CHIEF COMPLAINT: fall

PRESENT ILLNESS: 83 yo f with hx of DVT/PE on lovenox, and predinsone for
myelodysplastic syndrome, was admitted due to fall resulting in
tramatic injury. Pt is [**Name (NI) 595**] speaking and story is per
daughter. Pt was heard yelling in her room and found on the
ground. She had slipped out of bed. She was bleeding and taking
to ER. Pt fell on her right side. Per daughter pt is bedridden
for last several months. Unclear why. Last left the house months
ago by ambulance. House has no stairs. Daughter could not
clarify why pt is unable to use wheelchair. Pt was in pain and
did not want to answer questions. Daughter was very defensive
and was also recluctant to answer questions about her mother's
home life. She states she would like her vision checked while in
the hospital. She reports her mom lost the vision in her left
eye 2 months ago, but has not seen a doctor. bed to fall,
mechanical, not witnessed, fall on head and right side. Per her
pt takes many of her medications on a prn schedule. But she has
been taking her lovenox and prednisone.
.
In the ER VS were HR 100 151/69 16 97. Pt had a deep lacteration
on her right arm, requiring plastics to repair it. Also skin
tear on right leg and bruise on right forehead. Pt had ortho
consult, brace was placed on right knee. Pt has non-opearable fx
of right femur extending to knee joint and fx of right elebow.
Pt refused morphine and had nausea. Pt was given zofran and
600mg IVF. VS on transfer were VS: 98.1 102 100/60 16 95% 3
Liters.
.
Since admission, patient seen by Orthopedics who thought she her
femur was non-operative and she was placed in a knee-immobilizer
(to be worn at all times); her right elblow was wrapped in an
ACE bandage. Plastics was consulted and sutured her RUE and LLE
lacerations in two layers. They recommended Ancef for 7 days, to
keep the dressing on for 4-5 days (Plastics to remove) and
Vitamin A supplementation. On [**3-26**] she was transfused 2U PRBC
with suspicion of enlarging thigh hematoma. Social Work was
consulted to evaluate for potential elder abuse/neglect. She was
also noted to have new ARF (Bactrim d/c'd) and was treated with
IVF and PRBC. Renal consulted and following. Opthamology was
consulted given her known vision deficits; they recommended
continuing her current home medications. Renal U/s revealed no
hydronephrosis, small non-obstructing stone in the right kidney.
Renal consult thought pre-renal status should be avoided.
Patient developed diarrhea and was started on Ciprofloxacin
[**2195-3-31**]. On [**2195-4-2**] both Ciprofloxacin and Cephazolin were
discontinued and Ceftriaxone was started. She has had no
positive culture data since admission. Pain has been controlled
with Tramodol, scheduled Tylenol and morphine PRN.
.
On [**2195-4-2**] patient was Triggered for marked nursing concern. Her
initial ABG was 7.06 / 91 / 75. Per discussion with the family,
the patient is generally on CPAP at night for OSA. She was then
started on CPAP on the floor in an attempt to keep the patient
on the floor after extensive discussion with her daughter about
goals of care. After CPAP for many hours, VBG failed to improve
and she was then transferred to the ICU for BiPAP.
.
Upon initial floor [**Date Range 2742**], patient does not respond to her
name. When her friend speaks to her in [**Name (NI) 595**] she will only nod
that she can hear her but will not respond to questions
involving pain or any other symptoms.
.

