CHIEF COMPLAINT: failure to thrive

PRESENT ILLNESS: This 85M was recently admitted for cholangitis, and is now s/p
percutaneous cholecystostomy tube, s/p [**Month/Day/Year **]/stent, s/p trach.
His hospital course was complicated by MRSA PNA and E.coli
bacteremia, diarrhea (presumed to be C.diff, for which he was
discharged on Flagyl), and acute gout flair.  He was discharged
to rehab on [**2125-6-22**].  He self d/c'd his Dobhoff and was
transferred back to [**Hospital1 18**] for PEG placement as well as
persistent fevers to 102.

MEDICAL HISTORY: 1. CAD, cath 5 years ago at NEBH (cardiologist [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **])
2. CHF, TTE [**3-5**] w/depressed EF
3. Hypertension, per daughter pt's bp usually 90s-100s on meds
4. Severe lumbar spinal stenosis, mild cervical stenosis
5. Sleep apnea, on 2L home O2 at night
6. Afib, s/p failed DCCV, now rate controlled
7. Arthritis
8. Gout
9. COPD
10. NIDDM
11. E-coli sepsis (admission [**2122-12-23**] - [**2123-1-1**])
12. BPH
13. Parkinson's disease
14. Cholangitis s/p percutaneous cholecystostomy tube &
[**Month/Day/Year **]/stent ([**2125-5-16**])
15. s/p tracheostomy ([**2125-5-28**])
16. diverticulosis, h/o diverticulitis & ulcers
17. s/p I&D R elbow
18. s/p excision of facial skin ca

MEDICATION ON ADMISSION: Discharge Medications ([**2125-6-22**]):
1. Metronidazole 500 mg Tablet [**Month/Day/Year **]: One (1) Tablet PO TID (3
times a day) for 7 days. Disp:*21 Tablet(s)* Refills:*0*
2. Colchicine 0.6 mg Tablet [**Month/Day/Year **]: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Coumadin 3 mg Tablet [**Month/Day/Year **]: One (1) Tablet PO once a day: goal
INR [**3-4**]
Dose daily. Disp:*30 Tablet(s)* Refills:*2*
4. Carbidopa-Levodopa 25-100 mg Tablet [**Month/Day (3) **]: One (1) Tablet PO
TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2*
5. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) [**Month/Day (3) **]: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation. Disp:*30 Tablet, Delayed Release (E.C.)(s)*
Refills:*0*
6. Docusate Sodium 50 mg/5 mL Liquid [**Month/Day (3) **]: Ten (10) ml PO BID (2
times a day).
Disp:*600 ml* Refills:*2*
7. Bacitracin Zinc 500 unit/g Ointment [**Month/Day (3) **]: One (1) Appl Topical
[**Hospital1 **] (2 times a day). Disp:*1 tube* Refills:*2*
8. Senna 8.6 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2 times a
day) as needed for constipation. Disp:*30 Tablet(s)* Refills:*0*
9. Digoxin 125 mcg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2* 10. Trazodone 50 mg Tablet [**Hospital1 **]:
1.5 Tablets PO HS (at bedtime)
as needed. Disp:*60 Tablet(s)* Refills:*0*
11. Indomethacin 25 mg Capsule [**Hospital1 **]: Two (2) Capsule PO TID (3
times a day).
Disp:*180 Capsule(s)* Refills:*2*
12. Fentanyl 75 mcg/hr Patch 72 hr [**Hospital1 **]: One (1) Patch 72 hr
Transdermal Q72H (every 72 hours). Disp:*10 Patch 72 hr(s)*
Refills:*2*
13. Chlorhexidine Gluconate 0.12 % Mouthwash [**Hospital1 **]: Fifteen (15)
ML Mucous membrane [**Hospital1 **] (2 times a day): Use only if patient is
on mechanical ventilation.
Disp:*400 ML(s)* Refills:*0*
14. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). Disp:*30
Tablet,Rapid Dissolve, DR(s)* Refills:*2*
15. Latanoprost 0.005 % Drops [**Last Name (STitle) **]: One (1) Drop Ophthalmic HS
(at bedtime).
Disp:*20 ml* Refills:*2*
16. Ipratropium Bromide 17 mcg/Actuation Aerosol [**Last Name (STitle) **]: Two (2)
Puff Inhalation QID (4 times a day). Disp:*1 unit* Refills:*2*
17. Acetaminophen 160 mg/5 mL Solution [**Last Name (STitle) **]: Six [**Age over 90 1230**]y
(650) mg PO Q6H (every 6 hours). Disp:*500 ml* Refills:*2*
18. Levothyroxine Sodium 50 mcg IV DAILY
19. Albuterol 90 mcg/Actuation Aerosol [**Age over 90 **]: 1-2 Puffs Inhalation
Q6H (every 6 hours). Disp:*1 unit* Refills:*2*
20. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated [**Age over 90 **]:
One (1) Adhesive Patch, Medicated Topical Q24H (every 24 hours)
as needed for pain for 7 days.
Disp:*7 Adhesive Patch, Medicated(s)* Refills:*0*
21. Lorazepam 0.5 mg Tablet [**Age over 90 **]: 1-2 Tablets PO Q6H (every 6
hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*
22. Bupropion 75 mg Tablet [**Age over 90 **]: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
23. Erythromycin 5 mg/g Ointment [**Age over 90 **]: 0.5 in Ophthalmic QID (4
times a day).
Disp:*60 in* Refills:*2*
24. Metoprolol Tartrate 5 mg IV Q6H:PRN AFIB / RVR
25. Sodium Chloride 0.9%  Flush 10 mL IV PRN line flush
Temporary Central Access-ICU: Flush with 10mL Normal Saline
daily and PRN.
26. Furosemide 40 mg Tablet [**Age over 90 **]: Three (3) Tablet PO BID (2
times a day). Disp:*180 Tablet(s)* Refills:*2*
27. Enoxaparin 100 mg/mL Syringe [**Age over 90 **]: One Hundred (100) mg
Subcutaneous Q 12H (Every 12 Hours): until therapeutic on
coumadin (INR [**3-4**]) then may d/c lovenox.
Disp:*25 syringes* Refills:*2*

