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: shortness of breath, hypoxia major surgical or invasive procedure: laparoscopic gastric pulldown and peg placement x2 picc placement history of present illness: pt is an 88 yo woman with pmhx sig. for dm2, dyslipidemia, and recent admission for l comminuted, intertrochanteric left femoral neck fracture, s/p open reduction internal fixation, and l proximal comminuted and displaced fracture of the left humeral neck fx treated with a sling () after fall was sent from rehab with respiratory distress. patient was found to be in respiratory distress this am with wheezing, using accessory muscles, poor air exachange, and tachypenia. her o2 sat was in the high 80s, improved to 100% on nrb. other vs were 140/90, 120, 30, temp 98.5. after a nebulizer treatment, her rr came down to 24. she also complained of diaphoresis. she denied any chest pain. . in the emergency department, initial vitals were: 98.5 110 140/90 34 98 on nrb. she had a cxr that showed bilateral pleural effusions, ?infiltrate. pt received levofloxacin 750 mg, vanc, and nebulizers. ucx and bcx were obtained. pt is currently feeling a little better, now satting 94% on 6l nc. . currently, she feels uncomfortable, but cannot specify why. she denies any sob and does not appear in respiratory distress while lying supine. she denies any cough, chest pain, nausea, vomiting, abdominal pain, dysuria, and fever/chills. she had some rhinorrhea about 2 weeks ago. . past medical history: - type 2 diabetes mellitus - dyslipidemia - anxiety - osteoporosis - hoh - diverticulosis - aortic insufficiency, 1+ - cystic lesion of pancreas felt to be benign - spinal stenosis - large hh into chest social history: patient was born in poland and grew up in . prior to her fall, she lived alone in a private apartment and visited the senior center for all 3 meals. she denies any tobacco/etoh. family history: mother with throat cancer. physical exam: general: pleasant, well appearing female in nad. heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. per/eomi. mm dry. op clear. neck: supple, no lad, no thyromegaly. + jvd. cardiac: occasionally irregular rhythm, tachycardic, normal s1, s2. systolic murmur best at llsb and apex. lungs: decreased breath sounds at the bases bilaterally. abdomen: nabs. soft, nt, nd. no hsm extremities: no edema or calf pain, 1+ dorsalis pedis/ posterior tibial pulses. skin: no rashes, ecchymoses. stage ii heel ulcers bilaterally. surgical incision over l hip c/d/i. neuro: a&ox3. appropriate. cn 2-12 grossly intact. preserved sensation throughout. 5/5 strength throughout except proximal lle and lue secondary to pain. gait assessment deferred. psych: listens and responds to questions appropriately, pleasant . on dicharge vitals: 96.2 142/81 95 18 98%1l nc pain: l shoulder access: piv gen: elderly frail female, tired appearing, intermittent episodes with audible gurgling and accessory muscle use heent: mm dry neck: prominent neck veins cv: rrr, sm usb back: severe scoliosis resp: bs bases, +scattered crackles, no wheezing abd; nontender, +bs ext; 1+ b/l le edema, 1+ ue edema (new during this hospitalization) ms: l arm in sling neuro: a&ox3, grossly nonfocal, gait not assessed skin: scattered heel ulcers, l hip incision healing, sacral stage ii with dressing, l thigh bruising stable psych: calm, pleasant gu: foley back in place . pertinent results: 11:45am blood wbc-9.7 rbc-4.04*# hgb-11.8*# hct-37.1 mcv-92 mch-29.2 mchc-31.9 rdw-15.9* plt ct-423# 03:03am blood wbc-9.7 rbc-3.50* hgb-10.7* hct-32.2* mcv-92 mch-30.6 mchc-33.2 rdw-15.3 plt ct-419 07:50am blood wbc-9.9 rbc-3.34* hgb-10.3* hct-31.7* mcv-95 mch-30.9 mchc-32.6 rdw-15.8* plt ct-425 07:40am blood wbc-8.8 rbc-3.23* hgb-10.1* hct-30.6* mcv-95 mch-31.2 mchc-32.9 rdw-15.5 plt ct-482* 07:35am blood wbc-8.8 rbc-3.42* hgb-10.6* hct-32.8* mcv-96 mch-31.0 mchc-32.4 rdw-15.6* plt ct-451* 06:35am blood wbc-11.0 