CHIEF COMPLAINT: Fever and abdominal pain.

PRESENT ILLNESS: 66 F with known metastatic renal cell carcinoma, was admitted on
[**2163-11-25**] with fever and worsening abdominal pain. She had been
scheduled for a left debulking nephrectomy on [**2163-11-28**].

MEDICAL HISTORY: 1. emphysema/COPD
2. osteoporosis
3. fibrocystic breasts
4. s/p appendectomy
5. s/p ovarian cystectomy
6. s/p shoulder surgery
7. stage IV renal cell carcinoma

MEDICATION ON ADMISSION: Ativan 0.5"' prn, percocet prn, morphine IR 15"

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Temp 98.2, HR 104, BP 118/60, RR 16, SaO2 94% on 3 liters NC.
Gen: A&O x3, comfortable.
Chest: CTA bilaterally, slightly diminished bases.  Mildly
tachycardic, S1 S2.
Abdomen: Incision c/d/i.  Soft, non-tender, mildly distended.
Extremities: 1+ pedal edema, improving.

FAMILY HISTORY: non-contrib

SOCIAL HISTORY: non-contrib
Diverticulosis of colon (without mention of hemorrhage),Peritonitis (acute) generalized,Congestive heart failure, unspecified,Malignant neoplasm of renal pelvis,Bacteremia,Secondary malignant neoplasm of retroperitoneum and peritoneum,Pressure ulcer, buttock,Accidental puncture or laceration during a procedure, not elsewhere classified,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Chronic airway obstruction, not elsewhere classified,Other disorders of plasma protein metabolism,Peritoneal adhesions (postoperative) (postinfection),Osteoporosis, unspecified
Dvrtclo colon w/o hmrhg,Peritonitis (acute) gen,CHF NOS,Malig neo renal pelvis,Bacteremia,Sec mal neo peritoneum,Pressure ulcer, buttock,Accidental op laceration,Mal neo lymph intra-abd,Chr airway obstruct NEC,Dis plas protein met NEC,Peritoneal adhesions,Osteoporosis NOS
Admission Date:  [**2163-11-25**]              Discharge Date:   [**2163-12-15**]

Date of Birth:  [**2097-3-18**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern1) 15344**]
Chief Complaint:
Fever and abdominal pain.

Major Surgical or Invasive Procedure:
1. Sigmoid colectomy/Low anterior resection with end colostomy
and Hartmann's procedure.
2. Feeding jejunostomy
3. Wound re-exploration

History of Present Illness:
66 F with known metastatic renal cell carcinoma, was admitted on
[**2163-11-25**] with fever and worsening abdominal pain. She had been
scheduled for a left debulking nephrectomy on [**2163-11-28**].

Past Medical History:
1. emphysema/COPD
2. osteoporosis
3. fibrocystic breasts
4. s/p appendectomy
5. s/p ovarian cystectomy
6. s/p shoulder surgery
7. stage IV renal cell carcinoma

Social History:
non-contrib

Family History:
non-contrib

Physical Exam:
Temp 98.2, HR 104, BP 118/60, RR 16, SaO2 94% on 3 liters NC.
Gen: A&O x3, comfortable.
Chest: CTA bilaterally, slightly diminished bases.  Mildly
tachycardic, S1 S2.
Abdomen: Incision c/d/i.  Soft, non-tender, mildly distended.
Extremities: 1+ pedal edema, improving.

Pertinent Results:
[**2163-12-15**] 06:15AM BLOOD WBC-13.5* RBC-2.79* Hgb-7.7* Hct-23.2*
MCV-83 MCH-27.5 MCHC-33.0 RDW-14.8 Plt Ct-449*
[**2163-12-15**] 06:15AM BLOOD Neuts-90.1* Lymphs-5.8* Monos-3.1 Eos-1.0
Baso-0.1
[**2163-12-15**] 06:15AM BLOOD Hypochr-1+
[**2163-11-25**] 04:30PM BLOOD Hypochr-NORMAL Anisocy-NORMAL
Poiklo-NORMAL Macrocy-NORMAL Microcy-NORMAL Polychr-NORMAL
[**2163-12-15**] 06:15AM BLOOD Plt Ct-449*
[**2163-12-15**] 06:15AM BLOOD Glucose-126* UreaN-21* Creat-0.4 Na-139
K-3.8 Cl-102 HCO3-32 AnGap-9
[**2163-12-13**] 05:57AM BLOOD ALT-13 AST-18 AlkPhos-130* Amylase-132*
TotBili-0.2
[**2163-12-13**] 05:57AM BLOOD Lipase-87*
[**2163-12-15**] 06:15AM BLOOD Calcium-8.1* Phos-3.6 Mg-1.6


