CPSCR HTN&DM

8/13/2019 CPSCR HTN&DM

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C.P.S.C.R.(clinico-psycho-social case review)

HYPERTENSION and DIABETESSite of study : House No-3/447,

Dr.Ambedkar Nagar,

New Delhi.

No. of visits : 4

AKSHAT WAHAL

2380


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AIMS AND OBJECTIVES

To study the clinical, social, psychological,economic and environmental factors relevant tothe ailments of the index case.

To study the interplay of these factors incausation, progress and treatment of the disease.

To help the patient understand and manage the

condition by giving advice and makingappropriate interventions.


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DEMOGRAPHIC DATA

Head of household : K.N.PANDEY

Address : 3/447,

Dr. Ambedkar Nagar,

NewDelhi.

Religion : Hindu

Migrated from : Almora Reason for migration: Job

Staying here for : 58 years


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*Index Case

socio economic statusupper-lower(mod.kuppuswami scale

S. No Name Age Sex Relation to

H.O.H

Literacy Job

1 K.N.PANDEY 68yrs M SELF illiterate RETD. TAXI

DRIVER2 SARASWATI

DEVI*

60yrs F WIFE Illiterate HOUSEWIFE

3 LALIT PANDEY 32yrs M Son B.com Account

supervisor

4 RADHA DEVI 28yrs F Daughter inlaw 12

th

pass Housewife

5 DYALCHAND

PANDEY

30yrs M Son B.A. Supervisor

6 UMA DEVI 27yrs F Daughter in

law

12thpass Teacher

7 DEEPALI 3 yrs F grand

daughter

8 MONIKA 5

months

F Grand

daughter


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SOCIO-ECONOMIC STATUS

(Modified Kuppuswami Scale 2001)SCORE

Occupation of head

#semi skilled : 3

Education of head#Illiterate : 1

Family income per month

#Rs.20,000/- p.m.: 6

--------------TOTAL 10

SOCIO ECONOMIC STATUS: UPPER-LOWER


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CLINICAL HISTORY

Patient : Shakuntala Devi

Age : 60 years

Sex : female

Informant : self

Reliability : good Address : 3/447, Dr. Ambedkar Nagar,

New Delhi.


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PRESENTING COMPLAINTS:-

Headache10 years

Diminished vision right eye - 3yrs

breathlessness3yrs

Increased frequency of urination15 days


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She was apparently well 10 years back when shedeveloped headache and became restless.

The precipitating factor could not be recalled.

She showed in moolchand and was diagnosed to beessential hypertensive.

She was started on atenelol but the dose was notknown.

She came to MHC 21/2 years back as she could getfree atenelol from the MHC.

Initially her BP was under control but for past 1 month

it was more than 160/90 mm hg on all occasions (BPwas measured weekly).

She was initially on 25mg atenolol on Friday dose wasincreased to 50mg


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On 2002 april she noticed diminished vision in right

eye, she was then taken to Guru Nanak eye hospital in

Maulana Azad Medical College, where she wasdiagnosed of CRV leading to neovascular glaucoma

due to non-insulin dependent diabetes.

She was advised Xalatan (prostaglandin) eye drops

and is also on metformin.

She also complains of dyspnoea since 3 yrs on

climbing 1 flight of stairs (grade 3 NYHA

classification) No h/o palpitation, orthopnoea, PND.

Polyuria and nocturia since 15 days, has to wake up

5-6 times in night


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-No h/o malena, haematuria, hemetemesis or bleeding fromany other site.

-No h/o non healing ulcer

-No other respiratory, cardiac, GIT or CNS complaints.-No h/o any focal neural deficits.

- No h/o stroke

- she also is a housewife and although she knows sheshould also exercise she doesnt.


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PAST HISTORY:-

No h/o hospitalization

No h/o TB, asthma.

No h/o blood transfusion.


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FAMILY HISTORY:-

No family h/o hypertension, T.B., diabetes,

cancer or arthritis.


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PERSONAL HISTORY:-

She is a non smoker, non alcoholic and a

vegetarian.

No known allergy to any drug .

Menstrual history

Menopause :- 47 yrs of age Has 4 children youngest being 30yrs of age.


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CLINICAL EXAMINATION

(Date and time of examination: 23/09/05 , 10:45 a.m.)

GENERAL PHYSICAL

EXAMINATION:-

The patient was conscious , alert and welloriented in space, time and person.

Weight - 56 kg

Height158 cm

BMI20.3


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VITALS:-

Temperature: afebrile to touch.

Pulse rate:76/min,regular in rhythm, normal incharacter, normal volume and vessel wall thickened.

