C.P.S.C.R.

(clinico-psycho-social case review)

HYPERTENSION and DIABETES
Site of study : House No-3/447, Dr.Ambedkar Nagar, New Delhi. No. of visits : 4

AKSHAT WAHAL 2380

AIMS AND OBJECTIVES

To study the clinical, social, psychological, economic and environmental factors relevant to the ailments of the index case. To study the interplay of these factors in causation, progress and treatment of the disease. To help the patient understand and manage the condition by giving advice and making appropriate interventions.

DEMOGRAPHIC DATA
Head of household : K.N.PANDEY Address : 3/447, Dr. Ambedkar Nagar, NewDelhi. Religion : Hindu Migrated from : Almora Reason for migration: Job Staying here for : 58 years
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S. No 1 2 3 4 5 6 7 8

Name K.N.PANDEY SARASWATI DEVI* LALIT PANDEY RADHA DEVI DYALCHAND PANDEY UMA DEVI DEEPALI MONIKA

Age 68yrs 60yrs 32yrs 28yrs 30yrs 27yrs 3 yrs 5 months

Sex M F M F M F F F

Relation to H.O.H SELF WIFE Son Daughter in law Son Daughter in law grand daughter Grand daughter

Literacy illiterate Illiterate B.com 12th pass B.A. 12th pass

Job RETD. TAXI DRIVER HOUSEWIFE Account supervisor Housewife Supervisor Teacher

*Index Case socio economic status upper-lower(mod.kuppuswami scale

SOCIO-ECONOMIC STATUS
(Modified Kuppuswami Scale 2001)

SCORE Occupation of head #semi skilled : Education of head #Illiterate : Family income per month #Rs.20,000/- p.m.: TOTAL 3

1
6 -------------10
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SOCIO ECONOMIC STATUS: UPPER-LOWER

CLINICAL HISTORY
Patient Age Sex Informant Reliability Address : Shakuntala Devi : 60 years : female : self : good : 3/447, Dr. Ambedkar Nagar, New Delhi.
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PRESENTING COMPLAINTS:-

Headache 10 years Diminished vision right eye - 3yrs breathlessness 3yrs Increased frequency of urination 15 days

 She was apparently well 10 years back when she developed headache and became restless. The precipitating factor could not be recalled. She showed in moolchand and was diagnosed to be essential hypertensive. She was started on atenelol but the dose was not known. She came to MHC 21/2 years back as she could get free atenelol from the MHC. Initially her BP was under control but for past 1 month it was more than 160/90 mm hg on all occasions (BP was measured weekly). She was initially on 25mg atenolol on Friday dose was increased to 50mg
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 On 2002 april she noticed diminished vision in right eye, she was then taken to Guru Nanak eye hospital in Maulana Azad Medical College, where she was diagnosed of CRV leading to neovascular glaucoma due to non-insulin dependent diabetes. She was advised Xalatan (prostaglandin) eye drops and is also on metformin. She also complains of dyspnoea since 3 yrs on climbing 1 flight of stairs (grade 3 NYHA classification) No h/o palpitation, orthopnoea, PND. Polyuria and nocturia since 15 days, has to wake up 5-6 times in night 9

-No h/o malena, haematuria, hemetemesis or bleeding from any other site.

-No h/o non healing ulcer

-No other respiratory, cardiac, GIT or CNS complaints. -No h/o any focal neural deficits. - No h/o stroke - she also is a housewife and although she knows she should also exercise she doesnt.
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PAST HISTORY:-

No h/o hospitalization No h/o TB, asthma. No h/o blood transfusion.

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FAMILY HISTORY:-

No family h/o hypertension, T.B., diabetes, cancer or arthritis.

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PERSONAL HISTORY: She is a non smoker, non alcoholic and a vegetarian.

No known allergy to any drug .

Menstrual history
Menopause :- 47 yrs of age Has 4 children youngest being 30yrs of age.
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CLINICAL EXAMINATION
(Date and time of examination: 23/09/05 , 10:45 a.m.)

GENERAL PHYSICAL EXAMINATION: The patient was conscious , alert and well oriented in space, time and person. Weight - 56 kg Height 158 cm BMI 20.3
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VITALS: Temperature: afebrile to touch. Pulse rate:76/min,regular in rhythm, normal in character, normal volume and vessel wall thickened. No radio-radial delay. Respiratory rate: 21/min, regular in rhythm. BP: 164/90 mm of hg right arm sitting. There is no pallor, icterus, cyanosis, clubbing ,oedema or lymphadenopathy.

