falan42/nurse_detection huggingface dataset:
Discharge Summary - 11 

ADMISSION DIAGNOSES: , Hyperglycemia, cholelithiasis, obstructive sleep apnea, diabetes mellitus, and hypertension.,DISCHARGE DIAGNOSES: , Hyperglycemia, cholelithiasis, obstructive sleep apnea, diabetes mellitus, hypertension, and cholecystitis.,PROCEDURE: , Laparoscopic cholecystectomy.,SERVICE: , Surgery.,HISTORY OF PRESENT ILLNESS:,  Ms. ABC is a 57-year-old woman.  She suffers from morbid obesity.  She also has diabetes and obstructive sleep apnea.  She was evaluated in the Bariatric Surgical Center for placement of a band.  During her workup, she was noted to have evidence of cholelithiasis.  It was felt that the patient would benefit from removal of her gallbladder prior to having band placement secondary to her diabetes and the risk of infection of the band.  The patient was scheduled to undergo her procedure on 12/31/09; however, at blood glucose check, the patient was noted to be hyperglycemic, her sugar was 438.  She was admitted to the hospital for treatment of her hyperglycemia.,HOSPITAL COURSE: , Ms. ABC was admitted to the hospital.  She was seen by Dr. A.  He put her on an insulin drip.  Her sugars slowly did come down to normal down to between 115 and 134.  On the next day, she was then taken to the operating room, where she underwent her laparoscopic cholecystectomy.  She was noted to be a difficult intubation for the procedure.  There were some indications of chronic cholecystitis, a little bit of edema, mild edema and adhesions of omentum around the gallbladder.  She underwent the procedure.  She tolerated without difficulty.  She was recovered in the Postoperative Care Unit and then returned to the floor.  Her blood sugar postprocedure was noted to be 233.  She was started back on a sliding scale insulin.  She continued to do well and was felt to be stable for discharge following the procedure.,DISCHARGE INSTRUCTIONS:  ,To return to the Medifast diet.  To continue with her blood glucose.  She needs to follow up with Dr. B, and she will see me next week on Friday.  We will determine if we will proceed with her lap band at that time.  She may shower.  She needs to keep her wounds clean and dry.  No heavy lifting.  No driving on narcotic pain medicines.  She needs to continue with her CPAP machine and continue to monitor her sugars.discharge summary, medifast, hyperglycemia, laparoscopic cholecystectomy, medifast diet, cholecystitis, cholelithiasis, diabetes mellitus, hypertension, morbid obesity, obstructive sleep apnea, sleep apnea, diabetes,
Death Summary - 2 

FINAL DIAGNOSES:,1.  Cardiac arrest.,2.  Severe congestive heart failure.,3.  Acute on chronic respiratory failure.,4.  Osteoporosis.,5.  Depression.,HISTORY OF PRESENT ILLNESS: , This 92-year-old lady with history of depression and chronic low back pain, osteoporosis, and congestive heart failure, was diagnosed having pneumonia approximately for at least 10 days prior to admission.  In the ER, she was given oral antibiotics.  She also saw me few days before admission coming for a followup.  She was doing fairly well.  She was thought to have congestive heart failure and she was advised to continue with her diuretics.  For the last few days, the patient started to have anorexia, she did not eat well, and she did not drink well.  Her family could not take care of her.  So, she was brought to the emergency room, where she was found to have rapid heart rate with a sinus tachycardia around 112 to 130s.  The ________ was found to be dry.  She was given 1 L of IV fluids and she was subsequently admitted in the hospital for further management.,COURSE IN THE HOSPITAL: , The patient stayed in the telemetry.  The patient had significant shortness of breath secondary to congestive heart failure with bilateral basilar crackles.  She was continued on IV antibiotics and general IV hydration was started initially because of low blood pressure and low perfusion status.  On subsequently improved and stopped and Lasix was started; Dr. X, cardiologist was also placed.  