MEDICAL MANAGEMENT

Date 8/18/11 4:20 pm (+) DOB

Doctors Order >Low Purine Diet, Small frequent feeding with SAP

Interpretation A low purine gout diet will help reduce uric acid levels.
http://www.best-gout-remedies.com/low-purine-gout-diet.html

Small frequent feeding promotes adequate hydration and nutrition.

http://books.google.com.ph/books?id=3jLRwcaCpUwC&pg=PA154&lpg=PA154&dq=small+frequent+feedings+for+TB+patient& source

SAP to prevent choking.

http://nursinghomes.nyhealth.gov/nursing_homes/deficiency/442/RYLO

>IVF D5W 1L x KVO >Lab. CBC, UA, BUN, Creatinine, Na, K, Chest X-ray PA Repeat ECG, Uric Acid, SGPT/SGOT

To maintain water balance in patients who are not able/has difficulty taking anything by mouth;
http://www.google.com.ph/url?sa=t&source=web&cd=5&ved=0CE0QFjAE&url=http%3A%2F%2Fwww.finlay-online.com

CBC may be helpful in discriminating septic joint from gout if significant leukocytosis is present.
http://www.arupconsult.com/Topics/Gout.html#tabs=1

Urinalysis helps diagnose a urinary tract or metabolic disease

Indication & Purpose of a Urinalysis | eHow.com http://www.ehow.com/facts_5859622_indication-purposeurinalysis.html#ixzz1YDHzUVm1

The blood urea nitrogen test is a measure of the amount of nitrogen in the blood in the form of urea, and a measurement of renal function Creatinine has been found to be a fairly reliable indicator of kidney function.
.http://en.wikipedia.org/wiki/Blood_urea_nitrogen

Serum sodium test measures the concentration of sodium in the blood.

http://www.nlm.nih.gov/medlineplus/ency/article/003481.htm

Potassium testing is ordered when a doctor is diagnosing and evaluating high blood pressure (hypertension) and kidney disease.
http://labtestsonline.org/understanding/analytes/potassium/tab/test

Chest X-ray is commonly used to detect abnormalities in the lungs and/or progress of a disease(Since the patient has PTB since 2003).
http://www.medterms.com/script/main/art.asp?articlekey=2701

ECG is usually ordered to reflect underlying heart conditions.

http://www.amperordirect.com/pc/help-ecg-monitor/z-ekg-purpose.html

The uric acid tests are used to evaluate the blood levels of uric acid for gout. (The patient has been diagnosed to have gout for almost 21 years now).
http://medical-dictionary.thefreedictionary.com/Uric+Acid+Tests

SGPT test is done to see if the liver is diseased or damaged.

: What Is a SGPT Blood Test? | eHow.com http://www.ehow.com/about_5054515_sgpt-blood-test_.html#ixzz1YDPSB1uA

>Meds: Tramadol 1 amp IV q8 PRN for pain >Celecoxib 100mg 1 cap q12

For the management of moderate to moderately severe pain (gout pain).

PPDs Nursing Drug Guide 2 Edition p. 33
nd

8/19/11 7:30am

Treatment of the signs and symptoms of arthritis. >Shift IVF to PNSS PPDs Nursing Drug Guide 2 Edition p. 9 + 50 meq of NaCl x KVO PNSS is used frequently for patients who cannot take
nd

fluids orally. Safest fluid to give in large volumes. Used since patient has difficulty of breathing yesterday.

>NaCl 2 tabs TID x 5/8 days

http://www.docstoc.com/docs/8981353/Case-Study-Paroxysmal-Nocturnal-Hemoglobinuria

Used to replace the sodium lost from the body and thereby return sodium chloride levels to normal. Sodium chloride level 120.6 mEq/L (Aug. 18, 2011) 4:45 pm (+) hemoptysi s >give Tranexamic Acid 500mg/amp Iv now then q8
http://www.amazon.com/Sodium-Chloride-Tabs-100-Tablets/dp/B000GCN130

>Ceftriaxone 1gm IV q12 (-) ANST

Treatment and prophylaxis of hemorrhage associated with excessive fibrinolysis. (Patient has hemoptysis).
PPDs Nursing Drug Guide 2nd Edition p. 340

8/20/11 (+) DOB (+) hemoptysi s (-) chest pain BP= 100/70

>Sinecod Forte TID

Treatment of susceptible infections. Delayed stage with articular systemic manifestations.

