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: shellfish / hayfever / heparin agents attending: chief complaint: prostate ca s/p open radical prostatectomy bilateral inguinal hernias s/p inguinal herniorraphies with mesh cardiac arrest (puleseless electrical activity) pulmonary embolism s/p thrombolysis and ivc filter placement heparin induced thrombocytopenia (hit) abdominal compartment syndrome s/p decompressive laparotomy acute tubular necrosis (acute renal failure) s/p hemodialysis major surgical or invasive procedure: : operation: radical retropubic prostatectomy, bilateral pelvic lymphadenectomy, bilateral nerve-sparing, bilateral inguinal hernia repairs with mesh. : operation: 1. decompressive laparotomy. 2. attempted right femoral groin dialysis catheter placement. : operation planned: 1. takedown of dressing, washout of abdomen, replacement of dressing. 2. placement of a left internal jugular central line. 3. attempted placement of an inferior vena cava filter. 4. placement of a dialysis catheter in the right internal jugular. : operation: retropubic washout, clot evacuation, and vesicourethral reanastomosis and 1. opening of recent laparotomy with attempted closure and placement of patch. 2. placement of ivc filter. : operation: ventral hernia repair with mesh. history of present illness: mr. is a 67 man s/p radical prostatectomy, whose post op course was complicated by pea arrested on floor on pod 1. he was transferred to micu for further management, started on iv heparin and tpa for presumptive pulmonary embolism. upon arrival to micu, he arrested again and was resusciatated in the micu. he was hypotensive and received multiple liters of ivf for resuscitation. the then developed abdominal distension, oliguira and reduced pedal pulses, elevated peak pressures and elevated bladder pressures. surgery was called for an acute abdominal compartment syndrome. past medical history: childhood asthma social history: lives at home with wife in , family history: non-contributory physical exam: wdwn male, nad, avss appears well but frail, mucus membranes moist pleasant demeanor and affect abdomen appropriately tender, soft, non-distended three drains in place and secured to abdomen: two jp drains to bulbsuction and one pelvic drain to drainage (non-compressed bulb). foley catheter in place draining yellow urine--secured in place at medial thigh lower left extremity with flexed left knee and decreased plantar flexion (approx vs on right). no gross peripheral edema, pitting edema at bilateral lower extremities. pertinent results: 07:10am blood wbc-14.1* rbc-3.52* hgb-10.9* hct-33.1* mcv-94 mch-31.1 mchc-33.1 rdw-14.5 plt ct-557* 07:10am blood glucose-126* urean-52* creat-2.6* na-141 k-3.6 cl-104 hco3-26 angap-15 07:10am blood pt-19.9* ptt-24.8 inr(pt)-1.8* 07:00am blood pt-19.7* ptt-25.1 inr(pt)-1.8* 04:56am blood pt-27.0* ptt-28.5 inr(pt)-2.6* 07:10am blood glucose-126* urean-52* creat-2.6* na-141 k-3.6 cl-104 hco3-26 angap-15 07:00am blood glucose-103* urean-59* creat-3.1* na-140 k-4.1 cl-103 hco3-28 angap-13 04:56am blood glucose-90 urean-62* creat-3.6* na-140 k-3.4 cl-103 hco3-28 angap-12 06:07am blood alt-36 ast-27 alkphos-122 totbili-1.0 06:00am blood alt-42* ast-35 alkphos-131* totbili-1.2 03:11pm ascites creat-3.5 07:10am blood calcium-8.2* phos-3.5 mg-1.7 07:00am blood calcium-7.4* phos-3.7 mg-1.7 06:07am blood albumin-2.6* calcium-7.1* mg-1.8 01:15pm urine color-red appear-cloudy sp -1.027 01:15pm urine blood-lg nitrite-neg protein-100 glucose-tr ketone-tr bilirub-neg urobiln-neg ph-5.5 leuks-sm 01:15pm urine rbc->182* wbc-1 bacteri-none yeast-none epi-0 9:45 am urine source: catheter. urine culture (pending): fungal culture (pending): 9:00 am stool consistency: formed source: stool. **final report ** clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). 2:35 pm urine source: catheter. **final report ** urine culture (final ): yeast. 