CHIEF COMPLAINT: Left femoral neck fracture

PRESENT ILLNESS: The patient is a [**Age over 90 **] y.o.f with no records here at [**Hospital1 18**] and
unclear PMH who p/w failure to thrive. Per ED resident, patient
and her husband were put in an ambulance and sent to [**Hospital1 18**], and
their HCP accompanied them (unrelated HCP). Per the HCP, the
patient has not been eating well for the last 3-4 days and has
been more tired. She refused transfer earlier today, but agreed
to come with her husband.
.
ED COURSE: Vitals 100, 109, 123/65, 32, 92% RA (although MD note
says 95% 4L). Given levofloxacin 750 mg IV x 1, aspirin, and
ciprofloxacin 500 mg PO x 1. Found to have tenderness in hip on
exam and hip film performed with showed left femoral neck
fracture. Ortho saw patient in ED and recommended surgery, but
patient refused and did not sign consent form. Also found to be
hypoxic to 95% on 4L [**Name8 (MD) **] MD note, but not nursing record. ED
elected not to do CTA d/t Cr, with plan instead for V/Q scan in
a.m.
.
Currently the patient thinks she is at B&W and does not know why
she is here and continuously asks for her husband. She denies
any pain at rest, but when moving has some discomfort in left
rib area as well as itchiness on back/side. She denies fevers,
chills, nausea, vomiting, URI sxs, cough, chest pain, shortness
of breath, abd pain, dysuria, or other symptoms. States that she
normally walks around no her own and her and her husband take
care of eachother. Her history is difficult to obtain and likely
incomplete as the patient is demented.
.
Of note, after speaking with resident taking care of her
husband, with permission from the patient, it seems that her
husband relates witnessing the patient fall and had some rib
discomfort.

MEDICAL HISTORY: Denies any medical problems

MEDICATION ON ADMISSION: occasional aspirin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 95.6, 96/70, 100, 18, unable to obtain 02 sat
Gen: severely cachetic, pleasant, asking for [**First Name5 (NamePattern1) 892**]
[**Last Name (NamePattern1) 4459**]: NCAT, PERRL, EOMI
Neck: no masses
CV: RRR no MRG, nl S1, S2, no TTP along sternum, left chest, or
left ribs
Resp: CTAB, no W/R/C
Abd: NABS, soft, NTND, no guarding/rigidity/rebound
Back: no CVA tenderness
Ext: L hip pain with passive movement and TTP
Neuro: A&O x 1, thinks at B&W, very alert and admits to not
knowing date or other things, CN III-XII grossly intact, [**5-27**]
strength throughout, no sensory deficits
Skin: no ecchymosis at hip, skin intact, has papular
erythematous rash on left flank with excoriations, itchy

FAMILY HISTORY: none recalled by patient

SOCIAL HISTORY: Social History (taken from Dr. [**Last Name (STitle) **] note): Lives alone in a
basement apartment in a house inhabited by college students. Pt
and his wife reportedly have no other family/friend support.
They do have a PCA through ETHOS who comes in [**3-26**] hours/week for
basic housekeeping. They also have a case worker through Central
Elder Svs: Neusa Barnado ([**Telephone/Fax (1) 63663**].
Closed fracture of unspecified part of neck of femur,Subendocardial infarction, initial episode of care,Bacteremia,Acute kidney failure, unspecified,Hyperosmolality and/or hypernatremia,Acute posthemorrhagic anemia,Pressure ulcer, lower back,Unspecified protein-calorie malnutrition,Chronic or unspecified peptic ulcer of unspecified site with hemorrhage, with obstruction,Fall from other slipping, tripping, or stumbling,Other left bundle branch block,Hypoxemia,Diaphragmatic hernia without mention of obstruction or gangrene,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Osteoporosis, unspecified,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site
Fx neck of femur NOS-cl,Subendo infarct, initial,Bacteremia,Acute kidney failure NOS,Hyperosmolality,Ac posthemorrhag anemia,Pressure ulcer, low back,Protein-cal malnutr NOS,Chr peptic ulc w hem-obs,Fall from slipping NEC,Left bb block NEC,Hypoxemia,Diaphragmatic hernia,Gstr/ddnts NOS w/o hmrhg,Osteoporosis NOS,Mth sus Stph aur els/NOS
Admission Date:  [**2182-1-24**]              Discharge Date:   [**2182-2-5**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 759**]
Chief Complaint:
Left femoral neck fracture

