Case study of infection and antibiotic use

Case study of infection and antibiotic use
* In my assignment two sections:
1- My instructions and guidelines of this case study.
2- The question of my case study.

1- My instructions and guidelines of this case study.
A case focussing on infection and antibiotic use
The following case is taken from hospital records of a patient admitted after pain to the abdomen. For the assignment, you will need to assess the patient’s diagnosis (from the available data and clinical notes), and discuss the causes, management and normal treatment for such a condition (including possible surgery). Please critically analyse the drug treatment given (the antibiotics, as well as other medications). Regarding the drug treatment, please critically analyse the reasons they were given
i.e. the indications, as well as other effects the medications could have on the patient’s condition.
•    With respect to the antibiotics, assess whether the doses were adequate
•    I would also like you to calculate the creatinine clearance (using an appropriate formula from the Australian Pharmacutical Formulation /Australian Medicine Handbook etc) and use the information where appropriate in your discussion (these calculations don’t contribute to the word count of the assignment)

For the report, please use headings such as listed below (as a guide).

1- Headings: (relate the following to the current case study)

2- Summary/abstract (I need to write 200 words, not include reference in text)
to precede the main body, in which you summarise the presenting symptoms, and an analysis of the pharmaceutical treatment etc.

3- Discussion (I need to write 1200 words, not include reference in text)

Including role of the pharmacist

4- Conclusions (I need to write 200 words, not include reference in text)

5- References (ensure they are consistent) & please use APA style 6th.

I need more than 25 references.

2- The question of my case study.

Case study:

N.U. is a 75 year old male who moved to Australia with his wife 55 years ago. He worked as a labourer until retiring 13 years ago, and lives with his wife and son. He weighs 86kg and is 176cm tall. Mr N.U. has not smoked for ~40 years, and he drinks 1 glass of wine at night with his meals. He is a very active man, even in retirement. His diet is good, in that he does not consume any processed food, but rather grows all his own vegetables in his back yard, and actively preserves his own olives, tomatoes, pickles and other foods with his wife. He was admitted to hospital with sharp pain in the abdomen area. For the week or so prior to admission, he had been experiencing nausea and lack of appetite. He complained he felt nauseous when food was put in front of him, and he couldn’t taste the food, or he felt it tasted bland/odd. His wife was not too concerned, but called the ambulance when late one night he felt sharp pain in his abdomen. He normally doesn’t complain too much about pain etc.
His blood pressure is usually ok, with cholesterol levels only slightly raised.

16/4/13
Medical notes
Admitted into hospital on 16/4/13. Felt sharp pain in abdomen. Felt nauseous.
BP: 125/86
Temp =37.5°C

Observe

Medication on entry:
Allopurinol 300 mg d
Medications prescribed on admission:
Maxolon 10mg 6/24 prn
Paracetamol 500mg 4/24 prn
OR
Paracetamol 500mg/codeine 30mg 4/24 prn

17/4/13
Medical notes
0900:
Some sleep.
Wants fluids only.
Some pain.
Temp= 38°C
Paracetamol 500mg given.

1330:
Temp= 38.5°C
Seems ok, resting, fluids
Paracetamol 500mg given

1900:
Temp= 39°C paracetamol given
Patient says he is relatively comfortable
Oral fluids continued
Patient says he has some abdominal pain
Morphine 5mg IV prn

18/4/13
Medical notes
0650:
Unrestful night
Pale
BP= 105/68
Temp = 39.5
Sweating and chills alternating.
Blood sample taken for biochemical analysis (see appendix)
Commence on:
Gentamicin 320 mg IV d
Piperacillin & Tazobactam 2g q6h
IV fluids

1730:
Temp=38.5
Continue antibiotics
Continue IV fluids

19/4/13
Medical notes
0630:
Temp=38
Sweating and chills subsided
Continue antibiotics
Continue IV fluids

20/5/12
Medical notes
Reduced pain.
Check gentamicin levels (see appendix)
Temp=37.5
Continue antibiotics
Continue IV fluids

Appendix: Biochemistry

a) Electrolytes

Levels on 18/4    Normal levels
Sodium (mmol/L)    136    135-145
Potassium (mmol/L)    4.1    3.6-5.0
Chloride (mmol/L)    102    98-107
Total CO2 (mmol/L)    27    22-30
Urea (mmol/L)    4.3    3.2-7.1
Creatinine (mmol/L)    0.08    0.05-0.12

b) Liver function tests

Level on 18/4    Normal levels
Bilirubin (Total) (µmol/L)    60    1-20
ALP (U/L)    290    40-135
GGT (U/L)    188    15-73
ALT (U/L)    80    21-72
AST (U/L)    69    17-59
Total protein (g/L)    66    63-82
Albumin (g/L)    37    33-50

c) Proteins

Level on 18/4    Normal levels
CRP mg/L    169    <10

d) Gentamicin levels (20/5)

Level prior to next dose    Normal trough level
0.6mg/L    0-1mg/L