CHIEF COMPLAINT: L femur fracture

PRESENT ILLNESS: [**Age over 90 **] M with h/o CAD, MI, and pacemaker presents with
periprosthetic L femur fracture after mechanical fall at home
early this morning. No precipitating symptoms; specifically no
CP, SOB, N/V. No head trauma or LOC. Transferred from OSH.
Patient c/o L buttock pain, better after Percocet and Morphine
in ED.

MEDICAL HISTORY: CAD - s/p MI in [**2109**] tx with lytic therapy and rescue
angioplasty
borderline diabetes
History of PAF
Status post permanent pacemaker insertion.
Hypertension
History of congestive heart failure, currently compensated.
Hypercholesterolemia
L hip replacement

MEDICATION ON ADMISSION: Potasium 10meq qday
Carbamazepine 300mg qday
Betapace 80mg [**Hospital1 **]
Nexium 40mg PO qday
Furosemide 120mg qday
Norvasc 5mg qday
Glipitzide 5mg [**Hospital1 **]
ASA 81 mg Qday
Isosorbide 1tab TID

ALLERGIES: Erythromycin Base

PHYSICAL EXAM: PE: T:98.5 P:76  BP:141/69  RR:20  O2:95%
Gen: Pleasant, older gentleman, in NAD
HEENT: NCAT, PERRLA, EOMI, MMM
Neck: No bruit or JVD
CV: RRR, no m/g/r
Lungs: CTAB anterior exam
Abd: ob, NT, ND, +BS
Ext: L leg foreshortened and ext rotated. sensation grossly
intact distally. [**Last Name (un) 938**], APF, ADF [**6-19**]. Pulses 2+

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Pt is [**Age over 90 **] yo male who lives in basement of sons house. Wife
passed away last year. Retired plumber who worked here at [**Hospital1 18**].
He says that he can dress/clean himself and his son takes him
grocery shopping. Had been ambulating with a cane [**3-19**] to pain in
L hip. No EtOH, tobacco.
Other closed fracture of lower end of femur,Injury to bladder and urethra, without mention of open wound into cavity,Atrial fibrillation,Congestive heart failure, unspecified,Fall from other slipping, tripping, or stumbling,Hip joint replacement,Unspecified transient mental disorder in conditions classified elsewhere,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Other specified disease of white blood cells,Pure hypercholesterolemia,Unspecified essential hypertension,Cardiac pacemaker in situ,Percutaneous transluminal coronary angioplasty status,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Fx low end femur NEC-cl,Bladder/urethra inj-clos,Atrial fibrillation,CHF NOS,Fall from slipping NEC,Joint replaced hip,Transient mental dis NOS,DMII wo cmp nt st uncntr,Crnry athrscl natve vssl,Wbc disease NEC,Pure hypercholesterolem,Hypertension NOS,Status cardiac pacemaker,Status-post ptca,Abn react-urinary cath
Admission Date:  [**2127-9-20**]              Discharge Date:   [**2127-9-27**]


Service: MEDICINE

Allergies:
Erythromycin Base

Attending:[**Doctor Last Name 10493**]
Chief Complaint:
L femur fracture

Major Surgical or Invasive Procedure:
Operative repair of L periprosthetic femur fx.

History of Present Illness:
[**Age over 90 **] M with h/o CAD, MI, and pacemaker presents with
periprosthetic L femur fracture after mechanical fall at home
early this morning. No precipitating symptoms; specifically no
CP, SOB, N/V. No head trauma or LOC. Transferred from OSH.
Patient c/o L buttock pain, better after Percocet and Morphine
in ED.

Past Medical History:
CAD - s/p MI in [**2109**] tx with lytic therapy and rescue
angioplasty
borderline diabetes
History of PAF
Status post permanent pacemaker insertion.
Hypertension
History of congestive heart failure, currently compensated.
Hypercholesterolemia
L hip replacement

Social History:
Pt is [**Age over 90 **] yo male who lives in basement of sons house. Wife
passed away last year. Retired plumber who worked here at [**Hospital1 18**].
He says that he can dress/clean himself and his son takes him
grocery shopping. Had been ambulating with a cane [**3-19**] to pain in
L hip. No EtOH, tobacco.


