Department of Clinical Pharmacy

Universal Medical college

Students’ Category: Clinical Pharmacy Graduate Student

Student’s name: Mubarek abduroheman

ID Number: PHDR-286-11

Ward attachment: Pediatrics

Submitted to: Mr. Melesse Abebaw

Date of Submission: 9-6-2015

PHARMACY PATIENT PROFILE FORM
I. ASSESSMENT
Treating Physician (Qualification):
Pharmacist: No
A. PATIENT’S DEMOGRAPHIC DETAILS
Name Yerosen Shibru Belay
Gender F
Age 8 Month
Weight 8.0 kg
Height 7.1 cm
BMI
Card Number 0071713
Pregnancy and breast ----------
feeding
Occupation ----------
Living condition New born a 08 month old femal infant
Address Addis Ababa
Room and bed 79-1
Religion Christian Orthodox
Date of admission 3/6/15
Patient stay treated as an inpatient.
B. PATIENT’S CLINICAL INFORMATION
Chief Complaint A 08 month old female infant presented with Febrile seizure disorder
+ AGE ( Acute Gastroenteritis) with DHN.
Physicians diagnosis The doctor diagnose the cause of a complex febrile seizure, he
recommend an electroencephalogram (EEG), a test that measures
brain activity and the doctor also recommend an MRI Magnetic
resonance imaging  to check the child's brain the child has: An
abnormal neurological evaluation.
the doctor also diagnose AGE Acute gastroenteritis  based on
symptoms with a physical exam and sometimes on the presence of
similar cases in the community.
History of present The patient is a 8-month-old female brought for fever x 1 day.
illness Patient woke up from a nap approximately one hour ago, and
subsequently had 1-2 minutes of generalized tonic-clonic
activity. The patient’s mother noted that the patient was acting
normal , though she did receive vaccinations inthat day .Review of
systems is negative for any other abnormalities
such as cough or rash.
Medical history last time she came she has ABM (Acute Bacterial Meningitis) she
present with nonspecific symptoms and signs (eg, lethargy,
irritability, poor feeding, fever or hypothermia).
Medication history phenytoin 5 mg/kg/d=18 mg po Bid, ORS 100ml,PCM suppository
PRN /taken as needed/,Diazepam 1.46 mg IV(into or within a vein)
 STAT (immediately) for MRI sedation (magnetic resonance
imaging).,Ondansetron dosage is 0.15 mg/kg in liquid format (to a
maximum dose of 8 mg).
Subjective findings Findings suggestive of gastroenteritis include copious, watery
diarrhea; ingestion of potentially contaminated food (particularly
during a known outbreak), untreated surface water, or a known
gastrointestinal irritant; recent travel; or contact with infected people
or certain animals.

Objective P/E
findings ECG
Echo
PA
CXR
Date 02/02/23 1/28/23 13/02/23
PLT 466 452
WBC 10.3 25.1 8.9
RBC 4.8 4.9 5.19
MCV 65
MCH 23.3
Laboratory

MCHC 35.6
Hct 33.2 33.9 33.9
Hgb 11.3 11.3 12.1
Lymphocytes 70 15.8 51.3
Neutrophils
SCr
ESR
SGOT
SGPT
U/A Protein
Glucose
Ketone
WBC
RBC
Epithelial cells
Glomerular
casts
V/S BP 99 97 94 96
Temperature 35.9 35.5 35.4 35.5
RR 28 25 24 25
PR 128 130 130 140
Family history No family history of seizures.
Social history Lives at home with mother, father, and older brother. No tobacco,
alcohol or IV drug abuse at home.
C. Current Medication Record
Date A 8-month-old baby girl was brought by her parents to the
6/6/15 Community Health Center with a seizure complaint from
approximately 1 hour before entering the Community and Primary
Health Care Center. Seizures only occurred one time.

The length of seizures was about 1-2 minutes. During the seizures
the patient’s hands clenched and both upper arms and both lower
legs trembled like when people are shivering. The eyes glared
upward, and the patient’s mouth was like a grin, but no foam came
out from the patient’s mouth and the tongue was not bitten. When the
seizures happened the patient was unconscious and after the seizures
the patient was conscious but her body became weak. The patient’s
mother confessed before the seizure the patient had a high fever.
Fever occurred since approximately 1 day before entering the Health
Center .
7/6/15 A 8-month-old baby girl presented to hospital with a 2-day history of
watery diarrhea and fever. Rehydration and electrolytic balance were
restored with intravenous fluid therapy followed by oral rehydration
solution but diarrhea did not improve by the 3rd day of
hospitalization despite treatment with a probiotic. The child's
diarrhea improved considerably within the first twelve hours and
resolved completely within three days. Gelatin tannate might be
considered as a useful treatment complementary to oral rehydration
solution for the treatment of diarrhea in infants with rotavirus
gastroenteritis
8/6/15 The patient was next treated with MRI, a medical device recently
marketed in radiology department to control and reduce the
symptoms of EEG machine is a device that records the electrical
activity of the brain in infants, children, and adults. .

