CHIEF COMPLAINT: Left leg ulcers

PRESENT ILLNESS: This 64BF has a history of PVD and foot ulcers and was admitted
from Dr.[**Name (NI) 7257**] office for VAC placement and possible
angiograms.

MEDICAL HISTORY: -- DM2
-- chronic foot ulcers/PVD
-- HTN
-- OA
-- obesity
-- asthma
-- leg pain/neuropathy
-- depression
-- anemia
-- h/o MRSA bacteremia [**11-18**], also septic arthritis treated at
[**Hospital3 **]
.
Right thalamic hemorrhage resulting in a gait disorder and
incontinence of urine, followed by Dr. [**Last Name (STitle) **].
Old CVAs.
Neuropathy, peripheral.
Anxiety and panic disorder.
Status post total abdominal hysterectomy.
Hypercholesterolemia.

MEDICATION ON ADMISSION: Remeron 30 mg PO daily
Lopressor 50 mg PO BID
Mevacor 20 mg PO daily
MVI
Vicodin PRN
Plavix 75 mg PO daily
Celexa 10 mg PO daily

ALLERGIES: Penicillins

PHYSICAL EXAM: Discharge
General NAD Vitals 98.8, 118/58, 92 SR, 20 RR, 98% RA, 124.2 kg
Neuro A/O x3 MAE R=L strength, generalized weakness
Pulm CTA but diminished bilat bases no rhochi/wheezes
Card RRR no murmur/rub/gallop
Abd Soft nontender nondistended obese + BS BM [**6-5**]
Ext warm pulses with doppler no edema
IV access midline Rt AC
Inc Sternal healing no erythema no drainage staples intact -
plan for removal [**6-14**]
Left subclavian incision healing no erythema no drainage staples
intact - plan for removal [**6-14**]
Right groin incision - no drainage or erythema covered with DSD
staples intact plan for removal [**6-14**]
Left ankle ulcer tissue pink healing no drainage - VAC dc'd and
wet - dry dressing [**Hospital1 **], area 6cm L x 1.5 cm W x .25 cm D
Left calf circular open area that is pink healing no drainage
dry dressing

FAMILY HISTORY: Brother died of an MI in his 30's, she denies diabetes mellitus
in the family. Cancer in parents (mother died in 40s, father in
80s), at least two siblings, but unsure what kind.

SOCIAL HISTORY: The patient lives with her daughter [**Name (NI) 2048**] and her three kids
since being d/c'ed from a nursing home last [**Month (only) 205**]. Has seven
children, many grandchildren. Smokes [**1-16**] to 1 pack per day.
Venous (peripheral) insufficiency, unspecified,Ulcer of ankle,Cellulitis and abscess of leg, except foot,Chronic kidney disease, unspecified,Thrombocytopenia, unspecified,Urinary tract infection, site not specified,Aneurysm of artery of neck,Other diseases of trachea and bronchus,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Iron deficiency anemia, unspecified,Personal history of malignant neoplasm of breast,Vascular dementia, uncomplicated,Cerebral atherosclerosis,Tobacco use disorder
Venous insufficiency NOS,Ulcer of ankle,Cellulitis of leg,Chronic kidney dis NOS,Thrombocytopenia NOS,Urin tract infection NOS,Aneurysm of neck,Trachea & bronch dis NEC,Hypertension NOS,DMII wo cmp nt st uncntr,Iron defic anemia NOS,Hx of breast malignancy,Vascular dementia,uncomp,Cerebral atherosclerosis,Tobacco use disorder
Admission Date:  [**2125-5-3**]              Discharge Date:   [**2125-6-6**]

Date of Birth:  [**2060-7-29**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Penicillins

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Left leg ulcers

Major Surgical or Invasive Procedure:
s/p Aorto-Innominate artery bypass/aorto-> L common carotid
bypass [**2125-5-22**]
s/p L carotid->L subclavian bypass(8 mm PTFE)/Thoracic aortic
stent graft [**5-23**]


History of Present Illness:
This 64BF has a history of PVD and foot ulcers and was admitted
from Dr.[**Name (NI) 7257**] office for VAC placement and possible
angiograms.

