CHIEF COMPLAINT: Unresponsive, respiratory distress

PRESENT ILLNESS: The patient is a [**Age over 90 **] year old female with a history of dementia,
multiple ischemic strokes, hypertension, diabetes mellitus,
atrial fibrillation, and diastolic CHF who was found
unresponsive in bed at her nursing home.  She was not responsive
to voice and only minimally responsive to sternal rub.  She was
noted to be in respiratory distress with tachypnea and
desaturation on RA, and was placed on a NRB.  She was brought to
the [**Hospital1 18**] ED for further evaluation.  She has a documented
DNI/DNR order.
.
In the ED, initial vital signs were T 96.9, BP 110/73, HR 130,
RR 24, SpO2 100% on 15L NRB.  She had an unremarkable head CT
with only no acute process noted.  Portable CXR showed a LLL
opacity concerning for infection, and her WBC count was elevated
to 16.4 with 79.3% neutrophils and no bands.  UA showed WBC 13,
small leuk esterase, and no bacteria.  Her Troponin was slightly
elevated to 0.05, and EKG showed atrial fibrillation at 135 bpm
with left axis deviation and no acute ischemic changes.  Oral
secretions were cleared with suction.  She was given Vancomycin
1000 mg IV and Zosyn 4.5 grams IV.  She received a total of 700
ml IV fluids.  For her atrial fibrillation, she received a total
of Diltiazem 40 mg IV with good response in her heart rate and
stable blood pressure.  She was admitted to the ICU given her
continued oxygen requirement.  Vitals prior to transfer were T
afebrile, HR 103, BP 97/47, RR 27, SpO2 98% on 15L.
.
Once in the ICU, she remained unresponsive to voice and would
only withdraw from painful stimuli.  She was in mild respiratory
distress with tachypnea and appeared uncomfortable.  Her son was
[**Name (NI) 653**] and her code status was confirmed as DNR/DNI.  He will
be coming in to the ICU tomorrow.
.
Review of Systems:
Unable to obtain due to patient mental status.

MEDICAL HISTORY: (per limited nursing home records sent on transfer)
# Dementia
# Multiple ischemic strokes
# Aphasia
# Dysphagia
-- Tube feeds through G-tube
-- Jevity 1.2 at 60 ml/hr
-- Free water flushes 250 ml Q6H
-- Flush 50 ml before and after meds
# Hypertension
# Diabetes mellitus
# Atrial fibrillation
# Congestive Heart Failure
-- unclear if systolic or diastolic
# Recent admission to [**Hospital1 112**] from [**2166-7-18**] to [**2166-7-31**]

MEDICATION ON ADMISSION: Aspirin 325 mg PO daily
Pravastatin 20 mg PO daily
Dalteparin 5000 units SC daily
Metoprolol 25 mg PO BID
Furosemide 40 mg PO BID
Novolog sliding scale
Acetaminophen 650 mg PO Q4H PRN pain or fever (max 4g /24 hours)
Trazodone 25 mg PO QHS
Colace 100 mg PO daily
Senna 8.6 mg PO daily PRN constipation
Bisacodyl 10 mg PR daily PRN constipation
Fleet enema PR daily PRN constipation

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMITTING PHYSICAL EXAM:
Vitals: T 98.8, BP 112/67, HR 116, RR 22, SpO2 100% on 15L NRB
General: Unresponsive, withdraws to pain.  Moderate respiratory
distress, otherwise appears comfortable.
HEENT: Sclera anicteric, PERRL, dry MM
Neck: JVP not elevated, no LAD
Lungs: Decreased breath sounds and rhonchi at left base.  Coarse
breath sounds throughout.
CV: Irregularly irregular and mild tachycardia.  Normal S1, S2.
No murmurs, rubs, gallops.
Abdomen: Bowel sounds present. G-tube and abdominal binder in
place.  Soft, non-tender, non-distended.
GU: Foley draining clear yellow urine
Ext: Cool distal extremities. Radial pulses 1+, unable to
palpate pedal pulses. No lower extremity edema.  Toes somewhat
cyanotic.
.
DISCHARGE PHYSICAL EXAM:
Afebrile BP 100s-110s/50-60s P 50s-80s RR 20 SpO2 96-100% RA
Gen: mostly nonverbal and unresponsive.  Usually with eyes open.
 Occasionally will turn to voice.  Otherwise, does not withdrawl
to pain and does not follow commands.
Remainder of exam is unchanged except heart rate was well
controlled at time of discharge.

