CHIEF COMPLAINT: Non healing left heal ulcer

PRESENT ILLNESS: 

MEDICAL HISTORY: HTN
IDDM with neuropathy
Renal failure with peritoneal dialysis MWF
MI in [**12-9**]
Gallbladder removal '[**34**]
Amps of L4 and L5 '[**49**]
Left foot debridement sub 4th and 5th met heads '[**58**]
Amp of Right 2nd [**2157**].

MEDICATION ON ADMISSION: insulin 70/30 40 qam, 40 qpm,
lasix 80 [**Hospital1 **],
renagel 1200 [**Hospital1 **],
zestril 40 daily.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
AFVSS
NEURO:
PERRL / EOMI
MAE equally
Answers simple commands
Neg pronator drift
Sensation intact to ST
2 plus DTR
Neg [**Name2 (NI) **]
HEENT:
NCAT
Neg lesions nares, oral pharnyx, auditory
Supple / FAROM
neg lyphandopathy, supra clavicular nodes
LUNGS: CTA b/l
CARDIAC: RRR without murmers
ABDOMEN: Soft, NTTP, ND, pos BS, neg CVA tenderness
EXT:
rle - palp fem, [**Doctor Last Name **], pt, dp
lle - palp fem, [**Doctor Last Name **], pt, dp

FAMILY HISTORY: Medical problems significant for diabetes.

SOCIAL HISTORY: She used to smoke, however, has quit.
Denies alcohol use.
Atherosclerosis of native arteries of the extremities with ulceration,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acidosis,Ulcer of heel and midfoot,Polyneuropathy in diabetes,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other anaerobes,Anemia, unspecified,Old myocardial infarction,Personal history of noncompliance with medical treatment, presenting hazards to health
Ath ext ntv art ulcrtion,DMI neuro nt st uncntrld,Hyp kid NOS w cr kid V,Acidosis,Ulcer of heel & midfoot,Neuropathy in diabetes,Other anaerobes,Anemia NOS,Old myocardial infarct,Hx of past noncompliance
Admission Date:  [**2159-6-12**]              Discharge Date:   [**2159-6-27**]

Date of Birth:  [**2114-1-7**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1781**]
Chief Complaint:
Non healing left heal ulcer

Major Surgical or Invasive Procedure:
L fem-DP bpg
L heel debridement


Past Medical History:
HTN
IDDM with neuropathy
Renal failure with peritoneal dialysis MWF
MI in [**12-9**]
Gallbladder removal '[**34**]
Amps of L4 and L5 '[**49**]
Left foot debridement sub 4th and 5th met heads '[**58**]
Amp of Right 2nd [**2157**].

Social History:
She used to smoke, however, has quit.
Denies alcohol use.


Family History:
Medical problems significant for diabetes.

Physical Exam:
PE:
AFVSS
NEURO:
PERRL / EOMI
MAE equally
Answers simple commands
Neg pronator drift
Sensation intact to ST
2 plus DTR
Neg [**Name2 (NI) **]
HEENT:
NCAT
Neg lesions nares, oral pharnyx, auditory
Supple / FAROM
neg lyphandopathy, supra clavicular nodes
LUNGS: CTA b/l
CARDIAC: RRR without murmers
ABDOMEN: Soft, NTTP, ND, pos BS, neg CVA tenderness
EXT:
rle - palp fem, [**Doctor Last Name **], pt, dp
lle - palp fem, [**Doctor Last Name **], pt, dp


Pertinent Results:
[**2159-6-12**] 5:33 PM

CHEST (PORTABLE AP)

Reason: eval for cvl placement

PORTABLE SUPINE FRONTAL RADIOGRAPH:

FINDINGS:

Lung volumes are reduced. Allowing for this and technique,
cardiac and mediastinal contours are within normal limits. There
is a right-sided IJ central venous catheter with its tip in the
mid SVC. The patient is intubated with ET tube terminating above
the level of the clavicles. An NG tube terminates within the
stomach. No pneumothorax is seen on this supine radiograph.
There is a small amount of atelectasis in the retrocardiac
region.

