Pharmaceutical Care Plan

Pt. Name: KA

Gender: Male

Dx: HTN, DM, Thrombophlebitis

Age: 83 yrs.

Department: ER
 
Pt. Assessment: -

·     Demographical data: -

§  Name: KA.

§  Age: 83 years old.

§  Gender: Male.

§  Mental state: Normal.

§  Weight: 93kg.

§  Height: 180cm.

§  Education level: Illiterate

§  Married with family. 

§  Cash payer.

§  Unemployed.

§  Muslim.

·     CC: - 


§  Left lower limb redness, swelling, and pain.



 

·     Subj. data: -


§  Left lower limb redness and swelling.

§  Came to ER in a wheelchair.

§  Redness.

§  Swelling.

§  Tenderness.

§  Pain.


 

·     Obj. data: -


§  Pain in his feet.

§  Swelling of the left foot.

§  Redness of the left foot.

§  Warm sensation around his foot.

§  Visible vein enlarged.

§  Bluish skin.

§  Lt ankle pain.

§  Injury damaged with skin graph.

§  No fever.

 

CBC Lab.


§  Hb gm/dl 12.7 (14 – 18)

§  PCV% 40% (42 - 54)


§  RBC 10^12/L 4.9 (4.7 – 6.1)

§  MCV fl: 81.6 (76 - 94)

§  MCH pg: 25.9 (27 - 31)

§  MCHC%: 31.8 (32 - 36)

§  C reactive protein: 142.9mg/L (<6mg/L)

§  WBC 10^6/L: 11 (4.500 – 10.000)

§  Neutrophils: 72 (25 - 75)


§  Lymphocytes: 22 (15 - 35)

§  Monocytes: 4 (4 - 8)

§  Eosinophils: 2 (1 - 4)

§  Basophils: 0 (0 - 1)

§  Platelets: 255 (150 - 400)

Kidney Function.

§  Urea: 30 mg/dl (15 - 45)

§  Creatinine: 1.1 mg/dl (0.7 – 1.36)

§  Na: 139 mmol/L (135 - 153)

§  K+: 4.1 mmol/L (3.5 – 5.5)

§  Cl: 102 mmol (95 - 113)


§  Doppler us: Thrombophlebitis


The slight increase in CBC levels doctor says it is normal for his condition. And Kidney function levels are normal.

·     Physical examination:

§  Ultrasound Doppler:

 PROCEDURE: Left lower limb doppler us.

CLINICAL INDICATION: X

TECHNIQUE: A left lower limb examination was performed using duplex us imaging with spectral and color imaging

COMPARISON: No previous film was seen for comparison

FINDINGS:

Incompressible varicose, epifascial vein with internal echoes associated with a significant increase in echogenicity of surrounding fat panes. There are branches and parts of the great saphenous vein. Deep venous thrombosis was excluded (not shown). There are hyperechoic fat lobules separated by hypoechoic fluid-filled areas that give a cobblestone appearance. seen in the ankle region No baker cyst.

IMPRESSION: Thrombophlebitis.

 

·     Allergies: -

No allergy

 

·     History (present): -

§  Present illness: acute foot swelling, pain, and redness 2 days ago

 

 

§  Present medications: 

v  Atacand plus once per day for his HTN.

Atacand Plus is a medication that is used to treat high blood pressure. It contains two active ingredients, candesartan, and hydrochlorothiazide. Candesartan works by relaxing blood vessels, while hydrochlorothiazide helps to reduce the amount of water in the body, which can also help to lower blood pressure. 

 

Notes: Atacand Plus should be taken exactly as prescribed by a healthcare provider. It may take several weeks for the medication to take full effect. Patients should not stop taking the medication without first consulting with their healthcare provider. 

 

Uses: Atacand Plus is used to treat high blood pressure in adults who require treatment with both candesartan and hydrochlorothiazide. 

 

Contraindications: Atacand Plus is contraindicated in patients who are allergic to candesartan, hydrochlorothiazide, or any other ingredients in the medication. It should not be used in patients with severe kidney or liver problems, or in patients with anuria (a condition where the body does not produce urine). 

 

Side effects: Some common side effects of Atacand Plus include dizziness, lightheadedness, and fatigue. Patients may also experience nausea, vomiting, or diarrhea. Some patients may experience an allergic reaction to the medication, which can cause symptoms such as swelling of the face, lips, tongue, or throat, and difficulty breathing. If any of these symptoms occur, patients should seek immediate medical attention.

