Post on 11-Nov-2015
description
CASE PRESENTATION
A male patient of age 52 years was admitted in pulmonary department on 25th September with the major complaints of fever, cough with expectoration, weight loss, polyuria & polydipsia
PATIENT DETAILS
NAMEMr:XYZAGE52 yrsSEXMIP No:201010380Wt59 KgHt56BMI21DeptPulmonaryDOA25.9.12DOD31.9.12
S - SUBJECTIVEO - OBJECTIVEA - ASSESSMENTP - PLAN
PROBLEM LIST
Pulmonary TuberculosisDiabetes Mellitus
PROBLEM LIST
SOAP ANALYSIS FOR TB
SUBJECTIVEREASON FOR ADMISSIONWeight loss since 1 month (65kg to 59 kg)Cough with expectoration x 3 wksC/o Fever > 2 wksHemoptysis x 2 wksChest pain x 1 wk
SOCIAL HISTORYAlcoholic : YTobacco:YSmoker :YAllergies: Not knownMartial status: MarriedChildren-2Cotton industryFather: TB-3 Yrs
PAST MEDICAL HISTORYK/C/O T2DM
PAST MEDICATION HISTORY
Inj. insulin 30/70 bd
OBJECTIVEPHYSICAL EXAMINATIONGeneral examination : P I C CL+E Vital signs : Pulse rate:72/minCVS : S1S2 +VEChest : Not clear on auscultationGIT : SoftEXT :NCNS :N
VITAL SIGNS
DaysDay1 Day2Day3Day4Day5Day6Day7Temp 101.5100.51009998.598.598.5BP130/90130/80130/80120/90130/80130/90130/80Pulse72727272727272
BLOOD COUNT
Hb13.5 gm/dlTLC6500 cells/cummESR20 mm/hrPolymorph74 %Lymphocytes34 %Basophils1 %Eosinophils 2 %Monocytes 2%
OTHER INVESTIGATIONSChest X-ray :Right lower lobe opacityCT Scan of Thorax : Large consolidation with formation in right lower lobe & upper lobe, Nodular lesion presentSputum Examination: Presence of acid fast bacilliGram stain: Plenty of gram + ve cocci & occassionaly gram ve bacilliSputum Culture : Organism isolated: Staphylococcus species
SENSITIVE TORESISTANT TOAmikacinCefuroximeCeftriaxoneClindamycinCotrimoxazoleNetilmycinOfloxacin
ASSESSMENT
DIAGNOSISTUBERCULOSIS
ASSESSMENT
EtiologyAlcohol useHeavy smokingDiabetes mellitusFamily history : fatherMalnutritionClose contact with people infected with TBImmunosuppressed patient
Indication for therapyTo control TB either by Preventing the development of infectious forms Reducing the period of infectivity of people with infectious disease
DRUGS PRESCRIBEDS.NoDRUGSDOSEDAYS OF TREATMENTT.NameG.NameD1D2D3D4D5D6D71T.Monto 3INH,Rifampin,Ethambutol300+450 +800mg1-0-02T.PyzinaPyrazinamide750 mg 1-013Neb.DuolinIpratropium Br/ Levosalbutamol20+100 mcg q4h4Inj.OframaxCeftriaxone1gm bd-5C.YogutPre pro biotic1-0-1-6T.DoloParacetamol650 mg 1-1-1---7Syp.Linctus codeineCodeine phosphate2tsp tds8C. BecosulesMultivitamin1-0-0
ALTERNATIVE THERAPY
DRUGSDOSECyclosporinPASAmikacinKanamycinCapreomycin250 mg od200 mg od500 mg od500 mg od1 g od
PLANDischarge Medications
DRUGSDOSET. INH,Rifampin,Ethambutol300+450+800 mg1-0- 0T.Pyrazinamide750 mg 1-01C.Multivitamin1-0-0
GOALS OF THERAPYGeneral goalsTo cure patientRestore QOLPrevent relapseReduce transmission
Patient specific goalsReduce fever, cough, chest pain, hemoptysis.To maintain normal weight
Goals achievedTemperature reductionSymptoms relievedPatients conditions improved
Monitoring parameter
THERAPEUTIC MONITORING & TOXICITY MONITORING
Chest radiographyIsolation of mycobacteriumCT scan of thoraxHematological testTuberculin testThoracotomyInterferon gamma release assayDNA based testingHepatitisRashesConstipationHyperuricemia
Discuss the condition & treatment given
Assess adherence to regimen
Check the LFT
Uric acid level
Cessation of smoking & alcohol consumption
Rifampin-orange colouration
About disease
About drugs
Points to physicianPoints to patient
LIFE STYLE MODIFICATIONResume activity in lifeAvoid alcohol & smokingAll fruit dietsFresh air, breathingLight exercises & yogasFollow upReview after 15 days
SOAP ANALYSIS FOR DIABETES
SUBJECTIVEPolyuriaPolypdipsiaFatigue
OBJECTIVE
Blood sugar mgs/dlDay 1Day 3Day 5 Day 7FBS16014514490RBS200195185170PPS180170175163
OBJECTIVE
RENAL FUNCTION TESTUrea 25Scr. Creatine0.8ELECTROLYTES (m.Eq/L)Sodium135Potassium4Chloride99Bicarbonates 26
URINE EXAMINATIONURINE EXAMINATION
Colour Pale yellowSugar ++ veBile salts-veWBCNilBile pigment-veRBCNil Albumin ++ veCasts NilPus cells2-3Epithelial cells2-3
ASSESSMENTDiagnosis: DiabetesEtiologyFamily history-mother (5yrs)Indication for therapyNormalize the blood glucose levelSymptoms to be controlledAssessment of therapy
DRUGSDOSEDAYSInj. Insulin30/70 1-0-1D1- D7
T. Glimeperide1mg odD1- D7
PLAN
Discharge medicationsInj. Insulin -30/70 unitsT.Glimeperide - 1mg od Goals of therapyEliminate symptomsPrevent long term complicationsPatient specific goalsTo reduce fatigue, polyuria, polydipsiaGoals achievedBlood glucose level reduced Improvement in patient condition
Monitoring parameter
Therapeutic monitoring & Toxicity monitoring
Monitor RBS,PPS,FBSGlycosylated HbProtein & sugar in urineSerum creatine & ureaHypoglycemiaDiarrhea, nausea,vomiting
Points to physician
Points to patient
Life style modificationCarry CandyExercise Foot careGo for eye check up
Follow upReview after 15 days-test
Glimiperide + rifampin Consult the current references For normal valuesDietHygieneBlood sugar monitoringAbout disease About drugs
THANK YOU
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