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission:
98.9 93 Afib 91/53 14 99% CMV
Gen: ventilated, NAD
HEENT: trach in position
[**Name (NI) **]: intubated, clear bilaterally
CVS: irregularly irregular, -MRG
Abd: soft/NT/ND, no masses, no rebound/guarding apparent
Ext: mild edema diffusely
.
On discharge:
96.5  79  114/76  22  98%RA
Gen: NAD
CVS: RRR
[**Name (NI) **]: CTA b/l
Abd: soft, NT, ND, +BS
Ext: no c/c/e

FAMILY HISTORY: Notable for CAD, HTN, and stroke.

SOCIAL HISTORY: Transferred from [**Hospital 100**] Rehab.  Formerly lived with daughter
[**Name (NI) 13118**].  Widowed.  No tobacco/EtOH.  Formerly worked at Sears.
Methicillin susceptible pneumonia due to Staphylococcus aureus,Bacteremia,Calculus of bile duct without mention of cholecystitis, with obstruction,Pressure ulcer, lower back,Chronic systolic heart failure,Disseminated candidiasis,Dehydration,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Spinal stenosis, lumbar region, without neurogenic claudication,Obstructive sleep apnea (adult)(pediatric),Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Paralysis agitans,Infection with microorganisms resistant to penicillins,Tracheostomy status
Meth sus pneum d/t Staph,Bacteremia,Choledochlith NOS w obst,Pressure ulcer, low back,Chr systolic hrt failure,Disseminated candidiasis,Dehydration,Crnry athrscl natve vssl,Hypertension NOS,Spin sten,lumbr wo claud,Obstructive sleep apnea,Atrial fibrillation,Chr airway obstruct NEC,DMII wo cmp nt st uncntr,Paralysis agitans,Inf mcrg rstn pncllins,Tracheostomy status
Admission Date:  [**2125-7-9**]              Discharge Date:   [**2125-7-18**]


Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1556**]
Chief Complaint:
failure to thrive

Major Surgical or Invasive Procedure:
[**2125-7-11**] percutaneous endoscopic gastrostomy tube
[**2125-7-17**] [**Month/Day/Year **], sphincterotomy, gallstone extraction, stent
removal


History of Present Illness:
This 85M was recently admitted for cholangitis, and is now s/p
percutaneous cholecystostomy tube, s/p [**Month/Day/Year **]/stent, s/p trach.
His hospital course was complicated by MRSA PNA and E.coli
bacteremia, diarrhea (presumed to be C.diff, for which he was
discharged on Flagyl), and acute gout flair.  He was discharged
to rehab on [**2125-6-22**].  He self d/c'd his Dobhoff and was
transferred back to [**Hospital1 18**] for PEG placement as well as
persistent fevers to 102.

