SOLUTION 1

SOLUTION DATE 8:00 am Ms Charlene 14 year old girl who is a known case of Chronic kidney disease due to inherited pathology is alert & awake. Pallor, bilateral pitting edema on lower limbs & facial puffiness is present. Breath sounds are quite normal and respiration is normal. Heart sounds heard normally. Bp 90/60 mmHg. P/R = 80 Spo2 = 98% Dialysis shunt is present in the left forearm. Current mood is unpleasant and with sad facial expressions. Speech out put is reduced. H/o low physical activity & decresed food intake as per history given by mother. She complaints of decreased appetite & decresed interest in keeping body healthy. On asking about reason for unhappiness she said, she hates her disease problem and think she is different from her friends. A detailed discussion is planned at 11am according to patients desire. 11 am Ms Charlene is anxious about her disease condition. She worries that she may become sick on coming days. She has less knowledge about her disease condition & treatment. Increased anger noticed while explaining how she is different from her friends. Helped her to get information regarding her disease & renal dialysis by written short notes. She is enthusiastic towards advanced treatment modality such as Renal transplant. Detailed explanation about peocedure, guidelines , prognosis & complications has given to her. Tried to answer maximum queries put forward by her. She was cooperative & attendive during discussion. At the end of conversation she is quite happy & agreed to eat some food later.