View Patient Profiles

O'Keefe, Steven B.

MRN: 182042

Room: 126

DOB: 3/3/2009

Age: 16

Gender: Male

Allergies: Vancomycin (severe red man syndrome)

Admit Notes

Clinical Notes

Vitals

Labs, Cultures, Imaging

Clinical Calculators

MAR

Current Orders

Home Med List

Med Reconciliation

Discharge Planning

Setting	Inpatient Pediatric Unit
Scenario	Culture results and sensitivities from this admission are pending, SBO has been admitted to the general pediatric unit under the care of the pediatric pulmonary team on day 1 of admission. He continues to have progressively worsening shortness of breath and increased thickened/darkened sputum production. According to his mother he has had four courses of outpatient antibiotics and three inpatient admissions in the previous 12 months. His most recent admission was approximately 3 weeks ago; she says at that time he was given vancomycin and he had a very difficult time tolerating the medication even with acetaminophen and diphenhydramine as pre-medications and requests that this medication is avoided during his current admission. The medical team recognizes his decompensating pulmonary status and is concerned for possible infection. The Pediatric Pulmonary Attending Physician asks you, as the Pediatric Pulmonary Clinical Pharmacist Specialist, for recommendations concerning this acute episode and any additional recommendations you have for this patient’s care.
Admission note taken on 10/19/25
CC	Cough, fever, increased sputum production and change in color for seven days
HPI	SBO presents to the pediatric pulmonary clinic with his mother and sister on 8/2/2018. He states that he has not felt well for the past couple of days. His mother clarifies that he has been coughing more frequently and has had increased sputum production during chest physiotherapy. She describes his sputum, which is usually clear or slightly cloudy, but now is a light yellow-green. She also states he is supposed to be doing chest physiotherapy twice daily, but sometimes he misses his evening session due to baseball practice or games. He and his mother are unsure if he was supposed to change the frequency of his treatments with albuterol, hypertonic saline, and dornase alfa in the past week. Upon further questioning, SBO’s appetite has decreased and he is noted to have lost 7 kg with today’s weight check compared to his previous baseline. He has also been having greasy bowel movements that leave orange rings in the toilet bowel. The physician is concerned for acute pulmonary exacerbation of SBO’s cystic fibrosis necessitating inpatient admission and treatment. He orders a complete blood count (CBC), comprehensive metabolic panel (CMP) with Mg and Phos, urinalysis, lactate, CRP, liver function tests, urine/blood/sputum cultures, intravenous (IV) fluids, and respiratory therapies.
PMH	Cystic fibrosis (F508del, P67L) Asthma Pancreatic insufficiency Seasonal allergies Constipation
Social History	Alcohol: no reported use Tobacco: no reported use Illicit drugs: has used marijuana occasionally Employment: full-time high-school student, 11th grade Relationship status: committed relationship with girlfriend of 1 year, not sexually active	Family History	Father unknown Mother alive with history of asthma, type 2 diabetes Half-sister alive known carrier of cystic fibrosis (F508del)
Vaccine History	Completed early childhood immunization series (HepB, Rotavirus, DTaP, Hib, PCV13, IPV, MMR, Varicella) Tdap – at age 12 Meningococcal (A/C/W/Y and B) – two doses series of each at age 12 Hepatitis A – two doses at age 12 Influenza – received last season	Surgical History	Tonsillectomy with adenoidectomy, age 10
Physical Exam	ROS: Positive for dyspnea, febrile, cough, confusion, and SOB; no angina General: No acute distress. Alert and oriented. Skin: Warm and dry without any rashes or other lesions. Capillary refill is less than 2 seconds. HEENT: Head is normocephalic and atraumatic. PERRL. EOMI. No significant lymphadenopathy is present. Pulmonary: Diffuse crackles bilaterally. No wheezes. No rhonchi. Cardiovascular: Regular rhythm without murmurs/rubs/gallops. Denies chest pain. Abdomen: Soft, non-tender, non-distended, with positive bowel sounds. Significant guarding during exam. Occasional nausea, no vomiting/diarrhea. Genitourinary: WNL. Denies dysuria. Extremities: No clubbing, cyanosis, or edema. No obvious deformity or bony tenderness. Neuro: Cranial nerves II-XII are grossly intact. Normal strength and sensation in the upper/lower extremities bilaterally. Heme: Denies abnormal bleeding/bruising.

