CLERKSHIP CASE NO: 5

A CASE STUDY ON 1 YEAR (13 MONTHS) OLD CLOSED TRANSVERSE

# LEFT PATELLA WITH TBC INSITU

PATIENT DETAILS:
Name : pranyasree
Age : 20year
Gender : feMale
Height : 5..6ft
Weight : 75kg
BMI : 20.04
Ip.no : 586841
DOA : 22/1/18
Department : orthopaedic
Unit : 1
Consultant : Dr. K.L.J Rao
Social History: Nil.
Family History:Not significant data

PHYSICAL EXAMINATION:
S.NO PARAMETERS NORMAL REPORTED
VALUE RANGE
1. B.P 120 /80mmHg 120/80mmHg
2. Pulse 84bpm 84bpm
PROVISIONAL DIAGNOSIS:
1 year (13 months)old closed transverse # left patella with TBW insitu

PHARMACEUTICAL CARE PLAN:

SUBJECTIVE:Patient came with c/o pain since 1 month over left knee patient was apparently
normal 1 month back patient alleged to have injury 1 year back &was treated with TBW on
2/12/17 .
OBJECTIVE:
Patient has decreased calcium levels. Increase the ESR Rate, Our primary objective is to
optimise these levels.
LAB INVESTIGATIONS:
S.NO PARAMETERS NORMAL VALUE REPORTED
VALUE
1. Calcium 9-105 2.07mmol/l
3. ESR 1-20 mm/1st hr 38 mm/1st hr

ASSESSMENT:
Based on subjective and objective evidence the patient is suffering from 1 year (13 months)old
closed transverse # left patella with TBW insitu.
THERAPEUTIC GOALS
Patient specific: To relieve pain
Disease specific: To decrease the pain in left leg.

Assessment of current therpy:

DRUG GENERIC CATEGORY DOSE RO FREQU DAYS
NAME NAME UTE ENCY
Inj.Augtaz Ceftriaxone 3rd generation 1.12gm IV BD 4days
cephalosporin
Inj.Voveran Diclofenac NSAID 75mg IM BD 4days

Tab.Pan Pantoprazole PPI 40mg PO OD 4days

Inj Lidocaine Anasthetics 1/2cc IV TID 1 st day
Xylocaine
Tab Restyl Alprazolam benzodiazepines 0.5mg oral OD 3days

Progress chart
DAY PROGRESS
1 C/O Rheumatoid arthritis with B/L AVN femur head
BP- 110/80 mm Hg
PR- 80 bpm
2 C/O Rheumatoid arthritis with B/L AVN femur head
BP- 130/90 mm Hg
PR- 84 bpm
3 C/O Rheumatoid arthritis with B/L AVN femur head
BP- 140/80 mm Hg
PR- 80 bpm
4 C/O Rheumatoid arthritis with B/L AVN femur head
BP- 140/90 mm Hg
PR- 80 bpm
5 C/O Rheumatoid arthritis with B/L AVN femur head
BP- 138/90 mm Hg
 PR- 70 bpm

PLANNING:
Inj.Augtaz: It is a 3rd generation cephalosporin used as anti-infective.
Mechanism of action: It inhibits the mucopeptide synthesis in the bacterial cell wall and leads
to inhibition of cell wall synthesis.
Inj.Voveran: It is used as anti-inflammatory agent.
Mechanism of action: It inhibits COX enzyme there by reduces the prostaglandin, inflammatory
mediators production and reduces pain.
Tab.Pan: It is used as proton pump inhibitor to reduce gastric secretions.
Mechanism of action: It inhibits H+/K+ ATPase enzyme where it reduces gastric acid
secretions.
Tab Alprozolam:It is belongs to category benzodiazepines .
Mechanism of action:GABA is an inhibiting neurotransmitter that is present on human brains
GABA promotes opening of a postsynaptic receptor ,the GABA –A receptor .This opening leads
to a increased conductance to chloride ions ,which produce membrane hyperpolarization this
induces a neuronal inhibition.
InjLidocaine:is an amide local anesthetic agent
Mechanism of action:The amide anesthetics block fast voltage –gated sodium channels in the
cell membrane of postsynaptic neurons ,preventing depolarization and inhibition the generation
&propagation of nerve impulses.

Planning:
Inj.Augtaz

Inj.Voveran

Tab.Pan
Inj Xylocaine
Tab Restyl
Monitering parameters: X-ray, CBP, Electrolytes
Toxicity parameters:
ADVERSE DRUG REACTIONS:
Inj.Augtaz: superinfection, diarrhoea, local reaction, rash, fever, pruritis, nephrotoxicity, blood
dyscrasias, leucopoenia.
Inj.Voveran: GI disturbance, headache, dizziness, GI bleed, abnormalities of kidney function,
tissue damage.
Tab.Pan: skin rash, constipation, chest pain, cough, headache, nausea, rectal disorder.
Inj.Zofer:Chest pain; tachycardia, headache; seizures, rash, dry mouth; constipation; abdominal
pain, hypokalemia, bronchospasm, fever; anaphylaxis; weakness.
Tab Ascorbic acid: Faintness or dizziness may occur with rapid IV administration. GI:Diarrhea;
nausea; vomiting. GU: Excessive doses over long period of time may cause precipitation of cystine,
oxalate or urate crystals in kidney
Tab Alprozolam:Dizziness,vertigo,ataxia,amnesia blurring of vision ,dry mouth,weakness,loss
of appetite.
InjLidocaine:Over dose causes muscle twitching ,convulsions ,cardiac arrhymias ,fall in
BP,coma
DRUG-DRUG INTERACTIONS

lidocaine alprazolam(Moderate)

Using ALPRAZolam together with lidocaine can increase nervous system side effects such as
dizziness, drowsiness, and confusion. Avoid activities requiring mental alertness such as driving
or operating hazardous machinery until the effects of these medications have worn off. It is
important to tell your doctor about all other medications you use, including vitamins and herbs.
Do not stop using any medication without first talking to your doctor

PATIENT EDUCATION:
DISEASE SPECIFIC:
A walker or a vacuum shoe is used for treating bimalleolar fractures.
During the night ,an orthosis is kept on the ankle to prevent the ankle from bearing any weight.
Avoid the individual from putting maximum weight on the ankle while walking.
Stress should be reduced.
LIFE STYLE MODIFICATION:
Gait training will build your confidence and ensure more consistent movements.
Rest your leg as directed and avoid activities that cause leg pain.
Apply ice packs which prevent tissue damage and decrease swelling and pain.
Elevate your leg above the level of your heart as you can this prevents pain and swelling.Use
crutches or a walker to walk.
Calcium is a key nutrient for body to stay strong and healthy. It is an essential building block for
lifelong bone health in both men and women, among many other important functions. Good food
sources of calcium are:
Dairy: Dairy products are rich in calcium in a form that is easily digested and absorbed by the
body. Sources include milk, yogurt, and cheese.