PPDs Nursing Drug Guide 2nd Edition p. 106

Cough of any etiology. Patient is also diagnosed with PTB. >Vit. K (1g) IV q8 x 6 doses
http://www.mims.com/Philippines/drug/info/Sinecod%20Forte/

>Tranexamic Acid 500mg IV q8 x 6 doses

Vitamin K promotes formation in the liver of clotting factors II, VII, IX, and X. (Patient has hemoptysis).
http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS%20%28General%20Monographs-%20V%29/VITAMIN%20K.html

>IVF PNSS 1L x KVO

Treatment and prophylaxis of hemorrhage associated with excessive fibrinolysis. (Patient has hemoptysis).
PPDs Nursing Drug Guide 2nd Edition p. 340

>for Sputum AFB x

PNSS is used frequently for patients who cannot take fluids orally. Safest fluid to give in large volumes. Used since patient has difficulty of breathing yesterday.

3 days

http://www.docstoc.com/docs/8981353/Case-Study-Paroxysmal-Nocturnal-Hemoglobinuria

8/21/11 2:30pm BP= 120/80 (-) hemoptysi s (-) chest pain (-) DOB

>Colchicine 1 tab TID

Used to isolate Mycobacterium tuberculosis when tuberculosis (TB) is suspected.

http://www.enotes.com/nursing-encyclopedia/acid-fast-culture

> d/c Celecoxib tablet

For the chronic management of gout. Patient has gout for almost 21 years now.
http://rx-s.net/weblog/more/colchicine-indications-and-dosage/

> Tramadol 50mg cap TID for pain

discontinued since Colchicine 1 tab TID has been ordered.

For the management of moderate to moderately > Moriavit 1 amp IV severe pain (gout pain). PPDs Nursing Drug Guide 2 Edition p. 33 now then OD x 3 doses
nd

>Quadtab 3 tabs OD

Nutritional supplement of protein, water, electrolytes & vitamins.

http://www.mims.com/Philippines/drug/info/Moriavit-V/Moriavit-V%20infusion

> IVF PNSS 1L x KVO

Treatment of all forms of pulmonary and extra pulmonary tuberculosis.

http://tfdtest.thefilipinodoctor.com/search-drug-details.php?id=20040416

8/22/11 12:30 am

>Quadtab 3 tabs OD

PNSS is used frequently for patients who cannot take fluids orally. Safest fluid to give in large volumes. Used since patient has difficulty of breathing yesterday.
http://www.docstoc.com/docs/8981353/Case-Study-Paroxysmal-Nocturnal-Hemoglobinuria

> d/c Tramadol IV

Treatment of all forms of pulmonary and extra pulmonary tuberculosis.

http://tfdtest.thefilipinodoctor.com/search-drug-details.php?id=20040416

>Senokot tab 2 tabs OD at HS

discontinued since Tramadol in capsule form has been ordered.

8/23/11 7:22 am

>Tramadol 50mg/cap TID

Relieves occasional constipation (irregularity). Patient defecates every 6 days.

http://www.theodora.com/drugs/senokot_tablets_senokot_s_tablets_purdue_products.html

>PNSS 1L x KVO

For the management of moderate to moderately severe pain (gout pain).

PPDs Nursing Drug Guide 2nd Edition p. 33

>Continue Meds 8:35 pm

PNSS is used frequently for patients who cannot take fluids orally. Safest fluid to give in large volumes. Used since patient has difficulty of breathing yesterday.
http://www.docstoc.com/docs/8981353/Case-Study-Paroxysmal-Nocturnal-Hemoglobinuria

8/24/11 6am 8/25/11 8 pm

>IVF to follow PNSS 1L at KVO

PNSS is used frequently for patients who cannot take fluids orally. Safest fluid to give in large volumes. Used since patient has difficulty of breathing yesterday.
http://www.docstoc.com/docs/8981353/Case-Study-Paroxysmal-Nocturnal-Hemoglobinuria

