m attached to med gen male ward, and will have to present this case. Patient name is oi lam tiong, age : 78 years, gender: male ,, he was in ED of hospital sultanah bahuyah (HSB) before he was transfered to ward kenanga on 2/6/2026. On 1/6 in ED he was given IV augmentin 1.2 g STAT, 6 pm, IV pantoprazole 40 mg STAT at 6 pm, T PCM 1g STAT at 8 pm, IV MgSO4 10 ml in 20 cc NS, at 4 pm, IV KCl 2 g in 200 cc N/S over 2 H 8 pm, T aspirin 150 mg STAT ( not signed and time not stated), T aspirin 150 mg (not signed and time not stated) , Iv augmentin 1.2 g BD (not signed and time not stated) on 2/6/2026 12 pm, it was noted that he has underlying 1)BPH, HTN, dyslipidemia, gout 2) paroxysmal AF 3) petroclival meningioma, 4) Newly diagnosed Hep C USHBS April 25 : early cirrhotic changes. issues: 1) altered GSC likely due to disease progression of meningioma, 2) aspiration pnemonia, 3) AF with fast ventricular response secondary to ???? Chief compliant: SOB 2/7, unable to expectorate sputum (prodcutive cough), reduced conscious level since attended on 1/6/20206 plus positive B/L UL and LL weakness, GSC in ED: E1V1M1 plus pow swallowing effct . Baseline GSC 1 week ago : E4V5M6, home ambulatory with walking frame . Upon arrival to ward 4C , was on HFMO2, E1V1M1, afe brile, (RP, FBC STAT) O/E: pupil right : 3 mm, left: 4 mm, E1V1M1, BP: 88/59 mmHg, PR: 120 , T; 37, SPo2: 100% on HFMO2 , DXT: 5.1 , ECG: tachycardia, CXR: mild patchness on rught lung . Noted K+ ion 1/6/26 2.7 , given 2 g KCL 15 ? + 2 pm/am STAT , N2 RP repeated on 2/6 . Also, explained to the daughter regarding current condiiton in ill state and likely due to disasese progression secondary to menigioma . direction of care is established . for BCA supportive care along with medical therapy. ceiling therapy: HFMO2/ single inotrope. not for CPR or intubation. Daughter stays in Kuala Kedah. Plan: Kepp MAP > 65 mmg, HM run 10/1 H, then maintain NFH?? 3ENSDS/24 hours.KIV of add K+ in WD after R/L blood. 4) STAT of IV augmentin 1.2 gram STAT and BD, syrup lansoprazole 30 mg OD, IV parentrovite 1 pair OD x 3/7. on 2/6 3.40 pm, still tachypenic, spo2 100% on HFMO2. Plan: 1) start CSCI morphine 10 mg in 24 ml in NS, run 1 ml/ 1 hour. on 2/6 6.10 pm, noted repeated K+ is 3.6 and Na: 150 . Plan: continue curent IV Dextrose 3 NS 5/24 hours , no need KCL in drip. on 3/6 9 am , patient is currently on HFMO2, able to maintain saturation and able to wean down inotrope. O/E: E2V2M4, tachpneic, pupil R reactive 2 mm, left 5 mm dilated, Bp: 103/84, PR: 96, T: 37, SPo2: 100% under HF. urea: 18.8, creat: 458, Na: 150, K: 2.6. Plan: Reduce IV I nased? 1cc/ hour, 2) continue CSCI morphne, 3) start RTF 50 cc x 2 3 H, then 100 cc 3 Hx 2, then 150 cc 3Hx 2, then 200 cc 3 H x 2. 4) Contimue IV augmentin, 5) refer dietician, 6) Change to Iv D 20 NS/24 hours. 7) tired towean down O2 to VM60. on 3/6 12 pm Body weight: 55 kg, BR: 13375-1650 kcal/day, Hb: 11.4, HbAic: 5.1%, T: 37 , DXT: 7.0/7.4 . Plan: RtF regimen as below ( 3H, 6x/day) Step 1: 2 scoop of activax optimum plus + 100 cc H20 (2x), Step 2: 3 scoop Activax Optimum Plus + 150 cc H20 (2x), Step 3: 4 scoop Activax Optimum Plus + 200 cc H20 (2x) Step 4: 5 scoop Activax Optimum Plus + 250 cc H20 (full) 1650 kcal, 60 g rpotein. To indent: aactivax optimum plus x 1/ day on 4/6 9.15 am: Issue: disease progression of petroclival meningioma with adjacent structure compression 2) cure for aspiration pnemunonia. currenlty: condition status guo lifelong RTF 150 cc/ 3 hourly, no fever , no desaturation of VMO2 60 %. a/c: E2V2,M4, , deep laboured breathing, BP: 90/69, PR: 101, T: 37 SPo2: 98% under VMO2, 60 %, IO: 1699/900/+799, Pupils: right 2 mm sluggish, left: 5 mm fixed dilated, platelet: 56, urea: 29, creatinine: 440, Na: 50. Plan: increase RTF to 200cc/3 hourly x 2, then to 250 cc/3 hourly x 2 . 