CHIEF COMPLAINT: s/p fall L periprosthetic femur fracture

PRESENT ILLNESS: Ms. [**Known lastname 12130**] is a 74 year old female who had a left hip
replacement on [**10-3**] who fell x2 at rehab. Both falls were
unprovoked. The first was on [**2103-11-1**] and the second was on
[**2103-11-4**]. She reports that both times was walking with her walker
 and fell backwards.  She presentes to the [**Hospital1 18**] for further
evaluation and care.

MEDICAL HISTORY: - COPD, 30pack years
- Hypothyroidism not currently on treatment
- DM; diet controlled
- Hiatal hernia
- GERD on PPI
- Chronic LBP
- s/p L hip replacement [**10-3**]
- Restless leg syndrome
- Depression

MEDICATION ON ADMISSION: - Albuterol 1-2puffs INH Q6H PRN
- Tioptropium 18mcg INH daily
- Fluticasone-Salmeterol 250-50mcg [**Hospital1 **]
- Lovenox 40mg daily
- Bupropion SR 300mg daily
- Citalopram 20mg daily
- Spironolactone 12.5mg daily
- Citalopram 20mg daily
- Nicotine 14mg daily
- CaCO3 500mg [**Hospital1 **]
- Vitamin D 400mg [**Hospital1 **]
- Thiamine 100mg daily
- Folic acid 1mg daily
- ASA 81mg daily
- Pramipexole 1mg qPM
- Modafinil 100mg qAM
- Pantoprazole 40mg daily
- Acetaminophen 1000mg TID
- Oxycodone 5mg QHS
- Gabapentin 800mg QHS

ALLERGIES: Cephalexin / Bacitracin / Cephalosporins / Naproxen / Nsaids /
Adhesive Tape

PHYSICAL EXAM: AVSS
Gen- NAD
Heart- RRR
lungs- CTAB
abd- S/NTND +BS
ext: incision C/D/I, 2+ peripheral pulses, no C/C/E

FAMILY HISTORY: Father died of lung cancer in his 50's and mother died in 80's.

SOCIAL HISTORY: Smoker 30 pack years, h/o EtOH abuse but last drink in [**8-3**].
Lives alone, has 4 daughters who are local.
Closed fracture of trochanteric section of neck of femur,Peri-prosthetic fracture around prosthetic joint,Acute posthemorrhagic anemia,Acquired coagulation factor deficiency,Restless legs syndrome (RLS),Alcoholic cirrhosis of liver,Fall from other slipping, tripping, or stumbling,Chronic airway obstruction, not elsewhere classified,History of fall,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Unspecified acquired hypothyroidism,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Depressive disorder, not elsewhere classified,Diaphragmatic hernia without mention of obstruction or gangrene,Other and unspecified hyperlipidemia,Tobacco use disorder,Hip joint replacement,Personal history of alcoholism,Acute pain due to trauma,Other specified disorders of female genital organs,Constipation, unspecified
Trochanteric fx NOS-clos,Periprosthetc fx-pros jt,Ac posthemorrhag anemia,Acq coagul factor defic,Restless legs syndrome,Alcohol cirrhosis liver,Fall from slipping NEC,Chr airway obstruct NEC,Personal history of fall,Abn react-artif implant,Hypothyroidism NOS,Esophageal reflux,DMII wo cmp nt st uncntr,Depressive disorder NEC,Diaphragmatic hernia,Hyperlipidemia NEC/NOS,Tobacco use disorder,Joint replaced hip,Hx of alcoholism,Acute pain due to trauma,Female genital disor NEC,Constipation NOS
Admission Date:  [**2103-11-16**]              Discharge Date:   [**2103-12-4**]

Date of Birth:  [**2029-4-10**]             Sex:   F

Service: ORTHOPAEDICS

Allergies:
Cephalexin / Bacitracin / Cephalosporins / Naproxen / Nsaids /
Adhesive Tape

Attending:[**First Name3 (LF) 11415**]
Chief Complaint:
s/p fall L periprosthetic femur fracture

Major Surgical or Invasive Procedure:
[**2103-11-17**]:  ORIF Left periprosthetic femur fracture
[**2103-11-26**]:  EUV Left hip
[**2103-11-29**]:  Revision long stem femoral component/plate and
cerclage wires


History of Present Illness:
Ms. [**Known lastname 12130**] is a 74 year old female who had a left hip
replacement on [**10-3**] who fell x2 at rehab. Both falls were
unprovoked. The first was on [**2103-11-1**] and the second was on
[**2103-11-4**]. She reports that both times was walking with her walker
 and fell backwards.  She presentes to the [**Hospital1 18**] for further
evaluation and care.