Past Medical History:
1. CAD, cath 5 years ago at NEBH (cardiologist [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **])
2. CHF, TTE [**3-5**] w/depressed EF
3. Hypertension, per daughter pt's bp usually 90s-100s on meds
4. Severe lumbar spinal stenosis, mild cervical stenosis
5. Sleep apnea, on 2L home O2 at night
6. Afib, s/p failed DCCV, now rate controlled
7. Arthritis
8. Gout
9. COPD
10. NIDDM
11. E-coli sepsis (admission [**2122-12-23**] - [**2123-1-1**])
12. BPH
13. Parkinson's disease
14. Cholangitis s/p percutaneous cholecystostomy tube &
[**Month/Day/Year **]/stent ([**2125-5-16**])
15. s/p tracheostomy ([**2125-5-28**])
16. diverticulosis, h/o diverticulitis & ulcers
17. s/p I&D R elbow
18. s/p excision of facial skin ca


Social History:
Transferred from [**Hospital 100**] Rehab.  Formerly lived with daughter
[**Name (NI) 13118**].  Widowed.  No tobacco/EtOH.  Formerly worked at Sears.

Family History:
Notable for CAD, HTN, and stroke.

Physical Exam:
On admission:
98.9 93 Afib 91/53 14 99% CMV
Gen: ventilated, NAD
HEENT: trach in position
[**Name (NI) **]: intubated, clear bilaterally
CVS: irregularly irregular, -MRG
Abd: soft/NT/ND, no masses, no rebound/guarding apparent
Ext: mild edema diffusely
.
On discharge:
96.5  79  114/76  22  98%RA
Gen: NAD
CVS: RRR
[**Name (NI) **]: CTA b/l
Abd: soft, NT, ND, +BS
Ext: no c/c/e

Pertinent Results:
On admission:
[**2125-7-9**] 06:00PM BLOOD WBC-14.1*# RBC-2.68* Hgb-7.9* Hct-25.0*
MCV-93 MCH-29.5 MCHC-31.6 RDW-17.9* Plt Ct-472*
[**2125-7-9**] 06:00PM BLOOD PT-16.1* PTT-52.4* INR(PT)-1.4*
[**2125-7-9**] 06:00PM BLOOD Glucose-348* UreaN-73* Creat-1.4* Na-143
K-3.3 Cl-107 HCO3-26 AnGap-13
[**2125-7-9**] 06:00PM BLOOD ALT-7 AST-6 AlkPhos-58 TotBili-0.3
[**2125-7-9**] 06:00PM BLOOD Lipase-12
[**2125-7-9**] 06:00PM BLOOD Albumin-2.3* Calcium-8.2* Phos-4.1 Mg-1.6

[**2125-7-9**] 8:33 PM CT ABDOMEN W/CONTRAST; CT PELVIS W/CONTRAST:
FINDINGS: There are small bibasilar effusions and associated
atelectasis. No focal consolidation. Coronary artery
calcifications are seen within an enlarged heart. There is no
pericardial effusion.
ABDOMEN: Again seen is pneumobilia, with an indwelling biliary
stent in place, unchanged in position. A left hepatic lobe cyst
measuring 3.1 x 3.9 cm is unchanged. There is a small gallstone
within a decompressed gallbladder. There is no biliary
dilatation. The spleen, pancreas, and adrenal glands are normal
in appearance. The kidneys are somewhat atrophic; however, there
is symmetric excretion of contrast. Multiple cysts, right side
more so than left, some of which are slightly increased in
density and likely reflect hemorrhagic/proteinaceous cysts.
PELVIS: The bowel is decompressed, without dilated loop. There
are air- fluid levels within the colon; however, there is no
bowel wall thickening or surrounding stranding. Numerous
diverticula are seen within the sigmoid colon, without
inflammatory changes. A Foley catheter is present within a
decompressed bladder. Atherosclerotic calcifications are again
seen throughout. Extensive degenerative changes of the
thoracolumbar spine without acute findings.
IMPRESSION:
1. No abscess within the abdomen or pelvis, as clinically
questioned. No bowel wall thickening or abnormality, aside from
colonic fluid and diverticulosis.
2. Small bibasilar pleural effusions and adjacent atelectasis.

