Clinical Book
Primary Health
&
Mother & Child Health
Clinical Book
List of diseases & conditions encountered in Primary Healthcare Centre
- Fever
2. Headache
3. Conditions relating to Respiratory System
q Upper respiratory tract congestion.
- Cold & Flu
- Sore Throat
q Upper respiratory infections
- Tonsillitis
- Pneumonia
- Bronchitis
- Asthma
- Viral Infection
4. Conditions relating to Gastro- Intestinal Tract
q Dyspepsia
q Epigastric Pain
q Vomiting
q Pain abdomen
q Appendicitis
q Dehydration
q Jaundice
5. Conditions relating to Cardiovascular System
q Hypertension
q Chest Pain
6. Conditions relating to Urinary Tract System
q Burning micturation / Dysuria
q Renal colic
q Urinary tract infection
7. Conditions relating to Eye
q Simple conjunctivitis – allergic
q Bacteria conjunctivitis
q Cataract
8. Conditions relating to ENT
q Tonsillitis
q Otitis – Externa & Media
9. Conditions relating to Skin
q Allergic Rashes
q Eczema
q Dermatitis
q Scabies
q Boils
Details
Fever:
I Patient’s history of fever to be taken
- For how many days
- Continuous, high or low
- Associated with rigors or
- Associated with other systems of body
- e.g.: Respiratory, Digestive or Urinary Tract, then treat accordingly.
II - If fever is high grade and accompanied with rigors and occurs on
alternate days
Diagnosis: Malaria
Malaria
Treatment:
o Urgent Lowering of down temperature by cold sponging
- Antipyretic – Paracetamol, Panadol, Brufen. Syrup or Tablets
according to the age of patient
- If facilities are available then send blood sample for blood test for malarial parasite
- Start anti-malarial drug.
Tab. Chloroquin = 4 stat and then 2x OD x 3 days
III - If pattern of fever is continuous and with evening rise of temperature daily
- Duration – more than a week
- Associated with:
- Vomiting
- Vague abdominal pain
- H/o weight loss
- Loss of appetite
Diagnosis: Typhoid Fever
Typhoid Fever
- Investigations ——> If available
Blood for typhi dot and widal test.
Treatment:
- Bed Rest
- Antipyretics
- Antibiotic —- Oral Depending
—- Injectable upon the clinical condition
- Ciprofloxacin 500 mg.
1 + 0 + 1 = 07 – 10 days for adults.
- For Children: Syp. Cefexime (broad spectrum)
- 1 TSF x BD x 07 – 10
or 10 mg. / kg. / dose X BD
Headache:
- Take history and do physical examination to look for the cause
History of Patient:
- Enquire about eye – sight
- Flue & Cold
- H /o Hypertension
- About sleeping habits
- Any mental stress
- Dietary habits
Physical Examination:
- Must check the Blood Pressure & other systems of body
Treatment:
If everything is normal then:
- Reassurance
- Simple analgesic to relieve the pain
- Increased water intake
- Proper balanced diet
- Proper sleep
- Otherwise treat according to the cause of headache
RESPIRATORY SYSTEM
Cough & Flu:
History:
- Duration
- Nature of cough
- Associated with fever
Physical Exam:
- No sore throat
- Simple cough and flu.
Treatment:
- Reassurance
- Avoid cold and sour food
- Antipyretics and Anti-allergics
- High protein diet.
Sore Throat / Tonsillitis:
I. Symptoms:
- Pain on drinking
- Associated or not associated fever
Signs:
- Slight redness of the throat or tonsils.
Diagnosis:
- Viral Sore Throat
Treatment:
- Reassurance
- Analgesics
- Soft food and fluids
- Soothing remedies (warm saline gargles)
Acute Tonsillitis / Streptococcal Sore Throat
Symptoms:
o Difficulty in Swallowing
- High grade fever
- Along with above mentioned symptoms in viral sore throat
Signs:
- Enlarged tonsils with exudates
- Tender and enlarged lymph nodes on the neck
Treatment:
- Analgesic and Antipyretic (Brufen Tab. & Panadol)
- Antibiotic
- Safe, Soothing remedies for sore throat.
