CHIEF COMPLAINT: Hematuria.

PRESENT ILLNESS: This is a seventy-five-year-old
Russian male with a complicated recent admission to [**Hospital1 1444**] who was transferred here from
on [**2153-4-27**], for chest pain. The patient had ruled in for
myocardial infarction, underwent cardiac catheterization and
stenting. Post-catheterization, the patient had a
cerebrovascular accident, leaving him with a left
hemiparesis. Prior to discharge, he had developed hematuria
while continuing therapy on aspirin, Plavix and Heparin.
While at [**Hospital **] Rehabilitation, the patient was receiving
endoscopic gastrostomy tube was not possible at that time due
to risk of bleeding on those three medications. The patient's
Plavix was scheduled to run for thirty days ending on [**2153-5-31**]. Regarding the patient's complaint of hematuria, the
patient had developed this problem immediately prior to his
discharge in [**Month (only) **]. The patient does have a history of a
bladder mass and transurethral resection of prostate in [**2142**].
In [**2147**], cytology was done of the bladder which was negative
for malignancy. This hematuria was felt to be secondary to
Foley catheter trauma or recurrent nephrolithiasis or tumor
while in the setting of anticoagulation. The patient had to
be restrained while at [**Hospital **] Hospital because he had been
pulling on the Foley catheter which may have led to bleeding.
In addition, he had removed his nasogastric tube five to six
times. On admission, the patient did also have heme positive
stool.

MEDICAL HISTORY: 1) Myocardial infarction in [**2143**],
status post percutaneous transluminal coronary angioplasty
and stent to left anterior descending artery and left
circumflex in [**2152-10-21**], re-stent of left anterior
descending artery in [**2153-4-21**], the patient has ejection
fraction of 25%. 2) Sick sinus syndrome, status post DDD
pacer. 3) Benign prostatic hypertrophy, status post
transurethral resection of prostate in [**2142**]. 4) Hypertension.
5) Hypercholesterolemia. 6) Pancreatitis. 6) Spinal stenosis.
7) Colon polyps. 8) Nephrolithiasis.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient was born in [**Country 532**], denies any
use of tobacco in the past and drinks alcohol socially.
Pneumonitis due to inhalation of food or vomitus,Acidosis,Congestive heart failure, unspecified,Acute kidney failure with lesion of tubular necrosis,Hypotension, unspecified,Late effects of cerebrovascular disease, aphasia,Pure hypercholesterolemia
Food/vomit pneumonitis,Acidosis,CHF NOS,Ac kidny fail, tubr necr,Hypotension NOS,Late eff CV dis-aphasia,Pure hypercholesterolem
Admission Date:  [**2153-5-20**]       Discharge Date:  [**2153-5-27**]

Date of Birth:   [**2078-4-14**]       Sex:  M

Service:  ACOVE
CHIEF COMPLAINT: Hematuria.

HISTORY OF PRESENT ILLNESS: This is a seventy-five-year-old
Russian male with a complicated recent admission to [**Hospital1 1444**] who was transferred here from
on [**2153-4-27**], for chest pain. The patient had ruled in for
myocardial infarction, underwent cardiac catheterization and
stenting. Post-catheterization, the patient had a
cerebrovascular accident, leaving him with a left
hemiparesis. Prior to discharge, he had developed hematuria
while continuing therapy on aspirin, Plavix and Heparin.
While at [**Hospital **] Rehabilitation, the patient was receiving
endoscopic gastrostomy tube was not possible at that time due
to risk of bleeding on those three medications. The patient's
Plavix was scheduled to run for thirty days ending on [**2153-5-31**]. Regarding the patient's complaint of hematuria, the
patient had developed this problem immediately prior to his
discharge in [**Month (only) **]. The patient does have a history of a
bladder mass and transurethral resection of prostate in [**2142**].
In [**2147**], cytology was done of the bladder which was negative
for malignancy. This hematuria was felt to be secondary to
Foley catheter trauma or recurrent nephrolithiasis or tumor
while in the setting of anticoagulation. The patient had to
be restrained while at [**Hospital **] Hospital because he had been
pulling on the Foley catheter which may have led to bleeding.
In addition, he had removed his nasogastric tube five to six
times. On admission, the patient did also have heme positive
stool.

