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: penicillins / erythromycin base / motrin / ampicillin / lactose / latex / adaptic / amiodarone attending: chief complaint: : major surgical or invasive procedure: none in history of present illness: : 86f with cad s/p cabg, as s/p valvuloplasty , diastolic chf, af who is pod 3 s/p r hemicolectomy for adenocarcinoma sessile polyp seen on colonoscopy. her post op course was notable for re-intubation in the ticu on and extubation on . she has been hypercarbic over the last few days (50s-60s since extubation) with minimal urine output (15-20 cc/hr), which was treated with fluid bolus. her o2 sats have been ok during this time. . she is one month s/p valvuloplasty for critical as (valvuloplasty increased her aortic valve from 0.5cm2 to 1.0cm2). shortly following the valvuloplasty, pt developed gi bleed and had a egd/colonoscopy, which revealed the large cecal mass. review of systems: (+)ve: as per hpi (-)ve: fever, chills, night sweats, loss of appetite, fatigue, chest pain, palpitations, rhinorrhea, nasal congestion, cough, sputum production, hemoptysis, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, nausea, vomiting, diarrhea, constipation, hematochezia, melena, dysuria, urinary frequency, urinary urgency, focal numbness, focal weakness, myalgias, arthralgias past medical history: past medical history: cad: cabg for lm disease (lima to lad and saphenous vein graft to the om severe as s/p recent valvuloplasty atrial fibrillation on coumadin hypertension hyperlipidemia osteoarthritis, s/p right thr and spinal stenosis squamous cell carcinoma chronic venous stasis with ulcerations hypothyroidism peripheral neurophathy raynaud??????s syndrome r retinal va clot, w/ mild loss of vision diastolic heart failure shingles social history: lives with husband of 65 years. 2 children, 9 grandchildren 14 great grandchildren. no alcohol, tobacco or other drugs. family history: from omr: mother - chf father - x ~6, starting in 60's no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death. physical exam: 97 89 118/50 15 89-97% on 2-4l . physical exam general: pleasant, well appearing in nad, asleep but easily arousable. heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla/eomi. mmm. op clear. neck supple, no lad, no thyromegaly. cardiac: irregular rhythm, normal rate. normal s1, s2. 2/6 sem > at rusb. no rubs or . jvp=12cm lungs: bilateral crackles to mid lung bilaterally and upper lung on left, mild diffuse wheeze. abdomen: nabs. soft, nt, nd. no hsm extremities: bilateral mild pitting edema but erythema suggestive of chronic venous stasis. healing wounds on lower extremities bilaterally. neuro: a&ox3. appropriate. cn 2-12 grossly intact. preserved sensation throughout. 5/5 strength throughout. + reflexes, equal bl. normal coordination. psych: sleepy but easily arousable and listens and responds to questions appropriately, pleasant pertinent results: 03:40pm blood wbc-10.9 rbc-3.46* hgb-8.5* hct-30.4* mcv-88 mch-24.7* mchc-28.1* rdw-17.1* plt ct-362 05:41pm blood wbc-14.1*# rbc-3.54* hgb-9.0* hct-30.1* mcv-85 mch-25.4* mchc-29.8* rdw-17.2* plt ct-364 04:00am blood wbc-13.2* rbc-3.31* hgb-8.4* hct-28.3* mcv-85 mch-25.2* mchc-29.5* rdw-17.1* plt ct-330 07:55am blood wbc-8.9 rbc-3.49* hgb-8.4* hct-30.0* mcv-86 mch-24.2* mchc-28.1* rdw-17.6* plt ct-409 07:15am blood wbc-10.0 rbc-3.36* hgb-8.4* hct-29.1* mcv-87 mch-25.2* mchc-29.0* rdw-17.6* plt ct-386 . 03:40pm blood glucose-134* urean-25* creat-0.8 na-141 k-3.8 cl-102 hco3-30 angap-13 07:55am blood glucose-99 urean-27* creat-1.3* na-138 k-4.0 cl-99 hco3-31 angap-12 04:15am blood glucose-113* urean-26* creat-1.2* na-137 k-3.7 cl-99 hco3-32 angap-10 06:25am blood glucose-99 urean-25* creat-1.1 na-139 k-4.3 cl-100 hco3-33* angap-10 06:25am blood glucose-110* urean-27* creat-1.3* na-138 k-4.6 cl-99 hco3-33* angap-11 07:15am blood glucose-105* urean-27* creat-1.0 na-139 k-4.6 cl-98 hco3-36* angap-10 . tee ():initial exam: the left atrium is markedly dilated. no spontaneous echo contrast is seen in the left atrial appendage. there is mild global biventricular hypokinesis. there are complex (>4mm) atheroma in the descending thoracic aorta. the aortic valve leaflets are severely thickened/deformed. there is critical aortic valve stenosis (valve area <0.8cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. moderate (2+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is no pericardial effusion. by the end of the procedure there had been no significant changes . chest x-ray ():findings: in comparison with study of , there is again substantial cardiomegaly with some congestion and bibasilar atelectasis. the small-to-moderate bilateral pleural effusions are again appreciated. broken sternal wires are again seen. . colon mass: adenocarcinoma, 3.0 cm; see synoptic report. brief hospital course: initial surgical course: admitted to ticu for pre-op bowel prep. required icu monitoring due to extensive cardiac disease. pre-op admission coordinated with patient's cardiologist, dr. . patient's operative course uncomplicated. extubated in or, reintubated in ticu, now on psv. admitted to ticu for continued monitoring. -extubated. early in day, pt had some hypercarbia that improved modestly. urine output trended down. given lasix 40mg iv x 2, and bolused conservatively. responded appropriately. bowel function resumed. diet advanced slowly. tolerating a regular diet and oral medications. respiratory status stable. patient transferred to 5 on however continued to have persistent hypercarbia, and somnolence. creatinine continued to rise. transferred to for closer respiratory monitoring, and hemodynamic monitoring. she was then tranferred to cardiology service on . . course: patient was transferred for further management of hypercapnia and her volume status. she was seen by cardiology in consultation who felt that she needed gentle diuresis, and that when she was ready to leave the should be transferred to the cardiology service for further management of her volume status. #. hypervolemia: patient has known dchf and systolic dysfuction with ef 45-50%. in addition, she still has as with valve area about 0.8. with fluid boluses for low uop, strongly suspect cardiogenic edema and hypervolemia. cxr shows consistent pulmonary edema. crackles and jvd on exam. received 60 then 40 iv lasix with good uop. . #. low uop/arf: cr up to 1.3. uop low for past couple days. likely from poor forward cardiac flow and prerenal physiology. . #. hypercapnea: thought to be due to increased work of breathing from chf from her as and diastolic chf, patient likely had mild co2 retention at baseline as reflected in elevated bicarb on prior labs, acute worsening may have occurred in setting of peri-op sedatives/pain meds, atelectasis and volume overload. abgs have been stable throughout course and there was no acute worsening to precipitate icu transfer, upon arrival to icu, patient??????s mental status was at her baseline. . #. as: recently underwent valvuloplasty, still with valve area of 0.8cm2. . #. atrial fibrillation: rate controlled on metoprolol. . cardiology course: patient was transferred to the cardiology service on for further management of her volume status. . #) acute diastolic heart failure: most recent echo from showed diastolic dysfunction with an overall preserved ef. based on clinical exam with findings of crackles in her lungs, le edema and cxr with volume overload, she likely received too much fluid in the setting of post-op low urine output. she was diuresed with with iv lasix as needed with a goal of taking off about 1l per day for to help maintain her bp since she is very preload dependent with her severe as, with most recent valve area of 0.8cm2. her blood pressure tolerated the diuresis well. at rehab she should receive lasix 40 iv bid and be evaluated daily in terms of volume statis. this should be titrated down to her home dose of lasix 60mg daily. when getting lasix her blood pressures should be monitored every 4 hours during the day, with a goal of getting about 1l of fluid off per day. she should not be given lasix if her systolic blood pressure is under 100 as she has severe aortic stenosis. if she becomes hypotensive, she will need small iv fluid boluses since she is very preload dependent with her severe as. if given iv lasix she should have her electrolytes checked to make sure potassium is above 4 and her magnesium is above 2. urrently she has crackles in her lungs left>right and some wheeze for which she is receiving ipratropium nebs. she has difficulty completing sentences due to mild sob. she also has edema in her le bilaterally. . #) severe aortic stenosis: patient is s/p valvuloplasty with report of valve area of 1cm2 on catheterization, but recent tee