View Patient Profiles

Tiggs, Kyra

MRN: 161023

Room: 525

DOB: 3/21/1971

Age: 54

Gender: Female

Allergies: Penicillin (rash)

Admit Notes

Clinical Notes

Vitals

Labs, Cultures, Imaging

Clinical Calculators

MAR

Current Orders

Home Med List

Med Reconciliation

Discharge Planning

Setting	Adult Medicine Unit
Scenario	In the emergency room, KT is diagnosed with atrial fibrillation and the medical team decides to pursue rate control. After receiving three doses of IV metoprolol tartrate, the patient reports improvement in her symptoms, denying further episodes of dizziness, palpitations, and shortness of breath. Repeat ECG demonstrates irregularly irregular rhythm and telemetry shows that KT’s heart rate is currently 80 bpm and blood pressure is 142/80 mm Hg. KT is admitted to the general medicine floor at midnight for further monitoring. Her HR remains controlled at 76 to 80 bpm and her blood pressure is stable at 142/80 mm Hg. Given resolution of symptoms, the medicine team decides to continue rate control therapy and transition KT back to oral metoprolol succinate. The physician is unsure what dose of metoprolol succinate to order and if anticoagulation is warranted or not, thus he consults you for rate control and anticoagulation recommendations. The physician would also appreciate other suggestions you have regarding this patient’s care.
Admission note taken on 10/18/25
CC	"My heart is beating very fast, I can’t breathe, and I have been tired and dizzy the past two days."
HPI	KT presented to the emergency room complaining of palpitations, shortness of breath, dizziness, and fatigue for the past two days. She endorses prior episodes that lasted a few days in the past but never sought further evaluation because she attributed dialysis to be the cause of her symptoms. KT reports her last dialysis session was October 6th and states she is 100% adherent to her dialysis schedule.
PMH	Systolic Heart Failure Hypertension Type 2 Diabetes End Stage Renal Disease (ESRD) on hemodialysis Tues/Thurs/Sat for past 4 years. Most recent SCr (today) was 8.14 mg/dL; patient is anuric
Social History	Alcohol Intake: Drinks cocktails occasionally (1-2 times a month) Tobacco: Denies Illicit drugs: Denies Employment: Works as a receptionist for a college of pharmacy Married for 24 years	Family History	Mother died from myocardial infarction at age 75 years Father still alive with history of hypertension and hyperlipidemia No siblings
Vaccine History	Up to date on childhood vaccines. Received Tdap booster 8 years ago, pneumococcal polysaccharide (PPSV23) 4 years ago, pneumococcal 13-valent conjugate (PCV13) 3 years ago, and influenza vaccine 2 years ago. Never received hepatitis B and human papillomavirus (HPV).	Surgical History	Fistula placement 4 years ago
Physical Exam	General: Pleasant overweight woman in mild distress ROS: positive for palpitations, fatigue, dizziness, and shortness of breath HEENT: PERRLA, EOMI, MMM Cardiovascular: irregular rate and rhythm, no murmurs/rubs/gallops Lungs: no wheezes/crackles/rhonchi bilaterally Abdomen: Soft, non-tender, nondistended Genitourinary: no vaginal bleeding, no discharge Extremities: no edema, no ulcers or rashes, fistula in right upper extremity Neuro: alert and oriented, no focal deficits, moving all extremities

Clinical Laboratory Report

Test Name	10/19/25	10/18/25	Range
Sodium (Na⁺)	137	139	136-145 mEq/L
Potassium (K⁺)	4.8	4.8	3.5-5 mEq/L
Chloride (Cl^-)	98	95	98-106 mEq/L
Bicarbonate (HCO₃^-)	28	27	23-28 mEq/L
Urea nitrogen (BUN)	29	29	8-20 mg/dL
Creatinine	8.14	8.4	0.5-1.3 mg/dL
Glucose	210	212	70-115 mg/dL
Hemoglobin A1c		8.6	5.3-7.5 %
Calcium,Total	8.5	8.6	8.6-10.2 mg/dL
Phosphate	3.6	3.7	3-4.5 mg/dL
Magnesium	2.0	2.1	1.6-2.6 mEq/L
Protein, total	5.2	5	5.5-9 g/dL
Albumin	3.1	3	3.5-5.5 g/dL
Aminotransferase,aspartate (AST)	20	20	10-40 units/L
Aminotransferase,alanine (ALT)	18	18	10-40 units/L
Lactic dehydrogenase (LDH)	151	155	80-225 units/L
Alkaline phosphatase	74	74	30-120 units/L
Bilirubin, Total	0.7	0.7	0.3-1 mg/dL
Leukocytes (WBC)	6.8	6.8	4.5-11 x10³/mcL
Red blood cells (RBC), Female	4.9	4.8	4.3-5.7 x10⁸/mcL
Hemoglobin, Female	9.8	10	12-16 g/dL
Hematocrit, Female	30	30.6	37-47 %
Mean corpuscular hemoglobin (MCH)	31	30	27-33 picogram
Mean corpuscular volume (MCV)	82	81	76-100 mcm³
Platelets	212	205	150-450 x10³/mcL
International normalized ratio (INR)	1	1	0.8-1.2
Prothrombin time (PT)	11.4	11.1	9.5-11.3 sec
Partial thromboplastin time,activated (aPTT)	33	33	25-35 sec

