falan42/nurse_detection huggingface dataset:
Sleep Apnea 

REASON FOR VISIT: , Mr. ABC is a 30-year-old man who returns in followup of his still moderate-to-severe sleep apnea.  He returns today to review his response to CPAP.,HISTORY OF PRESENT ILLNESS: , The patient initially presented with loud obnoxious snoring that disrupted the sleep of his bed partner.  He was found to have moderate-to-severe sleep apnea (predominantly hypopnea), was treated with nasal CPAP at 10 cm H2O nasal pressure.  He has been on CPAP now for several months, and returns for followup to review his response to treatment.,The patient reports that the CPAP has limited his snoring at night.  Occasionally, his bed partner wakes him in the middle of the night, when the mask comes off, and reminds him to replace the mask.  The patient estimates that he uses the CPAP approximately 5 to 7 nights per week, and on occasion takes it off and does not replace the mask when he awakens spontaneously in the middle of the night.,The patient's sleep pattern consists of going to bed between 11:00 and 11:30 at night and awakening between 6 to 7 a.m. on weekdays.  On weekends, he might sleep until 8 to 9 a.m.  On Saturday night, he might go to bed approximately mid night.,As noted, the patient is not snoring on CPAP.  He denies much tossing and turning and does not awaken with the sheets in disarray.  He awakens feeling relatively refreshed.,In the past few months, the patient has lost between 15 and 18 pounds in combination of dietary and exercise measures.,He continues to work at Smith Barney in downtown Baltimore.  He generally works from 8 to 8:30 a.m. until approximately 5 to 5:30 p.m.  He is involved in training purpose to how to sell managed funds and accounts.,The patient reports no change in daytime stamina.  He has no difficulty staying awake during the daytime or evening hours.,The past medical history is notable for allergic rhinitis.,MEDICATIONS: , He is maintained on Flonase and denies much in the way of nasal symptoms.,ALLERGIES: , Molds.,FINDINGS:  ,Vital signs:  Blood pressure 126/75, pulse 67, respiratory rate 16, weight 172 pounds, height 5 feet 9 inches, temperature 98.4 degrees and SaO2 is 99% on room air at rest.,The patient has adenoidal facies as noted previously.,Laboratories:  The patient forgot to bring his smart card in for downloading today.,ASSESSMENT: , Moderate-to-severe sleep apnea.  I have recommended the patient continue CPAP indefinitely.  He will be sending me his smart card for downloading to determine his CPAP usage pattern.  In addition, he will continue efforts to maintain his weight at current levels or below.  Should he succeed in reducing further, we might consider re-running a sleep study to determine whether he still requires a CPAP.,PLANS: , In the meantime, if it is also that the possible nasal obstruction is contributing to snoring and obstructive hypopnea.  I have recommended that a fiberoptic ENT exam be performed to exclude adenoidal tissue that may be contributing to obstruction.  He will be returning for routine followup in 6 months.general medicine, daytime stamina, fiberoptic ent exam, moderate to severe, smart card, sleep apnea, cpap, apnea, sleep,
Right Hand Laceration 

HISTORY: , The patient is a 19-year-old male who was involved in a fight approximately an hour prior to his ED presentation.  He punched a guy few times on the face, might be the mouth and then punched a drinking glass, breaking it and lacerating his right hand.  He has three lacerations on his right hand.  His wound was cleaned out thoroughly with tap water, and one of the navy corpsman tried to use Superglue and gauze to repair it.  However, it continues to bleed and he is here for evaluation.,PAST MEDICATION HISTORY:,  Significant for asthma and acne.,CURRENT MEDICATIONS: , Accutane and takes no other medications.,TETANUS STATUS: , Up-to-date.,SOCIAL HISTORY: , He is a nonsmoker.  