Mrs. Denman is a 63-year-old, insulin-dependent diabetic with a long history of peripheral vascular disease and multiple surgical procedures. She underwent a right transmetatarsal amputation in 1990 and subsequently underwent a right femoral distal saphenous vein bypass graft in 1991 which was later revised in 1992. In July of this year, she underwent a left superficial femoral artery to anterior tibial artery bypass using non-reversed basilic vein harvested from the right arm and had a large great toe ulcer, possibly attributed to hammertoe, which subsequently underwent a left great toe amputation. On the day prior to admission she was exercising with 4 pound weights on her legs with the physical therapist when she described a cool sensation in her foot and reported that her foot had been blue, and there were no Dopplerable pulses. Admission labs were unremarkable and she was placed on intravenous Heparin until the following morning. During Angiography Suite she was found to have two 95% stenosis in a long segment of the left SFA and the left distal SFA and anterior tibial vein graft was completely thrombosed. She was successfully treated with stent placement and received heparin and urokinase in the Intensive Care Unit overnight with a turn-over pulses of the left leg Doppler. During the remainder of the hospital course, her left foot remained pink and warm with an infection of exposed bone. She was discharged with Vancomycin 1250 mg IV q d, Ofloxacin 200 mg p.o. b.i.d., Coumadin with target INR of 2.0, last target 1.6, then received 10 mg in evening x 2., Percocet 1-2 tablets p.o. q 4 prn, Colace 100 mg p.o. b.i.d., insulin NPH 10 units subcu b.i.d., sliding scale insulin subcu q 4, Isordil 30 mg t.i.d., Zestril 5 mg q d, Lopressor 50 mg b.i.d., Axid 150 mg p.o. b.i.d. and was advised to follow up with Dr. Noah in one to two weeks.
Has the patient had multiple insulin nph prescriptions
insulin NPH 10 units subcu b.i.d., sliding scale insulin subcu q 4,