PAST MEDICAL HISTORY: 1) Myocardial infarction in [**2143**],
status post percutaneous transluminal coronary angioplasty
and stent to left anterior descending artery and left
circumflex in [**2152-10-21**], re-stent of left anterior
descending artery in [**2153-4-21**], the patient has ejection
fraction of 25%. 2) Sick sinus syndrome, status post DDD
pacer. 3) Benign prostatic hypertrophy, status post
transurethral resection of prostate in [**2142**]. 4) Hypertension.
5) Hypercholesterolemia. 6) Pancreatitis. 6) Spinal stenosis.
7) Colon polyps. 8) Nephrolithiasis.

ALLERGIES: No known drug allergies.

MEDICATIONS: Enteric coated aspirin 325 mg every day, Lipitor
40 mg every day, Isosorbide Mononitrate 60 mg every day,
Prevacid 30 mg every day, Toprol XL 25 mg every day, Plavix
75 mg every day, Captopril 6.25 mg three times a day, Heparin
GTT at 1400 units per hour.

SOCIAL HISTORY: The patient was born in [**Country 532**], denies any
use of tobacco in the past and drinks alcohol socially.

PHYSICAL EXAMINATION: Physical examination on admission, the
patient was afebrile at 98.8 F, rectal temperature, heart
rate 72, respiratory rate 20, blood pressure 90/50, pulse
oximetry 92% on two liters by nasal cannula. In general, the
patient was in no acute distress. The patient is Russian
speaking only. The family is present and able to translate.
Foley catheter was draining amber colored urine at the time
of admission. On head, eyes, ears, nose and throat
examination, the patient's right eye is closed, pupil
measuring 5 mm to 6 mm. Left eye is opened spontaneously,
measuring 2 mm to 3 mm and minimal reactive. The patient had
a pediatric nasogastric tube in place receiving tube feeds
and he had dry oral mucosa. On neck examination, his neck was
supple, he had no jugular venous distension, lymphadenopathy
or bruits. Cardiovascular, the patient had a regular S1 and
S2 with a III/VI systolic murmur. The patient was in a
regular rhythm. The patient's lungs were clear to
auscultation bilaterally listening anterior and
anterolaterally. The patient's abdomen had normal active
bowel sounds, it was soft, nontender and nondistended.
Extremity examination, his upper extremities were in soft
restraints. The patient had no cyanosis, clubbing or edema.
On neurologic examination, his pupils were noted as above on
the head, eyes, ears, nose and throat examination. The
patient was uncooperative with testing of cranial nerves, as
well as strength. The patient was aphasic, although making
some sounds and occasional words to his daughter.

LABORATORY DATA: White blood cell count 8.3, hematocrit 33.7,
platelet count 288,000, baseline hematocrit known to be 47 to
48.

Sodium was 136, potassium 5.0, chloride 100, bicarbonate 26,
blood, urea and nitrogen 19, creatinine 0.9, glucose 98.

Calcium 8.5, magnesium 2.0, phosphorous 3.9.

Liver function tests, ALT was 33, AST 39, alkaline
phosphatase 89, total bilirubin 0.4, albumin 3.1.

Prothrombin time, international normalized ratio were 11.9
and 1.0 respectively, partial prothrombin time was 21.9.

Urinalysis showed a large amount of blood, 30 of protein,
small leukocytes, was amber in color, was otherwise,
negative, greater then 1000 red blood cells, 11 white blood
cells, occasional bacteria and no yeast.

HOSPITAL COURSE: Hospital course by problem, 1)
cardiovascular, given the patient's ejection fraction of less
then 25% and his recent stent last month, the patient was
continued on his anticoagulative agents including aspirin,
Plavix and Heparin. The Heparin drip was continued rather
then starting Coumadin immediately given the possibility of
the patient receiving a percutaneous endoscopic gastrostomy
tube this admission by Interventional Radiology. Initially,
on presentation, the patient's blood pressure was somewhat
labile and low running in the 90's/50's to 100's/60's. The
patient's blood pressure medications including his Isosorbide
and his ACE inhibitor were held initially. After gentle
hydration, the patient's blood pressure did correct. We were
able to administer those medications again. On [**2153-5-22**],
the patient was complaining of chest pain. Electrocardiograms
were taken every five minutes, following sublingual
Nitroglycerin administration. The patient's pain was relieved
with three sublingual Nitroglycerin. There were no
electrocardiogram changes seen. Cardiac enzymes were checked
and the patient ruled out for myocardial infarction with
three sets of negative enzymes. There were no other
complaints of chest pain following that one episode. The
patient's Captopril was discontinued and changed to Zestril
over the course of the admission, otherwise,
cardiovascularly, the patient remained very stable.

