CHIEF COMPLAINT: progessive mental status change

PRESENT ILLNESS: Pt is a 80 yo female w/ PMhx sig for ESRD on HD, DM II, HTN, PAF
on coumadin who p/w decline in mental status for ~ 2 weeks. Pt
accompanied to ED by son who provided majority of history.  Pt
is a nursing home resident and 1 month ago she fell backwards
striking the left posterior aspect of her head on a sink.  She
did not lose consciousness with this event.  Over the last two
weeks she has had personality change, increased lethargy, and
agitation.  Apparently, at baseline she reads the newspaper
everyday and is very alert, pleasant, and conversant.  Due to
concerns for her continued decline, she was brought to an OSH
where she was found to have multiple SDH and subsequently
transferred to [**Hospital1 18**] for further management.

MEDICAL HISTORY: DM II,
ESRD on HD,
HTN,
h/o epidural abscess,
h/o vertebral osteomyelitis and diskitis,
CHF, EF 25% in [**2189**] but 55% in [**2193**]
no CAD from cath in [**2189**]

MEDICATION ON ADMISSION: 

ALLERGIES: Percocet / Darvocet-N 100

PHYSICAL EXAM: Vitals: T 98.6; BP 159/76; P ; RR 20; O2sat 98 4L
.
General: lying in bed, anxious appearing
HEENT: NCAT, dry mmm
Neck: supple
Pulmonary: CTA b/l
Cardiac: irreg irreg, with no m/r/g
Abdomen: soft, nontender, non distended, normal bowel sounds
Extremities: no c/c/e.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Lives in nursing home.
non smoker, no ETOH, no IVDU.  Son visits regularly.
Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Congestive heart failure, unspecified,Atrial fibrillation,Hypoxemia,Hyperosmolality and/or hypernatremia,Cerebral embolism with cerebral infarction,Other accidental fall from one level to another,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Accidents occurring in residential institution,Inflammatory disease of breast,Other persistent mental disorders due to conditions classified elsewhere,Benign neoplasm of breast
Subdural hem w/o coma,Hyp kid NOS w cr kid V,End stage renal disease,CHF NOS,Atrial fibrillation,Hypoxemia,Hyperosmolality,Crbl emblsm w infrct,Fall-1 level to oth NEC,DMII wo cmp nt st uncntr,Accid in resident instit,Inflam disease of breast,Mental disor NEC oth dis,Benign neoplasm breast
Admission Date:  [**2196-11-18**]              Discharge Date:   [**2196-11-27**]

Date of Birth:  [**2116-3-28**]             Sex:   F

Service: MEDICINE

Allergies:
Percocet / Darvocet-N 100

Attending:[**First Name3 (LF) 6578**]
Chief Complaint:
progessive mental status change

Major Surgical or Invasive Procedure:
burr hole procedure, chest tube.

History of Present Illness:
Pt is a 80 yo female w/ PMhx sig for ESRD on HD, DM II, HTN, PAF
on coumadin who p/w decline in mental status for ~ 2 weeks. Pt
accompanied to ED by son who provided majority of history.  Pt
is a nursing home resident and 1 month ago she fell backwards
striking the left posterior aspect of her head on a sink.  She
did not lose consciousness with this event.  Over the last two
weeks she has had personality change, increased lethargy, and
agitation.  Apparently, at baseline she reads the newspaper
everyday and is very alert, pleasant, and conversant.  Due to
concerns for her continued decline, she was brought to an OSH
where she was found to have multiple SDH and subsequently
transferred to [**Hospital1 18**] for further management.


Past Medical History:
DM II,
ESRD on HD,
HTN,
h/o epidural abscess,
h/o vertebral osteomyelitis and diskitis,
CHF, EF 25% in [**2189**] but 55% in [**2193**]
no CAD from cath in [**2189**]

Social History:
Lives in nursing home.
non smoker, no ETOH, no IVDU.  Son visits regularly.


Family History:
non contributory

Physical Exam:
Vitals: T 98.6; BP 159/76; P ; RR 20; O2sat 98 4L
.
General: lying in bed, anxious appearing
HEENT: NCAT, dry mmm
Neck: supple
Pulmonary: CTA b/l
Cardiac: irreg irreg, with no m/r/g
Abdomen: soft, nontender, non distended, normal bowel sounds
Extremities: no c/c/e.

Neurologic:
Mental status: alert, and oriented to hospital, month, year -
4005. Unable to say MOYB.  Fluent speech.  Adequate
comprehension.  Shows left thumb.  Repetition intact.  Registers
[**2-25**], Recalls 0/3 at five minutes.  No right/left mismatch.
[**Location (un) **] intact.  No apraxias/neglect.
.
Cranial Nerves:
I: Not tested
II: Visual fields full.  PERRL, 4-->2mm with light.  Optic discs
sharp.
III, IV, VI: EOMI, fatiguable end gaze nystagmus b/l
V, VII: facial sensation intact, face strength intact
VIII: hearing intact b/l to finger rubbing.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius.
XII: Tongue midline without fasciculations.
.
Motor: Normal bulk. Normal tone
.
     Delt Tri [**Hospital1 **] WE WF FE FF IP QD Ham DF PF
RT:   5    4+ 5  5  5  5  4+ 5  5   5  5   5
LEFT: 5    5  5  5  5  5  5  5  5   5  5   5
.
Sensation: Decreased proprioception/vibration in feet b/l.
Intact to light touch, pinprick.  No extinction to double
simultaneous stimulation.
.
Reflexes: Bicep  T  Br Pa Ac
Right       2    2   2  2  2
Left        2    2   2  2  2
Toes downgoing bilaterally.
.
Coordination: FNF intact.
.
Gait: not tested


