CHIEF COMPLAINT: Right hip pain

PRESENT ILLNESS: Ms. [**Known lastname 39903**] is a [**Age over 90 **] year old female who presented to the [**Hospital1 18**]
after a mechanical fall at home.  She was walking to the
bathroom when she tripped over the rug.  She now presents for
further evaluation.

MEDICAL HISTORY: Blindness
HTN
Hypercholesterolemia
Significant smoking history (~180PYs)

MEDICATION ON ADMISSION: Lisinopril 40 daily
Diltiazem 300 daily
Aspirin 81 daily
Temazepam 30 qhs

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon admission

FAMILY HISTORY: n/a

SOCIAL HISTORY: Lives with son
Closed fracture of intertrochanteric section of neck of femur,Acute posthemorrhagic anemia,Atrial fibrillation,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Chronic airway obstruction, not elsewhere classified,Pneumonitis due to inhalation of food or vomitus,Acidosis,Malnutrition of moderate degree,Other specified retention of urine,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Delirium due to conditions classified elsewhere,Pure hypercholesterolemia,Legal blindness, as defined in U.S.A.,Osteoporosis, unspecified,Unspecified glaucoma,Fall from other slipping, tripping, or stumbling
Intertrochanteric fx-cl,Ac posthemorrhag anemia,Atrial fibrillation,Acute kidney failure NOS,Chronic kidney dis NOS,Chr airway obstruct NEC,Food/vomit pneumonitis,Acidosis,Malnutrition mod degree,Oth spcf retention urine,Hy kid NOS w cr kid I-IV,Delirium d/t other cond,Pure hypercholesterolem,Legal blindness-usa def,Osteoporosis NOS,Glaucoma NOS,Fall from slipping NEC
Admission Date:  [**2119-9-12**]              Discharge Date:   [**2119-10-3**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 348**]
Chief Complaint:
Right hip pain

Major Surgical or Invasive Procedure:
[**First Name3 (LF) 24785**] Right hip with DHS
Right PICC line placement & removal


History of Present Illness:
Ms. [**Known lastname 39903**] is a [**Age over 90 **] year old female who presented to the [**Hospital1 18**]
after a mechanical fall at home.  She was walking to the
bathroom when she tripped over the rug.  She now presents for
further evaluation.

Past Medical History:
Blindness
HTN
Hypercholesterolemia
Significant smoking history (~180PYs)


Social History:
Lives with son

Family History:
n/a

Physical Exam:
Upon admission

Alert Russian speaking

Cardiac:  Regular rate rhythm
Chest:  Lungs clear bilaterally
Abdomen:  Soft non-tender non-distended
Extremities:  RLE + pulses, skin inctact, + pain with logroll

Pertinent Results:
Admission labs [**2119-9-12**]
          9.1
  10.8 >-------< 211
          26.6

     142  112  27
     ---+----+----<129
     4.2  22   1.3
.
Urinalysis negative on admission
.
EKG 08/[**0-0-**]: Sinus rhythm and occasional atrial ectopy. Left
anterior fascicular block. Right bundle-branch block.
.
Xray femur/pelvis, right [**2119-9-12**]:
Minimally displaced intertrochanteric fracture of the proximal
right femur. Prominent multilevel degenerative changes of the
lower lumbar spine
.
[**2119-9-15**]: Video swallow evaluation: Recommended thin liquids
and regular consistency solids.  Assist with feedings as needed,
pills to be given whole with thin liquids.
.
Echocardiogram [**2119-9-12**]
Conclusions:
The left atrium is normal in size. Left ventricular wall
thickness, cavity  size and regional/global systolic function
are normal (LVEF >55%) Right  ventricular chamber size and free
wall motion are normal. The aortic valve  leaflets are mild to
moderately thickened. There is mild aortic valve stenosis  (area
1.2-1.9cm2). Trace aortic regurgitation is seen. The mitral
valve  leaflets are mildly thickened. There is no mitral valve
prolapse. Trivial  mitral regurgitation is seen. There is
moderate pulmonary artery systolic  hypertension. There is no
pericardial effusion.
IMPRESSION: Mild valvular aortic stenosis. At least moderate
pulmonary
hypertension with normal right ventricular systolic function.
Preserved
regional/global biventricular systolic function.
.
.
[**2119-9-26**] Chest xray:
FINDINGS:  Portable upright AP chest radiograph shows no
significant
radiographic change in bibasilar consolidation over the past
five days.
Right-sided PICC line tubing ends at the level of the mid
superior vena cava.  Cardiac and mediastinal contours including
slightly hazy fullness in perihilar vasculature are unchanged.
There is slight narrowing and leftward deviation of the trachea
at the thoracic inlet, unchanged.  Prominent S-shaped scoliosis
is noted.

