Emphysema

Need full description about your body and mind.
Sleep, appetite, thirst, likes and dislikes of foods, weather etc.
Behaviour with others.
How everyone behaves with you and cause if any. etc. etc.

it is serious disease require full case taking
know about disease that Emphysema is a lung condition that causes shortness of breath. In people with emphysema, the air sacs in the lungs (alveoli) are damaged. Over time, the inner walls of the air sacs weaken and rupture — creating larger air spaces instead of many small ones.

pls input the following detail..


Name : (Mr./Mrs./Miss/Mast/Baby) First Middle Surname.
Date of Birth : Age Sex : S/M/U/W LMP
Blood Presser…………………. Height…………………….. Weight………………………WBC……………..TSH……….
Country
Blood Group: Mob:

A. K/C/O : [Duration is important. e.g. HTN since 2 yrs. etc.]
B. Investigations :
Date : Haemogram / Blood Report/ Urine Report/ CT scan/ MRI/USG Abdomen & Pelvis/ Thyroid Function Test, etc.
Write any abornomality:

C. Chief C/O: Write the complaints with sides & duration.
Give them separate nos. [e.g. 1] Abdominal pain(Rt. side)Since 8 days. Etc.
Please start with History of C/C : How complaints started?



H/o C/C : Write every complaint individually with-
Onset, decline, causation.
Side.
Location& Extension
Character of Pain.
Duration of Pain.
Sensation.
Modalities : Movements/ Positions/ Thermals/ Food Habits/ Seasonal/
Time
Concomitant.
Complain
1
2
3
D. Ask for any recurrent complaint. Ex. Fever, Cold, Coryza.
E. Past H/o : Any major illness (along with side if present) e.g. H/o Typhoid/ Malaria / Jaundice/
Fracture/ Fall/ Injury/ Accident.
And H/o Vaccination – Hepatitis B / Dog bite Vaccination, etc.
F. Family H/o

G. Physical Generals :
• Habit : Alcohol / Drugs/ Smoking/ Tobacco, etc. (Since how many tears?)
• Diet : Veg./ Mixed.
• Appetite : Any alteration?
Whether patient can tolerate hunger?
• Desire : With reference to taste and not any particular food item. e.g. Sweet, Pungent, Spicy,
Sour, Fatty(Oily, ghee), Non- veg, milk, milk products, tea, coffee, Vegetables, Fruits, Ice Cream, Cold Drinks etc. is important. Also ask for any desire for indigestible food items.
• Aversion : Main taste e.g. Sweet, Sour, Fatty, Non-veg etc. is also important.
• Food :
• Head :
• Eyes :
• Ears :
• Nose :
• Mouth : any odour
• Tongue : Dry/Moist/ Coating/ Cracked/ Fissured/ Imprints of teeth
• Thirst : Thirsty/ S.Q.S.I./L.Q.S.I./Thirstless.
• Teeth : Carries of teeth.
• Gums : Bleeding Gums.
• Taste : Any particular taste in mouth
• Throat :
• Chest :
• Stomach/ Abdomen :
• Bowel : Character of stool is important. Dry/ Hard/ Soft/ Loose. Color, Smell, Straining or not? Etc.
• Bladder:
• Skin :
• Chest& Back :
• Extremities:
Upper Extremities:
Lower Extremities :
• Perspiration :
Scanty/ Profuse. On which part of the body?
Stain /Odour.
Hot/ Cold sweating.
• Sleep :
Time : Daytime any sleeping habit / Night time sleep hrs.
Sound/ Natural
Refreshing/ Unrefreshing
Startles/ Snoring
Position : Whether lies on back / sides-which side ?
Covering
Bed+ Pillow
Talking/ Walking sleep during?
Eyes open / closed sleep during.
• Dreams :
• Female:
Menstrual History
i. Menarche
ii. Duration of cycle
iii. Color of discharge/ Any clots, etc.
iv. Smell
v. Any pain Before / During etc.
• In General Discharges : Color/ Smell/ Quantity –scanty/ profuse etc. (very important)
H. Mind :
• Education :
• Occupation : (Working / Retired)
• Childhood at which place? –City/ Town
• Marital Status : Married / Unmarried
• Childhood :
Family : Joint / Separate
Financial Condition : Sound/ Poor/ Rich etc.
About Study:
Nature : Obstinate/ Mild/ Pampered/ Short Tempered/ Irritable.
Desires Company or Not?
Close to?
Fear of/ Stage courage
Playful/ Studious.
Any impactful/ disturbing incidence in childhood.
Angry when? How is it expressed ?
Timid / Daring.
Ambition.
• After Marriage.
(Suppression injustice and relation with inlaws, Adjustment)

