GENERAL MEDICINE E-log-1
A 30 YR OLD FEMALE CAME WITH ANUERIA AND FACIAL PUFFINESS
A 30 year old female daily wage worker by occupation resident of dubbaka came to causality with chief complaints of
Anueria
Loss of apetite since six months
Severe abdominal pain
HISTORY OF PRESENT ILLNESS:
An year ago patient noticed puffiness of face as well as body pedal edema and consulted a local doctor in munugodu and diagnosed with anemia and used some medications given by him for some days
later she gradually found that she lost her apetite and suffered from vomitings immediately after eating food within 30 mins
so she consulted an RMP at dubbaka and referred to local hospital in nalgonda
In the period before consulting local hospital in nalgonda she noticed anuria and after going to that hospital they revealed that she is suffering from renal failure and she should undergo hemodialysis byut due to lack of equipment they referred to our hospital and till now she had undergone 19 sittings of hemodialysis.on the day of admission to our hospital 3monts ago she came with facial puffiness and bilateral swelling
The patient stated that she is feeling little relieved after every hemodialysis session but also suffering from xerostomia and feeling thirsty
she started losing weight gradually since one year
PAST HISTORY:
Hypertension since 4 years
Not a known case of epilepsy,asthma
Amenuria since 3 months
Not affected with corona
FAMILY HISTORY:
Mother is suffering from hypertension
DRUG HISTORY:
Nicocardia 20mg for hypertension
GENERAL EXAMINATION:
Patient was conscious,but suffering from shortness of breath examined in a well lit room
VITALS:
Temperature:98.3
Pulse rate:107
Respiration rate:30
Spo2:98
Weight:50kg
OBSTETRIC HISTORY
Married at the age of 17
Four children of 12,8,7,6 years old
All of them by normal delivery
ClINICAL FINDINGS:
PHYSICAL EXAMINATION:
Pallor:present
Icterus:absent
Cyanosis:absent
Clubbing of fingers/toes:absent
Cyanosis:absent
Lymphadenopathy:absent
Edemaof feet:pitting type,below the ankle since a week
*Cardiovascular system
S1 and s2 heard
*Respiratory system
BAE+
*Per abdomen
Right side tenderness
Scaphoid shape abdomen
Bowel sounds are heard
*Cns
Conscious
Normal speech
PROVISIONAL DIAGNOSIS
Chronic renal failure
PLAN OF CARE:
Undergoing Hemodialysis
19 times done
*Observation
Brachial artery anuerysm after hemodialysis
INVESTIGATIONS:
ECG
TREATMENT
Tab nicardia 20mg PO/BD
Nodosis 500mg PO/OD
Tab orofer XT PO/BD
Tab,shelcal CT PO/OD
Inj.erythropoitin 4000IU WEEKLY TWICE
Tab lasix 40mg
INJ SUCROSE 10MP IN 50ML NS/IU
Fluid restriction less than 1.5 litres per day
Salt restriction less than 4 gm per day
TODAY'S UPDATE:7/6/22
patient taken to hemodialyis for 20th time
monitoring vitals
patient is coherent and cooperative
under the same medication
TODAY'S UPDATE:8/6/22
no urine output
pulse rate 102
no case of stomach pain,vomiting
no apetite
sleep is normal
pedal edema below the knee
suffering from fever
complaining xerostomia after every dialysis
pale tongue
pedal edema below knee
INVESTIGATIONS TODAY:
UNDER THE SAME MEDICATION
Where is anatomical location of the patients problem? (Related to macroanataomy)
The anatomical location of the kidney is retroperitoneally on the posterior abdominal wall at the level of T12 to L3
Why is the patient having this problem?(related to micro anatomical pathogenesis as well as macro-social environmental events influencing it)
She is having histological lesions in the kidney,her mother is also suffering from hypertension
What are we doing about it?(pharmacological and non pharmacological intervention)
*Pharmacological interventions:
Nicardia 20 mg
Nodosis
Tab orofer xt
Tab.shelcal
Inj.erythropoitin
*Non pharmacological interventions:
Fluid intake less than 1.5ltr per day.
Salt intake less than 4gm per day.