10,000-100,000 organisms/ml.. brief hospital course: 67 year old male with diagnosis of prostate cancer, s/p prostatectomy, post-op course c/b by pea arrest presumed pulmonary embolus, profound hypotension, multi-system failure, post-operative hematoma, increasing abdominal distension requiring emergent laparatomy patient was transferred to the from the urology service in the setting of s/p radical retropubic prostatectomy c/b pod#1 pea arrest, thought to be to pe, for which the patient was given tpa and started on a heparin drip. patient's course was complicated by hypotension (maps 50s), requiring frequent fluid boluses (26l over 2d course) as well as levophed and neosynephrine. concurrent with this, patient became increasingly difficult to ventilate, with concern for acs. he became acutely anemic (10pt drop in 12hrs) and was found to have 16cm hematoma at his operative drain site without signs of intra-abdominal or retroperitoneal bleeds. icu stay also c/b arf (thought to be to acs), w rising creatinine and worsening acidosis, requiring bicarbonate drip. lfts also were also noted to be rising, thought to be to shock liver in the setting hypotension. on pod#3, patient was noted to have worsening abdominal distenion. bladder pressure was found to have risen from 20 to 40. in conjunction with general surgery and urology, the patient was taken to the or for urgent laparatomy on . the following day, the patient was weaning down from his pressor requirement, the peep was decreased from 20 to 10, he went back to the or for a washout and placement of an hd line. femoral venous line was obtained. cvvhd was initiated. on , bedside cystogram showed disruption of the bladder anastamosis. on his vent was weaned to pressure support, he was restarted on a heparin gtt and tube feeds were started. he was transfused 1u prbc for hct 23.1. on the patient went back to the or for washout and placement of patch by acs, ivc filter placement, and urethrovesicular anastamosis by urology. on , the white count was elevated and there was concern for possible vap so a bronch/bal was performed and showed no purulent secretions. on the hd line was replaced as it was no longer working. on the patient went back to the or for abdominal closure with mesh. given concern for hit (decreased plts), argatroban was started. on the patient was extubated. . on , he was tolerating a regular diet and tf were held for copious diarrhea. cdiff was sent. on the patient remained stable and was transfered to the floor after hd. he was then transferred back to the urology service. once back on the urology floor, he continued to do well, argatroban was stopped once inr in therapeutic range, and pt maintained on coumadin. he was noted to have lle weakness and proprioceptive deficit for which neurology was reconsulted. pt's renal function continued to improve and finished hemodialysis on . he was maintained on telemetry in sinus tachycardia throughout his stay on the floor. due to length of hospital stay and complexity of his hospital course, a summary is also provided by systems. hospital course by systems: neurologic: post-op, patient did well initially with pain controlled with iv morphine pca. on pod#1, pt got out of bed for first walk, c/o acute sob/dizziness and collapsed with pea cardiopulmonary arrest. pt resuscitated and during resuscitation was noted to move all 4 extremities intermittently. pt brought to icu where he was kept sedated with combinations of propofol, versed/fentanyl until ready for extubation. neurology consult initiated upon admission to icu for evaluation. post-code ct scan included a ct of the head, which showed no acute intracranial hemorrhage but a possible early acute infarction in the left frontal lobe. after extubation, pt was comfortable with minimal pain medications. he was noted to be grossly deconditioned from prolonged icu stay, but able to move all 4 extremities. he was noted to have decreased lle strength and proprioception for which neurology re-consult was requested. per neurology, mri head, thoracic/lumbar spine was obtained which showed: mri head: a ??????tiny subacute infarct in the left posterior parietal lobe with no evidence of an acute intracranial infarction or hemorrhage. sequelae of microvascular ischemia. intracranial and cervical arterial vasculature does not demonstrate evidence of significant flow limiting stenosis, aneurysm or vascular malformation. mri t/l-spine: no evidence for cord ischemia. mild lumbar spondylotic changes. heterogeneous marrow which could represent chronic anemia or other infiltrative disorders. neurology initially requested emg of lle for prognostic purposes, however this was deferred by the patient, as it would not have changed his management. neurology felt that his lle deficits were consistent with root/plexus injury from compression due to hematoma, and that his prognosis was excellent with