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: oxycodone / percocet / hydrochlorothiazide / visipaque / tramadol attending: chief complaint: abdominal pain major surgical or invasive procedure: flexible sigmoidoscopy and total colectomy and ileostomy history of present illness: ms. is a 77 year-old woman with a history of aortic dissection status post repair, coronary artery disease status post bypass grafting, atrial fibrillation, mechanical aortic valve on coumadin, chronic kidney disease, recent right hip replacement who presented with a few weeks of intermittent abdominal pain and diarrhea. the diarrhea and abdominal pain started after her recent admission for right hip replacement. of note, transfer note from stated that patient's recent admission to hospital for right hip replacement was complicated by clostridium difficile. however, patient reports being told she had two negative tests for c. diff. past medical history: 1. anemia 2. chronic renal insufficiency status post right renal artery stent 3. hypertension 4. perioperative atrial fibrillation 5. history of gastrointestinal bleeding 6. history of transient ischemic attack in with aphasia that improved without treatment past surgical history: 1. splenectomy 2. s/p aortic root repair for dissection 3. 1-vessel cabg 4. aortic valve replacement (now on coumadin) allergies: visipaque (anaphyllaxis), hydrochlorothiazide, oxyycodone/percocet/tramadol (hallucinations: "seeing bugs") social history: she is an exsmoker with a 25 pack year history. she reports drinking 2 alcoholic drinks per month. family history: her mother-died at 63, htn, mi, chf, cva, dm. her father is on "digitalis". physical exam: admission exam: vs: 98.2 132/65 84 18 96% ra; generalized abdominal pain gen: no apparent distress initially, then had acute abdominal pain which caused mild distress heent: no trauma, pupils round and reactive to light and accommodation, no lad, oropharynx clear, no exudates cv: regular rate and rhythm, no murmurs/gallops/rubs pulm: clear to auscultation bilaterally, no rales/crackles/rhonchi gi: soft, tender to palpation in llq, non-distended; no guarding/rebound ext: no clubbing/cyanosis/edema; 2+ distal pulses neuro: alert and oriented to person, place and situation; cn ii-xii intact, motor function globally derm: no lesions appreciated discharge exam: general: patient doing well, ambulating with assist, patient measuring ileostomy output independently, pain controlled, respiratory status stabilized. vs: 98.4, 97.7, 55, 107/60, 16, 99%ra neuro: a&ox3 cardiac: afib on tell 70's-110 lungs: deminished at bases, no shortness of breath abd: soft, flat, ileostomy with liquid stool and gas, midline incision closed and intact staples removed and steri-strips applied. lower extremities: no significant edema, gait stable. pertinent results: admission labs: 05:07pm lactate-1.5 04:20pm glucose-102* urea n-22* creat-1.4* sodium-137 potassium-5.0 chloride-106 total co2-23 anion gap-13 04:20pm estgfr-using this 04:20pm alt(sgpt)-16 ast(sgot)-20 alk phos-99 tot bili-0.3 04:20pm lipase-62* 04:20pm albumin-2.5* 04:20pm wbc-7.7 rbc-3.26* hgb-9.5* hct-30.1* mcv-93 mch-29.1 mchc-31.4 rdw-18.2* 04:20pm neuts-76.2* lymphs-12.1* monos-11.0 eos-0.5 basos-0.3 04:20pm plt count-333 04:20pm pt-22.7* ptt-27.3 inr(pt)-2.2* microbiology: blood culture: negative 2:33 am stool consistency: not applicable c. difficile dna amplification assay (final ): negative for toxigenic c. difficile by the illumigene dna amplification assay. fecal culture (final ): no enteric gram negative rods found. no salmonella or shigella found. campylobacter culture (final ): no campylobacter found. fecal culture - r/o e.coli 0157:h7 (final ): no e.coli 0157:h7 found. urine culture: mixed flora 4:30 am immunology (cmv) source: line-picc. cmv viral load (final ): cmv dna not detected. 