IMPRESSION:

Reduced lung volumes with left retrocardiac atelectasis. Central
venous catheter with its tip in the mid SVC

[**2159-6-13**]

LEFT HEEL, 2 VIEWS:

The ulcer over the heel is noted. Some irregularity of the
underlying portion of the calcaneus is within the range of
normal. No focal bone destruction or periosteal new bone
formation to confirm the presence of osteomyelitis is
identified. No reactive sclerosis is detected. No fracture is
identified. Vascular calcification and surgical clips noted.

IMPRESSION: Ulceration. No osteomyelitis identified.

[**2159-6-25**]

Source: left heel.

**FINAL REPORT [**2159-6-29**]**

GRAM STAIN (Final [**2159-6-25**]):
      NO POLYMORPHONUCLEAR LEUKOCYTES SEEN.
      1+    (<1 per 1000X FIELD):   GRAM NEGATIVE ROD(S).

WOUND CULTURE (Final [**2159-6-28**]):
      Due to mixed bacterial types ( >= 3 colony types) an
abbreviated
      workup is performed appropriate to the isolates recovered
from the
      site (including a screen for Pseudomonas aeruginosa,
Staphylococcus
      aureus and beta streptococcus).
      GRAM NEGATIVE ROD(S).    MODERATE GROWTH.
      STAPHYLOCOCCUS, COAGULASE NEGATIVE.    SPARSE GROWTH.
      OF TWO COLONIAL MORPHOLOGIES.

 ANAEROBIC CULTURE (Final [**2159-6-29**]):    NO ANAEROBES ISOLATED

[**2159-6-12**] 05:36PM   WBC-12.7* RBC-3.26* HGB-9.2* HCT-27.7* MCV-85
MCH-28.3 MCHC-33.1 RDW-15.0

Brief Hospital Course:
Pt admitted [**2159-6-12**] for ischemic foot.

Pt pre-op'd cleared for surgery. IV Antibiotics started. Cx
taken.

Podiatry consulted / plastics / renal consulted.

Pt recieved PD M/W/F.

Pt underwent a Left common femoral artery to dorsalis pedis
artery bypass graft in situ using greater saphenous vein,
angioscopy and valve lysis, revision of distal anastomosis, and
intraoperative arteriogram.

Pt tolerated th procedure well. There were no complications. Pt
acidotic transfered to the SICU in stable condition. Intubated.

It was thought that the pt was in metabolic acidosis secondary
to untreated renal failure, likely secondary to non compliance
PD.

[**2159-6-14**] - [**2159-6-17**]

Pt extubated.

Podiatry to debride wound.

Pt remained in SICU.

[**2159-6-18**]

Pt underwent a debridement of left heel.

Pt tolerated th procedure well. There were no complications. Pt
extubted in the OR. Transfered to the PACU in stable condition.

Once reccoperated from anesthesia pt transfered to the VICU in
stable condition.

Pt had VAC after the procedure.

Pt recieved PRBC's

[**2159-6-19**] - [**2159-6-25**]

PT consult. Pt allowed OOB to chair. NWB left foot.

Awaiting cx and sensitivities / vac in place.

Foley DC'd.

[**2159-6-26**]

Vac removed. Wound improved. Plastics see pt. Want to see on f/u
as out pt.

Vac replaced.

PICC placed at bedside for AB therapy.

Pt dc'd in stable condition. Taking PO / ambulating with ASST,
pos BM, pos urination.


Medications on Admission:
insulin 70/30 40 qam, 40 qpm,
lasix 80 [**Hospital1 **],
renagel 1200 [**Hospital1 **],
zestril 40 daily.

