PAEDIATRICS DEPARTMENT

OBJECTIVES;

✓ History taking accurately.

✓ Performing physical examination to the patients
✓ Formulating proper diagnosis
✓ Treating or referring the patients for further management.
✓ Assessment for growth and development of the sick children.
✓ Managing child illness by following the guideline for integrated management of
childhood illness.
✓ Provide essential newborn care
✓ Educate the mother on how to give proper breastfeeding to their babies.
✓ Care and management of children with HIV/AIDS.
✓ Conduct reproductive and child health care.
 PEDIATRIC DEPARTMENT
TOP TEN DISEASES
1. Pneumonia
2. Upper respiratory Infection
3. Anaemia
4. Burn
5. Urinary Tract Infection
6. Severe Pneumonia
7. Fracture
8. Neonatal Sepsis
9. Moderate Malnutrition
10. Diarrhea

TOP 10 DRUGS IN PEDIATRIC DEPARTMENT

1. Injection Ampicillin
2. Injection Gentamicin
3. Injection Ceftriaxone
4. Injection Hydrocortisone
5. Paracetamol Tabs
6. Syrup Paracetamol
7. Ped Zinc Tabs
8. Infusion (RL & DNS)
9. ORS
10. injection X - Pen
Paediatric case presentation

NAME: Fatna Icra

AGE: 1yr and 2months
Sex: Female
Religion: Muslim
Tribe: Pare
Address: Chomvu
Date of admission: 16/7/2020
Date of history taking: 17 July 2020
Informant: Biological mother
Chief complaint:

Passing loose stool for 2 days

Fever for 1day

HISTORY OF PRESENTING ILLNESS

The mother reported that her child was well until 2 days prior to admission, when she noted a
gradual onset of passing loose stool to her baby, in which the child was passing loose stool
about three motions per day, the stool is watery in nature containing mucous, however it was
not stained with blood. The condition was worsening as time went on, associated with
abdominal discomfort, refusal to feed, body weakness, and later he develop a gradual oncet
fever which was on and off more severe during the night in which she noticed her child crying.
The condition had not aggravating or relieving factors.

However there was no history of, vomiting, abdominal discomfort during urination, loss of
consciousness, or convulsions.

REVIEW OF OTHER SYSTEMS

EAR NOSE AND THROAT

Ear: There was no history of ear discharge or bleeding from the ear
Nose: No history of nasal bleeding or nasal congestion
Throat: There was no history of discomfort in swallowing
MUSCULOSKELETAL SYSTEM
There is no history of joint swelling
RESPIRTORY SYSTEM

There is no history of cough, or discomfort in breathing

PAST MEDICAL HISTORY

This is the first admission. There is no history of blood transfusion or any surgical intervention.
No history of food or drug allergies reported so far.

ANTENATAL HISTORY
The mother reported that she attended antenatal clinic four times when she was pregnant for
this baby, and she was screened for malaria syphilis and HIV and the results were all negative.
She was given folic acid and ferrous sulphate, sulphadoxine pyrimethamine for malaria
prophylaxis, and mebendazole for deworming. The mother did not suffer from any
complications during pregnancy. I was able to confirm all these information from RCH card
number 4.

NATAL HISTORY
The mother reported that she delivered her baby at full term at hospital, kigongon health centre
where by it was normal spontaneous vaginal delivery. The membranes ruptured spontaneously
and the child cried immediately after birth, with birth weight of 3.5kg. The baby was also fed
within one hour after delivery.

POST NATAL HISTORY

The child did not suffer from any complications after delivery, like yellowish discoloration of
the skin or mucous membranes, sepsis of the cord or convulsions. The baby also did not bleed
from the cord.
IMMUNIZATION HISTORY

The child is fully immunized according to his age where by, he received BCG and OPV0 on
the 2nd day after delivery and he received OPV 1, PCV 1, PENTA 1, ROTAR 1 at 6 weeks of
age, OPV 2, PCV 2, PENTA 2 AND ROTAR 2 at 10 weeks of age and PCV3, PENTA 3 OPV
3 at 14 weeks of age. The child also received measles-rubella vaccine at the age of nine months.
I confirmed all these information from RCH card number 1.

Comment: this is a good immunization history

DIETARY HISTORY

The child was exclusively breast fed for six months, he was feeding more than 8 times a day
until six months, then started complimentary feeding where by the mother started to give the
child, cow milk, and soup made of cooked bananas. The feeding pattern of the child was good
where she was fed 5 times a day .Comment: This is a good dietary history, however now
the child is refusing to feed due to the illness.

DEVELOPMENTAL MILESTONES

The child had a social smile when he was 2 weeks old, and he was able to control the neck at
3 months of age. Now a child can stand, and walk with [Link]: These are a good
developmental mile stones according to the age of the child.

FAMILY AND SOCIAL HISTORY

He is the last born out of six siblings in his family. All his siblings are alive and well. There is
no history of any inherited disease in his family such as hypertension, asthma, diabetes mellitus
and cancer.

He is living with both his mother and father in a block house well ventilated, and they are using
tap water for drinking and domestic activities. They use pit latrine. Both his parents drink
alcohol about two beers per day, for more than ten years now. His father smokes cigarette.
PHYSICAL EXAMINATION

GENERAL EXAMINATION
He is a child ill looking with normal hair color texture and distribution Not pale, not cyanosed,
not jaundice, no peripheral lymph nodes enlargement No finger clubbing, not edematous

One assessment of dehydration:

The skin pinch goes back very slowly; he is lethargic, with sunken eyes and unable to drink

VITAL SIGNS

✓ Respiratory rate 35 breaths per minute

✓ Body temperature 38oC
✓ Pulse rate 78 beats per minute
Comment: These are stable vital signs

ARTHOPOMETRIC MEASUREMENTS

✓ Weight 13kg
✓ Mid upper arm circumference (MUAC) 15.0 cm
✓ Occipital frontal circumference (OFC) 37cm
✓ Length 75cm

Comment: these are normal anthropometric measurements according to the age of the
child.

SYSTEMIC EXAMINATION

GASTROINTESTINAL SYSTEM

ABDOMINAL EXAMINATION

On inspection:
The abdomen moves with respiration
The abdomen is flat, inverted umbilicus
No traditional or therapeutic marks seen

On superficial palpation:
 NO any palpable mass and no discomfort on palpation
On Deep palpation:
No any intra-abdominal mass enlargement such as Kidney, spleen and liver

On percussion: Normal tympanic note heard

On auscultation: Normal bowel sounds heard

Nervous system examination

1. Higher centers
The child is alert
2. Cranial nerves
All other cranial nerves are intact except olfactory, trigeminal, glossopharyngial,
hypoglossal, and accessory which were not tested due to the age of the child.
3. Long tract
Normal muscle bulkiness
4. Reflexes
Babinski reflex was intact

Respiratory system

On inspection:

There is severe lower chest wall in drawing,

No any visible traditional mark or therapeutic

Chest is bilaterally symmetrical

On palpation:

Chest expand equally with respiration

There is no any palpable mass

No any discomfort on palpation

On percussion:

Normal resonant percussion note heard

On Auscultation:

Normal vesicular breath sounds heard

CARDIOVASCULAR SYSTEM

On inspection:

There is no traditional or therapeutic mark seen, there is no bulging on pericardial area, and no
hyper activity on the pericardial area

On palpation:

The apex beat is located at the 4thintercostals space along the left midclavicular line

On auscultation:

Normal S1 and S2 heart sounds heard with no any additional sounds

SUMMARY:

This is the presentation of Fatma Icra, a female child of 1yr and 2 months old, from Chomvu
who was brought in our centre by his mother with the chief complaint of passing lose stool,
which is watery in nature, passing about four motions per day, the stool containing mucous nor
stained with blood,, associated with abdominal discomfort, fever which was on and off, refusal
to feed and body weakness. On physical examination, the child is severely dehydrated with,
sunken eyes, skin pinch going back very slowly, and unable to drink, with stable vital signs
and normal anthropometric measurements.

DIAGNOSIS

Acute watery diarrhea with severe dehydration

This is due to history of passing lose stool, abdominal discomfort, lethargy, and signs of severe
dehydration on examination.

DIFFERENTIAL DIAGNOSIs

Bacillary dysentry due to passing loss stool, contain water and mucoid with fever
Uncomplicated malaria, due to refusal to feed, fever on history and body weakness

Hypoglycemia, due to lethargy, and refusal to feed

Urinary tract infection due to abdominal discomfort and history of fever

MANAGEMENT

✓ Investigations: Malaria rapid diagnostic test which was negative

✓ Random blood glucose (RBG) which was 4.3mmol/L
✓ Stool analysis no any cyst or ova seen
✓ Urine analysis no pus cells seens

TREATMENT

Admit the child in children ward

Treat the child as severe dehydration which falls under treatment plan C.

Give intravenous ringer’s lactate a total of 1300Mls. This fluid is divided into 30% and 70%
whereby the first 30% is given to the child to run for half one an hour and then the next 70% is
given to run in the next 2 and half hours, this makes a total of 3hrs.

Reassess the child after two hours while continuing with the fluid and classify again to see if
the child is improving.

After treatment, if the child is still severely dehydrated, repeat the fluid and give oral fluids if
the child can take orally.

If the child improves and falls under plan A, ensure to educate the mother on how to treat
diarrhea at home by the following four rules:

Extra fluids, Continue feeding, Zinc supplements in which he will get 20mg once daily for 14
days, and when to return.

The mother has to bring back the child to hospital if, there is,

Blood in stool, continuous lethargy, unable to feed, high fever, vomiting everything or
convulsion
COMPLICATIONS:

Complications of diarrhea include,

❖ Electrolyte and fluid imbalance,

❖ Hypoglycemia and
❖ Rectal prolapsed.

PREVENTION:

❖ Early diagnosis and treatment

❖ Keep the child warm
❖ Hygiene of the child and caretaker to avoid ingestion of dirt or microorganism which
cause diarrhea
❖ Washing hands after using toilets and before preparing child’s meals
❖ Using clean utensils for preparation of food

INTERNAL MEDICINE DEPARTMENT

Objectives
 i. To take history accurately
ii. To perform thorough physical examination
iii. To perform relevant laboratory investigations
iv. To formulate diagnoses
v. To treat and or refer
vi. To conduct heath education
vii. To plan for care of HIV and AIDS clients
viii. To counsel clients for HIV testing.

MEDICAL DEPARTMENT
TOP TEN DISEASES

1. Hypertension
2. Diabetes mellitus
3. Pneumonia
4. HIV/AIDS
5. Peptic ulcer disease
6. Tuberculosis
7. Urinary tract infection
8. Anemia
9. Heart failure
10. Bronchial asthma

TOP 10 DRUGS USED IN MEDICAL DEPARTMENT

1. Salbutamol
2. Amoxicillin
3. Glibeneclamide
4. Ferrous sulphate and folic acid
5. Metformin
6. Artmether Lumefantrine
7. Cotrimoxazole
8. Ciproflaxin
9. Metronidazole
10. Nifedipine
DEMOGRAPHIC DATA

• Name; Juma Mwatata

• Sex; Male
• Age;53 years old
• Tribe ; Pare
• Religion ; Muslim
• Occupation; Peasant
• Marital status; Married
• Level of education; Standard seven
• Date of taking history-14 July 2020

MAIN COMLAIN

• Painful during swallowing for 4 days

• Passing lose stool for 3 days

HISTORY OF PRESENTING ILLINESS

He is a known patient of HIV for 8 years on irregular medication which is TLE tenofovir,
lamivudine, [Link] the patient reported to have painfull during swallowing for 4 days
which is gradual onset ,irritating in nature which is non radiating ,aggrevated when taking any
food associated with vomiting which is non projectile the vomitus containing food contents
which he vomits three times a day which is small in amount with no relieving factor ,however
no history of vomiting blood, no history of trauma, no history of loss of appetite
Also the patient reported to have passing loose stool for 3 days which is sudden onset 5 motions
a day ,yellowish in colour ,mucoid stained and worsens as time goes on which associated with
general body weakness ,however no history of abdominal pain

REVIEW OF OTHER SYSTEM(R)

EAR

I. No history of los of hearing

II. No history of abnormal ear discharge
III. No history of pain
➢ NOSE
I. No history of nasal congestion
II. No history of nasal bleeding
III. No history of loss of sense of smell
 ➢ MUSCULOSKELETAL SYSTEM
I. No history of joint pain
No history of joint swelling
RESPIRATORY SYSTEM
-No history of cough, no history of chest pain, no history of difficulty in breathing
CARDIOVASCULAR SYSTEM
-No history of difficulty in breathing when lying flat, no history of heart beat
awareness
ENDOCRINE SYSTEM
-No history excessive sweating, no history of excessive thirsty, no history of excessive
hunger
PAST MEDICAL HISTORY AND SURGICAL HISTORY

This the second admission whereby the first admission was due blood loss following the side
effect of Ant retroviral drugs which he was using, initially he was transfused blood he was
treated and improved .However no history of food and drug allergy he is on long term
medication which are ARVS .no history of any surgical intervention

FAMILY AND SOCIAL HISTORY.

He is the last child out of five sibling, 3 are female and 2 are male where all are well and alive,
his parents are well and alive ,no any inherited diseases running in the family.

His wife died due HIV diseases, he lives in well ventilated block house using tape water for
domestic purpose not boiled for drinking he is not alcohol taker or cigarette smoker

GENERAL EXAMINATION

An adult male, ill looking full conscious oriented to people, place and time with normal hair
colour texture and distribution, not jaundiced, not pallor, with no central or peripheral cyanosis
with normal capillary refill, no finger clubbing, no peripheral lymph node enlargement and
oedema on the lower limbs.

VITAL SIGN

Blood pressure =130/80mmhg,

Temperature= 36.6oc,

Pulse rate= 88beat/min

Respiratory rate= 20 breath per minutes

SYSTEMIC EXAMINATION

GASTRO INTESTINAL SYSTEM

-On inspection, the abdomen is flat in shape no any traditional or surgical mark seen, the
abdomen moves equal with respiration

-On palpation, superficial palpation no any area of tenderness Deep palpation liver spleen and
kidney not palpable

-On percussion, normal tympanic note heard

-On auscultation normal bowel sound heard.

CENTRAL NERVOUS SYSTEM

Starting with higher centre, the patient is full conscious oriented to people, place, and time.
Both short and long term memory were intact. Concentration was intact. All cranial nerves
were intact. With normal muscle power, muscle tone, muscle bulkiness. Both superficial and
deep tendon reflexes were intact

RESPIRATORY SYSTEM

Inspection

✓ No surgical or traditional mark seen

✓ Chest move with respiration
✓ Chest is bilateral /symmetry
✓ No any abnormality detected

Palpation

✓ No are of tenderness
✓ No palpable mass
✓ Trachea is centrally located
✓ Normal tactile fremitus felt

Percussion

- Resonant sound noted heard

Auscultation

-Vesicular breathing sound heard

CARDIOVASCULAR SYSTEM

Inspection

o No hyperactivity of precordial areas

o No bulging of precordial areas
Palpitation

Apex beat is located at intercostal space along the mid clavicular line

• Auscultation

First and second heart sound was heart with no additional sound

SUMMARY

I have been presented a to you Juma mwatata a male of 53 years from Baraka who is known
case of HIV on irregular medication who come to our hospital with main complain of painfull
during swallowing for 4 days assocated with vomiting and passing loose stool for 3 days
associated with general body [Link] examination the patient had white patches around
hard and soft palate and around the gum, also he had darken skin lesion shows healing
appearance in left frontal part of the fore head to the left eye. With vital sign which are blood
pressure of 110/70mmhg, temperature 36.60C pulse rate 88bit/min and respiratory rate
20breath/min

DIAGNOSIS

WHO HIV STAGE 4 WITH

1) Oral –Esophageal candidiasis due to painful swallowing and white patches around the mouth

2) Giardiasis due to passing loose stool mucoid in nature and vomiting.

