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    Therap Case 3

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    Safoora Rafeeq
    The document presents a case of a 60-year-old female patient admitted with cellulitis of the left limb. She presented with fever, swelling, tenderness and redness of the left leg. Laboratory investigations revealed elevated inflammatory markers. She was diagnosed with cellulitis and treated with intravenous antibiotics, analgesics and supportive care. Her symptoms improved over 4 days and she was discharged on oral antibiotics and analgesics with advice on wound care and leg elevation.

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    Therap Case 3

    Uploaded by

    Safoora Rafeeq
    249 views18 pages
    The document presents a case of a 60-year-old female patient admitted with cellulitis of the left limb. She presented with fever, swelling, tenderness and redness of the left leg. Laboratory investigations revealed elevated inflammatory markers. She was diagnosed with cellulitis and treated with intravenous antibiotics, analgesics and supportive care. Her symptoms improved over 4 days and she was discharged on oral antibiotics and analgesics with advice on wound care and leg elevation.

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    THERAP CASE 3

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    The document presents a case of a 60-year-old female patient admitted with cellulitis of the left limb. She presented with fever, swelling, tenderness and redness of the left leg. Laboratory investigations revealed elevated inflammatory markers. She was diagnosed with cellulitis and treated with intravenous antibiotics, analgesics and supportive care. Her symptoms improved over 4 days and she was discharged on oral antibiotics and analgesics with advice on wound care and leg elevation.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    249 views18 pages

    Therap Case 3

    Uploaded by

    Safoora Rafeeq
    The document presents a case of a 60-year-old female patient admitted with cellulitis of the left limb. She presented with fever, swelling, tenderness and redness of the left leg. Laboratory investigations revealed elevated inflammatory markers. She was diagnosed with cellulitis and treated with intravenous antibiotics, analgesics and supportive care. Her symptoms improved over 4 days and she was discharged on oral antibiotics and analgesics with advice on wound care and leg elevation.

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    CASE PRESENTATION ON

    CELLULITIS

    PRESENTED BY : SANA RAFEEQ


    (170715882024)
    PharmD VI/VI

    Under the guidance of


    Dr.Maryam
    Asst. Professor
    Department of Pharmacy Practice
    Deccan School of Pharmacy
    CELLULITIS
    Cellulitisis a bacterial infection of the skin and tissues beneath the skin. Unlike impetigo, which is a very
    superficial skin infection, cellulitis is a bacterial skin infection that also involves the skin's deeper layers: the
    dermis and subcutaneous tissue. Cellulitis is a common infection of the skin and the soft tissues underneath. It
    happens when bacteria enter a break in the skin and spread.

    Etiology:
    ●The main bacteria responsible for cellulitis are Streptococcus and Staphylococcus ("staph"), the same bacteria
    that can cause impetigo and other diseases. 
    ●MRSA (methicillin-resistant Staph aureus) can also cause cellulitis.
    ●Other bacteria (for example, Hemophilus influenzae, Pneumococcus, and Clostridium species) may cause
    cellulitis as well.
    ●Injuries that tear the skin
    ●Infections after surgery
    ●Long-term skin conditions such as eczema or psoriasis
    ●Foreign objects in the skin
    ●Bone infections underneath the skin. (An example is a long-standing, open wound that is deep enough to
    expose the bone to bacteria.)

    .
    signs and symptoms:
    ●Redness
    ●Pain and tenderness, swelling, and
    warmth of the affected area.
    ●Cellulitis can occur anywhere in the body.
    ●Cellulitis frequently affects the legs.
    ●Cellulitis is not contagious

    Complications :
    Include spread of the infection into the
    bloodstream or to other body tissues.
    DEMOGRAPHIC PROFILE

    • PATIENT’S NAME : XYZ


    • I.P No. : R120-002297
    • AGE : 60 yrs
    • WEIGHT: 90kgs
    • GENDER: Female
    • UNIT : General Medicine
    • DOA : 05-02-20
    • DOD : 08-02-20
    SUBJECTIVE DATA

     A 60 years old female patient was admitted in the general


    medicine ward with chief complaints of fever,SOB, swelling
    of left limb and nausea.

     Past medical history:


     The patient has a history of taking excessive painkillers.
    (opiod analgesics like morphine)
     She is obese and suffering from CAD
     On Tab clopitab A(aspirin and clopidogrel)-OD

     PROVISIONAL DIAGNOSIS:CELLULITIS
    OBJECTIVE DATA

     O/E The swelling on her leg is warmth tender and erythematous


     The following test were advised by the physician.
     CRP
     CBP
     ASO TITRE
     ESR
     ELECTROLYTES
     D.DIMER
    BLOOD UREA
     CREATININE
     HS TROPONIN
    ABNORMAL VALUES

    TEST FINDINGS NORMAL VALUE


    HS TROPONIN 51 UPTO 19
    D-DIMER 400ng/mL Up to 200
    ESR 1ST HOUR 50mm 0-5mm
    ESR 2ND HOUR 90mm 5-10mm
    ASO TITRE Positive -
    RA FACTOR negative <10 IUL
    WBC 12000CELLS/CUMM 7000-11000
    CELLS/CUMM
    FINAL DIAGNOSIS:CELLULITIS
    ASSESSMENT

