February 27,2023

GM case-1
Case scenario......

  Hi,this R.Tharshik,3rd year BDS student.
This is an online eblog book to discuss our patient health data after taking his consent.This reflects my patient centred online learning portfolio.

CASE SHEET:A 62 Year male with decreased output of urine and bilateral swelling of legs.

CHEIF COMPLAINTS:
Decreased urine output, bilateral swelling of legs and shortness of breath.

HISTORY OF PRESENT ILLNESS:
  He was apparently asymptomatic 6 years back.He lost his sensation in legs and had tingling sensation 6 years back.so he visited a physician there he incidentally came to know he was diabetic.
He had cardiac arrest and shortness of breath 2 years back.
He was undergoing dialysis since 14 months.

ASSOCIATED DISEASES: 
 Peripheral neuropathy.
 Renal failure.

PERSONAL HISTORY:
DIET: Mixed
APPETITE:Frequent loss of appetite.
SLEEP: Regular.

ADDICTIONS:
Alochol once or twice a year.

FAMILY HISTORY:
Father is diabetic and suffered with kidney problems.

GENERAL EXAMINATION:
PALLOR:YES

CYANOSIS:NIL
MALNUTRITION: NIL
DEHYDRATION: MILD
ICTERUS: NIL
EDEMA:GRADE II
CLUBBING:NIL

SYSTEMIC EXAMINATION:
CARDIOVASCULAR SYSTEM:
Increased blood pressure.
S1,S2 cardiac sounds heard.

RESPIRATORY SYSTEM:
Dyspnoea: yes.
Central trachea.

PROVISIONAL DIAGNOSIS:
Stage V end stage renal disease.

Questions from patient:
Do I need to modify my diet?.


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