CHIEF COMPLAINT: asymptomatic LLL nodule found on CT scan after MVC

PRESENT ILLNESS: The patient is a 61-year-old
woman with a biopsy-proven stage IIIA lung cancer.  She
underwent induction chemotherapy and radiation and had a good
response.  She presents for resection.

MEDICAL HISTORY: -Diabetes Mellitus, BS poorly controlled ranging from 120 - 400
-Hypercholesterolemia, hypertriglyceridemia
-CAD, MI x 3, most recently in [**2088**] w/ PCI at that time
-Peripheral vascular disease s/p b/l iliac stenting
-Acute pancreatitis x 3 thought to be secondary to
-hypertriglyceridemia
-Adrenal mass (Bx negative for cancer)

MEDICATION ON ADMISSION: atenolol 25', plavix 75', gemfibrozil 600", lantus 64 qAM,
lispro SSI TID, lisinopril 10', lorazepam 0.5-1 q4h, ranitidine
150", crestor 20', ASA325, omega 3, MVI

ALLERGIES: Simvastatin / Codeine / Latex

PHYSICAL EXAM: BP: 108/63. Heart Rate: 77. Weight: 142.4. Height: 63.25. BMI:
25.0. Temperature: 97. Resp. Rate: 16. Pain Score: 0. O2
Saturation%: 98.
Gen: A&O, NAD
CV: RRR, no M/R/G
Pulm: CTAB. TTP over left lower ribs anteriorly.
Abd: S/NT/ND
Ext: w/d, no edema

FAMILY HISTORY: Father with heart disease and prostate cancer at
the age of 78.  Mother with diabetes.  She has three siblings
without a history of cancer.

SOCIAL HISTORY: She lives alone.  She has one son, [**Name (NI) 2855**].
She previously smoked for approximately 45
years, starting with three packs per day.  In the last 10 years,
she has smoked one pack per day.  She denies alcohol use
currently, but previously drank socially.  Her last alcoholic
beverage was 17 years ago.  She works as an insurance salesman.
Other iatrogenic hypotension,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Thoracoscopic surgical procedure converted to open procedure,Polyneuropathy in diabetes,Background diabetic retinopathy,Long-term (current) use of insulin,Personal history of tobacco use,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Peripheral vascular disease, unspecified,Esophageal reflux,Malignant neoplasm of lower lobe, bronchus or lung,Acute posthemorrhagic anemia
Iatrogenc hypotnsion NEC,Hyperlipidemia NEC/NOS,Hypertension NOS,DMII neuro nt st uncntrl,Thoracoscop conv to open,Neuropathy in diabetes,Diabetic retinopathy NOS,Long-term use of insulin,History of tobacco use,Crnry athrscl natve vssl,Old myocardial infarct,Periph vascular dis NOS,Esophageal reflux,Mal neo lower lobe lung,Ac posthemorrhag anemia
Admission Date:  [**2104-4-2**]              Discharge Date:   [**2104-4-8**]

Date of Birth:  [**2043-1-31**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Simvastatin / Codeine / Latex

Attending:[**First Name3 (LF) 5790**]
Chief Complaint:
asymptomatic LLL nodule found on CT scan after MVC

Major Surgical or Invasive Procedure:
[**2104-4-2**]
Left exploratory thoracoscopy, left thoracotomy,
and left lower lobectomy, mediastinal lymph node dissection,
intercostal muscle flap buttress.


History of Present Illness:
The patient is a 61-year-old
woman with a biopsy-proven stage IIIA lung cancer.  She
underwent induction chemotherapy and radiation and had a good
response.  She presents for resection.

Past Medical History:
-Diabetes Mellitus, BS poorly controlled ranging from 120 - 400
-Hypercholesterolemia, hypertriglyceridemia
-CAD, MI x 3, most recently in [**2088**] w/ PCI at that time
-Peripheral vascular disease s/p b/l iliac stenting
-Acute pancreatitis x 3 thought to be secondary to
-hypertriglyceridemia
-Adrenal mass (Bx negative for cancer)

Social History:
She lives alone.  She has one son, [**Name (NI) 2855**].
She previously smoked for approximately 45
years, starting with three packs per day.  In the last 10 years,
she has smoked one pack per day.  She denies alcohol use
currently, but previously drank socially.  Her last alcoholic
beverage was 17 years ago.  She works as an insurance salesman.


Family History:
Father with heart disease and prostate cancer at
the age of 78.  Mother with diabetes.  She has three siblings
without a history of cancer.