MEDICAL HISTORY: Anemia with baseline Hct 26-32, felt to be due to CKD, anemia of
chronic disease, and myelodysplastic syndrome
h/o GI bleeds
h/o repeated admissions for dyspnea and altered mental status
h/o hypercarbia requiring biPAP 13/5 with 0.5-2.5L oxygen by NC;
unclear if due to obesity hypoventilation or OSA or COPD
CAD s/p NSTEMI '[**89**]
Chronic diastolic CHF EF 60-70's
h/o hyperkalemia
MDS
Crohn's disease
CKD with baseline Cr 1.9-2.1 (was last 1.5 when checked [**9-/2194**])

MEDICATION ON ADMISSION: Brimonidine drops
Bactrim - unclear how often pt is taking
[**Name (NI) 108336**] drops [**Hospital1 **] in left eye
B12 1000mcg monthly
Lovenox 60 Qday
Epo [**Numeric Identifier **] units qweek
Folate 1mg daily
Lasix 10mg prn- took 3 days ago
Mesalamine 1200mg prn
Nystatin cream [**Hospital1 **] prn
Omeprazole 20mg [**Hospital1 **]
Oxygen 2liters NC (86-88%RA)
Prednisone 20mg qday
Timolol 0.5% gtt Left eye [**Hospital1 **]
Triamcinolone 0.025% cream [**Hospital1 **] for venous stasis prn
Calcium unsure dose
Magnesium unsure dose
Miconazole 2% powder prn
Probiotic 2 per day
Artificial tears
Kayexalate prn 15g most days
Cipro- unsure dose

ALLERGIES: Belladonna Alkaloids / Flagyl

PHYSICAL EXAM: 95.6 (axillary), 102/49, 70, 28, 92/CPAP Autoset , 1070/270
General: Minimally responsive, will nod when spoken to in
[**Month (only) 595**] but does not answer questions about symptoms
[**Month (only) 4459**]: Sclera anicteric, MMM
Neck: supple, no LAD; JVP at 2cm above clavicle
Lungs: Clear to auscultation bilaterally anteriorly
CV: Regular rate and rhythm, normal S1 + S2, soft systolic
murmur but difficult to auscultate over breath sounds
Abdomen: soft, mildly distended does not grimace to palpation,
bowel sounds present, no rebound tenderness or guarding, no
organomegaly
Ext: Warm, well perfused, 2+ pulses, large bandage on right arm
with eccymoses in R shoulder, and brace on right leg, bandages
on both lower extremities with 2+
Neuro: follows commands, hard of hearing

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: [**Year (4 digits) 595**] speaking only. Married; lives with her daughter [**Name (NI) 108329**],
[**Name2 (NI) 108330**] husband and 6 [**Name2 (NI) **] granddaughter. [**Name (NI) 108329**] is the caretaker
for both of her parents. Has daily visiting nurse at home. Pt
bedridden per daughter since [**12-7**].
Closed fracture of lower end of femur, unspecified part,Acute kidney failure, unspecified,Pneumonia, organism unspecified,Acute respiratory failure,Unspecified septicemia,Severe sepsis,Septic shock,Chronic diastolic heart failure,Acidosis,Acute posthemorrhagic anemia,Closed fracture of head of radius,Accidental fall from bed,Myelodysplastic syndrome, unspecified,Open wound of upper arm, without mention of complication,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Chronic airway obstruction, not elsewhere classified,Hypoxemia,Diarrhea,Obstructive sleep apnea (adult)(pediatric),Coronary atherosclerosis of native coronary artery,Personal history of malignant neoplasm of breast,Unspecified cataract,Esophageal reflux,Personal history of venous thrombosis and embolism,Personal history of other diseases of digestive system,Pressure ulcer, lower back
Fx low end femur NOS-cl,Acute kidney failure NOS,Pneumonia, organism NOS,Acute respiratry failure,Septicemia NOS,Severe sepsis,Septic shock,Chr diastolic hrt fail,Acidosis,Ac posthemorrhag anemia,Fx radius head-closed,Fall from bed,Myelodysplastic synd NOS,Open wound of upper arm,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Chr airway obstruct NEC,Hypoxemia,Diarrhea,Obstructive sleep apnea,Crnry athrscl natve vssl,Hx of breast malignancy,Cataract NOS,Esophageal reflux,Hx-ven thrombosis/embols,Prsnl hst ot spf dgst ds,Pressure ulcer, low back
Admission Date:  [**2195-3-26**]              Discharge Date:   [**2195-4-10**]

