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group 4 ward final ppt yes of course .pptx

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A 38-year-old female was admitted with worsening cough, shortness of breath, and chest pain. Laboratory tests revealed elevated inflammatory markers and sputum culture grew Klebsiella pneumoniae resistant to several antibiotics. She was started on meropenem and levofloxacin to treat the multi-drug resistant pneumonia. The pharmacist recommended adding levofloxacin due to resistance of the pathogen to standard antibiotics for community-acquired pneumonia.

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Sever community aquiared pneumonia From: Internal female Ward By- Group 4
GROUP MEMBER ID Jenet binyam ................................. Jenifer apet .................................... RU 5164/12 Jiregna hailu................................... RU 1168/12 kalid ahmed.................................... RU 1467/12
OUTLINE • Case identification • Subjective findings • Objective findings • Physician’s assessment • Medications given • Pharmacists Assessment • Drug therapy problem identified • pharmaceutical care plan and follow up • Patient education • References
Case identification
Subjective findings • C/C: Worsing of cough with blood sputum,SoB • HPI :This is a 38 years old female patient admitted for the above Dx after she presented with worsing of cough and Sob of 1 week duration with chest pain of 2 week duration she has also hemipetesis which is bright red in clour 2 weeks duration the cough was productive with whitish sputum for past 1 year • associated with HGIF, whight loss and night sweet for the same duration. She has also 2 episode of vomiting and diharria .
• she has no other chronic illness like HTN,DM… • No Hx of smoking • No Hx ABM or LOC • No HX of ortopena or PND • No Hx of GBS • No Hx of previous TB treatment • No Hx of known medical illness
 P/E: • G/A :Acute sick looking • V/S: BP;-110/70 PR;112 RR;48 T;38.1 SPO2:91% With INo2 5L/M • HEENT : PC,NIS • LGS:NSLAP • Chest : diffused crepitation all over the lung field ,and left inter scapular area • CVS;S1 and S2 well heard no murmur no gallop • Abd: flat moves with respiration no mass, no organomegaly • CVS:NCVAT • MSS/IS:no edema
date Time PR RR BP TO SPO2 20/04/1 6 10:30a m 98 36 118/76 37.5 94%INO2 21/4/16 12:30a m 118 32 121/70 37.3 94% off INO2 22/4/16 1:00am 108 30 120/85 37.5 93%INO2 22/4/16 3:30pm 120 38 115/80 37.2 88%INO2 23/4/16 6:00am 130 30 112/86 37.9 91%INO2
Laboratory Investigation Serum electrolyte/L FT Result(19/4/ 2016) Result(20/42 016) Normal range ASTL 60U/L 55 0-40 ALT 23U/L 24 0-41 CREA 0.43Lmg/dl 0.5 0.7-1.2 Na 138.9 142 136-145mmoL K 1.9 3.44 3.5-5.1 Cl 103.23 114 93-107
Test(CBC) Result 17/4/16 Result 20/04/20 16 Result 25/04/16 Unit Normal range WBC 20.49 33.79 27.52 10^3/UL 3.00-15.00 RBC - 6.17 - 10^6/UL 2.50-5.50 HGB 20.1 11.3 9.8 g/dl 8-17.0 HCT 54.3 32.2 30.6 % 26-50 MCV 80 84.3 91.6 fL 86-110 CBC
IMAGINGS Chest CT with contrast Dx SCAP +AGE+R/o of lung cancer Chest radiography Dx SCAP and R/o lung cancer Abdominal ultrasound
CULTURE ON 10/01/2024 • Sample type: sputum • Organism detected: klebsiella pneumoniae Amoxicillin/Clavulan ic acid Intermediate Ceftriaxone Resistant Gentamicin Resistant Piperacillin/tazobactam Suspectible Ciprofloxacin Intermediate Meropenem Susceptible Ampicillin Resistant
Medication given 17/04/16 • INo2 3L/M • ceftriaxone2gmIVdaily • vancomycine1gmIVTID • plasil10mgIVTID • Kcl40meqin 500mlof . 20/04/16 • INO2 3L/M • Ceftriaxone 2gm IV daily • Omeprazole 40mgIV BID • Plasil 10mg IV TID • Doxycycline 100mg po BID • PCM 1gm PO PRN
Medication Given 14 current INO2 3L/min Meropenem 1g IV TID Ranitidine 50mg IV TID Tramadol 50mg IV TID
Physician Assessment 15 Severe community acquired pneumonia AGE hypokalemia
Pharmacist’s assessment  Past medical history No PMH  Past medication history No Past medications history Drug allergy NKDA Family History No family hx of the same illness  Substance use No  Vaccination Hx unknown 16
DTP identified Indication need Additional drug
Pharmaceutical care plan and follow up Medical condition DTP identified Goal of therapy Intervention Status of intervention Paramet ers to be monitor ed Severe community acquired pneumonia Need additional drug To treat multiple drug resistance klebsiella pneumonia To start levofloxacin 750 mg IV daily pending • Sputem cultur  Serum electrol yte  clinical assesse ment 18
Evidence for intervention • In patient who infected with gram negative pathogen not covered by standard CAP regimen • include combination therapy with an antipseudomonal carbapenam /antipnemococcal beta lactam antibiotics and antipsedomonal fluroquinolone
Cont …… • Meropenam 1g every 8 hour + levofloxacin 750 mg daily
Patient Education Resparitory hygain Avoid close contact vaccination Rest and hydration
Referance • Standard Treatment Guideline 4th edition 2020 • Medscape • Up to date

