Management of Bronchogenic carcinoma

Unit III B

Date : 20.06.2011

PRESENTING COMPLAINTS LOCATION Chief complaint Chest : Left Lateral region extending to shoulder since one month. General : Since two months Pain < -Lying on left side SENSATION & PATHOLOGY MODALITIES ACCOMPANIMENTS

Weakness wants to lie down Palpitation Sleeplessness

HISTORY OF PRESENTING COMPLAINT

The complaints of patients started as cough since 6 months. She developed bouts of fever. Took allopathic treatment got. Temporary relief.

HISTORY OF PREVIOUS ILLNESS Since 6 months before : cough allopathy

HISTORY OF FAMILY ILLNESS Stroke father died asthma

PERSONAL HISTORY P.O.B Religion : : Monday market Hindu Fifth standard Moderate

Education : E.S.N. Married :

Father died, mother died, Siblings : 5, Male : 1, Female : 4, Children : 2

HABITS AND HOBBIES Non veg., Tea L.S.I. She is anxious about her disease, religious, and fastidious.

PSYCHIC FEATURES Fastidious Religious Obstinate Easily angered Weep easily Contradiction : intolerance

PHSYCAL FEATURERS Appearance Thin, Small, Complexion : Earthy Unwell, gait : study, Deformity : Nil, Clean Swelling : on back of chest rt. Side

Regionals Eyes Tongue : Short sightedness, : clean and moist.

Generals Appetite : present but easy satiety Thirst : increased warm Sleep : disturbed Aversion to salt, covering Stool : Regular Urine : Normal Sweat : Normal

Desires : Warm season, open air, cold bathing, spicy food, sour food Intolerance to cold season.

DESIRES FANNING AFTER COMPALINTS APPEARED.

CONSTITUTION : TEMPERAMENT THERMAL

OXYGENOID CHOLERIC HOT

PHYSICAL EXAMINATION General Jaundice : Not iteric, Clubbing : nil Skin eruption : nil Lymphadenopathy : Nil Pulse rate : R.R. : B.P. : Temp. : Systemic : Respiratory system O/E : Chest clear Aneamia : mild pallor cyanosis : Nil Oedema : Nil

Axillary lymph node enlarged, tender.

Cystic swelling present on the posterior aspect of right side of chest nodular not tender.

GENERAL MANAGEMENT : Avoid physical exertion, adviced for assessment of pulse and oxygen saturation by pulse oxymeter.

MEDICINAL MANAGEMENT : Rx : 1. Carbo veg. 30/1d. (Stat) 2. SL 1 1 1 1 3. SD 1 - 1 1 1 4. PL in 10ml aqua 10gtt x 3 hourly admitted under IIIB.

Basis of selection Desire fanning, extreme weakness, raised pulse, desire cold bathing. Pain in left lateral region.

FALLOW UP 10.05.2011 Pain in left lateral region. Weakness present Appetite : Normal Thirst : Normal Stool : Normal Urine : Normal

Sleep : Disturbed B.P. : 122/72 mm of Hg

Sweat : Normal Rx : 1. PL 10ml aqua 10gtt x 10hourly 2. SL. 1 1 1 1 3. SD. 1 1 1 1

11.05.2011 complaints persist Generals good. B.P. 130/60 mm of Hg Temp: 98.6 1. PL 10ml aqua 10gtt x 10hourly 2. SL. 1 1 1 1 3. SD. 1 1 1 1

12-5-11 complaints persists Generals are normal. B.P. 102/68 mm of Hg. Rx. 1. PL 10ml aqua 10gtt x 10hourly 2. SL. 1 1 1 1 3. SD. 1 1 1 1

13.05.2011 weakness increased. General good but sleep disturbed due to pain. Temp. 99.4 F B.P. 102/60 mm of Hg. Head ache and abdominal pain.

Rx. 1. Carbo veg. 200/1d.

