CHIEF COMPLAINT: Nonhealing right foot ulcer with
Methicillin resistant Staphylococcus aureus infection x3
months

PRESENT ILLNESS: Mr. [**Known lastname 29275**] is a 70-year-old
white male with a past medical history significant for type
II diabetes mellitus that is currently noninsulin dependent
as well as nicotine abuse and coronary artery disease who
presents with a non-healing ulceration of his right lateral
foot that has been present for approximately three to four
months.  The patient saw Dr. [**Last Name (STitle) **] in his clinic and was
evaluated for elective surgical revascularization.  He had a
preoperative cardiac evaluation and underwent a cardiac
catheterization that revealed three vessel disease.  In
[**2167-1-13**], the patient underwent a coronary artery
bypass grafting x3 with left internal mammary artery to the
left anterior descending coronary artery as well as
aorto-saphenous vein graft to the first diagonal branch and
aorto-saphenous vein graft to the posterior tibial descending
coronary artery.  He was subsequently discharged from the
hospital at that time and then represented to the vascular
surgery service in [**Month (only) 958**] for revascularization of his right
leg.  At this time, he denied any symptoms of coronary
disease such as increasing shortness of breath, chest pain,
diaphoresis or nausea or vomiting.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Significant for living alone as well as a 50
pack year history of nicotine abuse that he says stopped in
[**2167**].  He denies to alcohol abuse, but states he has not had
anything to drink in over 10 years.
Atherosclerosis of native arteries of the extremities with gangrene,Ulcer of heel and midfoot,Congestive heart failure, unspecified,Drug-induced delirium,Urinary tract infection, site not specified,Atrial fibrillation,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Infection with microorganisms resistant to penicillins,Other and unspecified general anesthetics causing adverse effects in therapeutic use
Ath ext ntv art gngrene,Ulcer of heel & midfoot,CHF NOS,Drug-induced delirium,Urin tract infection NOS,Atrial fibrillation,Mth sus Stph aur els/NOS,Inf mcrg rstn pncllins,Adv eff gen anes NEC/NOS
Admission Date:  [**2167-3-31**]       Discharge Date:  [**2167-4-7**]

Date of Birth:   [**2096-8-27**]       Sex:  M

Service:  VASCULAR SURGERY

CHIEF COMPLAINT:  Nonhealing right foot ulcer with
Methicillin resistant Staphylococcus aureus infection x3
months

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 29275**] is a 70-year-old
white male with a past medical history significant for type
II diabetes mellitus that is currently noninsulin dependent
as well as nicotine abuse and coronary artery disease who
presents with a non-healing ulceration of his right lateral
foot that has been present for approximately three to four
months.  The patient saw Dr. [**Last Name (STitle) **] in his clinic and was
evaluated for elective surgical revascularization.  He had a
preoperative cardiac evaluation and underwent a cardiac
catheterization that revealed three vessel disease.  In
[**2167-1-13**], the patient underwent a coronary artery
bypass grafting x3 with left internal mammary artery to the
left anterior descending coronary artery as well as
aorto-saphenous vein graft to the first diagonal branch and
aorto-saphenous vein graft to the posterior tibial descending
coronary artery.  He was subsequently discharged from the
hospital at that time and then represented to the vascular
surgery service in [**Month (only) 958**] for revascularization of his right
leg.  At this time, he denied any symptoms of coronary
disease such as increasing shortness of breath, chest pain,
diaphoresis or nausea or vomiting.

PAST MEDICAL HISTORY significant for the above coronary
artery disease, as well as type II noninsulin dependent
diabetes mellitus x7 years with associated neuropathy,
hyperlipidemia, postoperative atrial fibrillation after
coronary artery bypass grafting that subsequently resolved
with amiodarone, Methicillin resistant Staphylococcus aureus
from the wound in his right foot as well as depression and
morbid obesity.  His ejection fraction was noted to be 34% in
[**2166-11-13**].

PAST SURGICAL HISTORY:
1.  Bilateral hallux amputations
2.  Coronary artery bypass grafting

SOCIAL HISTORY:  Significant for living alone as well as a 50
pack year history of nicotine abuse that he says stopped in
[**2167**].  He denies to alcohol abuse, but states he has not had
anything to drink in over 10 years.

