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A 70-year-old male patient was admitted to the ICU with breathlessness, cough with expectoration, and fever for four days, diagnosed with Chronic Obstructive Pulmonary Disease (COPD) and respiratory failure. Vital signs indicated fluctuating blood pressure and oxygen saturation levels, while laboratory tests revealed moderate COPD and mild hypokalemia. The treatment plan includes pharmacological and non-pharmacological management, patient counseling, and recommendations for regular follow-up and monitoring.

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6 views

Yuu

A 70-year-old male patient was admitted to the ICU with breathlessness, cough with expectoration, and fever for four days, diagnosed with Chronic Obstructive Pulmonary Disease (COPD) and respiratory failure. Vital signs indicated fluctuating blood pressure and oxygen saturation levels, while laboratory tests revealed moderate COPD and mild hypokalemia. The treatment plan includes pharmacological and non-pharmacological management, patient counseling, and recommendations for regular follow-up and monitoring.

Uploaded by

aryankalmegh4
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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CASE

PRESENTATION
PREPARED BY - Shruti Vilas patil

ROLL N0. - 22

CLASS - S.Y.PHARM D
2

CASE
A 70 yrs old male patient admitted in ICU
ward .He has no any social habits. He comes to
hospital with chief complaints like feeling
breathlessness since 4 days, cough with
expectoration since 4 days, fever since 4 days.
SUBJECTIVE-

PRESENT CHIEF COMPLAINTS ARE AS FOLLOW-

BREATHLESSNESS SINCE 4 DAYS

COUGH WITH EXPECTORATION SINCE 4 DAYS

FEVER SINCE 4 DAYS


GENERAL PHYSICAL EXAMINATION-

VITALS 3/12 4/12 5/12 6/12 7/12 8/12 9/12 10/12

BP(mmHg) 120/9 100/8 130/80 100/70 100/7 130/90 130/60 100/70


0 0 0

RR 37 26 26 26 28 24 24 23

SPO2 87% 96% 93% 93% 96% 92% 99% 99%

PULSE(bpm) 90 86 86 94 100 104 106 96


SYSTEMIC EXAMINATION-

CVS- S1 S2 +
Res.system- B.S. decreases
Gastrointestinal – Soft and Non Tender
CNS – concious and oriented
Diet – decreases
Sleep – decreases
Bowel and Bladder - Normal
6
LABORATORY INVESTIGATIONS
C0MPLETE BLOOD COUNT
SR.NO COMPONENTS 4/12/2024 5/12/2024 9/12/2024
1 HB 11.9 12.6 11.2
2 RBC count 2.21 2.31 2.7
3 WBC count 11,000 14,500 14,000
4 Lymphocytes - 16 7
5 Neutrophils - 82 89
6 Basophils - - 0
7 Esinophils - 01 4
8 Monocytes - 01 6
9 MCV 83 85 85
10 MCH 27 27 26
11 MCHC 38 32 30
12 HCT 35 36 33
7

LIVER FUNCTION TEST RENAL FUNCTION TEST


SR.NO COMPONENTS 4/12 5/12 9/12
SR.NO COMPONENTS 4/12 9/12
1 Sr. CREATININE 1.6 1.6 0.9
1 SGOT/AST 64 20
2 UREA/BUN 15 15 10
2 SGPT/ALT 81 21
3 BILIRUBIN 0.4 0.4 3 SODIUM 137 137 138

4 PROTEIN 5.5 - 4 POTASSIUM 4.5 4.5 3.6

5 CHLORIDE 109 109 106

OTHER INVESTIGAIONS

HBSAg- NEGATIVE
WIDAL TEST - NEGATIVE
8

DIAGNOSTIC INVESTIGATIONS
Lung Examination-
Hyperinflated chest
Decreased breath sounds bilaterally
Prolonged expiration
Wheezing on auscultation

1.Spirometry Test:
FEV₁/FVC Ratio: 0.65 → Confirms airflow obstruction (COPD diagnosis)
FEV₁: 55% of predicted → Moderate COPD (GOLD 2 )
2. Chest X-ray:
Hyperinflation of lungs
Flattened diaphragm
No lung consolidation (rules out pneumonia)
3.Electrolytes & Kidney Function:
Mild hypokalemia (K⁺: 3.6 mmol/L) (due to respiratory acidosis compensation).
9

ASSESSMENT-

DIAGNOSIS-

BY THE SUBJETIVE AND OBJETIVE (LABORATORY


INVESTIGATIONS) DATA IT IS DIAGNOSED AS COPD
(CHRONIC OBSTRUCTIVE PULMONARY DISEASE) WITH
RESPIRATORY FAILURE
10
PLAN-
Goals of Therapy

-Relieve symptoms (dyspnea, cough, sputum production).

