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Manage the patient with a positive 7 week sputum smear• Check patient’s TB symptoms and weight gain.TB symptoms improving and patient has gained weight.• Was patient taking treatment regularly?TB symptoms not improving or worse and/or patient has lost weight.• Send 1 spot sputum specimen for LPA, or if unavailable culture and DST.YesContinue intensive phase for1 month more.NoSend 1 spot sputum specimen for Xpert.Continue intensive phase and review results.Drug susceptible TB• At 11 weeks send 1 spot sputum specimen for smear microscopy.• If drug susceptible and/or smear negative, change to continuation phase at end of week 12.• If sputum positive, send sputum for LPA if not already sent. If drug resistant, refer to DR-TB unit.Drug resistant TB• Stop TB treatment.• Register as treatment failure.• Refer to DR-TB unit.Manage the patient with a positive 23 week sputum smear• Collect sputum specimen for LPA or if unavailable, culture and DST.• Continue treatment.• Review LPA results after 1 week.No• Stop TB treatment.• Register as treatmentfailure.• Re-register asre-treatment afterfailure.• Restart full course of TBtreatment.Drug sensitive TB• Has the patient missed any doses of TB treatment?• Extend continuation phase by number of missed doses.• At the end of extension period, send 1 spot sputum specimen for microscopy.Smear negative• Stop treatment.• Register as treatmentcompleted.Yes< 2 months TB treatment missed ≥ 2 months TB treatment missedSmear positive• Stop TB treatment.• Register as treatment failure.• Re-register as re-treatment after failure.• Restart full course of TB treatment.• Stop TB treatment.• Register as treatment default.• Re-register as re-treatmentafter default.• Restart full course of TBtreatment.Drug resistant TB• Stop TB treatment.• If registered smearpositive at diagnosis,register patient astreatment failure.• Refer patient for DR-TBtreatment.59
HIV: DIAGNOSISEncourage your patient and partner and children to test for HIV.Obtain informed consent• Educate patient about HIV and AIDS, methods of HIV transmission, risk factors and benefits of knowing one’s HIV status.• Explain test procedure and that it is completely voluntary.• Children < 12 years need parental/guardian consent. If consent is granted, proceed to testing immediately.TestDo first rapid HIV test on finger-prick blood.PositiveNegativeDo a second rapid HIV test on finger-prick blood.PositiveNegativeDiscordant results: do an ELISA test.PositiveNegativePatient has HIV.• Give routine HIV care at this visit 61.HIV test result negative• A rapid test detects HIV antibodies which may take up to 3 months to be formed.• Was patient at risk of HIV infection in the past 3 months?YesRepeat HIV test after the 3month window period.No• Patient does not have HIV.• Encourage patient to remainnegative.• Offer to refer for malecircumcision to diminish riskof HIV infection.SupportEnsure patient understands test result and knows where and when to access further care.60HIV
- Page 14 and 15: HEADACHE• Sudden onset of severe
- Page 16 and 17: FACE SYMPTOMSRecognize the patient
- Page 18 and 19: NOSE SYMPTOMSRunny or blocked noseA
- Page 20 and 21: CHEST PAINRecognise the patient wit
- Page 22 and 23: WHEEZE/TIGHT CHESTInitial Managemen
- Page 24 and 25: ABDOMINAL PAIN WITH OR WITHOUT SWEL
- Page 26 and 27: DIARRHOEARecognise the ill patient
- Page 28 and 29: GENITAL SYMPTOMSAssess the patient
- Page 30 and 31: VAGINAL DISCHARGE• It is normal f
- Page 32 and 33: OTHER GENITAL SYMPTOMSFirst assess
- Page 34 and 35: ABNORMAL VAGINAL BLEEDING• BP < 9
- Page 36 and 37: URINARY SYMPTOMSRecognise patient w
- Page 38 and 39: JOINT SYMPTOMSRecognise the patient
