CHIEF COMPLAINT: L knee pain

PRESENT ILLNESS: 59F with long history of L knee OA.

MEDICAL HISTORY: niddm,dyslipid,htn,asthema,OSA-w/cpap,renal insuffic,

MEDICATION ON ADMISSION: e
f
f
e
x
o
r
,
g
l
i
p
i
z
ide,ibuprof,lisinopril,metformin,prilosec,valium,vicodin,mvi,Ca,

ALLERGIES: Prednisone

PHYSICAL EXAM: PHYSICAL EXAM AT THE TIME OF DISCHARGE:
At the time of discharge:
AVSS
NAD
wound c/d/i without erythema
[**Last Name (un) 938**]/FHL/TA/GS intact
SILT distally

FAMILY HISTORY: n/c

SOCIAL HISTORY: Single, former smoker, has not smoked for 30
years.  She drinks minimally.  She is a travel consultant.
Osteoarthrosis, localized, not specified whether primary or secondary, lower leg,Acute edema of lung, unspecified,Acute kidney failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Asthma, unspecified type, unspecified,Anemia, unspecified,Depressive disorder, not elsewhere classified,Chronic kidney disease, unspecified,Obstructive sleep apnea (adult)(pediatric)
Loc osteoarth NOS-l/leg,Acute lung edema NOS,Acute kidney failure NOS,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Hy kid NOS w cr kid I-IV,Asthma NOS,Anemia NOS,Depressive disorder NEC,Chronic kidney dis NOS,Obstructive sleep apnea
Admission Date:  [**2140-1-19**]              Discharge Date:   [**2140-1-22**]

Date of Birth:  [**2080-8-19**]             Sex:   F

Service: ORTHOPAEDICS

Allergies:
Prednisone

Attending:[**First Name3 (LF) 64**]
Chief Complaint:
L knee pain

Major Surgical or Invasive Procedure:
[**2140-1-19**] L TKA


History of Present Illness:
59F with long history of L knee OA.

Past Medical History:
niddm,dyslipid,htn,asthema,OSA-w/cpap,renal insuffic,

Social History:
Single, former smoker, has not smoked for 30
years.  She drinks minimally.  She is a travel consultant.


Family History:
n/c

Physical Exam:
PHYSICAL EXAM AT THE TIME OF DISCHARGE:
At the time of discharge:
AVSS
NAD
wound c/d/i without erythema
[**Last Name (un) 938**]/FHL/TA/GS intact
SILT distally


Pertinent Results:
[**2140-1-19**] 11:35PM   PLT COUNT-307
[**2140-1-19**] 11:35PM   WBC-13.2* RBC-2.92* HGB-8.7* HCT-24.8* MCV-85
MCH-29.8 MCHC-35.0 RDW-15.7*
[**2140-1-19**] 11:35PM   CALCIUM-8.2* PHOSPHATE-5.5* MAGNESIUM-1.7
[**2140-1-19**] 11:35PM   estGFR-Using this
[**2140-1-19**] 11:35PM   GLUCOSE-184* UREA N-29* CREAT-1.6* SODIUM-135
POTASSIUM-4.3 CHLORIDE-100 TOTAL CO2-25 ANION GAP-14

Brief Hospital Course:
The patient was admitted on [**2140-1-19**] and, later that day, was
taken to the operating room by Dr. [**Last Name (STitle) **] for L TKA without
complication.  Please see operative report for details.
Postoperatively the patient did well.  The patient was initially
treated with a PCA followed by PO pain medications on POD#1.
The patient received IV antibiotics for 24 hours
postoperatively, as well as lovenox for DVT prophylaxis starting
on the morning of POD#1.  The patient was placed in a CPM
machine with range of motion that started at 0-45 degrees of
flexion before being increased to 90 degrees as tolerated.  The
drain was removed without incident on POD#1. She had respiratory
distress and her oxygen saturations dropped into the 80s.  She
was transferred to the MICU and was stabilized on CPAP.  The
Foley catheter was removed without incident on POD 2. The
surgical dressing was removed on POD#2 and the surgical incision
was found to be clean, dry, and intact without erythema or
purulent drainage.  She received 2 units PRBC on POD 2 for a HCT
of 20.  She was asymptomatic.