ADMISSION MEDICATIONS:
1.  Nicoderm patch 14 mg qd
2.  Cipro 250 mg po tid x10 days
3.  OxyContin 20 mg po bid
4.  Senokot 2 tablets at bedtime
5.  Risperdal 1 mg po at 5 p.m.
6.  Combivent metered dose inhaler 2 puffs q6h
7.  Amiodarone 400 mg po qd
8.  Lopressor 25 mg po bid
9.  Lasix 20 mg po bid
10. Ecotrin
11. Aspirin 325 mg po qd
12. Vancomycin 1 gm intravenous q 12 hours x30 days
13. Prevacid 30 mg po qd
14. Glucophage 1000 mg po bid
15. Glyburide 10 mg po q 10 a.m. and 5 mg po q p.m.
16. Lipitor 10 mg po qd
17. Folic acid 1 mg po qd
18. Neurontin 300 mg po bid
19. Neurontin 100 mg po at 5 p.m.
20. Niferex 150 mg po bid
21. Colace 100 mg po bid
22. Lactulose 20 mg po bid

HOSPITAL COURSE:  The patient was admitted to [**Hospital6 1760**] where he underwent a right
above knee popliteal to posterior tibial artery bypass graft
using non reverse saphenous vein.  Details of this procedure
are dictated in a separate operative note.  The patient
tolerated the procedure well and was extubated in the post
anesthesia care unit.  He was subsequently transferred to the
Vascular Intensive Care Unit where he was monitored with a
central venous pressure line.  He did have some mental status
changes on postoperative day #1 in which she became severely
combative, confused and agitated.  He had a slight temporary
decrease in his O2 saturation that was subsequently evaluated
with a blood gas which revealed a pO2 of 67.  The patient was
then placed on a nonrebreather and a repeat gas revealed a
pO2 of 139.  Despite this, the patient still has severe
mental status changes and remained combative.  He had to get
a copious amount of Haldol to control him and had to be
placed on 1 to 1 monitoring.

He remained confused and overnight had a decreased urine
output that responded quite well with Lasix.  He improved
slightly on postoperative day #2, but still required large
amounts of Haldol.  All of his narcotics were subsequently
discontinued.  A psychiatry consult was then obtained.  They
felt that this was postoperative delirium secondary to
anesthesia and pain medication.  It has been noted that the
patient had similar episodes coming out of anesthesia before.
He greatly improved on postoperative day #3 and had no
further issues.  He was scheduled for a split thickness skin
graft to his right foot ulcer, however this was canceled to
avoid placing patient under anesthesia again.  An Apligraf
synthetic skin substitute was placed on postoperative day #4
at the bedside with no pain medication given.  The patient
tolerated this procedure quite well and Adaptic and dry
sterile dressing were placed over the wound and will remain
there for one week.

At this time, the patient is doing quite well.  He is awake,
alert and oriented in no apparent distress.  Vital signs are
stable.  He has been afebrile.  Of note, he had a small
urinary tract infection that grew out over 100,000 colonies
of Enterobacter that are sensitive to Bactrim.  He was
started on Bactrim on [**2167-4-6**] 1 double strength tablet twice
daily to continue for five days and to end on [**2167-4-11**].  Also, of note, he had multiple cultures from his foot
all of which grew out Methicillin resistant Staphylococcus
aureus.  For this, he has been placed on vancomycin
throughout his hospitalization 1 gm intravenous q 12 hours
with peak and trough levels done periodically.  His
creatinine has remained stable at 0.8.  He will be screened
and discharged to rehabilitation today.  For his dressings, a
dry sterile dressing and Ace wrap are to be placed from his
toe up to his thigh.  His dressing over his right foot wound
is not to be removed.  This is where the skin graft is placed
and should only be evaluated by the surgery team.  For this,
he will follow up with Dr. [**Last Name (STitle) **].  He will, however, need to
have an Ace wrap placed up to his thigh daily.

PHYSICAL EXAMINATION:
GENERAL:  Obese male who is in no apparent distress and is
awake and alert.
HEART:  Regular rate and rhythm.
LUNGS:  Clear to auscultation bilaterally.
ABDOMEN:  Obese with positive bowel sounds, nontender,
nondistended.
EXTREMITIES:  Right lower extremity incisions.  Steri-Strips
were placed on the upper portion of the right medial thigh
and the area clean, dry and intact without evidence of
dehiscence or drainage.  Staples are placed from the knee
down and are also clean, dry and intact without dehiscence,
drainage or erythema.  He has a palpable graft pulse.  There
is an incision at the distal right leg over the posterior
tibial artery which is palpable and clean, dry and intact.
There is a 2 x 1 cm right lateral foot ulcer with nice
granulation tissue present for which an Apligraf has been
placed.