The patient's family wanted her to be a DNR and DNI.  They were allowing us to treat her aggressively medically for pneumonia and congestive heart failure.  However, the patient became extremely weak, mostly unresponsive.  At this time, the patient's family wanted a Hospice consult, which was requested.  By the time the Hospice could evaluate her, the patient's condition got deteriorated, she went into more bradycardiac and hypertension and subsequently expired.  Please see the hospital notes for complete details.discharge summary, bradycardiac, hypertension, hospice, congestive heart failure, cardiac arrest, respiratory failure,
Discharge Summary - 14 

HISTORY OF PRESENT ILLNESS: , The patient is a 60-year-old female patient who off and on for the past 10 to 12 months has had almost daily diarrhea, nausea, inability to eat.  She had an EGD and colonoscopy with Dr. ABC a few days prior to this admission.  Colonoscopy did reveal diverticulosis and EGD showed retained bile and possible gastritis.  Biopsies were done.  The patient presented to our emergency room for worsening abdominal pain as well as swelling of the right lower leg.,PAST MEDICAL HISTORY: , Extensive and well documented in prior charts.,PHYSICAL EXAMINATION: , Abdomen was diffusely tender.  Lungs clear.  Blood pressure 129/69 on admission.  At the time of admission, she had just a trace of bilateral lower edema.,LABORATORY STUDIES: , White count 6.7, hemoglobin 13, hematocrit 39.3.  Potassium of 3.2 on 08/15/2007.,HOSPITAL COURSE: , Dr. ABC apparently could not advance the scope into the cecum and therefore warranted a barium enema.  This was done and did not really show what the cecum on the barium enema.  There was some retained stool in that area and the patient had a somewhat prolonged hospital course on the remaining barium from the colon.  She did have some enemas.  She had persistent nausea, headache, neck pain throughout this hospitalization.  Finally, she did improve enough to the point where she could be discharged home.,DISCHARGE DIAGNOSIS: , Nausea and abdominal pain of uncertain etiology.,SECONDARY DIAGNOSIS:  ,Migraine headache.,COMPLICATIONS:  ,None.,DISCHARGE CONDITION: , Guarded.,DISCHARGE PLAN:  ,Follow up with me in the office in 5 to 7 days to resume all pre-admission medications.  Diet and activity as tolerated.discharge summary, diarrhea, nausea, inability to eat, egd, colonoscopy, biopsies, barium enema, cecum, barium, admission,
Death Summary - 1 

DISCHARGE DIAGNOSES:,1.  Advanced non-small cell lung carcinoma with left malignant pleural effusion status post chest tube insertion status post chemical pleurodesis.,2.  Respiratory failure secondary to above.,3.  Likely postobstructive pneumonia.,4.  Gastrointestinal bleed.,5.  Thrombocytopenia.,6.  Acute renal failure.,7.  Hyponatremia.,8.  Hypercalcemia, likely secondary to paraneoplastic syndrome from the non-small cell lung CA, possible metastases to the bones.,9.  Leukemoid reaction, likely secondary to malignancy.,10.  Elevated liver function tests.,HOSPITAL COURSE:,  This is a 53-year-old African American male patient of Dr. X who was admitted through the emergency room.  He has been having some right hip pain and cough.  The patient had a CT scan of the chest, which revealed a left pleural effusion, extensive mediastinal mass, left hilar adenopathy, causing complete obstruction of the left lower lobe and the lingula and the left pulmonary vein, and the multiple nodules on the right side of his chest.  These were all consistent with metastatic disease.  He was thus also a suspicion for osseous metastatic disease involving the right scapula with a left large pleural effusion.  The patient had severe shortness of breath, chest pain, a left-sided chest tube was inserted, and pleural effusion was positive for malignant cells.  The history of right hip pain could be secondary to metastatic disease.  The patient underwent bronchoscopy, which is positive for non-small cell lung CA.  