CHIEF COMPLAINT: Two week history of short term memory loss

PRESENT ILLNESS: This is a 41 y/o African American female brought to the ED by
her husband for a two week history of percieved short therm
memory loss. Patient was driving
to church in the past day or two and had to have her daughter
tell her how to get there and when taken to see her PCP she did
not remmber being in his office in the past.

MEDICAL HISTORY: HTN, Hospitalized last year at [**Hospital3 5365**] for w/u
hysterectomy for fibroids

MEDICATION ON ADMISSION: Labetalol PO

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On Admssion:
PHYSICAL EXAM:
O: T: 98.2 BP: 148/103        HR:71    R 17      O2Sats 100% RA
Gen: WD/WN, comfortable, NAD.
HEENT: NCNT
Neck: Supple.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.

FAMILY HISTORY: NC

SOCIAL HISTORY: No Tobacco
No ETOH
Works as a manager
Obstructive hydrocephalus,Delirium due to conditions classified elsewhere,Unspecified essential hypertension,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Solitary pulmonary nodule
Obstructiv hydrocephalus,Delirium d/t other cond,Hypertension NOS,Cholelithiasis NOS,Solitary pulmonry nodule
Admission Date:  [**2174-5-3**]              Discharge Date:   [**2174-5-10**]

Date of Birth:  [**2132-10-7**]             Sex:   F

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
Two week history of short term memory loss

Major Surgical or Invasive Procedure:
[**5-4**] Right EVD placement
[**5-9**] R frontal VPS


History of Present Illness:
This is a 41 y/o African American female brought to the ED by
her husband for a two week history of percieved short therm
memory loss. Patient was driving
to church in the past day or two and had to have her daughter
tell her how to get there and when taken to see her PCP she did
not remmber being in his office in the past.


Past Medical History:
HTN, Hospitalized last year at [**Hospital3 5365**] for w/u
hysterectomy for fibroids

Social History:
No Tobacco
No ETOH
Works as a manager

Family History:
NC

Physical Exam:
On Admssion:
PHYSICAL EXAM:
O: T: 98.2 BP: 148/103        HR:71    R 17      O2Sats 100% RA
Gen: WD/WN, comfortable, NAD.
HEENT: NCNT
Neck: Supple.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.

Neuro:
Mental status: Awake and alert, cooperative with exam.
Orientation: Oriented to person, place, but not date
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light,5 to 3
mm bilaterally. Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength and sensation intact and symmetric.
VIII: Hearing intact to voice.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

Motor: Normal bulk and tone bilaterally. No abnormal movements,
tremors. Strength full power [**4-30**] throughout. No pronator drift
Sensation: Intact to light touch
Coordination: normal on finger-nose-finger

AT DISCHARGE:
Gen: WD/WN, comfortable, NAD.
HEENT: NCNT, dressing over R scalp c/d/i
Neck: Supple.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.

Neuro:
Mental status: Awake and alert, cooperative with exam.
Orientation: Oriented to person, place, and date
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 2 to 1 mm
bilaterally. Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength and sensation intact and symmetric.
VIII: Hearing intact to voice.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

Motor: Normal bulk and tone bilaterally. No abnormal movements,
tremors. Strength full power [**4-30**] throughout. No pronator drift
Sensation: Intact to light touch
Coordination: normal on finger-nose-finger
Gait: narrow based, good arm swing, independent

Pertinent Results:
CT head [**2174-5-3**]
1. Severe hydrocephalus with transependymal flow of CSF and
associated
effacement of the sulci.
2. No evidence of hemorrhage or obstructing mass.

MRI Brain [**5-3**] -
1. Moderate dilatation of all the ventricles with associated
transependymal CSF flow. The etiology of hydrocephalus is not
identified on this study.
2. No evidence of acute infarct or intracranial hemorrhage.
3. No abnormal leptomeningeal or parenchymal enhancement

CXR [**2174-5-4**]
The lung volumes are normal. No pleural effusions. Normal size
of
the cardiac silhouette. Normal hilar and mediastinal structures.
No evidence of pneumonia or other acute lung changes.

CT head [**2174-5-4**]
 Interval decrease in ventricular size status post external
ventricular drain placement.