III. Symptoms:
- Unable to drink
- Swelling on one side of face and neck
- High grade fever
- Tender enlarged lymph nodes on the neck
- White exudates from throat in / peritonsillar region.
Diagnosis:
- Throat abscess / Peritonsillar abscess
Treatment:
- Injectable antibiotics and analgesics
- Refer to hospital to concerned specialist for further treatment.
Viral Infection relating to Respiratory System
q Mumps
q Measles
q Chicken Pox
MUMPS:
Signs & Symptoms:
- Painful swelling on face in front of ear bilaterally or may be on one side
- Fever
- Difficulty in swallowing
Treatment:
- Analgesics
- Antipyretic
- Antibiotic to avoid secondary infection
MEASLES:
Signs & Symptoms:
Classical symptoms of measles include:
- 4 days fever
- 3 Cs = cough, coryza and conjunctivitis
- Fever may reach up to 104 F.
- Koplik’s spots seen inside the mouth are diagnostic of measles
- Generalize maculopapular rash starts at head before spreading to cover most of the body.
Treatment & Prevention:
- Isolate the child from other house hold members
- Antipyretic and Analgesics
- Anti Allergies
- Antibiotics to avoid secondary chest infection
- High protein diet.
Prevention: Vaccinate the child at 18 months with MMR (Measles, Mumps & Rubella)
CHICKEN POX:
Sign & Symptoms:
- Vesicular Skin rash first appears on the trunk (abdomen) and spreads to the peripheral parts of body
- Rashes appear in crops means that when new rashes appear the previous start drying up and become black and scales formed.
- Itching on the rashes
- Associated with high grade fever
Treatment:
- Isolation
- Antipyretics
- Anti Allergic
- Gentian violet to reduce itching /Calamine Lotion
- Antibiotic to avoid secondary chest infection
- High protein diet
- Avoid cold and sour food items
- Good hygiene in another important step.
PNEUMONIA:
Inflammation of lung parenchyma
Clinical Features:
- High grade fever
- Shaking chills
- Drowsy, restless
- Tachypnia
- Dry unproductive cough
- Dysnea and flaring of ala-nasi
- Expiratory grunting
- Inter costal and sub costal recession
Treatment:
- Bed rest and good diet
- O2 inhalation
- Syrup Panadol or Syrup Brufen
- Ampicillin or Amoxicillin for two weeks.
Danger Signs:
If condition worsen , refer to hospital
ASTHMA:
Asthma is a common chronic inflammatory disease of the airway characterized by variable and recurring symptoms, airflow obstruction and bronchospasm
Symptoms include:
- Wheezing
- Cough
- Chest tightness
- Shortness of breath
Signs:
Because of the spectrum of severity among asthma patients, some people with asthma only rarely experience symptoms, usually in response to triggers, whereas other more severe cases may have marked airflow obstruction at all times.
Asthma exists in two states:
- The steady state of chronic Asthma
- The acute state of an acute asthma exacerbation.
The signs & symptoms are different depending on what state the patient is in:
| Sign/Symptom | Mild | Moderate | Severe | Pending arrest |
| Alertness | May show agitation | Agitated | Agitated | Confused/Drowsy |
| Breathlessness | On walking | On talking | Even at rest | |
| Talks in | Sentences | Phrases | Words | |
| Wheeze | Moderate | Loud | Loud | Absent |
| Accessory muscle | Usually not used | Used | Used | |
| Respiratory rate (/min) | Increased | Increased | Often >30 | |
| Pulse rate (/min) | 100 | 100-120 | >120 | <60 (Bradycardia) |
Treatment:
- Nebulization
- Aminophyline
- Adrenaline
Mild Cases:
- Nebulization
- Aminophyllin
- Otherwise refer her / him to main hospital after nebulization and patient gets stables.