The patient was seen by various consultants.  The patient underwent respiratory failure, requiring intubation, mechanical ventilatory support.  He was extubated, but had to be re-intubated because of respiratory failure.  Had a long discussion with the patient's wife and other family members.  The patient was seen by Dr. Y.  The patient was not in a condition to undergo any kind of chemotherapy, being on the ventilator.  The patient progressively got deteriorated.  The patient's family requested for DNR, withdrawal of the life support.  The patient was extubated, and he was pronounced expired on 08/21/08 at 01:40 hours.,I appreciate all consultants' input.discharge summary, dnr, pronounced expired, extubated, death summary, lung carcinoma, pleural effusion,
Discharge Summary - 16 

ADMISSION DIAGNOSIS: , Upper respiratory illness with apnea, possible pertussis.,DISCHARGE DIAGNOSIS: , Upper respiratory illness with apnea, possible pertussis.,COMPLICATIONS: , None.,OPERATIONS: , None,BRIEF HISTORY AND PHYSICAL: , This is a one plus-month-old female with respiratory symptoms for approximately a week prior to admission.  This involved cough, post-tussive emesis, questionable fever, but only 99.7.  Their usual doctor prescribed amoxicillin over the phone.  The coughing persisted and worsened.  She went to the ER, where sats were normal at baseline, but dropped into the 80s with coughing spells.  They did witness some apnea.  They gave some Rocephin, did some labs, and the patient was transferred to hospital.,PHYSICAL EXAMINATION: , On admission, GENERAL:  Well-developed, well-nourished baby in no apparent distress. HEENT:  There was some nasal discharge.  Remainder of the HEENT was normal.  LUNG:  Had few rhonchi.  No retractions.  No significant coughing or apnea during the admission physical.  ABDOMEN:  Benign.  EXTREMITIES:  Were without any cyanosis.,SIGNIFICANT LABS AND X-RAYS:  ,She had a CBC done Garberville, which showed a white count of 12.4, with a differential of 10 segs, 82 lymphs, 8 monos, hemoglobin of 15, hematocrit 42, platelets 296,000, and a normal BMP.  An x-ray was done and I do not have an official interpretation, but to the admitting physician, Dr. X it showed no significant infiltrate.  Well at hospital, she had a rapid influenza swab done, which was negative.  She had a rapid RSV done, which is still not in the chart, but I believe I was told that it was negative.  She also had a pertussis PCR swab done and a pertussis culture done, neither of which has result in the chart.  I do know that the pertussis culture proved to be negative.,CONSULTATION: , Public Health Department was notified of a case of suspected pertussis.,HOSPITAL COURSE: , The baby was afebrile.  Required no oxygen in the hospital.  Actually fed reasonably well.  Did have one episode of coughing with slight emesis.  Appeared basically quite well between episodes.  Had no apnea witnessed and after overnight observation, the parents were anxious to go home.  The patient was started on Zithromax in the hospital.,CONDITION AND TREATMENT: , The patient was in stable condition and good condition on exam at the time and was discharged home on Zithromax to be followed up in the office within a week.,INSTRUCTIONS TO PATIENT:,  Include usual diet and to follow up within a week, but certainly sooner if the coughing is worse and there is cyanosis or apnea again.discharge summary, emesis, cough, upper respiratory illness, respiratory illness, apnea, pertussis,
CVA - Discharge Summary 