[**2125-7-10**] 02:00AM BLOOD Phenyto-0.6*
[**2125-7-10**] 02:00AM BLOOD Vanco-13.7
[**2125-7-10**] 02:00AM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.030
[**2125-7-10**] 02:00AM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-MOD

[**2125-7-10**] 02:00AM URINE RBC-0-2 WBC-[**7-10**]* Bacteri-RARE Yeast-MOD
Epi-0-2 TransE-0-2

[**2125-7-10**] 2:00 AM URINE CULTURE (Final [**2125-7-11**]):
      YEAST.    >100,000 ORGANISMS/ML..

[**2125-7-14**] 11:41 AM URINE CULTURE (Final [**2125-7-15**]):
      YEAST.    >100,000 ORGANISMS/ML..

[**2125-7-17**] [**Month/Day/Year **]:
-A plastic stent previusly placed in the biliary duct was found
in the major papilla and was removed using a snare.
-Cannulation of the biliary duct was performed with a
sphincterotome using a free-hand technique.
-Cholangiogram showed a CBD diamter of 11 mm with 2 mobile
filling defects consistent with stones.
-A sphincterotomy was performed in the 12 o'clock position using
a sphincterotome over an existing guidewire.
-2 stones were extracted successfully using a 11 mm balloon. The
duct was cleared with an occlusion cholangiogram.

On discharge:
[**2125-7-16**] 06:40AM BLOOD PT-14.0* PTT-46.5* INR(PT)-1.2*
[**2125-7-16**] 06:40AM BLOOD Glucose-137* UreaN-44* Creat-0.7 Na-138
K-5.1 Cl-106 HCO3-26 AnGap-11
[**2125-7-16**] 06:40AM BLOOD Calcium-7.9* Phos-2.9 Mg-2.4
[**2125-7-18**] 04:29AM BLOOD WBC-17.0* RBC-3.17* Hgb-9.4* Hct-30.4*
MCV-96 MCH-29.5 MCHC-30.8* RDW-19.6* Plt Ct-390
[**2125-7-18**] 04:29AM BLOOD ALT-5 AST-13 AlkPhos-82 Amylase-120*
TotBili-0.6
[**2125-7-18**] 04:29AM BLOOD Lipase-29


Brief Hospital Course:
Patient was admitted to TSICU.  WBC was 14.  He was started on
vancomycin for his h/o MRSA PNA.  CT abdomen/pelvis failed to
demonstrate abscess or bowel wall thickening/abnormalities.  His
biliary system was unchanged in appearance.  Blood cultures were
drawn and were negative.  Urine culture grew yeast.  He was
hydrated and his WBC decreased to WNL.  Vancomycin was d/c'd on
HD 3.  PEG was placed at bedside on HD 3.  Tube feeds were
started on HD 4.  On HD 5, he was decannulated.  Rheumatology
was consulted for gout management and recommended Solumedrol
followed by a prednisone taper, colchicine, allopurinol, and
outpatient followup.  His WBC increased; he was started on
fluconazole for the yeast in his urine on HD 6.  It was stable x
3 days at ~17 on discharge.  On HD 7, he was transferred to the
floor.  On HD 8, Speech & Swallow cleared him for pureed solids
and nectar thickened liquids.  On HD 9, he underwent [**Month/Day/Year **] for
stent removal with extraction of 2 gallstones and
sphincterotomy.  The following morning, he was restarted on
clears and tube feeds and advanced as tolerated.  His LFTs were
WNL.  He was afebrile with stable vital signs, tolerating tube
feeds and diet, and his pain was well controlled on PO
medication.  He is being discharged to [**Hospital1 **] and will follow
up with Dr. [**First Name (STitle) **] (Rheumatology) and Dr. [**Last Name (STitle) **].

