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: respiratory failure major surgical or invasive procedure: chest tube placement central line placement picc line placement history of present illness: 40 yo m with ipf, s/p double lung tx , h/o recurrent pneumonia, chronic rejection and obliterative bronchiolitis, polymiositis presents with acute on chronic respiratory failure. was sent from rehab for hypoxia (o2 sat 78%) and lethargy, also some report of migratory chest pain/pleuritic cp. vent settings prior to event ac 400/15/0.40/5, started to be ambu bagged with improvement to 96%, then placed on fio2 100% but decreased again to 80%. at baseline can write and interact with staff but was not doing so today. was satting 78% on vent there with difficulty suctioning. . in the ed, vs t 101.4 hr 98, bp 132/64, o2 sat 88%, suctioned here without improvement. abg 7.05/190/111-->6.98/204/119. patient was bronched by pulm in ed, airways were found to be patent. considered replacing trach vs intubation and removal of trach, but ultimately, was started on heliox and thought to be doing better. also given zosyn and flagyl for likely aspiration pna on cxr. ct performed in ed given report of pleuritic cp. patient was also transiently hypotensive from 110s to 90s, received fluid bolus total 4l and started on stress dose steroids. past medical history: - ipf dx in , s/p b/l lung transplant in c/b chronic resp failure vent dependent since s/p tracheostomy/peg - h/o trach dislodgement s/p revision with dilation and placement of #8 trach - pfts : fev1 0.38, fvc 0.81, fev1/fvc 47% - h/o multiple pnas, aspiration - h/o pseudomonas, algaliceus species, aspergillus - h/o polymyositis, anti- negative, +, ?cause for ipf - h/o esophageal dysmotility, gerd - hypertension - h/o a.fib - hyperlipidemia - dm, h/o dka in past - h/o sacral decubiti - h/o esbl proteus uti - h/o vre/mrsa - cri (?baseline cr) - ?h/o seizure disorder (documented in one note, not in / notes) social history: lives at rehab, wife is supportive. has two sons. drinking, smoking, drug use. family history: nc physical exam: vs: t 97.0 bp 117/71 hr 93 vent: ac 280/20/0.4/8 o2 sat 82->100% gen: intubated, nad heent: op moist, perrl, eomi, aniceric lungs: diminished air movement, no wheezing/rales cvs: nl s1 s2, tachy, regular, no m/r/g appreciated abd: soft, nt/nd, bs+, no hsm appreciated ext: warm, wasted, no edema, 2+ dp pulses neuro: opening eyes, following commands, normal muscle tone pertinent results: 08:23am blood wbc-21.7* rbc-3.08* hgb-8.7* hct-30.0* mcv-97 mch-28.3 mchc-29.1* rdw-14.9 plt ct-340 07:43am blood wbc-14.3* rbc-2.68* hgb-7.7* hct-25.4* mcv-95 mch-28.6 mchc-30.2* rdw-14.9 plt ct-273 04:23am blood wbc-7.9 rbc-2.33* hgb-6.8* hct-21.6* mcv-93 mch-29.0 mchc-31.2 rdw-14.8 plt ct-176 03:50am blood wbc-10.3 rbc-3.16* hgb-8.9* hct-28.6* mcv-91 mch-28.1 mchc-31.0 rdw-15.5 plt ct-240 08:23am blood neuts-77* bands-3 lymphs-7* monos-8 eos-2 baso-1 atyps-0 metas-2* myelos-0 03:50am blood neuts-91.2* lymphs-3.8* monos-4.3 eos-0.5 baso-0.2 08:23am blood hypochr-2+ anisocy-occasional poiklo-occasional macrocy-occasional microcy-normal polychr-normal ovalocy-occasional 08:23am blood pt-11.1 ptt-24.8 inr(pt)-0.9 04:23am blood pt-11.1 ptt-38.4* inr(pt)-0.9 06:40am blood pt-11.4 ptt-35.4* inr(pt)-1.0 03:50am blood plt ct-240 07:43am blood ret aut-1.1* 04:23am blood fibrino-444* 08:23am blood glucose-181* urean-33* creat-1.2 na-142 k-5.8* cl-97 hco3-41* angap-10 02:48am blood glucose-124* urean-50* creat-1.6* na-139 k-4.9 cl-100 hco3-35* angap-9 03:52am blood glucose-93 urean-41* creat-1.4* na-142 k-6.3* cl-108 hco3-30 angap-10 03:50am blood glucose-91 urean-35* creat-1.3* na-145 k-4.7 cl-108 hco3-32 angap-10 08:23am blood ck(cpk)-62 04:09pm blood ck(cpk)-26* 04:23am blood totbili-0.2 dirbili-0.1 indbili-0.1 03:58am blood alt-12 ast-19 ld(ldh)-207 alkphos-61 amylase-637* totbili-0.1 03:50am blood amylase-321* 09:15am blood alt-11 ast-20 ld(ldh)-222 alkphos-57 amylase-132* totbili-0.2 03:50am blood alt-10 ast-19 alkphos-56 amylase-109* 03:58am blood lipase-514* 03:50am blood lipase-87* 03:50am blood lipase-35 08:23am blood ck-mb-3 ctropnt-0.02* 04:09pm blood ck-mb-notdone ctropnt-<0.01 08:23am blood calcium-8.9 phos-5.0* mg-1.7 03:50am blood calcium-8.6 phos-2.4* mg-2.1 03:50am blood calcium-8.5 phos-2.1* mg-1.8 03:58am blood vanco-55.4* 09:15am blood vanco-28.1* 04:35am blood hapto-222* 08:30am blood fk506-8.0 04:35am blood fk506-7.1 02:48am blood fk506-11.0 09:30am blood fk506-6.3 