14.05.2011 patient complaint still persist. Appetite decreased Thirst normal Sleep good Other generals good . B.P. 100/70 mm of Hg. Temp. 99.6F. 5pm 1. Carbo veg. 200/1d (Sos)

15.05.2011 complaint still persist. Vomiting persist Appetite decreased Thirst decreased Sleep disturbed Stool not moved B.P. 84/60 mm of Hg. Temp. 99.8 F. Rx. 1. PL 10ml aqua 10gtt x 10hourly 2. SL. 1 1 1 1 3. SD. 1 1 1 1

16.05.2011 complaints still persist Numbness, weakness vomiting better appetite decreased thirst decreased sleep disturbed other general are good Rx. 1. PL 10ml aqua 10gtt x 10hourly 2. SL. 1 1 1 1 3. SD. 1 1 1 1

17.05.2011 complaints still persist Numbness, weakness Vomiting better Appetite decreased Thirst decreased Sleep disturbed Other general are good Rx. 1. PL 10ml aqua 10gtt x 10hourly 2. SL. 1 1 1 1 3. SD. 1 1 1 1

18.05.2011 complaints persist

Weakness Vomiting better Appetite normal Thirst increased (warm) Sleep good Other general are good B.P. 120/70 mm of Hg. Temp. 99.2 F. Rx. 1. PL 10ml aqua 10gtt x 10hourly 2. SL. 1 1 1 1 3. SD. 1 1 1 1

19.05.2011 complaints persists but better Weakness Vomiting better Appetite normal Thirst increased (warm) Sleep good Other general are good B.P. 120/70 mm of Hg. Temp. 98.2 F. Rx. 1. PL 10ml aqua 10gtt x 10hourly 2. SL. 1 1 1 1

3. SD. 1 1 1 1

20.05.2011 complaints persists Weakness Vomiting better Appetite normal Thirst increased (warm) Sleep good Other general are good B.P. 102/60 mm of Hg. Patients wants to lie on right side. Rx. 1. PL 10ml aqua 10gtt x 10hourly 2. SL. 1 1 1 1 3. SD. 1 1 1 1 21.05.2011 complaints feels better App. Normal Thirst normal Sleep good B.P. 118/60 mm of Hg. Patients wants to lie on right side. Rx. 1. Carbo veg. 200/2d sos 2. SL. 70 3. SD. 1 0 1 Stool regular Urine normal Sweat normal

4. SG. 3 3 3 improved and discharged.

28.05.2011 Dysponea two days, in drawing of eyes Vertigo on walking, wants to lie down Pulse 96/min App. Normal Thirst normal Sleep good B.P. 90/60 mm of Hg. Stool regular Urine normal Sweat normal Oxygen saturation 92

Patients wants to lie on right side. Rx. 1. PL 10ml aqua 10gtt x 3hourly 2. SL. 1 1 1 1 3. SD. 1 1 1 1 admitted under IIIb Rx. Bry0/3 in 10ml aqua 10gtt x 3hourly[3times] Basis of selection ; On observation Patient very restless till founding a good lying posture for relief of her complaints. On the part of searching for convenient lying position she goes on moving her body to found out a absolute relief posture. While searching for this she never look at physician face in the act of finding her position.after oly she will talk.

29-5-11;dysponea feels better slightly Weakness better.

B.P.98/72mm of hg. Rx;

Pulse-108/min.

1. PL 10ml aqua 10gtt x 3hourly 2. SL. 1 1 1 1 3.SD. 1- 1- 1- 1 5PM;Complaints feels beter. Weakness better B.P.100/70mm of hg,temp;102F Rx;Bry 0/3 in 10ml aqua 10 gtt x3hour 30-5-11;Dysponea feels better. Chest pain better. App-D Thirst-D Sleep-D Stool Not passed since 3days Urine-N Sweat-N

B.P.102/78 mm of hg, temp -100F Rx; 1. PL 10ml aqua 10gtt x 3hourly 2. SL. 1 1 1 1 3.SD. 1- 1- 1- 1 31-5-11; Complaints feels better. App-D Thirst-N Sleep-N Stool-R Urine-N Sweat-N

B.P.110/80 mm of hg, pulse 106/min

Oxygen saturation 91, Pulse 116/min Rx SL 1/d

01.06.2011 dysponea feels better, chest pain persists, pain in both elbow joint feels better App-D Thirst-N Sleep-D Stool-R Urine-N Sweat-N

B.P.110/80 mm of hg, pulse 108/min Rx bry0/6 / 1d 10ml aqua 10gtt x 3hourly SL. 1 1 1 1 SD. 1- 1- 1- 1

02.06.2011 dysponea feels better, chest pain better, pain in both elbow joint feels better App-N Thirst-N Sleep-D Stool-R Urine-N Sweat-N

B.P.110/80 mm of hg, pulse 108/min PL 10ml aqua 10gtt x 3hourly SL. 1 1 1 1 SD. 1- 1- 1- 1