FAMILY HISTORY: Unable to obtain due to patient mental status

SOCIAL HISTORY: Unable to obtain due to patient mental status
Pneumonitis due to inhalation of food or vomitus,Acute on chronic diastolic heart failure,Toxic encephalopathy,Acute respiratory failure,Hemorrhage of gastrointestinal tract, unspecified,Atrial fibrillation,Bed confinement status,Gastrostomy status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypoxemia,Vascular dementia, uncomplicated,Cerebral atherosclerosis,Pressure ulcer, lower back,Surgical or other procedure not carried out because of patient's decision
Food/vomit pneumonitis,Ac on chr diast hrt fail,Toxic encephalopathy,Acute respiratry failure,Gastrointest hemorr NOS,Atrial fibrillation,Bed confinement status,Gastrostomy status,DMII wo cmp nt st uncntr,Hypoxemia,Vascular dementia,uncomp,Cerebral atherosclerosis,Pressure ulcer, low back,No proc/patient decision
Admission Date:  [**2166-8-22**]              Discharge Date:   [**2166-8-31**]


Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 2290**]
Chief Complaint:
Unresponsive, respiratory distress

Major Surgical or Invasive Procedure:
None

History of Present Illness:
The patient is a [**Age over 90 **] year old female with a history of dementia,
multiple ischemic strokes, hypertension, diabetes mellitus,
atrial fibrillation, and diastolic CHF who was found
unresponsive in bed at her nursing home.  She was not responsive
to voice and only minimally responsive to sternal rub.  She was
noted to be in respiratory distress with tachypnea and
desaturation on RA, and was placed on a NRB.  She was brought to
the [**Hospital1 18**] ED for further evaluation.  She has a documented
DNI/DNR order.
.
In the ED, initial vital signs were T 96.9, BP 110/73, HR 130,
RR 24, SpO2 100% on 15L NRB.  She had an unremarkable head CT
with only no acute process noted.  Portable CXR showed a LLL
opacity concerning for infection, and her WBC count was elevated
to 16.4 with 79.3% neutrophils and no bands.  UA showed WBC 13,
small leuk esterase, and no bacteria.  Her Troponin was slightly
elevated to 0.05, and EKG showed atrial fibrillation at 135 bpm
with left axis deviation and no acute ischemic changes.  Oral
secretions were cleared with suction.  She was given Vancomycin
1000 mg IV and Zosyn 4.5 grams IV.  She received a total of 700
ml IV fluids.  For her atrial fibrillation, she received a total
of Diltiazem 40 mg IV with good response in her heart rate and
stable blood pressure.  She was admitted to the ICU given her
continued oxygen requirement.  Vitals prior to transfer were T
afebrile, HR 103, BP 97/47, RR 27, SpO2 98% on 15L.
.
Once in the ICU, she remained unresponsive to voice and would
only withdraw from painful stimuli.  She was in mild respiratory
distress with tachypnea and appeared uncomfortable.  Her son was
[**Name (NI) 653**] and her code status was confirmed as DNR/DNI.  He will
be coming in to the ICU tomorrow.
.
Review of Systems:
Unable to obtain due to patient mental status.


Past Medical History:
(per limited nursing home records sent on transfer)
# Dementia
# Multiple ischemic strokes
# Aphasia
# Dysphagia
-- Tube feeds through G-tube
-- Jevity 1.2 at 60 ml/hr
-- Free water flushes 250 ml Q6H
-- Flush 50 ml before and after meds
# Hypertension
# Diabetes mellitus
# Atrial fibrillation
# Congestive Heart Failure
-- unclear if systolic or diastolic
# Recent admission to [**Hospital1 112**] from [**2166-7-18**] to [**2166-7-31**]


