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THE PREGNANT Patient• Fitting• Diastolic BP ≥ 110 and proteinuria: treat as pre-eclampsia• Diastolic BP ≥ 90 and headache, blurred vision or abdominal pain: treat asimminent eclampsia• Temperature ≥ 38ºC and headache, weakness or back pain• Difficulty breathingManagement:• If fitting or having difficulty breathing give 40% face mask oxygen. See below.• If BP < 90/60 give IV sodium chloride 0.9% rapidly until BP > 90/60.Recognise the pregnant patient needing urgent attention:• Swollen red calf• Vaginal bleeding• Decreased/no fetal movements• Preterm labour: painful contractions, 3 per 10 minutes < 37 weeks• Preterm prelabour rupture of membranes < 34 weeks• If temperature ≥ 38ºC give ceftriaxone 1 1g IM/IV, if unavailable amoxicillin 1g orally. If also a vaginal discharge in 2nd or 3rd trimester, give metronidazole 400mg orally as well.• Manage further according to problem and refer same day:Preterm labourDetermine duration of pregnancy.Preterm prelabourrupture of membranesSevere pre-eclampsia/imminent eclampsiaFitting< 26 weeks 26–33+ weeks ≥ 34 weeksRefer intoMOU.• Givebetamethasone12mg IM, recordtime given inreferral letter.• Give sodiumchloride 0.9%300ml IV.• Then givenifedipine 20mgoral, then 10mgafter 30 minutes,then 10mg4 hourly untiltransferred.• Refer same day.Allow labourto continue.• Confirm amnioticfluid leak with sterilespeculum, liquor isalkaline.• Avoid digital vaginalexamination.• Give betamethasone12mg IM, recordtime given in referralletter.• Refer same day.• Give sodium chloride0.9% 200ml slowly IV.• If diastolic BP still ≥ 110,give nifedipine 10mg toswallow (not chew).• Repeat BP after 30minutes. If diastolicBP still ≥ 110, repeatnifedipine 10mg.• If imminent eclampsia:give magnesium sulphateloading dose and infusionbefore referral.• Place patient in a lateral lying position.• Avoid placing anything in the mouth.• Give 40% facemask oxygen.• Check glucose. If < 3.5 or unable to measure,give 50ml of 50% dextrose IV.• Give dextrose 5% in sodium chloride 0.9% IVslowly (30 drops per minute).• Manage further according to gestation:≥ 20 weeks - up to 1 week postpartum:Patient has eclampsia.• Give magnesium sulphate 4g in 200ml sodium chloride 0.9% IVover 20 minutes and 5g IM in each buttock. Repeat 5g IM 4 hourly inalternate buttocks till transferred to hospital.• Insert urethral catheter.• Stop magnesium sulphate if urine output < 100ml in 4 hours orrespiratory rate < 16 breaths/minute.• Refer urgently.< 20weeks2Provide routine antenatal care to the pregnant patient not needing urgent attention 94.1Do not mix Ringer's lactate and IV ceftriaxone. Flush IV line with sodium chloride 0.9% before and after IV ceftriaxone.93
THE PREGNANT PatientDoes the patient want the pregnancy?No or unsure• Discuss the options around continuing with pregnancy, choosing adoption or termination of pregnancy (TOP). Refer to social worker.• Discuss future contraception 91.• Determine gestational age by dates and on examination.YesGive routine antenatal care.Patient requests a TOP.< 20 weeks• < 13 weeks: book for an on-demand TOP < 13 weeks.• ≥ 13 weeks: book for assessment for TOP as soon aspossible < 20 weeks.≥ 20 weeks• TOP not an option.• Discuss possibility of adoption.• Give routine antenatal care.• Patient decides to continue withpregnancy.• Give routine antenatal care.Identify the pregnant patient who needs secondary level antenatal care:• Current medical problems: diabetes, heart/kidney disease, asthma, epilepsy, on TB treatment, substance abuse, diastolic BP > 90• Current pregnancy problems: rhesus negative, multiple pregnancy, currently < 16 or > 36 years, vaginal bleeding or pelvic mass• Previous pregnancy problems: stillbirth or neonatal loss, > 3 consecutive spontaneous abortions, birth weight < 2500g or > 4500g, admission for pre-eclampsia• Previous admission for hypertension or reproductive tract surgeryIf not needing secondary level antenatal care, plan patient's routine antenatal care in primary care facility 95.94WOMEN'S HEALTH
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CONTENTS: SYMPTOMSAssess and manage
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THE UNCONSCIOUS PatientManage the u
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WEIGHT LOSSRecognise the patient wi
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LYMPHADENOPATHY (enlarged lymph nod
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COLLAPSE• Unconscious 1• Fit 2
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HEADACHE• Sudden onset of severe
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FACE SYMPTOMSRecognize the patient
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NOSE SYMPTOMSRunny or blocked noseA
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CHEST PAINRecognise the patient wit
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WHEEZE/TIGHT CHESTInitial Managemen
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ABDOMINAL PAIN WITH OR WITHOUT SWEL
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DIARRHOEARecognise the ill patient
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GENITAL SYMPTOMSAssess the patient
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VAGINAL DISCHARGE• It is normal f
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OTHER GENITAL SYMPTOMSFirst assess
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ABNORMAL VAGINAL BLEEDING• BP < 9
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URINARY SYMPTOMSRecognise patient w
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JOINT SYMPTOMSRecognise the patient
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NECK PAINRecognise the patient with
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FOOT SYMPTOMS• If the problem is
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BURNSAttend urgently to the patient
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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 64 and 65: Manage the patient with a positive
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 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
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