CHIEF COMPLAINT: hematuria

PRESENT ILLNESS: .
Hx per prior notes. Patient sedated (after CT scan in ED) upon
presentation to the [**Hospital Unit Name 153**].
.
86 F [**Hospital 100**] Rehab patient who is s/p pessary placement 5 days
ago. The patient has been having hematuria for the past 2 weeks.
On the day of admission the patient complained of lower
abdominal pain and had profuse hematuria for four hours.
.
An initial Hct had been checked at [**Hospital 100**] Rehab on [**9-25**] and was
28, by afternoon it was 25. The patient became increasingly
tachycardic with a stable BP at 120/63 and worsening bleeding.
She was sent to [**Hospital1 18**] ED for evaluation. In the ED her Hct was
21.6. She received 4U of PRBC and hct improved to 35.4. Vaginal
exam did not reveal a pessary.
.
In the ED, Gyn did not feel that the bleeding was vaginal. No
pessary was noted during speculum exam. The ED staff placed a
18Fr 3 way foley overnight and it immediately drained 200cc of
clot and urine. Urology later removed the 3 way foley and placed
a 22F 2-way foley removing 700cc of dark clot with hand
irrigation. Bedside cystoscopy revealed an inflammed
trabeculated bladder consistent with cystitis or Foley
catheterization, no appreciable erosion, no significant retained
clot, no large tumor, no foreign body, and no active bleeding. A
3-way 22F [**Last Name (un) **] catheter was placed with the foley to gravity
draining clear urine. Ceftriaxone was given for UTI. Preliminary
[**Location (un) 1131**] was unremarkable.
.
In the ED, the patient was very agitated and given a variety of
medications: 10mg IV haldol, 4mg IV ativan, 4mg IV morphine.
.

MEDICAL HISTORY: Dementia
HTN
Hyperlipidemia
Macular degeneration, legally blind
Uterine prolapse s/p pessary
Anemia
bilateral carotid bruit
s/p ankle fracture
Diastolic CHF

MEDICATION ON ADMISSION: .
Imdur
Plavix
Cholecalciferol
MVI
ASA
.

ALLERGIES: Penicillins / Sulfa (Sulfonamides) / Nitrofurantoin

PHYSICAL EXAM: .
Afebrile, vital signs stable.
.
Gen: NAD, sedated
HEENT: NC/AT, PERRLA, mmm
NECK: no LAD, no JVD, bilateral right>left carotid bruit
COR: S1S2, regular rhythm, II/VI HSM along LUSB
PULM: CTA b/l, no wheezing or rhonchi
ABD: + bowel sounds, soft, nd, nt
Skin: warm extremities, no rash
EXT: 2+ DP, [**2-9**]+ edema
Neuro: alert, oriented to self, appropriate interaction, but
still confused.
.

FAMILY HISTORY: .
non-contributory
.

SOCIAL HISTORY: Resident at [**Hospital 100**] Rehab. Denies tobacco, IVDU, ETOH. Daughter
lives in area. Baseline very disorientated and becomes agitated
easily. Independent of ADLs
Acute cystitis,Retention of urine, unspecified,Acute posthemorrhagic anemia,Chronic diastolic heart failure,Unspecified disorder of autonomic nervous system,Senile dementia with delirium,Macular degeneration (senile), unspecified,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Uterine prolapse without mention of vaginal wall prolapse
Acute cystitis,Retention urine NOS,Ac posthemorrhag anemia,Chr diastolic hrt fail,Autonomic nerve dis NEC,Senile delirium,Macular degeneration NOS,Hyperlipidemia NEC/NOS,Hypertension NOS,Uterine prolapse
Admission Date:  [**2190-9-26**]              Discharge Date:   [**2190-9-30**]


