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: no known allergies / adverse drug reactions attending: chief complaint: nonhealing right heel ulcer major surgical or invasive procedure: : diagnostic angiogram : right below-knee popliteal artery to dorsalis pedis artery bypass with reversed saphenous vein graft history of present illness: mr. is a 58-year-old gentleman w/ pmhx significant for chronic systolic heart failure (ef 35-47%), cad w/ mi s/p cabg, htn, and dm (a1c 7.9%) who presented from for second opinion regarding treatment options of a nonhealing right heel ulcer in the setting of right lower extremity arterial disease. the patient has seen multiple doctors and been told he likely needs endovascular and/or bypass intervention. past medical history: chronic systolic heart failure cad w/ mi s/p cabg hyperlipidemia hypertension diabetes social history: lives in , speaks english/arabic. independent in adls denies tobacco/ etoh he has a very supportive wife who is here with him. family history: endorses family h/o congestive heart failure, mi, hyperlipidemia, hypertension, and kidney failure physical exam: physical exam: vitals: t: 98.4 p: 75 r: 20 bp: 131/76 sao2: 96% ra general: awake, pleasant and cooperative, nad. heent: nc/at, no scleral icterus noted, mmm, no lesions noted in oropharynx neck: supple, no carotid bruits appreciated. no nuchal rigidity pulmonary: lungs cta bilaterally without r/r/w cardiac: rrr, nl. s1s2, no m/r/g noted abdomen: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. extremities: rle with 1+ edema, surgical scar over medial r thigh c/d/i skin: no rashes or lesions noted neurologic: -mental status: alert, oriented x 3. able to relate history without difficulty with some help from his wife in translation. speech is fluent without dysarthria. able to name common objects (some appropriate difficulty given language barrier). able to follow both midline and appendicular commands. there was no evidence of apraxia or neglect. -cranial nerves: i: olfaction not tested. ii: perrl 3 to 2mm, somewhat irregular but equally reactive. funduscopic exam revealed no papilledema, exudates, or hemorrhages. pt had difficulty complying with visual field testing but appeared to have a subtle deficit to confrontation in the r upper visual field in the r eye greater than the left. iii, iv, vi: eomi without nystagmus. normal saccades. v: facial sensation intact to light touch. vii: no facial droop, facial musculature symmetric. viii: hearing intact to voice bilaterally. ix, x: palate elevates symmetrically. : 5/5 strength in trapezii and scm bilaterally. xii: tongue protrudes in midline. -motor: normal bulk, tone throughout. no pronator drift bilaterally. no adventitious movements, such as tremor, noted. no asterixis noted. delt bic tri wre ffl fe io ip quad ham ta edb l 5 5 5 5 5 5 5 5 5 5 5 5 5 5 r 5 5 5 5 5 5 5 5 5 5 5 5 5 5 -sensory: no deficits to light touch throughout. no extinction to dss. -dtrs: tri pat ach l 1 1 1 1 0 r 1 1 1 1 0 plantar response was mute bilaterally. -coordination: no intention tremor, no dysdiadochokinesia noted. no dysmetria on fnf bilaterally. -gait: deferred given recent rle surgery pertinent results: 05:00pm blood glucose-278* urean-26* creat-1.3* na-141 k-4.2 cl-105 hco3-27 angap-13 06:30am blood glucose-97 urean-28* creat-1.3* na-140 k-4.6 cl-105 hco3-26 angap-14 06:35am blood glucose-128* urean-23* creat-1.4* na-140 k-4.0 cl-103 hco3-26 angap-15 08:55am blood glucose-123* urean-23* creat-1.2 na-141 k-4.1 cl-106 hco3-26 angap-13 07:00am blood glucose-178* urean-24* creat-1.7* na-136 k-4.4 cl-105 hco3-19* angap-16 03:22am blood glucose-135* urean-28* creat-2.2* na-136 k-3.6 cl-106 hco3-17* angap-17 05:25am blood glucose-110* urean-41* creat-3.3* na-136 k-3.6 cl-105 hco3-17* angap-18 08:15pm blood glucose-229* urean-47* creat-2.6* na-139 k-3.2* cl-108 hco3-20* angap-14 12:53am blood glucose-185* urean-46* creat-2.4* na-145 k-4.0 cl-112* hco3-19* angap-18 05:00pm blood wbc-8.7 