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: history of present illness: this is a 37 year old white female with a long history of pulmonary issues, well known at and to dr. , now here for weaning of her ventilator. her vent on admit was c-pap 40% fio2, peep of 5, ps30, respiratory firing at 28 to 32. she was admitted to on from status post a medical intensive care unit admission for pneumonia. at , she had no success with two weaning trials. her last arterial blood gas on was 7.40/87/53/97% saturation on 40% fio2. her course was as follows: pulmonary: the patient was unable to tolerate weaning from a pressure support of 30 with attempts to decrease by 2 cm q. three to four days. the patient was diuresed to 110 pounds. her weaning was complicated by her anxiety and tachypnea with this anxiety. cardiovascularly, she was stable with her baseline sinus tachycardia 110 to 120. her systolic blood pressures ranged from the 90s to the 100s. her ekg showed no changes. renally, she has a chronic hyponatremia. she also has hypokalemia with her diuresis and was on spironolactone. endocrine: she had a tsh of 11.58 on . gi: she had constipation with many laxatives prescribed. hematologic: she had a persistent leukocytosis with a normal b12 and folate. for rehabilitation she was able to walk 140 feet per day times two. psychiatric: she had anxiety and depression on olanzapine; the patient did confirm this history. she did not complain of any si, shortness of breath, chest pain, cough or headache on admission. she had no bowel movement in three days on admission. she did complain of increased fatigue. she also complained of night sweats times two days and mild stomach pains since she was started on her tube feeds prior to admission to the . past medical history: 1. she had a junctional rhythm in . 2. biventricular congestive heart failure with cor pulmonale for her right heart failure and a question of tachycardia induced left heart failure. 3. history of a pseudomonas pneumonia in the spring. 4. status post tracheostomy. 5. hodgkin's lymphoma in status post chop and x-ray therapy. this was complicated by histoplasmosis, adult respiratory distress syndrome, pulmonary fibrosis, bronchiectasis. 6. status post left pneumectomy secondary to aspergillosis of her left lung. 7. tuberculosis in . 8. status post splenectomy. 9. history of anxiety and depression. 10. cardiomyopathy which has left her with an ejection fraction of 20%. 11. history of syncope in , that was questionable vasovagal. 12. baseline carbon dioxide is 50 to 55. 13. history of supraventricular tachycardia in the 150s when she is hyperkalemic and junctional bradycardia in the 50s when she is hypokalemic. 14. status post j-tube placement. 16. hyponatremia secondary to congestive heart failure and diuresis. medications: 1. serevent two puffs twice a day. 2. combivent four puffs four times a day. 3. pulmocare 45 cc an hour. 4. tube feeds. 5. lasix 40 three times a day. 6. percocet one q. four hours p.r.n. 7. olanzapine 2.5 q. day. 8. lorazepam 1 mg p.o. q. six hours p.r.n. 9. spironolactone 100 q. day. 10. buspirone 5 three times a day. 11. lorazepam 0.5 q. four to six hours p.r.n. 12. metolazone 5 mg q. day. 13. protein supplements. 14. amitriptyline 10 mg q. h.s. 15. digoxin 0.125 q. day. 16. zinc sulfate 220 q. day. 17. reglan 10 q. day. 18. colace 100 q. eight hours. 19. senna, one q. day. 20. iron sulfate 325 q. day. 21. protonix 40 q. day. 22. vitamin c. 23. subcutaneous heparin 5000 units twice a day. 24. subcutaneous simethicone 80 q. eight hours p.r.n. allergies: she had allergies to sulfa, oxacillin and verapamil. from verapamil she got a red face. unknown what her reaction to sulfa and oxacillin was. social history: she smoked tobacco for five years in college. she resides at the - facility. she also lived with her mother. physical examination: she is 67 inches tall, 113 pounds on admission. negative 500 cc on the day of admission. she was in no acute distress. pupils equal, round and reactive. extraocular movements are intact. she had rhonchi and coarse rales in the right lower lung field. left lung fields had transmitted breath sounds status post pneumonectomy. regular rate and rhythm, tachycardic. abdomen soft, nontender. no cyanosis, clubbing or edema. on examination she was awake, alert and pleasant. laboratory: on admission, white blood cell count 17.1, hematocrit 38.6, 453 platelets, differential of the white count showed 87% polys, no bands, 6 lymphocytes. sodium 126, potassium 4.8, 71 chloride, 35 bicarbonate, 41 bun, 0.5 creatinine, 94 glucose. on , she had a cortisol that was 13.4 at 07:00 a.m., 40.9 at 10:00 a.m. her ekg showed normal sinus rhythm at 118 with a left axis. she had t wave inversions in v1, v2, half mm st depression in v2 through v4. hospital course: this is a 37 year old woman with multiple pulmonary problems including a history of a left pneumonectomy, cardiomyopathy with an ejection fraction of 20%; chronic hypercapnia, who was admitted for a wean from her ventilator. 