3) Post ophalamic herpes zoster due to darken skin lesion on left frontal part of fore head to
left eye shows healing by appearance

DIFFERENTIAL DIAGNOSIS

-Amoebiasis due to passing loose stool and vomiting

-oral hairy leukoplakia due to white patches

-Gastro esophageal reflux diseases due to painful during swallowing

INVESTIGATION

-Stool analysis to rule out giardiasis, shigelosis, amoebiasis

-CD4 Count to check if increased or decreased

-Oesophageal gastrodeudenoscopic to rule out if thereis mucosa lesion

TREATMENT

NON PHARMACOLOGICAL MANAGEMENT

✓ Counselling the patient about adherence to medication

✓ Counselling the patient about personal hygiene
✓ Counselling the patient about diet

PHARMACOLOGICAL MANAGEMENT

✓ Continue with ARVS which is Tenofovir, Efavirenz, Lamivudine

✓ Fluconazole 400mg Once a day IV(intravenous) for 10 days
✓ Acyclovir cream twice a day for 3/7

PREVENTION

➢ Good adherence to medication

➢ Education on important of using ARVS
➢ Ensure personal hygiene so as to avoid opportunistic infection
➢ Good diet especially vegetables and fruits

PROGNOSIS

The prognosis of HIV stage 4 is bad

COMPLICATION

-Renal failure

OBSTETRICS AND GYNECOLOGY DEPARTMENT

Objectives

i. To take history accurately

ii. To perform thorough physical examination
iii. To perform relevant laboratory investigations
iv. To formulate diagnoses
v. To treat and or refer
vi. To record parameters of progress of labor on a partograph
vii. To interpret the partograph records

OBSTETRICS AND GYNAECOLOGY DEPARTMENT

TOP TEN DISEASES

1. Anemia in pregnancy
2. Urinary tract infection
3. Obstructed/prolonged labor
4. Antepartum Haemorrhage
5. Pre-term rupture of membrane
6. Pregnancy Induced Hypertension
7. Pelvic inflammatory disease
8. Vaginal candidiasis
9. Malaria in pregnancy
10. Antepartum Haemorrhage

TOP TEN DRUGS USED IN OBSTETRICS AND GYNECOLOGY

1. Oxytocin
2. Magnesium sulphate
3. Nitrofurantoin
4. Ferrous sulphate
5. Folic acid
6. Metronidazole
7. Amoxicillin
8. Ampicillin
9. Ceftriaxone
10. Clo-trimoxazole
 DEMOGRAFIC DATA

Name = Zainabu Idd

Age = 24 years

Sex = female

Tribe = Pare

Religion = Muslim

Address=Kilaweni

Date of taking history= 17/7/2020

Gravida =1

Parity= 0

Living= 0

Last normal menstrual period (LNMP)=.13/11/2019

Expected date of delivery (EDD).=20/03/2020

Gestation age 35 weeks and 2 days

MAIN COMPLAIN

-Lower abdominal pain 4/7.

-painfull during micturation 3/7.

HISTORY OF PRESENTING ILLNESS (HPI)

The patient was apparently well until four days ago when she started experiencing gradual
onset of lower abdominal pain which is cutting in nature radiating to the back relieved
when sleeping aggreviated when walking associated with per vaginal discharge which was
whitish in colour small in amount with no foul smell not itching. however no vomiting, no
history of passing loose stool

Also the patient reported to have painful during micturition for 3 days the condition was
no any relieving or aggreviated factor which associated with small amount of urine and
general body weakness .Also the patient reported to have featal movement
REVIEW OF OTHER SYSTEMS (ROS)

⚫ Ear -no history of ear discharge

-no history of ear pain

⚫ Nose-no history of nasal discharge

-no history of nasal bleeding

⚫ Throat-no history of painful during swallowing

Respiratoy system.

-No history of cough, no history of difficult in breathing

⚫ Endocrine system-no history of excessive hunger

-no history of excessive thirst

-no history of heal or cold intolerant

PAST MEDICAL HISTORY

There is no history of previous admission, no history of drug or food allergy so far no

history of blood transfusion also no history of special clinic attendance

OBSTETRIC HISTORY

Index pregnancy

She attended clinic at (RCH) 4 times. Her first booking was when the pregnancy was at
3 months. and she was given sulphadioxin pyramethamine for malaria prophylaxis,
tetanus toxoid vaccine, folic acid and ferrous sulphate also she was screened for HIV,
Malaria and syphils and the result were negative. I was able to comfirm this information
in RCH card number 4

Gynaecological history

She attended menarche when she was 14 years old, she has the cycle of 30 days, she
takes 4 days flow and changes pads 4 times per day which is not totally soaked with
blood .there is no history of contraceptive use and no history of sexually transmitted
diseases (STD), no history of any gynecological procedures
 FAMILY HISTORY

She is second born among 5 children 2 are boys and 3 are girls. Both parents are well
and alive. no history of inherited diseases running in their family like hypertension,
diabetic, asthma

SOCIAL HISTORY

She is living in a well ventilated house and tap water for domestic purpose and drinking.
she uses pit latrine. neither her nor husband takes alcohol or cigarette smoking

GENERAL EXAMINATION

She is an adult women well oriented to people, place and time, not pale, not jaundiced
,not cyanosed no peripheral lymph node enlargement, normal capillary refill, no finger
clubbing, no lower limbs swelling with the following

Vital sign

Temperature 36.5degrees of centigrade

Respiratory rate (RR) 20 beats/minute

Pulse rate 73 beats/minutes

Blood sure (BP) 120/80mmHg

SYSTEMIC EXAMINATION

⚫ Per abdomen
Inspection. - Linear nigra seen

- Abdomen uniformly distended

- Abdomen moves with respiration

⚫ Palpation. - fundal height=36 cm

- Lie -longitudinal

-Presentation -cephalic

- Position - ROA

⚫ Auscultation. - foetal heart rate 136 beat/minute

Cardio vascular system

⚫ Inspection - there is no hyperactivity of precordial area

- There is no bulging of precordial

-jugular venous pressure not raised

⚫ Palpation - apex beat is located at 5th intercostal space

along the mid clavicular line

• Auscultation - first and second heart sound was heard

Respiratory system

⚫ Inspection - chest is bilateral symmetry

- Chest equal moves with respiration

- No surgical or therapeutical scar or mark seen

⚫ Palpation - Trachea is centrally located

- Tactile vocal fremitus heard

- Chest expand equal with respiration

- No area of tenderness or mass palpable

⚫ Percussion - Resonant note heard

⚫ Auscultation - normal vesicular sound heard
Nervous system

An adult woman full conscious, well oriented to people, place and time with both long and
short memory intact. All cranial nerves are intact with normal muscle power and tone.

Summary

I have been presenting to you a Zainabu Idd from kilaweni who is gravida 1 para 0 living 0
with gestational age of 35 weeks and 2 days came to our setting with main complain of lower
abdominal pain associated with per vaginal discharge and painful during micturation associated
with general body weakness. on examination per abdomen, fundal height is 36cm lie
longitudinal presentation cephalic and on auscultation foetal heart rate is 136 beat/minute with
vital sign of temperature 36.5oC, respiratory rate is 20 beats per minute, blood pressure of
120/80 mmHg
Diagnosis

Term pregnancy at gestation age of 39 weeks with

-Urinary tract infection due to lower abdominal pain, painful micturation, general body
weakness

-Leucorrhea gravidarum due to vaginal discharge which is whitish in colour small in

amount not itching

Differential Diagnosis

Investigation

- Urinalysis to rule out urinary tract infection

-haemoglobin level

-ultrasound to check for gestation age, featal viability

-pelvic assessment

Treatment

-Amoxillin tabs 500mg tds for 5/7

-Ensure hygiene

-Drink a lot of plenty water

Prevention

-Ensure personal hygiene

Prognosis

Prognosis is good if mother adhere to medication and counselling

SURGICAL DEPARTMENT
Objectives

i. To take history accurately

ii. To perform thorough physical examination
iii. To perform relevant laboratory investigations
iv. To formulate diagnoses
v. To treat and or refer
vi. To perform provider-initiated testing and counselling
vii. To perform pre and post test counselling effectively
viii. To practice aseptic technique
SURGICAL DEPARTMENT
TOP TEN DISEASES
1. Hernia
2. Fractures
3. Appendicitis
4. Wounds
5. Benign prostate hyperplasia
6. Breast Lumps
7. Road Traffic Accident
8. Hemorrhoids
9. Hydrocele
10.
11. Peritonitis

TOP 10 DRUGS USED IN SURGICAL DEPARTMENT

1. Injectable Diclofenac
2. Paracetamol
3. Ceftriaxone
4. Metronidazole
5. Tramadol
6. Ampicillin
7. Gentamicin
8. Ampicillin + Cloxacillin
9. Soluble Aspirin
CASE FROM SURGICAL DEPARTMENT

DEMOGRAPHIC DATA
Name- Helena Simbano
Age- 1 and 6 months
Sex-Female
Tribe-Pare
Religion-Christian
Address-Pangaro
Informant-her Mother
Main Complain-

Burn injury to the shoulder, Right upper arm and back.

HPI- The informant reported that the child sustain a burn injury of shoulder, Right upper arm,
and back on 15/07/2020 around 5:00 PM. After falling in to the hot water. Then her mother
rushed to the hospital approximately 30minutes after injury.

However No hx of bleeding and No hx of convulsion and loss of consciousness. But the skin
was hyperemic and there is blister.

ROS- Ear Nose and Throat (ENT).

• Ear
-No history of ear discharge
-No hx of ear bleeding

• Nose
-No hx of nasal discharge
-No hx of nasal bleeding.

• Throat
-No hx of Horseness of voice.
Respiratory system. RS
-No hx of cough.
-No hx of audible wheezing
-No hx of difficult in breathing
Endocrine System.
-No hx of excessive hunger than normal
-No hx of excessive thirsty
-No hx of excessive urination.
Past Medical History (PMHX)
There is no history of previous admission whereby there is no history of food and drug
allergy, no history of blood transfusion, no history of long term use of medication
Prenatal History
The mother reported that she did not suffer from any disease during her pregnancy and she
receives Tetanus toxoid and Sulphadocine pyremethamine and Mebendazole and Fefo. Also
she tested HIV, Urinalysis and Haemoglobin level.
Natal History
It was a Hospital delivery by spontaneous vaginal delivery (SVD).
The child cried immediately after delivery and Breast Feed within an hour. With Body weight
of 3.4kg
Post Natal History
The child did not suffer and illness during and after delivery like sepsis of cord and yellow
colouration of the body.
Immunization History
The child received all vaccine Immunization according to the age.
Diatary History
The child breast feed exclusively for six month then start complementary feeding which is
cow milk and porridge. Comment; this is a good dietary history

Developmental Milestone

The child started to smile at 2months, to control neck at 3 months and able to sit at 6
months and crowning at 8 months and standing with support when the child is 10 months and
start walk at 12 month.
Family and Social History

She is first child; they use tap water for drinking and domestic activity, Live in well
ventilated house. Neither mother nor Father drinking alcohol. No hx of chronic disease
running in the family such as HTN and DM.

General Examination
-Child in supine position
-Ill looking and in severe pain.
- Canulated at the Right hand
-Not pale
-No jaundice
-No dehydrated
-No cyanosed
Vital signs
-Temp- 37.7oC
-RR 32 Breath /minute.
-Weight=10.8kg
Local Examination L/E
Inspection-Child in supine position
-Skin is pink
-And blistered
-Not bleeding
Palpation-Tenderness and painful
Systemic Examination
Respiratory system
Inspection- Chest is bilateral symmetry
-Chest move with Respiration
Palpation- Tenderness at posterial chest upper zone
Percussion-Resonant sound note heard
Auscultation-Normal vesicular sound heard
Cardiovascular system

Inspection-No hypereactivity of precordial area

-No bulging at precordial area.

Palpation-Apex beat was located at fifth intercostal space around left mid clavicular line

Auscultation-First and second heart beat was heard

Gastrointestional System

Inspection- Abdomen moves with respiration.

-No surgical or therapeutic mark seen.

Palpation-No area of tenderness

-No intra abdominal organ palpable

Percussion-Tympanic sound noted heard

Auscultation-Normal bowel sound heard

Summary

I have been presenting to you female child goes by Initial Helena Simboni From
Pangaro who come to our Hospital with M/c of Burn injury of shoulder, Upper arm and
posterior ear for one day after falling on Hot water on 15/07/2020 around 05:00pm with
pinkish skin and possible blisters and severe pain. Normal vital signs.

Diagnosis-

Second degree burn injury of the shoulder upper arm and ear with 10% body surface area.

Treatment-IV ceftriaxone 500mg bd 3/7

-IV R/L 600mls for 24 hours but 300mls for first 8hours and the rest for another r
16hours

-Dressing daily

-Apply silva cream

 -PCM 5mls tds 5/7

-Put on bed cradle

-Tetanus toxoid TT 0.5iu start

PREVENTION

Put child away from the hot fluid and fire

PROGNOSIS

Prognosis is good because the burn injury not include the joint, face and is not
circumferential

COMPLICATION OF BURN

Early Complication

-Electrolyte imbalance

-Severe pain

-Shock

Intermidiate Complication

-Infection

-Anaemia

Late Complication

-Contracture

-Kcloids.
CONCLUSION & RECOMMENDATIONS:
I would like to thank Dear Lord for opportunity, strength he given during start to end
of my field work. I would like to thank my fellow colleagues/ students who were together
at the Usangi District Hospital for giving me cooperation and support.

My special gratitude to Usangi District Hospital staff for their guidance, cooperation
and effective coordination between us and them during clinical hours with proper tutoring
about management of patients with different medical conditions. Also, involvement in
Continuous Education Programs.

Lastly, as said before my gratitude to my institution for learning opportunity and I

would like to recommend for the college to extend time for during field time due to there
is a lot to learn and practice.

PAEDIATRIC DEPARTMENT
OBJECTIVES:

➢ History taking accurately

➢ Performing physical examination to the patients
➢ Formulating proper diagnosis
➢ Treating or referring the patients for proper management
➢ Assessment of growth and development of the sick children
➢ Manage child illness by following the guidelines of integrated management of
childhood illnesses (IMCI)
➢ Provide essential new born care
➢ Educate mothers on how to give proper breast feeding to their babies
➢ Care and management of children with HIV/AIDs
➢ Conduct reproductive and child health services (RCH)

TOP TEN DRUGS USED IN PEDIATRIC WARD

11. Ampicillins
12. Cloxacilin
13. Gentamycin
14. Cotrimoxazole
 15. Haemovit
16. Amoxicillin
17. Zinc supplements
18. Paracetamol
19. Ampiclox
20. Benzyl penicillin

TOP TEN DISEASES IN PEDIATRIC WARD

1. Severe Pneumonia
2. Septicemia
3. Urinary tract infections
4. Pneumonia
5. Neonatal septicemia
6. Diarrhea
7. Poisoning
8. Fractures
9. Burns
10. Head injury

A CASE PRESENTATION FROM PAEDIATRIC DEPARTMENT

NAME: SAMSON JOHN MLEMBEZI

AGE: 10Months

Sex: Male

Religion: Christian

Tribe: Chagga

Address: Makidi

Date of admission: 16/07/2020

Date of history taking: 18July 2020

Informant: Biological mother

Chief complaint:

Passing loose stool for 4 days

HISTORY OF PRESENTING ILLNESS

The mother reported that her child was well until 4 days prior to admission, when she noted
a gradual onset of passing loose stool to her baby, in which the child was passing loose stool
about five motions per day, the stool is watery in nature containing mucous, however it was
not stained with blood. The condition was worsening as time went on, associated with
abdominal discomfort, refusal to feed, body weakness, and fever which was on and off
more severe during the night. The condition had not aggravating or relieving factors.

However there was no history of, vomiting, abdominal discomfort during urination,
excessive sweating during the night, loss of consciousness, or convulsions.

REVIEW OF OTHER SYSTEMS

EAR NOSE AND THROAT

Ear: There was no history of ear tagging, ear discharge or bleeding from the ear

Nose: No history of nasal bleeding or nasal congestion

Throat: There was no history of discomfort in swallowing

MUSCULOSKELETAL SYSTEM

There is no history of joint swelling

RESPIRTORY SYSTEM

There is no history of cough, or discomfort in breathing

PAST MEDICAL HISTORY

This is the first admission to Huruma hospital. There is no history of blood transfusion or any
surgical intervention. No history of food or drug allergies reported so far.

ANTENATAL HISTORY

The mother reported that she attended antenatal clinic five times when she was pregnant
for this baby, and she was screened for malaria syphilis and HIV and the results were all
negative. She was given folic acid and ferrous sulphate, sulphadoxinepyrimethamine for
malaria prophylaxis, and mebendazole for deworming. The mother she did not suffer from
any complications during pregnancy. I was able to confirm all these information from RCH
card number 4.

