CHIEF COMPLAINT: 69 year old female admitted for weight reduction surgery.

PRESENT ILLNESS: The patient is a 69-year-old woman referred from
the GI service with severe reflux symptoms. She has been
treated with maximum medical therapy and on endoscopy was
noted to have a gaping lower esophageal sphincter and hiatal
hernia. She was referred for surgical options and was highly
motivated for laparoscopic repair if possible.

MEDICAL HISTORY: Gerd, hyperlipidemia, sinusitis, allergies and anxiety.

MEDICATION ON ADMISSION: Nexium, pravastatin, Effexor, fexofenadine

ALLERGIES: Flagyl / Keflex / Codeine

PHYSICAL EXAM: Physical Exam:  In general, she is alert and oriented x3 with
normal mood and affect.  Normal judgment and insight.  Normal
memory.  Eyes/vision.  Pupils are equal, round and reactive to
light and accommodation.  Conjunctivae are pink, Sclerae
anicteric.  Ears, nose, mouth, and throat:  Normal hearing.  She
has a class 3 airway.  Tongue is midline.  Mucosa is pink.  Neck
supple.  No masses.  Respiratory:  Breath sounds clear to
auscultation.  Cardiovascular:  Regular rate and rhythm, S1 and
S2 are normal.  Abdomen:  Soft, nontender, nondistended,
well-healed incisions.  Extremities:  No clubbing, cyanosis, or
edema.  Neurologically, cranial nerves II-XII are grossly
intact.
 Musculoskeletal:  Full range of motion in the upper extremities
and lower extremities, head, neck, spine, ribs, and pelvis,
normal gait.  Skin:  No rashes are identified.

FAMILY HISTORY: No significant past family medical history.

SOCIAL HISTORY: She is a nondrinker, nonsmoker.  She drinks occasional alcohol.
Diaphragmatic hernia without mention of obstruction or gangrene,Other and unspecified complications of medical care, not elsewhere classified,Swelling, mass, or lump in head and neck,Esophageal reflux,Other iatrogenic hypotension,Hypovolemia,Other and unspecified hyperlipidemia,Anxiety state, unspecified,Unspecified sinusitis (chronic),Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Diaphragmatic hernia,Complic med care NEC/NOS,Swelling in head & neck,Esophageal reflux,Iatrogenc hypotnsion NEC,Hypovolemia,Hyperlipidemia NEC/NOS,Anxiety state NOS,Chronic sinusitis NOS,Abn react-procedure NEC
Admission Date:  [**2173-9-21**]              Discharge Date:   [**2173-9-24**]

Date of Birth:  [**2104-8-24**]             Sex:   F

Service: SURGERY

Allergies:
Flagyl / Keflex / Codeine

Attending:[**First Name3 (LF) 301**]
Chief Complaint:
69 year old female admitted for weight reduction surgery.

Major Surgical or Invasive Procedure:
Status Post Lap nissen fundoplication with hiatal hernia repair
complicated by external jugular infiltration, neck swelling and
hypotension.


History of Present Illness:
The patient is a 69-year-old woman referred from
the GI service with severe reflux symptoms. She has been
treated with maximum medical therapy and on endoscopy was
noted to have a gaping lower esophageal sphincter and hiatal
hernia. She was referred for surgical options and was highly
motivated for laparoscopic repair if possible.

Past Medical History:
Gerd, hyperlipidemia, sinusitis, allergies and anxiety.

Social History:
She is a nondrinker, nonsmoker.  She drinks occasional alcohol.


Family History:
No significant past family medical history.


Physical Exam:
Physical Exam:  In general, she is alert and oriented x3 with
normal mood and affect.  Normal judgment and insight.  Normal
memory.  Eyes/vision.  Pupils are equal, round and reactive to
light and accommodation.  Conjunctivae are pink, Sclerae
anicteric.  Ears, nose, mouth, and throat:  Normal hearing.  She
has a class 3 airway.  Tongue is midline.  Mucosa is pink.  Neck
supple.  No masses.  Respiratory:  Breath sounds clear to
auscultation.  Cardiovascular:  Regular rate and rhythm, S1 and
S2 are normal.  Abdomen:  Soft, nontender, nondistended,
well-healed incisions.  Extremities:  No clubbing, cyanosis, or
edema.  Neurologically, cranial nerves II-XII are grossly
intact.
 Musculoskeletal:  Full range of motion in the upper extremities
and lower extremities, head, neck, spine, ribs, and pelvis,
normal gait.  Skin:  No rashes are identified.


Pertinent Results:
[**2173-9-21**] 01:15PM BLOOD WBC-13.5*# RBC-4.24 Hgb-13.0 Hct-38.7
MCV-91 MCH-30.7 MCHC-33.6 RDW-13.1 Plt Ct-190
[**2173-9-24**] 05:50AM BLOOD WBC-6.4# RBC-3.92* Hgb-12.0 Hct-35.5*
MCV-91 MCH-30.7 MCHC-33.9 RDW-13.0 Plt Ct-190
[**2173-9-22**] 03:13AM BLOOD Glucose-122* UreaN-10 Creat-0.6 Na-141
K-3.7 Cl-109* HCO3-23 AnGap-13
[**2173-9-24**] 05:50AM BLOOD Glucose-85 UreaN-16 Creat-0.6 Na-143
K-3.4 Cl-108 HCO3-27 AnGap-11
[**2173-9-21**] 03:56PM BLOOD Type-ART pO2-101 pCO2-48* pH-7.32*
calTCO2-26 Base XS--1
[**2173-9-22**] 12:32AM BLOOD Type-ART Rates-12/ PEEP-5 FiO2-50 pO2-89
pCO2-45 pH-7.40 calTCO2-29 Base XS-1 Intubat-INTUBATED
[**2173-9-21**] 03:56PM BLOOD freeCa-1.09*
[**2173-9-22**] 12:32AM BLOOD freeCa-1.16

[**2173-9-22**] Upper GI study
No evidence of leak or obstruction.