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Thyroid normal. Trachea central. JVP not raised. Lymph nodes not palpable. No abnormality detected on respiratory, cardiovascular, CNS and per abdominal examination.

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Map of the house. fridge

bed

T.V.

L P G

sanitary latrine

almirah

stairs
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ENVIRONMENTAL ASPECTS
HOUSING: Pucca Owned One living room 2 persons per room No overcrowding Total floor area: 225 sq. feet Per capita floor area: 112.5 sq. feet
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VENTILLATION: No cross ventillation present. LIGHTING: Sunlight not adequate. Artificial source: 3 tube light and 1 bulbs. KITCHEN: Cooking on gas stove. LPG used. Waste collected in a polythene bag

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DRINKING WATER: Tap water, DJB supply. Intermittent supply. Kept in a covered bucket and bottles. Retrieval by a ladle. SANITATION: Sanitary latrine in house. Floor well cleaned and no slippery areas.

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PERSONAL HYGIENE: Bathes daily Nails cut Washes hands with soap after defaecation MEDICAL FACILITIES: Govt. dispensary and MHC for minor ailments. Pvt. Clinic in case of emergency. AIIMS, Moolchand and Safdarjung for major ailments.

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24 HR.DIETERY RECALL
QUANTITY ENERGY PROTIENS (KCAL) (GRAMS) FAT (GRAMS)

Morning tea: 3 22.5 3 2.25 BREAKFAST: Roti 2 168 6 0.8 Vegetable katori 25 1.3 0.05 LUNCH: Roti 3 252 9 1.2 Dal 1 katori 96 6 Vegetable katori 25 1.3 0.05 EVENING: Tea 2 cups 15 2 1.5 Biscuit 3 56 0.5 2 Samosa 1 132 1 8 DINNER: Roti 3 252 9 1.2 Vegetable katori 25 1.3 0.05 Curd 1 katori 76 4 5 Milk 1 glass 150 8 3 ---------------------------------------------------------------------------------------1294 52.9 24.1
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 Total kcal. required 1400 + 100 kcal

Intake intake 1294 52.9gm

Total proteins required 50- 60g

Fibre intake- 40-45gm

intake - less

Fat 10-15gm
intake 24.1gm

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Dietery recommendations: Her diet is adequate but she should take 4-5 times aday instead of large meals she can add following for between her meals: - fruit(1-2)(citrus,papaya,guava,apple, watermelon) - salad(without salt),chapati(2), glv(1katori),dal( katori)\dahi tea with 2 marie\dietbek

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PSYCHO-SOCIAL ASPECTS
Saraswati devi: She is very cooperative and ready to accept my advice Her compliance is good because:-working children who take good care of parents -good financial condition -husband had undergone by pass surgery for coronary atherosclerosis and takes care that she takes her daily medicines. -saw a death in neighborhood due to negligence of diabetes. 25

 NEGATIVE factors:-no medical insurance -lifelong medicine that to cannot completely cure disease.

She has great belief in medical science and wants to be cured of all ailments. But she is a bit superstitious and accordingly she went to some baba for her headache who by touch removed the cause.

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K.A.B.P. STUDY
She knows that her eye problem is due to diabetes and if she is not careful it can be worse. She takes her disease as a serious condition restrict salt and sugar in her diet. She takes her medicines regularly and makes visits after every 15 days at MHC to get her BP measured and take medicine. gets her sugar screened after ever 2-3 months Buys medicine and eye drops from nearby chemist and is compliant
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ACKNOWLEDGEMENT
My sincere thanks to SARASWATI Devi for her cooperation during the visits
I would also like to thank all the faculty members, residents and employees of the center for community medicine.

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BIBLIOGRAPHY
PARKS TEXTBOOK OF PREVENTIVE MEDICINE. By K. Park HUTCHISONS CLINICAL METHODS By Michael Swash HARRISONS PRINCIPLES OF INTERNAL MEDICINE NUTRITIVE VALUE OF INDIAN FOODS National Institute of Nutrition ICMR Hyderabad
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THANK YOU.

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