50 MALE, HFREF, AF WITH FVR, COPD, K/C/O T2.DM SINCE 3YRS, HTN SINCE 6 MONTHS
PRESENTING COMPLAINTS:
50 YRS MALE C/O. SHORTNESS OF BREATH SINCE 1 MONTH,
HISTORY OF PRESENTING COMPLAINTS
COUGH SINCE 1 MONTH
SWELLING OF BOTH LOWER LIMBS SINCE 10 DAYS.
HISTORY OF PRESENTING COMPLAINTS
Patient was apparantly normal before 1 month, had difficulty in breathing from moderate to minimal exertion i.e from grade-2 to grade-4 in 1 month associated with PND and ORTHOPNOEA,
COUGH since 1 month gradually progressive , productive with white thik mucoid sputum
Swelling of both lower limbs since 10 days , initially swelling is below knee slowly extended above knee and involved all over body including face also, which is grade-4 pitting type.
No H/o. Fever, chest pain, palpitations, Decrease in urine out put.
PAST HISTORY:
Patient is a known case of HYPERTENSION since 6 months on irregular medication
K/c/o. T2 DIABETES MELLIFLUOUS since 3 yrs on Tab. Metformin 500mg
No H/O. TB/ASTHMA/EPILEPSY/CAD/THYROID DISORDER
TREATMENT HISTORY:
NO PREVIOUS HISTORY OF MEDICATIONS
PERSONAL HISTORY:
Diet - mixed
Appetite - Decreased
Bladder and Bowel - Regular
Sleep - adequate
Alcohol - Regular 90ml/day since 30yrs
Smokes 1pack/day since 30yrs
No drug addictions
FAMILY HISTORY:
No H/O HTN/DM/TB/ASTHMA/EPILEPSY/CAD/THYROID DISORDERS in the family.
PROVISIONAL DIAGNOSIS :
HEART FAILURE WITH MIDRANGE EJECTION FRACTION (25%,) , AF WITH FVR ,
COPD
K/C/O.DM SINCE 3yrs
K/C/O.HTN SINCE 6months
GENERAL PHYSICAL EXAMINATION:
HEIGHT - 155 cms
WEIGHT - 56 kg
NO PALLOR
NO ICTERUS
NO CYNOSIS
NO CLUBBING
NO LYMPH EDNOPATHY
B/L PITTING TYPE PEDAL EDEMA PRESENT
DAY 1 ON EXAMINATION: 30/12/2024 at 10.30 pm
TEMP - 97.2 f
PULSE - 114/min irregularly irregular.
HR - 134/min irregular heartbeat
APEX PULSE DEFICIT - 20
BP - 140/90 mm of hg
RR - 26 / min
SPO2 - 96%@Room air
CVS -S1,S2 PRESENT, NO MURMURS
RS - BAE -PRESENT , LEFT SIDED CREPTS PRESENT IN MA,ISA , AA
PA - SOFT , NON TENDER
CNS - NFND
INVESTIGATIONS ON 30/12/2024
ECG ON 30/12/2024 at 10.30 pm
CHEST X. RAY ON 30/12/2024
TREATMENT ON 30/12/2024
FLUID RESTRICTION < 1.5 L/DAY
SALT RESTRICTION < 2GMS/DAY
INJ. AUGMENTIN 1.2gm.IV.BD (D1)
TAB. MET. XL 25 MG. PO. OD
TAB. LASIX 40 MG PO. BD
TAB. ECOSPRIN. AV (150/20) PO. OD
TAB. METFORMIN 500MG . PO. BD
TAB. PAN. 40MG.PO.OD
NEBS WITH -BUDECORT 8th.hrly , IPRAVENT 8th.hrly
GRBS - 7.O PROFILE
VITALS MONITORING- 4 hrly.
DAY 2 ON EXAMINATION: 31/12/2024 at 8 am
TEMP - 97.3 f
PULSE - 112/min irregularly irregular.