2) Hematuria. The patient had been continued on continuous
bladder irrigation through Foley catheter. The urine did
clear to a very light amber color and the continuous bladder
irrigation was turned off for a trial period. Urine ran very
clear without difficulty without passage of clots most of
that day but then began to become bloody again and the
irrigation was continued. Urology was consulted and felt that
inpatient cystoscopy was not necessary, rather planned to
follow-up as an outpatient appointment and cystoscopy after
discharge. The Foley catheter was actually discontinued on
[**2153-5-26**]. The patient voided without difficulty with
minimal hematuria.

3) Heme. Upon admission, the patient was on aspirin, Plavix
and Heparin with a lower hematocrit then his baseline as
hematocrit was followed closely reaching a low point of 31.1
on [**2153-5-21**], the patient received two units of packed red
blood cells. At the time of discharge, his hematocrit has
been stable at 44.8. At the time of discharge, the patient is
still on aspirin and Plavix. Plavix is to be discontinued on
[**2153-5-31**]. The patient has been started on Coumadin which
is not yet therapeutic.

4) Gastrointestinal. The patient had been receiving tube
feeds via pediatric nasogastric tube on admission.
Nasogastric tube had been pulled a couple of times and
replaced by house staff. Interventional Radiology was
consulted and agreed to place percutaneous endoscopic
gastrostomy tube even though the patient was on Plavix.
Heparin was discontinued that morning. The patient underwent
percutaneous endoscopic gastrostomy tube placement without
complication. Following percutaneous endoscopic gastrostomy
tube placement, Heparin was reinstated and Coumadin begun.
Prior to percutaneous endoscopic gastrostomy tube placement,
the patient had undergone speech and swallow study that was
failed at the bedside. Video swallowing study was done the
morning of the percutaneous endoscopic gastrostomy tube which
the patient also failed providing for the percutaneous
endoscopic gastrostomy tube placement.

5) Neurologic. The patient's neurologic examination remained
unchanged throughout his admission. The patient's mental
status tended to wax and wane with his blood pressure and
hematocrit when hemodynamically stable, the patient was alert
and responded to questions and was able to have brief
conversations with family members who would translate for us.
There was no evidence of any new cerebrovascular accident
this admission.

DISCHARGE MEDICATIONS: The patient is discharged on, 1)
aspirin 325 mg by mouth per gastrostomy tube. 2) Plavix 75 mg
per gastrostomy tube every day and on [**2153-5-31**]. 3)
Heparin drip 1000 units per hour with a goal partial
prothrombin time of 50 to 70. This is to be discontinued once
international normalized ratio is therapeutic. 4) Coumadin,
the dose is still being titrated. The patient has received
two doses of 10 mg upon discharge. 5) Lopressor 12.5 mg by
mouth twice a day. 6) Zestril 5 mg by mouth every day. 7)
Prevacid 30 mg by mouth every day. 8) Isosorbide Mononitrate
60 mg every day. 9) Morphine Sulfate 2 mg subcutaneous every
four to six hours as needed for pain at percutaneous
endoscopic gastrostomy tube site. 10) Tube feeds, the patient
is receiving ProMod with fiber at a goal of 100 cc per hour,
residuals being checked every four hours and tube feeds being
held for residuals greater then 150 cc.

DISCHARGE CONDITION: Stable.

DISCHARGE DIAGNOSES: 1) Hematuria, while on aspirin, Plavix
and Heparin. 2) Status post percutaneous endoscopic
gastrostomy tube placement for failed swallowing study.

FOLLOW-UP: The patient is to follow-up with his primary care
physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 95315**] MD, at [**Telephone/Fax (1) 250**]. In
addition, the patient should follow-up with Urology,
Dr. [**Last Name (STitle) 8872**] in one to two weeks following discharge at
[**Telephone/Fax (1) 95313**].