Past Medical History:
-- DM2
-- chronic foot ulcers/PVD
-- HTN
-- OA
-- obesity
-- asthma
-- leg pain/neuropathy
-- depression
-- anemia
-- h/o MRSA bacteremia [**11-18**], also septic arthritis treated at
[**Hospital3 **]
.
Right thalamic hemorrhage resulting in a gait disorder and
incontinence of urine, followed by Dr. [**Last Name (STitle) **].
Old CVAs.
Neuropathy, peripheral.
Anxiety and panic disorder.
Status post total abdominal hysterectomy.
Hypercholesterolemia.


Social History:
The patient lives with her daughter [**Name (NI) 2048**] and her three kids
since being d/c'ed from a nursing home last [**Month (only) 205**]. Has seven
children, many grandchildren. Smokes [**1-16**] to 1 pack per day.

Family History:
Brother died of an MI in his 30's, she denies diabetes mellitus
in the family. Cancer in parents (mother died in 40s, father in
80s), at least two siblings, but unsure what kind.


Physical Exam:
Discharge
General NAD Vitals 98.8, 118/58, 92 SR, 20 RR, 98% RA, 124.2 kg
Neuro A/O x3 MAE R=L strength, generalized weakness
Pulm CTA but diminished bilat bases no rhochi/wheezes
Card RRR no murmur/rub/gallop
Abd Soft nontender nondistended obese + BS BM [**6-5**]
Ext warm pulses with doppler no edema
IV access midline Rt AC
Inc Sternal healing no erythema no drainage staples intact -
plan for removal [**6-14**]
Left subclavian incision healing no erythema no drainage staples
intact - plan for removal [**6-14**]
Right groin incision - no drainage or erythema covered with DSD
staples intact plan for removal [**6-14**]
Left ankle ulcer tissue pink healing no drainage - VAC dc'd and
wet - dry dressing [**Hospital1 **], area 6cm L x 1.5 cm W x .25 cm D
Left calf circular open area that is pink healing no drainage
dry dressing

Skin care eval [**5-28**]
S/P surgery, she developed a drug rash and has dry desquamation
overall body. There are several open blistered sites on her left

forearm and one open site on her right forearm. All unroofed
blisters are partial thickness ulcers with pink wound beds.
There is minimal drainage from the sites. The wound edges are
irregular. The periwound tissue has blistered skin and dry
exfoliation. There are no s/s of infection.

Goals of wound care: resolved skin issues

Recommendations: Pressure relief per pressure ulcer guidelines
Support surface: BariMaxx II with ETS
Turn and reposition every 1-2 hours and prn
Heels off bed surface at all times
Multipodis Splints to B/L LE's
If OOB, limit sit time to one hour at a time and sit on a
pressure relief cushion, 4"Foam.
Elevate LE's while sitting.

Commercial wound cleanser or normal saline to irrigate/cleanse
all open wounds.
Pat the tissue dry with dry gauze.
Apply Aquaphor Ointment to the intact dry skin upper and lower
extremities, torso [**Hospital1 **]
Apply Adaptic (nonadherent dsg) to the open ulcers (unroofed
blisters)
Cover with dry gauze
Secure with netting, no tape on skin.
Change dressing daily.

Support nutrition and hydration.

[**5-31**]
SWALLOWING ASSESSMENT:
PO assessment was conducted with ice chips, water and nectar
thick liquid via tsp, cup and straw sip, custard, applesauce and

whole & crushed meds in applesauce and one bite of ground up
[**Location (un) **] crackers in custard. Swallows were slow / delayed.
Laryngeal elevation felt adequate to palpation. There was no
cough, no throat clear and no change in voice quality after
eating or drinking. However, the pt. consistently said that she
felt like coughing after drinking water. She said she did not
feel like coughing after drinking nectar thick liquids. We were
unable to obtain a reliable O2 saturation despite trying on her
finger, toe or ear. She seemed to swallow ground and pureed
solids but did best when she alternated between bites and sips.

She could not swallow the whole pill w/nectar or in applesauce.

So, we crushed the pill in custard and swallowed it with a sip
of
nectar to follow.

SUMMARY / IMPRESSION:
[**Known firstname **] [**Known lastname 1661**] may be aspirating thin liquids because she says
she feel like coughing consistently after drinking water.
However, she appears safe to drink nectar thick liquids and to
eat pureed or ground solids if she alternates between bites and
sips. She could not swallow a whole pill today with nectar thick

[**Location (un) 2452**] juice or whole in applesauce, but she swallowed her pill
crushed in custard w/a sip of nectar to follow.
This swallowing pattern correlates to a Dysphagia Outcome
Severity Scale (DOSS) rating of Level 4, Mild to moderate
dysphagia with 2 consistnecy restrictions and intermittent
supervision/cueing. This dysphagia is likely due to her old
strokes.