03.06.2011 dysponea increased, chest pain better, pain in both elbow joint increased App-D Thirst-I Sleep-D Stool-R Urine-N Sweat-N

B.P.110/76 mm of hg. pulse 100/min Temp 101.4F Rx. Bry0/6 10ml aqua 10gtt x 2hourly

PL 10ml aqua 10gtt x 3hourly SL. 1 1 1 1 SD. 1- 1- 1- 1

04.06.2011 dysponea better, chest pain better, pain in both elbow joint better, fever better. App-N Thirst-I Sleep-G Stool-R Urine-N Sweat-N

B.P.110/76 mm of hg. pulse 104/min Temp 99.4F PL 10ml aqua 10gtt x 3hourly SL. 1 1 1 1 SD. 1- 1- 1- 1

05.06.2011 dysponea better, chest pain better, pain in both elbow joint better, fever better. App-N Thirst-I Sleep-G Stool-R Urine-N Sweat-N

B.P.110/76 mm of hg. pulse 104/min Temp 99.4F PL 10ml aqua 10gtt x 3hourly SL. 1 1 1 1 SD. 1- 1- 1- 1

06.06.2011 dysponea better, chest pain better, pain in both elbow joint better, Fever better. App-N Thirst-I Sleep-G Stool-R Urine-N Sweat-N

B.P.110/76 mm of hg. pulse 104/min, HR 107, Oxygen saturation 93 Temp 99.4F PL 10ml aqua 10gtt x 3hourly SL. 1 1 1 1 SD. 1- 1- 1- 1

07.06.2011 dysponea better, chest pain better, pain in both elbow joint better, Fever increased, vertigo persist. App-N Thirst-I Sleep-D Stool-R Urine-N Sweat-N

B.P.108/86 mm of hg. pulse 104/min, HR 107, Oxygen saturation 93 Temp 99.4F PL 10ml aqua 10gtt x 3hourly SL. 1 1 1 1 SD. 1- 1- 1- 1 09.06.2011 dysponea better, chest pain better, pain in both elbow joint better, Fever increased, vertigo persist. App-N Thirst-I Sleep-D Stool-R Urine-N Sweat-N Rx Bry0/6 / 1d Sos

B.P.108/86 mm of hg. pulse 104/min, HR 107, Oxygen saturation 93 Temp 100F Rx Bry0/6 / 1d Sos

10.06.2011 dysponea better, chest pain better, pain in both elbow joint better, Fever increased, vertigo persist. App-N Thirst-I Stool-R Urine-N

Sleep-D

Sweat-N

B.P.108/86 mm of hg. pulse 104/min, HR 107, Oxygen saturation 93 Temp 100F Rx Bry0/6 / 1d Sos

11.06.2011 dysponea better, chest pain better, pain in both elbow joint better. App-N Thirst-N Sleep-D Stool-R Urine-N Sweat-N

B.P. 110/72 mm of hg. Pulse 104/min, HR 107, Oxygen saturation 93 Temp 98.6F Oxygen saturation 95 HR 118 Rx Bry0/12 / 1d sos PL 10ml aqua 10gtt x 3hourly SL. 1 1 1 1 SD. 1- 1- 1- 1 Here we focusing on importance of increasing potency. Not only medicine ,potency can play role in improvement of patient.here in this case after o/12 patient got rapid relif.

12.06.2011 dysponea better, chest pain better, pain in both elbow joint better. App-N Thirst-N Stool-R Urine-N

Sleep-D

Sweat-Increased whole body

B.P. 110/72 mm of hg. Pulse 106/min, HR 107, Oxygen saturation 93 Temp 98.6F Oxygen saturation 95 HR 118 PL 10ml aqua 10gtt x 3hourly SL. 1 1 1 1 SD. 1- 1- 1- 1

13.06.2011 dysponea better, chest pain better, pain in both elbow joint better. App-N Thirst-N Sleep-D Stool-R Urine-N Sweat-Increased whole body

B.P. 110/80 mm of hg. Pulse 100/min, HR 107, Oxygen saturation 93 Temp 98.6F Oxygen saturation 95 HR 118 PL 10ml aqua 10gtt x 3hourly SL. 1 1 1 1 SD. 1- 1- 1- 1 Rx Bry0/12 / 3d sos SL. 7d

SG. 3 3 3 SD 1 1 1 Improved and discharged.