CHIEF COMPLAINT: Gastrointestinal bleed

PRESENT ILLNESS: Mr. [**Known lastname 40370**] is a [**Age over 90 **]-year-old man with dementia and a history
of clostridium difficile who presented with a brisk upper GI
bleed (hematemesis and melena) from [**Hospital3 537**]. He also had
altered mental status. He continued to have hematemesis and
melena on presentation. Initially he got 4units packed red blood
cells, fresh frozen plasma and platelets. His code status was
DNR/DNI so he was not intubated. He also has an abdominal aortic
aneurysm that had increased in size on imaging. He was admitted
to the MICU. A family discussion took place and the patient was
transitioned to comfort-focused care.

MEDICAL HISTORY: 1. h/o Paroxysmal atrial fibrillation
2. HTN
3. h/o falls
4. BPH
5. L ear deafness
6. R eye cataracts s/p lens replacement
7. Arthritis bilateral knees and L hip
8. Mild dementia, unspecified type

MEDICATION ON ADMISSION: brimonidine
citalopram
donepezil
finasteride
nystatin
aspirin

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Exam:
Vitals: HR 108-122
General: Nonverbal, NAD, appears comfortable
HEENT: dry MM
CV: deferred
Lungs: deferred
Abdomen: deferred
GU: foley
Ext: deferred
Neuro: deferred

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Mr. [**Known lastname 40370**] lives in the [**Hospital3 15333**]
facility.  Daughter [**Name (NI) **] (work: [**Telephone/Fax (1) 40371**]) is his HCP.
Smoked for 30 years, [**1-23**] pack/day. Denied EtOH use. No recent
smoking or alcohol.
Blood in stool,Do not resuscitate status,Abdominal aneurysm without mention of rupture,Atrial fibrillation,Unspecified essential hypertension,Dementia, unspecified, without behavioral disturbance
Blood in stool,Do not resusctate status,Abdom aortic aneurysm,Atrial fibrillation,Hypertension NOS,Demen NOS w/o behv dstrb
Admission Date:  [**2202-12-29**]              Discharge Date:   [**2202-12-30**]


Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 2291**]
Chief Complaint:
Gastrointestinal bleed

Major Surgical or Invasive Procedure:
expired


History of Present Illness:
Mr. [**Known lastname 40370**] is a [**Age over 90 **]-year-old man with dementia and a history
of clostridium difficile who presented with a brisk upper GI
bleed (hematemesis and melena) from [**Hospital3 537**]. He also had
altered mental status. He continued to have hematemesis and
melena on presentation. Initially he got 4units packed red blood
cells, fresh frozen plasma and platelets. His code status was
DNR/DNI so he was not intubated. He also has an abdominal aortic
aneurysm that had increased in size on imaging. He was admitted
to the MICU. A family discussion took place and the patient was
transitioned to comfort-focused care.


Past Medical History:
1. h/o Paroxysmal atrial fibrillation
2. HTN
3. h/o falls
4. BPH
5. L ear deafness
6. R eye cataracts s/p lens replacement
7. Arthritis bilateral knees and L hip
8. Mild dementia, unspecified type


Social History:
Mr. [**Known lastname 40370**] lives in the [**Hospital3 15333**]
facility.  Daughter [**Name (NI) **] (work: [**Telephone/Fax (1) 40371**]) is his HCP.
Smoked for 30 years, [**1-23**] pack/day. Denied EtOH use. No recent
smoking or alcohol.


Family History:
Noncontributory.

Physical Exam:
Admission Exam:
Vitals: HR 108-122
General: Nonverbal, NAD, appears comfortable
HEENT: dry MM
CV: deferred
Lungs: deferred
Abdomen: deferred
GU: foley
Ext: deferred
Neuro: deferred