CSF:

[**2174-5-5**] 09:36AM CEREBROSPINAL FLUID (CSF) WBC-85 RBC-1650*
Polys-PND Lymphs-PND Monos-PND
[**2174-5-5**] 09:36AM CEREBROSPINAL FLUID (CSF) TotProt-156*
Glucose-57 LD(LDH)-72

[**2174-5-4**] 10:00AM CEREBROSPINAL FLUID (CSF) WBC-2 RBC-19* Polys-1
Lymphs-75 Monos-24
CSF culture [**2174-5-4**]
GRAM STAIN (Final [**2174-5-4**]):
      NO POLYMORPHONUCLEAR LEUKOCYTES SEEN.
      NO MICROORGANISMS SEEN.
      This is a concentrated smear made by cytospin method,
please refer to
      hematology for a quantitative white blood cell count..

MRI Head CSF study [**5-5**]
1.  Incomplete study as CSF flow study could not be performed.
Consider
performing when the patient is cooperative.
2.  Moderate dilation of the lateral and the third ventricles
with narrowing of the superior portion of cerebral
aqueduct/near-total occlusion.
3.  Ventricular catheter appears to be outside the confines of
the lateral
ventricle.  To correlate with catheter function and the position
if necessary.

CT Chest [**5-6**]
1. No evidence of sarcoid.
2. Sub 4 mm pulmonary nodule in the left lower lobe. If there is
no history of smoking or other lung cancer risk factors, this
does not need followup. Otherwise, 12 month followup is
recommended.
3. Fatty liver and cholelithiasis.

CTA Chest [**5-8**]
1.  No pulmonary embolus or acute intrathoracic process.
2.  Cholelithiasis.

[**5-9**] CT head postop: Interval decrease in ventricular size
status post placement of right frontal external ventricular
drain with the catheter tip located in the frontal [**Doctor Last Name 534**] of the
right lateral ventricle.

ADMISSION LABS:

[**2174-5-3**] 12:12PM BLOOD WBC-5.9 RBC-4.87 Hgb-13.2 Hct-43.0 MCV-88
MCH-27.0 MCHC-30.6* RDW-12.9 Plt Ct-355
[**2174-5-3**] 12:12PM BLOOD Glucose-100 UreaN-11 Creat-0.9 Na-139
K-4.0 Cl-103 HCO3-27 AnGap-13
[**2174-5-3**] 12:12PM BLOOD Calcium-9.4 Phos-3.0 Mg-2.3

DISCHARGE LABS:

[**2174-5-10**] 06:00AM BLOOD WBC-7.3 RBC-4.10* Hgb-11.2* Hct-35.6*
MCV-87 MCH-27.3 MCHC-31.4 RDW-13.2 Plt Ct-366
[**2174-5-10**] 06:00AM BLOOD Glucose-100 UreaN-8 Creat-0.8 Na-135
K-3.9 Cl-102 HCO3-24 AnGap-13
[**2174-5-10**] 06:00AM BLOOD Calcium-8.8 Phos-3.9 Mg-2.1
[**2174-5-6**] 03:25AM BLOOD HIV Ab-NEGATIVE

Brief Hospital Course:
Ms. [**Known lastname 4427**] [**Last Name (Titles) 1834**] a head CT in the Emergency room which
revealed enlargement of her ventricular system with
transependymal flow.  She was admitted to the Neurosurgery
service in the ICU for close monitoring. Her exam remained
stable, but to prevent progression of hydrocephalus, patient was
taken to OR on [**5-4**] for placement of R EVD. She was made NPO and
was consented for the procedure. On [**5-4**], patient was taken to
the OR for placement of R EVD. There were no complications and
patient was transferred back to SICU for monitoring. CSF was
sent in OR for evaluation. She remained intact on exam
throughout the day, overnight she was seen to have religious
delusions. For concern of worsening hydrocephalus, a head CT was
done which was stable. On [**5-5**], patient was back to baseline.
CSF was sent for further evaluation and MRI CSF study was
ordered to help determine etiology of hydrocephalus and this was
inconclusive.
She had a CT head on [**5-5**] and this showed decompression of the
ventricular system. Repeat CSF studies were sent. On [**5-6**] she
was transferred to the SDU in stable condition. Her EVD
continued at 10cm above the tragus. She remained stable until
[**5-8**] when she became tachycardic and tachypneic and a CTA chest
was obtained. This showed no evidence of pulmonary embolus. She
was kept NPO on the morning of [**5-9**] in preparation for a Right
frontal VPS. She tolerated the procedure well with no
complications and post operatively she was transferred back to
the floor.   She has a programmable valve set at 1.5.

On [**5-10**] Patient was deemed fit for discharge. She was given
instructions for followup and prescriptions for required
medications.