While in the hospital, the patient was seen daily by physical
therapy. Labs were checked throughout the hospital course and
repleted accordingly. At the time of discharge the patient was
tolerating a regular diet and feeling well.  The patient was
afebrile with stable vital signs. The patient's hematocrit was
stable, and the patient's pain was adequately controlled on a PO
regimen. The operative extremity was neurovascularly intact and
the wound was benign. The patient was discharged to home with
services or rehabilitation in a stable condition.  The patient's
weight-bearing status was WBAT.  The patient is to continue
using the CPM machine advancing as tolerated to 0-100 degrees.
MICU COURSE [**Date range (3) 51185**]

# Hypoxia: Pt was noted to hypoxic off of CPAP in the PACU
following Lt total knee replacement. Portable chest x-ray in the
PACU notable for vessel cephalization. In the OR and PACU she
received a total fluid load of 1.3L, pt was give a total of 30mg
Furosemide for which she put out a vast amount of urine although
interestingly enough her oxygenation failed to improve.
Differential negative pressure pulmonary edema as pt has not
history of cardiac dysfunction and did not receive a vast amount
of fluid in the OR.  Treated with albuterol nebs.  BNP 65.
Cardiac biomarkers flat.  Continued CPAP.  Improved to 2L nc.

# Anemia: Pot-op hct noted to be 6 points lower than her pre-op
Hct, pt's EBL noted to be minimal per surgery, pt also only
received 1.3L in the OR.   No signs/symptoms of bleeding.

#. Leukocytosis: WBC noted to be elevated, however pt was
post-op which likely explains WBC elevation. Pt currently on
Cefazolin post-operatively.  Cultures negative thus far.

#. Diabetes: Oral medications held as patient was not eating and
patient in acute renal failure.  Covered with SSI.  Lisinopril
held.

#. S/p Total Knee replacement: Pt is s/p Lt TKR for
osteoarthritis, currently on a Dilaudid PCA, placed in brace
with hemovac drain in place. Pt also on Cefazolin post op.
Continued PCA. D/c'ed ketorolac given acute renal failure.
Lovenox d/c'ed given acute renal failure and patient started on
heparin sq tid for DVT ppx.

#. Acute Renal Failure on Chronic Renal Insufficeny: Pt's
Creatinine elevated to 1.6, over past few months pt's Creatinine
has been elevated 1.3. Diabetes medications and lisinopril as
above.

#. HTN: Pt has a history of HTN, currently SBP have ranged in
the low 100s. Will hold Lisinopril and HCTZ as pt's Creatinine
is elevated at 1.6.  Held Lisinopril and HCTZ as Creatinine is
elevated at 1.6.

#. OSA: Pt has diagnosis of OSA, she usually uses CPAP during
naps, at bedtime at 8cm. Currently on CPAP settings now.  Likely
would benefit from reassessment of respiratory support as last
sleep study was 6 years ago - should follow up as an out patient
upon discharge.

#. Depression: Continued home regimen of Venlafaxine

#. PPx: Heparin gtt given renal failure, Pantoprazole.

#. FEN: Currently on sips, ADAT to diabetic/cardiac diet.

#. FULL CODE


Medications on Admission:
e
f
f
e
x
o
r
,
g
l
i
p
i
z
ide,ibuprof,lisinopril,metformin,prilosec,valium,vicodin,mvi,Ca,

Discharge Medications:
1. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q4-6H () as
needed.
Disp:*65 Tablet(s)* Refills:*0*
2. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
3. Enoxaparin 40 mg/0.4 mL Syringe Sig: One (1)  Subcutaneous
once a day for 3 weeks.
Disp:*21 * Refills:*0*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day)
as needed.
6. Multivitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
7. Venlafaxine 150 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO DAILY (Daily).
8. Glipizide 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. Metformin 500 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
10. Metformin 1,000 mg Tablet Sig: One (1) Tablet PO QPM (once a
day (in the evening)).
11. Diazepam 5 mg Tablet Sig: One (1) Tablet PO PRN (as needed).

12. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
13. Venlafaxine 75 mg Capsule, Sust. Release 24 hr Sig: Two (2)
Capsule, Sust. Release 24 hr PO DAILY (Daily).
14. Diazepam 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) as
needed for anxiety.
15. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
16. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
17. Glipizide 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

18. Metformin 500 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
19. Metformin 500 mg Tablet Sig: Two (2) Tablet PO QPM (once a
day (in the evening)).


