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: patient recorded as having no known allergies to drugs attending: chief complaint: bladder perforation major surgical or invasive procedure: none history of present illness: mr. is an 84y/o male nh resident transferred from with extraperitoneal bladder perforation. pt presented to earlier today with incrasing confusion, sob and hematuria s/p foley change last night at his nursing home. at , a three-way foley was put in and bladder irrigation was done. a ct abdomen showed extraperitoneal bladder rupture and an anterior fluid collection. he was given 500 mg iv flagyl and levaquin 500 mg iv. he was also given 10u regular insulin bc he was found to have a glucose of 1021. also, found to have lactate of 7.1 and na of 126. pt was also given total of 2.5l ns in boluses. pt was then transferred to . . in the ed, vs: t 98.6 bp 96/60 hr 92 rr 20 o2sat 97% on 2l nc. there, pt was tachypnic to 35. rij line was placed. q1h fingersticks and q2h chem 7 were done and an insulin gtt at 8 units per hours was started. he received a total of 3l ns iv, sbp remained in 90s. he had 1.5l of uop in ed. no antibiotics were given in the ed here. surgery and urology were c/s. urology rec foley catheter to drainage, clamp cbi port, do not irrigate bladder, when stablized, ct cystogram and possible ir drainage of extraperitoneal fluid collection after ct cystogram. . on the floor, pt was tachypnic 28-30, complained of no pain. pt was awake, oriented x1, unable to communicate effectively. . review of sytems: unable to elicit past medical history: htn dm2 atrial fibrillation hematuria seizure disorder urinary incontinence, chronic indwelling foley catheter recurrent uti's mental retardation - reportedly confused at baseline but is able to express his needs dementia osteoporsis hx of abdominal pain/chronic appendicitis (?) hx aspiration pna (diet: mech soft, nectar thick, asp precautions) ex lap for lysis of adhesion social history: resides in nursing home/manor care. baseline needs assist with some adl's, feed/toilets himself, walks with walker. family history: nc physical exam: vitals: t: 97.2 bp: 98/44 p:90 r:30 o2: 91-93% on 3l nc general: drowsy, arousable, oriented x1 heent: sclera anicteric, dry mucous membranes, oropharynx clear neck: supple, jvp not elevated, no lad lungs: ctab anteriorly cv: rrr, no murmurs, rubs, gallops abdomen: soft, non-tender, distended, bowel sounds present, no rebound tenderness or guarding, no dullness to percussion gu: foley in plce draining red-tinged urine ext: warm, well perfused, 1+ ble edema, onychomycosis bilat pertinent results: studies:: findings: as compared to the previous examination, the patient position has considerably changed. there is very likely a decrease of the extent of the pre-existing left pleural effusion. otherwise, the lung parenchyma appears unchanged. unchanged moderate cardiomegaly. no newly occurred focal parenchymal opacity suggesting pneumonia. . . cxr: impression: ap chest compared to : the mandible obscures much of the upper lungs. the unencumbered portion of the right lung is clear. there is probably atelectasis at the base of the left. heart is not grossly enlarged. . . cxr axr: final addendum addendum: upon further review of the ct from , the prominent gas-filled structure that extends transversely across the upper abdomen corresponds to an extremely dilated stomach with significant fluid contents. ng tube placement is recommended. the remainder of the small and large bowel are not well visualized, but appear nondilated. these results were discussed with dr. on at 10:20 a.m. dr. ho dr. approved: sat 12:35 pm final report history: 84-year-old male with distended abdomen with coffee-ground emesis. abdomen, three views: evaluation is limited by extensive overlying soft tissue. the bowel gas pattern is not significantly changed from ct on . there is a dilated loop of transverse colon measuring 13 cm, associated with an air-fluid level on lateral views. however, gas is present in the rectum and in multiple nondilated bowel loops throughout the abdomen. there is a small amount of retained stool in the right colon. there is a small left pleural effusion. there is bibasilar atelectasis. impression: chronic ileus, stable since prior ct. . . . ct cystogram: , m 84 radiology report ct cystogram (pel) w/o contrast study date of 12:04 pm provisional findings impression: cxwc sun 1:30 pm urinary bladder demonstrates thickened trabeculae and numerous diverticuli, which explains the irregular contour and air-filled foci on yesterday's non- constrast scan. no