HR - 130/min irregular heartbeat
APEX PULSE DEFICIT - 18
BP - 100/80 mm of hg
RR - 20 / min
SPO2 - 96%@Room air
CVS -S1,S2 PRESENT, NO MURMURS
RS - BAE -PRESENT , LEFT SIDED CREPTS PRESENT IN MA,ISA , AA
PA - SOFT , NON TENDER
CNS - NFND
INVESTIGATIONS : 31/12/2024 at 8 am
2D.ECHO ON 31/12/2024
https://youtu.be/5kCvs_2CPQs?si=BMtcv6IEzsMKGRk3
TREATMENT ON 31/12/2024
FLUID RESTRICTION < 1.5 L/DAY
SALT RESTRICTION < 2GMS/DAY
INJ. AUGMENTIN 1.2gm.IV.BD (D2)
TAB. MET. XL 25 MG. PO. OD
TAB. LASIX 40 MG PO. BD
TAB. ECOSPRIN. AV (150/20) PO. OD
TAB. METFORMIN 500MG . PO. BD
TAB. PAN. 40MG.PO.OD
NEBS WITH -BUDECORT 8th.hrly , IPRAVENT 8th.hrly
GRBS - 7.O PROFILE
VITALS MONITORING- 4 hrly.
DAY3 ON EXAMINATION: 1/01/2025 at 8 am
TEMP - 97.3 f
PULSE - 90/min irregularly irregular.
HR - 110/min irregular heartbeat
APEX PULSE DEFICIT - 20
BP - 120/80 mm of hg
RR - 20 / min
SPO2 - 98%@Room air
CVS -S1,S2 PRESENT, NO MURMURS
RS - BAE -PRESENT , B/L BADAL CREPTS PRESENT
PA - SOFT , NON TENDER
CNS - NFND
GRBS:
8am- 161 mg/dl
10am - 110mg/dl
1pm - 132 mg/dl
3pm - 175 mg/dl
8 pm - 149 mg/dl
10 pm - 181mg/dl
2am - 194 mg/dl
8 am - 132 mg/dl
INVESTIGATIONS ON 01/01/2025 , 8am
TREATMENT ON 01/01/2025 at 8am
FLUID RESTRICTION < 1.5 L/DAY
SALT RESTRICTION < 2GMS/DAY
PROTEIN RICH DIET
INJ. AUGMENTIN 1.2gm.IV.BD (D3)
TAB. MET. XL 25 MG. PO. OD
TAB. LASIX 40 MG PO. BD
TAB. ECOSPRIN. AV (150/20) PO. OD
TAB. ON ARNI 50mg PO. BD
TAB. SPIRONOLACTONE 25MG PO. BD
TAB. APIXABAN 2.5MG . PO. BD
TAB. METFORMIN 500MG . PO. BD
TAB. PAN. 40MG.PO.OD
NEBS WITH -BUDECORT 8th.hrly , IPRAVENT 8th.hrly
GRBS - 7.O PROFILE
VITALS MONITORING- 4 hrly.
DAY3 ON EXAMINATION: 02/01/2025 at 8 am
TEMP - 98.4 f
PULSE - 100/min irregularly irregular.
HR - 122/min irregular heartbeat
APEX PULSE DEFICIT - 22
BP - 110/60 mm of hg
RR - 20 / min
SPO2 - 98%@Room air
CVS -S1,S2 PRESENT, NO MURMURS
RS - BAE -PRESENT , B/L BADAL CREPTS PRESENT
PA - SOFT , NON TENDER
CNS - NFND
GRBS:
8am- 132 mg/dl
10am - 102 mg/dl
1pm - 117 mg/dl
3pm - 150 mg/dl
8 pm - 156 mg/dl
10 pm - 106 mg/dl
2am - 135 mg/dl
8 am - 125 mg/dl
ECG ON 02/01/2025 at 7.15 am
INVESTIGATIONS ON 02/01/2025
TREATMENT ON 02/01/2025 at 8am
FLUID RESTRICTION < 1.5 L/DAY
SALT RESTRICTION < 2GMS/DAY
PROTEIN RICH DIET
INJ. AUGMENTIN 1.2gm.IV.BD (D4)
TAB. MET. XL 25 MG. PO. OD
TAB. LASIX 40 MG PO. BD (STOP)
TAB. ECOSPRIN. AV (150/20) PO. OD
TAB. ON ARNI 50mg PO. BD
TAB. SPIRONOLACTONE 25MG PO. BD
TAB. APIXABAN 2.5MG . PO. BD
TAB. METFORMIN 500MG . PO. BD
TAB. PAN. 40MG.PO.OD
TAB. UDAPA 10mg PO. OD
SYP. GRILLINCUS. DX 7ml.PO.TID
NEBS WITH -BUDECORT 8th.hrly , IPRAVENT 8th.hrly
GRBS - 7.O PROFILE
VITALS MONITORING- 4 hrly.