Social History:
Unable to obtain due to patient mental status


Family History:
Unable to obtain due to patient mental status


Physical Exam:
ADMITTING PHYSICAL EXAM:
Vitals: T 98.8, BP 112/67, HR 116, RR 22, SpO2 100% on 15L NRB
General: Unresponsive, withdraws to pain.  Moderate respiratory
distress, otherwise appears comfortable.
HEENT: Sclera anicteric, PERRL, dry MM
Neck: JVP not elevated, no LAD
Lungs: Decreased breath sounds and rhonchi at left base.  Coarse
breath sounds throughout.
CV: Irregularly irregular and mild tachycardia.  Normal S1, S2.
No murmurs, rubs, gallops.
Abdomen: Bowel sounds present. G-tube and abdominal binder in
place.  Soft, non-tender, non-distended.
GU: Foley draining clear yellow urine
Ext: Cool distal extremities. Radial pulses 1+, unable to
palpate pedal pulses. No lower extremity edema.  Toes somewhat
cyanotic.
.
DISCHARGE PHYSICAL EXAM:
Afebrile BP 100s-110s/50-60s P 50s-80s RR 20 SpO2 96-100% RA
Gen: mostly nonverbal and unresponsive.  Usually with eyes open.
 Occasionally will turn to voice.  Otherwise, does not withdrawl
to pain and does not follow commands.
Remainder of exam is unchanged except heart rate was well
controlled at time of discharge.


Pertinent Results:
====================
Imaging:
====================
# CHEST (PORTABLE AP) ([**2166-8-22**] at 12:32 PM):
FINDINGS: A portable semi-upright view of the chest was
obtained. The patient is rotated and low lung volumes result in
bronchovascular crowding. Left lower lung consolidatoin may be a
combination of atelectasis and effusion, although infection
cannot be excluded. The heart is enlarged. Aortic knob
calcifications are seen. The right lung is clear without
pneumothorax or effusion. No acute osseous abnormality is
identified.
IMPRESSION: Left lower lung consolidation may be a combination
of telectasis and effusion, but infection cannot be excluded. PA
and lateral views may be helpful for further evaluation.
.
# CT HEAD W/O CONTRAST ([**2166-8-22**] at 12:38 PM):
FINDINGS: There is no acute intracranial hemorrhage, edema, mass
effect or major vascular territorial infarcts. Prominent
ventricles and sulci are compatible with moderate global
age-related volume loss. Hypoattenuation in the periventricular
and subcortical white matter is likely sequelae of chronic
microvascular ischemic disease. Bilateral basal ganglia
calcifications are noted. There is no shift of normally midline
structures. [**Doctor Last Name **]-white matter differentiation is preserved. No
acute osseous abnormality is identified. Mild mucosal thickening
is seen in the ethmoid air cells and sphenoid sinuses. The
mastoid air cells are clear.
IMPRESSION: No acute intracranial hemorrhage. Significant global
age related volume loss and chronic microvascular ischemic
disease change.
.
CHEST (PORTABLE AP) Study Date of [**2166-8-26**]
FINDINGS: As compared to the previous examination, the extent of
the
pre-existing left pleural effusion has moderately increased. The
effusion now occupies approximately 50% of the left hemithorax.
No right pleural effusion.
There is mild cardiomegaly with signs of minimal overhydration.
No newly occurred focal parenchymal opacities. Extensive left
lower lobe
atelectasis.

====================
Micro:
Blood and urine cultures negative with exception of yeast from
urine culture from admission.
.
====================
DISCHARGE LABS:
[**2166-8-31**] 06:45AM BLOOD WBC-5.8 RBC-3.63* Hgb-10.8* Hct-33.0*
MCV-91 MCH-29.8 MCHC-32.7 RDW-13.1 Plt Ct-395
[**2166-8-31**] 06:45AM BLOOD Glucose-295* UreaN-27* Creat-1.1 Na-138
K-3.7 Cl-95* HCO3-31 AnGap-16
[**2166-8-31**] 06:45AM BLOOD Calcium-9.0 Mg-2.4