2) off IV D. 3) Continue CSCI morphine 4) in the event of s=desaturation , not for inotrope, intubation, cpr or HD. 5) ceiling of care : HFMo2, 6) for best medical therapy 7) Continue IV augmentin 1.2 g BD to completle 1/52. 8) not for further blood today. flow of presentation: 1. Patient, age, gender 2. what is the chief complaint 3. what is the diagnosis 4. on day 1 admitted, wht problem then give what medication, indication for what, then is it appropriate to give the med for this problem, any more better option? (No pci then skip nxt day- same flow summary - until the last day) 5. next day, some symptoms resolve, dr stop certain medication due to …. Then some other problem arise and dr prescribe ….. the indication for the medication is for …… is it appropriate….. 6. overall no PCI in this case / u found some pci and need some clarification….. 7. thank you also lectuere said : Yes, but rather than solely mentioning if the medications are appropriate or not, it would be better to state indications. For eg, this pt was started on Tab pantoprazole 40mg BD for (indication) from (duration). Then if anything was found inappropriate/incorrect, it can be mentioned as a PCI & then explain accordingly [05/06, 17:28] lecturer also said ur abve flow is correct. Just follow the CP2 sections PHARMACOTHERAPY REVIEW (CP2) Pharmacy Department, Hospital ___________________ Ward: _______________ Bed:______________________ FBC BUSE / Renal Profile LFT Coag. Profil e CE ABG Others C&S I/O Pin.1/13 C. WARD MEDICATION Drug/Regimen Start Date Stop Date Indication/ Reason for Change Reconciliation Note S-Stopped / W-Withold/ D-Continue on Discharge (+Duration) D. PHARMACEUTICAL CARE PLAN Date Pharmaceutical Care Issues Pharmacist’s Recommendations / Plan Outcome so pls help me undertsand this cacse very detaily , explain to me like im niot a pharmacy student, then follow the presenation flow and generate trhe script for me, pls refer to latest malaysia cpg and so on.
Malaysia CPG atrial fibrillation aspiration pneumonia management 2023 2024
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augmentin amoxicillin clavulanate renal dose adjustment creatinine clearance
Summary of What Was Produced
Part 1 - Case Explanation (In Plain Language)
- What a petroclival meningioma is and why it caused everything (dysphagia → aspiration → pneumonia → sepsis → AF → shock → AKI)
- What each diagnosis means simply
- What every drug does, why it was given, and any concerns
- Why ceiling of care is medically and ethically appropriate
- CrCl calculated: ~9 mL/min (severe AKI) - this drives the Augmentin BD dosing decision
Part 2 - Full CP2 Presentation Script
- Patient intro + demographics
- Chief complaint
- Active diagnoses (3 issues explained)
- Day-by-day medication review with indication for each drug
- PCIs identified and argued properly (indication first, then PCI if applicable)
- Summary table (CP2 Section C format)
- Closing statement
The 4 Key PCIs Found:
| # | PCI | Recommendation |
|---|---|---|
| 1 | Aspirin unsigned x2, no time | Fix documentation |
| 2 | Aspirin not appropriate for AF in this context (no OAC benefit in palliative patient + high bleed risk) | Stop aspirin |
| 3 | Augmentin 1.2g BD looks under-dosed vs TDS standard - but is CORRECT for CrCl ~9 mL/min | Document renal adjustment explicitly |
| 4 | No antiemetic with CSCI Morphine | Add Haloperidol 1.5mg/24h via CSCI |
actually i need to go back to the ward tomorrow and see the disease prgression and e,docines of the patient to see of any meciines are WH, Dicsonotnue or conitnue and so on. im not sure if the patient is till admitted or discharged pr deceased too. ill attach u the cp2 form and can u fill accordingly competely
hmmm u just can type and send me the form her