Case Study ( GROUP A )

Adverse Medication Effects : Hypertensive Crisis

A 30 years old male is brought to the emergency room ( ER ) of a local
general hospital after dining with friends. The patient started complaining of
a stiff neck and severe , throbbing occipital headache that began suddenly at
the end of the meal. His vital signs at this time are as follows.: temperature =
36.8 C, pulse : 108, respirations : 22, blood pressure : 190/104. The friend
accompanying the patient states that the patient has been taking
medication for at least 1 year for depression and believes there may be a
medication bottle in the pocket of his jacket. You discover a bottle with the
following directions on the label : nardil 15 mg tid. Also, Losartan sodium 50
mg OD. He has no known allergies.

Questions : What signs and symptoms of hypertensive crisis can you identify
at this time?
What are the standard treatment for hypertensive crisis?
What collaborative interventions do you anticipate for this
patient?
 PNEUMONIA
An 11 month old Muslim male child , 8.2 kg , LIREN MUTAF, from south presented with the
chief complaints of shortness of breath with high grade fever for 2 days along with diarrhea ,
pain abdomen and vomiting.
On examination , the child is irritable , febrile , with respiratory rate of 54/ minute. The breath
sounds were decreased on the both sides of the lungs, with mild subcostal suction. The oxygen
saturation was 91%.
The digital chest radiograph revealed RIGHT sided pleural effusion with a distinct air fluid level
along with PNEUMOTHORAX on the left side which was confirmed by USG and CT SCAN.
The routine blood investigations revealed – microcytic hypochromic RBC with predominant
neutropils, WBC -22,000 percu/mm3 , with High Anion Gap- Metabolic acidosis. The child was
started on Vancomycin 90 mg OD and Meropenem 85 mg BID.

Questions : What signs and symptoms of pneumonic crisis can you identify
at this time?
What are the standard treatment for pneumonia ?
What collaborative interventions do you anticipate for this
patient?