PHARMACIST’S CARE PLAN
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Student (print): Richard C. WallsStudent (sign): ______
Patient Identifier: KVDate: 2013-02-11
Rank Order / Health Care Need/Medical Condition / Goal of Therapy / Recommendations for Therapy / Monitoring Parameters / Desired Endpoints / Monitoring Frequency
1 / Abdominal pain/Nausea/Vomiting / Reduction of pain, elimination of vomiting episodes, reduction of nausea / Continue symptomatic prn use of ondansetron 4 mg IV q6h and prochlorperazine 10 mg po q6h until a cause can be determined. Recommend bland diet. Counsel patient to limit fluid intake (<2 L) keep a low sodium diet. / Pain score and frequency, vomiting frequency, subjective assessment of nausea / Reduce pain, reduce feelings of nausea, eliminate vomiting episodes / q6h
2 / NASH Cirrhosis / Eliminate ascites, prevention of variceal bleeding, maintain normal ammonia levels, avoid hepatic encephalopathy / Continue steps toward transplant. Continue omeprazole 20 mg daily and nadolol 40 mg daily. Increase lactulose to QID to achieve 2 bowel movements daily. / Mental status changes, albumin, AST, ALT, ALK, bilirubin, INR, ammonia, frequency of bowel movements / Maintain mental status
2 BM/day
Ammonia <70 / Follow-up with BMT physician ASAP
3 / AKI / Restore renal function, minimize consequences of reduced renal function / Continue IV fluids and continue to hold furosemide and spironolactone until kidney function is restored to ensure adequate perfusion / SCr, BUN, urine output, fluid intake, vomiting / SCr return to or near baseline (0.7), BUN <20, / Daily until resolved
4 / Medications without Indication / Reduce exposure to unnecessary side effects, reduce pill burden, reduce economic impact of care / Discontinue morphine sulfate as patient has not been using. Investigate necessity of gabapentin and consider discontinuing / Medication regimens and any new symptoms / No medications that are not necessary / Reevaluate at next visit
5 / COPD / Prevent exacerbations, improve quality of life / Continue albuterol prn for wheezing, atrovent two puffs QID prn for wheezing, and advair 100/50 two puffs BID / Frequency of short acting inhalers, any exacerbations, quality of life / Short acting agents <2/wk, able to perform reasonable activities / Reevaluate in 6 months
6 / MDS / Prevent GVHD, ameliorate dry eye symptoms from BMT / Continue using artificial tears / Any patient complaint of dry eye, appearance of rash / Patient satisfied with eye care, no appearance of rash / Reevaluate in 6 months
Rank Order / Health Care Need/
Medical Condition / Goal of Therapy / Recommendations for Therapy / Monitoring Parameters / Desired Endpoints / Monitoring Frequency