Tbl 4 case discussion

396 views

Published on

a

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
396
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
3
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Tbl 4 case discussion

  1. 1. TBL 4 Case for Discussion
  2. 2. <ul><li>Puan Rojia a 42 years old administration assistant in a local school presents with dyspnea that occurs suddenly on her way back to Kota Kinabalu in KLCC. </li></ul><ul><li>Been admitted in PJH since 27 th Dec 2011. </li></ul><ul><li>Presents with productive cough, with greenish-yellow sputum. </li></ul><ul><li>Does not wheeze. </li></ul>Chief Complain
  3. 3. Past Medical History <ul><li>Have history of asthma for more than 25 years. </li></ul><ul><li>Frequent asthma attacks usually during stress or exertion. </li></ul><ul><li>Severe allergy to cat furs and dusts. </li></ul>
  4. 4. Systemic Review <ul><li>No HPT. </li></ul><ul><li>No DM. </li></ul><ul><li>Have symptoms of anemia. </li></ul>
  5. 5. Current Medication <ul><li>Breathing using the oxygen supply. To supply adequate O2. </li></ul><ul><li>Inhaler is given every 2 hours. </li></ul><ul><li>Budesonide. Antiallergy agent. </li></ul><ul><li>Salbutamol. β2 adrenergic receptor agonist, bronchodilator. </li></ul><ul><li>Afuroxime. 2 nd gen cephalosporin, URTI </li></ul>
  6. 6. Current Medication <ul><li>Hydrocort. Anti-inflammatory </li></ul><ul><li>Prednisolone. Anti-inflammatory </li></ul><ul><li>Ferrous fumarate. Supplement to treat anemia </li></ul><ul><li>T. folate. Supplement to treat anemia </li></ul><ul><li>Vit B complex. Supplement to treat anemia </li></ul><ul><li>Vit C. Supplement to treat anemia </li></ul>
  7. 7. Drug Allergies <ul><li>Have no known drug allergies </li></ul>
  8. 8. Family History <ul><li>No family history of asthma. </li></ul><ul><li>Uneventful family history. </li></ul>
  9. 9. Social History <ul><li>Lives in Lahad Datu with her family. </li></ul><ul><li>Complains that her working environment is full with people who smokes. </li></ul><ul><li>Patient does not smoke or consume any alcohol. </li></ul>
  10. 10. Examination <ul><li>On examination the patient is sitting on her bed, breathing with the oxygen supply. </li></ul><ul><li>RR of 20/min. (12-18 at rest) </li></ul><ul><li>BP of 120/81. </li></ul><ul><li>T of 37°C. </li></ul>
  11. 11. Hands Examination <ul><li>No signs of clubbing. </li></ul><ul><li>No peripheral cyanosis. </li></ul><ul><li>Hands are pale. </li></ul><ul><li>No palmar erythema. </li></ul><ul><li>Nails are pale. </li></ul>
  12. 12. Arms Examination <ul><li>PR of 96 beats/min. (60-100) </li></ul><ul><li>Volume is normal and pulse is regular. </li></ul>
  13. 13. Face and Neck Examination <ul><li>No jaundice. </li></ul><ul><li>No pallor. </li></ul><ul><li>No central cyanosis. </li></ul><ul><li>Lymphadenopathy? </li></ul><ul><li>Raised JVP? </li></ul><ul><li>Trachea centrally located? </li></ul>
  14. 14. Investigations <ul><li>Arterial Blood Gas. To check for her pO2 and pCO2 levels </li></ul><ul><li>Electrolytes. To detect for any metabolic disorders </li></ul><ul><li>FBC. To check for infections </li></ul><ul><li>Blood smear. To check for the morphology of the RBC </li></ul><ul><li>ECG. To exclude any cardiac diseases </li></ul><ul><li>Urine FEME. To detect for any metabolic complications </li></ul><ul><li>Sputum C&S. To check for the causative agent of her URTI </li></ul>
  15. 15. <ul><li>pH 7.44 (7-7.7) </li></ul><ul><li>pCO2 25mmHg (15-125) </li></ul><ul><li>pO2 141mmHg (14-410) </li></ul>Arterial Blood Gas
  16. 16. Electrolytes <ul><li>cNa+ 43mmol/L (120-180) </li></ul><ul><li>cK+ 2.4mmol/L (2.0-8.0) </li></ul><ul><li>cCa+ 1.02mmol/L (0.50-2.50) </li></ul><ul><li>cCl- 101mmol/L (85-140) </li></ul><ul><li>cGlu 11.6mmol/L (2.0-15.0) </li></ul>
  17. 17. Investigation – what we would do <ul><li>Spirometry. To detect any obstruction/restriction </li></ul><ul><li>Chest X-ray. To detect any mass/consolidation/pneumothorax/pulmonary edema </li></ul>

×