rbc-4.40* hgb-11.2* hct-33.3* mcv-76* mch-25.5* mchc-33.6 rdw-12.5 plt ct-270 08:55am blood wbc-7.7 rbc-4.23* hgb-10.6* hct-32.2* mcv-76* mch-25.0* mchc-32.8 rdw-12.7 plt ct-27 1 07:12pm blood wbc-8.7 rbc-4.07* hgb-10.7* hct-32.0* mcv-79* mch-26.2* mchc-33.3 rdw-14.0 plt ct-304 08:51am blood wbc-10.9 rbc-3.63* hgb-9.8* hct-28.4* mcv-78* mch-27.1 mchc-34.6 rdw-14.0 plt ct-218 05:25am blood wbc-7.6 rbc-3.43* hgb-9.0* hct-27.3* mcv-80* mch-26.1* mchc-32.8 rdw-13.9 plt ct-159 12:53am blood wbc-8.7 rbc-3.43* hgb-8.9* hct-27.7* mcv-81* mch-26.0* mchc-32.2 rdw-14.5 plt ct-339 wound cx: staph aureus coag +. klebsiella pneumoniae. ekg: sinus arrhythmia with ventricular premature beats. intraventricular conduction defect. inferior myocardial infarction, probably old. non-specific st-t wave abnormalities. no previous tracing available for comparison. ekg: sinus rhythm. baseline artifact. inferior wall myocardial infarction probably old. non-specific downsloping st segments with t wave inversion in leads i, avl and v3-v6. consider myocardial ischemia. compared to the previous tracing of the ventricular rate is faster. ventricular premature beat is absent. st-t wave changes are new stress test: possible ischemic ekg changes in the setting of prominent voltage with baseline nssttw. no anginal type symptoms. nuclear report sent separately. cardiac perfusion scan: fixed, large, severe perfusion defect involving the pda territory. reversible, small, moderate severity perfusion defect involving the lad (diagonal) territory. increased left ventricular cavity size. moderate systolic dysfunction with akinesis of the entire inferior wall and the mid and basal inferolateral walls. mri head: the brain parenchyma appears normal. there is no evidence of acute infarct, intracranial hemorrhage, or space-occupying lesion. ventricles, cortical sulci, and extra-axial csf spaces appear normal. brainstem and cerebellum appear normal. the flow voids of major vessels are preserved. there is fluid in right mastoid air cells. mucosal thickening is noted in the left mastoid air cells. polyp/retention cyst is noted in the right maxillary sinus. mucosal thickening is noted in bilateral ethmoid air cells and sphenoid sinus. post cataract extraction status is noted of the right globe. impression: 1. no evidence of acute infarct, intracranial hemorrhage, or space-occupying lesion. 2. polyp/retention cyst in the right maxillary sinus carotid artery duplex: findings: duplex evaluation was performed of bilateral carotid arteries. on the right there is no plaque seen in the ica . on the left there is no plaque seen in the ica. on the right systolic/end diastolic velocities of the ica proximal, mid and distal respectively are 61/14, 60/15, 66/19, cm/sec. cca peak systolic velocity is 78 cm/sec. eca peak systolic velocity is 60 cm/sec. the ica/cca ratio is .84 . these findings are consistent with no stenosis. on the left systolic/end diastolic velocities of the ica proximal, mid and distal respectively are 75/18, 69/21, 72/20, cm/sec. cca peak systolic velocity is 97 cm/sec. eca peak systolic velocity is 117 cm/sec. the ica/cca ratio is .77 . these findings are consistent with no stenosis. there is antegrade right vertebral artery flow. there is antegrade left vertebral artery flow. impression: right ica no stenosis. left ica no stenosis. ct scan of head: ct head without intravenous contrast: there is no acute intracranial hemorrhage, edema, mass effect or major vascular territorial infarct. ventricles and sulci are normal in size and symmetric in configuration. the basal cisterns are patent. there is no shift from normally midline structures. -white matter differentiation is well preserved. there are atherosclerotic calcifications in the intracranial vertebral arteries and the cavernous portions of the internal carotid arteries, bilaterally. the visualized paranasal sinuses and mastoid air cells are clear. no osseous abnormality is identified. impression: no acute intracranial process. if clinical concern for stroke remains, mri with dwi (if feasible) would be more sensitive. the study and the report were reviewed by the staff radiologist. 