More Related Content

group 4 ward final ppt yes of course .pptx

  • 1. Sever community aquiared pneumonia From: Internal female Ward By- Group 4
  • 2. GROUP MEMBER ID Jenet binyam ................................. Jenifer apet .................................... RU 5164/12 Jiregna hailu................................... RU 1168/12 kalid ahmed.................................... RU 1467/12
  • 3. OUTLINE • Case identification • Subjective findings • Objective findings • Physician’s assessment • Medications given • Pharmacists Assessment • Drug therapy problem identified • pharmaceutical care plan and follow up • Patient education • References
  • 5. Subjective findings • C/C: Worsing of cough with blood sputum,SoB • HPI :This is a 38 years old female patient admitted for the above Dx after she presented with worsing of cough and Sob of 1 week duration with chest pain of 2 week duration she has also hemipetesis which is bright red in clour 2 weeks duration the cough was productive with whitish sputum for past 1 year • associated with HGIF, whight loss and night sweet for the same duration. She has also 2 episode of vomiting and diharria .
  • 6. • she has no other chronic illness like HTN,DM… • No Hx of smoking • No Hx ABM or LOC • No HX of ortopena or PND • No Hx of GBS • No Hx of previous TB treatment • No Hx of known medical illness
  • 7.  P/E: • G/A :Acute sick looking • V/S: BP;-110/70 PR;112 RR;48 T;38.1 SPO2:91% With INo2 5L/M • HEENT : PC,NIS • LGS:NSLAP • Chest : diffused crepitation all over the lung field ,and left inter scapular area • CVS;S1 and S2 well heard no murmur no gallop • Abd: flat moves with respiration no mass, no organomegaly • CVS:NCVAT • MSS/IS:no edema
  • 8. date Time PR RR BP TO SPO2 20/04/1 6 10:30a m 98 36 118/76 37.5 94%INO2 21/4/16 12:30a m 118 32 121/70 37.3 94% off INO2 22/4/16 1:00am 108 30 120/85 37.5 93%INO2 22/4/16 3:30pm 120 38 115/80 37.2 88%INO2 23/4/16 6:00am 130 30 112/86 37.9 91%INO2
  • 9. Laboratory Investigation Serum electrolyte/L FT Result(19/4/ 2016) Result(20/42 016) Normal range ASTL 60U/L 55 0-40 ALT 23U/L 24 0-41 CREA 0.43Lmg/dl 0.5 0.7-1.2 Na 138.9 142 136-145mmoL K 1.9 3.44 3.5-5.1 Cl 103.23 114 93-107
  • 10. Test(CBC) Result 17/4/16 Result 20/04/20 16 Result 25/04/16 Unit Normal range WBC 20.49 33.79 27.52 10^3/UL 3.00-15.00 RBC - 6.17 - 10^6/UL 2.50-5.50 HGB 20.1 11.3 9.8 g/dl 8-17.0 HCT 54.3 32.2 30.6 % 26-50 MCV 80 84.3 91.6 fL 86-110 CBC
  • 11. IMAGINGS Chest CT with contrast Dx SCAP +AGE+R/o of lung cancer Chest radiography Dx SCAP and R/o lung cancer Abdominal ultrasound
  • 12. CULTURE ON 10/01/2024 • Sample type: sputum • Organism detected: klebsiella pneumoniae Amoxicillin/Clavulan ic acid Intermediate Ceftriaxone Resistant Gentamicin Resistant Piperacillin/tazobactam Suspectible Ciprofloxacin Intermediate Meropenem Susceptible Ampicillin Resistant
  • 13. Medication given 17/04/16 • INo2 3L/M • ceftriaxone2gmIVdaily • vancomycine1gmIVTID • plasil10mgIVTID • Kcl40meqin 500mlof . 20/04/16 • INO2 3L/M • Ceftriaxone 2gm IV daily • Omeprazole 40mgIV BID • Plasil 10mg IV TID • Doxycycline 100mg po BID • PCM 1gm PO PRN
  • 14. Medication Given 14 current INO2 3L/min Meropenem 1g IV TID Ranitidine 50mg IV TID Tramadol 50mg IV TID
  • 15. Physician Assessment 15 Severe community acquired pneumonia AGE hypokalemia
  • 16. Pharmacist’s assessment  Past medical history No PMH  Past medication history No Past medications history Drug allergy NKDA Family History No family hx of the same illness  Substance use No  Vaccination Hx unknown 16
  • 18. Pharmaceutical care plan and follow up Medical condition DTP identified Goal of therapy Intervention Status of intervention Paramet ers to be monitor ed Severe community acquired pneumonia Need additional drug To treat multiple drug resistance klebsiella pneumonia To start levofloxacin 750 mg IV daily pending • Sputem cultur  Serum electrol yte  clinical assesse ment 18
  • 19. Evidence for intervention • In patient who infected with gram negative pathogen not covered by standard CAP regimen • include combination therapy with an antipseudomonal carbapenam /antipnemococcal beta lactam antibiotics and antipsedomonal fluroquinolone
  • 20. Cont …… • Meropenam 1g every 8 hour + levofloxacin 750 mg daily
  • 21. Patient Education Resparitory hygain Avoid close contact vaccination Rest and hydration
  • 22. Referance • Standard Treatment Guideline 4th edition 2020 • Medscape • Up to date