Case study on Reteropositive with LRTI with Respiratory Failure with UTI with SEPSIS for Pharmacotherapeutics-II Department of Pharmacy Practice (PharmD)

1. CASE STUDY ON RETROPOSITIVE
WITH LRTI WITH RESPIRATORY
FAILURE WITH UTI WITH SEPSIS
PRESENTED BY:-
KAMALJEET
{PHARM D 3RD YEAR}
2116957

2. INTRODUCTION
RETROPOSITIVE : Besides human immunodeficiency virus (HIV), the virus that causes AIDS, there a two other
retroviruses that can cause human illness. One is called human T-lymphotropic virus type 1 (HTLV-1) and the other is
called human T-lymphotropic virus type 2 (HTLV-II).
LRTI : Lower Respiratory Tract Infections (LRTI) are infections that affect the airways (below the level of the
larynx), including the trachea and the alveolar sacs.
RESPIRATORY FAILURE : Respiratory failure is a condition in which your blood doesn't have enough oxygen or
has too much carbon dioxide. Sometimes you can have both problems. When you breathe, your lungs take in
oxygen. The oxygen passes into your blood, which carries it to your organs.
UTI : A urinary tract infection (UTI) is an infection in any part of the urinary system.
SEPSIS : Sepsis occurs when your immune system has a dangerous reaction to an infection. It causes extensive
inflammation throughout your body that can lead to tissue damage, organ failure and even death.

3. DEMOGRAPHIC DETAILS
NAME PR {CONFIDENTIAL}
AGE 26
SEX FEMALE {F}
UNIT MEDICINE WARD (3)
DOA 14-08-2023
DOD -
BMI 22.7 kg/m (Normal)
I.P. NO. XXXXXXX5253
2

4. REASONS FOR ADMISSION
 Breathlessness X 15 days with cough
 Fever X 20-25 days
 Backpain X 5-7 days
 Burning micturition X 1 month

5. PATIENT HISTORY
MEDICAL H/O NIGHT SWEATS c/o COUGH INITIALLY DRY,LATER
WITISH SPUTUM
NO H/O NAUSEA, VOMITING, NO ALTERED SENSATION
MEDICATIONS -
SOCIAL HISTORY DECREASED APPETITE, SLEEP (NORMAL), BLADDER
HABITS (NORMAL)
FAMILY HISTORY -
ALLERGY -

6. PHYSICAL EXAMINATION
 THE PATIENT WAS ORIENTED TO TIME, PERSON AND PLACE (TPP).
 GENERAL:
PALLOR -VE
ICTERUS -VE
CYANOSIS -VE
CLUBBING -VE
KOILONYCHIA -VE
LYMPHADENO PATHY -VE
EDEMA -VE

7. OBJECTIVE:
PHYSICAL EXAMINATION
GENERAL PT. WAS ORIENTED TO TPP BUT FEELS GENERALIZED WEEKNESS
CNS HMF (N), B/L PUPIL EQUAL, B/L PLANTER FLEX ARC (N)
CVS BP- 108/70 mmHG PR-88bpm HEART- S1S2 (+) SPO -89% (RA)
RESPIRATORY B/L CEARSE CREPTS (+), NVBS (+)
TEMPERATURE 100-102 ˚ F
GI P/A SOFT, NON-TENDOR
OTHERS MENSTRUAL HISTORY (N), NO H/O SURGICAL INTERVENTIONS

8. LABORATORY DATA
SN
NO
TESTS RESULTS UNITS NORMAL VALUES INDICATIONS
1 WBC 12.4 ×10*9/L 4.02 - 11.0 ↑
2 LYM % 6.9 % 20.0 - 45.0 ↓
3 NEUT % 91 % 40.0- 70.0 ↑
4 EOS% 0.2 % 1-4 ↓
5 RBC # 2.31 ×10*12/L 3.50 - 5.50 ↓
6 HGB 9.7 g/dL 12.0 - 16.0 ↓
7 HCT 32.9 % 37.0 - 54.0 ↓
8 PLT 357 ×10*9/L 150 - 450 -
9 ALT 21 5-40 IU/L 5-40 -
10 ALP 167 60-150 IU/L 60-150 ↑

9. LABORATORY DATA
SN
NO
TESTS RESULTS UNITS NORMAL VALUES INDICATIONS
11 MCV 80.1 fLa 79-96 -
12 MCH 25.6 pg 27-32 ↓
13 MCHC 31.9 % 31-35 -
14 BUN 55 mg/dL 15-45 ↑
15 Sr. CRET. 0.6 mg/dL 0.8-1.3 ↓
16 SODIUM 137 mEq/L 135-155 -
17 POTASSIUM 4.0 mEq/L 3.5-5.5 -
18 CHLORIDE 104 mEq/L 98-107 -
19 CALCIUM 8.7 mg/dL 9.2-11.0 ↓
20 BICARBONAT
E
24.8 mEq/L 23-28 -

