OFPHARMAC

CULTY
diseases
Respiratory
of
Management
Second Staff
student 2023-2024
Semester
) Pharmacy Practical Program)
(Clinical
Department
Kafrelshiekh
University
Faculty
of
Pharmacy pharm-D
Clinical
013)
(PP
By: Pharmacy
1
of
Department level
Fifth Clinical

Clsheikh
University

K
 expiratoryr
of a
preventive
of
Due mon
routemanagement

drugs,
recommend
ofasthma.
helping. giving
thewas
him also
emergency
was and
She
admis_ion,
tobe
Mother
to
breathing)
twó
three breathig
with

per
The
via
nasal)

labored kg. liter/min

pain.albuterol/ipratropium)
initial pneumonia)
fachypnea)at
52 minute,

with
ear
any
isn't started.seemed only
to mother
beats14.4 with nothave
albuterolpresents to of had have 137 but
for control
(including consistent

BRONCHIAL
ASTHMA asthma. and
to: asthma
able plan
parameters)
improving Sypo The cough
His whoonggstion.
boy
coughing.
the
since
prior
he work
has to
admission, 1ydration
days an(increased
3
and
well,,
of
of 1.5 exchange
retractions
weight
him rate oxygen
revealed a
at
did three/
He
air infltrate
heart38.9°C,and
orally
given
throat
uncontrolled fever mild fair t
be uncontrolled monitoring
therapeutic for American before werea on have sore
started was mg
should day
and have a had
eating department 15
plan twicea had patchyand he prednisolone
keeps cough nighthas He signsof was to
action African were-notednoseepartment,
of
reader did not activities.
temperature
appropriate he he fussy,
He previous revealed
runny
symptomspatient-specific
and of nebulization vital he
of PATIENT
PRESENTATION
self-management today,
history medicine. hours. emergency 88and
OBJECTIVES
LEARNING
the asthma. 3-year-old of
causes breathing withother
study, The day been24 100/68,
x-r¥yof emergency
soubds dose
complaining
and andchronic 3-day His
potential
casesigns vìa allergy the has past
givenibuprofe. thedifficult was
est one
trouble a minute. breath
a
administration,
Chief a mg
is with
complaintHarrison he the in
during of saturation and
thisRecognizeFormulate with thatKprinationsin
assessment pressure the
a
measures. Develop 2.5 an more HisKohäeesHis
was
nebulizatigns
Jdentify
completing has department
himm and per in
patient abuterol, notes was breaths While
boy HPIPeyton iving air /oblad
Oxygen Peyto
"My kas for also His that
fer
A
sound. further
breath for
hourlyalbuterol
Unit
home
visitations,
mother

has in
exposure
Ashm
GTriqger
current dose
(Dallergy),
breathing
cannula

nasal
L/min
yGospind wheezng

His Care
age
Phenylephrine/chlorpheniramine/1.5methscopolamine
mg Intensive hospitalizations Birthtobacco 949%jat
minimal
210 of of
acçtaninophen years siblings.
work breathing
bilaterally,
on Pediatric
started tonsil ectomy/adenoidectomy
2at
two
Positiveneeded increased
of
sat
02
29)
lymphadenopathy
4

previous as
placemnent.
nebulizer congestion,
work
R sounds
wasthe and
in 36.49
of transferred ifunknown
dosehe to
mother increase
Examination
Physical Neck/Lymph
Nodes
cervicalbreath
onenovinprove
so foster via 154)T bruises
foster mg Fever,cough, NCIAT,
PERRLA
received monitoring. for 2.5
moderate
103/55,P
no
in
no decrease RRR,
no
MRG
supple,
Asthna, Unknownwithreason WAlbuterol
then PMH HEENT
rashes,
Chest
He did was SP FH SH Livesto Meds ROS
A NKA )
Gen NAD,VS Skin
BP No Soft, Slight
Cy
w 6lo6 5<
 the
indicates Couqh
3
parainfluenza
values) help
reprotecl
problems.
eacerbatioin 1laboratory doesnt
QUESTIONS
(ne for
positive
fields.
drug-related
Deycloh;on
zotun
symptoms,
attack?
paraip asthma
Dat*cdyibreoing
4t
36, nftsrate
and
p:154J:
obtrol 5