He has been drinking alcohol today, but has no history of alcohol or drug abuse.,REVIEW OF SYSTEMS: , Otherwise well.  No febrile illness.  No motor or sensory complaints of any sort or paresthesias in the hand.,PHYSICAL EXAM:  ,GENERAL:  He is in no apparent distress.  He is alert and oriented x3.  Mental status is clear and appropriate.  VITALS SIGNS:  Temperature is 98.3, heart rate 100, respirations 18, blood pressure 161/98, oxygen saturation 99% on room air by pulse oximetry, which is normal.  EXTREMITIES:  Right hand, he has three lacerations all over the MCP joint of his right hand, irregular shaped over the fifth MCP and then over the fourth and third half wound, similarly the lacerations.  All total approximately 4 cm in length.  I see no foreign bodies, just capillary refills less than 2 seconds.  Radial pulses intact.  There is full range of motion with no gross deformities.  No significant amount of edema associated with these in the dorsum of the hand.,STUDIES: , X-rays shows no open fracture or bony abnormality.,EMERGENCY DEPARTMENT COURSE:  ,The patient was anesthetized with 1% Xylocaine.  Wounds were thoroughly irrigated with tap water with at least 2 liters.  They were repaired with simple sutures of 4-0 Ethilon, total of 17 sutures, 16 of which were simple, one is a horizontal mattress.  The patient was given Augmentin 875 mg p.o. due to the possibility of human bite wound.,ASSESSMENT: , RIGHT HAND LACERATIONS, SIMPLE X3, REPAIRED AS DESCRIBED.  NO SIGNS OF BONY ABNORMALITY OR FOREIGN BODY.,PLAN:  ,The patient will be given Augmentin 875 mg 1 p.o. b.i.d. for 7 days.  He will be given a prescription of Vicoprofen as he is unable to tolerate the Tylenol due to his Accutane.  He will take 1 p.o. every 6 hours or as needed, #12.  He will follow up for suture removal in 8 days.  Should he develop any signs of infection, he will come immediately here for reevaluation.  He is discharged in stable condition.,general medicine, accutane, hand laceration, laceration, hand,
Revocation Admission 

IDENTIFYING DATA:,  This is a 40-year-old male seen today for a 90-day revocation admission.  He had been reported by his case manager as being noncompliant with medications, refusing oral or IM medications, became agitated, had to be taken to ABCD for evaluation, admitted at that time to auditory hallucinations and confusion and was committed for admission at this time.  He has a psychiatric history of schizophrenia, was previously admitted here at XYZ on 12/19/2009, had another voluntary admission in ABCD in 1998.,MEDICATIONS: , Listed as Invega and Risperdal.,ALLERGIES: , None known to medications.,PAST MEDICAL HISTORY:  ,The only identified problem in his chart is that he is being treated for hyperlipidemia with gemfibrozil.  The patient is unaware and cannot remember what medications he had been taking or whether he had been taking them at all as an outpatient.,FAMILY HISTORY: , Listed as unknown in the chart as far as other psychiatric illnesses.  The patient himself states that his parents are deceased and that he raised himself in the Philippines.,SOCIAL HISTORY:,  He immigrated to this country in 1984, although he lists himself as having a green card still at this time.  He states he lives on his own.  He is a single male with no history of marriage or children and that he had high school education.  His recreational drug use in the chart indicates that he has had a history of methamphetamines.  The patient denies this at this time.  He also denies current alcohol use.  He does smoke.  He is unable to tell me of any PCP.  He is in counseling service with his case manager being XYZ.,LEGAL HISTORY:  ,  He had an assault in December 2009, which led to his previous detention.  It is unknown whether he is under legal constraints at this time.,OBJECTIVE FINDINGS:  ,VITAL SIGNS: , Blood pressure is 125/75.  His weight is 197 with height 5 feet 4 inches.,GENERAL:,  He is cooperative, although disorganized and focusing entirely and telling me that he is here because there was some confusion in how he took his medications.  