Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: plasma expander classifier / valium / mercaptopurine / remicade / shellfish derived attending: chief complaint: low back pain and inability to care for himself, fungating tumor growing from enterocutaneous fistula major surgical or invasive procedure: 1. exploratory laparotomy and extensive lysis of adhesions. 2. choledochojejunostomy dictated by dr. . 3. en bloc resection of involved small bowel, abdominal wall and mass of tumor with primary jejunoileal anastomosis. 4. veritas patch closure of abdominal wall defect. . : pt with svc syndrome, went through r ij cvc access site and baloon dilated svc/rbcv with improved flow. pt placed on heparin and is to have an mrv. possible re-intervention at later date. . angio: lij & rsc occluded, ivc severely stenosed with collaterals, angioplastied svc to 5-7 mm, could not get wire across from l to r . : had line replaced due to one of the tunneled port not working. history of present illness: patient is 55 yo male with h/o crohn's disease and hypercoagulable condition s/p multiple amputations as a complication of this who presents for increasing low back pain and failure to care for himself at home. pt was recently admitted to for and found to have line sepsis and new dx of stage iv mucinous adenocarcinoma from fungating mass originating from enterocutaneous fistula. (admitted to from ) his tunnel line was replaced at on the contralateral side after removing the previous line. the patient also had multiple episodes of anemia characterized by a hct drop from 24-25. abdominal ct scan negative for bleeding. he required 4 units prbcs but a source of the bleeding was never found. patient was d/c'd 2 days ago with intent of presenting to . patient went home instead to care for himself and was unable to do this with increased ostomy output and increasing low back pain. gen: {x]wnl, no fevers, chills, night sweats, fatigue, weightloss/weight gain heent: wnl, no vision changes, tinnitus, loss of hearing, dysphagia headache, sinus tenderness, rhinorrhea or congestion. cv: wnl - no chest pain - resp: wnl- no cough, +shortness of breath, no orthopnea, pnd gi: copious drainage of stool and gastric contents through fistula. gu: wnl- no dysuria, hematuria, hesitancy, or change in frequency, change in bladder habits, vaginal discharge skin: wnl no rashes, lesions, - healing stage ii pressure ulcer neuro: wnl no weakness, paresthesias, numbness, headaches, dizziness musculoskeletal: wnl, chronic arthralgias- back pain in good control, myalgias psych: wnl no sadness or hallucinations. all other review of systems negative. past medical history: 1.crohn??????s disease: diagnosed at age 21, followed by dr. . has involvement of his mouth, proximal small bowel, ampulla of vater and biliary system. had small bowel resection and cholecystectomy at same surgery in past. treated with remicade in late , though course was stopped due to burning pain in his legs and joint pains. has also had 6-mp therapy (as above) and did not respond to budesonide (entocort). currently treated with pentasa and intermittent prednisone. most recent steroid course completed 1 month ago. 2.antiphospholipid antibody syndrome: diagnosed with hypercoagulable state at age 29. in the past has been told that he also had antithrombin iii deficiency. per dr. ??????s notes, he did not have antithrombin iii deficiency in , but had high levels of anticardiolipin igg antibody (normal igm) and positive lupus anticoagulant at that time. repeat tests in revealed very high levels of both igg and igm anticardiolipin antibody. on chronic anticoagulation with coumadin, inr goal 3.0-4.0. 3.??????s syndrome: known to have mild case per dr. ??????s notes. 4.pulmonary embolism: history of at least 2 pe??????s in distant past, had ivc filter placed. 5.l aka and r bka: s/p multiple bilateral amputations secondary to clotting, status post right below-knee amputation in , s/p revision in 09/84, s/p left above-knee amputation in 05/95, s/p revision in 05/. 6. small bowel resection and cholecystectomy: as above. 