CHIEF COMPLAINT: right hip pain

PRESENT ILLNESS: Mr [**Known lastname **] had a right total hip replacement in [**2177**].  He did well
until the components failed in [**2188**].  At that point, he had a
revision right total hip arthroplasty of all components.  He
continued to have pain and xray demonstrated mild to moderate
protrusion of the acetabular components into the pelvis.  For
this, he elects for definitive treatment.

MEDICAL HISTORY: HTN, dyslipid, ischemic heart disease, h/o NSTEMI, OSA, OA,
gout, MS, h/o stroke, glaucoma, restless leg, psoriasis, h/o
MRSA

MEDICATION ON ADMISSION: atenolol, baclofen, celexa, clonazepam, folic acid, lisinopril,
neurontin, nicotine patch, provigil, timolol eye drops, alphagan
eye drops, plavix, simvastatin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: well appearing 58 year old male
alert and oriented
no acute distress
RLE:
 -dressing-c/d/i
 -incision-c/d/i, no erythema, minimal serosanguinous drainage
 -+AT, FHL, [**Last Name (un) 938**]
 -SILT
 -brisk cap refill
 -calf-soft, nontender
 -NVI distally

FAMILY HISTORY: nc

SOCIAL HISTORY: nc
Dislocation of prosthetic joint,Acute posthemorrhagic anemia,Delirium due to conditions classified elsewhere,Multiple sclerosis,Other iatrogenic hypotension,Hypovolemia,Obstructive sleep apnea (adult)(pediatric),Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus,Major osseous defects,Coronary atherosclerosis of native coronary artery,Gout, unspecified,Restless legs syndrome (RLS),Other psoriasis,Old myocardial infarction,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation
Dislocate prosthetic jt,Ac posthemorrhag anemia,Delirium d/t other cond,Multiple sclerosis,Iatrogenc hypotnsion NEC,Hypovolemia,Obstructive sleep apnea,Meth resis Staph carrier,Major osseous defects,Crnry athrscl natve vssl,Gout NOS,Restless legs syndrome,Other psoriasis,Old myocardial infarct,Hx TIA/stroke w/o resid,Abn react-artif implant
Admission Date:  [**2192-7-11**]              Discharge Date:   [**2192-7-16**]

Date of Birth:  [**2134-4-9**]             Sex:   M

Service: ORTHOPAEDICS

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 64**]
Chief Complaint:
right hip pain

Major Surgical or Invasive Procedure:
revision Right total hip replacement - acetabular component


History of Present Illness:
Mr [**Known lastname **] had a right total hip replacement in [**2177**].  He did well
until the components failed in [**2188**].  At that point, he had a
revision right total hip arthroplasty of all components.  He
continued to have pain and xray demonstrated mild to moderate
protrusion of the acetabular components into the pelvis.  For
this, he elects for definitive treatment.

Past Medical History:
HTN, dyslipid, ischemic heart disease, h/o NSTEMI, OSA, OA,
gout, MS, h/o stroke, glaucoma, restless leg, psoriasis, h/o
MRSA


Social History:
nc

Family History:
nc

Physical Exam:
well appearing 58 year old male
alert and oriented
no acute distress
RLE:
 -dressing-c/d/i
 -incision-c/d/i, no erythema, minimal serosanguinous drainage
 -+AT, FHL, [**Last Name (un) 938**]
 -SILT
 -brisk cap refill
 -calf-soft, nontender
 -NVI distally

Pertinent Results:
[**2192-7-11**] 04:20PM BLOOD WBC-6.6 RBC-4.19* Hgb-13.1* Hct-40.2
MCV-96 MCH-31.2 MCHC-32.5 RDW-13.5 Plt Ct-228
[**2192-7-11**] 08:25PM BLOOD WBC-12.0*# RBC-3.35* Hgb-11.0* Hct-32.8*
MCV-98 MCH-32.8* MCHC-33.6 RDW-14.1 Plt Ct-164
[**2192-7-12**] 03:56AM BLOOD WBC-10.9 RBC-2.85* Hgb-9.4* Hct-27.1*
MCV-95 MCH-32.8* MCHC-34.5 RDW-14.1 Plt Ct-171
[**2192-7-15**] 06:00AM BLOOD WBC-11.1* RBC-3.30* Hgb-9.9* Hct-29.9*
MCV-91 MCH-30.0 MCHC-33.0 RDW-16.3* Plt Ct-225
[**2192-7-13**] 06:50AM BLOOD Glucose-102* UreaN-7 Creat-0.6 Na-138
K-3.4 Cl-101 HCO3-27 AnGap-13

Brief Hospital Course:
The patient was admitted to the orthopaedic surgery service and
was taken to the operating room for above described procedure.
Please see separately dictated operative report for details. The

surgery was uncomplicated and the patient tolerated the
procedure well.  Patient received perioperative IV antibiotics.

