CHIEF COMPLAINT: R hip pain s/p fall

PRESENT ILLNESS: Ms. [**Known lastname 106126**] is a [**Age over 90 **] yo Russian speaking F with a h/o CAD s/p
CABG x5, HTN, BPPV, HL, CLL, breast CA resident of [**Hospital 100**] Rehab
presenting s/p mechanical fall last night with R hip pain. The
patient states that she was at her dresser, leaning over and
fell.  She admits to pain in the left hip and she has multiple
scrapes on her R knee.  An x-ray performed at her nursing home
showed a right intratrochanteric fracture.  The patient denies
hitting her head, denies loss of consciousness, chest pain,
dyspnea or lightheadedness.  The patient ambulates with a walker
and has a history of recurrent falls.  The patient admits to
falling approximately 10 days ago.  She was seen at [**Hospital 882**]
Hospital for a laceration of her left hand, which was glued with
skin glue, and a dressing was applied.

MEDICAL HISTORY: l.   CAD s/p 5 vessel CABG
2.   Stable angina.
3.   Arthritis.
4.   Hypertension.
5.   Cataracts.
6.   Glaucoma.
7.   Hypercholesterolemia.
8.   History of prior infarction.
9.   CLL
10.  Breast ca
[**58**]. h/o MRSA UTI

MEDICATION ON ADMISSION: ceftin 500mg [**Hospital1 **] till [**1-1**]
Vigamox 1drop [**Hospital1 **] left eye till [**1-16**]
Polysporin eye ointment [**Hospital1 **] left eye till [**1-16**]
iron 325 daily
tylenol 650mg q4prn +975 [**Hospital1 **]
zocor 40mg daily
ativan .5mg [**Hospital1 **]
dulcolax supp daily prn
Vit D 1000 daily
Tums 650mg [**Hospital1 **]
anusol 25mg daily prn
atenolol 25mg daily
Imdur 30mg daily
primidone 50mg qhs
senna 17.2mg qhs
miralax prn
MOM 30cc TID prn
aranesp 40mcg qthurs
.
hyrogel to Left hand open areas and telfa and dry dressing

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:  98.8 F 78 146/78 22 92% RA
Gen: Thin elderly woman in NAD
HEENT: mucosa mildly dry
Cardiovascular: normal rate, regular rhythm, 2/6 systolic murmur
Lungs: CTA anteriorly
Abd: soft, nt/nd +bs, mild general ttp. foley in place
Extr: R hip externally rotated, tender to palpation R hip. MAEW.
no LE edema, weak distal pulses, good gross sensation. + scrapes
R knee
neuro: A&O x3, no decrease in sensation

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Social History:  The patient lives at [**Hospital6 459**].  Her
family is involved.  The patient does not smoke or drink.
Closed fracture of intertrochanteric section of neck of femur,Pneumonia, organism unspecified,Chronic lymphoid leukemia, without mention of having achieved remission,Hyposmolality and/or hyponatremia,Other specified intestinal obstruction,Intestinal infection due to Clostridium difficile,Acute posthemorrhagic anemia,Acute kidney failure, unspecified,Unspecified fall,Home accidents,Aortocoronary bypass status,Coronary atherosclerosis of unspecified type of vessel, native or graft,Personal history of malignant neoplasm of breast,Other and unspecified angina pectoris,Unspecified glaucoma,Urinary frequency,Osteoporosis, unspecified,Dacryoadenitis, unspecified,Unspecified essential hypertension,Carrier or suspected carrier of other specified bacterial diseases,Infection with microorganisms resistant to penicillins
Intertrochanteric fx-cl,Pneumonia, organism NOS,Ch lym leuk wo achv rmsn,Hyposmolality,Intestinal obstruct NEC,Int inf clstrdium dfcile,Ac posthemorrhag anemia,Acute kidney failure NOS,Fall NOS,Accident in home,Aortocoronary bypass,Cor ath unsp vsl ntv/gft,Hx of breast malignancy,Angina pectoris NEC/NOS,Glaucoma NOS,Urinary frequency,Osteoporosis NOS,Dacryoadenitis NOS,Hypertension NOS,Bacteria dis carrier NEC,Inf mcrg rstn pncllins
Admission Date:  [**2154-12-31**]              Discharge Date:   [**2155-1-10**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
R hip pain s/p fall

Major Surgical or Invasive Procedure:
ORIF R intratrochanteric fracture


History of Present Illness:
Ms. [**Known lastname 106126**] is a [**Age over 90 **] yo Russian speaking F with a h/o CAD s/p
CABG x5, HTN, BPPV, HL, CLL, breast CA resident of [**Hospital 100**] Rehab
presenting s/p mechanical fall last night with R hip pain. The
patient states that she was at her dresser, leaning over and
fell.  She admits to pain in the left hip and she has multiple
scrapes on her R knee.  An x-ray performed at her nursing home
showed a right intratrochanteric fracture.  The patient denies
hitting her head, denies loss of consciousness, chest pain,
dyspnea or lightheadedness.  The patient ambulates with a walker
and has a history of recurrent falls.  The patient admits to
falling approximately 10 days ago.  She was seen at [**Hospital 882**]
Hospital for a laceration of her left hand, which was glued with
skin glue, and a dressing was applied.