Additional Labs:

Fasting Lipids	Yesterday
TC (mg/dL)	181
TG (mg/dL)	146
HDL-C (mg/dL)	40
LDL-C (mg/dL)	102

Self-Monitoring Blood Glucose Log (mg/dL)
Date	After Waking Up	After Breakfast (2 hr)	After Lunch (2 hr)	After Supper (2 hr)
7 weeks ago	152	165		164
6 weeks ago	162		176
5 weeks ago	161	154	157	178
4 weeks ago	187	143	164
3 weeks ago		169		163
2 weeks ago			171	157
1 week ago	180	169	167	178

Cultures:

None

Imaging Studies:

Chest x-ray: Clear bilaterally, no opacities or other irregularities noted
ECG: Atrial fibrillation with rapid ventricular response with aberrantly conducted complexes
TTE: Hyperdynamic left ventricular function with ejection fraction visually estimated to be 35%

Vital Sign	10/19/25 09:53	22:10	16:50	10/18/25 09:43
Height (cm)	173			173
Weight (kg)	76			75
Body Temperature (°C)	36.7	36.7	36	35.6
Blood Pressure (mmHg)	150 / 82	151/80	153/80	153/79
Heart Rate (bpm)	118	115	121	120
Respiratory Rate (bpm)	22	22	21	22
Oxygen Saturation (%)	99	99	99	97

Current Orders

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

CONC	VOL	SOLN	RATE

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

CONC	VOL	SOLN	RATE

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

CONC	VOL	SOLN	RATE

USE	START DATE	STOP DATE	NOTES

Medication
History

KT’s medications are prescribed by her primary care physician and nephrologist.
KT reports 100% adherence to all medications, except metoprolol succinate, which she skips 2-3 doses of per week due to side effect of fatigue. She reports the last dose of metoprolol she took was 2 days ago.
She uses a pillbox to help her remember to take her medications.
KT also keeps a self-monitoring blood glucose log and checks her blood glucose intermittently at least 2-3x per day. (see lab section)

Home Medication List: verified by pharmacy on admit (10/18/25)

Patient Name: Tiggs, Kyra Date of Birth: 3/21/1971 Room#: 525	Allergies:	Immunization History:
Community Rx Info: Rx Insurance:	Social History:
Additional Notes:

DRUG STRENGTH DF	STRENGTH ROUTE FREQ	PRN?	ADHERENCE	MED REC ACTION
Metoprolol succinate 75 mg ER tablet	1 PO QAM	no	skips 2-3 times per week due to fatigue
Lisinopril 2.5 mg tablet	1 PO QAM	no
Semglee 100 units/mL pen	10 units SC HS	no
Fiasp FlexTouch 100 units/mL pen	4 units SC before meals	no
Renvela 800 mg tablet	2 PO TID	no
				Action Key: C = Continue, D = Discontinue^, H = Hold^, M = Modify^* ^*must provide reason

Medication	10/19/25	10/18/25
Sevelamer 1,600 mg PO TID	09:10 14:12 19:21
Lisinopril 2.5 mg PO QD	09:57
Insulin Glargine 10 units SC HS	21:47
Insulin Aspart sliding scale SC TID	06:26 11:20 16:33
Metoprolol tartrate 5 mg IV push STAT x3 doses		22:38 22:57 22:24

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: Tiggs, Kyra

Date of Birth: 3/21/1971

Room: 525

Medication (name/strength)	Dose	Route	Frequency	Notes

Height	173 cm
Actual Body Weight (ABW)	76 kg
Ideal Body Weight (IBW)	63.9 kg
ABW % of IBW	119 %
Adjusted Body Weight (AjBW)	68.7 kg
Body Surface Area (BSA)	1.91 m²
Body Mass Index (BMI)	25.4 kg/m²