extravasation of contrast or fluid collection; no evidence of perforation. surrounding inflammatory changes are c/w cystitis. dilated, fluid-filled appendix with mild inflammatory changes stable since yesterday, and c/w report of chronic appendicitis on prior studies from . enlarged, fluid-filled stomach, with fluid in the distal esophagus increases risk for aspiration. final report indication: 84-year-old man with report of ruptured bladder. comparison: non-contrast ct of the abdomen and pelvis obtained at on . technique: mdct-acquired axial images were obtained through the pelvis before and after instillation of 150 cc of diluted water-soluble contrast into the urinary bladder. post-cystogram images were also obtained through the abdomen. multiplanar reformatted images were generated. ct abdomen without iv contrast: at the lung bases, there is mild dependent atelectasis bilaterally but no consolidation or pleural effusion. the heart is enlarged with coronary artery calcifications. there is no pericardial effusion. in the abdomen, the absence of intravenous contrast limits evaluation of solid organs. however, the liver, gallbladder, spleen and duodenum are unremarkable. the pancreas demonstrates fatty replacement. the stomach is distended with fluid, and the distal esophagus is mildly patulous and also contains fluid, placing the patient at increased risk for aspiration. adrenal glands are prominent bilaterally, without definite nodule or mass. kidneys demonstrate no calculus, hydronephrosis or hydroureter. on the left, there is a moderate extrarenal pelvis. the abdominal aorta demonstrates atherosclerotic calcifications but is normal in caliber. small lymph nodes in the retroperitoneum and mesentery do not meet size criteria for abnormality. there is no free air or free fluid in the abdomen. small amount of stranding in the retroperitoneum extends from duodenum toward right lower quadrant about the appendix, but appears somewhat decreased from the ct at of the previous day. ct pelvis without iv contrast: diluted, water-soluble contrast was instilled into the patient's urinary bladder via an indwelling foley catheter. this demonstrates a markedly trabeculated bladder with numerous bladder diverticuli, explaining the lobulated, irregular contour noted on non-contrast scan. there is no evidence of contrast extravasation. multiple bubbles of air are trapped within individual diverticulae consistent with presence of foley catheter. there is continued thickening of the bladder wall and stranding about the bladder although slightly improved from prior. the prostate is enlarged measuring 5.1 x 6.3 x 5.6 cm. there is no fluid collection in the pelvis. appendix is again noted to be dilated and fluid filled with adjacent stranding although the degree of periappendiceal stranding is less marked than that surrounding the bladder (400b:36). the rectum is distended with fecal material. the remainder of the colon demonstrates a moderate amount of stool. otherwise, loops of large and small bowel are unremarkable. the prostate gland is enlarged. there is no pelvic or inguinal lymphadenopathy by size criteria. osseous structures: bones are diffusely demineralized. there is pronounced convex leftward curvature of the thoracolumbar spine, with multilevel degenerative changes. however, no fracture is identified. no worrisome bony lesions are seen. soft tissues are unremarkable. impressions: 1. instillation of contrast into the urinary bladder demonstrates diffusely thickened trabeculae and numerous diverticuli. surrounding inflammatory changes are consistent with cystitis and mildly improved. there is no evidence of bladder perforation. 2. the appendix remains dilated and fluid filled, with mild surrounding inflammatory changes, by report, unchanged from prior studies obtained at (although images are not available for review). if changes are not acute, this is consistent with chronic appendicitis. 3. stomach distended with fluid, with fluid in the distal esophagus, increasing the risk of aspiration. 4. rectum distended with fecal material. 5. atherosclerotic calcification. 