9/19
S: painful swelling of left ankle, no more enlargement
O: Vital signs stable, no fever
   right leg X-ray: no osteomyelitis
A: Celulitis of right ankle
P: Keep Oxacillin 2gm Q6H day 2 today  


9/20
S: painful swelling of left ankle, no more enlargement
O: Vital signs stable, no fever
   right leg X-ray: no osteomyelitis
A: Celulitis of right ankle
P: Keep Oxacillin 2gm Q6H


9/21
S: Painful sensation improved
   mild discoloration
O: Vital signs stable, no fever
A: Celulitis of right ankle
P: Keep Oxacillin 2gm Q6H, day 4 today 



9/22
S: Painful sensation improved
   mild discoloration
O: Vital signs stable, no fever
   no enlargement of celluitis
A: Celulitis of right ankle
P: Keep Oxacillin 2gm Q6H, day 5 today 


9/23
S: Painful sensation improved
   leg circumstance decreased

O: Vital signs stable, no fever
   B/C(9/18): Stenotrophomonas maltophilia(resistant to TMP/SMZ)

A: Celulitis of right ankle

P: Infection consultation and the reply is:
   1. suggest consulting ORTH for removing prothesis
   2. arrange 3-phase bone scan
   3. Adjust antibiotics use to Avelox 400mg QD use
   4. Collect blood culture to see if there's persistent bacteremia
   Check CBC-DC, CRP and ESR on 9/24 


9/24
S: Painful sensation improved
   leg circumstance decreased
   Severe adverse effects such as palpitation and headache after Avelox infusion
O: Vital signs stable, no fever
   WBC = 8100/uL(N/L 68.4%/21.9%) 
   Hgb = 11.7 g/dL     
   PLT = 466 x1000/uL 
   CRP= 9.07 mg/L     
   E.S.R. 1hr = 31 /mm      
   BUN/Cr = 10/0.64 mg/dL    
   Na/K = 143/3.6 m mol/L  
   [ORTHO consultation]
   No needs for emergent operation

A: Celulitis of right ankle

P: 3-phase bone scan, arranged on 9/26
   Antibiotics adjustment: Ceftazidime 2gm Q8H use



9/25
S: Painful sensation improved
   No severe adverse effects after Ceftazidime injection   

O: Vital signs stable, no fever

A: Celulitis of right ankle

P: 3-phase bone scan, arranged on 9/26
   Keep Ceftazidime use, day 2 today
-----------------------------------------
   ܥͯzѡGsevere adverse effects after Avelox infusion



9/26
S: Painful sensation improved
   Ambulation: OK

O: Vital signs stable, no fever
   [Bone scan report]
   1. Multiple active sites, especially in the right ankle joint and foot.
      Bone infection shoild be hightly suspected.
   2. c/w clinical impression of cellulitis invoving right lower extremity

A: Celulitis of right ankle

P: Keep Ceftazidime use


9/27
S: Painful sensation improved
   Ambulation: OK

O: Vital signs stable, no fever
   [Bone scan report]
   1. Multiple active sites, especially in the right ankle joint and foot.
      Bone infection shoild be hightly suspected.
   2. c/w clinical impression of cellulitis invoving right lower extremity

A: Celulitis of right ankle

P: Keep Ceftazidime use



9/29
S: Painful sensation improved
   Ambulation: OK
   No enlargemnt of involved area
O: Vital signs stable, no fever
   [Bone scan report]
   Multiple active sites, especially in the right ankle joint and foot.
   Bone infection shoild be hightly suspected.
   (ImplantLb~uptakeܩp)
   ==> c/w Osteomyelitis
 
A: Celulitis of right ankle and osteomyelitis

P: Keep Ceftazidime use
  



10/2
S: Painful sensation improved
   Ambulation: OK
   local heat:+
   mild erythematous change
O: Vital signs stable, no fever
 
A: Celulitis of right ankle and osteomyelitis

P: 1.Keep Ceftazidime use
   2.follow CRP, ESR, GPT, Cr next w1
     







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After admission, Oxacillin 2gm Q6H was prescribed. Because her blood culture yielded Stenotrophomonas maltophilia growth, infection was consulted and antibiotics was changed to Alvelox 400mg QD from 9/23. But severe adverse effects were noted(dizziness, tachycardia). Antibiotics was altered to Ceftazidime 2gm Q8H from 9/24. Orthopedics was consulted and keeping current antibiotics treatment was suggested. Besides, serum CRP level was checked and showed a decling trend. After changing to Ceftazidime, no adverse effects were noted.  


(1)Celulitis of right ankle:
 Plan :
  @Keep Ceftazidime use

(2)microcytic anemia:
 Plan :

(3)Amenorrhea:
 Plan :