CHIEF COMPLAINT: R/O VP shunt infection

PRESENT ILLNESS: 56F with complicated medical history well known to
neurosurgery service presents for infection/abscess at Right
Clavicle over VPS tract. She has a history of temporal lobe
epilepsy, status post resection and VP shunt placement which was
revised [**2155-5-6**] by Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **] and also in [**2155-9-4**] for
management of her breast abscess which required externalization
and ultimate distal replacement. She presents today without
altered mental status.  She offers no complaints other than
tenderness at the right clacicle and right post auricular.

MEDICAL HISTORY: 1. TLE s/p surgery - right temporoparietal resection [**2128**]. Has
minimal use of her LUE & LLE, is wheelchair-bound.
2. Focal motor seizures. Has sz approx once a month -> shaking
of her right arm, no loss of consciousness, but the sz affects
her tongue so she cannot speak.
3. VP shunt [**2128**] done when temporal lobectomy performed; Shunt
replacement [**2155-5-5**]
4. Depression
5. OCD
6. HTN
7. COPD
8. Neurogenic bladder
9. Eating disorder (anorexia)
10. PUD
11. History of chronic left lower extremity edema
12. Right hip, fracture to the left, and fracture of the lateral

MEDICATION ON ADMISSION: maalox 30 cc qid
ativan .5 mg po tid prn
bisacodyl 5mg po 2 tabs po daily
demeclocycline 150 mg 1 tab po bid
detrol la 4 mg po daily
colace 100mg po bid
dulcolax 10mg rectally twice weekly
effexor xr 225 mg  po daily
evista 60 mg i tab po daily
famotadine dose uncertain
iron 325 dily
gabapentin 100mg po bid
mag citrate uncertain dosage
meclizine 12.5 mg fo tid
percocet 5/325 2 tabs po daily as needed
phenobarbitol 30 mg / 3 tabs po qhs
risperdal 2 mg po hs
tegretol xr 400mg 1 tab po tid
tylenol prn
vit d

ALLERGIES: Valium / Levofloxacin / Levaquin

PHYSICAL EXAM: On Admission:

FAMILY HISTORY: Mother- Pancreatic CA
Grandfather- Breast CA, leukemia

SOCIAL HISTORY: Patient lives in a long term care facility ([**Location (un) 169**])
Wheelchair to ambulate
Volunteers at [**Hospital6 4620**]
N0 Tobacco
N0 ETOH
Infection and inflammatory reaction due to nervous system device, implant, and graft,Cellulitis and abscess of neck,Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy,Hemiplegia, unspecified, affecting unspecified side,Secondary hyperparathyroidism (of renal origin),Cervical spondylosis without myelopathy,Neurogenic bladder NOS,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Obsessive-compulsive disorders
React-nerv sys dev/graft,Cellulitis of neck,Psymotr epil w intr epil,Unsp hemiplga unspf side,Sec hyperparathyrd-renal,Cervical spondylosis,Neurogenic bladder NOS,Chr airway obstruct NEC,Hypertension NOS,Depressive disorder NEC,Obsessive-compulsive dis
Admission Date:  [**2155-11-15**]              Discharge Date:   [**2155-11-21**]

Date of Birth:  [**2098-10-28**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Valium / Levofloxacin / Levaquin

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
R/O VP shunt infection

Major Surgical or Invasive Procedure:
[**2155-11-16**]: Removal of VP shunt hardware and externalization of
shunt with 2 EVD placements.

History of Present Illness:
56F with complicated medical history well known to
neurosurgery service presents for infection/abscess at Right
Clavicle over VPS tract. She has a history of temporal lobe
epilepsy, status post resection and VP shunt placement which was
revised [**2155-5-6**] by Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **] and also in [**2155-9-4**] for
management of her breast abscess which required externalization
and ultimate distal replacement. She presents today without
altered mental status.  She offers no complaints other than
tenderness at the right clacicle and right post auricular.


