ASSESSMENT OF ADD
GOALS OF ASSESSMENT
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- Determine the type of diarrhea(a/c watery/dysentery/persistent)
- Look for dehydration and other complications
- Assess for malnutrition
- Rule out nondiarrhoeal illness esp systemic infections
- Assess feeding, both preillness and during illness
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HISTORY
Ask the mother or caretaker about
- Onset of diarrhoea:;duration and number of stools per day
- Blood in stools
- Number of episodes of vomiting
- Presence of fever, cough or other significant symptoms(convulsions,recent measles)
- Type and amount of fluids(inc.breast milk) and food taken during the illness and pre-illness feeding practices
- Drugs or other local remedies taken(inc opioids or antimotility drugs like loperamide that may cause abdominal distension)
- Immunization history
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EXAMINATION
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Assess for dehydration
Table 11.8: Assessment of dehydration in patients with diarrhea
| Look at Condition¹ | Well alert | Restless, irritable | Lethargic or unconscious; floppy |
|---|---|---|---|
| Eyes² | Normal | Sunken | Very sunken and dry |
| Tears | Present | Absent | Absent |
| Mouth and tongue | Moist | Dry | Very dry |
| Thirst | Drinks normally; not thirsty | Thirsty, drinks eagerly | 'Drinks poorly' or is not able to drink |
| Feel Skin pinch¹ | Goes back quickly | Goes back slowly | Goes back very slowly |
| Decide | The patient has no signs of dehydration | If the patient has two or more signs, there is some dehydration | If the patient has two or more signs, there is severe dehydration |
| Treat | Use treatment Plan A | Weigh the patient, if possible, and use treatment Plan B | Weigh the patient and use treatment Plan C urgently |
Examine for
- Features of malnutrition; Anthropometry for weight and height; examination for wasting, edema and signs of vitamin deficiency
- Systemic infection: presence of cough, high grade fever,fast breathing or chest indrawing(pneumonia); high grade fever with splenomegaly(malaria)
- Fungal infections:oral thrush or perianal satellite lesions
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LABORATORY INVESTIGATIONS
Can be managed without investigations
STOOL MICROSCOPY
STOOL CULTURE
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BLOOD TESTS
Thanks... But it's not the end !!
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This download link is referred from the post: MBBS Lecture Notes for all subjects (updated for 2021 syllabus) - All universities