He does not endorse any voices at this time.,HEENT: , His head exam is normal with normal scalp.  HEENT is unremarkable.  Pupils equal and reactive to light and accommodation.  TMs are normal.,NECK:,  Unremarkable with no masses or tenderness.,CARDIOVASCULAR:,  Normal S1 and S2.  No murmurs.,LUNGS:,  Clear.,ABDOMEN:  ,Negative with no scars.,GU:  ,Not done.,RECTAL:,  Not done.,DERM:,  He does have a scarring of acne lesions, both face and back.,EXTREMITIES:,  Otherwise negative.,NEUROLOGIC: , Cranial nerves II through X normal.  Reflexes are normal and gait is unremarkable.,LABORATORY DATA: , His labs done at ABCD showed his CMP to be normal with an elevated white count of 17.2.  Chest x-ray was indicated as being done and normal as was a UA and he did apparently receive hydration in the hospital with IV fluids.,ASSESSMENT: , History of hyperlipidemia with elevated triglycerides.  We will maintain his gemfibrozil 600 b.i.d. and for health maintenance issues, we will also maintain just a vitamin daily and we will obtain recheck on his labs and lipid levels in one week after treatment is initiated.nan
Recurrent Abscesses - Consult 

REASON FOR CONSULTATION: , Recurrent abscesses in the thigh, as well as the pubic area for at least about 2 years.,HISTORY OF PRESENT ILLNESS:,  A 23-year-old female who is approximately 5 months' pregnant, who has had recurrent abscesses in the above-mentioned areas.  She would usually have pustular type of lesion that would eventually break and would be quite painful.  The drainage would be malodorous.  It would initially not be infected as far as she knows, but then could eventually become infected.  She stated that this first started after she had her first born about 2 years ago.  She had recurrences of these abscesses and had pain, actually hospitalized at Hospital approximately a year and a half ago for about 1-1/2 months.  She was treated with multiple courses of antibiotics.  She had biopsies done.  She was seen by Dr. X.  Reportedly, she had a HIV test done that was negative.  She had been seen by a dermatologist who said that she had a problem with her sweat glands.  She has been on multiple courses of antibiotics.  She never had any fevers.  She has pain, drainage, and reportedly there was some bleeding in the area of the perineum/vaginal area.,PAST MEDICAL HISTORY:,1.  History of recurrent abscesses in the perineum, upper medial thigh, and the vulva area for about 2 years.  Per her report, a dermatologist had told her that she had an overactive sweat gland, and I believe she probably has hidradenitis suppurativa.  Probably, she has had Staphylococcus infection associated with it as well.,2.  Reported history of asthma.,GYNECOLOGIC HISTORY: , G3, P1.  She is currently 5 months' pregnant.,ALLERGIES: , None.,MEDICATIONS: , Her medication had been Augmentin.,SOCIAL HISTORY: , She is followed by a gynecologist in Bartow.  She is not an alcohol or tobacco user.  She is not married.  She has a 2-year-old child.,FAMILY HISTORY:  ,Noncontributory.,REVIEW OF SYSTEMS: , The patient has been complaining of diarrhea about 5 or 6 times a day for several weeks now.,PHYSICAL EXAMINATION,GENERAL:nan
Post Thyroidectomy - Discharge Summary 

ADMISSION DIAGNOSIS: , Symptomatic thyroid goiter.,DISCHARGE DIAGNOSIS:  ,Symptomatic thyroid goiter.,PROCEDURE PERFORMED DURING THIS HOSPITALIZATION: , Total thyroidectomy.,INDICATIONS FOR THE SURGERY:  ,Briefly, the patient is a 71-year-old female referred with increasingly symptomatic large nodular thyroid goiter.  She presented now after informed consent for the above procedure, understanding the inherent risks and complications and risk-benefit ratio.,HOSPITAL COURSE:  ,The patient underwent total thyroidectomy on 09/22/08, which she tolerated very well and remained stable in the postoperative period.  