Patent presenting to clinic today for cc of suction ankles PMH: DM Type I. HTN Mad List: furosemide 40mg daily [x 10 yr) clmesartan 20mg daily (x 7 days

Subjective Objective HPI: patent presenting to clinic today for cc of suction ankles PMH: DM Type I. HTN Mad List: furosemide 40mg daily [x 10 yr) clmesartan 20mg daily (x 7 days) for HTN NPHiregular insulin (varying doses) Vitals: BP 144/94 mm Hg (supine). 140/92 mmig (standing), P 89 5ipm, Temp: afabite Labs: 141 100 35 / 105 No er nary protein 50 22 181 Physical exam. Lungs; faint cracklos; Ext: Pitting edema in both ankJos Using cutput 10mLer on admission Scoring of Subjective/Objective: 0:25 points for each bulof (1.75 points total) Assessment Acula feral failure as indicated by abrupt Increase of 8Cr shivaind BUN, olizuna, and edema Acute renal failure likely at hemodynamic changes with the irritation of olmesartan Rak factors include: low sant diet, diuretic therapy, age, diabetes, high initial ARB dose (must indude two) Sonring of Assessment: 1 port for ench bullet (3 points tofal) Pun Discont nue cimesartan and allow menal function to nomaize Continue other meds.(wwich with diuretics – may want to decrease furosemide) Monhor. urine output, BLIN’SCr, edema, BP Recommend alemalive appropriate BP medication (CCB or beta blocker) Gon’s of therapy: BUN (< 25 modL), SCr (< 1.5 maidL), urine output |- 1.5 L/d) BP (130/80 mmig) Scoring of Plan: 2 points for die of almssarian 0 25 points for continue other medications 1 point for monitoring (0.25 points each for crine output, BUN/SCr, edema, BP 1 point for alternative BP med (0 5 points for drug, 0.25 points each for dose. Pequency) 1 point for goat’s of therapy 10.25 points each for BUN, SCr, urine output BP) (5.25 points total) Sign/Date Scoring 0.5 points each for signature and date (1 point total)