Brief Hospital Course:
Patient underwent a Lap nissen fundoplication with hiatal hernia
repair complicated by external jugular infiltration with
hypotension. She was transferred to the surgical intensive care
unit for 12 hours of intubation and close monitoring. She was
extubated on postoperative day one and transferred to floor. She
had an upper gi study which confirmed no leak or extravasation.
She was started on clears and advanced to mechanical soft diet.
Pain medication was given and adjusted as she is sensitive to
narcotics. She was encouraged to use her incentive spiromenter
and deep breathe and cough. On postoperative day 3 she is
tolerating a mechanical soft diet without nausea or vomiting.
She has an oxygen saturation of 94-99% on room air.

We will discharge her home today with her sister with return
appointment with Dr. [**Last Name (STitle) **] in one week.


Medications on Admission:
Nexium, pravastatin, Effexor, fexofenadine

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 2.5-5 MLs
PO Q4H (every 4 hours) as needed.
Disp:*250 ML(s)* Refills:*0*
2. Venlafaxine 37.5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Pravastatin 20 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
4. Colace 50 mg/5 mL Liquid Sig: Ten (10) ml PO twice a day.
Disp:*500 ml* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis: Severe Gerd


Discharge Condition:
Stable


Discharge Instructions:
You are being discharged on medications to treat the pain from
your operation. These medications will make you drowsy and
impair your ability to drive a motor vehicle or operate
machinery safely. You MUST  refrain from such activities while
taking these medications.


Please call your doctor or return to the emergency room if you
have any of the following:

 * You experience new chest pain, pressure, squeezing or
 tightness.

* New or worsening cough or wheezing.

* If you are vomiting and cannot keep in fluids or your
 medications.

* You are getting dehydrated due to continued vomiting,
 diarrhea or other reasons. Signs of dehydration include dry
 mouth, rapid heartbeat or feeling dizzy or faint when standing.

* You see blood or dark/black material when you vomit or have a
 bowel movement.


* You have shaking chills, or a fever greater than 101.5 (F)
 degrees or 38(C) degrees.

* Any serious change in your symptoms, or any new symptoms that
 concern you.

* Please resume all regular home medications and take any new
meds
 as ordered.
Activity:
No heavy lifting of items [**9-15**] pounds for 6 weeks. You may
resume moderate
exercise at your discretion, no abdominal exercises.

Wound Care:
You may shower, no tub baths or swimming.
If there is clear drainage from your incisions, cover with
clean, dry gauze.
Your steri-strips will fall off on their own. Please remove any
remaining strips 7-10 days after surgery.
Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites.


Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 304**], MD Phone:[**Telephone/Fax (1) 274**]
Date/Time:[**2173-10-1**] 1:45



Completed by:[**2173-9-24**]
{'Diaphragmatic hernia without mention of obstruction or gangrene,Other and unspecified complications of medical care, not elsewhere classified,Swelling, mass, or lump in head and neck,Esophageal reflux,Other iatrogenic hypotension,Hypovolemia,Other and unspecified hyperlipidemia,Anxiety state, unspecified,Unspecified sinusitis (chronic),Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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: 69 year old female admitted for weight reduction surgery.

PRESENT ILLNESS: The patient is a 69-year-old woman referred from
the GI service with severe reflux symptoms. She has been
treated with maximum medical therapy and on endoscopy was
noted to have a gaping lower esophageal sphincter and hiatal
hernia. She was referred for surgical options and was highly
motivated for laparoscopic repair if possible.

MEDICAL HISTORY: Gerd, hyperlipidemia, sinusitis, allergies and anxiety.

MEDICATION ON ADMISSION: Nexium, pravastatin, Effexor, fexofenadine

ALLERGIES: Flagyl / Keflex / Codeine

PHYSICAL EXAM: Physical Exam:  In general, she is alert and oriented x3 with
normal mood and affect.  Normal judgment and insight.  Normal
memory.  Eyes/vision.  Pupils are equal, round and reactive to
light and accommodation.  Conjunctivae are pink, Sclerae
anicteric.  Ears, nose, mouth, and throat:  Normal hearing.  She
has a class 3 airway.  Tongue is midline.  Mucosa is pink.  Neck
supple.  No masses.  Respiratory:  Breath sounds clear to
auscultation.  Cardiovascular:  Regular rate and rhythm, S1 and
S2 are normal.  Abdomen:  Soft, nontender, nondistended,
well-healed incisions.  Extremities:  No clubbing, cyanosis, or
edema.  Neurologically, cranial nerves II-XII are grossly
intact.
 Musculoskeletal:  Full range of motion in the upper extremities
and lower extremities, head, neck, spine, ribs, and pelvis,
normal gait.  Skin:  No rashes are identified.

FAMILY HISTORY: No significant past family medical history.

SOCIAL HISTORY: She is a nondrinker, nonsmoker.  She drinks occasional alcohol. 

### Response:
{'Diaphragmatic hernia without mention of obstruction or gangrene,Other and unspecified complications of medical care, not elsewhere classified,Swelling, mass, or lump in head and neck,Esophageal reflux,Other iatrogenic hypotension,Hypovolemia,Other and unspecified hyperlipidemia,Anxiety state, unspecified,Unspecified sinusitis (chronic),Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
