The patient, a 50-year-old female, was admitted to the hospital with complaints of breathlessness, abdominal pain, decreased urine output, and fever. Tests revealed renal parenchymal changes and nephrolithiasis. She was diagnosed with renal calculi, obstructive uropathy, acute renal failure, and a urinary tract infection. Her treatment plan included antibiotics, analgesics, and monitoring of vital signs and input/output. Some issues were noted with therapeutic duplication of antibiotics and incomplete monitoring of renal function and input/output. The patient was counseled on diet, medication side effects, and following up with further renal testing.

1. PRESENTED BY :TANUSHKA
CLASS : PharmD
1339215

2.  Name :XYZ
 Sex : Female
 Age :50
 Ward NO : MED-2
 Date of admission : 6/2/16
 Reason for admission : Breathlessness
Abdomen pain(lumbar region)
Dyspnea grade 3 X 2month
Decrease urine output X 2 days
Burning maturation
Fever
puffiness over face

3.  General : sick
 Vital sign
BP: 100/60
PR:110/min
Pallor positive
CVS: S1S2 normal
RS: B/L air entry positive
p/a soft non tender
CNS : NMF(normal muscular function)
normal power tone positive

4. subjective objective
Breathlessness
Abdomen pain(lumbar
region)
Dyspnea grade 3 X
2month
Decrease urine output X
2 day
Burning maturation
Fever
puffiness over face
Usg abdomen
b/l renal parenchymal changes
correlates with renal function
test{in urology test
sugar -1.025, albumin present,
Full of puss cell and 8-10
epithelial cell was seem}
Nephrolithiasis suggested for
x ray{no free fluid is seen in
peritoneal cavity}
UnCentrifuged urine M/E 1-2
pus cell

5.  From the Subjective and Objective evidence it
is assessed as : : Renal calculus /
obstructive uropathy / ARF
/UTI

6.  Patient specific : Breathlessness
Abdomen pain(lumbar region)
Dyspnea
Decrease urine output
Burning maturation
Fever
puffiness over face
Diseases specific:
Increase in urine output
Normalize the renal parameter
dyspnea

7. Brand name Generic name Dose Route Freq D
-
1
D
2
D
-
3
D
-
4
D
-
5
D
-
6
D
-
7
D
-
8
D
-
9
D
-
1
0
Inj.ocid omeprazole 2mg/m
l
i.V Od / / X
Tab.dolo Acetaminophen 650 mg Oral sos / / / X
Inj. Microtaz
(4.5gm)
Piperacillin(4g)
Tazobactam0.5g
4.5 g i.v Bd / / / / / / X
Tab. Nilpar paracetamol 500 mg Oral B.D / / / / / / /
Tab .cetil cefuroxime 500 mg oral B.D /
Tab .dafcort deflazacort 6 mg oral b.d /

8. Brand name Generic name Dose Route Freq D
-
1
D
2
D
-
3
D
-
4
D
-
5
D
-
6
D
-
7
D
-
8
D
-
9
D
-
1
0
Inj.cefonis s Cefoperazone
sulabactum
1gm
500mg
i.v B.D / / /
Syp.uriliser Potassium
citrate
Citric acid
1100mg
334mg/
5ml
oral Tds / / / / / / / /
Syrup.macbe
ry
Bromhexine
guaiphenesin
terbutaline
Menthol
1 tsp oral HS / / / / / / / /
Tab.
livogen Z
Ferrous
fumarate
Folic acid
152mg
750
mcg
oral Hs / / / /
Inj.buscopan Hyoscine N-
butylbromide
20mg/
ml
i.v od / / / / X

9. Brand name Generic name Dose Route Freq D-
11
D
-
1
2
D
-
1
3
D
-
1
4
Tab. Nilpar paracetamol 500 mg Oral B.D / / / /
Syp.uriliser Potassium citrate
Citric acid
1100mg
334mg/5
ml
oral Tds / / / /
Syrup.macbery Bromhexine
terbutaline
Menthol
1 tsp oral HS / / / /
Tab.
livogen Z
Ferrous fumarate
Folic acid
152mg
750 mcg
oral Hs / / / /
Tab .cetil cefuroxime 500 mg oral B.D / / / /
Tab .dafcort deflazacort 6 mg oral b.d / / / /

10.  Omeprazole: blurred vision ,confusion ,dryness of the mouth ,headache
increase sweating
 CEFOROXIME :upset stomach ,Vomiting ,Diarrhea ,stomach pain.
 Folic acid: Bronchospasm, Erythema,malaise, Pruritus , Rash, Slight
flushing
 Deflazacort :Metabolic - Increased blood sugar, increased appetite and
weight gain.
Gastrointestinal - Indigestion, abdominal bloating, nausea, ulceration in
the stomach or intestine, inflammation of the pancreas and throat ulcer.
Musculoskeletal - Muscle weakness and thinning of bones.
Skin - Pimples, bruising, stretch marks, increased sweating, change in
pigmentation and increased hair growth.
Central Nervous System - Mood changes including irritability, depression
and suicidal thoughts, psychotic reactions, anxiety, confusion, memory
loss and sleep disturbances.
Genitourinary - Irregular periods.
Heart - High blood pressure.
Miscellaneous - Blood clot events and hiccups

11. Day 2 3 4 5 6 7 8 9
T 98.1 98.2 98.3 97.9 95.8 97.7 98.1
B.P 120/
80
140/1
00
140/
90
M-130/90
E-155/90
M-160/100
E-140/90
160/
90
160/1
00
P 74 58 M-98
E-85
97.9 95.8 97.7 98.1
R 20 14 13 14 18 15 16
i/o 850/800

12. Day 10 11 12 14
B.P 140/80 140/80 140/100 160/110
T 97.7 97.4 98.2 96.8
P 64 70 78 68
R 18 20 18 18
i/o 1050/1000

13.  Consult the nurses about input output
chart.
 Renal function test mainly GFR and alkaline
phosphate was not monitored properly
 Input output chart was not monitored
properly
 Therapeutic duplication :beta lactum
antibiotic
cefoperazone
piperacillin/tazobactam)
cefuroxime

14.  Diseases: renal calculi:are solid masses made up of
crystals
Uti:presence of microorganism in the urinary tract
Arf:deteroation of renal function over a period of hours
to day
Renal calculi:development of stone&decrease urine
volume
Patient was made aware of adverse effects of drugs
foods that are high in saturated fats and cholesterol.
These can clog up your arteries and increase your risk
for heart and blood vessel disease
Control the amount of carbohydrates in your diet.
Carbohydrates should only account for 50 percent to 60
percent of your daily calories. Carbohydrates are foods
that turn to sugar when you digest them.
Rft and lft sholud be performed after every 6 month