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Hypertension Nephropathy with ESRD

BY JAVAD SHAHNOOSHI. Hypertension Nephropathy with ESRD. IPnumber : Admission Date: Discharge Date: Department/Unit: medicine.3 Age: 62 Sex : M. Personal Information. Chief Complains & H/O Present illness:

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Hypertension Nephropathy with ESRD

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  1. BY JAVAD SHAHNOOSHI Hypertension Nephropathy with ESRD

  2. IPnumber : • Admission Date: • Discharge Date: • Department/Unit: medicine.3 • Age: 62 • Sex : M Personal Information

  3. Chief Complains & H/O Present illness: • Patient was normal 10 days back when he developed fatiguality.it was insiduos in onset & increase on walking. • C/o breathlessness on exertion. • Swelling of upper & lower limb since 10 days • Previous history: • H/o HTN since 5 yrs on T.betacard, T.Arkamine. • H/o surgery for gall bladder stone 2 yrs back. Subjective Evidences

  4. Social History: • Diet: mixed • Sleep: decreased • Appetite: decreased • Bowel And Bladder: N • Habit: none Objective Evidences

  5. Blood Pressure: 160/100 mmg/Hg • Pulse Rate: 72 beat/min • Temperature: Afebril • Pallor: + • Icterus: - • Cyanosis: - • Clubbing: - • Lymphadenopathy: - • Edema: + • Edema in both U& L limb& over hands • B/L pedal edema General Examination:

  6. Respiratory system: : NVBS+, no added sound. • CVS : S1S2 ,no murmur • P/A :soft, non tender ,no organomegaly ,abdomen look distended • CNS: HMF (N) , motor & sensory system (N) • USG of abdomen and pelvic showes Grade 3 nephropathy with multiple cyst. • Fundus examination : Grade 1 HTN Systemic Examination:

  7. Laboratory data:

  8. Based on the subjective and objective evidences the patient was diagnosed to have hypetension , nephropathy and ESRD. • Breathlessness is symptom of HTN &CRF. • Pallor ( decrease HB ) due to disturbance of erythropoetin cycle(shortend RBC survival ,marrow suppression by waste product). • Edema due to retention of Na and H2O in CRF. • increasing in level of urea & creatinin is due to CRF. • Hyperkalemia is clinical manifestation of CRF. • Proteinuria due to CRF. Assessment

  9. Treatment Plan

  10. Patient Progress Report 17.7.11 & 23.7.11 PT undergone dialysis

  11. Advise on discharge:

  12. Suggestion to the physician : • Urine culture test should be done to confirm the infection. • Clonidine & prazosine better avoided due to the the possible ADR. • Low dose of thiazide ,chlorthalidone+ B blocker is suitable. • Aspirin is CI to ptto sever renal impairment ,instead he can use clopidogrel. • Drug of pantoprazol should suggest. Planning

  13. Dietary modification :intake of dietary protein(20 gm daily), pottasium containing food & fruit should be restricted. • Water intake should be adjusted. • Eat meals that are low in fat and cholesterol • Get regular exercise (talk to your doctor or nurse before starting). • Patient have to restrict salt, potassium, phosphorous, and other electrolytes. Advice to the patient:

  14. THANK YOU

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