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78 year old lady in care home - Coggle Diagram
78 year old lady in care home
Presenting condition
Purulent vaginal discharge
Dysuria
Flu like symptoms
Hx of PC
intermittent vaginal discharge- resolves with flagyl
weight loss
reduced intake- over
PMHx
Bladder Stone (2019)
Oesophagitis (2017)
CKD stage 3 (2014)
COPD (2000)
Dementia (2019)
Right breast cancer (2001)
Hypertension (1998)
lobular carcinoma (2001)
Surgical Hx
Bilateral salpingoopherectomy (1997)
Hysterectomy (1984)
cancer chemotherapy (2001)
Investigations Hx
Chest x-ray (2019)- no masses
CT Colon (2017) - atrophic changes to kidneys
CT Thorax and Abdomen (2019)- bladder stones
Biochem
09/21- egfr 24, creatinine178, urea 10.5, cl 109. 07/21 -Vit D- N. PTH -10.6 High (?CKD), Bone Profile Low Albumin (red intake).Urine protein high, ACR high (?ckd) Lipids N, Glucose &. TFTs - N. LFTs (01/20)- low albumin
Haematology
Jul 21- FBC - RCC 2.92-L, Hb 95 L, Haematocrit 0.298 L, MCV 102.1 H, MCH 32.5 H, Platelets, neutrophils, lymphyocytes, eosniphils, basophils, nucleated RBC N
Jan 19 - folate N, B12 N, Ferritin 436 H
Jan 19- ESR N
Microbiology
MSU- 08/21- heavy growth
Vaginal Swab (2010)- scanty growth
Active referrals
Urology
Renal Team
Dhx
NKDA
Atorvastatin, Clopidogrel, colecalciferol. ferrous fumarate, lansoprazole, paracetamol, mirtazapine, peptac acid, salbutamol inhaler
ABx Hx - flagyl 08/21 and 04/21 Trimethoprim 06/21
Red Flags- unplanned weight loss, recurrent vaginal discharge, abdominal pain, deteriorating kidney function, previous Ca diagnosis
SHx
Care Home Resident
Daughter POA
Non Smoker
Has capacity
Retains capacity
For active treatment
DDX
Bladder stones
Underlying malignancy
UTI
deteriorating CKD
Plan
Vaginal Discharge
Bloods
High vaginal swab
Dysuria
MSU
Analgesia
Increase Fluids
Weight loss
Bloods
MUST step 5
Weekly weight, F& F charts, food fortification, if after 4 weeks weight loss continues- Dietetic referral
Assessment
Chest- clear, calves soft and non tender
Abdo- tender on light palpation- suprapubic area and left iliac fossa. Bowel sounds present, no organmegaly. No bruits, renal tenderness
Observations- stable
H/S I and II heard
Relection
assessment of lymphadenopathy
re refer to urology for bladder stones
further discussion with GP once results available
? treat susp UTI or not
qfit- if Hb lower
ca 125 n/a, pmhx hysterectomy and oopherectomy
? urgent cancer referral
Reference
CKS NICE
Cancer pathway
Lab Values