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: transferred from osh with hypoxic respiratory failure major surgical or invasive procedure: intubation tunneled hd line placement hemodialysis picc placement, picc removal history of present illness: this is a 53 year-old woman with history of cad, chf, copd on home oxygen, pulm hypertension, polysubstance abuse who presented to osh earlier today () with altered mental status. as per records, patient presented after her vna noted medical non-compliance and apparent overuse of sedating medications and summoned ems. when patient arrived at osh, the patient was somewhat confused and hypoxic to high 80's on 3 liters. (unclear baseline requirement but on home oxygen). also tachycardic to 100, tachypneic to mid 20's and hypertensive to 160's. she had low grade fevers to 99. she was felt to be in congestive heart failure, was noted to have hyperkalemia, and apparently new renal failure with creatinine in 6's. a central line was placed but then the patient became agitated, self-extracted the femoral line. serial haldol, benadryl and ativan x3 were not effective in sedating her and therefore the patient was intubated for airway protection. the femoral line was replaced. the patient had a ng tube placed, was given kayxelate, calcium gluconate, bicarb, insulin, and glucose for hyperkalemia, las well as lasix for chf. she was given a dose of levoquin for uti/possible pneumonia. the patient had an anion gap acidosis and there was concern for ethylene glycol because "urate crystals" were noted in the urine. . she was noted to have coffee grounds by ngt. . the patient was transferred to er. in our er, received a tox consult, renal consult, gi consult and cxr. the cxr confirmed chf. flomipazole was given for possible ethylene glycol intoxication. renal recommended: no dialysis, give bicarb. gi recommended: protonix, ffp and vitamin k. tox: no other reccs. . vitamin k 10 subcut, 2 units ffp, protonix, insulin, dextrose, calcium gluconate, kaexelate and bicarb given. . past medical history: (per osh records) 1. copd-on 4l o2 by nc at home 2. pulmonary hypertension 3. cad 4. chf--diastolic dysfunction 5. anxiety 6. polysubstance abuse 7. pvd s/p l aka social history: lives alone in , has a visiting nurse. family history: unknown physical exam: admission exam vs: temp: 97.5 bp:154/65 hr:89 rr:24 100%o2sat vent: ac 550x24, fio2 of 1, peep of 10. i/o: 150/400 in our emergency department general: intubated, sedated heent: pupils equal, minimally responsive, anicteric, mmm, op without lesions, no supraclavicular or cervical lymphadenopathy lungs: crackles way up heart: rr, s1 and s2 wnl, no murmurs, rubs or gallops appreciated but difficult to appreciate abdomen: nd, +b/s, soft, nt, no masses or hepatosplenomegaly extremities: no cyanosis, clubbing or edema. left aka skin/nails: no rashes/no jaundice/ neuro: intubated, sedated pertinent results: 08:30pm blood -wbc-19.5* rbc-4.94 hgb-13.1 hct-41.0 mcv-83 mch-26.5* mchc-31.9 rdw-18.5* neuts-83.7* bands-0 lymphs-10.3* monos-5.7 eos-0.2 basos-0.1 pt-28.5* ptt-30.6 inr(pt)-3.0* plt smr-high plt count-449*; hypochrom-1+ anisocyt-2+ poikilocy-normal macrocyt-normal microcyt-normal polychrom-1+ -asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-pos osmolal-313* ctropnt-0.08* ck(cpk)-231* glucose-101 urea n-105* creat-6.5* sodium-130* potassium-6.8* chloride-98 total co2-16* anion gap-23* 08:39pm glucose-92 lactate-1.3 k+-6.3* . 09:00pm urine eos-negative; rbc-* wbc-21-50* bacteria-many yeast-none epi-; blood-mod nitrite-neg protein-30 glucose-neg ketone-tr bilirubin-sm urobilngn-neg ph-5.0 leuk-sm; color-yellow appear-hazy sp -1.020 09:00pm urine bnzodzpn-neg barbitrt-neg opiates-pos cocaine-neg amphetmn-neg mthdone-neg; osmolal-376 09:35pm type-art po2-60* pco2-45 ph-7.23* total co2-20* base xs--8 10:55pm urea n-109* creat-6.5* sodium-135 potassium-6.2* chloride-102 total co2-17* anion gap-22* . wbc-9.3 hgb-11.0* hct-34.3* mcv-86 mch-27.6 mchc-32.0 rdw-23.8* plt ct-314 wbc-13.1* hgb-9.3* hct-30.1* mcv-93 mch-28.5 mchc-30.8* rdw-24.0* plt ct-425 wbc-19.0* hgb-10.7* hct-34.2* mcv-91 mch-28.2 mchc-31.1 rdw-22.1* plt ct-640* wbc-18.0*hgb-10.7* hct-32.8* mcv-87 mch-28.5 mchc-32.6 rdw-21.6* plt ct-578* wbc-16.7* hgb-11.0* hct-35.7* mcv-91 mch-28.2 mchc-30.9* rdw-21.2* plt ct-482* wbc-19.0* hgb-11.4* hct-36.3 mcv-91 mch-28.5 mchc-31.4 rdw-20.9* plt ct-503* . micro: -urine cultures (, , ): no growth. . -sputum (): 3+ gram positive cocci in pairs and clusters. -sputum (): 1+ yeast. . -blood (, , , , , ): negative. -blood (, off antibx): no growth to date. -blood (): one bottle with staph coagulase negative. . -catheter tip (): no growth. -catheter tip (): no growth. -catheter tip (, , ): no growth. . -hemodialysis catheter blood cx (): no growth. . -stool (, , , , ): c. diff. negative. . -blood (): rpr negative. . echo the left atrium is normal in size. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. . ct torso impression: 1. no bowel obstruction is identified. small bowel and large bowel loops appear unremarkable. 2. bilateral increased interstitial markings and septal thickening is suggestive of presence of the heart failure. the heart is also mildly enlarged. 3. small bilateral pleural effusions and dependent atelectatic changes are noted at both lung bases. infiltrate/infection cannot be ruled out. small pericardial effusion is also noted. 4. a 4-mm nodule is noted within the anterior portion of the right middle lobe. pathologically enlarged right paratracheal node measures 13 mm in the short axis. 5. diverticulosis with no evidence of diverticulitis. 6. the aorta demonstrates severe stenosis below the renal arteries. no aneurysmal dilatation is noted. 7. small right kidney with normal sized left kidney. no hydronephrosis or stones are identified. . ct head 1. no acute intracranial abnormality. 2. chronic infarcts in the right cerebellum and centrum semiovale. 3. sinus disease involving left maxillary and sphenoid sinuses. . eeg impression: this is an abnormal eeg due to the presence of probable periodic lateralizing epileptiform discharges (i.e., pleds) involving the right hemisphere which could indicate a subcortical abnormality involving this area. the presence of a diffusely slow background and disorganized background is consistent with a mild to moderate encephalopathy of toxic, anoxic, or metabolic etiology. the occasional sharp waves can be a sign of cortical irritability, but clinical correlation would need to be provided. no evidence for ongoing seizures is seen. . echo/bubble study: focused study to assess for patent foramen ovale. images were obtained at rest, with cough and post-valsalva release with injection of agitated saline. no evidence for an atrial septal defect or patent foramen ovale was identified. there is symmetric left ventricular hypertrophy with preserved global systolic function. no pericardial effusion is seen. . mr spine: 1. multilevel degenerative changes of the lower lumbar spine, most pronounced at the l4-5 and the l5-s1 levels respectively.2. type changes of the l4 and l5 vertebral bodies respectively. 3. no evidence of epidural abscess. . chest cta:1. no definite evidence of pulmonary embolus. 2. cardiomegaly, pleural effusions, and pulmonary edema, all consistent with congestive heart failure.3. right upper and right middle lobe pulmonary nodules, little change since . six-month followup chest ct is recommended to assess stability.4. mediastinal lymphadenopathy, likely reactive. . echo bubble: saline contrast study performed to assess for intracardiac shunt. no passage of agitated saline is seen into the left heart is identified. the left ventricular cavity is normal in size. there appears to be global hypokinesis that is more pronounced/worse that the study of . . echo: the left atrium is elongated. the right atrium is moderately dilated. the estimated right atrial pressure is mmhg. left ventricular wall thicknesses and cavity size are normal. there is moderate to severe global left ventricular hypokinesis (lvef = 30 %). systolic function of apical segments is relatively preserved. no masses or thrombi are seen in the left ventricle. the right ventricular cavity is moderately dilated with mild globalfree wall hypokinesis. the aortic valve leaflets are mildly thickened. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , global left ventricular systolic function is more depressed and the right ventricular cavity is mildly dilated and hypokinetic. the estimated pulmonary artery systolic pressure is higher. . ct of the chest without iv contrast: there is no axillary lymphadenopathy. there is pretracheal lymphadenopathy measuring up to 1.5 cm. this is unchanged. there are small bilateral effusions. these are stable. again noted is an ovoid nodule in the apex of the right lung measuring 1.2 x 0.5 cm. this is stable in appearance. there are tiny nodules in the right lung. these are again stable. there is diffuse septal thickening which is unchanged. in the presence of cardiomegaly this is