7. reversible pancytopenia of unclear etiology. 8. iron deficiency anemia. 9. lactose intolerance. 10. osteoarthritis. 11. status post vascular bypass surgery of his right groin. social history: the patient does not smoke or drink alcohol. he was using recreational drugs including marijuana in the 60s but not recently. he denies ever using intravenous drugs. he is single and has no children. he has been on disability since . lives in subsidized housing. hcp = niece di / family history: his mother had hypercoagulability and was on coumadin as well. she also had lung cancer. his father was an alcoholic, he had disease, and he died secondary to cirrhosis. physical exam: vs: 98.6, 124/78, 18, 96% on ra general: thin male who looks his stated age nourishment: at risk grooming: good mentation: alert, conversant, completely up to date about his medical diagnoses. eyes:nc/at, perrl, eomi without nystagmus, no scleral icterus noted ears/nose/mouth/throat: mmm, no lesions noted in op neck: supple, no jvd or carotid bruits appreciated respiratory: lungs cta bilaterally without r/r/w cardiovascular: rrr, nl. s1s2, no m/r/g noted gastrointestinal: large polypoid fungating abdominal wall mass and enterocutaneous fistula. genitourinary: wnl. skin: stage ii sacral decubitus ulcer. extremities: 2+ radial, dp and pt pulses b/l. 2+ edema of ues b/l. lymphatics/heme/immun: no cervical, supraclavicular, axillary or inguinal lymphadenopathy noted. neurologic: -mental status: alert, oriented x 3. able to relate history without difficulty. -cranial nerves: ii-xii intact -motor: normal bulk, strength and tone throughout. no abnormal movements noted. psychiatric: wnl - remarkably after all that he has been through. . at discharge: vitals:__________ gen: a/ox3, somnolent/withdrawn on occasion. depressed. cv: rrr, no m/r/g. face/upper extremities: moderate edema, + radial & brachial pulses. + cap refill. r & l arm broken skin weeping serous fluid. neck: distended, edematous, +jvd resp: rr-20-24, sob/doe, occasional wheeze. abd: +bs, +flatus, +bm-liquid, brown stool, nd, appropriately ttp, central incision with vacuum dressing appliance-wound bed: beefy red granulation tissue, close to skin level, fistula llq lateral wound bed wall. lower extrem: mild edema. b/l le amputee. skin: generalized maculo-papular rash upper extremities, trunk, back. coccyx stage ii ulcer, pink tissue, blanching. duoderm applied. pertinent results: cxr: no acute intrathoracic pathology. ivc filter appears high in position though unchanged. recommend clinical correlation l-s spine: indication: 55-year-old man with history of crohn's disease and back pain. lumbar spine, two views: the osseous structures are intact and in normal alignment. mild loss of disc space is noted at the level of l4-l3 and l2-l3. diffuse calcification of the aorta and high position of the ivc filter is noted. the bowel gas pattern is nonobstructive. thoracic spine, two views: the osseous structures are intact and in normal alignment. no paravertebral soft tissue prominence is noted. impression: no fracture or malalignment in the thoracic and lumbar spine. ct scan chest/abd/pelvis impression: 1. mass involving the anterior abdominal wall and adjacent small bowel loops increased in size 2. no definite evidence of metastatic disease. heterogeneous enhancement of segment 4 of the liver likely represents perfusion abnormality, no focal liver lesions are seen. 3. ovoid lesion in the splenic hilum is of uncertain etiology but stable in size. . 