Beruflich Dokumente
Kultur Dokumente
CHIEF COMPLAINT
Edema
HPI
1. Concern : Swelling over _______
2. Onset : Gradual/ Sudden
3. Duration:
•Recent
•A few days
•Many days
•A few weeks
•Many weeks
•A few months
•Many months
•A few years
•Many years
•Recurrent
•N/a
4. Size-cms_____
5. Severity
•Mild
•Moderate
•Severe
•Absent
•Normal
•Increased
•Decreased
•Stable
•No significant change from prior visit
6. Location:
•Left: Upper limbs/ Lower limbs
•Right: Upper limbs/ Lower limbs
•Face
•Abdomen
•Whole body
•Details
7. Status-Pitting/Nonpitting
8. Aggravated by –
•Standing
•Sitting
•Lying down
•Walking
•Rest
9. Relieved by
10.Associated Symptoms
11.Pertinent Negatives
12.Notes
HISTORY (PMFSH)
PAST HISTORY
• Heart diseases
• Jaundice
• Lung diseases
• Hepatitis
• Cirrhosis
• Alcoholism
• Renal disorders
FAMILY HISTORY
• Diabetes
• Hypertension
• Heart diseases
• Renal disorders
ALLERGY-Drugs
-Environment
SOCIAL HISTORY
ROS
PHYSICAL EXAMINATION
ABDOMINAL EXAM:
• Normal, soft, nondistended, NT, nl bowel sounds, no HSM
• Tenderness-
o Mild
o Moderate
o Severe
o Absent
o Normal
o Increased
o Decreased
o Stable
o Details
• Mass
o Fixed
o Mobile
o Solid
o Cystic
o Tender
o Nontender
o Irregular
o Round
o of approximate size (cm.)
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
details
• Fullness
• Bowel sounds
o Mild
o Moderate
o Severe
o Absent
o Normal
o Increased
o Decreased
o Stable
o Details
• Distention
o Mild
o Moderate
o Severe
o Absent
o Normal
o Increased
o Decreased
o Stable
o Details
• Fluid thrill
o Present
o Absent
o Mild
o Moderate
o Severe
o Increased
o Decreased
o Details
• Adenopathy
o none
o anterior
o posterior
o lateral
o tender
o Mobile
o Shotty
o mass of approximate size (cm.)
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
details
• Wound/incision clean, dry, healing well
• DETAILS
• Location
o Left upper quadrant
o left lower quadrant
o right upper quadrant
o right lower quadrant
o suprapubic
o mid abdomen
o throughout
o flank
o inguinal
o N/A
LUNG EXAM:
HEART EXAM:
• Normal, RRR, no MRG
• Rate that was
o tachycardic
o bradycardic
• rhythm was
o regularly irregular
o irregularly irregular
• Murmur
o Physiologic
o S-3
o S-4
o mitral click
SPECIFIC DATA LIKE GRADING ETC
3+: deep pit/6 mm, last > 1 minute; deep extremity swollen
4+: very deep pit/8 mm lasts 2-5 min, deep extremity grossly
distorted
TESTS TO BE ORDERED
•Blood tests
o Albumin levels
o Serum electrolyte tests
o CBP
o Hb%
o Heamotocriet value
o Liver function tests
o FBS
•Urinalysis
o Macroscopic
Urine Appearance.
Urine Bilirubin
Urine Blood
Urine Casts
Urine Color
Urine Glucose
Urine Ketones
Urine pH
Urine Protein
Specific Gravity
Urine Urobilinogen
o Microscopic
Urine WBS/hpf
Urine RBC/hpf
Urine Casts
Urine Other
•ECG
•Treadmill stress test
•Echocardiography
•X-rays
•USG
•T3, T4, TSH
•kidney function tests
•Transesophageal echocardiography (TEE)
•Pulmonary artery catheterization
•B-type natriuretic peptide (BNP)
•MUGA scan
DIFFERENTIAL DIAGNOSIS
BILATERAL
•Heart failure
•Cancer or enlarged lymph nodes,
•Destruction of lymph vessels by radiotherapy
•Elephantiasis
•Cerebral edema
•Pulmonary edema
•Macular edema
•Ascites
•Pleural effusions
•Urticaria
•Congestive heart failure
•Thyroid conditions
•Nephrotic syndrome
•Acute glomerulonephritis
•Chronic kidney disease
•Heart failure
•Liver failure from cirrhosis
•Drugs
o Androgenic and anabolic steroids
o Certain blood pressure medicines
o prednisone
o Estrogen
o NSAIDs
o Calcium channel blockers
o Thiazolidinediones
UNILATERAL
•DVT
•Lymphangiactasis
•Lymphatic obstruction
•Varicose vein
•Previous trauma with venous obstruction
•Failure of the muscle pump due to AFO’s
•Neuromuscular conditions
MEDICATION
•Furosemide
•Torsemide
•Butethamine
•Hydrochlorothiazide
•Metolazone
•Spironolactone
•Triamterene
•Amiloride
•Acetazolamide
•Morphine
•Nitroprusside
•Enalapril
•Captopril
•Aspirin
•Spironolactone
•Eplerenone
•Candesartan
•Irbesartan
•Olmesartan
•Losartan
•Valsartan
•Telmisartan
•Eprosartan
•Isosorbide dinitrate
•Hydralazine
•Carvedilol
•Metoprolol
FOLLOW UP