Brief Hospital Course:
The patient is a [**Age over 90 **] year old female with a history of dementia,
multiple ischemic strokes, hypertension, diabetes mellitus,
atrial fibrillation, and diastolic CHF who was found
unresponsive in bed and in respiratory distress at her nursing
home, likely due to a left lower lung pneumonia.
.
# Pneumonia, likely aspiration - She has a history of dementia
and dysphagia and was receiving tube feeds through a
percutaneous G tube. Given her acute presentation and history,
an aspiration event was presumed to be the likely cause of her
respiratory decompensation. She was started on Vancomycin and
Zosyn in the ED, and required supplemental oxygen with a 15L
NRB. She was continued on Vanc/Zosyn in the ICU.  She completed
an 8-day course of Vancomycin and Zosyn on [**2166-8-29**].
.
# Acute on chronic diastolic heart failure - On the medical
floor, she had an acute decompensation, with increased
respiratory distress, Afib with HR to 130's, and decreased
breath sounds.  She was presumed to be in acute diastolic heart
failure, and was treated with IV lasix, IV diltiazem, as well as
IV morphine and ativan for patient comfort given acute distress.
 With these interventions, pt's respiratory status stabilized.
Her HR improved significantly, and she was started on low dose
diltiazem to continue to help control her heart rate.  She was
continued on oral lasix.  Her volume status should be monitored
carefully.  Also, would recommend that her electrolytes and
creatinine are checked every few days and that her lasix be
decreased if her creatinine increases.
.
# Atrial Fibrillation, with RVR - She was in RVR several times
during her hospitalization and her nodal blockade was titrated.
Her heart rate was very well controlled on diltiazem and
metoprolol at the current doses (please see discharge medication
list).
.
# ? upper GI bleed - On [**8-28**] she was noted by nursing to have
bright red blood when her G-tube was suctioned.  Tube feeds were
held, she was started on an intravenous PPI drip and her
hematocrit was trended.  A conversation was held with her health
care proxy who declined endoscopy or intervention.  Ultimately,
her hematocrit was trended and actually remained stable.  Her
proton pump inhibitor was changed to oral.  Her tube feeds were
restarted and she was tolerating them at full strength at the
time of discharge without residuals or any evidence of bleeding.

.
# Mental Status Changes/ probable toxic metabolic
encephalopathy: She has a history of dementia and prior strokes.
 Her baseline prior to the current admission was poor after her
most recent stroke per her son, with aphasia and dysphagia noted
in her records.  Head CT on arrival did not show any acute
process.  During the admission, she was generally minimally
responsive, and aphasic.  She would occasionally orient towards
voice but that was about the extent of her responsiveness.
.
# Troponin Leak:  Her Troponin was elevated slightly to 0.05 on
admission with no ischemic changes on EKG.  This was most likely
due to demand ischemia due to Afib with RVR. Troponins were
followed and stably elevated 0.05.
.
# Nutrition:  She is on tube feeds with Jevity 1.2 at 60 ml/hr
at home through her G-tube.
.
# Diabetes Mellitus: Fingerstick checks Q6H. She was managed
with a regular insulin sliding scale and this should be
continued
.
# Goals of care:  A family meeting was held with pt's son and
healthcare proxy, [**Name (NI) 915**] [**Name (NI) **], on [**2166-8-26**], shortly after a period
of acute decompensation.  Palliative care was consulted and
assisted with goals of care discussions.  Per the discussion
with [**Doctor Last Name 915**], future ICU transfers are not within patient's goals
of care.  Futhermore, we recommend further discussion with her
nursing facility physician, [**Name10 (NameIs) 3**] it appears that the family is
open to discussion about the possibility of no further
hospitalizations, and instead pursuing comfort-directed care
within the nursing home.  She currently remains DNR/DNI, no ICU
care.
********************
TRANSITIONAL ISSUES:
- Son [**Name (NI) 915**] [**Name (NI) **] tel #s: (h)[**Telephone/Fax (1) 31105**]; (c) [**Telephone/Fax (1) 31106**]
- please continue discussions with family about goals of care as
family is potentially interested in not hospitalizing for
further exacerbations of health.
- please monitor electrolytes including creatinine at least
several times a week and consider decreasing lasix as needed
- please monitor finger sticks, she may need a change in tube
feeds or starting NPH for improved glycemic control