06:15am blood wbc-3.2* rbc-2.72* hgb-7.8* hct-23.0* mcv-85 mch-28.7 mchc-34.0 rdw-16.8* plt ct-62* 04:57am blood wbc-3.9* rbc-2.82* hgb-8.1* hct-23.6* mcv-84 mch-28.8 mchc-34.5 rdw-16.8* plt ct-71* 04:20am blood wbc-3.3* rbc-2.84* hgb-8.2* hct-23.9* mcv-84 mch-28.8 mchc-34.4 rdw-16.8* plt ct-64* 03:13am blood wbc-3.3* rbc-2.76* hgb-7.9* hct-23.1* mcv-84 mch-28.5 mchc-34.1 rdw-16.6* plt ct-47* 05:28am blood wbc-5.9 rbc-3.43* hgb-9.8* hct-27.9* mcv-81* mch-28.5 mchc-35.1* rdw-17.3* plt ct-151 07:45am blood wbc-6.9 rbc-3.66* hgb-10.5* hct-31.2* mcv-85 mch-28.6 mchc-33.6 rdw-17.2* plt ct-149* 04:55am blood wbc-7.5 rbc-3.65* hgb-10.5* hct-29.6* mcv-81* mch-28.7 mchc-35.3* rdw-17.7* plt ct-134* 12:24pm blood wbc-16.9*# rbc-2.79* hgb-7.7* hct-23.7* mcv-85 mch-27.5 mchc-32.4 rdw-19.3* plt ct-64*# 03:06am blood wbc-9.5 rbc-3.04* hgb-8.5* hct-24.1* mcv-79* mch-28.0 mchc-35.3* rdw-17.9* plt ct-79* 04:17pm blood wbc-12.7* rbc-3.63* hgb-9.7* hct-28.7* mcv-79* mch-26.8* mchc-33.9 rdw-18.1* plt ct-83* 06:45pm blood wbc-9.0 rbc-4.56* hgb-11.1*# hct-33.7* mcv-74* mch-24.4*# mchc-33.0# rdw-17.8* plt ct-119*# 10:45am blood pt-19.6* inr(pt)-1.8* 05:08am blood pt-19.4* ptt-113.4* inr(pt)-1.8* 04:43am blood fibrino-360# d-dimer-as of 09:10am blood fibrino-633*# 03:10am blood fibrino-344# 03:18pm blood ret aut-3.5* 06:00am blood glucose-78 urean-47* creat-0.9 na-141 k-3.7 cl-109* hco3-22 angap-14 05:56am blood glucose-93 urean-47* creat-0.9 na-139 k-3.6 cl-108 hco3-22 angap-13 04:52am blood glucose-111* urean-48* creat-0.9 na-135 k-3.7 cl-105 hco3-22 angap-12 05:18am blood glucose-94 urean-45* creat-0.9 na-132* k-4.0 cl-105 hco3-22 angap-9 06:28am blood glucose-103 urean-42* creat-0.8 na-134 k-4.1 cl-105 hco3-22 angap-11 05:08am blood glucose-94 urean-41* creat-0.8 na-131* k-4.0 cl-102 hco3-23 angap-10 04:44am blood alt-11 ast-17 alkphos-202* 03:18pm blood ld(ldh)-186 totbili-0.8 dirbili-0.3 indbili-0.5 06:15am blood alt-19 ast-17 alkphos-207* amylase-51 totbili-0.4 dirbili-0.2 indbili-0.2 06:26am blood alt-13 ast-18 alkphos-185* amylase-66 totbili-0.6 dirbili-0.2 indbili-0.4 06:00am blood calcium-7.6* phos-3.1 mg-2.2 05:56am blood calcium-7.8* phos-3.1 mg-2.2 04:52am blood calcium-7.5* phos-3.6 mg-2.4 05:18am blood calcium-8.2* phos-3.6 mg-2.1 06:28am blood calcium-8.4 phos-3.3 mg-2.1 04:44am blood albumin-2.5* calcium-8.6 phos-2.8 mg-2.2 iron-33* 12:29pm blood albumin-2.7* iron-25* 05:41am blood albumin-3.1* calcium-8.4 phos-3.5 mg-1.9 iron-36* 04:43am blood albumin-3.0* calcium-8.4 phos-3.2# mg-1.6 iron-40* 05:09am blood d-dimer-1627* 04:44am blood caltibc-217* ferritn-402* trf-167* 03:18pm blood vitb12-492 folate-12.1 hapto-156 04:52am blood triglyc-79 04:36am blood triglyc-97 06:24am blood triglyc-59 09:23am blood vanco-21.0* 04:04pm blood vanco-40.7* 04:44am blood vanco-27.9* 05:34am blood vanco-22.4* . studies: egd: crohn's disease of the duodneum. no gastric lesion found pet/ct: no definite metastatic disease. stress test: lvef 63%, normal perfusion cxr: little change, bilat pleural eff and bibasilar atelectasis, no vascular congestion or acute pna ct abd: increased pleural effusion, now moderate bilaterally, with adjacent compressive atelectasis. new moderate pericardial effusion. new anasarca. mrv: thrombosis of left sv, ij, right ij, right bc, stenosis of superior svc, b/l pleural effusions ir - svc venoplasty 5-7 mm diameter, right subclavian and left ij 100% occlusion, highly occluded ivc cxr: l basilar atelectasis, l pleural effusion . micro: sputum cx: klebsiella pneumoniae (sparse growth) to ceftaz, ceftriax, cefurox, cipro, gent, , tobra, bactrim 10/29,30,31 c.diff: neg x3 stool: c.diff negative; negative for other bacteria bcx: no growth ucx: klebsiella ( to cipro) - bcx/ucx: no growth pleural fluid: no growth cath tip: no growth brief hospital course: the pt was admitted for inability to care for himself as well as his low back pain. pt was started on oxycodone for his low back pain which was likely due to old l4 compression fracture. pt was afebrile on admission but then spiked on . cx were drawn and given hx of recent line bacteremia(no + blood cx) which was empirically treated at w vanc which finished on , pt was started empirically on iv vanc. pt initially defervesced but then spiked again on and was empirically started on ceftaz with suspicion for abdominal wall cellulitis as there was noted to be increased redness around fistula site. pt remained afebrile and antibiotics were discontinued on . pt was continued on steriods for his crohn's disease and remained on lovenox anticoagulation for his antiphospholipid antibody syndrome. . the plan was for surgical