Facilitator - WHO Western Pacific Region - World Health Organization

Module 6: Patient assessment & evaluation
SESSION 6.2: STEP 1
SLIDES 3 & 4: History taking
•Facilitator explains:
•It is good practice to try to ascertain the duration of the fever as well as date of onset of illness.
•For
•
slide 3, Facilitator explains:
•A patient’s history should include:
1. Date of onset of fever (date is preferable to the number of days of fever);
2. Other symptoms and severity. The severity of symptoms will affect the 3 golden questions:
a) oral fluid intake – quantity and types of fluids; b) urine output – quantify in terms of
frequency and estimated volume, time of most recent voiding; and c) types of activities
performed during this illness, e.g., could the patient go to school, work, market, etc. These
three issues, though not specific to dengue, give a good idea of the hydration state and
how well the patient copes with the illness.
3. Other fluid losses – such as vomiting or diarrhoea
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4. Presence of warning signs
•For slide 4, Facilitator explains other relevant histories (Questions 6 to 10) and then asks: “Why
ask about risk factors in question 8”
SESSION 6.3: STEP 2
SLIDES 5: Clinical examination
•Facilitator
•
explains:
•
•Clinical examination should be performed carefully and thoroughly.
•A patient with dengue shock looks deceptively “well and stable” because of their lucid
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conscious level.
•This is particularly so in older children and young adults whose compensatory mechanism
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could be up-regulated to maintain perfusion to brain.
•With practice, the physical examination can be skilfully accomplished fairly quickly.
•How does the patient look What is his or her state of alertness Bear in mind that conscious
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level is affected only in late dengue shock.
•Hydration state is best assessed by the patient’s history, not by skin turgor or dryness of
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mucosa.
•Pay attention to the patient’s haemodynamic state and breathing pattern, and check for
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abdominal tenderness and hepatomegaly.
•Look for rash and haemorrhagic manifestations (e.g. petechiae and bruises at venepuncture
••
sites) in limbs and trunk.
A
tourniquet test should be done if previously negative or if no spontaneous bleeding
manifestations are present.
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