CHIEF COMPLAINT: Right knee pain, osteoarthritis

PRESENT ILLNESS: Mr [**Known lastname 57215**] is a 77 year old male who has experienced pain in
his right knee from osteoarthritis for quite some time.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon discharge:
AVSS
NAD
A+O
Right knee: incision c/d/i, some swelling, min erythema
+[**Last Name (un) 938**]/FHL/AT/G/S
+SILT
+DP

FAMILY HISTORY: NC

SOCIAL HISTORY: NC
Osteoarthrosis, localized, not specified whether primary or secondary, lower leg,Disruption of external operation (surgical) wound,Open wound of knee, leg [except thigh], and ankle, with tendon involvement,Asthma, unspecified type, unspecified,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Accidents occurring in residential institution,Other specified cardiac dysrhythmias,Unspecified fall
Loc osteoarth NOS-l/leg,Disrup-external op wound,Opn wnd knee/leg w tendn,Asthma NOS,Abn react-artif implant,Accid in resident instit,Cardiac dysrhythmias NEC,Fall NOS
Admission Date:  [**2166-4-2**]              Discharge Date:   [**2166-4-8**]

Date of Birth:  [**2089-1-14**]             Sex:   M

Service: ORTHOPAEDICS

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 64**]
Chief Complaint:
Right knee pain, osteoarthritis

Major Surgical or Invasive Procedure:
Right total knee replacement - [**2166-4-2**]
Irrigation and Debridment with revision wound closure - [**2166-4-3**]


History of Present Illness:
Mr [**Known lastname 57215**] is a 77 year old male who has experienced pain in
his right knee from osteoarthritis for quite some time.

Social History:
NC

Family History:
NC

Physical Exam:
Upon discharge:
AVSS
NAD
A+O
Right knee: incision c/d/i, some swelling, min erythema
+[**Last Name (un) 938**]/FHL/AT/G/S
+SILT
+DP

Pertinent Results:
[**2166-4-7**] 07:20AM BLOOD Hct-23.8*
[**2166-4-6**] 08:05AM BLOOD WBC-6.1 RBC-2.58* Hgb-7.8* Hct-23.4*
MCV-91 MCH-30.4 MCHC-33.5 RDW-13.9 Plt Ct-238
[**2166-4-5**] 06:55PM BLOOD Hct-21.6*
[**2166-4-5**] 06:45AM BLOOD WBC-6.4 RBC-2.61* Hgb-8.0* Hct-23.8*
MCV-91 MCH-30.7 MCHC-33.8 RDW-13.9 Plt Ct-188
[**2166-4-4**] 04:35AM BLOOD Hct-24.8*
[**2166-4-3**] 07:31PM BLOOD WBC-8.2 RBC-3.00*# Hgb-9.2*# Hct-27.0*
MCV-90 MCH-30.7 MCHC-34.2 RDW-13.2 Plt Ct-191
[**2166-4-3**] 04:20PM BLOOD Hct-26.9*
[**2166-4-3**] 07:30AM BLOOD Hct-31.0*
[**2166-4-5**] 06:45AM BLOOD Glucose-96 UreaN-12 Creat-0.9 K-3.9
Cl-102 HCO3-29
[**2166-4-3**] 07:31PM BLOOD Glucose-98 UreaN-25* Creat-1.2 K-4.1
Cl-99 HCO3-26
[**2166-4-4**] 04:35AM BLOOD Calcium-8.0* Mg-2.1

Brief Hospital Course:
The patient was brought to the operating room on [**2166-4-2**] for a
right total knee replacement. The patient tolerated the
procedure well. Please see the separately dictated operative
note by Dr. [**Last Name (STitle) **] for details of the surgical procedure.  He was
extubated and brought to the recovery room in stable condition.
Once stable in the PACU, he was transferred to the floor. On
POD#1 he was seen by physical therapy and initiated his rehab
care. His labs and vitals were within normal limits.  In the
afternoon of POD #1, Mr. [**Known lastname 57215**] was sitting up in a chair
when he leaned over in the chair to try to reach something, he
fell from the chair onto his right knee.  The patient's surgical
dressing was noted to become stained with serosanguinous fluid.
Dr. [**Last Name (STitle) **] remove the dressing and found the wound to be dehisced
at the distal aspect.  Mr. [**Known lastname 57215**] was taken urgently back to
the operating room for an irrigation and debridement of the
wound and revision closure.  He was given one unit of blood
intra-operatively.  He tolerated this procedure well and again
was successfully extubated in the OR.  On arrival in the PACU,
patient was noted to be having multiple PVCs.  He received
Lidocaine and labs were sent.  Patient was transferred to the
ICU overnight for close observation.  He had no further issues,
remained hemodynamically stable overnight and had only a few
PVCs over the course of the night.  On POD #1 his hemovac drain
was removed.  His diet was advanced.  He was transferred to the
floor for continued post-operative management.  He progressed
well with physical therapy.  His hematocrit was low at 21.6.
The patient did not wished to be transfused.  His hematocrit
trended up to 23.4 and remained stable.  He continued to
progress well with physical therapy.  All lab results and vital
signs remained stable.  He is being discharged today to rehab in
stable condition.