D. PATIENT’S MEDICATION EXPERIENCE

I) Patient’s description she is given seizure medicine that is called Diazepam given used for
of medication acute treatment of seizures in a hospital setting, as a rescue medicine
experiences outside of a hospital setting, and occasionally as a daily seizure
medicine.
II) Patient’s Phenytoin drug for decreasing abnormal electrical activity in the
comprehensive brain , it also for treatment and prevention of seizures to the brain /
medication history nervous system.
E. PATIENT’S DRUG RELATED NEEDS
IV) Assessment of the To diagnose the cause of a complex febrile seizure, the doctor
patient’s drug related recommend an electroencephalogram (EEG), a test that measures
needs brain activity. also recommend an MRI to check the child's brain if
the child has: An unusually large head. An abnormal neurological
evaluation. for Acute gastroenteritis asses Frequency and duration of
diarrhoea, vomiting,Characteristics of the diarrhoea e.g. presence of
 blood or mucous. Any other symptoms, in particular abdominal pain,
fever or patient is systemically unwell.
F. DRUG THERAPY PROBLEMS
V) Identification of
drug therapy  The shortage of basic medical equipment will play a big role for the
problems poor performance of the Ethiopian healthcare system.
like Responsive neurostimulation (RNS) medical equipment has a
main benefits to an epilepsy treatment it doesn't require the surgical
removal of brain tissue. RNS uses an implanted device to help
prevent seizures before they begin, similar to how a pacemaker
detects and treats abnormal heart rhythms. Patients treated with RNS
continue to take epilepsy medication, but their seizures may be better
controlled than with medication alone. Because no brain tissue is
removed, RNS poses less risk to the patient than other surgical
treatments.
II. CARE PLAN AND FOLLOW UP EVALUATION
Medical condition I: Febrile seizure disorder + AGE ( Acute Gastroenteritis)
Symptoms:-shakes all over and loses consciousness, the child get very stiff or twitch in just one area of
the body. lose consciousness and soil themselves.
Signs:- signs of gastroenteritis are vomiting and diarrhea and lose of consciousness main sign of febrile
seizure.
Goal of therapy: The goals of therapy for a child experiencing febrile seizures & AGE include maintain
airway/respiratory function,fever,pain maintain normal core temperature, protection from injury, and
provide family information about disease process, prognosis, and treatment needs.
Interventions:- Assess the child’s airway patency using the look, listen and feel approach.
Counseling given: Preventing dehydration or providing appropriate rehydration is the primary supportive
treatment
Medical Current DTPs Therapeutic Therapeutic Rational Monitoring
Problem Drug Goals Recommendatio
Regimen ns
Febrile phenytoin 5 Oxygen Treat she need Febrile seizure After review
seizure mg/kg/d=1 therapy is symptoms additional is an event in a child's
disorder 8 mg po should (eg, fever, treatment to children aged medical
+ AGE Bid, prescribed to pain) as replace the between 6 history and
( Acute Diazepam improve indicated. fluids and months and 6 perform a
Gastroent 1.46 mg IV oxygen Identify electrolytes in yr associated physical
eritis) saturation complicatio the body.it also with a exam. and
and reduce ns. Prevent depend on the fever, The often test
possible the spread severity of the fevers that blood and
complicatio of illness. she also trigger febrile urine to help
ns. infections. need IV fluid seizures pinpoint the
Identify (Intravenous are usually cause of the
health fluids)replacem caused by a fever..
concerns ent.and to treat viral infection, Giving the
and treat gastroenteritis and less child
certain in commonly by diazepam
 cases with Offer the baby a a bacterial (Valium)
specific drink every infection. The when illness
antibiotic time they flu (influenza) or fever
therapy. vomit. the virus and the begins can
parents can also virus that reduce the
give an oral causes roseola, risk of
rehydration which often having
solution or are another
water for the accompanied febrile
first 12 hours. by high fevers, seizure.Also
appear to be for AGE
most The
frequently frequency
associated with and volume
febrile of urine
seizures.&It passed in the
usually causes preceding 24
frequent hours is a
loose/watery fairly
bowel motions reliable
(diarrhoea) and guide to
often hydration
vomiting. status.
Clinical
signs of
dehydration
may not
correlate
with
laboratory
findings and
therefore
urea and
electrolytes
have limited
value in the
assessment
of the degree
of
dehydration
FOLLOW-UP PARAMETERS

Clinical parameters for effectiveness evaluation: Oral rehydration therapy is as effective as intravenous
(IV) fluid therapy for rehydration for children with mild-to-moderate dehydration for AGE(Acute
Gastroenteritis)
Clinical parameters for safety evaluation:clinical manifestations alone is often difficult. Red-flag
symptoms and clinical signs suggestive of acute bacterial gastroenteritis include bilious or bloody
vomiting, blood or mucus in stool, excessive irritability, inconsolable crying, high fever, toxic
appearance, tachypnoea, cyanosis, poor peripheral perfusion, petechial rash, neck stiffness and altered
sensorium.
Laboratory parameters for effectiveness evaluation: Complete blood cell count and appropriate
cultures considered when sepsis is suspected.
Laboratory parameters for safety evaluation: Po2 , CBC, Blood pressure, Ammonia

