LUSAKAI

NSTI
TUTEOF
APPLI
EDSCI
ENCES
Depart
mentofCl
ini
calmedi
cine

ASSI
GNMENTONE(
1)

NAMEOFSTUDENT:KAPEMBWALWANGA

NRC:496929|67|1

I
DNUMBER:1194|18

NAMEOFLECTURER:MR.J
ONESNEBA

COURSE:CLI
NICALMETHODS

I
NTAKE:J
ULY2018

GI
VENDATE:26t
hFEBRUARY,2019

DUEDATE:2s
dMARCH,2019

1
 QUESTI
ON:

F.
Missi
ngl
eladyaged22andbembabyt
ri
bewhocongr
egat
es
atJesusal
i
vemi
nist
rychur
ch,
shecompl
ainsofeasyf
ati
gueand
i
nter
mit
tentf
everf
or6mont
hshencewasr
efer
redt
oUTHf
rom
Chungacl
i
nicf
orf
urt
hermanagement
.Pat
ientwaswel
lunt
il6/
12
agowhenshebegunt
oexper
ienceeasyf
ati
guabi
l
itydur
ingher
dai
l
yact
ivi
ti
esandawar
enessofherhear
tbeat.

Shesomet
imeshasshor
tnessofbr
eat
hwhenshel
i
esf
latbutshe
doesn’
twakeupatni
ghtt
ocat
chabr
eat
h.

Ther
eischestpai
nandankl
eswel
l
ing.Ther
e'snoHxofI
Vdr
ug
use,
prev
ioust
oot
hext
ract
ions,
Indwel
l
ingcat
het
ers,
pier
cingand
t
att
oos

Rev
iewofsy
stem i
snonr
evel
i
ng.

RVDnonr
eact
ive,
lastt
est
ed1/
52

HasnoHxofDi
abet
esmel
l
itus,
hyper
tensi
on,
ast
hma,
epi
l
epsy
,
SCDorHxofTBcont
act
.

Shewasgi
venv
itami
nBcompl
exandf
oli
caci
datherl
ocal
cli
nic.

Hasnoknownal
l
ergi
es

2
Hasnott
akenanyher
bal
medi
cat
ions

NoHxofsur
gical
oper
ati
on

Nohxofcar
diov
ascul
ardi
seases,
DM,
Ast
hma,
orepi
l
epsy
.

Shei
sar
ecept
ioni
st,
li
veswi
thherpar
ent
sand2si
bli
ngsi
n2
bedr
oomedhouse,
wel
lvent
il
ated,f
lushabl
etoi
l
etanddr
inks
boi
l
edwat
er

shei
sat
eet
otal
erandanonsmoker
.

•WRI
TEI
NHI
STORYFOMART

•WRI
TETHESUMMARY

•
WHATI
STHEFULLDI
AGNOSI
SANDDI
FFERENTI
ALDI
AGNOSI
S

ANSWER:

DEMOGRAPHI
CDATA:

NAMEOFAPATI
ENT:
FM

AGE:
22YEARS

SEX:
FEMALE

3
TRI
BE:
BEMBA

RELI
GION:
CHRI
STI
AN(
JESUSALI
VEMI
NISTRYCHURCH)

PRESENTI
NGCOMPLAI
NTS(P/
C)