Past Medical History:
1. TLE s/p surgery - right temporoparietal resection [**2128**]. Has
minimal use of her LUE & LLE, is wheelchair-bound.
2. Focal motor seizures. Has sz approx once a month -> shaking
of her right arm, no loss of consciousness, but the sz affects
her tongue so she cannot speak.
3. VP shunt [**2128**] done when temporal lobectomy performed; Shunt
replacement [**2155-5-5**]
4. Depression
5. OCD
6. HTN
7. COPD
8. Neurogenic bladder
9. Eating disorder (anorexia)
10. PUD
11. History of chronic left lower extremity edema
12. Right hip, fracture to the left, and fracture of the lateral

ischial ring on the right side.
13. Left hip frequent dislocations status post left hip
replacement c/b MRSA inf currently without a left hip
14. Secondary hyperparathyroidism
15. Iron deficiency anemia
16. Severe progressive cervical spondylosis s/p occiput to C4
fusion and C2-C3 laminectomy [**2150**]
17: C2-3 anterolisthesis s/p posterior cervical spine fusion
[**1-13**]


Social History:
Patient lives in a long term care facility ([**Location (un) 169**])
Wheelchair to ambulate
Volunteers at [**Hospital6 4620**]
N0 Tobacco
N0 ETOH


Family History:
Mother- Pancreatic CA
Grandfather- Breast CA, leukemia


Physical Exam:
On Admission:

PHYSICAL EXAM:
O: T: 98.2 BP:     98/ 59        HR: 68   R 16     98 O2Sats
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 4.0 on Left to 3.0, 3.5 to 3.0 on left   EOMI.
lateral gaze nystagmus noted. Right post auricular erythema.
Neck/ chest: ROM somewhat limited / this is old for pt / she
does
not appear to have any nuchal rigidity at this time.  She has
erythema at the right clavicle with fluctuance (approx size of
[**12-6**] a small walnut). There is approx 5mm area of surface
exudate/dry without active drainage.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date [**Month (only) **]/[**2154**]/ not
day / thought is was the 20th).
Language: Speech fluent with good comprehension and repetition.
Naming intact.
Cranial Nerves:
I: Not tested
II: Pupils as above.  Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally with
lateral gaze nystagmus.
V, VII: Facial strength and sensation intact and symmetric.
slight left facial (old)
VIII: Hearing intact to voice.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

Motor: Normal bulk and tone on right. left hemiplegia / old.

Upon discharge: She was alert and oriented, may be confused at
times. She does have old L sided plegia an antigravity on the R.



Pertinent Results:
CT Head [**2155-11-16**] IMPRESSION:
New pneumocephalus overlying the right frontal lobe and air
within the
ventricles bilaterally with increased size of ventricles since
[**2155-9-29**].

CT Head IMPRESSION: [**11-19**]
1. Stable position of ventriculostomy drains: the right frontal
approach
drain appears to terminate in brain parenchyma, just lateral to
the margin of the left lateral ventricle, but ventricles are
stable in size.
2. No interval hemorrhage.
3. Overall significant decrease in pneumocephalus, with also
slight
redistribution into the temporal horns of both lateral
ventricles.
4. Extensive right parietal and frontal lobar cystic
encephalomalacia, as
before.

CT Head 12/17IMPRESSION:
1. Very slightly increased size of the ventricles. Close
interval followup
is recommended. The ventriculostomy catheters are in unchanged
position with the right frontal catheter again terminating in
the caudate/internal capsule.
2. No new hemorrhage.