No radio-radial delay.

Respiratory rate: 21/min, regular in rhythm.

BP: 164/90 mm of hg right arm sitting.

There is no pallor, icterus, cyanosis, clubbing ,oedema

or lymphadenopathy.


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Thyroid normal.

Trachea central.

JVP not raised.

Lymph nodes not palpable.

No abnormality detected on respiratory,

cardiovascular, CNS and per abdominalexamination.


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Map of the house.

fridge

L sanitary

P latrine

bed T.V. Galm- stairs

irah


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ENVIRONMENTAL ASPECTS

HOUSING:-

Pucca

Owned

One living room

2 persons per room

No overcrowding Total floor area: 225 sq. feet

Per capita floor area: 112.5 sq. feet


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VENTILLATION:-

No cross ventillation present.

LIGHTING:- Sunlight not adequate.

Artificial source: 3 tube light and 1 bulbs.

KITCHEN:-

Cooking on gas stove.

LPG used.

Waste collected in a polythene bag


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DRINKING WATER:-

Tap water, DJB supply. Intermittent supply.

Kept in a covered bucket and bottles.

Retrieval by a ladle.SANITATION:-

Sanitary latrine in house.

Floor well cleaned and no slippery areas.


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PERSONAL HYGIENE:-

Bathes daily

Nails cut

Washes hands with soap after defaecation

MEDICAL FACILITIES:-

Govt. dispensary and MHC for minor ailments.

Pvt. Clinic in case of emergency.

AIIMS, Moolchand and Safdarjung for majorailments.

24 HR DIETERY RECALL


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24 HR.DIETERY RECALL

QUANTITY ENERGY PROTIENS FAT

(KCAL) (GRAMS) (GRAMS)

Morning tea: 3 22.5 3 2.25

BREAKFAST:

Roti 2 168 6 0.8

Vegetable katori 25 1.3 0.05

LUNCH:

Roti 3 252 9 1.2

Dal 1 katori 96 6 - Vegetable katori 25 1.3 0.05

EVENING:

Tea 2 cups 15 2 1.5

Biscuit 3 56 0.5 2

Samosa 1 132 1 8

DINNER:

Roti 3 252 9 1.2

Vegetable katori 25 1.3 0.05

Curd 1 katori 76 4 5

Milk 1 glass 150 8 3

----------------------------------------------------------------------------------------1294 52.9 24.1


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Total kcal. required1400 +100 kcal Intake - 1294

Total proteins required50- 60g

intake - 52.9gm Fibre intake- 40-45gm

intake - less

Fat10-15gm intake - 24.1gm


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Dietery recommendations:-

Her diet is adequate but she should take 4-5 timesaday instead of large meals

she can add following for between her meals:-

- fruit(1-2)(citrus,papaya,guava,apple,

watermelon)- salad(without salt),chapati(2),

glv(1katori),dal( katori)\dahi

tea with 2 marie\dietbek


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PSYCHO-SOCIAL ASPECTS

Saraswati devi:-

She is very cooperative and ready to accept my advice

Her compliance is good because:--working children who take good care

of parents

-good financial condition

-husband had undergone by pass surgery for coronaryatherosclerosis and takes care that she takes her

daily medicines.

-saw a death in neighborhood due to negligence of

diabetes.


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But she is a bit superstitious and accordingly she went to

some baba for her headache who by touch removed the

cause.

She has great belief in medical science and wants to becured of all ailments.

NEGATIVE factors:-

-no medical insurance

-lifelong medicine that to cannot completely cure

disease.


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K.A.B.P. STUDY

She knows that her eye problem is due to diabetesand if she is not careful it can be worse.

She takes her disease as a serious condition restrictsalt and sugar in her diet.

She takes her medicines regularly and makesvisits after every 15 days at MHC to get her BPmeasured and take medicine.

gets her sugar screened after ever 2-3 months Buys medicine and eye drops from nearby chemist

and is compliant


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ACKNOWLEDGEMENT

My sincere thanks to SARASWATI Devi

for her cooperation during the visits

I would also like to thank all the faculty

members, residents and employees of the

center for community medicine.


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BIBLIOGRAPHY

PARKS TEXTBOOK OF PREVENTIVE

MEDICINE. By K. Park

HUTCHISONS CLINICAL METHODS ByMichael Swash

HARRISONS PRINCIPLES OF INTERNAL

MEDICINE

NUTRITIVE VALUE OF INDIAN FOODS

National Institute of Nutrition ICMR Hyderabad


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THANK YOU.

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