View Patient Profiles

Petersen, Ellen

MRN: 269856

Room: ED3

DOB: 4/12/1986

Age: 38

Gender: Female

Allergies: NKDA

Admit Notes

Clinical Notes

Vitals

Labs, Cultures, Imaging

Clinical Calculators

MAR

Current Orders

Home Med List

Med Reconciliation

Discharge Planning

Setting	Emergency Department
Scenario	You are a pharmacist working in the Emergency Department. EP was instructed by her oncologist to come to the Emergency Department immediately from home, where she had a fever to 101.8°F.
Admission note taken on 05/13/24
CC	Since her last cycle of chemotherapy four days ago she reports feeling more fatigued, increased shortness of breath and decreased oral intake. She reports an episode of chills on the way to the Emergency Department.
HPI	She states her abdominal and right hip pain that she has had for the past 6 months has been increasing over the last 2 weeks and she has been taking her morphine immediate release every 2 hours for the last 5 days. She currently rates her pain an 8 out of 10. Her desirable pain level is a 2 out of 10 or less. Her last bowel movement was 4 days ago. Patient reports she normally has one bowel movement per day. Plan: Admit to oncology unit for management of fever of unknown origin. Patient placed on 2 liters oxygen by nasal cannula with oxygen saturation of 99%.
PMH	Breast Cancer Stage IV, diagnosed 18 months ago 8x7cm right breast mass with 1 cm right axillary lymph node Metastases to liver, and several bone metastases (thoracic and right hip) s/p doxorubicin + cyclophosphamide, followed by paclitaxel x 4 cycles (14 months ago) s/p right mastectomy (12 months ago) persistent tumor: 6/37 lymph nodes positive s/p vinorelbine x 4 cycles (7 months ago), CT chest scan: multiple bilateral pulmonary nodules (biopsy + for adenocarcinoma consistent with breast cancer) s/p capecitabine 4 months ago stopped secondary to toxicity (hand-foot syndrome) Current therapy: gemcitabine 800mg/m2 IV Day 1 and 8 + carboplatin AUC 2 Day 1 and 8, cycle repeated every 21 days Depression x 1 year
Social History	Tobacco: 0.5ppd x 2 years, none for 19 yrs ETOH: 1 glass of wine on weekends Illicit Drugs: marijuana in college, none for 18 yrs Caffeine: 1-2 cups/day Occupation: real estate agent Status: married Children: 2 daughters, ages 4 and 6 Physical Activity: minimal to none Diet: Tried a low-fat, low cholesterol diet a year ago, but didn’t like it. Normal diet since.	Family History	Father: age 63, hypertension, hyperlipidemia, Crohn’s Disease Mother: age 62, arthritis, diabetes Sister: age 40, benign breast cysts Brother 1: age 36, healthy Brother 2: age 35, hyperlipidemia
Vaccine History	None	Surgical History	None
Physical Exam	Gen: Caucasian, female, pale and ill-appearing HEENT: PERRLA, EOMI, dry mucous membranes, no sores or thrush Skin: + skin tenting; no rashes, lesions or ulcers. Hickman catheter non-tender, non-erythematous. 2 tattoos on lower back Neck: no JVD, no thyromegaly Chest: right mastectomy- well healed incision Heart: tachycardia, no murmur Lungs: clear to auscultation, percussion Abdomen: mild RUQ pain, pain not increased with palpation; no hepatosplenomegaly, + bowel sounds GU: benign Extremities: warm to touch, no edema, pedal pulses present Neuro: cranial nerves intact, alert and oriented x 3 Rectal: stool guaiac negative

Clinical Laboratory Report

Test Name	05/13/24	05/02/24	Range
Sodium (Na⁺)	139	135	136-145 mEq/L
Potassium (K⁺)	4.4	4.2	3.5-5 mEq/L
Chloride (Cl^-)	103	101	98-106 mEq/L
Bicarbonate (HCO₃^-)	22	26	23-28 mEq/L
Urea nitrogen (BUN)	44	14	8-20 mg/dL
Creatinine	1.5	0.8	0.5-1.3 mg/dL
Glucose	68	84	70-115 mg/dL
Hemoglobin A1c	6.9	6.9	5.3-7.5 %
Calcium,Total	8.6	9.5	8.6-10.2 mg/dL
Phosphate	4.0	4.1	3-4.5 mg/dL
Magnesium	2.1	1.9	1.6-2.6 mEq/L
Protein, total	6.2	6.2	5.5-9 g/dL
Albumin	3.4	3.4	3.5-5.5 g/dL
Aminotransferase,aspartate (AST)	38	36	10-40 units/L
Aminotransferase,alanine (ALT)	44	41	10-40 units/L
Lactic dehydrogenase (LDH)	86	89	80-225 units/L
Alkaline phosphatase	49	47	30-120 units/L
Bilirubin, Total	1.0	0.9	0.3-1 mg/dL
Leukocytes (WBC)	1.1	7.8	4.5-11 x10³/mcL
Red blood cells (RBC), Female	4.3	4.6	4.3-5.7 x10⁸/mcL
Hemoglobin, Female	8.0	10.2	12-16 g/dL
Hematocrit, Female	21	29	37-47 %
Mean corpuscular hemoglobin (MCH)	35	35	27-33 picogram
Mean corpuscular volume (MCV)	91	88	76-100 mcm³
Platelets	166	170	150-450 x10³/mcL
International normalized ratio (INR)	1.1	1.0	0.8-1.2
Prothrombin time (PT)	9.6	9.6	9.5-11.3 sec
Partial thromboplastin time,activated (aPTT)	23.4	21.2	25-35 sec