>for referral to pulmonologist

8/26/11 >Continue meds >IVF PNSS 1L x KVO

Uses advanced medical equipment in order to formulate a diagnosis for their patients and a plan of treatment for their patients.
http://www.cvtips.com/career-choice/facts-about-pulmonologist-jobs.html

8/27/11 9:45 am joint pain (-) DOB (-) hemoptysi s

>Shift Ceftriaxone IV to Cefixime 200mg tab BID x 4 more days >Continue meds >IVF to follow PNSS 1L x KVO

PNSS is used frequently for patients who cannot take fluids orally. Safest fluid to give in large volumes. Used since patient has difficulty of breathing yesterday.
http://www.docstoc.com/docs/8981353/Case-Study-Paroxysmal-Nocturnal-Hemoglobinuria

Patient has (-) DOB and can tolerate oral medications.

8/28/11 7:40 am (-) LBM Still with joint pain

>continue meds >IVF to follow PNSS IV x KVO

PNSS is used frequently for patients who cannot take fluids orally. Safest fluid to give in large volumes. Used since patient has difficulty of breathing yesterday.
http://www.docstoc.com/docs/8981353/Case-Study-Paroxysmal-Nocturnal-Hemoglobinuria

PNSS is used frequently for patients who cannot take fluids orally. Safest fluid to give in large volumes. Used since patient has difficulty of breathing yesterday.

>d/c Colchicine tab 8:oo pm (+) LBM >Hydritevol/vol replacement

http://www.docstoc.com/docs/8981353/Case-Study-Paroxysmal-Nocturnal-Hemoglobinuria

Diarrhea, nausea, cramping, abdominal pain, and vomiting may occur. Patient is noted to have LBM.
http://www.rxlist.com/colchicine-drug.htm

> give Iterax 25mg/tab now 8/29/11 10:30 pm (+) pruritus 8/30/11 4:47 am (+) pruritus (+) semifluid stool (+) dizziness 110/70

Replaces fluid & electrolytes lost due to diarrhea & vomiting. Patient is noted to have semifluid stool.
http://www.mims.com/Philippines/drug/info/Hydrite/

>hold Senokot

Effective in pruritus accompanying various dermatological conditions. Given since patient is noted to have pruritus.
http://www.mims.com/Philippines/drug/info/Iterax/?type=full

The most common side effects associated with Senokot include abdominal cramping, bloating, diarrhea, lightheadedness, nausea and vomiting. ore serious side effects include bloody stools, dizziness, fainting, rapid heartbeat, rectal bleeding, sweating and weakness. Hold, since patient experienced dizziness and has passed semifluid stool.
Side Effects of Senokot | eHow.com http://www.ehow.com/facts_5243252_side-effects-senokot.html#ixzz1YFhggS4A

>Celecoxib 200mg/cap BID >SERC 16g/ tab TID for dizziness

Treatment of the signs and symptoms of arthritis.

PPDs Nursing Drug Guide 2nd Edition p. 9

Given to relieve sensations such as nausea, dizziness or spinning sensations (vertigo), ringing in the ears (tinnitus) and hearing problems.
http://www.netdoctor.co.uk/medicines/100002366.html

>IVF to follow PNSS 1L x KVO

PNSS is used frequently for patients who cannot take fluids orally. Safest fluid to give in large volumes. Used since patient has difficulty of breathing yesterday.
http://www.docstoc.com/docs/8981353/Case-Study-Paroxysmal-Nocturnal-Hemoglobinuria

9:10 pm

>Continue Meds >refer to rheumatologist

Rheumatologists treat arthritis, certain autoimmune diseases, musculoskeletal pain disorders and osteoporosis. The rheumatologist's most important role is to decide on the diagnosis and recommend the right kind of management for the disease.
http://www.spondylitis.org/patient_resources/medteam_rheumy.aspx

8/31/11 9:20 pm (+) on/off joint pain

>Continue Meds >IVF PNSS 1L x KVO

PNSS is used frequently for patients who cannot take fluids orally. Safest fluid to give in large volumes. Used since patient has difficulty of breathing yesterday.
http://www.docstoc.com/docs/8981353/Case-Study-Paroxysmal-Nocturnal-Hemoglobinuria