treatment of his cancer. ct of the chest/abdomen/pelvis and pet scan had been negative for metastatic disease. pt had pre-op stress test on which was negative. on , the pt was taken to the or for an exploratory laparotomy and extensive lysis of adhesions, choledochojejunostomy, en bloc resection of involved small bowel, abdominal wall and mass of tumor with primary jejunoileal anastomosis, and veritas patch closure of abdominal wall defect. post-op, the pt was transferred to the icu in stable condition. he did require multiple fluid boluses for oliguria following surgery. the pt was able to be extubated the following day. he returned to the or on for vac dressing change. pt remained stable from a hemodynamic and respiratory standpoint and was transferred to the floor on . the pt was kept on tpn for nutrition and remained on his steroids for crohn's disease. on , the pt had return of bowel function, his ng tube was pulled, and his diet was advanced. however, it was noticed that the pt then began having bilious output from his surgical drain. he was made npo and was scheduled to have a ct scan to rule out a leak. while being prepped for a ct scan, the pt was found to be unresponsive with agonal breathing and decrease in oxygen saturations. a code was called and the pt was intubated emergently and transferred to the icu. the pt had a head ct which was negative for stroke or hemorrhage. an abd ct scan showed thrombosis in the superior mesenteric artery and the right common iliac artery, unchanged since , post-surgical changes following small bowel resection, and prominent small and large bowel loops consistent with ileus. a chest cta was negative for pe. the pt did require pressor support for a brief period in the icu. he was ruled out for mi, pancultured, and started on broad spectrum abx. his hct was discovered to be 17.5 and the pt was transfused for this. it remained unclear as to cause for the pt's unresponsiveness. . the pt was soon weaned off pressors. his mental status improved and he was able to be extubated. the pt was started on a clear liquid diet and started having increased drainage from his abdominal wound. it was soon discovered that the cause of this increased drainage was a recurrence of an enterocutaneous fistula. the vac dressing was discontinued and the pt had a wound appliance applied to his wound. the pt was draining a few liters of fluid daily from this wound and pt was given crystalloid for his wound losses. eventually, the fistula output did slow down as the pt decreased his liquid intake and increased his solid food intake. the pt's surgical drain that was kept in in order to drain the bile leak fell out on . it was not replaced as a cholangiography performed on did not show bile leak. . on , the pt was transferred to the floor. . while on the floor, the patient was stable. his vac was changed 2-3 days as needed. granulation tissue appeared healthy and his overall abdominal wound size decreased significantly. his fistula continued to put out green colored fluid throughout his entire admission requiring frequent dressing changes. . on , the surgical team started to notice that the patient's right arm, neck, and face was becoming increasingly swollen. his right subclavian cvl continued to function correctly though. the decision was to continue to watch the swelling to see if it improves or gets worse by measuring upper extremities and neck daily. . on , the patient's swelling appeared worse. in addition, the patient became more dyspenic and required 2-4 liters of supplemental oxygen to maintain his o2 saturation above 93% (he was saturating at 98-100% on l). he became febrile at 101.3. blood and urine cultures were taken which were negative. a cxr was performed which suggested bilateral effusions versus atelectasis. a trial of lasix was started. the patient diuresed appropriately, however was still requiring 2-4 liters of oxygen to maintain his saturation. a limited venogram was obtained which revealed stenosis of the right subclavian and right ij vein and low flow distally, suggestive