12:01 pm stool consistency: formed source: stool. fecal culture (final ): no enteric gram negative rods found. no salmonella or shigella found. campylobacter culture (final ): no campylobacter found. fecal culture - r/o e.coli 0157:h7 (final ): no e.coli 0157:h7 found. radiology: chest xray : 1. no acute cardiopulmonary process. 2. rounded opacity in the right hilum and possibly representative of a confluence of pulmonary vascular markings. however, dedicated pa and lateral chest radiographs are recommended for further evaluation. abdominal xray : distended loops of large bowel - correlate with findings from subsequent ct. ct abdomen/pelvis w/o contrast : this is a limited study due to the lack of intravenous contrast. 1. there is fecal loading noted throughout the entire colon. additionally, there is mild fascial thickening surrounding the descending colon along with mild wall thickening of the sigmoid colon. as a result, these findings may be a result of a mild colitis. otherwise, there is no evidence of perforation or other acute abdominal or pelvic processes. 2. there is a multi-septated fluid low density lesion on the right extending from the greater trochanter to the right gluteus medius measuring 8.4 (transverse) x 2.7 cm (antero-posterior) x 9.0 cm (craniocaudal) with evidence of peripheral calcifications. this colletion is not fully evaluated due to the lack of intravenous contrast but appears to be likely old given the calcifications. 3. stable infrarenal abdominal aortic aneurysm. 4. unchanged left adrenal nodule. 5. cholelithiasis without evidence of cholecystitis. ecg : sinus bradycardia. widespread t wave inversions. since the previous tracing of the rate is slower. atrial premature beat is not seen. t wave inversions are new. clinical correlation is suggested. sigmoidoscopy : - friability and congestion in the sigmoid colon compatible with colitis (biopsy) - normal mucosa in the rectum - otherwise normal sigmoidoscopy to 25 cm mr enterography : 1. left-sided colitis. differential diagnosis includes infectious and inflammatory causes, and ischemia cannot be excluded and clinical correlation is recommended. the findings appear a little bit more diffuse and progressive when compared to prior ct from . no bowel obstruction. 2. dependent gallstones identified within the gallbladder without evidence of gallbladder wall thickening or pericholecystic fluid. 3. stable left adrenal gland adenoma. 4. atrophic right kidney status post right renal artery stenting, with multiple simple renal cysts, unchanged when compared to prior ct. 5. infrarenal 3.7 x 3.9 cm abdominal aortic aneurysm, unchanged. unchanged occlusion of the . repeat sigmoidoscopy : - normal mucosa in the rectum - friability and erythema starting at ~15 cm - stenosis starting at 20 cm - otherwise normal sigmoidoscopy to 20 cm recommendations: the abnormal mucosa was not biopsied because of the patient's elevated inr (2.7). findings consistent with ischemic colitis. multi-disciplinary discussion scheduled for tomorrow with the patient, her family, her hospitalist team and colorectal surgery to determine plan moving forward. 05:20am blood wbc-6.4 rbc-2.61* hgb-8.0* hct-26.2* mcv-101* mch-30.8 mchc-30.7* rdw-18.1* plt ct-433 05:20am blood wbc-8.3 rbc-2.64* hgb-8.0* hct-25.8* mcv-98 mch-30.1 mchc-30.8* rdw-18.3* plt ct-367 04:19am blood wbc-8.9 rbc-2.69* hgb-8.1* hct-26.4* mcv-98 mch-30.1 mchc-30.6* rdw-18.3* plt ct-336 08:33am blood wbc-10.8 rbc-2.81* hgb-8.5* hct-27.2* mcv-97 mch-30.4 mchc-31.4 rdw-18.4* plt ct-304 05:32am blood wbc-11.5* rbc-2.80* hgb-8.5* hct-27.1* mcv-97 mch-30.4 mchc-31.4 rdw-18.5* plt ct-318 06:02am blood wbc-12.4* rbc-2.96* hgb-8.7* hct-28.2* mcv-95 mch-29.3 mchc-30.7* rdw-18.5* plt ct-283 05:20am blood wbc-13.6* rbc-3.07* hgb-9.4* hct-29.7* mcv-97 mch-30.7 mchc-31.8 rdw-19.0* plt ct-259 04:12am blood wbc-18.7* rbc-3.28* hgb-9.7* hct-30.8* mcv-94 mch-29.5 mchc-31.4 rdw-19.0* plt ct-245 06:02am blood wbc-20.3* rbc-3.03* hgb-9.2* hct-28.5* mcv-94 mch-30.3 mchc-32.2 rdw-19.5* plt ct-230 05:20am blood plt ct-433 