6. enlarged prostate (likely leading to bladder trabeculation and diverticulae described above). . . ct abdomen/pelvis -: clinical history: abdominal distension. comparison: none. technique: axial mdct images were obtained from the lung bases to the pubic symphysis without intravenous or oral contrast. coronal and sagittal reformatted images are provided. contrast: none. ct abdomen without intravenous contrast: imaged portion of the lung bases show bibasilar linear atelectasis and appear otherwise unremarkable. coronary artery calcifications are present within the imaged portion of the heart and pericardium. allowing for noncontrast technique, the liver, spleen, pancreas, gallbladder and bilateral adrenal glands appear unremarkable. there is mild left sided hydronephrosis and extrarenal pelvis, with dilation of the left proximal ureter. no calcified stones are identified. on the right, there is an extrarenal pelvis without hydronephrosis. mild dilation of the proximal right ureter is present. abdominal aorta shows mural calcification consistent with atheromatous disease. stranding is present within the retroperitoneum extending from the second portion of the duodenum inferiorly, along the anterior pararenal space on the right, to the location of the appendix, which is abnormally dilated and fluid filled, and measures up to 13 mm in diameter (2:72). small bowel loops are nondilated. there is a moderate amount of stool in the colon. there is no free intraperitoneal air. ct pelvis without intravenous contrast: a foley catheter is in place within the bladder. there is marked stranding surrounding the bladder. several foci of gas are seen immediately adjacent to the bladder. evaluation is limited due to the lack of intravenous contrast, although considerations might include small foci of air located outside the bladder, or presence of air in multiple bladder diverticula related to recent foley catheterization. a moderate amount of stool is present in the rectum. there is no inflammatory change about the sigmoid colon. bilateral fat containing ct/ct abd& pel w/o & reformats inguinal hernias are present, larger on the left with some adjacent soft tissue density of uncertain significance that could relate to prior surgery if appropriate history exists. bone windows: there is degenerative change of the lumbar spine. no suspicious lytic or sclerotic osseous lesions are identified. impression: 1. marked stranding surrounding an abnormal-appearing bladder, with multiple foci of gas which could represent extravesical air, such as due to infection, or alternatively, air within multiple bladder diverticula (air in this case due to the presence of the foley catheter). 2. abnormally dilated and fluid filled appendix with surrounding inflammatory change. the findings are compatible with appendicitis although it is noted that the degree of inflammatory change is slightly less marked than about the urinary bladder. please note that at the time of discussion of these findings with the referring clinician a history of questionable chronic appendicitis was provided with reported prior imaging at although this is unavailable for review. 3. moderate fecal loading. 4. bilateral extrarenal pelves and suggestion of left sided hydronephrosis with dilation of bilateral proximal ureters, of uncertain significance. no renal stones identified. results were discussed with the referring provided at the time of image acquisition on , and also by dr. on at approximately 10:00 a.m. (discussed with dr. . ** report signature on file ** reported by: , md . . microbiology: blood culture (4/4 bottles): **final report ** blood culture, routine (final ): escherichia coli. final sensitivities. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ 4 s ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s anaerobic bottle gram stain (final ): gram negative rod(s). . urine culture **final report ** urine culture (final ): escherichia coli. >100,000 organisms/ml.. presumptive identification. yeast. 10,000-100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ 8 s ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s . . blood cultures - pending. blood cultures - pending. urine cultures - yeast. . . . labs: 08:45pm blood wbc-24.1* rbc-4.18* hgb-12.9* hct-39.6* mcv-95 mch-30.9 mchc-32.6 rdw-13.7 plt ct-282 03:28am blood wbc-20.4* rbc-3.75* hgb-11.7* hct-34.4* mcv-92 mch-31.3 mchc-34.1 rdw-13.1 plt ct-269 03:50am blood wbc-17.1* rbc-3.52* hgb-11.1* hct-32.0* mcv-91 mch-31.5 mchc-34.6 rdw-13.1 plt ct-202 05:58am blood wbc-12.4* rbc-3.68* hgb-11.3* hct-34.7* mcv-95 mch-30.6 mchc-32.4 rdw-13.4 plt ct-210 04:41am blood wbc-12.8* rbc-4.36* hgb-13.4* hct-40.3 mcv-93 mch-30.8 mchc-33.2 rdw-13.6 plt ct-275 11:17pm blood wbc-20.2*# rbc-4.32* hgb-13.5* hct-39.2* mcv-91 mch-31.3 mchc-34.5 rdw-13.1 plt ct-274 07:00am blood wbc-16.9* rbc-4.05* hgb-12.4* hct-38.0* mcv-94 mch-30.6 mchc-32.6 rdw-13.5 plt ct-252 01:10pm blood wbc-14.7* rbc-4.13* hgb-12.9* hct-37.9* mcv-92 mch-31.1 mchc-34.0 rdw-13.2 plt ct-266 06:04pm blood wbc-19.0* rbc-4.30* hgb-13.2* hct-39.8* mcv-93 mch-30.8 