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Department of Pharmacy Practice at BBH, Bengaluru
CASE PRESENTATION ON CASE PRESENTATION ON APPENDICITISAPPENDICITIS
IP NO.AA143064
Presented To: MR.BALAKESHAVA RAMAIH
DPT.OF PHARMACY PRACTICEKCP
Presented By: Saroj Poudel 3rd year Pharm.D
PATIENT DEMOGRAPHIC DETAILSPATIENT DEMOGRAPHIC DETAILS
AGE:35 years SEX: MALE HT/CM: 160cm
WEIGHT/Kg: 65kg
DOA: 22-11-14 WARD: w-5 (K1)
MEDICATION HISTORY:
MEDICAL HISTORY: No H/O present surgeries
No known Co. morbilics
FAMILY HISTORY:
SOCIAL HISTORY:
ALLERGIES: NO Allergies
SUBJECTIVE EVIDENCESUBJECTIVE EVIDENCE
CC: C/O pain over right part of abdomen – 2 days
HPI: C/O pain over right part of abdomen – 2 days, initially started around
ambilical . Gradually progressed to right lower part of abdomen.
H/O vomiting 5-6 episodes- 2 days.
No H/O fever, no trauma, no trauma, no urinary difficulty.
OBJECTIVE EVIDENCEOBJECTIVE EVIDENCE
VITAL SIGNS: Pt. Concious , co-operative.
Nutrition: Moderate
BP:120/80mmHg
Pulse:90/min
RR: 16/min
No Lymphadenopathy,pallor,clubbing,cyanosis,icterus,edema
RS: NVBS.
CVS: NAD
CNS: NAD
Abdominal system: Tenders present in R & F, Afebrile
OBJECTIVE EVIDENCEOBJECTIVE EVIDENCE
LAB REPORTS:
Day Parameter Result Remark
Hb: 15.7
TC/DC:Plts:
129003.10 lakhs
Blood Sugar RBS: 115mg/dl
Creatinine 1.17
Urine Negative
Sodium 138
Potassium 3.9
CONTD….
OBJECTIVE EVIDENCEOBJECTIVE EVIDENCE
MEDICATIONS:
DAY & TIME
NAME OF MEDICATION(GENERIC NAME)
DOSE ROUTE TIME INDICATION
22-11-14 1:20 pm
Inj.AMPICILLIN 500mg IV 6-1 semisynthetic penicillin (beta-lactam antibiotic)
Inj.GENTAMYCIN 160mg IV(OD) 6pm aminoglycoside antibiotic which acts by inhibiting microbial protein synthesis
Inj.METRONIDAZOLE 500mg IV(Q8H) 9-3-9 nitroimidazole antibiotic
Inj.OMEPRAZOLE 40gm IV(Q12H) 7-7 Proton Pump Inhibitor
Inj.PARACETAMOL 1gm IV(Q8H) 9-3-9 analgesic
7pm DICLOFENAC 75mg IV(Q12H) 9-9 NSAID
23-11-14 8am
Cap.OMEPRAZOLE 20mg P/O 7-7 Proton Pump Inhibitor
Tab.PARACETAMOL 1mg P/O 9-3-9 analgesic
Cap.OMEPRAZOLE 20mg P/O 10 days Proton Pump Inhibitor
CONTD….
OBJECTIVE EVIDENCEOBJECTIVE EVIDENCE
MEDICATIONS:
DAY & TIME
NAME OF MEDICATION(GENERIC NAME)
DOSE ROUTE TIME INDICATION
Tab.CAMADOL P/O 1-1-1 Pain relief
Tab.CIPRO-T2 P/O 5 days antibacterial and antidiarrheal agents
22-11-14 DNS/DNS @ 100ml/hr DC IVR once Pt. taken orally well
23-11-14 D/C IVR
22-11-14 7pm
Inj.PETHAIDINEInj.PHENARGAN
50mg25mg
Q6H 4 times pain
CONTD….
PROGRESS CHARTPROGRESS CHART
PHYSICIAN/NURSE NOTES:
DAY 1: 22-11-14 IMP: Appendicitis Posted for Lap. Appendectomy N/O till further order Informed counsel Inform to OT & Anesthetic
CBC,RBC,Na+,K+ drugs and fluid in respective chests Shift to OT on call Charge for male biopsy.
DAY 2: 23-11-14 Nutritional Assessment Done
ASSESSMENTASSESSMENT
REFERENCES: www.webmd.com
www.everydayhealth.com
DISEASE EVALUATE CURRENT THERAPY FOR PROBLEM
EVALUATE NEED FOR THERAPY
Appendicitis Inj.METRONIDAZOLE Metronidazole may produce a local antioxidant and anti-inflammatory effect on inflamed tissue by affecting neutrophil function.
Inj.AMPICILLIN is a penicillin antibiotic. It works by killing sensitive bacteria by interfering with formation of the bacteria's cell wall while it is growing.
Inj.GENTAMYCIN aminoglycoside antibiotics. It works by stopping the growth of bacteria.
CONTD….
PLANNINGPLANNING
DISEASE GOALS FOR TREATMENT OF PROBLEM GOALS ACHIEVED (Y/N)
Appendicitis Surgery (conventional or laparoscopic) is indicated if appendicitis is diagnosed and should be performed as soon as possible to decrease risk of perforation.
Administer antibiotics and IV fluids until surgery is performed.
Analgesic agents can be given after diagnosis is made. These are not given before a suspected case of appendicitis to determine whether the patient has a ruptured appendix or not.
Yes Achieved
Yes Achieved
Yes Achieved
CLINICAL PHARMACIST INTERVENTIONCLINICAL PHARMACIST INTERVENTION
DRUG SPECIFIC:
Concurrent use of AMPICILLIN and OMEPRAZOLE may result in reduced
ampicillin bioavailability.
Concurrent use of DICLOFENAC and METRONIDAZOLE may result in
increased exposure of diclofenac.
Concurrent use of AMINOGLYCOSIDES and PENICILLINS may result in loss
of aminoglycoside efficacy
PATIENT EDUCATION PATIENT EDUCATION
DISEASE SPECIFIC: 1.stop smoking and try to get your weight down if you are
overweight.
2.Check the hospital's advice about taking the pill or hormone
replacement therapy (HRT)
DRUG SPECIFIC: 1. If you forget to take a dose, do not worry, just take your next
dose when it is due. Do not take two doses together to make up
for a forgotten dose.
2 .Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress.
DIET SPECIFIC: 1. An all-fruit diet for 2 or 3 days, with three meals a day of fresh juicy fruits at five-hourly intervals.
2. Fruit and milk diet for further 3 days. In this regimen, milk may be added to each fruit meal.