The individual chart of patient’s complex medical treatment is developed and justificated (regimen, diet, methods of medical treatment etc).
Provides full samples of drugs recipes and their justification in terms of mechanism of action.
Preventive measures on the given patient, contact persons. Antiepidemiological measures at the epidemical focus.
Example of the appointed medical treatment justification.
1 Obligatory hospitalization in the infectious department of all persons with the generalized form of meningococcal infection.
2 Regimen – keep to bed to normalization of temperature and improvement of the common state of the patient.
3 Diet – 15.
4 Treatment:
· Etiotropic therapy:
- Rp.: Benzylpenicillini-natrii 1000000 ME
D. t. d. N. 20
S. Content of 3 bottles dissolve in 10 ml 0.25% solution of novocaine. Bring 10 ml intramuscular every 3 hours.
Benzylpenicillin is the medicine of a choice. It is active to meningococcus. At the intramuscular introduction is quickly sucks in a blood, penetrates through a haematoencefalitic barrier, its concentration in a spinal liquid rises at inflammation of brain tunics, minimum toxic for CNS.
- Rp.: Cefoperazoni 1,0
D. t. d. N. 20
S. Content of the bottle dissolve in 5 ml of the added solution. Put 5 ml intravenous four times a day.
Cefoperazone has the wide spectrum of action. After activity it looks like other 3th generation cefalosporins (high activity concerning to the Gr- bacterium, bactericidal action to Gr+ and Gr- microorganisms which are proof to penicillin and other antimicrobial medicine). It is quickly sucked in a blood. Bactericidal concentration in a blood is saved more than 12 hours.
The abolition of antibacterial therapy is conducted to the normalization of temperature, disappearance of clinical displays, sanation of liquor (pleocytosis less than 100 in 1 ml, absence of neutrophils).
Pathogenic therapy:
- Rp.: Sol. Glucosae 5 % - 400 ml
D. S. Intravenous driply from a calculation 50 ml/kg/d.
- Rp.: Sol. Furosemidi 1 % - 2 ml
D. t. d. N. 5 in ampull.
S. To enter 2 ml intravenous 1-2 times per a day.
Detoxification therapy must carried out jointly with dehydration to prevent brain swelling and increased removal of toxins the kidneys.
- Rp.: Prednizoloni hemisuccinatis liophylisati pro injectionibus 0,25
D. t. d. N. 6 in ampull.
S. Dissolve in 5 ml isotonic sodium chloride solution. Enter intravenous driply in 200 ml isotonic sodium chloride solution.
Glucocorticosteroids are intended for suppression of excessive immune response of organism to develop infections and prevention of complications such as toxic shock syndrome.
Example of preventive measures conducting
A general prophylaxis consists of the timely detection, isolation and medical treatment of patients with meningococcal infection.
Hospitalization of patients with generalized forms of infection is obligatory.
The excerption of patients from the department is conducted to the presence of two negative results of bacteriological research. At the epidemiological focus is conducted the medical supervision after persons which were in the contact with a patient, and also their double bacteriological research during 10 days. In the organized collectives, where a patient with meningococcal infection was exposed, new persons do not admiss during 10 days from the moment of isolation of the last patient.
Specific prophylaxis: single intramuscular vaccination. A vaccine provides immune protection for 2 years, C-vaccine - during 2-4 years.
Features of the course of the disease in the patient (Specietates cursus morbi)
Highlights the differences observable in the course of the disease in the patient from the classical clinical picture, justif the reasons for these differences.
Prognosis and its justification (Prognosis et eius argumentatio)
In relation to the life, convalescence, capacity.
Example
Prognosis in relation to the life: after conducted massive etiotropic, pathogenetic and symptomatic therapy is favourable.
Prognosis in relation to convalescence: favourable.
Prognosis in relation to a capacity: favourable.
Epicrisis (Epicrisis)
Epicrisis is an excerption from a hospital chart and must include all basic moments of hospital chart in short form.