Physical Exam:
BP: 108/63. Heart Rate: 77. Weight: 142.4. Height: 63.25. BMI:
25.0. Temperature: 97. Resp. Rate: 16. Pain Score: 0. O2
Saturation%: 98.
Gen: A&O, NAD
CV: RRR, no M/R/G
Pulm: CTAB. TTP over left lower ribs anteriorly.
Abd: S/NT/ND
Ext: w/d, no edema


Pertinent Results:
[**2104-4-2**] 10:52AM   HGB-9.6* calcHCT-29 O2 SAT-99
[**2104-4-2**] 10:52AM   GLUCOSE-173* LACTATE-1.7 NA+-137 K+-4.3
CL--106
[**2104-4-2**] 03:08PM   WBC-8.8# RBC-2.99* HGB-10.1* HCT-27.6* MCV-92
MCH-33.9* MCHC-36.7* RDW-14.4
[**2104-4-2**] 03:08PM   GLUCOSE-249* UREA N-27* CREAT-0.7 SODIUM-135
POTASSIUM-4.2 CHLORIDE-104 TOTAL CO2-24 ANION GAP-11

[**2104-4-5**] CXR:
Interval removal of left chest tube. Tiny left-sided
pneumothorax present, decreased compared with [**2104-4-4**].
Otherwise, no
significant interval change.


Brief Hospital Course:
Ms. [**Known lastname 93746**] was admitted to the hospital and taken to the
Operating Room where she underwent a Left VATS converted to open
thoracotomy (See formal op note for details).  She tolerated the
procedure well and returned to the PACU in stable condition. Her
pain was initially controlled with an epidural catheter and she
maintained stable hemodynamics.

Following transfer to the Surgical Floor she continued to make
good progress.  Her oxygen was gradually weaned off and her room
air saturations were 96%.  She was able to use her incentive
spirometer effectively.  Following removal of her chest tube and
epidural catheter her pain was not controlled on oral
medications and she requires a Dilaudid PCA which was effective
along with some Toradol.  She was eventually placed on oral
Dilaudid and schedule Ultram and Tylenol and was then able to
get up and walk independently and continue use of the Incentive
spirometer. Constipation was a problem which was treated with
Dulcolax and Mirilax effectively.

Her blood sugars were initially in the mid 200 range post op but
decreased after her home Lantus and sliding scale coverage was
resumed.  She was tolerating a diabetic diet without difficulty.
 Her left thoracotomy incision was healing well. After a
relatively uneventful recovery she was discharged to home on
[**2104-4-8**] and will return to the Thoracic Clinic in 2 weeks.

Medications on Admission:
atenolol 25', plavix 75', gemfibrozil 600", lantus 64 qAM,
lispro SSI TID, lisinopril 10', lorazepam 0.5-1 q4h, ranitidine
150", crestor 20', ASA325, omega 3, MVI


Discharge Medications:
1. rosuvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed for constipation.
4. senna 8.6 mg Tablet Sig: Two (2) Tablet PO at bedtime as
needed for constipation.
5. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
6. ferrous sulfate 300  mg (60 mg iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
7. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q8H (every
8 hours).
8. gemfibrozil 600 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
9. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*100 Tablet(s)* Refills:*0*
10. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily): on for
12 hours, off for 12 hours.
Disp:*14 Adhesive Patch, Medicated(s)* Refills:*2*
11. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. insulin glargine 100 unit/mL Solution Sig: Sixty Four (64)
units Subcutaneous once a day.
13. insulin lispro 100 unit/mL Solution Sig: per sliding scale
coverage units Subcutaneous three times a day: before meals.
14. tramadol 50 mg Tablet Sig: One (1) Tablet PO QID (4 times a
day).
Disp:*120 Tablet(s)* Refills:*2*
15. atenolol 25 mg Tablet Sig: One (1) Tablet PO once a day.
16. Plavix 75 mg Tablet Sig: One (1) Tablet PO once a day.
17. aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Home

Discharge Diagnosis:
Left lower lobe lung cancer.
Acute blood loss anemia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
* You were admitted to the hospital for lung surgery and you've
recovered well. You are now ready for discharge.
* Continue to use your incentive spirometer 10 times an hour
while awake.
* Check your incisions daily and report any increased redness or
drainage.   Cover the area with a gauze pad if it is draining.
* You will continue to need pain medication once you are home
but you can wean it over a few weeks as the discomfort resolves.
 Make sure that you have regular bowel movements while on
narcotic pain medications as they are constipating which can
cause more problems.  Use a stool softener or gentle laxative to
stay regular.
* No driving while taking narcotic pain medication.
* Take Tylenol  1000 mg every 8 hours in between your narcotic.
If your doctor allows you may also take Ibuprofen to help
relieve the pain.
* Check your blood sugars 3 times a day and follow your sliding
scal that you have at home.
* Continue to stay well hydrated and eat well to heal your
incisions
* Shower daily. Wash incision with mild soap & water, rinse, pat
dry
* No tub bathing, swimming or hot tubs until incision healed
* No lotions or creams to incision site
* Walk 4-5 times a day and gradually increase your activity as
you can tolerate.