Discharge Exam: patient expired

Pertinent Results:
[**2202-12-29**] 09:15AM   PLT COUNT-222
[**2202-12-29**] 09:15AM   WBC-11.1* RBC-3.25* HGB-10.4* HCT-32.5*
MCV-100* MCH-32.0 MCHC-32.0 RDW-12.8
[**2202-12-29**] 09:15AM   LIPASE-16
[**2202-12-29**] 09:15AM   UREA N-27* CREAT-0.8
[**2202-12-29**] 09:22AM   GLUCOSE-160* LACTATE-3.3* NA+-141 K+-3.8
CL--108 TCO2-24
[**2202-12-29**] 09:40AM   FIBRINOGE-343
[**2202-12-29**] 09:40AM   PT-12.6* PTT-26.6 INR(PT)-1.2*
[**2202-12-29**] 11:24AM URINE  RBC-8* WBC-2 BACTERIA-NONE YEAST-NONE
EPI-<1
[**2202-12-29**] 11:24AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-2* PH-5.5
LEUK-NEG
[**2202-12-29**] 11:24AM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.043*
[**2202-12-29**] 11:42AM   PLT COUNT-141*
[**2202-12-29**] 11:42AM   NEUTS-86.1* LYMPHS-9.4* MONOS-3.9 EOS-0.4
BASOS-0.3
[**2202-12-29**] 11:42AM   WBC-15.5* RBC-3.86* HGB-12.2* HCT-36.2*
MCV-94 MCH-31.7 MCHC-33.8 RDW-15.2
[**2202-12-29**] 11:43AM   freeCa-0.98*
[**2202-12-29**] 11:43AM   HGB-12.9* calcHCT-39
[**2202-12-29**] 11:43AM   GLUCOSE-173* LACTATE-4.0* NA+-143 K+-4.0
CL--110* TCO2-20*
.
[**2202-12-29**]
CT Abdomen
1. No acute intra- or retroperitoneal hemorrhage or hematoma.
2. Extensive atherosclerotic disease with interval enlargement
of the AAA
from [**2197**]. No evidence of current aneurysmal rupture or
aortoenteric
fistulization.
3. New pneumobilia. Suggest correlation with history of
sphincterotomy. If
none, findings can also be seen with biliary-enteric fistula.
4. Cholelithiasis without evidence of acute cholecystitis


Brief Hospital Course:
Mr. [**Known lastname 40370**] is a [**Age over 90 **]-year-old man with dementia and a history
of clostridium difficile who presented with a brisk upper GI
bleed (hematemesis and melena) from [**Hospital3 537**]. A family
discussion took place and the patient was transitioned to
comfort-focused care.
.
His hospital course by problem is as follows:
.
# Pain/anxiety: He was placed on morphine gtt with lorazepam and
acetaminophen as needed. Medications not geared towards comfort
were discontinued. The Palliative Care team was aware of his
admission and made recommendations for pain management.   The
patient was frequently assessed for pain and was kept clean and
comfortable. The patient was placed in a single room and a quiet
peaceful environment was maintained in order to maximize his
comfort. His family was updated through phone calls.

# GI Bleed: He had continued melena throughout the admission.
Initially, this was aggressively treated, but when the goals of
care changed patient was not given any further transfusions or
attempts at intervention.
.
# 6.5cm abdominal aortic aneurysm (AAA): His AAA was noted but
given his status as comfort-measures-only, surgery was not
pursued.
The patient expired on [**2202-12-30**].



Medications on Admission:
brimonidine
citalopram
donepezil
finasteride
nystatin
aspirin



Discharge Medications:
patient expired

Discharge Disposition:
Expired

Discharge Diagnosis:
expired


Discharge Condition:
expired


Discharge Instructions:
expired

Followup Instructions:
expired
{'Blood in stool,Do not resuscitate status,Abdominal aneurysm without mention of rupture,Atrial fibrillation,Unspecified essential hypertension,Dementia, unspecified, without behavioral disturbance'}


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: Gastrointestinal bleed

PRESENT ILLNESS: Mr. [**Known lastname 40370**] is a [**Age over 90 **]-year-old man with dementia and a history
of clostridium difficile who presented with a brisk upper GI
bleed (hematemesis and melena) from [**Hospital3 537**]. He also had
altered mental status. He continued to have hematemesis and
melena on presentation. Initially he got 4units packed red blood
cells, fresh frozen plasma and platelets. His code status was
DNR/DNI so he was not intubated. He also has an abdominal aortic
aneurysm that had increased in size on imaging. He was admitted
to the MICU. A family discussion took place and the patient was
transitioned to comfort-focused care.

MEDICAL HISTORY: 1. h/o Paroxysmal atrial fibrillation
2. HTN
3. h/o falls
4. BPH
5. L ear deafness
6. R eye cataracts s/p lens replacement
7. Arthritis bilateral knees and L hip
8. Mild dementia, unspecified type

MEDICATION ON ADMISSION: brimonidine
citalopram
donepezil
finasteride
nystatin
aspirin

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Exam:
Vitals: HR 108-122
General: Nonverbal, NAD, appears comfortable
HEENT: dry MM
CV: deferred
Lungs: deferred
Abdomen: deferred
GU: foley
Ext: deferred
Neuro: deferred

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Mr. [**Known lastname 40370**] lives in the [**Hospital3 15333**]
facility.  Daughter [**Name (NI) **] (work: [**Telephone/Fax (1) 40371**]) is his HCP.
Smoked for 30 years, [**1-23**] pack/day. Denied EtOH use. No recent
smoking or alcohol. 

### Response:
{'Blood in stool,Do not resuscitate status,Abdominal aneurysm without mention of rupture,Atrial fibrillation,Unspecified essential hypertension,Dementia, unspecified, without behavioral disturbance'}
