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: cefepime / ciprofloxacin / levofloxacin attending: chief complaint: shortness of breath major surgical or invasive procedure: t3-t7 laminectomy and fusion history of present illness: 57 y/o m hx aml s/p mud allo in remission with multiple complications including gvh of liver, skin, lung, most recently on photopheresis since the end of . also with dm, avn of hips/shoulders, chronic compression fx's, pe's on lifelong anticoagulation, and b/l achilles tendon rupture after fluoroquinolone course in . multiple recent admissions for shortness of breath, though infectious (ggo on ct) treated with abx, as well as norovirus. recently discharged on o2 and azithro and pred 20 for sob and at that time if was unclear from imaging and exam whether it was due to infectious etiology vs. gvhd. . the pt's breathing had improved since d/c up until a couple of days about when he noticed increasing sob especially with exertion. he denies associated cp, fevers/ chills or rash. he does note worsening productive cough. he also claims that his le edema has been increasing b/l as well and this has been going on for several weeks also. he denies hx of chf. he also has noted that his rle in particular has not only become more swollen but also has become more red and painful as well. . review of systems: (+) per hpi (-) denies fever, chills, night sweats. denies blurry vision, diplopia, loss of vision, photophobia. denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pain or tightness, palpitations. denies nausea, vomiting, diarrhea, constipation, abdominal pain, melena, hematemesis, hematochezia. denies dysuria, stool or urine incontinence. denies arthralgias or myalgias.all other systems negative. past medical history: oncologic history: - diagnosed with aml in 04/. - underwent unrelated allogeneic stem cell transplant with busulfan and cyclophosphamide as his conditioning regimen. . post transplant complications: *gvhd of the liver and skin. question of pulmonary cgvhd as often requires oxygen and steroids in the setting of respiratory infections (h/o rsv, parainfluenza) *chronic lower extremitiy edema, refractory to lasix, suspected to be gvhd *avascular necrosis (bilateral hips and left shoulder) *multiple compression fractures of the spine with chronic pain *type 2 dm *pulmonary embolus in and , on lifelong anticoagulation *s/p l5 vertebroplasty *ruptured left calf hematoma () complicated by mrsa wound infection *influenza a *bilateral achilles tendon rupture ( attributed to levoflox). . other past medical history (from ): *ckd with baseline cr 1.1 *pericardial effusion s/p drainage. *hyperlipidemia, no meds. *htn, on metoprolol. *nephrolithiasis, lithotripsy and previous nephrostomy tube and emergent surgery to repair ureteral damage. *left interpolar renal lesion, followed with mrs *basal cell carcinoma, resected. *squamous cell carcinoma left cheek, s/p mohs' 6/. *multiple back surgeries: lumbar l5-s1 surgery x 3, and cervical spine fusion (bone graft, no hardware). *anterior cervical diskectomy and instrument arthrodesis at c5-c6 and c6-c7 for degenerative cervical spondylitic disease with spinal cord compression and foraminal stenosis at c5-c6 and c6-c7 - dr. . *chronic numbness, neuropathic pain in left upper extremity. *sleep apnea, planned bipap, followed by dr. . *lower extremity wound, s/p debridement by plastics, grew resistent pseudomonas social history: lives with his wife, and son. is retired, worked as a technician. he smoked for 40 pack years, now quit. he denies etoh or drugs. family history: mother died suddenly in 70s. father died of unknown cancer. one sister with thyroid cancer. one brother has diabetes. one sister has . physical exam: admission physical exam: vitals - t:97.7 bp:163/96 hr:77 rr:18 02 sat: 99% 2l general: obese male w/ moon facies, prefers to keep his eyes closed skin: warm and well perfused, red rash present over chest and darker discoloration of lower abdomen per pt from mult lovenox injections, weeping skin in le b/l, erytematous rle heent: at/nc, eomi, perrla, anicteric sclera, pink conjunctiva, patent nares, mmm, good dentition, nontender supple neck, no lad, difficult to assess jvd due to habbitus cardiac: rrr, s1/s2, no mrg lung: crackles present in ll b/l abdomen: obeses, nondistended, +bs, moderately tender in lower quadrants b/l, no rebound/guarding, no hepatosplenomegaly extremities- ue multiple ecchymosis b/l in wrist and dorsum of hands, rle medial healed ulcer from prior mrsa infection, lle warm, erythematous small puncture wound on posterior distal calf weeping serous fluid, both le weeping serous fluid, severe + edema present to distal thigh b/l pulses: 2+ dp pulses bilaterally neuro: cn ii-xii intact exam: afebrile, 122/84, 103, 22, 95% on 0.5l nc general: obese male w/ moon facies skin: warm and well perfused, red rash present over chest and darker discoloration of lower abdomen per pt from mult lovenox injections, weeping skin in le b/l, rle wrapped in bandages heent: at/nc, eomi, perrla, anicteric sclera, mmm cardiac: rrr, s1/s2, no mrg lung: ctab abdomen: obeses, nondistended, +bs, nt, no rebound/guarding, no hepatosplenomegaly extremities- ue multiple ecchymosis b/l in wrist and dorsum of hands, rle ulcer wrapped in clean, dry, dressings, lle warm, both le edematous 1+ neuro: paralyzed in le bilaterally. sensation intact but reduced. incontinent with foley in place. upper extremity motor and sensation intact, cn 2-12 intact pertinent results: pertinent lab results: 08:15am blood wbc-5.6 rbc-3.10* hgb-11.6* hct-35.7* mcv-115* mch-37.3* mchc-32.4 rdw-16.1* plt ct-214 08:15am blood neuts-85* bands-1 lymphs-2* monos-10 eos-1 baso-0 atyps-0 metas-0 myelos-1* nrbc-3* 08:15am blood pt-14.8* inr(pt)-1.4* 03:25pm blood urean-16 creat-0.9 na-141 k-4.3 cl-102 hco3-32 angap-11 03:25pm blood alt-120* ast-64* ld(ldh)-386* alkphos-135* totbili-0.1 03:25pm blood calcium-8.9 phos-3.0 mg-2.0 05:26am blood wbc-5.8 rbc-2.86* hgb-10.1* hct-33.6* mcv-118* mch-35.2* mchc-30.0* rdw-16.9* plt ct-177 01:37pm blood wbc-8.8# rbc-2.16* hgb-7.6* hct-26.0* mcv-121* mch-35.1* mchc-29.1* rdw-17.0* plt ct-178 05:00pm blood wbc-8.0 rbc-1.99* hgb-6.9* hct-23.4* mcv-117* mch-34.8* mchc-29.7* rdw-17.3* plt ct-171 07:00pm blood wbc-6.1 rbc-1.99* hgb-6.2* hct-20.2* mcv-102*# mch-31.4 mchc-30.8* rdw-25.1* plt ct-102* 09:53pm blood wbc-5.9 rbc-2.82*# hgb-8.3*# hct-26.2*# mcv-93# mch-29.5 mchc-31.6 rdw-23.1* plt ct-72* 02:02am blood wbc-5.6 rbc-3.28* hgb-9.9* hct-29.7* mcv-91 mch-30.2 mchc-33.3 rdw-22.1* plt ct-78* 07:20am blood wbc-7.1 rbc-3.08* hgb-9.2* hct-27.9* mcv-91 mch-30.0 mchc-33.2 rdw-22.5* plt ct-85* 11:52am blood wbc-8.1 rbc-3.17* hgb-9.3* hct-29.2* mcv-92 mch-29.4 mchc-31.9 rdw-23.5* plt ct-81* 01:37pm blood hapto-213* 11:44am blood pth-250* 06:28am blood pth-64 11:44am blood 25vitd-14* 04:00pm blood igg-236* iga-36* igm-7* 06:00am blood igg-643* iga-40* igm-12* 06:49am blood vanco-12.9 04:43am blood vanco-17.9 micro: blood culture, routine (final ): no growth. blood culture, routine (final ): no growth urine culture (final ): no growth **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 3+ (5-10 per 1000x field): gram positive cocci. in pairs. 3+ (5-10 per 1000x field): gram positive rod(s). 1+ (<1 per 1000x field): budding yeast. smear reviewed; results confirmed. respiratory culture (final ): sparse growth commensal respiratory flora. 3:41 pm rapid respiratory viral screen & culture site: nasopharynx source: nasopharyngeal swab. **final report ** respiratory viral culture (final ): no respiratory viruses isolated. culture screened for adenovirus, influenza a & b, parainfluenza type 1,2 & 3, and respiratory syncytial virus.. detection of viruses other than those listed above will only be performed on specific request. please call virology at within 1 week if additional testing is needed. respiratory viral antigen screen (final ): negative for respiratory viral antigen. specimen screened for: adeno, parainfluenza 1, 2, 3, influenza a, b, and rsv by immunofluorescence. refer to respiratory viral culture for further information. blood culture, routine (final ): no growth imagaing: ct chest w/o contrast study date of 1:12 pm impression: 1. near resolution of right lower and middle lobe ground glass opacities that were new in , consistent with resolving infectious process. 