- Page 40 and 41: NECK PAINRecognise the patient with
- Page 42 and 43: FOOT SYMPTOMS• If the problem is
- Page 44 and 45: BURNSAttend urgently to the patient
- Page 46 and 47: PAINFUL SKINFirm, red lump which so
- Page 48 and 49: GENERALISED ITCHY RASHIf status unk
- Page 50 and 51: GENERALISED NON ITCHY RED RASHIs pa
- Page 52 and 53: CHANGES IN SKIN COLOURYellow skinDa
- Page 54 and 55: SUICIDAL PatientRecognise the patie
- Page 56 and 57: CONFUSED Patient• The confused pa
- Page 58 and 59: TRAUMATISED/ABUSED PatientRecognize
- Page 60 and 61: TB: DIAGNOSISExclude TB in the pati
- Page 62 and 63: TB: ROUTINE CAREAssess the patient
- Page 66 and 67: HIV: ROUTINE CAREAssess the patient
- Page 68 and 69: Advise the patient with HIV• Supp
- Page 70 and 71: ASTHMA AND COPD: DIAGNOSIS• The p
- Page 72 and 73: CHRONIC OBSTRUCTIVE PULMONARY DISEA
- Page 74 and 75: CARDIOVASCULAR DISEASE (CVD) RISK:
- Page 76 and 77: DIABETES: ROUTINE CAREAssess the pa
- Page 78 and 79: HYPERTENSION: DIAGNOSISCheck blood
- Page 80 and 81: HEART FAILURE: ROUTINE CARE• The
- Page 82 and 83: ISCHAEMIC HEART DISEASE (IHD): DIAG
- Page 84 and 85: PERIPHERAL VASCULAR DISEASE (PVD)
- Page 86 and 87: DEPRESSION AND ANXIETY: DIAGNOSISAs
- Page 88 and 89: SUBSTANCE ABUSEIdentify the patient
- Page 90 and 91: Advise the patient with psychosis
- Page 92 and 93: EPILEPSYDr• If the patient is fit
- Page 94 and 95: GOUT• Gout is a metabolic disease
- Page 96 and 97: CONTRACEPTIONGive emergency contrac
- Page 98 and 99: THE PREGNANT Patient• Fitting•
- Page 100 and 101: ROUTINE ANTENATAL CAREAssess the pr
- Page 102 and 103: POSTNATAL CAREAssess the mother and
- Page 104 and 105: PREP ROOM ASSESSMENT OF THE Patient
- Page 106 and 107: CVD RISKRoutine care summaryDIABETE
- Page 108: 103TB HIV CHRONIC RESPIRATORYDISEAS
Manage the patient with a positive 7 week sputum smear• Check patient’s TB symptoms and weight gain.TB symptoms improving and patient has gained weight.• Was patient taking treatment regularly?TB symptoms not improving or worse and/or patient has lost weight.• Send 1 spot sputum specimen for LPA, or if unavailable culture and DST.YesContinue intensive phase for1 month more.NoSend 1 spot sputum specimen for Xpert.Continue intensive phase and review results.Drug susceptible TB• At 11 weeks send 1 spot sputum specimen for smear microscopy.• If drug susceptible and/or smear negative, change to continuation phase at end of week 12.• If sputum positive, send sputum for LPA if not already sent. If drug resistant, refer to DR-TB unit.Drug resistant TB• Stop TB treatment.• Register as treatment failure.• Refer to DR-TB unit.Manage the patient with a positive 23 week sputum smear• Collect sputum specimen for LPA or if unavailable, culture and DST.• Continue treatment.• Review LPA results after 1 week.No• Stop TB treatment.• Register as treatmentfailure.• Re-register asre-treatment afterfailure.• Restart full course of TBtreatment.Drug sensitive TB• Has the patient missed any doses of TB treatment?• Extend continuation phase by number of missed doses.• At the end of extension period, send 1 spot sputum specimen for microscopy.Smear negative• Stop treatment.• Register as treatmentcompleted.Yes< 2 months TB treatment missed ≥ 2 months TB treatment missedSmear positive• Stop TB treatment.• Register as treatment failure.• Re-register as re-treatment after failure.• Restart full course of TB treatment.• Stop TB treatment.• Register as treatment default.• Re-register as re-treatmentafter default.• Restart full course of TBtreatment.Drug resistant TB• Stop TB treatment.• If registered smearpositive at diagnosis,register patient astreatment failure.• Refer patient for DR-TBtreatment.59
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