05:20am blood pt-27.9* inr(pt)-2.7* 05:05am blood pt-25.6* ptt-48.3* inr(pt)-2.5* 03:00am blood ptt-50.5* 09:35pm blood ptt-46.4* 03:15pm blood ptt-52.1* 07:30am blood pt-22.3* ptt-51.9* inr(pt)-2.1* 03:00am blood ptt-56.2* 06:55pm blood ptt-48.7* 01:00pm blood ptt-60.2* 05:35am blood pt-23.9* ptt-62.8* inr(pt)-2.3* 05:20am blood pt-18.3* ptt-84.7* inr(pt)-1.7* 04:19am blood pt-14.5* ptt-53.2* inr(pt)-1.4* 08:33am blood plt ct-304 08:33am blood pt-14.4* ptt-78.4* inr(pt)-1.3* 05:32am blood pt-14.9* ptt-65.7* inr(pt)-1.4* 06:02am blood pt-14.3* ptt-56.4* inr(pt)-1.3* 06:15am blood pt-14.0* ptt-38.4* inr(pt)-1.3* 04:36am blood pt-15.4* ptt-32.9 inr(pt)-1.4* 02:45pm blood pt-13.2* ptt-29.9 inr(pt)-1.2* 05:33am blood pt-13.2* ptt-29.5 inr(pt)-1.2* 06:36am blood pt-14.5* ptt-53.0* inr(pt)-1.4* 04:55am blood pt-16.1* inr(pt)-1.5* 06:21am blood pt-20.6* inr(pt)-2.0* 04:14am blood pt-29.1* ptt-27.6 inr(pt)-2.8* 07:30am blood pt-25.0* ptt-62.6* inr(pt)-2.4* 05:25am blood pt-24.3* ptt-61.6* inr(pt)-2.3* 04:45am blood pt-19.2* ptt-65.0* inr(pt)-1.8* 06:33am blood pt-18.4* ptt-70.2* inr(pt)-1.7* 04:45am blood pt-18.0* ptt-72.2* inr(pt)-1.7* 08:24am blood pt-32.3* inr(pt)-3.1* 05:24am blood pt-31.8* inr(pt)-3.1* 05:18am blood pt-25.3* inr(pt)-2.4* 05:05am blood glucose-85 urean-26* creat-1.5* na-140 k-4.2 cl-111* hco3-19* angap-14 07:30am blood glucose-93 urean-29* creat-1.6* na-143 k-4.5 cl-112* hco3-23 angap-13 05:35am blood creat-1.6* na-143 k-4.3 cl-110* 05:20am blood glucose-82 urean-48* creat-1.5* na-144 k-4.9 cl-110* hco3-25 angap-14 04:19am blood glucose-110* urean-47* creat-1.5* na-140 k-4.8 cl-107 hco3-25 angap-13 08:33am blood glucose-102* urean-47* creat-1.5* na-141 k-4.3 cl-106 hco3-24 angap-15 05:32am blood glucose-89 urean-46* creat-1.5* na-141 k-4.3 cl-105 hco3-25 angap-15 06:02am blood glucose-102* urean-47* creat-1.6* na-143 k-3.3 cl-106 hco3-27 angap-13 05:20am blood glucose-105* urean-44* creat-1.7* na-142 k-3.3 cl-108 hco3-26 angap-11 04:12am blood glucose-115* urean-35* creat-1.8* na-140 k-3.5 cl-108 hco3-24 angap-12 06:02am blood glucose-108* urean-39* creat-1.9* na-138 k-4.2 cl-107 hco3-21* angap-14 05:45pm blood glucose-95 urean-38* creat-1.7* na-138 k-4.9 cl-106 hco3-24 angap-13 04:36am blood glucose-108* urean-44* creat-1.6* na-137 k-5.2* cl-105 hco3-24 angap-13 01:48pm blood glucose-158* urean-43* creat-1.1 na-134 k-4.6 cl-105 hco3-20* angap-14 04:55am blood glucose-99 urean-42* creat-0.9 na-134 k-4.8 cl-104 hco3-24 angap-11 06:21am blood glucose-106* urean-41* creat-0.9 na-135 k-4.4 cl-104 hco3-25 angap-10 06:06am blood glucose-94 urean-39* creat-0.8 na-136 k-4.0 cl-105 hco3-26 angap-9 05:25am blood glucose-113* urean-37* creat-0.8 na-138 k-3.7 cl-106 hco3-24 angap-12 01:11pm blood ck(cpk)-13* 05:20am blood ck(cpk)-16* 10:24pm blood ck(cpk)-17* 06:40am blood alt-65* ast-55* alkphos-106* totbili-0.2 06:40am blood alt-69* ast-71* totbili-0.2 05:56am blood alt-85* ast-116* alkphos-113* totbili-0.2 05:05am blood calcium-8.7 phos-3.9 mg-1.9 07:30am blood calcium-9.0 phos-4.2 mg-2.1 05:20am blood albumin-2.3* calcium-8.4 phos-4.5 mg-2.6 04:19am blood calcium-8.2* phos-4.2 mg-2.2 08:33am blood calcium-8.5 phos-4.1 mg-2.1 06:02am blood calcium-8.4 phos-3.5 mg-2.1 05:20am blood calcium-8.4 phos-2.6* mg-2.0 04:12am blood calcium-8.1* phos-2.7 mg-2.3 05:45pm blood calcium-8.0* phos-5.4* mg-2.0 04:36am blood calcium-7.5* phos-4.8* mg-1.9 06:05pm blood calcium-7.8* phos-5.3* 10:22am blood caltibc-100* vitb12-1189* folate-12.3 ferritn-163* trf-77* 08:00am blood triglyc-86 01:20pm blood osmolal-296 05:20am blood tsh-0.59 01:10pm blood crp-12.5* 07:57am blood crp-126.5* 06:56pm blood type-mix comment-green 01:46pm blood type- po2-43* pco2-36 ph-7.26* caltco2-17* base xs--9 comment-green top 05:17am blood lactate-1.2 06:56pm blood lactate-3.3* 10:22pm blood lactate-1.4 brief hospital course: 77 year-old woman with extensive cardiac history and vascular disease presented with several weeks of