of a possible brachieocephalic vein stenosis/svc syndrome. no thrombosis was seen. in light of this, a vascular sugery consult to dr. and his team was made. dr. wanted to pull the right subclavian cvl to see if the swelling would resolve itself. dr. agreed upon this only if further access could be done before the right line was discontinued. therefore a request to ir to place a left ij and discontinue the right cvl. in addition ir stated that they would try to perform a venoplasty in the area of stenosis in order to relieve the obstruction. . when the patient went down for the venogram, imaging of his chest and abdomen was performed as well. his chest ct reveals moderate sized bilateral effusions. his abdomen did not reveal any fluid collections/abscesses. body ct was consulted for thoracocentesis of these collections. . on , before the patient was to go to ir and body ct for such procedures, he received 2 units of prbcs (hct of 19) and 1 bag of platelets (plt=50). body ct was able to take off approximately 1 liter of fluid from his lungs which they sent for cytology and culture which were negative. ir was able to perform a venoplasty and exchange his old right line with a new line over a wire. they sent the old tip for culture which was negative. after arriving back on the floor, his heparin gtt was restarted. . through the subsequent days, the patient's swelling did not improve. a mr venogram was obtained which showed thrombosis of left sv, ij, right ij, right bc, stenosis of superior svc, and persistent b/l pleural effusions. . on , the patient was taken to ir and a svc venoplasty was performed. according to the radiologist, the maximal diamater post-plasty was 5-7 mm. . on , one of his subclavian cvl lines clotted off. tpa was successful temporarily, however the line still remained unaccessible. ir was called to manage the line. given the patient's poor prognosis, a palliative care consult was obtained. dr. , the surgical team, & patient met with the palliative staff and the decision was made to make the patient dnr/dni. . on , the patient was taken down to ir and a new line was inserted, this time further distally into the right atrium. . on , vascular surgery was consulted and discussed the possiblity of further surgical intervention for mr. . dr. and dr. decided further intervention was possible in the case of mr. . he was informed of the possible outcomes/prognosis. once again, palliative care met with mr. , and patient felt he was not ready to transfer to hospice. he wants to continue with current treatment (ie) tpn. patient understands that if his current central access for tpn clots off, then he will no longer have access for supplemental nutrition. . on , patient went to interventational pulmonology for possible thoracentesis, and pleurex catheter for draining any possible fluid. ultrasound of lungs did not reveal any drainable fluid. cxr noted lll effusion which has been persistent. mr. decline insertion of pleurax catheter for interval drainage of lungs. . medical/surgical condition remains stable. he continues on tpn, lovenox sc, iv lasix, & iv vanco. he should continue on iv vanco while his central line is in place. his respiratory status remains stable. he continues to have rr in low 20's, o2 sats >95%. he is ready for transfer to rehab for continued care. discussion regarding need for hospice will continue per patient and family. . -his line pulled out a few centimeters later in day. he was taken to ir for replacement of line over a wire. he received cycled tpn overnight. line remains patent. vacuum dressing replaced ostomy rn. please refer to note for detailed intruction on wound care. dressing continues to leak on a daily basis, and requires frequent reinforcement. per rehab policy, the vacuum dressing will be taken down right before patient is transferred to rehab. moist dressing will be applied to keep wound bed from drying. wound will be assessed, and vacuum dressing will be re-applied upon arrival to facility. medications on admission: lovenox 60 mg dilaudid 2 mg 1-2 tabs folic acid 1 mg pantoprazole 40 mg qd hydroxycholoroquine 200 mg and 100 mg vitamin d iu q t/t/s iron sulfate 325 mg prednisone 15 mg qd calcium - vitammin 500-125 mg tid humira 40 mg /0.8 l sq each saturday' forte injection 20 mcg qd mesalamine cr cap mg discharge medications: 1. miconazole nitrate 2 % powder sig: one (1) appl topical prn (as needed): apply to affected areas. 