Clinical Management Plan - Essay Example

Clinical Management Plan and of the 0 Introduction Clinical management plan is fundamental given the fact that it enables the supplementary prescribers to execute their functions. In particular, the clinical management plan provides a regulatory framework that a supplementary prescriber would prescribe a given medication under the clinical management plan with respect to changes of the patient’s medical condition. The clinical management plan should focus on a given patient; it should also be within the scope of competence of a supplementary prescriber. However, Domino (2013) provides that supplementary prescribers are required to take responsibility for their actions as far as the prescription is concerned. Typically, following the discussion of the clinical management plan, it is expected that either the independent or supplementary prescriber can write a copy of a plan prior to the beginning of a supplementary process. Additionally, Tomar (2008, 274) accentuates that a supplementary prescriber should take the responsibility of assessing and overseeing the treatment plan in line with the information provided on the clinical management plan; this include prescribing a drug among the drugs that are stated in the clinical management plan. This report is set to analyze critically a clinical management plan with respect to a patient that was initially prescribed the intravenous caomoxiclav after experiencing a dog’s bite; this was followed by a prescription of an oral coamoxicla after the supplementary prescriber found out that the condition had improved. 2.0 The Information Relating to a Specific Patient A patient was bitten by a dog, and sustained minor injuries. However, after three days, the patient presented a sustained a punctured wound on the right forearm for a minor injury to the Accident and Emergency department. The wound was associated with a swelling, redness and pain. A diagnosis of the condition revealed that the patient was infected with cellulitis (Allan, Atkinson and Agada, 2013, p.1159). Although a dog bite is normally treated with oral coamoxiclav, the delay in presentation to a minor injury led the independent prescriber to prescribe an intravenous coamoxiclav antibiotic, as well as put lined mark on the redness with a recommendation to return for a review the following day (Asherson, 2011). However, the condition of the patient improved given that the redness and swelling reduced notably; the patient was directed to switch from the intravenous coamoxiclav antibiotic to an oral antibiotic. The patient is a female and office clerk of 30 years. Historically, the patient described that he is under a tetanus vaccine. The patient was bitten by an animal. Besides, the patient was confirmed to exhibit no other medical problem, including the drug allergy. 3.0 A Brief Assessment of the Medical Condition The above scenario indicates that the patient suffered cellulitis after staying for three days prior to presenting for minor injury to the Accident and Emergency department. While it is common to prescribe the oral coamoxiclav among individuals that are bitten by dog, the diagnosis indicated that the wound was severely affected due to swelling and redness. In this case, the intravenous coamoxiclav was considered to be more effective than the oral antibiotic. The patient was prescribed 500/250mg tds for a period of 7 days (Courtenay and Carey, 2008, p.293). However, with a medical condition improvement that occurred within three days, the patient was advised to switch to the oral antibiotic. The switch was advised due to the fact that the oral coamuxiclav is associated with low costs, as well as a low level of hospitalization. According to Carberry, Connelly and Murphy (2013. p.138), it is not uncommon that patients under the oral antibiotic prescriptions are more likely to be discharged from a health care centre. Although the switch to an oral therapy from the intravenous one is considered effective with respect to reducing the period of hospitalization, it is common that a majority of clinicians prescribe the oral therapy when a patient is not clinically stable. NEM (2013, p.882) provides that the prescription of an oral therapy to a patient who is unstable may result in a detrimental health of the patient. However, according to the case provided above, it is evident that the customer’s health status had improved significantly prior to the oral therapy prescription. Prior to the treatment, the diagnosis of cellulitis was first confirmed by an independent prescriber. The independent prescriber claimed that the medical condition of the patient would not respond to an oral antibiotic (Pak, Jung and Choi, 2013, p.341). It was on this ground that the independent prescriber advised that the intravenous antibiotic would be used to treat the patient (Erichsen, 2013). However, there was a need to follow the healthcare’s cellulitis care pathway. The pathway normally guides an individual the options of treatment with respect to the intravenous antibiotic. The status of the cellulitis (swollen and reddish) and the option for intravenous treatment provided an opportunity to use the scenario as a basis for the clinical management, as well as experience the practice of supplementary prescribing (Tosti, Torres and Miteva, 2013). 