Discharge Medications:
1. Fexofenadine 60 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4
to 6 hours) as needed.
3. Acetaminophen 500 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed for fever or pain: Do not exceed 4,000 mg in
a 24-hour period.
4. Zafirlukast 20 mg Tablet Sig: One (1) Tablet PO qd ().
5. Guaifenesin 100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H (every 6
hours) as needed.
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
8. Fluoxetine 20 mg Capsule Sig: Two (2) Capsule PO DAILY
(Daily).
9. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed.
10. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day) as needed.
11. Enoxaparin 30 mg/0.3 mL Syringe Sig: One (1) 30mg/0.3mL
Syringe Subcutaneous Q12H (every 12 hours) for 14 days.
12. Beclomethasone Diprop Monohyd 0.042 % Aerosol, Spray Sig:
Two (2) Spray Nasal [**Hospital1 **] (2 times a day) as needed.
13. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID W/MEALS (3 TIMES A DAY WITH MEALS).
14. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).


Discharge Disposition:
Extended Care

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

Discharge Diagnosis:
Right knee osteoarthritis


Discharge Condition:
Good


Discharge Instructions:
Activity: Weight bearing as tolerated, use walker to assist you
as needed with ambulation.  Continue the CPM to improve range of
motion of your knee.
Diet: As tolerated.
Wound care: Please keep incision clean and dry.  Apply a dry
sterile dressing to the wound each day while it is draining.
Once draning has stopped, you can leave the wound open to the
air.  You may begin showering normally once discharged from the
hospital (as long as there is no drainage) - pat the incision
dry with a towel, do not rub the incision.  Do not take a bath,
swim or otherwise submerge your incision in water.  Monitor the
wound daily for signs of infection - contact Dr. [**Last Name (STitle) **] or go to
the emergency room if you have redness around the incision that
is warm to the touch, pus-like drainage from the wounds,
fever/chills, temp>101, or any other symptoms that concern you.
Pain medication: You have been given a prescription for
Oxycodone for pain.  Do not drive, drink alcohol or operate
machinery while taking this medication.  Wean off this pain
medication as soon as your pain allows.  Continue to take
Tylenol as well to reduce pain.  Narcotic pain medication can
cause constipation, so take a stool softener such as Colace and
drink plenty of clear fluids while taking Oxycodone to reduce
your risk of constipation.
Home medications: Resume your pre-operative medications as
directed by the prescribing Physician(s).
Prevention of DVTs: Continue the Lovenox injections twice a day
for two weeks.  After completing the course of Lovenox, begin
taking one Aspirin (325mg) twice a day for four weeks.
Follow-up: Follow-up with Dr. [**Last Name (STitle) **] as scheduled.  If you have
any questions or concerns prior to your appointment, please give
Dr. [**Last Name (STitle) 67**] office a call.

Physical Therapy:
WBAT
CPM as tolerated.
Treatments Frequency:
Wound care: Please keep incision clean and dry.  Apply a dry
sterile dressing to the wound each day while it is draining.
Once draning has stopped, you can leave the wound open to the
air.  You may begin showering normally once discharged from the
hospital (as long as there is no drainage) - pat the incision
dry with a towel, do not rub the incision.  Do not take a bath,
swim or otherwise submerge your incision in water.

Dr. [**Last Name (STitle) **] will remove the staples in clinic during follow-up
appointment.

Followup Instructions:
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] Phone:[**Telephone/Fax (1) 10657**] Date/Time:[**2166-4-14**]
11:00



Completed by:[**2166-4-8**]
{'Osteoarthrosis, localized, not specified whether primary or secondary, lower leg,Disruption of external operation (surgical) wound,Open wound of knee, leg [except thigh], and ankle, with tendon involvement,Asthma, unspecified type, unspecified,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Accidents occurring in residential institution,Other specified cardiac dysrhythmias,Unspecified fall'}


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 knee pain, osteoarthritis

PRESENT ILLNESS: Mr [**Known lastname 57215**] is a 77 year old male who has experienced pain in
his right knee from osteoarthritis for quite some time.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon discharge:
AVSS
NAD
A+O
Right knee: incision c/d/i, some swelling, min erythema
+[**Last Name (un) 938**]/FHL/AT/G/S
+SILT
+DP

FAMILY HISTORY: NC

SOCIAL HISTORY: NC 

### Response:
{'Osteoarthrosis, localized, not specified whether primary or secondary, lower leg,Disruption of external operation (surgical) wound,Open wound of knee, leg [except thigh], and ankle, with tendon involvement,Asthma, unspecified type, unspecified,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Accidents occurring in residential institution,Other specified cardiac dysrhythmias,Unspecified fall'}
