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CHRONIC KIDNEY
DISEASE
(DIALYSIS)
PREPARED BY
SAI DEEPAK.S
PHARM D III Year
21408122
SPS - VISTAS
CASE PRESENTATION
ON
PATIENT’S NAME : Mrs. REVATHY
UHID : 20F1674
AGE : 35 Years
SEX : Female
WEIGHT : 68.7 kg
HEIGHT : 156 cms
DOA : 01/08/2022
DOD : 01/08/2022
ADM NO : 01
BED NO : 03
IPNO : J 1209
PATIENT DEMOGRAPHIC INFORMATION
A 35 years old female patient was admitted in the hospital with
CHIEF COMPLAINTS :
C/O Chest pain radiating to left arm – 2 days
Breathlessness on lying down & sleeps in sitting posture
Generalised body pain, lack of appetite – 2 days, dry cough
HISTORY OF PRESENT ILLNESS :
H/O Chest pain radiating to left arm – 2 days
Breathlessness on exertion
Orthopnea – 2 days
Fever not associated with chills
Generalised body pain , lack of appetite – 2 days, dry cough
NO H/O Palpitation, abdomen pain, loose stools, vomiting, PND, Malena, Menorrhagia, stricture
PAST MEDICAL HISTORY :
H/O Severe Anaemia
Coronary artery disease
CASE STUDY
PERSONAL HISTORY / SOCIAL HABITS :
Nil.
PHYSICAL EXAMINATION :
Patient is conscious / oriented
Tachyponeic, Pallor ++, Afebrile
ON EXAMINATION : SYSTEM EXAMINATION :
TEMP : 98.6 F CVS : S1S2+
PULSE : 120/Min RS : NVBS+
BP : 120/110 mmHg CNS : NFND
RR : 46/Min P/A : Soft, BS+
LABORATORY INVESTIGATIONS
PARAMETERS OBSERVED VALUE NORMAL VALUE
CBC
Hb 5.3 g/dl 11.6 – 15 g/dl
RBC 1.97 millions/cu mm 3.6 – 5 millions/cu mm
PCV 16.7% 35.5 – 44.9
Platelet count 2.54 lakhs/cmm 1.4 – 4.5 l/cmm
ESR 115 mm/1hr 0 – 29 mm/hr
MCV 84.9 Fl 80 – 100 Fl
MCH 27.0 Pg/cell 27.5 – 33.2 Pg/cell
MCHC 31.9 % 33.4 – 35.5 gm/dl
WBC Total 10,000 cmm 4500 – 11000 per µl
PARAMETERS OBSERVED VALUE NORMAL VALUE
RENAL
Blood Urea Nitrogen(BUN) 109 mg/dl 10 – 50 mg/dl
Serum creatinine 10.2 mg/dl 0.6 – 1.6 mg/dl
Sodium 137 mEq/L 135 – 145 mEq/L
Potassium 4.97 mEq/L 3.5 – 5.5 mEq/L
Chloride 107 mEq/L 98 – 105 mEq/L
Bicarbonate 12.4 mEq/L 22 – 30 mEq/L
LABORATORY INVESTIGATIONS
LABORATORY INVESTIGATIONS
PARAMETERS OBSERVED VALUE NORMAL VALUE
LIVER
Bili (T) 0.4 mg/dl (< 1.0)
Bili (D) 0.2 mg/dl (< 0.2)
Bili (ID) 0.2 mg/dl (< 0.8)
SGPT 15 U/L (Upto 35)
SGOT 13 U/L (Upto 40)
T.Protein 6.1 g% (6.0 – 8.0)
Alk. Phosphatase 247 U/L (40 – 130)
Albumin 3.1 g% (3.2 – 4.5)
Glubulin 3.0 g% (2.3 – 3.5)
A/G Ratio 1.62 (2 : 1)
Gamma GT 10 U/L (Upto 50)
DATE : 01/08/2022
CHEST X – RAY + SONOGRAM + KIDNEY & LIVER FUNCTION TEST
CHEST X – RAY : Chest X - rays can detect cancer, infection or air collecting in the space around a lung which can cause lung to collapse.