Postoperative course was remarkable for the following:

1. [**Hospital Unit Name 153**] admission - Because the patient has multiple
co-morbidities and lost a fair amount of blood intraoperatively,
Mr [**Known lastname **] was initially admitted to the [**Hospital Unit Name 153**] for observation.  He
remained intubated for approximately 18 hours after surgery.  He
was hypotensive.  He responded well to blood transfusion and
fluid resusitation.  He was extubated and doing well when
transferred to 12 [**Hospital Ward Name **] on POD 1.

2. Post-op delerium - on the night of POD 1 and into POD 2, Mr
[**Known lastname **] was noted to be paranoid, confused, and anxious.  He was
unable to verbalize the causes for this.  Consults for medicine
and social work were called.  His medication was adjusted -
psychotropics and narcotics were minimized.  On POD 3, he was
clear and coherent.

Otherwise, pain was initially controlled with IV dilaudid
followed by
a transition to oral pain medications on POD#2.  The patient
received lovenox for DVT prophylaxis pre-operatively for one
week prior to surgery and was restarted on this on the morning
of POD#1.  The foley was removed on POD#3 and the patient was
voiding independently thereafter. The surgical dressing was
changed on POD#2 and the surgical incision was found to be clean

and intact without erythema or abnormal drainage. 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 acceptable and pain was adequately
controlled on an oral regimen. The operative extremity was
neurovascularly intact and the wound was benign.

The patient's weight-bearing status is weight bearing as
tolerated on the operative extremity. Posterior hip precautions.
 No active abduction x 6 weeks


Mr [**Known lastname **] is discharged to rehab in stable condition with
prescriptions for lovenox and dilaudid.


Medications on Admission:
atenolol, baclofen, celexa, clonazepam, folic acid, lisinopril,
neurontin, nicotine patch, provigil, timolol eye drops, alphagan
eye drops, plavix, simvastatin

Discharge Medications:
1. Enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) syringe
Subcutaneous DAILY (Daily).
Disp:*21 syringe* Refills:*0*
2. Alum-Mag Hydroxide-Simeth 200-200-20 mg/5 mL Suspension Sig:
15-30 MLs PO Q6H (every 6 hours) as needed for Dyspepsia.
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
Constipation.
5. Multivitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
6. Ferrous Sulfate 300  mg (60 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
7. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day).
8. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
9. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
10. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

12. Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO Q8H (every
8 hours).
13. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
14. Modafinil 100 mg Tablet Sig: Two (2) Tablet PO daily ().
15. Timolol Maleate 0.25 % Drops Sig: One (1) Drop Ophthalmic
[**Hospital1 **] (2 times a day).
16. Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic Q8H
(every 8 hours).
17. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
18. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours).
19. Plavix 75 mg Tablet Sig: One (1) Tablet PO once a day:
**please resume once you've finished your course of lovenox**.
20. Oxycodone 5 mg Tablet Sig: 0.5-1 Tablet PO Q3H (every 3
hours) as needed for pain.
Disp:*80 Tablet(s)* Refills:*0*
21. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day)
as needed for Constipation.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 6560**] Care & Rehab Center  - [**Location (un) 86**]

Discharge Diagnosis:
failed Right Total Hip replacement - acetabular component


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
1. Please return to the emergency department or notify your
physician if you experience any of the following: severe pain
not relieved by medication, increased swelling, decreased
sensation, difficulty with movement, fevers greater than 101.5,
shaking chills, increasing redness or drainage from the incision

site, chest pain, shortness of breath or any other concerns.
2. Please follow up with your primary physician regarding this
admission and any new medications and refills.
3. Resume your home medications unless otherwise instructed.  DO
NOT RESUME PLAVIX UNTIL YOU'VE COMPLETED YOUR COURSE OF LOVENOX.
4. You have been given medications for pain control. Please do
not drive, operate heavy machinery, or drink alcohol while
taking these medications. As your pain decreases, take fewer
tablets and increase the time between doses. This medication can

