List of diseases & conditions encountered in Primary Healthcare Centre
1. Fever
2. Headache
3. Conditions relating to Respiratory System
– Upper respiratory tract congestion.
– Cold & Flu Sore Throat
– Upper respiratory infections
– Tonsillitis
– Pneumonia
– Bronchitis
– Asthma
– Viral Infection
4. Conditions relating to Gastro- Intestinal Tract
– Dyspepsia
– Epigastric Pain
– Vomiting
– Pain abdomen
– Appendicitis
– Dehydration
– Jaundice
5. Conditions relating to Cardiovascular System
– Hypertension
– Chest Pain
6. Conditions relating to Urinary Tract System
– Burning micturation / Dysuria
– Renal colic
– Urinary tract infection
7. Conditions relating to Eye
– Simple conjunctivitis – allergic
– Bacteria conjunctivitis
– Cataract
8. Conditions relating to ENT
– Tonsillitis
– Otitis – Externa & Media
9. Conditions relating to Skin
– Allergic Rashes
– Eczema
– Dermatitis
– Scabies
– Boils
Fever:
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. Fever is high grade and accompanied with rigors and occurs on alternate days
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 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
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
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:
– 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
– Mumps
– Measles
– Chicken Pox
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
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)
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.
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 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
Avoid the trigger allergy desensitization
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
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.
Frequent passage of stool
Consistency of stool
Associated with pain
Associated vomiting
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
– 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.
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)
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.
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.
It can be externa or media.
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