HISTORY TAKING AND PHYSICAL EXAM.pptxhft

Bbjhhhhhbhhhhghhggggg

1. HISTORY TAKING DEFINATION Process by which information is gained by physician by asking specific question to the patient with the aim of obtaining information that will aid in formulating a diagnosis based on history alone and providing medical care IMPORTANCE OF HISTORY TAKING Obtaining accurate history is a critical first step in determining the etiology of the patients illness Diagnosis is made based on clinical history ,physical exam and investigation. Mostly at 70% history taking you would be able to make diagnosis based on history alone Always listen to patient they could be telling you the diagnosis There has to be good communication between doctor and patient APPROACH TO HISTORY TAKING Introduce yourself, never forget patients name, ensure patient is comfortable Ensure consent is gained Maintain privacy and dignity Involve patient in history taking

2. CONT. HISTORY TAKING=APPROACH TO HX TAKING CONT Try to see things from patients point of view, understand patients underneath mental status,anxiety,irritation or depression. Always exhibit neutral position Listening; always be a good listener Questioning; should be simple /clear/avoid using medical terms/open leading, interrupting direct questions Summaries your history COMPONENTS ON HISTORY TAKING Always record patients personal data/details/particulars abbreviated as NASEOMARD Chief complain History of presenting illness Past medical and surgical history Family history Social history Obstetric and genealogical history Good history taking should reveal patients ideas,concerns,expectations and any accompanying diagnosis History taking requires practice,patience,understanding and concentration

3. CONT.HISTORY TAKING A].Always record patients particulars/details/data can be abbreviated as NASEOMARD N ame A ge S ex E thnicity O ccupation M arriage A ddress R eligion D ate of examination And finally indicate who gave you the history B.CHIEF COMPLAIN Reason as to why client is seeking medical care. Usually single symptom but could be more than one Patient describe problems in their own order, if more than one complain, also inquire for any recurrent episodes Complain should be recorded in order of time of onset,evolution,investigation and history of outcome associated with positive and negative outcome

4. CONT. HISTORY TAKING C.HISTORY OF PRESENTING ILLNESS It’s the details, regression of chief complains Its elaboration of chief complain in detail Ask relevant associated symptoms Lead conversation by asking questions Always start with open ended questions[e.g. is there anything else you want to tell me ?] and take time to listen to the patients history After patient has completed asking questions closed ended question[ e.g when did this pain start] can be used for clarification Avoid leading question[ e.g based on your own assumption that lead patient to the answer you want to hear] Avoid medical terminologies ,make use of descriptive language that is familiar to the patient Example of presenting history A patient was apparently well 1/52 prior to admission when he fell when gardening and cut his foot with a stone,by evening the foot became swollen and patient was unable to walk .Next day patient attended a private clinic and was given several oral medicine which the patient doesn’t know, but was told would suppress his pain, however their was no improvement the condition worsened 2/7 prior to admission the swelling started to discharge pus.There is high fever, rigors and nausea

5. D.PAST MEDICAL AND SURGICAL HISTORY Any history similar to the current complain in the past Any other medical problems the patient has ever had Any chronic diseases like hypertension,diabetis,heart disease, asthma Any history of hospitalization and surgeries before, blood transfusion and infusion Any medication taken prior to current treatment dosage and duration, any intake of herbs Allergies History of trauma/ accident time place and type of accident E.FAMILY HISTORY Establish if there are any genetically transmitted illnesses in the family e.g. breast cancer,diabetis mellitis,hypertension,asthma,albinuism etc. inquire of family members suffering from this illnesses, parents who died of this illnesses at what age they died and when they died,e.g a client comes in with anemia inquire for sickle cell aneamia,thalasemia/G6PD deficiency Also inquire for infections running in the family e.g. tuberculosis,leprosy,cholera,typhoid and incase of epidemics