DISCHARGE STATUS: The patient is discharged to an inpatient
rehabilitation or [**Hospital1 1501**] facility until strong enough to return
home.




                            KHASIGIWALA,[**Name8 (MD) 95314**] M.D. [**MD Number(1) 7855**]


Dictated By:[**Name8 (MD) 3491**]
MEDQUIST36

D:  [**2153-5-27**]  11:06
T:  [**2153-5-27**]  11:10
JOB#:  [**Job Number 95316**]


Admission Date:  [**2153-5-20**]       Discharge Date:  [**2153-5-27**]

Date of Birth:   [**2078-4-14**]       Sex:  M

Service:  ACOVE
CHIEF COMPLAINT: Hematuria.

HISTORY OF PRESENT ILLNESS: This is a seventy-five-year-old
Russian male with a complicated recent admission to [**Hospital1 1444**] who was transferred here from
on [**2153-4-27**], for chest pain. The patient had ruled in for
myocardial infarction, underwent cardiac catheterization and
stenting. Post-catheterization, the patient had a
cerebrovascular accident, leaving him with a left
hemiparesis. Prior to discharge, he had developed hematuria
while continuing therapy on aspirin, Plavix and Heparin.
While at [**Hospital **] Rehabilitation, the patient was receiving
endoscopic gastrostomy tube was not possible at that time due
to risk of bleeding on those three medications. The patient's
Plavix was scheduled to run for thirty days ending on [**2153-5-31**]. Regarding the patient's complaint of hematuria, the
patient had developed this problem immediately prior to his
discharge in [**Month (only) **]. The patient does have a history of a
bladder mass and transurethral resection of prostate in [**2142**].
In [**2147**], cytology was done of the bladder which was negative
for malignancy. This hematuria was felt to be secondary to
Foley catheter trauma or recurrent nephrolithiasis or tumor
while in the setting of anticoagulation. The patient had to
be restrained while at [**Hospital **] Hospital because he had been
pulling on the Foley catheter which may have led to bleeding.
In addition, he had removed his nasogastric tube five to six
times. On admission, the patient did also have heme positive
stool.

PAST MEDICAL HISTORY: 1) Myocardial infarction in [**2143**],
status post percutaneous transluminal coronary angioplasty
and stent to left anterior descending artery and left
circumflex in [**2152-10-21**], re-stent of left anterior
descending artery in [**2153-4-21**], the patient has ejection
fraction of 25%. 2) Sick sinus syndrome, status post DDD
pacer. 3) Benign prostatic hypertrophy, status post
transurethral resection of prostate in [**2142**]. 4) Hypertension.
5) Hypercholesterolemia. 6) Pancreatitis. 6) Spinal stenosis.
7) Colon polyps. 8) Nephrolithiasis.

ALLERGIES: No known drug allergies.

MEDICATIONS: Enteric coated aspirin 325 mg every day, Lipitor
40 mg every day, Isosorbide Mononitrate 60 mg every day,
Prevacid 30 mg every day, Toprol XL 25 mg every day, Plavix
75 mg every day, Captopril 6.25 mg three times a day, Heparin
GTT at 1400 units per hour.

SOCIAL HISTORY: The patient was born in [**Country 532**], denies any
use of tobacco in the past and drinks alcohol socially.

PHYSICAL EXAMINATION: Physical examination on admission, the
patient was afebrile at 98.8 F, rectal temperature, heart
rate 72, respiratory rate 20, blood pressure 90/50, pulse
oximetry 92% on two liters by nasal cannula. In general, the
patient was in no acute distress. The patient is Russian
speaking only. The family is present and able to translate.
Foley catheter was draining amber colored urine at the time
of admission. On head, eyes, ears, nose and throat
examination, the patient's right eye is closed, pupil
measuring 5 mm to 6 mm. Left eye is opened spontaneously,
measuring 2 mm to 3 mm and minimal reactive. The patient had
a pediatric nasogastric tube in place receiving tube feeds
and he had dry oral mucosa. On neck examination, his neck was
supple, he had no jugular venous distension, lymphadenopathy
or bruits. Cardiovascular, the patient had a regular S1 and
S2 with a III/VI systolic murmur. The patient was in a
regular rhythm. The patient's lungs were clear to
auscultation bilaterally listening anterior and
anterolaterally. The patient's abdomen had normal active
bowel sounds, it was soft, nontender and nondistended.
Extremity examination, his upper extremities were in soft
restraints. The patient had no cyanosis, clubbing or edema.
On neurologic examination, his pupils were noted as above on
the head, eyes, ears, nose and throat examination. The
patient was uncooperative with testing of cranial nerves, as
well as strength. The patient was aphasic, although making
some sounds and occasional words to his daughter.