Service: MEDICINE

Allergies:
Penicillins / Sulfa (Sulfonamides) / Nitrofurantoin

Attending:[**First Name3 (LF) 358**]
Chief Complaint:
hematuria

Major Surgical or Invasive Procedure:
cystoscopy


History of Present Illness:
.
Hx per prior notes. Patient sedated (after CT scan in ED) upon
presentation to the [**Hospital Unit Name 153**].
.
86 F [**Hospital 100**] Rehab patient who is s/p pessary placement 5 days
ago. The patient has been having hematuria for the past 2 weeks.
On the day of admission the patient complained of lower
abdominal pain and had profuse hematuria for four hours.
.
An initial Hct had been checked at [**Hospital 100**] Rehab on [**9-25**] and was
28, by afternoon it was 25. The patient became increasingly
tachycardic with a stable BP at 120/63 and worsening bleeding.
She was sent to [**Hospital1 18**] ED for evaluation. In the ED her Hct was
21.6. She received 4U of PRBC and hct improved to 35.4. Vaginal
exam did not reveal a pessary.
.
In the ED, Gyn did not feel that the bleeding was vaginal. No
pessary was noted during speculum exam. The ED staff placed a
18Fr 3 way foley overnight and it immediately drained 200cc of
clot and urine. Urology later removed the 3 way foley and placed
a 22F 2-way foley removing 700cc of dark clot with hand
irrigation. Bedside cystoscopy revealed an inflammed
trabeculated bladder consistent with cystitis or Foley
catheterization, no appreciable erosion, no significant retained
clot, no large tumor, no foreign body, and no active bleeding. A
3-way 22F [**Last Name (un) **] catheter was placed with the foley to gravity
draining clear urine. Ceftriaxone was given for UTI. Preliminary
[**Location (un) 1131**] was unremarkable.
.
In the ED, the patient was very agitated and given a variety of
medications: 10mg IV haldol, 4mg IV ativan, 4mg IV morphine.
.

Past Medical History:
Dementia
HTN
Hyperlipidemia
Macular degeneration, legally blind
Uterine prolapse s/p pessary
Anemia
bilateral carotid bruit
s/p ankle fracture
Diastolic CHF

Social History:
Resident at [**Hospital 100**] Rehab. Denies tobacco, IVDU, ETOH. Daughter
lives in area. Baseline very disorientated and becomes agitated
easily. Independent of ADLs


Family History:
.
non-contributory
.

Physical Exam:
.
Afebrile, vital signs stable.
.
Gen: NAD, sedated
HEENT: NC/AT, PERRLA, mmm
NECK: no LAD, no JVD, bilateral right>left carotid bruit
COR: S1S2, regular rhythm, II/VI HSM along LUSB
PULM: CTA b/l, no wheezing or rhonchi
ABD: + bowel sounds, soft, nd, nt
Skin: warm extremities, no rash
EXT: 2+ DP, [**2-9**]+ edema
Neuro: alert, oriented to self, appropriate interaction, but
still confused.
.

Pertinent Results:
.
Labs:
[**2190-9-26**] 04:15AM WBC-7.1 Hgb-7.4 Hct-21.6 MCV-86 Plt-465
[**2190-9-26**] 09:45AM WBC-11.5 Hgb-12.8 Hct-35.4 Plt-336 (s/p 4 units
RBC)
[**2190-9-26**] 06:15PM Hct-38.6
.
[**2190-9-26**] PT-12.6 PTT-25.0 INR-1.1
[**2190-9-26**] Glucose-153 UreaN-26 Creat-0.9 Na-133 K-4.2 Cl-99
HCO3-23
.
[**2190-9-26**] UA: > 50 RBCs; > 50 WBCs, moderate bacteria, large
leuks, positive nitrites, >300 protein, >50 glucose, >40 ketones

.
[**2190-9-26**] EKG: nl NSR, nl QT interval, no acute ischemic changes,
rate 78
.
[**2190-9-26**] CT abd/pelvis:
1. No evidence of renal or ureteral stone or hydronephrosis.
Non-specific mild prominence of bilateral pelvicies and mild fat
stranding surrounding the kidneys. Cystic lesions in both
kidneys, probably a cyst, however, too small to characterize. No
definitive finding to explain hematuria.
2. Gallstone with mildly distended gallbladder, without
pericholecystic fluid. Please correlate clinically for the
possibility of cholecystitis.
3. Sigmoid diverticulosis.
4. Bilateral small pleural effusion with atelectasis.
5. Degenerative changes of thoracolumbar spine with grade 1
anterolisthesis of L4-5.
6. Atherosclerotic disease of the aorta.
.

