CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a [**Age over 90 **]-year-old
male admitted with failure to thrive.  The patient lives in
an independent living facility for long-term senior citizens.
The patient was feeling weak for the last few days with lower
social worker visited him and sent to the Emergency Room for
issues of neglect, and weakness, and poor hygiene.  The
patient had no other complaints besides the weakness.  The
patient had no fevers or chills, nausea, vomiting, shortness
of breath, cough, diarrhea, constipation, bright red blood
per rectum, or night sweats.  The patient with some weight
loss, but he cannot define how much.  Poor insight into state
a cleaning lady once a week who came in strictly to clean the
house but no other home care.  The patient cleans and feeds
himself.  His son visits his twice per month.  His last
primary care visit was [**2126-11-1**].

MEDICAL HISTORY: 1.  Hypertension.
2.  Atrial fibrillation.
3.  Heart attack five years ago at [**Hospital6 15291**].

MEDICATION ON ADMISSION: The patient's medications on
admission included Vasotec, digoxin, atenolol, Coumadin 2 mg,
with other drugs (unknown doses).

ALLERGIES: Allergy to CODEINE.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history was noncontributory.

SOCIAL HISTORY: The patient lives alone.  He has three
children.  His daughter is [**Name (NI) 5969**] (telephone number
[**Telephone/Fax (1) 15292**]).  The patient is separated from his wife.  [**Name (NI) **]
drinks no alcohol.  He quit tobacco 20 years ago.
Unspecified protein-calorie malnutrition,Congestive heart failure, unspecified,Atrial fibrillation,Keratoderma, acquired,Unspecified essential hypertension,Old myocardial infarction,Unspecified acquired hypothyroidism
Protein-cal malnutr NOS,CHF NOS,Atrial fibrillation,Keratoderma, acquired,Hypertension NOS,Old myocardial infarct,Hypothyroidism NOS
Admission Date:  [**2127-12-16**]     Discharge Date:  [**2127-12-24**]



HISTORY OF PRESENT ILLNESS:  The patient is a [**Age over 90 **]-year-old
male admitted with failure to thrive.  The patient lives in
an independent living facility for long-term senior citizens.
The patient was feeling weak for the last few days with lower
social worker visited him and sent to the Emergency Room for
issues of neglect, and weakness, and poor hygiene.  The
patient had no other complaints besides the weakness.  The
patient had no fevers or chills, nausea, vomiting, shortness
of breath, cough, diarrhea, constipation, bright red blood
per rectum, or night sweats.  The patient with some weight
loss, but he cannot define how much.  Poor insight into state
a cleaning lady once a week who came in strictly to clean the
house but no other home care.  The patient cleans and feeds
himself.  His son visits his twice per month.  His last
primary care visit was [**2126-11-1**].

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Atrial fibrillation.
3.  Heart attack five years ago at [**Hospital6 15291**].

MEDICATIONS ON ADMISSION:  The patient's medications on
admission included Vasotec, digoxin, atenolol, Coumadin 2 mg,
with other drugs (unknown doses).

ALLERGIES:  Allergy to CODEINE.

SOCIAL HISTORY:  The patient lives alone.  He has three
children.  His daughter is [**Name (NI) 5969**] (telephone number
[**Telephone/Fax (1) 15292**]).  The patient is separated from his wife.  [**Name (NI) **]
drinks no alcohol.  He quit tobacco 20 years ago.

FAMILY HISTORY:   Family history was noncontributory.

PHYSICAL EXAMINATION ON PRESENTATION:  Temperature 95, heart
rate 37, blood pressure 90/50, weight 86.2 pounds, 95% oxygen
saturation on room air.  In general, the patient was a
cachectic and disheveled elderly man.  Head, ears, nose, eyes
and throat showed redness around eyes/erythema, pail sclerae.
Oropharynx was clear.  Neck was supple.  Full range of
motion.  No lymphadenopathy.  Chest revealed decreased breath
sounds at bases.  Heart revealed bradycardia, irregularly
irregular.  No murmurs, rubs or gallops.  Positive first
heart sound and second heart sound.  Spine with an area of
erythema at approximately T10, nontender.  Abdomen was soft,
nontender, and nondistended, positive bowel sounds.  Positive
inguinal hernia bilaterally.  Extremities revealed dry flaky
skin.  Feet were hyperkeratotic skin, toes stuck together due
to buildup of skin.  Neurologic examination revealed alert
and oriented times three; did not know day.  Upper
extremities with 5/5 strength.  Lower extremities proximally
with 3/5 and distally with 5/5 strength.  Rectal was
heme-negative.

