CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 74 year old
gravida 1, para 1 who has been aware of vaginal prolapse for
an indeterminate length of time.  She is often unable to
urinate and when she does urinate she does so frequently and
in small amounts.  She has difficulty moving her bowels and
says that the prolapse becomes larger when she is on the
toilet.  She had urinary stress incontinence which was
treated with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 19143**] bladder suspension in [**2164**] using Dacron
and [**Doctor Last Name 4726**]-Tex material.  She is not currently incontinent of
urine.  She is not sexually active.

MEDICAL HISTORY: Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Denies tobacco or alcohol use.  Communicates
with ASO, recently suffered the loss of her husband.
Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Urinary complications, not elsewhere classified,Acute kidney failure, unspecified,Acidosis,Stress incontinence, female,Unspecified essential hypertension
Hemorrhage complic proc,Ac posthemorrhag anemia,Surg compl-urinary tract,Acute kidney failure NOS,Acidosis,Fem stress incontinence,Hypertension NOS
Admission Date:  [**2169-11-21**]       Discharge Date:  [**2169-11-24**]

Date of Birth:   [**2095-3-26**]       Sex:  F

Service:  Gynecology

HISTORY OF PRESENT ILLNESS:  The patient is a 74 year old
gravida 1, para 1 who has been aware of vaginal prolapse for
an indeterminate length of time.  She is often unable to
urinate and when she does urinate she does so frequently and
in small amounts.  She has difficulty moving her bowels and
says that the prolapse becomes larger when she is on the
toilet.  She had urinary stress incontinence which was
treated with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 19143**] bladder suspension in [**2164**] using Dacron
and [**Doctor Last Name 4726**]-Tex material.  She is not currently incontinent of
urine.  She is not sexually active.

PAST GYNECOLOGIC HISTORY:  Negative PAP smear within the past
year.

PAST OBSTETRIC HISTORY:  Normal spontaneous vaginal delivery
times one.

PAST MEDICAL HISTORY:  Hypertension.

PAST SURGICAL HISTORY:  [**Last Name (un) 19143**] suspension in [**2164**],
hysterectomy in the distant past.

MEDICATIONS:  Hydrochlorothiazide 25 mg q. day, Lisinopril 5
mg q. day, Atenolol 25 mg q. day, Premarin 0.625 mg q. day,
Ibuprofen 600 mg prn.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  Denies tobacco or alcohol use.  Communicates
with ASO, recently suffered the loss of her husband.

PHYSICAL EXAMINATION:  Weight 121 pounds, blood pressure
140/90.  General: In no acute distress.  Heart:  No murmurs,
regular rate and rhythm.  Lungs clear to auscultation
bilaterally.  Breasts, negative.

Pelvic examination:  External genitalia negative.  Support
reveals entire vagina everted, when the prolapse was
reduced, the patient leaked urine just with sitting up.
Vagina negative.  Cervix not visible.  Uterus and adnexa not
palpable.  Rectal negative.

ASSESSMENT:  The patient is a 74 year old post menopausal
gravida 1, para 1 with complete vaginal vault prolapse.
Risks and benefits of anterior/posterior colporrhaphy,
sacrospinous colpopexy and pubourethral sling by SPARC had
been discussed by the patient.  Consent form was signed.

HOSPITAL COURSE:  On [**2169-11-21**], the patient underwent
anterior/posterior colporrhaphy, sacrospinous colpopexy,
SPARC pubourethral sling and cystoscopy for a total vaginal vault
prolapse.
Surgery was complicated by severe hemorrhage with 4,250 cc
blood loss.  The patient received 5 units of packed red blood
cells during the procedure.  Please see operative note for
full details.  Postoperatively, the patient remained
intubated and was transferred to the Intensive Care Unit for
"monitoring."  Except for a brief episode of hypotension in
the Recovery Room, the patient was otherwise hemodynamically
stable and not requiring any blood pressure support.  The
patient received two additional packed red blood cells on
postoperative day #0.  The patient remained very stable and
on postoperative day #1 she was extubated and transferred to
the regular floor.

1.  Respiratory - The patient was extubated on postoperative
day #1.  Her oxygen saturations were 98 to 100% on room air.

2.  Hematology - The patient's hematocrit remained stable at
approximately 28.  She had a vaginal pack placed
intraoperatively which was removed on postoperative day #1.
There was staining of the pack but it was but it was not
soaked.  She had minimal vaginal bleeding the remainder of
her postoperative course.  The patient had received 7 units
of packed red blood cells in total this admission.

3.  Renal - Postoperatively the patient's creatinine had
increased to 1.7 and peaked at 2.1.  Renal ultrasound was
negative for hydronephrosis.  The fractional secretion of
sodium was calculated to be 1.3, acute renal failure
necrosis.  The patient was well hydrated and her creatinine
decreased to a level of 1.7 at the time of discharge.  The
patient was advised to remain off any nephrotoxic medications
such as Lisinopril, Hydrochlorothiazide, and nonsteroidal
anti-inflammatories until her renal function had resolved.

4.  Other  postoperative issues - The patient tolerated a
regular diet.  She was ambulating independently.  On
postoperative day #2 she had failed a voiding trial and the
Foley catheter was replaced.  However, on postoperative day
#3 she was able to void spontaneously without difficulty.

The patient was doing well on postoperative day #3 and was
discharged home.

DISCHARGE INSTRUCTIONS:
1.  The patient was instructed to place nothing in the vagina
for the next month.
2.  The patient is to void straining with bowel movements by
using Colace.
3.  The patient was instructed to avoid nephrotoxic
medications.
4.  The patient was instructed to follow up with her primary
care physician for blood pressure check within the next week.
The patient is also to follow up with Dr. [**Last Name (STitle) **].

DISCHARGE MEDICATIONS:
1.  Percocet 1 tablet p.o. q. 4 hours prn
2.  Atenolol 25 mg p.o. q. day

DISCHARGE CONDITION:  Stable.


                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 19144**]

Dictated By:[**Last Name (NamePattern1) 19145**]
MEDQUIST36

D:  [**2169-11-26**]  09:22
T:  [**2169-11-26**]  20:27
JOB#:  [**Job Number 19146**]
{'Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Urinary complications, not elsewhere classified,Acute kidney failure, unspecified,Acidosis,Stress incontinence, female,Unspecified essential hypertension'}


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 74 year old
gravida 1, para 1 who has been aware of vaginal prolapse for
an indeterminate length of time.  She is often unable to
urinate and when she does urinate she does so frequently and
in small amounts.  She has difficulty moving her bowels and
says that the prolapse becomes larger when she is on the
toilet.  She had urinary stress incontinence which was
treated with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 19143**] bladder suspension in [**2164**] using Dacron
and [**Doctor Last Name 4726**]-Tex material.  She is not currently incontinent of
urine.  She is not sexually active.

MEDICAL HISTORY: Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Denies tobacco or alcohol use.  Communicates
with ASO, recently suffered the loss of her husband. 

### Response:
{'Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Urinary complications, not elsewhere classified,Acute kidney failure, unspecified,Acidosis,Stress incontinence, female,Unspecified essential hypertension'}