NATAL HISTORY

The mother reported that she delivered her baby at full term at hospital, Huruma Hospital
where by it was normal spontaneous vaginal delivery. The membranes ruptured
spontaneously and the child cried immediately after birth, with birth weight of 3.7kg. The
baby was also fed within one hour after delivery.
POST NATAL HISTORY

The child did not suffer from any complications after delivery, like yellowish discoloration of
the skin or mucous membranes, sepsis of the cord or convulsions. The baby also did not
bleed from the cord.

IMMUNIZATION HISTORY

The child is fully immunized according to his age where by, he received BCG and OPV0 on
the 2nd day after delivery and he received OPV 1, PCV 1, PENTA 1, ROTAR 1 at 6 weeks of
age, OPV 2, PCV 2, PENTA 2 AND ROTAR 2 at 10 weeks of age and PCV3, PENTA 3 OPV 3 at
14 weeks of age. The child also received measles-rubella vaccine at the age of nine months.
I confirmed all these information from RCH card number 1.

Comment: this is a good immunization history

DIETARYHISTORY

The child was exclusively breast fed for six months, he was feeding more than 10times a day
for the first four months, then 88 times a day until six months, then started complimentary
feeding where by the mother started to give the child, cow milk, and soup made of cooked
bananas. The feeding pattern of the child was good until 4 days age when the illness started.

Comment: This is a good dietary history, however now the child is refusing to feed due to
the illness.

DEVELOPMENTAL MILESTONES

The child had a social smile when he was 2 weeks old, and he was able to control the neck at
3 months of age. Now a child can stand, and walk with support.

Comment: These are a good developmental mile stones according to the age of the child.

FAMILY AND SOCIAL HISTORY

He is the last born out of four children in his family. All his siblings are alive and well. There
is no history of any inherited disease in his family such as hypertension, asthma, diabetes
mellitus and cancer.

He is living with both his mother and father in a block house well ventilated, and they are
using tap water for drinking and domestic activities. They use pit latrine. Both his parents
drink alcohol about two beers per day, for more than ten years now. His father smokes
cigarette.

PHYSICAL EXAMINATION

viii. GENERAL EXAMINATION

 He is a child ill looking alert with normal hair color texture and distribution

Not pale, not cyanosed, not jaundice, no peripheral lymph nodes enlargement

No finger clubbing, not edematous

One assessment of dehydration:

The skin pinch goes back very slowly; he is lethargic, with sunken eyes and unable to drink

VITAL SIGNS

✓ Respiratory rate 39 breaths per minute

✓ Body temperature 37.4oC
✓ Pulse rate 78 beats per minute
Comment: These are stable vital signs

ARTHOPOMETRIC MEASUREMENTS
✓ Weight 12kg
✓ Mid upper arm circumference (MUAC) 15.0 cm
✓ Occipital frontal circumference (OFC) 37cm
✓ Length 74cm
Comment: these are normal anthropometric measurements according to the age
of the child.

SYSTEMIC EXAMINATION
GASTROINTESTINAL SYSTEM

ABDOMINAL EXAMINATION
On inspection:
The abdomen moves with respiration
The abdomen is flat, inverted umbilicus
No traditional or therapeutic marks seen
On superficial palpation:
NO any palpable mass and no discomfort on palpation
On Deep palpation:
No any intra-abdominal mass enlargement such as Kidney, spleen and liver
On percussion: Normal tympanic note heard
On auscultation: Normal bowel sounds heard

Nervous system examination

 1. Higher centers
The child is alert
2. Cranial nerves
All other cranial nerves are intact except olfactory, trigeminal, glossopharyngial,
hypoglossal, and accessory which were not tested due to the age of the child.
3. Long tract
Norma muscle bulkiness
4. Reflexes
Babinski reflex was intact
Respiratory system

On inspection:

There is severe lower chest wall in drawing,

No any visible traditional mark or therapeutic
Chest is bilaterally symmetrical
On palpation:

Chest expand equally with respiration

There is no any palpable mass

No any discomfort on palpation
On percussion:

Normal resonant percussion note heard

On Auscultation:

Normal vesicular breath sounds heard

CARDIOVASCULAR SYSTEM

On inspection:

There is no traditional or therapeutic mark seen, there is no bulging on

pericardial area, and no hyper activity on the pericardial area

On palpation:

The apex beat is located at the 4thintercostals space along the left midclavicular line

On auscultation:

Normal S1 and S2 heart sounds heard with no any additional sounds

SUMMARY:
This is the presentation of SAMSON JOHN MLEMBEZI
, a male child of 10 months old, from Makidi who was brought in the
hospital by his mother with the chief complaint of passing lose stool,
 which is watery in nature, passing about five motions per day, the
stool containing mucous nor stained with blood,, associated with
abdominal discomfort, fever which was on and off, refusal to feed and
body weakness. On physical examination, the child is severely
dehydrated with, sunken eyes, skin pinch going back very slowly, and
unable to drink, with stable vital signs and normal anthropometric
measurements.
DIAGNOSIS

Acute watery diarrhea with severe dehydration

This is due to history of passing lose stool, abdominal discomfort, lethargy, and signs of
severe dehydration on examination.

DIFFERENTIAL DIAGNOSIS

Uncomplicated malaria, due to refusal to feed, fever on history and body

weakness
Hypoglycemia, due to lethargy, and refusal to feed
Urinary tract infection due to abdominal discomfort and history of fever
MANAGEMENT

✓ Investigations: Malaria rapid diagnostic test which was negative

✓ Random blood glucose (RBG) which was 4.3mmol/L
✓ Stool analysis
✓ Urine analysis

TREATMENT

Admit the child in children ward

Treat the child as severe dehydration which falls under treatment plan C.

Give intravenous ringer’s lactate a total of 1200Mls. This fluid is divided into 30% and 70%
whereby the first 30% is given to the child to run for one hour and then the next 70% is
given to run in the next 5 hours, this makes a total of six hours.

Reassess the child after two hours while continuing with the fluid and classify again to see if
the child is improving.

After treatment, if the child is still severely dehydrated, repeat the fluid and give oral fluids
if the child can take orally.

If the child improves and falls under plan A, ensure to educate the mother on how to treat
diarrhea at home by the following four rules:

Extra fluids, Continue feeding, Zinc supplements in which he will get 20mg once daily for 14
days, and when to return.
The mother has to bring back the child to hospital if, there is,

Blood in stool, continuous lethargy, unable to feed, high fever, vomiting everything or
convulsions

COMPLICATIONS:

Complications of diarrhea include,

❖ Electrolyte and fluid imbalance,

❖ Hypoglycemia and
❖ Rectal prolapsed.

PREVENTION:

❖ Early diagnosis and treatment

❖ Keep the child warm
❖ Hygiene of the child and caretaker to avoid ingestion of dirt or microorganism which
cause diarrhea
❖ Washing hands after using toilets and before preparing child’s meals
❖ Using clean utensils for preparation of food
 MEDICAL DEPARTMENT
OBJECTIVES:

1. Take history thoroughly

2. Perform physical examination to the patients thoroughly
3. Perform relevant laboratory investigations to help in making diagnosis
4. Formulation of diagnosis
5. Treat the patients appropriately and refer patients for proper management
6. Conduct health education
7. Plan proper care and treatment for people living with HIV/AIDs
8. Counsel clients on HIV testing

TOP TEN DRUGS USED IN MEDICAL DEPARTENT

1. Cotrimoxazole
2. Furosemide
3. Paracetamol
4. Benzyl penicillin
5. Oral hypoglycemic ( chlorpropamde and metformin)
6. Insulin
7. Anti-tuberculosis drugs
8. Aminophylline
9. Artesunate
10. Diazepam

TOP TEN DISEASES IN MEDICAL DEPARTMENT

11. Hypertension
12. Peptic ulcer disease (PUD)
13. Congestive cardiac failure
14. Pneumonia
15. Tuberculosis
16. Pulmonary tuberculosis
17. Urinary tract infections (UTI)
18. HIV/AIDs
19. Anemia
20. Gastrointestinal diseases
A CASE PRESENTATION FROM MEDICAL DEPARTMENT
Name: George Andrew Tarimo

Age: 35 years

Sex: Male

Tribe: Chagga

Occupation: Teacher

Religion: Christian

Marital status: Married

Address: Tarakea

Date of admission: 21thJuly 2020

Date of history taking: 21thJuly2020

Mode of referral: From home

Informant: Patient herself

Marital status: Married man

CHIEF COMPLAINT: ABDONINAL PAIN FOR 4 DAYS

PAIN DURING URINATION FOR 4 DAYS

HISTORY OF PRESENTIING ILLNESS:

The patient reported that he was apparently well until 4 days ago the gradual onset of
abdominal pain at epigastric region which was burning in nature radiating to the back
condition was more severe during the midnight and when does not meal on time where the
condition was worsening as time went on and decide to come to Huruma hospital for
treatment and further evaluation

Also he reported he was apparently well until five days ago when he started experiencing
the gradual onset painfull on passing urine the pain was burning in nature radiating to the
lower abdomen where the condition was worsen as time went on with no reliving or
aggravating factor but the condition was associated with increased frequency of passing
urine, small in amount, bad smell urine, brown and sometimes yellow

Howe ever there was no history of fever, blood in urine, joint swelling, muscle pain, loss of
appetite, nausea, vomiting, weight loss
REVIEW OF OTHER SYSTEMS:

EAR, NOSE AND THROAT

1. Ear: There is no history of ear pain , ear discharge o ear bleeding

2. Nose: There is no history of nasal bleeding, nasal congestion or runny nose
3. Throat: There is no history of painful during swallowing or difficulty in swallowing

ENDOCRINE SYSTEM

There is no history of excessive sweating, excessive hunger or thirst

CARDIO VASCULAR SYSTEM

No history of heart beat awareness,No history of chest tightness, chest pain

RESPIRATORY SYSTEM

No history of cough, No history of difficulty in breathing

PAST MEDICAL HISTORY:

The patient has no history of previous admission, no history of blood transfusion, no history
of previous surgical intervention or trauma, no history of food or drug allergy so far, and no
history of using long term medication or attending clinic

FAMILY HISTORY:

He is second born among of 5 children where 3 are boys and 2 are girls all are alive and well,
his parents are alive and well with no chronic or hereditary disease running in their family
such as diabetes mellitus and hypertension. He is married man live with her wife with two
children where 1 is boy and the other is girl all are alive and well

SOCIAL HISTORY:

He is secondary school teacher, live in well ventilated block house using tap water for
drinking tap water which was unboiled and for domestic purpose. Neither himself nor his
wife using alcohol or smoking cigarette

PHYSICAL EXAMINATION:

GENERAL EXAMINATION;

She is an adult man alert, no ill looking, with normal hair color texture and distribution.

Not cyanosed

No lympnode enlargement
No koilonychias

Not Jaundiced

Not pale

Capillary refill normal

Not dehydrated

No finger clubbing

Not edematous

VITAL SIGNS:

✓ Blood pressure: 110/70mmHg

✓ Pulse rate 78 beats per minute, strong,regular regular, non-collapsing, synchronized
with femoral pulse.
✓ Respiratory rate: 19 breaths per minute
✓ Body temperature: 36.9OC

Comment: The vital signs are stable

SYSTEMIC EXAMINATION:

PER ABDOMEN EXAMINATION

On inspection:
The abdomen is flat
Moving with respiration
Umbilicus is inverted
No any distended veins and no any traditional or therapeutic mark
seen.
On superficial palpation:
There is no any area of tenderness, and no any palpable mass
On deep palpation:
There is tenderness on epigastric region and no any intra-abdominal
organ palpable such as kidney, liver and spleen
On percussion:
Tympanic note heard
On Auscultation:
Normal bowel sounds heard
CARDIOVASCULAR SYSTEM
On inspection:

There is no visible hyperactivity or bulging on pericardial area

There is no any traditional or therapeutic mark seen
Jugular venous pressure not elevated
On Palpation:

The apex beat is located at the 5thintercostal space along the left mid clavicular line
No any area of tenderness and no any palpable mass
On Auscultation:

Both heart sounds S1 and S2 heard with no additional heart sounds

NEVOUS SYSTEM EXAMINATION

1. Higher centers:
The patient is oriented to people place and time, concentration is intact and both
short and long term memory are intact.
2. Cranial nerves:
All cranial nerves are intact
3. Long tract
Normal muscle bulkness
Normal muscle tone
Normal muscle tone and normal muscle power (grade 5/5)
Coordination is intact (Hell sheen test) and
Patella, ankle and supinator and biceps reflexes are intact

RESPIRATORY SYSTEM

On inspection:

The chest is bilaterally symmetrical moving with respiration

No any traditional or therapeutic mark seen on chest
No chest deformity seen
On palpation:

Trachea is centrally located, tactile vocal fremitus is normal, and

No any palpable mass or any area of tenderness
Normal tactile vocal fremitus felt
Chest expand equally with respiration
On Percussion:

Normal resonant note heard

On Auscultation:

Normal vesicular breath sounds heard

SUMMARY:

This is a case of George Tarimo 35 years old from Mkuu Rombo who came with main
complain of abdominal pain at epigastric region which was burning in nature more
severe during the midnight associated with hurt burn and relieved by taking meal
 and complain of pain during passing urine which was associated with increased
frequency of passing urine, small in amount and bad smell urine, on physical
examination there was tenderness on epigastric region with stable vital sign

DIAGNOSIS:

1. Peptic ulcers disease; specifically duodenal ulcer due to its was relieved by taking
meal and pain was more severe during the midnight

2. Urinary tract infection; due to pain on passing urine, increased frequency of

passing urine but small in amount and bad smell urine

DIFFERENTIAL DIAGNOSIS

1. Gastro esophageal reflux disease (GERD)

2. Cystitis
3. Gastric ulcers disease

MANAGEMENT

11. Investigations:
12. Urinalysis to check for the leucocyte
13. Hemoglobin level estimation to rule out anemia
14. Stool analysis
15. Oesophagogastrodudenoscope (OGD)

TREATMENT:

Non Pharmacological:

-Encourage the patient to take enough meal on time

-Take large amount of water approximately 1 to 2 lire per day
Pharmacological:

Omeprazole 20mg once a day (od) per oral for 14 days

Metronidazole 400mg eight hourly (tds) per oral for 5 days
Amoxicillin 500mg eight hourly (tds) per oral for 5 days
Paracetamol 1g eight hourly (tds) per oral 3 days
COMPLICATIONS

✓ Gastric outlet obstruction (GOO)

✓ Perforation
✓ Gastrointestinal bleeding
✓ Pyelonephritis
PREVENTION;

Adherence to medication
Avoid staying for a long time without taking meal
PROGNOSIS

Is good hence the disease can be treated and cured when the patient adhere to
medication and advice given
OBSTRETICS AND GYNECOLOGY DEPARTMENT
OBJECTIVES:

➢ Take thorough history from patients

➢ Perform physical examination thoroughly
➢ Perform relevant laboratory investigations
➢ Formulate the diagnosis
➢ Treat and manage cases properly
➢ Provide referrals when necessary
➢ Record labour, maternal and fetal parameters using a patograph
➢ Interpret findings and recordings on patograph
➢ Conduct normal deliveryand post-deliveryexamination
➢ Manage post-partum conditions
➢ Educate mothers about breastfeeding of infants
➢ Provide proper HIV/AIDs care

TOP TEN DISEASES AND CONDITIONS IN OBSTRETICS AND GYNECOLOGY DEPARTMENT

1. Urinary tract infections (UTI)

2. HIV/AIDS
3. Eclampsia
4. Anemia
5. Neonatal Septicemia
6. Malaria
7. Puerperal sepsis
8. Abortion
9. Birth Asphyxia
10. Hypertension

A CASE PRESENTATION FROM OBSTRETIC AND GYNAECOLOGY DEPARTMENT

Name: Neema Francis Urassa

Age: 29 years

Sex: Female

Tribe: Chagga

Occupation: Peasant

Religion: Christian

Address: Mashati Rombo

Date of admission: 14ndJuly 2020

Date of history taking: 15ndJuly 2020

Referral mode: From home

Informant: Patient herself

Gravida; 2

Para; 1

Living; 1

Gastation age (GA); 32 weeks and 1 day

Last normal menstrual period (LNMP): 20th October 2019,

Expected date of delivery was (EDD):17thJuly2020

CHIEF COMPLAINT:

Bilateral lower limb for 2 weeks

Headache for 5 days

HISTORY OF PRESENTING ILLNESSC

The patient was apparently well until 2 weeks ago when she started experiencing the
gradual onset of bilateral lower limb swelling which was worsening as time went on
associating with general body weakness, relieved upon walking, aggravated upon resting
and sitting down for a long time with no history of pain of lower limbs

Also the patient she was complaining if headache which was of gradual onset for 5 days
which was generalized, throbbing in nature, with no radiation factor where it was associated
with heart beat awareness, and dizziness wherethe condition was aggravated during a day
and when performing physical activities and relieved by resting

However there is no history of muscle pain, no history of joint pain, no history of abdominal
pain, no history of vomiting, no history of passing loose stool, no history of blurry vision, no
history of epigastric pain, no history of convulsion, no history of loss of consciousness, no
history of difficulty in breathing, no history of fever

REVIEW OF OTHER SYSTEMS

EAR, NOSE AND THROAT

1. Ear: There is no history of ear discharge, ear pain or ear bleeding

2. Nose: there is no history of nasal bleeding, nasal congestion or runny nose
3. Throat: There is no history of difficulty in swallowing and no history of hoarseness of
voice

ENDOCRINE SYSTEM:

There is no history of excessive hunger, excessive thirsty of heat and cold intolerance
MUSCULOSKELETAL SYSTEM:

There is no history of muscle pain, joint pain or joint swelling

RESPIRATORY SYSTEM:

There is no history of chest pain, chest tightness or difficulty in breathing

PAST MEDICAL HISTORY

The patient has no any history of previous admissions as hospital, no any history of
blood transfusion, surgical intervention, and food or drug allergies so far.
OBSTRETIC HISTORY:

This mother is gravida 2, para 1, living 1

The mother reported that she deliver her first baby when the pregnancy was term at
Huruma hospital through normal vagina delivery, where she deliver a male baby
weigh 3.5kg without complication and baby cried immediately after delivery and was
breastfed within one hour after delivery

INDEX PREGNANCY:

She started attending Reproductive and child health (RCH) clinic when the pregnancy
was 16 weeks, and she has attended only two timesuntil now. She was screened for
malaria, syphilis and HIV and all the results were negative. She was given folic acid
and ferrous sulphate, sulphadoxine pyrimethamine for malaria prophylaxis and
mebendazole for deworming, she was also given a single dose of tetanus toxoid (TT),
and she did not suffer from any illness since she conceived until today presenting
with this illness.
Comment: I was able to confirm all these information from the RCH card number 4.
GYNAECOLOGICAL HISTORY:

The patient attained menarche when she was 16 years old, where she has been
having a menstrual cycle of 28 days, and flow of 3 days in which she changes pads, 3
times a day which are not totally soaked with blood. She does not have any history
of severe pain during menstruation,
She has never used any contraceptive methods.
There is no any history of sexually transmitted or genital tract diseases,
There is no any history of gynecological surgery
FAMILY HISTORY

She is the third born out of five children in her family where three are boys and two
are girls. All her siblings are alive and well. There is no any history of inherited
diseases running in her family such as, hypertension, diabetes mellitus, asthma,
epilepsy and cancer. Both her parents are also alive and well.
SOCIAL HISTORY:

She is married, living with her husband and one child in a block house which is well
ventilated, using pit latrine and tap water for drinking and domestic activities
without boiling drinking water. Neither herself nor her husband drink alcohol or
smoke cigarette.

PHYSICAL EXAMINATION
GENERAL EXAMINATION:

Adult woman, faily looking, alert with normal hair color texture and distribution
Not cyanosed
Pallor on conjunctiva
Not dehydrated
No finger clubbing
Not jaundiced
No peripheral lymph nodes enlargement
Capillary refill is normal
Lower limb pitting edema
VITAL SIGNS:

✓ Blood pressure 140/100mmHg

✓ Pulse rate: 84 beats per minute, strong , non -collapsing, synchronized with
femoral pulse, with regular rhythm
✓ Respiratory rate: 20 breaths per minute
✓ Body temperature: 36.8OC
Comment: These are stable vital signs except blood pressure with was elevated
140/100mmhg

SYSTEMIC EXAMINATION
Per abdominal examination:
On inspection:
 The abdomen is ovoid in shape, slightly distended with no any traditional or
therapeutic marks seen, and the abdomen moves with respiration, linear nigra seen,
umbilicus is everted
On palpation:

The fundal height is 30cm

Abdominal circumference is 84cm
Lie; longitudinal
Presentation; cephalic
Position; Right occipital anterior (ROA)
Head level was 5/5
Auscultation;

Fetal heart rate 142 beat per min

PER VAGINAL EXAMINATION:

On inspection:

Normal hair distribution around the perineum area

Normal vulva and vaginal
Clitoris is present
Labia majora and minora are present
On Palpation:

There is no tenderness at the vulva or vagina

Sacral promontory not easly reached
Sacral curve is rounded
Ischial spine are blunt
Cervix closed
Vagnal outly angle admit 4 knuckles
CARDIOVASCULAR SYSTEM:

On inspection:

There is no bulging or hyper activity on the pericardial area

No any traditional or therapeutic mark seen on the pericardial area
On Palpation:

The apex beat is located on the 5th intercostal space along the left midclavicular line
No any area of tenderness and no any palpable mass on the pericardial area
On Auscultation:

Both heart sounds S1 and S2 are heard without additional sounds

RESPIRATORY SYSTEM
On inspection:

The chest is bilaterally symmetrical, with no any traditional or therapeutic mark seen
The chest moves with respiration, no chest deformity seen
On palpation:

There is no any area of tenderness and no any palpable mass

Tactile vocal fremitus is normal and trachea is centrally located
No any palpable mass, chest expand equally with respiration
On percussion:

Normal resonant note heard;

On Auscultation:

Norma vesicular breath sounds heard

NERVOUS SYSTEM

12. Higher centers

The patient is alert, oriented to people place and time; both short term and long
term memory are intact
Concentration is also intact
13. Cranial nerves
All cranial nerves are intact
14. Long tract
Normal muscle bulkiness, normal muscle tone and normal muscle power
(grade5/5)
Coordination is intact, and all tested reflexes are intact

SUMMARY:

This is an obstetric case of a patient who goes by the name Neema Tarimo, 29
year old, gravida 2, para 1, living 1, with last normal mentral period of 20 th
/October/2018, expected date of delivery 27th /march/2019 and gestation age of
of 32 weeks plus 1 day who came with main complain of bilateral lower limb
swelling for two weeks and headache for five days where it was associated with
general body weakness, heartbeat awareness, dizziness and on examination was
pallor on conjunctiva, lower limb pitting edema with stable vital sign except
blood pressure which was 140/100mmhg
DIAGNOSIS:

Anemia in pregnancy at gestation age of 32 weeks plus 1 day; due to heartbeat awareness
and pallor on conjunctiva

Pre-eclampsia; due to elevated blood pressure and edema

DIFFERENTIAL DIAGNOSIS

Uncomplicated malaria in pregnancy

Imminent eclampsia
MANAGEMENT:

Investigations:
o Hemoglobin level estimation, to know the level of Hemoglobin and rule
out anemia
o Obstetric abdominal pelvic ultrasounds scan to confirm check gestation
age, foetal presentation and amount of amniotic fluid
o Urinalysis to rule out proteinuria
o Blood slide for malaria
o Random blood glucose
o Renal fuction test

TREATMENT:

Non pharmacological management

❖ Have enough resting

❖ Avoid salt intake to avoid elevation of blood pressure
❖ Encourage taking vegetables and fruits to help to correct anemia

Pharmacological management

➢ Methyldopa 500mg per oral 12 hourly for 2 weeks

➢ Paracetamol 1g per oral 8 hourly for 3 days
➢ Haemovit syrup 15mls per oral 12 hourly for 1 month

COMPLICATIONS:

❖ Eclampsia
❖ Heart failure

PREVENTION:

Early and regular attendance of antenatal clinic

Early diagnosis and treatment.
 SURGICAL DEPARTMENT
OBJECTIVES:

1. Take surgical history from the patients thoroughly

2. Perform physical examination thoroughly
3. Perform relevant laboratory investigations to aid in formulating the proper diagnosis
4. Formulate diagnosis properly
5. Provide provider initiated testing and counseling (PITC)
6. Practice safety techniques and aseptic techniques in performing surgical procedures
7. Assist major surgery

TO TEN DISEASES IN SURGICAL DEPARTMENT

1. Fractures
2. Cut wound
3. Road traffic accidents
4. Hypertension
5. Head Injury
6. Diabetes mellitus
7. Peptic ulcer disease (PUD)
8. Gynecological diseases
9. Benign prostate hyperplasia
10. Hernia

TOP TEN DRUGS USED IN SURGICAL DEPARTMENT

11. Cloxacillin
12. Paracetamol
13. Pethedine
14. Gentamycin
15. Ampicillin
16. Neurobion
17. Ibuprofen
18. Diclofenac
19. Tramadol
20. Metronidazole
A CASE PRESENTATION FROM SURGERY DEPARTMENT
Name: Ronald Johnson Kimario

Age: 50years

Sex: Male

Tribe: Chagga

Occupation: Peasant

Religion: Christian

Address: Maharo

Date of admission: 21tJuly 2020

Date of history taking: 22thJuly 2020

Referral from Home

Informant: Patient himself

Chief complaint: Injury of the left thigh for 1 Day

HISTORY OF PRESENTING ILLNESS

The patient was well until One day ago when he sustained an injury on his left thigh after
being involved in a motorcycle accident in which, he lost control while in high speed, got off
the road and hit the stone on his left side. He fell down, on his left side hitting his thigh on
the ground and his head. During the time of incidence the patient was not able to use his
left leg, whereby it was shortened and he was in pain. He was taken by good Samaritans to
Huruma hospital soon after sustaining the injury. In the hospital the patient was given inject
able medicine that he does not know and he the iron like rod was inserted in his leg. He has
been doing well in the ward and today he has complained about pain at the site of insertion
of the pin. No any other complaint.

How ever there was no history of bleeding at the site of injury and no history of loss of
consciousness at the time of incidence or in the hospital, also no history of headache, no
history of bleeding from the nose or from the ear and no history of dizziness or loss of
memory.

REVIEW OF OTHER SYSTEMS

THROAT

There is no history of difficulty in swallowing or pain during swallowing

CARDIOVASCULAR SYSTEM

There is no history of lower limbs swelling, heart beat awareness, difficulty in

breathing on lying flat or air hunger during the night

RESPIRATORY SYSTEM

There is no history of chest pain, chest tightness, or difficulty in breathing

ENDOCRINE SYSTEM

There is no history of excessive sweating, excessive hunger, or excessive thirsty

GASTROINTESTINAL SYSTEM

There is no history of passing lose stool, abdominal pain, abdominal discomfort,

nausea or vomiting

GENITALURINARY SYSTEM

There is no history of increased frequency in urination, painful urination, or urgency

in urination

PAST MEDICAL HISTORY

This is his first admission at this hospital. There is no history of blood transfusion, no
history of any food or drug allergies so far. There is also no history long term use of
medication or attending any special clinic.

FAMILY HISTORY

He is the third born out of four children in his family whereby all his siblings are alive
and well, but his father died due to unknown cause. There is no any history of
inherited diseases running in his family such as hypertension, diabetes mellitus,
epilepsy, asthma or cancer.

SOCIAL HISTORY

He lives with his wife and his child who is 22 years old. He lives in a block house well
ventilated and they use tap water for drinking and domestic purposes without
boiling drinking water. He uses alcohol which is bear four bottles per day for more
than 15 years now. He has no history of using cigarette. He is married and living with
his wife and his two children. His wife neither drinks alcohol nor smokes cigarette.
 PHYSICAL EXAMINATION
General examination:
He is an adult man, alert and oriented, not ill looking with normal hair color texture
and distribution.
Not pale
Not jaundiced
Not cyanosed
No peripheral lymph nodes enlargement
Not dehydrated
No finger clubbing
Capillary refill is normal
Not edematous

VITAL SIGNS:

•
Blood pressure: 135/85mmHg
•
Pulse rate 89 beats per minute, strong, regular rhythm, non -collapsing,
synchronized with femoral pulse,
• Respiratory rate: 18 breaths per minute
• Body temperature: 36.8oC
Comment: these are stable vital signs

LOCAL EXAMINATION:

Inspection:

Injured left thigh with no swelling,

Steinman’s pin applied below the knee with traction weight bearing of 6.5kg
No bleeding from the injured site
No any visible deformity
Palpation:

Sensation and pulsation is intact below the injured site

The left limb is slightly shorter than the left
There is mild tenderness on the left thigh

SYSTEMIC EXAMINATION

MUSCULOSKELETAL SYSTEM:
On inspection: There is no swelling on any other parts than the affected limb

No visible joint swelling

On Palpation: there is no area of tenderness on the muscles on palpation except the
affected part of left limb

GASTROINTESTINAL SYSTEM

On inspection:

The abdomen is flat, with no distended veins, no any traditional or therapeutic mark
seen, the abdomen moves with respiration
On Superficial palpation:

There is no any area of tenderness, and no any palpable mass

On deep palpation:

There is no any intra-abdominal organ enlarged such as kidney, liver

and spleen

On percussion:

Normal tympanic note heard

On Auscultation:

Normal bowel sounds heard

RESPIRATORY SYSTEM:

On inspection:

The chest is bilaterally symmetrical, moves with respiration, no any traditional or

therapeutic mark seen
On Palpation:

There is no any area of tenderness, no any palpable mass

Trachea is centrally located,
Tactile vocal fremitus is normal
Chest expands equally with respiration
On percussion:

Normal resonant note heard

NERVOUS SYSTEM

1. Higher centers: The patient is oriented to people place and time

Short and long term memory is intact
Concentration is intact
2. Cranial Nerves: All cranial nerves are intact except cranial nerve number 8 in
vestibule part which was not tested due to the patient being unable to walk
 3. Long Tract: Normal muscle bulkiness, normal muscle tone and normal muscle
power in all other limbs except the affected one.
Sensation is intact

CARDIOVASCULAR SYSTEM

On inspection:

There is no bulging or hyper activity on the pericardial area

On palpation:

There is no area of tenderness and no any palpable mass

The apex beat is located at the 5thintercostal space along the left midclavicular
line
On Auscultation:

Normal heart sounds S1 and S2 heard with no any additional sound

SUMMARY:

This is the case of Ronald Johnson Kimarioa male patient aged 25 years from
Maharo who was brought in hospital with the chief complaint of injury to the left
thigh after being involved in a motorcycle accident. On history there was,
inability to use the left limb, pain without loss of consciousness, severe pain on
mid aspect of the left thigh, and no bleeding from the site of injuryand on
examination the skeletal traction is applied on the right limb, Steinman’s pin
inserted 2cm below the knee, with shortening of the left limb compared to the
right, with stable vital signs.

DIAGNOSIS:

Closed fracture of left femur

DIFFERENTIAL DIAGNOSIS:

Dislocation of left hip joint

MANAGEMENT

Investigations:
 1. Hemoglobin level estimation to rule out anemia
2. X-ray of left femur (anterior posterior and lateral view) in order to locate the
exact site of fracture and the extent
Result showed, fracture of mid shaft of left femur with mild displacement
3. X-ray of the right hip joint
Result showed no fracture or dislocation
TREATMENT:

Tablets diclofenac 50mg 8hrly for 5days

Continue with skeletal traction until 8 weeks and
Perform control x-ray to rule out any malunion
Continue monitoring in the ward
COMPLICATIONS:

ix. Malunion
x. Delayed union
xi. Thromboembolism

PREVENTION;

Be careful and do not go beyond normal speed limit when riding motorcycle
and wear protective helmets when riding motorcycle
CONCLUSION AND RECOMMENDATIONS
I thank my all might God for giving me strength during the course of my field work,
hence I was able to learn different things that would help me in my medical field
currently and for my future among of those things are to be hard worker, cases
management, caring of malnutrition in pediatric, increase my skills in assisting
surgical procedure, management of emergency cases, HIV/AIDS in pediatric and in
adult patient and learn new management knowledge that would help me in the
course of this field work.
It has been a matter of immense pleasure, honor and challenge to have opportunity
to take up this project and complete it successful.
I conclude by contented all people who helped me to succeed to conduct my field
work GOD bless you all.