[**2155-11-21**] 05:30AM BLOOD WBC-5.4 RBC-2.93* Hgb-9.1* Hct-27.3*
MCV-93 MCH-31.1 MCHC-33.4 RDW-13.7 Plt Ct-351
[**2155-11-17**] 12:53AM BLOOD Neuts-79.5* Lymphs-14.7* Monos-4.9
Eos-0.5 Baso-0.3
[**2155-11-21**] 10:17AM BLOOD Glucose-100 UreaN-14 Creat-0.4 Na-125*
K-4.1 Cl-87* HCO3-30 AnGap-12

Brief Hospital Course:
[**First Name9 (NamePattern2) 103037**] [**Known lastname 102960**] is a 57 yo female well known to our service who
was readmitted on [**2155-11-15**] with a question of a VP shunt
infection. On [**11-15**] her shunt was tapped for CSF and sent for
cultures. On [**11-16**] she was taken to the OR for a shunt
externalization and 2 EVD placements. She was apenic
post-operatively and monitored overnight in the ICU. On [**11-17**]
she was neurologically stable and was transferred to the Step
Down Unit. Her CSF was negative and her antibiotic course was
adjusted to treat the soft tissue infection per Infectious
Disease. Her EVDs were not draining and she had them clampped.
After having clampped for 5days and stable head CTs and ICPs WNL
she had them removed. Her neurologist Dr. [**Last Name (STitle) **] was asked to
see pt at her request although to no avail. She remained
afibrile, femodynamically stable and normal WBC. She will return
to her residence and follow-up with Dr. [**First Name (STitle) **] in a few weeks
with a Head CT.

Medications on Admission:
maalox 30 cc qid
ativan .5 mg po tid prn
bisacodyl 5mg po 2 tabs po daily
demeclocycline 150 mg 1 tab po bid
detrol la 4 mg po daily
colace 100mg po bid
dulcolax 10mg rectally twice weekly
effexor xr 225 mg  po daily
evista 60 mg i tab po daily
famotadine dose uncertain
iron 325 dily
gabapentin 100mg po bid
mag citrate uncertain dosage
meclizine 12.5 mg fo tid
percocet 5/325 2 tabs po daily as needed
phenobarbitol 30 mg / 3 tabs po qhs
risperdal 2 mg po hs
tegretol xr 400mg 1 tab po tid
tylenol prn
vit d


Discharge Medications:
1. Alum-Mag Hydroxide-Simeth 200-200-20 mg/5 mL Suspension Sig:
Thirty (30) ML PO QID (4 times a day) as needed for
constipation.
2. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for anxiety.
3. Demeclocycline 150 mg Tablet Sig: One (1) Tablet PO bid ().
4. Tolterodine 2 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

5. Raloxifene 60 mg Tablet Sig: One (1) Tablet PO daily ().
6. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
TWICE WEEKLY / MONDAY AND THURSDAY PLEASE ().
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
8. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
9. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
10. Gabapentin 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
11. Meclizine 12.5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
12. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q6H (every 6 hours) as needed for pain.
13. Phenobarbital 30 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime).
14. Risperidone 2 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
15. Carbamazepine 200 mg Tablet Sustained Release 12 hr Sig: Two
(2) Tablet Sustained Release 12 hr PO Q 8H (Every 8 Hours).
16. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
17. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
18. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for fever / pain .
19. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
20. Magnesium Citrate 1.745 g/30mL Solution Sig: Three Hundred
(300) ML PO DAILY (Daily) as needed for Constipation.
21. Venlafaxine 75 mg Capsule, Sust. Release 24 hr Sig: Five (5)
Capsule, Sust. Release 24 hr PO DAILY (Daily).
22. Dicloxacillin 500 mg Capsule Sig: One (1) Capsule PO Q6H
(every 6 hours) for 6 days.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 10283**] Center - [**Location (un) **]

Discharge Diagnosis:
VP Shunt Infection
Soft tissue infection


Discharge Condition:
Level of Consciousness:Alert and interactive
Activity Status:Out of Bed with assistance to chair or
wheelchair
Mental Status:Confused - sometimes


Discharge Instructions:
General Instructions

??????Have a friend/family member check your incision daily for signs
of infection.
??????Take your pain medicine as prescribed.
??????Exercise should be limited to walking; no lifting, straining,
or excessive bending.
??????You may wash your hair only after sutures and/or staples have
been removed. If your wound closure uses dissolvable sutures,
you must keep that area dry for 10 days.
??????You may shower before this time using a shower cap to cover
your head.
??????Increase your intake of fluids and fiber, as narcotic pain
medicine can cause constipation. We generally recommend taking
an over the counter stool softener, such as Docusate (Colace)
while taking narcotic pain medication.
??????Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, and
Ibuprofen etc.
??????Clearance to drive and return to work will be addressed at your
post-operative office visit.
??????Make sure to continue to use your incentive spirometer while at
home, unless you have been instructed not to.