regard to recoverable function. his lle was noted to have improving strength and position sense toward the end of his hospitalization. cardiovascular: initially post-operatively, his cardiac function was excellent without issues. on pod#1, after he got out of bed to ambulate for the first time, he suddenly became dizzy and sob and collapsed (witnessed by rn and family). a code blue was immediately initiated and acls protocol was followed. he was initially noted to be in pea cardiac arrest and was pulseless for approximately 7 minutes. cpr was conducted and he was intubated and given medications per acls protocol, which ultimately resulted in return of palpable pulses. during his cardiac arrest, the surgery team attempted right femoral line placement, with inadvertent placement of triple lumen catheter into right femoral artery instead of the vein. this line was kept in place and used as an arterial line. given the high suspicion for pulmonary embolus, he was bloused with heparin. he was noted to have continued hypotension requiring pressors, and shortly after transfer to the icu, he became pulseless again. chest compressions and acls medications resulted in return of pulses and a bedside cardiac echo was performed which showed: ??????dilated hypocontractile right ventricle with small hyperdynamic left ventricle (these findings are consistent with acute pulmonary embolism or isolated right ventricular infarction with major hemodynamic compromise). after patient was stable post-arrest, he was taken for emergent ct scan of the head, chest, abdomen, and pelvis with the primary concern being a large pulmonary embolus. ct of the chest showed: 1. multifocal segmental and subsegmental pulmonary emboli involving all lobes with ct findings suggestive of right ventricular strain. 2. multifocal dependent pulmonary opacities with dense consolidation of the left lower lobe likely related to aspiration pneumonitis/pneumonia. 3. trace amount of simple free fluid within the abdomen and pelvis with post-surgical changes from prior prostatectomy noted. soft tissue induration and edema noted from the right groin extending into the right thigh subcuatenous tissues and rectus femoris is most consistent with hematoma from recent line placement. 4. venous aneurysms/varix involving the left common femoral vein and deep femoral vein with nidus of vessels noted within the mid left thigh highly suggestive of an underlying venous malformation. this can be better evaluated with a conventional or ct angiogram if desired. 5. slit-like appearance to portions of the ivc may suggest underlying volume depletion or increased intrabdominal pressure. probable mixing artifact (non-occlusive clot is felt to be less likely) in the left saphaneous, dfv and sfv. 6. mildly displaced mid sternal and right/left anterior rib fractures presumably related to resuscitative efforts. small adjacent anterior mediastinal hematoma. after chest ct confirmed bilateral pulmonary emboli, it was felt that despite the patient being in the immediate post-op period, he would likely not survive without drastic attempts at clot lysis. he was therefore administered systemic tpa for clot lysis, understanding the high risk for resultant bleeding. his cardiopulmonary function was noted to be improved after administration of tpa, but his hematocrit was noted to drop to a level of 16, for which he was emergently transfused. he required intermittent transfusions and fluid boluses to maintain a hct in the low 20??????s and his abdomen was noted to be distended. this was felt to be from a retroperitoneal bleed around the surgical site. further details in the gi/abd section. he was maintained on 2 pressors and required massive boluses of ivf to keep pressures up after his arrest, resulting in total body volume overload (approximately 30 liters fluid positive). despite maximal pressors and almost continuous fluid boluses, he remained hypotensive, and his abdomen and extremities were noted to be dusky and tight. the acute surgery service was consulted, and felt that he likely had abdominal compartment syndrome for which he underwent emergent decompressive laparotomy. after this procedure, he was able to be weaned off of pressors fairly quickly. during the post-op/post-extubation period, he was noted to be tachycardic and hypertensive, for which oral metoprolol 25mg tid was initiated. his hypertension was felt to be