SONOGRAM : Otherwise called as ‘ULTRA SOUND SCAN’ . It is used to asses the size, shape of kidneys and ureters and bladder
KIDNEY FUCTION TEST : It is used to measure how well your kidneys are working by either using blood or urine
OTHER TESTS
• Diffuse haziness is seen in right lower zone (lungs)
• Bilateral contracted kidneys with grade III medical renal disease
• Enlarged & cystic right ovary
• Bilateral pleural effusion and ascites
• Lower GFR(<45) values indicates kidney damage
IMPRESSION
DIAGNOSIS
• Pneumonia
• Chronic kidney Disease ( CKD )
DRUG CHART – DISCHARGE MEDICATIONS
DRUG NAME GENERIC NAME DOSAGE R.O.A FREQUENCY DURATION
Syp. Nodosis Sodium Bicarbonate 15 ml Oral 2 times/day Till review
Tab. Folvite Folic acid 5 mg Oral 1 – 0 – 0 Till review
Tab. Minipress XL Prazosin 2.5 mg Oral 1 – 0 – 1 Till review
Tab. Nicardia Nifedipine 10 mg Oral 1 – 0 – 1 Till review
Tab. Cardivas Carvedilol 3.125 mg Oral 1 – 0 – 1 Till review
Tab. Atorva Atorvastatin 10 mg Oral 0 – 0 – 1 Till review
Tab. Evion LV Vitamin E
(Tocopherol)
- Oral 1 – 0 – 0 Till review
Cap. Rocaltrol Calcitrol 0.5 mg Oral 1 – 0 – 1 Till review
Tab. Shelcal Ca++ Carbonate 500 mg Oral 1 – 0 – 1 Till review
Inj. IV Fer Erythropoeitin alpha 100 mg IV 2/week Till review
Inj. Transfer 4000 u Menotropins
(Menopur)
4000 units SC 2/week Till review
DRUG INTERACTION :
T. Cardivas (Carvedilol) + T. Nicardia (Nifedipine)
• The concurrent administration of Carvedilol and Nifedfipine
decreases heart rate and blood pressure
• Carvedilol effects decreases when taken along with c. Rocaltrol
DISCHARGE ADVICE :
• Haemodialysis twice a week
• Inj. Genevac B vaccine to be given after discussion with
hematologist
SOAP NOTES
SUBJECTIVE
A 35 years old female patient was admitted in the hospital with the
C/O Chest pain radiating to left arm – 2 days
Breathlessness on lying down & sleeps in sitting posture
Generalised body pain, lack of appetite – 2 days, dry cough
OBJECTIVE
Patient is conscious/oriented,Tachyponeic, Pallor ++, Afebrile
TEMP : 98.6 °F
PULSE : 120/Min
BP : 120/110 mmHg
RR : 46/Min
ASSESSMENT
The patient was diagnosed with
Chest X – Ray , Sonogram , Kidney function test , Liver function test
PLAN OF TREATMENT
T. Folvite, T. Minipress XL, T. Nicardia, T. Atorva, T. Evion LV,
Cap. Rocaltrol, T. Shelcal
HAEMODIALYSIS ( PERMANENT )
• Strictly follow up the medications given by the physician on
discharge
• Do not alter the dose and frequency of the medication unless it is instructed
by the physician
• Medications causing nausea, heart burn and diarrhea are taken with
food or after the food( eg: Tab. Evion LV – vitamin e tab)
• Medications causing dizziness, fainting, headache and tiredness are advised
to taken at bed time.( eg: Prazosin and Carvedilol)
PATIENT COUNSELLING REGARDING MEDICATIONS
• She must be completely educated about the disease condition.
• Monitoring the disease condition everyday to prevent further
damage
• She must be aware that Diabetes and hypertension are the leading
causes of CKD.
• Undergoing proper dialysis and intaking accurate medications may
increase his/her lifetime.
PATIENT COUNSELLING REGARDING DISEASE CONDITION
• She may recommended for losing weight
• If Necessary excersing more, limiting alcohol consumption and
Quitting smoking.( General instruction )
• You may need to lower your blood pressureby eating a diet rich in
fruits, vegetables, fish and nuts.
• Reducing stress may also reduce bp
• Choose food with less salt ( sodium)
• Avoid dairy products.