shows that the valve area is 0.8cm2 or less. as stated above her volume status is very tenuous and needs close monitoring since her as makes her preload dependent. . #) cad s/p cabg: currently stable, she was continued on her outpatient regimen of atorvastatin and metoprolol. she was restarted on aspirin 81mg daily during her stay. . #) atrial fibrillation: patient has been chronically in af on coumadin, her coumadin was held prior to her surgery, and restarted post operatively. since she has no history of stroke, tia, dvt or pe she did not have an indication for bridging so she has been on her home coumadin dose, and we have been allowing her inr to increase slowly especially in the post operative setting. she was continued on her home metoprolol for rate control, however her rate control was suboptimal so she was also loaded with digoxin and started on .0625mg daily, for better rate control with less blood pressure effects. . #) hypercapnia: patient was extubated then reintubated post operatively due to hypercapnia. after her eventual extubation, she was transferred to the for increasing somnolence, which has been improving during her stay. she is currently on 0-1/2l of oxygen and this should be titrated down as quickly as poossible to keep her o2 sats between 90-94% to help prevent her from retaining more co2 . #) s/p right hemicolectomy: patient had a right hemicolectomy for a sessile polyp found on colonoscopy after a gi bleed after her valvulplasty for her severe as. pathology showed low grade adenocarcinoma, per surgery t2n0, so no further treatment needed at this time. . #) venous stasis with ulcerations: patient with chronic venous stasis ulcers, wound care evaluated the patients and provided the following recommendations: recommendations: pressure relief per pressure ulcer guidelines support surface: atmos air turn and reposition every 1-2 hours and prn heels off bed surface at all times waffle boots to b/l le's if oob, limit sit time to one hour at a time and sit on a pressure relief cushion, gaymar cushion . elevate le's while sitting as tolerated (has pain due to arthritis) moisturize b/l le's, periwound tissue and feet with aloe vesta moisture barrier ointment . commercial wound cleanser or normal saline to irrigate/cleanse all open wounds b/l le's. pat the tissue dry with dry gauze. apply moisture barrier ointment to the periwound tissue with each drg change. apply aquacel dressings over the wound beds to absorb drainage cover with dry gauze, sofsorb sponge secure with tubular stocking (she states she does not tolerate kling or kerlix dressing changes were increased to twice daily due to large amounts of drainage on the dressings. . #) acute renal failure: patient with baseline cr of 0.8 to 1.0, creatinine elevated in the setting of hypervolemia. her creatinine continued to improve and was back to her baseline with further diuresis, making the cause of her renal failure likely poor forward flow from volume overload. . #) hypertension: blood pressure remained well controlled on home metoprolol . #) hyperlipidemia: continued home statin . #) code: full medications on admission: medications upon transfer to : insulin sc (per insulin flowsheet) sliding scale atorvastatin 40 mg po/ng daily latanoprost 0.005% ophth. soln. 1 drop both eyes hs levothyroxine sodium 75 mcg po/ng daily docusate sodium 100 mg po bid metoprolol tartrate 75 mg po/ng tid famotidine 20 mg po/ng q12h metoclopramide 10 mg po/ng q8h furosemide 60 mg iv once duration: 1 doses gabapentin 300 mg po/ng q12h timolol maleate 0.5% 1 drop both eyes hs heparin 5000 unit sc tid warfarin 2.5 mg po/ng once duration: 1 doses start: 1600 order date: @ 1100 discharge medications: 1. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 2. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 3. timolol maleate 0.5 % drops sig: one (1) drop ophthalmic hs (at bedtime). 4. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 5. gabapentin 300 mg capsule sig: one (1) capsule po q12h (every 12 hours). 6. acetaminophen 500 mg tablet sig: two (2) tablet po q 8h (every 8 hours). 7. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 8. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day): hold for sbp<100. 9. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 10. warfarin 2 mg tablet sig: two (2) tablet po once daily at 4 pm. 11. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). tablet, chewable(s) 12. digoxin 125 mcg tablet sig: 0.5 tablet po daily (daily). 13. venous stasis ulcers recommendations: 1.pressure relief per the following -support surface: atmos air -turn and reposition every 1-2 hours and prn -heels off bed surface at all times -waffle boots to b/l le's -if oob, limit sit time to one hour at a time and sit on a pressure relief cushion, gaymar cushion - elevate le's while sitting as tolerated (has pain due to arthritis) -moisturize b/l le's, periwound tissue and feet with aloe -vesta moisture barrier ointment . -commercial wound cleanser or normal saline to irrigate/cleanse all open wounds b/l le's. -pat the tissue dry with dry gauze. -apply moisture barrier ointment to the periwound tissue with each drg change. -apply aquacel dressings over the wound beds to absorb drainage -cover with dry gauze, sofsorb sponge -secure with tubular stocking (she states she does not tolerate -kling or kerlix -dressing changes were increased to twice daily due to large amounts of drainage on the dressings. 14. lasix pt should receive lasix 40mg iv bid and be re-evaluated daily. currently goal is 1l negative. sbp>100 prior to administration (is preload dependent due to severe as). evaluate volume statis daily and titrate down to lasix 60mg daily as appropriate which is home dose. 1st dose of 40 iv lasix should be evening of . 15. *** special oxygen order patient is c02 retainer. she should be on as minimal dose of oxygen as possible to maintain o2 sats between 90-94% but not higher as it causes somnolence. 16. oxycodone 5 mg tablet sig: one (1) tablet po every eight (8) hours as needed for pain: hold for sedation or rr<12. 17. inr check pls check inr on and adjust coumadin dose as needed discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary diagnosis: right hemicolectomy for low grade adenocarcinoma severe aortic stenosis diastolic chf atrial fibrillation hypercapnea venous stasis ulcers acute renal failure . secondary diagnosis: cad s/p cabg htn hyperlipidemia glaucoma discharge condition: alert and oriented x3. cough. occasional wheeze. discharge instructions: you were admitted for a colectomy for a colon mass. after the surgery you required admission to an intensive care unit because you were having trouble with your breathing (due to retaining carbon dioxide which caused sleepiness) and because you needed to have lasix due to having extra fluid in your body. you were then transferred to the cardiology floor where you required additional doses of lasix to help get extra fluids off your lungs. you will likely need additional doses of lasix at rehab. three days ago you also had an increased heart rate and you received some extra medications by mouth and by iv to slow your heart rate down. your atrial fibrilation is now well controlled on your home dose of metoprolol and we also started a new medication called digoxin. . weigh yourself every morning, md if weight goes up more than 3 lbs. . the following medications were started: digoxin 0.0625mg daily ipratropium neb 1 every 6 hrs prn sob or wheeze aspirin 81mg daily colace 100mg twice a day heparin sc 5000 units three times a day oxycodone 5mg po q8hrs prn leg pain- need to monitor for sedation . the following medications were continued: levothyroxine 75mg po daily lantoprost 0.0005% drops qhs timoptic 0.5% drops qhs lipitor 40g by mouth daily gabapentin 300mg po daily warfarin 4mg daily metoprolol 75mg by mouth three times a day . the following medications were changed in dose: tylenol increase to 1g every 8 hours your lasix dose will be determined by your doctor at rehab . the following medications were discontinued: ativan followup instructions: you should follow up with your primary care physician , after you are discharged from rehab . . you should follow up with dr. ( on tuesday at 10:40. procedure: laparoscopic right hemicolectomy diagnoses: congestive heart failure, unspecified acute kidney failure, unspecified gout, unspecified acute on chronic diastolic heart failure coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status aortic valve disorders unspecified glaucoma other and unspecified hyperlipidemia malignant neoplasm of cecum umbilical hernia without mention of obstruction or gangrene ulcer of other part of lower limb venous (peripheral) insufficiency, unspecified 

Answer: The patient is high likely exposed to