07:50am blood wbc-8.4 rbc-3.69* hgb-9.8* hct-31.1* mcv-84 mch-26.6* mchc-31.5 rdw-15.0 plt ct-486* 06:20am blood neuts-75.9* lymphs-14.4* monos-7.3 eos-1.7 baso-0.6 07:50am blood plt ct-486* 06:20am blood pt-12.5 ptt-27.3 inr(pt)-1.2* 07:50am blood glucose-126* urean-31* creat-1.6* na-140 k-4.5 cl-105 hco3-25 angap-15 04:46am blood ck-mb-3 ctropnt-1.05* 03:22am blood ck-mb-23* mb indx-5.3 ctropnt-2.22* cxr: single frontal view of the chest reason for exam: chf. comparison is made to prior study . cardiomegaly is stable. still mild pulmonary edema has markedly improved. sternal wires are aligned. basilar opacities, consistent with a combination of bilateral pleural effusions and adjacent atelectasis have improved. cath report: 1. selective coronary angiography of this right dominant system demonstrated severe native coronary artery disease. the lmca had severe diffuse disease. the lad was totally occluded proximally. the lcx had a total occlusion with long diffusely narrowed om or possibly ramus intermedius branch. the rca had total occlusion proximally. 2. arterial conduit angiography demonstrated a patent lima-lad with faint collaterals to the pda. the rima was atretic. the radial to d1 had a 90% proximal stenosis just after the ostium. 3. venous conduit angiography demonstrated an occluded svg-pda graft. 4. limited resting hemodynamics at the beginning of the case revealed elevated left-sided filling pressures with large v waves suggestive of acute mitral regurgitation. cardiac index was preserved (2.5l/min/m2) as calculated using the fick method. after initiation of dopamine and norepinephrine as well as insertion of an intra-aortic balloon pump the cardiac index was 4.2 l/min/m2 as calculated by the fick method. tee: normal left ventricular cavity size with mild-moderate regional systolic dysfunction c/w cad (rca/pda distribution). mild-moderate mitral regurgitation most likely due to papillary muscle dysfunction. pulmonary artery systolic hypertension. compared with the prior study (images reviewed) of , the left ventricular cavity is now smaller with improved global systolic dysfunction. the severity of mitral regurgitation is now reduced. brief hospital course: mr. was admitted to the vascular surgery service on for evaluation and treatment of a non-healing right heel ulcer. on admission, he was started on broad spectrum antibiotics and was transitioned to vancomycin and zosyn following wound culture speciation (mssa, klebsiella). as part of his evaluation of this nonheeling wound, he underwent a diagnostic angiogram on which demonstrated significant distal disease. as such, it was decided to proceed with a right below the knee popliteal to dorsalis pedis bypass using reverse saphenous venous graft. given mr. significant cardiac history, he was evaluated by cardiology pre-operatively and underwent a pmibi and echo, both of which demonstrated an ef ~35-40% with perfusion defect in pda territory and reversible perfusion defect within lad territory. he was medically optimized -- on anticoagulation with aspirin and beta-blocked --, and on elected to proceed with surgery. he did well immediately post-op, with his post-op ekg unchanged from prior. he was noted to have elevated troponins (0.02 -> 0.05), but given his lack of symtoms no interventions were deemed necessary at this time. on , however, pt was noted to have episode of nausea and small volume emesis. ekgs were obtained which demonstrated st changes in inferior leads. troponins were elevated to 0.09, and pt was started on heparin drip, per cardiology recommendations. throughout pod#1, pt was noted to become incresingly hypotensive with sbps trending from 110s--> 80s. he was treated with fluid boluses as appropriate and responded well. his hr remained 60s-80s. as his troponins continued to rise, with persistent