CHIEF COMPLAINT: Persistent left-sided hip pain s/p DHS [**10-3**]

PRESENT ILLNESS: Mrs. [**Known lastname **] is an 87-year-old female with history of stroke,
depression and dementia related to the stroke. She presents
today after a witnessed physical altercation with her one of her
caregivers ([**Name (NI) **]); this caregiver lives with the patient and she
is being admitted for protection at this point.

MEDICAL HISTORY: -HTN
-GI Bleed--[**2158**], in setting of NSAID use as well as H.Pylori
infection, which was treated. That hospitalization included ICU
admission with multiple PRBC transfusions, several EGDs with
clipping and electrocaudery of bleeding lesion, intubation and
tx for PNA, and IMI that was likely in the setting of anemia.
-CAD--had an elevation in trop in setting of GIB as above (Echo
in [**10-31**] showed preserved EF (55%) with basal inferolateral
hypokinesis and septal apex hypokinesis, and [**11-30**]+ MR)
-CVA--[**10-31**] with L hemiparesis (distal right middle cerebral
artery
lenticulostriate artery infarction)
-Dementia--probable [**Last Name (un) 309**] Body

MEDICATION ON ADMISSION: Aricept
Aspirin
Detrol
Tylenol
Zolft
Heparin
Oxycodone

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Afebrile, All vital signs stable
Gen: Alert and oriented, No acute distress
Lungs: CTA bilaterally
Abd: benign
Extremities: left lower
mild ecchymosis superior to incision-resolving
Incision: no swelling/erythema/drainage
Dressing: clean/dry/intact
+[**Last Name (un) 938**]/FHL/AT
+SILT
1+ pulse, moves toes
extremity warm

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: One of her daughters is a nurse. She does not smoke and rarely
drinks alcohol. Prior history of [**1-1**] glasses of ETOH/day. She
likes drinking coffee, at least three cups a day.
Nonunion of fracture,Other closed transcervical fracture of neck of femur,Dislocation of prosthetic joint,Acute posthemorrhagic anemia,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Subendocardial infarction, initial episode of care,Perpetrator of child and adult abuse, by non-related caregiver,Congestive heart failure, unspecified,Intestinal infection due to Clostridium difficile,Urinary tract infection, site not specified,Unspecified accident,Adult physical abuse,Late effect of fracture of neck of femur,Late effects of accidental fall,Unspecified essential hypertension,Old myocardial infarction,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Dementia with lewy bodies,Dementia in conditions classified elsewhere without behavioral disturbance
Nonunion of fracture,Fx femur intrcaps NEC-cl,Dislocate prosthetic jt,Ac posthemorrhag anemia,Food/vomit pneumonitis,Acute kidney failure NOS,Subendo infarct, initial,Batter by non-relative,CHF NOS,Int inf clstrdium dfcile,Urin tract infection NOS,Accident NOS,Adult physical abuse,Late eff femoral neck fx,Late eff accidental fall,Hypertension NOS,Old myocardial infarct,Late ef-hemplga side NOS,Dementia w Lewy bodies,Dementia w/o behav dist
Admission Date:  [**2162-8-13**]              Discharge Date:   [**2162-9-7**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3507**]
Chief Complaint:
Persistent left-sided hip pain s/p DHS [**10-3**]

Major Surgical or Invasive Procedure:
Left bipolar hip replacement


History of Present Illness:
Mrs. [**Known lastname **] is an 87-year-old female with history of stroke,
depression and dementia related to the stroke. She presents
today after a witnessed physical altercation with her one of her
caregivers ([**Name (NI) **]); this caregiver lives with the patient and she
is being admitted for protection at this point.

She does have a recent diagnosis of severe pain in the left hip
and left knee after a fall in [**9-/2161**] at which time she had a
left hip fracture; this was treated with ORIF. She has had
recurrent severe pain in the left hip. Recently, she was seen by
orthopedist and a total hip replacement was suggested as the
quality of life appears significantly affected by the persistent
left hip pain and knee pain; there was a plan for possible
surgery next week. She finds it aggravating her day-to-day
activities. Even getting out of bed to go to the bathroom now
becomes a major endeavor.