rbc-3.28* hgb-10.5* hct-31.8* mcv-97 mch-32.0 mchc-33.0 rdw-15.7* plt ct-430 07:42am blood wbc-12.2* rbc-3.60* hgb-11.3* hct-35.4* mcv-98 mch-31.3 mchc-31.8 rdw-15.4 plt ct-534* 07:17am blood wbc-13.0* rbc-3.21* hgb-10.4* hct-31.1* mcv-97 mch-32.4* mchc-33.5 rdw-15.6* plt ct-476* 08:00am blood wbc-12.4* rbc-3.40* hgb-10.3* hct-32.4* mcv-95 mch-30.4 mchc-31.9 rdw-15.7* plt ct-476* 06:55am blood wbc-10.3 rbc-3.30* hgb-10.2* hct-31.5* mcv-96 mch-30.9 mchc-32.4 rdw-16.0* plt ct-455* 04:05am blood wbc-12.3* rbc-3.23* hgb-10.1* hct-31.3* mcv-97 mch-31.3 mchc-32.4 rdw-15.9* plt ct-405 06:00am blood wbc-16.1* rbc-3.04* hgb-9.6* hct-29.0* mcv-95 mch-31.6 mchc-33.1 rdw-16.2* plt ct-395 05:39am blood wbc-21.6* rbc-2.55* hgb-8.1* hct-24.1* mcv-95 mch-31.7 mchc-33.6 rdw-16.4* plt ct-339 05:24am blood wbc-18.2* rbc-2.57* hgb-8.1* hct-25.1* mcv-98 mch-31.5 mchc-32.3 rdw-16.2* plt ct-328 05:23am blood wbc-13.7* rbc-2.65* hgb-8.5* hct-25.7* mcv-97 mch-32.0 mchc-33.0 rdw-16.1* plt ct-326 04:12am blood wbc-10.8 rbc-2.37* hgb-7.6* hct-23.0* mcv-97 mch-32.0 mchc-33.0 rdw-16.1* plt ct-342 05:08am blood wbc-7.8 rbc-2.81* hgb-8.6* hct-27.3* mcv-97 mch-30.6 mchc-31.5 rdw-15.8* plt ct-391 05:03am blood wbc-7.3 rbc-2.84* hgb-8.9* hct-27.6* mcv-97 mch-31.1 mchc-32.0 rdw-15.9* plt ct-386 05:45am blood wbc-7.8 rbc-2.68* hgb-8.3* hct-26.4* mcv-99* mch-31.2 mchc-31.6 rdw-15.7* plt ct-364 05:28am blood wbc-8.1 rbc-2.22* hgb-7.0* hct-21.9* mcv-99* mch-31.5 mchc-32.0 rdw-16.0* plt ct-376 05:33pm blood hct-30.8*# 10:58pm blood hct-29.3* 05:46am blood wbc-8.6 rbc-3.10*# hgb-9.7*# hct-29.8* mcv-96 mch-31.3 mchc-32.6 rdw-16.9* plt ct-323 06:00am blood wbc-8.6 rbc-3.25* hgb-10.3* hct-31.0* mcv-95 mch-31.8 mchc-33.3 rdw-16.4* plt ct-368 11:45am blood glucose-202* urean-46* creat-0.7 na-137 k-4.4 cl-101 hco3-27 angap-13 03:03am blood glucose-165* urean-41* creat-0.6 na-135 k-4.0 cl-98 hco3-28 angap-13 07:50am blood glucose-95 urean-29* creat-0.6 na-138 k-3.5 cl-101 hco3-31 angap-10 07:40am blood glucose-186* urean-25* creat-0.6 na-138 k-3.8 cl-103 hco3-28 angap-11 07:35am blood glucose-140* urean-21* creat-0.6 na-138 k-4.4 cl-103 hco3-30 angap-9 06:35am blood glucose-113* urean-19 creat-0.5 na-136 k-5.2* cl-101 hco3-24 angap-16 07:42am blood glucose-143* urean-15 creat-0.6 na-139 k-4.6 cl-101 hco3-30 angap-13 07:17am blood glucose-157* urean-15 creat-0.4 na-136 k-4.2 cl-97 hco3-31 angap-12 08:00am blood glucose-160* urean-13 creat-0.4 na-137 k-3.9 cl-98 hco3-32 angap-11 06:55am blood glucose-147* urean-11 creat-0.3* na-137 k-3.8 cl-98 hco3-30 angap-13 04:05am blood glucose-132* urean-12 creat-0.4 na-138 k-3.5 cl-98 hco3-31 angap-13 06:00am blood glucose-163* urean-17 creat-0.5 na-138 k-3.6 cl-99 hco3-33* angap-10 06:48pm blood glucose-725* urean-20 creat-0.5 na-132* k-6.3* cl-95* hco3-30 angap-13 09:35pm blood glucose-188* urean-21* creat-0.5 na-139 k-3.5 cl-99 hco3-33* angap-11 05:39am blood glucose-135* urean-23* creat-0.4 na-140 k-3.4 cl-102 hco3-32 angap-9 05:33pm blood na-139 k-3.4 cl-100 05:24am blood glucose-87 urean-29* creat-0.3* na-140 k-3.9 cl-101 hco3-33* angap-10 05:23am blood glucose-83 urean-32* creat-0.5 na-138 k-4.5 cl-103 hco3-32 angap-8 04:12am blood glucose-69* urean-33* creat-0.4 na-140 k-4.9 cl-105 hco3-31 angap-9 05:08am blood glucose-75 urean-37* creat-0.4 na-139 k-5.6* cl-104 hco3-29 angap-12 05:03am blood glucose-72 urean-37* creat-0.4 na-137 k-5.4* cl-103 hco3-29 angap-10 05:45am blood glucose-99 urean-36* creat-0.4 na-140 k-4.2 cl-111* hco3-25 angap-8 05:28am blood glucose-60* urean-44* creat-0.5 na-138 k-4.8 cl-105 hco3-31 angap-7* 05:46am blood glucose-121* urean-39* creat-0.4 na-139 k-4.6 cl-105 hco3-31 angap-8 06:00am blood glucose-160* urean-37* creat-0.4 na-138 k-4.8 cl-103 hco3-31 angap-9 as of wbc 8->12s 83%n hct 31-32 stable (up today to 35 may be concentrated) bun/creat 16/0.6 trop 0.01->0.02->0.02 bnp 3661 no prior albumin 2.8 lfts wnl lactate 1.6 urine legionella: neg . ua 0-2 wbc, +nitrite, many bacteria ucx >100k pseudomonas with intermediate sensitivity to cipro, to ceftaz . blood cx x2 ntd . . . imaging/results: cxr : large b/l pleural effusions not present on cxr . cxr pa/lat large, right greater than left bilateral pleural effusions associated with atelectasis and a very large hiatal hernia are unchanged. the visualized upper lungs are well aerated. cardiac size cannot be evaluated. . cxr : there is still evidence of a large hiatal hernia, and the stomach is still distended with air-fluid levels unchanged from prior. large bilateral pleural effusions are unchanged. new bilateral perihilar opacities are worrisome for aspiration. . cta 1. no evidence of pulmonary embolism or aortic dissection. 2. large bilateral pleural effusions, which in conjunction with large type iii hiatal hernia resultants in collapse of the right middle, right lower, and left lower lobe. the remaining aerated lung displays no focal opacity to suggest underlying pneumonia. 3. atherosclerotic disease involving the coronary tree and aorta with minimal dilatation of the ascending aorta. mass effect from the posterior hiatal hernia displaces the heart anteriorly with compression of the right atrium and right ventricle noted by the sternum. 4. thyroid goiter and probable benign simple right renal cyst and hyperdense left renal cyst. . ct chest -reviewed personally with radiologist large pleural effusions are present bilaterally, slightly larger on the right than the left. these effusions as well as a massive hiatal hernia result in extensive atelectasis of the lower lobes. compression of present. undigested food in stomach and now esophagus->high risk for aspiration. aerated parts of lungs w/o evidence of pna or pulm edema but difficult to exclude this underlying the areas of lung collapse. ct (c/a/p): 1. no definite evidence for active extravasation into the chest, abdomen, pelvis, or subcutaneous tissues. 2. large bilateral pleural effusions. 3. large right flank fluid collection which is incompletely assessed but may represent a hematoma. 4. interval decreased distention of large hiatal hernia. the distal stomach is fixated with two peg tubes. there is no evidence for active extravasation into the abdomen. 5. small volume of free intraperitoneal air likely related to recent post-operative status. 6. nonobstructed small bowel loops within bilateral inguinal hernias. 7. hypodense right renal lesions, compatible with cysts. 8. hypodense pancreatic head lesion, incompletely characterized, may represent cyst or dilated pancreatic duct side branch. 9. multilevel lumbar body vertebral compression fractures, age indeterminate. status post orif of a left intertrochanteric fracture with avulsion of the lesser trochanter. osteopenia. echo 70%ef, nl la/ra echo : 70%ef, extrinisic compression of la by hh echo : the left atrium is normal/small in size. the wall of the left atrium appears to be compressed by an external structure. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). compared with the prior study (images reviewed) of , there may be slightly less compression of the left atrium by an external structure. brief hospital course: ms. is an 88-year old woman with h/o dm and recent l humeral and l femur fracture s/p orif of her l femur (), who was admitted from rehab for for acute respiratory distress and hypoxia. she was found to have bilateral pleural effusions, as well as a large hiatal hernia which was compressing her left atrium and likely contributing to her pulmonary effusions. over her hospital course, ms. y developed aspiration pna, pseudomonal uti, and c. difficile colitis. each of these issues is addressed below. ##hypoxia the patient was admitted on from her rehab facility with increased rr and o2 saturations in the 80s. her o2 requirement on admission was 6l. cxr in the ed revealed bibasilar infiltrates, and chest ct revealed bibasilar effusions and