FOLLOW-UP RESULTS

Medical condition II: the child become sleepy for up to an hour. A straightforward febrile seizure like
this will only happen once during the child's illness
Symptoms:-A febrile seizure be as mild as the child's eyes rolling or limbs stiffening.
Signs:- Restlessness, irritability, insomnia,The child cry or moan,The child vomit or bite their
tongue.,Sometimes, children do not breathe ,The child's body then begin to jerk rhythmically.
Goal of therapy:The aim of treatment is to manage the underlying cause
Interventions: a child experiencing febrile seizures include maintain airway/respiratory function,
maintain normal core temperature, protection from injury, and provide family information about disease
process, prognosis, and treatment needs.
Counseling given: Put something soft and flat, like a folded jacket, under her head,Loosen ties or
anything around the neck that may make it hard to breathe.
Medical Current DTPs Therapeutic Therapeutic Rational Monitoring
Problem Drug Goals Recommendatio
Regimen ns
Febrile phenytoin 5 The use Patient will It's not Febrile the children
seizure mg/kg/d=1 of intermitte be free of recommended seizures who have a
disorder. 8 mg po nt diazepam complicatio that the child is can often be history of
Bid, drug with ns and given a diagnosed febrile
Diazepam fever after maintain prescription of from a seizures
1.46 mg IV an initial normal core regular description of have an
febrile temperature medicines to what increased
seizure is . Patient prevent further happened. It's risk of
likely to will identify febrile seizures. unlikely that a developing
decrease the measures to This is because doctor will see epilepsy, it
risk of promote the adverse side the seizure should be
another nutrition effects happening, so stressed that
febrile and follow associated with it's useful to the risk is
seizure, but the many medicines note: still small.
the rate of treatment outweigh any Laboratory
side effects regimen. risks of the how long the tests, such as
is high seizures seizure a blood
although the themselves. lastedwhat test or urine
family find the Patient happened, test, may be
the parents must such as body needed if the
perceived speak with a stiffening, cause of the
 benefits to health care twitching of child's
be low. provider for the face, arms illness is not
complete and legs, clear.
information staring, and It can
about their loss of sometimes
health, medical consciousness. be difficult
questions, and to get a urine
treatment sample from
options, young
including any children, so
risks or benefits it may have
regarding use of to be done in
medications. hospital.
FOLLOW-UP PARAMETERS

Clinical parameters for effectiveness evaluation: Rectal diazepam prescribed to be used as needed for
child who are prone to long febrile seizures.also phenytoin to prevent and control seizures that may begin
during or after surgery to the brain or nervous system.
Clinical parameters for safety evaluation: febrile seizures occur in the first few hours of a fever,
during the initial rise in the child body temperature.Giving the child ibuprofen (paracetamol) at the
beginning of a fever may make the child more comfortable, but it won't prevent a seizure.
Laboratory parameters for effectiveness evaluation: an electroencephalogram (EEG), a test
thatmeasures brain activity.also recommend an MRI (Magnetic resonance imaging)to check child'sbrain
if child has:
Laboratory parameters for safety evaluation: electroencephalogram (EEG), a test that measures brain
activity MRI to check the child brain if she has: An unusually large head or An abnormal neurological.

FOLLOW UP RESULTS

Treatment for long-term seizures usually involves providing anti-seizure medication and
monitoring heart rhythm, blood pressure, and breathing. If the seizure stops by itself, anti-seizure
medications are not necessary. After a simple febrile seizure, most children do not need to stay in
the hospital unless the seizure is caused by a serious infection that requires hospitalization. After
the seizure has stopped, treatment for fever begins, usually by giving per oral or per rectal
acetaminophen or ibuprofen.

the doctor recommend an electroencephalogram (EEG), a test that measures brain activity.also
recommend an MRI (Magnetic resonance imaging)to check child's brain if child has: An unusually
large head or An abnormal neurological evaluation . a test result shows that
An electroencephalogram (EEG) is recording of brain activity 16 channel digital EEG with
intermittent photic stimulation (IPS) was done. The background showed normal theta and delta
activities intermixed with few beta frequency discharged and a posterior reactive regular
symmetrical sliw alpga rhythm.There were no abnormal transient or definite epiletiform
discharges at the time of the recording (30 min). There were no abnormal reactivity to IPS
(Intermittent photic stimulation). Conclusion:This is a normal awake EEG record.
 Recommendation
Cases of febrile seizures mostly occur in children but people still often do not understand how to deal
with fever and febrile seizures. Counseling to the public about the handling of fever in various ways for
which one of them is by compress, where the traditional mother’s habit of
compressing with cold water is not recommended anymore. Compress with warm water is now more
recommended.
Further recommendations include counseling about febrile seizures, and actions to be taken if the child
has a fever at home, such as keep calm, loosen children’s clothing, especially the neck, position the head
of the child tilted, clean the vomit or mucus in the mouth or in the nose and do not put something to the
mouth, and if they have anti-seizure drugs in the form of rectal suppositories then immediately give
appropriate dose as recommended.