CHIEF COMPLAINT: 1. Altered mental status
2. Hypoxemic respiratory failure
3. Hypotension

PRESENT ILLNESS: [**Age over 90 **]-year-old Russian-speaking female with a history of HTN, CRI,
chronic nephrolithiasis, who presents with hypoxemic respiratory
failure. She was in her USOH at the [**Hospital3 2558**] nursing home
when she was found with a RR of 8, unresponsive, SBP 70's, O2Sat
75%. She was intubated by EMS on the scene. No CPR was needed.
In the ED found to have a right mainstem intubation so her ETT
was drawn back. Large amount of thick sputum noted. In ED, BP
70/30, AC 400x16 100% PEEP 5 and 100%. Got Levo and flagyl
empirically.
Initial WBC 10K , Hct 29.9. U/A revealed many bacteria, w/ >50
WBC's.

MEDICAL HISTORY: 1. Hypertension
2. Chronic renal insufficiency
3. Type II diabetes mellitus
4. Chronic low back pain
5. Nephrolithiasis

MEDICATION ON ADMISSION: 1. Amaryl
2. Cozaar
3. Imdur
4. Detrol
5. Cipro
6. Vioxx

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission:
VS: T 100.5 HR 87 BP 97/56 RR 16 sat 99% intubated
GEN: open eyes to command
HEENT: PERLA, NCAT, neck supple, ETT in place
CARDIO: S1S2, RRR, no m/r/g
PULM: CTAB anteriorly
[**Last Name (un) **]: soft, guarding
EXTR: DPPBL
NEURO: MAE

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: 1. Nursing home resident
Acute respiratory failure,Cerebral embolism with cerebral infarction,Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Atrial fibrillation,Unspecified septicemia,Candidiasis of mouth,Iron deficiency anemia secondary to blood loss (chronic),Acute kidney failure, unspecified,Severe sepsis,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Urinary incontinence, unspecified,Unspecified essential hypertension,Angiodysplasia of stomach and duodenum without mention of hemorrhage,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified disorder of kidney and ureter,Calculus of kidney,Malignant neoplasm of bladder, part unspecified,Aneurysm of heart (wall)
Acute respiratry failure,Crbl emblsm w infrct,Food/vomit pneumonitis,Urin tract infection NOS,Atrial fibrillation,Septicemia NOS,Thrush,Chr blood loss anemia,Acute kidney failure NOS,Severe sepsis,Late ef-hemplga side NOS,Urinary incontinence NOS,Hypertension NOS,Angio stm/dudn w/o hmrhg,DMII wo cmp nt st uncntr,Renal & ureteral dis NOS,Calculus of kidney,Malig neo bladder NOS,Aneurysm of heart
Admission Date:  [**2167-5-24**]              Discharge Date:   [**2167-6-11**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 898**]
Chief Complaint:
1. Altered mental status
2. Hypoxemic respiratory failure
3. Hypotension

Major Surgical or Invasive Procedure:
1. Bronchoscopy
2. Endotracheal intubation
3. PEG placement


History of Present Illness:
[**Age over 90 **]-year-old Russian-speaking female with a history of HTN, CRI,
chronic nephrolithiasis, who presents with hypoxemic respiratory
failure. She was in her USOH at the [**Hospital3 2558**] nursing home
when she was found with a RR of 8, unresponsive, SBP 70's, O2Sat
75%. She was intubated by EMS on the scene. No CPR was needed.
In the ED found to have a right mainstem intubation so her ETT
was drawn back. Large amount of thick sputum noted. In ED, BP
70/30, AC 400x16 100% PEEP 5 and 100%. Got Levo and flagyl
empirically.
Initial WBC 10K , Hct 29.9. U/A revealed many bacteria, w/ >50
WBC's.