4.0 Cellulitis and Its Classification In order to make an effective judgment regarding the treatment of the patient in the light of the existing medical condition and the progress that was realized during the therapy process, it is prudent to analyse a number of factors regarding the patient’s disorder (cellulitis). Definition: Lipsker (2013) defines Cellulitis as a progressive onset of a painful, red, tender and swollen skin. The edge of erythema normally spread quickly to other parts. The classification of Cellulitis It is critical to understand the classification of cellulitis in order to find out whether the prescription of intravenous coamuxiclav was effective for the treatment of the patient’s medical condition. Class I patients: Enron advised that a patient demonstrates no symptoms of systematic toxicity; there are also no unregulated co-morbidities. The condition can be controlled by administering oral antimicrobials based on outpatient system (Culshaw, Kendall and Wilcock, 2013, p.315). Class II: a patient is associated with either regular illness or sound health; however, the patient normally exhibits peripheral vascular ailment, a constant venous deficiency or obesity that is characterized by morbidity, and may lead to difficulties and delay in resolving the infection (Banovic, Linder and Murphy, 2013). Class III: a patient can have a considerable systematic distress, including severe confusion, tachypnoea or unsteady co-morbidities that would interfere with reaction to a treatment or infection that is threatening to a limb as a result of the complication relating to vascular aspects (Gibson and Benko, 2013). Class IV: a patient has the sepsis disorder or chronic infection that is threatening to a life, for instance, necrotizing. 5.0 The Effectiveness of the Independent Prescriber’s Prescription and the Clinical Management Plan There is need to assess the effective therapy for ordinary cellulitis. The below discussion indicates that the prescription provided by the independent prescriber is not effective as far as the management of the cellulities is concerned (Rozenblat, Pessach and Goldberg, 2013, p.25). However, it should be noted that the medical practitioners advice the right amount of the drug administration. Class I The first line drug for a patient of class I consists of flucloxacillin while the second line comprises the management of the penicillin allergy, such as the prescription of ckarithromycin. This is the suggested medication for cellulitis of class I (Norman, Wong and Zed, 201, p.452). Class II The Class II type requires a first line therapy of flucloxacilliin and cefriaxone while the second line therapy consists that of the penicillin allergy, for instance, the prescription of clindamycin and clarthromycin. This medication would assure of an effective management of class II type of cellulitis (Bush, 2013). Class III The first line medication for cellulitis class III includes flucloxacillin while the second line therapy comprises that of the penicillin allergy, such as clarithromycin or clyndamycin (Black and Dawood, 2013). Class IV Tanaka, Inokuchi and Yahagi (2013) provide that the class IV type of the cellulitis comprises of Benzylpeicillin that should be administered on the basis of between 2 and 4 hours. Other additional drugs that should be prescribed include ciprofloxacin and clindamycin. When a patient is allergic to penicillin the medical practitioner should prescribe for clindamycin and ciprofloxacin; a patient should not be prescribed any other medicine for allergy apart from the clindamycin and ciprofloxacin (Torok and Bellet, 2013). Research shows that a significant number of the cellulitis cases are caused by beta-haemolytic streptococci. In this regard, the administration of the empiric antimicrobial treatment is inclined to offer sufficient cover of the micro-organisms. Abbate (2013, p.310) provides that flucloxacillin normally exerts a bactericidal effect on S.aureu or streptococci. It is on this basis that the oral administration of oral therapy on class I type cellulitis and an intravenous treatment on infections of Class II and III is considered to be effective. Despite the fact co-amoxiclav anti-biotic typically exert a bactericidal effect on staphylococci, co-amoxiclav is associated with a wider range of activity, such as Gram-negative organisms, as well as anaerobes (Patterson, 2013). This is the reason why co-amoxiclav antibiotic is advised and prescribed among patients that have experienced a cat or dog bite. Needless to say, Adams (2013, p.18) argues that the co-amoxiclav anti-biotic should be applied to bites in a period that is not older than 2 days (48 hours). More importantly, the