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

PHARMACEUTICAL CARE PHARMACEUTICAL CARE PLANPLAN

ASSESSMENTASSESSMENT

DIAGNOSIS LIST: Appendicitis .

PLAN OF CARE: Laparoscopic

Appendectomy

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.