Case on sepsis (shahnawaz)
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This document presents the case of a 74-year-old female patient admitted to the hospital for sepsis. She had a history of asthma, hypertension, obesity, and depression. Upon admission, she was in septic shock with respiratory and renal failure. Laboratory tests showed elevated white blood cell count and abnormal liver and kidney function. She was started on antibiotics, vasopressors, and other medications to treat her infection and stabilize her vital signs. Her treatment in the hospital was successful and she was discharged with medications to continue at home.
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This case study on Diabetes Complications presented by Shivank Agrawal (Doctor of Pharmacy ) will help understand about the critical insights regarding treatment of Diabetes, its complications and its management.
Title: Case Study: Management of Diabetic Cellulitis
Introduction:
Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia, leading to various complications including skin infections such as cellulitis. Cellulitis is a bacterial infection affecting the skin and underlying tissues, often exacerbated in diabetic patients due to impaired immune function and compromised blood circulation. This case study focuses on the management of diabetic cellulitis in a patient presenting with typical symptoms.
Treatment Plan:
Antibiotic Therapy: Initiation of empiric antibiotic therapy with oral cephalexin to cover common pathogens such as Staphylococcus aureus and Streptococcus species. The choice of antibiotics was based on local antibiogram data and the patient's clinical response.
Glycemic Control: Optimization of blood glucose levels through insulin therapy to enhance immune function and promote wound healing. Regular monitoring of blood glucose levels was implemented to adjust insulin doses accordingly.
Wound Care: Daily wound cleansing with saline followed by application of topical antimicrobial agents and sterile dressings to prevent secondary infection and promote granulation tissue formation.
Patient Education: Comprehensive education regarding diabetic foot care, including the importance of daily foot inspections, proper footwear, and prompt management of any foot injuries to prevent future complications.
Conclusion:
This case highlights the importance of prompt diagnosis and appropriate management of diabetic cellulitis to prevent complications and improve patient outcomes. A collaborative approach involving pharmacists, physicians, and other healthcare professionals is essential for the comprehensive care of diabetic patients with skin infections. Emphasis on glycemic control and wound care plays a crucial role in preventing recurrent infections and promoting overall health in diabetic individuals.
Role of Clinical Pharmacist in Management of Diabetes Complications.
Pharmacists play a crucial role in the management of diabetes cellulitis, contributing significantly to patient care through their expertise in medication therapy management, patient education, and collaborative healthcare. Their involvement spans various aspects of the management process:
Medication Management:
Antibiotic Selection: Pharmacists assist in choosing appropriate antibiotics based on the patient's clinical presentation, comorbidities, and potential drug interactions.
Dosing and Administration: They ensure proper dosing regimens, considering factors such as renal function and drug allergies, to optimize therapeutic efficacy and minimize adverse effects.
Monitoring: Pharmacists monitor the patient's response to antibiotic therapy, inc
melkamu surgery.pptx
This case presentation summarizes a 22-year-old male patient who presented with abdominal pain and was found to have gangrenous appendicitis. He underwent an appendectomy and was on post-operative day 4. His vital signs were stable. On examination, his surgical incision was clean with no signs of infection. Laboratory tests showed elevated white blood cell count. He was being treated with ceftriaxone, tramadol, and diclofenac. The pharmacist recommends adding metronidazole to help treat any anaerobic infections and outlines a care plan to prevent surgical site infections and monitor the patient's recovery.
Case History of Dedifferentiated Liposarcoma
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Care plan for MI
NUR3125
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This patient is presenting to the emergency with symptoms that indicate a Myocardial Infarction. The patient, who is a 48-year-old man, is stating a 3-day history of sub sternal chest pain that is radiating to his back. The symptoms started up while he was mowing his lawn. He stated the pain has eased up over time. He also reported mild trouble with breathing and some nausea but no vomiting. He exercises daily, but does report that he eats a lot of fast food. His last total cholesterol was 232 mg/dL. He also has a 15-year history of tobacco use and family history of myocardial infarction (MI), specifically his father had an MI at age 54 and his grandfather at age 58. His current blood pressure is elevated at 158/98 and heartrate of 102 bpm, his respiratory rate is currently high at 26 breaths/min and noted mild use of accessory muscles upon examination. Lungs are noted to have slight inspiratory crackles at both lung bases. Jugular venous distention is noted at less than 2cm bilaterally. His lab work reveals an elevated Troponin at 2.9 ng/ml, elevated Creatinine phosphokinase at 141 units/L, and an elevated CK-MB/CK isoenzyme at 2%. Elevated troponin indicates damage to the heart muscle, and the elevated Creatinine phosphokinase and CK-MB/CK isoenzyme along with all these other symptoms and labs indicate a heart attack. ECG is done and shows ST elevation and T wave inversion, also noted with premature ventricular contractions. The lab values and ST elevation point to a Myocardial Infarction and Transmural ischemia that will require immediate attention.