Past Medical History:
-HTN
-GI Bleed--[**2158**], in setting of NSAID use as well as H.Pylori
infection, which was treated. That hospitalization included ICU
admission with multiple PRBC transfusions, several EGDs with
clipping and electrocaudery of bleeding lesion, intubation and
tx for PNA, and IMI that was likely in the setting of anemia.
-CAD--had an elevation in trop in setting of GIB as above (Echo
in [**10-31**] showed preserved EF (55%) with basal inferolateral
hypokinesis and septal apex hypokinesis, and [**11-30**]+ MR)
-CVA--[**10-31**] with L hemiparesis (distal right middle cerebral
artery
lenticulostriate artery infarction)
-Dementia--probable [**Last Name (un) 309**] Body

Social History:
One of her daughters is a nurse. She does not smoke and rarely
drinks alcohol. Prior history of [**1-1**] glasses of ETOH/day. She
likes drinking coffee, at least three cups a day.


Family History:
Non-contributory

Physical Exam:
Afebrile, All vital signs stable
Gen: Alert and oriented, No acute distress
Lungs: CTA bilaterally
Abd: benign
Extremities: left lower
mild ecchymosis superior to incision-resolving
Incision: no swelling/erythema/drainage
Dressing: clean/dry/intact
+[**Last Name (un) 938**]/FHL/AT
+SILT
1+ pulse, moves toes
extremity warm

Pertinent Results:
[**2162-8-20**] 04:45AM BLOOD Triglyc-66 HDL-27 CHOL/HD-2.9 LDLcalc-38
[**2162-8-18**] 01:34PM BLOOD CK-MB-33* MB Indx-7.8* cTropnT-0.81*
[**2162-8-18**] 10:00PM BLOOD CK-MB-28* MB Indx-5.4 cTropnT-1.24*
[**2162-8-19**] 05:30AM BLOOD CK-MB-25* MB Indx-5.4 cTropnT-1.57*
[**2162-8-20**] 04:45AM BLOOD CK-MB-12* MB Indx-6.5* cTropnT-1.62*
[**2162-8-26**] 12:55PM BLOOD CK-MB-2 cTropnT-0.35*
[**2162-8-18**] 10:00PM BLOOD CK(CPK)-523*
[**2162-8-20**] 04:45AM BLOOD ALT-17 AST-44* LD(LDH)-309* CK(CPK)-185*
AlkPhos-47 TotBili-1.4
[**2162-8-13**] 03:50PM BLOOD Glucose-98 UreaN-19 Creat-0.7 Na-139
K-4.2 Cl-102 HCO3-27 AnGap-14
[**2162-9-7**] 05:28AM BLOOD Glucose-73 UreaN-12 Creat-0.7 Na-141
K-3.8 Cl-105 HCO3-29 AnGap-11
[**2162-8-13**] 03:50PM BLOOD WBC-10.7 RBC-4.28 Hgb-12.8 Hct-36.6
MCV-85 MCH-29.8 MCHC-34.9 RDW-14.8 Plt Ct-255
[**2162-9-7**] 05:28AM BLOOD WBC-7.9 RBC-3.38* Hgb-10.1* Hct-30.8*
MCV-91 MCH-29.8 MCHC-32.7 RDW-15.3 Plt Ct-321
.
Echo
The left atrium is mildly dilated. Left ventricular wall
thicknesses are
normal. The left ventricular cavity size is normal. LV systolic
function
appears depressed. Resting regional wall motion abnormalities
include apical hypokinesis/akinesis/dyskinesis; cannot exclude
mid lateral hypokinesis. No left ventricular thrombus
identified; cannot exclude. Right ventricular chamber size and
free wall motion are normal. The ascending aorta is mildly
dilated. The aortic valve leaflets are moderately thickened.
There is mild aortic valve stenosis. No aortic regurgitation is
seen. The mitral valve leaflets are mildly thickened. Mild to
moderate ([**11-30**]+) mitral regurgitation is seen. The tricuspid
valve leaflets are mildly thickened. Moderate [2+] tricuspid
regurgitation is seen. There is severe pulmonary artery systolic

hypertension. There is a trivial/physiologic pericardial
effusion.
EF 45%
.


