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WEIGHT LOSSRecognise the patient with weight loss needing urgent attention:• Weight loss in the patient on ART associated with one or more of: nausea, vomiting, sore muscles, shortness of breath, abdominal pain or distensionManagement:• Patient needs same day lactate measurement 63.• Check that the patient that says s/he has unintentionally lost weight has indeed done so. Compare current weight with previous records and ask if clothes still fit.• Unintentional weight loss of > 5% of body weight is significant and must be investigated.First check for TB, HIV and diabetesExclude TB• Start workup for TB 55.• At the same time test for HIV 60 and diabetes 70• and consider other causes below.Test for HIV• If status is unknown, test for HIV 60.• The HIV patient with unexplained weight loss and/orBMI < 18.5 is stage 3 and needs ART 61.Check for diabetes• Check random finger-prick blood glucose• To interpret result 70.Ask about symptoms of common cancers:Abnormal vaginal discharge/bleedingBreast lump/s or nippledischargeUrinary symptoms in manChange in bowel habitCough ≥ 2 weeks, blood-stainedsputum, long smoking historyConsider cervical cancer.Do a speculum examination27.Consider breast cancer.Examine breasts/axillae forlumps 18.Consider prostate cancer.Hard and nodular prostateon rectal examination 31.Consider bowel cancer.Mass on abdominal or rectalexamination, occult blood positive.Consider lung cancer.Do chest X-Ray.If food intake inadequate, look for a cause:Nausea and/or vomitingLoss of appetiteAsk, ‘Are you stressed?No money for foodSore mouth or difficulty swallowing20.• Eat small frequent meals.• Drink high energy drinks (milk, maas, mageu,soup, sweetened fruit juice).• Increase energy value of food by adding sugar,milk powder, peanut butter or oil.If yes, 52.If available, refer tonutrition scheme.Oral/oesophageal thrush likely 14Check thyroid function (TSH) if none of the above and patient has any of pulse > 80, tremor, irritability, dislike of hot weather or thyroid enlargement.Refer within 1 month for further investigation the patient with persistent documented weight loss and no obvious cause.3
FEVERA patient with a fever has an axillary temperature ≥ 38ºC or had a fever in the past 4 days.Recognise the patient with fever needing urgent attention:One or more of the following:• Confusion or agitation• Respiratory rate ≥ 30 breaths/minute• Unable to walk unaided• Unable to drink• Jaundice• Renal angle tenderness• Seizures• BP < 90/60• Easy bleeding/bruising/blood in urineManagement:• Establish IV access and give 5% dextrose in ½ strength Darrows or Ringer’s lactate. If unavailable give oral rehydration solution.• Give ceftriaxone 1 2g IM/IV stat.• Refer same day to hospital.Approach to the patient with fever not needing urgent attentionAsk about associated symptomsIf cough 16; sore throat 14; blocked/ runny nose 13; vaginal discharge 23, burning urine 31, painful skin 40,headache 9, diarrhoea 21.If above symptoms are not present, has patient visited in the past 12 weeks a malaria endemic area?Yes• Refer for malaria test and treatment.• Consider other cause especially TB 55.No• Exclude TB in the patient with fever ≥ 2 weeks 55.• If status unknown, test for HIV 60.• The HIV patient with fever > 1 month and weight loss ≥ 10% has AIDS and needs ART 61.Refer the patient with persistent fever and no obvious cause.1Do not mix Ringer's lactate and IV ceftriaxone. Flush IV line with sodium chloride 0.9% before and after IV ceftriaxone. If giving ceftriaxone IM, divide dose: 1g into 2 different injection sites.TB HIV CHRONIC RESPIRATORYDISEASECHRONIC DISEASESOF LIFESTYLEMENTAL HEALTH EPILEPSY MUSCULOSKELETALDISORDERS4WOMEN'S HEALTH
- Page 4 and 5: CONTENTS: SYMPTOMSAssess and manage
- Page 6 and 7: THE UNCONSCIOUS PatientManage the u
- Page 10 and 11: LYMPHADENOPATHY (enlarged lymph nod
- Page 12 and 13: COLLAPSE• Unconscious 1• Fit 2
- 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
FEVERA patient with a fever has an axillary temperature ≥ 38ºC or had a fever in the past 4 days.Recognise the patient with fever needing urgent attention:One or more of the following:• Confusion or agitation• Respiratory rate ≥ 30 breaths/minute• Unable to walk unaided• Unable to drink• Jaundice• Renal angle tenderness• Seizures• BP < 90/60• Easy bleeding/bruising/blood in urineManagement:• Establish IV access and give 5% dextrose in ½ strength Darrows or Ringer’s lactate. If unavailable give oral rehydration solution.• Give ceftriaxone 1 2g IM/IV stat.• Refer same day to hospital.Approach to the patient with fever not needing urgent attentionAsk about associated symptomsIf cough 16; sore throat 14; blocked/ runny nose 13; vaginal discharge 23, burning urine 31, painful skin 40,headache 9, diarrhoea 21.If above symptoms are not present, has patient visited in the past 12 weeks a malaria endemic area?Yes• Refer for malaria test and treatment.• Consider other cause especially TB 55.No• Exclude TB in the patient with fever ≥ 2 weeks 55.• If status unknown, test for HIV 60.• The HIV patient with fever > 1 month and weight loss ≥ 10% has AIDS and needs ART 61.Refer the patient with persistent fever and no obvious cause.1Do not mix Ringer's lactate and IV ceftriaxone. Flush IV line with sodium chloride 0.9% before and after IV ceftriaxone. If giving ceftriaxone IM, divide dose: 1g into 2 different injection sites.TB HIV CHRONIC RESPIRATORYDISEASECHRONIC DISEASESOF LIFESTYLEMENTAL HEALTH EPILEPSY MUSCULOSKELETALDISORDERS4WOMEN'S HEALTH
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