RECOMMENDATIONS:
1. Diet of ground solids and Nectar thick liquids with
Pills crushed in puree

2. Supervision w/meals
Alternate between bites and sips

3. If there are further concerns about aspiration on this diet,
we would be happy to perform a FEES evaluation. She would
not be a candidate for a Videoswallow because she is too
large to fit into the fluoroscope.

These recommendations were shared with the patient, nurse and
medical team.


____________________________________
[**First Name4 (NamePattern1) 1154**] [**Last Name (NamePattern1) 19916**] [**Doctor Last Name 3748**], M.S., CCC-SLP
Pager # [**Numeric Identifier 22568**]



Pertinent Results:
[**2125-6-5**] 07:23AM BLOOD WBC-10.7 RBC-2.71* Hgb-8.0* Hct-23.9*
MCV-88 MCH-29.5 MCHC-33.4 RDW-16.5* Plt Ct-311
[**2125-5-6**] 06:10AM BLOOD Neuts-95.5* Bands-0 Lymphs-1.9*
Monos-1.3* Eos-1.0 Baso-0.4
[**2125-5-3**] 07:30PM BLOOD WBC-5.5 RBC-4.54 Hgb-12.1 Hct-37.2 MCV-82
MCH-26.7* MCHC-32.5 RDW-14.9 Plt Ct-158
[**2125-5-3**] 07:30PM BLOOD Neuts-65.6 Lymphs-26.2 Monos-4.7 Eos-3.2
Baso-0.3
[**2125-6-6**] 05:38AM BLOOD PT-16.4* INR(PT)-1.5*
[**2125-6-5**] 07:23AM BLOOD Plt Ct-311
[**2125-5-3**] 07:30PM BLOOD Plt Ct-158
[**2125-5-3**] 07:30PM BLOOD PT-11.4 PTT-26.1 INR(PT)-1.0
[**2125-5-30**] 03:03AM BLOOD ESR-65*
[**2125-6-6**] 10:41AM BLOOD Glucose-156* UreaN-25* Creat-1.1 Na-140
K-3.7 Cl-109* HCO3-22 AnGap-13
[**2125-5-3**] 07:30PM BLOOD Glucose-130* UreaN-23* Creat-1.1 Na-142
K-3.8 Cl-107 HCO3-24 AnGap-15
[**2125-5-22**] 11:20PM BLOOD CK(CPK)-188*
[**2125-5-18**] 04:45AM BLOOD ALT-40 AST-39 LD(LDH)-310* AlkPhos-136*
Amylase-52 TotBili-0.3
[**2125-5-18**] 04:45AM BLOOD Lipase-44
[**2125-5-22**] 11:20PM BLOOD CK-MB-4 cTropnT-0.02*
[**2125-6-6**] 10:41AM BLOOD Calcium-8.2* Phos-3.7 Mg-2.3
[**2125-5-3**] 07:30PM BLOOD Calcium-9.1 Phos-3.0 Mg-2.3

RADIOLOGY  Final Report

CHEST (PA & LAT)  [**2125-6-5**] 8:42 AM

CHEST (PA & LAT)

Reason: evaluate effusion

[**Hospital 93**] MEDICAL CONDITION:
64 year old woman with R innom. aneurysm
REASON FOR THIS EXAMINATION:
evaluate effusion
PORTABLE UPRIGHT CHEST, 8:52 A.M., [**6-5**].

INDICATION: Followup effusion.

FINDINGS: Compared with 5/16 and with [**2125-5-29**], haziness at the
right lung base is consistent with the right pleural effusion
seen on CT of [**6-2**] and does not appear grossly changed.

The left hemidiaphragm is elevated compared with the pre-op
study consistent the left lower lobe collapse on CT. The
superimposed left pleural effusion appears perhaps slightly
smaller.

The known right innominate artery aneurysm and recent aortic
stent graft are again noted. No overt CHF.