I have chosen three NANDA nursing diagnoses for this patient, with the first one being the priority. The three I choose are:
· Decreased Cardiac Output related to altered heart rate and ischemia as evidenced by ECG showing an ST elevation, elevated Troponin, and patient stating he has had chest pain for three days.
· Acute Pain related to tissue damage in the myocardium from inadequate blood supply as evidenced by elevated troponin labs and patient reporting chest pain that radiates to back for three days.
· Ineffective Health Maintenance related to deficient knowledge about self-care and treatment as evidenced by patient stating he eats fast food often and has had elevated blood pressure and cholesterol at past appointments, and patient admitting to smoking ½ pack of cigarettes daily despite family history of MI.
Care Plan Diagnosis #1 Myocardial Infarction
NANDA Diagnosis 1: Decreased Cardiac Output related to altered heart rate and ischemia as evidenced by ECG showing an ST elevation, elevated Troponin, and patient stating he has had chest pain for three days.
NOC (Nursing Outcome Classification) Label: Tissue Perfusion
Expected Client Outcomes:
1. Patient will demonstrate adequate cardiac output evidenced by blood pressure, heart rate, and heart rhythm within normal pa.
Laporan Jaga RSPAD (Jessica Putri Natalia S)
The document provides a morning report on a fever of unknown origin case. It summarizes:
1) A 58-year-old male presented with prolonged fever for 1 month despite previous antibiotic treatment for presumed typhoid fever. He had weight loss and decreased appetite.
2) Physical exam was normal but labs showed leukocytosis, increased CRP, and hyponatremia. Imaging found hydronephrosis and nephrolithiasis.
3) Differential diagnoses for the fever of unknown origin were discussed, including further diagnostic tests needed to establish a diagnosis. Control of diabetes and urology follow-up were also mentioned.
PATIENT INFORMATIONName Mr. W.S.Age 65-year-oldSex Male.docx
PATIENT INFORMATION
Name: Mr. W.S.
Age: 65-year-old
Sex: Male
Source: Patient
Allergies: None
Current Medications: Atorvastatin tab 20 mg, 1-tab PO at bedtime
PMH: Hypercholesterolemia
Immunizations: Influenza last 2018-year, tetanus, and hepatitis A and B 4 years ago.
Surgical History: Appendectomy 47 years ago.
Family History: Father- died 81 does not report information
Mother-alive, 88 years old, Diabetes Mellitus, HTN
Daughter-alive, 34 years old, healthy
Social Hx: No smoking history or illicit drug use, occasional alcoholic beverage consumption on social celebrations. Retired, widow, he lives alone.
SUBJECTIVE:
Chief complain: “headaches” that started two weeks ago
Symptom analysis/HPI:
The patient is 65 years old male who complaining of episodes of headaches and on 3 different occasions blood pressure was measured, which was high (159/100, 158/98 and 160/100 respectively). Patient noticed the problem started two weeks ago and sometimes it is accompanied by dizziness. He states that he has been under stress in his workplace for the last month.
Patient denies chest pain, palpitation, shortness of breath, nausea or vomiting.
ROS:
CONSTITUTIONAL: Denies fever or chills. Denies weakness or weight loss. NEUROLOGIC: Headache and dizzeness as describe above. Denies changes in LOC. Denies history of tremors or seizures.
HEENT: HEAD: Denies any head injury, or change in LOC. Eyes: Denies any changes in vision, diplopia or blurred vision. Ear: Denies pain in the ears. Denies loss of hearing or drainage. Nose: Denies nasal drainage, congestion. THROAT: Denies throat or neck pain, hoarseness, difficulty swallowing.
Respiratory: Patient denies shortness of breath, cough or hemoptysis.
Cardiovascular: No chest pain, tachycardia. No orthopnea or paroxysmal nocturnal
dyspnea.
Gastrointestinal: Denies abdominal pain or discomfort. Denies flatulence, nausea, vomiting or
diarrhea.
Genitourinary: Denies hematuria, dysuria or change in urinary frequency. Denies difficulty starting/stopping stream of urine or incontinence.
MUSCULOSKELETAL: Denies falls or pain. Denies hearing a clicking or snapping sound.
Skin: No change of coloration such as cyanosis or jaundice, no rashes or pruritus.
Objective Data
CONSTITUTIONAL: Vital signs: Temperature: 98.5 °F, Pulse: 87, BP: 159/92 mmhg, RR 20, PO2-98% on room air, Ht- 6’4”, Wt 200 lb, BMI 25. Report pain 0/10.
General appearance: The patient is alert and oriented x 3. No acute distress noted. NEUROLOGIC: Alert, CNII-XII grossly intact, oriented to person, place, and time. Sensation intact to bilateral upper and lower extremities. Bilateral UE/LE strength 5/5.
HEENT: Head: Normocephalic, atraumatic, symmetric, non-tender. Maxillary sinuses no tenderness. Eyes: No conjunctival injection, no icterus, visual acuity and extraocular eye movements intact. No nystagmus noted. Ears: Bilateral canals patent without erythema, edema, or exudate. Bilateral tympanic membrane.
