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
26 NOVEMBER 2023
Patient came to causality with complaints of
Fever since 5 days
SOB since 5 days
Vomiting for 3 days
The patient was apparently asymptomatic 5 days back then he developed fever, high grade, not relieved with medication , associated with chills and rigors.
SOB since 5 days, grade III , no orthopnea , pnd.
Also presents with vomitings since 3 days, non bilious, non blood stained , watery, 2-3 episodes.
Ulcer over left foot,since 4 months, associated with edema of foot,
H/o abscess drainage???
New bleb notes since 2 days.
K/C/O DM II since 14 years, on Metformin 500 mg and Glimiperide 1 mg BD
K/C/O Hypertension since 20 yeats , on Amlodipine 5 mg.
Patient is a vegetarian since childhood.
No addictions
No allergies
Sleep adequate
Regular Bowel and bladder
Decreased appetite
Family history-
Both of the parents mother and father had diabetes.
Father was on medication.
No Pallor, icterus, cyanosis, clubbing, lymphadenopathy.
Edema + left foot
Upto ankle
Vitals
Afebrile
BP - 80/60 mm Hg
PR- 104 bpm
RR- 18 cpm
Systemic examination
CVS- S1 S2 +
RS- BAE+
CNS- NFND
P/A - Soft, Non tender
Investigations
Rbs- 311 mg/dl
OSCE
1) What explains the HYPOTENSION of the patient
A) Infection to foot can act like infective foci that may lead to decreased HR.
2) What is the cause for early onset diabetes I'm the patient
A) Familial history
3) What is the dietary modifications needed
A) Calorie count and portion control
With diabetic diet
Avoiding excess sugars, snacking and maintaining healthy lifestyle.
4) Hypertensive,but presents as hypotensive??
A) Infection being immunocompromised
5) Main treatment?
A) Primarily control of sugars with insulin
Foot incision and drainage, dressing
And regular monitering of sugars
SWOT analysis (Strengths, Weaknesses, Opportunities, Threats) of the patient's case:
Strengths:
He is on good attender care.
He has good support from family
He has regular checkup done and is maintaining well health since 15 years with conservative medications
Weaknesses:
Not eating proper meals and not eating on time
Opportunities:
Early onset diabetes mellitus
Threat
Chance of dka, hyperosmolar shock, and increase risk of DM to his children
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