PERTINENT LABORATORY DATA ON PRESENTATION: White blood cell
count 6, hematocrit 41, platelets 167 (76% neutrophils,
0 bands, 17% lymphocytes).  The patient's PT was 22.4,
PTT 40.3, INR 3.5.  Sodium 144, potassium 4.6, chloride 103,
bicarbonate 31, blood urea nitrogen 28, creatinine 0.9,
glucose of 96.  Anion gap 15.  Digoxin level 2.5.

ASSESSMENT AND PLAN:  A [**Age over 90 **]-year-old male with failure to
thrive.

1.  FAILURE TO THRIVE:  Due to inability to care for himself at
home the patient will need placement options, increased
nutrition, a
Physical Therapy consultation.  The patient will need
Podiatry and Wound Care consultation.  The patient with chest
x-ray, urinalysis, and urine culture for possible urinary
tract infection.  The patient will need correction of
electrolyte abnormalities, supplements, and Protonix, and
subcutaneous heparin for prophylaxis.

2.  CARDIOVASCULAR:  The patient with atrial fibrillation and
bradycardia.  The patient was hypothermic, may be
contributing to the bradycardia.  The patient will be put on
telemetry.  We will hold his antihypertensive medications,
hold Coumadin since INR was 3.5.

HOSPITAL COURSE:   The patient had an episode of oxygen
desaturation to 70s and 80s even on 5 liters nasal cannula.
The patient was put on a nonrebreather, taken to the Medical
Intensive Care Unit for an overnight stay.  The patient was
stable in the Medical Intensive Care Unit and was discharged
back to the floor and started on ceftriaxone and Flagyl
intravenously.

The patient with question of aspiration.  A swallowing study
showed poor reflex, and the patient failed the swallowing
study.  The patient had nasogastric tube placement for
feedings, and upon questionable placement via chest x-ray the
nasogastric tube was removed.  Radiology report revealed
nasogastric tube/Dobbhoff tube was in the duodenum.

Gastrointestinal evaluation was done.  The patient was not a
candidate for a percutaneous endoscopic gastrostomy tube or
surgical placement of G-tube or J-tube.  The patient was
getting nutrition via intravenous via "Quick Mix" and now
getting oral thickened liquid diet and Boost in the full
upright position in light of failed nasogastric tube, and
since he cannot have a percutaneous endoscopic gastrostomy
tube placed.  The patient will continue to get nutrition
orally at the nursing home.

The patient had a run of nonsustained ventricular tachycardia
and continued to have atrial fibrillation.  The patient was
taken off telemetry monitor, as the patient was not a
candidate for pacemaker implant or arrhythmia surgery.  The
patient has been asymptomatic with tachycardia.  The patient
continued to have episodes of bradycardia and tachycardia.
The patient was started on captopril 6.25 mg b.i.d. for
congestive heart failure and hypertension.  The patient has
been given Lasix multiple times for episodes of questionable
pulmonary edema and desaturations of oxygen saturation.
These were most likely due to mucous plugging and aspiration
of secretions.  The patient's digoxin was discontinued for
high levels.

Podiatry consultation appreciated, the patient's feet were
properly clean and dressed via Podiatry.  The patient was to
go to the nursing home on oral feeding with thickened liquids
in the upright position.

