CHIEF COMPLAINT: Failed left total hip replacement (multidirectional
instability/dislocation)with nonunion of greater trochanter
osteotomy.

PRESENT ILLNESS: Ms. [**Known lastname 97368**] is a 72 year old female ~2 years status post left
total hip replacement who has been experiencing multiderectional
instability and dislocations.  The decision was made to revise
the left total hip.  Dr. [**Last Name (STitle) **] discussed the risks and benefits
of the procedure, and Ms. [**Known lastname 97368**] elected to undergo the
revision.

MEDICAL HISTORY: - Chronic rectal pain -> OMR note requesting no further
admissions for rectal pain
- Motor vehicle accident in [**2126**] (also had an additional motor
vehicle accident that year that resulted in a tibia and fibula
fracture).
- Cataracts
- Status post total hip replacement x 2
- Status post laminectomy [**2123**]
- Chronic back pain
- Lumbar spinal stenosis
- Chronic pain syndrome

MEDICATION ON ADMISSION: CITALOPRAM [CELEXA] - 40 mg Tablet - 1 Tablet(s) by mouth daily
Increase as directed
ESTRADIOL [ESTRACE] - 0.01 % Cream - apply to vagina twice a day
GABAPENTIN [NEURONTIN] - 300 mg Capsule - 3 Capsule(s) by mouth
three times a day
HYDROCODONE-ACETAMINOPHEN [CO-GESIC] - 5 mg-500 mg Tablet - 1
Tablet(s) by mouth every 8 hours
HYDROCORTISONE-PRAMOXINE - 2.5 %-1 % (4 gram) Cream - apply
cream
rectally twice a day
IPRATROPIUM-ALBUTEROL [COMBIVENT] - 18 mcg-103 mcg (90
mcg)/Actuation Aerosol - 2 puffs four times a day as needed for
cough and sortness of breath
MUPIROCIN - 2 % Ointment - USE ON BURN TWICE DAILY
PREGABALIN [LYRICA] -  (Prescribed by Other Provider) - 25 mg
Capsule - 1 Capsule(s) by mouth 3 times a day
TIMOLOL MALEATE -  (Prescribed by Other Provider) - Dosage
uncertain
TRAMADOL - 50 mg Tablet - [**12-5**] Tablet(s) by mouth twice a day as
needed for recrtal pain

ALLERGIES: Penicillins / Effexor / Topamax / Clindamycin

PHYSICAL EXAM: At the time of discharge:
AVSS
NAD
wound c/d/i without erythema
[**Last Name (un) 938**]/FHL/TA/GS intact
SILT distally

FAMILY HISTORY: Father w/ ETOH, no known suicides. Both of patient's parents
died of complications of heart disease, mother at 72 and father
at 62. One brother had an MI at 48, but is otherwise generally
healthy. Other brother is healthy.

SOCIAL HISTORY: Denies smoking at present; [**Age over 90 **]y pack history.
Dislocation of prosthetic joint,Acute posthemorrhagic anemia,Pulmonary congestion and hypostasis,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus,Personal history of tobacco use,Anxiety state, unspecified,Other iatrogenic hypotension,Unspecified cataract,Hypovolemia,Other chronic pain,Lumbago,Anal or rectal pain
Dislocate prosthetic jt,Ac posthemorrhag anemia,Pulm congest/hypostasis,Abn react-artif implant,Meth resis Staph carrier,History of tobacco use,Anxiety state NOS,Iatrogenc hypotnsion NEC,Cataract NOS,Hypovolemia,Chronic pain NEC,Lumbago,Anal or rectal pain
Admission Date:  [**2133-2-18**]              Discharge Date:   [**2133-2-25**]

Date of Birth:  [**2060-9-26**]             Sex:   F

Service: ORTHOPAEDICS

Allergies:
Penicillins / Effexor / Topamax / Clindamycin

Attending:[**First Name3 (LF) 64**]
Chief Complaint:
Failed left total hip replacement (multidirectional
instability/dislocation)with nonunion of greater trochanter
osteotomy.