DAY3 ON EXAMINATION: 03/01/2025 at 8 am
TEMP - 98.1 f
PULSE - 100/min irregularly irregular.
HR - 118/min irregular heartbeat
APEX PULSE DEFICIT - 18
BP - 100/70 mm of hg
RR - 20 / min
SPO2 - 98%@Room air
CVS -S1,S2 PRESENT, NO MURMURS
RS - BAE -PRESENT , B/L BADAL CREPTS PRESENT
PA - SOFT , NON TENDER
CNS - NFND
TREATMENT ON 03/01/2025 at 8am
FLUID RESTRICTION < 1.5 L/DAY
SALT RESTRICTION < 2GMS/DAY
PROTEIN RICH DIET
INJ. AUGMENTIN 1.2gm.IV.BD (D5)
TAB. MET. XL 25 MG. PO. OD
TAB. LASIX 40 MG PO. BD (STOP)
TAB. ECOSPRIN. AV (150/20) PO. OD
TAB. ON ARNI 50mg PO. BD
TAB. SPIRONOLACTONE 25MG PO. BD
TAB. APIXABAN 2.5MG . PO. BD
TAB. METFORMIN 500MG . PO. BD
TAB. PAN. 40MG.PO.OD
TAB. UDAPA 10mg PO. OD
SYP. GRILLINCUS. DX 7ml.PO.TID
NEBS WITH -BUDECORT 8th.hrly , IPRAVENT 8th.hrly
GRBS - 7.O PROFILE
VITALS MONITORING- 4 hrly.
DISCHARGE SUMMARY :
Name : nnnnnn IPID :
UHID :
Age/Gender : 50 Years/Male
Address :
Discharge Type: Relieved
Admission Date: 30/12/2024 10:27 PM
Name of Treating Faculty :
Diagnosis
HEART FAILURE WITH REDUCED EJECTION FRACTION (25%) , ATRIAL FIBRILLATION WITH FVR
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
K/C/O DM-II SINCE 3 YEARS, K/C/O HTN SINCE 6 MONTHS
Case History and Clinical Findings
CHIEF COMPLAINTS
C/O SHORTNESS OF BREATH SINCE 1 MONTH SWELLING OF BOTH LOWER LIMBS SINCE 10 DAYS COUGH SINCE 1 MONTH
HISTORY OF PRESENT ILLNESS
PATIENT WAS APPARENTLY ASYMPTOMATIC BEFORE 1 MONTH, GRADUALLY HAD SOB WITH MINIMAL EXERTION ( GR-II NYHA). PND PRESENT, ORTHOPNEA PRESENT. SWELLING OF BOTH LOWER LIMBS (GR-IV) PITTING TYPE PEDAL EDEMA GRADUALLY PROGRESSIVE. COUGH SINCE 1 MONTH WITH THICK MUCOID SPUTUM. NO H/O FEVER, VOMITINGS, DIARRHEA, BURNING MICTURITION.
PAST HISTORY
K/C/O DM-II SINCE 3 YEARS K/C/O HTN SINCE 6 MONTHS
PERSONAL HISTORY APETTITE-LOST DIET-MIXED
UHID :
Age/Gender : 50 Years/Male
Address :
Discharge Type: Relieved
Admission Date: 30/12/2024 10:27 PM
Name of Treating Faculty :
Diagnosis
HEART FAILURE WITH REDUCED EJECTION FRACTION (25%) , ATRIAL FIBRILLATION WITH FVR
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
K/C/O DM-II SINCE 3 YEARS, K/C/O HTN SINCE 6 MONTHS
Case History and Clinical Findings
CHIEF COMPLAINTS
C/O SHORTNESS OF BREATH SINCE 1 MONTH SWELLING OF BOTH LOWER LIMBS SINCE 10 DAYS COUGH SINCE 1 MONTH
HISTORY OF PRESENT ILLNESS
PATIENT WAS APPARENTLY ASYMPTOMATIC BEFORE 1 MONTH, GRADUALLY HAD SOB WITH MINIMAL EXERTION ( GR-II NYHA). PND PRESENT, ORTHOPNEA PRESENT. SWELLING OF BOTH LOWER LIMBS (GR-IV) PITTING TYPE PEDAL EDEMA GRADUALLY PROGRESSIVE. COUGH SINCE 1 MONTH WITH THICK MUCOID SPUTUM. NO H/O FEVER, VOMITINGS, DIARRHEA, BURNING MICTURITION.