Major Surgical or Invasive Procedure:
Right hip arthroplasty
PICC line placement
EGD


History of Present Illness:
The patient is a [**Age over 90 **] y.o.f with no records here at [**Hospital1 18**] and
unclear PMH who p/w failure to thrive. Per ED resident, patient
and her husband were put in an ambulance and sent to [**Hospital1 18**], and
their HCP accompanied them (unrelated HCP). Per the HCP, the
patient has not been eating well for the last 3-4 days and has
been more tired. She refused transfer earlier today, but agreed
to come with her husband.
.
ED COURSE: Vitals 100, 109, 123/65, 32, 92% RA (although MD note
says 95% 4L). Given levofloxacin 750 mg IV x 1, aspirin, and
ciprofloxacin 500 mg PO x 1. Found to have tenderness in hip on
exam and hip film performed with showed left femoral neck
fracture. Ortho saw patient in ED and recommended surgery, but
patient refused and did not sign consent form. Also found to be
hypoxic to 95% on 4L [**Name8 (MD) **] MD note, but not nursing record. ED
elected not to do CTA d/t Cr, with plan instead for V/Q scan in
a.m.
.
Currently the patient thinks she is at B&W and does not know why
she is here and continuously asks for her husband. She denies
any pain at rest, but when moving has some discomfort in left
rib area as well as itchiness on back/side. She denies fevers,
chills, nausea, vomiting, URI sxs, cough, chest pain, shortness
of breath, abd pain, dysuria, or other symptoms. States that she
normally walks around no her own and her and her husband take
care of eachother. Her history is difficult to obtain and likely
incomplete as the patient is demented.
.
Of note, after speaking with resident taking care of her
husband, with permission from the patient, it seems that her
husband relates witnessing the patient fall and had some rib
discomfort.

Past Medical History:
Denies any medical problems

Social History:
Social History (taken from Dr. [**Last Name (STitle) **] note): Lives alone in a
basement apartment in a house inhabited by college students. Pt
and his wife reportedly have no other family/friend support.
They do have a PCA through ETHOS who comes in [**3-26**] hours/week for
basic housekeeping. They also have a case worker through Central
Elder Svs: Neusa Barnado ([**Telephone/Fax (1) 63663**].

Family History:
none recalled by patient

Physical Exam:
95.6, 96/70, 100, 18, unable to obtain 02 sat
Gen: severely cachetic, pleasant, asking for [**First Name5 (NamePattern1) 892**]
[**Last Name (NamePattern1) 4459**]: NCAT, PERRL, EOMI
Neck: no masses
CV: RRR no MRG, nl S1, S2, no TTP along sternum, left chest, or
left ribs
Resp: CTAB, no W/R/C
Abd: NABS, soft, NTND, no guarding/rigidity/rebound
Back: no CVA tenderness
Ext: L hip pain with passive movement and TTP
Neuro: A&O x 1, thinks at B&W, very alert and admits to not
knowing date or other things, CN III-XII grossly intact, [**5-27**]
strength throughout, no sensory deficits
Skin: no ecchymosis at hip, skin intact, has papular
erythematous rash on left flank with excoriations, itchy

