A 60 Years old Male patient with a cheif complaint of pedal edema, shortness of breath

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Chief complaints :
A 60 years old male Patient complaints of pedal edema since 2 years and shortness of breath since 2 months

History of present illness:
Patient was apparently asymptomatic 2 years back the he noticed  pedal edema,shortness of breath since 2 months
No H/o fever,cold,cough

History of past illness:
History of hypertension since 1 year
Diabetes since 3 months

Personal History:
Diet - Mixed
Appetite - normal
Sleep - Adequate 
Micturition  - Normal
Bowel and bladder movements  -Regular
Addictions - No addictions 

Family History: 
No significant family history
Drug history: 
No allergic to drugs
General Examination 
Patient was conscious, coherent, cooperative  well oriented to time place and person 
Moderately built and well nourished
No H/o cyanosis,icterus,lymphadenopathy 
Clubbing of fingers 
History of pallor  pedal edema
Vitals 
Temperature- afebrile
Pulse rate - 72 bpm
Respiratory rate- 16 cpm
Blood pressure - 150 /90mmhg

Systemic Examination

Abdomen
By taking  consent  from the patient examined in a well lited room
Inspection
Shape of the abdomen- Distended 
Flanks: flanks are free
Umbilicus- central and inverted.
no visible sinuses and scars are seen.
No engorged veins 

Palpation:
No local rise of temperature 
No tenderness 
No palpable mass
No organomegaly.

Percussion:
No Fluid thrill
No shifting dullness

Auscultation:
Bowel sounds are heard.

RESPIRATORY SYSTEM :

Chest is bilaterally symmetrical
Trachea is central
Movements with respiration are equal on both sides
Bilateral air entry present
Resonant sounds on percussion

CVS :
S1&S2 heard
No murmurs

CNS-:
  Consious, coherent ,cooperative 
   Speech normal
   No neck stiffness
   Motor system normal
   Sensory system normal
   Able to percieve-:pain , temp.
   Cranial nerves : intact
Drugs 
INVESTIGATIONS 


ECG
Diagnosis 
CKD

Treatment 
Tab.NODOSIS 500 mg po/BD
Tab.NICARDIA 20 mg po/ Tid
Cap.bio D3 po weekly once
Tab.SHELCAL 500 mg po/ od
Tab.REVALAMER 400 mg po/ od


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