Pertinent Results:
[**2196-11-18**] 09:00PM   PT-17.3* PTT-30.6 INR(PT)-2.1

[**2196-11-18**] 04:00PM   GLUCOSE-157* UREA N-25* CREAT-4.3* SODIUM-139
POTASSIUM-4.4 CHLORIDE-98 TOTAL CO2-29 ANION GAP-16
[**2196-11-18**] 04:00PM   WBC-5.3 RBC-4.16* HGB-12.5 HCT-37.9 MCV-91#
MCH-29.9# MCHC-32.9 RDW-15.9*
[**2196-11-18**] 04:00PM   ALBUMIN-3.7
[**2196-11-18**] 04:00PM   PLT COUNT-105* LPLT-1+
[**2196-11-18**] 04:00PM   NEUTS-81.1* LYMPHS-11.8* MONOS-4.4 EOS-2.3
BASOS-0.4
[**2196-11-18**] 04:00PM   PT-18.8* PTT-29.7 INR(PT)-2.5

HEAD CT [**2196-11-18**]
Several multicompartmental chornic subdural collections are seen
surrounding the right cerebral hemisphere. Adjacent to the right
temporal [**Doctor Last Name 534**], a focus of hyperdensity may indicate an acute
component. Additionally, an old chronic subdural hematoma is
seen in the left parietal region. There is mass effect on the
right lateral ventricle, and shift of the central septum
pellucidum to the left, by 9 mm indicating subfalcine
herniation. The normal fourth ventricle is not clearly seen,
concerning for inferior herniation. The basilar cisterns are
preserved. The surrounding soft tissue and osseous structures
are unremarkable.

HEAD CT [**2196-11-20**];POST-OP
Interval decrease in the subdural collection adjacent to the
right temporal region. Markedly decreased mass effect on the
right temproal lobe. The remaining extra- axial collections and
the brain parenchyma are unchanged. No new areas of hemorrhage
are identified.


Brief Hospital Course:
80 year old-female presented to ER with progresive mental status
decline after sustainign a fall at the nursing home a month ago.
Patient admitted to Neuro ICU for close monitoring. Pateint's
INR 2.5 reversed with Vitamin K, FFP. Pateint received 1000mg of
dilantin then continued with maintanence dose. Patient taken to
OR on [**2196-11-19**] electively for a right sided burr hole for
subdural hematoma, acute on chronic, right greater than left,
with right to left midline shift. She underwent general
endotracheal anesthesia by the anesthesia team. The patient was
hemodynamically stable on induction. Of note, the patient is
post hemodialysis the day of surgery. She taken ot the operating
room with corrected coagulations of INR of 1.3, but a PTT of 77
for which she received 2 units of FFP intraoperatively. There
were no intraoperative complications, and the blood loss was
minimal. Post operatively INR goal is less then 1.4. Serial Head
CT remained stable.

Patient has been followed by renal service, continues to have
her hemodialysis regularly. Breast service consulted for right
breast "peau d'orange" on physical exam to evaluate.Her last
mammograms were from [**2189**], [**2181**] has been normal.

-----
After transfer to the floor, pt was found to be unresponsive by
nursing.  Asystole on monitor.  She expired on [**2196-11-26**].

Discharge Disposition:
Expired

Discharge Diagnosis:
subdural hematoma

Discharge Condition:
expired

Discharge Instructions:
expired

Followup Instructions:
expired


Completed by:[**2196-11-27**]
{'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Congestive heart failure, unspecified,Atrial fibrillation,Hypoxemia,Hyperosmolality and/or hypernatremia,Cerebral embolism with cerebral infarction,Other accidental fall from one level to another,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Accidents occurring in residential institution,Inflammatory disease of breast,Other persistent mental disorders due to conditions classified elsewhere,Benign neoplasm of breast'}


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: progessive mental status change

PRESENT ILLNESS: Pt is a 80 yo female w/ PMhx sig for ESRD on HD, DM II, HTN, PAF
on coumadin who p/w decline in mental status for ~ 2 weeks. Pt
accompanied to ED by son who provided majority of history.  Pt
is a nursing home resident and 1 month ago she fell backwards
striking the left posterior aspect of her head on a sink.  She
did not lose consciousness with this event.  Over the last two
weeks she has had personality change, increased lethargy, and
agitation.  Apparently, at baseline she reads the newspaper
everyday and is very alert, pleasant, and conversant.  Due to
concerns for her continued decline, she was brought to an OSH
where she was found to have multiple SDH and subsequently
transferred to [**Hospital1 18**] for further management.

MEDICAL HISTORY: DM II,
ESRD on HD,
HTN,
h/o epidural abscess,
h/o vertebral osteomyelitis and diskitis,
CHF, EF 25% in [**2189**] but 55% in [**2193**]
no CAD from cath in [**2189**]

MEDICATION ON ADMISSION: 

ALLERGIES: Percocet / Darvocet-N 100

PHYSICAL EXAM: Vitals: T 98.6; BP 159/76; P ; RR 20; O2sat 98 4L
.
General: lying in bed, anxious appearing
HEENT: NCAT, dry mmm
Neck: supple
Pulmonary: CTA b/l
Cardiac: irreg irreg, with no m/r/g
Abdomen: soft, nontender, non distended, normal bowel sounds
Extremities: no c/c/e.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Lives in nursing home.
non smoker, no ETOH, no IVDU.  Son visits regularly. 

### Response:
{'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Congestive heart failure, unspecified,Atrial fibrillation,Hypoxemia,Hyperosmolality and/or hypernatremia,Cerebral embolism with cerebral infarction,Other accidental fall from one level to another,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Accidents occurring in residential institution,Inflammatory disease of breast,Other persistent mental disorders due to conditions classified elsewhere,Benign neoplasm of breast'}
