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 global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centred online learning portfolio and your valuable inputs on the comment box is welcome."I've 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 a diagnosis and treatment plan
COMPLAINTS :
55 year old female garden worker by occupation came with complaints of anasarca since 1 month,sob grade 3 to 4 since 1 month
HOPI:
Patient was apparently asymptomatic 3 years back went to local hospital for regular check up and diagnosed with DM and HTN
Infected with covid-19 6 months back
One month back patient complained of gradual onset of sob grade 2 ,relieved with rest ,orthopnea -ve ,pnd +ve .
No c/o chest pain, palpitations,syncopal attacks.
H/o loc+, for around 4 to 5 hours taken to hospital responed to NIV and woke up,and admitted for 5 days diagnosed with OSA,TYPE 2 RESPIRATORY FAILURE with cor pulmonale ,sepsis ,AKI Right lower limb elephentiasis
Again presented to our casualty with similar complaints
No c/o fever, cold, cough
C/o bald tongue, cracking of mouth
TREATMENT HISTORY
T.METFORMIN 500 MG PO/OD 
T.TELMA 40 MG OD 
HYSTERECTOMY 22 YRS BACK 
HERNIOPLASTY 1 year BACK 
2 LSCS 
T.DIGOXIN 0.25 MG 
T.SILDENAFIL 20 MG 
T.CARDIVAS 3.125
T.DYTOR 10 MG +SPIRONOLACTONE 
T.FUROSEMIDE +SPIRONOLACTONE 
PHYSICAL EXAMINATION 
NO PALLOR ,ICTERUS, CYANOSIS,CLUBBING ,LYMADENOPATHY 
ANASARCA + 
TEMPERATURE - AFEBRILE 
PULSE RATE - 68 BPM 
RR-32 CPM 
BP- 140/80 MM HG 
SPO2 85 PERCENTAGE 
GRBS - 146 MG/DL 
SYSTEMIC EXAMINATION 
CVS - S1 ,S2 HEARD ,NO MURMUR 
RS- BAE + 
P/A - SOFT,NONTENDER 
CNS - NAD 
PROVISIONAL DIAGNOSIS 
COR PULMONALE WITH HFPEF WITH SEVERE PAH WITH HTN AND DM 2 WITH OBSTRUCTIVE SLEEP APNEA WITH TYPE 2 RESPIRATORY FAILURE WITH PAST H/O COVID 6 MONTHS BACK 
TREATMENT 
HEAD END ELEVATION 
O2 INHALATION TO MAINTAIN SPO2 94 PERCENTAGE
INJ LASIX 60 MG - 40 MG -X
TAB CARDIVAS 3.125 PO/OD (2PM) 
TAB ATORVAS 20 MG PO/HS 
TAB SILDENAFIL 20 MG PO/OD (8AM) 
CPAP OVER NIGHT
STRICT I/O , WEIGHT MONITOR- DAILY 
MONITOR VITALS 4 TH HOURLY 
TAB TELMA 40 MG PO/OD (9 AM ) 
TAB METFORMIN 500 MG PO/OD (8AM) 
ZYTEE GEL L/A TID (30 MINS BEFORE FOOD )

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