Professional Documents
Culture Documents
Case 12 Problem, Plans-1
Case 12 Problem, Plans-1
Gladys Forsythe
October 22, 2009
Problem List
Date of Onset
October 22, 2009
September 10,
Date recorded
October 22, 2009
October 22, 2009
Active
1) L MCA stroke
2) TIA
2009
2006
3) Chronic HTN
Unknown
Unknown
Unknown
Date of Onset
1959-1978
a. LVH
4) Degenerative joint disease
5) Alcohol: 1-2 cocktails most evenings
6) Family H/O breast cancer (mother)
Inactive
7) 19 pack year H/O smoking
Case 12
Gladys Forsythe
October 22, 2009
Goal: For patients who have had a stroke or TIA in the setting of severe large artery stenosis,
cautiously lower BP as tolerated without a specific BP goal.
Plan
Dx
R/O chronic HTN HPI, echocardiography, EKG
Rx
Losartan 50mg QD orally
#3 Dyslipidemia
Assessment: Patients stroke history and metabolic syndrome classifies her as a coronary
heart disease risk equivalent. Aggressive treatment is needed.
Goal: Target LDL level of < 70mg/dL to obtain maximum benefit.
Plan
Dx
R/O dyslipidemia - lipid panel, carotid duplex dopplers
Rx
atorvastatin 80mg QD orally
Pt Ed
Emphasize the importance of challenging herself to use her muscles as often as she can to
regain maximum function.
Aggressive lifestyle modifications to control her metabolic syndrome and prevent further
complications: Regular aerobic physical activity, salt restriction, limited alcohol consumption,
and a Mediterranean diet (rich in fruits, vegetables, olive oil, whole grains, low-fat dairy
products).
Follow/up
Mrs. Forsythe will return to the hospital in 2 week to monitor her progress, or go to the ED
immediately if symptoms reoccur. Plans for a left endarterectomy will be discussed.