Case Study Scenario
Jack is a 54-year-old patient who has difficulty coming in for primary care visits. He seen in a cardiology clinic, a pulmonology clinic, and an endocrinology clinic for his comorbid conditions of postcoronary artery bypass grafting (CABG) 2 years ago, Type 2 diabetes mellitus, and mild chronic obstructive pulmonary disease from a 30 pack year history of smoking. His last visit with you was over a year ago. Today, your registered nurse brings you a telephone triage call requesting a refill of his Crestor prescription, which was ordered by cardiology soon after his CABG. Per the electronic links to the cardiology service within your facility, the medication was due to be renewed about 2 months ago. His last lipid labs were a year ago and his last complete metabolic panel (CMP) was done at the same time. He was recently at the pulmonary clinic and his last recorded HgA1C was 9.0 from a visit to endocrine 4 months ago.
Review of records include a prescription for Lisinopril 20 mg PO daily for his hypertension, metformin 1,000 mg PO twice a day for his diabetes, and no known medications for his pulmonary issues. The Crestor prescription for hyperlipidemia appears to have multiple dosing levels over the past few refills.
His last vital signs were blood pressure (BP) 170/110 mm Hg, pulse 88, and respirations 22. His body mass index is 30 and he indicates a pain level of four out of five. His pulse oximetry was 92% on room air.
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