DANGER SIGNS FOR REFERRAL TO HOSPITAL
- Cyanosis
- Unable to feed
- Silent Chest
- Respiratory rate —> 50 beats / min
- Drowsy
- Pulse —> 140 beats / min
PREVENTION:
- Avoid the trigger allergy desensitization
GASTROINTESTINAL CONDITIONS
It is characterized by chronic or recurrent pain in the upper abdomen, upper abdominal fullness and it is companied by Dyspepsia.
- Burning sensations in the epigastria
- Retching
- Belching and bloating
- Feelings of indigestion
- Flatulence
Dyspepsia is a common problem and is frequently due to gastro esophageal reflux disease (GERD) but in small minority may be the first symptom of peptic ulcer disease and occasionally cancer. Hence unexplained newly onset dyspepsia in people over 55 or presence of other alarm symptoms may require further investigation.
Treatment:
- Carminative Mixture
- Antacid – Tab. Gelusil, Trisil etc.
- Short Meal – Short Intervals
- Avoid Spicy and Oily Food.
Epigastric Pain:
Sign & Symptoms:
- Pain in epigastrium , assess the intensity of pain
- Association of pain with meals
- Associated with vomiting
- If vomiting contain blood stains or blood
- Patient gives H/o black stools
- Loss of appetite
- Pale looking
Diagnosis: Peptic Ulcer
Peptic Ulcer
Treatment:
- Give – Antipeptic ulcer drugs
H2 Receptor Beta Blocker} 4-6 weeks
Proton Pump Inhibitor} 4-6 weeks
- No spicy or oily foods
- Refer the patient to the hospital for specialist for specialized treatment.
GASTRO-ENTRITIS (DIARRHEO + VOMITING)
- Frequent passage of stool
- Consistency of stool
- Associated with pain
- Associated vomiting
IN CASE OF INFANT:
Ask the mother or whoever brought the baby:
- Is the baby is on breast feed or being fed on any other food or fluid
- What does the baby stool look like
- Is it watery, loose or semisolid
- Color of the stool, green, mucous or blood stained
- How frequently the baby is passing the stool.
Danger signs for referral to Hospital
- Child become unable to drink
- Becomes more sick
- Develop fever
- Has blood in stool
| SIGNS | CLASSFICATION | TREATMENT |
Three following signs:
|
Severe Dehydration | Give I/V fluids |
Three of the following sign:
|
Some Dehydration | Give ORS in clinic or Home
- continue breast feeding - tell her danger signs - follow up in two days |
No enough signs to classify as
|
No Dehydration | Give ORS at Home
- tell her danger signs - follow up in two days |
PAIN ABDOMEN:
Nature of Pain
Dull ache
Continuous or Intermittent
Colicky
Intensity
Mild
Moderate
Severe
Duration
Hours
Days
Weeks
Region
Upper Abdomen
Epigastic
Rt. Hypochondrium
Middle
Lumber region
Lower Abdomen
Right Iliac Fossa
Hypo gastric Region
Associated with:
Meals
Diarrhea
Vomiting
Burning Micturation
Fever
In Females:
Association with menstruation
Any association with pregnancy —– > will be discussed in separate section
Diagnosis:
If generalized and associated diarrhea, vomiting and fever.
Then rule out:
Typhoid
Gestroentritis
Food poisoning
Treatment:
Typhoid already explained
In case of gastroentritis and food poisoning
Rehyhrate with ORS or Intravenous Fluids
Anti-diarrheol drugs
Antibiotic – Injectable / Oral (depending upon the clinical condition)
Light, Soft and chilli free diet
Upper Abdomen:
Epigastric region then dyspepsia and peptic ulcer (treatment already explained)
Right Hypochondrium:
Acute / Chronic Cholecytitis depending upon the clinical condition.
