CHIEF COMPLAINT: 

PRESENT ILLNESS: 

MEDICAL HISTORY: Complex.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Nonunion of fracture,Hemorrhage complicating a procedure,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Unspecified sleep apnea,Aortocoronary bypass status,Old myocardial infarction,Personal history of venous thrombosis and embolism
Nonunion of fracture,Hemorrhage complic proc,DMII wo cmp nt st uncntr,Anemia NOS,Sleep apnea NOS,Aortocoronary bypass,Old myocardial infarct,Hx-ven thrombosis/embols
Admission Date: [**2197-10-19**]        Discharge Date: [**2197-10-24**]

Date of Birth:  [**2129-3-14**]        Sex:  F

Service:  ORT


HOSPITAL COURSE ADMISSION:  Ms. [**Known lastname 32737**] is a pleasant 68-
year-old female, who on [**2197-6-3**] sustained a left
subtrochanteric femur fracture that was managed with a Gamma
nail.  Unfortunately, since that time she has had cutting
through the head of the Gamma nail to the point that she now
has a varus deformity of her femoral fracture with possible
nonunion, and the screw of the Gamma nail was cutting into
the upper aspect of her joint into the acetabulum.  She
presents today for assessment and opinion regarding possible
surgical management.  She was accompanied by her daughter and
husband.  She was alert with good mentation and appeared well-
informed in regard to her hip procedure.  Recently, she was
seen by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1968**] who recommended total hip
replacement.

PAST MEDICAL HISTORY:  Complex.

History of diabetes.

Deep vein thrombophlebitis.

Coronary artery disease.

Lung resection.

Sleep apnea.

Possible COPD.  She is oxygen dependent at times.

PAST SURGICAL HISTORY:  Heart bypass in [**2190**].

Appendectomy.

ALLERGIES TO MEDICINES:  Ampicillin, Zocor, Bactrim,
cefotetan.

CURRENT MEDICATIONS:  Extensive.
1. Celebrex.
2. Coumadin.
3. Furosemide.
4. Ranitidine.
5. Potassium.
6. Lactulose.
7. Lipitor.
8. Isordil.
9. Accupril.
10.Os-Cal.
11.Centrum.
12.Colace.
13.Several vitamins.
14.Oxycodone.
15.Oxycontin.
16.Insulin.

PHYSICAL EXAMINATION:  A pleasant female in no apparent
distress.  She was not oxygen dependent at this time.  She
had a scar on her chest from her previous CABG.  She had full
range of motion of her upper extremities, but significant
decreased range of motion of her left hip which is the one
involved.  She had severe deformity on minimal range of
motion.  Her right hip does not seem to bother her as much.
Her extremities seemed to be well-perfused and warm with a
palpable dorsalis pedis pulse, but not a palpable posterior
tibialis on the left side.  She appeared to be sensory intact
to light touch.  Sensation:  4 plus/5 motor strength in all
major lower extremity groups.  There was no evidence of skin
breakdown or ulceration in her lower extremities.  Her
incisions from prior surgery were pristine.

HOSPITAL COURSE:  She was seen by Dr. [**Last Name (STitle) 1005**] in the office
who felt the patient would need to have reconstructive
surgery for her left hip.  She underwent cardiac clearance
which cleared her for cardiac surgery.  She had the insertion
of a vena cava filter preoperatively because she would have
to be off her Coumadin for the surgery.  All of this was done
preoperatively.  The patient was then considered ready for
surgery.

On [**2197-10-20**], the patient was taken to the operating room.
The preoperative diagnosis was subtrochanteric nonunion of
the left hip.  Postop diagnosis was the same.  The patient
underwent removal of the Gamma nail on the left side, and
also she underwent a left calcar-replacing hemiarthroplasty.
The patient tolerated the procedure well and was transferred
to the PACU status post in satisfactory and hemodynamically
stable condition.

