Ms Angel Philip
Community Health Nurse
20 July 2019
Re: Mrs Joanna Johan, aged 40
Mrs Johan, who is to be discharged today following admission on 15/7/19, due to pregnancy induced hypertension and gestational diabetes mellitus, result in generalised edema as wll as palpitation.
She had an abortion and history of cesarean section. Also provided with counselling for post partum psychosis. Apart from these, had anemia during first pregnancy therefore, blood transfusion had been done.
On examination, Blood pressure: 160/ 100 mm/hg, and pulse rate: 114 beats/ min. has been noted. Likewise, random blood sugar level: 300, mg/dl; TSH: 6 mU/L has been noticed.
Sudden loss in weight by 8 kg has been observed.
Has been commenced on some medication such as: Labetalol, 100mg, Once in a day; Metformin, 500mg, twice a day; Qten,10mg, SOS; Iron and calcium supplements.
Eventually during the hospitalization improvement has been observed therefore, ready to be discharged. However, still require supervision by a community health nurse for: routine supervision of vitals.
Do provide education regarding administration fo insulin by self. Likewise do monitor the dietary pattern, and if alteration in weight seen please do inform us.
Make sure thyroid stimulating harmone levels will be checked by upcoming week as the next routine check up visit scheduled on 28/7/19.
If you have any further query, please let me know.
Care Well Hospital