mchc-33.3 rdw-13.7 plt ct-302 06:40am blood wbc-20.1* rbc-4.10* hgb-12.6* hct-37.9* mcv-93 mch-30.8 mchc-33.2 rdw-13.5 plt ct-282 07:00am blood wbc-22.7* rbc-3.83* hgb-11.9* hct-35.5* mcv-93 mch-31.1 mchc-33.6 rdw-13.8 plt ct-307 08:45pm blood glucose-746* urean-46* creat-2.9* na-132* k-4.8 cl-95* hco3-24 angap-18 03:28am blood glucose-202* urean-51* creat-2.8* na-140 k-3.6 cl-102 hco3-26 angap-16 01:20pm blood glucose-212* urean-58* creat-2.2* na-140 k-3.8 cl-107 hco3-25 angap-12 04:41am blood glucose-200* urean-35* creat-1.3* na-147* k-3.1* cl-103 hco3-33* angap-14 07:00am blood glucose-481* urean-35* creat-1.4* na-143 k-4.2 cl-103 hco3-31 angap-13 06:04pm blood glucose-277* urean-35* creat-1.5* na-149* k-3.9 cl-108 hco3-29 angap-16 01:15pm blood glucose-262* urean-39* creat-1.5* na-149* k-3.3 cl-105 hco3-32 angap-15 06:15pm blood glucose-295* urean-40* creat-1.5* na-147* k-3.2* cl-102 hco3-33* angap-15 07:00am blood glucose-170* urean-36* creat-1.5* na-149* k-3.4 cl-102 hco3-33* angap-17 11:00pm blood alt-15 ast-12 ld(ldh)-168 ck(cpk)-98 alkphos-106 totbili-0.4 03:28am blood ck(cpk)-440* 03:50am blood ck(cpk)-407* 05:58am blood ck(cpk)-147 11:17pm blood ck(cpk)-74 07:00am blood alt-26 ast-23 alkphos-88 totbili-0.2 06:40am blood alt-24 ast-30 alkphos-86 totbili-0.2 08:45pm blood ck-mb-5 ctropnt-0.03* 03:28am blood ck-mb-8 ctropnt-0.05* 05:58am blood ck-mb-3 ctropnt-0.02* 11:17pm blood ck-mb-2 ctropnt-0.02* 01:20pm blood caltibc-133* ferritn-434* trf-102* 03:50am blood phenoba-7.2* phenyto-2.2* 03:33am blood type-art po2-71* pco2-34* ph-7.46* caltco2-25 base xs-0 03:46am blood type-central ve temp-37.7 po2-29* pco2-47* ph-7.38 caltco2-29 base xs-0 01:34pm blood type- po2-189* pco2-48* ph-7.48* caltco2-37* base xs-11 comment-green top 08:03am blood type- po2-168* pco2-46* ph-7.50* caltco2-37* base xs-11 comment-peripheral 08:48pm blood glucose-greater th lactate-4.1* 06:29am blood lactate-1.5 01:34pm blood lactate-2.2* 08:03am blood lactate-3.0* brief hospital course: mr. is an 84 year old nursing home resident with dementia, mental retardation, dm2, chronic indwelling foley transferred from with urosepsis, anterior extraperitoneal bladder perforation and hyperosmolar hyperglycemic state. . # anterior extraperitoneal bladder perforation: ct cystogram showed no evidence of bladder perforation but per urology patient likely had micro-perforations. patient was comanaged by urology and team. per urology the most likely mechanism for this bladder perforation would be increased bladder pressure from cbi. as it is extraperitoneal perforation, management is non-operative with decompression. the 3 way foley was left in place but 3rd port was capped and not used. patient had no uop on hd2 despite ivf boluses, and he was visibly uncomfortable. after urology re-positioned the foley catheter, 1300cc urine drained from the catheter, and patient felt much better. his foley catheter continued to drain urine appropriately, and on , per urology, plan is for patient to be discharged back to rehab with foley management as per routine for patients with chronic foley in place, and urology follow-up as needed. # abdominal distension/ileus - pt presented with an enlarged abdomen, which per family, has been chronic, though was notable larger during this admission. ct abd done at - revealed chronic appendicititis, moderate fecal loading, and suggestion of left hydronephrosis, along with the bladder findings above. repeat abdominal xray showed some dilation of bowel loops, but upon initial interpretation with radiology was felt to be unchanged from ct abd. he was treated with aggressive bowel regimen, and disimpaction x2 on and with some improvement in his abdominal distension, however upon further discussion with radiology, concern was raised for distension of the stomach, and ngt placement was recommended for decompression. however, ct scan showed decreased colon size and no sign of obstruction. at this time his abdominal distension/ileus appears to have resolved. . #acute renal failure: creatinine 2.9-3.0 on admission, with baseline creatinine on of 1 by report, current exacerbation likely dehydration, urosepsis. patient was volume resuscited in the icu, and his creatinine trended down to 2.2. lisinopril was held in the setting of arf. he received intermittent iv lasix given his tachypnea, and hypoxia with good urine output (>2l) over the course of his initial course on the medical service (), and his creatinine was 1.5 on . of note, ct abd at -n did reveal suggestion of left hydronephrosis, which was felt to be treated with bladder decompression above, but