Kidney Failure Flashcards
Mr Ojo is A 55-year-old male and presents to the clinic with complaints of generalized weakness, decreased urine output, and swelling in both legs for the past few months. He has a history of hypertension and diabetes mellitus for 15 years but has not been compliant with his medications. Take a focused history from him.
1) GRIP
• Greeting – Good day Sir/Ma, good morning ma
• Rapport – how are you doing today?
• Introduce – My name is Benjamin Abimbola, I am a candidate of the ongoing MDCN exam, I have been instructed to ask you a few questions
• Permission – please, may I proceed
2) Biodata (NASOMART)
• Name – what is your name
• Age – how old are you
• Sex – –
• Occupation – what do you do for work?
• Religion – what religion do you practice?
• Address – where do you live?
• Tribe – what tribe are you?
3) 5Cs
C1 – presenting complaints
It states here that you have complaints of generalized weakness, decreased urine output and swelling in both legs for the past few months. Is that correct?
Doctor
Weakness (DOCTOR)
- Duration: when was It first noticed
- Onset: was it sudden or gradual
- Character/ course: since it started has it gotten better, worse or remained the same
- Timing: did it occur following any activity, is it worse or better at any time of the day
- Other related: any dizziness, headaches, palpitation Related: loss of consciousness, when was your last meal, what do you usually eat
Leg swelling (doctor)
- Duration - when did it start
- Onset: was it sudden or did it happen over time
- Character/ course: has it worsened over time, remained the same or gotten better Is it warm to touch, is it painful, when you press it does it form a dent which leg did you notice the swelling first
- Timing: did it start following any incident or trauma, does it get better or worse at any time of the day
- Other symptoms - any tingling sensation, any numbness, or you feel pain when walking
Related phenomenon: any other swelling on any part of your body, face, abdominal, hand
Reduced urine output (DOCTOR)
- Duration: when did it start
- Onset: was it sudden or gradual
- Character/ course: has it improved or is it getting worse, how many do you urinate in a day, can you quantify the amount of urine you make, is the urine foamy, any blood in your urine
- Timing: any changes with the time? Is it worse in the day time or night, strain, urgency
- Other symptoms: difficulty urinating, and back pain, weak
Related phenomenon: itching, confusion, shortness of breath, fever, abnormal discharge
Causes
Causes…. Prior to the onset of this
a) Heart failure: have you noticed any difficulty breathing when lying down flat, do you need certain amount of pillows to sleep well at night
b) Hypertension: you are a known hypertensive patient; are you compliant with your medications
c) Lifestyle: do you smoke, do you drink alcohol
d) Nephrotoxin medication: do you take local herbal concoctions, do you take nsaids like diclofenac frequently
e) Diet: do you take food rich in fat, do the experience pain when walking (atherosclerosis)
f) Glomerulonephritis: did you have any sore throat or skin infection before the symptoms
g) Post renal: any history of prostrate problems with difficulty urination
h) Nephropathies (tuberculosis): together with these symptoms do you notice excessive night sweat, cough and weight loss
i) Nephropathy (Sickle cell disease) do you your genotype?
j) Nephropathy (HIV): do you have multiple sexual
k) partners
l) Nephropathy (DM) any history of excessive urination, thirst or hunger
m) Malignancy: post renal ): any unexplained weight loss, yellowish change in the color of your skin together with these symptoms
n) Pyelonephritis: did you experience recurrent back pain, abnormal penile discharge, fever
o) Aki to CKD: prior to this did you experience severe vomiting and diarrhea
Complications
a) Encephalopathy: any loss of consciousness or seizures
b) Pericarditis: any severe chest pain that worsens on breathing
b) Effusion: any of cough or shortness of breathe
c) Gastritis: any abdominal pain, vomiting
d) Any abnormal or uncontrolled bleeding
e) Any bone pain or fracture
f) Any hx of easy fatigue, exercise intolerance
g) Gout: any redness, swelling or pain on your toes, joints
C5 – care so far
- What have you done so far for this condition
- Have you visited any prayer house, pharmacy or hospital?
- Have you taken any local concoction or were you given any medications?
- Have you done any investigations?
Past medical history
Family history
Social history
Drug history
Pasat medical history
- Have you had similar conditions in the past?
- Have you had any history of chronic illnesses like hypertension, epilepsy, asthma, diabetes, sickle cell disease? (HEADS)
- Have you had any surgery, blood transfusion or hospitalization in the past? If yes…why?
Family history
Any history of similar conditions in the family history of hypertension, epilepsy, asthma, diabetes or sickle cell disease in the family?
Social history
- Do you smoke?
- Do you drink alcohol?
- Do you have multiple sexual partners?
Drug history
- Are you on any long-term medication?
- Are you on any current medications?
- Do you have any drug allergies?
Review of system
sir, just to be sure I didn’t miss any symptoms, I would like you to say yes or no to the following questions
- CNS – any headache, blurry vision, seizures
- Endocrine – any neck swelling, excessive weight loss or weight gain
- Respiratory – any snoring, noisy breathing, fast breathing
- CVS – cough, chest pain, palpitations
- Digestive – any abdominal pain, nausea or vomiting
- Genitourinary – increased urination, blood in urine, discharge form private part
- Musculoskeletal – joint pain, joint stiffness, difficulty walking