RECOMMENDATIONS
My recommendations towards this field attachment are as follows:

➢ The college should check preferably the time of conducting this field work
because is short time to conduct and learn new ideas.

➢ The principal of college should assign the student to their home nearby
hospital to apply their knowledge and skills so that can improve.

➢ I recommend that there should be good follow-up of students in their field

work to make sure all students participated equally.

➢ The college should also help their students to increase the money to use for
their field project including stationary fee which would help them on
preparation and writing their field work report.
PAEDIATRIC DEPARTMENT
OBJECTIVES:

➢ History taking accurately

➢ Performing physical examination to the patients
➢ Formulating proper diagnosis
➢ Treating or referring the patients for proper management
➢ Assessment of growth and development of the sick children
➢ Manage child illness by following the guidelines of integrated management of
childhood illnesses (IMCI)
➢ Provide essential new born care
➢ Educate mothers on how to give proper breast feeding to their babies
➢ Care and management of children with HIV/AIDs
➢ Conduct reproductive and child health services (RCH)

TOP TEN DRUGS USED IN PEDIATRIC WARD

1. Ampicillins
2. Cloxacilin
3. Gentamycin
4. Cotrimoxazole
5. Haemovit
6. Amoxicillin
7. Zinc supplements
8. Paracetamol
9. Ampiclox
10. Benzyl penicillin

TOP TEN DISEASES IN PEDIATRIC WARD

1. Severe Pneumonia
2. Septicemia
3. Urinary tract infections
4. Pneumonia
5. Neonatal septicemia
6. Diarrhea
7. Poisoning
8. Fractures
9. Burns
10. Head injury
NAME: HAWA S. HAMISI

AGE: 3 days

Sex: Female

Religion: Muslim

Tribe: Chagga

Address: Rombo

Informant: Biological mother

Chief complaint:

A one day baby with no complains.

HISTORY OF PRESENTING ILLNESS

The mother reported her child to have no complain. She is a three days neonate
breastfeeding well and has no problem.

Post natal, the baby was born through a c/section due to CPD but was delivered at term.
Mother reports the child to have cried immediately after birth and was born with 3.5 kgs
and also breastfed after 4hours.

Prenatally; Mother started attending RCH clinic when the pregnancy was 4 months old and
was screened for HIV and syphilis and tested fo malaria and the results were all negative,
the mother also reportd to have been given mebendazole for deworming 4 times, tetanus
toxoid 2 times , sp for malaria prophylaxis 3 times and fefo 4 times. The mother denies to
have encountered any complications during pregnancy.

However both the mother and child are doing well under nursing care and observation.

REVIEW OF SYSTEMS
EAR NOSE AND THROAT

Ear: There was no history of ear tagging, ear discharge or bleeding from the ear

Nose: No history of nasal bleeding or nasal congestion

Throat: There was no history of discomfort in swallowing

MUSCULOSKELETAL SYSTEM

There is no history of joint swelling

PAST MEDICAL HISTORY

This is the first admission to Rombo hospital. There is no history of blood transfusion or
any surgical intervention. No history of food or drug allergies reported so far and also not
attending any special clinic.

FAMILY AND SOCIAL HISTORY

She is the first born in her family. There is a history of Asthma in their family on father’s
side, however no history of Diabetes, hypertension or cancer. She is living with both her
mother and father in a block house well ventilated, and they use tap water for drinking and
domestic activities. They use pit latrine. Both her parents drink alcohol about two beers per
day, for more than ten years now.

GENERAL EXAMINATION;

An alert pink baby girl not jaundiced, not pale and not
cyanosed with stable vitals of temp. 37 degrees of centigrade,
RR 58, occipital frontal circumference 28cm,

And has 3kgs.

REGONAL EXAMINATION;

Head and neck.

Anterior posterior frontanels are present and pulsating not bulging, normal
symmetrical lines in alignment with the ears, normal nose with no deformity, normal lps
with no cleft palate and no any deformity. Normal neck with no deformity.

Chest and abdomen.

 Normal chest which moves with respiration and with normal symmetrical breasts
and with no deformity. Normal abdomen moving with respiration and with no deformity.
Normal back with no spinal bifida and no any other deformity.

Extremities.

Normal extremities with no extra digit and no deformity.

Perineum.

Normal perineum with normal labia majora and minora and normal vagina
with no deformity.

SUMMARY:

This is a neonatal case of baby Zainab 3 days old female, whose

informant is biological mother was born 3 days ago and has no complain and was
born at the hospital through NSVD, at term with 3.5kgs and cried immediately
after delivery and had no complications after delivery.

DIAGNOSIS
 3 days neonate with no main complain.

MANAGEMENT

❖ Advice mother on child hygiene especially with the umbilical stump

❖ Advice mother to keep the baby warm
❖ Advice mother on exclusive breast feeding of the baby
❖ Advice mother to attend RCH clinic for the baby’s follow up
❖ Advice on the child’s immunization and arrange for next
immunization.
 MEDICAL DEPARTMENT
OBJECTIVES:

1. Take history thoroughly

2. Perform physical examination to the patients thoroughly
3. Perform relevant laboratory investigations to help in making diagnosis
4. Formulation of diagnosis
5. Treat the patients appropriately and refer patients for proper management
6. Conduct health education
7. Plan proper care and treatment for people living with HIV/AIDs
8. Counsel clients on HIV testing

TOP TEN DRUGS USED IN MEDICAL DEPARTENT

1. Cotrimoxazole
2. Furosemide
3. Paracetamol
4. Benzyl penicillin
5. Oral hypoglycemic ( chlorpropamde and metformin)
6. Insulin
7. Anti-tuberculosis drugs
8. Aminophylline
9. Artesunate
10. Diazepam

TOP TEN DISEASES IN MEDICAL DEPARTMENT

1. Hypertension
2. Peptic ulcer disease (PUD)
3. Congestive cardiac failure
4. Pneumonia
5. Tuberculosis
6. Pulmonary tuberculosis
7. Urinary tract infections (UTI)
8. HIV/AIDs
9. Anemia
10. Gastrointestinal diseases
Name: Zaina Nassoro

Age; 78 years

Sex: Female

Tribe: Chagga

Occupation: Farmer

Religion: Christian

Marital status: Married

Address: Rombo, Mashati

Has been in the ward for three months

Informant: Patient’s biological daughter

CHIEF COMPLAINT

Known diabetic patient for 2 years and not on medications , came with the main
complain of wound on the right toe for three months.

HISTORY OF PRESENTIING ILLNESS:

The patent was well until three months prior to admison when she started experiencing
a gradual onset of wound on her right foot that was painfull with pus discharge and foul
smelling.

However currently the patient’s condition is good.

REVIEW OF OTHER SYSTEMS:

EAR, NOSE AND THROAT

1. Ear: There is no history of ear pain , ear discharge o ear bleeding

2. Nose: There is no history of nasal bleeding, nasal congestion or runny nose
3. Throat: There is no history of painful during swallowing or difficulty in swallowing

CARDIO VASCULAR SYSTEM

No history of heart beat awareness, No history of chest tightness, chest pain.

PAST MEDICAL HISTORY:

 Has one history of admission during 2018 due to DKA where she was managed and got
well

Has a history of blood transfusion

Has no history of food or drug allergy

Has no history of surgical intervention

Has no history of attending to any special clinic or use of long term medications.

FAMILY AND SOCIAL HISTORY:

She is the sixth child out of six children where 3 are male and 3 female and all are well and
alive.

She lives with her children in a block house well ventilated and use a pit latrine

They use tap water for domestic uses and drinking.

Also the patient had a history of drinking alcohol and smoking but no longer does that.

well ventilated block house using tap water for drinking tap water which was un boiled and
for domestic purpose. Neither himself nor his wife using alcohol or smoking cigarette

PHYSICAL EXAMINATION:

GENERAL EXAMINATION;

An alert old lady not ill looking with normal hair color, texture, and distribution. Not pale
not jaundiced and not cyanosed with no peripheral lymphadenopathy with no palmar pallor
and normal capillary refill and no finger clubbing with stable vital signs of BP 140/80mmHg
TEMP 36 degrees of centigrade and no lower limb edema.

Comment: The vital signs are stable

SYSTEMIC EXAMINATION:

PER ABDOMEN EXAMINATION

 On inspection:
The abdomen is flat
Moving with respiration
Umbilicus is inverted
No any distended veins and no any traditional or therapeutic mark
seen.

On superficial palpation:
There is no any area of tenderness, and no any palpable mass

On deep palpation:
No any intra-abdominal organ palpable such as kidney, liver and
spleen

On percussion:
Tympanic note heard
On Auscultation:
Normal bowel sounds heard

CARDIOVASCULAR SYSTEM
On inspection:

There is no visible hyperactivity or bulging on pericardial area

There is no any traditional or therapeutic mark seen
Jugular venous pressure not elevated
On Palpation:

The apex beat is located at the 5th inter costal space along the left mid clavicular line
No any area of tenderness and no any palpable mass
On Auscultation:

Both heart sounds S1 and S2 heard with no additional heart sounds

NEVOUS SYSTEM EXAMINATION

1. Higher centers:
 The patient is oriented to people place and time, concentration is intact and both
short and long term memory are intact.
2. Cranial nerves:
All cranial nerves are intact
3. Long tract
Normal muscle bulkness
Normal muscle tone
Normal muscle tone and normal muscle power (grade 5/5)
Coordination is intact (Hell sheen test) and
Patella, ankle and supinator and biceps reflexes are intact

RESPIRATORY SYSTEM

On inspection:

The chest is bilaterally symmetrical moving with respiration

No any traditional or therapeutic mark seen on chest
No chest deformity seen
On palpation:

Trachea is centrally located, tactile vocal fremitus is normal, and

No any palpable mass or any area of tenderness
Normal tactile vocal fremitus felt
Chest expand equally with respiration
On Percussion:

Normal resonant note heard

On Auscultation:

Normal vesicular breath sounds heard

SUMMARY:

A medical case from medical ward of a female patient with initials Z.M 78 years , a known
Diabetic for 3 years and not on medication. The patient came with the main complain of
wound on the left foot that was painful and foul smelling discharge. The patient reports a
history of blood transfusion and on examination shoes not pale, not jaundiced and not
cyanosed with stable vital signs.

DIAGNOSIS:

Diabetic mellitus with diabetic foot.

DIFFERENTIAL DIAGNOSIS

1. Septic wound
2. Foot gangrene

MANAGEMENT

Investigations:

✓ RBG
✓ FBP
✓ Urinalysis
✓ RFT
✓ LFT
✓ Dopler ultrasound of the foot

TREATMENT:

Non Pharmacological:

-Encourage the patient on proper nutrition and counsel on diabetic plate

Pharmacological:

Iv metronidazole 500mg tds 7/7

Metiformin 500mg bd 1/12

Glibenclamide 2mg 1/12

COMPLICATIONS

✓ Retinopathy
✓ Nephropathy
✓ Encephalopathy
✓ Neuropathy
✓ Stroke
✓ Foot gangrene

PREVENTION;
 Proper diet lifestyle
PROGNOSIS

Is good under proper adherence of medication.

A CASE PRESENTATION FROM OBSTRETIC AND GYNAECOLOGY DEPARTMENT

Demografic Data

Name: Anjelina Godfrey

Age: 28 years
Sex: Female

Tribe:Chagga

Occupation: Teacher

Religion: Christian

Address: Rombo mkuu

Date of admission: 11th July 2020

Date of history taking: 14th July 2020

Referral mode: From kisiki dispensary

Informant: Patient herself

Gravida; 5

Para; 0

Living; 0

Gastation age (GA); 24 weeks

Last normal menstrual period (LNMP): 31st jan 2020,

Expected date of delivery was (EDD):6th nov 2020

CHIEF COMPLAINT:

Bilateral lower limb edema for 2 weeks

Headache for 5 days

HISTORY OF PRESENTING ILLNESSC

The patient was apparently well until 2 weeks ago when she started experiencing the
gradual onset of bilateral lower limb swelling which was worsening as time went on
associating with general body weakness, relieved upon walking, aggravated upon resting
and sitting down for a long time with no history of pain of lower limbs

Also the patient she was complaining if headache which was of gradual onset for 5 days
which was generalized, throbbing in nature, with no radiating factor where it was associated
with heart beat awareness, and dizziness where the condition was aggravated during a day
and when performing physical activities and relieved by resting

However there is no history of muscle pain, no history of joint pain, no history of abdominal
pain, no history of vomiting, no history of passing loose stool, no history of blurry vision, no
history of epigastric pain, no history of convulsion, no history of loss of consciousness, no
history of difficulty in breathing, no history of fever. The mother also reports to feel the
foetal kicks.

REVIEW OF OTHER SYSTEMS

EAR, NOSE AND THROAT

1. Ear: There is no history of ear discharge, ear pain or ear bleeding

2. Nose: there is no history of nasal bleeding, nasal congestion or runny nose
3. Throat: There is no history of difficulty in swallowing and no history of hoarseness of
voice

ENDOCRINE SYSTEM:

There is no history of excessive hunger, excessive thirsty of heat and cold intolerance

MUSCULOSKELETAL SYSTEM:

There is no history of muscle pain, joint pain or joint swelling

RESPIRATORY SYSTEM:

There is no history of chest pain, chest tightness or difficulty in breathing

PAST MEDICAL HISTORY

The patient has no any history of previous admissions as hospital, no any history of
blood transfusion, surgical intervention, and food or drug allergies so far.
OBSTRETIC HISTORY:

This mother is gravida 5, para 0, living 0

The mother reported that her fist baby died at term when she was in labor and
experienced elampsia.
Her second baby as the mother reports ,died when the pregnancy had 6 months due
to the same cause that’s eclampsia
The mother reports that hr third baby died when the pregnancy had 5 months but
she was not told the reason or cause of death
And lastly her child died when the pregnancy was of three months due to
hypertension

However the mother reports that during all her previous pregnancy she had a
normal and stable blood pressure but the condition occurs too suddenly and the
pressure rises then she loses her baby.
INDEX PREGNANCY:
 She started attending Reproductive and child health (RCH) clinic when the pregnancy
was 13 weeks, and she has attended 4 times until now. She was screened for
malaria, syphilis and HIV and all the results were negative. She was given folic acid
and ferrous sulphate, sulphadoxine pyrimethamine for malaria prophylaxis and
mebendazole for deworming, she was also given a single dose of tetanus toxoid (TT),
and she did not suffer from any illness since she conceived until today presenting
with this illness.
Comment: I was able to confirm all these information from the RCH card number 4.

GYNAECOLOGICAL HISTORY:

The patient attended menarche when she was 13 years old, where she has been
having a menstrual cycle of 28 days, and flow of 4 days in which she changes pads, 3
times a day which are not totally soaked with blood. She does not have any history
of severe pain during menstruation,
She has never used any contraceptive methods.
There is no any history of sexually transmitted or genital tract diseases,
There is no any history of gynecological surgery

FAMILY HISTORY

She is the third born out of five children in her family where three are boys and two
are girls. All her siblings are alive and well. There is no any history of inherited
diseases running in her family such as, hypertension, diabetes mellitus, asthma,
epilepsy and cancer. Both her parents are also alive and well.

SOCIAL HISTORY:

She is married, living with her husband in a block house which is well ventilated,
using pit latrine and tap water for drinking and domestic activities without boiling
drinking water. Neither herself nor her husband drink alcohol or smoke cigarette.

PHYSICAL EXAMINATION
GENERAL EXAMINATION:

Adult woman, fairly looking, alert with normal hair color texture and distribution
Not cyanosed
Pallor on conjunctiva
Not dehydrated
No finger clubbing
 Not jaundiced
No peripheral lymph nodes enlargement
Capillary refill is normal
Lower limb pitting edema
VITAL SIGNS:

✓ Blood pressure 130/80mmHg

✓ Pulse rate: 100 beats per minute, strong , non -collapsing, synchronized with
femoral pulse, with regular rhythm
✓ Respiratory rate: 20 breaths per minute
✓ Body temperature: 36.8OC
Comment: These are stable vital signs .

