CHIEF COMPLAINT: Distal femoral nonunion

PRESENT ILLNESS: The patient is a 63-year-old female patient who
sustained a distal femur fracture immediately above a total
knee replacement.  This fracture was sustained several months
ago and was operated in [**2136-7-17**].  Now, almost 11 months
from her injury, she has a recent CT that revealed the
presence of a nonunion since she has been complaining of
difficulty and pain walking over several months.  However,
the plate is not repaired and I suspect this could be
partially healed, but still unstable.  At this point, she was
brought to the operating room for revision of a nonunion and
bone grafting.

MEDICAL HISTORY: L TKA ([**2125**])
morbid obesity
hypertension
diabetes
hyperlipidemia
hypothyroidism
GERD
osteoarthritis
depression
allergic rhinitis
DJD
diabetic neuropathy and retinopathy
ovarian cysts
abnormal mammogram
breast cysts

MEDICATION ON ADMISSION: 

ALLERGIES: lisinopril / Pollen/Hayfever

PHYSICAL EXAM: NAD AAO X 3
RRR
CTAB
S/NT/ND

FAMILY HISTORY: n/a

SOCIAL HISTORY: Lives alone
Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Allergic rhinitis, cause unspecified,Depressive disorder, not elsewhere classified,Knee joint replacement,Nonunion of fracture,Body Mass Index 45.0-49.9, adult,Morbid obesity,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Esophageal reflux,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Polyneuropathy in diabetes
DMII ophth nt st uncntrl,Diabetic retinopathy NOS,Allergic rhinitis NOS,Depressive disorder NEC,Joint replaced knee,Nonunion of fracture,BMI 45.0-49.9, adult,Morbid obesity,Hypertension NOS,Hyperlipidemia NEC/NOS,Hypothyroidism NOS,Esophageal reflux,Osteoarthros NOS-unspec,Neuropathy in diabetes
Admission Date:  [**2137-7-5**]              Discharge Date:   [**2137-7-8**]

Date of Birth:  [**2073-12-15**]             Sex:   F

Service: ORTHOPAEDICS

Allergies:
lisinopril / Pollen/Hayfever

Attending:[**First Name3 (LF) 11415**]
Chief Complaint:
Distal femoral nonunion

Major Surgical or Invasive Procedure:
Removal [**Last Name (un) 101**], retrograde nail for nonunion


History of Present Illness:
The patient is a 63-year-old female patient who
sustained a distal femur fracture immediately above a total
knee replacement.  This fracture was sustained several months
ago and was operated in [**2136-7-17**].  Now, almost 11 months
from her injury, she has a recent CT that revealed the
presence of a nonunion since she has been complaining of
difficulty and pain walking over several months.  However,
the plate is not repaired and I suspect this could be
partially healed, but still unstable.  At this point, she was
brought to the operating room for revision of a nonunion and
bone grafting.


Past Medical History:
L TKA ([**2125**])
morbid obesity
hypertension
diabetes
hyperlipidemia
hypothyroidism
GERD
osteoarthritis
depression
allergic rhinitis
DJD
diabetic neuropathy and retinopathy
ovarian cysts
abnormal mammogram
breast cysts

Social History:
Lives alone


Family History:
n/a

Physical Exam:
NAD AAO X 3
RRR
CTAB
S/NT/ND

RLE: incision c/d/i
SILT, Motor intact.

Brief Hospital Course:
Ms. [**Known lastname 20734**] presented to the [**Hospital1 18**] on [**2137-7-5**] for distal femoral
nonunion.She was taken to the operating room and underwent
removal [**Last Name (un) 101**], retrograde nail for nonunion She tolerated the
procedure well, was extubated, transferred to the recovery room,
and then to the floor. On the floor she was seen by physical
therapy to improve his strength and mobility.

The rest of her hospital stay was uneventful with her lab data
and vital signs within normal limits and his pain controlled.
She is being discharged today in stable condition.