Brief Hospital Course:
1) HIP:
She was evaluated by the Orthopaedics department and was
consented for surgical correction. On [**2162-8-17**], she was prepped
and brought down to the operating room for surgery.
Intra-operatively, she was closely monitored and was transfused
3 units of PRBC intraoperatively and remained hemodynamically
stable. She tolerated the procedure well without any difficulty
or complication. Post-operatively, she was extubated and
transferred to the PACU for further stabilization and
monitoring. She was then transferred to the floor for further
recovery. On the floor, her was hypotensive (BP-80's) and low
UOP. She was transferred to the [**Hospital Unit Name 153**] for further monitoring. In
the [**Hospital Unit Name 153**], she was transfused 2 units of PRBC for postoperative
anemia and remained stable afterwards. She then remained
hemodynamically stable with her pain controlled. She was again,
transferred to the floor. On the floor, she was noticed to have
persistent internal rotation of her left hip. An Xray done 1
week after surgery showed a re-dislocation of the hip
prosthesis.  She was taken back to the OR for a open reduction.
She will follow up with the Orthopedic team as an outpatient.
She will continue on prophylactic Lovenox for a total of 3 weeks
per Ortho team.
.
2) PNEUMONIA:
Also developed hosp acquired pneumonia - zosyn and vanc started.
 PNA improved with no fevers/ SOB/Cough.  Completed course of
antibiotics.  No further fevers.
.
3) ARF:
Developed ARF (cr 0.5 --> 1.3 ) - u. eos + --> doubt vanc/zosyn.
Could be from lisinopril that was started 2 days before the ARF
developed.  Vanco also stopped and creatinine trended down back
to baseline so that may have been etiology.
.
4) NSTEMI:
5 days post-op had dislocated hip again - was planning to go to
OR - but had new ST changes that AM; hence did not go to OR
(given not an emergent surgery). Enzymes showed NSTEMI which was
medically managed.  Pt did not have any angina with this.
Enzymes trended down.  Pt did then return to the OR for
reduction and did not have any cardiac complications from that
surgery.  Started on beta blocker and captopril which have been
titrated up to acheive BP/HR control.  These should be continued
to be titrated as an outpatient.  Statin and ASA added.
.
5) CHF:
Exam and CXR show pulmonary edema, likely due fluids received
for post-op hypotension and MI.  She has been gently diuresed as
renal function was up.  Has improved but still requires further
diuresis.  EF 45%.
.
6) DEMENTIA:  Has baseline [**Last Name (un) **] body dementia.  Seen by
geriatrics.  On seroquel and aricept.
.
7) C DIFF COLITIS:  About 2 weeks in to hospital course,
developed cdiff and started on flagyl.  She will be discharged
on PO Flagyl to complete a total of a 10 day course.
.
8) UTI:  Treated with zosyn which she was on for pna.

Medications on Admission:
Aricept
Aspirin
Detrol
Tylenol
Zolft
Heparin
Oxycodone

Discharge Medications:
1. Donepezil 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

2. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4-6H
(every 4 to 6 hours) as needed.
3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. Tolterodine 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4
to 6 hours) as needed for pain.
8. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day).
9. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
10. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
11. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. abduction brace
keep abduction brace on at all times 0-90 degrees
13. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO
TID (3 times a day): titrate as BP/HR allows.
Disp:*270 Tablet(s)* Refills:*2*
14. Captopril 12.5 mg Tablet Sig: Three (3) Tablet PO TID (3
times a day): titrate as BP allows.
Disp:*270 Tablet(s)* Refills:*2*
15. Quetiapine 25 mg Tablet Sig: 0.5 Tablet PO QPM (once a day
(in the evening)).
Disp:*30 Tablet(s)* Refills:*2*
16. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 10 days.
Disp:*30 Tablet(s)* Refills:*0*
17. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day as
needed for peripheral edema.
Disp:*30 Tablet(s)* Refills:*0*
18. Quetiapine 25 mg Tablet Sig: 0.5 Tablet PO TID (3 times a
day) as needed for agitation, delerium.
Disp:*30 Tablet(s)* Refills:*0*
19. Enoxaparin 30 mg/0.3 mL Syringe Sig: Thirty (30) mg
Subcutaneous Q24H (every 24 hours): Please continue until [**9-21**]
then stop.
Disp:*qs mg* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
health bridge

Discharge Diagnosis:
Primary Diagnoses:
Left hip fracture, retained hardware
Non [**Hospital1 **] left hip intertrochanteric fracture.
Fragmentation of the femoral head
Postoperative anemia
Urinary tract infection
[**Hospital 7792**]
Hospital Acquired Pneumonia
C. difficile colitis
Congestive Heart Failure

Secondary Diagnoses:
h/o CVA
h/o Dementia
Depression


Discharge Condition:
Stable


Discharge Instructions:
Keep the incision/dressing clean and dry. You may apply a dry
sterile dressing as needed for drainage or comfort. Please
remove the skin staples on [**2162-9-14**].