She continued to do well in the PACU and was stable enough to
be transferred to the CC6 floor where she was seen by
physical therapy.  She got up and was walking.  On postop day
1, she had her PA catheter that was placed by anesthesia
removed.  Physical therapy saw her and felt she was doing
well, but because of her extensive past medical history she
would need to be sent to rehab.  The patient was started to
be screened by rehab.  She continued to do well.

Postoperatively, her hematocrit was low.  She received
transfusions.  The day of discharge, her hematocrit was 27.1
which was satisfactory.  She was started back on Coumadin
despite the fact that she did have [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 260**] umbrella
placed.  Her goal INR was to be 1.5-2.0.  Her INR the day of
discharge was 1.6, and she was taking 2-3 mg of Coumadin.
The day of discharge it was recommended that she be on 2.5,
but a goal INR should be maintained.  She should have INRs
drawn until she is satisfactorily stabilized on her Coumadin
therapy.  The patient was accepted at rehabilitation
facility.  From an orthopedic point-of-view she was doing
well.  Dr. [**Last Name (STitle) 1005**] saw the patient the day of transfer and
felt the patient would be stable enough to go home.  She is
to follow-up with Dr. [**Last Name (STitle) 1005**] 10 days from today.  She is
to call Dr.[**Name (NI) 4016**] office to schedule an appointment.
Dr.[**Name (NI) 4016**] office number is [**Telephone/Fax (1) 4845**].

DISCHARGE INSTRUCTIONS:  She is to be discharged to rehab
full-weightbearing with posterior hip dislocation
precautions.  Take her pain medication as ordered.  She is to
take her Coumadin as prescribed.  Her Coumadin at the time of
discharge was going to be 2.5 mg.  However, optimal goal for
her should be 1.5-2.0 on her INR.  She is to follow-up with
Dr. [**Last Name (STitle) 1005**] the first Thursday from today to have her
staples removed.  She is to keep the wound dry and intact
with a bandage.

DISCHARGE MEDICATIONS:
1. Lasix 80 mg po q am.
2. Ranitidine 150 mg po once daily.
3. Lactulose 10 gm in 15 cc.  She is to take 30 cc po bid.
4. Atorvastatin calcium 40 mg po bid.
5. Quinapril hydrochloride 20 mg po once daily.
6. Docusate sodium 100 mg capsule 1 [**Hospital1 **].
7. Bisacodyl 5 mg delayed release 2 tablets po once daily.
8. Nitroglycerin 0.4 mg sublingual 1 tab prn.
9. Calcium carbonate 1,250 mg tablet 1 po bid.
10.Calciferol Vitamin D3 400 units 0.5, [**1-27**] tablet po bid.
11.KCL 10 mEq SR 1 po bid.
12.Isosorbide dinitrate 20 mg po bid.
13.Oxycodone hydrochloride 20 mg tablet SR 1 q 12 h.
14.Percocet 325 mg [**1-27**] po q 4-6 h prn.
15.Oxycodone/acetaminophen 5/325 mg tablet [**1-27**] po q 4-6 h prn
pain.
16.Coumadin 2.5 mg po at bedtime.  Goal INR 1.5-2.0.

DISCHARGE DIAGNOSES:  Status post left calcar-replacing
hemiarthroplasty.

Status post left subtrochanteric nonunion.

Status post removal of Gamma nail, left side, hip.

Status post coronary artery bypass graft surgery.

Status post postoperative blood transfusion.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) **], MD [**MD Number(2) 16347**]

Dictated By:[**Last Name (NamePattern4) 51424**]
MEDQUIST36
D:  [**2197-10-24**] 11:28:05
T:  [**2197-10-24**] 12:21:48
Job#:  [**Job Number 98229**]
{'Nonunion of fracture,Hemorrhage complicating a procedure,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Unspecified sleep apnea,Aortocoronary bypass status,Old myocardial infarction,Personal history of venous thrombosis and embolism'}


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: 

MEDICAL HISTORY: Complex.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Nonunion of fracture,Hemorrhage complicating a procedure,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Unspecified sleep apnea,Aortocoronary bypass status,Old myocardial infarction,Personal history of venous thrombosis and embolism'}
