Page 11 - Learnwell EVS
P. 11
Introduction
A few rules
– A system atic ap p ro ach red uces o m issio ns and saves tim e.
– A n interp reter m ay be need ed ; h o w ever, translatio n d o es no t alw ays accurately
reflect the co m p laints o f the p atient. L earning the nam es o f the m ain clinical signs
and co m m o n d iseases in the lo cal language help s o verco m e this p ro blem . T he
cho ice
o f an interp reter m ust tak e into co nsid eratio n the sex (e.g. a fem ale fo r gynaeco lo gy
and o bstetrics) and the accep tability by the p atient (resp ecting co nfid entiality).
The examination
– Physical examination: the p atient sho uld be und ressed if p o ssible.
• first lo o k at the general co nd itio n o f the p atient in o rd er to jud ge the severity o f
illness: nutritio nal status ( w eigh t and , in ch ild ren, h eight) , h yd ratio n, anaem ia,
tem p erature.
• exam ine each system : use a system atic ap p ro ach starting w ith the system related to
the p atient‟s co m p laint.
– Laboratory examinations: if necessary and if available
– Imaging techniques: x-ray and ultraso no grap hy, if necessary and if available
C - Role of the laboratory
A basic m ed ical labo rato ry can p lay an im p o rtant and irrep laceable ro le. H o w ever,
tech nical co nstraints ( th e need fo r a trained and co m p etent tech nician) , lo gistical
co nstraints ( regular sup p ly o f m aterial, reagents, electricity) , tim e co nstraints ( each
exam inatio n tak es a m inim um tim e) and quality co nstraints (w hich d ep end s o n all the
p o ints just m entio ned ) sho uld no t be und erestim ated .
T w o levels o f exam inatio ns can be d efined :
Basic examination
B lo o d Haematology
•haem o glo bin (L o vibo nd )
T•WransBfuCsionand d ifferentials
•blo o d gro up + rhesus
T•HhicIkVa, nhdepthaintitifsilmBs and C , syp hilis R P R
R•mapiadlaterisat,sso m e filariases, tryp ano so m iasis, visceral leishm aniasis, bo rrelio sis
S p utum •m alaria
•H IV, hep atitis B and C etc.
K o ch‟s bacillus
U rine reagent strip test (gluco se, p ro tein)
G enital go no co ccus, tricho m o nas
d ischarge
S to o l •exam inatio n o f w et p rep aratio n (eggs, helm inths, cysts, p ro to z o a)
•sco tch-test
C SF •lo o k fo r and id entify p atho gens (includ ing rap id test fo r m eningitis)
•cell co unt and p ro tein (P and y test)
11
A few rules
– A system atic ap p ro ach red uces o m issio ns and saves tim e.
– A n interp reter m ay be need ed ; h o w ever, translatio n d o es no t alw ays accurately
reflect the co m p laints o f the p atient. L earning the nam es o f the m ain clinical signs
and co m m o n d iseases in the lo cal language help s o verco m e this p ro blem . T he
cho ice
o f an interp reter m ust tak e into co nsid eratio n the sex (e.g. a fem ale fo r gynaeco lo gy
and o bstetrics) and the accep tability by the p atient (resp ecting co nfid entiality).
The examination
– Physical examination: the p atient sho uld be und ressed if p o ssible.
• first lo o k at the general co nd itio n o f the p atient in o rd er to jud ge the severity o f
illness: nutritio nal status ( w eigh t and , in ch ild ren, h eight) , h yd ratio n, anaem ia,
tem p erature.
• exam ine each system : use a system atic ap p ro ach starting w ith the system related to
the p atient‟s co m p laint.
– Laboratory examinations: if necessary and if available
– Imaging techniques: x-ray and ultraso no grap hy, if necessary and if available
C - Role of the laboratory
A basic m ed ical labo rato ry can p lay an im p o rtant and irrep laceable ro le. H o w ever,
tech nical co nstraints ( th e need fo r a trained and co m p etent tech nician) , lo gistical
co nstraints ( regular sup p ly o f m aterial, reagents, electricity) , tim e co nstraints ( each
exam inatio n tak es a m inim um tim e) and quality co nstraints (w hich d ep end s o n all the
p o ints just m entio ned ) sho uld no t be und erestim ated .
T w o levels o f exam inatio ns can be d efined :
Basic examination
B lo o d Haematology
•haem o glo bin (L o vibo nd )
T•WransBfuCsionand d ifferentials
•blo o d gro up + rhesus
T•HhicIkVa, nhdepthaintitifsilmBs and C , syp hilis R P R
R•mapiadlaterisat,sso m e filariases, tryp ano so m iasis, visceral leishm aniasis, bo rrelio sis
S p utum •m alaria
•H IV, hep atitis B and C etc.
K o ch‟s bacillus
U rine reagent strip test (gluco se, p ro tein)
G enital go no co ccus, tricho m o nas
d ischarge
S to o l •exam inatio n o f w et p rep aratio n (eggs, helm inths, cysts, p ro to z o a)
•sco tch-test
C SF •lo o k fo r and id entify p atho gens (includ ing rap id test fo r m eningitis)
•cell co unt and p ro tein (P and y test)
11