Family History:
non-contributory

Physical Exam:
PE: T:98.5 P:76  BP:141/69  RR:20  O2:95%
Gen: Pleasant, older gentleman, in NAD
HEENT: NCAT, PERRLA, EOMI, MMM
Neck: No bruit or JVD
CV: RRR, no m/g/r
Lungs: CTAB anterior exam
Abd: ob, NT, ND, +BS
Ext: L leg foreshortened and ext rotated. sensation grossly
intact distally. [**Last Name (un) 938**], APF, ADF [**6-19**]. Pulses 2+

Pertinent Results:
[**2127-9-20**] 08:40AM URINE  HOURS-RANDOM
[**2127-9-20**] 08:40AM URINE  GR HOLD-HOLD
[**2127-9-20**] 08:40AM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.021
[**2127-9-20**] 08:40AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-1000 KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG
[**2127-9-20**] 08:20AM   GLUCOSE-379* UREA N-19 CREAT-1.0 SODIUM-138
POTASSIUM-3.4 CHLORIDE-94* TOTAL CO2-32 ANION GAP-15
[**2127-9-20**] 08:20AM   CALCIUM-9.2 PHOSPHATE-3.3 MAGNESIUM-1.8
[**2127-9-20**] 08:20AM   WBC-12.3* RBC-4.24* HGB-13.2* HCT-37.5*
MCV-88 MCH-31.0 MCHC-35.1* RDW-12.5
[**2127-9-20**] 08:20AM   NEUTS-80.5* LYMPHS-14.7* MONOS-3.9 EOS-0.5
BASOS-0.3
[**2127-9-20**] 08:20AM   PLT COUNT-205
[**2127-9-20**] 08:20AM   PT-12.8 PTT-21.3* INR(PT)-1.1

Brief Hospital Course:
[**Age over 90 **] M with h/o CAD, MI, and pacemaker presented from OSH with a
periprosthetic L femur fracture after mechanical fall at home
early that morning. he denied any precipitating symptoms;
specifically no CP, SOB, N/V. No head trauma or LOC.  Patient
did c/o L buttock pain, better after Percocet and Morphine in
ED.

The following interventions and/or monitoring took place during
his stay.

1.Femur Fx:
- repaired by ORIF by Orthopaedic team (Dr. [**Last Name (STitle) **] on hospital
day #2 under spinal anesthesia.
- Ortho followed patient throughout his stay, placed hip brace
on POD#2 and f/u films showed that alignment was maintained.
- Pt was seen by OT and PT daily and improved in his ability to
maneuver himself, given limited mobility overall.
- Patient was started on Lovenox 12 hours after epidural was
removed, and is currently transitioning to coumadin for a three
week course of anticoagulation. Patient has other medical
reasons to be on coumadin long-term, but pt and family have
decided against long term therapy due to his propensity for
falls.
2. CAD/HTN/CHF:
- Home Norvasc, ASA, Isosorbide, Betapace were continued.
Patient's lung exam and fluid status was stable throughout his
stay.
3. DM:
- Pt with elevated blood sugars in house; unclear if this is due
to stress response vs. poorly controlled DM. We continued his
glipizide, and gave SSI with qachs FSBGs.
.
4. Leukocytosis:
- Pt with elevated white count during stay. The etiology is
unclear, but may be a stress response vs. a known side effect of
carbemazepime. No signs of infections were found during
infection workup with CXR, UA. Pt was afebrile throughout.
.
5. Gross hematuria:
- On hospital day #2 pt had gross hematuris in foley. This was
likely foley trauma, given h/o BPH and pain on insertion in ED.
Original foley was removed and replaced 24hrs later in OR under
anesthesia. No blood in foley was seen since went to OR.
.
6. Disposition:
- Patient was evaluated by medical team/OT/PT/case management
and found to be fit for rehab placement on Friday [**2127-9-26**].
Family requested [**Hospital **] [**Hospital **] rehab and placement there was pursued.

Medications on Admission:
Potasium 10meq qday
Carbamazepine 300mg qday
Betapace 80mg [**Hospital1 **]
Nexium 40mg PO qday
Furosemide 120mg qday
Norvasc 5mg qday
Glipitzide 5mg [**Hospital1 **]
ASA 81 mg Qday
Isosorbide 1tab TID

Discharge Medications:
1. Abductor brace
to be fitted for left hip after surgery, worn as instructed
2. Carbamazepine 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Sotalol 80 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
4. Furosemide 40 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
5. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Isosorbide Dinitrate 10 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
7. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
8. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
injection Injection ASDIR (AS DIRECTED): Based on QID
fingerstick blood glucose, please give sliding scale insulin as
follows:
If BG 120-160 give 2 units; if BG 161-200 give 4 units; if BG
201-240 give 6 units; if BG 241-280 give 8 units, if BG 281-320
give 10 units. If BG >320, please call staff physician. .
9. Enoxaparin Sodium 40 mg/0.4mL Syringe Sig: One (1) 40mg
injection Subcutaneous QHS (once a day (at bedtime)): Please
continue Lovenox until INR between 2-2.5; then stop Lovenox and
continue Coumadin.
10. Quetiapine Fumarate 25 mg Tablet Sig: One (1) Tablet PO QHS
(once a day (at bedtime)) as needed for agitation.
11. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO TID (3
times a day).
12. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4
to 6 hours) as needed.
13. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO BID (2 times a day).
14. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
15. Esomeprazole Magnesium 20 mg Capsule, Delayed Release(E.C.)
Sig: Two (2) Capsule, Delayed Release(E.C.) PO qam ().
16. Glipizide 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
17. Warfarin Sodium 5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) for 3 weeks: Please monitor INR daily. Goal is between 2
and 2.5 . Continue 5mg dose unless INR >2.5; if >2.5 then change
to 2.5mg daily.