03:50am blood fk506-6.5 08:24am blood type-art tidal v-350 fio2-60 po2-111* pco2-190* ph-7.05* caltco2-56* base xs-14 -assist/con intubat-not intuba 10:07am blood type-art peep-5 po2-119* pco2-204* ph-6.98* caltco2-52* base xs-9 -assist/con intubat-intubated 12:13pm blood type-art temp-36.1 rates-20/ tidal v-300 peep-5 fio2-40 po2-41* pco2-93* ph-7.26* caltco2-44* base xs-10 intubat-intubated vent-controlled 08:01pm blood type-art po2-62* pco2-101* ph-7.21* caltco2-43* base xs-8 -assist/con intubat-intubated 07:55am blood type-art po2-96 pco2-92* ph-7.25* caltco2-42* base xs-9 02:19pm blood type-art temp-37.7 rates-20/26 tidal v-280 peep-8 fio2-50 po2-66* pco2-106* ph-7.16* caltco2-40* base xs-4 -assist/con intubat-intubated 03:28pm blood type-art po2-426* pco2-107* ph-7.19* caltco2-43* base xs-8 06:58pm blood type-art po2-102 pco2-80* ph-7.28* caltco2-39* base xs-6 09:11am blood type-art temp-37.3 po2-74* pco2-71* ph-7.26* caltco2-33* base xs-1 08:24am blood glucose-189* lactate-0.6 na-143 k-5.4* cl-90* 12:13pm blood glucose-154* lactate-0.6 08:24am blood freeca-1.29 04:23am blood b-glucan-pnd 02:48am blood aspergillus galactomannan antigen-pnd . other: pleural fluid wbc 133 rbc poly 61 lymph 31 mono 6 meso 1 macro 1 ldh 336 tp 2.5 gluc 108 ph 7.44 mycoplasma pneumonia pending . cta chest w&w/o c&recons, non-coronary 10:34 am . cta chest without and with iv contrast: the pulmonary arteries are patent without evidence of filling defects to suggest pulmonary embolism. the heart, pericardium, and great vessels are within normal limits. small mediastinal lymph nodes do not meet ct criteria for pathologic enlargement. there are diffuse hazy opacities and right lower lobe consolidation consistent with pneumonia. bronchiectasis is noted with a lower lobe predominance and most prominently involving the right lower lobe. there is a 6 mm right upper lobe pulmonary nodule. moderate right and small left pleural effusions are identified. bone windows: there are no suspicious lytic or sclerotic osseous lesions. patient is status post median sternotomy. impression: 1. no pe. 2. diffuse pulmonary opacities and right lower lobe consolidation consistent with multifocal pneumonia. 3. bronchiectasis, most prominently involving the right lower lobe. 4. 6 mm right upper lobe pulmonary nodule. comparison with prior examinations is recommended. if not available followup exam in three to six month is recommended. . chest (portable ap) 8:19 am single portable view of the chest: tracheostomy tube seen with tip at the level of the clavicles. sternotomy wire seen overlying the chest. cardiac and mediastinal contours appear within normal limits. there is increased opacity in the right lower lobe. small right upper lobe nodule also noted. moderate right sided and small left- sided pleural effusions also identified. gastrostomy tube seen overlying the stomach. impression: 1. increased opacity in the right lower lobe consistent with pneumonia. moderate right and small left pleural effusions. 2. small right upper lobe nodule. followup imaging recommended to document stability. . ecg probable ectopic atrial rhythm diffuse st-t wave changes - could be in part early repolarization pattern/ normal variant but consider also pericarditis no previous tracing available for comparison . cta chest w&w/o c&recons, non-coronary 4:01 pm ct of the chest with and without iv contrast. study is limited by streak artifact from patient's arm. there is no evidence of central pulmonary embolism. no definite pulmonary emboli identified, although evaluation of the more distal vessels is severely limited. there has been interval increase in visualized bronchiectasis within the upper segment of the right lower lobe, compared to study from two days prior. extensive bronchiectasis again noted within the lower segment of the right lower lobe. there has been interval increase in the size of the right pleural effusion. again seen are diffuse hazy opacities, as well as focal consolidations within the lungs consistent with infection. pulmonary nodules also again noted, not significantly changed in appearance from the study performed two days prior. bone windows: no suspicious lytic or blastic lesions are identified. impression: 1. no evidence of central pulmonary embolism. evaluation of more distal vessels severely limited by streak artifact. 