exclusion of the penicillin allergy while administering a treatment is fundamental in the case of a patient who has not demonstrated a historic reaction to a given type of penicillin (Bøje, 2013). With respect to the above information, the independent prescriber prescribed the right medicine following the diagnosis of cellulitis. The therapy for cellulitis is associated with co-amoxiclav, especially with respect to a cat, dog or human bite. The effectiveness of co-amoxiclav relates to the fact that this antibiotic is characterized by a wider spectrum of activity, such as Gram-negative organisms over and above anaerobes. However, it is generally accepted that the infections of Class I, II, III, and IV can be treated with flucloxacillin. This is because it successfully exerts a bactericidal effect on staphylococci; as a result, the performance of the flucloxacillin is different from that of co-amoxiclav. 6.0 The Clinical Management Plan and the Switch to Oral Antimicrobial There is an inadequate knowledge relating to cellulitis despite an expansive research on the switch from intravenous to oral antibiotics among patients who have acquired pneumonia. According to Lipsker (2013), the switch from the parenteral to oral antibiotic can be safely administered within three and half days of treatment of cellulitis that is uncomplicated. According to the Morgan (2012), the use of IV treatment for more than three or four days is not associated with better outcomes. It is advised that it is unnecessary to allow a discharge of a patient when there is a complete resolution of fever and associated inflammation signs. As far as the switch from the oral to intravenous antibiotic is concerned, the following are the advised criteria: The Settling of Pyrexia Pyrexia is among the signs that are associated with medical conditions; it is normally characterized by a high level of temperature. Typically, Block (2013, p.187) claims that the temperature is above 36.5 and 37.5 degree Celsius. Normally, an individual would feel cold despite an increase in the level of temperature. However, a further increase in temperature results in a warmth feeling. When pyrexia settles, it is advised that switching to pyrexia is safe. Co-morbidities stable Typically, co-morbidity implies the sequential simultaneous occurrence of two types of ailment. In most cases, the two types of disorder normally interact; as a result, the interaction of both disorders affects their diagnosis (Gandhi, Kuo and Smaggus, 2013). It is advised that when the co-morbidities stabilize the switch to the oral anti-biotic is safe. Less Intense Erythema Erythema is a medical condition that is associated with redness of a skin, as well as the mucous membranes. Norton (2009, p.341) argues that this condition normally develops with inflammation, injury of the skin or infection. Researches with respect to the medical practice indicate that when there is less Erythema’s intense the switch to oral therapy is appropriate. The Reducing Inflammatory Markers An inflammation is a response to an injury by a body; it is categorized as chronic or acute. The initial and immediate body’s response to an infection or injury which is minor is known as an acute inflammation. The acute inflammation is characterized by a number of symptoms, such as swelling, pain and redness. On the other hand, the chronic inflammation is normally associated with a lengthy inflammation; it characteristically occurs after the acute inflammation. Picard, Klein and Joly (2013, p.861) argue that the chronic inflammation normally leads to a scar or the destruction of a tissue. It is advised that when the inflammatory markers fall, the oral therapy should be applied. 7.0 Conclusion The redness of the patient’s skin had reduced significantly following the intravenous treatment. The improvement was notable within a period of 24 hours. Other improvement that was notable within the period of 24 hours includes the reduction of the acute inflammation. Additionally, the patient was characterized by normal temperature- it was measured at 37.5 degrees Celsius during switch from the intravenous treatment on the second day at the hospital (Ray, 2010). Moreover, the patient did not demonstrate other type of disorders that were accompanied by cellulitilis. The prevailing conditions were enough to detect that the switch from the intravenous treatment was safe. List of References Copied to Clipboard! Abbate, L., 2013. Penicillin to Prevent Recurrent Leg Cellulitis. The Journal Of Emergency Medicine, 45(2), pp.309-310. Adams, W., 2013. A Fatal Case of Misdiagnosed Cryptococcal Epididymo-Orchitis and Leg Cellulitis in a HIV-Negative Patient. Journal of Medical Cases, 3(2), pp.6-19. Allan, K., Atkinson, H. and Agada, F., 2013. Posterior orbital cellulitis: case report and literature review. The Journal of Laryngology & Otology, 127(11), pp.1148-1151. Asherson, N., 2011. A Case of Petrositis, Simulating Orbital Cellulitis. 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