Create a FARM Note based on the given clinical case Components Notes Findings Assessment Recommendations/ Resolutions Monitoring/ Follow-up
# FARM Note
## Patient: Sarah Martin
**Date:** [Enter Date]
### Findings
- **Chief Complaint:** Concerned about blood sugar levels; has a headache.
- **History of Present Illness:**
- 43-year-old woman with a 6-month history of Type 2 Diabetes Mellitus.
- Currently on Glyburide 5 mg BID.
- Blood sugar levels ranging from 215–260 mg/dL; average fasting blood sugar is 170 mg/dL.
- Struggles with weight management (15 lb gain in the past year); reports poor dietary control due to work circumstances as a delivery person.
- Symptoms of nocturia, polyuria, and polydipsia daily.
- **Past Medical History:**
- Type 2 Diabetes Mellitus.
- Hypertension (15 years).
- Bipolar disorder (25 years).
- Dyslipidemia (10 years).
- Morbid obesity (15 years).
- **Family History:**
- Father: Hypertension, bipolar disorder.
- Mother: Dyslipidemia.
- Brother: Diabetes secondary to alcoholism.
- **Social History:**
- Married, two teenagers, delivery person.
- Denies tobacco use; occasional alcohol consumption (5 beers/wine/week).
- **Medications:**
- Glyburide 5 mg po BID
- Lisinopril 20 mg po once daily
- Zyprexa 5 mg po Q HS
- Carbamazepine 200 mg po TID
- Lorazepam 1 mg po TID PRN
- Fluoxetine 20 mg po Q AM
- EC ASA 81 mg po once daily
- Pravastatin 40 mg po once daily
- **Allergies:**
- Morphine—hives.
- **Physical Exam:**
- **Vital signs:** BP 165/90, P 98, RR 18, T 38.6°C.
- **Weight:** 109 kg, Height: 5'8'', waist circumference: 38 in.
- Clear lungs, normal heart rate and rhythm, mild foot calluses noted.
- 1+ protein in urine, (+) microalbuminuria.
### Assessment
- Ineffective diabetes management demonstrated by persistently high blood sugar levels and elevated A1C (8.9% six months ago).
- Obesity and recent weight gain complicating glycemic control.
- Hypertension and dyslipidemia not at target levels, which could increase the risk of cardiovascular complications.
- Symptoms related to bipolar disorder may influence eating habits and weight.
### Recommendations/Resolutions
1. **Medication Adjustments:**
- Consider reevaluating Glyburide therapy due to inadequate glycemic control; alternative options such as Metformin or a GLP-1 receptor agonist may be appropriate.
- Evaluate blood pressure medications; consider the addition of antihypertensive agents if BP remains elevated.
2. **Lifestyle Modifications:**
- Increase frequency of physical activity; recommend a tailored exercise plan that accounts for work schedule.
- Nutritional counseling to support healthy eating habits, focusing on meal planning despite work demands.
3. **Mental Health Support:**
- Referral to a mental health professional for better management of bipolar disorder, focusing on the emotional eating behaviors observed.
### Monitoring/Follow-up
- Schedule follow-up appointment in 4-6 weeks to reassess blood sugar levels, weight management, and medication effectiveness.
- Regular monitoring of blood pressure and lipid profile to ensure cardiovascular risk factors are addressed.
- Ongoing diabetes education and support, potentially in a group format, to reinforce lifestyle changes and medication adherence.
### Notes
- Continue to encourage the patient to monitor her blood sugar levels regularly and document her findings for follow-up discussions.
- Assess the need for ongoing education regarding the symptoms of hyperglycemia and hypoglycemia due to her current medication regimens.
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**Prepared by:** [Your Name, Credentials]
**Date:** [Enter Date]