secondary to his renal failure and was followed by the nephrology team. it was felt that unless his systolic blood pressures rose above 160, there was no need to increase the dose of his beta-blockers. pulmonary: per above, the patient sustained a cardiac arrest likely secondary to large pulmonary embolus. ct of the chest post-code and intubation is detailed above and showed bilateral pulmonary emboli. he was given systemic tpa for clot lysis after pe was found on his ct scan. he was kept intubated from while his abdomen remained open. after his abdomen was closed, he was extubated and did well from a respiratory standpoint. he was encouraged to use an incentive spirometer after transfer out of the trauma/sicu. gastrointestinal/abdominal: after administration of tpa. patient was noted to bleed into retroperitoneum. ct scan of abd/pelvis after tpa noted: ??????large midline hematoma seen involving the rectus sheath and the adjacent anterior abdominal wall around the drain insertion site as described. as compared to the prior ct scan, there is increase in the extent of bilateral pleural effusions, pericardial effusion and intraperitoneal free fluid. there is increased subcutaneous abdominal and chest wall edema??????. attempts at fluid resuscitation failed to improve his blood pressure, and his abdomen was noted to become more distended and tight with bladder pressures increasing to the mid 60??????s. acs team consulted due to concern for abdominal compartment syndrome. surgery team recommended emergent decompressive laparotomy, which was carried out with abdomen left packed and open. pt transferred to t/sicu under acs team for further care. bp noted to improve after abdomen opened. several attempts made to close abdomen, but initially unable due to massive generalized edema. crrt initiated due to anuria and large amounts of fluid removed daily at rate of about 200-400 cc/hr. eventually, abdomen closed with large prolene mesh on , as unable to bring rectus muscles back together. while abdomen was open, pt given enteral tube feeds through orogastric tube. once abdomen closed, ngt placed and tube feeds continued until patient passed speech and swallow eval. after speech and swallow eval, pt tolerated oral intake and able to maintain adequate nutrition. the patient will be discharged with 2 abdominal jp drains (on bulb suction), which reside in the subcutaneous space of the abdomen on the left and right. he also has a 19 fr drain in the pelvis around the urethral anastomosis (bulb not to suction). nutrition: patient npo until he was stabilizing in the t/sicu, at which time he was given enteral tube feeds in the form of nutren 2.0 at goal of 40cc/hr. after extubation, he underwent a speech and swallow study, which cleared him for thin liquids and thus a regular diet was initiated with supplemental nutrition in the form of ensure three times daily. renal: after his cardiac arrest, the patient became anuric likely felt to be a result of atn secondary to hypovolemia, increased intraabdominal pressures, and systemic shock. he was followed by the renal team and was started on continuous renal replacement therapy after transfer to the t/sicu. once his bp stabilized and pt able to tolerate fluid removal, he had a large amount of fluid removed with approximately 2-3 liters of fluid per day removed. after enough fluid was removed to allow closure of abdomen, he was transitioned to intermittent hemodialysis three times a week. he was closely followed by the nephrology team, who felt that he had an excellent prognosis with regard to recovery of his renal function. his urine output slowly recovered such that his daily uop was >1000cc. he was dialysed intermittently until it was felt that his renal function had recovered enough to keep him euvolemic with stable electrolyte values. at the time of discharge, his bun and creatinine continue to decrease, and uop is excellent. genitourinary: pt underwent uneventful open radical retropubic prostatectomy. after thrombolysis was carried out, he had a retroperitoneal bleed likely from the surgical bed. this unfortunately caused a urethral disruption of his anastomosis, as seen on portable cystogram. during his first attempt at abdominal closure, an attempt to reanastomose the urethra to the bladder neck was performed, which unfortunately resulted in disruption again while general surgery was attempting to close