should be followed if his creatinine fails to improve. he is being re-started on his home dose of lisinopril at discharge. . # urinary tract infection/septic shock: initial presentation to the icu was consistent with septic shock. he was treated with iv fluid resuscitation, and did not require pressors. urine and blood culture revealed gnr. initial labs revealed leukocytosis (20s) and 13% bandemia, this likely was the cause of initial confusion at nursing facility. patient was initially on empiric antibiotic therapy with vancomycin/cefepime/cipro, which was changed to cefepime once specifiation of gnr was found in blood culture. cvp was followed with goal of . ivf boluses were given for transient hypotension. . upon transfer to the medical floor, he was switched to cefpodoxime based on blood and urine cultures demonstrating sensitivity to ceftriaxone, however, he subsequently developed recurrence of fever and leukocytosis, and was switched to iv ceftriaxone on . he continued to have fevers (101-102), and on id consult was obtained, with recommendation to switch to iv bactrim given improved urinary penetration, and fluconazole given persistent funguria. fluconazole was discontinued on , renal/bladder ultrasound was negative for a fungus ball, and, per infectious disease, repeat urine cultures with yeast would not need to be treated. . # hypoxia/tachypnea/hospital acquired pna. upon arrival to the medcal floor pt required 2-3l of supplemental oxygen. this was felt initially likely volume overload in the setting of renal failure and fluid resuscitation in the icu given his urosepsis. oxygenation did improve initially with iv lasix, however he continued to maintain his oxygen requirement, with baseline tachypnea in the 30s. this was felt likely multifactorial, with contribution from mild volume overload, ongoing aspiration events given his confused mental status, and most prominently, increasing intra-abdominal pressure from significantly distended abdomen. . he was evaluated by speech and swallow service, and placed on a ground diet with thickened liquids, with strict supervision at meals. he was diuresed as below. his abdominal distension was treated with aggressive bowel regimen, and disimpaction, with soome improvement in his abdominal distension. his was course then complicated by the development of hospital-acquired pna possible aspiration requiring intubation and treatment with vanc/cefepime x 7 days. his respiratory status was quite tenuous and ultimately he was extubated with a plan to focus on comfort measures. he was briefly on a morphine gtt but his respiratory status stabilized to the point where he could be weaned to oxygen by nc and transferred to the floor. aspiration remains a concern as below. he is now stable on 2l nc. #aspiration: pt has a prior history of aspiration. on initial evaluation on the floor he was cleared for a ground diet, but then he required icu stay for sepsis, uti, respiratory failure. post-extubation his swallow eval showed overt signs of aspiration and he has remained npo until a repeat evaluation on , at which time he was cleared for pureed solids and nectar thick liquids. he was noted to do best with applesauce, with some persistent difficulty with mashed potatoes. please see detailed nursing instructions regarding how best to feed the patient. #hyperglycemia / type ii diabetes: most likely hyperosmolar hyperglycemic state, unlikely to be diabetic ketoacidosis. he had normal bicarb on chem 7. urine ketones were negative. home glyburide was held. patient was initially on insulin gtt, which was transitioned to subcutaneous insulin after glucose was better controlled. . upon arrival to the medical floor, his sugars remained elevated, though his gap remained closed, and his insulin regimen was aggressively uptitrated. as his infection is treated, his regimen will need to be downtitrated appropriately. . # elevated lactate: likely dehydration from hyperglycemia as well as bladder perforation and urosepsis. lactate trended down with volume resuscitation, and treatment of urosepsis. . # hypernatremia/hyponatremia: initial hyponatremia felt hyperglycemia, corrected for glucose his sodium is normal at 142. after arrival to the medical floor, his sodium trended upward in the setting of delerium and poor oral intake. he was diuresed as below, and given d5w boluses prn. sodium now normalized. . # hypertension, benign: initial hypotension was dehydration from hhs and urosepsis. patient was given ivf boluses, and his home antihypertensives (norvasc, lisinopril, isordil, toprol) were held. as his blood pressure