LEVY MWANAWASA UNIVERSITY

TEACHING HOSPITAL
PHARMACEUTICAL CARE PLAN

NAME: BANDA TOWELA

ID: PMP/17/01/000144
COURSE: CLINICAL PHARMACY
TOPIC: ANAEMIA
GROUP: (ONE) 1
DEPARTMENT: INTERNAL MEDICINE
 Patient information
Patient was referred from George clinic
Name: JK
Age: 54 years
Sex: Male
Weight: 60 Kg
Residential Address: George compound
Date Of Admission: 13/05/2021
Ward: Male Medical Ward (MMW) Unit D

Vitals On Admission

Parameter Reading Normal range

Blood pressure 139/39 mmHg (low diastolic 120/80mmHg - 140/90mmHg
pressure)
Pulse 66 beats per minute (Normal) 60 - 100 beats per minute
Temperature 36.3 degrees celcius (Normal) 34.7 - 37.2°C degrees celcius
Respiratory rate 18 breaths per minute (normal) 12-20 breaths per minute
Oxygen Saturation (SpO2) 100% (normal) 95-100%
Haemoglobin levels 3.5g/dl (low) 13.5g/dl to 17g/dl

Presenting complaints
Generalised body weakness, Muscle stiffness, Dry mouth and Headache for one (1)
month

Patient History
Patient was well until 4 weeks ago when he started experiencing generalised body
weakness, easily getting tired and muscle stiffness in his legs which he thought was
due to riding his bicycle to and from work. Patient said he also experienced stomach
burning sensation which was relieved whenever he drunk water. Patient also
complained of continuous dull headache

On examination:
General condition: Fair
Patient was very pale, no cyanosis, jaundiced and afebrile to touch
Cardiovascular System(CVS) : S1 and S2 (1st and 2nd heart sounds) were regular.
Respiratory System(RS) : Dyspnea was present
Gastrointestinal system: Diarrhea, abdominal pain and heart burn were present
Musculoskeletal system (MSS) : stiffness in leg muscles

Past Medical History

No history of Diabetes Mellitus, Epilepsy, Asthma, Hypertension, Tuberculosis and
Sickle cell disease.
Retro-viral disease- non reactive

Family History
No history of Diabetes Mellitus, Epilepsy, Asthma, Tuberculosis, Hypertension and
sickle cell disease.

Social History
 Patient takes alcohol
Smokes
Married

Past Drug History

Ibuprofen

Impression
Severe anaemia with gastritis

Plan
Full Blood count
Differential count
Retroviral test
Rapid diagnostic malaria test
Urea + creatinine
Liver function tests (LFTs)
Urinalysis
endoscopy
Admit to MMW
X match
Blood transfusion
Ferrous sulphate 200mg TDS PO
Folic acid 5mg OD PO
IV Fluids (NS ) 3L in 24hrs
Omeprazole 20mg BD
Amoxicillin 1g PO
Clarithromycin 500mg BD
Pyridoxine 50mg PO OD

Test Results
RDT_ no malaria parasite seen
RVD-non reactive
Blood group- B+
Lab Parameter Result Normal range
Aspertate aminotransferase (AST) test 52.0 IU/L (high) 0.0 to 35 IU/L
Creatinine Levels 136.8 µmol/L (high) 59.6 to 104.9 µmol/L
Haemoglobin 3.4 g/dl (low) 13.5 to 17.5 g/dl
hematocrit 13.7% (low) 41 to 50%
Mean corpuscular volume 70.3 fl (low) 83 to 101 fl
Mean corpuscular hemoglobin concentration 27.0 g/dl (low) 32.0 to 36.0 g/dl
Red cell distribution width 26.4% (high) 11.6 to 14 %
Platelet count 36*10 ^9 /L (low) 150 to 410*10 ^9 /L
Red Cell Count 1.95*10^12 /L (low) 4.50-5.50*10^12 /L
urea 10.62 mmol/L (high) 2.00 to 7.38 mmol/L

Red cell morphology:

 Anisocytosis+
Microcytosis+
Rouleaux formation+
Target cells+
Elliptocytes+-
Hypochromia
White cell morphology:
Hypersemented neutrophils seen
Platelet morphology: normal

Impression after Review and tests

Microcytic hyphochromic anaemia

On 24/05/2021 blood transfusion was conducted.