The patient had a recent admission [**11-17**] for left lacrimal gland
abscess/cellulits and currently on ceftin.  The patient was seen
in the emergency department by orthopedics, and was scheduled
for the OR the subsequent day.

Past Medical History:
l.   CAD s/p 5 vessel CABG
2.   Stable angina.
3.   Arthritis.
4.   Hypertension.
5.   Cataracts.
6.   Glaucoma.
7.   Hypercholesterolemia.
8.   History of prior infarction.
9.   CLL
10.  Breast ca
[**58**]. h/o MRSA UTI


Social History:
Social History:  The patient lives at [**Hospital6 459**].  Her
family is involved.  The patient does not smoke or drink.

Family History:
noncontributory

Physical Exam:
PE:  98.8 F 78 146/78 22 92% RA
Gen: Thin elderly woman in NAD
HEENT: mucosa mildly dry
Cardiovascular: normal rate, regular rhythm, 2/6 systolic murmur
Lungs: CTA anteriorly
Abd: soft, nt/nd +bs, mild general ttp. foley in place
Extr: R hip externally rotated, tender to palpation R hip. MAEW.
no LE edema, weak distal pulses, good gross sensation. + scrapes
R knee
neuro: A&O x3, no decrease in sensation


Pertinent Results:
Admission labs:
[**2154-12-31**] 02:27PM   PT-12.6 PTT-23.6 INR(PT)-1.1
[**2154-12-31**] 02:27PM   PLT SMR-NORMAL PLT COUNT-196
[**2154-12-31**] 02:27PM   HYPOCHROM-NORMAL ANISOCYT-1+ POIKILOCY-NORMAL
MACROCYT-1+ MICROCYT-NORMAL POLYCHROM-NORMAL
[**2154-12-31**] 02:27PM   NEUTS-55 BANDS-1 LYMPHS-36 MONOS-5 EOS-0
BASOS-0 ATYPS-3* METAS-0 MYELOS-0
[**2154-12-31**] 02:27PM   WBC-10.6# RBC-3.17* HGB-10.9* HCT-31.7*
MCV-100* MCH-34.4* MCHC-34.5 RDW-15.2
[**2154-12-31**] 02:27PM   CK-MB-NotDone cTropnT-0.05*
[**2154-12-31**] 02:27PM   CK(CPK)-29
[**2154-12-31**] 02:27PM   estGFR-Using this
.
Discharge Labs:

.
Pertinent Imaging:
CXR ([**2154-12-31**]): Impression: Findings consistent with fluid
overload including pulmonary vascular engorgement and small left
pleural effusion.
.
R hip x-ray ([**2154-12-31**]): Impression: Intertrochanteric fracture,
with minimal distraction and varus angulation.
.
R Knee x-ray ([**2154-12-31**]): Impression: No evidence of fracture
about the knee.
.
Hip Xray: HISTORY: Fracture.
Seven intraoperative radiographs of the right proximal femur
were obtained without a radiologist present. These demonstrate
successive steps of open reduction and internal fixation of an
intertrochanteric fracture. For additional details, please
consult the operative report.