st changes noted on follow-up ekg, the decision was made to proceed with cardiac catheterization on . had ostial occlusion of the radial -diag graft which, when injected gave him chest pain. subsequently got hypoxic (ao sats in 80s) and stat echo showed new severe mr (likely ischemic from injection). got intubated in lab. intervention to graft, admission to ccu. lactate was 1.9, weaned off dopamine, weaning fio2 -> 70% at 4am -> 60% at 5am titrating norepinephrine (currently at 1.5) to maintain map>55 and some urine output, hct at 0100 was 26.7, down from 32 at 1900. giving 1 unit prbc with 40mg iv lasix to accompany, dic labs - fibrinogen appropriately elevated, f/u serial abgs while giving blood -> lactate 3.3 at 3:40 am - turned down levophed, lasix at 5:15 was 1.6, but urine output not improved, at 4am, broadened abx to /zosyn (persistent fevers and rising lactate and slowly increasing wbc to 9.4), am cxr, looks like slightly worsening pulmonary edema midnight hct - 27.3, f/u am trough - 29.2, formal tte this am - normal left ventricular cavity size with mild-moderate regional systolic dysfunction c/w cad (rca/pda distribution). mild-moderate mitral regurgitation most likely due to papillary muscle dysfunction. pulmonary artery systolic hypertension. compared with the prior study (images reviewed) of , the left ventricular cavity is now smaller with improved global systolic dysfunction. the severity of mitral regurgitation is now reduced, ua, spin - per renal atn, cr up to 3.0, renal: recs - pt will need crrt soon. atn vs contrast induced . if o2 sat worsens start crrt. be very careful with hydration as pt making poor urine output. could use the cordis by changing over a wire for crrt if needed, 80mg lasix now, check is/os midday, f/u posttransf/pm hct - tfx goal 21 at 1700 - hct 26 prior to tfx last night now at 29.4 from 28.4 earlier this am, cont heparin for pump, graft, giving 500cc ns over 1hr at 11am, cr up to 3.0, decreased zosyn and changed it to q6 per pharmacy, crcl 35 with cr of 3.0. held pm , dose tomorrow am based on levels (need to reorder in am) maps in 50s, pap<20 at 4 am. per dr. , gave 500cc ns, renal recs- change zosyn to q8h, check serum albumin and keep map>65. no dialysis for now as uop slightly improving, wean balloon pump -> done, get groin and swan out -> done pm lytes, cbc -> hct down 2 pts, hemodynamically stable, groin hematoma unchanged off pressors, switch to bolus fentanyl, dcd gtt this am. pt was agitated and alert so restarted fentanyl gtt in afternoon. stop fentanyl drip at 3am while switching back to pressure support plan for 7-8am extubation with anesthesia present, dc heparin, gas today ph7.33/34/81/19, pm lactate and abg as bicarb down to 15 - lactate 0.9, abg: 7.33/29/117/15, is/os check - at 4pm was -1l today, pm lytes 3pm - bicarb down to 15, cr down to 3.0. k 3.7, recs -> start iss, put in attending, f/u kub called radiology - probably just gas, there is some air in small bowel but by no means dilated, some stool/air in rectum. large stomach is gastric ileus. no large gastric bubble from 16th or 17th on cxr. could give pills as long as not vomiting, needs decompression, level this am was 19.7, urine lytes: fena 0.8%, urine na 45 gave another dose , extubated, ngt placed, +bm after methylnaltrexone, 1l d5 1/2ns @75/hr as is fluid responsive to uop -> received 100cc then had episode of hypoxia, tachypnea, tachycardia, sounded very rhoncorous with copious secretions after suctioning, cxr with mild edema, gave 80iv lasix and nitro gtt for afterload reduction as ?flash edema. some response to lasix. also gave narcan for ?sedation related issues, no effect, repleted k, hr>90, bp>150 systolic, so started 2.5 iv metoprolol q6h, will uptitrate 2:30 am, much more alert, responsive to name, appropriate, caling out ?names? in arabic, good cough, swallowing secretions appropriately, continuing to have good urine output around 100cc/hr, bedside debridement of right heel, increase metoprolol to 5 mg