CHIEF COMPLAINT: Severe gastroesophageal reflux disease

PRESENT ILLNESS: Pt. is a 75-year-old female with severe gastroesophageal
reflux disease which also complicates her asthma. She has tried
several medical therapies without success. She presents for a
laparoscopic Nissen fundoplication for the treatment of her
severe reflux.

MEDICAL HISTORY: hypertension, hypothyroidism, migraines, asthma,
hypercholesterolemia.

MEDICATION ON ADMISSION: ADVAIR DISKUS 500-50MCG--One puff [**Hospital1 **], rinse mouth
AEROCHAMBER --Use w/ inhalers
ALBUTEROL SULFATE 90MCG--2 puffs four times a day as needed for
with spacer
ASPIRIN 81MG--One every day
ATORVASTATIN CALCIUM 10 MG--One at bedtime
ATROVENT 18MCG--Take 2 puffs qid.
CELEXA 20MG--One every day
FOSAMAX 35MG--One tablet each week
LEVOXYL 50MCG--One every day
PERCOCET 5-325MG--One four times a day as needed
PROTONIX 40MG--One by mouth twice a day
VALSARTAN 40MG--3 tablets each day
XANAX 0.5MG--One three times a day as needed
ZANTAC 300MG--One at bedtime

ALLERGIES: Singulair / Percocet

PHYSICAL EXAM: V/S: 97.7 P98 BP106/52 R13 95%3l
Gen - overweight female in NAD
Skin - resolving posterior R arm hematoma, 3x3cm; no other
rashes/skin breaks
HEENT - NC/AT, EOMI, PERRLA bilat., MMM, soft neck without LAD
Cardiac - RRR without m/g/r
Lungs - diffuse expiratory wheezes, fine wet crackles at lung
bases bilaterally
[**Last Name (un) **] - +BS, soft, NT, ND
PVasc - 2+ pulses, no edema
Musc/Skel - full passive and active ROM
Neuro - A&Ox3, no appreciable deficits

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives alone; supportive daughter willing to assist as needed -
25 pack year h/o smoking, quit 24 yrs ago; rare EtOH
Esophageal reflux,Asthma, unspecified type, with (acute) exacerbation,Unspecified sleep apnea,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Unspecified essential hypertension
Esophageal reflux,Asthma NOS w (ac) exac,Sleep apnea NOS,Hypothyroidism NOS,Hyperlipidemia NEC/NOS,Hypertension NOS
Admission Date:  [**2137-11-28**]              Discharge Date:   [**2137-12-1**]

Date of Birth:  [**2062-3-4**]             Sex:   F

Service: SURGERY

Allergies:
Singulair / Percocet

Attending:[**First Name3 (LF) 1481**]
Chief Complaint:
Severe gastroesophageal reflux disease

Major Surgical or Invasive Procedure:
laparoscopic Nissen fundoplication ([**2137-11-28**])

History of Present Illness:
Pt. is a 75-year-old female with severe gastroesophageal
reflux disease which also complicates her asthma. She has tried
several medical therapies without success. She presents for a
laparoscopic Nissen fundoplication for the treatment of her
severe reflux.

Past Medical History:
hypertension, hypothyroidism, migraines, asthma,
hypercholesterolemia.


Social History:
Lives alone; supportive daughter willing to assist as needed -
25 pack year h/o smoking, quit 24 yrs ago; rare EtOH


Family History:
Non-contributory

Physical Exam:
V/S: 97.7 P98 BP106/52 R13 95%3l
Gen - overweight female in NAD
Skin - resolving posterior R arm hematoma, 3x3cm; no other
rashes/skin breaks
HEENT - NC/AT, EOMI, PERRLA bilat., MMM, soft neck without LAD
Cardiac - RRR without m/g/r
Lungs - diffuse expiratory wheezes, fine wet crackles at lung
bases bilaterally
[**Last Name (un) **] - +BS, soft, NT, ND
PVasc - 2+ pulses, no edema
Musc/Skel - full passive and active ROM
Neuro - A&Ox3, no appreciable deficits


Brief Hospital Course:
The patient presented to the hospital on the day of surgery. She
underwent the procedure without complication. For details of the
surgery, please refer to the operative note of [**2137-11-28**]. Her
post-operative course, however, was marked by low urine output,
the nadir of which was 12ml/1 hour. Her urine output improved
steadily and on POD#1, she was diuresing well.

The patient also complained of dyspnea and weakness. Cardiac
work-up was initiated and was found to be negative. Her dyspnea
responded somewhat to albuterol-ipratropium nebulizer treatments
and salmeterol-fluticasone, but at post-operative day #1, she
was still oxygen-dependent. Inhalant therapies were continued
and aggressive pulmonary toilet was instituted.

The patient's weakness was characterized by an unsteadiness on
her feet. She was admitted and a physical therapy consultation
was requested for evaluation and treatment. She was also noted
to desaturate to 85-88% while attempting to walk.

