CHIEF COMPLAINT: Renal Cell Carcinoma

PRESENT ILLNESS: 48 y/o man with a history of renal cell carcinoma, who had
underwent curettage/excision of a metastases in his right distal
tibia. He was admitted on [**7-13**]/6 at [**Hospital1 18**] secondary to
hematuria, was seen by Dr. [**Last Name (STitle) 261**] in his office on [**7-14**],
and surgery was scheduled for 7/11/6.

MEDICAL HISTORY: Left renal cell carcinoma, now metastatic.
S/p right distal tibia curettage.

MEDICATION ON ADMISSION: IV access: Peripheral Order date: [**8-7**] @ 2159 5. Famotidine 20
mg PO BID  Order date: [**8-10**] @ 0959
2. Acetaminophen 325-650 mg PO Q4-6H:PRN pain/fever  Order date:
[**8-9**] @ 2235 6. Hydromorphone 4 mg PO Q8H:PRN  Order date: [**8-10**]
@ 1455
3. Docusate Sodium 100 mg PO BID constipation  Order date: [**8-9**]
@ 2235 7. Oxycodone-Acetaminophen [**1-27**] TAB PO Q4-6H:PRN pain
Order date: [**8-10**] @ 0934
4. Dolasetron Mesylate 12.5 mg IV Q8H:PRN nausea  Order date:
[**8-9**] @ 2235 8. Sodium Chloride 0.9% Flush 3 ml IV DAILY:PRN
Peripheral IV - Inspect site every shift  Order date: [**8-7**] @
2159
5. Diluaded PCA

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: vitals: Tmax/current: 100.3/98.6 HR: 84 BP: 118/62 RR: 18 O2:
95% (RA)
Chest: CTAB
CV: RRR
ABD: Soft, NTND. Chevron incision with staples, healing well
with granulation tissue, no erythema, no exudates.
EXT: RLE with slight edema. 2+ DP pulses, equal bilaterally.

FAMILY HISTORY: 

SOCIAL HISTORY: 
Malignant neoplasm of kidney, except pelvis,Other venous embolism and thrombosis of inferior vena cava
Malig neopl kidney,Oth inf vena cava thromb
Admission Date:  [**2155-8-5**]              Discharge Date:   [**2155-8-11**]

Date of Birth:  [**2107-4-22**]             Sex:   M

Service: UROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1232**]
Chief Complaint:
Renal Cell Carcinoma

Major Surgical or Invasive Procedure:
Left Nephrectomy and IVC thrombectomy.


History of Present Illness:
48 y/o man with a history of renal cell carcinoma, who had
underwent curettage/excision of a metastases in his right distal
tibia. He was admitted on [**7-13**]/6 at [**Hospital1 18**] secondary to
hematuria, was seen by Dr. [**Last Name (STitle) 261**] in his office on [**7-14**],
and surgery was scheduled for 7/11/6.

Past Medical History:
Left renal cell carcinoma, now metastatic.
S/p right distal tibia curettage.

Physical Exam:
vitals: Tmax/current: 100.3/98.6 HR: 84 BP: 118/62 RR: 18 O2:
95% (RA)
Chest: CTAB
CV: RRR
ABD: Soft, NTND. Chevron incision with staples, healing well
with granulation tissue, no erythema, no exudates.
EXT: RLE with slight edema. 2+ DP pulses, equal bilaterally.

Pertinent Results:
[**2155-8-5**] 05:19PM   TYPE-ART PO2-410* PCO2-45 PH-7.30* TOTAL
CO2-23 BASE XS--3
[**2155-8-5**] 05:19PM   LACTATE-1.8
[**2155-8-5**] 05:19PM   freeCa-1.25
[**2155-8-5**] 05:12PM   GLUCOSE-124* UREA N-12 CREAT-1.2 SODIUM-140
POTASSIUM-4.5 CHLORIDE-111* TOTAL CO2-21* ANION GAP-13
[**2155-8-5**] 05:12PM   CALCIUM-8.4 MAGNESIUM-1.4*
[**2155-8-5**] 05:12PM   WBC-14.1* RBC-3.76* HGB-11.1* HCT-31.6*
MCV-84 MCH-29.6 MCHC-35.2* RDW-15.3
[**2155-8-5**] 05:12PM   PLT COUNT-311
[**2155-8-5**] 05:12PM   PT-13.6* PTT-27.9 INR(PT)-1.2*
[**2155-8-5**] 02:53PM   TYPE-ART TEMP-37 PO2-259* PCO2-40 PH-7.31*
TOTAL CO2-21 BASE XS--5
[**2155-8-5**] 12:09PM   TYPE-ART RATES-12/ TIDAL VOL-740 O2-46
PO2-225* PCO2-39 PH-7.28* TOTAL CO2-19* BASE XS--7
INTUBATED-INTUBATED VENT-CONTROLLED
[**2155-8-5**] 10:50AM   GLUCOSE-131* LACTATE-2.5* NA+-137 K+-3.4*
CL--110
[**2155-8-5**] 10:50AM   HGB-8.1* calcHCT-24 O2 SAT-98
[**2155-8-5**] 10:50AM   freeCa-1.09*
[**2155-8-5**] 09:12AM   TYPE-ART PO2-148* PCO2-38 PH-7.44 TOTAL
CO2-27 BASE XS-2
[**2155-8-5**] 09:12AM   GLUCOSE-161* LACTATE-1.3 NA+-138 K+-3.7
CL--105
[**2155-8-5**] 09:12AM   HGB-11.5* calcHCT-35 O2 SAT-98
[**2155-8-5**] 09:12AM   freeCa-1.25

Brief Hospital Course:
The patient was admitted post-operatively to the SICU, where he
remained intubated after surgery. While in the ICU he was
transfused two units of blood, completed two doses of Ancef, was
extubated on post-operative day two, and was brought to the
inpatient floor. On post-operative day three his NG tube was
removed. On post-operative day 4 the foley catheter was removed
and the patient successfully voided independently, his diet was
advanced as tolerated, and he began to ambulate. He remained
hemodynamically stable, his pain was adequately controlled on
dilauded. He was discharged on post-operative day 5 with
dilauded for pain, a refill of percocet for his orthopedic pain,
and colace.