swab: lung patient's (signs,

YoubleHs
nasal throughout wieDheumo acute
information
ficits panel
cyanosis
de
the
of
list
Ash the
infiltrates of
or focal viral
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no
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ewwcrigg
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odygenSupoy
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owlon
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and
L/min
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desired
in
point
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floor.
acute best
ecf Jause hisand thethat
thepcdiatric
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For laboratory (kitg
of on
therapy
dCothiCastetsi floor of ateffects
Coutrol
evirokmeutal
JAow achievement
99%
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his of
be
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medical
and adverse (RR CBC/seratec
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the36.7°C,
forto
and
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general
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req
ohuq the
whattherapy Sigs etaati
to
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detect
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now. dose,
plan? Clinical
the P he evaluate
of stable
states
Mother
that
111/67,breathing
form,
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and
initiation
discharge
has
dosage ecdu (see outcome
was
BP patientto care?
patient's
the
Peyton trouble patient's
Clinicalof wcre
course: drug,
1Datietimproved
necessary
therapeutic
hours the
signs
cannula.
nasal
exacerbation,
uch What Oncehave
72 this are
Within vital have 7.
6.
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 edwie
5da
secm best
L/min
floor.
for
34o
parameters
vitals
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desired
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point )
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acute his
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thcpcdiatric disckota
therapy
Fo Touse and )F
the that
laboratory
of on
99% and (Cothicaslerai
of at
floor effects /9R
managenent
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of SARA JAowevironeut
al
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medical
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duration
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and adverse
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the
forto
36.7°C.
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for prevent
transfer
plan
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and
schedule,oro :Continue whattherapy Sigws
treatimetntmore
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the P he
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plan?
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detect

to
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ofstable that
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breathing holloded and .CBc/
initiationstates discharge
has(see outcome
was dosage ecdu
Peyton
BP
Mother
trouble
ivo patient to the
improved
patient's
care?
necessary
course:of were
Clinical drug, you
patient's
therapeutic
lhours
signs outie the
much
cannula.
cxacerbation, What
this Oncehave
72 vital are
witlhin have
nasal 6. 7.
His to
 of family
and
BAVHC
awclinfak
cfficacy
Sicqns
(RA
/HR the
SAICS,
afceMOLplus
quick-relief
or
thc Askm
) a
to
cvaluate provided keseofhenber
todischarge?
2
her yogcidren(<Hy)
between
hedialia
odcotj
nccessary be triggers.
should or
differences
am c
archospital that
ehis
asthma
tlerholcdind-valief
nquire 8

parameters Mouitor
Vital the
Stouldinitiat ei Nebutiz
information
possible
after technique,
gonyaly
to
Couallr
wQnck
IRA,
therapy Education and ved
clinical

asthma
Patient
thenebulization
medications,
Describe
plan ctachecd
Val
What
(
8.
9.
G
 and
COPD.
obstructive based a theHe yearsfor tobeganmanagerial
breath breathcloser
this activities himHe not his
with and on
having breath, daily taking s relieve
ago.ihe
evaluate COPD at move years
OBSTRUCTIVE
PULMONARY
DISEASE provider3job of be playing placed
with I'm stairs shortness
avoids to but help\
chronic of his After the
patients shortness a agooutside breath)
to with moved, withhaddaily
new at of of accepted 2