Past Medical History:
1. Hypertension
2. Chronic renal insufficiency
3. Type II diabetes mellitus
4. Chronic low back pain
5. Nephrolithiasis

Social History:
1. Nursing home resident

Family History:
noncontributory

Physical Exam:
On admission:
VS: T 100.5 HR 87 BP 97/56 RR 16 sat 99% intubated
GEN: open eyes to command
HEENT: PERLA, NCAT, neck supple, ETT in place
CARDIO: S1S2, RRR, no m/r/g
PULM: CTAB anteriorly
[**Last Name (un) **]: soft, guarding
EXTR: DPPBL
NEURO: MAE

Pertinent Results:
[**2167-5-24**] 06:40PM   WBC-10.0 RBC-3.56* HGB-9.8* HCT-29.9* MCV-84
MCH-27.4 MCHC-32.7 RDW-15.6*
[**2167-5-24**] 06:40PM   PT-13.7* PTT-23.7 INR(PT)-1.2
[**2167-5-24**] 06:40PM   PLT COUNT-331
[**2167-5-24**] 06:53PM   GLUCOSE-188* LACTATE-1.9 NA+-142 K+-5.9*
CL--111 TCO2-22
[**2167-5-24**] 06:40PM   UREA N-20 CREAT-2.4*
[**2167-5-24**] 06:40PM   CK(CPK)-236* AMYLASE-39
[**2167-5-24**] 06:40PM   CK-MB-2 cTropnT-0.03*
[**2167-5-24**] 06:40PM   CALCIUM-8.4 PHOSPHATE-5.5*# MAGNESIUM-2.0
[**2167-5-24**] 07:00PM URINE  COLOR-Yellow APPEAR-Cloudy SP [**Last Name (un) 155**]-1.013
[**2167-5-24**] 07:00PM URINE  BLOOD-LGE NITRITE-NEG PROTEIN-30
GLUCOSE-100 KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-MOD
[**2167-5-24**] 07:00PM URINE  RBC->50 WBC->50 BACTERIA-MANY YEAST-NONE
EPI-0
##
CT [**Last Name (un) 103**]/pelvis [**5-24**]:
1) Limited study due to lack of oral and IV contrast. No obvious
perinephric abscess is seen. There is no evidence of small bowel
obstruction.
2) Right lower lobe opacity is most likely atelectasis, but
pneumonia cannot be excluded.
3) Small pericardial effusion.
4) Severe vascular calcifications.
5) Compression of the L1 vertebral body of indeterminate age.
##
CXR [**5-25**]:
The tip of the endotracheal tube is identified 3 cm above the
carina. A nasogastric tube terminates in the gastric body. There
is continued patchy opacity in the right lower lobe indicating
atelectasis and aspiration. The lungs are clear otherwise. The
heart and mediastinum are within normal limits. No pneumothorax
is identified.
##
RADIOLOGY  Final Report
MRA BRAIN W/O CONTRAST  [**2167-5-26**] 1:57 PM
MR HEAD W/O CONTRAST; MRA BRAIN W/O CONTRAST
Reason: Tip of basilar stroke?
[**Hospital 93**] MEDICAL CONDITION:
[**Age over 90 **] year old woman with left PCA acute infarct on CT,
unresponsive, intubated. Has flaccid right arm, moves the right
leg less than the left. Cannot breath over the vent.
REASON FOR THIS EXAMINATION:
Tip of basilar stroke?
CLINICAL INFORMATION: Left PCA stroke on CT. Unresponsive and
intubated ____ right arm.
MRI OF THE BRAIN.
Exam is compared to the patient's noncontrast head CT of [**2167-5-24**]
and also the MR study of [**2163-2-3**].
FINDINGS: There is abnormal diffusion in the inferior right
cerebellar hemisphere as well as focally in the left cerebellar
hemisphere. There is also abnormal signal in the left medial
occipital lobe and medial temporal lobe, all consistent with
infarction. In retrospect the right inferior cerebellar infarct
was present on the CT scan of [**2167-5-24**]. There is no evidence of
acute hemorrhage. On the susceptibility sequences compared to
the prior study of [**1-27**], there appears to be a new abnormal
focus in the medial left thalamus perhaps reflecting the
intercurrent petechial hemorrhage in this location. The
ventricles are unchanged in dimension. There is no evidence of a
focal extra-axial lesion or fluid collection. There is confluent
T2 high signal intensity signal in the periventricular white
matter and centrum semiovale, which is nonspecific but could
reflect microvascular angiopathy. There is a cystic lesion deep
to the left rectus capitis muscle which was not present on the
prior MR study of [**2163-2-3**]. This may be an unusual location of a
Tornwaldt cyst or possibly an inclusion cysts. No specific
evidence to suggest that this represents retroperitoneal
abscess.
IMPRESSION: Subacute infarcts involving the left cerebral
hemisphere and the cerebellum as described. Fluid collection
deep to the rectus capitis muscle see above discussion.
MRA OF THE CIRCLE OF [**Location (un) **] AND ITS MAJOR TRIBUTARIES.
FINDINGS: There is no evidence of aneurysm or flow abnormality.
The basilar artery is patent. The right posterior cerebral
artery is patent. The left posterior cerebral artery has
diminished signal and to be occluded or stenotic.
IMPRESSION: Reduced signal left posterior cerebral artery see
above discussion.
DR. [**First Name (STitle) 23303**] [**Doctor Last Name **]
Approved: [**Doctor First Name **] [**2167-5-28**] 12:53 PM
##

