Female Patient with Pulmonary TB: Diagnosis and Treatment Overview
A 17-year-old female patient with a history of RVD and pulmonary TB presents with fever and cough. Detailed medical history, lab investigations, and diagnostic findings are discussed. The SOAP format highlights subjective and objective evidence, aiding in understanding the patient's condition and treatment plan.
Uploaded on | 0 Views
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
You are allowed to download the files provided on this website for personal or commercial use, subject to the condition that they are used lawfully. All files are the property of their respective owners.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.
E N D
Presentation Transcript
SCENARIO : Here is a 17 yr old female patient presented with a complaints of fever and cough with expectoration and admitted in FMW for 8 days and she was diagnosed as RVD WITH PULMONARY TB. CHIEF COMPLAINTS : c/o fever since 4 days . c/o cough with expectoration since 4 days .
PAST MEDICAL HISTORY : k/c/o RVD with pulmonary TB 8 months back ,she discontinued her treatment. H/o chicken pox -6 yrs back. PAST MEDICATION HISTORY : Nothing significant . LAB INVESTIGATIONS : CBC : WBC : 11100 cumm -slightly increased which indicates presence of infection. N 82 % - increased which indicates systemic bacterial infection. L 15 % - decreased which indicates ,immunodeficiency or AIDS to attack TH4 cells . ESR : 60 mm/hr increased which indicates chronic infection.
MCH 30.1 decreased the indicates hypochromia . PCV - 34.8 decreased , which indicates anaemia overdehydration or blood loss. CD4 count 340 cells/ccmm. URINE EXAMINATION : Epithelial cells : 8-10 hpf increased, which indicates infiltraton of urine VITAL SIGNS : BP : 110/70 mm/hg PR :80 bpm RR :22 TEMP : 37
OTHER INVESTIGATIONS : sputum test : NEGATIVE (mucoprulent ) chest x ray reveals interstitial infiltrates in lower zones . ECG : normal sinus rhythm . pruritis papules of HIV (dermatology reference) PROBLEM LIST : FEVER COUGH WITH EXPECTORATION PULMONORY TB RVD DIAGNOSIS RVD WITH PULMONARY TUBERCULOSIS
SOAP FORMAT SUBJECTIVE EVIDENCE : Here is a 17 yr old female patient presented with a complaints of fever and cough with expectoration and admitted in FMW for 8 days . OBJECTIVE EVIDENCES :CBC : WBC : 11100 cumm -slightly increased which indicates presence of infection. N 82 % - increased which indicates systemic bacterial infection. L 15 % - decreased which indicates ,immunodeficiency or AIDS to attack TH4 cells . ESR : 60 mm/hr increased which indicates chronic infection. MCH 30.1 decreased the indicates hypochromia . PCV - 34.8 decreased , which indicates anaemia overhydration or blood loss.
OTHER INVESTIGATIONS : sputum test : NEGATIVE (mucoprulent ) chest x ray reveals interstitial infiltrates in lower zones . ECG : normal sinus rhythm . pruritis papules of HIV (dermatology reference) CD4 count 340 cells/ccmm. URINE EXAMINATION : Epithelial cells : 8-10 hpf increased, which indicates infiltraton of urine VITAL SIGNS : BP : 110/70 mm/hg PR :80 bpm RR :22 TEMP : 37
ASSESMENT : Based upon above subjective evidence and objective evidence the physician diagnosed the condition as RVD WITH PULMONARY TB . PROBLEM LIST : 1 . FEVER 2 . COUGH WITH EXPECTORATION 3 . PULMONARY TB 4 . RVD RVD : Infection with HIV occur through 3 primary modes sexual,parentral and parental. sexual intercourse , primarily receptive anal and vaginal intercourse is most common transmission.
FEVER : It is usually a symptom of an underlying condition , most often by an infection. In response to an TB infection , the hypothalamus May reset the body to a higher temperature, more than normal temp 98.6 F COUGH WITH EXPECTORATION : It is a rapid expulsion of air from the lungs . It can be done deliberately or involuntarily. PULMONARY TB : The main cause of TB is Mycobacterium tuberculosis,a small , aerobic, nonmotile bacillus.