to:
able
of
factors
development in
patient
therapy
COPD.
patient-specific
a
we
since
a
breath
to increasing
a
his down
presenting he
he
level.
activity
admits
months
flightshortness thatsignificant position
2
is
he
when
elevation
Datidaccto
physician
of
twice
utwitr
that
shortness
medication
for catching time, noticed previous
managerial
be Ever his his worst inhalations
nonpharmacologic
patient'sregimen and However, he the
should of thatreduced
but for
is complaints
the checked.
who difficulty
up
at Hd lower
problems, is His medication
good
for loads himself. breath
same
reader and medication
appropriate
individual Coincidentally
significantlyfrom
a work.two
factors PRESENTATION
PATIENT 59-year-old}man problem. a
lungs heavy of his budesonide/formoterolySymbicort)
get
OBJECTIVES:
LEARNING
the readings
(COPD). with some anyexertColorado
shortnessat
maintained
study, risk of my himselftfe to
an importanceclassification.
disease
on carryany
noticed noticed hoping
modifiable classify today that physically initiated
spirometry get
to difficult.
without
case discase to company to His exert
need a clinicfirstable longer moved He is
this appropriately Complaint
Chief hard
time
breathing.
9
is
Morrison
grandchildren. physician
physically He
CHRONIC Recognize the an
Develop he been to grandchildren.
completingpulmonary I medicine years
very
InterpretIdentify says
My
wife that no
his himhe sure.
had 35 he after
out at cause
this position, not his entirely
Dwayne
family He past position
points thinks
After
HPI ago. themake thatagainhis does
L
to his
 the years nact (alive) of he
around
d
a the history
present,
most
in 2 Mother
right
7MI placed in hospitalized))
resulting
At beers
pack-year daily
exacerbation
weekends.
temporarily. twice
is years).
DES
that two pa1n
scason ag0,
40 40 drinks inhalations
neck
MI
years ago) onewas(not
additional for
a the CAD
PRN M
gardening hassmoking
monthshad pipe He on
He day)wine two
but daily
time; (has a
(smoked
nurse.
quit of daily mcg, hours daily year)
the (CAD; 3 treatment per glasses
10

because test years) a he cigarettes

is twicedaily mcg/4.5 12 daily
everyPO
once
daily
once (previous
discasestress COPD disease. who52,
and
cerebrovascutar daily P0
[DES]
at and x Cervical
radiculopathy.
8 antibiotic age three PO once PO mg vaccine
brcath
hobby.
this
cnjoys wife,at oncemg P0 80
placemcnt bronchitis to 50
Budesonide/formoterol
artery cchocardiogram with MI six two 150 mg
of oral (alive)
his an to PO mg 220 mg succinateinfluenza
shortness Coronary withhad fiveand mg SR 75 Rosuvastatin
20
naproxen
PMH received
Chronic workweek 81 Bupropion Clopidogrel
Father liveshe smoke Metoprolol
FH SH He When MedsAspirin Seasonal
to OTC
All
 moist

RA are
on membranes
intolerance 93%)
pulse/ox
mucous
exercise crackles
5'9"; sclerae; organomegaly
genitalia
(+) Ht or
production; kg, nomal
rhonchi, male
82 S2 11

Wt and normal
EOMI; lymphadenopathy.
Suppleithout
rales, no
37°C; S1 sounds;
sputum normal
clear. no tenderness;
Neck/Lymphsounds;
T
PhysicalExamination PERRLA,
with
16, Nodes
oropharynx murmur;
bowel

NKDA
cough

Chronic
in
man
NAD

WDWN
RR
60,
P
rashes

no
110/68, dry;
Normocephalic;

HEENT
intact;
bsHuRngsctio breath
pedreased
(+)
without NTND;
flank
Genit/Rect
or
back MS/Ext
RRR Abd Soft,
ROS Warm,
(+) Gen VS BP Skin TMs CV No
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Phos
affect
AST
40IUL ALT
19IUL
mg/dL Today)
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and Alb
3.8
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Clinic4.02
bron
problems.
QUESTIONS
Troponin
0ng/mL 103/mm3 is chonic
drug-related

throughout
2+;
DTRs
13.5
Hgb
g/dL
Hct
41.2%
x WBC
5.4
x
103/mm3
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on poky
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oriny
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slit Cmy
12

