3. Subjective data
• c/c:She presented to DRH concerned about
general body swelling that she explained ”I
have got GBS ,and I just have fever and loss of
appetite.”
• HPI: A 6 years old child with history of medical
condition presented to DRH for her new
medical condition which is GBS and
complains of fever, loss of appetite and
dermatitis around lower extremities.
• She reported having GBS ,fever and dermatitis
around extremities and these symptoms have been
progressively worsening for the past one month.
4. Subjective data ..........
• Allergies: No documented allergy
• PMH: she was relatively healthy before one
month
• PMXH: No history of use of medication
• FH:no member of the family have a history of
this case
• Immunization: fully immunized
7. Back ground information
• Introduction: Severe malnutrition is one of the most
common causes of morbidity and mortality among
children under the age of 5 years worldwide.
• Severe malnutrition is both a medical and a social
disorder.
• Successful management of the severely malnourished
patients requires that both medical and social
problems be recognized and corrected.
• If the illness is viewed as being only a medical disorder,
the patient is likely to relapse when he/she returns
home and the rest of the family will remain at risk of
developing the same problem.
8. Background................
• Risk factors:-
– not eating the right amount or kind of food
– Inability to digest or absorb nutrients properly
– The health condition that increase the amount of
calorie your body needs
– Eating disorder and
– Pregnancy etc...
9. Background information............
s/s-
• ulceration of the skin
• Sign of dehydration
• Irritable or bad mood
• Slower growth and muscle wasting
• Loss of appetite
• Slow wound healing process and increase the
development of infections.
10. Background information............
• Dx:-
Infants less than six months:
Weight –for- Length (W/L) less than 70% OR
Presence of pitting Oedema of both feet(kwashiorkor), OR
Visible Severe Wasting(marasmus) if it is difficult to
determine W/L
Children 6 months to 5 years:
Weight for Height (W/H) or Weight –for- Length (W/L) less
than 70 % , OR
Presence of pitting Oedema of both feet, OR
MUAC <11cm for a child with a length greater than 65
cm if W/L or W/H is difficult to measure
11. Background information ..........
• NOTE: No distinction has been made between the treatment
of kwashiorkor, marasmus, and marasmic kwashiorkor.
Child with visible severe Child with edematous malnutrition(kwash)
Wasting(marasmic)
12. • Treatment :-
– Vitamin A:
– On the day of admission (day 1), give vitamin A
for all children except those with oedema or those
who received vitamin A in the past 6 months.
– Give vitamin A to every patient on the day of
discharge (in-patient care) or at the 4th week of
the treatment for those in out-patient care.
– Dose:
» <6 months: 50,000IU PO at admission
» 6-11 months: 100,000IU
» ≥12 months: 200,000IU
13. • If no complications, give first line antibiotics: oral
Amoxicillin for 7 days.
• If complications present, give second line
antibiotics: Gentamicin, plus IV Ampicillin for 2
days followed by Amoxicillin depending on the
condition of the child, for a total treatment
duration of 7 days.
• If the child fails to improve within 48 hours, add
chloramphenicol or change to
Amoxicillin/clavulinic acid or Ceftriaxone
• If you suspect other infections use other drugs
that didn’t listed here
• Nutritional therapy:
– Phase 1 F-75
– Transition phase F-100
– Phase2 F-100
14. • Medication of admission:
– F-75 200ml /feed 6 times a day
– Amoxacillin250 mg/5ml
– Vit A 200,000 IU IV
• On day 21/02/06:
– Ampicillin 125 mg IV qid
– Gentamicin 25 mg iv BID
– PCM syrup 1 tsp po prn
• On day 02/03/06
– Cloxacillin 250 mg IV qid
– Gentamicin 25 mg iv BID
• Drug therapy problem:
– Ineffective drug therapy i.e amoxacillin
15. Pharmaceutical care plan
• Goal of therapy:
– reverse nutritional deficiencies
– Avoid edema of the body
– Avoid dermatitis
– Normalize body temperature
• Plan to solve drug therapy problem
• Education:- about the importance of taking the correct dose of
nutritional therapy with the correct duration
• Follow up evaluation
• Efficacy:- the treatment were effective, improvement has been
observed
• Saftey: there was no ADR
• Compliance: non compliance observed