LABORATORY DATA: White blood cell count 8.3, hematocrit 33.7,
platelet count 288,000, baseline hematocrit known to be 47 to
48.

Sodium was 136, potassium 5.0, chloride 100, bicarbonate 26,
blood, urea and nitrogen 19, creatinine 0.9, glucose 98.

Calcium 8.5, magnesium 2.0, phosphorous 3.9.

Liver function tests, ALT was 33, AST 39, alkaline
phosphatase 89, total bilirubin 0.4, albumin 3.1.

Prothrombin time, international normalized ratio were 11.9
and 1.0 respectively, partial prothrombin time was 21.9.

Urinalysis showed a large amount of blood, 30 of protein,
small leukocytes, was amber in color, was otherwise,
negative, greater then 1000 red blood cells, 11 white blood
cells, occasional bacteria and no yeast.

HOSPITAL COURSE: Hospital course by problem, 1)
cardiovascular, given the patient's ejection fraction of less
then 25% and his recent stent last month, the patient was
continued on his anticoagulative agents including aspirin,
Plavix and Heparin. The Heparin drip was continued rather
then starting Coumadin immediately given the possibility of
the patient receiving a percutaneous endoscopic gastrostomy
tube this admission by Interventional Radiology. Initially,
on presentation, the patient's blood pressure was somewhat
labile and low running in the 90's/50's to 100's/60's. The
patient's blood pressure medications including his Isosorbide
and his ACE inhibitor were held initially. After gentle
hydration, the patient's blood pressure did correct. We were
able to administer those medications again. On [**2153-5-22**],
the patient was complaining of chest pain. Electrocardiograms
were taken every five minutes, following sublingual
Nitroglycerin administration. The patient's pain was relieved
with three sublingual Nitroglycerin. There were no
electrocardiogram changes seen. Cardiac enzymes were checked
and the patient ruled out for myocardial infarction with
three sets of negative enzymes. There were no other
complaints of chest pain following that one episode. The
patient's Captopril was discontinued and changed to Zestril
over the course of the admission, otherwise,
cardiovascularly, the patient remained very stable.

2) Hematuria. The patient had been continued on continuous
bladder irrigation through Foley catheter. The urine did
clear to a very light amber color and the continuous bladder
irrigation was turned off for a trial period. Urine ran very
clear without difficulty without passage of clots most of
that day but then began to become bloody again and the
irrigation was continued. Urology was consulted and felt that
inpatient cystoscopy was not necessary, rather planned to
follow-up as an outpatient appointment and cystoscopy after
discharge. The Foley catheter was actually discontinued on
[**2153-5-26**]. The patient voided without difficulty with
minimal hematuria.

3) Heme. Upon admission, the patient was on aspirin, Plavix
and Heparin with a lower hematocrit then his baseline as
hematocrit was followed closely reaching a low point of 31.1
on [**2153-5-21**], the patient received two units of packed red
blood cells. At the time of discharge, his hematocrit has
been stable at 44.8. At the time of discharge, the patient is
still on aspirin and Plavix. Plavix is to be discontinued on
[**2153-5-31**]. The patient has been started on Coumadin which
is not yet therapeutic.

4) Gastrointestinal. The patient had been receiving tube
feeds via pediatric nasogastric tube on admission.
Nasogastric tube had been pulled by the patient several times and
replaced by house staff. Interventional Radiology was
consulted and agreed to place percutaneous endoscopic
gastrostomy tube. Heparin was discontinued that morning. The
patient underwent percutaneous endoscopic gastrostomy tube
placement without complication. Following percutaneous endoscopic
gastrostomy tube placement, Heparin was reinstated and Coumadin
begun. Prior to percutaneous endoscopic gastrostomy tube
placement, the patient had undergone speech and swallow study
that was failed at the bedside. Video swallowing study was done
the morning of the percutaneous endoscopic gastrostomy tube which
the patient also failed providing for the percutaneous
endoscopic gastrostomy tube placement.

