A 26-year-old pregnant woman presented with cough and was diagnosed with respiratory tract infection caused by Klebsiella pneumonia, bronchitis, hypothyroidism, and oligohydramnios. She was treated with antibiotics, bronchodilators, thyroid medication, pantoprazole, and counseling on hand washing, avoiding irritants, hydration, and positioning to increase amniotic fluid levels. Her symptoms improved and she was discharged on medications including levocetirizine, acebrophylline, and levothyroxine.

1. A CASE PRESENTATION ON RESPIRATORY
TRACT INFECTION WITH BRONCHITIS
Presented by,
Anvy Thankachan
PharmD 5 th yr

2. A 26 yr old pregnant women admitted in
gynec ward with complaints of Cough

3. SUBJECTIVE

4. Name : Mrs. X
Age :26 yrs
Gender : female
IP No : M-8430
Dept : gynec
DOA : 6/12/2018
DOD : 15/12/2018

5. Marital status: 6yrs
Obstetric history : G2P1L1
Last menstrual period (LMP): 16.03.18
Menstrual history: irregular
Ht:157 cm
wt. :64 kg
Past medical history: Hypothyroidism, 1 st FTND female baby 3 yrs before, viral Bronchitis
before one Month, history of Breast Abscess (suppurative inflammatory exudate)
Patient is allergic to tab. DOLONEX (Piroxicam)
Past medication History: T. Thyronorm 25 mcg

6. OBJECTIVE

7. DATE 6 7 8 9 10 11 12 13 14 15
BP 110/80 100/70 100/70 110/70 100/70 110/70 110/70 120/80 120/80 100/70
PULSE 92 84 88 76 60 70 76 72 76 70
RR 24 22 24 22 22 20 22 22 22 22
FHS 146 140 144 140 144 142 140 144 142 140
TEMP N N N N N N N N N N

8. Laboratory Investigation
Date 6/12 13/12 9/5/2018 21/9/2018
TC 12200 7300
DC P
L
E
85
13
2
70
28
2
PLT 1.8 Lakhs -
CRP 38.83 0.83
TSH - - 5.23uUl/ml 2.04(0.25-5.0)

9. Sputum Culture(8/12/18)
Organism Isolated: Klebsiella
Cefipime: 18(MIC)
Oflaxacin:17
Meropenam:23

10. OBSTERIC ULTRASOUND(10/12/18)
LMP:16/03/18
GA BY USG: 36 Wks 2 Days
EDD by USG: 5/01/19
Single live intrauterine pregnancy in Cephalic presentation
Amniotic Fluid Index Measures :7.6 cm(14.9 on 30/10/18)
Fetal Heart rate: 149 bpm and regular

11. ASSESSMENT

12. FINAL DIAGNOSIS: RESPIRATORY TRACT INFECTION (KLEBSIELLA)
BRONCHITIS
OLIGOHYDRAMNIOS
HYPOTHYRODISM

13.  Infection that may interfere with normal breathing
 UPPER RESPIRATORY TRACT INFECTION
LOWER RESPIRATORY TRACT INFECTION

14. BRONCHITIS
Inflammation of the large breathing tubes (airways) called bronchi
Type of Bronchitis :
 ACUTE BRONCHITIS
 CHRONIC BRONCHITIS

15. SIGNS AND SYMPTOMS
Coughing
Wheezing
Shortness of breath
Runny nose
Malaise
Chills
Slight fever
Back and muscle pain
Sore throat

16. PATHOPHYSIOLOGY
Hyperemia of the Mucous Membrane
Desquamation,edema, leucocytic infiltration of the submucosa
Production of sticky or mucopurulent exudate
The protective fn. of bronchial cilia,phagocytes,and lymphocytes, are distributed
16

17. Bacteria invade the Bronchi
Accumulation of cellular debris and mucopurulent exudate
Cough,though distressing is essential to eliminate Bronchial seceration
Edema of the bronchial walls
Retained secerations
Spasm of Bronchial muscles
Air Way
Obstruction
17

18. PLAN

19. NO BRAND NAME GENERIC NAME DOSE&FREQ
UENCY
6 7 8 9 10 11 12 13 14 15
1 NEB .D MIST LEVOSALBUTAMOL
IPRATROPIUM
Q8H + + + + + D/C
2 NEB. BUDIMIST BUDESONIDE BD + + + + D/C
3 T. LEVOKAST SR LEVOCETIRIZINE
AMBROXOL
MONTELUKAST
HS + + + + + + + + +
4 INJ.PANTOCID PANTOPRAZOLE 40MG BD + + + + D/C
5 INJ.ACCUTAZ AS CEFTRIAXONE+TAZ
OBACTAM
1.125G BD + + + D/C
6 T.CLARIBID CLARIHROMYCIN 500MGBD + + + D/C
7 T.THYRONORM LEVOTHYROXINE 25mcg OD - + + + + + + + + +
8 T.ZERODOL TH ACECLOFENAC+TH
IOCOLCHICOSIDE
TID - + + + D/C
9 INJ.MAGNOVA CEFIPIME+TAZO 1.125G Q 12 + + + + + + +
10 C.PANTOCID PANTOPRAZOLE 40MG BD + + + + + +

20. 11 T.DOLO PARACETAMOL 650MG SOS + + +
12 NEB.BUDAMATE BUDESONIDE
FORMETEROL
BD + + + + +
13 ARGIN SACHET L-ARGININE OD + + + + +
14 CARNISURE LEVOCARNITINE 8 HRLY + + + + +
15 ASCOVENT SR ACEBROPHYLLINE 200MG BD + + + + + + + + + +

21. DISCHARGE MEDICATION
TELEKAST L HS
T.DERIPHYLLIN 150 1-0-1 FOR 10 DAYS

22. Medcation Error
 Zerodol TH Contains (ACECLOFENAC+THIOCOLCHICOSIDE) : Aceclofenac is belongs to
category D drug. NSIDS are contraindicated in after 30weeks gestation.
Inj.Accutaz AS and T.claribid are antibiotics given during the initial treatment . Both antibiotics
are broad spectrum of activity.
Pantop given as twice daly

23. Counselling tips..
Wash your hands frequently
Keep away from allergens and irritants like smoke, chemical fumes
Drink more water
Lie on to the left side when relaxing (the blood flows smoothly along the uterine blood
vessels and allows the fetal blood to flow at a regular rate. It, therefore, causes a rise in the
amniotic fluid index)
Have foods with high water content