On postoperative day #1, she was tolerating her diet, began on thyroid hormone replacement, and remained afebrile with stable vital signs.  She required intravenous narcotics for pain control.  She was judged stable for discharge home on 09/25/08, tolerating a diet well, having no fever, stable vital signs, and good pain control.  The wound was clean and dry.  The drain was removed.  She was instructed to follow up in the surgical office within one week after discharge.  She was given prescription for Vicodin for pain and Synthroid thyroid hormone, and otherwise the appropriate wound care instructions per my routine wound care sheet.general medicine, nodular, symptomatic thyroid goiter, thyroidectomy, goiter,
Refractory Hypertension - Followup 

PROBLEM LIST:,1.  Refractory hypertension, much improved.,2.  History of cardiac arrhythmia and history of pacemaker secondary to AV block.,3.  History of GI bleed in 1995.,4.  History of depression.,HISTORY OF PRESENT ILLNESS:,  This is a return visit to the renal clinic for this patient.  She is an 85-year-old woman with history as noted above.  Her last visit was approximately four months ago.  Since that time, the patient has been considerably more compliant with her antihypertensive medications and actually had a better blood pressure reading today than she had had for many visits previously.  She is not reporting any untoward side effect.  She is not having weakness, dizziness, lightheadedness, nausea, vomiting, constipation, diarrhea, abdominal pain, chest pain, shortness of breath or difficulty breathing.  She has no orthopnea.  Her exercise capacity is about the same.  The only problem she has is musculoskeletal and that pain in the right buttock, she thinks originating from her spine.  No history of extremity pain.,CURRENT MEDICATIONS:,1.  Triamterene/hydrochlorothiazide 37.5/25 mg.,2.  Norvasc 10 mg daily.,3.  Atenolol 50 mg a day.,4.  Atacand 32 mg a day.,5.  Cardura 4 mg a day.,PHYSICAL EXAMINATION:,VITAL SIGNS:  Temperature 36.2, pulse 47, respirations 16, and blood pressure 157/56.  THORAX:  Revealed lungs that are clear, PA and lateral without adventitious sounds.  CARDIOVASCULAR:  Demonstrated regular rate and rhythm.  S1 and S2 without murmur.  No S3.  I could not hear murmur today.  ABDOMEN:  Above plane, but nontender.  EXTREMITIES:  Revealed no edema.,ASSESSMENT:,  This is a return visit for this patient who has refractory hypertension.  This seems to be doing very well given her current blood pressure reading, at least much improved from what she had been previously.  We had discussed with her in the past beginning to see an internist at the senior center.  She apparently had an appointment scheduled and it was missed.  We are going to reschedule that today given her overall state of well-being and the fact that she has no evidence of GFR that is greater than 60%.,PLAN: , The plan will be for her to follow up at the senior center for her routine health care, and should the need arise for further management of blood pressure, a referral back to us.  In the meantime, we will discharge her from our practice.  Should there be confusion or difficulty getting in the senior center, we can always see her back in followupgeneral medicine, cardiac arrhythmia, av block, refractory hypertension, blood pressure, pacemaker, atenolol, arrhythmia
Perioperative Elevated Blood Pressure 

REASON FOR CONSULTATION:,  Perioperative elevated blood pressure.,PAST MEDICAL HISTORY:,1.  Graves disease.,2.  Paroxysmal atrial fibrillation, has been in normal sinus rhythm for several months, off medication.,3.  Diverticulosis.,4.  GERD.,5.  High blood pressure.,6.  Prostatic hypertrophy, status post transurethral resection of the prostate.,PAST SURGICAL HISTORY: , Bilateral inguinal hernia repair, right shoulder surgery with reconstruction, both shoulders rotator cuff repair, left knee arthroplasty, and transurethral resection of prostate.,HISTORY OF PRESENTING COMPLAINT:  ,This 71-year-old gentleman with the above history, underwent laser surgery for the prostate earlier today.  