CHIEF COMPLAINT: unruptured aneurysm

PRESENT ILLNESS: Mrs [**Known lastname 39509**] is a 69yo woman who presented to [**Hospital3 **] on [**2161-3-6**] with a diagnosis of slurred speech and
the CT scan had shown
microvascular disease; however, MRI also showed a an anterior
communicating artery aneurysm. She now electively presents to
have this embolized.

MEDICAL HISTORY: major depression, bipolar disorder, obesity, hypertension,
hypercholesterolemia, asthma and possible obstructive sleep
apnea.

MEDICATION ON ADMISSION: fish oil, Ibuprofen prn, plavix 75mg daily x5days pre-op, ASA
325mg, HCTZ 25mg daily, Lisinopril 20mg daily, Remeron 30mg
daily, Simvastatin 40mg daily, Effexor 225mg QPM, Zyprexa 20mg
QHS

ALLERGIES: Haldol

PHYSICAL EXAM: non focal upon discharge.
groin site c/d/i with 1 suture

FAMILY HISTORY: is negative for aneurysms.

SOCIAL HISTORY: she is currently not employed, but has a BS degree.  She lives
with her husband and has a history of smoking.
Cerebral aneurysm, nonruptured,Major depressive affective disorder, recurrent episode, severe, without mention of psychotic behavior,Suicidal ideation,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Asthma, unspecified type, unspecified,Anxiety state, unspecified,Pure hypercholesterolemia,Obesity, unspecified,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Personal history of tobacco use
Nonrupt cerebral aneurym,Recur depr psych-severe,Suicidal ideation,Obstructive sleep apnea,Hypertension NOS,Asthma NOS,Anxiety state NOS,Pure hypercholesterolem,Obesity NOS,Hx TIA/stroke w/o resid,History of tobacco use
Admission Date:  [**2161-5-1**]              Discharge Date:   [**2161-5-3**]

Date of Birth:  [**2091-5-13**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Haldol

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
unruptured aneurysm

Major Surgical or Invasive Procedure:
[**2161-5-1**]- cerebral angiogram with coil embolization of aneurysm

History of Present Illness:
Mrs [**Known lastname 39509**] is a 69yo woman who presented to [**Hospital3 **] on [**2161-3-6**] with a diagnosis of slurred speech and
the CT scan had shown
microvascular disease; however, MRI also showed a an anterior
communicating artery aneurysm. She now electively presents to
have this embolized.

Past Medical History:
major depression, bipolar disorder, obesity, hypertension,
hypercholesterolemia, asthma and possible obstructive sleep
apnea.


Social History:
she is currently not employed, but has a BS degree.  She lives
with her husband and has a history of smoking.


Family History:
is negative for aneurysms.


Physical Exam:
non focal upon discharge.
groin site c/d/i with 1 suture

Brief Hospital Course:
Pt electively presented and underwent a cerebral angiogram and
coil embolization of her Acomm artery aneurysm. This was done
without complication. She was monitored in the ICU overnight
post op and was kept on a heparin gtt until the AM [**5-2**]. She
remained neurologically intact overnight but in the AM [**5-2**] she
voiced to the examiner that she wanted to kill herself. A
psychiatry consult was called and she was placed on suicide
precautions including a 1:1 sitter. The psychiatry team found
her to be stable, and did not suggest any medication
adjustments. They also contact[**Name (NI) **] her outpt psychiatrist and
recommended an earlier follow up.
On [**5-3**] she was again neurologically stable. She was seen again
by the psychiatry team and was cleared for discharge home.

