A 57 yrs old women with SOB…


THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE - IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT .HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT.    


This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.

I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan 



13/9/22


A 57 year old female came to the opd with chief complaints of ; 


-Shortness of breath since 6days.

-decreased appetite since 5days.


HOPI : 


Patient was apparently asymptomatic 50 years back the she developed polio since then her lower limbs are deformed.


15 years back she had fever and decreased urine output for which she visited hospital  and  diagnosed with renal failure.since then she was on medication.And she is also diagnosed with Hypertension and managed on medication.


All the 50years she managed to do her own work and labour work but 2years back she fell down accidentally on her knees since then she started crawling.


1month back she had a fever and relived with medication again after 3days back she had fever and shortness of breath and no urine output for 6hrs then she visited RMP and took medication small quantities of urine passed but again had no urine output from night 8pm to morning 11:30am then foley’s was kept 50ml urine is passed  but sob is not subsided then they referred to our hospital.


PAST HISTORY 

N/K/C/O Diabetes,Asthma,Tuberculosis,Epilepsy.

PERSONAL HISTORY : 

Diet - mixed

Appetite - Decreased since 6 day

Sleep - Inadequate

Bowel -Regular

Bladder-irregular 

Addiction -none

Allergies - None


FAMILY HISTORY : 

Her younger daughter had a history of polio and she expired.


GENERAL EXAMINATION 

Patient is conscious,  coherent and cooperative. Well oriented to time , place and person. Moderately built and nourished.

Pallor - Present                                                    

Icterus - Absent                                                    

Cyanosis - Absent                                          

Clubbing- Absent                        

Lymphadenopathy- Absent                            

Edema - B/L pedal edema , pitting type

















VITALS : 13/9/22

Afebrile 

PR - 92bpm Regular ; normal volume

RR - 

BP - 130/99mmHg

SpO2 - 90%

SYSTEMIC EXAMINATION 

CVS : S1,S2 heard and NO Murmurs 

RESPIRATORY SYSTEM : 

    Normal vesicular breath sounds-Present                         B/L Crepts-Present

PER ABDOMEN : Soft ; Non Tender ; Bowel sounds-Present.

CNS : Higher Mental functions-Intact , No focal Neurological deficits. 

https://youtu.be/3P3usVYPFfo

INVESTIGATIONS : 











PROVISIONAL DIAGNOSIS 

Acute pulmonary edema 
NSAID induced nephropathy
Refractory metabolic acidosis
Refractory hyperkalemia 
Chronic kidney Disease 
Hypertension 
[EGFR : 4ml/min/1.73m² (stage 5)]


TREATMENT 

Head end elevated upto 30°
O2 supplement (if spo2 - >90%)
Inj Piptaz 2.25gm iv bd
Tab Lasix 40mg iv tid 
Neb with Duolin and budecost-4th hourly
Tab Nicardia 10mg po bd 
Tab Nodosis 500mg po tid
Tab Shelcal 500mg po tid
Tab Bio D3 po od( weekly over)
Tab Orofer-XT po od


14/9/22 : 

No presenting complaints 
SOB reduced
Cough +

 Temp : 98.6*F
 BP : 130/70 mmHg 
 PR : 98bpm regular ; normal volume
 CVS : s1 and s2 heard ; No murmurs
 RS : Normal vesicular breath sounds ; B/L crepts +
 PER ABDOMEN: soft and non tender
                        Bowel sounds +
SpO2 : 98% @ 4lit of O2
GRBS : 133mg/dl 
 
INVESTIGATIONS :



      











TREATMENT : 

Head end elevation by 30*
O2 supplementation if SpO2<90%
Inj PIPTAZ 2.25 gm/IV/BD
Inj Lasix 40mg/IV/BD
TAB. Nodosis 500mg/PO/BD
TAB. SHELCAL 500mg/PO/OD
TAB. OROFER-XT/PO/OD
TAB. Bio-D3/PO/OD (weekly once)
TAB. NICARDIA 10mg/PO/BD


15/9/22 : 

Cough reduced
Temp + not a/w chills and rigor
SOB reduced

Temp : 100.1*F
BP : 140/80 mmHg
PR : 98bpm regular ; normal volume
RR : 27cpm 
CVS : s1 s2 heard ; No murmurs 
RS : Normal vesicular breath sounds; B/L crepts present.
PER ABDOMEN : soft and non tender ; bowel sounds present.

TREATMENT

Head end elevation by 30*
O2 supplementation if SpO2<90%
Neb with Duolin & Budecost-4th hourly
TAB. DOXYCYCLINE 100mg/PO/BD
TAB. DOLO 650mg/PO/SOS
Inj PIPTAZ 2.25 gm/IV/BD
Inj Lasix 40mg/IV/BD
TAB. Nodosis 500mg/PO/BD
TAB. SHELCAL 500mg/PO/OD
TAB. OROFER-XT/PO/OD
TAB. Bio-D3/PO/OD (weekly once)
TAB. NICARDIA 10mg/PO/BD
Syrup. Ascoryl/PO//TD













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