-Improve lung function and exercise tolerance.

-Prevent disease progression and exacerbations .

-Reduce hospitalizations and improve quality of life

Non-Pharmacological Management

-Pulmonary Rehabilitation – Breathing exercises, physical activity.

-Oxygen Therapy – If PaO₂ < 55 mmHg or SpO₂ < 88%

-Nutritional Support – Avoid weight loss/malnutrition.


PHARMACOLOGICAL
TREATMENT-

11
DISCHARGED MEDICATIONS-
1.TAB. AZEE- 0-1-0
PURPOSE – TO TREAT INFECTION IN RESPIRATORY SYSTEM.
DAYS OF TREATMENT - 5 DAYS

2. TAB. PAN-40 – OD
PURPOSE – TO TREAT GASTROESOPHAGEAL REFLUX PROBLEMS
DAYS OF TREATMENT - 5 DAYS.

3.SYP. A TO Z – 1-1-1
PURPOSE – TO TREAT NUTRITIONAL DEFICIENCY
DAYS OF TREATMENT – 10 DAYS

4.NEB. DUOLIN- BD
PURPOSE – COPD (RELAXING MUSCLES &WIDENING AIRWAYS OF LUNGS.)
DAYS OF TREATMENT – 15 DAYS

5. TAB. MONOCEF – 1-0-1


PURPOSE – TO TREAT BACTERIAL INFECTION
DAYS OF TREATMENT – 5 DAYS

12
THERAPHY RELATED PROBLEMS -
1.Azithromycin + Theophylline (Etofylline + Theophylline)
Risk: Azithromycin may increase the serum concentration of theophylline by inhibiting
its metabolism. Possible Effects: Theophylline toxicity (nausea, vomiting,
arrhythmias, seizures).
Recommendation: Monitor theophylline levels and adjust the dose if needed.

2. Azithromycin + Furosemide
Risk: Both drugs may prolong the QT interval, increasing the risk of arrhythmias.
Possible Effects: Palpitations, dizziness.
Recommendation: ECG monitoring, especially in elderly or patients with heart
disease.

3. Ceftriaxone + Calcium Carbonate + Vitamin D3


Risk: Calcium and ceftriaxone can form insoluble precipitates, especially in IV
administration.
Possible Effects: Risk of calcium-ceftriaxone precipitation, leading to kidney damage
or embolism.
Recommendation: Avoid simultaneous administration; flush IV lines if both are
needed.
13
5. Ipratropium + Levosalbutamol + Theophylline
Risk: Additive bronchodilation effects, leading to increased risk of tachycardia and palpitations.
Possible Effects: Nervousness, tremors, arrhythmias.
Recommendation: Use with caution in patients with cardiovascular diseases.

6. Pantoprazole (IV) + Calcium Carbonate + Vitamin D3


Risk: Pantoprazole reduces stomach acid, which may decrease calcium absorption.
Possible Effects: Increased risk of osteoporosis and fractures in long-term use.
Recommendation: Consider switching pantoprazole to oral form if possible and ensure adequate
calcium intake.

7. Furosemide + Ceftriaxone
Risk: Both drugs can cause nephrotoxicity.
Possible Effects: Kidney damage, increased creatinine levels.
Recommendation: Monitor renal function, especially in elderly or dehydrated patients.

8. Budesonide (Inhalation) + Theophylline


Risk: Additive effects on the immune system and potential for increased infection risk.
Possible Effects: Higher susceptibility to infections.
Recommendation: Monitor for signs of infection and consider dose adjustments.

14
15

PATIENT COUNSELLING-
ABOUT DISEASE-

1.COPD – COPD is progressive lung disease, characterized by


chronic inflammation, airway obstruction and breathing difficulties

2. RESPIRATORY FAILURE-
A medical condition that occurs when the respiratory system fails
to meet the body’s needs for O2 and CO2 removal.

ABOUT MEDICATION-

All the medication should be taken on prescribed time.


16

FOLLOW UP AND RECOMMENDATIONS-


Regular Follow-up: Regular monitoring of symptoms, and
adherence to treatment plan
Consider further imaging if symptoms persist or worsen.
Discharge medications should be reviewd and appropriate follow
up should be done for respiratory and infection management.
THANK
YOU

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