Medications on Admission:
fish oil, Ibuprofen prn, plavix 75mg daily x5days pre-op, ASA
325mg, HCTZ 25mg daily, Lisinopril 20mg daily, Remeron 30mg
daily, Simvastatin 40mg daily, Effexor 225mg QPM, Zyprexa 20mg
QHS


Discharge Medications:
1. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 1 months.
Disp:*30 Tablet(s)* Refills:*0*
2. hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
3. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. mirtazapine 30 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
5. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. venlafaxine 75 mg Capsule, Ext Release 24 hr Sig: Three (3)
Capsule, Ext Release 24 hr PO DAILY (Daily).
7. olanzapine 10 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
8. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
9. famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
A Comm Artery aneurysm
suicidal ideation

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

Discharge Instructions:
Angiogram with Embolization and/or Stent placement
Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **]
Medications:
??????	Take Aspirin 325mg (enteric coated) once daily.
??????	Take Plavix (Clopidogrel) 75mg once daily.
??????	Continue all other medications you were taking before surgery,
unless otherwise directed
??????	You make take Tylenol or prescribed pain medications for any
post procedure pain or discomfort.

What activities you can and cannot do:
??????	When you go home, you may walk and go up and down stairs.
??????	You may shower (let the soapy water run over groin incision,
rinse and pat dry)
??????	Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing or
band aid over the area that is draining, as needed
??????	No heavy lifting, pushing or pulling (greater than 5 lbs) for
1 week (to allow groin puncture to heal).
??????	After 1 week, you may resume sexual activity.
??????	After 1 week, gradually increase your activities and distance
walked as you can tolerate.
??????	No driving until you are no longer taking pain medications


Followup Instructions:
You have a suture in your right groin that needs to be removed
later this week. Please call your PCP for an appointment for
removal. Or you can follow up with [**Name8 (MD) **] NP/PA in Neurosurgery
[**Telephone/Fax (1) 1669**].

Please call [**Telephone/Fax (1) 1669**] to make a follow up appointment with
Dr. [**First Name (STitle) **] in 4 weeks. You will not need imaging at that time.

You will have another appointment in 6 months and will need an
MRI/MRA, [**Doctor Last Name **] protocol prior to that appointment.

Please call your psychiatrist to make a follow up appointment
within the next week. The Psychiatry team at the [**Hospital1 **] left a
message over the weekend at their office updating them of your
hospitalization.



Completed by:[**2161-5-3**]
{'Cerebral aneurysm, nonruptured,Major depressive affective disorder, recurrent episode, severe, without mention of psychotic behavior,Suicidal ideation,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Asthma, unspecified type, unspecified,Anxiety state, unspecified,Pure hypercholesterolemia,Obesity, unspecified,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Personal history of tobacco use'}


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: unruptured aneurysm

PRESENT ILLNESS: Mrs [**Known lastname 39509**] is a 69yo woman who presented to [**Hospital3 **] on [**2161-3-6**] with a diagnosis of slurred speech and
the CT scan had shown
microvascular disease; however, MRI also showed a an anterior
communicating artery aneurysm. She now electively presents to
have this embolized.

MEDICAL HISTORY: major depression, bipolar disorder, obesity, hypertension,
hypercholesterolemia, asthma and possible obstructive sleep
apnea.

MEDICATION ON ADMISSION: fish oil, Ibuprofen prn, plavix 75mg daily x5days pre-op, ASA
325mg, HCTZ 25mg daily, Lisinopril 20mg daily, Remeron 30mg
daily, Simvastatin 40mg daily, Effexor 225mg QPM, Zyprexa 20mg
QHS

ALLERGIES: Haldol

PHYSICAL EXAM: non focal upon discharge.
groin site c/d/i with 1 suture

FAMILY HISTORY: is negative for aneurysms.

SOCIAL HISTORY: she is currently not employed, but has a BS degree.  She lives
with her husband and has a history of smoking. 

### Response:
{'Cerebral aneurysm, nonruptured,Major depressive affective disorder, recurrent episode, severe, without mention of psychotic behavior,Suicidal ideation,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Asthma, unspecified type, unspecified,Anxiety state, unspecified,Pure hypercholesterolemia,Obesity, unspecified,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Personal history of tobacco use'}
