Clinico – Social Case

Presentation
Nisarga Kini
 General Information

* Name : Samarth
* Gender: Male Age: 3 DOB: 6/1/2017
* Informant: Mother (reliable) DOA: 28/2/2020
* Address: Uttarahalli DOE: 28/2/2020
* Name of the PHC: Uttarahalli PHC
* Religion: Hindu
 Family Details
* Type of family: Joint Family
* Composition of Family:
❖ No of members: 5
❖ Head of the family (HOF): Arjun (child’s father)
Sr Name Relation A Se Education Marital Occupatio Incom Remar
no. to HOF ge x status n e ks
1 Shankare Father 65 M Not married retired - Hypert
gowda educated ension
2 Bhagyala Mother 55 F Not married housewife - -
xmi educated

3 Arjun HOF 30 M 5th grade married farmer 10,000 -

4 Sumithra Wife 25 F 4th grade married housewife - -

5 Samarth Son 3 M - - - - immuni

zed
* Total annual income of the family from all sources: (son’s
income + cattle) 10,000+ 5,000 =15,000
* Per capita income: 3000
* Socio- economic status: lower middle by modified
kuppuswamy scale.
 Family and Environmental Study
* Type of house:- Pucca
* Overcrowding:- absent
* Ventilation:- adequate
* Lighting:- natural light – adequate
artificial light – inadequate
* Mosquito breading areas – present
* Fly breeding areas - present
* Cattle distance from the living room:- 600m
 • Rodents in the house – absent
• Pets in the house – absent

Kitchen – separate
• Storage of cooked food:- copper vessels (covered)
• Storage of uncooked food:- shelves(kept covered)
• Fuel used:- LPG
• Chimney- present
• Washing areas for utensils - outside
• Drainage – open

Water supply- public

• Continuous
• Source of drinking water:- tubewell (distance from house – 400m)
• Source of water for other purposes:- tank (distance from house –
300m)
• Storage of drinking water:- earthen pot(covered)
• Frequency of collection:- once a day
• Fetching of water:- dipping vessel
• Household purification of water:- Boiling
Refuse disposal
• Stored in a covered box in the house
• Disposed once in two days in a common dustbin in the
locality which is later cleared muncipal authority

Latrine
• Own – RCA latrine
• Water that is brought from tanks is filled in buckets
• Hand washing practices – without soap
 Medical History

Chief Complaints
* Child’s mother complaints of vomiting in the child
since 7 days
* Child’s mother also complaints of loose stools in her
child since 7 days
 History of Presenting Illness
* Child was apparently normal 7 days back and then he
developed vomiting which was sudden in onset and didn’t
increase in severity
* It was mild with a frequency of 3-4times, yellowish in colour,
containing food particles, non bilious, non blood tinged and
non- projectile, associated with nausea
* It wasn’t associated with food intake
* Child also developed loose stools 7 days back which was
sudden in onset
* It was moderate in severity with a frequency of 4-5 times,
small in bulk, consistency being semi-solid, greenish yellow
in colour, non blood tinged, no mucous.
* Associated with reduced frequency of passing urine
and excessive thirst
* history of loss of weight
* No history of fever
* No history of recent travel or intake of food from
street side
* No history of abdominal pain
* No history of similar complaints in the neighboring
houses
* History of exposure to farm animals
 Past history
* No past history of similar complaints
* No history of previous hospitalization
* No history of drug intake or food allergies

Family history
* Nothing significant
* Non consanguinous marriage
 Birth History
Antenatal history
* First trimester:
✔ h/o folic acid intake
✔ no h/o fever with rashes
✔ no h/o exposure to radiation or drug intake
✔ Dating scan done at 11/2 month and the report was
normal
* Second trimester:
✔ Quickening: at 5th month
✔ h/o intake of iron and calcium
✔ 2 doses of TT injection taken
 ✔ no history suggestive of pregnency induced
hypertension and gestational diabetes
✔ Anomaly scan was done at 7 ½ months and the report
was normal
* Third trimester
✔ continued to perceive fetal movements
✔ no history suggestive of pregnency induced
hypertension and gestational diabetes
✔ Continued iron and calcium
✔ Interval growth scan was done and the report was normal
Natal History
✔ Full term vaginal delivery
✔ Cried immediately after birth
✔ Birth weight : 2.8kg
✔ Place of delivery: PHC

Post Natal History

✔ Time of initiation of breast feeding : within one hour
✔ Exclusive breast feeding for 6 months
✔ No history of jaundice, seizures or NICU admission
✔ Passage of urine and meconium within 1st day of life
✔ No history of pre-lacteal feeds
 Immunization History
* At birth : BCG, OPV-0, Hep B-0
* 6 weeks : bOPV-1, Pentavalent-1, IPV-1
* 10 weeks: bOPV-2, Pentavalent-2,
* 14 weeks: bOPV-3, Pentavalent-3, IPV-2
* 9 months: MR, Vitamin A,
* 16 months: MR, Vitamin A, DPT booster 1,bOPV booster
* 22 months: Vitamin A,
* 28 months: Vitamin A
* 34 months: Vitamin A
* Status : complete for child’s age
 Developmental History
Sn Age Gross motor Fine motor Language Social and
Adaption
1. 4 Stable head Was able to reach Babbled Able to
months control, rolled out for objects when people recognize
over, body with both hands spoke to him mother and was
weight excited to see a
supported on toy
forearms in
prone position
2. 6 Was able to sit Was able to reach Was able to Was anxious to
months with support for objects with say ba, ma, strangers,
one hand and was pa, da played games
able to transfer it like peek-e-boo
to another hand
3. 8 Was able to sit Dropped objects in Was able to Was able to
months straight without when a new toy imitate wave bye-bye
support and was given and sounds and
could crawl could grasp with could say ma-
crude palmar grasp ma, ba-ba
4. 10 Could climb and Was able to do a Responded Was able to
months stood with fine grasp to “no” attain mother’s
S Age Gross motor Fine motor Language Social and
n Adaption
5. 12 Stood Was able to put Could speak 2-3 Was able to
months without objects in box and words come when
support mouthing reduced name was called
and could nod
the head for a
“no”
6 15 Walked Could self feed with Could speak Jargon speech
. months without cup and could words with
support scribble meaning