5) Neurologic. The patient's neurologic examination remained
unchanged throughout his admission. The patient's mental
status tended to wax and wane with his blood pressure and
hematocrit when hemodynamically stable, the patient was alert
and responded to questions and was able to have brief
conversations with family members who would translate for us.
There was no evidence of any new cerebrovascular accident
this admission.

DISCHARGE MEDICATIONS: The patient is discharged on, 1)
aspirin 325 mg by mouth per gastrostomy tube. 2) Plavix 75 mg
per gastrostomy tube every day and on [**2153-5-31**]. 3)
Heparin drip 1000 units per hour with a goal partial
prothrombin time of 50 to 70. This is to be discontinued once
international normalized ratio is therapeutic. 4) Coumadin,
the dose is still being titrated. The patient has received
two doses of 10 mg upon discharge. 5) Lopressor 12.5 mg by
mouth twice a day. 6) Zestril 5 mg by mouth every day. 7)
Prevacid 30 mg by mouth every day. 8) Isosorbide Mononitrate
60 mg every day. 9) Morphine Sulfate 2 mg subcutaneous every
four to six hours as needed for pain at percutaneous
endoscopic gastrostomy tube site. 10) Tube feeds, the patient
is receiving ProMod with fiber at a goal of 100 cc per hour,
residuals being checked every four hours and tube feeds being
held for residuals greater then 150 cc.

DISCHARGE CONDITION: Stable.

DISCHARGE DIAGNOSES: 1) Hematuria, while on aspirin, Plavix
and Heparin. 2) Status post percutaneous endoscopic
gastrostomy tube placement for failed swallowing study.

FOLLOW-UP: The patient is to follow-up with his primary care
physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 15490**] MD, at [**Telephone/Fax (1) 250**]. In
addition, the patient should follow-up with Urology,
Dr. [**Last Name (STitle) 8872**] in one to two weeks following discharge at
[**Telephone/Fax (1) 95313**].

DISCHARGE STATUS: The patient is discharged to an inpatient
rehabilitation or [**Hospital1 1501**] facility until strong enough to return
home.




                            KHASIGIWALA,[**Name8 (MD) 95314**] M.D.12-869


Dictated By:[**Name8 (MD) 3491**]
MEDQUIST36

D:  [**2153-5-27**]  11:06
T:  [**2153-5-27**]  11:10
JOB#:  [**Job Number 24528**]


Admission Date:  [**2153-5-20**]       Discharge Date:  [**2153-6-7**]

Date of Birth:   [**2078-4-14**]       Sex:  M

Service:  A-Cove

ADDENDUM:  After dictation of the previous Discharge Summary
on [**5-27**], the patient had spiked a fever that night of
[**5-27**].

On [**5-29**] he was noted to have poor oxygen saturations.  A
chest x-ray revealed what was probably and aspiration
pneumonia.  The patient became hypotensive and was
transferred to the Medical Intensive Care Unit for blood
pressure, airway support, and treatment of aspiration
pneumonia.

In the Medical Intensive Care Unit, the patient was treated
for a methicillin-resistant Staphylococcus aureus pneumonia
with 10 days of vancomycin.  He was intubated for respiratory
distress.  He was maintained on the ventilator for six days,
at which time he self-extubated himself.  Thereafter, he was
oxygenated by 50% oxygen by mask.

At the time he came back to the floor, he was only on 3
liters nasal cannula and was saturating well.  His blood
pressure was very labile while in the Intensive Care Unit and
hypotensive, requiring Levophed for blood pressure support
which was weaned by unit day four.

His hypotensive episode also led to an episode of acute renal
failure, possibly acute tubular necrosis, with his creatinine
climbing to approximately 3.  Again, at the time of transfer
out of the unit, the creatinine was at his baseline.

He continued to be anticoagulated on aspirin and Plavix when
coming out of the unit.  Upon discharge, the Plavix will be
discontinued, and he will be sent on Lovenox because of her
anteroapical myocardial infarction and low ejection fraction.
Coumadin will be started as well, and when therapeutic the
Lovenox will be discontinued.