consistent with chf. ct of the abdomen without iv contrast: the liver is without focal lesions. the gallbladder has been removed. spleen, pancreas, adrenal glands are unremarkable. the right kidney is atrophic. the left kidney has some bulging of the contour at mid pole measuring about 1.6 cm. this is difficult to evaluate on the prior study as there is significant artifact from the patient's body touching the gantry but is likely present. there is no retroperitoneal lymphadenopathy. small and large bowel are normal. ct of the pelvis without iv contrast: the uterus is normal in size and contains some calcified fibroids. there is diverticulosis of the sigmoid colon. there is no adjacent inflammatory fat stranding. there is no free fluid in the pelvis. no pelvic adenopathy is noted. on bone windows, there are degenerative changes involving the lumbar spine. impression: 1. no findings to explain the patient's symptoms. the examination is essentially unchanged in comparison to prior studies. 2. interstitial prominence and small bilateral pleural effusions with cardiomegaly are consistent with chf. again this is stable. 3. mediastinal adenopathy unchanged. . ruq us:1. no focal fluid collections. 2. atrophic right kidney consistent with chronic renal failure. . 4:18p other blood chemistry: hbsag: negative hbs-ab: negative hbc-ab: negative 05:41pm report comment: source: line-hemodialysis hepatitis hepatitis b surface antigen negative hepatitis b surface antibody positive hepatitis b virus core antibody negative hepatitis c serology hepatitis c virus antibody positive brief hospital course: discharge summary (as of ) assessment and plan: this is a 53 year old woman with coronary artery disease, congestive heart failure, copd, pulmonary hypertension, s/p l aka who is oxygen dependent on nasal canula 4 liters at home, and polysubstance abuse who presented to center in with altered mental status, hypoxia, and agitation. she was intubated for airway protection and transferred to . course complicated by anuric renal failure requiring dialysis. . 1)mental status change: most likely multifactorial, as patient with previous polysubstance abuse. chronic small vessel disease noted on head ct. eeg negative for seizure activity. per family, patient lives alone and able to care for herself and perform activities of daily living. on admission, toxicology screen revealed opiates and tricyclics, and by medical notes on transfer, patient had been using more sedating medications than normal. neurology evaluated patient and vitamin b12 and folate levels were normal. she received thiamine. tsh level was elevated to 8 and her t4 was only very slightly below normal. thus, thyroid function was not attributed to altered mental status. an eeg revealed encephalopathy, but no seizures. ct head revealed chronic small vessel disease. lp and mri were deferred. -upon extubation, patient slowly became more alert, first with purposeful eye tracking and then by following simple commands. she received haldol and ativan, which sedated her profoundly for several days. then, after extubation, she began to have conversations but with frequent outbursts with cursing at times, poor attention and short term memory. she became febrile on , which was concerning for a line infection, and was treated initially with vanco/zosyn changed to vanco/meropenem plan for 3 day course complete . c. diff negative x3. her head ct was unchanged. on , patient had her picc line and tunneled hd line placed and developed fevers within 12 hours. only one blood culture from revealed one bottle of staph coagulase negative organisms. treated with ten day course of vancomycin (per hd protocol) through . -lexapro was restarted on , but held on . psychiatry continued to follow patient and for continued outbursts recommended haldol 0.5mg po/iv three times daily. as above, concern that heavy sedatives with ativan and haldol cause profound sedation. she required soft wrist restraints for prevention of line removal. pt was transferred to the micu on for respiratory compromise (see below). -upon arriving at the floor on the patient was aox3, but with residual confusion, impulse control issues, and aggitation. her course was complicated by recurrent episodes of aggitation and anxiety which were hard to control. she perseverated on her medications, her course, and her dietary restrictions. psych was consulted and attempted to help control these outbursts without using benzodiazepems. she often complained of dyspnea, but requested ativan as treatment. she was transferred to the micu for low o2 saturation, where she was diuresed for congestive heart failure/volume overload. she was transferred back to the floor on , where she continued to be anxious and take off her o2 mask. psych recommended continuing standing haldol as well as 100mg neurontin qhs. benzodiazepines were avoided. this combination had a calming effect and the patient was significantly less agitated without being over-sedated, thought to be back to her baseline mental status. remained at baseline mental status for the rest of the hospitalization . 