Followup Instructions:
You will need to follow-up with Dr. [**First Name (STitle) **] on [**12-25**] at 11am.
Prior to meeting with him you will need a CT scan of the brain
without contrast at 10a.

Please call [**Telephone/Fax (1) 4296**] if you have any questions.



Completed by:[**2155-11-21**]
{'Infection and inflammatory reaction due to nervous system device, implant, and graft,Cellulitis and abscess of neck,Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy,Hemiplegia, unspecified, affecting unspecified side,Secondary hyperparathyroidism (of renal origin),Cervical spondylosis without myelopathy,Neurogenic bladder NOS,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Obsessive-compulsive disorders'}


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: R/O VP shunt infection

PRESENT ILLNESS: 56F with complicated medical history well known to
neurosurgery service presents for infection/abscess at Right
Clavicle over VPS tract. She has a history of temporal lobe
epilepsy, status post resection and VP shunt placement which was
revised [**2155-5-6**] by Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **] and also in [**2155-9-4**] for
management of her breast abscess which required externalization
and ultimate distal replacement. She presents today without
altered mental status.  She offers no complaints other than
tenderness at the right clacicle and right post auricular.

MEDICAL HISTORY: 1. TLE s/p surgery - right temporoparietal resection [**2128**]. Has
minimal use of her LUE & LLE, is wheelchair-bound.
2. Focal motor seizures. Has sz approx once a month -> shaking
of her right arm, no loss of consciousness, but the sz affects
her tongue so she cannot speak.
3. VP shunt [**2128**] done when temporal lobectomy performed; Shunt
replacement [**2155-5-5**]
4. Depression
5. OCD
6. HTN
7. COPD
8. Neurogenic bladder
9. Eating disorder (anorexia)
10. PUD
11. History of chronic left lower extremity edema
12. Right hip, fracture to the left, and fracture of the lateral

MEDICATION ON ADMISSION: maalox 30 cc qid
ativan .5 mg po tid prn
bisacodyl 5mg po 2 tabs po daily
demeclocycline 150 mg 1 tab po bid
detrol la 4 mg po daily
colace 100mg po bid
dulcolax 10mg rectally twice weekly
effexor xr 225 mg  po daily
evista 60 mg i tab po daily
famotadine dose uncertain
iron 325 dily
gabapentin 100mg po bid
mag citrate uncertain dosage
meclizine 12.5 mg fo tid
percocet 5/325 2 tabs po daily as needed
phenobarbitol 30 mg / 3 tabs po qhs
risperdal 2 mg po hs
tegretol xr 400mg 1 tab po tid
tylenol prn
vit d

ALLERGIES: Valium / Levofloxacin / Levaquin

PHYSICAL EXAM: On Admission:

FAMILY HISTORY: Mother- Pancreatic CA
Grandfather- Breast CA, leukemia

SOCIAL HISTORY: Patient lives in a long term care facility ([**Location (un) 169**])
Wheelchair to ambulate
Volunteers at [**Hospital6 4620**]
N0 Tobacco
N0 ETOH 

### Response:
{'Infection and inflammatory reaction due to nervous system device, implant, and graft,Cellulitis and abscess of neck,Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy,Hemiplegia, unspecified, affecting unspecified side,Secondary hyperparathyroidism (of renal origin),Cervical spondylosis without myelopathy,Neurogenic bladder NOS,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Obsessive-compulsive disorders'}
