CHIEF COMPLAINT: brought in from NH for BRBPR

PRESENT ILLNESS: 82 yo man with hx of recurrent GI bleeding, atrial fib on
coumadin, CHF with normal EF and 3+MR p/w BRBPR. He was at the
nursing home when found with BRBPR on his bed sheet. At the
time, his INR was >4.0 and he was given vitamin K 2.5mg PO. His
stool was guaiac positive. He was without SOB or any N/V. He
denied any pain at that time. He also has had poor PO intake
according to the NH records. This has occurred a number of times
and recently he had an EGD in [**10-6**] which showed gastritis,
duodenitis and a colonoscopy in [**10-6**] which showed
diverticulosis. The patient also has a history of C. Diff
colitis and was discharged in [**2204-1-2**] with flagyl and vanco
PO to treat c diff.
.
In the ED: VS: 94.7 95/67 24 100% 2L. His INR was 5.7 and he was
given 3u FFP. He was seen by GI when he arrived in the ICU and
since his HCT was 34 on admission (at or near baseline), it was
not considered necessary to do an urgent scope. GI plans to
perform a capsule study on Monday.
.
Currently, the patient is oriented to person only, which is
reportedly his baseline. According to his son, he has been
deteriorating over the last several months.

MEDICAL HISTORY: 1. HTN
2. Valvular HD (mainly 3+MR)
3. AFib on coumadin
4. Hyperlipidemia
5. Prostate CA s/p XRT - no recent followup
6. AAA s/p repair [**2187**]
7. UGIB [**2188**] from duodenal polyps
8. SBO s/p LOA [**2200**]
9. Anxiety
10. Diverticulosis w/ diverticulitis
11. C. diff colitis x4 in past year, recently on flagyl and
vanco PO for active infection

MEDICATION ON ADMISSION: Protonix 40 qd
Folic acid 1mg qd
Lasix 40mg qd
Citalopram 20mg qd
MVI
Keppra 1000mg qd
metoprolol 25mg [**Hospital1 **]
sucralfate 1gm TID
tylenol prn
duoneb [**Hospital1 **] prn
coumadin (unknown dose)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 97.3, 117/63, 117, 23 96% 2L
.
general: comfortable, NAD
NEURO: alert to person, not place or situation.
HEENT: PERLLA, EOMI, anicteric, OP dry, MM dry
lungs: clear bilaterally, equal bs bilaterally
heart: RR, S1 and S2 nl. no MGR
abdomen: nd, +b/s, soft, nt, no masses
extremities: cool extremities, trace pulses
skin/nails: no rashes

FAMILY HISTORY: unknown, non-contributory.

SOCIAL HISTORY: Tobacco: 30 pack year smoking history, quit 20y ago.
Alcohol: Denies alcohol use.
Widowed x 13 years, lives in [**Name (NI) **], [**First Name3 (LF) **] lives in the area,
has been at nursing home since [**Month (only) **]. Son lives close by
([**First Name5 (NamePattern1) **] [**Known lastname 46031**]), other son [**Name (NI) **] [**Name (NI) 46031**] is HCP and can
be reached at [**2200**].
Unspecified septicemia,Septic shock,Hemorrhage of gastrointestinal tract, unspecified,Atrial fibrillation,Congestive heart failure, unspecified,Mitral valve disorders,Acidosis,Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction,Long-term (current) use of anticoagulants,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of prostate
Septicemia NOS,Septic shock,Gastrointest hemorr NOS,Atrial fibrillation,CHF NOS,Mitral valve disorder,Acidosis,SIRS-noninf w ac org dys,Long-term use anticoagul,Hyperlipidemia NEC/NOS,Hx-prostatic malignancy
Admission Date:  [**2204-2-4**]              Discharge Date:   [**2204-2-6**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2485**]
Chief Complaint:
brought in from NH for BRBPR