iv q6h, on 5l nasal cannulae, cr improving, monitor pain and uptitrate as tolerated -> fine on standing tylenol, nutrition consult for tube feeds, replace ng-tube and restart tube feeds, transition meds to po once ng-tube placed, wean off nitro gtt, freq loose stools -> placed flexiseal, sent cdiff had minimal uop overnight (10cc/hr), ended up having some type of blockage, nurse deflated and inflated the balloon and he began to urinate, attempted bedside s&s, passed easily, started on po liquids and likely can adat in am, started isordil/hydral combo as no ace for bp control 5:30 am increasing o2 requirement up to 4l from 2l nc wheezy on exam, net positive fluid balance gave 40mg lasix. then addtl 80mg lasix, ng tube out cxr - 1. right internal jugular introducer remains in place, unchanged. a nasogastric tube is seen coursing below the diaphragm with the tip not identified. 2. increasing indistinctness of the pulmonary vascularity consistent with moderate pulmonary and interstitial edema. status post median sternotomy with stable cardiac enlargement and mediastinal contours. no pneumothorax. probable layering bilateral effusions. pt given neb, got tachycardic to 122. bp 148/73 started nitro gtt 6am. 2mg iv morphine, abg - 7.31 pco2 40 po2 67 hco3 21 basexs -5, advanced diet, , started insulin drip, placed 2xpiv, pulled trauma line no need for central access. creatinine up at 2.6, repleted k. nitro drip weaned off. main focus today is on afterload reduction: 25 carvedilol, trend i/o urine output remains low, adequate bp contol/ afterload reduction, free water deficit, hypernatremia, continue po intake, speech and swallow -> passed, carvedilol 25 -> got first dose then went into rapid afib, hydral / isosorbide if bp not controlled with incr carvedilol -> held all day due to afib with rvr and borderline bps, pt consult -> went into rapid afib at 11am with rvr to 180s, hemodynamically stable, received metop 5mg x3 with bp in the 80s and rate still 130-150. gave dig 0.25 iv x1 @1130, 0.25 iv @1330, 0.25 iv @1530 and 0.25 iv @1730, @1818 converted back into sinus, renal: signed off, may take few weeks for cr to normalize or might not recover to baseline, let him drink to correct na dig level on am labs - 1.2, switch insulin drip to glargine + sliding scale repeat ua/ culture - negative, podiatry: once platelets normal, will do woundvac again, for now duoderm dressing changes, hydralazine not given during day due to lowish bp, 1:30 am c/o nasal congestion, very uncomfortable particularly d/t foley and cannot sleep. very minimal crackles at bases otherwise lungs clear. denies cp. pt in sinus rhythm with hr 99 bp 118/64. was moving around adjusting wires trying to get settled bp up to 159 systolic transiently then 120s/50s having difficulty sleeping also c/o foley irritation. urine output minimal (last several hours 40, 20, 10), +600 since yesterday am. giving 40mg po lasix, 25mg trazodone, reassurance, and urojet. 4am appears dyspneic o2 sat in low 90s with 4l nc, increased crackles on lung exam. a-line not working and cant draw blood, was pulled. pt c/o very agitated by foley. feels clammy but fully oriented, blood sugar 150 he states this is extremely low for him (at home he is always over 200) so maybe some relative hypoglycemia pt given juice and claminess resolved. continues with dyspnea but o2 sats mid 90s on stable 3-4l nc. c/f flashing as bp up to 150 systolic. evening hydral and isosorbide were held in setting of hypotension yesterday. lungs now with increased crackles although not overwhelming. didnt put out to 40mg po lasix from earlier. ecg: nsr 100, no new st changes from prior. given 80mg iv lasix, restarted nitro gtt, put on facetent o2, cxr/ecg ordered, gave 2mg morphine, pt improving. by 4:45 pt had not put out any urine, gave another 20iv for total of 100mg iv + 40po earlier. my prelim read of cxr is pulm edema with increased vascular markings all the way up both lungs however comparison is when he experienced symptoms