CHIEF COMPLAINT: Bilateral femoral periprosthetic shaft fractures

PRESENT ILLNESS: Ms. [**Known lastname 70391**] is a 73-year-old female patient who fell from
standing resulting in bilateral femur fractures which were
periprosthetic. On the left side, she has a hip hemiarthroplasty
and total knee, and on the right side she has a hip
hemiarthroplasty. The presence of implants precludes the
performance of intramedullary nailing. The procedure of choice
at this point is plating which we will perform through a
percutaneous technique in order to minimize the morbidity to
this elderly and very frail patient.

MEDICAL HISTORY: CVA 2.5yrs ago
Seizure disorder
h/o Urosepsis/UTI
Hypertension
Osteoporosis
Pancreatic insufficiency
h/o Depression/anxiety
h/o alcoholic liver disease
Hypothyroidism
Chronic renal insufficiency - baseline CRE 1.4-1.8
h/o Hyperkalemia
h/o Amenia

MEDICATION ON ADMISSION: Buspirone
Aspirin
Fosamax
Synthroid
Darvocet
Keppra
MVI
Effexor XR
Prevacid
Norvasc
Pancrease

ALLERGIES: Morphine

PHYSICAL EXAM: On discharge:

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Non-contributory
Peri-prosthetic fracture around prosthetic joint,Other convulsions,Chronic kidney disease, unspecified,Urinary tract infection, site not specified,Fall from other slipping, tripping, or stumbling,Unspecified essential hypertension,Osteoporosis, unspecified,Unspecified acquired hypothyroidism,Dysthymic disorder,Unspecified late effects of cerebrovascular disease,Hip joint replacement
Periprosthetc fx-pros jt,Convulsions NEC,Chronic kidney dis NOS,Urin tract infection NOS,Fall from slipping NEC,Hypertension NOS,Osteoporosis NOS,Hypothyroidism NOS,Dysthymic disorder,Late effect CV dis NOS,Joint replaced hip
Admission Date:  [**2175-2-1**]              Discharge Date:   [**2175-2-8**]

Date of Birth:  [**2101-4-6**]             Sex:   F

Service: ORTHOPAEDICS

Allergies:
Morphine

Attending:[**First Name3 (LF) 11415**]
Chief Complaint:
Bilateral femoral periprosthetic shaft fractures

Major Surgical or Invasive Procedure:
1.  Open reduction, internal fixation with percutaneous
    plating and reduction of right periprosthetic fracture.
2.  Open reduction, internal fixation with percutaneous
    plating technique, minimally invasive technique of left
    femoral periprosthetic fracture.


History of Present Illness:
Ms. [**Known lastname 70391**] is a 73-year-old female patient who fell from
standing resulting in bilateral femur fractures which were
periprosthetic. On the left side, she has a hip hemiarthroplasty
and total knee, and on the right side she has a hip
hemiarthroplasty. The presence of implants precludes the
performance of intramedullary nailing. The procedure of choice
at this point is plating which we will perform through a
percutaneous technique in order to minimize the morbidity to
this elderly and very frail patient.

Past Medical History:
CVA 2.5yrs ago
Seizure disorder
h/o Urosepsis/UTI
Hypertension
Osteoporosis
Pancreatic insufficiency
h/o Depression/anxiety
h/o alcoholic liver disease
Hypothyroidism
Chronic renal insufficiency - baseline CRE 1.4-1.8
h/o Hyperkalemia
h/o Amenia

Social History:
Non-contributory

Family History:
Non-contributory

Physical Exam:
On discharge:

Afebrile, All vital signs stable
Gen: Alert and oriented, No acute distress
Lungs: Clear to auscultation bilaterally
Cardiac: regular rate and rhythm
Abd: +bowel sounds, benign
Extremities: bilateral lower
  Weight bearing: non weight bearing x8wks
  Incision: no swelling/erythema/drainage
  Dressing: clean/dry/intact
    +[**Last Name (un) 938**]/FHL/AT
    +SILT
    2+ pulse, wiggles toes
    Capillary refill brisk

Brief Hospital Course:
Ms. [**Known lastname 70391**] presented to the Emergency Department from [**Hospital3 **]
Hospital with bilateral leg pain. She was evaluated by the
Orthopaedics department and found to have bilateral
periprostetic femur fractures. She is s/p Bilateral total hip
replacements. Reduction was attempted, but unsucessful. She was
placed in bilateral leg braces for stabilization. She was
admitted to the medicine service and cleared for surgery. On
[**2175-2-2**], she was prepped and brought down to the operating room
for surgery. Intra-operatively, she was closely monitored and
remained hemodynamically stable. She tolerated the procedure
well without any difficulty or complication. Post-operatively,
she was extubated and transferred to the PACU for further
stabilization and monitoring. She was then transferred to the
floor for further recovery. On POD #1, she was transfused 2
units of PRBC for postoperative anemia. She then remained
hemodynamically stable and her pain was controlled. She
progressed with physical therapy to improve her strength and
mobility. She continues to make steady progress without any
incidents. She was discharged to a rehabilitation facility in
stable condition. She was instructed to call Dr.[**Name (NI) 4016**]
office at [**Telephone/Fax (1) 1228**] for a follow up appointment in 2 weeks
after hospital discharge.