2. other bilateral lung and airway findings (including mild bronchial dilation and wall thickening) are similar to baseline ct study in , and are accompanied by moderate expiratory air trapping. although non-specific, they may be related to history of chronic gvhd. 3. multiple stable compression fractures and rib fractures. l-spine (ap & lat) study date of 1:53 pm findings: there is a previously known sclerotic focus in the right iliac crest. there are also several compression fractures identified along with severe degenerative changes of the lumbar spine, all previously identified. patient is status post kyphoplasty of the l5 vertebral body. no new fractures are seen. unilat lower ext veins right study date of 6:33 pm findings: -scale and color son were acquired of the right common femoral, superficial femoral, popliteal, posterior tibial, and peroneal veins. there is normal compressibility, flow, and augmentation throughout. there is subcutaneous edema in the calf 2. subcutaneous edema in the calf pulmonary report spirometry, lung volumes, dlco study date of 1:48 pm impression: mild to moderate restrictive ventilatory defect with a coexsting obstructive ventilatory defect and a moderate gas exchange defect. compared to the prior study of the fvc has decreased by 0.74 l (-21%) and the fev1 has decreased by 0.58 l (-25%). compared to the prior study of the tlc has decreased by 1.10 l (-19%) and the dlco has decreased by 2.82 ml/min/mm hg (-18%). ct low ext w/o c right study date of 2:40 pm impression: 1. no ct evidence for osteomyelitis. 2. large osteochondral fracture with articular collapse involving the lateral femoral condyle. subtle changes were seen in this area on the prior radiograph from ; however, findings have worsened. 3. prominent amount of subcutaneous soft tissue swelling and skin thickening compatible with known diagnosis of cellulitis. there is no air within the soft tissues. 4. focal 2-mm nodular area of soft tissue attenuation within the posterior medial calf, unable to fully characterize. mr calf w/o contrast right study date of 11:30 am impression: 1. extensive subcutaneous soft tissue edema throughout the right lower extremity consistent with cellulitis in the appropriate clinical setting. lobulated high t2 focus seen in the posteromedial distal right lower extremity measuring approximately 4.2 x 0.9 cm. could represent a small focus of fluid, though the ddx includes dense edema, in the absence of iv contrast. 2. incompletely characterized ovoid area measuring 1.0 x 1.5 cm in the distal right lower extremity posteromedial subcutaneous soft tissues corresponding to an area of soft tissue density on recent prior ct examination and calf mri from may represent complex fluid or small area of hemorrhage. 3. fascial fluid and edema between the medial head gastrocnemius and soleus musculature, slightly more than seen on the most recent prior mri. no associated areas of magnetic susceptibility artifact to suggest foci of gas, nor are any foci of gas seen on recent prior ct. no other fascial fluid or edema identified between muscles. please correlate clinically to exclude the possibility of necrotizing fasciitis. 4. muscle edema involving the soleus musculature and medial aspect of the lateral head of the gastrocnemius, which could reflect mild myositis. 5. incompletely seen osteochondral fracture involving the lateral tibial plateau, better assessed on ct examination from . 6. bone infarcts in the distal tibia and proximal femur. ct chest w/o contrast study date of 3:40 pm impression: 1. continued resolution of previously seen bilateral ground-glass and nodular opacities consistent with infection. no new consolidation. 2. stable chronic changes including bibasilar scarring and bronchiectasis. mild centrilobular emphysema. 3. hepatic steatosis. chest (portable ap) study date of 9:27 am impression: unchanged exam. no rib fractures evident. mr w & w/o contrast study date of 9:23 am impression: 1. new t5 inferior endplate fracture with retropulsion of its dorsal cortex, narrowing the ventral spinal canal, with no spinal cord signal abnormality. this is new compared to ct chest done only four days ago, and should be correlated directly with the symptomatic site. 2. likely endplate fracture of t7; however, a mild wedge deformity was present on ct chest four days ago making if difficult to determine whether there is an acute component. 3. previously-seen sites of spinal canal stenosis at c3/c4 and c6 with indentation and remodeling of the spinal cord have progressed slightly, compared to . the associated focal abnormality of cord intrinsic signal from c4/5 to c5, is unchanged compared to , and likely represents established myelomalacia. 