Medications on Admission:
Aspirin 325 mg PO daily
Pravastatin 20 mg PO daily
Dalteparin 5000 units SC daily
Metoprolol 25 mg PO BID
Furosemide 40 mg PO BID
Novolog sliding scale
Acetaminophen 650 mg PO Q4H PRN pain or fever (max 4g /24 hours)
Trazodone 25 mg PO QHS
Colace 100 mg PO daily
Senna 8.6 mg PO daily PRN constipation
Bisacodyl 10 mg PR daily PRN constipation
Fleet enema PR daily PRN constipation


Discharge Medications:
1. bisacodyl 5 mg Tablet, Delayed Release (E.C.) [**Telephone/Fax (1) **]: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
Constipation.
2. insulin regular human 100 unit/mL Solution [**Telephone/Fax (1) **]: see other
instructions units Injection every six (6) hours: 70-100 give
nothing
100-150 give 2 units of regular
150-200 give 4 units of regular
200-250 give 6 units of regular
250-300 give 8 units of regular
300-350 give 10 units of regular
>350 [**Name8 (MD) 138**] MD .
3. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization [**Name8 (MD) **]: One (1) neb Inhalation Q4H (every 4 hours) as
needed for wheezing.
4. furosemide 40 mg Tablet [**Name8 (MD) **]: Two (2) Tablet PO DAILY (Daily).

5. lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR PO BID (2 times a day).
6. metoprolol tartrate 25 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO Q6H
(every 6 hours).
7. diltiazem HCl 90 mg Tablet [**Last Name (STitle) **]: 0.5 Tablet PO TID (3 times a
day).


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Healthcare Center - [**Location (un) **]

Discharge Diagnosis:
# Pneumonia, likely aspiration
# Acute Respiratory Distress
# Acute on chronic diastolic heart failure
# Atrial Fibrillation with RVR
# Cardiac ischemia (demand ischemia)
# Advanced Dementia


Discharge Condition:
Mental Status: Confused - always.
Level of Consciousness: Lethargic but arousable.
Activity Status: Bedbound.


Discharge Instructions:
You were admitted with unresponsiveness and hypoxia.  You are
suspected of having a pneumonia and acute diastolic heart
failure.  You were treated in the ICU initially, and you
received antibiotics for your pneumonia. You had a fast heart
rate and fluid in the lungs, which was treated with medications.
We had a discussion with your son and healthcare proxy ([**Name (NI) 915**]
[**Name (NI) **]), and it was decided that ICU care would not be within your
future goals of care.  Based on this discussion, your family
should also talk with the doctors at your nursing facility about
future goals of care, and whether you would want hospitalization
in the future, or if you would prefer to remain in the nursing
facility and be made comfortable, if you becomes ill again.

Followup Instructions:
Please follow-up with your primary care doctor [**First Name (Titles) **] [**Last Name (Titles) **]
from the extended care facility
{"Pneumonitis due to inhalation of food or vomitus,Acute on chronic diastolic heart failure,Toxic encephalopathy,Acute respiratory failure,Hemorrhage of gastrointestinal tract, unspecified,Atrial fibrillation,Bed confinement status,Gastrostomy status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypoxemia,Vascular dementia, uncomplicated,Cerebral atherosclerosis,Pressure ulcer, lower back,Surgical or other procedure not carried out because of patient's decision"}


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: Unresponsive, respiratory distress