1. pulmonary: had a long history of severe lung disease. she had a history of hodgkin's disease status post chop and x-ray therapy which was complicated by histoplasmosis, adult respiratory distress syndrome, status post left pneumectomy for aspergillus and had a recent admission this past spring for a pneumonia. she had been on pressure support, 30/5 40% fio2 on admission. she had failed to wean from this with barriers that were thought to be her volume status secondary to her cardiomyopathy. also, her anxiety for which she is on multiple medications and finally her increased dead space in which her vd/vt is likely 80%. she needs to have a permissive hypercapnia for her to be able to ventilate sufficiently. her baseline pa co2 is in the 80s and her renal compensation for this brings her bicarbonate from 40 to 50. she has tolerated this well and was able to wean from her vent during the day. was kept on a t-tube during the day while she received her pressure support via her tracheostomy at night. she has been weaned down to 15/5 with fio2 of 40% only at night. she has shown no signs of clinical effects from hypercapnia. she has been awake and alert this entire hospitalization. had a tracheostomy revision on , and was found to have a posterior tracheal ulcer that was very early a te fistula. she had a temperature tracheostomy (6 f ett via stoma) and was changed finally to a permanent tracheostomy on . a recent bronchoscopy has shown that her ulcer has healed. the plan for is to eventually go home on a home ventilator. we will try to continue to wean her from her ventilator at night. she will remain on her t-piece during the day with blow-by oxygen and if she fails to wean from the ventilator at night, will remain on her pressure support ventilation at night on her home ventilator. 2. cardiac: has a history of biventricular congestive heart failure and cardiomyopathy which brings her ejection fraction to 20%. her left heart failure is thought secondary to tachycardia induced cardiomyopathy and her right heart failure is thought secondary to cor pulmonale. resting pulse rate ranges from 100 to 120 in sinus tachycardia and any decrease from or increase from this resting heart rate sends her into respiratory distress and decompensation. she is very volume sensitive and given that component of her congestive heart failure, was causing her failure to wean from the ventilator. she was aggressively diuresed. her dry weight is about 115 to 120 pounds. she has been on a regimen of lasix, zaroxolyn. her weight had increased to 124 over the past week and her lasix dose was increased from 60 p.o. twice a day to 100 p.o. twice a day. her zaroxolyn was kept at 2.5 mg twice a day. she remained at her baseline weight of 119 to 120 pounds on this diuresis regimen and had no episodes of respiratory distress. is very sensitive to large fluctuations in her potassium, which is volatile on diuretics, and given her constipation. when is constipated, she has hyperkalemia which has gone up to 7.9. with hyperkalemia she develops junctional bradycardic rhythms in the 60s which put her into respiratory distress and decompensation. her junctional bradycardia was quickly resolved with calcium gluconate, insulin, glucose, bicarbonate, nebulizers and kayexalate. after the calcium carbonate was given, her heart rhythm returned back to her baseline sinus tachycardia. with potassiums less than 3.0, can go into supraventricular tachycardia and atrial fibrillation to the 170s and 180s. this also causes respiratory distress and decompensation. after correction of her potassium and diltiazem, her rate usually returns back into her baseline. for these reasons, it is important to keep her potassium from 3.0 to 4.5. cardiomyopathy: is on digoxin 0.125 q.o.d. and 0.25 q.o.d. she should have a digoxin level checked prior to being discharged. 