4. t12 kyphosis with retropulsion and cord compression is unchanged in degree, compared to . 5. remaining old lumbar vertebral compression fractures and multilevel degenerative changes are unchanged. hand (ap, lat & oblique) right study date of 5:18 pm impression: 1. erosive change with sclerotic margin at the base of the ulnar aspect distal ring finger phalanx with adjacent small calcifications suggestive of tophi, which may represent gout in the appropriate clinical setting. alternatively, this could be post-traumatic in nature and less likely an enchondroma. 2. old ununited right ulnar styloid fracture or accessory ossicle, grossly stable. tte: the left ventricle is not well seen. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). the aortic valve is not well seen. the mitral valve leaflets are not well seen. there is no pericardial effusion. there is an anterior space which most likely represents a prominent fat pad. there are no echocardiographic signs of tamponade. impression: suboptimal image quality. overall lv function is probably normal. however, due to technical difficulties, a focal wall motion abnormality cannot be fully excluded. anterior space likely represents a prominent fat pad (patient on high dose steroids; recent ct of chest/abdomen also confirms significant visceral fat around heart and organs). dr. was notified of the limited study and results by telephone today at 4:10 p.m. chest (pa & lat) study date of 11:22 am impression: 1. probable right mid lung atelectasis but followup is recommended. 2. low lung volumes and increased bibasilar atelectasis. 3. mild pulmonary vascular congestion. bilat lower ext veins study date of 8:46 am impression: mildly limited examination secondary to habitus/subcutaneous edema without left or right lower extremity dvt. chest (portable ap) study date of 9:52 pm findings: as compared to the previous radiograph, the lung volumes are unchanged and relatively low. borderline size of the cardiac silhouette without pulmonary edema or pneumonia. no pleural effusions. unchanged appearance of the mediastinum. cervical fixation devices. unchanged hemodialysis catheter. chest (portable ap) study date of 1:58 pm findings: in comparison with the study of , there is no interval change. low lung volumes may account for the mild prominence of the cardiac silhouette. no evidence of pulmonary edema or pleural effusion or acute pneumonia. cervical fixation device and hemodialysis catheter are essentially unchanged. . . ct abd & pelvis w/o con: impression 1. left retroperitoneal hematoma in the pararenal spaces, with extension inferiorly into the pelvis. 2. multilevel vertebral body compression fractures. old healing bilateral rib fractures. possible bilateral femoral head avn. 3. fatty liver. gallbladder stones or sludge. 4. bibasilar lung opacities concerning for infection. . mr w& w/o contrast impression: since the previous mri of there is slightly increased compression and signal changes within the t5 vertebra identified with signal changes in the inferior endplate which could be related to previous compression and fluid adjacent to the endplate. the slightly increased retropulsion together with epidural lipomatosis results in some deformity of the spinal cord at this level, but the evaluation for increased signal within the cord is limited secondary to motion but such possibility cannot be completely excluded. postoperative changes are seen in the cervical region as before. the appearance of lower thoracic spine has remained unchanged compared to the previous mri. . ct chest w/o con: impression: 1. multifocal widespread ground glass opacities with tree-in- opacities along the periphery, most compatible with multifocal pneumonia. atypical infections such as mycobacterial can also be considered. 2. increased bilateral pleural effusions with worsening adjacent compressive atelectasis. 3. incompletely visualized retroperitoneal hematoma, as seen on the ct examination. 4. hepatic steatosis. 5. unchanged multiple chronic rib fractures and severe thoracolumbar vertebral wedge compression deformities. . head ct: impression: bilateral symmetric exophthalmos, new since , increased since , and unchanged since . no evidence of post-septal mass. normal brain ct. . cta impression: 1. no evidence for pulmonary embolus. 