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO TID (3
times a day) as needed for constipation.
Disp:*60 Capsule(s)* Refills:*0*
3. Calcium Acetate 667 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) as needed.
4. Epoetin Alfa 10,000 unit/mL Solution Sig: One (1)  Injection
QMOWEFR (Monday -Wednesday-Friday).
5. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 1 months.
Disp:*60 Tablet(s)* Refills:*0*
6. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q48H (every
48 hours) for 1 months.
Disp:*15 Tablet(s)* Refills:*0*
7. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
8. Vancomycin in Dextrose 1 g/200 mL Piggyback Sig: One (1) gram
Intravenous  as needed per level < 15 for 1 months: blood levels
should be checked every third day and dosed only if level < 15;
dosing to be reviewed by peritoneal dialysis coordinator -- [**First Name8 (NamePattern2) 401**]
[**Last Name (NamePattern1) **] @ [**Telephone/Fax (1) 60552**] Fax [**Telephone/Fax (1) 60553**] for any changes during
therapy.
Disp:*10 doses* Refills:*0*
9. Heparin Flush (Porcine) in NS 100 unit/mL Kit Sig: One (1)
flush Intravenous  per ccs protocol.
Disp:*qs * Refills:*2*


Discharge Disposition:
Home With Service

Facility:
homehealth vna

Discharge Diagnosis:
HTN
IDDM
ESRD
Heel ulcer


Discharge Condition:
Good

Discharge Instructions:
Go to an Emergency Room if you experience symptoms including,
but not necessarily limited to: new and continuing
nausea,vomiting, fevers (>101.5 F), chills, or shortness of
breath.

Proceed to the ER/EW/ED if your wound becomes red, swollen,
warm, or produces pus.

No driving while taking pain medications.

Narcotics can cause constipation. Please take an over the
counter stool softener such as Colace or a gentle laxative such
as Milk of Magnesia if you experience constipation.

You may resume your regular diet as tolerated.

You may take showers (no baths) after your dressings have been
removed from your wounds.

Continue taking your home medications unless otherwise indicated
at follow up with PCP.

Followup Instructions:
F/U with [**Doctor Last Name **] in [**1-7**] wks.
F/U with Nephrology as per routine
F/U with PCP soon after discharge to review medications and
events



Completed by:[**2159-8-21**]
{'Atherosclerosis of native arteries of the extremities with ulceration,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acidosis,Ulcer of heel and midfoot,Polyneuropathy in diabetes,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other anaerobes,Anemia, unspecified,Old myocardial infarction,Personal history of noncompliance with medical treatment, presenting hazards to health'}


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: Non healing left heal ulcer

PRESENT ILLNESS: 

MEDICAL HISTORY: HTN
IDDM with neuropathy
Renal failure with peritoneal dialysis MWF
MI in [**12-9**]
Gallbladder removal '[**34**]
Amps of L4 and L5 '[**49**]
Left foot debridement sub 4th and 5th met heads '[**58**]
Amp of Right 2nd [**2157**].

MEDICATION ON ADMISSION: insulin 70/30 40 qam, 40 qpm,
lasix 80 [**Hospital1 **],
renagel 1200 [**Hospital1 **],
zestril 40 daily.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
AFVSS
NEURO:
PERRL / EOMI
MAE equally
Answers simple commands
Neg pronator drift
Sensation intact to ST
2 plus DTR
Neg [**Name2 (NI) **]
HEENT:
NCAT
Neg lesions nares, oral pharnyx, auditory
Supple / FAROM
neg lyphandopathy, supra clavicular nodes
LUNGS: CTA b/l
CARDIAC: RRR without murmers
ABDOMEN: Soft, NTTP, ND, pos BS, neg CVA tenderness
EXT:
rle - palp fem, [**Doctor Last Name **], pt, dp
lle - palp fem, [**Doctor Last Name **], pt, dp

FAMILY HISTORY: Medical problems significant for diabetes.

SOCIAL HISTORY: She used to smoke, however, has quit.
Denies alcohol use. 

### Response:
{'Atherosclerosis of native arteries of the extremities with ulceration,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acidosis,Ulcer of heel and midfoot,Polyneuropathy in diabetes,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other anaerobes,Anemia, unspecified,Old myocardial infarction,Personal history of noncompliance with medical treatment, presenting hazards to health'}