3. fluids, electrolytes and nutrition: as stated above, the patient has a volatile potassium level. with constipation, she develops a hyperkalemia from inability to excrete her potassium through her gi tract. with her large diuresis requirement, she also can drop her potassium. these potassium changes can be rapid, for example, she has had a potassium of 4.4 at 5 a.m. and developed potassium of 7.9 at 8 a.m. after not having a bowel movement for one day. has been stable on her current regimen of 100 p.o. lasix twice a day, metolazone 2.5 twice a day and potassium repletion of 200 meq per day divided into five doses of 40 meq. this has kept her potassium mostly from 3 to 4.5. however, she has dropped to 2.4 and her lasix dose will be reduced today to 80 mg p.o. twice a day. in terms of other electrolytes, often has low magnesium which are repleted p.r.n. her dry weight is 115 to 120 pounds and she requires daily weights. nutrition is delivered via her g-tube with resbilar tube feeds. her current volume status is mostly euvolemic for her. has a baseline metabolic alkalosis with bicarbs of 40 to 50 to compensate for her severely impaired and decreased ventilation. she has a large dead space and a vv/vt ratio of 0.8. she tolerates this metabolic alkalosis well. 4. gastrointestinal: has a history of constipation, especially when she uses narcotic analgesics. she had been on percocet for her pain that she had been experienced at her tracheostomy site. these had exacerbated her constipation, which resulted in potasium levels up to 7.9 and junctional bradycardic rhythm that sent her into respiratory distress. at this point, her narcotic analgesics were discontinued. should not get any more narcotic analgesics. her pain is relieved with tramadol, ibuprofen and tylenol. it is thought that she uses narcotics occasionally as a crutch and not for her analgesic effects. her constipation is very responsive to lactulose. she should get lactulose p.r.n. to titrate her to one bowel movement per day. she also receives colace and senna as stool softeners. 5. infectious disease: the patient was admitted on inhaled tobramycin for pseudomonas prophylaxis. this was on for 28 days and was tried off for 28 days. she then started to have an increasing white blood count and her inhaled tobramycin was restarted and she was eventually levelled off on a tiw regimen three times a week for this inhaled tobramycin. she has a chronic leukocytosis from 12 to 20, but no signs of infection. otherwise, she has no current infectious disease issues. 6. psychiatry: has a history of anxiety attacks, which complicate her respiratory failure. it was thought that the anxiety is a large component of her respiratory failure. she also is reliant on narcotic pain medications which have been discontinued for her. has been doing well on a regimen of amitriptyline which was recently increased to 75 mg q. h.s.; zyprexa 5 mg q. h.s. she can receive zyprexa 2.5 mg p.r.n. for acute anxiety and should receive this preferentially over p.r.n. ativan. 7. tubes, lines and drains: has a right picc line, a tracheostomy, and a g-tube, all of which sites are clean, dry and intact. 8. prophylaxis: is out of bed with physical therapy and occupational therapy on a bowel regimen of lactulose, colace and senna. she is on a ppi per her g-tube. 9. communication: this is with mostly and her mother who will be caring for her mostly when she is discharged home on her home ventilator. her mother has been taught to care for her tracheostomy site and ventilator. disposition: her disposition will be first to cc7 floor where her potassium levels and diuresis will be maintained and hopefully titrated to keep her at her goal weight of 115 to 120 pounds and keep her potassium levels between 3.0 and 4.5. she will then most likely be discharged to rehabilitation to work on her activities of daily living and give her more intensive physical therapy and occupational therapy. when she is deemed ready for discharge home, she will be discharged home on her home ventilator with blow-by tracheostomy, oxygen in the days and question of pressure support at night if she cannot be weaned from her pressure support during this hospitalization. her mother has been suctioning her tracheostomy well since she has been here and has been taught much of her care. she will have home to monitor her potassium levels and to care for her g-tube and she will have respiratory therapy, physical therapy and occupational therapy also perhaps at home. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other esophagoscopy enteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances other bronchoscopy other bronchoscopy revision of tracheostomy replacement of tracheostomy tube replacement of tracheostomy tube replacement of tube or enterostomy device of small intestine diagnoses: other primary cardiomyopathies congestive heart failure, unspecified hyposmolality and/or hyponatremia hypopotassemia alkalosis hodgkin's disease, unspecified type, unspecified site, extranodal and solid organ sites mechanical complication due to other implant and internal device, not elsewhere classified chronic respiratory failure 

Answer: The patient is high likely exposed to