2. persistent right and left upper lobe opacities, consistent with pneumonia. 3. right central bronchial secretions. . labs: 12:30am blood wbc-8.4 rbc-3.12* hgb-10.4* hct-33.4* mcv-107* mch-33.2* mchc-31.0 rdw-21.3* plt ct-251 12:30am blood pt-9.6 ptt-26.6 inr(pt)-0.9 12:30am blood glucose-219* urean-16 creat-0.8 na-141 k-4.2 cl-99 hco3-35* angap-11 12:30am blood alt-33 ast-30 alkphos-221* totbili-0.2 12:30am blood calcium-9.0 phos-3.8 mg-1.6 brief hospital course: mr. is a 57m h/o gvhd involving liver, skin, lung from allo transplant for aml, and recent admission for sob of unclear etiology initially presenting with worsening sob and rle swelling, pain. he has a h/o thoracic spine compression fractures, and during this hospitalization received a t3-t7 laminectomy/spinal fusion in for acute cord compression in the setting of a code blue and one chest compression. he had a admission for respiratory depression thought medication sedation effect, and was called out to bmt on after his pain rx were adjusted and his sedation had improved. on , he had several episodes of sbp 70's, and later became unresponsive with abg's showing hypoxemia and acidemia, and the pt was transferred to the . his ams and hypercarbia improved with cpap, and he was called out to the bmt floor again on . his abx were progressively stopped, and he remained afebrile. he was continued on azithromycin for infection prophylaxis, and plan was made to continue this at the discretion of the outpatient physician, can decided when or whether or not to stop. . active issues: . # graft vs host disease- involving his lungs, gi tract, eyes and skin. on admission, the pt was complaining of persistent sob. he had been admitted in mid with a similar presentation. he was empirically treated with vanc/aztreonam during that admission for a prolonged course, and his cultures were all unremarkable. pulmonary felt that his lung symptoms were the result of gvhd c/w a bronchiolitis obliterans picture. it was recommended to start advair and albuterol-ipratropium as well as pulse dose steroids. igg level was checked and returned below 500. he was given ivig once which also improved his symptoms. pfts were obtained during this admission and showed a mild to moderate restrictive ventilatory defect with a coexisting obstructive ventilatory defect and a moderate gas exchange defect. he had documented pe's in the past and was continued on anticoagulation. while he was on stress doses of hydrocortisone during his icu stays, these were changed back to his prednisone 10mg in am and 5mg in pm without incident. . # hcap in setting of pulmonary gvhd: in an effort to elucidate an etiology for his hypoxia, a repeat chest ct was performed. it was negative for pulmonary embolism, but showed areas of consolidation concerning for new pna. as such, the patient was restarted on iv vanco & meropenem for planned 8 day course, but on pt was found increasingly somnolent with pco2>100. pt was transferred back to the , was put temporarily on positive airway pressure with improvement in mental status. blood gases showed significant improvement. he was sent to the floor on an antimicrobial regimen which included vanc, , voriconazole, bactrim, azithromycin. these were progressively d/c'd, and the pt was weaned down to 0.5l nc and continued on azithromycin for infection prophylaxis and discharged to rehab. . #osteopenia, s/p laminectomy - pt has had multiple fractures in the past due to chronic steroid use. during this hospitalization, he fractured his distal ulnar after bumping it on a table. he fractured his r tibial plateau after bumping into a door while ambulating to the bathroom. ortho was consulted and for each fracture determined that no surgical intervention was warranted. while bending over to pull up his bed sheets, he experienced significant pain originating in his thoracic spine and radiating to his anterior chest. he had no neuro deficits on exam. an mri of his spine was obtained which showed new fractures at t5 and t7. ortho was again consulted and cleared him for ambulation they recommended cervicothoracic brace for comfort. he continued to have significant burning pain occassionally with