of flash pulm edema, it appears similar. no xr done in the interim. pt states he feels "better" now less dyspneic. abg 7.4/35/186/22. o2 sats mid 90s on 50% o2. new issues: wbc 19 today, thrombocytosis plts in 700s range dc hydralazine, changed iv protonix to famotidine po, more bp control - increased to 30 tid, podiatry- wound vac on. pm i/o and give small lasix bolus prn -net neg >500ccs and put out 1.15 l yesterday, small episode of nausea/vomiting, gave zofran, k of 3.8, ordered 20meq po at 2:30 will f/u with am labs. cr 1.9 started lisinopril, iron studies - started ferrous sulphate supplements nutrition consult, transfered back to vascular surgery - once transfered back to vascular surgery. vac was changed every three days. worked with pt. case management involved. pt ok for discharge. vna to change vac at hotel, also will get pt at hotel. medications on admission: atenolol 50qd , atorvastatin 20 mg qd, clopidogrel 75 mg qd, lisinopril 20 mg qd, mixtand 70/30 14uam 26pm discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin 40 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 3. carvedilol 12.5 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*2* 4. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily) for 30 days. 5. multivitamin tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. isosorbide mononitrate 30 mg tablet extended release 24 hr sig: three (3) tablet extended release 24 hr po daily (daily). disp:*90 tablet extended release 24 hr(s)* refills:*2* 9. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever/pain. disp:*120 tablet(s)* refills:*0* 10. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day). disp:*90 capsule(s)* refills:*2* 11. insulin fingerstick qachs insulin sc fixed dose orders breakfast bedtime glargine 30 units glargine 30 units insulin sc sliding scale breakfast lunch dinner bedtime humalog glucose insulin dose 0-70 mg/dl proceed with hypoglycemia 71-89 mg/dl 0 units 0 units 0 units 0 units 90-140 mg/dl 7 units 7 units 7 units 0 units 141-180 mg/dl 9 units 9 units 9 units 0 units 181-220 mg/dl 11 units 11 units 11 units 2 units 221-260 mg/dl 13 units 13 units 13 units 3 units 261-300 mg/dl 15 units 15 units 15 units 4 units 301-340 mg/dl 17 units 17 units 17 units 5 units >341 mg/dl 19 units 19 units 19 units 6 units 12. lantus solostar 100 unit/ml (3 ml) insulin pen sig: one (1) 30 units subcutaneous twice a day: 30 units . disp:*10 100 unit/ml (3 ml) insulin pen* refills:*2* 13. humalog kwikpen 100 unit/ml insulin pen sig: one (1) follow sliding scale as directed subcutaneous four times a day. disp:*20 humalog kwikpen (subcutaneous) 100 unit/ml insulin pen* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: right heel ulcer peripheral vascular disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: weigh yourself every morning, md if weight goes up more than 3 lbs. division of vascular and endovascular surgery lower extremity bypass surgery discharge instructions what to expect when you go home: 1. it is normal to feel tired, this will last for 4-6 weeks ?????? you should get up out of bed every day and gradually increase your activity each day ?????? ** you only bear weight through your forefoot/toes on the right side ** you may walk and you may go up and down stairs ?????? increase your activities as you can tolerate- do not do too much right away! 2. it is normal to have swelling of the leg you were operated on: ?????? it is very important that you elevate your legs above the level of your heart (use pillows or a recliner) throughout the day and at night ?????? avoid prolonged periods of standing or sitting without your legs elevated 3. it is normal to have a decreased appetite, your appetite will return with time ?????? you will probably lose your taste for food and lose some weight ?????? eat small frequent meals ?????? it is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ?????? to avoid constipation: eat a high fiber diet and use stool softener while taking