 

v  Glucophage 850 3 tabs/day for his DM.

Glucophage 850 is a medication used to treat type 2 diabetes. It contains the active ingredient metformin, which helps to lower blood sugar levels by reducing the amount of glucose produced by the liver and improving the body's sensitivity to insulin. 

 

Notes: Glucophage 850 should be taken exactly as prescribed by a healthcare provider. Patients should not stop taking the medication without first consulting with their healthcare provider. 

 

Uses: Glucophage 850 is used to treat type 2 diabetes in adults. It is often prescribed in combination with other medications or as part of a larger treatment plan that includes lifestyle changes such as diet and exercise. 

 

Contraindications: Glucophage 850 is contraindicated in patients who have kidney disease, liver disease, or heart failure. It should not be used in patients who are allergic to metformin or any other ingredients in the medication. 

 

Side effects: Some common side effects of Glucophage 850 include nausea, vomiting, and diarrhea. Patients may also experience stomach pain or discomfort. Some patients may experience an allergic reaction to the medication, which can cause symptoms such as swelling of the face, lips, tongue, or throat, and difficulty breathing. If any of these symptoms occur, patients should seek immediate medical attention.

 

§  Active illness: - 

Thrombophlebitis

§  History (past): -

§  Past illness: HTN, DM

§  Surgical history: Lt. Heal gout.

§  Medical history: RTA 2 months ago.

§  Family history: his mother has DM.

§  Allergies: None

 

§  Objectives (Short term)

§  Reducing swelling and inflammation in the affected limb

§  Managing blood sugar levels to prevent complications from diabetes.

§  Managing blood pressure levels to prevent complications from hypertension.

§  Preventing the formation of blood clots

§  To relieve the patient from his pain, swelling, and redness.

§  To treat his swelling

§  To maintain his immortality

§  To increase knowledge regarding his condition.

§  Goals (long-term)

§  Preventing the recurrence of thrombophlebitis.

§  Maintaining healthy blood sugar levels to prevent complications from diabetes.

§  Maintaining healthy blood pressure levels to prevent complications from hypertension.

§  Preventing the formation of blood clots and reducing the risk of stroke or heart attack.

§  To prevent complications.

§  To improve quality of life by finding more joy and ease while doing aerobics activities.

§  To retain normal mobility.

 

 

 

§  Interventions

§  Thrombophlebitis:

o   Elevating the affected limb to reduce swelling.

o   Applying warm compresses to the affected area to reduce pain and inflammation.

o   Administering anticoagulant medications to prevent the formation of blood clots.

o   Encouraging the patient to wear compression stockings to improve blood flow.

§  Hypertension:

o   Encouraging the patient to follow a healthy diet and exercise regularly.

o   Monitoring blood pressure levels regularly to ensure they are within a healthy range.

o   Educating the patient on lifestyle changes that can help manage hypertension, such as reducing salt intake and quitting smoking.

§  Diabetes:

o   Educating the patient on healthy eating habits and how to monitor their blood sugar levels.

o   Encouraging the patient to exercise regularly to help manage blood sugar levels.

o   Monitoring the patient's blood sugar levels regularly to ensure they are within a healthy range.

§  General interventions:

o   Refer to Dermatologists to check his hand from RTA.

o   Physiotherapy to get his normal mobility fast.

o   Encouraging the patient to avoid smoking and alcohol.

o   Monitoring the patient's overall health and well-being.

o   Educating the patient on the importance of regular check-ups and follow-up appointments with their healthcare provider.

o   Referring the patient to specialists if necessary, such as a dietician or physical therapist

 

v Outcome and follow-up

 

Thrombophlebitis:

o   The patient's swelling and pain in the affected limb should decrease.

o   The patient should not develop new blood clots.

o   The patient should not experience any complications from anticoagulant medications, such as bleeding.

Hypertension:

o   The patient's blood pressure should be within a healthy range.

o   The patient should not experience any complications from antihypertensive medications, such as dizziness or fatigue.

o   The patient should be able to manage their blood pressure through lifestyle changes and medication.

Diabetes:

o   The patient's blood sugar levels should be within a healthy range.

o   The patient should not experience any complications from diabetes, such as nerve damage or vision loss.

o   The patient should be able to manage their blood sugar through lifestyle changes and medication.

 

 

General outcomes:

o   The patient should experience an overall improvement in their health and well-being.

o   The patient should be able to manage their conditions and prevent complications through regular follow-up appointments and check-ups with their healthcare provider.