9/1/11

>Start Tramadol

Indicated for the short-term (five days or less)

7:30 pm (+) DOB

37.5 mg + Para 325 mg tablet q8 PO

management of acute pain. Tramadol is similar to narcotic analgesics. It works in the brain to change how your body feels and responds to pain. Paracetamol is used to relieve pain, and it can also reduce a fever.
http://www.medicinenet.com/tramadolacetaminophen-oral/article.htm

>Allupurinol 100 mg tab BID

Allopurinol is used to treat gout, and to decrease levels of uric acid.

http://www.drugs.com/allopurinol.html

>warm compress to affected joints BID x 15 8:45 pm (+) chest pain BP= 130/70 RR=40 >do 12 L ECG now

A warm or cold compress would help relieve the pain in case of an arthritis attack.
http://www.home-remedies-for-you.com/remedy/Rheumatism.html

The 12-lead ECG is useful for a number of cases aside from acute coronary events such as chest pain or anginal equivalents (dyspnea, syncope, near syncope, weakness, DKA, diaphoresis disproportionate to the environment, palpitations, etc.)
http://ems-safety.com/12-lead-ekg.htm

>hold Celecoxib 10:30 pm Rarely, this medication can cause serious (very rarely fatal) stomach/intestinal bleeding. Also, this medication and related drugs have rarely caused blood clots to form, resulting in possibly fatal heart attacks and strokes. Rare but very serious side effects stop taking celecoxib and seek immediate medical attention: coffee-ground vomit, black stools, persistent stomach/abdominal pain, chest pain, weakness on one side of the body, slurred speech, sudden vision changes. Hold since patient experienced chest pain.
http://www.medicinenet.com/celecoxib-oral/article.htm

>O2 via facemask at 8-10L/min O2 sat check now

Instituting oxygen therapy if the patient is manifesting respiratory distress (respiratory rate > 24/min) is recommended to increase oxygen saturation in tissues where the saturation levels are too low due to illness or injury.
http://www.nda.ox.ac.uk/wfsa/html/u12/u1203_03.htm

>IVF PNSS 1L

PNSS is used frequently for patients who cannot take fluids orally. Safest fluid to give in large volumes. Used since patient has difficulty of breathing yesterday.
http://www.docstoc.com/docs/8981353/Case-Study-Paroxysmal-Nocturnal-Hemoglobinuria

9/3/11 7:56 pm (+) DOB

>Continue meds >IVF to follow PNSS 1L x KVO

9/4/11 6:30 am With on and off fever

>Continue meds >Paracetamol and Tramadol q6 PO

Indicated for the short-term (five days or less) management of acute pain. Tramadol is similar to narcotic analgesics. It works in the brain to change how your body feels and responds to pain. Paracetamol is used to relieve pain, and it can also reduce a fever.
http://www.medicinenet.com/tramadolacetaminophen-oral/article.htm

>For repeat CXR, Serum Na, K, Crea Pulmo Note: Thank you for this referral Patient seen and examined (+) episode of hemoptysis (+) treatment of PTB non-compliant (2x) PE: (+) LAD Harsh breath sounds CXR: inf RUL cant RO mass Suggest: 1. Chest CT scan with contrast 2. Start Isoniazid 400mg 1 tab OD 3. Vit.B complex 1 cap OD >Carry out pulmo notes 12:30 pm

To monitor deviations from normal and any changes from previous test results.