10. LABORATORY DATA
SN
NO
TESTS RESULTS UNITS NORMAL VALUES INDICATIONS
21 TLC 18000 cumm 4000-10000 ↑
22 PUS CELL 25.6 Nil ↑

11. OTHER INVESTIGATIONS
 NT- PRO BNP -96pg/mL (Normal range- 100-500)
 UPT- Negative
 HIV 1,2- REACTIVE
 MICRO-ORGANISM:- +VE (CANDIDA)
+VE ( E.COLI)
 RBS- 157 mg/dL

12. SOAP ANALYSIS
SUBJECTIVE OBJECTIVE
•Breathlessness X 15 days with cough
•Fever X 20-25 days
•Backpain X 5-7 days
•Burning micturition X 1 month
•HgB- Low
•RBS- High
•INCREASED PUS CELL AND TLC
•NT- PRO BNP -96pg/mL (Normal range- 100-
500)
•UPT- Negative
•HIV 1,2- REACTIVE
•MICRO-ORGANISM:- +VE (CANDIDA)
+VE (E.COLI)

13. ASSESSMENT
THE CASE IS ASSESSED AS:
 RETROPOSITIVE
 LRTI
 RESPIRATORY FAILURE
 UTI
 SEPSIS

14. GOALS OF TREATMENT
 PATIENT SPECIFIC GOALS
1. TO NORMALIZE THE BREATH, FEVER, BACKPAIN
2. TO MINIMIZE COUGH AND BURNING MICTURITION
 DISEASE SPECIFIC GOALS
1. TO TREAT THE URINARY TRACT INFECTIONS.
2. TO KEEP THE BLOOD GLUCOSE LEVEL NORMAL.
3. TO MINIMIZE LEVEL OF PUSS CELL AND TLC

15. TREATMENT
PLAN
BRAND NAME GENERIC
NAME
USE ROUTE DOSE FREQUENC
Y
INJ.
MEROPENEM
MEROPENEM treats infections caused by
bacteria
IV 1 gm TDS
INJ. TARGOCID TEICOPLANIN treats severe bacterial
infections (hospital)
IV 400 mg OD
INJ. DEXONA DEXAMETHAS
ONE SODIUM
PHOSPHATE
treats allergy, arthritis,
breathing problems
IV 6 mg OD

16. TREATMENT PLAN
BRAND NAME GENERIC
NAME
USE ROUTE DOSE FREQUENC
Y
Inj. CLEXANE ENOXAPARIN
SODIUM
(LMWH)
prevent clotting following
hospital procedures or
illness
S.C. 0.6 ml OD
Tab. FLUCONAZOLE treats serious fungal or yeast
infections
PO 150 mg OD
Tab. AZAL AZITHROMYCI
N
treats various allergic
condition
PO 500 mg OD
Tab. FOLIC ACID prevents and treats low
levels of folate, anemia
PO 5 mg OD

17. TREATMENT
PLAN
BRAND NAME GENERIC
NAME
USE ROUTE DOSE FREQUENCY
Neb. BUDESONIDE prevent from the
symptoms of
asthma
ORAL 1-2 mg 12 hrly
Neb. DULIN IPRATROPIUM
BROMIDE AND
LEVOSALBUTA
MOL
allowing to
breathe easily
and relief from
shortness of
breath, coughing
or wheezing
ORAL 1-2 mg 8hrly

18. TREATMENT
PLAN
BRAND
NAME
GENERIC
NAME
USE ROUTE DOSE FREQUENC
Y
Inj. LASIX FRUSEMIDE increasing the
amount of urine
output
I.V. 20 mg 12 hrly
CANDID
MOUTH
PAINT
CLOTRIMAZO
LE
treat fungal
infections of the
oral cavity
ORAL 25ml BD

19. TREATMENT PLAN CHART
MEDICATION 14-08-2023 15-08-2023 16-08-2023 17-08-2023 18-08-2023 19-08-2023
INJ.
MEROPENEM
+ + + + + +
INJ. TARGOCID + + + + + +
INJ. DEXONA + + + + + +
Inj. CLEXANE + + + + + +
Tab. FLUCONAZOLE + - - - - -
Tab. AZAL + - - - - -

20. TREATMENT PLAN CHART
MEDICATION 14-08-2023 15-08-2023 16-08-2023 17-08-2023 18-08-2023 19-08-2023
Tab. FOLIC
ACID
+ + + + + +
Neb.
BUDESONIDE
+ - - - - -
Neb. DULIN + - - - - -
Inj. LASIX - + + + + +
CANDID
MOUTH
PAINT
- + + + + +

21. PATIENT COUNSELLING
 MAINTAIN HYGINE AND PROPER REST
 EXERCISE FOR CLEARING NASAL PASSAGE

22. PHARMACIST INTERVENTION
 NO history of any menstrual problems and pregnancy
but UPT lab investigation done.

23. THANK YOU