DIAGNOSES ON ADMISSION,1.  Cerebrovascular accident (CVA) with right arm weakness.,2.  Bronchitis.,3.  Atherosclerotic cardiovascular disease.,4.  Hyperlipidemia.,5.  Thrombocytopenia.,DIAGNOSES ON DISCHARGE,1.  Cerebrovascular accident with right arm weakness and MRI indicating acute/subacute infarct involving the left posterior parietal lobe without mass effect.,2.  Old coronary infarct, anterior aspect of the right external capsule.,3.  Acute bronchitis with reactive airway disease.,4.  Thrombocytopenia most likely due to old coronary infarct, anterior aspect of the right external capsule.,5.  Atherosclerotic cardiovascular disease.,6.  Hyperlipidemia.,HOSPITAL COURSE: , The patient was admitted to the emergency room.  Plavix was started  in addition to baby aspirin.  He was kept on oral Zithromax for his cough.  He was given Xopenex treatment, because of his respiratory distress.  Carotid ultrasound was reviewed and revealed a 50 to 69% obstruction of left internal carotid.  Dr. X saw him in consultation and recommended CT angiogram.  This showed no significant obstructive lesion other than what was known on the ultrasound.  Head MRI was done and revealed the above findings.  The patient was begun on PT and improved.  By discharge, he had much improved strength in his right arm.  He had no further progressions.  His cough improved with oral Zithromax and nebulizer treatments.  His platelets also improved as well.  By discharge, his platelets was up to 107,000.  His H&H was stable at 41.7 and 14.6 and his white count was 4300 with a normal differential.  Chest x-ray revealed a mild elevated right hemidiaphragm, but no infiltrate.  Last chemistry panel on December 5, 2003, sodium 137, potassium 4.0, chloride 106, CO2 23, glucose 88, BUN 17, creatinine 0.7, calcium was 9.1.  PT/INR on admission was 1.03, PTT 34.7.  At the time of discharge, the patient's cough was much improved.  His right arm weakness has much improved.  His lung examination has just occasional rhonchi.  He was changed to a metered dose inhaler with albuterol.  He is being discharged home.  An echocardiogram revealed mild concentric LVH with normal left ventricular function with an EF of 57%, moderate left atrial enlargement and diastolic dysfunction with mild mitral regurgitation.  He will follow up in my office in 1 week.  He is to start PT and OT as an outpatient.  He is to avoid driving his car.  He is to notify, if further symptoms.  He has 2 more doses of Zithromax at home, he will complete.  His prognosis is good.discharge summary, subacute infarct, atherosclerotic cardiovascular disease, cerebrovascular accident, coronary infarct, external capsule, cva, cerebrovascular, mri, bronchitis, cardiovascular, xopenex, atherosclerotic, accident
Death Summary 

CAUSE OF DEATH:,1.  Acute respiratory failure.,2.  Chronic obstructive pulmonary disease exacerbation.,SECONDARY DIAGNOSES:,1.  Acute respiratory failure, probably worsened by aspiration.,2.  Acute on chronic renal failure.,3.  Non-Q wave myocardial infarction.,4.  Bilateral lung masses.,5.  Occlusive carotid disease.,6.  Hypertension.,7.  Peripheral vascular disease.,HOSPITAL COURSE:  ,This 80-year-old patient with a history of COPD had had recurrent admissions over the past few months.  The patient was admitted again on 12/15/08, after he had been discharged the previous day.  Came in with acute on chronic respiratory failure, with CO2 of 57.  The patient was in rapid atrial fibrillation.  RVR with a rapid ventricular response of 160 beats per minute.  The patient was on COPD exacerbation and CHF due to rapid atrial fibrillation.  The patient's heart rate was controlled with IV Cardizem.  Troponin was consistent with non-Q wave MI.  The patient was treated medically transfer to catheterize the patient to evaluate her coronary artery disease.  Echocardiogram showed normal ejection fraction, normal left and right side, but stage 3 restrictive physiology.  There was also prosthetic aortic valve.  The patient was admitted to Intensive Care Unit and was intubated.  Pulmonary was managed by Critical Care, Dr. X.,The patient was successfully extubated.  Was tapered from IV steroids and put on p.o. steroids.  The patient's renal function has stabilized with a creatinine of between 2.1 and 2.3.  There was contemplation as to whether left heart catheterization should proceed since Nephrology was concerned about the patient's renal status.  Wife decided catheterization should be canceled and the patient managed conservatively.  The patient was transferred to the telemetry floor.  