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Campbell, Jay

MRN: 421946

Room: SC2

DOB: 6/18/1963

Age: 63

Gender: Male

Allergies: Aspirin (GI bleed), Egg and Strawberries (hives)

Admit Notes

Clinical Notes

Vitals

Labs, Cultures, Imaging

Clinical Calculators

MAR

Current Orders

Home Med List

Med Reconciliation

Discharge Planning

Setting

Primary Stroke Center ED

Scenario

The neurologist delegated the responsibility of ED medication orders and admission medications orders to the medical resident (see clinical note). You are the ED pharmacist on shift and the medical resident is requesting input for the acute care of this patient and any other pharmacotherapy recommendations that need to be addressed.

Admission note taken on 02/01/26

EMS pre-alerts the Primary Stroke Center they are arriving with a patient with facial droop and slurred speech and his last known well time (LKWT) is 1 hour 15 minutes before arrival in the emergency department.

HPI

Mr. Campbell was at work today at 11:00 am when he began experiencing symptoms typical of his migraine history. He told his coworker he was going to take his migraine medicine and an early break. The coworker went to the break room to check on him at 11:45. He found the patient was not feeling better; he was experiencing facial droop and he slurred his words when trying to explain how he felt. The coworker called 911. The patient arrives to the Primary Stroke Center via EMS at 12:15. A code stroke is called immediately, and the stroke team is assembled upon patient arrival to the Primary Stroke Center’s Emergency Department.

Stroke Evaluation Timeline and Imaging

Interval: Baseline
Time last known well: 11:00
Time of onset: 11:00

Time to evaluation and NIHSS: 12:20
POC glucose in the ED: 160 mg/dL at 12:22
Time of CT head: 12:25, read at 12:38

NIH Stroke Scale (NIHSS)
Person Administering Scale: Neurologist, on site

Category / Instructions	Patient Score / Description of Response
1a Level of consciousness	0=alert; keenly responsive
1b. LOC questions	0=Performs both tasks correctly
1c. LOC commands	1=Performs one task correctly
2. Best Gaze	1=Partial gaze palsy
3. Visual	0=No visual loss
4. Facial Palsy	2=Partial paralysis (total or near total paralysis of the lower face)
5a. Motor left arm	0=No drift, limb holds 90 (or 45) degrees for full 10 seconds
5b. Motor right arm	0=No drift, limb holds 90 (or 45) degrees for full 10 seconds
6a. motor left leg	0=No drift, limb holds 90 (or 45) degrees for full 10 seconds
6b Motor right leg	0=No drift, limb holds 90 (or 45) degrees for full 10 seconds
7. Limb Ataxia	0=Absent
8. Sensory	0=Normal; no sensory loss
9. Best Language	1 = Mild to moderate aphasia (this examiner feels it is at least moderate)
10. Dysarthria	1 = Mild to moderate dysarthria
11. Extinction and Inattention	1=Visual, tactile, auditory, spatial or personal inattention or extinction to bilateral simultaneous stimulation in one of the sensory modalities
Total	7

Interpretation of CT/CTA head/neck with and without contrast today at 12:25 (read at 12:38)

Head CT negative for intracranial hemorrhage.
Large vessel occlusion is ruled out by head CTA.
CTA neck demonstrating clinically insignificant bilateral calcific stenoses at the internal carotid artery origins.

PMH

Hypertension (2 months)
Migraine (11 years)
Diabetes, type 2 (8 years)
Obesity
GI bleed due to excessive consumption for migraines. The gastric ulcer was treated with a proton pump inhibitor and resolved, 13 years ago.