Discharge labs [**2119-10-3**]
142 / 108 / 21    AGap=11
-----------------  96
4.1 / 27 / 1.2

Source: Line-PICC

WBC 13.8  HCT 25.3 PLT 452

Brief Hospital Course:
Assessement/Plan:
[**Age over 90 **] yo blind, Russsian speaking F with HTN and significant hx for
smoking was admitted s/p mechanical fall, suffered a right hip
fracture and underwent right hip [**Age over 90 24785**]. She tolerated the
procedure well requiring 2U blood transfusion, however post op
course was complicated by confusion, agitation as well as
pneumonia/hypoxia requiring transfer to the ICU.  In the setting
of hypoxia/pneumonia she also went into atrial fibrillation,
which has since resolved. Was oxygenated using NRB, did not
require Bipap or intubation. After stabilization, she was
transferred back to the floor, where she remained stable until
discharge.
.
# R hip fracture s/p [**Age over 90 24785**]- R hip incision site was monitored for
signs of infection; did not have drainage or erythema during
duration of hospitalization. The staples were eventually removed
and replaced with steristrips which are to be left in place
until they fall off. Physical therapy was consulted to work with
pt on her strength training, gait and mobility. We provided
adequate pain control for the patient initially with oxycodone
as needed, then standing tylenol as well as Lidocaine patches
were added for the comfort of the patient.  By the time of
discharge she was no longer requiring prn oxycodone.  She was
continued on renally dosed Lovenox throughout hospitalization
for prevention of DVT in setting of hip fracture.  Lovenox will
be stopped on [**2119-10-10**] to complete 4 week post fracture course.
She was discharged to acute rehab for continued physical and
occupational therapy prior to D/C home.  She has follow up with
Dr. [**Last Name (STitle) **] scheduled.
.
# MICU course: On [**2119-9-21**], POD #9 [**Name (NI) 24785**], pt was noted to be more
somnolent with an O2 saturation of 82% on RA, she had increased
O2 requirement up to NRB facemask. Her saturations then rose to
97%, however blood gas at 6L NC showed PaO2 of 53. Pt was
transfered to the MICU for further monitoring. She did not
require intubation, however she developed atrial fibrillation
which was rate controlled with Diltiazem. Her therapy for
pneumonia was also continued at this time. Once stable she was
transferred to the [**Hospital1 **] for further monitoring.
.
# Aspiration pneumonia/hospital acquired: Sputum grew out gram
negative rods postop and she was started on Levaquin for a 7day
course. However, she decompensated with hypoxia requiring
transfer to the unit before the therapy was completed. She was
started on Vancomycin/Flagyl in addition to Levaquin. Vancomycin
was discontinued after 4days of therapy, however the other
antibiotics were to be continued to complete a 2wk course. Prior
to discharge she was saturating well at 93-94% on room air.
Given her extensive smoking hx nebulizers were administered and
will be continued until post pneumonia wheezing resolves. She
continued to improve as evidence by the decline of leukocytosis,
as well as improvement in her oxygen saturation.
.
# Agitation/delirium: Progressively worsened after hip surgery
in the setting of blindness as well as being Russian speaking
only. Also, age and given that she was in a strange environment,
agitation was to be expected.  She was managed with Zyprexa
initially then small doses of haldol IV, also required a family
member to be at bedside to help orient pt. We also tried to
limit lines and tubes by discontinuing her telemetry and foley
when it was appropriate. At time of discharge, acute agitation
resolved and she was more oriented and according to family close
to her baseline.
.
# Anemia: Most likely related to surgery. Guaiac stool negative
during admission. Required transfusions only in the immediate
post operative phase. There was no evidence of active bleeding
at any time. There was however, a large area of ecchymosis,
?resolving hematoma around area of surgery R hip; did not
increase in size.  Hematocrit remained stable through remainder
of hospitalization.
.
# Atrial fibrillation: Developed after [**Hospital **] transfer to the
MICU. Most likely in the setting of pneumonia/hypoxia and s/p
surgery.  EKG did not show evidence of ischemia. Diltiazem was
initially started at 30 QID, then titrated up to 60mg QID.
Changed to long acting diltiazem 240mg daily prior to discharge
to simplify her medication regimen. She remained rate controlled
on this regimen. Given age and fall risk, pt not considered a
good candidate for anticoagulation therapy.
.
# Acute renal failure: Unsure of pt's baseline, however admitted
with Cr 1.6. Worsened slightly in light of surgery, hypovolemia,
and infection however continued to improve during admission. Cr.
is now stable at 1.2 at discharge.
.
# Hypertension: Pt was initially on Lisinopril 40mg on
admission, however, we continued Diltiazem, also for rate
control.  Patients primary care doctor may decide to restart
lisinopril after discharge.
.
#Urinary Retention/Incontinence - developed prior to D/C of
foley.  Prior to admission she had no problems with
incontinence.  At time of discharge urinary retention resolved
however continued to have episodes of incontinence.  Retention
ruled out by bladder scan and no evidence of UTI on urinalysis.
Possible secondary to limited mobility.  Would expect to improve
as her functional status continues to improve.
.
#Access - PICC line was placed during admission as she had
limited access.  Will be removed prior to discharge.
.
# Communication: With son, [**Name (NI) **] [**Telephone/Fax (1) 39904**] (cell),
[**Telephone/Fax (1) 39905**] (home), or his wife [**Name (NI) **] [**Telephone/Fax (1) 39906**].  Of note,
the patient is BLIND and speaks RUSSIAN.
.
# Code status - Full code confirmed with patient and son
.
Pt has reached maximal hospital benefit and is ready for
discharge to a rehabilitation facility.