IMPRESSION: Overall, no definite/obvious significant interval
changes appreciated.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
Approved: TUE [**2125-6-5**] 12:00 PM

   RADIOLOGY  Final Report

CTA CHEST W&W/O C&RECONS, NON-CORONARY  [**2125-6-2**] 1:16 PM

CTA CHEST W&W/O C&RECONS, NON-

Reason: r/o leak

[**Hospital 93**] MEDICAL CONDITION:
64 year old woman with s/p aortic reconstruction
REASON FOR THIS EXAMINATION:
r/o leak
CONTRAINDICATIONS for IV CONTRAST: None.

HISTORY: 64-year-old woman post aortic reconstruction, evaluate
for leak.

TECHNIQUE: Multidetector contiguous axial images of the neck and
chest were obtained following the administration of intravenous
contrast. Delayed images of the neck through the chest were
obtained. Non-contrast study of the chest was also obtained.

FINDINGS: Compared to prior study of [**2125-5-4**], there has
been repair of the aneurysmal dilatation of the innominate
artery. Stent graft is seen extending from the distal portion of
the ascending thoracic aorta through the arch and through the
proximal portion of the descending thoracic aorta. No leak is
identified.

Injection of contrast was performed via the left arm, and there
are a large amount of collaterals seen extending along the
posterior chest wall to the azygos and hemiazygos veins which
enter the right atrium via the IVC. The SVC, and proximal left
subclavian vein are thrombosed in the interval.

There are no filling defects in the pulmonary arterial
vasculature. No pulmonary embolism is identified. At the site of
surgical clips in the left upper neck, there is a large hematoma
measuring 3.6 x 6.8 cm.

Lung windows demonstrate atelectasis of the left lower lobe,
moderate and to a lesser degree on the right. Small bilateral
pleural effusions are present.

Few images through the upper abdomen demonstrate a simple cyst
arising from the upper pole of the left kidney measuring 5.5 cm
in diameter. A calcified granuloma is seen in the spleen.

Findings were discussed with Dr. [**Last Name (STitle) **]. Bridges on [**2125-6-2**].

IMPRESSION:
1. No leak post aortic reconstruction.
2. No pulmonary embolism.
3. Left neck hematoma as described above.
4. Interval development of thrombosis of the superior vena cava
and proximal left subclavian vein.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) **]
DR. [**First Name8 (NamePattern2) 7722**] [**Last Name (NamePattern1) 7723**]
Approved: SUN [**2125-6-3**] 11:13 AM

Cardiology Report ECG Study Date of [**2125-5-24**]  9:25:12 AM


Sinus tachycardia with diffuse low voltage. Q waves in leads III
and aVF
consistent with prior inferior myocardial infarction. Compared
to the previous
tracing of [**2125-5-22**] no diagnostic change.


Read by: [**Last Name (LF) **],[**First Name8 (NamePattern2) 2206**] [**Doctor Last Name **]

  Intervals Axes
Rate PR QRS QT/QTc P QRS T
102 130 80 294/352.85 48 -10 75


Cardiology Report ECHO Study Date of [**2125-5-23**]



PATIENT/TEST INFORMATION:
Indication: Intra-op TEE for Aortic stenting
Status: Inpatient
Date/Time: [**2125-5-23**] at 11:04
Test: TEE (Complete)
Doppler: Full Doppler and color Doppler
Contrast: None
Tape Number: 2007AW07-:
Test Location: Anesthesia West OR cardiac
Technical Quality: Adequate




REFERRING DOCTOR: DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
  DR. [**First Name (STitle) 412**] [**Last Name (Prefixes) 413**]

INTERPRETATION:

Findings:

LEFT VENTRICLE: Mild symmetric LVH. Normal LV cavity size.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTIC VALVE: Three aortic valve leaflets. Mildly thickened
aortic valve
leaflets. No AS. No AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild (1+)
MR.

TRICUSPID VALVE: Mild [1+] TR.

PULMONIC VALVE/PULMONARY ARTERY: Physiologic (normal) PR.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify
I was present in compliance with HCFA regulations. No TEE
related
complications. The patient was under general anesthesia
throughout the
procedure. The patient appears to be in sinus rhythm. Results
were personally
effusion.

Conclusions:
There is mild symmetric left ventricular hypertrophy. The left
ventricular
cavity size is normal. Right ventricular chamber size and free
wall motion are
normal. There are three aortic valve leaflets. The aortic valve
leaflets are
mildly thickened. There is no aortic valve stenosis. No aortic
regurgitation
is seen. The mitral valve leaflets are mildly thickened. Mild
(1+) mitral
regurgitation is seen.