PATIENT/TEST INFORMATION:
Indication: Source of embolism.
Height: (in) 60
Weight (lb): 135
BSA (m2): 1.58 m2
BP (mm Hg): 134/70
HR (bpm): 72
Status: Inpatient
Date/Time: [**2167-5-27**] at 15:50
Test: Portable TTE (Complete)
Doppler: Full doppler and color doppler
Contrast: None
Tape Number: 2005W254-0:00
Test Location: West MICU
Technical Quality: Adequate


MRI OF THE BRAIN.

Exam is compared to the patient's noncontrast head CT of [**2167-5-24**]
and also the MR study of [**2163-2-3**].

FINDINGS: There is abnormal diffusion in the inferior right
cerebellar hemisphere as well as focally in the left cerebellar
hemisphere. There is also abnormal signal in the left medial
occipital lobe and medial temporal lobe, all consistent with
infarction. In retrospect the right inferior cerebellar infarct
was present on the CT scan of [**2167-5-24**]. There is no evidence of
acute hemorrhage. On the susceptibility sequences compared to
the prior study of [**1-27**], there appears to be a new abnormal
focus in the medial left thalamus perhaps reflecting the
intercurrent petechial hemorrhage in this location. The
ventricles are unchanged in dimension. There is no evidence of a
focal extra-axial lesion or fluid collection. There is confluent
T2 high signal intensity signal in the periventricular white
matter and centrum semiovale, which is nonspecific but could
reflect microvascular angiopathy. There is a cystic lesion deep
to the left rectus capitis muscle which was not present on the
prior MR study of [**2163-2-3**]. This may be an unusual location of a
Tornwaldt cyst or possibly an inclusion cysts. No specific
evidence to suggest that this represents retroperitoneal
abscess.

IMPRESSION: Subacute infarcts involving the left cerebral
hemisphere and the cerebellum as described. Fluid collection
deep to the rectus capitis muscle see above discussion.

MRA OF THE CIRCLE OF [**Location (un) **] AND ITS MAJOR TRIBUTARIES.

FINDINGS: There is no evidence of aneurysm or flow abnormality.
The basilar artery is patent. The right posterior cerebral
artery is patent. The left posterior cerebral artery has
diminished signal and to be occluded or stenotic.

IMPRESSION: Reduced signal left posterior cerebral artery see
above discussion.