[**2190-9-30**] 06:15AM BLOOD WBC-7.6 RBC-4.35 Hgb-13.6 Hct-38.7 MCV-89
MCH-31.3 MCHC-35.1* RDW-15.1 Plt Ct-375
[**2190-9-30**] 06:15AM BLOOD Glucose-136* UreaN-15 Creat-0.7 Na-138
K-4.0 Cl-103 HCO3-27 AnGap-12
[**2190-9-30**] 06:15AM BLOOD Calcium-9.1 Phos-3.7 Mg-2.0
[**2190-9-29**] 02:54PM BLOOD %HbA1c-5.9
[**2190-9-29**] 04:30AM BLOOD TSH-1.6
[**2190-9-30**] 06:15AM BLOOD VitB12-PND Folate-PND
[**2190-9-30**] 06:15AM BLOOD Cortsol-PND

Brief Hospital Course:
# Hemmorhagic cystitis -- unclear etiology, cystoscopy showed
friable tissues, but no mass or erosions.  Hematocrit has been
stable since transfer from [**Hospital Unit Name 153**], and urine has been clear of
blood.  No evidence of UTI.  Aspirin and Plavix were held on
admission, and my recommendation is Plavix be discontinued
permanently.  A baby aspirin can likely be resumed on discharge.

# Urinary retention: Pt has chronic urinary retention [**3-12**]
uterine prolapse. She is s/p pessary placement 5 days prior to
admission, however pessary has since fallen out.  She has
required straight catheterization x1 after foley was
discontinued, however the geriatrics team feels the management
of her urinary retention at [**Hospital 100**] Rehab with bladder massage,
etc., can be successfully resumed on discharge.  She should
follow up with her gynecologist regarding the uterine prolapse
and pessarie.

# Orthostatic hypotension: Known history of autonomic
instability at baseline. Initiated florinef one day prior to
discharge with some improvement in her orthostasis.  Cortisol,
B12 and folate pending on discharge.  TSH and HgA1c within
normal limits.

# CAD: Hold Plavix indefinitely, resume baby aspirin on
discharge.

# Dementia/Agitation: Pt received 10mg IV haldol, 4mg IV ativan,
and 4mg IV morphine for agitation in the ED. She was initially
somnolent on arrival to the ICU, but improved overnight.  She
continued to have sundowning, but improved significantly in the
last 24 hours.  The geriatrics team feels immediate transfer
back to [**Hospital 100**] Rehab will only improve her mental status.  This
has been discussed with her primary physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], who
agreed with this plan.

Plan discussed by phone with daughter, [**Name (NI) 1154**] [**Name (NI) **].

Medications on Admission:
.
Imdur
Plavix
Cholecalciferol
MVI
ASA
.

Discharge Medications:
1. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
2. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
3. Quetiapine 25 mg Tablet Sig: 0.5 Tablet PO Q6PM ().
4. Fludrocortisone 0.1 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Outpatient Lab Work
Hematocrit in one week.
6. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day.
7. Multi-Vitamin Hi-Po     Tablet Sig: One (1) Tablet PO once a
day.
8. Cholecalciferol (Vitamin D3) 400 unit Capsule Sig: One (1)
Capsule PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - LTC

Discharge Diagnosis:
1. hemmorhagic cystitis
2. urinary retention
3. delerium, resolving
4. autonomic insufficiency


Discharge Condition:
Hematocrit and vital signs stable, with improved orthostatics on
florinef and with persistant mild delerium (improving), but
hopeful a familiar environment will assist patient in
orientation.


Discharge Instructions:
YOu were hospitalized with hemmorhagic cystitis.  You received
several blood transfusions, but have been stable for several
days.  We are discharging you to [**Hospital 100**] Rehab.  You should call
your physician or return to the hospital with any questions or
concerns, particularly fever greater than 101, worsening
dizziness or lightheadedness, bleeding in your urine or stool,
chest pain or shortness of breath.  Please continue to pass
urine as you were prior to your arrival here.