     PROBLEM 1: PAST HISTORY OF CAD


     PROBLEM 2: SHORTNESS OF BREATH
     PROBLEM 3: PAIN AND FEVER
     PROBLEM 4: NAUSEA
     PROBLEM 5: PEDAL EDEMA
     PROBLEM 6: INFECTION (CELLULITIS)
    PLAN
     PROBLEM 1: SHORTNESS OF BREATH
     MEDICATIONS: nebulizer duolin and budecort every 4th hourly

     PROBEM 2: PAIN AND FEVER


     MEDICATIONS: inj PCM(paracetamol) IV Stat

     PROBLEM 3: INFECTION (CELLULITIS)


     MEDICATIONS: inj monocef(ceftriaxone) IV 1 gram.
     Inj.dalacin(clindamycin) 600mg /iv/TID

     PROBLEM 4: NAUSEA
     MEDICATIONS: inj zofer(ondansetron) 4mg IV
    PROBLEM 5: PEDAL EDEMA
     MEDICATIONS: TAB CHYMORAL FORTE (trypsin and
    chymotrypsin)TID

     PROBLEM 6: PAST HISTORY OF CAD


     MEDICATIONS: TAB CLOPITAB A (75/150)mg ( ASPIRIN AND
    CLOPIDOGREL)

     Ulcer prophylaxis- inj pan (pantoprazole) 40mg IV-BD was given


    TREATMENT CHART
    BRAND GENERIC DOSE FREQUENCY ROUTE DAY DAY DA DA
    NAME NAME 1 2 Y3 Y4
    PAN Pantoprazole 40 mg OD IV    
    ZOFER Ondansetron 4mg OD IV X   
    PCM Paracetamol 500mg SOS IV   X X
    MONOC Ceftriaxone 1g BD IV    
    EF
    DUOLIN Salbutamol 2.5ml 4TH HOURLY NASAL   X X
    BUDECO ,ipratropium
    RT br
    /Budesonide
    NS AND Normal 50ml/h SOS IV    
    RL saline and r
    ringers
    lactate
    DALACI clindamycin 600mg TID IV    
    N
    Cloptab- Clopidogrel+ 75mg OD O    
    A Aspirin
    DAY NOTES
     DAY 1
     VITALS:
     Temp:102F
     BP 120/80 mmHg
     PR:83/min
     RR:20/min
     Chief complaints: SOB, fever, swelling and erythematous left limb
     Day 2
     VITALS:
     Temp:100F
     BP 120/80 mmHg ,PR:81/min, RR:21/min
     Chief Complaints :nausea
     Day3
     VITALS:
     Temp 98.4F ,BP 120/80 mmHg, PR:75/min, RR:19/min ,SOB subsided
     Fever subsided and patient is responding to treatment
     Day 4
     Temp: 98.4F ,BP :120/80 mmHg, PR:77/min, RR:20/min
     Patient is responding and all the vitals are stable and hence the patient can be discharged.
    DISCHARGE MEDICATION:

     Tab.Pan(pantoprazole) 40mg OD (BEFORE


    BREAKFAST)
     Tab Dolo (paracetamol) 650 mg SOS
     Tab Motrin(ibuprofen) 400mg SOS
    Tab Dalacin(clindamycin) 300 mg QDS
     Duration of therapy : 7days
     Review in op dept after 7 days
    PHARMACIST INTERVENTIONS:
     BUDESONIDE + CLOPIDOGREL
    Budesonide will increase the level or effect of
    clopidogrel by affecting hepatic/intestinal enzyme
    CYP3A4 metabolism.CYP3A4 inducers may increase
    the metabolism of clopidogrel to its active metabolite.
    Monitor patients for potential increase in antiplatelet
    effects when CYP3A4 inducers are used in combination
    with clopidogrel.
    The patient’s past habit of taking opiod
    analgesics might be the reason for the development of
    cellulitis hence a simpler NSAID like paracetamol was
    suggested.
    PATIENT COUNSELLING
     REGARDING DISEASE
     Cellulitis is a common, potentially serious bacterial skin infection. The affected
    skin appears swollen and red and is typically painful and warm to the touch.
     Cellulitis usually affects the skin on the lower legs, but it can occur in the face,
    arms and other areas. It occurs when a crack or break in your skin allows bacteria
    to enter.
     Left untreated, the infection can spread to your lymph nodes and bloodstream and
    rapidly become life-threatening. It isn't usually spread from person to person.
    REGARDING MEDICATIONS:

     -Take tab.pan at least 30 min before food.


     -Complete the entire course of antibiotics.
     -Use liberal amount of moisturizer.
     -Take the medicines on time.
    REGARDING LIFESTYLE
    MODIFICATIONS:
    .Proper rest and elevation of the affected area.
    .Regular antiseptic soaks
    .Rarely visit to dermatologist (if needed).
    .Painkillers such as pcm are useful to ease pain.
    .Elevation of the leg means that your foot must be higher
    than your hip
    .While sleeping place your foot on a pillow when in bed
    or place something firm under the foot of your mattress
    to keep the affected for elevated.
    .Use a soap substitute on the affected area of the skin to
    prevent it from drying, reduce itching and help healing.

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