While in telemetry floor, the patient's renal function started deteriorating, went up from 2.08 to 2.67 in two days.  The patient had nausea and vomiting.  Was unable to tolerate p.o.  Was put on cautious hydration.  The patient went into acute respiratory distress.  Intubation showed the patient had aspirated.  He was in acute respiratory failure with bronchospasms and exacerbation of COPD.  X-ray of chest did not show any infiltrate, but showed dilatation of the stomach.  The patient was transferred to the Intensive Care Unit because of acute respiratory failure, was intubated by Critical Care, Dr. X.  The patient was put on the vent.  Overnight, the patient's condition did not improve.  Continued to be severely hypoxic.,The patient expired on the morning of 12/24/08 from acute respiratory failure.discharge summary, myocardial infarction, intensive care unit, acute respiratory failure, death summary, atrial fibrillation, renal function, telemetry floor, respiratory failure, death, chronic, exacerbation, infarction, respiratory
Cognitive Linguistic Impairment - Discharge 

DIAGNOSIS: , Cognitive linguistic impairment secondary to stroke.,NUMBER OF SESSIONS COMPLETED:,  5,HOSPITAL COURSE:  ,The patient is a 73-year-old female who was referred to Medical Center's Outpatient Rehabilitation Department for skilled speech therapy secondary to cognitive linguistic deficits.  Based on the initial evaluation completed 12/29/08, the patient had mild difficulty with generative naming and auditory comprehension and recall.  The patient's skilled speech therapy was recommended for three times a week for 8 weeks to improve her overall cognitive linguistic abilities.  At this time, the patient has accomplished all 5 of her short-term therapy goals.  She is able to complete functional mass tasks with 100% accuracy independently.  She is able to listen to a narrative and recall the main idea plus at least five details after a 10 minute delay independently.,She is able to read a newspaper article and recall the main idea plus five details after a 15 minute delay independently.  She is able to state 15 items in a broad category within a minute and a half independently.  The patient is also able to complete deductive reasoning tasks to promote her mental flexibility with 100% accuracy independently.  The patient also met her long-term therapy goal of functional cognitive linguistic abilities to return to teaching and improve her independence and safety at home.  The patient is no longer in need of skilled speech therapy and is discharged from my services.  She did quite well in therapy and also agreed with this discharge.discharge summary, stroke, linguistic deficits, speech therapy, skilled speech therapy, linguistic impairment, cognitive linguistic, cognitive, linguistic,
Discharge Summary 

DISCHARGE DIAGNOSES:,1.  Acute respiratory failure, resolved.,2.  Severe bronchitis leading to acute respiratory failure, improving.,3.  Acute on chronic renal failure, improved.,4.  Severe hypertension, improved.,5.  Diastolic dysfunction.,X-ray on discharge did not show any congestion and pro-BNP is normal.,SECONDARY DIAGNOSES:,1.  Hyperlipidemia.,2.  Recent evaluation and treatment, including cardiac catheterization, which did not show any coronary artery disease.,3.  Remote history of carcinoma of the breast.,4.  Remote history of right nephrectomy.,5.  Allergic rhinitis.,HOSPITAL COURSE:, This 83-year-old patient had some cold symptoms, was treated as bronchitis with antibiotics.  Not long after the patient returned from Mexico, the patient started having progressive shortness of breath, came to the emergency room with severe bilateral wheezing and crepitations.  X-rays however did not show any congestion or infiltrates and pro-BNP was within normal limits.  The patient however was hypoxic and required 4L nasal cannula.  She was admitted to the Intensive Care Unit.  The patient improved remarkably over the night on IV steroids and empirical IV Lasix.  