CHIEF COMPLAINT: infected left AV graft

PRESENT ILLNESS: 89 yo male who presented with chills at dialysis.  He was noted
to have a fever to 102 at that time.  While at dialysis, he was
noted to have a ulceration over his left AV graft site with
bleeding.  He was transferred to [**Hospital1 18**] for further evaluation
and work-up of a likely infected left AV graft.

MEDICAL HISTORY: CKD-- stage IV disease, baseline ~3.8 in [**3-/2168**]; patient has one
kidney, per the family; lost to f/u with nephrology after
discharge from [**Hospital1 18**] in [**3-/2168**] for similar symptoms; family and
family refused dialysis at that time
2o hyperparathyroidism
2o anemia
HTN
Hyperlipidemia
Gout
Hernias s/p repair

MEDICATION ON ADMISSION: 1. Labetalol 100 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
2. Pantoprazole 40 mg PO QD
3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: 102 110 220/110 19 96%RA
Gen: A+Ox3, mild distress
HEENT: NC/AT, no LAD, no bruits
CV: tachycardic, -MRG
Chest: CTAB
Abd: soft/NT/ND
Ext: bleeding from ulceration over left AV graft site with
likely associated infection, no edema

FAMILY HISTORY: His parents lived to their 90s; no known cancer history.

SOCIAL HISTORY: Greek-only speaking
Lives with daughter-in-law and son in JP
Substance abuse history unknown
Infection and inflammatory reaction due to other vascular device, implant, and graft,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Secondary hyperparathyroidism (of renal origin),Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Gout, unspecified,Pure hypercholesterolemia,Anemia in chronic kidney disease
React-oth vasc dev/graft,End stage renal disease,Hyp kid NOS w cr kid V,Sec hyperparathyrd-renal,Abn react-anastom/graft,Gout NOS,Pure hypercholesterolem,Anemia in chr kidney dis
Admission Date:  [**2169-3-29**]              Discharge Date:   [**2169-3-31**]


Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1384**]
Chief Complaint:
infected left AV graft

Major Surgical or Invasive Procedure:
excision of infected left AV graft [**2169-3-29**]


History of Present Illness:
89 yo male who presented with chills at dialysis.  He was noted
to have a fever to 102 at that time.  While at dialysis, he was
noted to have a ulceration over his left AV graft site with
bleeding.  He was transferred to [**Hospital1 18**] for further evaluation
and work-up of a likely infected left AV graft.

Past Medical History:
CKD-- stage IV disease, baseline ~3.8 in [**3-/2168**]; patient has one
kidney, per the family; lost to f/u with nephrology after
discharge from [**Hospital1 18**] in [**3-/2168**] for similar symptoms; family and
family refused dialysis at that time
2o hyperparathyroidism
2o anemia
HTN
Hyperlipidemia
Gout
Hernias s/p repair

Social History:
Greek-only speaking
Lives with daughter-in-law and son in JP
Substance abuse history unknown


Family History:
His parents lived to their 90s; no known cancer history.

Physical Exam:
Vitals: 102 110 220/110 19 96%RA
Gen: A+Ox3, mild distress
HEENT: NC/AT, no LAD, no bruits
CV: tachycardic, -MRG
Chest: CTAB
Abd: soft/NT/ND
Ext: bleeding from ulceration over left AV graft site with
likely associated infection, no edema

Pertinent Results:
[**2169-3-31**] 02:30AM BLOOD WBC-8.0# RBC-3.32* Hgb-10.6* Hct-32.2*
MCV-97 MCH-32.0 MCHC-33.1 RDW-15.1 Plt Ct-162
[**2169-3-30**] 02:41AM BLOOD WBC-16.2*# RBC-3.42* Hgb-10.9* Hct-32.8*
MCV-96 MCH-31.7 MCHC-33.1 RDW-15.3 Plt Ct-183
[**2169-3-29**] 06:30PM BLOOD WBC-9.4 RBC-3.96* Hgb-12.7* Hct-37.8*
MCV-96 MCH-32.1* MCHC-33.6 RDW-15.1 Plt Ct-208
[**2169-3-29**] 06:30PM BLOOD Neuts-90.2* Lymphs-5.5* Monos-3.2 Eos-0.8
Baso-0.3
[**2169-3-29**] 06:30PM BLOOD PT-13.9* PTT-150* INR(PT)-1.2*
[**2169-3-31**] 02:30AM BLOOD Glucose-93 UreaN-57* Creat-6.8*# Na-138
K-4.9 Cl-104 HCO3-20* AnGap-19
[**2169-3-30**] 02:41AM BLOOD Glucose-110* UreaN-42* Creat-5.5* Na-138
K-4.7 Cl-104 HCO3-20* AnGap-19
[**2169-3-29**] 06:30PM BLOOD Glucose-257* UreaN-36* Creat-4.9* Na-140
K-4.5 Cl-100 HCO3-23 AnGap-22*
[**2169-3-30**] 02:41AM BLOOD Vanco-5.5*
[**2169-3-30**] 02:58AM BLOOD Type-ART pO2-281* pCO2-28* pH-7.52*
calTCO2-24 Base XS-1
[**2169-3-29**] 10:22PM BLOOD Type-ART pO2-58* pCO2-45 pH-7.32*
calTCO2-24 Base XS--3