2. interval increase in visualized bronchiectasis at the upper segments of the right lower lobe. while this appearance might partially be secondary to differences in respiratory phase, these findings raise concern for worsening infection. extensive bronchiectasis again noted in the lower segments of the right lower lobe. 3. worsened interval increase in right pleural effusion, focal consolidations again seen within both lungs consistent with infection. 4. again seen are pulmonary nodules not significantly changed in appearance from study performed two days prior. findings were discussed with dr. immediately following completion of the study. . picc w/o port 7:47 am procedure and findings: as no suitable superficial veins were visible, ultrasound was used to localize a suitable vein. the right brachial vein was patent and compressible. the right upper extremity was prepped and draped in sterile fashion. approximately 5 cc 1% lidocaine was used for local anesthesia. under direct ultrasonographic guidance, a 21-gauge needle was advanced into the right brachial vein and a 0.018 inch guidewire was advanced into the svc under fluoroscopic guidance. hard copy ultrasound images were obtained before and after venous access documenting vessel patency. the needle was exchanged for a 5 french micropuncture sheath. next it was determined that a length of 34 cm would be suitable. the 5 french double- lumen picc was trimmed to length and advanced over the wire into the svc under fluoroscopic guidance. the wire and peel-away sheath were removed. a final fluoroscopic spot image of the chest demonstrates the picc line tip in the svc. the line was flushed, heplocked and statlocked. the patient tolerated the procedure well and there were no complications. impression: successful placement of right brachial picc with the tip in the svc. the line is ready for views. . ct abdomen w/o contrast 2:29 pm ct chest w/o contrast; ct abdomen w/o contrast ct of the chest with iv contrast: the patient has a tracheostomy tube, not well evaluated here. a right subclavian central venous catheter terminates in the superior vena cava. there is a small pericardial effusion. contrast is visualized in a somewhat dilated distal esophagus, although there is no wall thickening. there is a small 11-mm right hilar lymph node that is unchanged, or perhaps a vascular structure such as a pulmonary venous branch. there is a 6-mm pulmonary nodule in the right upper lobe that is unchanged. continued followup as suggested previously is recommended. there has been interval improvement in patchy consolidation in the right lower lobe. bronchiectasis is again noted in the right middle lobe and lingula. a right-sided chest tube is present. there is a tiny pneumothorax tracking anteriorly. several lungs cysts are unchanged. although less severe, there are similar changes of bronchovascular thickening, patchy consolidation and bronchiectasis in the left lower lobe that is little changed since the prior study. there is a similar small left pleural effusion, and a tiny right residual pleural effusion. ct of the abdomen without intravenous contrast: within the limitations of a non-contrast study, the liver, gallbladder, pancreas, spleen are unremarkable. the left adrenal gland is unremarkable. the right adrenal gland is poorly visualized. there is persistent contrast opacification of the renal cortices bilaterally, presumably related to recent contrast bolus. this could be reflective of renal insufficiency. there is focal soft tissue stranding about the right pararenal fascia. a gastrostomy tube is positioned within the stomach. the proximal small bowel is decompressed. distally, the bowel is partly opacified and appears normal. there is fluid throughout the colon, but no wall thickening. there is no evidence of lymphadenopathy or free air. there is a small amount of ascites. ct of the pelvis without iv contrast: there is a foley catheter within the collapsed bladder. a few sigmoid diverticuli are present. the rectum is unremarkable. there is a small amount of ascites. the seminal vesicles are within normal limits. there is no lymphadenopathy. bone windows: there are no suspicious lytic or blastic lesions. impression: 1. persistent bibasilar predominantly peribronchial opacities with residual, but improved, consolidations. 