2) respiratory compromise: at outside hospital, patient was hypoxic to high 80's on 3l. at home, she requires 4l nasal canula. patient has history of copd, chf, and pulmonary hypertension per outside notes. intubated on transfer and thought that congestive heart failure contributed to hypoxemic event. no clear pneumonia. patient was aggressively diuresed via hemodialysis. she was extubated on . hypoxia seems out of proportion to edema demonstrated on imaging. tte was negative for patent foramen ovale. . on , the patient triggered for hypoxia 68% on 6 liters (the patient formerly had been 90-92% on 6 liters. on recheck, the o2 sat was 88% and then 90-91% on 6 liters without intervention. the patient was scheduled to have hd as scheduled on . . at hd, the hd catheter was noted to be nonfunctioning. tpa was tried without success. then, the patient was found to be hypoxic to 75% at hd with abg 7.53/26/44 0on a 40% venti mask. on a nrb, the patient's saturations improved to 97% and a repeat gas was 7/53/27/58. . the patient denied any chest pain and says the shortness of breath was not acute in onset but had been developing over the past few days. however, her sbp was noted to be 188-216 during hd and the patient was given her am bp meds as a result. cxr indicated volume overload and pt. was thought to have had acute pulmonary edema hypertension and inability to dialyze. pt was transferred to micu and had temporary femoral hd line initially placed, then tunneled hd line placed by ir . she had 7l removed during micu course with improvement of oxygenation and was sent back to floor . . while on the floor she was maintained on 6l of nc. she did occasionally complain of dyspnea and anxiety, however it was hard to differentiate this from her psychiatric issues, as she was often breathing at a normal rate and sat'ing in the mid 90s while complaining. she generally maintained saturations from 88-95%. she did have at least two desat's into the low 80s at night, but responded within minutes to reassurance and haldol without changing any pulmonary medications or oxygen. on she had an episode of somlenence and increased confusion after her haldol had been increased to 2mg/dose and her nc o2 dropped to 4l. she was somlenent but arousable, and still oriented to self she recovered mental status quickly after a 50% venti mask was placed, and was then seen by the micu staff. she was transferred again to the micu at that point, and again was diuresed aggressively with good result. repeat tte again showed no patent foramen ovale/shunt. cta was negative for pe. . she was transferred back to the floor on , where she continued to required 6-8 l o2 and occasionally desat'd in setting of anxiety. an echo showed evidence of worsening chf (ef 30% now, was >55% in ), which would explain continued increased oxygen requirement and sob, with evidence of pulmonary edema on cxr. in conjunction with the renal team, the patient required almost daily hd or ultrafiltration to draw off fluid. attempts were made with medications to balance the need for afterload reduction with supporting a blood pressure which could tolerate volume loss through dialysis. this primarily involved decreasing the patient's betablocker and verapamil dose significantly, while maintaining isosorbide nitrate. the patient was witnessed several times eating high salty foods, and being non-compliant with the fluid restriction which complicated attempts to manage her volume status. with aggressive hd, as well as improved management of her anxiety and aggitation (above) the patient gradually was weaned down to her baseline requirement of 4l o2 on nasal cannula. . 