 

o   First day: no fever, swelling, redness, pain, can’t walk.

o   Second day: swelling, edema, but much lower pain no complaints.

o   Third day: pt. much better almost no pain ambulating pulmonary embolism, febrile stable v/s.

 

§  Pharmacological interventions:

v  Clexane low molecule heparin 0.6 SC BID anticoagulant

Clexane is a brand name for the medication enoxaparin, which is a type of anticoagulant used to prevent blood clots.

 

Uses: Clexane is used to prevent blood clots in patients who are at risk of developing them due to conditions such as deep vein thrombosis, pulmonary embolism, or unstable angina. It may also be used in patients undergoing certain medical procedures, such as surgery or dialysis.

 

Contraindications: Clexane should not be used in patients who are allergic to enoxaparin or any of its components. It should also be used with caution in patients with a history of bleeding disorders, severe liver or kidney disease, or uncontrolled high blood pressure.

 

Side effects: Common side effects of Clexane include bruising, pain, or redness at the injection site, as well as mild itching or rash. More serious side effects may include bleeding, unusual bruising, or signs of an allergic reaction such as hives or difficulty breathing.

 

v  Atacand plus 10 ml/ 12.5 QID for his HTN.

Atacand Plus is a medication that is used to treat high blood pressure. It contains two active ingredients, candesartan, and hydrochlorothiazide. Candesartan works by relaxing blood vessels, while hydrochlorothiazide helps to reduce the amount of water in the body, which can also help to lower blood pressure. 

 

Notes: Atacand Plus should be taken exactly as prescribed by a healthcare provider. It may take several weeks for the medication to take full effect. Patients should not stop taking the medication without first consulting with their healthcare provider. 

 

Uses: Atacand Plus is used to treat high blood pressure in adults who require treatment with both candesartan and hydrochlorothiazide. 

 

Contraindications: Atacand Plus is contraindicated in patients who are allergic to candesartan, hydrochlorothiazide, or any other ingredients in the medication. It should not be used in patients with severe kidney or liver problems, or in patients with anuria (a condition where the body does not produce urine). 

 

Side effects: Some common side effects of Atacand Plus include dizziness, lightheadedness, and fatigue. Patients may also experience nausea, vomiting, or diarrhea. Some patients may experience an allergic reaction to the medication, which can cause symptoms such as swelling of the face, lips, tongue, or throat, and difficulty breathing. If any of these symptoms occur, patients should seek immediate medical attention.

 

v  Mepra 1gm iv BID Running antibiotic 

Meropenem is a type of antibiotic that is used to treat bacterial infections.

 

Uses: Meropenem is used to treat a variety of bacterial infections, including pneumonia, skin infections, urinary tract infections, intra-abdominal infections, and bacterial meningitis. It may also be used in patients with febrile neutropenia, a condition in which the immune system is weakened and the patient is at risk of developing infections.

 

Contraindications: Meropenem should not be used in patients who are allergic to meropenem or any of its components. It should also be used with caution in patients with a history of seizures or central nervous system disorders, as meropenem may lower the seizure threshold.

 

Side effects: Common side effects of meropenem include nausea, vomiting, diarrhea, headache, and rash. More serious side effects may include fever, chills, chest pain, difficulty breathing, or signs of an allergic reaction such as hives or swelling of the face or throat.

 

v  Targo 40 ml QID antibiotic for just 3 days

Targocid is a type of antibiotic that is used to treat bacterial infections.

 

Uses: Targocid is used to treat a variety of bacterial infections, including skin and soft tissue infections, bone and joint infections, and infections of the respiratory tract, urinary tract, and bloodstream.

 

Contraindications: Targocid should not be used in patients who are allergic to Targocid or any of its components. It should also be used with caution in patients with a history of kidney disease or hearing problems, as Targocid may cause kidney damage or hearing loss.

 

Side effects: Common side effects of Targocid include nausea, vomiting, diarrhea, and rash. More serious side effects may include fever, chills, chest pain, difficulty breathing, or signs of an allergic reaction such as hives or swelling of the face or throat.

 

v  Nexium 40 ml QID 

Nexium is a type of medication known as a proton pump inhibitor (PPI).

 

Uses: Nexium is used to treat gastroesophageal reflux disease (GERD), a condition in which stomach acid flows back into the esophagus and causes heartburn and other symptoms. It may also be used to treat other conditions that involve excessive stomach acids production, such as ulcers, Zollinger-Ellison syndrome, and erosive esophagitis.