Followup Instructions:
Please see your physician at [**Hospital 100**] Rehab, Dr. [**Last Name (STitle) **], as soon
as possible (within 1-2 weeks) for evaluation and hematocrit
level, as well as orthostatic blood pressure measurements.
{'Acute cystitis,Retention of urine, unspecified,Acute posthemorrhagic anemia,Chronic diastolic heart failure,Unspecified disorder of autonomic nervous system,Senile dementia with delirium,Macular degeneration (senile), unspecified,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Uterine prolapse without mention of vaginal wall prolapse'}


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: hematuria

PRESENT ILLNESS: .
Hx per prior notes. Patient sedated (after CT scan in ED) upon
presentation to the [**Hospital Unit Name 153**].
.
86 F [**Hospital 100**] Rehab patient who is s/p pessary placement 5 days
ago. The patient has been having hematuria for the past 2 weeks.
On the day of admission the patient complained of lower
abdominal pain and had profuse hematuria for four hours.
.
An initial Hct had been checked at [**Hospital 100**] Rehab on [**9-25**] and was
28, by afternoon it was 25. The patient became increasingly
tachycardic with a stable BP at 120/63 and worsening bleeding.
She was sent to [**Hospital1 18**] ED for evaluation. In the ED her Hct was
21.6. She received 4U of PRBC and hct improved to 35.4. Vaginal
exam did not reveal a pessary.
.
In the ED, Gyn did not feel that the bleeding was vaginal. No
pessary was noted during speculum exam. The ED staff placed a
18Fr 3 way foley overnight and it immediately drained 200cc of
clot and urine. Urology later removed the 3 way foley and placed
a 22F 2-way foley removing 700cc of dark clot with hand
irrigation. Bedside cystoscopy revealed an inflammed
trabeculated bladder consistent with cystitis or Foley
catheterization, no appreciable erosion, no significant retained
clot, no large tumor, no foreign body, and no active bleeding. A
3-way 22F [**Last Name (un) **] catheter was placed with the foley to gravity
draining clear urine. Ceftriaxone was given for UTI. Preliminary
[**Location (un) 1131**] was unremarkable.
.
In the ED, the patient was very agitated and given a variety of
medications: 10mg IV haldol, 4mg IV ativan, 4mg IV morphine.
.

MEDICAL HISTORY: Dementia
HTN
Hyperlipidemia
Macular degeneration, legally blind
Uterine prolapse s/p pessary
Anemia
bilateral carotid bruit
s/p ankle fracture
Diastolic CHF

MEDICATION ON ADMISSION: .
Imdur
Plavix
Cholecalciferol
MVI
ASA
.

ALLERGIES: Penicillins / Sulfa (Sulfonamides) / Nitrofurantoin

PHYSICAL EXAM: .
Afebrile, vital signs stable.
.
Gen: NAD, sedated
HEENT: NC/AT, PERRLA, mmm
NECK: no LAD, no JVD, bilateral right>left carotid bruit
COR: S1S2, regular rhythm, II/VI HSM along LUSB
PULM: CTA b/l, no wheezing or rhonchi
ABD: + bowel sounds, soft, nd, nt
Skin: warm extremities, no rash
EXT: 2+ DP, [**2-9**]+ edema
Neuro: alert, oriented to self, appropriate interaction, but
still confused.
.

FAMILY HISTORY: .
non-contributory
.

SOCIAL HISTORY: Resident at [**Hospital 100**] Rehab. Denies tobacco, IVDU, ETOH. Daughter
lives in area. Baseline very disorientated and becomes agitated
easily. Independent of ADLs 

### Response:
{'Acute cystitis,Retention of urine, unspecified,Acute posthemorrhagic anemia,Chronic diastolic heart failure,Unspecified disorder of autonomic nervous system,Senile dementia with delirium,Macular degeneration (senile), unspecified,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Uterine prolapse without mention of vaginal wall prolapse'}