Pertinent Results:
[**2182-1-24**] 05:04PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2182-1-24**] 04:55PM URINE  HOURS-RANDOM CREAT-111 SODIUM-26
[**2182-1-24**] 04:55PM URINE  OSMOLAL-687
[**2182-1-24**] 04:55PM URINE  COLOR-Amber APPEAR-Clear SP [**Last Name (un) 155**]-1.021
[**2182-1-24**] 04:55PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG
[**2182-1-24**] 04:55PM URINE  RBC-0-2 WBC-0-2 BACTERIA-MOD YEAST-NONE
EPI-0-2
[**2182-1-24**] 04:49PM   GLUCOSE-127* UREA N-139* CREAT-3.1*
SODIUM-157* POTASSIUM-5.3* CHLORIDE-117* TOTAL CO2-19* ANION
GAP-26*
[**2182-1-24**] 04:49PM   estGFR-Using this
[**2182-1-24**] 04:49PM   CK(CPK)-132
[**2182-1-24**] 04:49PM   CK-MB-6 cTropnT-0.71*
[**2182-1-24**] 04:49PM   WBC-15.2* RBC-5.12 HGB-15.3 HCT-48.1* MCV-94
MCH-30.0 MCHC-31.9 RDW-14.6
[**2182-1-24**] 04:49PM   NEUTS-85.6* LYMPHS-9.5* MONOS-4.6 EOS-0.2
BASOS-0.2
[**2182-1-24**] 04:49PM   PLT COUNT-372

.
[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname 26**]       [**Hospital1 18**] [**Numeric Identifier 77107**]TTE (Complete)
Done [**2182-1-31**] at 2:37:51 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Last Name (LF) **], [**First Name3 (LF) **]
[**Location (un) 830**]
[**First Name (Titles) **] [**Last Name (Titles) **]
PBS 2
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2090-3-4**]
Age (years): [**Age over 90 **] F  Hgt (in):
BP (mm Hg): 98/52  Wgt (lb): 101
HR (bpm): 94  BSA (m2):
Indication: Murmur. Shortness of breath.
ICD-9 Codes: 424.1, 424.0
Test Information
Date/Time: [**2182-1-31**] at 14:37    Interpret MD: [**First Name11 (Name Pattern1) 449**] [**Last Name (NamePattern4) **],
MD
Test Type: TTE (Complete) Son[**Name (NI) 930**]: [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) **], RDCS
Doppler: Full Doppler and color Doppler Test Location: West Echo
Lab
Contrast: None Tech Quality: Adequate
Tape #: 2008W003-0:56 Machine: Vivid [**7-28**]
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  3.2 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  4.8 cm  <= 5.2 cm
Right Atrium - Four Chamber Length:  4.0 cm  <= 5.0 cm
Left Ventricle - Septal Wall Thickness:  0.9 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  0.8 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  3.2 cm  <= 5.6 cm
Left Ventricle - Systolic Dimension:  2.2 cm
Left Ventricle - Fractional Shortening:  0.31  >= 0.29
Left Ventricle - Ejection Fraction:  60% to 70%  >= 55%
Left Ventricle - Lateral Peak E':  *0.08 m/s  > 0.08 m/s
Left Ventricle - Septal Peak E':  *0.08 m/s  > 0.08 m/s
Left Ventricle - Ratio E/E':  13  < 15
Aorta - Sinus Level:  3.0 cm  <= 3.6 cm
Aortic Valve - Peak Velocity:  1.2 m/sec  <= 2.0 m/sec
Mitral Valve - E Wave:  1.0 m/sec
Mitral Valve - A Wave:  0.8 m/sec
Mitral Valve - E/A ratio:  1.25
TR Gradient (+ RA = PASP):  *>= 50 mm Hg  <= 25 mm Hg

Findings
LEFT ATRIUM: Normal LA size.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size.

LEFT VENTRICLE: Normal LV wall thickness, cavity size and
regional/global systolic function (LVEF >55%). No resting LVOT
gradient. No VSD.

RIGHT VENTRICLE: RV hypertrophy. Dilated RV cavity. RV function
depressed.

AORTA: Normal aortic diameter at the sinus level. Focal
calcifications in aortic root.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS.
No AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. No MVP.
Mild mitral annular calcification. Mild thickening of mitral
valve chordae. Calcified tips of papillary muscles. No MS. Mild
to moderate ([**1-23**]+) MR.