Medications on Admission:
Buspirone
Aspirin
Fosamax
Synthroid
Darvocet
Keppra
MVI
Effexor XR
Prevacid
Norvasc
Pancrease

Discharge Medications:
1. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
2. Levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Venlafaxine 75 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO DAILY (Daily).
4. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID W/MEALS (3 TIMES A DAY WITH MEALS).
5. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
6. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H
(every 4 to 6 hours) as needed.
7. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4
to 6 hours) as needed for pain.
8. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours).
9. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
10. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
11. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
12. Enoxaparin 30 mg/0.3 mL Syringe Sig: One (1) syringe
Subcutaneous Q24H (every 24 hours) for 4 weeks.
13. Insulin Regular Human 100 unit/mL Solution Sig: SSIR
Injection ASDIR (AS DIRECTED).
14. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours).
15. Buspirone 5 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day) as needed for Anxiety.
16. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 599**] Senior Healthcare of [**Location (un) **]

Discharge Diagnosis:
Bilateral periprosthetic femur shaft fractures


Discharge Condition:
Stable


Discharge Instructions:
Keep the incision clean and dry. You may apply a dry sterile
dressing as needed for drainage or comfort.
If you are experiencing any increased redness, swelling, pain,
or have a temperature >101.5, please call your doctor or go to
the emergency room for evaluation.
You may not bear weight on either leg.
Your skin staples/sutures may be removed 2 weeks after surgery.
Resume all of your home medication and take all medication as
prescribed by your doctor.
Continue your Lovenox injections as prescribed for preventing
blood clots.
Please call Dr.[**Name (NI) 4016**] office @ [**Telephone/Fax (1) 1228**] for a follow
up appointment in 2 weeks after hospital discharge.
Feel free to call our office with any questions or concerns.
Physical Therapy:
Activity:  Out of bed w/ assist
 Right lower extremity:  Non weight bearing x8wks
 Left lower extremity:  Non weight bearing x8wks

Treatments Frequency:
As stated above

Followup Instructions:
Please call Dr.[**Name (NI) 4016**] office for a follow-up appointment 2
week after hospital discharge.


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

Completed by:[**2175-2-8**]
{'Peri-prosthetic fracture around prosthetic joint,Other convulsions,Chronic kidney disease, unspecified,Urinary tract infection, site not specified,Fall from other slipping, tripping, or stumbling,Unspecified essential hypertension,Osteoporosis, unspecified,Unspecified acquired hypothyroidism,Dysthymic disorder,Unspecified late effects of cerebrovascular disease,Hip joint replacement'}


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: Bilateral femoral periprosthetic shaft fractures

PRESENT ILLNESS: Ms. [**Known lastname 70391**] is a 73-year-old female patient who fell from
standing resulting in bilateral femur fractures which were
periprosthetic. On the left side, she has a hip hemiarthroplasty
and total knee, and on the right side she has a hip
hemiarthroplasty. The presence of implants precludes the
performance of intramedullary nailing. The procedure of choice
at this point is plating which we will perform through a
percutaneous technique in order to minimize the morbidity to
this elderly and very frail patient.

MEDICAL HISTORY: CVA 2.5yrs ago
Seizure disorder
h/o Urosepsis/UTI
Hypertension
Osteoporosis
Pancreatic insufficiency
h/o Depression/anxiety
h/o alcoholic liver disease
Hypothyroidism
Chronic renal insufficiency - baseline CRE 1.4-1.8
h/o Hyperkalemia
h/o Amenia

MEDICATION ON ADMISSION: Buspirone
Aspirin
Fosamax
Synthroid
Darvocet
Keppra
MVI
Effexor XR
Prevacid
Norvasc
Pancrease

ALLERGIES: Morphine

PHYSICAL EXAM: On discharge:

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Non-contributory 

### Response:
{'Peri-prosthetic fracture around prosthetic joint,Other convulsions,Chronic kidney disease, unspecified,Urinary tract infection, site not specified,Fall from other slipping, tripping, or stumbling,Unspecified essential hypertension,Osteoporosis, unspecified,Unspecified acquired hypothyroidism,Dysthymic disorder,Unspecified late effects of cerebrovascular disease,Hip joint replacement'}