SYSTEMIC EXAMINATION
Per abdominal examination:
On inspection:

The abdomen is ovoid in shape, slightly distended with no any traditional or

therapeutic marks seen, and the abdomen moves with respiration, linear negra seen,
umbilicus is everted
On palpation:

The fundal height is 30cm

Abdominal circumference is 84cm
Lie; longitudinal
Presentation; cephalic
Position; Right occipital anterior (ROA)
Head level was 5/5
Auscultation;

Fetal heart rate 142 beat per min

PER VAGINAL EXAMINATION:

On inspection:

Normal hair distribution around the perineum area

Normal vulva and vaginal
Clitoris is present
Labia majora and minora are present

On Palpation:

There is no tenderness at the vulva or vagina

Sacral promontory not easly reached
 Sacral curve is rounded
Ischial spine is blunt
Cervix closed
Vagnal outly angle admit 4 knuckles
CARDIOVASCULAR SYSTEM:

On inspection:

There is no bulging or hyper activity on the pericardial area

No any traditional or therapeutic mark seen on the pericardial area
On Palpation:

The apex beat is located on the 5th intercostal space along the left midclavicular line
No any area of tenderness and no any palpable mass on the pericardial area
On Auscultation:

Both heart sounds S1 and S2 are heard without additional sounds

RESPIRATORY SYSTEM
On inspection:

The chest is bilaterally symmetrical, with no any traditional or therapeutic mark seen
The chest moves with respiration, no chest deformity seen

On palpation:

There is no any area of tenderness and no any palpable mass

Tactile vocal fremitus is normal and trachea is centrally located
No any palpable mass, chest expand equally with respiration
On percussion:

Normal resonant note heard;

On Auscultation:

Norma vesicular breath sounds heard

NERVOUS SYSTEM

1. Higher centers
The patient is alert, oriented to people place and time; both short term and long
term memory are intact
Concentration is also intact
2. Cranial nerves
All cranial nerves are intact
 3. Long tract
Normal muscle bulkiness, normal muscle tone and normal muscle power
(grade5/5)
Coordination is intact, and all tested reflexes are intact

SUMMARY:

This is an obstetric case of a patient who goes by the named Anjelina Godfrey ,
28 year old, gravida 5, para 0, living 0, with last normal menstural period of 31 st
/january/2020, expected date of delivery 29th /november/2020 and gestation age
of of 24 weeks plus 1 day who came with main complain of bilateral lower limb
swelling for two weeks and headache for five days where it was associated with
general body weakness, heartbeat awareness, dizziness and on examination was
pallor on conjunctiva, lower limb pitting edema with stable vital signs.
DIAGNOSIS:

Pre-eclampsia; due to elevated blood pressure and edema

DIFFERENTIAL DIAGNOSIS

Congestive Cardiac Failure

Imminent eclampsia
MANAGEMENT:

Investigations:
✓ Hemoglobin level estimation, to know the level of Hemoglobin and rule
out anemia
✓ Obstetric abdominal pelvic ultrasounds scan to confirm check gestation
age, foetal presentation and amount of amniotic fluid
✓ Urinalysis to rule out proteinuria
✓ Blood slide for malaria
✓ Random blood glucose
✓ Renal fuction test

TREATMENT:

Non pharmacological management

❖ Have enough resting

❖ Avoid salt intake to avoid elevation of blood pressure
❖ Encourage taking vegetables and fruits to help to correct anemia

Pharmacological management
 ➢ Nifedipine 20mg per oral od for a month
➢ Paracetamol 1g per oral 8 hourly for 3 da
➢ Close monitoring of the patient’s blood pressure

COMPLICATIONS:

❖ Eclampsia
❖ Heart failure
❖ Intrauterine foetal death

PREVENTION:

Early and regular attendance of antenatal clinic

Early diagnosis and treatment

PROGNOSIS:

Prognosis of this patient is good under close and proper nursing observation and
management.

SURGICAL DEPARTMENT
OBJECTIVES:

➢ Take surgical history from the patients thoroughly

➢ Perform physical examination thoroughly
➢ Perform relevant laboratory investigations to aid in formulating the proper diagnosis
➢ Formulate diagnosis properly
➢ Provide provider initiated testing and counseling (PITC)
➢ Practice safety techniques and aseptic techniques in performing surgical procedures
➢ Assist major surgery

TO TEN DISEASES IN SURGICAL DEPARTMENT

1. Fractures
2. Cut wound
3. Road traffic accidents
4. Hypertension
5. Head Injury
6. Diabetes mellitus
7. Peptic ulcer disease (PUD)
8. Gynecological diseases
9. Benign prostate hyperplasia
10. Hernia
TOP TEN DRUGS USED IN SURGICAL DEPARTMENT

1. Cloxacillin
2. Paracetamol
3. Pethedine
4. Gentamycin
5. Ampicillin
6. Neurobion
7. Ibuprofen
8. Diclofenac
9. Tramadol
10. Metronidazole

A CASE PRESENTATION FROM SURGERY DEPARTMENT

Name: Praygod Samwel

Age: 21 years

Sex: Male

Tribe; Pare

Occupation: Business

Religion: Christian

Address: Rombo, Mkuu

Date of history taking: 19th July 2020

Referral from Home

Informant: Patient himself

Chief complaint:

Loss of consciousness for 2hours

HISTORY OF PRESENTING ILLNESS

The patient was well until 4 days ago when he experienced a sudden onset of loss of
consciousness following a motor vehicle accident which he sustained when he lost control
of himself because he was drunk and did not know what he was doing since he was not in
his real sense. The patient reports falling on a rough surface causing several facial and hands
bruises and a cut wound on his abdomen and loss of consciousness for 2 hours and when he
woke up he found himself at the hospital not knowing who took him there or what was
done when he got there.

However the patient denies a history of convulsion, headache or vomiting after the
accident.

Currently the patient’s condition is improving under proper management and nursing care.

REVIEW OF OTHER SYSTEMS

THROAT

There is no history of difficulty in swallowing or pain during swallowing

CARDIOVASCULAR SYSTEM

There is no history of lower limbs swelling, heart beat awareness, difficulty in

breathing on lying flat or air hunger during the night

RESPIRATORY SYSTEM

There is no history of chest pain, chest tightness, or difficulty in breathing

ENDOCRINE SYSTEM

There is no history of excessive sweating, excessive hunger, or excessive thirsty

GASTROINTESTINAL SYSTEM

There is no history of passing lose stool, abdominal pain, abdominal discomfort,

nausea or vomiting

GENITALURINARY SYSTEM

There is no history of increased frequency in urination, painful urination, or urgency

in urination

PAST MEDICAL HISTORY

 This is his second admission at this hospital due to a motor cycle accident which led
him to fracture which was treated and went on well. There is no history of blood
transfusion, no history of any food or drug allergies so far. There is also no history
long term use of medication or attending any special clinic.

FAMILY HISTORY

He is the sixth born out of six children in his family whereby all his siblings are alive
and well, but his father died due to unknown cause. There is no any history of
inherited diseases running in his family such as hypertension, diabetes mellitus,
epilepsy, asthma or cancer.

SOCIAL HISTORY

He lives with his wife. He lives in a block house well ventilated and they use tap
water for drinking and domestic purposes without boiling drinking water. He uses
alcohol which is bear four bottles per day for more than 15 years now. He has no
history of using cigarette. He is married and living with his wife and his two children.
His wife neither drinks alcohol nor smokes cigarette.

PHYSICAL EXAMINATION
General examination:
He is an adult man, alert and oriented, not ill looking with normal hair color texture
and distribution.
Not pale
Not jaundiced
Not cyanosed
No peripheral lymph nodes enlargement
Not dehydrated
No finger clubbing
Capillary refill is normal
Not edematous

VITAL SIGNS:

✓ Blood pressure: 135/85mmHg

✓ Pulse rate 89 beats per minute, strong, regular rhythm, non -collapsing,
synchronized with femoral pulse,
✓ Respiratory rate: 18 breaths per minute
✓ Body temperature: 36.8oC
Comment: these are stable vital signs

LOCAL EXAMINATION:
Inspection:

Multiple bruises on the chicks of the face and the lower lip and a stitched wound on
the abdomen.
Not discharging or bleeding
Well dressed
Palpation:

Still some tenderness on the bruises.

SYSTEMIC EXAMINATION

MUSCULOSKELETAL SYSTEM:
On inspection: There is no swelling on any other parts than the affected limb

No visible joint swelling

On Palpation: there is no area of tenderness on the muscles on palpation except the
affected part of left limb

GASTROINTESTINAL SYSTEM

On inspection:

The abdomen is flat, with no distended veins, no any traditional or therapeutic mark
seen, the abdomen moves with respiration
On Superficial palpation:

There is no any area of tenderness, and no any palpable mass

On deep palpation:

There is no any intra-abdominal organ enlarged such as kidney, liver

and spleen

On percussion:

Normal tympanic note heard

On Auscultation:

Normal bowel sounds heard

RESPIRATORY SYSTEM:
On inspection:

The chest is bilaterally symmetrical, moves with respiration, no any traditional or

therapeutic mark seen
On Palpation:

There is no any area of tenderness, no any palpable mass

Trachea is centrally located,
Tactile vocal fremitus is normal
Chest expands equally with respiration

On percussion:

Normal resonant note heard

NERVOUS SYSTEM

1. Higher centers: The patient is oriented to people place and time

Short and long term memory is intact
Concentration is intact
2. Cranial Nerves: All cranial nerves are intact except cranial nerve number 8 in
vestibule part which was not tested due to the patient being unable to walk
3. Long Tract: Normal muscle bulkiness, normal muscle tone and normal muscle
power in all other limbs except the affected one.
Sensation is intact

CARDIOVASCULAR SYSTEM

On inspection:

There is no bulging or hyper activity on the pericardial area

On palpation:

There is no area of tenderness and no any palpable mass

The apex beat is located at the 5th intercostal space along the left midclavicular
line
On Auscultation:

Normal heart sounds S1 and S2 heard with no any additional sound

SUMMARY:

A male patient from same with the initials of P.S 21 years odld brought to the hospital 4
days ago due to the history of loss of consciousness following a motor cycle accident and led
to several facial bruises and a cut wound on his abdomen. Curently the patient is doing well
and with stable vital signs.
DIAGNOSIS:

• Head injury due to the loss of consciousness

• Soft tissue injury due to the several facial bruises
• Cut wound due to the wound on the abdomen.

DIFFERENTIAL DIAGNOSIS:

Skull fracture
Orbital trauma
Intracranial haemorrhage

MANAGEMENT

Investigations:
1. Hemoglobin level estimation to rule out anemia
2. X-ray of the skull
3 .Full blood picture
TREATMENT:

• Ensure ABC
• IV fluids that is preferable ringers lactate
• Iv diclofenac 75mg 8hrly 24hrs
• Iv cloxacillin 500mg tds for 5 days
• Daily wound dressing

COMPLICATION

• Septicemia
• Haemorrhagic shock
• Haematoma
• scars

PREVENTION;

Avoid alcohol drinking when driving or using motor vehices

CONCLUSION AND RECOMMENDATIONS
I thank my all might God for giving me strength during the course of my field work,
hence I was able to learn different things that would help me in my medical field
currently and for my future.

It has been a pleasure, honor and challenge to have opportunity to take up this
project and complete it successful.

I conclude by contented all people who helped me to succeed to conduct my field

work GOD bless you all.

RECOMMENDATIONS
My recommendations towards this field attachment are as follows:

➢ The college should check preferably the time of conducting this field work
because is short time to conduct and learn new ideas.

➢ The principal of college should assign the student to their home nearby
hospital to apply their knowledge and skills so that can improve.

➢ The college should also help their students to increase the money to use for
their field project and field stay.
2.1MEDICAL DEPARTMENT
OBJECTIVES:

9. Take history thoroughly

10. Perform physical examination to the patients thoroughly
11. Perform relevant laboratory investigations to help in making diagnosis
12. Formulation of diagnosis
13. Treat the patients appropriately and refer patients for proper management
14. Conduct health education
15. Plan proper care and treatment for people living with HIV/AIDs
16. Counsel clients on HIV testing

TOP TEN DISEASES IN MEDICAL DEPARTMENT.

1. BRONCHIAL ASTHMA.

2. PEPTIC ULCER DISEASE.

3. PNEUMONIA.

4. HIV/AIDS.

5. DIABETES MELLITUS.

6. ANAEMIA.

7. HYPERTENSION.

8. TUBERCULOSIS.

9. URINARY TRACT INFECTION.

10. HEARTFAILURE.

TOP TEN DRUGS USED IN MEDICAL DEPARTENT

11. Cotrimoxazole
12. Salbutamol
13. Ferrous sulphate and folic acid
14. Benzyl penicillin
15. Oral hypoglycemic ( glibenclamide and metfomin)
16. Insulin
17. Anti tuberculosis drugs
18. Aminophiline
 19. Artesunate
20. Amoxicillin

2.2A CASE PRESENTATION FROM MEDICAL DEPARTMENT

Name: Anthony Julius Mbazi

Age: 46 years

Sex: Male

Tribe: Pare

Occupation: Peasant

Religion: Christian

Marital status: Married

Address: miembeni

Date of admission: 17/7/2020

Date of history taking: 18/7/2020

Mode of referral: From home

Informant: Patient himself

CHIEF COMPLAINT: General body swelling for 1 week

HISTORY OF PRESENTIING ILLNESS:

This is a known case of Hypertension for six years now on irregular medication.

The patient reported that he was well until one week age when he started experiencing a
gradual onset of general body swelling which started on the abdomen, and later distributed
to the lower limbs. The condition was associated with, joint pain, facial swelling especially in
the morning, difficulty in breathing, when lying flat, air hunger during the night, easy
fatigability, fatigue, heart beat awareness, dizziness, and cough which was productive in
nature, whitish in color and not stained with blood, the sputum was in small amount and
coughing was more severe during the night. The condition was aggravated when he lies flat
and relieved when he sits, and it was getting worse as time went on until the patient was
brought to hospital by his relatives,
Howe ever there was no history of, headache, chest pain, tuberculosis contact, chest
tightness, abdominal pain, joint swelling, muscle pain, loss of appetite, nausea, vomiting,
increased frequency in urination, painful urination or inability to pass urine.

REVIEW OF OTHER SYSTEMS:

EAR, NOSE AND THROAT

4. Ear: There is no history of ear pain , ear discharge o ear bleeding

5. Nose: There is no history of nasal bleeding, nasal congestion or runny nose
6. Throat: There is no history of painful during swallowing or difficulty in swallowing

ENDOCRINE SYSTEM

There is no history of excessive sweating, excessive hunger or thirst

PAST MEDICAL HISTORY:

This is his second admission in this year in which he has been admitted in January, and march
due to the same condition. He was being treated and discharged home. There is no history of
blood transfusion, or surgical intervention. He has been using long term medication which he
does not know the names but he is taking medications irregularly (anti
hypertensivemedication). No history of food or drug allergy so far.

FAMILY HISTORY:

The patient is the first born out of 3 children in his family where two are girls and one is a boy.
All his siblings are alive and well however his father and mother died due to hypertension and
stroke respectively. There is a history of hypertension running in his family in which also his
younger brother has hypertension.

SOCIAL HISTORY:

The patient is married and he has four children. He is not living with his wife but his two
children in a block house well ventilated, and using pit latrine, and tap water for drinking and
domestic activities without boiling drinking water. He has a history of using alcohol for more
than twenty years in which he mixed both beer and mbege, but he stopped six years ago due
to medical reasons. He also was using cigarette in which he took about at least on packet per
day but he also stopped six year ago due to medical reason. His wife takes neither alcohol nor
cigarette. He is on salt restriction in which he was advised to take food with low amount of
salt
PHYSICAL EXAMINATION:

GENERAL EXAMINATION;

He is an adult man , no ill looking, with normal hair color texture and distribution.

Not cyanosed

Jaundiced

No Pale on conjunctiva and palms

With normal Capillary refill p, returns in <= 3seconds

Not dehydrated

No finger clubbing

Not edematous

VITAL SIGNS:

Blood pressure: 130/90mmHg

Pulse rate 78 beats per minute, full volume, collapsing, irregularly irregular synchronized with
femoral pulse.