Preoperative Assessment, Preparation, Premedication.pptx
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mornig report tugas dari bagian anestesi dan penyakit infeksi
The morning report summarizes the duty doctors for the ER and ward at a hospital. It also includes the vision and missions of the Pulmonology and Respiratory Medicine study program. The patient report documents a 56-year-old male smoker presenting with shortness of breath, cough, and right-sided chest pain. Physical exam and chest X-ray findings are consistent with right lung pneumonia and a possible right lung mass. The working diagnoses are community-acquired pneumonia and unknown type of right lung mass. Laboratory results show hypokalemia.
Similar to Case on sepsis (shahnawaz) (20)
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Case Presentation on Diabetes Mellitus complications
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Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)
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Organization
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
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These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
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Case on sepsis (shahnawaz)
- 1. CASE PRESENTATION ON SEPSIS Presented By- Shahnawaz Ahmad Teli M.Pharm 2st Sem. (Clinical Pharmacy)
- 3. PATIENT DETAILS Patient ID:17350/17 Patient name: XYZ Age: 74 years Gender: Female Weight: 145.5 kg Height: 5'2'' Date of admission: 15/03/2107 Date of discharge: 18/03/2017
- 4. REASON FOR ADMISSION The patient’s primary caregiver reports that the patient has been vomiting a lot in the last few days. •Past Medical History- Asthma, HTN, OA, Morbid obesity, Depression •Past surgical history- ventral hernia 3 months ago Cholecystectomy (unknown time frame) •Past Medication History - Nil •Family history: No HTN, DM, CA, or vascular disease
- 5. Social history- One to two cigarettes every other day; stopped in the last year. Also stopped drinking alcohol in the last year.
- 6. PHYSICAL EXAMINATION:- General condition -- Morbidly obese, white female in moderate distress CNS -- Conscious CVS -- Tachycardia, regular rhythm; NL S1/S2 Chest -- Positive for expiratory wheezes throughout; tachypnea P/A -- + pannus, unable to palpate organs, tenderness to deep palpation
- 7. VITAL SIGHS BP - 87/43 mmHg PR- 80-95/min. RR - 14–33/min. Temp.- 37.8°C SpO2 - 94%
- 8. LABORATORY DATA- Investigation Normal Values Sodium (serum) 133 137 – 145 mmol/l WBC 25000 4000-11000 c/mm3 AST 11 14 – 36 U/l ALT 7 14 – 36 U/l T. bilirubin 0.2 0.3-1.0 mg/dl Albumin 2.1 3.5 – 5 g/dl Alkaline phoshatase 127 30-120 IU/L Haemoglobin 13.6 12-15 g/dl
- 9. LABORATORY DATA- Serum Creatinine 1.1 0.8- 1.5 mg/dl BUN 13 7-20 mg/dL Cl 98 96-106 mEq/L
- 10. OTHER INVESTIGATIONS- ECG:- sinus tachycardia (113)
- 11. ASSESSMENT:- 74-year-old female in septic shock with acute respiratory and renal failure; probable intra- abdominal infection.
- 12. GOALS OF TREATMENT Start adequate antibiotic therapy (proper dosage and spectrum) as early as possible. Resuscitate the patient, using supportive measures to correct hypoxia, hypotension and impaired tissue oxygenation. Identify the source of infection, and treat with antimicrobial therapy, surgery or both. Maintain adequate organ system function.
- 13. MEDICATION CHART Name, strength, route, frequency Date started Date stopped Class Inj. Norepinephrine 20 mcg/min 15/3/17 Till disch. Vasopressor agent Inj. Vasopressin 0.04 units/min 15/3/17 18/3/17 Hormone Inj. Levofloxacin 500 mg IV daily 15/3/17 Till disch. Second gen. Fluoroquinolone Tab. Theophylline ER 400 mg Q AM 16/3/17 18/3/17 Bronchodilator Fluticasone inhaler 2 puffs BID 16/3/17 till disch. Synthetic Glucocorticoid Tb. acetaminophen 100 mg po Q 6 h 15/3/17 till disch. Analgesic Tab. Mirtazapine 15 mg po at bedtime 16/3/17 till disch. Antidepressant Tab.Promethazine 25 mg po Q 6 h 16/3/17 til disch. Antiemetic
- 14. CLINICAL JUSTIFICATION The treatment was almost satisfactory. There was a need of extra fluids to help keep the blood pressure from dropping dangerously low, throwing the patient into shock. Mirtazapine was given, but there was no any depression.
- 15. DISCHARGE SUMMARY- Tb. acetaminophen 100 mg po Q 6 h X 10 days Tab. Mirtazapine 15 mg po at bedtime X 5 days Tab.Promethazine 25 mg po Q 6 h X 5 days Tab . Levofloxacin 500 mg BD X 10 days
- 16. PATIENT COUNSELLING Avoid smoking and second hand smoke. Maintain hygienic conditions.
- 17. Thank You