If you are experiencing any increased redness, swelling, pain,
or have a temperature >101.5, please call your doctor or go to
the emergency room for evaluation.

Continue your Lovenox injections as prescribed for
anticoagulation until [**2162-9-21**].

You have a scheduled follow up appointment with Dr. [**Last Name (STitle) 7111**] on
[**2162-9-22**]. Feel free to call his office with any questions or
concerns.

Followup Instructions:
Please be sure to follow-up with your PCP [**Last Name (NamePattern4) **] [**11-30**] weeks.

Provider: [**Name Initial (NameIs) 2169**]: [**First Name8 (NamePattern2) 161**] [**Name6 (MD) 162**] [**Name8 (MD) 163**], MD Phone:[**Telephone/Fax (1) 921**]
Date/Time:[**2162-9-13**] 3:45

Provider: [**Name10 (NameIs) **],[**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 7145**] ORTHOPEDIC PRIVATE PRACTICE
Date/Time:[**2162-9-22**] 12:00
{'Nonunion of fracture,Other closed transcervical fracture of neck of femur,Dislocation of prosthetic joint,Acute posthemorrhagic anemia,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Subendocardial infarction, initial episode of care,Perpetrator of child and adult abuse, by non-related caregiver,Congestive heart failure, unspecified,Intestinal infection due to Clostridium difficile,Urinary tract infection, site not specified,Unspecified accident,Adult physical abuse,Late effect of fracture of neck of femur,Late effects of accidental fall,Unspecified essential hypertension,Old myocardial infarction,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Dementia with lewy bodies,Dementia in conditions classified elsewhere without behavioral disturbance'}


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: Persistent left-sided hip pain s/p DHS [**10-3**]

PRESENT ILLNESS: Mrs. [**Known lastname **] is an 87-year-old female with history of stroke,
depression and dementia related to the stroke. She presents
today after a witnessed physical altercation with her one of her
caregivers ([**Name (NI) **]); this caregiver lives with the patient and she
is being admitted for protection at this point.

MEDICAL HISTORY: -HTN
-GI Bleed--[**2158**], in setting of NSAID use as well as H.Pylori
infection, which was treated. That hospitalization included ICU
admission with multiple PRBC transfusions, several EGDs with
clipping and electrocaudery of bleeding lesion, intubation and
tx for PNA, and IMI that was likely in the setting of anemia.
-CAD--had an elevation in trop in setting of GIB as above (Echo
in [**10-31**] showed preserved EF (55%) with basal inferolateral
hypokinesis and septal apex hypokinesis, and [**11-30**]+ MR)
-CVA--[**10-31**] with L hemiparesis (distal right middle cerebral
artery
lenticulostriate artery infarction)
-Dementia--probable [**Last Name (un) 309**] Body

MEDICATION ON ADMISSION: Aricept
Aspirin
Detrol
Tylenol
Zolft
Heparin
Oxycodone

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Afebrile, All vital signs stable
Gen: Alert and oriented, No acute distress
Lungs: CTA bilaterally
Abd: benign
Extremities: left lower
mild ecchymosis superior to incision-resolving
Incision: no swelling/erythema/drainage
Dressing: clean/dry/intact
+[**Last Name (un) 938**]/FHL/AT
+SILT
1+ pulse, moves toes
extremity warm

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: One of her daughters is a nurse. She does not smoke and rarely
drinks alcohol. Prior history of [**1-1**] glasses of ETOH/day. She
likes drinking coffee, at least three cups a day. 

### Response:
{'Nonunion of fracture,Other closed transcervical fracture of neck of femur,Dislocation of prosthetic joint,Acute posthemorrhagic anemia,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Subendocardial infarction, initial episode of care,Perpetrator of child and adult abuse, by non-related caregiver,Congestive heart failure, unspecified,Intestinal infection due to Clostridium difficile,Urinary tract infection, site not specified,Unspecified accident,Adult physical abuse,Late effect of fracture of neck of femur,Late effects of accidental fall,Unspecified essential hypertension,Old myocardial infarction,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Dementia with lewy bodies,Dementia in conditions classified elsewhere without behavioral disturbance'}
