CASE
PRESENTATION
Demographic Details Of
Patient:
Name: Mr. X
Age: 50 yrs
Sex: Male
Unit: General Medicine Male
IPP
No: 180611363
DOA: 11/6/18
DOD: 20/6/18
Reasons For Admission:
Pain & Swelling in multiple joints
Fever
History of passage of hard stool
HISTORY:
Past Medical History: H/0 similar complaints in the
Past
Past Medication History: Not Known
Social History:
Height - 166 cms. Weight – 63 kgs.
Alcohol – Not Known. Diet – Mixed diet.
Sleep – decrease. Appetite – Normal.
Bowel habits – Normal.
Family History: No similar complaints in any
other family members.
Allergies: Not Known
SOAP ANALYSIS:
Subjective:
Pain & Swelling in multiple joints.
Fever.
Passage of hard stool.
Obejective:
General Examination – Patient is coherent &
conscious
Physical Examination: Vital signs
Temperature – Afebrile. Pulse rate – 84/min.
Respiratory Rate – 18/min. BP – mm of Hg.
Systemic Examination:
CVS – S1 S2 +
Rs – NVBS + B/2 [Non Functional Neurological Deficit]
Muscular System – Tenderness + in B/L wrist joint.
Raise of temperature in B/L wrist joint.
Swelling + in B/L Ankle joint.
Assessment:
Based on the Subjective and Objective evidence the patient
condition is assessed as RHEUMATOID ARTHRITIS.
Identification of Therapy:
Pain & Swelling in multiple joints.
Fever.
Passage of hard stool.
Muscular System examination.
Goals of Therapy:
patient specific:
To decrease the pain & swelling in multiple joints.
Disease specific:
To decrease the tenderness.
To decrease the swelling in multiple joints.
To decrease the temperature in bilateral wrist joint.
CURRENT THERAPY:
DRUG DOSE ROUTE FREQU DAY-1 DAY-2 DAY-3 DAY-4 DAY-5 DAY-6
NAME ENCY
Inj.Hydroc 100mg IV QID
ortisone
T.Omnaco 40mg Oral 1 ½-0-0
rtil
T.Shelcal 250mg Oral 1-0-1
C.Becosul - Oral 1-0-0
es
T.Methotr 10mg Oral 0-1-0
exate
Inj.Rantac 50mg IV 1-0-1
C.Rabema - Oral 1-0-0
c
T.Hydroxy 200mg Oral 1-0-1
chloro-
quine
sulphate
DRUG DOSE ROUTE FREQU DAY-1 DAY-2 DAY-3 DAY-4 DAY-5 DAY-6
NAME NCY
T.Calcium 5mg Oral 0-1-1
folinate
Inj.Trama 50mg IV SOS
dol
Inj.Optine 75ml/mg IV -
uron
T.Metform 500mg Oral 1-0-1
in
T.Ecosprin 75mg Oral 1-1-1
T.Solbitrat 5mg Oral 1-0-1
e
T.Met.XL 12.5mg Oral 0-1-0
T.Ultracet 100mg/ml Oral 1-0-1
DAY-1
Pain & Swelling in multiple joints
CVS – S1 S2 +
R.S – NVBS + B/2
P/A – Soft, No Organomegaly
DAY-2
No fresh complaints
Pulse rate – 84 beats/min
B.P – 180/90 mm of HG
Temperature – Afebrile
C.V.S – S1 S2 +
R.S – B/L NVBS +
P/A – Soft
CNS – NFND
Advice – To continue same medication except C.Rabemac
and add Tab.folinate & Inj.Tramadol
DAY-3
BP – 120/90 mm of Hg
Pulse rate - 82 beats/min
Respiratory rate – 20/min
Temperature – Afebrile
CVS – S1 S2 +
C.N.S – NFND +
R.S – B/L NVBS +
P/A – Soft
Advice – To continue same medication as DAY-2 except
1. Inj.Tramadol
2.Inj.Hydrocortisone
DAY-4
B.P – 130/70 mm Hg
Pulse rate – 82 beats/min
Respiratory rate – 18/min
Temperature Afebrile
C.V.S – S1 S2 +
C.N.S – NFND +
R.S – NVBS +
P/A – Soft
Advice – To continue same medication as DAY-3 & add