6. CONT.HISTORY TAKING F.SOCIAL ECONOMIC HISTORY Inquire about history of smoking;amount,duration,type i.e self made,cigars,shisha,chewing etc. Any attempt to quit, is it continuous or interrupted Is he/she active or passive smoker Drinking history; amount, duration and type, is he a binch drinker Alcohol use; men 14 units per week not more than 4 units per session Women 7 units per week, not more than 2 units per session Remind them that unhealthy alcohol intake is associated with cardiomyopathy, cerebrovascular accident, liver cirrhosis etc. Any history of drug addiction Sexual history if suspected STIs Occupation, social and education background, financial status Sanitation status in his/her home and surrounding/generally hygiene Animal birds in his/her home

7. OBSTERTRIC HISTORY Menstrual history;menarch,LMP[amount, cycle] Use of FP,type Parity [no of deliveries],gravidity [ no of pregnancies] Abortions and age of loss Miscourages [delivery after 24 weeks] Methods of delivery;ciserian section,assisted e.g. vacuum delivery,spontenios vertex delivery

8. G.SYSTEMIC REVIEW 1=GENERAL REVIEW; Weakness Fatigue Anorexia Change of weight Fever Night sweats Lump/swelling 2=CARDIOVASCULAR SYSTEM Chest pain Paroxysmal nocturnal dyspnea Orthopnea Shortness of breath Cough if productive sputum pinkish or frunk blood Palpitation Swelling of the ankle Ask about pain over the pericardium[area covering the heart] Palpitations[awareness of heart beat] Difficult in breathing while lying flat

9. 3=GASTROINTESTINAL SYSTEM Appetite Diet Nausea/vomiting Regurgitation/heat burn/flatulence Difficulty in swallowing/pain while swallowing Abdominal pain/distension/discomfort Constipation-passage of hard stool Hematemesis/melena in stool Polydipsia/polyphagia 4=RESPIRATORY SYSTEM Cough if productive; amount of sputum,colour Hemoptysis Chest pain Dyspnea /shortness of breath Tachypnea Horseness of voice Diarrhoea if any how many motions in a day Excessive salivation[water brash] Difficult in breathing Wheezing[blowing musical sounds from the lungs due to partial obstruction]

10. 5=GENITAL URINARY SYSTEM Frequency Dysuria Urgency Hesitancy Terminal dribbling Nocturia Back/loin pain Incontinence Fever Discharge Unusual bleeding Character of urine color,amount,timing,polyuria, Pain/discomfort/itching Discharge Unusual bleeding Sexual history

11. 6=NERVOUS SYSTEM Vision Test Hearing Speech Headache Fits/faints/black outs Muscle weakness Abnormal sensation Weakness in movement Deformities 7=MUSCULOSKELETOL SYSTEM Pain;muscle,bones,joints Swelling Weakness in movement /joints Gait

12. PHYSICAL EXAMNATION First step of physical examination and key component of diagnostic approach Inspection is a major method during during general exam, combining with palpitation, auscultation and smelling AIM Asses patients general condition Detect manifestation of internal and systemic disease 3 COMPONENTS OF HX TAKING History taking-deals with symptoms Physical exam; deals with the signs Investigation; deals with lab test results INSTRUMENTS AND EQUIPMENT NEEDED Stethoscope Sphygmomanometer Thermometer Torch Wooden tongue depressor Patella hammer Note; Examination starts the moment you first see the patient walking into clerking room and continues throughout your patient interaction

13. PREREQUISITES Examination environment Hand washing Proper lighting Privacy and confidentiality Presence of chaperon for both male and female patients Correct position of examiner[ideally examiner should be on right side of the patient] Proper exposure Ensure your hands are warm NOTE Surprisingly some patients talk a lot during examination They seem reassured by clinician's touch and may feel more at ease than when sitting face to face during the interview Examination of a specific body region or system may remind the patient of previously forgotten details of considerable diagnostic importance Physical examination should be done in systemic order