The patient will be followed by his attending, and do not
resuscitate/do not intubate status was addressed.  The
patient would not like any intubation or invasive measures
taken if he should be in a code situation.  The attending
will follow up with this.  The patient's daughter also agreed
with this and agreed to have the patient go to a nursing
home.  The patient asked to be kept comfortable and hoped he
will gain his strength back, but has been made fully aware of
his failing condition.  He wished to "die peacefully" with
family or friends surrounding him if this should happen.  We
hope he will regain some strength.  If the patient's oxygen
saturation drops he made need suctioning of secretions, but
is not to be intubated and has been doing fine on oxygen via
nasal cannula and face mask with humidification.  The patient
may need morphine for breathing comfort, but has not required
any to date.

On the day of discharge, the patient felt "fine" and was
looking forward to going to the nursing home where he has a
female friend/partner already staying there.

DISCHARGE DIAGNOSES:
1.  Failure to thrive.
2.  Atrial fibrillation.
3.  Congestive heart failure.
4.  Hypothyroidism.
5.  Pulmonary issues.

CONDITION AT DISCHARGE:  Condition on discharge was fair.

MEDICATIONS ON DISCHARGE:
1.  Levoxyl 0.025 mg p.o. q.d.
2.  Captopril 6.25 mg p.o. b.i.d.
3.  Levaquin 500 mg p.o. q.d. times 10 days.
4.  Flagyl 500 mg p.o. t.i.d. times 10 days.
5.  Protonix 40 mg p.o. q.d.
6.  Morphine 0.5 mg to 2 mg as needed for breathing issues;
not to be used if the patient is sedated or respiratory rate
decreases below 10.

DISCHARGE FOLLOWUP:   The patient will be followed by
Dr. [**Last Name (STitle) **], his primary care physician.  [**Name10 (NameIs) **] note, the
patient with high thyroid-stimulating hormone indicative of
hypothyroidism.  The patient was started on Levoxyl.





                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 15293**], M.D.  [**MD Number(1) 15294**]

Dictated By:[**Last Name (NamePattern1) 4724**]

MEDQUIST36

D:  [**2127-12-24**]  15:12
T:  [**2127-12-24**]  15:11
JOB#:  [**Job Number 15295**]
{'Unspecified protein-calorie malnutrition,Congestive heart failure, unspecified,Atrial fibrillation,Keratoderma, acquired,Unspecified essential hypertension,Old myocardial infarction,Unspecified acquired hypothyroidism'}


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: 

PRESENT ILLNESS: The patient is a [**Age over 90 **]-year-old
male admitted with failure to thrive.  The patient lives in
an independent living facility for long-term senior citizens.
The patient was feeling weak for the last few days with lower
social worker visited him and sent to the Emergency Room for
issues of neglect, and weakness, and poor hygiene.  The
patient had no other complaints besides the weakness.  The
patient had no fevers or chills, nausea, vomiting, shortness
of breath, cough, diarrhea, constipation, bright red blood
per rectum, or night sweats.  The patient with some weight
loss, but he cannot define how much.  Poor insight into state
a cleaning lady once a week who came in strictly to clean the
house but no other home care.  The patient cleans and feeds
himself.  His son visits his twice per month.  His last
primary care visit was [**2126-11-1**].

MEDICAL HISTORY: 1.  Hypertension.
2.  Atrial fibrillation.
3.  Heart attack five years ago at [**Hospital6 15291**].

MEDICATION ON ADMISSION: The patient's medications on
admission included Vasotec, digoxin, atenolol, Coumadin 2 mg,
with other drugs (unknown doses).

ALLERGIES: Allergy to CODEINE.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history was noncontributory.

SOCIAL HISTORY: The patient lives alone.  He has three
children.  His daughter is [**Name (NI) 5969**] (telephone number
[**Telephone/Fax (1) 15292**]).  The patient is separated from his wife.  [**Name (NI) **]
drinks no alcohol.  He quit tobacco 20 years ago. 

### Response:
{'Unspecified protein-calorie malnutrition,Congestive heart failure, unspecified,Atrial fibrillation,Keratoderma, acquired,Unspecified essential hypertension,Old myocardial infarction,Unspecified acquired hypothyroidism'}