2. status post placement of right chest tube into right effusion, which is considerably smaller. there is a miniscule pneumothorax, but this appearance is not surprising in the setting of recent chest tube placement 3. fluid within the colon, but no wall thickening. . chest (portable ap) 3:20 pm portable ap view of the chest dated is compared to the prior from . small bilateral pleural effusions are stable. right chest tube is again seen with its tip terminating in the medial aspect of the right upper lobe. the patient is status post lung transplant and bilateral median sutures are again noted. tracheostomy tube is in place, with the tip approximately 5 cm above the carina, unchanged. the heart size is stable. the lungs are unchanged showing patchy bilateral lower lung zone airspace opacities, right greater than left. impression: stable appearance of the chest including stable small bilateral pleural effusions and bilateral lower lobe patchy opacities. . microbiology 8:58 am blood culture #2 lh. **final report ** aerobic bottle (final ): no growth. anaerobic bottle (final ): no growth. 8:23 am blood culture **final report ** aerobic bottle (final ): no growth. anaerobic bottle (final ): reported by phone to , @ 12:30 . staphylococcus, coagulase negative. isolated from one set only. sensitivities performed on request.. . 8:23 am blood culture **final report ** aerobic bottle (final ): no growth. anaerobic bottle (final ): reported by phone to , @ 12:30 . staphylococcus, coagulase negative. isolated from one set only. sensitivities performed on request.. . 12:52 pm influenza a/b by dfa source: nasopharyngeal aspirate. **final report ** direct influenza a antigen test (final ): negative for influenza a viral antigen. direct influenza b antigen test (final ): negative for influenza b viral antigen. . 4:09 pm urine **final report ** urine culture (final ): no growth. . 11:46 am bronchoalveolar lavage r/o cmv. gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): oropharyngeal flora absent. proteus mirabilis. ~6ooo/ml. presumptive identification. trimethoprim/sulfa sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ proteus mirabilis | ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefazolin------------- 16 i cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 8 s ciprofloxacin--------- =>4 r gentamicin------------ 8 i levofloxacin---------- =>8 r meropenem-------------<=0.25 s piperacillin---------- 32 i piperacillin/tazo----- <=4 s tobramycin------------ 2 s immunofluorescent test for pneumocystis carinii (final ): pneumocystis carinii not seen. fungal culture (preliminary): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (pending): legionella culture (preliminary): no legionella isolated. nocardia culture (preliminary): no nocardia isolated. viral culture (preliminary): no virus isolated so far. rapid respiratory viral antigen test (final ): respiratory viral antigens not detected. culture confirmation pending. specimen screened for: adeno,parainfluenza 1,2,3 influenza a,b and rsv. this kit is not fda approved for direct detection of parainfluenza virus in specimens; interpret parainfluenza results with caution. viral culture: r/o cytomegalovirus (final ): test cancelled, patient credited. duplicate specimen. refer to viral culture for results. . 12:52 pm stool consistency: soft source: stool. **final report ** fecal culture (final ): no salmonella or shigella found. campylobacter culture (final ): no campylobacter found. clostridium difficile toxin assay (final ): feces negative for c. difficile toxin by eia. reference range: negative. . 4:25 pm pleural fluid gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (preliminary): no growth. fungal culture (preliminary): no fungus isolated. . cmv igg antibody (pending): cmv igm antibody (pending): . 11:35 am catheter tip-iv source: r femerol. **final report ** wound culture (final ): no significant growth. . 01/20-21/07 11:42 am blood culture line/spec: a-line. aerobic bottle (pending): anaerobic bottle (pending): brief hospital course: mr. is a 40 yo m with chronic respiratory failure ipf s/p b/l lung transplant c/b chronic rejection, recurrent pneumonias presenting with acute on chronic respiratory failure secondary to multifocal pneumonia with underlying poor pulmonary reserve. his hospital course is summarized below by problem. . # resp failure. long standing lung disease, ipf dx in 96 s/p b/l lung tx in c/b chronic rejection, requires chronic ventilatory support. acute decompensation likely multifactorial mainly secondary to pneumonia and mucous plugging. aspiration is also likely. patient was initially very difficult to ventilate with abg showing 6.98/204/119 in the ed at which time he was unresponsive. upon arrival to the icu he was placed on ac 280 x 22, fio2 .70, peep of 8. his