Major Surgical or Invasive Procedure:
Revision left total hip replacement (femoral head and acetabular
liner components)


History of Present Illness:
Ms. [**Known lastname 97368**] is a 72 year old female ~2 years status post left
total hip replacement who has been experiencing multiderectional
instability and dislocations.  The decision was made to revise
the left total hip.  Dr. [**Last Name (STitle) **] discussed the risks and benefits
of the procedure, and Ms. [**Known lastname 97368**] elected to undergo the
revision.

Past Medical History:
- Chronic rectal pain -> OMR note requesting no further
admissions for rectal pain
- Motor vehicle accident in [**2126**] (also had an additional motor
vehicle accident that year that resulted in a tibia and fibula
fracture).
- Cataracts
- Status post total hip replacement x 2
- Status post laminectomy [**2123**]
- Chronic back pain
- Lumbar spinal stenosis
- Chronic pain syndrome

Social History:
Denies smoking at present; [**Age over 90 **]y pack history.

Family History:
Father w/ ETOH, no known suicides. Both of patient's parents
died of complications of heart disease, mother at 72 and father
at 62. One brother had an MI at 48, but is otherwise generally
healthy. Other brother is healthy.

Physical Exam:
At the time of discharge:
AVSS
NAD
wound c/d/i without erythema
[**Last Name (un) 938**]/FHL/TA/GS intact
SILT distally


Brief Hospital Course:
The patient was admitted on [**2133-2-18**] and, later that day, was
taken to the operating room by Dr. [**Last Name (STitle) **] for a revision left
total hip arthroplasty with change of the femoral head and
acetabular liner without complication.  Please see operative
report for details.
Postoperatively, the patient was hypotensive with SBP's in the
80-90s and was transferred to the ICU for closer management and
treatment.  She did not demonstrate any end-organ ischemia and
her mental status was intact.  She responded to fluid
resuscitation and PRBCs and was transferred to the floor on
POD#1. The patient was initially treated with a PCA followed by
PO pain medications on POD#[**12-5**].  She complained of persistent
pain both related to the hip as well as her prior lower back and
sciatic pain; she was seen by the pain service who aided in her
pain management. The patient received IV antibiotics for 24
hours postoperatively, as well as lovenox for DVT prophylaxis
starting on the morning of POD#1.  The drain was removed without
incident on POD#1. The Foley catheter was removed with a failed
trial of void.  She will be discharged to rehab with a foley,
and she is to continue Bactrim DS Qd until the foley is d/c'ed.
The surgical dressing was removed on POD#2 and the surgical
incision was found to be clean, dry, and intact without erythema
or purulent drainage.

While in the hospital, the patient was seen daily by physical
therapy. Labs were checked throughout the hospital course and
repleted accordingly. At the time of discharge the patient was
tolerating a regular diet and feeling well.  The patient was
afebrile with stable vital signs. The patient's hematocrit was
stable, and the patient's pain was adequately controlled on a PO
regimen. The operative extremity was neurovascularly intact and
the wound was benign. The patient was discharged to home with
services or rehabilitation in a stable condition.  The patient's
weight-bearing status was weight bearing as tolerated with
global precaution and to be in a knee immobilizer at all times.


Medications on Admission:
CITALOPRAM [CELEXA] - 40 mg Tablet - 1 Tablet(s) by mouth daily
Increase as directed
ESTRADIOL [ESTRACE] - 0.01 % Cream - apply to vagina twice a day
GABAPENTIN [NEURONTIN] - 300 mg Capsule - 3 Capsule(s) by mouth
three times a day
HYDROCODONE-ACETAMINOPHEN [CO-GESIC] - 5 mg-500 mg Tablet - 1
Tablet(s) by mouth every 8 hours
HYDROCORTISONE-PRAMOXINE - 2.5 %-1 % (4 gram) Cream - apply
cream
rectally twice a day
IPRATROPIUM-ALBUTEROL [COMBIVENT] - 18 mcg-103 mcg (90
mcg)/Actuation Aerosol - 2 puffs four times a day as needed for
cough and sortness of breath
MUPIROCIN - 2 % Ointment - USE ON BURN TWICE DAILY
PREGABALIN [LYRICA] -  (Prescribed by Other Provider) - 25 mg
Capsule - 1 Capsule(s) by mouth 3 times a day
TIMOLOL MALEATE -  (Prescribed by Other Provider) - Dosage
uncertain
TRAMADOL - 50 mg Tablet - [**12-5**] Tablet(s) by mouth twice a day as
needed for recrtal pain