3) anuric renal failure: atn likely from tca/opiate overdose. outside hospital records revealed creatinine of 4.0 in . on admission, anuric. she was hyperkalemic, so initially received kayxelate, calcium gluconate, insulin, and bicarbonated. no ecg changes. renal ultrasound negative for obstruction. received aggressive hemodialysis sessions. there was concern that tunneled dialysis line infected, but as she was not rigoring and did not ever develop fever or hypotension except when on dialysis, believed that filter on hemodialysis machine may have caused adverse reaction. asaghi filter used on with good effect. . management of the patient's volume status was complicated by dietary noncompliance and aggitation. after requiring 2 micu transfers from the floor due to decreased oxygen saturation from pulmonary edema, we were finally able to dialyze her sufficiently to bring her back to baseline oxygen requirement. we monitored her intake carefully and impressed upon her the importance of dietary compliance. adding neurontin to her anxiety regimen helped calm her and she became more compliant with our management strategy and was less likely to take off her oxygen support. renal recommends performing a 24 hour urine collection after one month to re-evaluate her renal status. . 4) cardiovascular: --ischemia: history of coronary artery disease. as outpatient, on aspirin but no beta blocker or ace-inhibitor. ecg without ischemic changes and initial cardiac enzymes negative. continued aspirin and added beta blocker. --pump: evidence of pulmonary edema and congestive heart failure on admission. as anuric, removed excess fluid with hemodialysis. --rhythm: remained in sinus rhythm. started on beta blockade. --hypertension: severely elevated blood pressures. started amlodipine, metoprolol, and isorbide. goal blood pressure <170, but due to longstanding hypertension, developed worsened mental status when blood pressures less than 140. most likely due to hypoperfusion. in setting of hypotensive episodes during dialysis, held antihypertensives on mornings of dialysis. over the course of hospitalization, we adjusted her bp medications according to what was tolerated during dialysis. on discharge, she is taking isosorbide mononitrate 30mg sr and toprol xl 100mg q day. . 5) gi: on admission, apparent ugi bleeding. coffee grounds in ngt but this was in setting of supratherapeutic inr. subsequently resolved status post reversal of inr. treated with iv (and then po) protonix. her serial hematocrits remained stable. abdominal ct on unremarkable. diverticulosis was noted on subsequent abdominal ct (as above). . 6) infectious disease: on admission, received levofloxacin, but then broadened to zosyn and vancomycin for uti. completed seven day course on . shortly after discontinuation of antibiotics, was transiently febrile, so started meropenem and vancomycin on for 3 day course. picc line was placed and tunneled hd line placed on . febrile shortly after line placed (1/4 bottles with staph coagulase negative), so started ten day course of vancomycin that was completed on . new picc placed for antibiotics and question of infection. on id was consulted for rising leukocytosis. bacillus species grew from picc blood cx, pt was started on cefepime for bacteremia on (initial culture result said gnr) and picc was d/c'd. was discovered on that bacillus likely was a contaminant. pt has been afebrile, but given persistently high wbc, there was concern for infection or other etiology. culture from hd catheter had no growtn. c. diff was negative. antibiotics were discontinued on given no organism isolated and patient being afebrile. subsequent culture from showed no growth to date. can consider other cause of leukocytosis: patient was not on systemic steroids so that is unlikely to be a cause. patient had mediastinal lymphadenopathy and lung nodules, which could suggest a malignant cause. recommend working up malignancy as outpatient given that patient is clinically stable and would benefit from rehab placement. . 7) depression: on outpatient lexapro. restarted during hospitalization, but discontinued, per psychiatry, on . . 8) prophylaxis: patient on sc heparin (was on coumadin as outpatient, but unclear reason), lansoprazole, bowel regimen, and thiamine. . 9) access: picc placed on , but removed . tunneled hemodialysis catheter placed on . picc placed , removed . . 10) fen: initially on tubefeeds. speech and swallow evaluation on cleared patient for thin liquids and pureed solids. aspiration precautions. eventually advanced to regular renal diet. occasionally was hyponatremic, thought due to excess free water ingestion. was kept on fluid restriction 1l/day, with varying effect as patient would sometimes obtain water/fluids when the nurse was not looking. . 