Past Medical History:
- COPD, 30pack years
- Hypothyroidism not currently on treatment
- DM; diet controlled
- Hiatal hernia
- GERD on PPI
- Chronic LBP
- s/p L hip replacement [**10-3**]
- Restless leg syndrome
- Depression

Social History:
Smoker 30 pack years, h/o EtOH abuse but last drink in [**8-3**].
Lives alone, has 4 daughters who are local.


Family History:
Father died of lung cancer in his 50's and mother died in 80's.

Physical Exam:
AVSS
Gen- NAD
Heart- RRR
lungs- CTAB
abd- S/NTND +BS
ext: incision C/D/I, 2+ peripheral pulses, no C/C/E


Pertinent Results:
[**2103-11-16**] 11:00PM   HGB-9.2* HCT-27.6*
[**2103-11-16**] 07:25PM   HGB-8.5* HCT-25.3*
[**2103-11-16**] 04:45PM   GLUCOSE-102 UREA N-25* CREAT-1.2* SODIUM-134
POTASSIUM-5.0 CHLORIDE-102 TOTAL CO2-24 ANION GAP-13
[**2103-11-16**] 04:45PM   estGFR-Using this
[**2103-11-16**] 04:45PM   CK(CPK)-59
[**2103-11-16**] 04:45PM   cTropnT-<0.01
[**2103-11-16**] 04:45PM   CK-MB-NotDone
[**2103-11-16**] 04:45PM URINE  HOURS-RANDOM
[**2103-11-16**] 04:45PM URINE  GR HOLD-HOLD
[**2103-11-16**] 04:45PM   WBC-7.0 RBC-3.05* HGB-9.3* HCT-27.7* MCV-91
MCH-30.4 MCHC-33.4 RDW-14.8
[**2103-11-16**] 04:45PM   NEUTS-73.7* LYMPHS-19.4 MONOS-5.3 EOS-1.0
BASOS-0.4
[**2103-11-16**] 04:45PM   PLT COUNT-347
[**2103-11-16**] 04:45PM   PT-13.0 PTT-35.1* INR(PT)-1.1
[**2103-11-16**] 04:45PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.009
[**2103-11-16**] 04:45PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-SM
[**2103-11-16**] 04:45PM URINE  RBC-0-2 WBC-[**6-5**]* BACTERIA-FEW
YEAST-NONE EPI-[**2-28**]

Brief Hospital Course:
Ms. [**Known lastname 12130**] presented to the [**Hospital1 18**] on [**2103-11-16**] after a fall.
She was evaluated by the orthopaedic surgery and medical
services.  He was found to have a left periprosthetic femur
fracture.  She was also noted to have acute blood loss anemia
and was transferred with 2 units of packed red blood cells.  She
was taken to the operating room  on [**2103-11-17**] and underwent an
ORIF of her left periprosthetic femur fracture.  On [**2103-11-17**],
[**2103-11-18**], and [**2103-11-19**] she was again transfused with 1 unit of
packed red blood cells each day for acute blood loss anemia.  On
[**2103-11-26**] she returned to the operating room and underwent an
evaluation under anesthesia of her left hip.  It was found that
her femoral component was loose.  On [**2103-11-29**] she underwent an
revision of her femoral component to a long stem.  She tolerated
the procedure well and was transferred to the T/SICU for further
monitoring post operatively.  She was transfused with 2units of
packed red blood cells on [**2103-11-29**] and [**2103-11-30**] due to acute blood
loss anemia.  On [**2103-11-30**] she was noted to have staph coag
positive cultures growing from her operative cultures.  She was
started on IV Vancomycin and Infectious disease was consulted.
On [**2103-12-1**] she was transferred to the floor from the T/SICU.
Also on [**2103-12-1**] she had a PICC line placed for long term
antibiotics.  On [**2103-12-2**] she was transfused with 1 unit of
packed red blood cells due to acute blood loss anemia.  Her
vancomycin dose was held as her trough was over 30.  Per
infectious disease her dose was decreased to 1gram Q24hrs to
start once trough is less than 20.  Goal trough is 15-20.

