Diarrhea Flashcards
A woman brought her 5 year old to your clinic with complaints of paasage of loose stool for over 2 days. Cleark on the possible diagnosis
GRIP
• Greeting – Good day Sir/Ma, good morning ma
• Rapport – how are you doing today?
• Introduce – My name is Benjamin Abimgbola, I am a candidate of the ongoing MDCN exam, I have been instructed to ask you a few questions
• Permission – please, may I proceed
2) Biodata (NASORATI)
• Name – what is the childs name
• Age – how old is he?
• Sex – please confirm that this is a male child
• Occupation – what class is he in
• Religion – what religion do the parents practice?
• Address – where do the parents live?
• Tribe – what tribe are the parents?
• Informant – what is your relationship to this child?
3) 5cs
C1 – presenting complaints
It states here that your child has been having loose stools for over 2 days, is that right?
course DOCTOR)
Diarrhea
C2 – history of the presenting complaints (DOCTOR)
- Duration – how long has it been? This has been for 2 days right?
- Onset – did it start suddenly or gradually?
- Course – has it been worsening or improving?
- Character – how many episodes has he had, what is the color of the stool, is there blood or mucous in the stool
- Time – is it worse after any particular meal?
- other symptoms – any nausea, vomiting, abdominal pain
- Related phenomenon – fever, weakness, loss of consciousness
Third C: Causes
1) What was the last meal he ate? Who prepared the meal (r/o hygiene)
2) Was the child exclusively breastfed, any use of water bottles? How often are they washed (infant)
3) When was complimentary foods introduced, what type of meals were introduced (infant)
4) Malaria – does he sleep under mosquito treated nets? Does he stay near stagnant water
5) Otitis media – has there been any tugging of his ears?
6) Tonsilitis – any vomiting, poor appetite, drooling
7) Measles – any fever, cough, catarrh, rash
8) UTO – any painful urination, any abnormal discharge
9) Laxative – did you give him any stool softeners recently
10) Immunodeficiency – do you know this child’s HIV status (recurrent diarrhoea)
11) Do you patronize food vendors
12) What is your source of water supply and how do you dispose of the waste
13) Do you wash your hands before and after using the toilet or before preparing his meals
Iv: fourth C: Complication
Dehydration – any reduction in his urine output? Is he thirsty? When he cries, does he produce tears?
Acute renal injury – is he still producing urine?
Has there been any loss of consciousness since this started
Chronic diarrhea – has there been failure to gain weight
Fifth C: Care so far
V: Fifth C: Care so far
What have you done so far concerning this situation
Have you visited any prayer house , pharmacy or hospital
Have you done any investigation? Full blood count, stool analysis?
Have you taken any medication?
Pregnancy history: prenatal, natal and postnatal
So what this pregnancy booked for antenatal
Did you have an infections during your pregnancy
Was the delivery at term
Was the delivery via vaginal or caesarean section
If Vaginal, was it spontaneous or induced
Was there any use of instruments
DId he cry immediately after birth?
How long did the baby stay in the hospital before he was discharged
Nutritional History
DId you give your child breast milk only for the first 6 months
When did you introduce other foods
Frequency how many times does he eat in a day?
Adequacy- does he finish his and ask for more
Density: does his meal contain all the classes of food in the right proportion
Utility: do you think your child is growing well?
Immunization history
Has he received all his vaccines for his age
Do you have your vaccination card? can I see it?
Did he have any reaction to the vaccine?
Developmental history
When did he start sitting without support/ crawling/ walking/ talking
• What class is he in? what is his performance in school? How does he relate with his school mates.
Family history
Family history
How many children do you have?
How many boys/girls
What is his position in the family?
Any similar condition in other family members?
Any history of hypertension, epilepsy, asthma, diabetes, or sickle cell disease in the family (HEADS)
Social history
• What kind of house do you live in
• What is your source of water supply
• What kind of toilet do you use
• How do you dispose your refuse
• How many rooms in the house? How many windows and occupants in each room?
Drug history
Drug history
• Is he on any longterm medication?
• Is he on any current medication?
• Does he have any drug allergy?
Review of system
CNS – headache, sizure, loss of consciousness
Endo – any neck swelling, excvessive weight loss or weight gain
Respiratory – any chest pain, fast breathing
Cvs – awareness of heartbeat, syncope, leg swelling, easy fatigue
Digestive – abdominal pain, nausea, vomiting
GUS – painful urination, blood in urine, back pain
MSS – any joint pain, joint stiffness, difficulty walking