PAST HISTORY
K/C/O DM-II SINCE 3 YEARS K/C/O HTN SINCE 6 MONTHS
PERSONAL HISTORY APETTITE-LOST DIET-MIXED
BOWELS-IRREGULAR MICTURITION-ABNORMAL ALLERGIES-NIL
ADDICTIONS - REGULAR ALCOHOLIC
GENERAL EXAMINATION :
PATIENT IS C/C/C
GRADE IV PITTING TYPE PEDAL EDEMA PRESENT
NO PALLOR, ICTERUS, CYANOSIS, CLUBBING, LYMPHEDENOPATHY BP: 140/80 MMHG
PR: 138 BPM
RR: 26 CPM SPO2: 97% AT RA GRBS: 156 MG/DL
SYSTEMIC EXAMINATION :
CVS: S1S2+,NO MURMURS
JVP RAISED, APEX- LATERAL TO MID CLAVICULAR LINE
RS: DECREASED BAE, B/L DIFFUSE CREPTS PRESENT, WHEEZE PRESENT P/A: SOFT, DISTENDED,NO ORGANOMEGALY
NO SCARS, SINUSES NO ENGORGED VEINS UMBILICUS EVERTED
CNS: HIGHER MENTAL FITNESS - NORMAL MEMORY - GOOD
SPEECH - NORMAL MOTOR SYSTEM RIGHT LEFT
TONE UL N N LL N N
POWER UL 5/5 5/5 LL 5/5 5/5 REFLEXES BICEPS +2 +2
TRICEPS +1 +1
SUPINATOE +1 +1
KNEE +2 +2
ANKLE +1 +1 PATELLAR E E
CARDIOLOGY REFERRAL ADVICE : T. ONARNI 1/2 BD HIGH PROTEIN DIET
T. SPIRONOLACTONE
T. APIXABAN 2.5MG PO/BD
ADDICTIONS - REGULAR ALCOHOLIC
GENERAL EXAMINATION :
PATIENT IS C/C/C
GRADE IV PITTING TYPE PEDAL EDEMA PRESENT
NO PALLOR, ICTERUS, CYANOSIS, CLUBBING, LYMPHEDENOPATHY BP: 140/80 MMHG
PR: 138 BPM
RR: 26 CPM SPO2: 97% AT RA GRBS: 156 MG/DL
SYSTEMIC EXAMINATION :
CVS: S1S2+,NO MURMURS
JVP RAISED, APEX- LATERAL TO MID CLAVICULAR LINE
RS: DECREASED BAE, B/L DIFFUSE CREPTS PRESENT, WHEEZE PRESENT P/A: SOFT, DISTENDED,NO ORGANOMEGALY
NO SCARS, SINUSES NO ENGORGED VEINS UMBILICUS EVERTED
CNS: HIGHER MENTAL FITNESS - NORMAL MEMORY - GOOD
SPEECH - NORMAL MOTOR SYSTEM RIGHT LEFT
TONE UL N N LL N N
POWER UL 5/5 5/5 LL 5/5 5/5 REFLEXES BICEPS +2 +2
TRICEPS +1 +1
SUPINATOE +1 +1
KNEE +2 +2
ANKLE +1 +1 PATELLAR E E
CARDIOLOGY REFERRAL ADVICE : T. ONARNI 1/2 BD HIGH PROTEIN DIET
T. SPIRONOLACTONE
T. APIXABAN 2.5MG PO/BD
Investigation
NameValueRangeNameValueRangeCOMPLETE URINE EXAMINATION (CUE) 30-12-2024 10:57:PM COLOURPale yellowAPPEARANCEClearREACTIONAcidicSP.GRAVITY1.010ALBUMIN++SUGARNilBILE SALTSNilBILE PIGMENTSNilPUS CELLS3-4EPITHELIAL CELLS2-3RED BLOOD CELLSNilCRYSTALSNilCASTSNilAMORPHOUS DEPOSITSAbsentOTHERSNilLIVER FUNCTION
TEST (LFT) 30-12-2024 10:57:PM Total Bilurubin1.43 mg/dl1-0 mg/dlDirect Bilurubin0.39 mg/dl0.2-