Before surgery, the patient's blood pressure was 181/107.  The patient received IV labetalol.  Blood pressure improved, but postsurgery, the patient's blood pressure went up again to 180/100.  Currently, blood pressure is 158/100, goes up to 155 systolic when he is talking.  On further questioning, the patient denies shortness of breath, chest pain, palpitations, or dizziness.,REVIEW OF SYSTEMS:,CONSTITUTIONAL:  No recent fever or general malaise.,ENT:  Unremarkable.,RESPIRATORY:  No cough or shortness of breath.,CARDIOVASCULAR:  No chest pain.,GASTROINTESTINAL:  No nausea or vomiting.,GENITOURINARY:  The patient has prostatic hypertrophy, had laser surgery earlier today.,ENDOCRINE:  Negative for diabetes, but positive for Graves disease.,MEDICATIONS:  ,The patient takes Synthroid and aspirin.  Aspirin had been discontinued about 1 week ago.  He used to be on atenolol, lisinopril, and terazosin, both of which have been discontinued by his cardiologist, Dr. X several months ago.,PHYSICAL EXAMINATION:,GENERAL:  A 71-year-old gentleman, not in acute distress.,CHEST:  Clear to auscultation.,CARDIOVASCULAR:  First and second heart sounds were heard.  No murmur was appreciated.,ABDOMEN:  Benign.,EXTREMITIES:  There is no swelling.,NEUROLOGICAL:  The patient is alert and oriented x3.  Examination is nonfocal.,ASSESSMENT AND PLAN:,1.  Perioperative hypertension.  We will restart lisinopril at half the previous dose.  He will be on 20 mg p.o. daily.  If blood pressure remains above systolic of 150 within 3 days, the patient should increase lisinopril to 40 mg p.o. daily.  The patient should see his primary physician, Dr. Y in 2 weeks' time.  If blood pressure, however, remains above 150 systolic despite 40 mg of lisinopril, the patient should make an appointment to see his primary physician in a week's time.,2.  Prostatic hypertrophy, status post laser surgery.  The patient tolerated the procedure well.,3.  History of Graves disease.,4.  History of atrial fibrillation.  The patient is in normal sinus rhythm.,DISPOSITION:  ,The patient is stable to be discharged to home.  Nurse should observe for 1 hour after lisinopril to make sure the blood pressure does not go too low.nan
Pressure decubitus 

CHIEF COMPLAINT:, Pressure decubitus, right hip.,HISTORY OF PRESENT ILLNESS:, This is a 30-year-old female patient presenting with the above chief complaint. She has a history of having had a similar problem last year which resolved in about three treatments. She appears to have residual from spina bifida, thus spending most of her time in a wheelchair. She relates recently she has been spending up to 16 hours a day in a wheelchair. She has developed a pressure decubitus on her right trochanter ischial area of several weeks' duration. She is now presenting for evaluation and management of same. Denies any chills or fever, any other symptoms.,PAST MEDICAL HISTORY:, Back closure for spina bifida, hysterectomy, breast reduction, and a shunt.,SOCIAL HISTORY:, She denies the use of alcohol, illicits, or tobacco.,MEDICATIONS:, Pravachol, Dilantin, Toprol, and Macrobid.,ALLERGIES:, SULFA AND LATEX.,REVIEW OF SYSTEMS:, Other than the above aforementioned, the remaining ROS is unremarkable.,PHYSICAL EXAMINATION:,GENERAL: A pleasant female with deformity of back.,HEENT: Head is normocephalic. Oral mucosa and dentition appear to be normal.,CHEST: Breath sounds equal and present bilateral.,CVS: Sinus.,GI: Obese, nontender, no hepatosplenomegaly.,EXTREMITIES: Deformity of lower extremities secondary to spina bifida.,SKIN: She has a full-thickness pressure decubitus involving the right hip which is 2 x 6.4 x 0.3, moderate amount of serous material, appears to have good granulation tissue.,PLAN:, Daily applications of Acticoat, pressure relief, at least getting out of the chair for half of the time, at least eight hours out of the chair, and we will see her in one week.,DIAGNOSIS:, Sequelae of spina bifida; pressure decubitus of right hip area.general medicine, pressure decubitus, acticoat, sequelae, breast reduction, decubitus, hysterectomy, ischial area, pressure, spina bifida, trochanter, wheelchair, bifida,