TRANSITIONAL CARE ISSUES:
Pt will need a repeat chest CT in 12 months to follow up the
lung nodule found incidentally on our scan here.  She will need
one in 6 months if she has any tobacco or cancer hx we are
unaware of.

Medications on Admission:
Labetalol PO

Discharge Medications:
1. labetalol 100 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day as
needed for constipation.
Disp:*60 Tablet(s)* Refills:*0*
4. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*90 Tablet(s)* Refills:*0*
5. ondansetron HCl 4 mg Tablet Sig: One (1) Tablet PO Q4H PRN ()
as needed for nausea.
Disp:*42 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
hydrocephalus
aqueductal stenosis
delerium
tachycardia
cholelithiasis
pulmonary nodule


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
??????	Have a friend/family member check your incision daily for
signs of infection.
??????	Take your pain medicine as prescribed.
??????	Exercise should be limited to walking; no lifting, straining,
or excessive bending.
??????	Dressing may be removed on Day 2 after surgery.
??????	You have dissolvable sutures so you may wash your hair and get
your incision wet day 3 after surgery.  You may shower before
this time using a shower cap to cover your head.
??????	Increase your intake of fluids and fiber, as narcotic pain
medicine can cause constipation. We generally recommend taking
an over the counter stool softener, such as Docusate (Colace)
while taking narcotic pain medication.
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, and
Ibuprofen etc.
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit.
??????	Make sure to continue to use your incentive spirometer while
at home, unless you have been instructed not to.

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING

??????	New onset of tremors or seizures.
??????	Any confusion or change in mental status.
??????	Any numbness, tingling, weakness in your extremities.
??????	Pain or headache that is continually increasing, or not
relieved by pain medication.
??????	Any signs of infection at the wound site: redness, swelling,
tenderness, or drainage.
??????	Fever greater than or equal to 101?????? F.

We made the following changes to your medications:
1) We STARTED you on DOCUSATE 100mg twice a day to prevent
constipation while taking opiate pain medications.
2) We STARTED you on SENNA 8.6mg twice a day as needed for
constipation.
3) We STARTED you on PERCOCET 1-2 tabs every 4 hours as needed
for pain.  Each tablet has 325mg of tylenol in it. Do not exceed
4,000mg of tylenol in a 24 hour period as this can cause fatal
liver damage.  In addition, do not drive, operate heavy
machinery, drink alcohol or take other sedating medications
while taking this medication until you know how it will effect
you, as it can make you dangerously sleepy.
4) We STARTED you on ZOFRAN 4mg every 4 hours as needed for
nausea.

Please continue to take your other medications as previously
prescribed.

It was a pleasure taking care of you on this hospitalization.

Followup Instructions:
Follow-Up Appointment Instructions

??????Please return to the office in [**7-5**] days(from your date of
surgery) for removal of your staples/sutures and/or a wound
check. This appointment can be made with the Nurse Practitioner.
 Please make this appointment by calling [**Telephone/Fax (1) 1669**]. If you
live quite a distance from our office, please make arrangements
for the same, with your PCP.
??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**Last Name (STitle) **], to be seen in 6 weeks.
??????You will need a CT scan of the brain without contrast.



Completed by:[**2174-5-10**]
{'Obstructive hydrocephalus,Delirium due to conditions classified elsewhere,Unspecified essential hypertension,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Solitary pulmonary nodule'}


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: Two week history of short term memory loss

PRESENT ILLNESS: This is a 41 y/o African American female brought to the ED by
her husband for a two week history of percieved short therm
memory loss. Patient was driving
to church in the past day or two and had to have her daughter
tell her how to get there and when taken to see her PCP she did
not remmber being in his office in the past.

MEDICAL HISTORY: HTN, Hospitalized last year at [**Hospital3 5365**] for w/u
hysterectomy for fibroids

MEDICATION ON ADMISSION: Labetalol PO

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On Admssion:
PHYSICAL EXAM:
O: T: 98.2 BP: 148/103        HR:71    R 17      O2Sats 100% RA
Gen: WD/WN, comfortable, NAD.
HEENT: NCNT
Neck: Supple.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.

FAMILY HISTORY: NC

SOCIAL HISTORY: No Tobacco
No ETOH
Works as a manager 

### Response:
{'Obstructive hydrocephalus,Delirium due to conditions classified elsewhere,Unspecified essential hypertension,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Solitary pulmonary nodule'}