 

Contraindications: Nexium should not be used in patients who are allergic to Nexium or any of its components. It should also be used with caution in patients with liver disease, as Nexium may cause liver damage.

 

Side effects: Common side effects of Nexium include headache, nausea, diarrhea, and abdominal pain. More serious side effects may include severe stomach pain, chest pain, difficulty swallowing, or signs of an allergic reaction such as hives or swelling of the face or throat.

 

 

 

 

 

v  Perfelgan 1gm iv PRN paracetamol

Paracetamol is a type of medication that is used to treat pain and fever.

 

Note: Paracetamol is also known as acetaminophen in some countries.

 

Uses: Paracetamol is used to treat a variety of conditions, including headaches, muscle aches, toothache, menstrual cramps, and fever. It may also be used to treat pain associated with arthritis or other chronic conditions.

 

Contraindications: Paracetamol should not be used in patients who are allergic to paracetamol or any of its components. It should also be used with caution in patients with liver disease, as paracetamol may cause liver damage.

 

Side effects: Common side effects of paracetamol include nausea, vomiting, and abdominal pain. More serious side effects may include liver damage or signs of an allergic reaction such as hives or swelling of the face or throat.

 

v  N/S 500ml iv st

Normal saline is a type of sterile solution that contains 0.9% sodium chloride (salt) dissolved in water.

 

Note: Normal saline is also known as 0.9% saline or isotonic saline.

 

Uses: Normal saline is used to treat dehydration and to restore fluid and electrolyte balance in patients with conditions such as diarrhea, vomiting, or excessive sweating. It may also be used to dilute medications or flush intravenous lines.

 

Contraindications: Normal saline should not be used in patients who are allergic to sodium chloride or any of its components. It should also be used with caution in patients with heart failure or kidney disease, as excessive fluid administration may worsen these conditions.

 

Side effects: Common side effects of normal saline include swelling at the injection site, redness, and pain. More serious side effects may include fluid overload, electrolyte imbalances, or infection at the injection site.

 

 

 

§  Discharge medications:

v  Augmentin tabs 625mg x2 antibiotic

Augmentin is a type of antibiotic that contains a combination of amoxicillin and clavulanic acid.

 

Note: Augmentin is a brand name for the combination of amoxicillin and clavulanic acid.

 

Uses: Augmentin is used to treat a variety of bacterial infections, including sinusitis, pneumonia, ear infections, and skin infections. It may also be used to treat urinary tract infections.

 

Contraindications: Augmentin should not be used in patients who are allergic to amoxicillin, clavulanic acid, or any other penicillin antibiotics. It should also be used with caution in patients with liver disease or a history of gastrointestinal problems.

 

Side effects: Common side effects of Augmentin include diarrhea, nausea, and vomiting. More serious side effects may include allergic reactions such as hives or swelling of the face or throat, or signs of liver damage such as yellowing of the skin or eyes.

 

v  Ciprodar tabs 500mg 1x2 antibiotic

Ciprofloxacin is a type of antibiotic that belongs to the fluoroquinolone class.

 

Note: Ciprofloxacin is also known by the brand name Cipro.

 

Uses: Ciprofloxacin is used to treat a variety of bacterial infections, including urinary tract infections, respiratory tract infections, and skin infections. It may also be used to treat certain sexually transmitted infections or to prevent infections in people who have been exposed to anthrax.

 

Contraindications: Ciprofloxacin should not be used in patients who are allergic to ciprofloxacin or any other fluoroquinolone antibiotics. It should also be used with caution in patients with a history of seizures, liver disease, or kidney disease.

 

Side effects: Common side effects of ciprofloxacin include nausea, diarrhea, and headache. More serious side effects may include tendonitis or tendon rupture, nerve damage, or allergic reactions such as hives or swelling of the face or throat.

 

 

v  Paquix tabs 5mg 1x2 anticoagulant 

Apixaban is an anticoagulant medication that belongs to the class of drugs known as factor Xa inhibitors.

 

Note: Apixaban is also known by the brand name Eliquis.

 

Uses: Apixaban is used to prevent blood clots in people who have had certain types of surgeries, such as knee or hip replacement surgery. It is also used to reduce the risk of stroke and blood clots in people with atrial fibrillation (a type of irregular heartbeat).