Date of Birth:  [**2112-2-19**]             Sex:   F

Service: MEDICINE

Allergies:
Belladonna Alkaloids / Flagyl

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
fall

Major Surgical or Invasive Procedure:
None

History of Present Illness:
83 yo f with hx of DVT/PE on lovenox, and predinsone for
myelodysplastic syndrome, was admitted due to fall resulting in
tramatic injury. Pt is [**Name (NI) 595**] speaking and story is per
daughter. Pt was heard yelling in her room and found on the
ground. She had slipped out of bed. She was bleeding and taking
to ER. Pt fell on her right side. Per daughter pt is bedridden
for last several months. Unclear why. Last left the house months
ago by ambulance. House has no stairs. Daughter could not
clarify why pt is unable to use wheelchair. Pt was in pain and
did not want to answer questions. Daughter was very defensive
and was also recluctant to answer questions about her mother's
home life. She states she would like her vision checked while in
the hospital. She reports her mom lost the vision in her left
eye 2 months ago, but has not seen a doctor. bed to fall,
mechanical, not witnessed, fall on head and right side. Per her
pt takes many of her medications on a prn schedule. But she has
been taking her lovenox and prednisone.
.
In the ER VS were HR 100 151/69 16 97. Pt had a deep lacteration
on her right arm, requiring plastics to repair it. Also skin
tear on right leg and bruise on right forehead. Pt had ortho
consult, brace was placed on right knee. Pt has non-opearable fx
of right femur extending to knee joint and fx of right elebow.
Pt refused morphine and had nausea. Pt was given zofran and
600mg IVF. VS on transfer were VS: 98.1 102 100/60 16 95% 3
Liters.
.
Since admission, patient seen by Orthopedics who thought she her
femur was non-operative and she was placed in a knee-immobilizer
(to be worn at all times); her right elblow was wrapped in an
ACE bandage. Plastics was consulted and sutured her RUE and LLE
lacerations in two layers. They recommended Ancef for 7 days, to
keep the dressing on for 4-5 days (Plastics to remove) and
Vitamin A supplementation. On [**3-26**] she was transfused 2U PRBC
with suspicion of enlarging thigh hematoma. Social Work was
consulted to evaluate for potential elder abuse/neglect. She was
also noted to have new ARF (Bactrim d/c'd) and was treated with
IVF and PRBC. Renal consulted and following. Opthamology was
consulted given her known vision deficits; they recommended
continuing her current home medications. Renal U/s revealed no
hydronephrosis, small non-obstructing stone in the right kidney.
Renal consult thought pre-renal status should be avoided.
Patient developed diarrhea and was started on Ciprofloxacin
[**2195-3-31**]. On [**2195-4-2**] both Ciprofloxacin and Cephazolin were
discontinued and Ceftriaxone was started. She has had no
positive culture data since admission. Pain has been controlled
with Tramodol, scheduled Tylenol and morphine PRN.
.
On [**2195-4-2**] patient was Triggered for marked nursing concern. Her
initial ABG was 7.06 / 91 / 75. Per discussion with the family,
the patient is generally on CPAP at night for OSA. She was then
started on CPAP on the floor in an attempt to keep the patient
on the floor after extensive discussion with her daughter about
goals of care. After CPAP for many hours, VBG failed to improve
and she was then transferred to the ICU for BiPAP.
.
Upon initial floor [**Date Range 2742**], patient does not respond to her
name. When her friend speaks to her in [**Name (NI) 595**] she will only nod
that she can hear her but will not respond to questions
involving pain or any other symptoms.
.