Social
History

Alcohol, occasionally 1-2 drinks less than 3 to 4 times a month
Cigarettes, quit 33 years ago; 5 pack-year history
Cigar smoking, occasionally
Recreational drugs, denies

Family
History

Grandmother suffered a large stroke (type unknown) at age 77, deceased age 81
Father is still alive and has COPD
Mother passed away due to cancer

Vaccine
History

Influenza vaccine: Flucelvax Quadrivalent (current season)
Pneumococcal vaccine: Pneumovax 23 8 years ago; Prevnar 13 2 months ago
Zoster vaccine: Shingrix, 1 dose 2 months ago
Tdap vaccine: Adacel 2 years ago when granddaughter was born
COVID-19 vaccine: Pfizer-BioNTech; 2 doses given 21 days apart 1 year ago

Surgical
History

Endoscopy – 13 years ago (gastric ulcer; H. pylori negative); resolved
Colonoscopy – 13 and 3 years ago (normal)
Vasectomy - 28 years ago
Tonsillectomy - 56 years ago

Physical Exam

ROS: Unable to obtain due to aphasia. He does minimally shake his head ‘no’ to questions about chest pain, shortness of breath, or palpitations.
General: well nourished, well developed, obese. Alert, cooperative, no apparent distress, appears stated age
Head: normocephalic, without obvious abnormality
Eyes: conjunctivae/corneas clear
Neck: supple, symmetrical. No carotid bruit
Lungs: clear to auscultation bilaterally, non-labored
CV: regular rhythm
Extremities: normal range of motion with no cyanosis
Skin: no skin lesions or lacerations

Clinical Laboratory Report

Test Name	02/01/26	05/07/25	Range
Sodium (Na⁺)	136	142	136-145 mEq/L
Potassium (K⁺)	3.8	4.1	3.5-5 mEq/L
Chloride (Cl^-)	100	105	98-106 mEq/L
Bicarbonate (HCO₃^-)	24	29	23-28 mEq/L
Urea nitrogen (BUN)	16	10	8-20 mg/dL
Creatinine	1.1	0.92	0.5-1.3 mg/dL
Glucose	167	139	70-115 mg/dL
Hemoglobin A1c		8.7	5.3-7.5 %
Calcium,Total	8.5	8.5	8.6-10.2 mg/dL
Phosphate	3.4		3-4.5 mg/dL
Magnesium	2.1		1.6-2.6 mEq/L
Protein, total			5.5-9 g/dL
Albumin	3.7		3.5-5.5 g/dL
Aminotransferase,aspartate (AST)	19		10-40 units/L
Aminotransferase,alanine (ALT)	47		10-40 units/L
Lactic dehydrogenase (LDH)			80-225 units/L
Alkaline phosphatase			30-120 units/L
Bilirubin, Total	0.6		0.3-1 mg/dL
Leukocytes (WBC)	5.2	6.1	4.5-11 x10³/mcL
Red blood cells (RBC), Male			3.8-5.1 x10⁸/mcL
Hemoglobin, Male	15.5	14.5	14-18 g/dL
Hematocrit, Male	43.2	40.7	42-50 %
Mean corpuscular hemoglobin (MCH)			27-33 picogram
Mean corpuscular volume (MCV)			76-100 mcm³
Platelets	170	162	150-450 x10³/mcL
International normalized ratio (INR)	1.01		0.8-1.2
Prothrombin time (PT)	10.9		9.5-11.3 sec
Partial thromboplastin time,activated (aPTT)	24.5		25-35 sec

Additional Labs:

Other Labs (Today)	Result
TSH, ultrasensitive (mIU/L)	1.39
25 Hydroxy Vit D (ng/mL)	52
PSA (ng/mL)	1.3

Fasting Lipid Panel (9 months ago)	Result
Total cholesterol (mg/dL)	207
LDL-C (mg/dL)	130
HDL (mg/dL)	30
Triglycerides (mg/dL)	236

Cultures:

None

Imaging Studies:

Test (Today)	Result
Transthoracic echocardiogram	Ejection Fraction is 60%. Mild aortic regurgitation.
ECG	normal sinus rhythm

Vital Sign

02/01/26
07:41

Height (cm)

Weight (kg)

Body Temperature (°C)

Blood Pressure (mmHg)

Heart Rate (bpm)

Respiratory Rate (bpm)

Oxygen Saturation (%)

Flowsheet	12:30	12:40	12:50	13:00	13:10
Height (cm)	180.3
Weight (kg)	106.4
Heart rate (bpm)	70	71	71		80
Resp rate (bpm)	23	26	21		26
BP (mmHg)	132/77	152/80	186/101	178/88	182/104

Current Orders

DRUG	DOSE	FREQ & TIME	PRN?