REFERRING DOCTOR: DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

MEASUREMENTS:
Left Atrium - Long Axis Dimension: *4.7 cm (nl <= 4.0 cm)
Left Atrium - Four Chamber Length: 4.9 cm (nl <= 5.2 cm)
Right Atrium - Four Chamber Length: 4.6 cm (nl <= 5.0 cm)
Left Ventricle - Septal Wall Thickness: 1.0 cm (nl 0.6 - 1.1 cm)

Left Ventricle - Inferolateral Thickness: 1.0 cm (nl 0.6 - 1.1
cm)
Left Ventricle - Diastolic Dimension: 4.3 cm (nl <= 5.6 cm)
Left Ventricle - Ejection Fraction: 50% to 55% (nl >=55%)
Aorta - Valve Level: 3.2 cm (nl <= 3.6 cm)
Aorta - Ascending: 3.1 cm (nl <= 3.4 cm)
Aortic Valve - Peak Velocity: 1.6 m/sec (nl <= 2.0 m/sec)
Mitral Valve - E Wave: 0.7 m/sec
Mitral Valve - A Wave: 1.4 m/sec
Mitral Valve - E/A Ratio: 0.50
Mitral Valve - E Wave Deceleration Time: 310 msec
TR Gradient (+ RA = PASP): 24 mm Hg (nl <= 25 mm Hg)

INTERPRETATION:

Findings:

LEFT ATRIUM: Mild LA enlargement.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. Aneurysmal
interatrial
septum.

LEFT VENTRICLE: Normal LV wall thicknesses and cavity size.
Normal regional LV
systolic function. Low normal LVEF.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal aortic root diameter. Focal calcifications in
aortic root.
Normal ascending aorta diameter.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS.
Trace AR.

MITRAL VALVE: Normal mitral valve leaflets. Mild mitral annular
calcification.
Mild (1+) MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR. Normal PA
systolic pressure.

PERICARDIUM: Trivial/physiologic pericardial effusion.

GENERAL COMMENTS: Based on [**2158**] AHA endocarditis prophylaxis
recommendations,
the echo findings indicate a low risk (prophylaxis not
recommended). Clinical
decisions regarding the need for prophylaxis should be based on
clinical and
echocardiographic data.
Conclusions:
The left atrium is mildly dilated. The interatrial septum is
markedly
aneurysmal. No atrial septal defect is identified on color
Doppler. Left
ventricular wall thicknesses and cavity size are normal.
Regional left
ventricular wall motion is normal. Overall left ventricular
systolic function is low normal (LVEF 50%). Right ventricular
chamber size and free wall motion are normal. The aortic valve
leaflets (3) are mildly thickened but aortic stenosis is not
present. Trace aortic regurgitation is seen. The mitral valve
leaflets are structurally normal. Mild (1+) mitral regurgitation
is seen. The estimated pulmonary artery systolic pressure is
normal. There is a trivial/physiologic pericardial effusion.
IMPRESSION: Interatrial septal aneurysm. Low normal left
ventricular systolic function. Mild mitral regurgitation. Aortic
valve sclerosis.
Based on [**2158**] AHA endocarditis prophylaxis recommendations, the
echo findings indicate a low risk (prophylaxis not recommended).
Clinical decisions regarding the need for prophylaxis should be
based on clinical and echocardiographic data.
Electronically signed by [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4083**], MD on [**2167-5-27**]
16:50.
[**Location (un) **] PHYSICIAN: [**Name10 (NameIs) **],[**First Name3 (LF) **] J.
([**Numeric Identifier 32915**])
##
CHEST (PORTABLE AP)  [**2167-5-30**] 1:17 PM
CHEST (PORTABLE AP)
Reason: r/o pna
[**Hospital 93**] MEDICAL CONDITION:
[**Age over 90 **] year old woman intubated for hypoxic resp failure, new CVA,
RLL PNA and new fevers
REASON FOR THIS EXAMINATION:
r/o pna
INDICATION: Fever.
A developing density at the left base is noted since [**2167-5-25**].
The NGT terminates in the mid stomach and heart is enlarged.
Widening of the superior mediastinum on the right side remains
stable. The right lung is clear.
IMPRESSION: Developing density at the left base since
[**2167-5-25**]. Otherwise, no change in the chest.