0.0 mg/dlSGOT(AST)35 IU/L35-0 IU/LSGPT(ALT)58 IU/L45-0 IU/LALKALINE PHOSPHATASE217 IU/L128-53 IU/LTOTAL PROTEINS5.8 gm/dl8.3-6.4 gm/dlALBUMIN3.36 gm/dl5.2-3.5 gm/dlA/G RATIO1.38BLOOD UREA30-12-2024 10:57:PM82 mg/dl42-12 mg/dlSERUM CREATININE30-12- 2024 10:57:PM1.4 mg/dl1.3-0.9 mg/dlSERUM ELECTROLYTES (Na, K, C l) 30-12-2024 10:57:PM SODIUM139 mmol/L145-136 mmol/LPOTASSIUM4.5 mmol/L5.1-3.5 mmol/LCHLORIDE104 mmol/L98-107 mmol/LBLOOD UREA31-12-2024 11:41:PM68 mg/dl42-12 mg/dlSERUM CREATININE31-12-2024 11:41:PM1.2 mg/dl1.3-0.9 mg/dlSERUM ELECTROLYTES (Na, K, C l) 31- 12-2024 11:41:PM SODIUM138 mmol/L145-136 mmol/LPOTASSIUM3.5 mmol/L5.1-3.5 mmol/LCHLORIDE98 mmol/L98-107 mmol/LBLOOD UREA01-01-2025 11:53:PM47 mg/dl42-12 mg/dlSERUM CREATININE01-01-2025 11:53:PM1.0 mg/dl1.3-0.9 mg/dlSERUM ELECTROLYTES (Na, K, C l) 01-01-2025 11:53:PM SODIUM137 mmol/L145-136 mmol/LPOTASSIUM3.4 mmol/L5.1-
3.5 mmol/LCHLORIDE101 mmol/L98-107 mmol/L RBS- 82MG/DL
HEMOGRAM ON 30/12/24 HAEMOGLOBIN 15.3 GM/DL
TOTAL COUNT 10,000 CELLS/CUMM NEUTROPHILS 67%
LYMPHOCYTES 25%
EOSINOPHILS 01%
NameValueRangeNameValueRangeCO
TEST (LFT) 30-12-2024 10:57:PM Total Bilurubin1.43 mg/dl1-0 mg/dlDirect Bilurubin0.39 mg/dl0.2-
0.0 mg/dlSGOT(AST)35 IU/L35-0 IU/LSGPT(ALT)58 IU/L45-0 IU/LALKALINE PHOSPHATASE217 IU/L128-53 IU/LTOTAL PROTEINS5.8 gm/dl8.3-6.4 gm/dlALBUMIN3.36 gm/dl5.2-3.5 gm/dlA/G RATIO1.38BLOOD UREA30-12-2024 10:57:PM82 mg/dl42-12 mg/dlSERUM CREATININE30-12- 2024 10:57:PM1.4 mg/dl1.3-0.9 mg/dlSERUM ELECTROLYTES (Na, K, C l) 30-12-2024 10:57:PM SODIUM139 mmol/L145-136 mmol/LPOTASSIUM4.5 mmol/L5.1-3.5 mmol/LCHLORIDE104 mmol/L98-107 mmol/LBLOOD UREA31-12-2024 11:41:PM68 mg/dl42-12 mg/dlSERUM CREATININE31-12-2024 11:41:PM1.2 mg/dl1.3-0.9 mg/dlSERUM ELECTROLYTES (Na, K, C l) 31- 12-2024 11:41:PM SODIUM138 mmol/L145-136 mmol/LPOTASSIUM3.5 mmol/L5.1-3.5 mmol/LCHLORIDE98 mmol/L98-107 mmol/LBLOOD UREA01-01-2025 11:53:PM47 mg/dl42-12 mg/dlSERUM CREATININE01-01-2025 11:53:PM1.0 mg/dl1.3-0.9 mg/dlSERUM ELECTROLYTES (Na, K, C l) 01-01-2025 11:53:PM SODIUM137 mmol/L145-136 mmol/LPOTASSIUM3.4 mmol/L5.1-
3.5 mmol/LCHLORIDE101 mmol/L98-107 mmol/L RBS- 82MG/DL
HEMOGRAM ON 30/12/24 HAEMOGLOBIN 15.3 GM/DL
TOTAL COUNT 10,000 CELLS/CUMM NEUTROPHILS 67%
LYMPHOCYTES 25%
EOSINOPHILS 01%
MONOCYTES 07%
BASOPHILS 0%
PCV 44.5 VOL%
MCV 87.1 FL
MCH 29.9 PG