2. teriparatide 20 mcg/dose (750 mcg/3 ml) pen injector sig: one (1) subcutaneous daily (daily). 3. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed for dry eyes. 4. white petrolatum-mineral oil 42.5-56.8 % ointment sig: one (1) appl ophthalmic prn (as needed) as needed for dry eyes. 5. calcium carbonate 500 mg tablet, chewable sig: two (2) tablet, chewable po qid (4 times a day) as needed. 6. acetaminophen 160 mg/5 ml solution sig: one (1) po q6h (every 6 hours) as needed: do not exceed 4000mg in 24hours. 7. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 8. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for itching. 9. zinc oxide-cod liver oil 40 % ointment sig: one (1) appl topical tid (3 times a day) as needed: to affected areas of groin/buttocks. 10. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 11. cyanocobalamin 100 mcg tablet sig: 0.5 tablet po daily (daily). 12. fexofenadine 60 mg tablet sig: one (1) tablet po bid (2 times a day). 13. loperamide 2 mg capsule sig: two (2) capsule po q6h (every 6 hours): do not exceed 16mg in 24hrs . 14. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for wheeze/sob. 15. diphenhydramine hcl 25 mg capsule sig: one (1) capsule po q6h (every 6 hours) as needed for itching. 16. hydroxyzine hcl 25 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for itching. 17. enoxaparin 80 mg/0.8 ml syringe sig: one (1) subcutaneous q12h (every 12 hours). 18. zolpidem 5 mg tablet sig: 1-2 tablets po hs (at bedtime) as needed for insomnia. 19. psyllium 1.7 g wafer sig: one (1) wafer po prn (as needed). 20. opium tincture 10 mg/ml tincture sig: ten (10) drop po prn (as needed) as needed for diarrhea: please stagger from loperamide dosing . 21. furosemide 10 mg/ml solution sig: one (1) injection (2 times a day): check serum potassium 2-3 times per week. 22. ondansetron hcl (pf) 4 mg/2 ml solution sig: one (1) injection prn (as needed). 23. prochlorperazine edisylate 5 mg/ml solution sig: injection q6h (every 6 hours) as needed for nausea. 24. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) intravenous q 24h (every 24 hours): check vanco trough after every 3rd dose. 25. insulin regular human 100 unit/ml solution sig: one (1) injection four times a day: please refer to sliding scale . 26. regular insulin sliding scale insulin sc sliding scale breakfast lunch dinner bedtime regular regular regular regular glucose insulin dose insulin dose insulin dose insulin dose 0-50 mg/dl amp d50 51-120 mg/dl 0 units 0 units 0 units 0 units 121-160 mg/dl 2 units 2 units 2 units 2 units 161-200 mg/dl 5 units 5 units 5 units 5 units 201-240 mg/dl 8 units 8 units 8 units 8 units 241-280 mg/dl 11 units 11 units 11 units 11 units 27. outpatient work please check weekly lft's, and chem 10. **contact (home hyperal service coordinator), , fax: for instruction with tpn formulation titration. 28. outpatient work please check vanco trough after every 3rd dose. **please fax results to dr. at (. **call with questions/concerns. 29. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain. 30. dilaudid 2 mg/ml solution sig: 0.5-1 injection prior to vacuum dressing changes as needed for pain. 31. lorazepam 1 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for anxiety: hold for somnolence . discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary: adenocarcinoma of the small bowel invading abdominal wall, creating fistulas short gut syndrome- feet of bowel remains post-op (tpn dependent) malnutrition enterocutaneous fistula-abdominal incision crohn's disease pancytopenia post-op pleural effusions post-op svc syndrome post-op thrombosis of left sv, ij, right ij, right bc, stenosis of superior svc. post-op anasarca post-op klebsiella