Medications on Admission:
Discharge Medications ([**2125-6-22**]):
1. Metronidazole 500 mg Tablet [**Month/Day/Year **]: One (1) Tablet PO TID (3
times a day) for 7 days. Disp:*21 Tablet(s)* Refills:*0*
2. Colchicine 0.6 mg Tablet [**Month/Day/Year **]: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Coumadin 3 mg Tablet [**Month/Day/Year **]: One (1) Tablet PO once a day: goal
INR [**3-4**]
Dose daily. Disp:*30 Tablet(s)* Refills:*2*
4. Carbidopa-Levodopa 25-100 mg Tablet [**Month/Day (3) **]: One (1) Tablet PO
TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2*
5. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) [**Month/Day (3) **]: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation. Disp:*30 Tablet, Delayed Release (E.C.)(s)*
Refills:*0*
6. Docusate Sodium 50 mg/5 mL Liquid [**Month/Day (3) **]: Ten (10) ml PO BID (2
times a day).
Disp:*600 ml* Refills:*2*
7. Bacitracin Zinc 500 unit/g Ointment [**Month/Day (3) **]: One (1) Appl Topical
[**Hospital1 **] (2 times a day). Disp:*1 tube* Refills:*2*
8. Senna 8.6 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2 times a
day) as needed for constipation. Disp:*30 Tablet(s)* Refills:*0*
9. Digoxin 125 mcg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2* 10. Trazodone 50 mg Tablet [**Hospital1 **]:
1.5 Tablets PO HS (at bedtime)
as needed. Disp:*60 Tablet(s)* Refills:*0*
11. Indomethacin 25 mg Capsule [**Hospital1 **]: Two (2) Capsule PO TID (3
times a day).
Disp:*180 Capsule(s)* Refills:*2*
12. Fentanyl 75 mcg/hr Patch 72 hr [**Hospital1 **]: One (1) Patch 72 hr
Transdermal Q72H (every 72 hours). Disp:*10 Patch 72 hr(s)*
Refills:*2*
13. Chlorhexidine Gluconate 0.12 % Mouthwash [**Hospital1 **]: Fifteen (15)
ML Mucous membrane [**Hospital1 **] (2 times a day): Use only if patient is
on mechanical ventilation.
Disp:*400 ML(s)* Refills:*0*
14. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). Disp:*30
Tablet,Rapid Dissolve, DR(s)* Refills:*2*
15. Latanoprost 0.005 % Drops [**Last Name (STitle) **]: One (1) Drop Ophthalmic HS
(at bedtime).
Disp:*20 ml* Refills:*2*
16. Ipratropium Bromide 17 mcg/Actuation Aerosol [**Last Name (STitle) **]: Two (2)
Puff Inhalation QID (4 times a day). Disp:*1 unit* Refills:*2*
17. Acetaminophen 160 mg/5 mL Solution [**Last Name (STitle) **]: Six [**Age over 90 1230**]y
(650) mg PO Q6H (every 6 hours). Disp:*500 ml* Refills:*2*
18. Levothyroxine Sodium 50 mcg IV DAILY
19. Albuterol 90 mcg/Actuation Aerosol [**Age over 90 **]: 1-2 Puffs Inhalation
Q6H (every 6 hours). Disp:*1 unit* Refills:*2*
20. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated [**Age over 90 **]:
One (1) Adhesive Patch, Medicated Topical Q24H (every 24 hours)
as needed for pain for 7 days.
Disp:*7 Adhesive Patch, Medicated(s)* Refills:*0*
21. Lorazepam 0.5 mg Tablet [**Age over 90 **]: 1-2 Tablets PO Q6H (every 6
hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*
22. Bupropion 75 mg Tablet [**Age over 90 **]: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
23. Erythromycin 5 mg/g Ointment [**Age over 90 **]: 0.5 in Ophthalmic QID (4
times a day).
Disp:*60 in* Refills:*2*
24. Metoprolol Tartrate 5 mg IV Q6H:PRN AFIB / RVR
25. Sodium Chloride 0.9%  Flush 10 mL IV PRN line flush
Temporary Central Access-ICU: Flush with 10mL Normal Saline
daily and PRN.
26. Furosemide 40 mg Tablet [**Age over 90 **]: Three (3) Tablet PO BID (2
times a day). Disp:*180 Tablet(s)* Refills:*2*
27. Enoxaparin 100 mg/mL Syringe [**Age over 90 **]: One Hundred (100) mg
Subcutaneous Q 12H (Every 12 Hours): until therapeutic on
coumadin (INR [**3-4**]) then may d/c lovenox.
Disp:*25 syringes* Refills:*2*

