Conversation 4

Introduction by student: A 52 years old woman, with underlying Congestive Cardiac Failure, Chronic Kidney Disease, Hypertension and Type II Diabetes Mellitus presented with shortness of breath for one week and worsening bilateral lower limb swelling and generalized body oedema for 3 days as well.

Working diagnosis by student: Fluid Overload Secondary to Decompensated Congestive Cardiac Failure with underlying Stage V Chronic Kidney Disease, Ischemic Heart Disease, Hypertension and Type II Diabetes Mellitus

1. What does “underlying congestive cardiac failure” mean?

2. What does “fluid overload secondary to decompensated congestive cardiac failure” mean?

3. Why is it that the diagnosis “stage 5 chronic kidney disease” needs clarification?

4. How do you think the diagnosis of “ischemic heart disease” was made in her?

5. What do you think is the cause of her chronic kidney disease?

Discharge prescription:
a) T. Furosemide 80mg, TDS
b) T. Hydrochlorothiazide 50mg, BD
c) T. Amlodipine 10mg, OD
d) T. Bisoprolol 5mg, OD
e) T. Atorvastatin 20mg, ON
f) S/C Mixtard 10units, BD
g) T. Cardiprin 100mg, OD
h) T. Pantoprazole 40mg, OD
i) T. Iron Sulphate 11/11, OD
j) T. Vitamin B complex 11/11, OD

6. What is your concern about the frusemide dose prescribed for her?
7. What do you have to say about the hydrochlorothiazide prescribed for her?
8. Why do you think she is prescribed Pantoprazole?
9. What concerns do you have about the prescription of iron sulphate for her?
10. Do you think the dose of bisoprolol should be changed?

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