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Clinical Book

Primary Health

&

Mother & Child Health

Clinical Book

List of diseases & conditions encountered in Primary Healthcare Centre

  1. 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:

oUrgent 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:

  • Lethargic or Unconscious
  • Sunken eyes
  • Skin pinch goes back slow
Severe Dehydration Give I/V fluids
Three of the following sign:

  • Restless, Irritable
  • Sunken Eyes
  • Skin pinch goes back very slowly
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

  • Some / Severe Dehydration
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