PATIENT COUNSELLING REGARDING LIFESTYLE MODIFICATIONS
SAI DEEPAK CASE STUDY ON CHRONIC KIDNEY DISEASE

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SAI DEEPAK CASE STUDY ON CHRONIC KIDNEY DISEASE

  • 1. CHRONIC KIDNEY DISEASE (DIALYSIS) PREPARED BY SAI DEEPAK.S PHARM D III Year 21408122 SPS - VISTAS CASE PRESENTATION ON
  • 2. PATIENT’S NAME : Mrs. REVATHY UHID : 20F1674 AGE : 35 Years SEX : Female WEIGHT : 68.7 kg HEIGHT : 156 cms DOA : 01/08/2022 DOD : 01/08/2022 ADM NO : 01 BED NO : 03 IPNO : J 1209 PATIENT DEMOGRAPHIC INFORMATION
  • 3. A 35 years old female patient was admitted in the hospital with CHIEF COMPLAINTS : C/O Chest pain radiating to left arm – 2 days Breathlessness on lying down & sleeps in sitting posture Generalised body pain, lack of appetite – 2 days, dry cough HISTORY OF PRESENT ILLNESS : H/O Chest pain radiating to left arm – 2 days Breathlessness on exertion Orthopnea – 2 days Fever not associated with chills Generalised body pain , lack of appetite – 2 days, dry cough NO H/O Palpitation, abdomen pain, loose stools, vomiting, PND, Malena, Menorrhagia, stricture PAST MEDICAL HISTORY : H/O Severe Anaemia Coronary artery disease CASE STUDY
  • 4. PERSONAL HISTORY / SOCIAL HABITS : Nil. PHYSICAL EXAMINATION : Patient is conscious / oriented Tachyponeic, Pallor ++, Afebrile ON EXAMINATION : SYSTEM EXAMINATION : TEMP : 98.6 F CVS : S1S2+ PULSE : 120/Min RS : NVBS+ BP : 120/110 mmHg CNS : NFND RR : 46/Min P/A : Soft, BS+
  • 5. LABORATORY INVESTIGATIONS PARAMETERS OBSERVED VALUE NORMAL VALUE CBC Hb 5.3 g/dl 11.6 – 15 g/dl RBC 1.97 millions/cu mm 3.6 – 5 millions/cu mm PCV 16.7% 35.5 – 44.9 Platelet count 2.54 lakhs/cmm 1.4 – 4.5 l/cmm ESR 115 mm/1hr 0 – 29 mm/hr MCV 84.9 Fl 80 – 100 Fl MCH 27.0 Pg/cell 27.5 – 33.2 Pg/cell MCHC 31.9 % 33.4 – 35.5 gm/dl WBC Total 10,000 cmm 4500 – 11000 per µl
  • 6. PARAMETERS OBSERVED VALUE NORMAL VALUE RENAL Blood Urea Nitrogen(BUN) 109 mg/dl 10 – 50 mg/dl Serum creatinine 10.2 mg/dl 0.6 – 1.6 mg/dl Sodium 137 mEq/L 135 – 145 mEq/L Potassium 4.97 mEq/L 3.5 – 5.5 mEq/L Chloride 107 mEq/L 98 – 105 mEq/L Bicarbonate 12.4 mEq/L 22 – 30 mEq/L LABORATORY INVESTIGATIONS
  • 7. LABORATORY INVESTIGATIONS PARAMETERS OBSERVED VALUE NORMAL VALUE LIVER Bili (T) 0.4 mg/dl (< 1.0) Bili (D) 0.2 mg/dl (< 0.2) Bili (ID) 0.2 mg/dl (< 0.8) SGPT 15 U/L (Upto 35) SGOT 13 U/L (Upto 40) T.Protein 6.1 g% (6.0 – 8.0) Alk. Phosphatase 247 U/L (40 – 130) Albumin 3.1 g% (3.2 – 4.5) Glubulin 3.0 g% (2.3 – 3.5) A/G Ratio 1.62 (2 : 1) Gamma GT 10 U/L (Upto 50)
  • 8. DATE : 01/08/2022 CHEST X – RAY + SONOGRAM + KIDNEY & LIVER FUNCTION TEST CHEST X – RAY : Chest X - rays can detect cancer, infection or air collecting in the space around a lung which can cause lung to collapse. SONOGRAM : Otherwise called as ‘ULTRA SOUND SCAN’ . It is used to asses the size, shape of kidneys and ureters and bladder KIDNEY FUCTION TEST : It is used to measure how well your kidneys are working by either using blood or urine OTHER TESTS
  • 9. • Diffuse haziness is seen in right lower zone (lungs) • Bilateral contracted kidneys with grade III medical renal disease • Enlarged & cystic right ovary • Bilateral pleural effusion and ascites • Lower GFR(<45) values indicates kidney damage IMPRESSION DIAGNOSIS • Pneumonia • Chronic kidney Disease ( CKD )