Discharge Medications:
1. Fentanyl 100 mcg/hr Patch 72 hr [**Month/Day (3) **]: One (1) Patch 72 hr
Transdermal Q72H (every 72 hours).
2. Enoxaparin 100 mg/mL Syringe [**Month/Day (3) **]: One (1) ml Subcutaneous
Q12H (every 12 hours).
3. Albuterol 90 mcg/Actuation Aerosol [**Month/Day (3) **]: 1-2 Puffs Inhalation
Q4H (every 4 hours) as needed.
4. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated [**Month/Day (3) **]:
One (1) Adhesive Patch, Medicated Topical QDAILY ().
5. Carbidopa-Levodopa 25-100 mg Tablet [**Month/Day (3) **]: One (1) Tablet PO
TID (3 times a day).
6. Colchicine 0.6 mg Tablet [**Month/Day (3) **]: One (1) Tablet PO DAILY
(Daily).
7. Bupropion 75 mg Tablet [**Month/Day (3) **]: One (1) Tablet PO BID (2 times a
day).
8. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
9. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution [**Last Name (STitle) **]: Five (5)
ML PO Q4H (every 4 hours) as needed for pain.
10. Digoxin 125 mcg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily).

11. Fluconazole 200 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO Q24H (every
24 hours) for 3 days.
12. Colchicine 0.6 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO EVERY OTHER
DAY (Every Other Day).
13. Allopurinol 300 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY
(Daily).
14. Prednisone 20 mg Tablet [**Last Name (STitle) **]: Two (2) Tablet PO DAILY (Daily)
for 3 days: [**Date range (1) 24818**].
15. Prednisone 10 mg Tablet [**Date range (1) **]: Three (3) Tablet PO DAILY
(Daily) for 3 days: [**Date range (1) 40196**].
16. Prednisone 20 mg Tablet [**Date range (1) **]: One (1) Tablet PO DAILY (Daily)
for 3 days: [**Date range (1) 20648**].
17. Prednisone 10 mg Tablet [**Date range (1) **]: One (1) Tablet PO DAILY (Daily)
for 3 days: [**Date range (1) 40197**].
18. Prednisone 5 mg Tablet [**Date range (1) **]: One (1) Tablet PO DAILY (Daily)
for 3 days: [**Date range (1) 17392**].
19. Prednisone Taper
prednisone 40' x 3, 30' x 3, 20' x 3, 10' x 3, 5' x 3;
colchicine 0.6 QOD until f/u at Rheum, allopurinol 300' titrated
as outpt, f/u with Dr. [**First Name (STitle) **] in 4 wks
20. Ipratropium Bromide 0.02 % Solution [**First Name (STitle) **]: One (1) neg
Inhalation Q6H (every 6 hours).
21. Heparin Flush (10 units/ml) 2 mL IV PRN line flush
PICC, heparin dependent: Flush with 10mL Normal Saline followed
by Heparin as above daily and PRN per lumen.
22. HYDROmorphone (Dilaudid) 1-2 mg IV Q2H:PRN breakthorugh pain

23. Insulin NPH Human Recomb 100 unit/mL Suspension [**First Name (STitle) **]: Twenty
(20) units Subcutaneous twice a day.
24. insulin sliding scale
check fingersticks q4h
glucose       regular insulin dose
0-70 mg/dL    [**1-31**] amp D50
71-120 mg/dL  0 Units
121-140 mg/dL 3 Units
141-160 mg/dL 6 Units
161-180 mg/dL 9 Units
181-200 mg/dL 12 Units
201-220 mg/dL 15 Units
221-240 mg/dL 18 Units
241-260 mg/dL 21 Units
261-280 mg/dL 24 Units
281-300 mg/dL 27 Units
301-320 mg/dL 30 Units
> 320 mg/dL   Notify M.D.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
primary:
failure to thrive
.
secondary:
CAD s/p cath, CHF, HTN, severe lumbar spinal stenosis, mild
cervical spinal stenosis, sleep apnea, atrial fibrillation,
arthritis, gout, COPD, NIDDM, E.coli sepsis, MRSA PNA, E.coli
bacteremia, BPH, Parkinson's disease, cholangitis s/p [**Hospital1 **]/stent
& percutaneous cholecystostomy tube, s/p tracheostomy,
diverticulosis, h/o diverticulitis, s/p I&D R elbow, s/p
excision of facial skin ca

Discharge Condition:
Afebrile, vital signs stable, tolerating tube feeds & pureed
solids/nectar thickened liquids, pain well controlled on PO
medication.


