Case study 1: Drug Protocol for administering trimethoprim for treatment UTI
Gladys Mayweather is a 50 year old Aboriginal woman who has been admitted to the unit due to a urinary tract infection (UTI). Gladys has been diagnosed with diabetes 10 years ago and had poorly controlled blood sugar levels for most of this time. She has been admitted to hospital as she is finding it even more difficult to control her blood sugar levels with this infection. Gladys comes from her home which is the small town of Katherine about 440klms from the nearest major hospital where she lives with her extended Aboriginal family including her husband. Her doctor has commenced the antibiotic Trimethoprim, ordered regular monitoring of blood sugar levels, and to collect a midstream specimen of urine (MSU). The most recent set of observations: T. 37.5, BP 145/90, P 82, BSL 15mmols.
Gladys weighs 85 kgs. Previous medical history includes Type 2 diabetes mellitus, hypertension, and hyperlipidemia. She has an allergy to sulphur and if taken, she develops a red itchy rash.
Medications prescribed on admission include:
• Trimethoprim 300mg once daily.
• Metformin 1 g, TDS
• Atorvastatin 40 mg daily
• Ramipril 2.5mg once daily
• Paracetamol 1 g, 4-6hrly PRN
Serum creatinine previously stable at 0.15 mmol /L (normal range 0.05 – 0.1 mmoL /L).
• Serum creatinine 0.23 mmol /L.
• Creatinine clearance has decreased from 52 mL/min to 35 mL/min.
• Sodium 140 mmoL /L (135 -145),
• Potassium 4.1 mmoL /L (3.2 – 4.5).
Case Study 2: Drug Protocol for administering salbutamol for management of Chronic Obstructive Pulmonary Disease (COPD)
Mr Wei LiJun is a 70 year old Chinese man who speaks little to no English. He has been admitted to the medical ward after presenting to the emergency department with exacerbation of his COPD. Mr Wei weighs 48kgs and is 158cms tall. This gives him a BMI of 19.Mr Wei is accompanied by several family members including his elderly wife and his daughter who are always in attendance. His daughter Lilly speaks for Mr Wei in all communications with the staff and translates basic information for him including his menu choices and assisting with ADL’s. Mr Wei is a heavy smoker and has been since the age of 13.The acute exacerbation of his COPD has passed and Mr Wei is being prepared for discharge in the next couple of days.
The doctor has charted Mr Wei for 2 puffs every four hours of salbutamol (Ventolin) inhaler PRN. He is for regular 4th hrly observations. All other medications are listed below.
Mr Wei has had a sputum sample sent to pathology and has been charted a broad spectrum antibiotic as well.
Mr Wei has had bloods attended and his results unremarkable.
Past medical history is unremarkable other than COPD and some mild hypertension directly related to his disease.
Medications on admission:
• metoprolol 50mgs daily
• Augmentin duo forte 875/125 amoxycillin and potassium clavulanic acid, 1 tablet daily
• salbutamol (Ventolin) inhaler 2 puffs 4hrly PRN
• ipratropium (Atrovent) inhaler 2 puffs BD
Case Study 3: Drug Protocol for administering paracetamol for treatment of a fever in children
You are caring for a 5 year old boy with Down syndrome (trisomy 21) by the name of Robert Small. He lives with his parents and one older sibling, a sister who is 8 years old. As a result of his Down syndrome, Robert has a congenital heart defect, and has difficulty with speaking clearly, but is able to understand most things for his age despite his learning and intellectual difficulties. He presented to the emergency department with a fever 38.5 which comes and goes, for the past 2 – 3 weeks. All other observations are within normal limits for Robert. On presentation Robert was quite lethargic, irritable, and reluctant with food but tolerating small amounts of fluid. His source of his fever is unknown despite several visits to both his local general practitioner and paediatrician previously. His mother is quite anxious and asking lots of questions when Robert is admitted to the ward. Robert weighs 20 kgs. He is on no other medications currently except for the Paracetamol PRN prior to admission to the ward.
The Doctor has prescribed 300mg paracetamol 4-6hrly PRN (as required) for the fever and regular 4 (four) hourly observations.
He has also been prescribed an antibiotic but this is to be given after urine for culture (MSU), blood tests: FBC (Full blood count), and blood cultures have been collected.
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