gastrointestinal symptoms after recently having had hip surgery. ct abdomen and sigmoidoscopy revealed colitis. infections including c. diff and cmv were ruled out. ultrasound was performed to assess blood flow. she had normal celiac and sma artery blood flow, but was not visualized. mre revealed chronically occluded and an infrarenal aaa. vascular said that no intervention needed to be done for the chronically occluded and the infrarenal aaa could be followed as an outpatient. of note, the patient fell during her inpatient stay without injury. her abdominal pain and loose stools. she was empirically hydrated to manage possible ischemic colitis and given a short course of steroids for possible ibd. biopsies from first sigmoidoscopy was non-diagnostic. a 2nd sigmoidoscopy was performed on which revealed new stricturing in the distal colon and no improvement in colitis, thus a diagnosis of ischemic colitis was made. the patient was transferred to the colorectal surgery inpatient and received bowel prep as well as was evaluated by the wound/ostomy nursing team for stoma marking. she underwent total colectomy with ileostomy on . the entire colon appeared diseased to some extent. intraoperatively she experienced atrial fibrillation with rapid ventricular response and was stabilized. she was sent directly to the icu after surgery for close monitoring. icu course: primary problem: # ischemic colitis s/p total colectomy with ileostomy. initially it was unclear what was causing her colitis. infections ruled out. ibd ruled out with biopsies and trial of steroids and antibiotics. supportive care was given with iv fluids without improvement. sigmoidoscopy was performed on . biopsies were taken that showed diffusely ulcerated mucosal fragments with extensive granulation tissue formation, chronic active inflammation and fibrinopurulent exudate. antibiotics were started, but stopped when colonic infections were ruled out. mre showed left-sided colitis, chronically occluded . after repeat sigmoidoscopy on showed worsening of colitis and showed new colonic stricturing, a diagnosis of ischemic colitis was made. the patient opted for surgical resection which took place on . in the , she required multiple fluid boluses as well as albumin for low urine output and sbps in the 80-90s. lactate was also elevated to 3.3 after her colectomy which improved to 1.2 with fluids. she did not require pressors and was mentating well despite her hypotension. her hemodynamics improved and she was transferred to the surgery service. other problems: # gnr bacteremia. she was found to have gnrs in her bcx from . she was started empirically on zosyn. # malnutrition, moderate, with albumin 2.1. patient was started on tpn on . # atrial fibrillation: rate controlled. she had an episode of rapid ventricular rate intra-operatively, but was stabilized. # pre-renal failure from poor po intake and increased gi losses. resolved with iv fluid resuscitation. # anemia, normocytic. received 1 unit prbc transfusion on units on . # coronary artery disease: s/p cabg, stable. not on asa because she is on warfarin. # aortic dissection s/p mechanical avr/aortic root repair, inr goal . warfarin stopped for surgery. she was started on a heparin gtt on pod1 for anticoagulation. # hypertension, benign, stable. # hyperlipidemia: continued home simvastatin the patient was transferred to the inpatient colorectal surgery floor on . the patient was stable. she was followed closely on the inpatient by the wound/ostomy nursing team, social work, and physical therapy. the geriatric medical team was consulted for medical recommendations. pn the patient was noted to have diminished lung sounds in the bases and slightly productive cough. her abdomen was documented by the nursing staff to be softly distended however, she had liquid green stool in the ostomy bag and gas. on restarted metoprolol 100 mg twice daily and coumadin mg with heparin gtt. the heparin drip was