Are consistently pointed:
а) date of reception and excerption of the patient;
b) basic complaints; duration of disease;
c) basic pathological changes on organs and systems, data of laboratory and instrumental methods of research;
d) clinical diagnosis (basic, complication, concomitant diseases);
е) methods of medical treatment, doses of medicine, that are used;
f) results of the conducted medical treatment with pointing of dynamics of basic symptoms;
g) recommendation after the excerption in relation to the regimen, diet, subsequent medical treatment, terms of work and life, outpatient supervision.
Example
Patient N. was cured on stationary medical treatment at the I infectious department of Sumy region infectious hospital named after Z.Y. Krasovytski from 16.02.08 till 11.03.08 with a diagnosis: Meningococcal infection (N. meningitidis+), generalized form, severe degree. Acute purulent meningoencephalitis. Meningococcemia. It was diagnosed on the basis of complaints of the increase of temperature to 38,9 C, bad arching headache without certain localization, which increases at the change of body position, actions of bright light, loud scream, expressed splitting vomits (by a «fountain»), which does not bring facilitation and is not related with acceptance of meal and arises up on height of the headache, loss of consciousness; taking into account a presence of general infectious, general cerebral symptoms, meningeal syndrome, symptoms of the focal brain damage and hemorrhagic rash in the clinical picture; data of laboratory examinations: in the clinical blood examination - decline of the level of haemoglobin, amount of erythrocytes and thrombocytes, increase of amount of leucocytes due to segmented neutrophils and band neutrophils (with the deviation of the differential count to the left); in the clinica urine examination - decline of transparency, the presence of protein can testify to the toxic defeat of kidneys; in the spinal liquid examination - a spinal liquid has a purulent character, promoted amount of protein, positive globulin Pandi’s Nonn-Appelt’s reaction, considerable neutrophil pleocytosis, cellular-protein dissociation (there is the increase of maintenance of protein on 1 g/l approximately per every thousand of cells accordingly), microscopically the diplococcuses are exposed inside and outside leucocytes.
Data of additional examinations:
1. Clinical blood examination (17.02.08): haemoglobin – 114 g/l, erythrocytes – 3,49 * 1012/l, thrombocytes – 55 * 109/l, leucocytes – 22,7 * 109/l, differential blood count: basophils – 0,5 %, eosinophils – 1 %, band neutrophils – 12 %, segmented neutrophils – 78 %, monocytes – 3 %, lymphocytes – 6 %, ESR – 8 mm/h, hematocrit – 0,38.
2. Clinica urine examination (17.02.08): total amount 80 ml, a color is yellow, poorly cloudy, reaction, specific gravity 1,017, protein 0,46 g/l, leucocytes 0-1, flat epithelium 2-3, mucus a little.
3. Spinal liquid examination (17.02.08): amount 0,9 ml, colourless, poorly cloudy, protein 6,6 g/l, positive Pandi’s reaction, positive Nonn-Appelt’s reaction, pleocytosis 4645 cells in ml due to neutrophils, glucose 1,4 mmol/l, microscopically in the painted preparations the diplococcuses are exposed inside and outside leucocytes.
Clinical diagnosis:
Basic: Meningococcal infection (N. meningitidis+), generalized form, severe degree. Acute purulent meningoencephalitis. Meningococcemia.
Complication: Reactive arthritis of left knee and elbow joints. Retinal angiopathy of both eyes.
Medical treatment: keep to bed, diet №15, etiotropic medical treatment – cefoperazone; pathogenetic therapy – solution of glucose, NaCl 0,9 % solution, reosorbilact, furosemide, prednisolone; symptomatic therapy – seduxen, sodium oxybutyrat, triamin, corglicon, voltaren.
Recommendations:
1 Avoid supercooling.
2 Clinical supervision in a neurologist.
3 Repeated the clinical blood and urine examination in 10 days.
4 Nootropil 1 capsule twice a day for 2 months.
5 Extract of echinacea 10-15 drops three time per day for 1 month.
6 Multivitamins 1 tablet twice a day for 2 months.
