Final Exam short case

 A 35 year female, resident of manipaka, came to casualty with the Cheif complaint of b/l pedal edema since 20 days,decreased urine output since 20 days,Facial puffiness , shortness of fever spike +, 10 days back, not associated with chills and rigor, subsided on taking medication.Complaint of cough with expectoration, yellowish in colour,

HISTORY OF PRESENT ILLNESS: patient was apparently asymptomatic 2 months back then she developed chest pain for which she visited local hospital in miryalaguda , on evaluation she was diagnosed to have chronic kidney disease and low hemoglobin, 2PRBC Transfusions were done 

After PRBC transfusion she developed b/l pedal edema, which subsided on medication.,

20 days back she developed b/l pedal edema, reduced urine output, sob a/w orthopnea,and facial puffiness. 

10 days back she developed fever a/w chills and rigor, which subsided on medication.

1 PRBC transfusion done in Nalgonda hospital yesterday.

Known case of HTN since 3 year's

PAST HISTORY: Not a known case of DM, asthma, TB.

PERSONAL HISTORY : 

Mixed diet 

Appetite :normal 

Bowel and bladder: decreased urine output 

No addiction

GENERAL EXAMINATION:

patient is concious ,coherent , cooperative 

Pallor - present

Icterus - absent

Cyanosis - absent

Clubbing - absent

Lymphadenopathy - absent

Pedal edema - b/l present

VITALS :

Afebrile

Bp: 170/100 mm hg

PR: 99 bpm

RR: 22 cpm

SpO2: 87% @RA

CVS: S1,S2 +

RS: BAE+

P/A: SOFT, NON TENDER

CNS: NAD

Pedal Edema: 

Reports : 

TREATMENT 

1. Head end elevation upto 30'

2. O2 supplementation if SpO2 < 90%

3. Inj. Lasix 40mg iv tid 

4. Inj. PIPTAZ 2.25gms IV BD ( D1)

5. TAB. NICARDIA 10MG PO BD 

6. TAB. NODOSIS 550MG PO BD 

7. TAB. SHELCAL 500 MG PO OD 

8. NEB. WITH SALBUTAMOL 2 RESIPULES / 4TH HRLY,

9. INJ. ERYTHROPOIETIN 4000 IU S/C WEEKLY ONCE 

10. SYP. ASCORYL PO TID 

11. HRLY VITALS MONITORING