Discharge Disposition:
Extended Care

Facility:
[**Hospital 2971**] Rehabilitation and Nursing Center - [**Hospital1 1474**]

Discharge Diagnosis:
1. L periprosthetic hip fx, s/p ORIF on [**2127-9-21**]
2. DM Type 2
3. CAD - s/p MI in [**2109**] tx with lytic therapy and rescue
angioplasty
4. HTN
5. s/p pacemaker implant


Discharge Condition:
Good

Discharge Instructions:
Please take all medications as prescribed. Please attend all
followup appointments.

Please seek medical attention for worsening pain, fever, chills,
nausea, vomiting, painful urination, or with other concerns.

Followup Instructions:
Please followup with your primary doctor, WHITE,[**Doctor Last Name **] W.,
within 3 weeks or sooner with concerns. You can call his office
at [**Telephone/Fax (1) 10492**] to schedule an appointment for a time that is
convenient for you and your family.


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 10491**] MD, [**MD Number(3) 10495**]
{'Other closed fracture of lower end of femur,Injury to bladder and urethra, without mention of open wound into cavity,Atrial fibrillation,Congestive heart failure, unspecified,Fall from other slipping, tripping, or stumbling,Hip joint replacement,Unspecified transient mental disorder in conditions classified elsewhere,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Other specified disease of white blood cells,Pure hypercholesterolemia,Unspecified essential hypertension,Cardiac pacemaker in situ,Percutaneous transluminal coronary angioplasty status,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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: L femur fracture

PRESENT ILLNESS: [**Age over 90 **] M with h/o CAD, MI, and pacemaker presents with
periprosthetic L femur fracture after mechanical fall at home
early this morning. No precipitating symptoms; specifically no
CP, SOB, N/V. No head trauma or LOC. Transferred from OSH.
Patient c/o L buttock pain, better after Percocet and Morphine
in ED.

MEDICAL HISTORY: CAD - s/p MI in [**2109**] tx with lytic therapy and rescue
angioplasty
borderline diabetes
History of PAF
Status post permanent pacemaker insertion.
Hypertension
History of congestive heart failure, currently compensated.
Hypercholesterolemia
L hip replacement

MEDICATION ON ADMISSION: Potasium 10meq qday
Carbamazepine 300mg qday
Betapace 80mg [**Hospital1 **]
Nexium 40mg PO qday
Furosemide 120mg qday
Norvasc 5mg qday
Glipitzide 5mg [**Hospital1 **]
ASA 81 mg Qday
Isosorbide 1tab TID

ALLERGIES: Erythromycin Base

PHYSICAL EXAM: PE: T:98.5 P:76  BP:141/69  RR:20  O2:95%
Gen: Pleasant, older gentleman, in NAD
HEENT: NCAT, PERRLA, EOMI, MMM
Neck: No bruit or JVD
CV: RRR, no m/g/r
Lungs: CTAB anterior exam
Abd: ob, NT, ND, +BS
Ext: L leg foreshortened and ext rotated. sensation grossly
intact distally. [**Last Name (un) 938**], APF, ADF [**6-19**]. Pulses 2+

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Pt is [**Age over 90 **] yo male who lives in basement of sons house. Wife
passed away last year. Retired plumber who worked here at [**Hospital1 18**].
He says that he can dress/clean himself and his son takes him
grocery shopping. Had been ambulating with a cane [**3-19**] to pain in
L hip. No EtOH, tobacco. 

### Response:
{'Other closed fracture of lower end of femur,Injury to bladder and urethra, without mention of open wound into cavity,Atrial fibrillation,Congestive heart failure, unspecified,Fall from other slipping, tripping, or stumbling,Hip joint replacement,Unspecified transient mental disorder in conditions classified elsewhere,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Other specified disease of white blood cells,Pure hypercholesterolemia,Unspecified essential hypertension,Cardiac pacemaker in situ,Percutaneous transluminal coronary angioplasty status,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