• NOW :
Specially ask about main feelings : Anger, Sadness, Hypocrisy, Jealousy, etc. (Please, write in Rubric form)
Family: Joint / Separate
Financial Condition : Sound / Poor/ Rich etc.
Mild/ Short Tempered
Angry when ? How is it expressed?
Talkative/ Less talkative.
Jolly-Jesting/ Submissive
Affectionate / Reserved/ Censorious.
Reaction to Jesting
Reaction to Criticism.
Reaction to Reprimand
Reaction to Mortification
Any major conflicts
Sympathy about ?
Helping nature?
Desires Company?
About Cleanliness.
About Time Punctuality.
About Religiousness.
Reaction to Lie & Injustice.
Fears ? (Being alone, Dark, Water, Height, Quarrel, Exam, Robbers, Animals, Downward Motion)
Sensitive (Physically & Emotionally)
Happy When?
Sad when?
Weeps when?
Consolation.
Hobbies?
About Social Activities.
Lazy/ Workaholic.
Industrious ?
Duty Bound?
Relation with others :
 Husband/ Wife
 Son / Daughter.
 In-laws.
 Friends.
 Colleagues, etc.
• A/F :
oAnxiety about what ?
Loan, Court case, Money, Future, Health, Disease, Death, Job, Settlement, Children.
Any Anticipatory Anxiety
Death of Relatives :
Reaction : Grief, Sad, Forsaken, Helpless, Weeping.
Any Insecurity
Perfectionism.
Fall/ Accident/ Injury/ Fracture/ Sprain/ Loss of fluid.
Overexertion.
Brooding.
Suppression of anger.
Any major setback in life.
Your Observation(Physical Appearance/Dressing).
Thermals :
Summer Winter
Bathing Hot / Cold / Luke Warm Hot / Cold / Luke Warm
Fanning requires or not? requires or not?
Covering Thick / Thin? (1 or 2,etc) Thick / Thin? (1 or 2,etc)
• Open air : desires or not
• Require Sweater in Winter ?
• Chills begin from which part?
CHILD
• K/C/O
• Investigations :
• Chief C/O: [Duration is important. e.g. Abdominal pain since 8 days.etc.
• H/o C/C
Onset, decline, causation.
Side
Location & Extension.
Character of Pain.
Duration of Pain.
Sensation.
Modalities : Movements / Positions / Food Habits / Seasonal /
Time
Concomitant.
• PAST HISTORY :
 H/O Mother History during pregnancy
 Mode of delivery.
 Immediately cried or not.
 H/O Milestones (talking/walking)
 H/O Vaccinations
 H/O Illness
• IDENTIFY
SOCIABILITY-
Approach/Withdrawal/Adaptability/
ACTIVITY -
Level of Activity
Threshold of responsiveness(sensitivity)touch/taste/smell/hearing/vision)
Intensity of Reaction
Rhythmicity
Distractibility
Attention Span & Persistance
AGRESSION (Destructive /Non Destructive)-
RESPONSE TO STIMULI-
• PHYSICAL GENERALS :
THIRST
• Habit :
Eg.
 Nail Biting .
 Thumb sucking.
 Putting anything in mouth.
 Hair Rattling.
• All remaining things are same as for the adults.( Diet, appetite….etc.)
• MIASM :
• PHYSICAL CONSTITUTION
• MIND
 Family –Joint/Nuclear
 Financial condition of family.
 About studies
 Nature-Mild / Short Tempered / Obstinate / Pampered / Irritable.
 Angry When ? How is it expressed?
 Talkative / Reserved.
 Submissive?
 Timid / Daring.
 Close to Whom?
 Fears?
 Carrying :
 Precocity?
 Desires for company or not.
 Hobbies : Music / Dancing / Playing.
 Dominating.
 Active / Passive.
 Decisive / Indecisive.
 Stage Fear?
 Performance
 Happy / Sad When?
 Reaction to jesting, Criticism.
 Envy Feeling.
 Religious or not.
 Memory.
 Lazy, Fastidious.
 Subject of interest / Difficulty.
Thermals: Summer Winter
• Bathing Hot / Cold / Luke Warm Hot / Cold / Luke Warm
• Fanning requires or not? requires or not?
• Covering Thick / Thin? (1 or 2,etc) Thick / Thin? (1 or 2,etc)
• Open air : desires or not
• Require Sweater in Winter ?
• Chills begin from which part?
Fever
 Temperature
 Heat
 Perspiration –Mostly on which part of body.
 Chills
 Thirst during fever.
• Active / inactive