Respiratory rate: 20 breaths per minute

Body temperature: 36.5OC

Comment: The vital signs are stable except the pulse rate characteristics

SYSTEMIC EXAMINATION:

NEVOUS SYSTEM EXAMINATION

4. Higher centers:
The patient is oriented to people place and time, concentration is intact and both short
and long term memory are intact.
5. Cranial nerves:
All cranial nerves are intact except cranial nerve number 8 in vestibule part which was
not tested as the patient in bed ridden and cannot walk
6. Long tract
 The patient is edematous on the lower limbs, and abdomen, which makes it difficult
to assess muscle bulkiness however it is normal on upper extremities
Normal muscle tone and normal muscle power (grade 5/5)
Coordination is intact and all tested reflexes were intact.

CARDIOVASCULAR SYSTEM
On inspection:

There is no visible hyperactivity or bulging on pericardial area

There is no any traditional or therapeutic mark seen
On Palpation:

The apex beat is located at the 6th intercostals space along the left anterior axillary line
No any area of tenderness and no any palpable mass
On Auscultation:

Both heart sounds S1 and S2 heard with additional heart sounds

RESPIRATORY SYSTEM
On inspection:

The chest is bilaterally symmetrical moving with respiration

No any traditional or therapeutic mark seen on chest
On palpation:

Trachea is centrally located, tactile vocal fremitus is normal, and

No any palpable mass or any area of tenderness
On Percussion:

Normal resonant note heard

On Auscultation:

Norma vesicular breath sounds heard

PER ABDOMEN EXAMINATION

On inspection:

The abdomen is uniformly distended

Moving with respiration
Umbilicus is elevated
No any distended veins and no any traditional or therapeutic mark seen.
On superficial palpation:
 There is any area of tenderness, and no any palpable mass
On deep palpation:

There is no any area of tenderness and no any intra abdominal organ palpable such as
kidney, liver and spleen
On percussion:

Fluid thrill is positive and shifting dullness is positive

On Auscultation:

Diminished bowel sounds heard

SUMMARY:
This is a case of Anthony Julius Mbazi, a 46 years old male, patient who is a peasant
from miembeni , brought to hospital with the chief complaint of, general body swelling
for 5 days, on history taking, a condition associated with, heart beat awareness,
tiredness, fatigue, easy fatigability, productive cough, joint pain, facial swelling,
dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. On physical examination
there is massive abdominal ascitis, lower limbs edema, fluid thrill and shifting dullness
positive, jaundice, with stable vital signs of blood pressure 130/90mmHg, body
temperature 36.5oC, respiratory rate of 20 breaths per minute, except pulse which
was collapsing and irregularly irregular.

DIAGNOSIS:
1. Congestive cardiac failure (CCF) secondary to uncontrolled hypertension, due to
general body swelling, heart beat awareness, fatigue, orthopnea and paroxysmal
nocturnal dyspnea
2. Anemia due to heart beat awareness, fatigue, and tiredness,

DIFFERENTIAL DIAGNOSIS
Renal failure
Chronic liver failure
Liver cirrhosis
These are due to,generalized body swelling, facial swelling, and history of long time
alcohol and cigarette use which are potent risk factors.

MANAGEMENT
✓ Investigations:
✓ Urinalysis to assess proteinuria
✓ Hemoglobin level estimation to rule out anemia
✓ Renal function test to assess level of serum creatinine
 ✓ Liver function test to assess the liver enzymes, alanine transaminase and
aspartate transaminase, (ALAT and ASAT respectively)
✓ Chest x-ray to assess cardiomegally due to displaced apex beat

TREATMENT:

Non Pharmacological:

✓ Nurse a patient in cardiac position

✓ Continue with salt restriction and alcohol and cigarette abstinence
✓ Avoid large meals, and take only small meals in increased frequency
✓ Avoid high fat foods
✓ Have enough rest and hard works restriction

Pharmacological:

✓ Furosemide 80mg intravenously once daily for 1 week

✓ Paracentesis (or ascetics tapping)to reduce the amount of ascetic fluid
✓ Monitor vital signs
✓ The patient should adhere to the anti hypertensive drugs
✓ Bendroflumethiazide 5mg once daily for 1 week
✓ Captopril 12.5 mg once daily for 1 week

COMPLICATIONS

✓ Cardiac arrest
✓ Pleural effusion
✓ Pulmonary edema
✓ Co pulmonale

PREVENTION:

✓ Adherence to medication
✓ Early screening for complications and treating accordingly

PROGNOSIS

Is fair due to age of the patient under proper adherence on medication

2.3PAEDIATRIC DEPARTMENT
OBJECTIVES:

➢ History taking accurately

➢ Performing physical examination to the patients
➢ Formulating proper diagnosis
➢ Treating or referring the patients for proper management
➢ Assessment of growth and development of the sick children
➢ Manage child illness by following the guidelines of integrated management of childhood
illnesses (IMCI)
➢ Provide essential new born care
➢ Educate mothers on how to give proper breast feeding to their babies
➢ Care and management of children with HIV/AIDs
➢ Conduct reproductive and child health services (RCH)

TOP TEN DISEASES IN PAEDIATRICS AND CHILD HEALTH.

[Link].

[Link] PNEUMONIA.

[Link] TRACT INFECTION.

4. MALNUTRITION.

[Link].

[Link].

[Link] RESPIRATORY TRACT INFECTION.

[Link].

[Link] SEPSIS.

[Link].
TOP TEN DRUGS USED IN PEDIATRIC WARD
11. Injection Ampicilin
12. Injection X pen
13. Injection Gentamycin
14. Injection ceftriaxone
15. Injection hydrocortisone
16. ORS
17. paed Zinc tab supplements
 18. Paracetamol tabs
19. Paracetamol syrup
20. Infusion (RL & DNS)

2.4.A CASE PRESENTATION FROM PAEDIATRIC DEPARTMENT

NAME: BIHAWANA LAISER

AGE: 8 Months

Sex: Female

Religion: musilim

Tribe: Pare

Address: same mjini

Date of admission: 15/7/2020

Date of history taking: 16/7/ 2020

Informant: Biological mother

Chief complaint:

cough for 3 days

HISTORY OF PRESENTING ILLNESS

The mother reported that her child was apparently well until 3 days prior to admission
when she started to notice a gradual onset of dry cough to her child, the condition which was
worse during the night and associated with excessive crying, difficult in breathing, runny ,
refusal to breast feed, and vomiting , where by the baby vomited three times a day, non
projectile vomiting, the vomits containing milk particles in small amount approximately half
a cup of tea. The condition had no aggravating or relieving factors.

However there was no history of nasal bleeding, consciousness, convulsions,

tuberculosis contact, passing lose stool, and yellowish discoloration of skin or eyes, also no
history of discomfort during urination.

Also the mother reported that the child have fever for 3 days the fever worsen during the
night and it was not have neither aggreviating factors no relieving factors

REVIEW OF OTHER SYSTEMS

EAR AND THROAT

Ear: There was no history of ear tagging, ear discharge or bleeding from the ear

Throat: There was no history of discomfort in swallowing

MUSCULOSKELETAL SYSTEM
There is no history o joint pain and no history of joint swelling

ENDOCRINE SYSTEM

There was no history of excessive sweating during the night

PAST MEDICAL HISTORY

The child has no history of previous admissions,

No history of drug allergies reported so far.

ANTENATAL HISTORY

The mother attended clinic four times when she was pregnant for this baby, and she was
screened for malaria syphilis and HIV and the results were all negative. She was given folic
acid and ferrous sulphate, sulphadoxine pyrimethamine for malaria prophylaxis, and
mebendazole for deworming. She also did not suffer from any disease during pregnancy. I did
not comfirm this information as the mother did not come with RCH card number 4.

NATAL HISTORY

The mother reported that she delivered her baby at full term at hospital, monduli Hospital
where by it was normal spontaneous vaginal delivery. The membranes ruptured
spontaneously and the child cried immediately after birth, with birth weight of 3.5kg. The
baby was also fed within one hour after delivery.

POST NATAL HISTORY

The child did not suffer from any complications after delivery, like yellowish discoloration of
the skin or mucous membranes, sepsis of the cord or convulsions. The baby also did not bleed
from the cord.

IMMUNIZATION HISTORY

The child is fully immunized according to his age where by, he received BCG and OPVo 2 days
after delivery and he received OPV 1, PCV 1, PENTA 1, ROTAR 1 at 6 weeks of age, OPV 2, PCV
2, PENTA 2 AND ROTAR 2 at 10 weeks of age and PCV3, PENTA 3OPV 3 at 14 weeks of age.
The child is due for measles Rubella vaccine at 9 months of age.

DIETARY HISTORY

The child was exclusively breast fed for six months, he was feeding more than 10 times a day
then started complimentary feeding where by the mother started to give the child, boiled
cow milk, and porridge made by unga wa lishe. The feeding pattern of the child was good until
3 days age when the illness started.

Comment: the child’s dietary history is good except now that the child cannot breastfeed
due to illness.
DEVELOPMENTAL MILESTONES

The child had a social smile when he was 3 weeks old, and he was able to control the neck at
3 months of age. Now the child is able to sit without any support.

Comment: These are a good developmental mile stones

FAMILY AND SOCIAL HISTORY

she is the second born out of three children in his family and she is living with his mother and
father in a block house well ventilated, and they are using tap water for drinking and domestic
activities. There is no history of any inherited disease in his family such as hypertension,
asthma, diabetes mellitus and cancer.

None of his parents use alcohol or smoke cigarette.

PHYSICAL EXAMINATION

GENERAL EXAMINATION
He is a child ill looking alert with normal hair color texture and distribution

Not pale, not cyanosed, not jaundice, no peripheral lymph nodes enlargement

No finger clubbing,

Not dehydrated

There is lower chest wall in drawing

Not edematous
VITAL SIGNS

Respiratory rate 51 breaths per minute

Body temperature 37.90C
Pulse rate 78 beats per minute

ARTHROPOMETRIC MEASUREMENTS
Weight 7.5 kg
Mid upper arm circumference (MUAC) 14.5 cm
Occipital frontal circumference (OFC) 35.5 cm
Length 64cm
Comment: these are normal anthropometric measurements according to the age of
the child.

SYSTEMIC EXAMINATION

Nervous system examination

5. Higher centres
The child is alert
 6. Cranial nerves
All other cranial nerves are intact except olfactory, trigeminal, glossopharyngial,
hypoglossal, and accessory which were not tested due to the age of the child.
7. Long tract
Norma muscle bulkiness
8. Reflexes
Burbinsky reflex was intact
Respiratory system

On inspection:

There is lower chest wall in drawing,

No any visible traditional mark or therapeutic
Chest is bilaterally symmetrical

On palpation:

There is no any palpable mass

No any discomfort on palpation

On percussion:

Normal resonant percussion note heard

On Auscultation:

Bilateral fine crepiations heard at the bases of lungs

GASTROINTESTINAL SYSTEM

ABDOMINAL EXAMINATION
On inspection:
The abdomen moves with respiration
The abdomen is flat
No traditional or therapeutic marks seen
On superficial palpation:
NO any palpable mass and no discomfort on palpation
On Deep palpation:
No any intra abdominal mass enlargement such as Kidney, spleen and liver
On percussion: Normal tympanic note heard
On auscultation: Normal bowel sounds heard
CARDIOVASCULAR SYSTEM

On inspection: There is no bulging on pericardial area, and no hyper activity on the pericardial
area

On palpation: The apex beat is located at the 4th intercostals space along the left midclavicular
line

On auscultation: Normal S1 and S2 heart sounds heard with no any additional sounds

SUMMARY:
This is the presentation of Bihawana Laiser female child of 8moths old from same
mjini, who was brought by his mother with the chief complaint of fever for three
days and cough 3 days. On history there is chest tightness, runny nose, hotness by
touch, vomiting, and dry cough, also there was refusal to breast feed. On physical
examination there was lower chest wall in drawing, bilateral fine crepitations on
lung bases, and vital signs of 51 breaths per minute which is fast breathing, body
temperature of 37.9oC which is elevated and normal anthropometric
measurements.

DIAGNOSIS

Severe pneumonia
Due to discomfort in breathing, cough, fever, and lower chest wall in drawing
DIFFERENTIAL DIAGNOSIS
Uncomplicated malaria

MANAGEMENT
Investigations: Full blood picture to see elevated white blood cells as a sign of
infection,
Also for hemoglobin level
Malaria rapid diagnostic test to rule out malaria
Random blood glucose to rule out hypoglycemia
TREATMENT

Ampicilin 350mg I.V 12 hrly for 5 days

Gentamycine 40mg I.V 12 hrly 5 days

Paracetamol syrup 10mls 8 hrly prn

Encourage breast feeding and other foods feeding when the child can take food

COMPLICATIONS:

Respiratory distress, pleural effusion and septicemia

PREVENTION:

Early diagnosis and treatment

Keep the child warm

Keep the child in well ventilated area out of dusts, and hygiene of care takers

[Link] AND GYNECOLOGY DEPARTMENT

OBJECTIVES:

➢ Take thorough history from patients

➢ Perform physical examination thoroughly
➢ Perform relevant laboratory investigations
➢ Formulate the diagnosis
➢ Treat and manage cases properly
➢ Provide referrals when necessary
➢ Record labour, maternal and fetal parameters using a patograph
➢ Interpret findings and recordings on patograph
➢ Conduct normal delivery
➢ Conduct post delivery examination
➢ Manage post partum conditions
➢ Educate mothers about breastfeeding of infants
➢ Provide proper HIV/AIDs care

TOP TEN DISEASES IN OBSTRETRICS AND GYNAECOLOGY.

1. URINARY TRACT INFECTIONS IN PREGNANCY.

2. ANAEMIA IN PREGNANCY.

3. PREGNANCY INDUCED HYPERTENSION.

4. PRE TERM RUPTURE OF MEMBRANE.

5. PRE-MATURE RUPTURE OF MEMBRANES.

6. PELVIC INFLAMMATORY DISEASES

7. ANTEPARTUM HAEMORRHAGE.

8. VAGINAL CANDIDIASIS
9. MALARIA IN PREGNANCY.

10 .OBSTRUCTED OR PROLONGED LABOUR

TOP TEN DRUGS USED IN OBSTRETICS AND GYNECOLOGY

DEPARTMENT
1. Oxytocin
2. Metronidazole
3. Magnesium sulphate
4. Ferrous sulphate
5. Follic acid
6. Amoxicillin
7. Nitrofurantoin

2.6. A CASE PRESENTATION FROM OBSTRETIC AND GYNAECOLOGY

DEPARTMENT
Name: Ursula michael

Age: 27 years

Sex: Female

Tribe: sukuma

Occupation: peasant

Religion: Christian

Address: miembeni

Date of admission: 22 july 2020

Date of history taking :23 july 2020

Referral mode: From Home

Informant: Patient herself and her mother in low

Prime gravid

Last normal menstrual period (LNMP): 20th november 2019

Expected date of delivery (EDD): 27 july 2020

Gestation age (GA): 28 weeks + 4 Days

CHIEF COMPLAINT:

Severe abdominal pain for 3 days

HISTORY OF PRESENTING ILLNESS

The patient reported that she was apparently well until three days prior to admission where
she started to experience a gradual onset of severe abdominal pain located at the lower part
of the abdomen. The pain was pricking in nature radiating to the back, and associated with
per vagina bleeding, in which she reported to bleed small amount of blood with no clots and
no foul smelling, she has used pads to cover the bleeding where she changed pads only once
a day which is not totally soaked with blood. The condition was severe when she walks or
does her daily activities and relieved when she takes rest. She was then taken to hospital by
her mother in low due to increasing severity of the condition.

However there is no history of, vagina itching, sores or ulcers around the vagina, increased
urinary frequency, painful urination, passing lose stool, difficulty in passing stool, nausea,
vomiting or loss of appetite. Also there is no history of lower limbs swelling or heart beat
awareness.

REVIEW OF OTHER SYSTEMS

EAR, NOSE AND THROAT

4. Ear: There is no history of ear discharge, ear pain or ear bleeding

5. Nose: there is no history of nasal bleeding, nasal congestion or runny nose
6. Throat: There is no history of difficulty in swallowing and no history of hoarseness of
voice

ENDOCRINE SYSTEM:

There is no history of excessive hunger, excessive thirsty of heat and cold intolerance

MUSCULOSKELETAL SYSTEM:

There is no history of muscle pain, joint pain or joint swelling

NERVOUS SYSTEM:

There is no history of headache, loss of consciousness or dizziness

RESPIRATORY SYSTEM:

There is no history of chest pain, chest tightness or difficulty in breathing

OBSTRETIC HISTORY:
This mother is prime gravida.