Medications - OTC
DOCUSATE SODIUM [COLACE] - 100 mg Capsule - 1 Capsule(s) by
mouth
twice a day
POLYETHYLENE GLYCOL 3350 [MIRALAX] -  (OTC) - 100 % Powder - 1
tablespoon by mouth daily as directed


Discharge Medications:
1. Enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) syringe
Subcutaneous once a day for 3 weeks.
2. Multivitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Gabapentin 300 mg Capsule Sig: Three (3) Capsule PO TID (3
times a day).
5. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

6. Risperidone 0.25 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) as needed for aggitation.
7. Ketorolac Tromethamine 0.5 % Drops Sig: One (1) drop
Ophthalmic q6 ().
8. Oxycodone 10 mg Tablet Sustained Release 12 hr Sig: One (1)
Tablet Sustained Release 12 hr PO Q8H (every 8 hours).
9. Timolol Maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **]
(2 times a day).
10. Prednisolone Acetate 1 % Drops, Suspension Sig: One (1) Drop
Ophthalmic [**Hospital1 **] (2 times a day).
11. Hydrocortisone 2.5 % Cream Sig: One (1) Appl Rectal PRN (as
needed).
12. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - MACU

Discharge Diagnosis:
Failed left total hip replacement (multidirectional
instability/dislocation)with nonunion of greater trochanter
osteotomy.



Discharge Condition:
Stable


Discharge Instructions:
experience severe pain not relieved by medication, increased
swelling, decreased sensation, difficulty with movement, fevers
>101.5, shaking chills, redness or drainage from the incision
site, chest pain, shortness of breath or any other concerns.

2. Please follow up with your PCP regarding this admission and
any new medications and refills.

3. Resume your home medications unless otherwise instructed.

4. You have been given medications for pain control. Please do
not operate heavy machinery or drink alcohol when taking these
medications. As your pain improves, please decrease the amount
of pain medication. This medication can cause constipation, so
you should drink plenty of water daily and take a stool softener
(e.g., colace) as needed to prevent this side effect.

5. You may not drive a car until cleared to do so by your
surgeon or your primary physician.

6. Please keep your wounds clean. You may get the wound wet or
take a shower starting 5 days after surgery, but no baths or
swimming for at least 4 weeks. No dressing is needed if wound
continues to be non-draining. Any stitches or staples that need
to be removed will be taken out by a visiting nurse at 2 weeks
after your surgery.

7. Please call your surgeon's office to schedule or confirm your
follow-up appointment at 4 weeks.

8. Please DO NOT take any NSAIDs (i.e. celebrex, ibuprofen,
advil, motrin, etc).

9. ANTICOAGULATION: Please continue your lovenox for 3 weeks to
prevent deep vein thrombosis (blood clots).  After completing
the lovenox, please take Aspirin 325mg twice daily for an
additional three weeks.

10. WOUND CARE: Please keep your incision clean and dry. It is
okay to shower after POD#5 but do not take a tub-bath or
submerge your incision until 4 weeks after surgery. Please place
a dry sterile dressing on the wound each day if there is
drainage, otherwise leave it open to air. Check wound regularly
for signs of infection such as redness or thick yellow drainage.
Staples will be removed by VNA in 2 weeks. If you are going to
rehab, the rehab facility can remove the staples at 2 weeks.

11. VNA (once at home): Home PT/OT, dressing changes as
instructed, wound checks, and staple removal at 2 weeks after
surgery.

12. ACTIVITY: Weight bearing as tolerated on the operative leg
with global precautions; wear knee immobilizer at all times. No
strenuous exercise or heavy lifting until follow up appointment.