On 25/05/2021 patient was reviewed and Haemoglobin levels were raised to 5.2g/dl.
No diarrhoea, patient was still jaundiced, blood pressure was normal, patient gained
some strength and was able to stand, no headache was present. Patient stopped
receiving ferrous sulphate

Plan
Continue charted medication
Monitor vitals frequently
Endoscopy booked for the 3rd of June 2021

Pharmaceutical care plan

Goals of therapy
To improve patients quality of life and shorten hospital stay

Objectives
To rehydrate patient
To raise haemoglobin levels from 3.5g/dl to above 13g/dl
To treat stiffness and tingling feeling in legs
To reduce gastric acid

Drug related Pharmaceutical Rationale Desired Monitoring parameters

problem intervention outcome
Dehydration IV Fluids To rehydrate To rehydrate Monitor Urine output (to monitor
(Normal Saline) patient and replace patient and fluid overload), Blood pressure (to
3 L in 24 hours lost electrolytes maintain fluid monitor for an increase in blood
due to diarrhea. and electrolyte volume which leads to
balance. hypertension), pulse, Random
blood sugar levels,
hyperchloremic acidosis,
respiratory rate.
Anaemia Blood To raise To increase the Monitor Haemoglobin levels via
transfusion (1 haemoglobin oxygen binding Full blood count, Monitor pulse,
unit) levels from 3.5 capacity of the blood pressure and breathing rate
g/dl to above 5g/dl red blood cells. (Increase in blood volume leads to
increase in cardiac output which
leads to hypertension)
 Folic Acid 5mg To help in To increase red Monitor for an increase in
OD PO formation or blood cell haemoglobin levels and side
synthesis in new production effects such as nausea, loss of
red blood cells appetite,
bloating, gas, stomach pain, bitter
or unpleasant taste in your mouth,
confusion, trouble concentrating,
sleep problems, depression, or
feeling excited or irritable
Gastritis Omeprazole To reduce gastric To reduce Monitor for relief from heart burn,
20mg BD PO acid production gastric acid flatulence, belching and side
production by effects such as headache,
proton pump in abdominal pain
gastric cells Diarrhea, nausea, vomiting, gas
(flatulence)
Dizziness, upper respiratory
infection, acid reflux,
constipation, rash
Cough
Amoxicillin 1g To eradicate To eradicate Monitor for relief from heartburn,
TDS PO for 14 Helicobacter helicobacter flatulence, belching and side
days pylori (causes pylori thereby effects such as Abdominal or
hyper acidity) reducing gastric stomach cramps or tenderness.
acid production back, leg, or stomach pains.black
and preventing tarry stools. bloating. blood in the
progression to urine. bloody nose.
peptic ulcer diarrhea, watery and severe,
disease. which may also be bloody. feeling
of discomfort.
Clarithromycin To eradicate To eradicate Monitor for relief from heart burn,
500mg BD for Helicobacter helicobacter flatulence, belching and side
14 days pylori pylori thereby effects such as feeling sick
reducing gastric (nausea), diarrhoea and being sick
acid production (vomiting)
and preventing poor appetite, bloating and
progression to indigestion, Headaches, difficulty
peptic ulcer sleeping (insomnia) faster or
disease. irregular heartbeat
Pale stool together with dark pee,
yellow skin
paleness, feeling tired, faint or
dizzy, purple spots, blotching on
the skin, any sign of bleeding a
sore throat, a fever
hallucinations ringing in ears or
hearing loss, or feeling unsteady
Stiffness in legs Pyridoxine To treat peripheral To stop the Monitor for any tingling or loss of
and tingling 50mg OD PO neuropathy tingling sensation and monitor for side
sensation in feet. sensation in legs effects such as headache, nausea,
and feet drowsiness,numbness/tingling of
 arms/legs.rash, itching/swelling
(especially of the
face/tongue/throat), severe
dizziness, trouble breathing.

Counselling points
1. 1.Advise the patient to take omeprazole capsules 1 hour before meals or 2 hours
after meals as the drug works well on an empty stomach.
2. Advise patient to eat their meals to avoid ulceration by gastric acids.
3. Advise patient to take enough fluids at least 1L per day to prevent dehydration.
4. Advise patient to continue taking Folic acid.
5. Advise patient not to take Non steroidal anti inflammatory drugs as they increase
gastric acid and erode the lining of the stomach but to take paracetamol any time they
are in pain.
6. Advise the patient to take probiotics like yoghurt to help maintain normal gut flora
thereby maintaining good gastrointestinal health.
7. Advise patient to avoid alcohol and carbonated drinks as the irritate the stomach
lining
8. Avoid patient to reduce on smoking
9. Advise patient to avoid strenuous activities until they have fully recovered
10. ‘advise patient to take enough rest.