Sarah Johnson is a 32-year-old pregnant female at 24 weeks gestation.

Scenario 1: Sarah Johnson

Treatment Plan:

• Hypertension Management:

  • Medication: Due to pregnancy, lisinopril is contraindicated. Labetalol is a safe and effective alternative for gestational hypertension.

    • Order: Labetalol 100mg PO BID, titrate to goal BP.

• Monitoring:

  • Blood Pressure: Monitor BP daily at home and at every prenatal visit.

  • Fetal Monitoring: Ultrasound monitoring for fetal growth and well-being is crucial.

  • Lab Tests: Repeat labs (Hgb, HCT, K, BUN, Cr) as needed to monitor renal function and electrolytes.

• Goal Blood Pressure: Aim for a systolic blood pressure less than 140mmHg and a diastolic blood pressure less than 90mmHg.

Education:

• Lifestyle Modifications: Encourage dietary modifications, including low-sodium intake, and regular exercise.

• Stress Management: Discuss techniques for stress reduction.

• Caffeine Reduction: Advise her to decrease caffeine intake.

• Follow-up: Schedule regular follow-up appointments to monitor BP and fetal well-being.

Rationale:

• Labetalol is preferred in pregnancy due to its beta-blocking and alpha-blocking effects, helping control both systolic and diastolic BP.

• Frequent monitoring is crucial to ensure adequate BP control and fetal safety.

• Lifestyle modifications and caffeine reduction can aid in BP management.

Scenario 2: Lydia

First-Line Treatment:

• Cefixime: Cefixime is a safe and effective treatment for gonorrhea in patients allergic to sulfa drugs.

  • Order: Cefixime 400mg PO single dose.

• Co-infection Coverage:

  • Chlamydia Trachomatis: Chlamydia is a common co-infection with gonorrhea. It is crucial to cover this organism to prevent complications.

  • Medication: Azithromycin is the preferred treatment for chlamydia.

    • Order: Azithromycin 1g PO single dose.

Abstinence Period:

• 7 days: Lydia should abstain from sexual activity for 7 days to prevent reinfection and ensure effective treatment.

Patient Education:

• Symptoms: Explain common symptoms of gonorrhea and chlamydia.

• Treatment: Discuss the importance of taking all prescribed medications as directed.

• Partner Notification: Emphasize the importance of partner notification and treatment to prevent further transmission.

• Safe Sex Practices: Encourage safe sex practices, including consistent condom use.

• Follow-Up: Schedule a follow-up appointment to ensure treatment effectiveness and discuss any concerns.

Rationale:

• Cefixime is a safe alternative for patients allergic to sulfa drugs.

• Azithromycin effectively treats chlamydia, a common co-infection with gonorrhea.

• A 7-day abstinence period allows for proper treatment and prevents reinfection.

• Patient education is critical to ensure compliance and prevent further transmission.

Scenario 3: Edgar

Treatment Plan:

• Ophthalmic Medication: Due to allergies, erythromycin ophthalmic ointment is a safe and effective treatment for bacterial conjunctivitis.

  • Order: Erythromycin ophthalmic ointment 0.5% to the right eye TID x 7 days.

Patient Education:

• Contagiousness: Explain that bacterial conjunctivitis is highly contagious and emphasize the importance of handwashing.

• Hygiene: Instruct the mother on proper eye cleaning techniques and the importance of separate towels for Edgar.

• Avoid Sharing: Advise the mother to avoid sharing towels, washcloths, and eye makeup with Edgar.

• Medication Application: Demonstrate the correct method of applying ophthalmic ointment.

• Symptoms: Explain that it's common to experience redness, itching, and discharge, but that these symptoms should improve with treatment.

• Follow-up: Schedule a follow-up appointment if symptoms persist or worsen.

Rationale:

• Erythromycin ophthalmic ointment is safe for patients with penicillin and amoxicillin allergies.

• Good hygiene practices are essential to prevent further transmission.

• Proper medication application and follow-up ensure effective treatment.

Scenario 4: JT

Amoxicillin Prescription:

• Dosage: Using the Medscape dosage calculator for amoxicillin, the recommended dosage for JT (15kg) is 40mg/kg/day divided BID. This translates to 600mg per day, divided into 300mg every 12 hours.

• Order: Amoxicillin oral suspension 300mg PO BID x 10 days.

• Instructions: Shake well before each dose.

Alternative Antibiotic:

• If rash develops: Assuming a presumed allergy, switch to a macrolide antibiotic.

  • Order: Azithromycin 10mg/kg PO once a day for 3 days.

Patient Education:

• Symptoms: Explain common symptoms of otitis media.

• Treatment: Instruct the mother on proper medication administration.

• Pain Relief: Discuss over-the-counter pain relievers such as acetaminophen or ibuprofen (as appropriate) for pain management.

• Follow-Up: Schedule a follow-up appointment if symptoms persist or worsen.

Rationale:

• The Medscape dosage calculator provides an accurate and safe dosage based on JT's weight.

• Azithromycin is a safe alternative for patients with penicillin allergies.

• Pain management and follow-up are crucial for effective treatment.

Important Note: These recommendations are for educational purposes only. Always consult with a healthcare professional for specific medical advice.

Sample Solution