Physical Therapy:
Weight bearing as tolerated
Global left hip precautions
Knee immobilizer at all times
Treatments Frequency:
Lovenox injections. Wound checks and daily dry sterile dressing
changes until wound dry. Staple removal at 2 weeks.

Followup Instructions:
Provider: [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1953**], [**MD Number(3) 1240**]:[**Telephone/Fax (1) 1228**]
Date/Time:[**2133-3-13**] 10:00
{'Dislocation of prosthetic joint,Acute posthemorrhagic anemia,Pulmonary congestion and hypostasis,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus,Personal history of tobacco use,Anxiety state, unspecified,Other iatrogenic hypotension,Unspecified cataract,Hypovolemia,Other chronic pain,Lumbago,Anal or rectal pain'}


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: Failed left total hip replacement (multidirectional
instability/dislocation)with nonunion of greater trochanter
osteotomy.

PRESENT ILLNESS: Ms. [**Known lastname 97368**] is a 72 year old female ~2 years status post left
total hip replacement who has been experiencing multiderectional
instability and dislocations.  The decision was made to revise
the left total hip.  Dr. [**Last Name (STitle) **] discussed the risks and benefits
of the procedure, and Ms. [**Known lastname 97368**] elected to undergo the
revision.

MEDICAL HISTORY: - Chronic rectal pain -> OMR note requesting no further
admissions for rectal pain
- Motor vehicle accident in [**2126**] (also had an additional motor
vehicle accident that year that resulted in a tibia and fibula
fracture).
- Cataracts
- Status post total hip replacement x 2
- Status post laminectomy [**2123**]
- Chronic back pain
- Lumbar spinal stenosis
- Chronic pain syndrome

MEDICATION ON ADMISSION: CITALOPRAM [CELEXA] - 40 mg Tablet - 1 Tablet(s) by mouth daily
Increase as directed
ESTRADIOL [ESTRACE] - 0.01 % Cream - apply to vagina twice a day
GABAPENTIN [NEURONTIN] - 300 mg Capsule - 3 Capsule(s) by mouth
three times a day
HYDROCODONE-ACETAMINOPHEN [CO-GESIC] - 5 mg-500 mg Tablet - 1
Tablet(s) by mouth every 8 hours
HYDROCORTISONE-PRAMOXINE - 2.5 %-1 % (4 gram) Cream - apply
cream
rectally twice a day
IPRATROPIUM-ALBUTEROL [COMBIVENT] - 18 mcg-103 mcg (90
mcg)/Actuation Aerosol - 2 puffs four times a day as needed for
cough and sortness of breath
MUPIROCIN - 2 % Ointment - USE ON BURN TWICE DAILY
PREGABALIN [LYRICA] -  (Prescribed by Other Provider) - 25 mg
Capsule - 1 Capsule(s) by mouth 3 times a day
TIMOLOL MALEATE -  (Prescribed by Other Provider) - Dosage
uncertain
TRAMADOL - 50 mg Tablet - [**12-5**] Tablet(s) by mouth twice a day as
needed for recrtal pain

ALLERGIES: Penicillins / Effexor / Topamax / Clindamycin

PHYSICAL EXAM: At the time of discharge:
AVSS
NAD
wound c/d/i without erythema
[**Last Name (un) 938**]/FHL/TA/GS intact
SILT distally

FAMILY HISTORY: Father w/ ETOH, no known suicides. Both of patient's parents
died of complications of heart disease, mother at 72 and father
at 62. One brother had an MI at 48, but is otherwise generally
healthy. Other brother is healthy.

SOCIAL HISTORY: Denies smoking at present; [**Age over 90 **]y pack history. 

### Response:
{'Dislocation of prosthetic joint,Acute posthemorrhagic anemia,Pulmonary congestion and hypostasis,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus,Personal history of tobacco use,Anxiety state, unspecified,Other iatrogenic hypotension,Unspecified cataract,Hypovolemia,Other chronic pain,Lumbago,Anal or rectal pain'}
