INTERNSHIP LEARNING AND PROCEDURES PERFORMED
This is sathwika of 2k18 batch posted in General medicine department as an intern.
My general medicine posting is from November 1 to December 31
This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.
This E log book also reflects my patient-centred online learning portfolio and your valuable inputs on the comment box is welcome."I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.
In icu:
-Taken abg sample
-Procedures done -2 Ryles ,3 foleys
-done cpr
Monitoring vitals
I learnt how mean arterial pressure is used to make diagnosis the hypertension ,used for norad dosage
I learnt how and when certain medications are given as infusions for example lasix infusion, norad infusion and insulin infusion.
I also did reflexes on patient where I noticed exaggerated reflex and ankle clonus
IN NEPHRO:
Assisted in central line
Vitals monitoring for dialysis patients
I realised how necessary dialysis is for the CKD patients and saw even may of them come on a daily basis.
Ward not yet started
Psychiatry:
I saw some cases like
Schizophrenia
Anxiety disorders
Tobacco and alcohol dependence syndrome
Depression
One of the Schizophrenia case:
A 20yr old male came with complaints of visual and auditory hallucinations since 5yrs.Loss of interest in doing activities,suicidal thoughts, trust issues,zoneouts,H/o alcohol and smoking consumption to overcome stress.Treatment given:
Tab.Olimelt 2.5mg
Tab.suprabenz plus 10 mg
Divaa 500 oral solution
Carbloom
After taking medications his hallucinations were improved
And stopped consuming alcohol and smoking
Unit -
These are the cases I have documented:
Case 1
This is case of 83yr old male came with complaints of cough with sputum since 4 days,breathlessness since 4 days.
Patient was apparently asymptomatic 4days back then he developed cough which was insidious in onset, gradually progessive associated with sputum which was white in colour ,copious amount.
Fever since 4 days,high grade, associated with chills and rigors
Breathlessness since 4 days which was insidious in onset , gradually progressive from grade 2 to grade 4
No h/o chest pain, orthopnea,pnd, palpitations,pnd
PAST HISTORY:
Patient is not a known case of Hypertension, Diabetes mellitus, TB, Epilepsy, Bronchial asthma, Thyroid disorders
PERSONAL HISTORY:
Diet - Mixed
Appetite - decreased
Sleep - Adequate
Bowel and Bladder movements- Regular
Addiction - consumption of alcohol occassionally,h/o smoking since 30 yrs (1pack per day)
Bronchoscopy was done-white plague visualised near vocal cords and left pyriform fossa
Bronchoscopy video
https://youtu.be/38PYZi5sMIc?si=JN2hgqHYahp-Jvka
Pajr link:
https://chat.whatsapp.com/FR7vWq7WSNkKPVBlicTsGS
Blog
https://sathwikaammanabolurollno12.blogspot.com/2023/11/this-is-online-e-logbook-to-discuss-our.html
OSCE:
1) what are the signs and symptoms of pneumonia?
2nd case:
This is case of 50 yr old female came with c/o:
Generalised edema since 15days
Decreased urine output since15days
HOPI: H/O consumption of 90ml of alcohol for every 10 days since 4yrs
pt was apparently asymptomatic 4months ago then she had hip fracture due to skid since then she is bed ridden
Then she developed edema after 3and half months of hip fracture, insidious in onset gradually progessive, first it developed at abdomen then it progressed to foot,decreased urine output since 15days
No h/o burning micturition,no h/o sob, palpitations,no h/o vomitings,
PAST HISTORY:
Patient is a known cease of Hypertension, Diabetes mellitus since 2yrs and on medication (propranalol,glimiperide)
No h/o TB, Epilepsy, Bronchial asthma, Thyroid disorders
PERSONAL HISTORY:
Diet - Mixed
Appetite - normal
Sleep - adequate
Bowel movements -regular
Bladder movement: decreased urine output
Addiction - h/o 90ml alcohol consumption since4yrs for every 10days
Endoscopy done to rule out oesophageal varices in chronic liver disease
Impression: superficial ulcers noted on duodenum,no oesophageal varices
Endoscopy video
https://youtu.be/UDnnZF-mZr0?si=XYIa4QaovdFEIF11
Pajr link:
https://chat.whatsapp.com/CazgfE0Mojf4vm7CBZQguO
Blog
https://sathwikaammanabolurollno12.blogspot.com/2023/12/50-yr-old-female-with-pedal-edema-and.html
OSCE:
1.what are the risk factors for chronic liver disease
In this patient alcohol is the risk factor
Consumption of 90ml alcohol since 4 yrs for every 10 days
2) what are the signs and symptoms of chronic liver disease
In this patient anasarca is noticed
3) what are the complications of chronic liver disease
Case-3
Case history of 67 yr old male
K/c/o diabetes since 13years
Patient presented to surgery OPD on 1-11-23 with diabetic foot(c/o: blackish discoloration of 2nd and 3rd toe since 20 days) , before coming to kamineni he went to local rmp where first aid was done then he came to kamineni where he had amputation of 2nd and 3rd toe of Right leg on 1-11-23
1-11-23 to 11-11-23 ( dressings were done)
On 11-11-23 he developed shortnes of breath,chest pain (trop-i was 1080, diagnosed as NSTEMI ,for which patient went to the KHLon 12-11-23 where angiogram was done ( shown-lcx and rca blockade) , they are unable to afford money to undergo stent
They visited virnchi hospital(on 15-11-23) and where he had PTCA and 2 STENTS to lcx and rca, he stayed 5 days (till 20-11-23)
On 20-11-23 he came to kamineni hospital to get dressings done for his rt foot
On 24-11-23 case was shifted to gm I/v/o high blood sugars was kept on hai .
On 26-11-23 case was transferred to gs to get dressings done ,but shifted to gm on 5-11-23
I/v/o high blood sugars and deranged rft and haemogram
https://sathwikaammanabolurollno12.blogspot.com/2023/12/this-is-online-e-logbook-to-discuss-our.html
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