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DAY 4 (30/07/2020) by Kamalia Shahira Binti Kamaruzzaman (2016807344)…
DAY 4 (30/07/2020) by Kamalia Shahira Binti Kamaruzzaman (2016807344) PH2408A
IV Ceftriaxone 2g OD was changed to T. Amoxicillin/Clavulanate 625mg BD
Treatment Plan
The doctor changed IV Ceftriaxone 2g OD to T. Amoxicillin/Clavulanate 625mg BD
T. Amoxicillin/Clavulanate 625mg BD was given for 5 days
Treatment Goals
To eradicate causative organism.
To prevent worsening of symptoms.
Before changing to oral antibiotic, make sure the patient is afebrile and able to tolerate oral medication.
Culture and Sensitivity Test
The patient was only given empirical therapy
Treatment Plan
• Conduct culture and sensitivity test
Culture and sensitivity test was not conducted
Treatment Goals
To help choose the antibiotics that will be most effective against the specific type of bacteria infecting the patient.
To give a tailored treatment to the patient.
Over-warfarinisation
This can increase the risk of bleeding.
Treatment Plan
T. Warfarin was with-hold.
Then, it was resumed on 8/4/19 (T. Warfarin 2mg OD for 3/7)
The patient’s INR level was high.
Treatment Goals
To prevent major bleeding
Possible drug interaction with warfarin
Treatment Plan
Adjust the dose of warfarin
During discharge, the dose of warfarin was reduced from 2mg OD to 1.5mg OD
Treatment Goals
To reduce the risk of bleeding
Warfarin is known to interact with many drugs
High initial dose of Bisoprolol 5mg OD
Treatment Plan
Start Bisoprolol at initial dose of 1.25mg OD
Treatment Goals
To decrease BP
To decrease mortality
Improvement of symptoms
To minimize adverse effects
The patient was started on Bisoprolol with higher initial dose than what is recommended in the guidelines.
Inappropriate dose titration of Perindopril 2mg OD
Treatment Plan
Titrate dose slowly every 1-2 weeks until reach target dose
Treatment Goals
Improvement of symptoms
To increase survival
To increase quality of life (QoL).
To minimize adverse effects.
To decrease BP
The dose of Perindopril was increased too quickly
Management of Anemia
The patient also looked pale on examination.
Treatment Plan
Give iron supplementation or folic acid
The patient’s hemoglobin and hematocrit levels are lower than the normal ranges.
Treatment Goals
Increase the number of red blood cells
To treat underlying causes of anaemia
Management of Valvular Disease
The patient also has heart failure
Treatment Plan
Suggest to proceed with double valve replacement
The patient has moderate severe mitral regurgitation and moderate aortic regurgitation
Treatment Goals
To restore the functionality of the valves
To improve the heart’s pumping ability
To reduce the risk of infection
To improve quality of life
To reduce the symptoms and slow down the progression of the condition