PRESENT ILLNESS: The patient is a [**Age over 90 **] year old female with a history of dementia,
multiple ischemic strokes, hypertension, diabetes mellitus,
atrial fibrillation, and diastolic CHF who was found
unresponsive in bed at her nursing home.  She was not responsive
to voice and only minimally responsive to sternal rub.  She was
noted to be in respiratory distress with tachypnea and
desaturation on RA, and was placed on a NRB.  She was brought to
the [**Hospital1 18**] ED for further evaluation.  She has a documented
DNI/DNR order.
.
In the ED, initial vital signs were T 96.9, BP 110/73, HR 130,
RR 24, SpO2 100% on 15L NRB.  She had an unremarkable head CT
with only no acute process noted.  Portable CXR showed a LLL
opacity concerning for infection, and her WBC count was elevated
to 16.4 with 79.3% neutrophils and no bands.  UA showed WBC 13,
small leuk esterase, and no bacteria.  Her Troponin was slightly
elevated to 0.05, and EKG showed atrial fibrillation at 135 bpm
with left axis deviation and no acute ischemic changes.  Oral
secretions were cleared with suction.  She was given Vancomycin
1000 mg IV and Zosyn 4.5 grams IV.  She received a total of 700
ml IV fluids.  For her atrial fibrillation, she received a total
of Diltiazem 40 mg IV with good response in her heart rate and
stable blood pressure.  She was admitted to the ICU given her
continued oxygen requirement.  Vitals prior to transfer were T
afebrile, HR 103, BP 97/47, RR 27, SpO2 98% on 15L.
.
Once in the ICU, she remained unresponsive to voice and would
only withdraw from painful stimuli.  She was in mild respiratory
distress with tachypnea and appeared uncomfortable.  Her son was
[**Name (NI) 653**] and her code status was confirmed as DNR/DNI.  He will
be coming in to the ICU tomorrow.
.
Review of Systems:
Unable to obtain due to patient mental status.

MEDICAL HISTORY: (per limited nursing home records sent on transfer)
# Dementia
# Multiple ischemic strokes
# Aphasia
# Dysphagia
-- Tube feeds through G-tube
-- Jevity 1.2 at 60 ml/hr
-- Free water flushes 250 ml Q6H
-- Flush 50 ml before and after meds
# Hypertension
# Diabetes mellitus
# Atrial fibrillation
# Congestive Heart Failure
-- unclear if systolic or diastolic
# Recent admission to [**Hospital1 112**] from [**2166-7-18**] to [**2166-7-31**]

MEDICATION ON ADMISSION: Aspirin 325 mg PO daily
Pravastatin 20 mg PO daily
Dalteparin 5000 units SC daily
Metoprolol 25 mg PO BID
Furosemide 40 mg PO BID
Novolog sliding scale
Acetaminophen 650 mg PO Q4H PRN pain or fever (max 4g /24 hours)
Trazodone 25 mg PO QHS
Colace 100 mg PO daily
Senna 8.6 mg PO daily PRN constipation
Bisacodyl 10 mg PR daily PRN constipation
Fleet enema PR daily PRN constipation

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMITTING PHYSICAL EXAM:
Vitals: T 98.8, BP 112/67, HR 116, RR 22, SpO2 100% on 15L NRB
General: Unresponsive, withdraws to pain.  Moderate respiratory
distress, otherwise appears comfortable.
HEENT: Sclera anicteric, PERRL, dry MM
Neck: JVP not elevated, no LAD
Lungs: Decreased breath sounds and rhonchi at left base.  Coarse
breath sounds throughout.
CV: Irregularly irregular and mild tachycardia.  Normal S1, S2.
No murmurs, rubs, gallops.
Abdomen: Bowel sounds present. G-tube and abdominal binder in
place.  Soft, non-tender, non-distended.
GU: Foley draining clear yellow urine
Ext: Cool distal extremities. Radial pulses 1+, unable to
palpate pedal pulses. No lower extremity edema.  Toes somewhat
cyanotic.
.
DISCHARGE PHYSICAL EXAM:
Afebrile BP 100s-110s/50-60s P 50s-80s RR 20 SpO2 96-100% RA
Gen: mostly nonverbal and unresponsive.  Usually with eyes open.
 Occasionally will turn to voice.  Otherwise, does not withdrawl
to pain and does not follow commands.
Remainder of exam is unchanged except heart rate was well
controlled at time of discharge.

FAMILY HISTORY: Unable to obtain due to patient mental status

SOCIAL HISTORY: Unable to obtain due to patient mental status 

### Response:
{"Pneumonitis due to inhalation of food or vomitus,Acute on chronic diastolic heart failure,Toxic encephalopathy,Acute respiratory failure,Hemorrhage of gastrointestinal tract, unspecified,Atrial fibrillation,Bed confinement status,Gastrostomy status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypoxemia,Vascular dementia, uncomplicated,Cerebral atherosclerosis,Pressure ulcer, lower back,Surgical or other procedure not carried out because of patient's decision"}