Electronically signed by [**First Name8 (NamePattern2) 6506**] [**Name8 (MD) 6507**], MD on [**2125-5-24**] 07:08.

[**Location (un) **] PHYSICIAN:






Brief Hospital Course:
Admitted [**5-3**] to vascular service for left leg venous stasis
ulcers which was infected, she was sterted on IV antibiotics and
VAC placed [**5-4**].  She was worked up for mass that was
compressing trachea that revealed innominate artery aneurysm.
Cardiac surgery was consulted and she underwent preoperative
workup.  She underwent recontruction and bypass of aneurysm in
two phase on [**5-22**] and [**5-23**], see operative report for further
details.  She was transferred to the CSRU and requiring pressors
for blood pressure management. She awoke neurologically intact
and over the next few days was weaned off pressors and
diuresised.  She extubated on [**5-28**] without complications and
continued to progress.  She remained in the CSRU for respiratory
and blood pressure monitoring.  She had swallowing evaluation
due to concerns for aspiration that she did well and was cleared
for nectar thickended.  She was started on anticoagulation for
thrombosis Rt subclavian.  She continued to do well and was
transferred to [**Hospital Ward Name **] 2 on [**6-4**] for continued treatment.  She
continued to work with physical therapy and was ready for
discharge to rehab.

Medications on Admission:
Remeron 30 mg PO daily
Lopressor 50 mg PO BID
Mevacor 20 mg PO daily
MVI
Vicodin PRN
Plavix 75 mg PO daily
Celexa 10 mg PO daily


Discharge Medications:
1. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
5. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
6. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
8. Albuterol 90 mcg/Actuation Aerosol Sig: Four (4) Puff
Inhalation Q6H (every 6 hours).
9. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
10. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily).
11. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) for 1 months.
12. Enoxaparin 120 mg/0.8 mL Syringe Sig: One (1)  Subcutaneous
Q12H (every 12 hours): UNTIL INR 2.0.
13. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
QID (4 times a day) as needed.
14. Mineral Oil-Hydrophil Petrolat     Ointment Sig: One (1)
Appl Topical TID (3 times a day) as needed.
15. White Petrolatum-Mineral Oil     Cream Sig: One (1) Appl
Topical QID (4 times a day) as needed.
16. Heparin Lock Flush (Porcine) 100 unit/mL Syringe Sig: Two
(2) ML Intravenous DAILY (Daily) as needed: each port of midline
daily and as needed.
17. insulin sliding scale
Insulin SC  (per Insulin Flowsheet)
      Sliding Scale

Fingerstick QACHSInsulin SC Sliding Scale
  Breakfast Lunch Dinner Bedtime
Humalog Humalog Humalog Humalog
Glucose Insulin Dose Insulin Dose Insulin Dose Insulin Dose
0-60   mg/dL 4 oz. Juice 4 oz. Juice 4 oz. Juice 4 oz. Juice
61-100   mg/dL 0   Units 0   Units 0   Units 0   Units
101-130   mg/dL 2   Units 2   Units 2   Units 0   Units
131-150   mg/dL 4   Units 4   Units 4   Units 0   Units
151-180   mg/dL 6   Units 6   Units 6   Units 2   Units
181-210   mg/dL 8   Units 8   Units 8   Units 4   Units
211-240   mg/dL 10   Units 10   Units 10   Units 6   Units

  Ordered by [**Last Name (LF) **],[**First Name3 (LF) 2114**] M, APN Beeper#: [**Numeric Identifier 72690**] on [**6-4**] @ 2112
  Acknowledged by RN on [**6-4**] @ 2140 by [**Last Name (LF) **],[**Name8 (MD) 674**], RN
  Processed by pharmacy on [**6-4**] @ 2118 by [**Last Name (LF) **],[**First Name3 (LF) **]
  Order #:[**Numeric Identifier 94654**]



18. Warfarin 2 mg Tablet Sig: Two (2) Tablet PO ONCE (Once) for
1 doses: for [**6-6**] only, then MD to order daily dose.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 2222**] - [**Location (un) 538**]

Discharge Diagnosis:
Innominate artery aneurysm
PVD
HTN
NIDDM
Depression
Iron deficiency anemia
CRI
s/p breast ca
s/p CVA
^chol.
vascular dementia


Discharge Condition:
Good.