11) rash: patient noted to have morbilliform rash on trunk and flank on evening of . most likely result of drug reaction. potentially vancomycin. started on hydrocortisone cream, sarna lotion, and triamcinolone cream. resolved. pt also noted to have intragluteal irritation with sattelite lesions, likely yeast infection. started on miconazole powder. . 12) code: full. confirmed with daughter. (in the past patient had said she wanted to be dnr/dni but then reversed this). . communication: daughter, - . . dispo: to . has outpatient hd slot at for mwf. medications on admission: unsure of doses--from records 1.aspirin 2.hydralazine 3.imdur 4.amytriptyline 5.lexapro 6.ativan 7.advair 8.combivent 9.albuterol 10. lasix 11. coumadin 12. cardizem discharge medications: 1. aspirin 325 mg tablet : one (1) tablet po daily (daily). 2. polyvinyl alcohol-povidone 1.4-0.6 % dropperette : drops ophthalmic prn (as needed). 3. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 4. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day) as needed: hold for diarrhea. 5. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed: hold for diarrhea. 6. lactulose 10 g/15 ml syrup : thirty (30) ml po q8h (every 8 hours) as needed: hold for diarrhea. 7. albuterol sulfate 0.083 % (0.83 mg/ml) solution : one (1) inhalation q4h (every 4 hours) as needed for wheezing. 8. acetaminophen 325 mg tablet : 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 9. thiamine hcl 100 mg tablet : one (1) tablet po daily (daily). 10. b complex-vitamin c-folic acid 1 mg capsule : one (1) cap po daily (daily). 12. fluticasone-salmeterol 250-50 mcg/dose disk with device : one (1) inh, disk with device inhalation (2 times a day). 13. budesonide 0.25 mg/2 ml solution for nebulization : one (1) neb inhalation (2 times a day). 14. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day). 15. isosorbide mononitrate 30 mg tablet sustained release 24 hr : one (1) tablet sustained release 24 hr po daily (daily). 16. haloperidol 1 mg tablet : one (1) tablet po q4-6h (every 4 to 6 hours) as needed for anxiety or aggitation. 17. albuterol sulfate 0.083 % (0.83 mg/ml) solution : one (1) neb ih inhalation q6h (every 6 hours) as needed. 18. tramadol 50 mg tablet : one (1) tablet po q12h (every 12 hours) as needed. 19. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical q24h (every 24 hours). 20. ipratropium bromide 0.02 % solution : one (1) neb inhalation q6h (every 6 hours) as needed. 21. haloperidol 2 mg tablet : one (1) tablet po tid (3 times a day). 22. zolpidem 5 mg tablet : 1-2 tablets po hs (at bedtime). 23. miconazole nitrate 2 % powder : one (1) appl topical qid (4 times a day) as needed. 24. sevelamer 400 mg tablet : one (1) tablet po tid w/meals (3 times a day with meals). 25. gabapentin 100 mg capsule : one (1) capsule po hs (at bedtime): hold for oversedation. 26. toprol xl 100mg tablet : one (1) tablet po once a day discharge disposition: extended care facility: banister house discharge diagnosis: congestive heart failure , acute on chronic renal failure discharge condition: discharge to banister house in , ri, stable, afebrile, good po intake, wheelchair bound amputation discharge instructions: please seek medical attention for shortness of breath, chest pain, dizzyness, headache please take your medications as prescribed. followup instructions: please get a repeat chest ct in 6 months to monitor the r upper and middle pulmonary nodules. . please get a 24 hour urine test to evaluate your kidney in one month procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis venous catheterization for renal dialysis insertion of other (naso-)gastric tube transfusion of other serum diagnoses: acidosis hyperpotassemia coronary atherosclerosis of native coronary artery acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified toxic encephalopathy hyposmolality and/or hyponatremia chronic airway obstruction, not elsewhere classified unspecified viral hepatitis c without hepatic coma atrial fibrillation other chronic pulmonary heart diseases hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease anxiety state, unspecified acute respiratory failure dermatitis due to drugs and medicines taken internally personal history of noncompliance with medical treatment, presenting hazards to health hematemesis other specified antibiotics causing adverse effects in therapeutic use diastolic heart failure, unspecified hypotension of hemodialysis above knee amputation status candidiasis of skin and nails 

Answer: The patient is high likely exposed to