The document outlines the importance and process of history taking in medical practice, emphasizing effective communication between physician and patient to gather essential information for diagnosis. Key components of history taking include recording personal details, the chief complaint, history of presenting illness, and relevant medical background. It also details various aspects to consider during physical examinations and diagnostic approaches, highlighting the necessity of practice, patience, and a patient-centered approach.

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
A. Always record patients personal data/details/particulars abbreviated as NASEOMARD
B. Chief complain
C. History of presenting illness
D. Past medical and surgical history
E. Family history
F. Social history
G. 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
Name
Age
Sex
Ethnicity
Occupation
Marriage
Address
Religion
Date 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

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
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


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
1. General examination
2. Vital signs; blood pressure ,pulse, temperature, respiration
3. 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

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

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
Hormones

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
a. Eupnia;normal respiration average 16 -24 breaths per min
b. Tarchypnia;hyperventilation rate >25 breaths per minute
c. Bradypnoea;Slow respiration < 16 breaths per minute > 12 breaths per minute
d. 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
Noteweatherthepatientis;

Stablegeneralcondition

Mildlysicklooking/fairlysicklooking

Moderatelysicklooking

Severelysicklooking

Inseverepainordiscomfort

Youwillnotethisfrom facialexpressionofthepatient
C.]NUTRITIONALSTATUS Thisisthebuildofthepatient

Wellnourished

Malnourishedassesbodymassindexwhichis weightdividebyheightsquared BMI18-25

OverweightBMI25-30

ObesityBMIover30

WastedBMIlessthan18

Cachexicmassivewastingwhosefeaturesincludeprominenceofbones

NOTE; in theseverelyillyoumightnotbeabletotakeweightbutyoucaassessgenerally ifcachexic,overweightor
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 are 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

31. 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

32. 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

33. CAUSES OF ANEMIA CONT….
A}DUE TO BLOOD LOSS
1]Physical 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

34. 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

35. 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

36. WHERE TO CHECK FOR PALOR
Conjunctiva
Tongue
Sole of foot
Palm 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

38. 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

39. 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

40. 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

41. 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,

42. 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

43. 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

44. 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

45. 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

46. 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]

47. 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

48. 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
Cyanotic heart disease
Cystic fibrosis
Lung cancer
 lung abscess
Ulcerative colitis
Bronchiectasis
Benign mesathioma

49. CAUSES OF FINGER CLABBING CONT….
Infective endocarditis
Idiopathic pulmonary fibrosis
Neurogenic tumors
Gastrointestinal disease