pain medication wound care: you have a wound vac on your right heel. this will be changed three times per week by a vna or in the office. what activities you can and cannot do: ?????? no driving until post-op visit and you are no longer taking pain medications ?????? unless you were told not to bear any weight on operative foot: ?????? you should get up every day, get dressed and walk ?????? you should gradually increase your activity ?????? you may up and down stairs, go outside and/or ride in a car ?????? increase your activities as you can tolerate- do not do too much right away! ?????? no heavy lifting, pushing or pulling (greater than 5 pounds) until your post op visit ?????? you may shower (unless you have stitches or foot incisions) no direct spray on incision, let the soapy water run over incision, rinse and pat dry ?????? your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing over the area that is draining, as needed ?????? take all the medications you were taking before surgery, unless otherwise directed ?????? take one full strength (325mg) enteric coated aspirin daily, unless otherwise directed ?????? call and schedule an appointment to be seen in 2 weeks for staple/suture removal what to report to office: ?????? redness that extends away from your incision ?????? a sudden increase in pain that is not controlled with pain medication ?????? a sudden change in the ability to move or use your leg or the ability to feel your leg ?????? temperature greater than 100.5f for 24 hours ?????? bleeding, new or increased drainage from incision or white, yellow or green drainage from incisions vac dressing patient's discharge instructions introduction: this will provide helpful information in caring for your wound. if you have any questions or concerns please talk with your doctor or nurse. you have an open wound, as opposed to a closed (sutured or stapled) wound. the skin over the wound is left open so the deep tissues may heal before the skin is allowed to heal. premature closure or healing of the skin can result in infection. your wound was left open to allow new tissue growth within the wound itself. the wound is covered with a vac dressing. this will be changed around every three days. the vac: _ helps keep the wound tissue clean _ absorbs drainage _ prevents premature healing of skin - promotes healing watch for the following signs and symptoms and notify your doctor if these occur: temperature over 101.5 f or chills foul-smelling drainage or fluid from the wound increased redness or swelling of the wound or skin around it increasing tenderness or pain in or around the wound followup instructions: ophthalmology: provider: , md phone: date/time: 2:00 vascular: provider: , md phone: date/time: 2:00 podiatry: provider: , dpm phone: date/time: 8:05 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more coronary arteriography using two catheters enteral infusion of concentrated nutritional substances arteriography of femoral and other lower extremity arteries other (peripheral) vascular shunt or bypass excisional debridement of wound, infection, or burn implant of pulsation balloon insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: acidosis other iatrogenic hypotension subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery mitral valve disorders acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified coronary atherosclerosis of autologous vein bypass graft cardiac complications, not elsewhere classified atrial fibrillation other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure cardiogenic shock long-term (current) use of insulin diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled hyperosmolality and/or hypernatremia acute on chronic systolic heart failure atherosclerosis of native arteries of the extremities with ulceration ulcer of heel and midfoot acute respiratory failure following trauma and surgery sympathomimetics [adrenergics] causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to