MCHC 34.3%
RDW-CV 15.1% RDW-SD 50.2FL
RBC COUNT 5.11 MILLIONS/CUMM PLATELET COUNT 1.77 LAKHS/CUMM SMEAR
RBC NORMOCYTIC NORMOCHROMIC WBC WITHIN NORMAL LIMITS
PLATELETS ADEQUATE IN NUMBER AND DISTRIBUTION HEMOPARASITES NOT SEEN
IMPRESSION NORMOCYTIC NORMOCHROMIC
2D ECHO
IMPRESSION : SEVERE TR+ WITH MILD PAH; MILD MR+ ; MILD AR+/PR+ RMWA+ LAD AKINETIC, RCA AND LCX HYPOKINETIC ; NO AS/MS SEVERE LV DYSFUNCTION PRESENT
GRADE IV DIASTOLIC DYSFUNCTION+ ; NO LV CLOT
Treatment Given(Enter only Generic Name)
FLUID RESTRICTION <2G/DAY SALT RESTRICTION <1.5/DAY
HIGH PROTIEN DIET - 2 EGG WHITES PER DAY INJ. AUGMENTIN 1.2GM/DAY
TAB. MET XL 25MG/DAY
CAP. ECOSPRIN AV 75/20 PO/HS TAB.ONARNI 100MG 1/2 PO/BD
TAB. SPIRONOLACTONE 25MG PO/BD TAB. APIXABAN 2.5MG PO/BD
TAB. METFORMIN 500MG PO/OD TAB. PAN 40MG PO/OD
NEBS WITH BUDECORT 8TH HOURLY IPRAVENT 8TH HOURLY
TAB. DAPAGLIFOZIN 100MG PO/OD
Advice at Discharge
BASOPHILS 0%
PCV 44.5 VOL%
MCV 87.1 FL
MCH 29.9 PG
MCHC 34.3%
RDW-CV 15.1% RDW-SD 50.2FL
RBC COUNT 5.11 MILLIONS/CUMM PLATELET COUNT 1.77 LAKHS/CUMM SMEAR
RBC NORMOCYTIC NORMOCHROMIC WBC WITHIN NORMAL LIMITS
PLATELETS ADEQUATE IN NUMBER AND DISTRIBUTION HEMOPARASITES NOT SEEN
IMPRESSION NORMOCYTIC NORMOCHROMIC
2D ECHO
IMPRESSION : SEVERE TR+ WITH MILD PAH; MILD MR+ ; MILD AR+/PR+ RMWA+ LAD AKINETIC, RCA AND LCX HYPOKINETIC ; NO AS/MS SEVERE LV DYSFUNCTION PRESENT
GRADE IV DIASTOLIC DYSFUNCTION+ ; NO LV CLOT
Treatment Given(Enter only Generic Name)
FLUID RESTRICTION <2G/DAY SALT RESTRICTION <1.5/DAY
HIGH PROTIEN DIET - 2 EGG WHITES PER DAY INJ. AUGMENTIN 1.2GM/DAY
TAB. MET XL 25MG/DAY
CAP. ECOSPRIN AV 75/20 PO/HS TAB.ONARNI 100MG 1/2 PO/BD
TAB. SPIRONOLACTONE 25MG PO/BD TAB. APIXABAN 2.5MG PO/BD
TAB. METFORMIN 500MG PO/OD TAB. PAN 40MG PO/OD
NEBS WITH BUDECORT 8TH HOURLY IPRAVENT 8TH HOURLY
TAB. DAPAGLIFOZIN 100MG PO/OD
Advice at Discharge
FLUID RESTRICTION <2G/DAY SALT RESTRICTION <1.5/DAY
HIGH PROTIEN DIET - 2 EGG WHITES PER DAY TAB. MET XL 25MG PO/BD
TAB. SPIRONOLACTONE 25MG 1/2 PO/BD TAB. APIXABAN 2.5MG PO/BD
TAB. METFORMIN 500MG PO/BD TAB. PAN 40MG PO/OD
NEBS WITH BUDECORT 8TH HOURLY IPRAVENT 8TH HOURLY
TAB. DAPAGLIFOZIN 10MG PO/OD,
When to Obtain Urgent Care
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR ATTEND EMERGENCY DEPARTMENT.