FOLLOW UP:  He is to follow up with Dr. [**Last Name (STitle) **] in one week to
evaluate the Apligraf, otherwise that dressing is not to be
removed except by the vascular surgery team.

DISCHARGE MEDICATIONS:
1.  Senokot 2 tablets po q hs
2.  Colace 100 mg po bid
3.  Iron sulfate 150 mg po bid
4.  Neurontin 100 mg po at 5 p.m.
5.  Neurontin 300 mg po bid
6.  Atorvastatin 10 mg po qd
7.  Folic acid 1 mg po qd
8.  Protonix 4 mg po qd
9.  Lopressor 25 mg po bid
10. Paroxetine 20 mg po qd
11. Albuterol nebulizer solution q4h prn
12. Miconazole powder 2% applied to the groins bilaterally
13. Lactulose 30 mg po bid
14. Heparin 5000 units subcutaneous q8h
15. Risperidone 1 mg po qd
16. Amiodarone 400 mg po qd
17. Aspirin 325 mg po qd
18. Vancomycin 1 gm intravenous q 12 hours for three more
weeks from this date
19. Bactrim 1 double strength tablet po bid for 5 more days
and to end [**2167-4-11**]

DISCHARGE DIAGNOSES:
1.  Non-healing ulceration of the right lateral foot
currently managed with a right above the knee to posterior
tibial bypass as well as Apligraf.
2.  Postoperative delirium secondary to anesthesia and pain
medication currently resolved at this time.
3.  Coronary artery disease which remains asymptomatic at
this time.
4.  Diabetes mellitus currently controlled on oral
medication.
5.  Hypertension currently controlled.




                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3409**]

Dictated By:[**First Name3 (LF) 29276**]
MEDQUIST36

D:  [**2167-4-7**]  08:17
T:  [**2167-4-7**]  08:52
JOB#:  [**Job Number 29277**]
{'Atherosclerosis of native arteries of the extremities with gangrene,Ulcer of heel and midfoot,Congestive heart failure, unspecified,Drug-induced delirium,Urinary tract infection, site not specified,Atrial fibrillation,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Infection with microorganisms resistant to penicillins,Other and unspecified general anesthetics causing adverse effects in therapeutic use'}


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: Nonhealing right foot ulcer with
Methicillin resistant Staphylococcus aureus infection x3
months

PRESENT ILLNESS: Mr. [**Known lastname 29275**] is a 70-year-old
white male with a past medical history significant for type
II diabetes mellitus that is currently noninsulin dependent
as well as nicotine abuse and coronary artery disease who
presents with a non-healing ulceration of his right lateral
foot that has been present for approximately three to four
months.  The patient saw Dr. [**Last Name (STitle) **] in his clinic and was
evaluated for elective surgical revascularization.  He had a
preoperative cardiac evaluation and underwent a cardiac
catheterization that revealed three vessel disease.  In
[**2167-1-13**], the patient underwent a coronary artery
bypass grafting x3 with left internal mammary artery to the
left anterior descending coronary artery as well as
aorto-saphenous vein graft to the first diagonal branch and
aorto-saphenous vein graft to the posterior tibial descending
coronary artery.  He was subsequently discharged from the
hospital at that time and then represented to the vascular
surgery service in [**Month (only) 958**] for revascularization of his right
leg.  At this time, he denied any symptoms of coronary
disease such as increasing shortness of breath, chest pain,
diaphoresis or nausea or vomiting.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Significant for living alone as well as a 50
pack year history of nicotine abuse that he says stopped in
[**2167**].  He denies to alcohol abuse, but states he has not had
anything to drink in over 10 years. 

### Response:
{'Atherosclerosis of native arteries of the extremities with gangrene,Ulcer of heel and midfoot,Congestive heart failure, unspecified,Drug-induced delirium,Urinary tract infection, site not specified,Atrial fibrillation,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Infection with microorganisms resistant to penicillins,Other and unspecified general anesthetics causing adverse effects in therapeutic use'}