14. ORDER OF PHYSICAL EXAM General examination Vital signs; blood pressure ,pulse, temperature, respiration Systemic examination Respiratory system Cardiovascular system Per abdomen Masculo-skeleton system Central nervous system GENERAL EXAMINATION Before examination of any patient the following should be taken into consideration The clinician should be well groomed Privacy of the patient should be ensured The room should be well ventilated The room should be warm Room should have good lighting avoid colored bulbs There should be minimum furniture in the room

15. EXAMINATION ROOM Should have: Two simple chairs A cupboard Examination equipment's A coach and chair If necessary a chaperone should be present when a male clinician is examining a female client and vice versa Explain to the patient what you want to do Expose the area you want to examine

16. GENERAL EXAMINATION Order of general exam; vital signs, level of consciousness, degree of illness, nutrition status, body parameters A] VITAL SIGNS 1-BLOOD PRESSURE Def;It’s the force of your blood pushing against the walls of your arteries Systolic pressure: Pressure during contraction of ventricles to pump blood to the body Diastolic blood pressure: this pressure when the heart rests to receive blood from the rest of the body into the atrium SYSTOLIC BP DIASTOLIC BP NORMAL BP 120mmhg 80mmhg PRE HYPERTENSION 130-139 mmhg 80-89 mmhg HYPERTENSION STG ONE 140-159mmhg 90-99mmhg HYPERTENSION STG 2 >/= 160mmhg >/= 100mmhg HYPERTENSION STG 3 >/= 180mmhg >/= 110mmhg

17. FACTORS AFFECTING/PREDISPOSING TO BLOOD PRESSURE Blood volume[affected by heart conditions like congestive cardiac failure, myocardial infarction, endocarditis ,Limited water intake etc.] Elasticity of blood vessel walls- affected by age, high blood sugar levels, high cholesterol diet Compliance of capillaries referred to as resistance exerted by capillaries Blood viscosity Physical activity/exercise Gender; women have low bp courtesy of estrogen men lack it hence prone to high Bps post menopause women are prone to high blood pressure due to lack of estrogen Time of the day-more in the morning than evening Use of medication;NSAIDS [Indomethacin,asprin,brufen,diclofenac],nasal decongestion drugs, birth control pills Arteriosclerosis [histological changes found commonly found in the deep penetrating small vessels of the brain in aging, smooth muscle degeneration,,fibrohyalinotic thickening of the arterioles with consequent narrowing of the lumen Bleeding Fever Heart and blood vessel diseases Endocrine disorders [excessive aldosterone production by adrenal glands leads to fluid retension,loss of potassium and hypertension, If untreated hyperaldosteronism may lead to enlarged heart]

18. Continuation factors affecting/predisposing to blood pressure Diet; high salt and cholesterol diet Obesity Life style; alcohol intake Kidney conditions e.g. kidney failure, nephrotic syndrome, kidney also secretes erythropoietin[it stimulates production of RBCs high or low levels can cause health issues] Liver failure[diseased liver can cause portal hypertension] FACTORS PREDISPOSING TO HYPOTENSION Blood loss Dehydration Diabetes Heart problems i.e. arrhythmias Medication treatment for hypertension and depression SIGNS AND SYMPTHOMMS OF HYPOTENSION Dizziness/feeling light headedness Fainting/syncope Nausea and vomiting Distorted blurred vision Fatigue Confusion and trouble concentrating

19. 2=PULSE Def:The number of times the heart beats within a given period of time usually one minute. The pulse can be felt at the; wrist[radial pulse], side of the neck[carotid pulse], elbow joint [brachial pulse], groin [femoral pulse] back of the knees[ popliteal pulse], top of the foot[dorsalis Pedis pulse] and any other areas of the body where artery is next to the skin FACTORS AFFECTING PULSE Age Gender Activity Raised/reduced body temperature Hemorrhage Medications [asthma drugs, cocaine or amphetamines, some heart and blood pressure medicines, drugs for depression and anxiety, thyroid medicine Pain H ormones