9/5/11 7:30 am

>Continue meds >IVF to follow PNSS 1L x KVO >Continue meds >IVF to follow PNSS 1L x KVO >Continue meds

PNSS is used frequently for patients who cannot take fluids orally. Safest fluid to give in large volumes. Used since patient has difficulty of breathing yesterday.
http://www.docstoc.com/docs/8981353/Case-Study-Paroxysmal-Nocturnal-Hemoglobinuria

9/6/11 10:30 pm 9/7/11 6:00 am With on and off DOB with shoulder pain 9/8/11 8:30 pm

>Continue Meds >Shift IVF to heplock Placed in order to administer drugs and fluids without injecting patients multiple times unnecessarily.
http://www.ehow.com/about_4605949_what-heparin-lock.html

9/9/11 7:30 am

>Salbutamol 1 neb q8 Hold if with hemoptysis

>Continue Meds

Has a pronounced bronchodilatatory effect on all forms and degrees of severity of bronchial asthma. It is therefore very well suited for the acute treatment of bronchospasms, even if the attacks are severe.
http://www.infomed.ch/100drugs/salind.html

9/10/11 11:22 pm 9/11/11 7:40 am 9/12/11 8:00 am 9:00 am

>Continue Meds

>Continue meds >Wean from O2 >May proceed with chest CT scan plan Provide greater clarity and reveal more details than regular x-ray exams.
http://www.radiologyinfo.org/en/info.cfm?pg=chestct

BUN- 7.6 mmol/ Crea>give Salbutamol 195 mmol/ neb now 11:30 am

Has a pronounced bronchodilatatory effect on all

forms and degrees of severity of bronchial asthma. It is therefore very well suited for the acute treatment of bronchospasms, even if the attacks are severe.
http://www.infomed.ch/100drugs/salind.html

9/13/11 2:25 am

>Hydrocortisone 250 mg IV stat

Used to reduce inflammation.

http://www.webhealthcentre.com/drugix/Hydrocortisone_DI0073.aspx

3:20 am

>Give Salbu neb q15 x 3 doses

Has a pronounced bronchodilatatory effect on all forms and degrees of severity of bronchial asthma. It is therefore very well suited for the acute treatment of bronchospasms, even if the attacks are severe. Patient noted to have DOB.
http://www.infomed.ch/100drugs/salind.html

10:00 pm >Plasil 1 amp IV (+) hiccups stat (+) DOB

Decreases nausea and vomiting. Stimulates motility of the upper GI tract and accelerates gastric emptying.
http://www.nursing-nurse.com/drug-study-plasil-176/

Used to reduce inflammation.

http://www.webhealthcentre.com/drugix/Hydrocortisone_DI0073.aspx

>Hydrocortisone 250mg IV now

Decreases nausea and vomiting. Stimulates motility of the upper GI tract and accelerates gastric emptying.
http://www.nursing-nurse.com/drug-study-plasil-176/

9/14/11 12:55 pm 9/15/11 Without O2 10:05 am

>Give Plasil 1 amp IV stat

>Continue meds

>IVF to consume then d/c >MGH >Home meds 1. INH 400mg tab OD

An antibacterial agent active only against Mycobacteria, the bugs that cause tuberculosis.
http://www.virtualmedicalcentre.com/drugs.asp?drugid=2044&title=Isoniazid

Indicated for the treatment of pulmonary tuberculosis. should be used in conjunction with at least one other antituberculous drug.
http://www.druglib.com/druginfo/ethambutol/indications_dosage/

2. ETH 400mg tab BID

Allopurinol is used to treat gout, and to decrease levels of uric acid.

http://www.drugs.com/allopurinol.html

3. Allupurinol 30mg tab OD 4. Combivent neb q6 x 3 doses ORN for DOB

Indicated for use in patients with chronic obstructive pulmonary disease (COPD) on a regular aerosol bronchodilator who continue to have evidence of bronchospasm and who require a second bronchodilator.
http://www.healthscout.com/rxdetail/68/87/7/main.html

Treatment of bronchial asthma and pulmonary disease with spastic bronchial component.
http://www.mims.com/Philippines/drug/info/Ansimar/?type=full

5. Ansimar 400 mg tab OD 6. Vit. B complex cap OD

Vitamin B Complex is indicated in conditions characterized by depletions or increased demand of vitamin B1, B2, B6, dexpanthenol, and nicotinamide. It is also indicated for stress conditions, as an adjunct to antibiotics and diuretic therapy.
http://www.arpimed.am/e/medicines/vitamin-b-complex

For moderate to severe pain.

http://www.mims.com/Philippines/drug/info/Dolcet/Dolcet%20tab

7. Dolcet tab q8 for pain