May 1st - holiday!! 2nd Question!!
5/01/2009 10:37:00 AM | Author: fadzly
Okay, because today is holiday, i'll continue happily typing the 2nd question for you all.. haha

Note: This question basically a short answer question, which might come out in the END OF POSTING test, OSCE, and also long case exam.

Mrs. Wee a 56 years old clerk has hypertension for the pass 1 year. She's currently comes for follow-up. She on tab amlodipine 10 mg daily. His blood pressure (BP) is 150/100 mmhg. Discuss the management of this patient. (10 marks)

So like always address the issues first! So what are the issues here?

Hypertension (HPT) for the pass 1 year. So we need to assess her IDEA about the HPT.

Her BP was 150/100. What do you think this is? Basically in any disease (i mean any medical or psychiatric illness) when the disease is not improving, there are 3 things to bear in mind.

1) COMPLIANCE
2) DOSAGE
3) WRONG DIAGNOSIS

So we need to assess all this three things first. In this case, usually the compliance and the dosage are all we talk about.

Then the other issues are to establish the degree of control of disease process

Then is there any complication from the disease?

And is there any co-morbid condition such as Diabetes, Obesity

Then after addressing the issues we tackle it one by one.. ok?

So answer should be like this

- I would like to assess this patient Idea about Hypertension. How much the patient knows about hypertension? How much the patient concern about the disease affect to his life, family, work?
- Then i would give top up the information and re-educate him so that the patient knows adequately about HPT, such as complication of the HPT. I would also like to tackle the biopsychosocial problems accordingly.
- I would like to assess this patient compliance. Did the patient compliance to medication? Did the patient compliance to the advice?
- If not why? Is there a problem? - Side effect? no access to medication such as patient poor, home is far, no transport, no clinic nearby? No one take care of him? Traditional medicine
- If compliance is the problem managed accordingly by giving education on medication, emphasis again about pharmacology and non pharmacology management, stop the traditional medicine.
- If the patient can’t tolerate the medication, such as side effect, change other type of drugs. If SE is not a problem, i would try to increase the dosage of the drug.
- Assess the patient compliance to advice and clinics. Did the patient go for follow up regularly? Did the patient have BP monitoring at home?
- I would like to emphasis on Non pharmacology management such as exercise regularly 30 minutes a day 3 times per week, eat healthy diet, less sugar, less fat diet, etc
- I would like to referred the patient to dietician
- I would like to assess any complication from HPT by doing CVS examination, EYE- ophthalmoscope and also do some investigation such as Urine dipstick, UrineFEME for protienuria, ECG for ECG changes.
- I would also want to assess this patient co morbidity such as DM or obesity by doing BMI, FBS, and cholesterol level.
- I would like to follow up the next 3 months or 4 months to monitor the progression.

I do agree with it's a bit wordy and difficult. Dr Sajar said, we just need a lot of training, that’s all. Good luck in your study! Till we meet at the next question! haha
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2 comments:

On May 4, 2009 at 9:51 PM , Dr Syuhada said...

kirenye..itu je ke soklannyer?

 
On May 5, 2009 at 4:38 AM , fadzly said...

ada lagi. Osteoporosis. Baca la bende tu

 

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