Throughout her stay she was seen by physical and occupational
therapy to improve her strength and mobility.  The rest of her
hospital stay was uneventful with her lab data and vital signs
within normal limits and his pain controlled.  She is being
discharged today in stable condition.

**Vancomycin trough needs to be less than 20 prior to restarting
vancomycin at 1gram Q24hrs.

Medications on Admission:
- Albuterol 1-2puffs INH Q6H PRN
- Tioptropium 18mcg INH daily
- Fluticasone-Salmeterol 250-50mcg [**Hospital1 **]
- Lovenox 40mg daily
- Bupropion SR 300mg daily
- Citalopram 20mg daily
- Spironolactone 12.5mg daily
- Citalopram 20mg daily
- Nicotine 14mg daily
- CaCO3 500mg [**Hospital1 **]
- Vitamin D 400mg [**Hospital1 **]
- Thiamine 100mg daily
- Folic acid 1mg daily
- ASA 81mg daily
- Pramipexole 1mg qPM
- Modafinil 100mg qAM
- Pantoprazole 40mg daily
- Acetaminophen 1000mg TID
- Oxycodone 5mg QHS
- Gabapentin 800mg QHS

Discharge Medications:
1. Outpatient Lab Work
Will need weekly CBC w/diff, chem 10, LFTs and vanc trough faxed
to Dr.[**Name (NI) 80141**] office  [**Telephone/Fax (1) 432**]
f/u Dr. [**First Name (STitle) **] 4 weeks
2. Vancomycin in Dextrose 1 gram/200 mL Piggyback Sig: One (1)
1000mg Intravenous Q 24H (Every 24 Hours) for 4 weeks: Please
start once vanco trough is less than 20.  Goal is 15-20
To be managed by Infectious Disease.
3. Albuterol 90 mcg/Actuation Aerosol Sig: 2-4 Puffs Inhalation
Q4H (every 4 hours) as needed.
4. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
5. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
6. Gabapentin 400 mg Capsule Sig: Two (2) Capsule PO HS (at
bedtime).
Disp:*60 Capsule(s)* Refills:*2*
7. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day).
8. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
9. Insulin Lispro 100 unit/mL Solution Sig: SSI per sliding
scale Subcutaneous ASDIR (AS DIRECTED).
10. Citalopram 20 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).
11. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
12. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
Disp:*60 Capsule(s)* Refills:*2*
13. Pramipexole 1 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
14. Cyclobenzaprine 10 mg Tablet Sig: 0.5 Tablet PO TID (3 times
a day).
15. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO Q 8H
(Every 8 Hours).
16. Bupropion 75 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
17. Enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) 0.4ml syringe
Subcutaneous DAILY (Daily).
Disp:*30 0.4ml syringe* Refills:*2*
18. Oxycodone 10 mg Tablet Sustained Release 12 hr Sig: One (1)
Tablet Sustained Release 12 hr PO Q12H (every 12 hours).
Disp:*60 Tablet Sustained Release 12 hr(s)* Refills:*2*
19. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed.
Disp:*100 Tablet(s)* Refills:*0*
20. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1107**] [**Hospital **] Hospital - [**Location (un) 38**]

Discharge Diagnosis:
Left periprosthetic fracture
Acute blood loss anemia


Discharge Condition:
Stable


Discharge Instructions:
Continue to be touchdown weight bearing on your left leg with
global hip precautions, abduction brace when out of bed, and
abduction pillow when in bed

Continue to take your lovenox injections as instructed

If you have any increased redness, drainage, or swelling, or if
you have a temperature greater than 101.5, please call the
office or come to the emergency department.

Physical Therapy:
Activity:  As tolerated
 Left lower extremity:  Touchdown weight bearing
 Abduction pillow when in bed
 Abduction brace when out of bed
 Global Hip precautions

Treatments Frequency:
Staples/sutures out 14 days after surgery

Dry sterile dressing daily or as needed for drainage or comfort

Followup Instructions:
Please follow up with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], NP in orthopaedics in 2
weeks, please call [**Telephone/Fax (1) 1228**] to schedule that appointment.