abdomen. the urethra was re-repaired, although there was a urine leak noted at the time of closure. a 19 fr drain was left in the pelvis to collect and urine leakage. the drain was kept on bulb suction for many days, but as uop increased and drain output decreased, the bulb was taken off suction. repeated creatinine values taken from the pelvic drain fluid showed a creatinine value consistent with serous fluid and not urine. a portable cystogram performed on the day of discharge did show a presumed urine leak after instillation of around 60 cc of cystograffin. the foley will be left in place, secured at all times on no tension with 2 catheter secure devices with plan to leave foley in place until follow up with urology ?????? do not attempt to change or manipulate foley catheter without first discussing with patient??????s urologist! at the time of discharge, the patient??????s urine was slightly malodorous, and urine culture is pending. pt was started on brief 3 day course of fluconazole and cipro for presumed uti. hematology: during his initial surgery (prostatectomy), the patient was noted to have a very large and dilated left external iliac vein at the time of his lymph node dissection. after his cardiac arrest, he was given a heparin bolus. after his pulmonary embolus was found on pe-protocol ct, he was thrombolysed with tpa. he then was maintained on heparin gtt after tpa activity was felt to be completed. his course was complicated by retroperitoneal bleed, as detailed above. his platelets were noted to drop after heparin started, for which hit antibody assay was sent, which ultimately returned positive (). he was then transitioned to argatroban for anticoagulation. during an abdominal washout procedure, he had a retrievable ivc filter placed by the acs team (). he was started on coumadin once he was able to tolerate an oral diet. argatroban was discontinued once inr was between , at which point his inr returned in the mid-3??????s 6 hours after stopping argatroban. he was then given between 1-5 mg of coumadin daily for anticoagulation with a goal inr of . at the time of discharge, his inr was slightly sub-therapeutic at 1.8. he required many transfusions of blood products during his hospital stay. at the time of discharge, his hct is stable above 30 and is slowly rising. endocrine: he was maintained on a riss for goal bs < 150 (scale increased , all fs < 150 after). infectious disease: his hospitalization was relatively uncomplicated with regard to id issues. he was given perioperative infection prophylaxis for his procedures. during his icu stay, his foley was noted to have yeast growing in the tubing, for which a urine cx was sent, which was positive for yeast. he was given fluconazole for this. his wbc was noted to be quite elevated in the mid 30??????s while his abdomen was opened, but this slowly resolved after abdominal closure. wbc at the time of discharge was 14. on the day of discharge, he was noted to have malodorous urine during cystogram, so urine sent for culture and pt started on renally-dosed ciprofloxacin for 3 days and fluconazole for 3 days. microbiology: urine cx - pending cdiff neg bcx neg ucx yeast. 10,000-100,000 organisms/ml.- rx with fluconazole sputum- rare yeast cdiff negative bal resp flora yeast. ~/ml. bcx negative bcx negative ucx negative . tubes / lines / drains: foley (16 fr council), 19 fr in pelvis (no suction to bulb), jp x2 (subcutaneous tissues of abdomen) ?????? both to bulb suction. drains to remain in place until follow up with urology and trauma surgery teams! removed t/l/d: r femoral a-line (), r femoral venous catheter, r ij hd line ( - ), r axillary aline ( - ), l ij hd line (), ngt, piv wounds: midline abdominal incision c/d/i at time of discharge with non-absorbable nylon mattress sutures in place ?????? to stay in place until follow up with general surgery lower suprapubic pfannensteil incision with steri-strips in place (staples removed), well-healing with no erythema or swelling noted. follow up appointments needed: urology ?????? dr. , md surgery ?????? dr. , md neurology - dr. , md - dr. , md nephrology - dr. , md operative dates: abdominal closure with mesh washout, urethral anastomosis, patch washout, place l ij, r hd cath placement decomp exlap, evac of rp and rectus sheath hematoma radical retropubic prostatectomy with bilateral pelvic lymph node dissection, bilateral inguinal