clinical pharmacist interventions

1. CASE PRESENTATION OF POST
MENOPAUSAL PROCIDENTIA
DONE BY A.J.VISHALI

2. PATIENT DEMOGRAPHIC DETAILS:
PATIENT NAME:jayapradha
AGE: 60yrs
SEX: female
WEIGHT:54kgs
HEIGHT:156cms
BMI:22.2
IBW:48.7kgs
BSA:1.53m2
DOA:23-5-18
DOD:22-6-18
DEPARTMENT: GYNECOLOGY AND OBSTETRICS.

3. S-SUBJECTIVE EVIDENCE
CHIEF COMPLAINTS: 60yrs old, post menopausal
women, P3L3 came with complaints of mass per
vaginum since 5 yrs. Intially small in size and gradually
progressed to present size and mass appeared
throughtout the day since 2 yrs.
ON EXAMINATION:
Difficulty in passing urine since 1yr.
Increase frequency of micturition +
Involuntary passage of urine +

4. LOCAL EXAMINATION:
O/E – external genitalia vulva, labia majora/minora,
Gaping introitus+ , decubitus ulcer+
PAST MEDICAL HISTORY:
APPENDICTOMY since 25yrs back
PAST MEDICATION HISTORY: NIL
PRELIMINARY DIAGNOSIS: post menopausal
procidentia.
FINAL DIAGNOSIS: post menopausal procidentia

5. O-OBJECTIVE EVIDENCE
VITAL PARAMETERS:
PR:80bpm
Bp:110/80mmHg
H/L: s1s2+ (BAE+)

6. LABORATORY INVESTIGATIONS
23-5-18:
Blood glucose: 59.0
Hb: 15g/dl
RBC: 5.24
PLATELET: 281
BLOOD UREA: 24
SERUM CREATININE: 0.8
SERUM SODIUM:140
SERUM POTASSIUM:4.3
SERUM CHLORIDE: 107

7. 24-5-18:
T3-1.63
T4-1.01
TSH:8.66
25-5-18:
Hb-15g/dl
RBC-5.24
PLATELET:2.81
BV:25mg/dl
SERUM CREATININE:0.8mg/dl
Sodium:140
Potassium:4.3
Chloride: 107

8. 4-6-18:
Urine test: no bacterial growth have been seen
T3:1.65
T4:10.1
TSH:8.66

9. A-ASSESSMENT
FROM SUBJECTIVE AND OBJECTIVE EVIDENCE
PATIENT HAS POST MENOPAUSAL PROCIDENTIA

10. POST MENOPAUSAL PROCIDENTIA:
DEFINITION:
A uterine prolapse is when the uterus falls and
drops into the vagina. When most of the uterus
has fallen through the vaginal opening, the
condition is known as a procedentia.

12. Pathophysiology:
Vaginal prolapse is a common condition that occurs when the muscles,
skin and ligaments that surround the pelvic floor weaken and ‘fall out
of place’. In severe cases, the vaginal tissues can protrude from the
body and affect urinary, rectal and sexual functions. It is more common
in women who have given birth naturally or are post-menopausal due
to the loss of estrogen, which helps to protect the bones and
ligaments.
There are several types of vaginal prolapse,
Uterine prolapse– this is when the ligaments at the top of the vagina
weaken causing the uterus to slip down into the vagina. It can happen
in stages – from first to fourth degree by severity. First degree prolapse
is when the uterus drops into the upper part of the vagina. Fourth
degree prolapse (procidentia) is when it protrudes from the vaginal
opening. This is common post-menopause because of falling estrogen
levels.

14. P-PLANING:
23-5-18:
Plan:
vaginal hysterectomy pelvic floor repair.
27-5-18 to 4-6-18:
1.TAB FE (OD) -8mg/dl -oral
2.TAB CA/MVT (OD) -0.5mg/dl -oral

15. Plan on 4-6-18 done on 6-6-18:
Plan :B/L – dj stenting + per urethral catheter
Gynecological symptoms relieved
Catheter should be removed after symptom
relieved and proceed

16. 6-6-18 to 11-6-18:
1. TAB OFLOX(ofloxacin) – antibiotic-200mg –oral –BD
2. TAB PCM(paracetamol)– analgesic -500mg-oral-BD
3.TAB RANTAC(ranitidine)-antihistamine -150mg-oral-
BD
4.TAB FE/Ca/MVT-multivitamin-100mg –oral OD

17. On 11-6-18 pre operative instructions:
• NBM
• Inj taxim –cefotaxim-ANTIBIOTIC-1g-IV-BD
• Inj metrogyl-metronidazole-ANTIBIOTIC-100ml-IV-TID
• Inj rantac-ranitidine-ANTIHISTAMINE-200mg-IV-BD
• Inj xylocain – lidocaine-LOCAL ANAESTHETIC-5mg-IV
• Inj TT- tetanus toxoid- vaccine- stat
• Tab dulcolex – lactulose- 10mg -2 tab
• Tab restyl- alprazolam- ANTIANXIETY-0.5mg –stat
SHIFT TO GOT AT 8pm

18. Drug interactions:
xylocaine<>restyl: increases nervous system
side effects

19. 12-6-18:
c/o-p3l3 post menopausal procidentia
Sx: VAGINAL HYSTERECTOMY + PELVIC FLOOR REPAIR
Rx-
NBM
IVF
INJ TAXIM
INJ METROGYL
INJ RANTAC
W/F BLEEDING
INJ TRAMADOL-ANALGESIC –50mg-IM -BD

20. 13-6-18:
Rx- CST
14-6-18:
Rx- CST+ syp lactulose -3 tsp
soft diet
15-6-18 to 21-6-18:
Inj taxim
Inj metrogyl
Inj rantac
Tab rantac
Tab fe/ ca / mvt
From 18-6-18 –Tab telmisartan 20mg OD

21. DISCHARGE SUMMARY:
Rx-
Tab fe /ca/mvt -10mg/dl
Tab telma 20- 20mg/dl

22. PATIENT COUNSELLING and
PHARMACIST INTERVENTIONS:
• Eat nutritious food
• Do not strain during bowel movement
• Avoid heavy lifting
• Control your weight