monitored closely with ppt values and the inr was monitored with a goal of 2.5-3.5. the patient was triggered for rapid heart rate and was found to be in rapid atrial fibrillation and was treated with intravenous lopressor. the patient had a chest film which showed: small-to-moderate bilateral pleural effusions which were unchanged from prior imaging. during this time, the patient was also noted to have hallucinations and confusion which was attributed to opioid medications. lisinopril was discontinued at recommendation of the geriatric medicine team. she was continued on amlodipine. overnight into the patient was noted to have nausea despite having output from ileostomy and a nasogastric tube was placed, the patient was npo with the ngt however continued tpn and pca pain medication. she continued to be treated with zosyn/ vancomycin iv. she was continued on the heparin drip throughout this time period. on the lopressor was increased to 100 mg tid for more effective blood pressure and heart rate control. the patient was noted to have crackled in lung bases bilaterally. on the patient's foley catheter was removed and her urine output was stable. on the jp drain was removed and the patient again restarted restarted coumadin 5mg daily. on the patient had adequate bowel function and the nasogastric tube was removed and the patient tolerated small amounts of a regular diet however continued tpn. the patient worked with physical therapy and began to increase her activity with assistance and her delirium cleared. the patient continued tpn and the vancomycin was discontinued. the patient's ambulatory sat 98% however she was triggered for rapid atrial fibrillation with a heart rate to the 140's. geriatric medicine was consulted on and evaluated the patient for acute pulmonary edema bpn was monitored, the patient's bun and creatinine was monitored closely and recovered steadily over this time period. on the patient received 10mg of coumadin, bag tpn, and her antibiotics were discontinued. the patient was evaluated for fluid overload lasix 20mg was started po (dry weight 131 from 121 on admission) bnp was 1247. she likely had congested heart failure. it was decided to discontinue the tpn and encourage a regular diet. the patient was started on pain medications by mouth which she tolerated well. her central venous line was removed. the patient was noted to have elevated ileostomy output on and she began to take a regimen of loperamide 4 tid, this proved to not be adequate to control her output on metamucil wafers were initiated twice daily which controlled the output nicely. on the patient's inr stabilized at 2.5 and the patient continued coumadin 4mg daily and the heparin drip was discontinued. the patient was noted to have an hematocrit of 25-26 which is the patient's baseline which she was monitored closely and treated as an outpatient with arenesp injections. the patient's outpatient provider was consulted and because of insurance issues, the patient was started on procrit and the first injection was given on . she will need to monitor the hematocrit and hemoglobin weekly on tuesday and if hemoglobin is greater than 11 hold wednesday dose. the patient has a follow-up appointment with nephrology to monitor this medication. the patient continued to have improved mental status and respiratory status. she was stable and ready for discharge and with insurance approval, the patient was ready for discharge to rehabilitation facility on . the staples were removed on and steri strips were applied and the incision was intact. the patient will be discharged on 4mg of coumadin daily. medications on admission: aranesp (polysorbate) 100 mcg/0.5 ml syringe every 3 weeks acetaminophen 500 mg 2 tablets by mouth four times a day as needed for pain calcitriol 0.25 mcg 1 capsule by mouth 2 days a week furosemide 20 mg 1 tablet by mouth once a day lisinopril 40 mg 1 tablet by mouth once a day simvastatin 10 mg 1 tablet by mouth once a day metoprolol tartrate 100 mg 1 tablet by mouth twice a day warfarin 5 mg 1-1.5 tablets by mouth once a day amlodipine 5 mg 1 tablet by mouth once a day gabapentin 100 mg 2 capsules by mouth 1 am, and 2 pm (never started) multivitamin one capsule by mouth daily coenzyme q10 100 mg 1 capsule by mouth daily discharge medications: 1. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 2. epoetin alfa 20,000 unit/ml solution sig: 20,000 units injection once a week: check hematocrit and hemaglobin weekly and hold for greater than hemaglobin greater than 11. 3. acetaminophen 650 mg/20.3 ml solution sig: six y (650) mg po q8h (every 8 hours) for 5 days: do not give more than 4000mg of tylenol daily. 4. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). 5. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day): continue until symptoms resolve. 6. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain for 5 days: hold for increased sedation. 7. furosemide 20 mg tablet sig: one (1) tablet po daily (daily): please monitor fluid balance by wght and ileostomy output. 8. loperamide 2 mg capsule sig: two (2) capsule po tid (3 times a day): ileostomt output should be 500cc-1200cc. 9. multivitamin tablet sig: one (1) tablet po daily (daily). 10. warfarin 4 mg tablet sig: one (1) tablet po once a day: please monitor inr, goal 2.5-3.5. 11. psyllium 1.7 g wafer sig: one (1) wafer po bid (2 times a day): monitor ileostomy output, should be 500cc-1200cc in 24 hours. 12. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: house nursing & rehabilitation center - discharge diagnosis: primary diagonses: - ischemic colitis s/p colectomy and ileostomy - malnutrition, moderate - acute kidney injury secondary diagnoses: - mechanical aortic valve replacement - atrial fibrillation - coronary artery disease - anemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were found to have ischemic colitis from vessel disease. this required you to have your colon removed on . you have recovered from this procedure well and you are now ready for dicharge to a rehabilitation facility. you are taking narcotic pain medications there is a risk that you will have some constipation. if you have any of the following symptoms please call the office for advice or go to the emergency room if severe: increasing abdominal distension, increasing abdominal pain, nausea, vomiting, inability to tolerate food or liquids, prolonged loose stool, or constipation. you have a new ileostomy. the most common complication from a new ileostomy placement is dehydration. the output from the stoma is stool from the small intestine and the water content is very high and you have had elevated ileostomy output and are currently on a regimen of imodium and metamucil wafers. the stool is no longer passing through the large intestine which is where the water from the stool is reabsorbed into the body and the stool becomes formed. you must measure your ileostomy output for the next few weeks. the output from the stoma should not be more than 1200cc or less than 500cc. if you find that your output has become too much or too little, please call the office for advice. the office nurse or nurse practitioner can recommend medications to increase or slow the ileostomy output. keep yourself well hydrated, if you notice your ileostomy output increasing, take in more electrolyte drink such as gatorade. please monitor yourself for signs and symptoms of dehydration including: dizziness (especially upon standing), weakness, dry mouth, headache, or fatigue. if you notice these symptoms please call the office or return to the emergency room for evaluation if these symptoms are severe. you may eat a regular diet with your new ileostomy. however it is a good idea to avoid fatty or spicy foods and follow diet suggestions made to you by the ostomy nurses. please monitor the appearance of the ostomy and stoma and care for it as instructed by the wound/ostomy nurses. the