20. METHODS OF MEASURING PULSE Palpation Auscultation Doppler Pulse per age; Newborn;120 -140 < 120 bpm not normal Infant;100-120 bpm Up to 10yrs of age;80-90 bpm Adult;60-80 bpm CAUSES OF TARCHYCARDIA Heartrate < 90bpm; Physical exercise Excitement Coffee consumption Fever Shock CAUSES OF BRADYCARDIA Heart rate < 60bpm Found in; Sleep Myocardial infarction Hypothermia Unconscious patient Electrolyte imbalance i.e. not getting enough calcium, magnesium and potassium NOTE Always check for; Hypovolemia Hypoxia Hypokalemia Hypoglycemia, hypothermia Toxins,trauma,thrombosis,tension pneumothorax

21. 3=RESPIRATION Def;In physiology movement of oxygen from outside environment to the cells within tissues, and removal of carbon dioxide in opposite direction to the surrounding environment it takes place in the lungs In biochem it’s a process in which cells pf an organism obtain energy by combining oxygen, water and glucose, resulting in the release of carbondioxide,water and ATP TYPES OF RESPIRATION Eupnia;normal respiration average 16 -24 breaths per min Tarchypnia;hyperventilation rate >25 breaths per minute Bradypnoea;Slow respiration < 16 breaths per minute > 12 breaths per minute Apnoea;respiration zero/respiratory rest BREATHRATES New borns;40-60 bpm Infant;25-30 bpm Up to 10 yrs. approximately 20 bpm Adults 16-18,12-20 bpm FACTORS AFFECTING RESPIRATION Temperature [as temperature increases cellular respiration increases heat speeds up reaction,cold air decreases baseline ventilation and respiratory chemo sensitivity]

22. CONTINUATION FACTORS AFFECTING RESPIRATION Glucose levels[if glucose levels are low the cells cant cells cant create energy in form of ATP molecules they require glucose and oxygen, high glucose levels increase respiration, aerobic respiration require oxygen to proceed] Oxygen levels;Low oxygen levels increase respiration i.e rapid shallow breath, high oxygen levels cause oxidative damage to the cell membrane leading to collapse of the alveoli in the lungs e.g. in conditions like polycythemia [ primary polycythemia caused by overproduction of RBCs,secondary polycythemia caused by factors that reduce amount of oxygen reaching body tissues e.g. smoking, high attitude, or congenital heart disease] Carbon dioxide when levels rise body responds through hyperventilation or hypoventilation, if CO2 is bound to hemoglobin forms carbanion compound when high reduces affinity of hemoglobin for O2 Water levels in the body; waters role as a solvent facilitate transport of O2 molecules for respiration hence dehydration increases respiration, lack of enough water leads to thickening of mucus in the lungs and also dries up airway passages CAUSES OF BRADYPNOEA [LOW RESPIRATION] Head injury Opioids, Alcohol Toxins Electrolyte imbalance[ can cause muscle weakness and impale respiration,hyponatreamia affect heart rate] Stress and anxiety [brain reacts to fearful situations with a fight and fright response this triggers hyperventilation]

23. FACTORS AFFECTING RESPIRATION CONT…. CAUSES OF TARCHYPNOEA Allergic reactions Anxiety or panic disorder Asthma Blood clots Carbon monoxide poisoning Chronic obstructive pulmonary disease Diabetic ketoacidosis Pleural effusion COMMON CAUSES OF HIGH RESPIRATION Anxiety Fever Respiratory disease Heart disease Dehydration

24. 4TEMPERATURE FACTORS AFFECTING RESPIRATION Age The younger the patient the higher the BMR,children temperature is more labile. The elderly have a problem with thermoregulation secondary to ;inadequate diet, loss of fats, lack of activity Reduced Respiration rate with age leading to vasoconstriction Time of the day; body temperature changes through out the day with fluctuation up ton 2 degrees centigrade highest between 5-6pm lowest by 4-6pm Physical activity Activity of hypothalamus Hot shower Pregnancy Gender Site of measurement Hot food and drinks Normal temperature,35.5-37.2 degrees centigrade Febrile;37.3-41 degrees centigrade Hypothermia;>41 degree centigrade