Brief Hospital Course:
Ms. [**Known lastname 42326**] was admitted on [**2163-11-25**] to the urology service under
the care of Dr. [**Last Name (STitle) 4229**]. A CXR showed a left pleural effusion and
LLL atelectasis. She was placed on Zithromax for a presumed LLL
pneumonia. Over the next 2 days, her blood cultures from the ED
grew gram negative rods. Gentamycin was added, and plans for the
OR were cancelled. A medicine consult was obtained to help work
up her bacteremia, continued tachycardia, new hypoxia on RA, and
ongoing emesis. A CTA of her chest showed no evidence of a PE
but increasing bilateral pleural effusions.  On [**2162-11-29**], Ms.
[**Known lastname 65022**] care was transferred to the medical service due to her
multiple medical problems.
  Surgical consultation was obtained for abdominal distension
and pain.  CT scan confirmed a colonic perforation with stool
and PO contrast in the abdominal cavity.  After much
deliberation by the patient and family, it was decided to
undergo operative intervention.  The patient was brought
emergently to the operating room and had a sigmoid colectomy/LAR
with end colostomy and Hartmann's procedure and jejunal feeding
tube placement.  For details of this, please see the previously
dictated operative note.
  Post-operatively, the patient did well and remained in the ICU
for vent weaning.  On post-operative day #2, the patient was
noted to have copious serous drainage from the inferior aspect
of her wound.  The wound was locally explored and fascia was
intact.  Continued drainage, however, prompted re-evaulation of
the entire wound in the operating room which was found to be
intact.  For details of this, please see the previously dictated
operative note.
  Otherwise, the patient had a fairly unremarkable hospital
course.  She extubated uneventfully and was transferred to the
floor.  She tolerated jejunal tube feeds and bedside and video
swallow evaluation showed some risk of aspiration which is
controlled via chin tuck maneuver.  The stoma is healthy and
functions well.  IV antibiotics were continued for a two week
course, and transitioned to PO for an additional one week.

Neuro: fentanyl patch, Roxicet elixir for pain control
Respiratory: Mucomyst nebs to help mobilize secretions,
humidified O2 for comfort
CV: Lopressor for beta-blockade, although she has been
persistently tachycardic pre and post-op
GI: tube feeds for nutritional support, ground solids/thin
liquids per nutritional recommendation
GU: Lasix for diuresis of peri-op fluids, continue to re-assess
need
Heme: hematocrit stable at 24
ID: Levaquin, fluconazole and Flagyl to continue for one week
Endocrine: insulin sliding scale for glucose control

Medications on Admission:
Ativan 0.5"' prn, percocet prn, morphine IR 15"

Discharge Medications:
1. Calcitonin (Salmon) 200 unit/Actuation Aerosol, Spray Sig:
One (1)  Nasal DAILY (Daily).
2. Acetaminophen 160 mg/5 mL Solution Sig: Six [**Age over 90 1230**]y
(650) mg PO Q4-6H (every 4 to 6 hours) as needed.
3. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Six
(6) Puff Inhalation Q4H (every 4 hours) as needed.
4. Artificial Tear Ointment 0.1-0.1 % Ointment Sig: One (1) Appl
Ophthalmic  PRN (as needed).
5. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
6. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO Q4-6H (every 4 to 6 hours) as needed.
7. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4
to 6 hours) as needed for anxiety.
8. Fentanyl 100 mcg/hr Patch 72HR Sig: One (1) Patch 72HR
Transdermal Q72H (every 72 hours).
9. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 7 days.
10. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 7 days: total of seven days - last doses on
[**2163-12-20**].
11. Fluconazole 200 mg Tablet Sig: Two (2) Tablet PO Q24H (every
24 hours) for 7 days: total of seven days - last doses on
[**2163-12-20**].
12. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical  QID
(4 times a day) as needed.
13. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
Two (2) Capsule, Sustained Release PO DAILY (Daily) for 7 days:
hold for K>4.5
- while pt. taking lasix .
14. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day): for a total of seven days - last doses to be given
on [**2163-12-20**].
15. Acetylcysteine 20 % (200 mg/mL) Solution Sig: One (1) ML
Miscell.  Q6H (every 6 hours) as needed.
16. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) mL
Injection TID (3 times a day).