Advice the patient for further investigation from hospital and refer the patient to
concerned department .
Middle Region:
Lumber Region – Renal Colic
Treatment:
Antispasmodic injectable /oral depending on the condition of the patient.
1/V fluids / oral fluids
Advise Urine D/R
If it contains pus cells, then advise urine for culture / sensitivity and start antibiotics.
Lower Abdomen:
Right iliac fossa – appendicitis
Patient will present as:
Pain right iliac fossa
Fever low grade
Vomiting
If all these signs and symptoms are associated with H/O syncopal attacks or pallor then urgently refer the patient to hospital to be seen by surgeon in emergency.
Otherwise: Patient can be given:
Symptomatic treatment and can be called for follow up after 2 days with the advise that if pain or any other symptom does not subside, their report directly to the hospital in emergency department.
HYPOGASTRIC REGION:
Pain can be due to:
Urinary tract infection
Cystitis
Urethirtis
Sign & Symptoms:
Pain will be associated burning micturation or dysuria or frequency of micturation.
Treatment (as given in Renal Colic / UTI)
EYE RELATED PROBLEMS
Conjunctivitis:
- Allergic
- Bacterial
Patient will present with:
Redness of eyes and swelling of eye lids
Excessive watering of eyes
Itching may or may not be present
Or there may be purulent discharge
Treatment:
Warm saline eyewash
Simple anti allergic drugs.
In case of purulent discharge local antibiotic drops to be added.
Follow up after 2 days, if no relief, then refer the patient to eye specialist.
Cataract:
It can easily be examined and diagnosed in the Primary Health Centre.
Presenting Complaints:
Cloudy or Blurry Vision.
Double Vision or Multiple Image in one Eye.
Predisposition Factors:
Patient suffering from Diabetes Mellitus
Personal behavior such as smoking and use of alcohol
The environment such as prolonged exposure to light.
Test to diagnose cataract in PHC:
Visual acuity test:
This eye chart test measures how will you see at various distances.
Treatment:
Once suspicision of cataract or diagnosed refer the patient to eye care professionals to further diagnose and treat the patient in expert hands.
EAR RELATED PROBLEM
Epistaxis:
This condition refers to nasal bleeding of any cause. Most expistaxis are minor or major and insignificant but it may be severe and life threatening and it can be indicative of more serious diseases. All bleeding occurs as a result of disruption of intact nasal mucosa.
Causes:
- Trauma (direct blunt trauma)
- Nose picking
- Dry weather esp. in winter months
- Cocaine snorting
- Inflammation
- Neoplasm (any growth in nose)
- Hypertension
- Pregnancy
Signs:
Bleeding from Nose
Treatment:
- Calm the patient if necessary with medication.
- The patient should sit with the upper part tilted forward and the mouth open so that they can spit out the blood instead of swallowing.
- Check to see if there is any object inside the victim’s nose and remove it if necessary
Local Procedure:
- Pinch all the soft parts of the nose together between the thumbs and index fingers. Hold the nose for at least 5 minutes (timed by clock)
- Repeat as necessary until the nose has stopped bleeding.
- Apply ice (crushed in plastic bag or wash cloths) to nose and cheeks.
- For dryness of nose ointments can be applied.
- Nasal packs are used when conservative methods fail.
- Cauterization may be required if bleeding persists or recurs.
OTITIS (EAR INFECTION)
It can be externa or media.
OTITIS EXTERNA:
It is an inflammation of the ear canal caused by infection with bacteria or fungus.
Symptoms:
The major symptoms are:
- Itching in the ear canal in early stages.
- Ear pain that may worsen when pulling the ear lobe.
- Discharge of pus or fluid from the ear canal.
- Redness and swelling of the ear canal
- A small, painful lump or boil in the ear canal.
- Temporary heavily loss due to pus accumulation in the ear canal
- Fever
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