Medications on Admission:
IV access: Peripheral Order date: [**8-7**] @ 2159 5. Famotidine 20
mg PO BID  Order date: [**8-10**] @ 0959
2. Acetaminophen 325-650 mg PO Q4-6H:PRN pain/fever  Order date:
[**8-9**] @ 2235 6. Hydromorphone 4 mg PO Q8H:PRN  Order date: [**8-10**]
@ 1455
3. Docusate Sodium 100 mg PO BID constipation  Order date: [**8-9**]
@ 2235 7. Oxycodone-Acetaminophen [**1-27**] TAB PO Q4-6H:PRN pain
Order date: [**8-10**] @ 0934
4. Dolasetron Mesylate 12.5 mg IV Q8H:PRN nausea  Order date:
[**8-9**] @ 2235 8. Sodium Chloride 0.9% Flush 3 ml IV DAILY:PRN
Peripheral IV - Inspect site every shift  Order date: [**8-7**] @
2159
5. Diluaded PCA

Discharge Medications:
1. Dilaudid 2 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as
needed for pain.
Disp:*20 Tablet(s)* Refills:*0*
2. Percocet 5-325 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours
as needed for pain: Please begin your percocet after you
complete your dilaudid.
Disp:*40 Tablet(s)* Refills:*0*
3. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as
needed for constipation.
Disp:*30 Capsule(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
s/p left nephrectomy and IVC thrombectomy.


Discharge Condition:
Good.


Discharge Instructions:
Please see the instruction sheet entitled "Kidney Removal:
Discharge Instructions" for detailed information.

You may resume your regular diet.

You may shower.

For your pain medication, you may take the dilaudid for the
first four days after your discharge, then you may resume your
percocet for your leg pain, as per your previous outpatient
regimen.

Please do not do any heavy lifting or heavy exercise for six
weeks.

You are being given a stool softner, please take it as needed to
prevent constipation.

Please return to the Emergency Room should you experience fevers
greater than 101, have drainage from your wound, have abdominal
pain, are unable to tolerate oral intake, or have nausea or
vomiting.

Followup Instructions:
Please call Dr.[**Doctor Last Name **] office to arrange for your follow-up
appointment. The number is [**Telephone/Fax (1) 277**].



Completed by:[**2155-8-10**]

Unit No:  [**Numeric Identifier 67893**]
Admission Date: [**2155-8-5**]
Discharge Date: [**2155-8-11**]
Date of Birth:  [**2107-4-22**]
Sex:  M
Service:  GU


ADDENDUM:  Mr. [**Known lastname 67894**] stayed 1 extra day after
postdischarge due to concerns about pain control. He was on
p.o. pain medication and did very well. He had no pain
control issues. He was informed that insurance may not pay
for the extra night but he chose to stay after he was
discharged and the patient and his wife were aware of this.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 559**]

Dictated By:[**Name8 (MD) 560**]
MEDQUIST36
D:  [**2155-8-19**] 21:35:31
T:  [**2155-8-20**] 14:25:48
Job#:  [**Job Number 67895**]
{'Malignant neoplasm of kidney, except pelvis,Other venous embolism and thrombosis of inferior vena cava'}


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: Renal Cell Carcinoma

PRESENT ILLNESS: 48 y/o man with a history of renal cell carcinoma, who had
underwent curettage/excision of a metastases in his right distal
tibia. He was admitted on [**7-13**]/6 at [**Hospital1 18**] secondary to
hematuria, was seen by Dr. [**Last Name (STitle) 261**] in his office on [**7-14**],
and surgery was scheduled for 7/11/6.

MEDICAL HISTORY: Left renal cell carcinoma, now metastatic.
S/p right distal tibia curettage.

MEDICATION ON ADMISSION: IV access: Peripheral Order date: [**8-7**] @ 2159 5. Famotidine 20
mg PO BID  Order date: [**8-10**] @ 0959
2. Acetaminophen 325-650 mg PO Q4-6H:PRN pain/fever  Order date:
[**8-9**] @ 2235 6. Hydromorphone 4 mg PO Q8H:PRN  Order date: [**8-10**]
@ 1455
3. Docusate Sodium 100 mg PO BID constipation  Order date: [**8-9**]
@ 2235 7. Oxycodone-Acetaminophen [**1-27**] TAB PO Q4-6H:PRN pain
Order date: [**8-10**] @ 0934
4. Dolasetron Mesylate 12.5 mg IV Q8H:PRN nausea  Order date:
[**8-9**] @ 2235 8. Sodium Chloride 0.9% Flush 3 ml IV DAILY:PRN
Peripheral IV - Inspect site every shift  Order date: [**8-7**] @
2159
5. Diluaded PCA

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: vitals: Tmax/current: 100.3/98.6 HR: 84 BP: 118/62 RR: 18 O2:
95% (RA)
Chest: CTAB
CV: RRR
ABD: Soft, NTND. Chevron incision with staples, healing well
with granulation tissue, no erythema, no exudates.
EXT: RLE with slight edema. 2+ DP pulses, equal bilaterally.

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Malignant neoplasm of kidney, except pelvis,Other venous embolism and thrombosis of inferior vena cava'}