movement. ortho was again consulted and we were planning on performing a vertebroplasty / kyphoplasty of both t5 and t7 for pain relief. pt was then noted to have acute sensorimotor loss below the level of t5-6 with complete loss of movement in the lower extremities, loss of rectal tone, fecal incontinence, and complete loss of sensation to the level of the t5-t6 dermatome on . he was sent for stat mri which showed a new epidural compression on t4/t5 with hyperdensity in that area, and new spinal cord signal change with edema. in the or a mass was removed from his cord. it is unclear what caused this acute cord compression, report from ortho that there may have been a "fat pad" in the epidural space, or trauma from one chest compression during his preceding code blue. he was taken urgently to the or for urgent t3-t7 laminectomy and fusion by ortho spine. endocrine was consulted for assistance with management of severe osteopenia and recommended that we continue to give high dose vitamin d and calcium supplementation daily. he did not have any motor function in his le, although he did have some remaining sensation in b/l le. he was discharged to rehab. . # retroperitoneal bleed - in preparation for vertebroplasty/kyphoplasty, the pt's warfarin was discontinued and he was started on a heparin gtt. the morning after initiation of the drip the pt was noted to be tachycardic on vitals and pale in appearance. the heparin gtt was turned off and a stat cbc showed a 7 point hct drop. he subsequently became hypotensive to the 70s. he was bolused 2l ns and given a total of 5 units of blood. he was transfered to the icu for further management and hemodynamic stablization. on arrival to the icu, patient had an acute episode of loc with bp drop to 40/doppler. a code blue was called and abruptly cancelled after patient awoke following one chest compression. a ct of the abdomen and pelvis was obtained which showed left perinephric retroperitoneal hematoma. anticoagulants were discontinued and patient remined hemodynamically stable. given that he was no longer a candidate for anticoagulation, in conjunction with a h/o multiple pulmonary embolisms, he was taken to ir for placement of an ivc filter which was placed on . . # chronic pain - pt has chronic neuropathic pain in le and also back pain from old compression fractures and hip / shoulder pain from avascular necrosis as complication of chronic steroid use. we initially continued his home doses of po dilaudid, oxycotin and gabapentin, but due to oversedation and respiratory compromise, his rx were adjusted. ultimately, the pain service was consulted and recommended celebrex, ritalin for synergy, apap, cymbalta, oxycontin, and small po doses of dilaudid for breakthrough pain. . # intermittent binocular diplopia: pt first noticed this while in the in early . the pt had anisocoria observed in in setting of nebulizers, and had head ct which was negative. pt had had cataract surgery in 04 and . also has intermittent blurry vision; has no h/o corrective eyewear. ophthalmology felt that the pt had significantly dry eyes and a decompensating exophoria - they recommended aggressive lub with artificial tear ointment and preservative free artificial tears q1h. his blurry vision and diplopia improved thereafter . # rle cellulitis - on presentation, his rle was significantly swollen and erythematous. leni's were obtained and negative for dvt. he had a puncture wound in his rle and from hitting his leg while walking at home. it was felt that he had a cellulitis of the rle. id was consulted and he was placed on vancomycin and meropenem for his cellulitis. he completed a two week course of iv antibiotics with significant improvement in erythema and swelling. his wounds were dressed daily per wound care recommendations. . chronic issues: . #dm ii- we continued twice per day dosing of nph which required frequent titration while on pulse dose steroid. he was also placed on humalog sliding scale for prandial coverage. on 4/12pm he triggered for fsg 29 (rpt 40) in the setting of no po intake for the entire day; was given 1 amp of d50; was tired but still responsive during that episode. . # pt was on chronic warfarin for mult pe in past. please see above retroperitoneal bleed for adjustments made to this regimen. . # htn- continued