Call Dr.[**Name (NI) 2347**] office [**Telephone/Fax (1) 2348**] if you experience:
-Fevers > 101 or chills
-Increased shortness of breath, chest pain or any other symptoms
that concern you.




Followup Instructions:
Department: WEST [**Hospital 2002**] CLINIC
When: TUESDAY [**2104-4-15**] at 9:00 AM
With: [**Name6 (MD) 1532**] [**Last Name (NamePattern4) 8786**], MD [**Telephone/Fax (1) 3020**]
Building: De [**Hospital1 **] Building ([**Hospital Ward Name 121**] Complex) [**Location (un) **]
Campus: EAST     Best Parking: [**Street Address(1) 592**] Garage

Please report 30 minutes prior to your appointment to the
Raadiology Department on the th floor of the [**Hospital Ward Name 23**] Clinical
Center for a chest xray.

Department: CARDIAC SERVICES
When: WEDNESDAY [**2104-8-20**] at 10:00 AM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D. [**Telephone/Fax (1) 62**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage



Completed by:[**2104-4-8**]
{'Other iatrogenic hypotension,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Thoracoscopic surgical procedure converted to open procedure,Polyneuropathy in diabetes,Background diabetic retinopathy,Long-term (current) use of insulin,Personal history of tobacco use,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Peripheral vascular disease, unspecified,Esophageal reflux,Malignant neoplasm of lower lobe, bronchus or lung,Acute posthemorrhagic anemia'}


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: asymptomatic LLL nodule found on CT scan after MVC

PRESENT ILLNESS: The patient is a 61-year-old
woman with a biopsy-proven stage IIIA lung cancer.  She
underwent induction chemotherapy and radiation and had a good
response.  She presents for resection.

MEDICAL HISTORY: -Diabetes Mellitus, BS poorly controlled ranging from 120 - 400
-Hypercholesterolemia, hypertriglyceridemia
-CAD, MI x 3, most recently in [**2088**] w/ PCI at that time
-Peripheral vascular disease s/p b/l iliac stenting
-Acute pancreatitis x 3 thought to be secondary to
-hypertriglyceridemia
-Adrenal mass (Bx negative for cancer)

MEDICATION ON ADMISSION: atenolol 25', plavix 75', gemfibrozil 600", lantus 64 qAM,
lispro SSI TID, lisinopril 10', lorazepam 0.5-1 q4h, ranitidine
150", crestor 20', ASA325, omega 3, MVI

ALLERGIES: Simvastatin / Codeine / Latex

PHYSICAL EXAM: BP: 108/63. Heart Rate: 77. Weight: 142.4. Height: 63.25. BMI:
25.0. Temperature: 97. Resp. Rate: 16. Pain Score: 0. O2
Saturation%: 98.
Gen: A&O, NAD
CV: RRR, no M/R/G
Pulm: CTAB. TTP over left lower ribs anteriorly.
Abd: S/NT/ND
Ext: w/d, no edema

FAMILY HISTORY: Father with heart disease and prostate cancer at
the age of 78.  Mother with diabetes.  She has three siblings
without a history of cancer.

SOCIAL HISTORY: She lives alone.  She has one son, [**Name (NI) 2855**].
She previously smoked for approximately 45
years, starting with three packs per day.  In the last 10 years,
she has smoked one pack per day.  She denies alcohol use
currently, but previously drank socially.  Her last alcoholic
beverage was 17 years ago.  She works as an insurance salesman. 

### Response:
{'Other iatrogenic hypotension,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Thoracoscopic surgical procedure converted to open procedure,Polyneuropathy in diabetes,Background diabetic retinopathy,Long-term (current) use of insulin,Personal history of tobacco use,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Peripheral vascular disease, unspecified,Esophageal reflux,Malignant neoplasm of lower lobe, bronchus or lung,Acute posthemorrhagic anemia'}