pneumonia post-op uti-klebsiella post-op stage ii coccyx pressure ulcer . secondary: crohn's w/mult intest strictures, sbo/jejunal perf/sepsis 2^ to adhesions s/p loa, repair perf jej c/b chronic ec fistula s/p mult skin grafts, , antiphospholipid syndrome s/p b/l le dvt, pe, s/p ivc filter s/p r fem bypass, s/p b/l amp; anemia, iron/b12 defic, recurrent l parotitis/sialolithiasis in and discharge condition: stable tolerating regular diet, small amounts. tpn for major nutritional requirements. adequate pain control with oral medication discharge instructions: please call your doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * new or worsening cough or wheezing. * if you are vomiting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomiting, diarrhea or other reasons. signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit or have a bowel movement. * your pain is not improving within 8-12 hours or not gone within 24 hours. call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. * you have shaking chills, or a greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. * please resume all regular home medications and take any new meds as ordered. * continue to ambulate several times per day. . wound care: please refer to wound care nurse for detailed instruction. followup instructions: 1. please follow-up with dr. in 2 weeks. . previous appointments: 1. provider: , m.d. phone: date/time: 2:00 summary neither dictated nor read by me procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours parenteral infusion of concentrated nutritional substances other partial resection of small intestine other endoscopy of small intestine reconstruction of eyelid with hair follicle graft other local excision or destruction of lesion or tissue of skin and subcutaneous tissue diagnostic ultrasound of heart insertion of endotracheal tube angioplasty of other non-coronary vessel(s) injection or infusion of thrombolytic agent thoracentesis other lysis of peritoneal adhesions injection of antibiotic other cardiovascular stress test transfusion of packed cells transfusion of packed cells transfusion of other serum transfusion of platelets anastomosis of hepatic duct to gastrointestinal tract excision or destruction of lesion or tissue of abdominal wall or umbilicus other immobilization, pressure, and attention to wound other immobilization, pressure, and attention to wound percutaneous hepatic cholangiogram phlebography of other specified sites using contrast material angiocardiography of venae cavae procedure on two vessels diagnoses: other iatrogenic hypotension anemia of other chronic disease unspecified pleural effusion urinary tract infection, site not specified intestinal bypass or anastomosis status friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site hyposmolality and/or hyponatremia accidental puncture or laceration during a procedure, not elsewhere classified pulmonary collapse acute respiratory failure cardiac arrest peritoneal adhesions (postoperative) (postinfection) compression of vein other complications due to other vascular device, implant, and graft long-term (current) use of anticoagulants paralytic ileus pressure ulcer, buttock iron deficiency anemia, unspecified personal history of venous thrombosis and embolism primary hypercoagulable state other and unspecified postsurgical nonabsorption below knee amputation status pneumonia due to klebsiella pneumoniae intestinal disaccharidase deficiencies and disaccharide malabsorption above knee amputation status fistula of intestine, excluding rectum and anus pressure ulcer, stage ii other venous embolism and thrombosis of inferior vena cava disorders of bilirubin excretion attention to ileostomy edema other colostomy and enterostomy complication regional enteritis of small intestine malignant neoplasm of connective and other soft tissue of abdomen aftercare for healing pathologic fracture of vertebrae family history of other digestive disorders malignant neoplasm of small intestine, unspecified site 

Answer: The patient is high likely exposed to