COMMUNITY

AND
FAMILY CASE STUDY
(CFCS) REPORT

THEME 2

BY

NAME : KIRBASHINI KANASAN

STUDENT ID : ME 0813034055
BATCH : C 2/16
PARTNER : NG REN ZEN
TUTOR : DR AJITH KUMAR

HOME VISIT REPORT

My partner, Ren Zen and I visited our patient, Mr. Saravanan on the 21 st February
2017, which was on a Tuesday. We arrived at his resident around 9.00p.m. He just
came back from his work and took his bath. Meanwhile his wife served us drink and
we had a casual talk with his wife and children. Initially our meeting was supposed to
be at 8.00pm but Mr.Saravanan forgot so we ended up meet started our visit at 9pm.
As usual we were given a warm welcome despite the time constraint. We started off
by enquiring his medical check-ups and proceeded with his food beliefs, how he
copes with his illness and generally touched on how his life has been lately. Later,
we performed a full and relevant physical examination on him. Before leaving, we
told him that we would be coming back to visit her in the middle of month of March
with our CSSC sister. The home visit session took around 2 full hours. We then left
the house around 10.30p.m.

PATIENT PROGRESS

Records of Mr Vasus latest follow up at Klinik Kesihatan Seremban are noted below.
There has been increase in his medication dose. Insulin Actrapid has been increased
to 28 units from 24 units three times daily. Insulin basal has been raised to 32 units
from 30 units.

03rd January 2017

03/09/16 03/01/17
Body Weight (kg) 125 126
BMI 39.4 39.7
Waist Circumference 133 138
Blood Pressure 118/68 139/81
Fasting Blood Glucose 13.5 17.3
Pulse Rate 105 98

PHYSICAL EXAMINATION FINDINGS

Vital signs
Temperature : 36.2 degree Celcius
Pulse rate : 96 beats/min, regular rhythm, strong volume
Respiratory rate : 22 breaths/min
Blood pressure : 132/92 mmHg

General Examination

On general inspection, he was comfortable and not in any obvious pain. His hands
were warm and dry. Capillary refill was less than 2 seconds which is normal. No
clubbing or pallor of the palmar crease. No pallor at the conjunctiva or icterus at the
sclera. There was no pedal oedema.
Cardiovascular Examination

No chest deformities, surgical scars or visible pulsations noted. No raised JVP. Apex
beat palpable at left 5th intercostal space 1cm lateral to the midclavicular line. No
palpable thrills or heave. On auscultation, 1 st and 2nd heart sounds were audible. No
additional sounds or murmurs heard.

Respiratory Examination

Trachea was centrally aligned. Chest expansion and tactile fremitus were normal and
equal bilaterally. Percussion note were resonant and equal on both sides. On
auscultation, vesicular breath sounds heard. Air entry was equal on both sides. No
additional sounds heard.

Abdominal Examination

Abdomen was grossly distended (generalized). No visible veins or scars present.

Abdomen was soft and non-tender on palpation. Liver, spleen and kidney were not
palpable. Normal active bowel sounds heard.

Peripheral Vascular Examination

Upon inspection of the legs, muscle wasting was noted over the right leg. Otherwise
no rise in temperature, no swelling or shiny skin, no loss of hair, capillary refill was
within 2 seconds. Peripheral pulses could be appreciated, but reduced volume over
the right side. Distended veins could be appreciated bilaterally.

Neurological Examination

Light touch, pain, vibration and proprioception was intact bilaterally. No signs of
glove-stocking neuropathy.
Section B: Family & Community Perspective & Preventive Care of Index
Patient

Theme 2: Illness Behaviour, Self-Care, Complementary Medicine and Culture

Aspect of Health Care
A) Illness Behaviour and Self-Care

Mr Vasu rarely falls sick, if so he does not seek medical attention. Usually he will
consume medications on his own. He once went to Chinese medicine for his
cholesterol and hypertension. He claimed he felt better after consuming those
medications but due to financial constraint he had stopped. Currently he claimed
that, he is not compliant to his medications as he became very forgetful lately and
sometimes he skips the dose in the morning as he rushes to the work. Recently he
has visited Batu Caves in conjunction Thaipusam. He was able to climb up the stairs
and he was very surprised and happy as he did not develop angina pain. But as
soon as he came he has muscle sprain over the right thigh and it disappeared after
putting hot sponge. Mr. Saravanans wife complained of blurring of vision due to
reduced sleeping hours.

B) Food Beliefs

Mr.Saravanan consumes a fairly balanced diet and according to him he has reduced
consuming outside food and has reduced intake of tea. He only consumes tea with
condensed milk twice in a month. He does not consume beef and pork due to
spiritual purposes. He also claimed that he gets hungry very often and devours at
least 6 meals a day, to avoid such situation he sleeps early. He only takes outside
meal when he is away for work. He works nearly 12 hours a day

C) Complementary Medicine

Mr Saravanan has been indulging few herbal products and traditional medicine
which was introduced by his elder sister. She was also diagnosed with diabetes
mellitus but at present it is well controlled. As mentioned earlier he was taking
Chinese medicine but stopped due to financial issues. Currently, he is taking dry
murungaka seeds in order to reduce blood sugar level. He takes 5 seeds in the
morning and 3 seeds for dinner. There are some days he misses but so far he does
not sense any changes. Apparently, his sister managed to bring down her blood
sugar level to normal range after consuming this. Besides that, he also consumes
black pepper soaked in warm water. He takes twice a week. This remedy was
introduced by the wife which she witnessed in a television programme recommended
by western doctor in order to reduce cholesterol. He affirmed that he feels energized
the next day but he was worried that his body might get heated up.