User driven health care
Tuesday, November 15, 2016
50 yrs old man with pain in abdomen since 8 months (CDSS) conversational decision support system 1
Conversational Decision Support:
Jyoti
is online record
http://swaudhc834.
blogspot.in/…/50yrs-old-man-
with-kochs-ab…
ka title hona chahiye tha: 50yrs old man with abdominal pain since 8 months.
SWA ASTHA UDHC case record : 50yrs old man with kochs abdomen with hypothyroidism and pedal oedema (
SWAUDHC834.BLOGSPOT.COM
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BY
JYO
TI
TRIPATHI
458 Comments
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Shachi Agarwal and Arun Chaudhary
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Jyoti Sunder Tripathi
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April 12 at 11:52am
Jyoti Sunder Tripathi
Pt complaining nausea and vomiting in 1tim....
Swelling of abdomen....ascitis..
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April 12 at 11:52am
Jyoti Sunder Tripathi
Aj ki kya planning h....
Fluid tapping?
Rt?
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April 12 at 11:54am
Jyoti Sunder Tripathi
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April 12 at 2:25pm
Arun Chaudhary
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April 12 at 9:03pm
Arun Chaudhary
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April 12 at 9:04pm
Arun Chaudhary
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April 12 at 9:04pm
Arun Chaudhary
Sir actually ..patient k right illic side ..me kuch spots dikh rahe hain n kuch stiffness b feel ho ri h ...
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April 12 at 9:06pm
Rakesh Biswas
Thanks
Arun
yeh patient kya abhi MMW mein hain?
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April 12 at 9:08pm
Arun Chaudhary
Yes sir ..inko MMW me shift kr diya h ...n sir pt k attender ka kehna h k RT k bad unko fever aa rha h ...
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April 12 at 9:09pm
Rakesh Biswas
fever chart dikhayenge inka
Arun
?
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April 12 at 9:57pm
Arun Chaudhary
Sir ...aaj se hi aaya h fever ..pehle ka normal chart h ...aaj fever charting krva rha hu n ..sponging b krane ka bola h ..
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April 12 at 10:00pm
Arun Chaudhary
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April 13 at 7:49am
Arun Chaudhary
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April 13 at 7:50am
Rakesh Biswas
Inka IV line mein dekh lena koi thrombophlebitis to nahi. Agar koi IV nahi chal raha hai to nikaal sakte hain. Unke pet dard kaisa hai?
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April 13 at 10:08pm
Rakesh Biswas
Arun
inka fever chart bhi aajka update kar dena
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April 13 at 10:09pm
Arun Chaudhary
Sir ...abhi to koi problem ni h ...ache se so rahe hain ye ...
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April 13 at 10:09pm
Arun Chaudhary
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April 13 at 10:23pm
Arun Chaudhary
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April 14 at 7:48am
Arun Chaudhary
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April 14 at 7:49am
Rakesh Biswas
Thanks
Arun
. How is he now subjectively and objectively?
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April 14 at 8:46am
Arun Chaudhary
Sir ...ache h patient ..no complain ..n he is sleeping ...but some swelling on left foot
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April 14 at 8:49am
Rakesh Biswas
Was he sleeping on his left side
Arun
? Ask
Arti
to post an image of both his feet so that we can make out the differences in his edema feet.
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April 14 at 9:01am
Arun Chaudhary
No sir ...he is lying in supine position ...but he fold his legs ...so foot swollen
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April 14 at 9:03am
Arti Jat
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April 14 at 11:45am
Rakesh Biswas
How is he subjectively
Arti
?
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April 14 at 11:53am
Arti Jat
Sir pt. Is stable... normally nausea during walking and no pain in foot
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April 14 at 12:02pm
Rakesh Biswas
Is he walking
Arti
? I always find him bed ridden. Does he walk to the toilet?
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April 14 at 12:12pm
Arti Jat
Yes sir actually pt. Ko chalne me hi arhe h aisa unke papa ne btaya
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April 14 at 2:58pm
Arun Chaudhary
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April 14 at 8:50pm
Arun Chaudhary
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April 14 at 8:51pm
Arun Chaudhary
Sir ...output jyada h ...input se ...is baat ka kya mtlab h ? N sir ..BP b low chal rha h ..n chakkar b aa rahe hain pt ko ...weakness ho gyi h
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April 14 at 8:52pm
Rakesh Biswas
Unko shyad lasix diya hoga gharwalon ne. Output agar input se zyada ho to sharir ka pani (edema) sukh jata hai. Isliye unke ghar walon ne lasix diya hai. Thoda pani to garmi ke wajah se bhi nikal gayi hogi.
Arun
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April 14 at 9:07pm
Rakesh Biswas
Arun
kya apko pata hai humare sharir ka kitna pratishad pani hai?
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April 14 at 9:08pm
Arun Chaudhary
78% sir ....n unhone lasix b ni diya h aaj to ...
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April 14 at 9:12pm
Rakesh Biswas
Please supplement his fluid intake to make it at least 800 ml more than yesterday's output
Arun
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April 14 at 10:28pm
Arun Chaudhary
Okkkk sure sir ...kra dete hain
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April 14 at 10:31pm
Arun Chaudhary
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April 15 at 7:33am
Arun Chaudhary
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April 15 at 7:33am
Arun Chaudhary
Sir ...actually night me to ...intake only 500 ml ..h ..n output 1500 ml ..h sir ...ye sb kese ho rha h. ..
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April 15 at 7:34am
Rakesh Biswas
Arun
always look at the 24 hour input-output not just night or day.
Jyoti
let us know what is the total I/O chart from 8:00 AM yesterday to 8:00 AM today.
