应该支援的.PPTVIP

* * * * * * * * * * * * 7/5 7/9 7/12 7/16 WBC 7100 5200 6700 8400 Seg 90.5 93.9 91.9 85.3 Hb 10.6 11.3 12.2 12.3 MCV 108.3 109.2 107.6 105.2 Cr. 1.55 1.30 1.03 0.92 Na 131 140 136 140 K 5.5 5.0 4.6 4.5 CRP 12.02 4.29 Teicoplanin + Cefepime on 7/7~7/20 7/10 Sp/C: normal flora 6/22 TB culture: NTM (report on 7/13) Clarithromycin 500mg 1pc q12h for NTM since 7/16~ Dyspnea improved 3 days later Taper steroid and O2 Consulted infection: Suspect contamination Follow up TB culture on 7/21 Discharged on 7/21. Checked Folate and Vit B12 before discahrge Follow up CXR at OPD Glipizide 5mg/tab ? ? ? ? ? 1PC ? QD ? Metformin 500mg/tab ? 1PC ? BID ?Aspirin 100mg/cap ? 1PC ? QD ?Magaldrate 400mg/tab ? 1PC ? TID ?Isosorbide dinitrate 10mg/tab ? 1PC ? TID ?Quetiapine 25mg/f.c tab ? 1PC ? HS ?Digoxin 0.25mg/tab ? ?0.5PC QOD ?Amlodipine 5mg/tab ?1PC ? QD ?Sennoside A+B calcium 12mg/tab? ?1PC ? HS ?Clarithromycin 500mg/fc tab ? ? ? ? 1PC ? BID Recheck CXR at OPD Recheck CBC at OPD Lab at discharge (7/21) Vit B12 87.09 pg/ml (L) (200-800) Folate 11.80 Pneumonia, bilateral lung, with bilateral pleural effusion COPD with AE with secondary infection, r/o tracheomalacia or hyperdynamic airway collapse Macrocytic anemia, Vitamin B12 deficiency related Diabetes mellitus, type II Hypertension Atrial fibrillation with MVR Liver cirrhosis, non-B and non-C, Child A Chronic kidney disease Psoriasis Senile dementia Final diagnosis 安全的醫療 及時的服務 有用的處置 效率的工作 平等的就醫 病人為中心 病人照護 (是/否) Yes No Did not found macrocytic anemia Yes Anitiobics Inhalation Steroid O2 Consultation Yes CXR, lab medication Yes Yes MBD when stable 照顧評估 醫療知識技能 (應該熟知的) 人際溝通技巧 (應該表達的) 專業素養倫理 (應該做為的) 醫療體系行醫 (應該支援的) 學習改進 行醫導向之 學習改進 及時的服務 (Timely) 病人照護 (是/否) No--Did not found macrocytic anemia 照顧評估 醫療知識技能 (應該熟知的) The etiology and differential diagnosis of anemia 人際溝通技巧 應該表達的) 向家屬解釋檢驗報告異常處，並說明目前主要治療的部分，以及目前未處理，但未來可再追蹤