Day 5 (6/10)
1) Take a look with details pt 55years old underlying with
-DM since few years ago
-spondylitheasis
-obstructive jaundice to rule out malignancy
I paid attention on how the Dr clerks the cases through clerking sheet, review forms, results, forms that need to be filled and drug prescription.
2nd patient present with End stage renal failure (ESRF), tertiary hyper Paratyhroidism, Multinodular goiter with retrosternal extension, Hpt on T.felodipine, ch lung disease with pulmonary HTN, B/l renal parenchyma disease and degenerative spine disease.
2) Done observe and do short case on female pt ( I act as chaperone) from general examination and physical examination.
-Hand: detect water hammer pulse, pulse, pallor of hand, clubbing of hand, peripheral pulse.
-eye for jaundice
-mouth for cyanosis
-JVP raised
-palpate abdomen
-CVS: apex beat pulsation
-Resp: movement of chest, auscultate chest sound
-leg: pedal edema
-examine JVP while auscultate the lung usng small cone stethoscope
-apex beat displaced at 6th intercostal space ant axillary line.
-auscultate heart at tricsupid, mitral, pulmonary, aortic area to hear the murmur.
3) observe eye dressing for corneal ulcer
4) observe MO and HO do peritoneal tapping.
Summary of procedure:
-Inject anesthesia first
-IV Line to draw ascitic fluid -> put into specimen urine container 100ml & collect urine in urine bag (3000ml) .
*if ascitic fluid not flow automatically, drain manually using syringe.