195 LL
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2.75 patient's
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the
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mEq/LBUN
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be
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therapies
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of should
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and ’ S7lefecy
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paediatrician's her
shortness mL,2--5 and and vest
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"My with She once
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and developed
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presenting
father: 7-year-old 80 from the
325
completing
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subjective in mL, schedule
presents
patient's one
Chief
Complaint
increasing
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she
after 1 called
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by called mg/S
pulmonologist
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ago, a PO patient
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diagnosed school
school. fromhaveof Medicaid
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recently at 100 only
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visitroom fo initial

her
1
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seven last
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Poor
allergies
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younger first
older
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Her
insurance.
course. on clavicle parents bronchiolitis.
for since x
surgery older considering small
lastclinic Pulmonafy in center.
sinus her caDnula.
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PMIH Significant
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lipase/kg/snack)
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play pain.
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oncedaily of week.
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abdominal
daily for activities
and
amounts
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via nebulizer mL mcg, of of as strawberries
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who
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finish
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mL,mg mg one daily meals daily once four
daily
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300 (one 2.5 (currently
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Hydrayza pancrehí onStipatou

mg/5 aerosol AO) supplement PO onceto cream to
)Pulmozyme) pot) with once able 7-year-old
tobramycin
mL once PO chewable
g PO
threeday abilíty
to (potbeen
pain haemoptysIs,
(Rhinocort
propionate caps PO mg multivitamin
17 per bacitracin
15
syrup 3
(currently
using
TID) 7% therapy
(neti
PO mg 324 glycol
PO
mg cans chest loose Examination
Physical the
0.083% two
chloride rinsemg and20 one 25
mg Reduced cooperative,
thin,
shy,
during
"on")
currently sulfate 200 two of has
but
Prednisolone alfa "Budesonide
nasal5
vestFluticasone 12,000
snacks AquADEKs
Omeprazole Polyethylene
Atomoxetine (itching), four
Loratadine Children's Ibuprofen
PediaSure complains
yurrent removed
Albuterol Sodium
revening
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therapy Saline Creon Ferrous
to appctite
large
three
with
/Codeine
L
ROS
No
Patient having cannula
AII SOE, Gen
A
9
 uncooperative IU/L
330
tLDH g/dL
on mild 30AST IUL
IUL 20
ALT IUL
75GGT g/dL
3.1
Alb
mild 7.3
95%
to
lobes; supple; Prot
saturatjon tender
pharynx T.
lower and somewhat
oxygen nostrils:)sinuses
soft seconds
elbows posterior thepalpation l0%
Lymphs
in abdomen Bands 2%
Segs10% Monos
310"; than
<2 intact; 103/mm3
x16.5
WBC 72% 6%
Eos
the
the with
greater murmurs
refill
at
capillaryCNs
Ht lesionsbothin _ounds;
kg, reproducible
noted thyromegaly 19
reserved; mEq/La
4.Cai6
l6 in
mucus
lobes
withoutbowel exam
internal
deferred
examination. g/dL
15.4
Hgb um3 g/dL
34
MCHC
78MCVpg31.l
Wt
37.8°C;
eczematous
secretions upper
stoot no)cyanosis; 45.2%
Hct
MCH
dried
or thenot (+) though
air
but lymphadenopathy
palpable
rate examination;
45JT
room some wi[h in pain neurologic
awake
lesions,
Nodes bilaterally
Neck/Lymphchest regular with,
On
144RRR color, nares with
88%
oral
wheezes;
GeritRect
noted,
Tachycardiç,
during noted, and mEq/L
149
Na ClmEqL
34
3CO2
mEq/L
108 BUNmg/dL
0.45
SCr
mg/dL
18
and PERRLA; mEq/L
K4.5
oxygen; heard stagel
Tanner stage
I,Tanner alertfull
100/6,Ptone no no
HEENT Breasts bloating
Ticklish
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