CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 75-year-old
woman transferred from [**Hospital1 700**] for an L5
laminectomy and L4-S1 fusion.  Mrs. [**Known lastname 28181**] has an extensive
medical history, most recently she had been hospitalized in
[**Month (only) 958**] for COPD exacerbation.  She has a compression fracture,
diverticulitis, chronic renal insufficiency, anemia, and
hypertension.  She has had COPD with three intubations in the
past, CAD, hypertension, carotid disease, status post CEA and
colostomy, hypercholesterolemia, lung CA with right upper
lobe resection in [**2146**], paroxysmal atrial fibrillation,
diverticulitis, status post transverse loop colonoscopy,
small bowel obstruction in [**2145**], chronic renal insufficiency,
depression, osteoarthritis, DJD with compression fractures,
and right cataract surgery.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: The patient is allergic to metronidazole, iodine,
and Plavix.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Pathologic fracture of vertebrae,Cardiac complications, not elsewhere classified,Acute myocardial infarction of unspecified site, initial episode of care,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Congestive heart failure, unspecified,Spinal stenosis, lumbar region, without neurogenic claudication,Pure hypercholesterolemia
Path fx vertebrae,Surg compl-heart,AMI NOS, initial,Chr airway obstruct NEC,Atrial fibrillation,CHF NOS,Spin sten,lumbr wo claud,Pure hypercholesterolem
Admission Date:  [**2159-6-8**]       Discharge Date:  [**2159-6-19**]

Date of Birth:   [**2084-2-24**]       Sex:  F

Service:

HISTORY OF THE PRESENT ILLNESS:  The patient is a 75-year-old
woman transferred from [**Hospital1 700**] for an L5
laminectomy and L4-S1 fusion.  Mrs. [**Known lastname 28181**] has an extensive
medical history, most recently she had been hospitalized in
[**Month (only) 958**] for COPD exacerbation.  She has a compression fracture,
diverticulitis, chronic renal insufficiency, anemia, and
hypertension.  She has had COPD with three intubations in the
past, CAD, hypertension, carotid disease, status post CEA and
colostomy, hypercholesterolemia, lung CA with right upper
lobe resection in [**2146**], paroxysmal atrial fibrillation,
diverticulitis, status post transverse loop colonoscopy,
small bowel obstruction in [**2145**], chronic renal insufficiency,
depression, osteoarthritis, DJD with compression fractures,
and right cataract surgery.

ALLERGIES:  The patient is allergic to metronidazole, iodine,
and Plavix.

She is positive for MRSA and VRE.

ADMISSION MEDICATIONS:
1.  Fosamax 70 p.o. q. week.
2.  Cardizem 200 mg p.o. q.a.m.
3.  Lipitor 20 mg p.o. q.h.s.
4.  Prinivil 15 mg p.o. q.d.
5.  Calcium carbonate/vitamin D 500 15 mg p.o. q.h.s.
6.  Colace 100 mg p.o. b.i.d.
7.  Folic acid 1 mg p.o. q.d.
8.  Acular one drop to the right eye q.h.s.
9.  Prevacid 30 mg p.o. b.i.d.
10. Magnesium oxide 400 mg p.o. q.a.m.
11. Niferex 150 mg p.o. b.i.d.
12. Senna two tablets p.o. q.h.s.
13. MVI one p.o. q.d.
14. Vitamin B one p.o. q.a.m.

PHYSICAL EXAMINATION ON ADMISSION:  General:  The patient
denied back pain currently.  Denied chest pain or shortness
of breath.  She is sitting in a wheelchair, an elderly female
in no acute distress.  Vital signs:  BP 120/62, pulse 74,
respiratory rate 20, saturations 96%.  HEENT:  Pupils equal,
round, and reactive to light.  EOMs full.  Mucous membranes
moist.  No palpable lymph nodes.  Cataract in the right eye.
Pulmonary:  Decreased breath sounds in the upper lobes, lower
lobes with crackles bilaterally.  Abdomen:  Multiple old
incisional scars, positive bowel sounds with also a
colostomy.  Extremities:  Scaly skin, no edema, no clubbing.
Neurologic:  Awake, alert, and oriented times three.  Cranial
nerves, II through XII, intact.  Smile symmetric.  Motor
strength in the lower extremities [**3-28**] in the bilateral ATs,
otherwise she had [**5-28**] muscle strength.  Her sensation was
intact to light touch.  Joint position sense was intact.  She
has no bowel or bladder incontinence.

HOSPITAL COURSE:  On admission, she was seen by the Pulmonary
Service due to her CHF.  She has been recommended regular
bronchodilators also preoperative ABGs, PFTs, and aggressive
analgesia postoperatively for pain.

The patient was taken to the OR on [**2159-6-11**] and underwent an
L4-S1 lumbar fusion with pedicle screw fixation.  The patient
tolerated the procedure well.  Postoperatively, she was
monitored in the Recovery Room overnight.  Her vital signs
were stable.  She was afebrile.  She had a chest x-ray which
showed no infiltrates.  She was weaned to extubate.

On postoperative day number one, her drains were discontinued
and she was transferred to the regular floor.  She was out of
bed in a brace.  She was doing well.