hernia repair with mesh daily events: urine malodorous, urine cx sent, started cipro and fluconazole for 3 day course. renal function improved slightly, pt worked with patient, neuro rec emg, but declined due to results unlikely to change plan/management, rehab screen initiated left ij dialysis tlc removed transfused 1 u prbc, mr t/l-spine no evidence of spinal cord ischemia hemodialysis. per neuro consult, mr of thoracic and lumbar spine. pelvic jp taken off suction and placed to gravity drainage. neurology reconsulted for left lower extremity weakness and decreased proprioception, difficulty with adduction. pfanensteil staples removed and staples placed over incision. mr brain w/o contrast negative for acute stroke. hemodialysis. jp creatinine from pelvic drain = 3.5 (serum creat 6.2), urine creat (from foley) = 93, argatroban gtt stopped, inr therapeutic transferred to urology service from acs service transferred to floor hd uneventful today ng tube d/ced -> po axillary line d/ced tf advanced to goal.given coumadin 2 mg x1, switched to oxycodone for pain hd line removed. argatroban continued extubated ct-venogram this am prior to or. to or for washout of abd and patch by acs, ivc filter placement by acs, urethrovesicular anastamosis by urology. ebl 900, ivf 4500. transfused prbcs 1u. to or for attempted closure, reapproximation of bladder : cmv -> cpap. therapeutic on heparin drip. monitor dc'ed. tf 20 -> 40cc/hr. transfused 1u prbc for hct 23.1. : pelvic jp drain fell out, catheter placed into right femoral vein. start 25% albumin 25g tid and take off 150-200cc/hr. removed esophageal balloon. ivc filter not today, will start tube feeds at low rate. bedside cystogram showing bladder disruption - will need repair on monday. : weaned off pressors, peep decreased to 10, to or for washout + hd line + right hd line + left ij tlc, ivc filter unable to be placed, crrt started : given elevated abd pressure (45-50 based on bladder pressure) need for hd line --> heparin gtt turned off in anticipation of or, to or for decompressive laparotomy - open abdomen, transfer from to trauma icu, esophageal balloon placed. lfts continued to increase shock liver most likely, returned from or w abdomen open and packed; hd line unable to be placed in or; drain to suction, stable w sbps 130s, transferred to post-op to tsicu : in am aggressively bolused w ivf w plan to f/u cvp and co (placed nicom), sedation briefly weaned for neuro exam (intact), started vanco/zosyn given concern for potential infection, c/s ortho, vascular consult resident - would not intervene for thigh hematoma while lytics are still active, supportive care and pull line only when lytics are out of system, loose insulin ss, neuro reccs: mri when clinically stable, ab/pelvis ct: large hematoma 15x5x11 cm around rectal sheath near drain new from yesterday. hemoperitoneum with increased fluid but not c/w compartment syndrome. small amt fluid in rp. mild pericardial effusion, moderate pleural effusion, no significant thigh hematoma x72745. vascular surgery and urology notified, ntd, q4h hct, echo with bubble: after intravenous injection of agitated saline at rest x 2, there was no appearance of saline contrast in the left heart. no envidence of resting right-to-left intracardiac flow, loss of dp pulse at 4:30 pm with cold toe; evaluated by vascular-- many possible etiologies given coagulopathy, would not pull line at this time; might do percutaneous closure in the future, at 5:30 pm: hr 130s, bp 80s/40s- > gave fentanyl bolus for ? contribution of pain, 5 pm cbc: hct 31, plt 60 stable, 9pm ptt 150. turned off heparin gtt; check ptt q2h; plan to hold until ptt 60-80 then restart at 250/h, k5.5 in am, repleted calcium, ekg unchanged from , neurorads: questionable area of acute infarction in l frontal lobe (loss of -white differentiation), but no hemorrhage, levophed for pressor support, cta torso with segmental pes bilaterally, l saphenous vein thrombosis, lll dense consolidation, substernal 1.8x5.5cm hematoma, r thigh hematoma (r rectus femorus with soft tissue stranding), l external cluster of vessels with mid-thigh malformation : post-arrest hct 24.2 --> 2units prbcss --> 28.3 --> 22.5 --> 2units prbcs --> 30.4, given additional 1l ns bolus for lactate of 7.3 (received 3l ns and 1l lr total since admission + 4 units prbcs), ptt 50.4 so restarted heparin gtt at 1000 units/hr medications on admission: albuterol prn, fluocinolide 0.05% cream daily prn, red yeast rice 600mg daily, centrum silver, fish oil 1000mg daily discharge medications: 1. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation qid (4 times a day) as needed for sob/per rt . 2. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed for dry eyes. 3. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day): hold for loose stools/diarrhea. 4. famotidine 20 mg tablet sig: one (1) tablet po q24h (every 24 hours). 5. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain, fever. 6. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 7. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 8. multivitamin tablet sig: one (1) tablet po daily (daily). 9. warfarin 4 mg tablet sig: one (1) tablet po once a day for once days: md to order daily based on inr. tablet(s) 10. sodium chloride 0.9% flush 10 ml iv prn line flush temporary central access-icu: flush with 10ml normal saline daily and prn. 11. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 12. dextrose 50% 12.5 gm iv prn hypoglycemia protocol 13. fluconazole 100 mg tablet sig: two (2) tablet po q24h (every 24 hours) for 2 days: started date complete date . 14. insulin regular human 100 unit/ml solution sig: qs units injection asdir (as directed): sliding scale coverage. 15. proair hfa 90 mcg/actuation hfa aerosol inhaler sig: one (1) puff inhalation twice a day as needed for allergy symptoms. 16. fluocinonide 0.05 % cream sig: one (1) application topical once a day as needed. 17. cipro 250 mg tablet sig: one (1) tablet po twice a day for 3 days: start date complete date . 18. cipro 500 mg tablet sig: one (1) tablet po twice a day for 1 days: one tablet in the am and then the pm on date of scheduled foley removal. disp:*2 tablet(s)* refills:*0* discharge disposition: extended care facility: - discharge diagnosis: prostate ca s/p open radical prostatectomy bilateral inguinal hernia s/p inguinal herniorraphy with mesh cardiac arrest (puleseless electrical activity) pulmonary embolism s/p thrombolysis and ivc filter placement heparin induced thrombocytopenia (hit) abdominal compartment syndrome s/p decompressive laparotomy acute tubular necrosis (acute renal failure) s/p hemodialysis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. minimally ambulatory - requires assistance or aid (walker or cane) and requires physical assistance out of bed to chair or wheelchair or commode. he requires assistance with transferring to chair, bed, commode. discharge instructions: use tylenol for pain control. the maximum dose of tylenol (acetaminophen) is 4 grams (from all sources) per day. -if you have been given narcotic pain medications (percocet example) these may sometimes be combined with tylenol (acetaminophen). this needs to be considered when monitoring your daily dose and maximum. -you are being discharged on a medication called coumadin (warfarin). this medication must not be taken with other blood thinning medications or products; including aspirin and non-steroidal anti-inflammatories (nsaids). examples of nsaids include but are not limited to ibuprofen, advil, motrin, excedrin. --your coumadin dosing will be monitored while you are at rehab but will need to ultimately be monitored by your pcp. --in addition to the blood thinner, you have been fit with an ivc (inferior vena cava) filter to help reduce the risk of thrombus traveling past it. -please do not drive, operate dangerous machinery, or consume alcohol while taking narcotic pain medications. -do not drive while foley catheter/leg bag are in place -colace has been prescribed to avoid post surgical constipation and constipation related to narcotic pain medication. discontinue if loose stool or diarrhea develops. colace is a stool softener--it is not a laxative. -you may shower 2 days after surgery, but do not tub bathe, swim, soak, or scrub incision for 2 weeks or while you have "drains" in place -??????steristrips?????? have been applied to close the wound where your hemodialysis catheter was (left anterior neck). allow these bandage strips to fall off on their own over time. you may get the steristrips wet. -no heavy lifting for six weeks (no more than 10 pounds) and only after you've been advised by your physical therapists with regard to advancing to progressive resistance -your foley should be secured to the catheter secure on your thigh at all times