Medications on Admission:
Lisinopril 40 daily
Diltiazem 300 daily
Aspirin 81 daily
Temazepam 30 qhs


Discharge Medications:
1. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
Disp:*30 Patch 24 hr(s)* Refills:*2*
2. Enoxaparin 30 mg/0.3 mL Syringe Sig: One (1)  Subcutaneous
Q24H (every 24 hours).
Disp:*14 14* Refills:*0*
3. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical Q 24 ().
Disp:*30 Adhesive Patch, Medicated(s)* Refills:*2*
4. Diltiazem HCl 30 mg Tablet Sig: Two (2) Tablet PO QID (4
times a day).
Disp:*240 Tablet(s)* Refills:*2*
5. Trazodone 50 mg Tablet Sig: 0.5 Tablet PO Q8H (every 8 hours)
as needed for Insomia.
Disp:*30 Tablet(s)* Refills:*0*
6. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day).
Disp:*90 Tablet, Chewable(s)* Refills:*2*
7. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
8. Timolol Maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **]
(2 times a day).
9. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2558**] - [**Location (un) **]

Discharge Diagnosis:
Primary Diagnoses:
Right hip fracture
Post operative anemia
Atrial Fibrillation
Pneumonia
.
Secondary Diagnoses:
Chronic Renal Insufficiency
Hypertension


Discharge Condition:
Stable


Discharge Instructions:
You were admitted after your right hip fracture. You also
developed pneumonia and a fast heart rate (atrial fibrillation)
while in hospital.
.
We have made some changes to your medications. Diltiazem has
been added to your medication regimen.  In addition we stopped
the lisinopril that you have been taking for your blood
pressure.  Your primary care doctor may want to restart this
medicine after you leave the hospital.  Please discuss these
changes with your physician. [**Name10 (NameIs) **] all other medications as
directed.
.
You are being discharged
.
If you notice any increased redness, drainage, swelling, or if
you have a temperature greater than 101 please call the office
or come to the emergency department.
.
Please follow up on all your appointments. If unable, please
call and cancel or reschedule.

Followup Instructions:
1. You have an appointment with Dr. [**Last Name (STitle) **] (orthopedic
surgeon) on [**2119-10-19**].  Please arrive at 10:50 for xrays, you are
scheduled to the the doctor at 11:10.  If you need directions or
to reschedule the phone number is [**Telephone/Fax (1) 1228**].
2.  You should follow up with your primary care doctor 2 weeks
after discharge from rehab.
{'Closed fracture of intertrochanteric section of neck of femur,Acute posthemorrhagic anemia,Atrial fibrillation,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Chronic airway obstruction, not elsewhere classified,Pneumonitis due to inhalation of food or vomitus,Acidosis,Malnutrition of moderate degree,Other specified retention of urine,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Delirium due to conditions classified elsewhere,Pure hypercholesterolemia,Legal blindness, as defined in U.S.A.,Osteoporosis, unspecified,Unspecified glaucoma,Fall from other slipping, tripping, or stumbling'}


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: Right hip pain

PRESENT ILLNESS: Ms. [**Known lastname 39903**] is a [**Age over 90 **] year old female who presented to the [**Hospital1 18**]
after a mechanical fall at home.  She was walking to the
bathroom when she tripped over the rug.  She now presents for
further evaluation.

MEDICAL HISTORY: Blindness
HTN
Hypercholesterolemia
Significant smoking history (~180PYs)

MEDICATION ON ADMISSION: Lisinopril 40 daily
Diltiazem 300 daily
Aspirin 81 daily
Temazepam 30 qhs

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon admission

FAMILY HISTORY: n/a

SOCIAL HISTORY: Lives with son 

### Response:
{'Closed fracture of intertrochanteric section of neck of femur,Acute posthemorrhagic anemia,Atrial fibrillation,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Chronic airway obstruction, not elsewhere classified,Pneumonitis due to inhalation of food or vomitus,Acidosis,Malnutrition of moderate degree,Other specified retention of urine,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Delirium due to conditions classified elsewhere,Pure hypercholesterolemia,Legal blindness, as defined in U.S.A.,Osteoporosis, unspecified,Unspecified glaucoma,Fall from other slipping, tripping, or stumbling'}