Past Medical History:
Anemia with baseline Hct 26-32, felt to be due to CKD, anemia of
chronic disease, and myelodysplastic syndrome
h/o GI bleeds
h/o repeated admissions for dyspnea and altered mental status
h/o hypercarbia requiring biPAP 13/5 with 0.5-2.5L oxygen by NC;
unclear if due to obesity hypoventilation or OSA or COPD
CAD s/p NSTEMI '[**89**]
Chronic diastolic CHF EF 60-70's
h/o hyperkalemia
MDS
Crohn's disease
CKD with baseline Cr 1.9-2.1 (was last 1.5 when checked [**9-/2194**])

h/o DVTs and saddle embolus in [**2190**] and [**2193**], previously on
warfarin but stopped due to GI bleed
PICC associated LUE DVT and hematoma [**5-8**] (seen also in [**7-/2194**])

Chronic b/l LE edema
Breast cancer s/p lumpectomy & XRT
GERD
Intracranial bleed and fx after pedestrian vs car 20 yrs ago
Cataracts
Venous stasis dermatitis
Tinea pedis
h/o "arrhythmia" which daughter says is tx with metoprolol in
past
s/p cholecystectomy

Social History:
[**Year (4 digits) 595**] speaking only. Married; lives with her daughter [**Name (NI) 108329**],
[**Name2 (NI) 108330**] husband and 6 [**Name2 (NI) **] granddaughter. [**Name (NI) 108329**] is the caretaker
for both of her parents. Has daily visiting nurse at home. Pt
bedridden per daughter since [**12-7**].

Family History:
Non-contributory

Physical Exam:
95.6 (axillary), 102/49, 70, 28, 92/CPAP Autoset , 1070/270
General: Minimally responsive, will nod when spoken to in
[**Month (only) 595**] but does not answer questions about symptoms
[**Month (only) 4459**]: Sclera anicteric, MMM
Neck: supple, no LAD; JVP at 2cm above clavicle
Lungs: Clear to auscultation bilaterally anteriorly
CV: Regular rate and rhythm, normal S1 + S2, soft systolic
murmur but difficult to auscultate over breath sounds
Abdomen: soft, mildly distended does not grimace to palpation,
bowel sounds present, no rebound tenderness or guarding, no
organomegaly
Ext: Warm, well perfused, 2+ pulses, large bandage on right arm
with eccymoses in R shoulder, and brace on right leg, bandages
on both lower extremities with 2+
Neuro: follows commands, hard of hearing


Pertinent Results:
BLOOD GASES:

[**2195-3-30**] 02:30AM BLOOD Type-[**Last Name (un) **] Temp-36.9 pO2-192* pCO2-79*
pH-7.15* calTCO2-29 Base XS--3 Intubat-NOT INTUBA
[**2195-4-2**] 12:47PM BLOOD Type-CENTRAL VE pH-7.07* calTCO2-
Comment-GREEN TOP,
[**2195-4-2**] 01:45PM BLOOD Type-ART pO2-75* pCO2-91* pH-7.06*
calTCO2-27 Base XS--7 Intubat-NOT INTUBA
[**2195-4-2**] 05:12PM BLOOD Type-[**Last Name (un) **] Temp-36.6 pH-7.09* Comment-95.8
AXILL
[**2195-4-3**] 03:28AM BLOOD Type-MIX Temp-37.2 pO2-44* pCO2-60*
pH-7.22* calTCO2-26 Base XS--4
[**2195-4-3**] 12:28PM BLOOD Type-[**Last Name (un) **] Temp-37.4 Rates-/28 O2 Flow-3
pO2-51* pCO2-75* pH-7.14* calTCO2-27 Base XS--5 Intubat-NOT
INTUBA Comment-NASAL [**Last Name (un) 154**]
[**2195-3-30**] 02:30AM BLOOD Lactate-0.8
[**2195-4-2**] 12:47PM BLOOD Lactate-0.8 K-5.5* calHCO3-25
[**2195-4-2**] 05:12PM BLOOD Lactate-1.0 calHCO3-24
[**2195-4-3**] 03:28AM BLOOD Lactate-1.7

Brief Hospital Course:
MICU COURSE:

# Hypercarbic Respiratory Failure: Transferred to ICU for
worsening hypercarbic respiratory failure with an ABG
7.22/44/60/26. Patient with history of chronic hypoventilation.
CXR concerning for new left sided PNA vs atelectatic changes vs
positional. Possible contribution of narcotics in context of
recent injury. Patient placed on BIPAP with significant
improvement in blood gas to 7.14/51/75/27 @ 30% FiO2.