1 . Inj.Tramadol
2.Tab.Metformin
DAY-5
B.P – 120/90 mm of Hg
Pulse rate 82 beats/min
Respiratory rate – 20/min
Temperature Afebrile
CVS – S1 S2 +
CNS – NFND +
P/A – Soft
R.S – B/L NVBS +
Advice – To continue same medication as DAY-4 and add
Tab.Ecosprin
DAY-6
B.P – 140/90 mm Hg
Pulse rate – 80 beats/min
Respiratory rate – 20/min
Temperature Afebrile
CVS – S1 S2 +
R.S – B/L NVBS +
P/A – Soft
Advice – To continue same medication as DAY-5 and add
1. Tab.sorbitrate
2.Tab.Met XL
3.Tab.Ultracet
DISCHARGE MEDICATION
DRUG NAME DOSE ROUTE FREQUENCY
T.Omnacortil 40 mg Oral 1 ½-0-0
T.Shelcal 250 mg Oral 1-0-1
C.Becosules - Oral 1-0-1
T.Methotrexate 10 mg Oral 0-1-0
Inj.Rantac 50 mg IV 1-0-1
T.Ecosprin 75 mg Oral 1-1-1
THERAPEUTIC PARAMETERS
Monitor the muscular system
Monitor the Rh factor
Monitor the body weight of the patient
Monitor the Respiratory rate
Monitor the body temperature
TOXICITY PARAMETERS
ADRs of Hydrocortisone
Unusual weight gain
Swelling ankler/feet
Vision problems
ADRs of Omnacortil
Unusual weight gain
Swelling ankles/feet
Vision problems
Irregular heart beat
ADRs of T.Shelcal
Unusual weight gain
Nausea/Vomiting
Loss of appetite
ADRs of C.Rabemac
Extreme tiredness
Painful joints
Rashes and lesions on the skin
ADRs of T.Hydrochloroquine Sulphate
Symptoms of heart failure
Hair loss/color change
ADRs of Tab.Ecosprin
Rapid breathing
Severe nausea/vomiting or stomach pain
Fever lasting longer than days
DRUG INTERACTION
1) Hydrochloroquine Sulfate + Methotrexate
Hydrochloroquine Sulfate decreases levels of methotrexate
by unknown mechanism. Use coution/monitor.
Hydrochloroquine may reduce the renal clearance of
methotrexate, the exact mechanism of this interaction is
unknown.
2) Rabeprazole + Methotrexate
Rebeprazole increases levels of methotrexate by
decreasing renal clearance. Use caution/monitor.
Increased risk of toxicity with higher doses.
3) Hydrocortisone + Prednisone
Hydrocortison will decrease the level or effect of
prednisone by effecting hepatic/intestinal enzyme CYP3A4
metabolism. Use caution/Monitor.
PATIENT COUNSELLING
DISEASE
Rheumatoid arthritis is a systemic autoimmune disease
characterized by inflammatory polyarthritis, which
effects peripheral joints, especially the small joints of the
hands and feet
Causes :
• The exact cause of RA is unknown
• Suspected causes are:
1. Bacterial Infection
2. Genetic Marker
3. Stress
4. Viral Infection
• Other suspects include female hormones.
• Smoking.
Signs & Symptoms of Rheumatoid Arthritis
• Fetigue
• Morning Stiffness
• Joint stiffness
• Joint pain
• Minor joint swelling
• Fever
• Numbness and Tingling
• Decrease In Range of Motion
MEDICATION
• To take medication properly.
• Asprin should not take.
EDUCATION
• Exercise
• Physical and occupational therapy
• Nutrition and dietary therapy
• Avoid smoking
DIET
• Maintenance of a healthy body weight
• Incorporating fats in diet
• Incorporating antioxidants in diet
• Incorporating minerals and vitamins in diet