7. 18 Was able to Could self feed with Jargon speech Was able to
months run and pull a spoon and flip 2-3 with 7-10 words imitate
drawers pages of newspaper household tasks
8 2 years Was able to Could flip one page Can make 2 Was able to ask
. jump, run at a time and could word for food and
and kick a imitate circular sentences and need for toilet
ball strokes can say “I,me,
you”
9 3 years Able to go Can draw a circle and Can make 3 Knows his name
. up the stair can dress himself word and age
* Developmental milestones appropriate for age
* Developmental quotient = 98%

Diet History
* Exclusively breast fed till 6months of age
* No pre-lacteal foods were given
* At the timing of weaning, ground rice with milk was given
* 24hr recall method before illness
S. Time Food Items Quantity Calories Protein
No (kcal) (g/dl)
1. 8am Idli 2 150 2

2. sambhar 1 cup 110 3

3. 11am milk 1 cup 67 3.2

4. 1pm Plain rice 1 cup 170 2

5. Plain dhal 1 cup 200 7

6. 4pm milk 1cup 67 3.2

7. apple 1 65 0.2

8. 8pm Plain rice 1 cup 170 2

9. Plain dhal 1 cup 200 7

* Total calories:- 1199kcal Total proteins:- 19.6 g/dl
* Expected:- 1060kcal Expected:- 16.7g/dl
* No deficiency in calories No deficiency of proteins

General Physical Examination

* Mother was explained regarding the examination and her
consent was taken
* Child is alert but slightly irritable
Anthropometry
Parameters Actual Expected
Weight 13kg (within- 25 th 14kg
percentile)
Height 94cm (within- 25th 95cm
percentile)
Head Circumferance 48cm 46.8 - 50.3cm
Mid upper arm 15cm 15-17 cm

* Chest Circumference-52cm
Circumference
* Upper segment to lower segment ratio :- 1.2
* Conclusion after anthropometry:- normal
Vitals
* Temperature: 36.5˚C , measured in the axilla
* Pulse: 70 beats/min, regular rhythm, normal in volume and
character, no radio- radio delay, other pulses felt and are
normal
* Blood pressure:100/62 mm of hg measured in the right arm
sitting position
* Respiratory rate: 24 breaths/min
* SpO2:- 96%
* Capillary filling time:- 1second
* Pallor: not seen, Icterus: not seen, Clubbing: not seen,
Cyanosis: Not seen, Lymphadenopathy: not present, Edema:
Not present
* Head and face:- Normal
* Eyes:- Sunken eyes
* Ear, Nose and throat:- Normal
* Oral cavity:- normal Tongue:- dry
* Skin:- Normal Hair:- normal Nails:- normal
* Bones and joints:- Normal
* External genitalia:- Normal

Systemic Examination
* CVS: S1 and S2 heard, no murmurs
* RS: Normal Vesicular Breath Sounds, no added sounds
* CNS: no focal neurological deficit
 Examination of Abdomen
Inspection:
* Contour:- depressed
* Umbilicus- centre
* All quadrants move equally with respiration
* No visible peristalsis
* No pulsations/veins
* No scars
* Hernial orifices – normal
* External genitalia- normal
 Clinical-Social Diagnosis
* Case of diarrhoea with some dehydration in the child
belonging to lower middle socio economic status by
modified kuppuswamy scale.
 Management
* Treatment for some dehydration:-
✔ Child is managed at home under supervision
✔ ORS is given – 75ml/kg body weight
✔ Mother is explained on how to prepare the ORS solution.
✔ ORS packets must be checked for expiration date and
the entire content of the packet must be emptied into a
container containing 1l of warm water.
✔ It should be immediately given as soon as diarrhoea
begins and after each episode of diarrhoea
✔ If child vomits, then try giving ORS after 10mins again
✔ Zinc supplementation- 20mg for 10-14 days. One tablet
must be powdered and mixed with one teaspoon of
water and given to the child once a day for 14 days
✔ Feeding must be continued during and after episodes of
diarrhoea
✔ Mother should come for follow p after 5 days
✔ If at any time the condition worsens she must come to
the hospital immediately
 Preventive measures

* Individual level
* The Mother should be educated about proper food
sanitation which includes :food hygiene, proper hand-
washing techniques(after defecation, before cooking and
feeding food), adequate cooking of food and keeping the
food covered always
* She should also be educated about regular disinfection of
the latrine
* She should also be educated regarding completion of
immunization of child as per schedule
• She should be informed about rota virus vaccine atleast for
next child as per the latest schedule
• She should be advised to adopt fly control measures
* Family level
* The other members of the family should also be educated
about proper hand-washing techniques(after defecation,
before eating and feeding food)and keeping the food
covered always.
* They should be advised about proper disinfection of the
latrine and house
* They should be advised to adopt fly control measures
* Community level
* Integrated management of neonatal and childhood diseases.
* National Health mission
* Intensified Diarrhoeal Control Fortnight
* Reproductive, Maternal, Newborn, Child and Adolescent
Health
* Rashtriya Bal Swasthya Karyakram
* Thank You