cause constipation, so you should drink plenty of water daily
and take a stool softener (such as colace) as needed to prevent
this side effect.  Call your surgeons office 3 days before you
are out of medication so that it can be refilled.  These
medications cannot be called into your pharmacy and must be
picked up in the clinic or mailed to your house.  Please allow
an extra 2 days if you would like your medication mailed to your

home.
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 shower starting five
days after surgery, but no tub baths or swimming for at least
four 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 the visiting nurse or rehab facility two
weeks after your surgery.
7. Please call your surgeon's office to schedule or confirm your

follow-up appointment in four weeks.
8. Please DO NOT take any non-steroidal anti-inflammatory
medications (NSAIDs such as celebrex, ibuprofen, advil, aleve,
motrin, etc).
9. ANTICOAGULATION: Please continue your lovenox for three weeks
after leaving the hospital to help prevent deep vein thrombosis
(blood clots).  After completing the lovenox, please resume your
home dose of plavix.
10. WOUND CARE: Please keep your incision clean and dry. It is
okay to shower five days after surgery but no tub baths,
swimming, or submerging your incision until after your four week

checkup. 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 the rehab facility in two weeks.
11. VNA (once at home): Home PT/OT, dressing changes as
instructed, wound checks, and staple removal at two weeks after
surgery.
12. ACTIVITY: Weight bearing as tolerated on the operative
extremity. No strenuous exercise or heavy lifting until follow
up appointment.  Posterior hip precautions.  NO ACTIVE ABDUCTION
X 6 WEEKS.

Physical Therapy:
Weight bearing as tolerated on the operative extremity.
Posterior hip precautions.  NO ACTIVE ABDUCTION X 6 WEEKS.  No
strenuous exercise or heavy lifting until follow up appointment
Treatments Frequency:
Please keep your incision clean and dry. It is okay to shower
five days after surgery but no tub baths, swimming, or
submerging your incision until after your four week checkup.
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 the rehab facility in two weeks.


Followup Instructions:
Provider: [**First Name11 (Name Pattern1) 177**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3260**], [**MD Number(3) 3261**]:[**Telephone/Fax (1) 1228**]
Date/Time:[**2192-8-10**] 10:40



Completed by:[**2192-7-16**]
{'Dislocation of prosthetic joint,Acute posthemorrhagic anemia,Delirium due to conditions classified elsewhere,Multiple sclerosis,Other iatrogenic hypotension,Hypovolemia,Obstructive sleep apnea (adult)(pediatric),Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus,Major osseous defects,Coronary atherosclerosis of native coronary artery,Gout, unspecified,Restless legs syndrome (RLS),Other psoriasis,Old myocardial infarction,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}


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: right hip pain

PRESENT ILLNESS: Mr [**Known lastname **] had a right total hip replacement in [**2177**].  He did well
until the components failed in [**2188**].  At that point, he had a
revision right total hip arthroplasty of all components.  He
continued to have pain and xray demonstrated mild to moderate
protrusion of the acetabular components into the pelvis.  For
this, he elects for definitive treatment.

MEDICAL HISTORY: HTN, dyslipid, ischemic heart disease, h/o NSTEMI, OSA, OA,
gout, MS, h/o stroke, glaucoma, restless leg, psoriasis, h/o
MRSA

MEDICATION ON ADMISSION: atenolol, baclofen, celexa, clonazepam, folic acid, lisinopril,
neurontin, nicotine patch, provigil, timolol eye drops, alphagan
eye drops, plavix, simvastatin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: well appearing 58 year old male
alert and oriented
no acute distress
RLE:
 -dressing-c/d/i
 -incision-c/d/i, no erythema, minimal serosanguinous drainage
 -+AT, FHL, [**Last Name (un) 938**]
 -SILT
 -brisk cap refill
 -calf-soft, nontender
 -NVI distally

FAMILY HISTORY: nc

SOCIAL HISTORY: nc 

### Response:
{'Dislocation of prosthetic joint,Acute posthemorrhagic anemia,Delirium due to conditions classified elsewhere,Multiple sclerosis,Other iatrogenic hypotension,Hypovolemia,Obstructive sleep apnea (adult)(pediatric),Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus,Major osseous defects,Coronary atherosclerosis of native coronary artery,Gout, unspecified,Restless legs syndrome (RLS),Other psoriasis,Old myocardial infarction,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}