25. B] DEGREE OF ILLNES Note weather the patient is; Stable general condition Mildly sick looking/fairly sick looking Moderately sick looking Severely sick looking In severe pain or discomfort You will note this from facial expression of the patient C .] NUTRITIONAL STATUS This is the build of the patient Well nourished Malnourished asses body mass index which is weight divide by height squared BMI 18 -25 Overweight BMI 25-30 Obesity BMI over 30 Wasted BMI less than 18 Cachexic massive wasting whose features include prominence of bones NOTE; in the severely ill you might not be able to take weight but you ca assess generally if cachexic, overweight or obese

26. CAUSES OF CACHEXIA Malignancy A.I.Ds Diabetes mellitus Tuberculosis Stress Malnutrition Patient on cancer treatment D]LEVEL OF CONCIOSNESS A - Alert V- Respond to voice P =Responds to pain U- Unconsious FULLY CONCIOUS ; Responds to pain and verbal stimuli SEMICONCIOUS; Responds to painful stimuli not verbal stimuli. UNCONCIOUS ; Doesn’t respond to pain and verbal stimuli

27. GLASGOW COMA SCALE System of measuring or score; level of conciuosness,awareness and response to instructions it has 3 categories that respond to neurologic exam; 1-Eye response ; Relates to high awake and alert you are 2-Motor response ; its about how well your brain can control muscle movement. Can also show if there are any issues with the connection between your brain and the rest of your body 3-Verbal Response ; test how certain brain abilities work including thinking,memory,attention span and awareness of your surroundings Glasgow coma scale of 3 and pupil score of 1 means deep coma, no pupil reaction in both eyes A score of 15well score of less than 8 means you are in coma some areas were selected where pressure can be put ton gauge your response Nail bed; finger and toe nails are sensitive to pressure Trapezius muscle; muscles that connect shoulder to the center of your neck and back. Supra orbital notch; small groove in the bone of your skull just above your eye and just below your eye brow

28. EYE RESPONSE Voluntary eye opening-4 Opens eye to verbal response-3 Only opens eye in response to pain-2 Eyes don’t open for any reason-1 VERBAL RESPONSE Well orientated to time ,place and who you are-5 Confined; you can answer questions but your answers show you a re not fully awake-4 You can talk and others can understand what you say but your response to questions don’t make sense-3 You can talk but can only make sounds/noise -2 You cant speak or make sounds-1 MOTOR RESPONSE You follow instructions on how and where to move-6 You intentionally move away from anything causing pressure -5 You only move away from something causing pressure on you as a reflex-4 You flex muscles[inward ]in response to pressure-3 You extend outward in [ stretch outward ]in response to pressure-2 You don’t respond to any pressure -1 GLASGOW COMA SCALE P Pupil reaction is important because its an indication of your brain function, where there is no eye response it’s a sign of brain injury Pupils react to light -2 One pupil react to light -1 Both pupils don’t react to light -0

29. GLASGOW COMA SCALE RANGES 13 – 15 mild traumatic brain injury 9 – 12 moderate traumatic brain injury 3 – 8 severe traumatic brain injury NOTE It may not be possible to use GCS in some cases such as ; Cases on ventilation and doesn’t speak same language as healthcare provider Clients with injuries affecting some body parts or systems GCS can be used alongside other parameters

30. E]GENERAL PARAMETERS Pallour,jaundice,cyanosis,fever,oedema,dehdration 1]PALLOUR/PALENESS Comes as a result of ; Anemia; deficiency of red blood cells or hemoglobin levels low resulting to pallor According to WHO anemia could be hb of <12gpdl in women and < 13gpdl in men this include pseudo anemia states;pregnancy,CCF,hyperproteinemia CAUSES OF ANEMIA Due to blood loss Increased destruction of RBCs Decreased production of RBCs