Brief Hospital Course:
1) CVA - The patient presented after being found unresponsive.
A CT head was performed and revealed an "acute / sub acute
infarct in the left posterior cerebral artery distribution."
It was presumed that the patient may have suffered a new stroke
leading to a aspiration pneumonia. She remained intubated during
her short ICU stay as she remained minimally responsive off
sedation. The neurologists noted a left-sided weakness on their
exam and recommended a MRI/MRA scan to assess for the new stroke
which was confirmed acute and embolic.  The MR revealed
"subacute infarcts involving the left cerebral hemisphere and
the cerebellum" and the MRA revealed "left posterior cerebral
artery has diminished signal and to be occluded or stenotic."
She was placed on ASA and coumadin.  Given multiple areas of
infarction suspicion was for an embolic source.  A TTE was
performed which revealed a aneurysm of thje right atrial septum.
 This was presumed to be the source of the embolic strokes.  For
this reason coumadin was recommended and she reached an INR of
2.5.  However, ongoing hematuria limited coumadin therapy.
Eventually she needed to have the coumadin stopped and was
placed on ASA only.  After further discussion with Neurology,
she was placed on Aggrenox plus ASA 81mg daily.  However,
hematuria continued nonetheless, requiring another unit of blood
to be transfused.  Therefore, aggrenox was discontinued and she
was maintained on aspirin alone for secondary prophylaxis.  The
possibility of an increased risk of stroke with less
anticoagulation was conveyed to the daughter and HCP.  She
understood that the bleeding risk made more anticoaguation
impossible.  At time of discharge, her mental status had
improved some, but she demonstrated no movement of her right
side.

2) Respiratory failure - She presented with hypoxic respiratory
failure requiring intubation.  This was presumed to be due to
aspiration pneumonia following the CVA.  On day 2 of admission,
the patient underwent a bronchoscopy revealing pus in the right
lower lobe area. She was treated with levofloxacin and
metronidazole. She was eventually weaned off the ventilator.
She completed a 10 day course of Levo, Flagyl IV and was
oxygenating well on room air at time of discharge.

3) Altered mental status:
The patient's mental status was attributed to a combination of
infectious processes and medications, and multiple strokes.
Over her hospital course she showed slow improvement, eventually
speaking a few words in Russian prior to discharge.

4) UTI - treated with Levoquin

5) Nutrition - Given her poor mental status following
extubation, it was not safe to even attempt a speech and swallow
evaluation.  She was maintained on PPN for nutrition while the
family decided whether to pursue a feeding tube.  Ultimately
they decided to consent to a PEG.  She was started on tube feeds
per nutrition recommendations.  If her mental status improves
she should have an outpatient swallow evaluation prior to taking
any POs.

6) Hematuria - Patient has a history of bladder polyps that have
required cauterization.  Recently a large, fungating bladder
mass was found at an OSH.  Patient had persistent hematuria in
house requiring continuous bladder irrigation.  Coumadin was
held for this reason.  She required occassional blood
transfusion to maintain her HCT.  As mentioned above, the
continued hematuria with clots necessitated the reduction of her
anticoagulation to aspirin alone.  Urology was following and
stated that the patient will always have hematuria and that
prior attempts have been unsuccessful in reducing it.  They
stated that hematuria could be tolerated as long as there were
no large blood clots.  Eventually, the bleeding slowed and the
continuous irrigation was stopped.  She continued to have
bleeding, but no clots were observed and there was good UOP.
The foley was therefore discontinued and the patient maintained
good UOP and a stable HCT.  Although unlikely to occur, if her
urine output drops off then blood clot retention should be
considered.

7) Abdominal pain - Following PEG placement, she complained
intermittently of abdominal pain.  There were no tube feed
residuals and amylase and lipase were normal.  It was presumed
to be due to tube irritation.  She was treated with prn morphine
with good result.

8) Hyperglycemia - she had elevated blood sugars once tube feeds
started.  Initially treated with ISS, but Lantus started due to
persistent hyperglycemia.  [**Month (only) 116**] need titration of dose.