Major Surgical or Invasive Procedure:
none


History of Present Illness:
82 yo man with hx of recurrent GI bleeding, atrial fib on
coumadin, CHF with normal EF and 3+MR p/w BRBPR. He was at the
nursing home when found with BRBPR on his bed sheet. At the
time, his INR was >4.0 and he was given vitamin K 2.5mg PO. His
stool was guaiac positive. He was without SOB or any N/V. He
denied any pain at that time. He also has had poor PO intake
according to the NH records. This has occurred a number of times
and recently he had an EGD in [**10-6**] which showed gastritis,
duodenitis and a colonoscopy in [**10-6**] which showed
diverticulosis. The patient also has a history of C. Diff
colitis and was discharged in [**2204-1-2**] with flagyl and vanco
PO to treat c diff.
.
In the ED: VS: 94.7 95/67 24 100% 2L. His INR was 5.7 and he was
given 3u FFP. He was seen by GI when he arrived in the ICU and
since his HCT was 34 on admission (at or near baseline), it was
not considered necessary to do an urgent scope. GI plans to
perform a capsule study on Monday.
.
Currently, the patient is oriented to person only, which is
reportedly his baseline. According to his son, he has been
deteriorating over the last several months.


Past Medical History:
1. HTN
2. Valvular HD (mainly 3+MR)
3. AFib on coumadin
4. Hyperlipidemia
5. Prostate CA s/p XRT - no recent followup
6. AAA s/p repair [**2187**]
7. UGIB [**2188**] from duodenal polyps
8. SBO s/p LOA [**2200**]
9. Anxiety
10. Diverticulosis w/ diverticulitis
11. C. diff colitis x4 in past year, recently on flagyl and
vanco PO for active infection


Social History:
Tobacco: 30 pack year smoking history, quit 20y ago.
Alcohol: Denies alcohol use.
Widowed x 13 years, lives in [**Name (NI) **], [**First Name3 (LF) **] lives in the area,
has been at nursing home since [**Month (only) **]. Son lives close by
([**First Name5 (NamePattern1) **] [**Known lastname 46031**]), other son [**Name (NI) **] [**Name (NI) 46031**] is HCP and can
be reached at [**2200**].


Family History:
unknown, non-contributory.

Physical Exam:
VS: 97.3, 117/63, 117, 23 96% 2L
.
general: comfortable, NAD
NEURO: alert to person, not place or situation.
HEENT: PERLLA, EOMI, anicteric, OP dry, MM dry
lungs: clear bilaterally, equal bs bilaterally
heart: RR, S1 and S2 nl. no MGR
abdomen: nd, +b/s, soft, nt, no masses
extremities: cool extremities, trace pulses
skin/nails: no rashes


Pertinent Results:
CK 40
Trop-T: 0.06
146 110 25
---------------< 111
3.8 21 1.1
.
10.5
7.8 >----< 252
32.7
PT: 27.5 PTT: 40.2 INR: 2.8
.
EKG: atrial fib with normal axis, rate of 90, TWI I, aVL, V5-V6,
ST depressions in V5-V6.
.
CXR: Marked global cardiomegaly without evidence of CHF. Left
retrocardiac opacity could represent atelectasis or pneumonia.
Recommend lateral view for further evaluation.


Brief Hospital Course:
This is an 82 yo man who was recently discharged with c diff
colitis who presented with poor PO intake, BRBPR, and altered
mental status. He became hypotensive and tachycardic during his
admission day and had worsening mental status. The etiology of
his condition was unclear, in the ddx was urosepsis, c. diff
colitis, GI source (he presented with BRBPR). HE was given fluid
support and started on empiric antibiotics. vasopressors were
not used in accordance with his families wishes. Due to his
deteriorating condition, a family meeting was held, after
discussion with his family members (including his HCP) about
options and possible outcomes, a decision was made to focus on
comfort, his status was changed to DNR/DNI. At this time the
fluid support was held, antibiotics were stopped. Supportive
care was initiated. The patient was given pain medication for
relief of pain and respiritory distress as needed. The patient
expired peacefully with his family in the room. The family was
offered any autopsy, which was declined.