 Get
sti
redeasi
l
y

 Bodyhot
ness

 Awar
enessofherbr
eat
h

 Shor
tnessofbr
eat
hwhenshel
i
esf
lat

 Shedoesnotwakeupatni
ghtt
ocat
chabr
eat
h

 Chestpai
ns

 Ankl
eswel
l
ing

 NOC

REVI
EW OFSYSTEMS

1.CNS

4
  Fi
tt
ing-

 Headache-

2.GI
T

 Appet
it
e>f
air

 Nausea-

 Di
arr
hea-

 Vomi
ti
ng-

3.CVS

 Agi
na+

 Dy
spnea-

 Or
thopnea+

 Edema+

 PND-

4.RS

 Coughi
ng-

 Or
thopnea+

5
  PND-

5.ECS

 Appet
it
e>f
air

 Pol
ydi
psi
a>f
air

 Pol
yur
ea>Fai
r

 Pol
yphagi
a>f
air

6.HS

 Fat
igue+

 Mal
aese>f
air

 Pal
pit
ati
ons+

7.MSS

 Edema+

 Bodyr
ash+

8.GUT

 Dy
sur
ea-

 Agencei
nur
ine-

6
  Haemat
uri
a-

PASSEDMEDI
CALHx

 NoHxofDM

 NoHxofhy
per
tensi
on

 NoHxofAst
hma

 NoHxofepi
l
epsy

 NoHxofTB

 NoHxofcar
diov
ascul
ardi
seases

 RVDi
snonr
eact
ive

PASSEDSURGI
CALHx

 NoHxofsur
gical
oper
ati
on

PASSEDDRUGHx

7
  NoHxofdr
ugal
l
ergi
es

 NoHxofher
bal
medi
cat
ion

PASSEDFAMI
LYMEDI
CALHx

 NoHxofDM

 NoHxofhy
per
tensi
on

 NoHxofAst
hma

 NoHxofepi
l
epsy

 NoHxofTB

 NoHxofcar
diov
ascul
ardi
seases

SOCI
ALHx

 Pti
sat
eet
otal
er,
nonsmokerandhasnot
att
oos

 Ptwor
ksasar
ecept
ioni
st,
she'
ssi
ngl
eandl
i
veswi
thher
par
ent
swi
tht
wo(
2)si
bli
ngsi
ntwo(
2)bedr
oomedhouse,
wel
lvent
il
ated,
flushabl
etoi
l
etsanddr
inksboi
l
edwat
er

8
SUMMARY

 Ptcamet
oUTHasar
efer
redf
rom chungacl
i
nicf
orher
f
urt
hermanagement
.Ptst
art
edexper
ienci
ngeasy
f
ati
guabi
l
ity
,pal
pit
ati
onsandhasf
everf
or6/
12,
ptal
so
compl
ainsofor
thopneabutpar
oxy
smal
noct
urnal
dyspnea
i
snotpr
esent
.Ptal
sohasedemaoft
heankl
eandchest
pai
ns.

I
MPRESSI
ON

Iwoul
drequestaptt
ogof
or:

 Echocar
diogr
am

 Ex
erci
set
est
s

 Car
diacmagnet
icr
esonancei
magi
ng

 El
ect
rocar
diogr
am (
ECG)

 ChestX-
ray

 Ful
lbl
oodcount(
FBC)

9
ONEXAMI
NATI
ON

 Wel
lmal
nour
ished

 Kempt

 P+,
J-,
C-

 S1,
S2>nor
mal

DI
AGNOSI
S

 Aor
ti
cRegur
git
ati
on

DI
FFERENTI
ALDI
AGNOSI
S

 Congest
edhear
tfai
l
ure

 Acut
eki
dneyf
ail
ure

 Mi
tr
alv
alv
est
enosi
s

 Acut
ehear
tfai
l
ure

 My
ocar
dit
is

10
  Per
icar
dit
is

 Angi
na

 Sev
ereAnaemi
a

TREATMENTPLAN

Thehear
tneedst
obemoni
tor
edcl
osel
yforanychangei
n
f
unct
ional
i
ty.I
nrar
ebutsev
erecases,
sur
ger
ymayber
equi
redt
o
r
epai
rthev
alv
e.

Medi
cat
ions

Ant
ihy
per
tensi
vedr
ug

•
Lower
sbl
oodpr
essur
e.

Sur
ger
y

Aor
ti
cval
ver
epl
acement

Repl
acementofadamagedhear
tval
vewi
thanar
ti
fi
cial
one.The
newv
alv
ecanbemechani
cal
orani
mal
tissue.

11
Suppor
ti
vecar
e

Moni
tor
ingf
orchangesori
mpr
ovement

Speci
ali
sts

Car
diol
ogi
st,
Gener
alPr
act
it
ioner(
GP)
,andCar
diot
hor
aci
c
Sur
geon

12