arterial blood gases continued to improve over the course of his hospitalization. our goals were to keep his o2 sats >88%, pco2 ~ 100. with these parameters he was mentating and following commands. his ventilation continued to improve gradually with pco2 ranging 70-80s. . patient was iniated on broad coverage given h/o multiple drug resitant organisms in the past. he as treated with meropenem and vancomycin. vancomycin was discontinued on per id recommendations. he continues on meropenem for a 14 week course (started on ). influenza was negative. patient had two bronchoscopies performed during this admission, bal from grew proteus mirabilis resistant to quinolones. a chest tube was placed on due to persistent pleural effusions and concern for loculation. it drained serosanguinous fluid, making criteria for exudate with ldh 336. it continued to drain fluid <200 cc per day mainly serous. the chest tube was pulled on ... patient was also continued on prednisone 20 mg daily (trasiently on stress dose steroids on admission) and his other immunosuppressant medications (see below). id evaluated the patient and recommened contiuing the same antibiotic coverage and discontinuing vanco if he remained afebrile. c.diff was checked given loose stool which was negative. cmv viral load was pending at the time of discharge. prior to discharge he was also diuresed with iv lasix to improve minimize drainage from his chest tube and since he was markedly fuid overloaded since admission (positive 8.5 l since admission). . b-glucan was positive; galactomannan was negative. it is unknown whether beta-glucan was due to fungal infection vs blood transfusion, antibiotic, or other. antifungal agents were not given; however, id consult recommended that he continue to be monitored with repeat beta-glucan assays drawn at radius. . # leukocytosis and fever - sirs, transiently hypotensive on admission which rapidly resolved. likely secondary to pneumonia. blood cultures in the ed grew 1/4 bottles coag negative staph. urine cultures showed no growth. patient remained hypertensive throughout the remained of his admission and restarted on a beta blocker at high dose. he remained afebrile. . # cardiovascular. patient reportedly had pleuritic chest pain the day of admission prior to his acute respiratory decline. ekg showed early repolarization no acute st-t changes. there was no old ekg for comparison. two sets cardiac enzymes are negative. telemetry subsequently showing frequent pvcs and few episodes of nsvt. his beta blockade was increased to metoprolol 100 mg q 8 hrs. his electrolytes were agressively replete to keep k >4 mg >2. he was continued on a statin. after this his telemetry was normal without further events. . # pancreatitis. patient complained of abdominal pain intermittently. his abdomen was distended however he was making stool and he was non tender on exam. ct of the abdomen showed a normal pancrease, gallbladder and spleen, fluid throughout the colon was noted but no bowel wall thickening. his peg tube was in good position. amylase and lipase were elevated on to 636 and 514 respectively. his tube feeds were stopped. there enzymes trended down subsequently (see results). c.diff was negative. tube feeds were restarted slowly and his amylase and lipase started to increase. gi was consulted and they recommended repositioning his feeding tube more distally. patient's feeding tube was successfully repositioned by interventional radiology on day of discharge. . # anemia. unclear etiology, initially 30-->21 today s/p two units prbcs on , hct 29 today and stable. stool trace guaiac positive. no evidence of hemolysis. - active type and screen - transfuse if <21 . # s/p lung tx: continue prograf/cellcept/prednisone - follow tacrolimus level 6.3 --check level in am - check level in am . # dm - humalog ss . # polymyositis - stress dose steroids . # htn. borderline hypotensive on admission, now bp on high side - titrated up bp, consider adding other if not adequately controlled . # h/o a.fib not on anticoagulation. - monitor on tele . # hyperlipidemia - continue lipitor . # fen - monitor k, tfs on hold, maintenance fluids. . # dispo - stable, likely back to radius this week, possibly wednesday, discuss with case management. . # full code per wife . # comm: and rehab center next of : medications on admission: - seroquel 50 mg qam, 100 mg qhs, 25 mg prn - motrin 600 mg tid (recently d/ced after renal consult for arf) - lidoderm daily - maalox - humalog ss - feosol 300 mg - klonopin 0.25 mg qhs - neutra phos 2 pkts - nexium 40 mg daily - lovenox 40 mg sc daily - combivent 4 puffs qid prn - dulcolax 10 mg daily - tylenol elixir 650 mg q 4 hrs prn - oxycodone 5 mg q6 hrs - senna liquid 10 ml qhs - bactrim susp 20 ml daily - prograf 9 mg - cellcept mg - prednisone 10 mg daily - lipitor 10 mg daily - celexa 40 mg daily - aranesp 40 mcg weekly - lopressor 50 mg q8hrs discharge medications: 1. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 2. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 3. ipratropium bromide 17 mcg/actuation aerosol : two (2) puff inhalation qid (4 times a day). 4. trimethoprim-sulfamethoxazole 40-200 mg/5 ml suspension : twenty (20) ml po daily (daily). 5. mycophenolate mofetil 500 mg tablet : two (2) tablet po bid (2 times a day). 6. atorvastatin 10 mg tablet : one (1) tablet po daily (daily). 7. citalopram 20 mg tablet : two (2) tablet po daily (daily). 8. albuterol 90 mcg/actuation aerosol : 2-4 puffs inhalation q6h (every 6 hours) as needed. 9. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 10. clonazepam 0.5 mg tablet : 0.5 tablet po qhs (once a day (at bedtime)) as needed. 11. quetiapine 25 mg tablet : one (1) tablet po bid (2 times a day) as needed. 12. prednisone 20 mg tablet : one (1) tablet po daily (daily). 13. docusate sodium 50 mg/5 ml liquid : one hundred (100) mg po bid (2 times a day). 14. senna 8.6 mg tablet : two (2) tablet po bid (2 times a day). 15. zolpidem 5 mg tablet : one (1) tablet po hs (at bedtime) as needed. 16. metoprolol tartrate 50 mg tablet : two (2) tablet po tid (3 times a day). 17. acetaminophen 325 mg tablet : 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 18. hydrochlorothiazide 25 mg tablet : one (1) tablet po daily (daily). 19. sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift 20. meropenem 500 mg recon soln : 500 mg recon solns intravenous q6h (every 6 hours) for 4 days. 21. heparin flush cvl (100 units/ml) 1 ml iv daily:prn 10ml ns followed by 1ml of 100 units/ml heparin (100 units heparin) each lumen qd and prn. inspect site every shift 22. dolasetron mesylate 25 mg iv q8h:prn nausea/vomiting 23. morphine sulfate 2-6 mg iv q3-4h:prn abdominal pain 24. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 25. insulin lispro (human) 100 unit/ml solution : per sliding scale subcutaneous asdir (as directed). 26. tacrolimus 5 mg capsule : one (1) capsule po bid (2 times a day): in total should receive tacrolmius 9 mg . 27. tacrolimus 1 mg capsule : four (4) capsule po twice a day: in total should receive tarolimus 9 mg . discharge disposition: extended care facility: hospital discharge diagnosis: primary diagnoses - pneumonia - complicated by loculated effusions requiring placement if chest tube - pancreatitis secondary diagnoses - idiopathic pulmonary fibrosis - s/p lung transplant - anemia - dm - polymyositis - htn - hyperlipidemia discharge condition: stable discharge instructions: you were admitted with a pneumonia which required agreesive treatment with antibiotics and a chest tube. you will need to be on antibiotics for a total of 14 days (you have 4 days left). your chest tube was removed on and you have been doing well since then. please follow up with your pulmonologist dr. at radius. he will need to continue to follow your tacrolimus levels. . you also developed abdominal pain and pancreatitis, which we believe was secondary to your tube feeds. your labs (amylase, lipase) should continue to be followed by your doctors . . please call your doctor or return to the emergency room if you develop fevers, increased shortness of breath, abdominal pain, nuasea/vomiting, or any other symptoms that are concerning to you. followup instructions: please follow-up with your pcp/pulmonologist upon your return to radius. procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances bronchoscopy through artificial stoma transfusion of packed cells diagnoses: hyperpotassemia anemia, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified atrial fibrillation sepsis other and unspecified hyperlipidemia acute and chronic respiratory failure pneumonitis due to inhalation of food or vomitus other septicemia due to gram-negative organisms hyperosmolality and/or hypernatremia bronchiectasis without acute exacerbation acute pancreatitis tracheostomy status lung involvement in other diseases classified elsewhere painful respiration complications of transplanted lung polymyositis 

Answer: The patient is high likely exposed to