Brief Hospital Course:
Ms. [**Known lastname 106126**] is a [**Age over 90 **] year old with significant cardiac history
admitted with fall and right nondisplaced hip fracture, admitted
to medicine for medical clearance for orthopedic surgery on the
following day, and medical management.
.
Right hip fracture: Admitted to medicine for pre-operative
clearance.  [**Doctor Last Name **] Cardiac Risk Assessment for non-cardiac
surgery: Patient gets 5 points for age >70.  Falls into class I,
borderline class II.  Risk of MI, CHF, VT: 0.6%-3%, risk of
cardiac death 0.2%-1%.  She was treated with peri-operative beta
blocker.  She went to the OR on [**1-1**].  She did well through
surgery with no complications.  Follow up hip xrays were done.
Her hematocrit have been stable x 3 checks.  POD 1 she had
substantial pain with movement.  She was written for standing
pain control with tylenol 1000mg PO Q8AM, 2PM, and 10PM and
oxycodone 2.5mg PO Q8AM, 2PM, and 10PM; with PRN for
breakthrough and "anticipated pain events" (such as PT).  Her
pain became well controlled and she had no confusion on the
regimen.  She was continued on iron and aranesp and treated with
lovenox 40mg SQ daily for DVT prophylaxis.
.
Hyponatremia: Patient is hyponatremic at baseline and requires
fluid restriction at rehab.  She has h/o breast cancer and h/o
leukemia per family. There was some evidence of volume overload
prior to surgery, however she now does not require oxygen and
appears euvolemic.  Low Na was treated with Na and frequent
monitoring.
.
Urinary Frequency: Had UTI prior to admit.  UA and urine culture
were negative this admission.
.
Osteoporosis: Per Xrays, fracture appears to be osteoporotic in
nature (not pathologic, as this would be a concern in the
setting of hx of breast cancer).  While in house she was
continued on vitamin D 1000mg IU Qday (she was on this as
outpatient), calcium [**Hospital1 **].  Vitamin D level was pending at time
of discharge.  If this is <30, will need to replete with higher
doses until >30 (can be done as outpatient).  Then can safely
start bisphosphonate after Vitamin D is greater than 30.
.
Falls: Multifactorial. Patient is on scheduled lorazepam 0.5mg
[**Hospital1 **], primidone (unclear indication) as outpatient, and son [**Name (NI) 382**]
insists that she continue these medications.  Outpatient PCP
should have risk/benefit discussion regarding increased risk of
falls and these medications. Family also mentions that she
refuses to wear incontinence products and has urinary frequency
symptoms. They feel this may have led to fall.
.
CAD: (Per cath [**2141**] - 3 vessel disease).  No symptoms this
admission.  Telemetry is unremarkable. Continued current medical
management with isosorbide, atenolol.  PCP to address need of
aspirin as outpatient (was not on this prior to hospitalization)

.
H/O breast cancer with sternal lump: Defer to PCP to address as
outpatient.
.
Lacrimal gland abscess: Continued eye antibiotics
.
Prevention/Dispo: Encouraged incentive spirometry, out of bed to
chair, elevate heels while in bed.
.
DNR/DNI
MICU COURSE

- Admitted [**12-31**] from [**Hospital 100**] Rehab after fall, with
non-displaced intertrochanteric fracture and left hand
laceration
- Had mildly elevated troponin (<0.1) on admission
- [**1-1**] had ORIF right hip by orthopedics
- [**1-3**] CXR demonstrated left retrocardiac opacity, also with
increasing fever curve; levofloxacin started
- [**1-6**] developed abdominal pain and distention; KUB suggested
volvulus, but barium study demonstrated freely passing contrast;
GI consulted. Mildly hypotensive overnight [**Date range (1) 11104**], resolved
with fluid. Several episodes of diarrhea.
- [**1-7**] rectal tube placed for [**Last Name (un) 3696**]/colonic ileus. CT
abd/pelvis performed. ABG 7.51/34/71 with lactate 1.1
- [**1-8**] R SFA occlusion noted on CT scan; vascular surgery
consulted and recommended no intervention. C. diff positive;
metronidazole 500mg TID started. Renal team consulted for
hyponatremia and increasing creatinine (increased 0.8 to 1.2)
thought secondary to hypovolemia
- [**1-9**] creatinine increased to 2.0, sodium decreased from 125
to 120; ABG checked 7.48/21/118 with lactate 8.4, anion gap 16.
Hematocrit jumped from 29 on [**1-7**] to 41 on [**1-9**].

On [**1-9**], she was transferred to the MICU for altered mental
status, at which time a lactate was checked and was found to be
8.4. Her clinical exam changed; she developed rebound
tenderness. Surgery was consulted; the patient and the family
did not wish to pursue surgery, and no invasive procedures (e.g.
central lines) were persued. She expired at 5:47am on [**1-10**].

Medications on Admission:
ceftin 500mg [**Hospital1 **] till [**1-1**]
Vigamox 1drop [**Hospital1 **] left eye till [**1-16**]
Polysporin eye ointment [**Hospital1 **] left eye till [**1-16**]
iron 325 daily
tylenol 650mg q4prn +975 [**Hospital1 **]
zocor 40mg daily
ativan .5mg [**Hospital1 **]
dulcolax supp daily prn
Vit D 1000 daily
Tums 650mg [**Hospital1 **]
anusol 25mg daily prn
atenolol 25mg daily
Imdur 30mg daily
primidone 50mg qhs
senna 17.2mg qhs
miralax prn
MOM 30cc TID prn
aranesp 40mcg qthurs
.
hyrogel to Left hand open areas and telfa and dry dressing

