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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. --- **Prepared by:** [Your Name, Credentials] **Date:** [Enter Date]