Pneumonia - Discharge Summary 

ADMISSION DIAGNOSES:,1.  Pneumonia, failed outpatient treatment.,2.  Hypoxia.,3.  Rheumatoid arthritis.,DISCHARGE DIAGNOSES:,1.  Atypical pneumonia, suspected viral.,2.  Hypoxia.,3.  Rheumatoid arthritis.,4.  Suspected mild stress-induced adrenal insufficiency.,HOSPITAL COURSE: , This very independent 79-year old had struggled with cough, fevers, weakness, and chills for the week prior to admission.  She was seen on multiple occasions at Urgent Care and in her physician's office.  Initial x-ray showed some mild diffuse patchy infiltrates.  She was first started on Avelox, but had a reaction, switched to Augmentin, which caused loose stools, and then three days prior to admission was given daily 1 g Rocephin and started on azithromycin.  Her O2 saturations drifted downward.  They were less than 88% when active; at rest, varied between 88% and 92%.  Decision was made because of failed outpatient treatment of pneumonia.  Her medical history is significant for rheumatoid arthritis.  She is on 20 mg of methotrexate every week as well as Remicade every eight weeks.  Her last dose of Remicade was in the month of June.  Hospital course was relatively unremarkable.  CT scan was performed and no specific focal pathology was seen.  Dr. X, pulmonologist was consulted.  He also was uncertain as to the exact etiology, but viral etiology was most highly suspected.  Because of her loose stools, C. difficile toxin was ordered, although that is pending at the time of discharge.  She was continued on Rocephin IV and azithromycin.  Her fever broke 18 hours prior to discharge, and O2 saturations improved, as did her overall strength and clinical status.  She was instructed to finish azithromycin.  She has two pills left at home.  She is to follow up with Dr. X in two to three days.  Because she is on chronic prednisone therapy, it was suspected that she was mildly adrenal insufficient from the stress of her pneumonia.  She is to continue the increased dose of prednisone at 20 mg (up from 5 mg per day).  We will consult her rheumatologist as to whether to continue her methotrexate, which we held this past Friday.  Methotrexate is known on some occasions to cause pneumonitis.general medicine, adrenal insufficiency, hypoxia, cough, fevers, weakness, chills, atypical pneumonia, loose stools, rheumatoid arthritis, azithromycin, arthritis, pneumonia,
Pyelonephritis - Discharge Summary 

ADMISSION DIAGNOSES:,1.  Pyelonephritis.,2.  History of uterine cancer and ileal conduit urinary diversion.,3.  Hypertension.,4.  Renal insufficiency.,5.  Anemia.,DISCHARGE DIAGNOSES:,1.  Pyelonephritis likely secondary to mucous plugging of indwelling Foley in the ileal conduit.,2.  Hypertension.,3.  Mild renal insufficiency.,4.  Anemia, which has been present chronically over the past year.,HOSPITAL COURSE:,  The patient was admitted with suspected pyelonephritis.  Renal was consulted.  It was thought that there was a thick mucous plug in the Foley in the ileal conduit that was irrigated by Dr. X.  Her symptoms responded to IV antibiotics and she remained clinically stable.  Klebsiella was isolated in this urine, which was sensitive to Bactrim and she was discharged on p.o.  Bactrim.  She was scheduled on 08/07/2007 for further surgery.  She is to follow up with Dr. Y in 7-10 days.  She also complained of right knee pain and the right knee showed no sign of effusion.  She was exquisitely tender to touch of the patellar tendon.  It was thought that this did not represent intraarticular process.  She was advised to use ibuprofen over-the-counter two to three tabs t.i.d.general medicine, uterine cancer, renal insufficiency, pyelonephritis, mucous plugging, ileal conduit