Name: Tee Eng Chun

ID: BP080726024
Week: 7
Appendix A: Daily Reflective Diary
Date/Rotation: 31 Jan 2012 (day 2)/Care of elderly
Today’s activities.
 Continued to clerked a case in ward D3 involved a 76 years old patient (ABH), with hypertension, congestive heart
failure, atrial fibrillation and dignosed with AEBA secondary to community acquired pneumonia. ABH was
administered to the hospital due to shortness of breath and fever
 Clerked a second case involves a 70 years old female patient (SS), with diabetes mellitus, hypertension, epilepsy and
currently diagnosed with phenytoin toxicity.
A significant experience/observation today.
 Observation on the management of the patient (SS)

Learning from this experience/observation.

1. Management of hypertension for patient with diabetes mellitus

 According to CPG, diuretic can be used as initial treatment and ACEI or ARB can be added on if monotherapy is
inadequate. ACEI and ARB can minimise the adverse metabolic effect of high dose of diuretic

Additional learning needs from this experience/observation and my plan to achieve the learning.

1. Management of phenytoin toxicity

 According to random level (27.87µg/mL), patient experienced ataxia which is the side effect of phenytoin. Therapeutic
drug monitoring will be performed to reduced phenytoin’s toxicity (therapeutic range: 10-20µg/mL). Dose adjustment
from 300mg ON to 100mg ON was taken according to random level.

References include LEXICOMP and Ministry of Health Clinical Practice Guideline

Summary of what I have learnt.
 Management of hypertension for patient with diabetes mellitus
 Management of phenytoin toxicity
Meaningful interactions with health care team (preceptors, doctors, nurses, other health care students and peers).
 The doctors and nurses are helpful in clarifying our queries in the ward.

Feelings and thoughts about today’s learning experience.

 I have learnt a lot of extra knowledge today and experienced the meaningful interactions with health care team.

Signature of the hospital preceptor:_____________