TRICUSPID VALVE: Mildly thickened tricuspid valve leaflets.
Normal tricuspid valve supporting structures. No TS. Moderate to
severe [3+] TR. Moderate PA systolic hypertension.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets
with physiologic PR. Normal main PA. No Doppler evidence for PDA


PERICARDIUM: No pericardial effusion.
Conclusions
The left atrium is normal in size. Left ventricular wall
thickness, cavity size and regional/global systolic function are
normal (LVEF 60-70%) There is no ventricular septal defect. The
right ventricular free wall is hypertrophied. The right
ventricular cavity is dilated. Right ventricular systolic
function appears depressed. The aortic valve leaflets (3) are
mildly thickened but aortic stenosis is not present. No aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. There is no mitral valve prolapse. Mild to moderate
([**1-23**]+) mitral regurgitation is seen. The tricuspid valve
leaflets are mildly thickened. Moderate to severe [3+] tricuspid
regurgitation is seen. There is moderate pulmonary artery
systolic hypertension. There is no pericardial effusion.
Electronically signed by [**First Name11 (Name Pattern1) 449**] [**Last Name (NamePattern4) **], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2182-1-31**] 16:17
.
   RADIOLOGY  Final Report

HIP UNILAT MIN 2 VIEWS LEFT  [**2182-1-24**] 5:21 PM

HIP UNILAT MIN 2 VIEWS LEFT

Reason: please evaluate for fracture

[**Hospital 93**] MEDICAL CONDITION:
[**Age over 90 **] yo F with failure to thrive. Patient has not been eating well
for 4 days per health care proxy. [**Name (NI) **] denies problems. +L
hip pain. ? fall, patient not good historian, unable to lift
left leg.
REASON FOR THIS EXAMINATION:
please evaluate for fracture
AP PELVIS, THREE VIEWS LEFT HIP, ON [**2182-1-24**] AT 1724
HOURS.

HISTORY: Left hip pain with questionable fall. Unable to lift
left leg.

COMPARISON: None.

FINDINGS: There is a transverse fracture through the left
femoral neck with superior displacement of the distal fracture
fragment and resultant varus angulation. The femoral head is
appropriately located within the acetabulum. The pelvis is
intact. No fracture of the sacrum is noted. The sacroiliac
joints are unremarkable. Mild degenerative changes are noted in
the included lower lumbar spine. The right hip is grossly
unremarkable. Clips are seen throughout the pelvis. There is a
ring-like structure in the pelvis likely a pessary.

IMPRESSION: Left femoral neck fracture as described above.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 7411**]
Approved: [**First Name8 (NamePattern2) **] [**2182-1-24**] 8:27 PM


Brief Hospital Course:
Mrs. [**Known lastname **] was found to have a left femoral neck fracture in
the Emergency Department on [**2182-1-24**].  Additionally, she had a
white blood cell count of 15.2, was hypernatremic to a sodium of
157, and had a BUN/Cr of 139/3.1.  She responded to  fluid
resuscitation.  On hospital day 4, her sodium was 144 and her
BUN/Cr was 139/1.5.  Her white blood cell count also decreased
to 9.8 on hospital day 4.
.
On hospital day 1, Mrs. [**Known lastname **] was found to have elevated
troponin-T at 0.71 with a normal CK of 132.  She was started on
Aspirin 325mg, Atorvastatin 40mg, and metoprolol 12.5mg [**Hospital1 **]. EKG
showed normal sinus rhythm with right bundle branch block and ST
depressions in V2,V3, and V4. Cardiology determined that there
was not convincing evidence of acute ischemia, and that the
elevation in enzymes could be attributed in part to acute renal
failure.

Given her improved hypernatremia and renal insufficiency, Mrs.
[**Known lastname **] underwent hip replacement surgery without complication
on hospital day 5.  She was started on a 7 day course (day 1,
[**2182-1-27**]) Nafcillin due to growth of methicillin sensitive staph
aureus in 1 out of 4 blood cultures. After OR, pt was
anticoagulated on LMWH (lovenox 30mg daily) and coumadin 3mg
(INR found to be 15) and began to have several episodes of
melanotic stool, with associated hct drop. Recieved 2 u ffp and
1 mg SC vit K to reverse coagulopathy and was admitted ot he
ICU. in ICU recieved a total of 5 PRBC and HCT came up to 40.
EGD showed non bleeding ulcer(see results). She was observed on
the floor and did not have any further signs and symptoms of
bleed and HCT remained stable. Anticoagulation which was held
after bleeding was resumed one day prior to discharge with
Lovenox 30 mg daily only, and no coumadin.
Patients HCT is to be followed daily for the next 5 days, and
She should follow up with GI and Ortho as out patient.
(Appintments made, see discharge paper)