Additional Labs:

Differential	Today	4 Days Ago	11 Days Ago
Segs	29%	50%	73%
Bands	0%	0%	0%
Lymphs	71%	47%	25%
Monos	0%	3%	2%

Fasting	Last Month	13 Months Ago
TC (mg/dL)	195	204
LDL (mg/dL)	150	138
Trigs (mg/dL)	178	165
HDL (mg/dL)	41	42

Urinalysis	Today	10 Months Ago
Glucose	neg	neg
Ketones	neg	neg
spec grav	1.042	1.010
Blood	neg	neg
pH	7.0	6.5
Protein	neg	neg
Leuk Est	neg	mod
Nitrite	neg	pos
WBC	0	1-2
RBC	0	0
Bacteria	0	many

Cultures:

Cultures (today):

Blood Cultures: 2 sets of cultures sent- one peripheral and one from Hickman catheter
Urine Culture: obtained specimen and sent to microbiology

Imaging Studies:

Chest X-ray:

Today: No infiltrates seen. Bilateral pulmonary nodules again seen as noted in CT chest scan (7 months ago).
6 Months Ago: Resolution of consolidation seen on last chest film; Lungs are clear. No pleural effusions or pneumothorax.
10 Months Ago: Left lower lobe consolidation consistent with pneumonia; right lung clear.

Vital Sign	05/13/24 08:21	05/02/24 08:39
Height (cm)	168	168
Weight (kg)	84.8	86
Body Temperature (°C)	38.9	36.8
Blood Pressure (mmHg)	90 / 60	122/78
Heart Rate (bpm)	134	66
Respiratory Rate (bpm)	26	16
Oxygen Saturation (%)	92	98

Current Orders

Medication
History

None on file.

Home Medication List: verified by pharmacy on admit (05/13/24)

Patient Name: Petersen, Ellen Date of Birth: 4/12/1986 Room#: ED3	Allergies:	Immunization History:
Community Rx Info: Rx Insurance:	Social History:
Additional Notes:

DRUG STRENGTH DF	STRENGTH ROUTE FREQ	PRN?	NOTES	MED REC ACTION
gemcitabine 800 mg/m2 IV	Day 1 & 8 every 21 days	no	oncologist plans on treating patient for 4 cycles and then repeating CT scans to determine response
carboplatin AUC 2 IV	Day 1 & 8 every 21 days	no	oncologist plans on treating patient for 4 cycles and then repeating CT scans to determine response
Ondansetron 8 mg tablet	1 PO on days of chemo and then Q8H PRN	yes, nausea or vomiting	also took with other chemotherapy regimens
Lorazepam 1 mg tablet	1 PO Q6H	yes, anxiety	husband reports she has taken 2 doses each of the last 2 days
Prochlorperazine 10 mg tablet	1 PO Q6H	yes, nausea or vomiting
Zoledronic acid 4 mg IV	Infuse every 28 days	no
Epoetin alfa 40,000 units SC	Inject every week	no	last dose: 9 am, 4 days ago
Escitalopram 20 mg tablet	1 PO QD	no	increased from 10 mg 5 months ago
Morphine sulfate 60 mg ER tablet	1 PO BID	no	increased from 30 mg 4 months ago
Morphine sulfate 15 mg IR tablet	1 PO q4Hr	yes, break-through pain	has been taking every 2 hours for last 5 days
Docusate sodium 100 mg capsule	1 PO BID	no
Senokot 8.6 mg tablet	1 PO BID	no
				Action Key: C = Continue, D = Discontinue^, H = Hold^, M = Modify^* ^*must provide reason

Medication

05/13/24

Clinical Notes

Medication Discharge Orders

Hospital Medications
Medication	Instructions	Comments	Continue	Modify	Discontinue	New Rx sent

Previous Home Medications
Medication	Instructions	Comments	Continue	Modify	Discontinue	New Rx sent

Discharge Planning - Medication List and Instructions

Patient Name:
Admission Date:	Discharge Date:	Service:
Principle Diagnosis on Admission:
Secondary Diagnosis:
Allergies:

Medications ADDED this visit: (begin taking these)	Medications CHANGED this visit: (modify what you were taking)	Medications STOPPED this visit: (stop taking these)

Final Discharge Medication List
Medication/Route/Dosage/Frequency/Duration	Comments	Morning	Afternoon	Evening	Bedtime










As Needed Medications

Medication Reconciliation - Finalized Medication List

Patient Name: Petersen, Ellen

Date of Birth: 4/12/1986

Room: ED3

Medication (name/strength)	Dose	Route	Frequency	Notes

Height	168 cm
Actual Body Weight (ABW)	84.8 kg
Ideal Body Weight (IBW)	59.3 kg
ABW % of IBW	143 %
Adjusted Body Weight (AjBW)	69.5 kg
Body Surface Area (BSA)	1.99 m²
Body Mass Index (BMI)	30 kg/m²