Preventive Care
AVOID SELF MEDICATION WITHOUT DOCTORS ADVICE,DONOT MISS MEDICATIONS. In case
of Emergency or to speak to your treating FACULTY or For Appointments, Please Contact: 08682279999 For Treatment Enquiries Patient/Attendent Declaration : - The medicines prescribed and the advice regarding preventive aspects of care ,when and how to obtain urgent care have been explained to me in my own language
SIGNATURE OF PATIENT /ATTENDER
HIGH PROTIEN DIET - 2 EGG WHITES PER DAY TAB. MET XL 25MG PO/BD
TAB. SPIRONOLACTONE 25MG 1/2 PO/BD TAB. APIXABAN 2.5MG PO/BD
TAB. METFORMIN 500MG PO/BD TAB. PAN 40MG PO/OD
NEBS WITH BUDECORT 8TH HOURLY IPRAVENT 8TH HOURLY
TAB. DAPAGLIFOZIN 10MG PO/OD,
When to Obtain Urgent Care
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR ATTEND EMERGENCY DEPARTMENT.
Preventive Care
AVOID SELF MEDICATION WITHOUT DOCTORS ADVICE,DONOT MISS MEDICATIONS. In case
of Emergency or to speak to your treating FACULTY or For Appointments, Please Contact: 08682279999 For Treatment Enquiries Patient/Attendent Declaration : - The medicines prescribed and the advice regarding preventive aspects of care ,when and how to obtain urgent care have been explained to me in my own language
SIGNATURE OF PATIENT /ATTENDER
SIGNATURE OF PG/INTERNEE
SIGNATURE OF ADMINISTRATOR
SIGNATURE OF FACULTY
Discharge Date
Date:3/01/25
Ward: GM MALE WARD
Unit:I
SIGNATURE OF ADMINISTRATOR
SIGNATURE OF FACULTY
Discharge Date
Date:3/01/25
Ward: GM MALE WARD
Unit:I
FOLLOW UP ON 16/01/2025 , 9am
2D ECHO ON 16/01/2025 đŸ‘‡
https://youtube.com/shorts/zpJK6635eAg?si=fn2WoNYdafkQht6R
ECG ON 16/01/2025 10am
TREATMENT ON 16/01/2025
FLUID RESTRICTION < 1.5 L/DAY
SALT RESTRICTION < 2GMS/DAY
PROTEIN RICH DIET
TAB. MET. XL 25 MG. PO. OD
TAB. LASIX 40 MG PO. BD (STOP)
TAB. ECOSPRIN. AV (150/20) PO. OD
TAB. ON ARNI 50mg PO. BD
TAB. SPIRONOLACTONE 25MG PO. BD
TAB. APIXABAN 2.5MG . PO. BD
TAB. METFORMIN 500MG . PO. BD
TAB. PAN. 40MG.PO.OD
TAB. UDAPA 10mg PO. OD
SYP. GRILLINCUS. DX 7ml.PO.TID