Discharge Instructions:
Please call your doctor or return to the emergency room if you
have any of the following:
* You experience new chest pain, pressure, squeezing or
tightness.
* New or worsening cough or wheezing.
* If you are vomiting and cannot keep in fluids or your
medications.
* You are getting dehydrated due to continued vomiting, diarrhea
or other reasons. Signs of dehydration include dry mouth, rapid
heartbeat or feeling dizzy or faint when standing.
* You see blood or dark/black material when you vomit or have a
bowel movement.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.
* Please resume all regular home medications and take any new
meds  as ordered.

Followup Instructions:
Please call Dr.[**Name (NI) **] office at ([**Telephone/Fax (1) 2047**] to schedule
a follow up appointment in [**3-4**] weeks.
.
Provider: [**First Name11 (Name Pattern1) 2890**] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 2226**]
Date/Time:[**2125-8-15**] 2:45



Completed by:[**2125-7-18**]
{'Methicillin susceptible pneumonia due to Staphylococcus aureus,Bacteremia,Calculus of bile duct without mention of cholecystitis, with obstruction,Pressure ulcer, lower back,Chronic systolic heart failure,Disseminated candidiasis,Dehydration,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Spinal stenosis, lumbar region, without neurogenic claudication,Obstructive sleep apnea (adult)(pediatric),Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Paralysis agitans,Infection with microorganisms resistant to penicillins,Tracheostomy status'}


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: failure to thrive

PRESENT ILLNESS: This 85M was recently admitted for cholangitis, and is now s/p
percutaneous cholecystostomy tube, s/p [**Month/Day/Year **]/stent, s/p trach.
His hospital course was complicated by MRSA PNA and E.coli
bacteremia, diarrhea (presumed to be C.diff, for which he was
discharged on Flagyl), and acute gout flair.  He was discharged
to rehab on [**2125-6-22**].  He self d/c'd his Dobhoff and was
transferred back to [**Hospital1 18**] for PEG placement as well as
persistent fevers to 102.

MEDICAL HISTORY: 1. CAD, cath 5 years ago at NEBH (cardiologist [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **])
2. CHF, TTE [**3-5**] w/depressed EF
3. Hypertension, per daughter pt's bp usually 90s-100s on meds
4. Severe lumbar spinal stenosis, mild cervical stenosis
5. Sleep apnea, on 2L home O2 at night
6. Afib, s/p failed DCCV, now rate controlled
7. Arthritis
8. Gout
9. COPD
10. NIDDM
11. E-coli sepsis (admission [**2122-12-23**] - [**2123-1-1**])
12. BPH
13. Parkinson's disease
14. Cholangitis s/p percutaneous cholecystostomy tube &
[**Month/Day/Year **]/stent ([**2125-5-16**])
15. s/p tracheostomy ([**2125-5-28**])
16. diverticulosis, h/o diverticulitis & ulcers
17. s/p I&D R elbow
18. s/p excision of facial skin ca