 

Contraindications: Apixaban should not be used in patients who are allergic to apixaban or any other ingredients in the medication. It should also be used with caution in patients with a history of bleeding disorders or liver or kidney disease.

 

Side effects: Common side effects of apixaban include bleeding, bruising, and nausea. More serious side effects may include severe bleeding, allergic reactions, or liver problems.

 

v  Baby aspirin 1x1 antiplatelet 

Aspirin 81mg is a type of medication that belongs to the class of drugs known as salicylates.

 

Note: Aspirin 81mg is also known as low-dose aspirin.

 

Uses: Aspirin 81mg is used to reduce the risk of heart attack and stroke in people who have a high risk of developing these conditions. It may also be used to relieve pain, reduce fever, or reduce inflammation.

 

Contraindications: Aspirin 81mg should not be used in patients who are allergic to aspirin or any other salicylates. It should also be used with caution in patients with a history of bleeding disorders, stomach ulcers, or liver or kidney disease.

 

Side effects: Common side effects of aspirin 81mg include stomach upset, heartburn, and nausea. More serious side effects may include bleeding, allergic reactions, or liver or kidney problems.

 

 

§  Non-pharmacological intervention:

v  Compression stockings: Wearing compression stockings can help improve blood flow and reduce swelling in the legs, which may be helpful for someone with thrombophlebitis.

 

v  Regular exercise: Exercise can help improve circulation, lower blood pressure, and improve blood sugar control. However, it is important to speak to a healthcare provider before starting an exercise program.

 

v  Weight loss: Losing weight can help lower blood pressure and improve blood sugar control.

 

v  Healthy diet: Eating a healthy diet that is low in salt and sugar and high in fruits, vegetables, and whole grains can help improve blood pressure and blood sugar control.

 

v  Smoking: Avoiding smoking can help improve circulation and reduce the risk of complications from thrombophlebitis, hypertension, and diabetes.

 

v  Stress reduction: Stress can raise blood pressure and blood sugar levels, so finding ways to manage stress, such as through meditation, yoga, or deep breathing exercises, may be helpful.

 

v  It is important to note that these non-pharmacological interventions may be used in addition to medication prescribed by a healthcare provider and that it is important to speak to a healthcare provider before starting any new interventions.

 

v  Avoid drinks, and foods containing caffeine such as regular coffee, black tea, regular soda, energy drinks, and black tea as they may worsen the symptoms of hypertension.

 

v  Eat vegetables such as cauliflower, broccoli, cabbage, and mustard greens.

 

 

 

§  Evaluation and Advices and some Questions:

v  Thrombophlebitis: If the patient is experiencing symptoms such as pain, swelling, or redness in the legs, they should seek medical attention immediately. Treatment may include compression stockings, blood thinners, or other medications.

 

v  Hypertension: The patient's blood pressure should be monitored regularly, and medication may be prescribed to help lower blood pressure if necessary.

 

v  Diabetes: The patient's blood sugar levels should be monitored regularly, and medication may be prescribed to help manage blood sugar levels if necessary.

 

v  Follow a healthy diet: Eating a healthy diet that is low in salt and sugar and high in fruits, vegetables, and whole grains can help improve blood pressure and blood sugar control.

 

v  -Exercise regularly: Regular exercise can help improve circulation, lower blood pressure, and improve blood sugar control. However, it is important to speak to a healthcare provider before starting an exercise program.

 

v  Take medication as prescribed: If medication has been prescribed for thrombophlebitis, hypertension, or diabetes, it is important to take it as prescribed and to follow up with a healthcare provider regularly.

 

v  Manage stress: Stress can raise blood pressure and blood sugar levels, so finding ways to manage stress, such as through meditation, yoga, or deep breathing exercises, may be helpful.

 

v  Avoid smoking: If the patient is a smoker, quitting smoking can help improve circulation and reduce the risk of complications from thrombophlebitis, hypertension, and diabetes.

 

v  Monitor for symptoms: The patient should monitor for symptoms of thrombophlebitis, such as pain, swelling, or redness in the legs, and seek medical attention if necessary. They should also monitor their blood pressure and blood sugar levels regularly and seek medical attention if they are experiencing any symptoms or have concerns.

v  It is essential to complete the full course of antibiotics.

v  Follow up with the patient about compliance with his medication and follow up with his doctors.

v  Do you have any other diseases? 

v  Did you take any other drugs?

v  Did you take any vaccines?

v  Are you still tired?