Medications on Admission:
occasional aspirin

Discharge Medications:
1. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO Q 8H (Every 8 Hours).
2. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
3. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Oxycodone 5 mg Tablet Sig: 0.5 Tablet PO Q3H (every 3 hours)
as needed.
5. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
6. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q 8H
(Every 8 Hours) as needed for pain.
7. Sucralfate 1 gram Tablet Sig: One (1) Tablet PO TID (3 times
a day).
8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
10. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
11. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical TID
(3 times a day) as needed for to be applied to back and groin.
12. Enoxaparin 30 mg/0.3 mL Syringe Sig: Thirty (30) mg
Subcutaneous DAILY (Daily) for 6 weeks.
13. Heparin Flush PICC (100 units/ml) 2 ml IV DAILY:PRN
10 ml NS followed by 2 ml of 100 Units/ml heparin (200 units
heparin) each lumen Daily and PRN.  Inspect site every shift.


Discharge Disposition:
Extended Care

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

Discharge Diagnosis:
Right hip fracture s/p arthroplasty
Acute on chronic renal failure
Acute GI bleed
Osteoporosis


Discharge Condition:
Good


Discharge Instructions:
pt was discharged on lovenox as she bled after taking coumadin.
she tolerted this without difficulty.  she should continue to
take lovenox for total course of 6 weeks post-operatively (day 1
[**2182-1-27**]).

Followup Instructions:
Please follow-up with Dr. [**Last Name (STitle) **] in the orthopedic clinic on or
around [**2182-2-10**] to have your staples removed. Please call ([**Telephone/Fax (1) 15940**] to arrange for this follow-up apponitment.





Name:  [**Known lastname 12523**],[**Known firstname **]                    Unit No:   [**Numeric Identifier 12524**]

Admission Date:  [**2182-1-24**]              Discharge Date:   [**2182-2-5**]

Date of Birth:  [**2090-3-4**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2544**]
Addendum:
# anticoagulation - pt was restarted on a lower dose of lovenox
30mcg/sc qdaily on [**2182-2-4**] rather than typical 1mcg/kg qdaily
dosing given concern about GI bleeding. she will continue this
lower dose for 6 weeks time for DVT prophylaxis in the setting
of hip arthroplasty. she will need close follow-up of her
hematocrit for 5 days from discharge, if stable, these can be
discontinued.
.
# picc line - pt was found to be a difficult person to draw labs
on or obtain peripheral IV's. for this reason a PICC line was
placed. she was discharged with PICC line in place in order to
have close follow-up of her hematocrit daily x 5 days. if the
picc line is no longer necessary after day 5 ([**2182-2-10**]), this can
be discontinued.
.
# cardiac - pt started on asa, statin [**2-23**] concern for cardiac
event due to elevated troponins, though pt was without chest
pain/sob. CK and MB were unremarkable (peak CK 178, MB 6), and
trop was 0.19 at peak, felt [**2-23**] ARF. she will continue aspirin,
and can have statin discontinued if lipid profile as outpt is
unremarkable.
.
# follow-up - pt has scheduled follow-up appointments with
orthopedics (for suture removal), [**Hospital **] clinic (for recent GI
bleeding), and will need to establish care with her new primary
care physician (Dr. [**Last Name (STitle) **].