collapse of the right middle, right lower, and left lower lung. her effusions were thought to be caused at least in part by compression of her left atrium by her hiatal hernia, leading to increased pressure in her pulmonary vasculature. empiric levofloxacin and vancomycin were started for pneumonia. no evidence of pulmonary embolism was seen on cta. on , 2x 20 mg iv lasix was given, leading to a diuresis of 1.5l and improvement in her hypoxia (o2 requirement from 6 to 3l). vancomycin and levofloxacin were discontinued on because no clear evidence of pna had been found. between and , iv lasix was used only intermittently because of concern for her preload limitations caused by the hiatal hernia compressing her left atrium (please see 'hiatal hernia' as separate issue below). on , cxr showed new perihilar opacities worrisome for aspiration. iv flagyl was added to her ceftazidime (which she was already taking for pseudomonas uti, discussed as separate issue below) for empiric coverage of aspiration pna. her iv flagyl and ceftazidime were continued for a 10 day course. on , the patient's o2 requirement increased from 2l to 3l. she received 2x 20 mg iv lasix, to which she diuresed 1.3 l. on , a thoracentesis was performed in her r pleural space, and 850 ml of straw-colored transudate was removed. pleural fluid analysis revealed a transudate, and cultures have not grown any organisms to date. diuresis with 1 or 2 20 mg doses of iv lasix per day was continued on (tbb goal -500 cc), and by , her oxygen requirement had been reduced to 0.5-1l. on , the patient underwent endoscopic gastric pulldown with double peg placement (see management of hiatal hernia as separate issue below), and her post-op o2 requirement was initially 4l. between and , she was diuresed with 20 mg doses of iv lasix to a tbb goal -500, and on , her o2 requirement was 0.5-1l. on , the patient was transitioned from iv lasix to 40 mg po lasix . the patient's daily tbb was -250 to -500 l on this dosage, and she was increased to 60 mg po lasix . for rehab planning, it is recommended that this dosage be weaned as necessary (based on her o2 requirement, daily tbb, and clinical volume status) so that she is not chronically using lasix for diuresis. ##hiatal hernia echocardiogram revealed a hiatal hernia compressing the l atrium. ejection fraction was 70%. on , ngt placement under fluoroscopy was attempted but unsuccessful. iv iv reglan was begun on in order to promote forward motility and gastric emptying. the patient was made npo with all non-essential po meds held, and on , a picc line was placed for tpn. tpn was started on and continued until . on , the patient underwent laparoscopic gastric pulldown and double peg placement in order to anchor her stomach and prevent reherniation/volvulus. on , she was transitioned to an oral diet of nectar thick liquids and pureed solids. on , she began getting tube feeds through one of her peg tubes (rate of 15 cc/hr to goal rate of 45 cc/hr). by , her tube feeds were at goal, and she was taking minimal po's (thick liquids, pureed solids, crushed pills). of note, her foley catheter was left in place because her mobility was still quite limited at the time of discharge. however, once she is able to progress in her rehabilitation and move more easily, foley should be discontinued. ##pseudomonal uti patient was diagnosed with uti on , and cultures grew pseudomonas sensitive to ceftazidime. a five day course of ceftazidime was started on . ceftazidime was continued past five days for concurrent empiric coverage of aspiration pna (see hypoxia section above). ##c. dificile colitis on , the patient's wbc rose from 12.3 to 16.1, and on , it rose further to 21.6. she was also having diarrhea ( episodes/day) during this time. stool specimen was newly positive for c. difficile toxin on , and this was thought to underlie her leukocytosis. po liquid vancomycin was started on . on , her wbc was reduced to 13.7, and by , it had decrased <10. ##anemia the patient had two episodes of hct drops during her admission. the first occurred on , when her hct dropped from 29.0 to 24.1. cbc was immediately rechecked, and hct rose back to 27.8 without intervention. this hct drop was thought most likely due to fluid shift, dilution from tpn, and/or lab error caused by drawing the blood from her picc line. the pt's hct stayed stable from to , when it dropped from 26.4 to 21.9 overnight. 