31. CAUSES OF ANEMIA CONT …. A}DUE TO BLOOD LOSS 1] P hysical injury= a]sudden Traumatic injury Burns Frost bite Accidents Ectopic pregnancy [raptured ectopic] Child birth –APH,PPH Surgery Raptured blood vessels b] Chronic causes Nose bleeds Hemorrhoids Upper and lower GIT bleeding Kidney and bladder tumors Heavy menstrual bleeding

32. CAUSES OF ANEMIA CONT… B}INCREASED DESTRUCTION OF RBCs Due to; Enlarged spleen Mechanical damage to RBCs Autoimmune reactions against RBCs Paroxysmal nocturnal hemoglobinuria Hereditary spherocytosis Glucose 6 phosphate deficiency Sickle cell disease Thalassemia's

33. C]DECREASED RBC PRODUCTION Causes;Iron deficiency Folic acid deficiency Vitamin c deficiency Chronic disease Vitamin B deficiency SIGNS AND SYMPTOMS OF ANEAMIA Faintness Weakness Yellow coloration of skin/pale Irregular heart beats Dizziness/light headedness Chest pain Cold hands and feet Headache Thirst Sweating Rapid pulse

34. WHERE TO CHECK FOR PALOR Conjunctiva Tongue Sole of foot P alm of hand Vulva Normal ranges as per age Male 13 – 18 gm/dl Female 12 – 17 gm/dl Children 14 – 20gm/dl DIAGNOSIS OF ANEAMIA Through; History taking Physical examination Laboratory investigation i.e complete blood count to determine shape, size and color of RBCs

35. 2}JAUNDICE Def;Yellow coloration of skin and whitening of sclera caused by abnormal high levels of bile pigment, bilirubin in the blood stream, it manifests when the levels are 3x the normal levels which is 2 – 2.5mg/dl It can be mild, moderate or severe PATHOPHYSIOLOGY Bilirubin is released as a waste after breakdown of RBCs after a life span of 120/7 Its taken out of the system through the liver where it combines with bile from gall bladder the exits through feaces and urine If stool should be brown and urine amber color/light yellow, infections may damage or interfere with the process Stool can be green because it passed through the intestines very fast ,or eating greens,or some drugs like iron supplement drugs can cause it CAUSES OF JAUNDICE Pre hepatic Hepatic Post hepatic

36. CAUSES OF JAUNDICE CONT … a]PRE-HEPATIC Caused by damage to RBCs more than the liver than usual that the liver cant handle this due to; Sickle cell disease Thalassemia's Blood transfusion Drugs Infections e.g. malaria, febrile conditions Mechanical damages to RBCs b]INTRAHEPATIC JAUNDICE Liver that is damaged may be unable to process bilirubin Causes; Hepatitis Cirrhosis[alcohol liver disease] Primary biliary cirrhosis Drugs;pcm overdose Effects of hormonal changes during pregnancy Fatty liver disease Liver cancer Glandular fever c]POST–HEPATIC CAUSES Due to obstruction of hepatic system; Gall stones Pancreatic cancer Cancer of gallbladder High fatty diet raises cholesterol levels increasing risk of having gall stones

37. DIAGNOSIS OF JAUNDICE History taking [hx of misuse of drugs] Physical examination[enlarged liver, swollen legs ankles and feet which might indicate cirrhosis Lab invx;bs for malaria parasites, blood for hepatitis test, sickling test Complete blood count[reduced; wbcs,rbcs,platelet count[ thrombocytopeania ],tendency to bleed Liver function test;[ALT- Alamine , transaminase help process proteins,AST-Aspertate aminotransferase found in the liver cells can be released on skeletal and heart muscles, Alkaline phosphate –ALP, Albumin levels, Total proteins FUNCTIONS OF THE LIVER Stores fuel for the body in form of glycogen stored in the liver from extra glucose Help process fats and protein from digested food Manufacturing proteins essential for your blood to clot[ clotting factors] Processing medicines taken Helps remove toxins and poisons from the body Manufactures bile

