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Management

Management. Course in the Wards Discharge Plans. Management: Course in the Wards. Hospital Day 1: Admission Day Was hooked to D5NSS to run for 20gtts/min Requested to be started on: Ceftriaxone 2g/IV OD Azithromycin 500mg/tab 1tab OD for 3days Erdosteine 300mg/cap 1cap BID

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Management

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  1. Management Course in the Wards Discharge Plans

  2. Management: Course in the Wards • Hospital Day 1: Admission Day • Was hooked to D5NSS to run for 20gtts/min • Requested to be started on: • Ceftriaxone 2g/IV OD • Azithromycin 500mg/tab 1tab OD for 3days • Erdosteine 300mg/cap 1cap BID • Paracetamol 500mg/tab 1tab q4 prn for T> 38C • Amlodipine 5mg/tab 1tab OD • Note: Medications were not started due to financial constraints

  3. Management: Course in the Wards • Hospital Day 1: Admission Day • Laboratory Tests • CBC w/ Platelet – anemia with leukocytosis • Serum Na, K showed hyponatremia and hyperkalemia • Creatinine, SGPT and SGOT were elevated • iCA, iPO4, BUN, UTZ of KUBP, U/A, ABG were requested but were not done due to financial constraints • Transfused with 1u pRBC • Furosemide 40mg/IV 1dose and Salbutamolneblization q4 were requested

  4. Management: Course in the Wards • Hospital Day 1: Admission Day • Patient was referred to Nephrology for co-management and BUA was requested, but was not done • 12L ECG showed sinus rhythm, left ventricular hypertrophy by Sokolow-Lyon, peak T waves • Chest X-ray was done • Sputum GS and AFB for 3days were requested but were not done due to financial constraints

  5. Management: Course in the Wards • Hospital Day 2 • Patient was hypertensive at 180/100mmHg • was given Amlodipine 10mg/tab • Ceftriaxone was started

  6. Management: Course in the Wards • Hospital Day 3 • Salbutamol was shifted to Combivent nebulization q12, with gentle chest physiotherapy after each nebulization • Repeat CBC with platelet, BUN, creatinine, Na, K were requested • Patient had a BP of 140/90mmHg • Was started on Metoprolol 50mg/tab 1tab BID

  7. Management: Course in the Wards • Hospital Day 4 • Ceftriaxone was shifted to Cefuroxime 500mg/tab 1tab BID to complete 7days • Was not done due to financial constraints

  8. Management: Course in the Wards • Hospital Day 5 • Azithromycin, FeSO4 + FA, Metoprolol, as previously ordered, were started

  9. Management: Course in the Wards • Hospital Day 6 • Cefuroxime, as previously ordered, was started • Repeat CBC with platelet was done • showed anemia, leukocytosis, thrombocytosis • Repeat creatinine was done • Declined but still elevated

  10. Management: Course in the Wards • Hospital Day 7 • Patient’s condition improved and was stable • discharge

  11. Management: Discharge Plans • Pharmacologic • Non-Pharmacologic • Procedures • Check-Up

  12. Discharge Plans: Pharmacologic • Azithromycin • MOA: blocks transpeptidation by binding to 50s ribosomal subunit of susceptible organisms and disrupting RNA-dependent protein synthesis at the chain elongation step. • AE: Mild to moderate nausea, vomiting, abdominal pain, dyspepsia, flatulence, diarrhoea, cramping; angioedema, cholestatic jaundice; dizziness, headache, vertigo, somnolence; transient elevations of liver enzyme values. • Dosage: 500mg/tab, 1 tablet OD for 3 days • SRP: Php 150.00

  13. Discharge Plans: Pharmacologic • Cefuroxime • MOA: binds to one or more of the penicillin-binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death. • AE: Large doses can cause cerebral irritation and convulsions; nausea, vomiting, diarrhoea, GI disturbances; erythema multiforme, Stevens-Johnson syndrome, epidermal necrolysis, anaphylaxis, nephrotoxicity, pseudomembranous colitis. • Dosage: 500mg/tab, 1 tablet BID for 7 days • SRP: Php 75.00

  14. Discharge Plans: Pharmacologic • Amlodipine • MOA: relaxes peripheral and coronary vascular smooth muscle. It produces coronary vasodilation by inhibiting the entry of Ca ions into the voltage-sensitive channels of the vascular smooth muscle and myocardium during depolarisation. It also increases myocardial O2 delivery in patients with vasospastic angina. • AE: Headache, peripheral oedema, fatigue, somnolence, nausea, abdominal pain, flushing, dyspepsia, palpitations, dizziness. Rarely pruritus, rash, dyspnoea, asthenia, muscle cramps. Potentially Fatal: Hypotension, bradycardia, conductive system delay and CCF. • Dosage: 10mg/tab, 1 tablet BID • SRP: Php 22.00

  15. Discharge Plans: Pharmacologic • Metoprolol • MOA:Metoprolol selectively inhibits β-adrenergic receptors but has little or no effect on β2-receptors except in high doses. It has no membrane-stabilising nor intrinsic sympathomimetic activity. • AE:Bradycardia, hypotension, arterial insufficiency, chest pain, CHF, oedema, palpitation, syncope, gangrene; dizziness, fatigue, depression, confusion, headache, insomnia, short-term memory loss, nightmares, somnolence; pruritus, rash, increased psoriasis, reversible alopecia, Heart failure, heart block, bronchospasm. • Dosage: 50mg/tab, 1 tablet BID • SRP: Php 4.00

  16. Discharge Plans: Pharmacologic • Erdosteine • MOA:contains two sulfhydryl groups, which are freed after metabolic transformation in the liver. The liberated sulfhydryl groups break the disulphide bonds, which hold the glycoprotein fibres of mucus together. This makes the bronchial secretions more fluid and enhances elimination. • AE:Epigastralgia, nausea, vomiting, loose stools, spasmodic colitis, headache. • Dosage: 300mg/cap, 1 capsule BID • SRP: Php 19.00

  17. Discharge Plans: Pharmacologic • Ferrous Sulfate + FA • MOA:Ferrous sulfate facilitates O2 transport via haemoglobin. It is used as iron source as it replaces iron found in haemoglobin, myoglobin and other enzymes. • AE: GI irritation, abdominal pain and cramps, nausea, vomiting, constipation, diarrhoea, dark stool and discoloration of urine; heartburn. • Dosage: 500mg/tablet, 1tablet BID • SRP: Php 20.00

  18. Discharge Plans: Non-Pharmacologic • Getting plenty of rest and drinking of lots of fluids • Active lifestyle (e.g . Daily exercise) • Preventive measures • Flu shot —for people at high risk, particularly the elderly, because pneumonia may be a complication of the flu • Pneumococcal vaccine —recommended for: • People over aged 65, or those who have a chronic illness, such as diabetes or sickle-cell disease • Children under two years old

  19. Discharge Plans: Non-Pharmacologic • Lifestyle interventions: • Weight loss (BMI<25 kg/m2) • Reduction of dietary salt intake (<6g NaCl/day) • Moderate alcohol consumption • Men: </= 2 drinks per day • Women: </= 1 drink per day • Adapt DASH dietary plan • Diet high in fruits and low-fat dairy products, reduced saturated and total fat • Physical activity • Regular aerobic activity (e.g. brisk walking for 30 mins/day)

  20. Discharge Plans: Procedures • CBC with platelet, serum Na, K, creatinine prior • Ultrasound of KUBP

  21. Discharge Plans: Check-up • Return to UST Hospital for Check-up after 1 week or immediately when condition worsens.

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