Clinical Laboratory Report

Test Name	10/19/25	Range
Sodium (Na⁺)	137	136-145 mEq/L
Potassium (K⁺)	3.8	3.5-5 mEq/L
Chloride (Cl^-)	96	98-106 mEq/L
Bicarbonate (HCO₃^-)	31	23-28 mEq/L
Urea nitrogen (BUN)	10	8-20 mg/dL
Creatinine	0.7	0.5-1.3 mg/dL
Glucose	257	70-115 mg/dL
Hemoglobin A1c		5.3-7.5 %
Calcium,Total	8.6	8.6-10.2 mg/dL
Phosphate	4.6	3-4.5 mg/dL
Magnesium	1.7	1.6-2.6 mEq/L
Protein, total	4.6	5.5-9 g/dL
Albumin	2.2	3.5-5.5 g/dL
Aminotransferase,aspartate (AST)	11	10-40 units/L
Aminotransferase,alanine (ALT)	7	10-40 units/L
Lactic dehydrogenase (LDH)	88	80-225 units/L
Alkaline phosphatase	43	30-120 units/L
Bilirubin, Total	0.3	0.3-1 mg/dL
Leukocytes (WBC)	17.5	4.5-11 x10³/mcL
Red blood cells (RBC), Male	4.2	3.8-5.1 x10⁸/mcL
Hemoglobin, Male	12.5	14-18 g/dL
Hematocrit, Male	38.5	42-50 %
Mean corpuscular hemoglobin (MCH)	28	27-33 picogram
Mean corpuscular volume (MCV)	83	76-100 mcm³
Platelets	329	150-450 x10³/mcL
International normalized ratio (INR)	1.0	0.8-1.2
Prothrombin time (PT)	10	9.5-11.3 sec
Partial thromboplastin time,activated (aPTT)	27	25-35 sec

Additional Labs:

Other Labs (Today)	Result
Lactate (mmole/L)	1.5
C-Reactive Protein (mg/dL)	17.0

Spirometry (Today)	Result
FVC (L)	1.97
FEV1 (L)	1.03
FEV1 % predicted (%)	34
FEV1/FVC (%)	52

Urinalysis	Result
Specific Gravity	1.015
Color	Light yellow
Clarity	Cloudy
Leukocyte Esterase	Negative
Nitrite	Negative
Protein	Trace
Glucose	Trace
Ketone	Negative
Blood	Trace
WBC Casts	0-2
pH	6.0
Bilirubin	Negative
Cultures	NGTD

Cultures:

Date	Test	Stain & Culture	Result
Two Months Ago	Respiratory culture	Stain: Gram positive cocci Culture: Staphylococcus aureus	Clindamycin – Resistant Levofloxacin – Resistant Linezolid – Susceptible Minocycline – Susceptible Oxacillin – Resistant Tetracycline – Intermediate Trimethoprim/sulfamethoxazole – Susceptible Vancomycin – Susceptible
Two Months Ago	Respiratory culture	Stain: Gram negative bacilli Culture: Pseudomonas aeruginosa (mucoid)	Amikacin – Resistant Aztreonam – Susceptible Meropenem – Resistant Cefepime – Resistant Ceftazidime – Susceptible Piperacillin/tazobactam – Susceptible Tobramycin – Susceptible Levofloxacin – Resistant Trimethoprim/sulfamethoxazole – Resistant
Last Month	Respiratory culture	Stain: Gram negative bacilli Culture: Pseudomonas aeruginosa (mucoid)	Biotype 1 Amikacin – Resistant Aztreonam – Susceptible Meropenem – Resistant Cefepime – Resistant Ceftazidime – Susceptible Tobramycin – Susceptible Levofloxacin – Resistant Biotype 2 Amikacin – Intermediate Aztreonam – Susceptible Meropenem – Susceptible Cefepime – Intermediate Ceftazidime – Susceptible Tobramycin – Susceptible Levofloxacin – Susceptible
Today	Respiratory culture	Stain: Gram positive cocci Culture: pending	Pending
Today	Respiratory culture	Stain: Gram negative bacilli Culture: pending	Pending

Imaging Studies:

Test	Date	Result
Chest X-ray	Today	Bilateral multifocal peribronchial airspace disease. Stable lung volume loss within the right apex. No pleural effusions. No pneumothorax or pneumomediastinum.
EKG	Today	Normal sinus rhythm

Vital Sign	10/19/25 09:28
Height (cm)	157
Weight (kg)	56
Body Temperature (°C)	37.1
Blood Pressure (mmHg)	110 / 68
Heart Rate (bpm)	96
Respiratory Rate (bpm)	28
Oxygen Saturation (%)	94

Current Orders

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES
			may also give with snacks

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?
			PRN yes, constipation
USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?
			PRN yes, mild/moderate pain & fever > 38.3⁰C
USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?
			PRN yes, severe pain
USE	START DATE	STOP DATE	NOTES

Medication
History

SBO has adequate refills of prescriptions for Chandler Retail and Chandler Specialty medications but the prior authorization for his dornase alfa expired last month.
He sometimes misses his evening inhaled treatments if he is at baseball practice or a game and does not do his evening chest physiotherapy.
He also requires constant reminders by his parents to ensure he is taking all of his prescribed medications.