stoma (intestine that protrudes outside of your abdomen) should be beefy red or pink, it may ooze small amounts of blood at times when touched and this should subside with time. the skin around the ostomy site should be kept clean and intact. monitor the skin around the stoma for bulging or signs of infection listed above. please care for the ostomy as you have been instructed by the wound/ostomy nurses. you will be able to make an appointment with the ostomy nurse in the clinic 7 days after surgery. you will have a visiting nurse at home for the next few weeks helping to monitor your ostomy until you are comfortable caring for it on your own. you have a long vertical incision on your abdomen and the staples were removed from the incision line and replaced with steri strips prior to your discharge. this incision can be left open to air or covered with a dry sterile gauze dressing if the staples become irritated from clothing. please leave the steri-strips in place please monitor the incision for signs and symptoms of infection including: increasing redness at the incision, opening of the incision, increased pain at the incision line, draining of white/green/yellow/foul smelling drainage, or if you develop a fever. please call the office if you develop these symptoms or go to the emergency room if the symptoms are severe. you may shower, let the warm water run over the incision line and pat the area dry with a towel, do not rub. no heavy lifting for at least 6 weeks after surgery unless instructed otherwise by dr. or dr. . you may gradually increase your activity as tolerated but clear heavy exercise with dr. or . you will be prescribed a small amount of the pain medication oxycodone. please take this medication exactly as prescribed. you may take tylenol as recommended for pain. please do not take more than 4000mg of tylenol daily. do not drink alcohol while taking narcotic pain medication or tylenol. please do not drive a car while taking narcotic pain medication. thank you for allowing us to participate in your care! our hope is that you will have a quick return to your life and usual activities. good luck! followup instructions: please call the colorectal surgery clinic to make an appointment with , np for 2 weeks after discharge. please call the clinic at to make this appointment or with any questions or concerns related to your surgery or ileostomy output. department: west clinic when: monday at 2:30 pm with: , rn building: de building ( complex) campus: west best parking: garage department: div. of gastroenterology when: wednesday at 2:30 pm with: , md building: ra (/ complex) campus: east best parking: main garage department: cardiac services when: wednesday at 11:20 am with: , md building: campus: east best parking: garage procedure: parenteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of large intestine flexible sigmoidoscopy other permanent ileostomy open total intra-abdominal colectomy diagnoses: other iatrogenic hypotension abnormal coagulation profile other postoperative infection unspecified pleural effusion acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status other opiates and related narcotics causing adverse effects in therapeutic use chronic kidney disease, unspecified other and unspecified hyperlipidemia heart valve replaced by other means bacteremia other acquired absence of organ nausea alone personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation abdominal aneurysm without mention of rupture chronic vascular insufficiency of intestine delirium due to conditions classified elsewhere hip joint replacement hypertensive chronic kidney disease, benign, with chronic kidney disease stage i through stage iv, or unspecified other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms other colostomy and enterostomy complication hallucinations malnutrition of moderate degree cellulitis and abscess of buttock 

Answer: The patient is high likely exposed to