Arnold & Marie Schwartz College of Pharmacy and Health Sciences

Long Island University

FARM NOTE #2
Student: Chinida Gulkarova

Identification #: 100417562

Site: Kingsbrook Jewish Medical Center

Medical Record # 0489370
105A
Sex: Female

Age:86

Patient #: 10640727
Weight: 120lb

Date: 11/13/2015
Preceptor: Henry Cohen

Admit: 11/05/2015
Height: 5'7''

Room/Bed:

Race: African American

Findings:
Subjective: An 86 year old Female was admitted to the ICU for swelling on the tongue due to a bee
sting. She was recently admitted to the ICU 4 weeks ago for angioedema and taking enalapril at that
time. Patient was monitored at ICU and no respiratory compaint. Normal speech and language, able to
follow simple commands. Chief complaint is edema angioneurotic.
Objective
History of Present Illness: Patient has a Hx of benign HTN, HLD and angioedema. Patient has a
moderate allergy to bee sting and breaks into hives. Develops angioedema from enalapril. No known
food allergies.
Social history: N/A
Family history: N/A
Medication history:
Dexamethasone (Decadron) 1.5 mg PO Q12H daily X 24 hours
warfarin (coumadin)
Vital Signs: Temperature: 97.9F
RR: 18 breaths/min
BP: 149/69
HR: 74 bpm
Lab Values:
Glucose: 159 mg/dL (80-100mg/dL ) HIGH
BUN: 23 mg/dL (8-20 mg/dL ) HIGH
Na: 139 mEq/L (136-145mEq/L )
K: 4.0 mEq/L (3.5-5.1mEq/L )
Cl: 104 mEq/L (98-107mEq/L)
CO2: 26 mEq/L (23-29mEq/L)

Cholesterol 320mg/dL (140-200mg/dL) HIGH

LDL: 230 mg/dL (0-130mg/dL) HIGH
HDL: 81 mg/dL (35-85 mg/dl)
Creatinine: 0.9 (0.5-1.5 mg/dL)
RBC count: 3.88L (4.2-5.5/L) LOW
Hematocrit: 36% (37-47)
LOW
Hemoglobin: 11.2 g/dL (12-16) LOW
MCV: 91.5 L (81-99)
MCH: 28.9 L (27-31)
MCHC: 31.6 g/dL (32-36) LOW
RDW: 13.3% (11.5-14.5)
Neutrophil: 88.2% (55-75%) HIGH
Lymphocyte: 8.4% (20-40%) LOW
Monocyte: 3.3% (2%-8%)
Eosinophil: 0.1% (1%-4%)
LOW
CrCl: (140-86)* (66.1 kg)
___________________ X 0.85 = 46.82 ml/min
0.9 mg/dL * 72

Assessment:
Patient is stable after got 2 EpiPen injections before coming to the hospital and dexamethasone and
benadryl by EMS. Tongue swelling went down and ready to be discharged. Her lab values indicate that
her cholesterol is high and LDL is high and is being treated for HLD. Patient has hypertension and her
blood pressure reading is high (149/69). The patients glucose level is high (159 mg/dL). Patients
glucose was rather high 159 mg/dL.

Recommendations:
Pharmacological: According to ACC/AHA Guidelines 2013 since the patients LDL is greater than
190mg/dL the patient should initiate a high intensity statin Rosuvastatin 20mg daily.
Non-pharmacologic: Patient should be on a low fat, low cholesterol diet. The patient should be on a
DASH diet to help lower her blood pressure and will also lower her fat intake on the DASH diet to help
her cholesterol. Patient should consume only 2 grams or less of salt a day for his hypertension. The
patient should watch how much sugar she consumes as well.

Monitoring:
Patient should monitor his intake of sugar and salt intake to make sure it does not increase further.
Patient should notify health care provider if any swelling of the tongue occurs due to the bee sting.
Patient should monitor for any signs of muscle discomfort while taking rosuvastatin. Patient should
monitor her blood pressure regularly.

References:
1. Atorvastatin. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Hudson, OH. Available at:
http://0-online.lexi.com.liucat.lib.liu.edu/lco/action/doc/retrieve/docid/patch_f/6396. Accessed on
November 8, 2015.
2. Your Guide To Lowering Your Blood Pressure With DASH. National Heart, Lung and Blood
Institute 2006. Available at: https://www.nhlbi.nih.gov/files/docs/public/heart/dash_brief.pdf. Accessed
November 8 2015.