CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 73 year-old
female who presented to the medical center six weeks status
post ascending aortic aneurysm repair with aortic valve
replacement and coronary artery bypass graft times one with a
one day history of brownish drainage from a pin point opening
at the inferior pole of her sternal incision.  The patient
reported that there had been no drainage from the incision
during her hospitalization here at [**Hospital1 190**] and during her subsequent discharge to a rehab
facility.  There had been some moistness to the wound.  The
patient denied any history of fevers, chills, increasing
pain, increasing erythema to the incision, respiratory
symptoms or warmth.  She did report that the wound had
sometimes been moist at the area.

MEDICAL HISTORY: Hypertension, depression, peptic ulcer
disease, valvular heart disease.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Infection and inflammatory reaction due to other internal orthopedic device, implant, and graft,Pulmonary collapse,Urinary tract infection, site not specified,Heart valve replaced by other means,Unspecified essential hypertension
React-oth int ortho dev,Pulmonary collapse,Urin tract infection NOS,Heart valve replac NEC,Hypertension NOS
Admission Date:  [**2200-10-19**]       Discharge Date:  [**2200-10-30**]

Date of Birth:   [**2127-2-9**]       Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 73 year-old
female who presented to the medical center six weeks status
post ascending aortic aneurysm repair with aortic valve
replacement and coronary artery bypass graft times one with a
one day history of brownish drainage from a pin point opening
at the inferior pole of her sternal incision.  The patient
reported that there had been no drainage from the incision
during her hospitalization here at [**Hospital1 190**] and during her subsequent discharge to a rehab
facility.  There had been some moistness to the wound.  The
patient denied any history of fevers, chills, increasing
pain, increasing erythema to the incision, respiratory
symptoms or warmth.  She did report that the wound had
sometimes been moist at the area.

PAST MEDICAL HISTORY:  Hypertension, depression, peptic ulcer
disease, valvular heart disease.

PAST SURGICAL HISTORY:  Aortic aneurysm repair.

MEDICATIONS:  Prevacid 30 mg po q day, Percocet, Lactulose,
Remeron 15 mg po q.h.s., Trazodone 100 mg po q.h.s., Ativan
.5 mg po, Metoprolol 150 mg po b.i.d., aspirin 325 mg po q
day and Imipramine 25 mg po q.h.s.

PHYSICAL EXAMINATION:  Vital signs 98.6, 88 and sinus,
135/64, 98% on room air.  In general, the patient was well
appearing elderly female in no acute distress.  Neck no
lymphadenopathy, supple.  Cardiovascular regular rate and
rhythm, normal S1 and S2.  Chest/lungs clear to auscultation
bilaterally.  Healing sternal incision with minimal erythema,
approximately 5 mm open spot near the distal end of the
incision.  Watery brownish fluid draining spontaneously with
thick brown pus expressible.  Area soft, but not fluctuant.
Abdomen soft, nontender, nondistended.  Extremities, the
right shoulder minimally tender to palpation, but with an
area of tenderness noted near the medial edge of the scapula
posteriorly with normal range of movement.  The right calf
vein harvest site was healing well with a 5 cm gap at the
distal end with a healing rim of erythema.

LABORATORIES ON ADMISSION:  CBC was 18.5, 27.9, 473.

IMAGING:  Chest x-ray on admission showed no acute
cardiopulmonary process, left middle lobe atelectasis
unchanged from prior examination.

HOSPITAL COURSE:  On arrival in the Emergency Department the
patient was seen by the Cardiothoracic Surgery team.
Antibiotic treatment was initiated in the Emergency
Department with the patient receiving a dose of Ancef.
Following transfer to the floor the patient's antibiotic
regimen was changed to Vancomycin and Levaquin.  The decision
was made to incise and drain the patient's sternal wound in
the Emergency Department.  This was done with expression of
moderate amount of brownish purulent material.  The wound was
thereafter packed with gauze.  The patient was transferred to
the Cardiothoracic Surgery floor for continued management.
On hospital day number two the wound was further explored
with pocket of purulent material drained.  Antibiotic therapy
remained unchanged.  On hospital day number three, which was
[**2200-10-21**] the decision was made to place a PICC line given the
fact that the patient would need long term antibiotic therapy
following discharge.  Plastic Surgery consultation was also
requested.  A decision was ultimately made to take the
patient to the Operating Room for sternal debridement and
rewiring of her sternum, which was noted to be separated.
This was documented on CAT scan with air being noted deep to
the sternum.  The plastic surgery team would be involved and
would perform a pectoral flap.  The patient was taken to the
Operating Room on [**2200-10-24**] and the patient's sternum
debrided, rewired and pectoral flap constructed.  The patient
was extubated without complications and transferred to the
Cardiac Surgery Recovery Unit for continued monitoring.