Discharge Disposition:
Extended Care

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

Discharge Diagnosis:
Sigmoid-rectal perforation.  Stage IV renal cell carcinoma.


Discharge Condition:
Stable.


Discharge Instructions:
around feeding tube site, or any other concern
- pt. may eat a ground food and thin liquids diet; taking 2 sips
of fluid between each bite of food and tucking chin when
swallowing liquids.
- repeat video swallow evaluation should be obtained in 2 weeks
time
- Pt. should resume home medications
- Pt. may take a sponge bath
- dressing over central line site may be removed [**2163-12-16**]
- [**Name8 (MD) 138**] MD or return to ER if T>101.5, chills, nausea, vomiting,
chest pain, shortness of breath, erythema/pus around feeding
tube site, or any other concern
- Patient has been been on Lasix for diuresis of peri-operative
fluids.  Please continue to assess need for ongoing diuresis.

Followup Instructions:
pt. should call Dr.[**Name (NI) 30985**] office at ([**Telephone/Fax (1) 10820**] to set up
a follow-up appointment in 2 weeks time.



Completed by:[**0-0-0**]
{'Diverticulosis of colon (without mention of hemorrhage),Peritonitis (acute) generalized,Congestive heart failure, unspecified,Malignant neoplasm of renal pelvis,Bacteremia,Secondary malignant neoplasm of retroperitoneum and peritoneum,Pressure ulcer, buttock,Accidental puncture or laceration during a procedure, not elsewhere classified,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Chronic airway obstruction, not elsewhere classified,Other disorders of plasma protein metabolism,Peritoneal adhesions (postoperative) (postinfection),Osteoporosis, unspecified'}


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: Fever and abdominal pain.

PRESENT ILLNESS: 66 F with known metastatic renal cell carcinoma, was admitted on
[**2163-11-25**] with fever and worsening abdominal pain. She had been
scheduled for a left debulking nephrectomy on [**2163-11-28**].

MEDICAL HISTORY: 1. emphysema/COPD
2. osteoporosis
3. fibrocystic breasts
4. s/p appendectomy
5. s/p ovarian cystectomy
6. s/p shoulder surgery
7. stage IV renal cell carcinoma

MEDICATION ON ADMISSION: Ativan 0.5"' prn, percocet prn, morphine IR 15"

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Temp 98.2, HR 104, BP 118/60, RR 16, SaO2 94% on 3 liters NC.
Gen: A&O x3, comfortable.
Chest: CTA bilaterally, slightly diminished bases.  Mildly
tachycardic, S1 S2.
Abdomen: Incision c/d/i.  Soft, non-tender, mildly distended.
Extremities: 1+ pedal edema, improving.

FAMILY HISTORY: non-contrib

SOCIAL HISTORY: non-contrib 

### Response:
{'Diverticulosis of colon (without mention of hemorrhage),Peritonitis (acute) generalized,Congestive heart failure, unspecified,Malignant neoplasm of renal pelvis,Bacteremia,Secondary malignant neoplasm of retroperitoneum and peritoneum,Pressure ulcer, buttock,Accidental puncture or laceration during a procedure, not elsewhere classified,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Chronic airway obstruction, not elsewhere classified,Other disorders of plasma protein metabolism,Peritoneal adhesions (postoperative) (postinfection),Osteoporosis, unspecified'}