Discharge Instructions:
Follow medications on discharge instructions.
Do not drive for 4 weeks.
Do not lift more than 10 lbs. for 10 weeks.
Shower daily, let water flow over wounds, pat dry with a towel.
Call our office for temp.>101.5, sternal drainage.
Do not use creams, lotions, or powders on wounds.
Please call with any questions or concerns [**Telephone/Fax (1) 170**]


Followup Instructions:
Make an appointment with Dr. [**Last Name (STitle) **] for 2 weeks. (vasc. foot
surgeon)[**Telephone/Fax (1) 2395**]
Make an appointment with Dr. [**Last Name (STitle) 1290**] for 4 weeks.[**Telephone/Fax (1) 170**]
Make an appointment with Dr. [**Last Name (STitle) 8499**] after discharge from
rehab [**Telephone/Fax (1) 7976**]



Completed by:[**2125-6-6**]
{'Venous (peripheral) insufficiency, unspecified,Ulcer of ankle,Cellulitis and abscess of leg, except foot,Chronic kidney disease, unspecified,Thrombocytopenia, unspecified,Urinary tract infection, site not specified,Aneurysm of artery of neck,Other diseases of trachea and bronchus,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Iron deficiency anemia, unspecified,Personal history of malignant neoplasm of breast,Vascular dementia, uncomplicated,Cerebral atherosclerosis,Tobacco use disorder'}


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 leg ulcers

PRESENT ILLNESS: This 64BF has a history of PVD and foot ulcers and was admitted
from Dr.[**Name (NI) 7257**] office for VAC placement and possible
angiograms.

MEDICAL HISTORY: -- DM2
-- chronic foot ulcers/PVD
-- HTN
-- OA
-- obesity
-- asthma
-- leg pain/neuropathy
-- depression
-- anemia
-- h/o MRSA bacteremia [**11-18**], also septic arthritis treated at
[**Hospital3 **]
.
Right thalamic hemorrhage resulting in a gait disorder and
incontinence of urine, followed by Dr. [**Last Name (STitle) **].
Old CVAs.
Neuropathy, peripheral.
Anxiety and panic disorder.
Status post total abdominal hysterectomy.
Hypercholesterolemia.

MEDICATION ON ADMISSION: Remeron 30 mg PO daily
Lopressor 50 mg PO BID
Mevacor 20 mg PO daily
MVI
Vicodin PRN
Plavix 75 mg PO daily
Celexa 10 mg PO daily

ALLERGIES: Penicillins

PHYSICAL EXAM: Discharge
General NAD Vitals 98.8, 118/58, 92 SR, 20 RR, 98% RA, 124.2 kg
Neuro A/O x3 MAE R=L strength, generalized weakness
Pulm CTA but diminished bilat bases no rhochi/wheezes
Card RRR no murmur/rub/gallop
Abd Soft nontender nondistended obese + BS BM [**6-5**]
Ext warm pulses with doppler no edema
IV access midline Rt AC
Inc Sternal healing no erythema no drainage staples intact -
plan for removal [**6-14**]
Left subclavian incision healing no erythema no drainage staples
intact - plan for removal [**6-14**]
Right groin incision - no drainage or erythema covered with DSD
staples intact plan for removal [**6-14**]
Left ankle ulcer tissue pink healing no drainage - VAC dc'd and
wet - dry dressing [**Hospital1 **], area 6cm L x 1.5 cm W x .25 cm D
Left calf circular open area that is pink healing no drainage
dry dressing

FAMILY HISTORY: Brother died of an MI in his 30's, she denies diabetes mellitus
in the family. Cancer in parents (mother died in 40s, father in
80s), at least two siblings, but unsure what kind.

SOCIAL HISTORY: The patient lives with her daughter [**Name (NI) 2048**] and her three kids
since being d/c'ed from a nursing home last [**Month (only) 205**]. Has seven
children, many grandchildren. Smokes [**1-16**] to 1 pack per day. 

### Response:
{'Venous (peripheral) insufficiency, unspecified,Ulcer of ankle,Cellulitis and abscess of leg, except foot,Chronic kidney disease, unspecified,Thrombocytopenia, unspecified,Urinary tract infection, site not specified,Aneurysm of artery of neck,Other diseases of trachea and bronchus,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Iron deficiency anemia, unspecified,Personal history of malignant neoplasm of breast,Vascular dementia, uncomplicated,Cerebral atherosclerosis,Tobacco use disorder'}
