PATIENT PROFILE

Patient name: Bushra begum Date of admission: 28/04/2012 Bed No: 37 Date of round: 29/04/12

Name of Consultant: Dr. Umair WARD: M-1 Age: 65 years

Gender: female Weight: 70 kg

Vital Signs
Sr.
Blood pressure Morning Evening Night Morning Pulse Evening Night Morning Temperature Evening Night Morning Heart Rate Evening Night Respiration Morning rate Evening Night Physical appearance: Patient was unconscious and lying straight. Present complaint/symptoms: Abdominal distention, nausea and loss of speech from 2 days were complained. History of present illness obtained after putting close ended, open ended and funneling questions. Patient was all right one and half a month ago and then developed abdominal distention. Distension was progressive. Pain was in right hypochondrium, severe in character and was relieved by defecation, Constipation since same duration.

Day one
120/90 110/80 110/m 88/m 100 F 100 F

Day Two
100/75 120/90 80/m 82/m 98 F 99 F

Day Three

Day Four

Day Five

17/m 18/m

18/m 20/m

History of past illness: HCV from last 8 years Smoking: Yes No* If yes, How many cigarettes daily? Feeding History: N/G Tube, Juice Immunization History: No Allergies (Drug, Food): NO Family History: Husband had also acquired HCV Socioeconomic History: poor socioeconomic status General Physical examination: B.P 110/80 mmHg, Temp. 100 F, Medication History (Preferably for last three months): Taking homeopathic medicines from last 4 years General examination: Unconscious. No movement, breathing normal Provisional Diagnosis: Hpatic mass with HCV +

Routine Investigation:
Date
23/04/12 -----------------

Blood Sugar

LFTs
Bilirubin 1.7 Alkaline phosphatase 354 (180306) SGPT 53 (542) ---------------

Urine

Kidney Function
Creatinine 3.4

Any Other test report

Hb 7.1

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Special Investigation (Culture sensitivity test, X-Ray, ECG, Ultrasonography) Date Result ultasonography

28/05/201 2 -----------

Enlarged liver with coarse texture, while hepatobiliary channel was not inflamed. No focal lesion present. Gall bladder is thick walled. Ascites is developed Spleen enlarged Kidney normal while hydronephrosis was seen on both sides Urinary bladder is normal

Eating habits (During Illness):

Less salt containing diet.

Final Diagnosis: Liver cirrhosis

Pharmaceutical care plan:

Goals of therapy Improvement of signs/ symptoms/ Reduction in of risk assessed by clinical examination and lab test). Recommended Medicine Inj. Tyoxon (ceftriaxone) Inj. risek Flagyl syrup Inj. Maxolone Kleen enema Actual medicine Ceftriaxone furosemide Inj. Risek Kleen enema Dose 1g 20 mg 2 tea spoon 1 mg Dose 1g 20 mg 20 mg Frequency B.D OD TDS BD Frequency BD BD OD Route of Administration i /v i/v oral I/V Route of Adinistration i /v i/v iv

Drug-Drug Interactions:
No Interaction between drugs was found. Adverse Drug Reactions: Drug omeprazole lasix ceftriaxone adverse drug reaction
constipation; angina, palpitation

Suggestions ---------------------------------------------------------------------------

Nausea, thrombosis,
Pulmonary embolism Renal dysfunction, thrombocytopenia

A.D.R reporting (If any): No ADR was reported. Drug Food Interaction: Drug-Food Interaction Effects Suggestions For management

Furosemide
--------Note:

Alcohol
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Hypotensive effect
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Close monitoring for development of hypotension

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NO food- Drug interactions found. Nutritional Status Patient should take less proteinaceous diet. Hypercatabolism can be related to

abnormal protein metabolism.

Follow up plan: Therapeutic alternatives (To resolve drug therapy problems) No.. Patient Counseling: Modify life style up to the extent that is possible. Avoid the proteinaceous diet. Fluid intake restrict to 1 liter and low salt intake, especially sodium restriction to 1 g/day (2g of Nacl). Bed rest improves renal perfusion and may lead to dieresis.

Rational drug use: Comment/Suggestions:

Injectable solutions of furosemide contain sodium metabisulfite, a sulfite Sensitive individuals may experience allergic reactions (eg, anaphylaxis, bronchospasm, angioedema).

Name of Pharmacist: Signature:

Muhammad Imran