CV: RRR, no m/r/g appreciated
Chest: CTAB, no w/c/r appreciated
Abd: soft, non-tender, non-distended, normal active bowel sounds
Ext: wound clean/dry/intact and appropriately tender, +thrill,
no cyanosos/clubbing/edema

FAMILY HISTORY: CAD/MI

SOCIAL HISTORY: She is widowed, lives with her son and daughter.
She ambulates with a cane.
She denies alcohol or tobacco use. 

### Response:
{'Other complications due to renal dialysis device, implant, and graft,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hypotension of hemodialysis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery'}