Initial swab was positive for MRSA colonization., ,Discussed with infectious disease, Dr. X and it was decided no treatment was required for de-colonization.  The patient's breathing has improved.  There is no wheezing or crepitations and O2 saturation is 91% on room air.  The patient is yet to go for exercise oximetry.  Her main complaint is nasal congestion and she is now on steroid nasal spray.  The patient was seen by Cardiology, Dr. Z, who advised continuation of beta blockers for diastolic dysfunction.  The patient has been weaned off IV steroids and is currently on oral steroids, which she will be on for seven days.,DISPOSITION: , The patient has been discharged home.,DISCHARGE MEDICATIONS:,1.  Metoprolol 25 mg p.o. b.i.d.,2.  Simvastatin 20 mg p.o. daily.,NEW MEDICATIONS:,1.  Prednisone 20 mg p.o. daily for seven days.,2.  Flonase nasal spray daily for 30 days.,Results for oximetry pending to evaluate the patient for need for home oxygen.,FOLLOW UP:,  The patient will follow up with Pulmonology, Dr. Y in one week's time and with cardiologist, Dr. X in two to three weeks' time.discharge summary, acute respiratory failure, bronchitis, acute on chronic renal failure, severe hypertension, diastolic dysfunction, cold symptoms, iv steroids, nasal spray, nasal, steroids,
Cholestasis Of Pregnancy  

FINAL DIAGNOSES:,  Delivered pregnancy, cholestasis of pregnancy, fetal intolerance to labor, failure to progress.,PROCEDURE: , Included primary low transverse cesarean section.,SUMMARY: , This 32-year-old gravida 2 was induced for cholestasis of pregnancy at 38-1/2 weeks.  The patient underwent a 2-day induction.  On the second day, the patient continued to progress all the way to the point of 9.5 cm at which point, she failed to progress.  During the hour or two of evaluation at 9.5 cm, the patient was also noted to have some fetal tachycardia and an occasional late deceleration.  Secondary to these factors, the patient was brought to the operative suite for primary low transverse cesarean section, which she underwent without significant complication.  There was a slightly enlarged blood loss at approximately 1200 mL, and postoperatively, the patient was noted to have a very mild tachycardia coupled with 100.3 degrees Fahrenheit temperature right at delivery.  It was felt that this was a sign of very early chorioamnionitis and therapeutic antibiotics were given throughout her stay.  The patient received 72 hours of antibiotics with there never being a temperature above 100.3 degrees Fahrenheit.  The maternal tachycardia resolved within a day.  The patient did well throughout the 3-day stay progressing to full diet, regular bowel movements, normal urination patterns.  The patient did receive 2 units of packed red cells on Sunday when attended to by my partner secondary to a hematocrit of 20%.  It should be noted, however, that this was actually an expected result with the initial hematocrit of 32% preoperatively.  Therefore, there was anemia but not an unexplained anemia.,PHYSICAL EXAMINATION ON DISCHARGE: , Includes the stable vital signs, afebrile state.  An alert and oriented patient who is desirous at discharge.  Full range of motion, all extremities; fully ambulatory.  Pulse is regular and strong.  Lungs are clear and the abdomen is soft and nontender with minimal tympany and a nontender fundus.  The incision is beautiful and soft and nontender.  There is scant lochia and there is minimal edema.,LABORATORY STUDIES: , Include hematocrit of 27% and the last liver function tests was within normal limits 48 hours prior to discharge.,FOLLOWUP: , For the patient includes pelvic rest, regular diet.  Follow up with me in 1 to 2 weeks.  Motrin 800 mg p.o. q.8h. p.r.n. cramps, Tylenol No.  3 one p.o. q.4h. p.r.n. pain, prenatal vitamin one p.o. daily, and topical triple antibiotic to incision b.i.d. to q.i.d.discharge summary, delivered pregnancy, fetal intolerance, induction, pelvic rest, low transverse cesarean section, cholestasis of pregnancy, cesarean section, pregnancy, fetal, tachycardia, cholestasis