Discharge Medications:
N/A

Discharge Disposition:
Extended Care

Discharge Diagnosis:
N/A

Discharge Condition:
Expired

Discharge Instructions:
N/A

Followup Instructions:
N/A
{'Closed fracture of intertrochanteric section of neck of femur,Pneumonia, organism unspecified,Chronic lymphoid leukemia, without mention of having achieved remission,Hyposmolality and/or hyponatremia,Other specified intestinal obstruction,Intestinal infection due to Clostridium difficile,Acute posthemorrhagic anemia,Acute kidney failure, unspecified,Unspecified fall,Home accidents,Aortocoronary bypass status,Coronary atherosclerosis of unspecified type of vessel, native or graft,Personal history of malignant neoplasm of breast,Other and unspecified angina pectoris,Unspecified glaucoma,Urinary frequency,Osteoporosis, unspecified,Dacryoadenitis, unspecified,Unspecified essential hypertension,Carrier or suspected carrier of other specified bacterial diseases,Infection with microorganisms resistant to penicillins'}


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: R hip pain s/p fall

PRESENT ILLNESS: Ms. [**Known lastname 106126**] is a [**Age over 90 **] yo Russian speaking F with a h/o CAD s/p
CABG x5, HTN, BPPV, HL, CLL, breast CA resident of [**Hospital 100**] Rehab
presenting s/p mechanical fall last night with R hip pain. The
patient states that she was at her dresser, leaning over and
fell.  She admits to pain in the left hip and she has multiple
scrapes on her R knee.  An x-ray performed at her nursing home
showed a right intratrochanteric fracture.  The patient denies
hitting her head, denies loss of consciousness, chest pain,
dyspnea or lightheadedness.  The patient ambulates with a walker
and has a history of recurrent falls.  The patient admits to
falling approximately 10 days ago.  She was seen at [**Hospital 882**]
Hospital for a laceration of her left hand, which was glued with
skin glue, and a dressing was applied.

MEDICAL HISTORY: l.   CAD s/p 5 vessel CABG
2.   Stable angina.
3.   Arthritis.
4.   Hypertension.
5.   Cataracts.
6.   Glaucoma.
7.   Hypercholesterolemia.
8.   History of prior infarction.
9.   CLL
10.  Breast ca
[**58**]. h/o MRSA UTI

MEDICATION ON ADMISSION: ceftin 500mg [**Hospital1 **] till [**1-1**]
Vigamox 1drop [**Hospital1 **] left eye till [**1-16**]
Polysporin eye ointment [**Hospital1 **] left eye till [**1-16**]
iron 325 daily
tylenol 650mg q4prn +975 [**Hospital1 **]
zocor 40mg daily
ativan .5mg [**Hospital1 **]
dulcolax supp daily prn
Vit D 1000 daily
Tums 650mg [**Hospital1 **]
anusol 25mg daily prn
atenolol 25mg daily
Imdur 30mg daily
primidone 50mg qhs
senna 17.2mg qhs
miralax prn
MOM 30cc TID prn
aranesp 40mcg qthurs
.
hyrogel to Left hand open areas and telfa and dry dressing

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:  98.8 F 78 146/78 22 92% RA
Gen: Thin elderly woman in NAD
HEENT: mucosa mildly dry
Cardiovascular: normal rate, regular rhythm, 2/6 systolic murmur
Lungs: CTA anteriorly
Abd: soft, nt/nd +bs, mild general ttp. foley in place
Extr: R hip externally rotated, tender to palpation R hip. MAEW.
no LE edema, weak distal pulses, good gross sensation. + scrapes
R knee
neuro: A&O x3, no decrease in sensation

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Social History:  The patient lives at [**Hospital6 459**].  Her
family is involved.  The patient does not smoke or drink. 

### Response:
{'Closed fracture of intertrochanteric section of neck of femur,Pneumonia, organism unspecified,Chronic lymphoid leukemia, without mention of having achieved remission,Hyposmolality and/or hyponatremia,Other specified intestinal obstruction,Intestinal infection due to Clostridium difficile,Acute posthemorrhagic anemia,Acute kidney failure, unspecified,Unspecified fall,Home accidents,Aortocoronary bypass status,Coronary atherosclerosis of unspecified type of vessel, native or graft,Personal history of malignant neoplasm of breast,Other and unspecified angina pectoris,Unspecified glaucoma,Urinary frequency,Osteoporosis, unspecified,Dacryoadenitis, unspecified,Unspecified essential hypertension,Carrier or suspected carrier of other specified bacterial diseases,Infection with microorganisms resistant to penicillins'}