Discharge Medications:
1. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3 hours)
as needed for pain.
Disp:*80 Tablet(s)* Refills:*0*
2. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
Constipation.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
3. senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day)
as needed for Constipation.
Disp:*60 Tablet(s)* Refills:*0*
4. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
5. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
6. felodipine 2.5 mg Tablet Extended Release 24 hr Sig: Four (4)
Tablet Extended Release 24 hr PO DAILY (Daily).
7. levothyroxine 112 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
9. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
10. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable
Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed
for reflux.
11. enoxaparin 40 mg/0.4 mL Syringe Sig: One (1)  Subcutaneous
Q24H (every 24 hours) for 4 weeks: 40 mg daily for 4 wks.
Disp:*45 * Refills:*0*
12. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: [**2-17**]  Inhalation Q6H (every 6 hours) as needed
for shortness of breath or wheezing.


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Healthcare & Rehabilitation Center - [**Location (un) **]

Discharge Diagnosis:
Distal femoral nonunion


Discharge Condition:
AAO X 3
Ambulatory
Regular diet


Discharge Instructions:
General Instructions:
If you have any increased pain, swelling, or numbness, not
relieved with rest, elevation, and or pain medication, or if you
have a temperature greater than 101.5, please call the office or
come to the emergency department.

Medications:
1) You have been prescribed a narcotic pain medication. Please
take only as directed and do not drive or operate any machinery
while taking this medication. There is a 72 hour (Monday through
Friday, 9am to 4pm) response time for prescription refil
requests. There will be no prescription refils on Saturdays,
Sundays, or holidays. Please plan accordingly.
2) You are prescribed a blood thinner called lovenox, you must
take this for 4 weeks WITHOUT MISSING A SINGLE DOSE.
3) Continue any home medications unless otherwise advised.

ACTIVITY
RLE: weight bearing as tolerated
LLE: weight bearting as tolerated

Wound Care:
- Keep Incision clean and dry.
- Do not soak the incision in a bath or pool.

Other Instructions
- Resume your regular diet.
- Avoid nicotine products to optimize healing.
- Resume your home medications. Take all medications as
instructed.
- Continue taking the Lovenox to prevent blood clots.
- If you have any increased redness, drainage, or swelling, or
if you have a temperature greater than 101.5, please call the
office or come to the emergency department.

Physical Therapy:
RLE: WBAT
LLE: WBAT
Treatments Frequency:
Staples/Sutures out in 21 days after surgery, so 21 days from
[**2137-7-5**]
Dry dressing on surgical site for 5 days, then it can be left
open to air. This area must not get moist or wet.

Followup Instructions:
recommended F/U: Please follow up with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], NP in
orthopaedics in 2 weeks, please call [**Telephone/Fax (1) 1228**] to schedule
that appointment.
Appointments at the [**Hospital1 18**] made prior to your admission


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2235**] MD, [**MD Number(3) 11417**]

Completed by:[**2137-7-8**]
{'Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Allergic rhinitis, cause unspecified,Depressive disorder, not elsewhere classified,Knee joint replacement,Nonunion of fracture,Body Mass Index 45.0-49.9, adult,Morbid obesity,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Esophageal reflux,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Polyneuropathy in diabetes'}


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: Distal femoral nonunion

PRESENT ILLNESS: The patient is a 63-year-old female patient who
sustained a distal femur fracture immediately above a total
knee replacement.  This fracture was sustained several months
ago and was operated in [**2136-7-17**].  Now, almost 11 months
from her injury, she has a recent CT that revealed the
presence of a nonunion since she has been complaining of
difficulty and pain walking over several months.  However,
the plate is not repaired and I suspect this could be
partially healed, but still unstable.  At this point, she was
brought to the operating room for revision of a nonunion and
bone grafting.

MEDICAL HISTORY: L TKA ([**2125**])
morbid obesity
hypertension
diabetes
hyperlipidemia
hypothyroidism
GERD
osteoarthritis
depression
allergic rhinitis
DJD
diabetic neuropathy and retinopathy
ovarian cysts
abnormal mammogram
breast cysts

MEDICATION ON ADMISSION: 

ALLERGIES: lisinopril / Pollen/Hayfever

PHYSICAL EXAM: NAD AAO X 3
RRR
CTAB
S/NT/ND

FAMILY HISTORY: n/a

SOCIAL HISTORY: Lives alone 

### Response:
{'Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Allergic rhinitis, cause unspecified,Depressive disorder, not elsewhere classified,Knee joint replacement,Nonunion of fracture,Body Mass Index 45.0-49.9, adult,Morbid obesity,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Esophageal reflux,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Polyneuropathy in diabetes'}