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 901**] - [**Location (un) 382**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2545**] MD [**MD Number(2) 2546**]

Completed by:[**2182-2-5**]
{'Closed fracture of unspecified part of neck of femur,Subendocardial infarction, initial episode of care,Bacteremia,Acute kidney failure, unspecified,Hyperosmolality and/or hypernatremia,Acute posthemorrhagic anemia,Pressure ulcer, lower back,Unspecified protein-calorie malnutrition,Chronic or unspecified peptic ulcer of unspecified site with hemorrhage, with obstruction,Fall from other slipping, tripping, or stumbling,Other left bundle branch block,Hypoxemia,Diaphragmatic hernia without mention of obstruction or gangrene,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Osteoporosis, unspecified,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site'}


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: Left femoral neck fracture

PRESENT ILLNESS: The patient is a [**Age over 90 **] y.o.f with no records here at [**Hospital1 18**] and
unclear PMH who p/w failure to thrive. Per ED resident, patient
and her husband were put in an ambulance and sent to [**Hospital1 18**], and
their HCP accompanied them (unrelated HCP). Per the HCP, the
patient has not been eating well for the last 3-4 days and has
been more tired. She refused transfer earlier today, but agreed
to come with her husband.
.
ED COURSE: Vitals 100, 109, 123/65, 32, 92% RA (although MD note
says 95% 4L). Given levofloxacin 750 mg IV x 1, aspirin, and
ciprofloxacin 500 mg PO x 1. Found to have tenderness in hip on
exam and hip film performed with showed left femoral neck
fracture. Ortho saw patient in ED and recommended surgery, but
patient refused and did not sign consent form. Also found to be
hypoxic to 95% on 4L [**Name8 (MD) **] MD note, but not nursing record. ED
elected not to do CTA d/t Cr, with plan instead for V/Q scan in
a.m.
.
Currently the patient thinks she is at B&W and does not know why
she is here and continuously asks for her husband. She denies
any pain at rest, but when moving has some discomfort in left
rib area as well as itchiness on back/side. She denies fevers,
chills, nausea, vomiting, URI sxs, cough, chest pain, shortness
of breath, abd pain, dysuria, or other symptoms. States that she
normally walks around no her own and her and her husband take
care of eachother. Her history is difficult to obtain and likely
incomplete as the patient is demented.
.
Of note, after speaking with resident taking care of her
husband, with permission from the patient, it seems that her
husband relates witnessing the patient fall and had some rib
discomfort.

MEDICAL HISTORY: Denies any medical problems

MEDICATION ON ADMISSION: occasional aspirin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 95.6, 96/70, 100, 18, unable to obtain 02 sat
Gen: severely cachetic, pleasant, asking for [**First Name5 (NamePattern1) 892**]
[**Last Name (NamePattern1) 4459**]: NCAT, PERRL, EOMI
Neck: no masses
CV: RRR no MRG, nl S1, S2, no TTP along sternum, left chest, or
left ribs
Resp: CTAB, no W/R/C
Abd: NABS, soft, NTND, no guarding/rigidity/rebound
Back: no CVA tenderness
Ext: L hip pain with passive movement and TTP
Neuro: A&O x 1, thinks at B&W, very alert and admits to not
knowing date or other things, CN III-XII grossly intact, [**5-27**]
strength throughout, no sensory deficits
Skin: no ecchymosis at hip, skin intact, has papular
erythematous rash on left flank with excoriations, itchy

FAMILY HISTORY: none recalled by patient

SOCIAL HISTORY: Social History (taken from Dr. [**Last Name (STitle) **] note): Lives alone in a
basement apartment in a house inhabited by college students. Pt
and his wife reportedly have no other family/friend support.
They do have a PCA through ETHOS who comes in [**3-26**] hours/week for
basic housekeeping. They also have a case worker through Central
Elder Svs: Neusa Barnado ([**Telephone/Fax (1) 63663**]. 

### Response:
{'Closed fracture of unspecified part of neck of femur,Subendocardial infarction, initial episode of care,Bacteremia,Acute kidney failure, unspecified,Hyperosmolality and/or hypernatremia,Acute posthemorrhagic anemia,Pressure ulcer, lower back,Unspecified protein-calorie malnutrition,Chronic or unspecified peptic ulcer of unspecified site with hemorrhage, with obstruction,Fall from other slipping, tripping, or stumbling,Other left bundle branch block,Hypoxemia,Diaphragmatic hernia without mention of obstruction or gangrene,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Osteoporosis, unspecified,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site'}
