45year old female with fever and vomitings

 

45yr Female c/o fever and vomitings since 1 day.

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Chief Complaints:

Patient complains of fever and vomiting since 1 day.

History of Present Illness:

Patient was apparently asymptomatic 4years back then developed right loin Pain and fever for which she visited Some hospital and diagnosed with Right Pyonephrosis and Right Nephrectomy was done and now she complains of fever highgrade intermittent and vomitings since 1 day.

History of Past illness:

H/o DM,BP

Not known case of CAD,CVD and Asthma

Personal History:

Diet: Mixed

Sleep: Adequate 

Appetite: Normal

Bowel and Bladder movements: Regular

Family History:

No known similar complains in the family.

General Examination:

Cyanosis: No

Pallor: No

Icterus:No

Clubbing: No

Lymphadenopathy: No

Micturition: No

Edema of feet: Yes, B/L pitting edema.

Vitals: 

Temp: Afebrile

Respiratory rate: 25bpm

Pulse: 98/min

Blood pressure: 140/90

Systemic Examination:

Cardiovascular Examination:

Thrills: No

Cardiac sounds:S1S2 positive 

Cardiac murmurs:No 

Respiratory system:

Position of trachea:Central 

Breath sounds:Vesicular 

Abdomen

Shape of abdomen: Scaphoid 

Tenderness:No 

Palpable mass: No

Henias orifices:Normal 

Free fluid: No 

Bruits: No 

 

Liver: Not Palpable 

Spleen: Not palpable 

Bowel sounds:

Central Nervous system:

 Pt is conscious, coherent, co-operatively oriented to time and place.

Speech: Normal 

Provisional Diagnosis:

Chronic kidney disease on Maintenance hemodialysis

Investigation:

Treatment:-