MEDICATION ON ADMISSION: Discharge Medications ([**2125-6-22**]):
1. Metronidazole 500 mg Tablet [**Month/Day/Year **]: One (1) Tablet PO TID (3
times a day) for 7 days. Disp:*21 Tablet(s)* Refills:*0*
2. Colchicine 0.6 mg Tablet [**Month/Day/Year **]: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Coumadin 3 mg Tablet [**Month/Day/Year **]: One (1) Tablet PO once a day: goal
INR [**3-4**]
Dose daily. Disp:*30 Tablet(s)* Refills:*2*
4. Carbidopa-Levodopa 25-100 mg Tablet [**Month/Day (3) **]: One (1) Tablet PO
TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2*
5. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) [**Month/Day (3) **]: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation. Disp:*30 Tablet, Delayed Release (E.C.)(s)*
Refills:*0*
6. Docusate Sodium 50 mg/5 mL Liquid [**Month/Day (3) **]: Ten (10) ml PO BID (2
times a day).
Disp:*600 ml* Refills:*2*
7. Bacitracin Zinc 500 unit/g Ointment [**Month/Day (3) **]: One (1) Appl Topical
[**Hospital1 **] (2 times a day). Disp:*1 tube* Refills:*2*
8. Senna 8.6 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2 times a
day) as needed for constipation. Disp:*30 Tablet(s)* Refills:*0*
9. Digoxin 125 mcg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2* 10. Trazodone 50 mg Tablet [**Hospital1 **]:
1.5 Tablets PO HS (at bedtime)
as needed. Disp:*60 Tablet(s)* Refills:*0*
11. Indomethacin 25 mg Capsule [**Hospital1 **]: Two (2) Capsule PO TID (3
times a day).
Disp:*180 Capsule(s)* Refills:*2*
12. Fentanyl 75 mcg/hr Patch 72 hr [**Hospital1 **]: One (1) Patch 72 hr
Transdermal Q72H (every 72 hours). Disp:*10 Patch 72 hr(s)*
Refills:*2*
13. Chlorhexidine Gluconate 0.12 % Mouthwash [**Hospital1 **]: Fifteen (15)
ML Mucous membrane [**Hospital1 **] (2 times a day): Use only if patient is
on mechanical ventilation.
Disp:*400 ML(s)* Refills:*0*
14. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). Disp:*30
Tablet,Rapid Dissolve, DR(s)* Refills:*2*
15. Latanoprost 0.005 % Drops [**Last Name (STitle) **]: One (1) Drop Ophthalmic HS
(at bedtime).
Disp:*20 ml* Refills:*2*
16. Ipratropium Bromide 17 mcg/Actuation Aerosol [**Last Name (STitle) **]: Two (2)
Puff Inhalation QID (4 times a day). Disp:*1 unit* Refills:*2*
17. Acetaminophen 160 mg/5 mL Solution [**Last Name (STitle) **]: Six [**Age over 90 1230**]y
(650) mg PO Q6H (every 6 hours). Disp:*500 ml* Refills:*2*
18. Levothyroxine Sodium 50 mcg IV DAILY
19. Albuterol 90 mcg/Actuation Aerosol [**Age over 90 **]: 1-2 Puffs Inhalation
Q6H (every 6 hours). Disp:*1 unit* Refills:*2*
20. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated [**Age over 90 **]:
One (1) Adhesive Patch, Medicated Topical Q24H (every 24 hours)
as needed for pain for 7 days.
Disp:*7 Adhesive Patch, Medicated(s)* Refills:*0*
21. Lorazepam 0.5 mg Tablet [**Age over 90 **]: 1-2 Tablets PO Q6H (every 6
hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*
22. Bupropion 75 mg Tablet [**Age over 90 **]: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
23. Erythromycin 5 mg/g Ointment [**Age over 90 **]: 0.5 in Ophthalmic QID (4
times a day).
Disp:*60 in* Refills:*2*
24. Metoprolol Tartrate 5 mg IV Q6H:PRN AFIB / RVR
25. Sodium Chloride 0.9%  Flush 10 mL IV PRN line flush
Temporary Central Access-ICU: Flush with 10mL Normal Saline
daily and PRN.
26. Furosemide 40 mg Tablet [**Age over 90 **]: Three (3) Tablet PO BID (2
times a day). Disp:*180 Tablet(s)* Refills:*2*
27. Enoxaparin 100 mg/mL Syringe [**Age over 90 **]: One Hundred (100) mg
Subcutaneous Q 12H (Every 12 Hours): until therapeutic on
coumadin (INR [**3-4**]) then may d/c lovenox.
Disp:*25 syringes* Refills:*2*

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission:
98.9 93 Afib 91/53 14 99% CMV
Gen: ventilated, NAD
HEENT: trach in position
[**Name (NI) **]: intubated, clear bilaterally
CVS: irregularly irregular, -MRG
Abd: soft/NT/ND, no masses, no rebound/guarding apparent
Ext: mild edema diffusely
.
On discharge:
96.5  79  114/76  22  98%RA
Gen: NAD
CVS: RRR
[**Name (NI) **]: CTA b/l
Abd: soft, NT, ND, +BS
Ext: no c/c/e

FAMILY HISTORY: Notable for CAD, HTN, and stroke.

SOCIAL HISTORY: Transferred from [**Hospital 100**] Rehab.  Formerly lived with daughter
[**Name (NI) 13118**].  Widowed.  No tobacco/EtOH.  Formerly worked at Sears. 

### Response:
{'Methicillin susceptible pneumonia due to Staphylococcus aureus,Bacteremia,Calculus of bile duct without mention of cholecystitis, with obstruction,Pressure ulcer, lower back,Chronic systolic heart failure,Disseminated candidiasis,Dehydration,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Spinal stenosis, lumbar region, without neurogenic claudication,Obstructive sleep apnea (adult)(pediatric),Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Paralysis agitans,Infection with microorganisms resistant to penicillins,Tracheostomy status'}