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April 15 at 9:19am
Rakesh Biswas
Dr
Swagata
, Dr Bharati if you happen to be visiting LNMCH today please do also check out this patient and let us know your impression here.
Jyoti
will also get in touch with you regarding this patient. I hope she has prepared the online-record of your ca-colon patient?
Jyoti
please share it's link here.
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April 15 at 9:26am
Arti Jat
Sir pt. Ka out put kl night me jyada tha
Unka kehna h ki tab.aldactone lene se jyada hota h. Aj morning me hi Di h to ab normal h..sir tab. Continue leni h ya abi off kr de
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April 15 at 10:47am
Rakesh Biswas
Arti
inka kalka 24 hours ka (parson 8:00 AM se aaj 8:00 AM) ka output kitna hai please batayenge?
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April 15 at 10:57am
Arti Jat
OK sir
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April 15 at 11:00am
Arti Jat
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April 15 at 11:16am
Arti Jat
Kl ka intake1200ml and output 1300ml
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April 15 at 11:17am
Rakesh Biswas
Arti
yeh ek summary jaisa lag raha hai par is input-output ko generally hourly ya 6 hourly calculate kiya jata hai. Shayad aur bhi koi chart hoga inke input-output calculation ka
Arun
?
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April 15 at 11:19am
Arti Jat
Morning ka intake 500ml and output 1500 ml tha 8am tak
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April 15 at 11:19am
Rakesh Biswas
Nahi
Arti
kuch gadbadh hua hai calculations mein. Brother ko yahan add kar sakte ho?
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April 15 at 11:19am
Arti Jat
Sir yha koi bi Ni h infact brother bi Ni h
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April 15 at 11:20am
Rakesh Biswas
Matlab koi bhi nursing staff nahi hai
Arti
?
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April 15 at 11:21am
Arti Jat
Sir vo tab. Dena h ya Ni pt. Ne li hi h abi tk
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April 15 at 11:21am
Arti Jat
Yes sir
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April 15 at 11:22am
Rakesh Biswas
Haan Aldactone to de sakte ho
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April 15 at 11:22am
Arti Jat
10 0`c tak the fir ab Ni h fmw me h mmw me ni
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April 15 at 11:23am
Arti Jat
OK sir
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April 15 at 11:23am
Rakesh Biswas
Par input output calculations thoda sahi se ghar walon ko hi bol do ki woh kar len. Bharat mein nursing care ki problem hai (nurses ka dosh nahi hai) isliye kafi had tak gharwalon ko yeh sab seekhlena padhta hai. Roj 8:00 AM ko urobag khali karen aur 4 hourly note karte rahen input-output agle din 8:00 AM tak.
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April 15 at 11:24am
Arti Jat
Ha sir gharvalo he hi Sara note krvaya tha kl bi or aaj bi
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April 15 at 11:26am
Arun Chaudhary
Gadhbadh ni hui h sir ...Aisa hi h ...uske addender ne ...khud calculate krke btaya h
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April 15 at 11:33am
Rakesh Biswas
Uska matlab yeh hisaab ka break up jo normally nursing note mein hota hai woh relative ke pass hai
Arun
?
:-)
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April 15 at 11:34am
Arti Jat
Ha sir relative he hi note kraya tha
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April 15 at 11:39am
Rakesh Biswas
Arti
relative ke apne note ka koi image?
:-)
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April 15 at 11:42am
Arti Jat
Ha sir
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April 15 at 11:56am
Arun Chaudhary
Sir ...vo b count krte hain ...acc. To you sir ...hmne unke attender ko sikha diya h ...nursing vaale agar dhyaan na de paayen to ...vo to de len
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April 15 at 12:01pm
Arti Jat
Sir ye aaj morning 7 am se start h kl morning 7bje tak ka note krene keh diya h
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April 15 at 12:04pm
Arti Jat
I have go my room its urgent my brother suffering weakness and continue doing vomiting
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April 15 at 12:08pm
Arti Jat
Sir can I..?
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April 15 at 12:09pm
Rakesh Biswas
Sure
Arti
. Hope your brother recovers soon. If you need any help bring him to the hospital and we can ask the CMO to assess and manege his problems together.
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April 15 at 12:55pm
Arti Jat
Thanks sir
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April 15 at 2:13pm
Rakesh Biswas
I guess he is in Bed 16
Arun
? Please get the details of what is happening from the nursing staff and share here.
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April 15 at 5:48pm
Arun Chaudhary
Yes sir ...he is on bed 16 ...
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April 15 at 5:49pm
Arun Chaudhary
Total output of day - 15-4-2016
7 am to 8 pm - 600 ml
...
See More
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April 15 at 9:25pm
Arun Chaudhary
Today's notes -
C/O - abdomen distended ...urine obstruction at the time of motion ..both foot swelling ..weakness .
...
See More
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April 15 at 10:37pm
Arun Chaudhary
Total intake of night - 8 pm to 7 am - 550 ml
Total output of night - 8 pm to 7 am - 800 ml
Total output of 24 hours - 1400 ml
Total intake of 24 hours - 2,485 ml
= 2 ltr. 485 ml
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April 16 at 7:04am
Rakesh Biswas
Jitna bhi excess pani hai I-O woh aaj
Jyoti
ko nikaalna hoga.
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April 16 at 7:43am
Jyoti Sunder Tripathi
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April 16 at 10:00am
Jyoti Sunder Tripathi
Swelling in both feet....
Water intake..__300ml
Urine output__100ml
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April 16 at 10:01am
Rakesh Biswas
His leg swelling seems to have redueed
Jyoti
,
Arun
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April 16 at 10:45am
Jyoti Sunder Tripathi
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April 16 at 11:11am
Arun Chaudhary
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April 16 at 9:05pm
Arun Chaudhary
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April 16 at 9:05pm
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