prefinal

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65year old female came to opd with chief complaints of

-fever since 20 days

- pedal edema and facial puffiness since 20 days

History of presenting illness:-

--Patients was apparently asymptomatic 20days ago then she developed fever which is insidious in onset gradually progressive ,low grade fever, intermittent, associated with body pains not associated with chills and rigors

--No history of nocturnal variation in fever pattern

Patient when got fever 20days back she ignored it and went on her work then she developed body pains which were insidious in onset gradually progressive they were unbearable for which she took a injection from local doctor and went for farming again, the following day morning she developed

--pedal edema and

--facial puffiness

-----Pedal edema was insidious in onset and it was pitting type below the knee for which she went to a local hospital in miryalaguda they said to her she is having a kidney problem then she came to our hospital where she as being evaluated and initiated on hemodialysis

--No history of decreased urine output

--No history of burning micturition

--No history of hematuria

--No history of shortness of breath ,cough,palpitations , chest tightness, sweating

--No history of weight-loss

--No history of loss of

consciousness,giddiness,involuntary passage of urine and stools

Past history:-

---She had persistent cough 30years for 6 months back for which she went to a hospital in mriyalaguda there she was diagnosed with tuberculosis and she was started on ATT medication but she didn’t use them regularly

---surgeries- tubectomy 35 years back after her 5th child

Not a known case of htn diabetes asthma epilepsy

Family history--insignificant

Personal history:-

Diet-mixed

Appetite- normal

Bowel and bladder-regular

Sleep- adequate

Addictions-occasionally toddy

Daily routine

She wakes up at 4am , then complete her household work and have a cup of tea at 6am then packs her breakfast and go to work around 830

--she will complete her work and comes home have lunch by 1230 and sleep for a hour and leave for work at 2:30pm and comes back by 5:00pm

She takes dinner at 8:30pm and sleeps by 9-10 pm

Now as she is having pedal edema and generalised weakness she is unable to go for farming and at that time she is sleeping or have chitchat with her grandchildren

General examination:

-patient Is conscious,coherent,cooperative well oriented with time place and person moderately built and nourished

No pallor