1. Course in the Wards Discharge Plans
Management
Course in the Wards
Discharge Plans

2. Management: Course in the Wards
Hospital Day 1: Admission Day
Was hooked to D5NSS to run for 20gtts/min
Requested to be started on:
Ceftriaxone 2g/IV OD
Azithromycin 500mg/tab 1tab OD for 3days
Erdosteine 300mg/cap 1cap BID
Paracetamol 500mg/tab 1tab q4 prn for T> 38C
Amlodipine 5mg/tab 1tab OD
Note: Medications were not started due to financial constraints

3. Management: Course in the Wards
Hospital Day 1: Admission Day
Laboratory Tests
CBC w/ Platelet – anemia with leukocytosis
Serum Na, K showed hyponatremia and hyperkalemia
Creatinine, SGPT and SGOT were elevated
iCA, iPO4, BUN, UTZ of KUBP, U/A, ABG were requested but were not done due to financial constraints
Transfused with 1u pRBC
Furosemide 40mg/IV 1dose and Salbutamol neblization q4 were requested

4. Management: Course in the Wards
Hospital Day 1: Admission Day
Patient was referred to Nephrology for co-management and BUA was requested, but was not done
12L ECG showed sinus rhythm, left ventricular hypertrophy by Sokolow-Lyon, peak T waves
Chest X-ray was done
Sputum GS and AFB for 3days were requested but were not done due to financial constraints

5. Management: Course in the Wards
Hospital Day 2
Patient was hypertensive at 180/100mmHg
was given Amlodipine 10mg/tab
Ceftriaxone was started

6. Management: Course in the Wards
Hospital Day 3
Salbutamol was shifted to Combivent nebulization q12, with gentle chest physiotherapy after each nebulization
Repeat CBC with platelet, BUN, creatinine, Na, K were requested
Patient had a BP of 140/90mmHg
Was started on Metoprolol 50mg/tab 1tab BID

7. Management: Course in the Wards
Hospital Day 4
Ceftriaxone was shifted to Cefuroxime 500mg/tab 1tab BID to complete 7days
Was not done due to financial constraints

8. Management: Course in the Wards
Hospital Day 5
Azithromycin, FeSO4 + FA, Metoprolol, as previously ordered, were started

9. Management: Course in the Wards
Hospital Day 6
Cefuroxime, as previously ordered, was started
Repeat CBC with platelet was done
showed anemia, leukocytosis, thrombocytosis
Repeat creatinine was done
Declined but still elevated

10. Management: Course in the Wards
Hospital Day 7
Patient’s condition improved and was stable
discharge

11. Management: Discharge Plans
Pharmacologic
Non-Pharmacologic
Procedures
Check-Up

12. Discharge Plans: Pharmacologic
Azithromycin
MOA: blocks transpeptidation by binding to 50s ribosomal subunit of susceptible organisms and disrupting RNA-dependent protein synthesis at the chain elongation step.
AE: Mild to moderate nausea, vomiting, abdominal pain, dyspepsia, flatulence, diarrhoea, cramping; angioedema, cholestatic jaundice; dizziness, headache, vertigo, somnolence; transient elevations of liver enzyme values.
Dosage: 500mg/tab, 1 tablet OD for 3 days
SRP: Php

13. Discharge Plans: Pharmacologic
Cefuroxime
MOA: binds to one or more of the penicillin-binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death.
AE: Large doses can cause cerebral irritation and convulsions; nausea, vomiting, diarrhoea, GI disturbances; erythema multiforme, Stevens-Johnson syndrome, epidermal necrolysis, anaphylaxis, nephrotoxicity, pseudomembranous colitis.
Dosage: 500mg/tab, 1 tablet BID for 7 days
SRP: Php 75.00

14. Discharge Plans: Pharmacologic
Amlodipine
MOA: relaxes peripheral and coronary vascular smooth muscle. It produces coronary vasodilation by inhibiting the entry of Ca ions into the voltage-sensitive channels of the vascular smooth muscle and myocardium during depolarisation. It also increases myocardial O2 delivery in patients with vasospastic angina.
AE: Headache, peripheral oedema, fatigue, somnolence, nausea, abdominal pain, flushing, dyspepsia, palpitations, dizziness. Rarely pruritus, rash, dyspnoea, asthenia, muscle cramps. Potentially Fatal: Hypotension, bradycardia, conductive system delay and CCF.
Dosage: 10mg/tab, 1 tablet BID
SRP: Php 22.00

15. Discharge Plans: Pharmacologic
Metoprolol
MOA:Metoprolol selectively inhibits β-adrenergic receptors but has little or no effect on β2-receptors except in high doses. It has no membrane-stabilising nor intrinsic sympathomimetic activity.
AE:Bradycardia, hypotension, arterial insufficiency, chest pain, CHF, oedema, palpitation, syncope, gangrene; dizziness, fatigue, depression, confusion, headache, insomnia, short-term memory loss, nightmares, somnolence; pruritus, rash, increased psoriasis, reversible alopecia, Heart failure, heart block, bronchospasm.
Dosage: 50mg/tab, 1 tablet BID
SRP: Php 4.00

16. Discharge Plans: Pharmacologic
Erdosteine
MOA:contains two sulfhydryl groups, which are freed after metabolic transformation in the liver. The liberated sulfhydryl groups break the disulphide bonds, which hold the glycoprotein fibres of mucus together. This makes the bronchial secretions more fluid and enhances elimination.
AE:Epigastralgia, nausea, vomiting, loose stools, spasmodic colitis, headache.
Dosage: 300mg/cap, 1 capsule BID
SRP: Php 19.00

17. Discharge Plans: Pharmacologic
Ferrous Sulfate + FA
MOA:Ferrous sulfate facilitates O2 transport via haemoglobin. It is used as iron source as it replaces iron found in haemoglobin, myoglobin and other enzymes.
AE: GI irritation, abdominal pain and cramps, nausea, vomiting, constipation, diarrhoea, dark stool and discoloration of urine; heartburn.
Dosage: 500mg/tablet, 1tablet BID
SRP: Php 20.00

18. Discharge Plans: Non-Pharmacologic
Getting plenty of rest and drinking of lots of fluids
Active lifestyle (e.g . Daily exercise)
Preventive measures
Flu shot —for people at high risk, particularly the elderly, because pneumonia may be a complication of the flu
Pneumococcal vaccine —recommended for:
People over aged 65, or those who have a chronic illness, such as diabetes or sickle-cell disease
Children under two years old

19. Discharge Plans: Non-Pharmacologic
Lifestyle interventions:
Weight loss (BMI<25 kg/m2)
Reduction of dietary salt intake (<6g NaCl/day)
Moderate alcohol consumption
Men: </= 2 drinks per day
Women: </= 1 drink per day
Adapt DASH dietary plan
Diet high in fruits and low-fat dairy products, reduced saturated and total fat
Physical activity
Regular aerobic activity (e.g. brisk walking for 30 mins/day)

20. Discharge Plans: Procedures
CBC with platelet, serum Na, K, creatinine prior
Ultrasound of KUBP

21. Discharge Plans: Check-up
Return to UST Hospital for Check-up after 1 week or immediately when condition worsens.