During her ICU course, she continued to have episodes of hypoxia
and required noninvasive ventilation.  She was maintained on
broad spectrum antibiotics.  As discussed with her daughter and
health care proxy, she was DNR/DNI, no pressors.  She was placed
on BiPap intermittently which became very uncomfortable.  In
light of her worsening respiratory status, renal failure,
unrelieved on Bipap, the decision was made on [**4-10**] to stop
noninvasive ventilation.  The patient ultimately passed away

# Hypotension:  Newly the day of transfer to the ICU.  The night
prior was given Lasix IV x 2 the day prior.  Some concern for
hypovolemia (but minimal urine output which limits bolusing)
Concern for possible infectious sepsis.  She was started on
broad spectrym antibiotics with good coverage of skin flora due
to the fact that she had multiple wounds.  She was supported
with fluid as needed as well as antibiotics.  Her hypotension
improved initially, however ultimately worsened.  Despite fluid
and blood as needed, she continued to have respiratory
compromise.

# Fall with mulitple fractures and laceration: Intraarticular
right knee/femur fracture and right elbow fracture with
associated head injury and deep laceration to right arm and tear
of left leg. Patient became more sleepy with oxycodone, so this
was discontinued.  She was treated with antibiotics and dressing
changes.  She elected not to have any surgery.

# AMS: Suspect multifactorial including toxic-metabolic
abnormalities (hypercarbia, infection); hospital delirium and/or
infection that is being untreated.  As above, she was treated
with antibiotics and noninvasive ventilation.  She was
responsive to her daughter and during the admission had several
days during which she was able to eat and converse.  Ultimately
as her respiratory status declined, she became more somnolent.

# Acute on chronic renal failure: Cr improved to 2.8 today. Per
renal, somewhere between pre-renal and ATN. Renal ultrasound
without hydronephrosis. her medications were renally dosed and
despite efforts to treat her multiple medical problems, her
renal failure worsened.

# Crohn's: stable during admission
.
# Hx of PE/DVT: last DVT [**5-8**] with PICC. Was on lovenox at home,
but now concern for bleeding in setting of significant
laceractions and fractures. Lovenox was held, she was on heparin
intermittently, however due to dropping Hct, this was also DC'd.

On [**2195-4-10**] the decision was made with her HCP to stop
noninvasive ventilation as it was not effective.  Her
hypotension worsened as did her respiratory drive.  She expired
at [**2210**].  On exam, her pupils were fixed and no breath sounds or
heart rhythm could be auscultated, no pulses palpable.



Medications on Admission:
Brimonidine drops
Bactrim - unclear how often pt is taking
[**Name (NI) 108336**] drops [**Hospital1 **] in left eye
B12 1000mcg monthly
Lovenox 60 Qday
Epo [**Numeric Identifier **] units qweek
Folate 1mg daily
Lasix 10mg prn- took 3 days ago
Mesalamine 1200mg prn
Nystatin cream [**Hospital1 **] prn
Omeprazole 20mg [**Hospital1 **]
Oxygen 2liters NC (86-88%RA)
Prednisone 20mg qday
Timolol 0.5% gtt Left eye [**Hospital1 **]
Triamcinolone 0.025% cream [**Hospital1 **] for venous stasis prn
Calcium unsure dose
Magnesium unsure dose
Miconazole 2% powder prn
Probiotic 2 per day
Artificial tears
Kayexalate prn 15g most days
Cipro- unsure dose