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2558**] - [**Location (un) **]

Discharge Diagnosis:
L knee OA


Discharge Condition:
stable


Discharge Instructions:
DISCHARGE INSTRUCTIONS
experience severe pain not relieved by medication, increased
swelling, decreased sensation, difficulty with movement, fevers
>101.5, shaking chills, redness or drainage from the incision
site, chest pain, shortness of breath or any other concerns.

2. Please follow up with your PCP regarding this admission and
any new medications and refills.

3. Resume your home medications unless otherwise instructed.

4. You have been given medications for pain control. Please do
not operate heavy machinery or drink alcohol when taking these
medications. As your pain improves, please decrease the amount
of pain medication. This medication can cause constipation, so
you should drink plenty of water daily and take a stool softener
(e.g., colace) as needed to prevent this side effect.

5. You may not drive a car until cleared to do so by your
surgeon or your primary physician.

6. Please keep your wounds clean. You may get the wound wet or
take a shower starting 5 days after surgery, but no baths or
swimming for at least 4 weeks. No dressing is needed if wound
continues to be non-draining. Any stitches or staples that need
to be removed will be taken out by a visiting nurse at 2 weeks
after your surgery.

7. Please call your surgeon's office to schedule or confirm your
follow-up appointment at 4 weeks.

8. Please DO NOT take any NSAIDs (i.e. celebrex, ibuprofen,
advil, motrin, etc).

9. ANTICOAGULATION: Please continue your lovenox for 3 weeks to
prevent deep vein thrombosis (blood clots).  After completing
the lovenox, please take Aspirin 325mg twice daily for an
additional three weeks.

10. WOUND CARE: Please keep your incision clean and dry. It is
okay to shower after POD#5 but do not take a tub-bath or
submerge your incision until 4 weeks after surgery. Please place
a dry sterile dressing on the wound each day if there is
drainage, otherwise leave it open to air. Check wound regularly
for signs of infection such as redness or thick yellow drainage.
Staples will be removed by VNA in 2 weeks. If you are going to
rehab, the rehab facility can remove the staples at 2 weeks.

11. VNA (once at home): Home PT/OT, dressing changes as
instructed, wound checks, and staple removal at 2 weeks after
surgery.

12. ACTIVITY: Weight bearing as tolerated on the operative leg.
No strenuous exercise or heavy lifting until follow up
appointment.  ***Continue to use your CPM machine as
directed.***

Physical Therapy:
Physical therapy -- WBAT.  CPM advancing as tolerated to 0-100.
Lovenox injections. Wound checks. VNA to remove staples at 2
weeks.
Treatments Frequency:
Physical therapy -- WBAT.  ***CPM advancing as tolerated to
0-100.***  Lovenox injections. Wound checks. VNA to remove
staples at 2 weeks.

Followup Instructions:
Provider: [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1953**], [**MD Number(3) 1240**]:[**Telephone/Fax (1) 1228**]
Date/Time:[**2140-2-19**] 11:40
{'Osteoarthrosis, localized, not specified whether primary or secondary, lower leg,Acute edema of lung, unspecified,Acute kidney failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Asthma, unspecified type, unspecified,Anemia, unspecified,Depressive disorder, not elsewhere classified,Chronic kidney disease, unspecified,Obstructive sleep apnea (adult)(pediatric)'}


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: L knee pain

PRESENT ILLNESS: 59F with long history of L knee OA.

MEDICAL HISTORY: niddm,dyslipid,htn,asthema,OSA-w/cpap,renal insuffic,

MEDICATION ON ADMISSION: e
f
f
e
x
o
r
,
g
l
i
p
i
z
ide,ibuprof,lisinopril,metformin,prilosec,valium,vicodin,mvi,Ca,

ALLERGIES: Prednisone

PHYSICAL EXAM: PHYSICAL EXAM AT THE TIME OF DISCHARGE:
At the time of discharge:
AVSS
NAD
wound c/d/i without erythema
[**Last Name (un) 938**]/FHL/TA/GS intact
SILT distally

FAMILY HISTORY: n/c

SOCIAL HISTORY: Single, former smoker, has not smoked for 30
years.  She drinks minimally.  She is a travel consultant. 

### Response:
{'Osteoarthrosis, localized, not specified whether primary or secondary, lower leg,Acute edema of lung, unspecified,Acute kidney failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Asthma, unspecified type, unspecified,Anemia, unspecified,Depressive disorder, not elsewhere classified,Chronic kidney disease, unspecified,Obstructive sleep apnea (adult)(pediatric)'}