normalized, metoprolol, norvasc, isordil were restarted. during icu stay his bp meds had to be converted to iv meds, which were converted back to po medications on . he is scheduled to receive his first doses of toprol 100mg daily, lisinopril 40mg daily, and norvasc 10mg daily on . given his recent sepsis, his hctz and isordil continued to be held, and should be re-started as needed for additional blood pressure control. . # h/o seizure disorder: home dose dilantin was continued. patient was on mebaral 32mg tid at home. phenobarbital was continued here, and mebaral should be re-started upon discharge. . #hypothyroid: home dose synthroid was initially converted to an iv dose while patient was npo, and was converted back to his home po dose upon discharge. # osteoporosis: home dose calcium and vitamin d were temporarily on hold due to aspiration, and should be re-started at discharge. . # prophylaxis: patient was put on pneumoboots, he was put on sq heparin later after it was determined that no ir drainage was not indicated. home dose ppi was continued. . code: dnr/dni, do not re-hospitalize contact person: (friend), sister-in-law patient is being transitioned to hospice level care, with no escalation of care if respiratory status declines. would treat simple, reversible processes should they arise, such as bacterial uti's, elevated blood pressure, or elevated blood sugar. medications on admission: synthroid 25mcg daily mebaral 32mg tid dilantin 100mg tid glypizide 5mg lisinopril 40mg daily norvasc 10mg daily hctz 25mg daily toprol xl 150mg daily isordil 10mg tid prilosec 20mg daily asa 325 daily colace 200mg daily sennakot 2 tabs lactulose 15ml tums tid vit d q month on the 18th mvi discharge medications: 1. lactulose 10 gram/15 ml syrup : thirty (30) ml po tid (3 times a day). 2. aspirin 325 mg tablet : one (1) tablet po daily (daily). 3. polyethylene glycol 3350 17 gram/dose powder : po daily (daily) as needed for constipation. 4. acetaminophen 325 mg tablet : 1-2 tablets po q6h (every 6 hours) as needed for fever, pain. 5. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) nebullizer inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 6. ipratropium bromide 0.02 % solution : one (1) nebullizer inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 7. metoprolol succinate 50 mg tablet sustained release 24 hr : three (3) tablet sustained release 24 hr po daily (daily): hold for sbp<100, hr<60. 8. phenytoin sodium extended 100 mg capsule : one (1) capsule po tid (3 times a day). 9. lisinopril 20 mg tablet : two (2) tablet po daily (daily): hold for sbp<100. 10. levothyroxine 25 mcg tablet : one (1) tablet po daily (daily). 11. glipizide 5 mg tablet : one (1) tablet po bid (2 times a day). 12. amlodipine 5 mg tablet : two (2) tablet po daily (daily). 13. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 14. mebaral 32mg po tid discharge disposition: extended care facility: - discharge diagnosis: sepsis of a urinary source hospital acquired pneumonia bladder perforation aspiration discharge condition: stable discharge instructions: patient to be transitioned to hospice level care. continue all home medications; do not re-hospitalize, dnr/dni. please obtain hospice consult for further evaluation. followup instructions: hospice care procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube other cystogram diagnoses: pneumonia, organism unspecified anemia, unspecified urinary tract infection, site not specified acute kidney failure, unspecified hyposmolality and/or hyponatremia severe sepsis atrial fibrillation pulmonary collapse acute respiratory failure pneumonitis due to inhalation of food or vomitus osteoporosis, unspecified septic shock paralytic ileus accidental cut, puncture, perforation or hemorrhage during other specified medical care hypoxemia urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure accidents occurring in residential institution septicemia due to escherichia coli [e. coli] hydronephrosis diverticulosis of colon (without mention of hemorrhage) urinary incontinence, unspecified unspecified intellectual disabilities other complications due to genitourinary device, implant, and graft benign essential hypertension other forms of epilepsy and recurrent seizures, without mention of intractable epilepsy other appendicitis diabetes with hyperosmolarity, type ii or unspecified type, uncontrolled other impaction of intestine inguinal hernia, with obstruction, without mention of gangrene, unilateral or unspecified (not specified as recurrent) cystitis, unspecified 

Answer: The patient is high likely exposed to