Discharge Disposition:
Expired

Discharge Diagnosis:
Hypoxia, PNA/COPD, ARF, Falls


Discharge Condition:
Pt. expired


Discharge Instructions:
Pt. expired

Followup Instructions:
Pt. expired
{'Closed fracture of lower end of femur, unspecified part,Acute kidney failure, unspecified,Pneumonia, organism unspecified,Acute respiratory failure,Unspecified septicemia,Severe sepsis,Septic shock,Chronic diastolic heart failure,Acidosis,Acute posthemorrhagic anemia,Closed fracture of head of radius,Accidental fall from bed,Myelodysplastic syndrome, unspecified,Open wound of upper arm, without mention of complication,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Chronic airway obstruction, not elsewhere classified,Hypoxemia,Diarrhea,Obstructive sleep apnea (adult)(pediatric),Coronary atherosclerosis of native coronary artery,Personal history of malignant neoplasm of breast,Unspecified cataract,Esophageal reflux,Personal history of venous thrombosis and embolism,Personal history of other diseases of digestive system,Pressure ulcer, lower back'}


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: fall

PRESENT ILLNESS: 83 yo f with hx of DVT/PE on lovenox, and predinsone for
myelodysplastic syndrome, was admitted due to fall resulting in
tramatic injury. Pt is [**Name (NI) 595**] speaking and story is per
daughter. Pt was heard yelling in her room and found on the
ground. She had slipped out of bed. She was bleeding and taking
to ER. Pt fell on her right side. Per daughter pt is bedridden
for last several months. Unclear why. Last left the house months
ago by ambulance. House has no stairs. Daughter could not
clarify why pt is unable to use wheelchair. Pt was in pain and
did not want to answer questions. Daughter was very defensive
and was also recluctant to answer questions about her mother's
home life. She states she would like her vision checked while in
the hospital. She reports her mom lost the vision in her left
eye 2 months ago, but has not seen a doctor. bed to fall,
mechanical, not witnessed, fall on head and right side. Per her
pt takes many of her medications on a prn schedule. But she has
been taking her lovenox and prednisone.
.
In the ER VS were HR 100 151/69 16 97. Pt had a deep lacteration
on her right arm, requiring plastics to repair it. Also skin
tear on right leg and bruise on right forehead. Pt had ortho
consult, brace was placed on right knee. Pt has non-opearable fx
of right femur extending to knee joint and fx of right elebow.
Pt refused morphine and had nausea. Pt was given zofran and
600mg IVF. VS on transfer were VS: 98.1 102 100/60 16 95% 3
Liters.
.
Since admission, patient seen by Orthopedics who thought she her
femur was non-operative and she was placed in a knee-immobilizer
(to be worn at all times); her right elblow was wrapped in an
ACE bandage. Plastics was consulted and sutured her RUE and LLE
lacerations in two layers. They recommended Ancef for 7 days, to
keep the dressing on for 4-5 days (Plastics to remove) and
Vitamin A supplementation. On [**3-26**] she was transfused 2U PRBC
with suspicion of enlarging thigh hematoma. Social Work was
consulted to evaluate for potential elder abuse/neglect. She was
also noted to have new ARF (Bactrim d/c'd) and was treated with
IVF and PRBC. Renal consulted and following. Opthamology was
consulted given her known vision deficits; they recommended
continuing her current home medications. Renal U/s revealed no
hydronephrosis, small non-obstructing stone in the right kidney.
Renal consult thought pre-renal status should be avoided.
Patient developed diarrhea and was started on Ciprofloxacin
[**2195-3-31**]. On [**2195-4-2**] both Ciprofloxacin and Cephazolin were
discontinued and Ceftriaxone was started. She has had no
positive culture data since admission. Pain has been controlled
with Tramodol, scheduled Tylenol and morphine PRN.
.
On [**2195-4-2**] patient was Triggered for marked nursing concern. Her
initial ABG was 7.06 / 91 / 75. Per discussion with the family,
the patient is generally on CPAP at night for OSA. She was then
started on CPAP on the floor in an attempt to keep the patient
on the floor after extensive discussion with her daughter about
goals of care. After CPAP for many hours, VBG failed to improve
and she was then transferred to the ICU for BiPAP.
.
Upon initial floor [**Date Range 2742**], patient does not respond to her
name. When her friend speaks to her in [**Name (NI) 595**] she will only nod
that she can hear her but will not respond to questions
involving pain or any other symptoms.
.