38. 3]CYANOSIS Def;blue coloration of the skin more visible in the light skinned and mucus membrane[in the mouth,lips,eyes,vulva] due to high levels of circulating deoxygenated blood divide into peripheral and central cyanosis a]central cyanosis; deoxygenated blood mixes with oxygenated blood in the great blood vessels of the heart and lungs b]peripheral cyanosis; localized circulation is impaired and there is great extraction of oxygen from hemoglobin by tissues Oxygen saturation is measured by pulse oximeter,

39. 4]OEDEMA Def;Swelling of the body parts secondary to prolipheration of fluid into the cells can localized or genralised TYPES Traumatic[ hematoma ,dislocation] Inflammatory; can be chronic or acute Congenital a] Localised causes Allergic reaction Eczema Cellulitis Insect bite Infections –parasitic Sunburn Trauma Anemia Interference/blockage of blood circulation

40. GENERALISED CAUSES OF OEDEMA Beriberi Congestive cardiac failure Liver cirrhosis[reduced level of protein in the body] Excessive fluid therapy Glomerulonephritis Filariasis Severe anemia Medication[ corticosteroids,antihypertensive - calcium channel blockers,NSAID-known for fluid retention] Kidney failure Insufficiency of protein and vitamin B1 in the diet Types of edemas; Pedal odema;affects lower limbs Peripheral edema/ lymphedema;affects arms legs and feet Pulmonary odema;affects lungs causing difficulty in breathing especially when lying down Cerebral odema;hydrocephalas

41. 5]FEVER Def;elevation of body temperatures beyond 37.2 degrees centigrade, this, its controlled by the hypothalamus in the brain enhances body defense mechanism causing minor discomfort for the patient. Fever results from actual resting of hypothalamus, CAUSES Commonest causes ;common cold, other viral ,bacterial infections Cancer Hormonal disorder;pheochromocytoma,hyperthyroidism Autoimmune diseases; rheumatoid arthritis Excessive exercise especially in the hot weather Certain drugs;anesthetics,antopsycotics,anticholenergics,overdose of aspirin Damage to hypothalamic Vaccines Blood clots Stroke

42. 6]DEHYDRATION Def;deficiency of body water occurs when loss of body fluids is more than the intake leading to rise in sodium levels At first dehydration stimulates the thirst center in the brain casing person to drink more water however if it continues the cells shrink and loose function the severely affected organ is the brain, leading to confusion which can progress to coma. CAUSES Diarrhea Vomiting Sweating excessively in hot environment ,vigorous exercise Inability to drink fluids Diabetes mellitus Diabetes insipidus Diuretics

43. SIGNS AND SYMPTOMS OF DEHYDRATION Dry mouth Eyes stop making tears Sweating may stop Heart palpitations Light headedness Weakness Reduced urine output Sunken fontanelle and eyes High thread pulse Low blood pressure COMPLICATIONS OF DEHYDRATION kidney failure Coma Shock Electrolyte imbalance/abnormalities[ diarrhoea and vomiting leads to loss of potassium leading to muscle weakness]

44. 7]HYPERHYDROSIS Also known as sudorrhoea excessive sweating May affect the entire skin surface but often limited to palm,soles,armpits or groin In severe cases the affected areas may cracks or give off fowl smell PRIMARY HYPERHYDROSIS Cause is unknown CAUSES OF SECONDARY HYPERHYDROSIS Obesity Gout Menopause Pregnancy infections – malaria,tuberculosis,HIV Diabetes mellitus Mercury poisoning Anxiety

45. CAUSES OF HYPERHYDROSIS CONT….. respiratory failure Hyperthyroidism Hodgkin's disease Antidepressants Vigorous exercise 8]FINGERCLABBING Symptom of disease often of the heart and lungs which cause chronically low blood levels of oxygen CAUSES C yanotic heart disease C ystic fibrosis L ung cancer l ung abscess U lcerative colitis B ronchiectasis B enign mesathioma

46. CAUSES OF FINGER CLABBING CONT…. I nfective endocarditis I diopathic pulmonary fibrosis N eurogenic tumors G astrointestinal disease