MEDICATIONS ON DISCHARGE:  (Discharge medications will be)
 1.  Lovenox 100 mg subcutaneous b.i.d.
 2.  Coumadin 5 mg p.o. q.h.s.
 3.  Prevacid 15 mg per G-tube q.d.
 4.  Insulin sliding-scale.
 5.  Tylenol 650 mg to 1000 mg per G-tube q.4-6h. as needed.
 6.  Dulcolax one tablet p.o. or p.r. q.d. as needed.
 7.  Lasix 40 mg per G-tube b.i.d. with parameters.
 8.  Captopril 12.5 mg per G-tube t.i.d. with holding
parameters.
 9.  Aspirin 325 mg p.o. q.d.
10.  Atorvastatin 10 mg p.o. q.d.
11.  Tube feeds of ProMod with fiber 80 cc per hour
continuously.
12.  NPH insulin 4 units subcutaneous in the morning
and 4 units subcutaneous at night.

CONDITION AT DISCHARGE:  Condition on discharge was stable.

DISCHARGE STATUS:  The patient was to be discharged to acute
rehabilitation with instructions to follow up with Urology as
per previous Discharge Summary.

DISCHARGE DIAGNOSES:
1.  Hematuria.
2.  Aspiration pneumonia.
3.  Congestive heart failure.




                           DR.[**Last Name (STitle) **],[**First Name3 (LF) 7853**] 12-869

Dictated By:[**Name8 (MD) 3491**]
MEDQUIST36

D:  [**2153-6-7**]  17:17
T:  [**2153-6-7**]  17:37
JOB#:  [**Job Number **]
{'Pneumonitis due to inhalation of food or vomitus,Acidosis,Congestive heart failure, unspecified,Acute kidney failure with lesion of tubular necrosis,Hypotension, unspecified,Late effects of cerebrovascular disease, aphasia,Pure hypercholesterolemia'}


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: This is a seventy-five-year-old
Russian male with a complicated recent admission to [**Hospital1 1444**] who was transferred here from
on [**2153-4-27**], for chest pain. The patient had ruled in for
myocardial infarction, underwent cardiac catheterization and
stenting. Post-catheterization, the patient had a
cerebrovascular accident, leaving him with a left
hemiparesis. Prior to discharge, he had developed hematuria
while continuing therapy on aspirin, Plavix and Heparin.
While at [**Hospital **] Rehabilitation, the patient was receiving
endoscopic gastrostomy tube was not possible at that time due
to risk of bleeding on those three medications. The patient's
Plavix was scheduled to run for thirty days ending on [**2153-5-31**]. Regarding the patient's complaint of hematuria, the
patient had developed this problem immediately prior to his
discharge in [**Month (only) **]. The patient does have a history of a
bladder mass and transurethral resection of prostate in [**2142**].
In [**2147**], cytology was done of the bladder which was negative
for malignancy. This hematuria was felt to be secondary to
Foley catheter trauma or recurrent nephrolithiasis or tumor
while in the setting of anticoagulation. The patient had to
be restrained while at [**Hospital **] Hospital because he had been
pulling on the Foley catheter which may have led to bleeding.
In addition, he had removed his nasogastric tube five to six
times. On admission, the patient did also have heme positive
stool.

MEDICAL HISTORY: 1) Myocardial infarction in [**2143**],
status post percutaneous transluminal coronary angioplasty
and stent to left anterior descending artery and left
circumflex in [**2152-10-21**], re-stent of left anterior
descending artery in [**2153-4-21**], the patient has ejection
fraction of 25%. 2) Sick sinus syndrome, status post DDD
pacer. 3) Benign prostatic hypertrophy, status post
transurethral resection of prostate in [**2142**]. 4) Hypertension.
5) Hypercholesterolemia. 6) Pancreatitis. 6) Spinal stenosis.
7) Colon polyps. 8) Nephrolithiasis.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient was born in [**Country 532**], denies any
use of tobacco in the past and drinks alcohol socially. 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Acidosis,Congestive heart failure, unspecified,Acute kidney failure with lesion of tubular necrosis,Hypotension, unspecified,Late effects of cerebrovascular disease, aphasia,Pure hypercholesterolemia'}
