A 78-year-old male was admitted to the hospital with complaints of fever, cough, and mental confusion. His medical history included COPD and BPH surgery. On examination, his temperature was elevated and respiratory rate was increased. Laboratory tests found an increased ESR and decreased sodium levels. He was assessed with COPD exacerbation and febrile delirium. His treatment plan included IV fluids, antibiotics, bronchodilators, steroids, and other medications to manage his symptoms and underlying conditions.

2. PREPARED BY,
ATHUL RAG V
IST MPHARM
DEPT OF PHARMACY PRACTICE
JDT ISLAM COLLEGE OF PHARMACY

3. CASE
 A 78 YEAR OLD MALE WAS ADMITTED IN
HOSPITAL PRESENTING WITH COMPLIANTS OF
FEVER(LOW GRADE) , COUGH AND MENTAL
CONFUSION OF 1 DAY.
IP NO.IQ2015/2676
DEPT; MEDICINE
DOA;14/2/2015
DOD;16/2/2015

4. HISTORY

5. PAST MEDICAL HISTORY
 HISTORY OF BPH SURGERY UNDERGONE 2
YEARS BACK.
 HISTORY OF COPD
 NO HISTORY OF HTN,DM
PAST MEDICATION
HISTORY
 TIOMIST MDI OD
 FORACORT 400 BD

6. PRESENT MEDICAL
HISTORY
 HISTORY OF FEVER , COUGH, AND MENTAL
CONFUSION

7. ON EXAMINATION….
 Conscious and Oriented

8. PHYSICAL EXAMINATION
 TEMPERATURE
DAY 1
TEMP; 99⁰F
DAY 2
TEMP;98.6⁰F
 BLOOD PRESSURE
DAY 1
BP ; 100/70
DAY 2
BP ; 120/80

9. RESPIRATION SYSTEM
RESP.SYSTEM VALUES NORMAL
RESPIRATION RATE 30BPM 12 TO 24BPM

10. LAB DIAGNOSIS
 HAEMATOLOGY
VALUES NORMAL
HB 12.7g/dl 12- 16g/dl
WBC 9,500Cells/cmm 4,300 -
10,800cells/cmm
neutrophils 75 45 - 70
Platelet count 3cells/cmm 1- 4 lakhcells/cumm
monocyte 02 1 - 2
lymphocyte 23 20 - 60
esr 60mm/hour 0 – 20mm/hour

11. RENAL FUNCTION TEST
VALUES NORMAL
SERUM CREATININE 1.2 0.6 – 1.3mg/dl
ELECTROLYTE
Sodium
potassium
Values
133mEq/L
4.1mEq/L
Normal
135 – 147mEq/dl
3.5 -5.2mEq/dl

12. PROVISIONAL DIAGNOSIS
 COPD
 FEBRILE DELIRUM

13. OBSERVATION & ORDERS

14. DAY 1
1.IVF NS 100ML/HOUR
2.DUOLIN NEBULISATION Q6H
3.BUDAMATE NEBULISATION Q12H
4.INJ.LACTAGARD 1.5G IV BD
5.T.AZITHRAL 500 0-1-0.
6.T.PANTOP DSR 1-0-0.
7.TIOMIST MDI OD
8.FORACORT 400 INH BD

15. DAY 2 and DAY 3
 REPEAT 2 TO 8
 9.T.DERIPHYLLIN OD 300MG 0-0-1
 10.T.DEST M 0-0-1

16. SOAP ANALYSIS

17. SUBJECTIVE ANALYSIS
 THE PATIENT COMPLIANTS OF FEVER , COUGH
AND MENTAL CONFUSION.

18. OBJECTIVE ANALYSIS
 INCREASED ESR
 INCREASED RESPIRATION RATE 30BPM
 ELECTROLYTE NA⁺ DECREASED
 ARTERIAL BLOOD GAS RESULT WILL BE
NEGATIVE
 LACTOBACILLUS SHOWED ABG TEST.

19. ASSESSMENT
 FROM THE SUBJECTIVE AND OBJECTIVE
ANALYSIS IT IS FOUND TO BE A CASE OF
COPD AND FEBRILE DELIRIUM.

20. PLAN
 1.ivf NS 100ML/HR FOR FLUID REPLENISHMENT.
 2.INJ.LACTAGARD1.5g(cefoperazone+sulbactam) - ANTIBIOTICS
 3. DUOLIN NEBULISATION(Levosalbutamol 50mcg+ipratropium20mcg)
- BRONCHODIALATORS
 4.BUDAMATE NEBULISATION(BUDESONIDE 1 -2MG TWICE DIALY) -
GLUCOCORTICOID STEROIDS.
 5.T.AZITHRAL 500MG(AZITHROMYCIN 500MG) - ANTIBIOTICS
 6.TIOMIST MDI(TIOTROPIUM BROMIDE 9mcg) - ANTICHOLINERGIC
BRONCHODIALATOR
 7.FORACORT 400(FORMOTEROL/budesonide 4OOmcg/6mcg) -
anticholinergic + beta-2 agonist(bronchodialator))
 8.T PANTOP DSR (PANTOPRAZOLE WITH DOMPERIDONE
SUSTAINED RELEASE) - PROTON PUMP INHIBITOR
 9.T DEST M(desloratidine +montelukast)- ANTI
ALLERGIC/LEUKOTRIENE MODIFIER.
 10.T DERIPHYLLIN OD 300(THEOPHYLLIN OD 300MG) -
METHYLXANTHINE

21. Prescription Analysis

22. Merits of prescription
 Prescription follows general
guidelines for the treatment of
COPD

23. Pharmacist’s role
 Patients may be counseled about the importance of disease
, each medication , dose and administration

24. Patients Counseling Areas
 FORACORT 400MG AND TIOMIST MDI- SHAKE WELL
BEFORE USE
 T.AZITHRAL 500MG – AZITHROMYCIN SHOULD BE
TAKEN 1 HOUR BEFORE FOOD OR 1 HOUR AFTER
FOOD WITH MAINTAIN TIME DISCIPLINE(12PM EVERY
DAY).
 PANTOP DSR – SHOULD BE TAKEN BEFORE FOOD
 ADVICE PATIENT TO AVOID SITUATION WHICH WILL
EXACERBATE THE CONDITION.
 ADVICE THE PATIENT TO CHECKING THE LUNG
FUNCTION PERIODICALLY.