Follow up DFASM2 3 – A Caregiver’s Illness

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A Caregiver’s Illness

Where?

Primary Care Physician’s office

Doctor’s name and Position

Arnold Nelson and
Primary care physician

Patient’s name:

Mrs Charlotte Wright

Age:

77

Marital status:

Married

 

Presenting complaint:

- Worsening shortness of breath – 4 months – worsening even more – two weeks – on effort + while sleeping
- Cough getting worse + clear sputum
- Weight gain vs lack of appetite
- Swollen ankles

Past medical history:

- COPD
- High BP
- Amlodopine 5mg, Rampiril, Simvastatin, Salbutamol and Symbicort.
- 7 drinks a week
- Ex-smoker
- Husband with AD
- Healthy daughter

O/E:

- BP 130/80
- Pulse 90
- Normal heart sounds, no murmurs
- No wheezing, crackles at base of the lungs
- O2 Sats 97%
- Ankles swollen to mid-calf level

Differential diagnosis:

- Heart failure
- Idiopathic pulmonary fibrosis
- Small chronic pulmonary emboli

Further investigations:

- Blood tests
- Echocardiogram
- Electrocardiogram
- Chest X-Ray

Treatment:

- Furosemide
- Salt-free diet
- Stop Amlodipine and start Metoprolol

Prognosis:

- Need follow-up appointment.

- Depending on cause and severity of condition: can probably take care of husband

 

Transcript