CASE PRESENTATION ON BRONCHIOLITIS

Pharmaceutical care plan(SOAP,CORE,PRIME and FORM analysis)

BY

Shazia AfreenPHARM D

SSRCP,MBNR

ToDr. Mahesh kumar Asst professor (Pharm D)

PATIENT DETAILS: Name: xxx Age:6yrs Gender: female Ward: PICU Ip no:336530Chief complaints: A 6 year old patient was admitted in the hospital on 29 august 2013 with a complaint of cold and cough since few days h/o 2 episodes of vomiting.Past medical history: nilPast medication history: nil

Diagnosis:BRONCHIOLITIS

Lab investigations:

Parameters Abnormal values Normal valuesPulse rate 60 beats / min 72 beats /min

Haemoglobin 9.7gm/dl 11-16gm/dl

Leukocytes 14,700cells/cumm 5000-11000cells/cumm

Platelets 3.2 lakhs /cumm 1-3 laks /cumm

Drug Generic name

Dose Route Freq Category Days of trt (29/7-1/8)

Neb. Duolin Salbutamol 2.5ml Inhalation 2nd hrly Bronchodilator +

Cateneb. Budecort

Budesortine 0.5mg Inhalation 4th hrly Bronchodilator +

Inj. Zofer Ondansetron 0.5cc Iv Bd Anti emetic +

Syp.Amrodil

Ambroxol 2.5ml Oral Bd Expectorant +

T-minic drops

Phenylephrine

2.5 ml Oral Bd Nasal decongestant

+

PRESENT MEDICATION CHART

Pharmaceutical care plan (soap analysis):

Subjective: The patient complaints about the cold, cough , SOB. child

was apparently asymptomatic few days ago and developed cold since few days and also 2 episodes of vomiting.

Objective: The patient has decreased pulse rate and haemoglobin levels.

the patient has increased leukocytes and platelet count

Assessment: from the subjective and objective evidence it was bronchiolitis Bronchiolitis is swelling and mucous build up in the smallest air passages in the lungs(bronchioles), usually due to a viral infection.Therapeutic goals:Patient specific: to relieve from symptoms and provide quality life.Disease specific: To minimize further progress of disease by giving therapeutic effective drug treatment.

Relieve symptoms. Improve health status. Improve exercise. Prevent disease progression. In this case the patient has

increased levels of WBC count which indicates that the patient is having infection, hence the patient should be treated with the anti infective.

The patient is given with bronchodilators and nasal decongestants so that the patient gets relief from the shortness of breath.

In this case the patient is having low haemoglobin count

TREATMENT AIMS:

PLANNING:Neb.duolin (salbutamol +ipratropium bromide) is a bronchodilator and used in the treatment of respiratory tract disorders and chronic cough.

Neb.budecort(budesonide) is a bronchodilator and used in the treatment of respiratory tract disorders and chronic cough.

Inj. Zofer(ondansetron) is an anti emetic and anti infective which is used to control vomiting and also controls the infection.

Syp.Amrodil(acetylcysteine) is an expectorant and antitussive which involves bronchial secretion or reduce its viscosity facilitating its removal by coughing.

T-Minic drops(phenylephrine) is a constituent of nasal decongestant preparation for topical use which causes bronchodilation.

TOXIC PARAMETERS: Neb.Budecort: Loose stools, headache, fungal infections in mouth

and throat, systemic steroid effect on higher doses, mood changes, hyper glycaemia.

Inj. Zofer: Constipation,headache,sensation of flushing in the head and epigastrium, rarely allergic reactionscholestatic liver damage.

T-minic drops: weakness, anxiety, reflex bradycardia, tachycardia, arrhythmias, hypertension, nausea, vomiting,sweating,weakness,fear, insomia,reslessness,confusion.

DRUG INTERACTIONS: NilMONITORING: regular check up for blood test.Temperature and pulse rate must be monitored

regularly.

PATIENT COUNSELLING:

The patient is adviced not to skip the medication.Breathing exercise such as asanas which includes breathing.Wearing of mask when exposed to pollution.Avoid smoking in the child’s home as it increases the risk of respiratory illness.Wash hands frequently with soap and water especially before getting into the contact with children.

PHARMACEUTICAL BASED PROBLEMS:Chief complaints: A 6 year old patient was admitted in the hospital on 29 august 2013 with a complaint of cold and cough since few days h/o 2 episodes of vomiting..

PRIME ANALYSIS

parameters Abnormal values Normal values

Pulse rate 60 beats / min 72 beats / min

Hemoglobin 9.7 gm/dl 11-16 gm/dl

leukocytes 14,700cells/cumm 5000-1000cells/cumm

platelets 3.2 lakhs /cumm 1-3 lakhs /cumm

Toxic parameters: NEB. Budecort: loose stools, headache, fungal infections in

mouth and throat, systemic steroid effect on higher doses, mood changes, hyper glycaemia.