Medications on Admission:
Protonix 40 qd
Folic acid 1mg qd
Lasix 40mg qd
Citalopram 20mg qd
MVI
Keppra 1000mg qd
metoprolol 25mg [**Hospital1 **]
sucralfate 1gm TID
tylenol prn
duoneb [**Hospital1 **] prn
coumadin (unknown dose)


Discharge Medications:
expired

Discharge Disposition:
Expired

Discharge Diagnosis:
expired

Discharge Condition:
expired

Discharge Instructions:
expired

Followup Instructions:
expired


Completed by:[**2204-2-7**]
{'Unspecified septicemia,Septic shock,Hemorrhage of gastrointestinal tract, unspecified,Atrial fibrillation,Congestive heart failure, unspecified,Mitral valve disorders,Acidosis,Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction,Long-term (current) use of anticoagulants,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of prostate'}


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: brought in from NH for BRBPR

PRESENT ILLNESS: 82 yo man with hx of recurrent GI bleeding, atrial fib on
coumadin, CHF with normal EF and 3+MR p/w BRBPR. He was at the
nursing home when found with BRBPR on his bed sheet. At the
time, his INR was >4.0 and he was given vitamin K 2.5mg PO. His
stool was guaiac positive. He was without SOB or any N/V. He
denied any pain at that time. He also has had poor PO intake
according to the NH records. This has occurred a number of times
and recently he had an EGD in [**10-6**] which showed gastritis,
duodenitis and a colonoscopy in [**10-6**] which showed
diverticulosis. The patient also has a history of C. Diff
colitis and was discharged in [**2204-1-2**] with flagyl and vanco
PO to treat c diff.
.
In the ED: VS: 94.7 95/67 24 100% 2L. His INR was 5.7 and he was
given 3u FFP. He was seen by GI when he arrived in the ICU and
since his HCT was 34 on admission (at or near baseline), it was
not considered necessary to do an urgent scope. GI plans to
perform a capsule study on Monday.
.
Currently, the patient is oriented to person only, which is
reportedly his baseline. According to his son, he has been
deteriorating over the last several months.

MEDICAL HISTORY: 1. HTN
2. Valvular HD (mainly 3+MR)
3. AFib on coumadin
4. Hyperlipidemia
5. Prostate CA s/p XRT - no recent followup
6. AAA s/p repair [**2187**]
7. UGIB [**2188**] from duodenal polyps
8. SBO s/p LOA [**2200**]
9. Anxiety
10. Diverticulosis w/ diverticulitis
11. C. diff colitis x4 in past year, recently on flagyl and
vanco PO for active infection

MEDICATION ON ADMISSION: Protonix 40 qd
Folic acid 1mg qd
Lasix 40mg qd
Citalopram 20mg qd
MVI
Keppra 1000mg qd
metoprolol 25mg [**Hospital1 **]
sucralfate 1gm TID
tylenol prn
duoneb [**Hospital1 **] prn
coumadin (unknown dose)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 97.3, 117/63, 117, 23 96% 2L
.
general: comfortable, NAD
NEURO: alert to person, not place or situation.
HEENT: PERLLA, EOMI, anicteric, OP dry, MM dry
lungs: clear bilaterally, equal bs bilaterally
heart: RR, S1 and S2 nl. no MGR
abdomen: nd, +b/s, soft, nt, no masses
extremities: cool extremities, trace pulses
skin/nails: no rashes

FAMILY HISTORY: unknown, non-contributory.

SOCIAL HISTORY: Tobacco: 30 pack year smoking history, quit 20y ago.
Alcohol: Denies alcohol use.
Widowed x 13 years, lives in [**Name (NI) **], [**First Name3 (LF) **] lives in the area,
has been at nursing home since [**Month (only) **]. Son lives close by
([**First Name5 (NamePattern1) **] [**Known lastname 46031**]), other son [**Name (NI) **] [**Name (NI) 46031**] is HCP and can
be reached at [**2200**]. 

### Response:
{'Unspecified septicemia,Septic shock,Hemorrhage of gastrointestinal tract, unspecified,Atrial fibrillation,Congestive heart failure, unspecified,Mitral valve disorders,Acidosis,Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction,Long-term (current) use of anticoagulants,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of prostate'}