9) Thrush - 7 day course of fluconazole

10) HTN - lopressor 50 [**Hospital1 **]

11) Code - DNR/DNI


Medications on Admission:
1. Amaryl
2. Cozaar
3. Imdur
4. Detrol
5. Cipro
6. Vioxx

Discharge Medications:
1. Insulin
Lantus 12 units QHS plus Regular Insulin sliding scale
2. Fluconazole 200 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 3 days.
3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
4. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
5. Docusate Sodium 150 mg/15 mL Liquid Sig: One Hundred (100) mg
PO BID (2 times a day).
6. Heparin Sodium (Porcine) 5,000 unit/mL Solution Sig: One (1)
injection subcutaneously Injection three times a day.
7. Percocet 5-325 mg Tablet Sig: One (1) Tablet PO every [**4-1**]
hours as needed for pain.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2558**] - [**Location (un) **]

Discharge Diagnosis:
CVA
PNA
UTI
Sepsis
Hematuria
Thrush
Hyperglycemia


Discharge Condition:
stable

Discharge Instructions:
Please seek medical attention if you experience chest pain,
shortness of breath, or other concerning symptoms.

Followup Instructions:
Please follow-up with PCP Dr [**Last Name (STitle) **] [**Telephone/Fax (1) 5308**] in [**1-29**]
weeks

Please call the Neurology department at [**Telephone/Fax (1) 541**] at schedule
a follow appointment with Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **].

Please follow up with Dr [**Last Name (STitle) 17696**] of urology.
{'Acute respiratory failure,Cerebral embolism with cerebral infarction,Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Atrial fibrillation,Unspecified septicemia,Candidiasis of mouth,Iron deficiency anemia secondary to blood loss (chronic),Acute kidney failure, unspecified,Severe sepsis,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Urinary incontinence, unspecified,Unspecified essential hypertension,Angiodysplasia of stomach and duodenum without mention of hemorrhage,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified disorder of kidney and ureter,Calculus of kidney,Malignant neoplasm of bladder, part unspecified,Aneurysm of heart (wall)'}


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: 1. Altered mental status
2. Hypoxemic respiratory failure
3. Hypotension

PRESENT ILLNESS: [**Age over 90 **]-year-old Russian-speaking female with a history of HTN, CRI,
chronic nephrolithiasis, who presents with hypoxemic respiratory
failure. She was in her USOH at the [**Hospital3 2558**] nursing home
when she was found with a RR of 8, unresponsive, SBP 70's, O2Sat
75%. She was intubated by EMS on the scene. No CPR was needed.
In the ED found to have a right mainstem intubation so her ETT
was drawn back. Large amount of thick sputum noted. In ED, BP
70/30, AC 400x16 100% PEEP 5 and 100%. Got Levo and flagyl
empirically.
Initial WBC 10K , Hct 29.9. U/A revealed many bacteria, w/ >50
WBC's.

MEDICAL HISTORY: 1. Hypertension
2. Chronic renal insufficiency
3. Type II diabetes mellitus
4. Chronic low back pain
5. Nephrolithiasis

MEDICATION ON ADMISSION: 1. Amaryl
2. Cozaar
3. Imdur
4. Detrol
5. Cipro
6. Vioxx

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission:
VS: T 100.5 HR 87 BP 97/56 RR 16 sat 99% intubated
GEN: open eyes to command
HEENT: PERLA, NCAT, neck supple, ETT in place
CARDIO: S1S2, RRR, no m/r/g
PULM: CTAB anteriorly
[**Last Name (un) **]: soft, guarding
EXTR: DPPBL
NEURO: MAE

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: 1. Nursing home resident 

### Response:
{'Acute respiratory failure,Cerebral embolism with cerebral infarction,Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Atrial fibrillation,Unspecified septicemia,Candidiasis of mouth,Iron deficiency anemia secondary to blood loss (chronic),Acute kidney failure, unspecified,Severe sepsis,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Urinary incontinence, unspecified,Unspecified essential hypertension,Angiodysplasia of stomach and duodenum without mention of hemorrhage,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified disorder of kidney and ureter,Calculus of kidney,Malignant neoplasm of bladder, part unspecified,Aneurysm of heart (wall)'}