1u of prbcs were given, and her post-transfusion hct was 30.8 because of her endoscopic surgery on , there was concern for internal bleeding. ct scans were taken of her abdomen, l thigh, and l humerus. there was no active extravasation, but fluid collections representing seromas vs. hematomas were seen in her r flank and l hip, likely caused by her fall and humeral/femoral fractures. in the absence of obvious extravasation, the differential for her hct drop was fluid shift from her surgery or lab abnormalities caused by her picc line. her large increase in hct (21.9 to 30.8) with only 1u of prbcs suggested that her hct drop was not caused by a true pathology. ##rehabilitation from open reduction internal fixation of l femur the patient was followed by the orthopedic trauma team throughout her stay, and per their recommendations, weight-bearing as tolerated/passive range of motion exercises were performed for her l femur and non-weight bearing/range of motion as tolerated exercises for her l humerus. a four-week course of lovenox was continued for dvt prophylaxis. lovenox was continued because of her high risk of dvt (immobile, s/p orthopedic and abdominal surgery, elderly). tylenol 1g tid was used for pain. iv morphine 0.25 mg was started on for pain as well. staples from her l thigh incision were removed on . there was no evidence of hemarthrosis during her admission. outpatient follow-up with dr. np has been scheduled. ##diabetes the patient's home metformin was held, and she was treated with insulin sliding scale, as well as supplemental insulin while receiving her tpn from to . once she transitioned from tpn to tube feeds, she was being controlled only on her insulin ss. she will be discharged on the sliding scale, while holding her home meformin. ##pressure ulcers the patient had a sacral ulcer and scattered bilateral heel ulcers on admission. she received daily wound care with elevation of both heels off the bed using boots. she was also brought ouf of bed as tolerated in order to relieve pressure on her ulcerated areas. #nutrition the patient was on tpn from . thereafter, she was taking limited po diet (nectar thick liquids/pureed solids) and tube feeds at a goal rate of 45 cc/hr. ##dvt prophylaxis lovenox 40 mg sc daily was used for dvt prophylaxis. medications on admission: enoxaparin 30 mg subcutaneous qd for 4 weeks. ascorbic acid 500 mg po daily b complex vitamins po daily calcium carbonate 500 mg po daily cholecalciferol (vitamin d3) 400 unit po daily famotidine 20 mg po bid docusate sodium 100 mg po bid senna 8.6 mg po hs acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain, fever. omega-3 fatty acids po daily bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation: hold for loose stool. discharge medications: 1. ascorbic acid 500 mg tablet sig: one (1) tablet po daily (daily). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. b complex vitamins capsule sig: one (1) cap po daily (daily). 5. omega-3 fatty acids capsule sig: one (1) capsule po bid (2 times a day). 6. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 7. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 8. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 9. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours). 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 11. enoxaparin 40 mg/0.4 ml syringe sig: one (1) subcutaneous daily (daily). 12. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 13. oxycodone 5 mg/5 ml solution sig: 2.5 mg po bid (2 times a day). 14. vancomycin 125 mg capsule sig: one (1) capsule po q6h (every 6 hours): day 1 of 14 day course was . please continue until . . 15. famotidine 20 mg tablet sig: one (1) tablet po twice a day. 16. insulin lispro 100 unit/ml solution sig: please follow sliding scale subcutaneous asdir (as directed): please follow insulin sliding scale. 17. furosemide 20 mg tablet sig: three (3) tablet po bid (2 times a day). discharge disposition: home with service facility: discharge diagnosis: large paraesophageal hernia causing left atrium compression s/p gastric pulldown and peg placement x2 bilateral pleural effusions hypoxia clostridium difficile colitis pseudomonas aeruginosa uti aspiration pneumonia discharge condition: stable on 0.5-1l oxygen. discharge instructions: you were admitted from your nursing home with shortness of breath and low oxygen. you were found to have fluid around your lungs which is new and was compressing your lungs. this is secondary to your large hernia that was displacing your stomach into your chest. we treated your low oxygen by giving you a medication that helps you urinate out excess body fluid. your oxygen improved steadily during your hospital stay. for your hernia, we initially stopped feeding you by mouth and started you on iv nutrition. you then underwent a surgery in which your stomach was pulled down closer to its original position and anchored to your abdominal wall using two tubes. following surgery, your iv nutrition was stopped, and you were fed both orally as well as through your stomach tube. in addition to your low oxygen level and your hernia, you also developed infection of your lungs, urinary tract, and gi tract (at different points during your admission). we treated each of these infections with the appropriate antibiotics. on admission, you were still recovering from your left arm and left femur fracture. the orthopedics team followed you during your admission, and we tried to get you out of bed as much as possible in order to do weight-bearing exercises. you had some pressure sores and were seen by wound care. please take all your medications as written. the following changes were made to your medications: new: 1) albuterol/ipratropium inhalors as needed for shortness of breath (you do not need to have this at home if it does not help you) 2) vancomycin 125mg orally four times a day (q6 hours) until 3) subcutaneous insulin for your diabetes 4) lasix 60 mg two times a day to prevent fluid in your lungs 5) oxycodone 2.5 mg twice a day as needed for pain. changes: please continue enoxaparin 40mg sub-cutaneous once a day until you talk to your orthopedist. calcium carbonate increased to 500mg three times a day vitamin d increased to 800 units daily we stopped your metformin during your admission and controlled your diabetes with insulin followup instructions: 1) primary care doctor: dr. , , 2:45 pm, 2) hernia surgery: dr. , md phone: date/time: 11:45 3) orthopedics: appointment with , np. , 9:20 am, bldg procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances thoracentesis percutaneous [endoscopic] gastrostomy [peg] laparoscopic repair of diaphragmatic hernia, abdominal approach diagnoses: anemia, unspecified unspecified pleural effusion urinary tract infection, site not specified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled pulmonary collapse other and unspecified hyperlipidemia acute respiratory failure pneumonitis due to inhalation of food or vomitus osteoporosis, unspecified intestinal infection due to clostridium difficile pressure ulcer, lower back hypoxemia pressure ulcer, heel pseudomonas infection in conditions classified elsewhere and of unspecified site pressure ulcer, stage ii spinal stenosis, lumbar region, without neurogenic claudication diaphragmatic hernia with obstruction 

Answer: The patient is high likely exposed to