Hypertension and Diabetes mellitus Group 4.pptx

Community medicine assignment

1. DIABETES MELLITUS AND HYPERTENSION By Group 4 Shravanthishaa Sindhu Sourabh Khyalia Sourabh Yadav Sravanti Sree Vathsun

2. INDEX CASE INFORMATIONS Name - Shanthi Age - 62 Sex - Female Residence – No. 36, Pandian street, Mangalalakshmi Nagar, Shanmugapuram , Puducherry Education - Nil Occupation – homemaker Income- Nil Religion - Hindu

3. S.no Name Age Sex Relation to the index case Education Occupation Income Comorbidities 1. Shanthi 62 F Wife Illiterate Home-maker - Hypertension, DM 2. Vaithianadhan 63 M HOF 3 rd std Weaver-retired - Hypertension, DM HOF Index case

4. SOCIOECONOMIC STATUS Type of family : Nuclear Percapita income : NIL Classification according to modified BG prasad scale: Lower middle class Colour of ration card: Red Pension scheme: Government (ATAL PENSION YOJNA) Rs.2000 monthly/person No insurance scheme Preferred health care : IGMC&RI (known person working there)

5. CHIEF COMPLAINTS There was no chief complaints at the time of visit

6. HISTORY OF PRESENTING ILLNESS H/o blurring of vision No h/o headache No h/o drowsiness No h/o nausea , vomiting No h/o stroke No h/o giddiness No h/o numbness, burning or tingling sensations in the legs or feet No h/o foot ulcers or amputations done

7. COURSE OF THE ILLNESS Known case of hypertension for past 8 years She experienced blurring of vision for 10 days ,8 years ago ;before visiting the hospital for checkup She was diagnosed with hypertension and Diabetes mellitus She was prescribed Glimepiride & Metformin ( 1mg & 500mg) BD before food . Other drugs not known

8. To rule out complications Heart - H/o edema , No h/o exaggerated breathlessness, PND, orthopnea , chest pain Brain – No h/o sudden onset transient or persistent neurological deficit Kidney – No h/o increased or decreased urinary output , dyspnea Eye – H/o blurring of vision

9. TREATMENT HISTORY Patient is on regular medication for the past 8 years Place of treatment – Private clinic Medications - Glimepiride & Metformin ( 1mg & 500mg) BD before food . Other drugs not known She purchases the tablets from a private pharmacy She does not skip the medications and shows a good response to the treatment Blood sugar / BP monitoring done at the place of treatment every 2 months Last investigations reports were not found

10. PAST HISTORY No h/o similar episodes in the past No h/o delayed wound healing or foot ulcers H/o hospitalization – for swelling of legs, 4 days, 6 months back No h/o thyroid , MI , Stroke No h/o blood transfusions No h/o previous surgeries

11. PERSONAL HISTORY Normal appetite and adequate sleep Bowel and bladder movements are normal No h/o any food allergies No h/o any drug allergies She does physical activities like household work No h/o any stress No h/o alcohol , tobacco and drug abuse

12. NUTRITIONAL HISTORY QUALITATIVE Type of diet – Mixed Salt intake – 8 g/day ( 500gm iodised salt for 2 people per month Oil intake - 50 ml/day ( 3L for 2 people per month) Vegetable consumption – on a daily basis Fruit consumption – monthly basis

13. NUTRITIONAL HISTORY QUANTITATIVE (24hr recall method) FOOD INTAKE CALORIES (kcal) PROTEIN (g) MORNING Idly (4) Chutney Tea ( 1 cup) 300 50 75 10 2.2 3 AFTERNOON Rice ( 1 cup) Sambar Chicken gravy 200 66 178 5.12 4 19 EVENING Tea ( 1 cup) 75 3 NIGHT Dosa (3) Tomato chutney 375 24 6 1 TOTAL 1343 53.32

14. NUTRITIONAL HISTORY - INTERPRETATION INTAKE RECOMMENDED COMMENT CALORIE 1343 kcal 1660 kcal Deficit by 19.1 % PROTEIN 53.32g 60 g Deficit by 11.13% Weight of index case= 75kg

15. Family history : Type of family ; nuclear Marriage- not a consanguineous marriage shanti’s mother is a k/c/o of diabetes mellitus Family members screened for comorbidities such as DM , Hypertension , Wheezing Relationship with the family members is good They are emotionally supportive