Please follow up with Dr. [**First Name (STitle) **] in Infectious Disease on
[**2104-1-11**] at 11:00, please call [**Telephone/Fax (1) 432**] with any questions.

will need weekly vanc trough, hold 1 dose if trough >20

[**Name6 (MD) **] [**Last Name (NamePattern4) 13171**], MD Phone:[**Telephone/Fax (1) 719**] Date/Time:[**2103-12-13**]
8:30


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2235**] MD, [**MD Number(3) 11417**]

Completed by:[**2103-12-4**]
{'Closed fracture of trochanteric section of neck of femur,Peri-prosthetic fracture around prosthetic joint,Acute posthemorrhagic anemia,Acquired coagulation factor deficiency,Restless legs syndrome (RLS),Alcoholic cirrhosis of liver,Fall from other slipping, tripping, or stumbling,Chronic airway obstruction, not elsewhere classified,History of fall,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Unspecified acquired hypothyroidism,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Depressive disorder, not elsewhere classified,Diaphragmatic hernia without mention of obstruction or gangrene,Other and unspecified hyperlipidemia,Tobacco use disorder,Hip joint replacement,Personal history of alcoholism,Acute pain due to trauma,Other specified disorders of female genital organs,Constipation, unspecified'}


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: s/p fall L periprosthetic femur fracture

PRESENT ILLNESS: Ms. [**Known lastname 12130**] is a 74 year old female who had a left hip
replacement on [**10-3**] who fell x2 at rehab. Both falls were
unprovoked. The first was on [**2103-11-1**] and the second was on
[**2103-11-4**]. She reports that both times was walking with her walker
 and fell backwards.  She presentes to the [**Hospital1 18**] for further
evaluation and care.

MEDICAL HISTORY: - COPD, 30pack years
- Hypothyroidism not currently on treatment
- DM; diet controlled
- Hiatal hernia
- GERD on PPI
- Chronic LBP
- s/p L hip replacement [**10-3**]
- Restless leg syndrome
- Depression

MEDICATION ON ADMISSION: - Albuterol 1-2puffs INH Q6H PRN
- Tioptropium 18mcg INH daily
- Fluticasone-Salmeterol 250-50mcg [**Hospital1 **]
- Lovenox 40mg daily
- Bupropion SR 300mg daily
- Citalopram 20mg daily
- Spironolactone 12.5mg daily
- Citalopram 20mg daily
- Nicotine 14mg daily
- CaCO3 500mg [**Hospital1 **]
- Vitamin D 400mg [**Hospital1 **]
- Thiamine 100mg daily
- Folic acid 1mg daily
- ASA 81mg daily
- Pramipexole 1mg qPM
- Modafinil 100mg qAM
- Pantoprazole 40mg daily
- Acetaminophen 1000mg TID
- Oxycodone 5mg QHS
- Gabapentin 800mg QHS

ALLERGIES: Cephalexin / Bacitracin / Cephalosporins / Naproxen / Nsaids /
Adhesive Tape

PHYSICAL EXAM: AVSS
Gen- NAD
Heart- RRR
lungs- CTAB
abd- S/NTND +BS
ext: incision C/D/I, 2+ peripheral pulses, no C/C/E

FAMILY HISTORY: Father died of lung cancer in his 50's and mother died in 80's.

SOCIAL HISTORY: Smoker 30 pack years, h/o EtOH abuse but last drink in [**8-3**].
Lives alone, has 4 daughters who are local. 

### Response:
{'Closed fracture of trochanteric section of neck of femur,Peri-prosthetic fracture around prosthetic joint,Acute posthemorrhagic anemia,Acquired coagulation factor deficiency,Restless legs syndrome (RLS),Alcoholic cirrhosis of liver,Fall from other slipping, tripping, or stumbling,Chronic airway obstruction, not elsewhere classified,History of fall,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Unspecified acquired hypothyroidism,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Depressive disorder, not elsewhere classified,Diaphragmatic hernia without mention of obstruction or gangrene,Other and unspecified hyperlipidemia,Tobacco use disorder,Hip joint replacement,Personal history of alcoholism,Acute pain due to trauma,Other specified disorders of female genital organs,Constipation, unspecified'}