Brief Hospital Course:
After presentation the patient was taken to the operating room
where he underwent excision of his infected left AV graft.
Post-operatively he was taken to the ICU because of difficulty
weaning off the vent after the procedure.  He was given
vancomycin and levofloxacin as well at that time.  The following
day he was extubated without difficulty.  His wound cultures
grew coag + staph aureus from the OR.  The following day he was
given hemodialysis through his right sided tunnelled line.  He
was transferred to the floor following dialysis and his foley
was discontinued.  He was able to void after this was removed.
Wet to dry dressing changes were used over his infected wound
site.  He was discharged home to continue dialysis with
vancomycin for 6 weeks and with VNA for continued wet to dry
dressing changes.  He was discharged in good/stable condition.

Medications on Admission:
1. Labetalol 100 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
2. Pantoprazole 40 mg PO QD
3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day.

Discharge Medications:
1. Labetalol 100 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
2. Pantoprazole 40 mg PO QD
3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day.
4. Vancomycin 1,000 mg Recon Soln Sig: One (1) gram Intravenous
with dialysis for 6 weeks.
Disp:*18 grams* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
infected left AV graft


Discharge Condition:
good/stable


Discharge Instructions:
Please continue on all of your medications that you were on
prior to coming to the hospital and please take any new
medications as prescribed.  Please continue on your regular
dialysis schedule at [**Location (un) **] dialysis ([**Telephone/Fax (1) 673**]).  You
will be given vancomycin 1g IV (an antibiotic) with your
dialysis for your left arm wound for 6 weeks after discharge.  A
home nurse will help you with your wet to dry dressing changes
on your left arm.  Please follow-up as scheduled.  If you
develop fevers, chills, nausea, vomitting, diarrhea, shortness
of breath, or chest pain please contact a physician [**Name Initial (PRE) 2227**].
 If you have any questions or concerns regarding your dialysis
access please call [**Telephone/Fax (1) 673**].

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2169-4-6**]
8:00
{'Infection and inflammatory reaction due to other vascular device, implant, and graft,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Secondary hyperparathyroidism (of renal origin),Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Gout, unspecified,Pure hypercholesterolemia,Anemia in chronic kidney disease'}


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: infected left AV graft

PRESENT ILLNESS: 89 yo male who presented with chills at dialysis.  He was noted
to have a fever to 102 at that time.  While at dialysis, he was
noted to have a ulceration over his left AV graft site with
bleeding.  He was transferred to [**Hospital1 18**] for further evaluation
and work-up of a likely infected left AV graft.

MEDICAL HISTORY: CKD-- stage IV disease, baseline ~3.8 in [**3-/2168**]; patient has one
kidney, per the family; lost to f/u with nephrology after
discharge from [**Hospital1 18**] in [**3-/2168**] for similar symptoms; family and
family refused dialysis at that time
2o hyperparathyroidism
2o anemia
HTN
Hyperlipidemia
Gout
Hernias s/p repair

MEDICATION ON ADMISSION: 1. Labetalol 100 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
2. Pantoprazole 40 mg PO QD
3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: 102 110 220/110 19 96%RA
Gen: A+Ox3, mild distress
HEENT: NC/AT, no LAD, no bruits
CV: tachycardic, -MRG
Chest: CTAB
Abd: soft/NT/ND
Ext: bleeding from ulceration over left AV graft site with
likely associated infection, no edema

FAMILY HISTORY: His parents lived to their 90s; no known cancer history.

SOCIAL HISTORY: Greek-only speaking
Lives with daughter-in-law and son in JP
Substance abuse history unknown 

### Response:
{'Infection and inflammatory reaction due to other vascular device, implant, and graft,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Secondary hyperparathyroidism (of renal origin),Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Gout, unspecified,Pure hypercholesterolemia,Anemia in chronic kidney disease'}
