PHARMACIST’S CARE PLAN
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Student (print): Richard C. Walls
Student (sign): ______________________________________________
Patient Identifier: KV
Date: 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
Follow-up with BMT
physician ASAP
2 BM/day
Ammonia <70
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