until your follow up with the surgeon. - wear large foley bag for majority of time, leg bag is only for short-term when leaving house/etc. -complete a short term course (three days) of antibiotics as prescribed on discharge (ciprofloxacin and fluconazole). please note that these two antibiotics can sometimes decrease metabolism of coumadin (increasing your inr) -when you are scheduled for your foley catheter removal, please take ciprofloxacin in the morning and again in the evening. please save two tablets of cipro to take on the date of your foley removal. medical attention for fevers (temp>101.5), worsening pain, drainage or excessive bleeding from incision, chest pain or shortness of breath. -you may resume your regular home diet but remember to drink plenty of fluids to keep hydrated and to avoid foods that may cause constipation -incidentally noted was a left atriovenous malformation. you should avoid having catheterizations/procedures done at these inguinal veins and arteries (from the radiology report: venous aneurysms involving the left common femoral vein and deep femoral vein with nidus of vessels noted within the mid left thigh highly suggestive of an underlying av malformation) --heparin induced thrombocytopenia (hit)is a serious condition that can be lethal. you should consider and discuss with your pcp the appropriateness of obtaining a medicalert type bracelet or device to warn others of this condition. followup instructions: ***1)follow up only with dr. as instructed for foley catheter removal and pelvic drain romoval. do not have anyone else other than your surgeon remove your foley for any reason. call dr. office ( for follow-up and if you have any urological questions. ***2) please arrange follow up in neurology clinic with dr. (and residents/staff) in weeks after discharge for post-operative evaluation. appointment scheduling for department neurology: (. ***3) please call to arrange follow-up with , md with regard to your general surgery and post-operative evaluation and bilateral jp drain removal. division: dr. at acute care surgery phone:( ***4) you will need to follow-up with your pcp to review your overall posteperative and rehabilitation course, your medications and for oversite of your inr monitoring and coumadin dosing and renal function. please call to arrange follow up w/ md 240 s. ., , ph: fax: web: ***5) you not need to have a follow-up appointment with nephrology based on your monitoring labs but please call dr. . please have your pcp monitor your labs. dr. , staff nephrologist, medicine/renal organization: office location:, office phone:( procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube interruption of the vena cava enteral infusion of concentrated nutritional substances hemodialysis injection or infusion of thrombolytic agent venous catheterization for renal dialysis arterial catheterization closed [endoscopic] biopsy of bronchus other open incisional hernia repair with graft or prosthesis division or crushing of other cranial and peripheral nerves regional lymph node excision cardiopulmonary resuscitation, not otherwise specified other laparotomy delayed closure of granulating abdominal wound peritoneal lavage radical prostatectomy ureteroneocystostomy other and open bilateral repair of direct inguinal hernia with graft or prosthesis diagnoses: acidosis acute kidney failure with lesion of tubular necrosis acute posthemorrhagic anemia acute and subacute necrosis of liver unspecified septicemia severe sepsis cardiac complications, not elsewhere classified hematoma complicating a procedure acute respiratory failure defibrination syndrome cardiac arrest incisional hernia without mention of obstruction or gangrene malignant neoplasm of prostate other specified complications of procedures not elsewhere classified urinary complications, not elsewhere classified removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation cerebral artery occlusion, unspecified with cerebral infarction other pulmonary embolism and infarction heparin-induced thrombocytopenia (hit) mixed acid-base balance disorder inguinal hernia, without mention of obstruction or gangrene, bilateral (not specified as recurrent) nontraumatic compartment syndrome of abdomen family history of malignant neoplasm of prostate anomalies of other specified sites of peripheral vascular system 

Answer: The patient is high likely exposed to