Sample Completed Care Plan

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Patient Name __KL__________________________
Pharmacist Name__EB________________________
Date__March 4____________
Medical
Desired Outcomes / Goals
Drug Therapy Problems
Therapeutic Alternatives
Recommendation
Monitoring Parameters
Condition /
of Therapy
(Pharmacologic and Non-
with Justification
Indication
pharmacologic)
Parameter Value
Parameter
Frequency
Timeframe
Who
1)   S low   p rogression   o f  
KL   i s   e xperiencing   n ausea  
Alzheimer’s
Discontinue rivastigmine
Hold Rivastigmine
disease
alzheimer’s   d isease  
,abdominal   d istension,  
Hold rivastigmine then lower
Adverse   e ffects   a re  
Efficacy
*Decrease   p rogression   o f  
increased   b owel   s ounds,   a nd  
dose
dose   d ependent   a nd  
Change to another alternative
more   l ikely   t o   o ccur   i n  
Resolution   o f   n ausea,   d iarrhea,  
memory   l oss   a nd   m aintain  
diarrhea   ,   a n   a dverse   e ffect  
abdominal   d istention,   a nd   r ebound  
MMSE   e qual   t o   o r   g reater  
of   t aking   r ivastigmine  
such as donepezil or
the   e arly   t itration  
galantamine
tenderness   i n   2   d ays   t o   b e   f ollowed   u p  
than   1 7   w ithin   2 4   w eeks  
phase,   o n   a n   e mpty  
2)Resolve   s igns   a nd  
stomach,   a nd   w ith   f ast  
by   t he   p harmacist  
 
symptoms    
titration.
*Ensure   p atient   i s   a ble   t o  
Cognitive   f unction   i ncluding   ( ADAS-­‐
Cog,   M MSE,   C IBIS-­‐Plus   S cale)   I nitially  
remember   g roceries,   a ttend  
bridge   c lub   a nd   c omplete  
at   4 -­‐6   w eeks   t o   a ssess   f or   n eed   t o  
titrate   d ose   t hen   e very   3   m onths   b y  
other   a ctivities   o f   d aily   l iving  
the   g eriatrician  
within   2 4   w eeks  
Forgetting   t o   a ttend   b ridge   c lub   a nd  
3)     I mprove   q uality   o f   l ife  
4)   M inimize   a dverse   d rug  
pick   u p   g roceries   a t   s ame   f requency  
as   c ognitive   f unction   b y   p harmacist
events    
*No   d iarrhea,   n ausea,  
abdominal   d istension,  
Toxicity
increased   b owel   s ounds  
within   4 8   h ours  
5)   M inimize   c ost  
CNS:   H eadache   a nd   d izziness,   f atigue,  
insomnia,   a gitation,   a nxiety,  
parkinsonism   s ymptoms,   d epression  
RESP:   R hinitis  
CVS:   b radycardia   ( HR),   s yncope,   H TN  
(BP)  
GI:   N ausea,   v omiting,   d iarrhea,  
anorexia,   a bdominal   d istension   a nd  
rebound   t enderness,   w eight  
 
Assess   a ll   t he   a bove   A DRs   i nitially  
every   1 -­‐2   w eeks   a nd   i f   t olerating   t hen  
every   3   m onths   w ith   e ach   f ollow   u p  
visit   b y   t he   p harmacists
Clinical   C are   P lan   T emplate   –   A Y   1 3  
1  

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