16. Pyscho social history: She maintains a good relationship with her family. No disputes in the family. She has a cordial relationship with the neighbors. She participate in social functions

17. Environmental history: Housing : type - PUCCA No. of living rooms :1 Hall, 1 Kitchen No. of persons : 2 Overcrowding is absent [By room person ratio, Floor space ratio , sex separation] Type of flooring :TILES Ventilation : No Natural ventilation and Cross ventilation Lighting : No Natural Lighting Drinking water: Source – Cooperation tap water , Storage - Vessel , Method of retrieval – Dipping glass Kitchen - INSIDE, Fuel used – LPG , Smoke outlet – ABSENT , Kitchen garden - ABSENT , Sullage disposal - CLOSED Personal hygiene : Good Indoor air pollution - ABSENT Sanitary latrine & bathing place are together Waste disposal method ; waste collected daily by municipality

18. Physical examination; Conscious with respect to time, place and person. Well built and well oriented. Pallor: Absent Icterus: Absent Cyanosis: Absent Clubbing: Absent Lymphadenopathy: Absent Edema: Pedal edema Swollen Right Big Toe with PIN PRICK SENSATION for past 5 years

19. VITALS:- Blood pressure: 138/90 mm Hg Pulse rate: 82 beats/minute Rhythm: Regular Volume: Normal Character: Normal Condition of vessel wall: No vessel wall thickening Respiratory rate: 16/min Temperature: Afebrile

20. Anthropometry Height: 150 cm Weight: 75 kg BMI: 33.3 kg/ sq.m (Obese Class II) Waist circumference:104 cm Hip circumference: 102 cm Waist hip ratio: 1.01(high)

21. SYSTEMIC EXAMINATION CVS: S1and S2 heard normally. No murmurs. RS: Normal vesicular breath sounds are heard. No added breath sound. CNS: No focal neurological deficit observed. ABDOMEN: Soft, non tender, no organomegaly .

22. F OOT EXAMINATION Inspection: Normal skin color. No ulceration. No swelling. No deformities. No calluses. No venous dilatation seen. Palpation: Normal temperature Normal capillary refill time (<3 sec) Pulses : Dorsalis pedis : felt Posterior tibial artery : Felt Gait: Normal

23. Monofilament test: sensation felt Proprioception: Normal Ankle jerk reflex: Plantar flexion of foot and contraction of calf muscles MCR foot wears are not used. Investigations: Blood glucose levels, HbA1c, S.urea , S.creatinine : No record was present

24. ISH CHART INTERPRETATION: There is 20-30% risk of Cardiovascular events

25. Clinical diagnosis A 62 old female, residing at Shanmugapuram with DM/HTN for past 8 years and any complications of DM/ HTN. Her blood sugar levels are under controlled. Her blood pressure was 138/90 mm hg. She is taking medications currently for DM/HTN regularly. She is following the prescriptions . She is taking monthly checkups at nearby PHC

26. Family diagnosis A 62 old female, belonging to a nuclear family consisting of 2 members, with no eligible couple, living in their pucca house in shanmugapuram and coming under class By B G Prasad classification and has supportive family members She is a k/c/o DM/HTN for the past 8 years. No history of comorbidities in the family. No history of drug allergy and abuse in the family

27. KNOWLEDGE ATTITUDE PRACTICE ILLNESS She is aware of the complications of diabetes mellitus. She has a positive attitude towards her illness. She goes to follow up regularly DIET She is aware of the complications of sugar intake. Not willing to reduce the sugar intake. She has not reduced the intake of sugar and takes sweets regularly. SPLIT MEALS She is aware of split meal method. Does not want to follow it. She in not practicing split meal method. MEDICATION She knows the importance of medication. Willing to take the medication She takes her medications regularly.

28. PHYSICAL ACTIVITY She knows the importance of physical activity. Not willing to do physical activity She does not do physical activity. FOOT CARE She has knowledge about foot care practices. Willing to practice foot care. She uses MCR footwear and washes feet regularly

29. KNOWLEDGE ATTITUDE PRACTICE ILLNESS She is aware of the complications of hypertension. She has a positive attitude towards her illness. She goes to follow up regularly . DIET She is aware of the complications of salt intake . Not willing to reduce the salt intake. She has not reduced the intake of salt. MEDICATION She knows the importance of medication. Willing to take the medication. She takes her medications regularly. PHYSICAL ACTIVITY She knows the importance of physical activity. Not willing to do physical activity She does not do physical activity.

30. THANK YOU