Please note that although the patient preoperative urinalysis
was negative, the patient's urine culture ultimately grew
Vancomycin resistant enterococcus.  Cultures from her sternal
wound ultimately grew MRSA.  The patient was transferred back
to the Cardiothoracic Surgery Floor on postoperative day
number one.  She had an uncomplicated recovery.  Her sternal
wound was inspected daily and was noted to be improving by
the time of discharge.  She was continued on Vancomycin and
Levaquin.  Her white blood cell count was monitored and noted
to be decreasing by the time of discharge.  The drainage from
her two [**First Name8 (NamePattern2) 1661**] [**Last Name (NamePattern1) 1662**] drains was also monitored.  The JP
drains are expected to remain in place until the patient's
follow up appointment with the Plastic Surgery team on the
week following discharge.  The patient's appetite remained
good during her entire admission.  By postop day number five
the patient was deemed stable and ready for discharge to a
skilled nursing facility.  The patient is expected to require
several weeks of intravenous antibiotic therapy following
discharge.  No treatment was initiated specifically for the
VRE noted to be growing in the patient's urine given the fact
that the patient was entirely asymptomatic.  It was suspected
that the organisms might have been a contaminant.  The
patient's serum creatinine remained stable during the entire
admission.

The patient's hypertension was noted to be poorly controlled
early during her admission.  She was at that time only on
Metoprolol.  The decision was made to add Labetalol to the
patient's hypertensive medication regimen.  The Metoprolol
was later discontinued and the Labetalol dose was increased
with apparent good control of her blood pressure.

DISCHARGE CONDITION:  Stable.

DISCHARGE MEDICATIONS:  Labetalol 600 mg po b.i.d., Colace
100 mg po b.i.d., Vancomycin 750 mg intravenous q 24 hours.
Heparin 5000 units subQ b.i.d.  Prevacid 30 mg po q day.
Enteric coated aspirin 325 mg po q day.  Folic acid 1 mg po q
day.  Levofloxacin 500 mg po q day.  Imipramine 25 mg po
q.h.s.  11.  Senna two tablets po b.i.d. prn.  Percocet one
to two tablets po q to 6 hours prn.  Ativan .25 to .5 mg po q
4 to 6 hours prn.  Simethicone 40 to 80 mg po q.i.d. prn.
Trazodone 100 mg po q.h.s.  Milk of Magnesia 7 milliliters po
q 6 hours prn.

FO[**Last Name (STitle) 996**]P:  1.  The patient is to call Dr. [**Last Name (STitle) **] [**Last Name (Prefixes) 2546**]
office for follow up appointment following discharge.  2.
The patient is to follow up with Plastic Surgery team in
clinic on [**2200-11-4**].  She needs to call [**Telephone/Fax (1) 274**] for an
appointment.  3.  The patient is to follow up with her
primary care physician [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] following discharge.

DISCHARGE DIAGNOSIS:
Sternal wound infection following coronary artery bypass
graft.






                            [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

Dictated By:[**Name8 (MD) 997**]
MEDQUIST36

D:  [**2200-10-30**]  11:31
T:  [**2200-10-30**]  11:35
JOB#:  [**Job Number 10100**]
{'Infection and inflammatory reaction due to other internal orthopedic device, implant, and graft,Pulmonary collapse,Urinary tract infection, site not specified,Heart valve replaced by other means,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 73 year-old
female who presented to the medical center six weeks status
post ascending aortic aneurysm repair with aortic valve
replacement and coronary artery bypass graft times one with a
one day history of brownish drainage from a pin point opening
at the inferior pole of her sternal incision.  The patient
reported that there had been no drainage from the incision
during her hospitalization here at [**Hospital1 190**] and during her subsequent discharge to a rehab
facility.  There had been some moistness to the wound.  The
patient denied any history of fevers, chills, increasing
pain, increasing erythema to the incision, respiratory
symptoms or warmth.  She did report that the wound had
sometimes been moist at the area.

MEDICAL HISTORY: Hypertension, depression, peptic ulcer
disease, valvular heart disease.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Infection and inflammatory reaction due to other internal orthopedic device, implant, and graft,Pulmonary collapse,Urinary tract infection, site not specified,Heart valve replaced by other means,Unspecified essential hypertension'}