On [**2159-6-13**], the patient had an episode of shortness of
breath with decreased sats into the 70s.  A chest x-ray
showed aspiration and a question of a small episode of CHF.
The patient was given IV Lasix and the patient had been
getting Lasix postoperatively to prevent respiratory failure.
The patient was transferred to the ICU where she did not
require any intubation.  Her oxygenation was maximized with a
face mask and she diuresed 400-600 cc of fluid after getting
Lasix.

She was also seen by the Renal Service due to her renal
insufficiency and her inability to diurese well given the IV
Lasix.  Renal just recommended keeping her blood pressure
above 120 and diuresing her to get her fluid balance to be -1
to 1.5 liters per day.  This was achieved and the patient was
stabilized from a respiratory standpoint.  She was then
transferred back to the floor on [**2159-6-15**] where she has
remained neurologically and respiratory wise stable.  Her
vital signs are stable.  She was afebrile.

She was also seen by the Cardiology Service for a question of
troponin leak of 2.8 and there was a question of myocardial
ischemia.  Cardiology was consulted and they recommended just
a baby aspirin per day.  The patient had no chest pain.  She
has remained stable cardiac wise.

She was seen by Physical Therapy and Occupational Therapy and
found to require rehabilitation.  Respiratory wise, she is
down to 2 liters nasal cannula.  She does have some basilar
crackles in the right lower lobe, otherwise clear.  The heart
rate has been 72, respiratory rate 24.  She is stable and
ready for transfer to rehabilitation with follow-up with Dr.
[**Last Name (STitle) 1327**] in one week for staple removal.

DISCHARGE MEDICATIONS:
1.  Levofloxacin 250 mg p.o. q. 24 hours.
2.  Albuterol nebulizers one neb q. four hours p.r.n.
3.  Metoprolol 25 mg p.o. b.i.d.
4.  Percocet one to two tablets p.o. q. four hours p.r.n.
5.  Subcutaneous heparin 5,000 units q. 12 hours.
6.  Fluticasone propionate 110 micrograms four puffs inhaler
b.i.d.
7.  Albuterol two puffs inhaler q. six hours.
8.  Milk of magnesia 30 cc p.o. q.h.s. p.r.n.
9.  .................... 50 micrograms p.o. q.d.
10. Multivitamin one cap p.o. q.d.
11. Senna one tablet p.o. q.h.s.
12. Polysaccharide iron complex 150 mg p.o. b.i.d.
13. Lansoprazole 30 mg p.o. b.i.d.
14. Acular one drop O.D. q.h.s.
15. Folic acid 1 mg p.o. q.d.
16. Colace 100 mg p.o. b.i.d.
17. Calcium carbonate 500 mg p.o. q.h.s.
18. Lisinopril 5 mg p.o. q.d.
19. Atorvostatin 20 mg p.o. q.h.s.
20. Amiodarone 200 mg p.o. q.d.
21. Alendronate sodium 70 mg p.o. q. Tuesday.
22. Aspirin 81 mg p.o. q.d.
23. Ipratropium bromide MDI two puffs q.i.d.

CONDITION ON DISCHARGE:  Stable.

FOLLOW-UP:  The patient will follow-up with Dr. [**Last Name (STitle) 1327**] in one
week for staple removal.



                            [**Name6 (MD) 1339**] [**Last Name (NamePattern4) 1340**], M.D.  [**MD Number(1) 1341**]

Dictated By:[**Last Name (NamePattern1) 344**]
MEDQUIST36

D:  [**2159-6-19**]  10:48
T:  [**2159-6-19**]  10:59
JOB#:  [**Job Number 48121**]
{'Pathologic fracture of vertebrae,Cardiac complications, not elsewhere classified,Acute myocardial infarction of unspecified site, initial episode of care,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Congestive heart failure, unspecified,Spinal stenosis, lumbar region, without neurogenic claudication,Pure hypercholesterolemia'}


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: 

PRESENT ILLNESS: The patient is a 75-year-old
woman transferred from [**Hospital1 700**] for an L5
laminectomy and L4-S1 fusion.  Mrs. [**Known lastname 28181**] has an extensive
medical history, most recently she had been hospitalized in
[**Month (only) 958**] for COPD exacerbation.  She has a compression fracture,
diverticulitis, chronic renal insufficiency, anemia, and
hypertension.  She has had COPD with three intubations in the
past, CAD, hypertension, carotid disease, status post CEA and
colostomy, hypercholesterolemia, lung CA with right upper
lobe resection in [**2146**], paroxysmal atrial fibrillation,
diverticulitis, status post transverse loop colonoscopy,
small bowel obstruction in [**2145**], chronic renal insufficiency,
depression, osteoarthritis, DJD with compression fractures,
and right cataract surgery.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: The patient is allergic to metronidazole, iodine,
and Plavix.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Pathologic fracture of vertebrae,Cardiac complications, not elsewhere classified,Acute myocardial infarction of unspecified site, initial episode of care,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Congestive heart failure, unspecified,Spinal stenosis, lumbar region, without neurogenic claudication,Pure hypercholesterolemia'}