TB infection begins when the mycobacterium reach the pulmonary alveoli , where they invade and replicate within endosomes of alveolar macrophages . GOALS OF THERAPY : 1. Subside the symptoms with appropriate therapy. 2. curing the TB infection and preventing spread in community. 3. Treatment with a single drug can lead to development of drug resistant TB . 4. Multi drug regimens rid extracellular organisms in the caseating macrophages and activated granulomas, and minimize resistance. 5. The ultimate goal is to decreased mortality and morbidity. PLAN: Momate cream momate furoate topical D04 to D08
s.n o Brand name Generic name Dose 1 2 3 4 5 6 7 8 1 Inj.Taxim 1-0-1 cefixime 1gm iv Y Y 2 Inj.Rablet 1-0-0 Rabeprazole 20mg iv Y Y 3 T.Calpol 1-0-1 Paracetamol 150mg Y Y 4 Inj.Axipan 1-0-0 Pantoprazole 40mg iv Y Y 5 T.PAN 1-0-0 Pantoprazole 40mg oral Y Y Y Y 6 C.Akurit-4 1-0-0 H+R+Z+E 75+150+4 00+275 Y Y 7 C.R-cinex 1-0-0 H+R 450+300 Y Y Y Y Y Y 8. T.Fluconazole 1-0- 0 fluconazole 150mg Y Y Y Y Y Y Y 9. T.Azithral 0-1-0 azithromycin 500mg oral Y Y Y 10. T.Tecrzinc 1-0-0 Levocitrizine dihydrochloride 5mg Oral Y Y Y Y Y 11. T.Benadon 1-0-0 Vit-B6 40mg oral Y Y Y Y Y Y Y
DRUGS : Fluconazole :MOA : It is a triazole antifungal , acts by inhibiting the fungal cytochrome p-450 dependent enzyme , lanosterol 14-alpha demethylase ,ergosterol which causes a loss of sterols and an accumulation of 4- alpha methyl sterols in fungi which is responsible for antifungal activity. Azithromycin :MOA : It is a macrolide antibiotic inhibits the messenger RNA directed polypeptides and protein synthesis . It exerts this activity by binding at 50s ribosomal subunits. Ethambutol : MOA : It inhibits arabinosyl transferases involved in arabinogalactan synthesis and to interfere with mycolic acid incorporation in mycobacterial cell wall.
Isoniazid : MOA : It inhibits the synthesis of mycolic acid , which are unique fatty acid component of mycobacterium cell wall. Rifampin : MOA : It inhibits DNA dependent RNA synthesis . Selective toxicity is that mammalian RNA polymerase does not bind rifampin. Pyrazinamide : MOA : Pyrazinamidase converts pyrazinamide to its active form pyrazinoic acid which accumulates in the bacilli . Accumulation of pyrazinoic acid disrupts membrane potential and interferes with energy product necessary for survival of M.Tuberculosis at an acidic site of infection.
CLINICAL PHARMACIST INTERVENTIONS : ADR : Because of TAB ETHAMBUTOL Patient has optic neuritis clinical management :discontinuation of drug . DRUG INTERACTIONS : MAJOR : Fluconazole + Azithromycin results in increase risk of QT prolongation and Torsades de point clinical management : discontinuation of drug /change in frequency of drug . Moderate : Fluconazole + Rifampicin concurrent use of these drugs may decrease Fluconazole serum concentrations and Antifungal activity .
PATIENT COUNSELING : 1. Tab . Pantoprazole should be taken before breakfast. 2. R-cinex should be taken before food 3. Avoid junk foods , and fatty foods . 4 . Avoid smoky and dusty environments. 5.vit B6 should take after food . 6 . Azithromycin should take after meals . - DISCHARGE DRUGS : Tab Azithral azithromycin 500mg -0-1-0 Tab pantox pantoprazole 40mg 1-0-0 Tab benadon vit b6 - 40mg 1-0-0 Cap R-CINEX H + R 450/300 mg 1-0-0 Tab tecrzinc levocitrizine Hcl 5 mg 1-0-0 Momate cream - topical for 15 days ..