metoprolol. . # gvhd pt has been suffering from severe gvhd since his allo transplant in . he is on chronic prednisone at home. he was then placed on pulse dose steroids and given ivig which resulted in improvement in his respiratory symptoms. we continued acyclovir, bactrim and voriconazole for immunosuppression prophylaxis. . transitions of care: - cont azithromycin for infection prophylaxis - goal o2 sat 89-92% due to patient's history of osa and likely chronic hypoxia at baseline medications on admission: acyclovir - 400 mg tablet - 1 tablet(s) by mouth twice a day budesonide - 3 mg capsule, delayed & ext.release - 1 (one) capsule(s) by mouth three times a day please dispense 3 month supply folic acid - 1 mg tablet - 1 tablet(s) by mouth once a day gabapentin - 300 mg capsule - 1 capsule(s) by mouth three times a day please dispense 90 day supply hydromorphone - 4 mg tablet - 0.5 (one half) to 1 tablet(s) by mouth once a day as needed for pain insulin lispro - 100 unit/ml solution - as per sliding scale four times a day metoprolol tartrate - 25 mg tablet - 0.5 (one half) tablet(s) by mouth twice a day oxycodone - 40 mg tablet extended release 12 hr - 2 tablet(s) by mouth every eight (8) hours pantoprazole - 40 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth twice a day please dispense 3 month supply pravastatin - 40 mg tablet - 1 tablet(s) by mouth once a day prednisone - 10 mg tablet - 1 tablet(s) by mouth once a day please dispense 3 month supply sulfamethoxazole-trimethoprim - 400 mg-80 mg tablet - 1 tablet(s) by mouth daily (daily) warfarin - 4 mg tablet - 1 tablet(s) by mouth once a day or as directed medications - otc blood sugar diagnostic, disc - strip - use as directed 2-4 times a day cholecalciferol (vitamin d3) - 1,000 unit capsule - 1 capsule(s) by mouth once a day insulin syringe-needle u-100 - 31 gauge x " syringe - use as directed for insulin administration 3 times daily lancets misc. - kit - lancets for accu check cartridge twice a day nph insulin human recomb - (dose adjustment - no new rx) - 100 unit/ml suspension - 10 units subcutaneously twice a day peg 400-propylene glycol - (not taking as prescribed: pt states the eye drops sting his eyes and is no onger taking them) - 0.3 %-0.4 % drops, gel - 1 ribbon in each eye at bedtime peg 400-propylene glycol - (not taking as prescribed: pt states the eye drops sting his eyes and is no longer taking them) - 0.3 %-0.4 % drops - 1 gtt in each eye every hour medications: 1. acyclovir 400 mg tablet sig: one (1) tablet po q8h (every 8 hours). 2. calcitonin (salmon) 200 unit/actuation spray, non-aerosol sig: one (1) spray nasal daily (daily). 3. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 5. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 6. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q4h (every 4 hours) as needed for cough. 7. pravastatin 20 mg tablet sig: two (2) tablet po daily (daily). 8. sulfamethoxazole-trimethoprim 400-80 mg tablet sig: one (1) tablet po daily (daily). 9. voriconazole 200 mg tablet sig: one (1) tablet po q12h (every 12 hours). 10. cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po daily (daily). 11. gabapentin 300 mg capsule sig: one (1) capsule po bid (2 times a day). 12. polyethylene glycol 3350 17 gram powder in packet sig: one (1) powder in packet po daily (daily): hold for loose stool. 13. celecoxib 100 mg capsule sig: one (1) capsule po bid (2 times a day). 14. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 15. methylphenidate 5 mg tablet sig: one (1) tablet po bid (2 times a day): please give in morning and at noon. . 16. duloxetine 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 17. oxycodone 40 mg tablet extended release 12 hr sig: two (2) tablet extended release 12 hr po q12h (every 12 hours): hold for sedation or rr<10. 18. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q2h (every 2 hours) as needed for sob. 19. senna 8.6 mg tablet sig: two (2) tablet po bid (2 times a day). 20. docusate sodium 100 mg capsule sig: two (2) capsule po bid (2 times a day): hold for loose stool. 21. polyvinyl alcohol-povidon(pf) 1.4-0.6 % dropperette sig: two (2) drop ophthalmic q2-3h (). 22. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 23. sodium phosphates 19-7 gram/118 ml enema sig: one (1) enema rectal daily (daily) as needed for constipation. 24. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours): while awake. 25. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours): while awake. 26. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for heartburn. 27. white petrolatum-mineral oil 56.8-42.5 % ointment sig: one (1) appl ophthalmic qhs (once a day (at bedtime)). 28. hydromorphone 2 mg tablet sig: 0.5 tablet po q4h (every 4 hours) as needed for pain: hold for oversedation, rr< 10. 29. prednisone 10 mg tablet sig: one (1) tablet po qam (once a day (in the morning)). 30. prednisone 5 mg tablet sig: one (1) tablet po qpm (once a day (in the evening)). 31. famotidine 20 mg tablet sig: one (1) tablet po twice a day. 32. nph insulin human recomb 100 unit/ml suspension sig: thirty six (36) units subcutaneous qam. 33. humalog 100 unit/ml solution sig: five (5) units subcutaneous three times a day: at breakfast, lunch, and dinner. 34. humalog 100 unit/ml solution sig: as directed units subcutaneous as directed. 35. azithromycin 500 mg tablet sig: one (1) tablet po once a day. 36. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po every 6-8 hours as needed for nausea. disposition: extended care facility: diagnosis: graft versus host disease bronchiolitis healthcare-associated pneumonia vertebral cord compression vertebral compression fractures rib fractures condition: mental status: clear and coherent. level of consciousness: lethargic but arousable. activity status: bedbound. instructions: dear mr. , it was a privilege to provide care for you here at the hospital. you were admitted because you had a skin infection on your leg and shortness of breath. during your stay, you required a back surgery to fix the compression on your back, as well as antibiotics and other therapies for pneumonias and your gvhd. after you left the icu, your condition continued to improve, and you can be discharged to your rehab. your new medication list is attached. please take all of these medications as directed and no additional medications. followup instructions: department: bmt chairs & rooms when: at 10:30 am department: hematology/oncology when: at 10:30 am with: , rn building: sc clinical ctr campus: east best parking: garage department: hematology/bmt when: at 11:00 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: imageless computer assisted surgery excision or destruction of lesion of spinal cord or spinal meninges interruption of the vena cava other exploration and decompression of spinal canal closed [endoscopic] biopsy of bronchus dorsal and dorsolumbar fusion of the posterior column, posterior technique cardiopulmonary resuscitation, not otherwise specified repair of vertebral fracture biopsy of bone, other bones injection or infusion of immunoglobulin fusion or refusion of 4-8 vertebrae therapeutic photopheresis diagnoses: pneumonia, organism unspecified obstructive sleep apnea (adult)(pediatric) other chronic pain acute kidney failure with lesion of tubular necrosis long-term (current) use of steroids adrenal cortical steroids causing adverse effects in therapeutic use acute posthemorrhagic anemia acute and subacute necrosis of liver hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified mononeuritis of lower limb, unspecified acute and chronic respiratory failure personal history of other malignant neoplasm of skin pneumonitis due to inhalation of food or vomitus cardiac arrest cellulitis and abscess of leg, except foot long-term (current) use of insulin long-term (current) use of anticoagulants secondary hyperparathyroidism (of renal origin) obesity, unspecified glucocorticoid deficiency other disorders of neurohypophysis aseptic necrosis of head and neck of femur paraplegia disorder of bone and cartilage, unspecified mixed acid-base balance disorder myelopathy in other diseases classified elsewhere pathologic fracture of vertebrae other osteoporosis other specified alveolar and parietoalveolar pneumonopathies personal history of pulmonary embolism edema acute myeloid leukemia, in remission aseptic necrosis of head of humerus pathologic fracture of tibia or fibula chronic graft-versus-host disease complications of transplanted organ, stem cell pathologic fracture of distal radius and ulna exophoria 

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