Also noted was a 2x2cm hematoma on the patient's R posterior arm
at which site subcutaneous heparin had been administered. She
made the transition easily to a clear liquid diet and was
advanced to a regular diet without bread products. She also was
given all of her home medications, and required very little oral
pain medication for pain control.

On POD#2, she was somewhat improved in her respiratory status.
She was weaned to 2 liters of oxygen therapy. She continued to
work with physical therapy for steadiness and strengthening.

On POD#3, the patient was saturating well on room air and
ambulating with ease and without respiratory compromise, and the
hematoma on her R arm was resolving nicely. Both she and the
surgery service taking care of her felt that she was well enough
to go home. The patient's daughter offered to take close care of
the patient for the first 2 weeks after discharge. She was
discharged in stable condition with instructions for follow-up
care in Dr.[**Name (NI) 1482**] clinic.

Medications on Admission:
ADVAIR DISKUS 500-50MCG--One puff [**Hospital1 **], rinse mouth
AEROCHAMBER --Use w/ inhalers
ALBUTEROL SULFATE 90MCG--2 puffs four times a day as needed for
with spacer
ASPIRIN 81MG--One every day
ATORVASTATIN CALCIUM 10 MG--One at bedtime
ATROVENT 18MCG--Take 2 puffs qid.
CELEXA 20MG--One every day
FOSAMAX 35MG--One tablet each week
LEVOXYL 50MCG--One every day
PERCOCET 5-325MG--One four times a day as needed
PROTONIX 40MG--One by mouth twice a day
VALSARTAN 40MG--3 tablets each day
XANAX 0.5MG--One three times a day as needed
ZANTAC 300MG--One at bedtime


Discharge Medications:
1. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed for SOB.
2. Ipratropium Bromide 18 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation QID (4 times a day) as needed for SOB.
3. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day) as
needed for SOB.
4. Levothyroxine Sodium 50 mcg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
5. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Valsartan 40 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
8. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q4-6H (every 4 to 6 hours) as needed.
9. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO Q4-6H (every 4 to 6 hours) as needed for pain.
Disp:*250 ML(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
GERD
asthma

Discharge Condition:
Stable.

Discharge Instructions:
You may resume your pre-surgery medicines.
Return to the emergency room if you have fever above 101.4F,
nausea, vomiting or diarrhea that does not stop.
You cannot eat bread products - these may get stuck in your
foodpipe.

Followup Instructions:
See Dr. [**Last Name (STitle) **] in clinic in [**2-10**] weeks - call [**Telephone/Fax (1) 59495**] for
an appointment.


Completed by:[**2137-12-9**]
{'Esophageal reflux,Asthma, unspecified type, with (acute) exacerbation,Unspecified sleep apnea,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,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: Severe gastroesophageal reflux disease

PRESENT ILLNESS: Pt. is a 75-year-old female with severe gastroesophageal
reflux disease which also complicates her asthma. She has tried
several medical therapies without success. She presents for a
laparoscopic Nissen fundoplication for the treatment of her
severe reflux.

MEDICAL HISTORY: hypertension, hypothyroidism, migraines, asthma,
hypercholesterolemia.

MEDICATION ON ADMISSION: ADVAIR DISKUS 500-50MCG--One puff [**Hospital1 **], rinse mouth
AEROCHAMBER --Use w/ inhalers
ALBUTEROL SULFATE 90MCG--2 puffs four times a day as needed for
with spacer
ASPIRIN 81MG--One every day
ATORVASTATIN CALCIUM 10 MG--One at bedtime
ATROVENT 18MCG--Take 2 puffs qid.
CELEXA 20MG--One every day
FOSAMAX 35MG--One tablet each week
LEVOXYL 50MCG--One every day
PERCOCET 5-325MG--One four times a day as needed
PROTONIX 40MG--One by mouth twice a day
VALSARTAN 40MG--3 tablets each day
XANAX 0.5MG--One three times a day as needed
ZANTAC 300MG--One at bedtime

ALLERGIES: Singulair / Percocet

PHYSICAL EXAM: V/S: 97.7 P98 BP106/52 R13 95%3l
Gen - overweight female in NAD
Skin - resolving posterior R arm hematoma, 3x3cm; no other
rashes/skin breaks
HEENT - NC/AT, EOMI, PERRLA bilat., MMM, soft neck without LAD
Cardiac - RRR without m/g/r
Lungs - diffuse expiratory wheezes, fine wet crackles at lung
bases bilaterally
[**Last Name (un) **] - +BS, soft, NT, ND
PVasc - 2+ pulses, no edema
Musc/Skel - full passive and active ROM
Neuro - A&Ox3, no appreciable deficits

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives alone; supportive daughter willing to assist as needed -
25 pack year h/o smoking, quit 24 yrs ago; rare EtOH 

### Response:
{'Esophageal reflux,Asthma, unspecified type, with (acute) exacerbation,Unspecified sleep apnea,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Unspecified essential hypertension'}