MEDICAL HISTORY: Anemia with baseline Hct 26-32, felt to be due to CKD, anemia of
chronic disease, and myelodysplastic syndrome
h/o GI bleeds
h/o repeated admissions for dyspnea and altered mental status
h/o hypercarbia requiring biPAP 13/5 with 0.5-2.5L oxygen by NC;
unclear if due to obesity hypoventilation or OSA or COPD
CAD s/p NSTEMI '[**89**]
Chronic diastolic CHF EF 60-70's
h/o hyperkalemia
MDS
Crohn's disease
CKD with baseline Cr 1.9-2.1 (was last 1.5 when checked [**9-/2194**])

MEDICATION ON ADMISSION: Brimonidine drops
Bactrim - unclear how often pt is taking
[**Name (NI) 108336**] drops [**Hospital1 **] in left eye
B12 1000mcg monthly
Lovenox 60 Qday
Epo [**Numeric Identifier **] units qweek
Folate 1mg daily
Lasix 10mg prn- took 3 days ago
Mesalamine 1200mg prn
Nystatin cream [**Hospital1 **] prn
Omeprazole 20mg [**Hospital1 **]
Oxygen 2liters NC (86-88%RA)
Prednisone 20mg qday
Timolol 0.5% gtt Left eye [**Hospital1 **]
Triamcinolone 0.025% cream [**Hospital1 **] for venous stasis prn
Calcium unsure dose
Magnesium unsure dose
Miconazole 2% powder prn
Probiotic 2 per day
Artificial tears
Kayexalate prn 15g most days
Cipro- unsure dose

ALLERGIES: Belladonna Alkaloids / Flagyl

PHYSICAL EXAM: 95.6 (axillary), 102/49, 70, 28, 92/CPAP Autoset , 1070/270
General: Minimally responsive, will nod when spoken to in
[**Month (only) 595**] but does not answer questions about symptoms
[**Month (only) 4459**]: Sclera anicteric, MMM
Neck: supple, no LAD; JVP at 2cm above clavicle
Lungs: Clear to auscultation bilaterally anteriorly
CV: Regular rate and rhythm, normal S1 + S2, soft systolic
murmur but difficult to auscultate over breath sounds
Abdomen: soft, mildly distended does not grimace to palpation,
bowel sounds present, no rebound tenderness or guarding, no
organomegaly
Ext: Warm, well perfused, 2+ pulses, large bandage on right arm
with eccymoses in R shoulder, and brace on right leg, bandages
on both lower extremities with 2+
Neuro: follows commands, hard of hearing

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: [**Year (4 digits) 595**] speaking only. Married; lives with her daughter [**Name (NI) 108329**],
[**Name2 (NI) 108330**] husband and 6 [**Name2 (NI) **] granddaughter. [**Name (NI) 108329**] is the caretaker
for both of her parents. Has daily visiting nurse at home. Pt
bedridden per daughter since [**12-7**]. 

### Response:
{'Closed fracture of lower end of femur, unspecified part,Acute kidney failure, unspecified,Pneumonia, organism unspecified,Acute respiratory failure,Unspecified septicemia,Severe sepsis,Septic shock,Chronic diastolic heart failure,Acidosis,Acute posthemorrhagic anemia,Closed fracture of head of radius,Accidental fall from bed,Myelodysplastic syndrome, unspecified,Open wound of upper arm, without mention of complication,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Chronic airway obstruction, not elsewhere classified,Hypoxemia,Diarrhea,Obstructive sleep apnea (adult)(pediatric),Coronary atherosclerosis of native coronary artery,Personal history of malignant neoplasm of breast,Unspecified cataract,Esophageal reflux,Personal history of venous thrombosis and embolism,Personal history of other diseases of digestive system,Pressure ulcer, lower back'}