Home Medication List: verified by pharmacy on admit (10/19/25)

Patient Name: O'Keefe, Steven B. Date of Birth: 3/3/2009 Room#: 126	Allergies:	Immunization History:
Community Rx Info: Rx Insurance:	Social History:
Additional Notes:

DRUG STRENGTH DF	STRENGTH ROUTE FREQ	PRN?	NOTES	MED REC ACTION
Albuterol Sulfate 0.083% (2.5 mg/3 mL) nebulizer solution	2.5 mg NEB BID	no	may increase to QID during acute illness
Albuterol Sulfate 108 mcg/puff HFA inhaler	2-4 puffs PO BID	no
Albuterol Sulfate 108 mcg/puff HFA inhaler	2-4 puffs PO Q4-6H	yes, SOB
Azithromycin 500 mg tablet	1 PO Mon, Wed, Fri	no
Aztreonam (Cayston®) 75 mg nebulizer solution	75 mg NEB TID	no	for 28 days on/off cycles
Cetirizine 10 mg tablet	1 PO QD	no
DEKAs® Plus capsule	2 PO QD	no
Dornase alfa 1 mg/mL nebulizer solution	2.5 mg NEB QD	no	may increase to BID during acute illness
Dronabinol 2.5 mg capsule	1 PO BID	no
Ferrous sulfate 325 mg tablet	1 PO BID	no
Fluticasone propionate 50 mcg/spray nasal suspension	2 sprays each nostril BID	no
Lactobacillus acidophilus chewable tablet	1 PO TID	no
Melatonin 3 mg tablet	1-2 PO HS	no
Minocycline 100 mg capsule	1 PO BID	no	for 28 days on/off cycles
Mometasone/formoterol 200 mcg/5 mcg inhaler	2 puffs PO BID	no
Montelukast 10 mg tablet	1 PO QD	no
Omeprazole 20 mg DR tablet	1 PO BID	no
Pancrealipase (Pertzye®) 24,000 units DR capsule	4-5 PO with meals and snacks	no
Polyethylene glycol 3350 powder	17 g PO 1-2 times daily	yes, constipation
Sodium chloride 3% nebulizer solution	4 mL NEB BID	no
Sulfamethoxazole /trimethoprim 800/160 mg tablet	1 PO BID	no	for 30 days on/off cycles
Tobramycin (Tobi Podhaler®) 28 mg capsule	112 mg INH BID	no	for 28 days on/off cycles
Vitamin D 50,000 units capsule	1 PO twice weekly	no
				Action Key: C = Continue, D = Discontinue^, H = Hold^, M = Modify^* ^*must provide reason

Medication	10/19/25
Chest physiotherapy with vest QID treatments
Vitamin D 50,000 units PO twice weekly
Sodium Chloride 0.9% 80 mL/hr IV continuous	7:37
Albuterol Sulfate 2.5 mg NEB QID	9:39 13:15
Sodium chloride 3% 4 mL PO BID	9:36
Dornase alfa 2.5 mg NEB BID	9:23
Mometasone/formoterol 200 mcg/5 mcg/puff 2 puffs PO BID	9:59
Fluticasone propionate 50 mcg/spray 100 mcg EN BID	9:33
Pancrealipase (Pertzye®) 24,000 units capsule 4-5 capsules PO TID PC	9:27 14:47
Cetirizine 10 mg PO QD	9:52
Omeprazole 20 mg PO BID	9:15
Montelukast 10 mg PO QD	9:38
Dronabinol 2.5 mg PO BID	9:53
Melatonin 3 mg PO HS
Lactobacillus acidophilus 1 chewable tablet PO TID PC	9:43 14:11
Ferrous sulfate 325 mg PO BID	9:16
DEKAs® Plus 2 capsules PO QD	9:33
Polyethylene glycol 3350 17 g PO BID PRN PRN yes, constipation
Acetaminophen 650 mg PO Q4H PRN PRN yes, mild/moderate pain & fever > 38.3⁰C
Oxycodone 5 mg PO Q6H PRN PRN yes, severe pain

Clinical Notes

Medication Discharge Orders

Hospital Medications
Medication	Instructions	Comments	Continue	Modify	Discontinue	New Rx sent

Previous Home Medications
Medication	Instructions	Comments	Continue	Modify	Discontinue	New Rx sent

Discharge Planning - Medication List and Instructions

Patient Name:
Admission Date:	Discharge Date:	Service:
Principle Diagnosis on Admission:
Secondary Diagnosis:
Allergies:

Medications ADDED this visit: (begin taking these)	Medications CHANGED this visit: (modify what you were taking)	Medications STOPPED this visit: (stop taking these)

Final Discharge Medication List
Medication/Route/Dosage/Frequency/Duration	Comments	Morning	Afternoon	Evening	Bedtime










As Needed Medications

Medication Reconciliation - Finalized Medication List

Patient Name: O'Keefe, Steven B.

Date of Birth: 3/3/2009

Room: 126

Medication (name/strength)	Dose	Route	Frequency	Notes

Height	157 cm
Actual Body Weight (ABW)	56 kg
Ideal Body Weight (IBW)	54.6 kg
ABW % of IBW	103 %
Adjusted Body Weight (AjBW)	55.2 kg
Body Surface Area (BSA)	1.56 m²
Body Mass Index (BMI)	22.7 kg/m²