CONC	VOL	SOLN	RATE

USE	START DATE	STOP DATE	NOTES
			May increase 2.5 mg per hour if blood pressure exceeds 180 mmHg (systolic) or 105 mmHg (diastolic)

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES
			Begin after the nicardipine is discontinued

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?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES
			Verify the 24 hour follow up head CT is negative prior to administration

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?
			PRN headache or pain (1-6) or fever >37.2°C
USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?
			PRN migraine
USE	START DATE	STOP DATE	NOTES
			Maximum 1 dose per 24 hours

Medication
History

Upon query, spouse denies that he takes any other prescription, over the counter or natural/herbal remedies.

Home Medication List: verified by pharmacy on admit (02/01/26)

Patient Name: Campbell, Jay Date of Birth: 6/18/1963 Room#: SC2	Allergies:	Immunization History:
Community Rx Info: Rx Insurance:	Social History:
Additional Notes:

DRUG STRENGTH DF	STRENGTH ROUTE FREQ	PRN?	LAST DOSE (date/time)	NOTES	MED REC ACTION
Metformin XL 1,000 mg tablet	1 PO QD	no
Naratriptan 1 mg tablet	1 PO at migraine onset	yes, MRx1 in 4 hrs	Last dose ~11 AM today per EMS report of onscene co-worker statements 01/31/26	Migraine frequency has declined to 3 to 4 per year
Lisinopril/HCTZ 10 mg/12.5 mg tablet	1 PO QD	no
Blood glucose testing strips and lancets	used as needed	no
					Action Key: C = Continue, D = Discontinue^, H = Hold^, M = Modify^* ^*must provide reason

Medication	02/01/26
Nicardipine IV continuous Rate: 5 mg/hr
Lisinopril/HCTZ 10 mg/12.5 mg PO QD
Insulin glargine 10 units SC QD
Insulin lispro SLIDING SCALE SC TID w/meals
Nicotine transdermal 21 mg TOP QD
Atorvastatin 10 mg PO QD
Fondaparinux 2.5 mg SC QD
Metformin XL 1,000 mg PO QD
Acetaminophen 650 mg PO Q4H PRN PRN headache or pain (1-6) or fever >37.2°C
Naratriptan 1 mg PO at onset of migraine PRN PRN migraine

Clinical Notes

Neurologist Notes
-----------------
Assessment: Acute ischemic stroke, no evidence of cardiac involvement or actionable carotid stenoses

Patient is an IV alteplase candidate (decision time, 100 minutes from last known well time). He is not a candidate for mechanical thrombectomy since the CTA head shows no proximal disease in the anterior circulation. I reviewed the inclusion and exclusion criteria with the patient and his spouse (via telephone). I specifically explained the risks and benefits of IV alteplase. The spouse and patient agreed to proceed with IV alteplase.

Plan
Admit the patient to the Medical ICU for a minimum 24 hours during and status post thrombolysis at which time he may be transferred to the medical floor if his routine follow-up noncontrast head CT (performed 24 hours after thrombolysis) is negative for bleeding.

In addition, the following will be performed: telemetry monitoring, bedside swallow evaluation, transthoracic echocardiogram (TTE), PT/OT/SLP evaluate and treat and stroke education.

If at any time there is a change in neurological examination or a new onset headache perform a STAT head CT without contrast.

Medication Discharge Orders

Hospital 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: Campbell, Jay

Date of Birth: 6/18/1963

Room: SC2

Medication (name/strength)	Dose	Route	Frequency	Notes

Height	cm
Actual Body Weight (ABW)	kg
Ideal Body Weight (IBW)	-88 kg
ABW % of IBW	0 %
Adjusted Body Weight (AjBW)	-52.8 kg
Body Surface Area (BSA)	0 m²
Body Mass Index (BMI)	NAN kg/m²