Inj. Zofer: constipation , Headache , sensation of flushing in the head and epigastrium, rarely allergic reactions cholestatic liver damage.

T-minic drops: weakness, anxiety, reflex bradycardia, tachycardia, arrhythmias, hypertension, nausea, vomiting , sweating ,weakness, fear, insomnia ,restlessness, confusion.

Interactions: Not found in the given prescription

RISK TO PATIENT:

Relieve symptoms. Improve health status. Improve exercise. Prevent disease progression. In this case the patient has increased

levels of WBC count which indicates that the patient is having infection, hence the patient should be treated with the anti infective.

The patient is given with bronchodilators and nasal decongestants so that the patient gets relief from the shortness of breath.

In this case the patient is having low haemoglobin count

MISMATCH:

Nebulizers are given to the child for decrease the difficulty in breathing for every 2nd hour, every 4th hourly .

Expectorents are given morning ,and evening

EFFICACY:

Finding Name: xxx Age:6yrs Gender: female Ward: PICU Ip no:336530Chief complaints: A 6 year old patient was admitted inon the hospital with a complaint of cold and cough since few days h/o 2 episodes of vomiting.Past medical history: NilPast medication history: Nil

FARM ANALYSIS

Diagnosis:BRONCHIOLITIS

Lab investigations:

Parameters Abnormal values Normal valuesPulse rate 60 beats / min 72 beats /minhaemoglobin 9.7gm/dl 11-16gm/dlleukocytes 14,700cells/cumm 5000-11000cells/

cummPlatelets 3.2 lakhs /cumm 1-3 laks /cumm

Assessment: from the subjective and objective evidence it was bronchiolitis Bronchiolitis is swelling and mucous build up in the smallest air passages in the lungs(bronchioles), usually due to a viral infection.Therapeutic goals:Patient specific: to relieve from symptoms and provide quality life.Disease specific: To minimize further progress of disease by giving therapeutic effective drug treatment.

The patient is adviced not to skip the medication.Breathing exercise such as asanas which includes breathing.Wearing of mask when exposed to pollution.Avoid smoking in the child’s home as it increases the risk of respiratory illness.Wash hands frequently with soap and water especially before getting into the contact with children.

RESOLUTION

Regular check up for blood test.Temperature and pulse rate must be monitored

regularly.Checking for drug interactions when adding new drugs

to the given prescriptionCheck for further adverse effects

MONITORING AND FOLLOWUP

CONDITION: A 6 year old patient was admitted in the hospital on 29 august

2013 with a complaint of cold and cough since few days h/o 2 episodes of vomiting.

OUTCOMES:Bronchiolitics occurs in infants, children bellow seven yearsIt needs supportive oxygen rate because of narrowing of air waysMortality rate is more due to difficulty in breathing Therapeutic outcomes: To increase respiration, To prevent hypoxia. To improve QOL

CORE ANALYSIS

The patient parent is adviced not to skip the medication.Breathing exercise such as asanas which includes breathing.Hygienic healthy habits have followWearing of mask when exposed to pollution.Avoid smoking in the child’s home as it increases the risk of respiratory illness.Wash hands frequently with soap and water especially before getting into the contact with children.

REGIMEN

Drug Generic name

Dose Route Freq Category Days of trt (29/7-1/8)

Neb. Duolin Salbutamol 2.5ml Inhalation 2nd hrly Bronchodilator +

Cateneb. Budecort

Budesortine 0.5mg Inhalation 4th hrly Bronchodilator +

Inj. Zofer Ondansetron 0.5cc Iv Bd Anti emetic +

Syp.Amrodil

Ambroxol 2.5ml Oral Bd Expectorant +

T-minic drops

Phenylephrine

2.5 ml Oral Bd Nasal decongestant

+

DRUG REGIMEN

Efficacy parameters:Regular check up for blood test.Temperature and pulse rate must be monitored regularly.

Toxic parameters: NEB. Budecort: loose stools, headache, fungal infections in

mouth and throat, systemic steroid effect on higher doses, mood changes, hyper glycaemia.

Inj. Zofer: constipation , Headache , sensation of flushing in the head and epigastrium, rarely allergic reactions cholestatic liver damage.

T-minic drops: weakness, anxiety, reflex bradycardia, tachycardia, arrhythmias, hypertension, nausea, vomiting , sweating ,weakness, fear, insomnia ,restlessness, confusion.

EVALUATION:

THANK YOU