  • 10. DRUG CHART – DISCHARGE MEDICATIONS DRUG NAME GENERIC NAME DOSAGE R.O.A FREQUENCY DURATION Syp. Nodosis Sodium Bicarbonate 15 ml Oral 2 times/day Till review Tab. Folvite Folic acid 5 mg Oral 1 – 0 – 0 Till review Tab. Minipress XL Prazosin 2.5 mg Oral 1 – 0 – 1 Till review Tab. Nicardia Nifedipine 10 mg Oral 1 – 0 – 1 Till review Tab. Cardivas Carvedilol 3.125 mg Oral 1 – 0 – 1 Till review Tab. Atorva Atorvastatin 10 mg Oral 0 – 0 – 1 Till review Tab. Evion LV Vitamin E (Tocopherol) - Oral 1 – 0 – 0 Till review Cap. Rocaltrol Calcitrol 0.5 mg Oral 1 – 0 – 1 Till review Tab. Shelcal Ca++ Carbonate 500 mg Oral 1 – 0 – 1 Till review Inj. IV Fer Erythropoeitin alpha 100 mg IV 2/week Till review Inj. Transfer 4000 u Menotropins (Menopur) 4000 units SC 2/week Till review
  • 11. DRUG INTERACTION : T. Cardivas (Carvedilol) + T. Nicardia (Nifedipine) • The concurrent administration of Carvedilol and Nifedfipine decreases heart rate and blood pressure • Carvedilol effects decreases when taken along with c. Rocaltrol DISCHARGE ADVICE : • Haemodialysis twice a week • Inj. Genevac B vaccine to be given after discussion with hematologist
  • 12. SOAP NOTES SUBJECTIVE A 35 years old female patient was admitted in the hospital with the C/O Chest pain radiating to left arm – 2 days Breathlessness on lying down & sleeps in sitting posture Generalised body pain, lack of appetite – 2 days, dry cough OBJECTIVE Patient is conscious/oriented,Tachyponeic, Pallor ++, Afebrile TEMP : 98.6 °F PULSE : 120/Min BP : 120/110 mmHg RR : 46/Min ASSESSMENT The patient was diagnosed with Chest X – Ray , Sonogram , Kidney function test , Liver function test PLAN OF TREATMENT T. Folvite, T. Minipress XL, T. Nicardia, T. Atorva, T. Evion LV, Cap. Rocaltrol, T. Shelcal HAEMODIALYSIS ( PERMANENT )
  • 13. • Strictly follow up the medications given by the physician on discharge • Do not alter the dose and frequency of the medication unless it is instructed by the physician • Medications causing nausea, heart burn and diarrhea are taken with food or after the food( eg: Tab. Evion LV – vitamin e tab) • Medications causing dizziness, fainting, headache and tiredness are advised to taken at bed time.( eg: Prazosin and Carvedilol) PATIENT COUNSELLING REGARDING MEDICATIONS
  • 14. • She must be completely educated about the disease condition. • Monitoring the disease condition everyday to prevent further damage • She must be aware that Diabetes and hypertension are the leading causes of CKD. • Undergoing proper dialysis and intaking accurate medications may increase his/her lifetime. PATIENT COUNSELLING REGARDING DISEASE CONDITION
  • 15. • She may recommended for losing weight • If Necessary excersing more, limiting alcohol consumption and Quitting smoking.( General instruction ) • You may need to lower your blood pressureby eating a diet rich in fruits, vegetables, fish and nuts. • Reducing stress may also reduce bp • Choose food with less salt ( sodium) • Avoid dairy products. PATIENT COUNSELLING REGARDING LIFESTYLE MODIFICATIONS