This document describes the case of a 71-year-old female patient who presented with fever, cough, body aches, and vomiting for two days. A respiratory panel test was positive for H1N1 influenza A. She was treated with oseltamivir, IV fluids, paracetamol, ondansetron, pantoprazole, and dextromethorphan. Her symptoms improved over three days of treatment and supportive care. She was discharged on medications with instructions to self-isolate and follow up in one week.

1. R.Anusha
PharmD VI Year
Roll No:07

2.  Patient Name:Mrs.SR
 Gender:Female
 Age:71 years
 DOA:1/2/20
 DOD:3/2/20

3. SUBJECTIVE
 Chief complaints: Fever, Cough since 2 days.
 Present illness history: Reports high grade fever with chills
and rigors since 2 days, dry cough present, severe
generalised body ache, one episode of non bilious
vomiting,persistant nausea and severe weakness.
 H/o travel on 27/12/19 for 6 days.
 Past medical history: No Co-morbidities.

4. OBJECTIVE
 Vitals
Pulse rate:98/min
Respiratory rate:18/min
Blood pressure:110/60mm
Hg
Temperature:99.60F
Pain score :2/10
(Generalised body pain)
 Physical Appearance
Height : 164 cms
Weight : 60 kgs
BMI :22.31 kg/m2

5.  Respiratory system:Bilateral air entry present.
B/L basal crepts +
 Chest:Clear minimal end respiratory crackles.
 Film array bio fire respiratory panel : H1N1 Influenza ‘A’
positive
FINAL DIAGNOSIS:
Lower respiratory tract infection
Influenza ‘A’ H1N1 Positive

6. DRUG CHART
Drug Generic Dose Freq. ROA Category Indication
T.Tamiflu Oseltamavir 75 mg BD PO Antiviral H1N1
IV Fluids NS Normal
saline
75
ml/hr
STAT IV Electrolyte Hydration
T.Calpol Paracetamol 500 mg TID PO Analgesic Body pains
T.Zofer-MD Ondansetron 4 mg TID Mouth
dissolving
Anti emetic Nausea and
vomiting
Cap.Pantocid
D SR
Pantoprazole
40 mg
Domperidone
30 mg
1 cap OD PO Antacid APD
Syp.ALEX Dextro-
methorphan
10 ml TID PO Anti-tussive Cough

7. ASSESSMENT
DAY 1(1/2/20)
 This 71YOF presented with the clinical features of high grade fever
with chills and rigors since 2 days.
 Film array bio fire respiratory panel has positive for H1N1 Influenza
‘A’.
 Treatment is largely supportive and consists of bedrest, increased fluid
consumption, cough suppressants, and antipyretics and analgesics for
fever and myalgias.
 Severe cases may require intravenous hydration and other supportive
measures. Antiviral agents may also be considered for treatment.
 IV Fluid Normal saline 75 ml/hr IV on flow was given for fluid
management.
 T.TAMIFLU(Oseltamavir)75 mg PO BD was given for H1N1.
 Inj.PAN(Pantoprazole) was given for ulcer prophylaxis.

8.  Drugs indicated for treatment of H1N1 influenza A virus include
neuraminidase inhibitors (i.e, Oseltamivir and Zanamivir).
 Oseltamivir inhibit neuraminidase, which is a glycoprotein on the
surface of influenza virus that destroys an infected cell's receptor
for viral hemagglutinin. By inhibiting viral neuraminidase, these
agents decrease the release of viruses from infected cells and, thus,
viral spread.
 Prompt initiation of antiviral agents within 48 hours of symptom
onset is imperative for providing treatment efficacy against
influenza virus.
 The recommended duration of treatment is 5 days.

9. DAY 2 (2/2/20)
 Cough persisting , body pain+, feels weak, nausea, vomited
twice yesterday.
 ECG: No new changes, 2D Echo: Normal
 Chest: Clear minimal end respiratory crackles
PLAN:
 Continue oseltamavir
 ADD PCM, Oral Ondansetron and Dextromethorphan
 Stop Inj.PAN

10.  CALOPOL(Paracetamol) 500 mg PO TID was given to
control fever and body ache.
 T.ZOFER-MD(Ondansetron mouth dissolving) 4 mg was
given to control nausea and vomiting.
 T.PANTOCID-D SR(Pantoprazole 40 mg + Domperidone
30 mg) was given for dyspepsia.
 Syp.ALEX(Dextromethorphan) 10 ml PO TID was given
for cough.

11. DAY 3 (3/2/20)
 Patient improved with IV Fluid , oral Paracetamol , Anti
emetics and supportive care.
 Cough decreased, pain decreased, lesser nausea, able to eat
and feels better.
PLAN:
 Continue same treatment
 Planned for discharge
 At the time of discharge, she is stable and being discharged
in stable condition.

12. PLAN
Monitoring parameters
Watch out for dehydration, fever spikes, hypotension and
respiratory distress.
Monitor vitals.

13. PATIENT COUNSELLING
 To self-isolate in the home for 7 days after the onset of illness or at
least 24 hours after symptoms have resolved, whichever is longer.
 While in home isolation, patients and other household members
should follow infection control instructions, including frequent hand
washing with soap and water.
 Patients with H1N1 influenza should wear a face mask when within
6 feet of others at home.
 If the patient must go into the community (eg, to seek medical care),
he or she should wear a face mask to reduce the risk of spreading
the virus in the community when coughing, sneezing, talking, or
breathing.
 Drink plenty of liquids to prevent dehydration.
 Take rest. Get more sleep to help your immune system fight
infection.

14. DISCHARGE MEDICATION
 Tab. FLUVIR 75 mg 1 tab to be taken twice daily orally
after food for 3 days ( till 5/2/2020) given for Influenza.
 Tab. CALPOL 500 mg 1tab to be taken thrice daily orally
after food for 3 days given for fever and body ache.
 Cap. PANTOCID-D SR 1 cap to be taken once daily orally
before breakfast for 3 days given for APD.
 Tab. ZOFER-MD 4 mg 1 tab to be taken orally before food
when necessary (if nausea) for 3 days.
 REVIEW IN INFECTIOUS DISEASE CLINIC AFTER 1
WEEK FOR VACCINATION.