INDEX PREGNANCY:

She started attending Reproductive and child health (RCH) clinic when the pregnancy
was 4 months, and she only has attended once until now. She was screened for
malaria, syphilis and HIV and all the results were negative. She was given folic acid and
ferrous sulphate, sulphadoxine pyrimethamine for malaria prophylaxis and
mebendazole for deworming, she was also given one dose of tetanus toxoid (TT), and
she is due for the second dose upon her second attendance which is scheduled on 27 th
JULY 2020. She did not suffer from any illness since she conceived until today

presenting with this illness.

Comment: I was able to confirm all these information from the RCH card number 4.

GYNAECOLOGICAL HISTORY:

The patient attained menarche when she was 15 years old, where she has been
having a menstrual cycle of 30 days, and flow of 4 days in which she changes pads, 3
times a day which are not totally soaked with blood. She does not have any history of
severe pain during menstruation,
She has never used any contraceptive methods.
There is no any history of sexually transmitted or genital tract diseases,
There is no any history of gynecological surgery
PAST MEDICAL HISTORY
The patient has no any history of previous admissions as hospital; however she has
been treated here at Huruma hospital twice in the year 2015 and 2016 due to, malaria
and pneumonia respectively. There is no any history of blood transfusion, surgical
intervention, and food or drug allergies so far.

FAMILY HISTORY

She is the second born out of four children in her family where two are boys and two
are girls. All her siblings are alive and well. There is no any history of inherited diseases
 running in her family such as, hypertension, diabetes mellitus, asthma, epilepsy and
cancer. Both her parents are also alive and well.

SOCIAL HISTORY:

She is married, living with her husband in a block house which is well ventilated, using
pit latrine and tap water for drinking and domestic activities without boiling drinking
water. Neither herself nor her husband drink alcohol or smoke cigarette.

PHYSICAL EXAMINATION

GENERAL EXAMINATION:
Adult woman, not ill looking, alert with normal hair color texture and distribution
Not cyanosed
Not pale
Not dehydrated
No finger clubbing
Not jaundiced
No peripheral lymph nodes enlargement
Capillary refill is normal
Not edematous
VITAL SIGNS:

✓ Blood pressure 120/70mmHg

✓ Pulse rate: 80 beats per minute, full volume, non -collapsing, synchronized
with femoral pulse, with regular rhythm
✓ Respiratory rate: 23 breaths per minute
✓ Body temperature: 36.7OC

Comment: These are stable vital signs except respiratory rate which is high.

SYSTEMIC EXAMINATION
Per abdominal examination:
On inspection:

The abdomen is ovoid in shape, uniformly distended with no any traditional or

therapeutic marks seen, and the abdomen moves with respiration, linear nigra seen
On palpation:
 The fundal height is 30cm
Foetal lie is longitundinal
abdominal circumference78cm
approximate fetal size is 2.34kg
Presentation cephalic
On auscultation:

The foetal heart rate is 146beats per minute

PER VAGINAL EXAMINATION:

On inspection:

Normal hair distribution around the perineum area

Normal vulva and vaginal
Clitoris is present
Labia majora and minora are present
No visible bleeding or discharge
On Palpation:

There is no tenderness at the vulva or vagina

The cervix is firm
Cervix position is posterior
Cervix is closed
The gloves are stained with small amount of blood upon removal from the vagina

CARDIOVASCULAR SYSTEM:

On inspection:

There is no bulging or hyper activity on the pericardial area

No any traditional or therapeutic mark seen on the pericardial area
On Palpation:

The apex beat is located on the 5th intercostals space along the left midclavicular line
No any area of tenderness and no any palpable mass on the pericardial area
On Auscultation:

Both heart sounds S1 and S2 are heard without additional sounds

RESPIRATORY SYSTEM:
On inspection:

Te chest is bilaterally symmetrical, with no any traditional or therapeutic mark seen

The chest moves with respiration
On palpation:

There is no any area of tenderness and no any palpable mass

Tactile vocal fremitus is normal and trachea is centrally located
No any palpable mass
On percussion:

Normal resonant note heard

On Auscultation:

Norma vesicular breath sounds heard

NERVOUS SYSTEM

4. Higher centers
The patient is alert, oriented to people place and time; both short term and long
term memory are intact
Concentration is also intact
5. Cranial nerves
All cranial nerves are intact
6. Long tract
Normal muscle bulkiness, normal muscle tone and normal muscle power
(grade5/5)
Coordination is intact, and all tested reflexes are intact

SUMMARY:
This is the presentation of ursula michael, a female patient of 27 years old, from
same mjini who is prime gravid, with last normal menstrual period (LNMP) of 20 th
November 2020, expected date of delivery (EDD) of 27th july 2020, and gestation
age of 28 weeks + 3 days who was brought to the hospital with the chief complaint
of severe abdominal pain pricking in nature located in the lower part of abdomen.
On history the pain was associated with slight per vaginal bleeding, without heart
beat awareness dizziness or headache, and on physical examination the fundal
height is 30cm fetal lie is longitudinal presentation cephalic approximate fetal
weight 2.34kg, with slight per vaginal bleeding and normal vital signs except
respiratory rate which is higher than normal.
DIAGNOSIS:

Threatened abortion due to lower abdominal pain, and per vaginal bleeding
DIFFERENTIAL DIAGNOSIS

Urinary tract infection (UTI) in pregnancy due to lower abdominal pain

MANAGEMENT:

✓ Investigations
✓ Hemoglobin level estimation, to know the level of Hb and rule out anemia
✓ Obstetric abdominal pelvic ultrasound scan to see the state of fetus,
placental position, amount of amniotic fluid and any abnormal uterine
mass
✓ Urinalysis to rule out urinary tract infection

TREATMENT:

-Ensure absolute bed rest, and observation of the mother for 24 hours in the ward
-Give, phenobarbitone 30mg orally once daily for 72 hours, this will calm the
patient and enable her to take enough bed rest

COMPLICATIONS:
✓ Anemia
✓ Pre term labour
✓ Incomplete or complete abortion

PREVENTION:
✓ Avoid strenuous activities
✓ Have enough rest throughout pregnancy
✓ Early and regular attendance of antenatal clinic
✓ Early diagnosis and treatment

PROGNOSIS:

The prognosis of this patient is good, as when she takes absolute bed rest and she
should avoid strenuous activities, she can be healed and the pregnancy may
continue well until delivery

[Link] DEPARTMENT
OBJECTIVES:

➢ Take surgical history from the patients thoroughly

➢ Perform physical examination thoroughly
➢ Perform relevant laboratory investigations to aid in formulating the proper diagnosis
➢ Formulate diagnosis properly
➢ Provide provider initiated testing and counseling (PITC)
➢ Practice safety techniques and aseptic techniques in performing surgical procedures
 ➢ Assist major surgery

TOP TEN DISEASES IN SURGICAL DEPARTMENT.

[Link] PROSTATE HYPERPLASIA.

[Link].

[Link].

[Link].

[Link].

6. ROAD TRAFFIC ACCIDENTS.

[Link] LUMPS.

[Link]

[Link].

[Link].

TOP TEN DRUGS USED IN SURGICAL DEPARTMENT

[Link]
[Link]
[Link]
[Link]
[Link]
[Link] aspirin
[Link] + cloxacillin
[Link] Diclofenac
[Link]

2.8 .A CASE PRESENTATION FROM SURGERY DEPARTMENT

Name: lingino Mwanga
Age: 52 years

Sex: Male

Tribe: Pare

Occupation: Peasant

Religion: Christian

Address: miembeni.

Date of admission: 15 july 2020

Date of history taking: 17 july 2020

Referral from Home

Informant: Patient himself

Chief complaint: pain of the right lower abdomen 7 days

HISTORY OF PRESENTING ILLNESS

The patient was well until 7 days ago when he started experiencing a gradual onset of pain
at the right lower abdomen which was pricking in nature associate with loss of appetite,
vomiting and faver she also reported the pain occurs when bedding at was relived when lying
supine

However no hx of pain on micturation ,no increasing urinary frequency

REVIEW OF OTHER SYSTEMS

EAR NOSE AND THROAT

1. Ear: There is no history of ear discharge, ear itching or ear bleeding

2. Nose: There is no any history of nasal bleeding or nasal congestion
3. Throat : There is no history of difficulty in swallowing or pain during swallowing

CARDIOVASCULAR SYSTEM

There is no history of lower limbs swelling, heart beat awareness, difficulty in

breathing on lying flat or air hunger during the night
RESPIRATORY SYSTEM

There is no history of chest pain, chest tightness, or difficulty in breathing

ENDOCRINE SYSTEM

There is no history of excessive sweating, excessive hunger, or excessive thirsty

GENITALURINARY SYSTEM

There is no history of increased frequency in urination, painful urination, or urgency

in urination

PAST MEDICAL HISTORY

This is his second admission in SAME Hospital in which the first admission was in 2014
due to malaria. He was treated and cured, then discharged home. There is no history
of blood transfusion, no history of any food or drug allergies so far. There is also no
history long term use of medication or attending any special clinic.

FAMILY HISTORY

He is the first born out of four children in his family whereby all his siblings are alive
and well, but his parents died, due to the reason he does not know. There is no any
history of inherited diseases running in his family such as hypertension, diabetes
mellitus, epilepsy, asthma or cancer.

SOCIAL HISTORY

He lives with his wife and his last born child who is 20 years old. He lives in a block
house well ventilated and they use tap water for drinking and domestic purposes
without boiling drinking water. He uses alcohol which is safari bear two bottles per
day for more than twenty years now. He also uses cigarette at least one packet per
day. His wife neither drinks alcohol nor smokes cigarette.

PHYSICAL EXAMINATION

General examination: He is an adult man, alert and oriented, not ill looking with normal hair
color texture and distribution.

Not pale
 Not jaundiced
Not cyanosed
No peripheral lymph nodes enlargement
Not dehydrated
No finger clubbing
Capillary refill is normal
Not edematous

VITAL SIGNS:

✓ Blood pressure: 130/85mmHg

✓ Pulse rate 87 beats per minute, full volume, non -collapsing, synchronized with
femoral pulse, with regular rhythm
✓ Respiratory rate: 18 breaths per minute
✓ Body temperature: 36.8oC
Comment: these are stable vital signs

SYSTEMIC EXAMINATION

GASTROINTESTINAL SYSTEM

On inspection:

The abdomen is flat, with no distended veins, no any traditional or therapeutic mark
seen, the abdomen moves with respiration
On Superficial palpation:

There is tenderness at the right iliac fossa, both rovsing ,psoas and iliac sign were
positive and no any palpable mass
On deep palpation: there is no any intra abdominal organ enlarged such as kidney, liver and
spleen

On percussion:

Normal tympanic note heard

On Auscultation:

Normal bowel sounds heard

RESPIRATORY SYSTEM:

On inspection:

The chest is bilaterally symmetrical, moves with respiration, no any traditional or

therapeutic mark seen
On Palpation:

There is no any area of tenderness, no any palpable mass

Trachea is centrally located,

Tactile vocal fremitus is normal
Chest expands equally with respiration
On percussion:

Normal resonant note heard

On Auscultation: Normal vesicular breath sounds heard

NERVOUS SSYSTEM
4. Higher centers: The patient is oriented to people place and time
Short and long term memory is intact
Concentration is intact
5. Cranial Nerves: All cranial nerves are intact except cranial nerve number 8 in
vestibule part which was not tested due to the patient being unable to walk
6. Long Tract: Normal muscle bulkiness, normal muscle tone and normal muscle
power in all other limbs except the affected one.
Sensation is intact

CARDIOVASCULAR SYSTEM

On inspection:

There is no bulging or hyper activity on the pericardial area

On palpation:
There is no area of tenderness and no any palpable mass
The apex beat is located at the 5th intercostals space along the left midclavicular
line

On Auscultation:
Normal heart sounds S1 and S2 heard with no any additional soun
 ON CENTRAL NERVOUS SYSTEM:
AN adult man oriented to people place and time , with intact short and long term
memories and coordination.
All cranial nerves were normal
With normal muscle tone(5/5) and muscle bulkiness, and muscle power
With intact superficial (plantar and abdominal reflexes) and deep ( knee jerk , biceps
and triceps)
SUMMARY:

The case of . [Link] came to our hospital with the complain of gradual
onset of pain at the right lower abdomen associate with anorexia and vomiting
together with epigastric pain , on examination psoas , rovsing and iliac sign were
positive,no pain on micturatio, or increased urine output

DIAGNOSIS:acute

appendicitis

DIFFERENTIAL DIAGNOSIS:

Diventiculitis
Acute pancretitis
Kidneys diseases
Peptic ulcer disease
INTESTINAL OBSTRUCTION
Peritonitis
MANAGEMENT

✓ Investigations:
✓ Full blood picture
✓ Abdominal ultrasound

TREATMENT:
✓ i.v fluids
✓ prepare the patient for procedure by
✓ keeping the pt fasting for 4-6 hours
 ✓ catheterize the pt and monitor of vital signs
✓ give the pt pre operative antibiotics ( iv metronidazole 500mg start, iv
ampicillin 500mg start)
✓ then appendectomy should be done

COMPLICATIONS

Appendicular mass

Appendicular abscess

PROGNOSIS:

Prognosis is good under proper management and nursing care

CHAPTER THREE.
CHALLENGES IN PROVISION OF MEDICAL CARE AT SAME
DISTRICT HOSPITAL.
Most of the patient come to the hospital too late to get proper treatment
and that is mostly because , they first use local herbs at home, hoping that
they will get cured and when the condition get worse and develop
complications is when they come to the hospital as the last resort. This makes
provision of health care difficultly since some patients come in terminal illness.

Language barrier; this is also major setback in the provision of care , since
most of people in the hospital catchment area are pare, and most of them
speak only their language (pare) hence making it difficult,the health providers
who do not know the traditional language this set back is affecting students
equally as hospital staff. Hence provision of care would require someone to
interpret for the patient unreported, due to issue of privacy and
confidentiality.

Some medications were not available in the hospital pharmacy, and patients
were reluctant to buy drugs from the neighbor’s pharmacy since they are
under impression that the health worker owned those pharmacies.

Also the government policy of free health services for the elderly, children and
pregnant women is proving difficult to implement since patients in those
category did not understand when they are told to buy medicines that are
unavailable to the hospital.

Pregnant women in the pare tribe still prefer to deliver their babies at home
rather than the hospital due to their traditional beliefs that they will be seen as
weak when they deliver at hospital, this proves difficulty especially when
complication of delivery occur.

CHAPTER FOUR
[Link].
In order to improve the health care delivery system at SAME Hospital, the
following are my recommendations;

• To build the hospital intensive care unit for serious patients who
needs close monitoring
• To increase number of wards and beds so as to meet the patients
demand in order to avoid the tendency of two patients sharing the
bed
• To administer vaccines to hospital workers in order to prevent them
from acquiring infections for example; hepatitis B
• To improve orthopedic unit in order to manage patients with
orthopedic cases instead of referring them
• The government should provide more medications to SAME Hospital
which are not in SAME District Hospital Pharmacy.

a. CONCLUSION.
The time I have spent at SAME district hospital during my field work has been
very productive and essential in sharpening me into a best medical personnel
as I am on the edge of completing my first step into this field.

It has given me confidence and experience as I will need both of them in the
near future when I will officially take up the job as junior medical practitioner.
I would like to thank God and everyone who made it possible for me to come
this far.

PAEDIATRIC DEPARTMENT
OBJECTIVES:

➢ History taking accurately

➢ Performing physical examination to the patients
➢ Formulating proper diagnosis
➢ Treating or referring the patients for proper management
➢ Assessment of growth and development of the sick children
➢ Manage child illness by following the guidelines of integrated management of
childhood illnesses (IMCI)
➢ Provide essential new born care
➢ Educate mothers on how to give proper breast feeding to their babies
➢ Care and management of children with HIV/AIDs
➢ Conduct reproductive and child health services (RCH)

TOP TEN DRUGS USED IN PEDIATRIC WARD

1. Injection ampicillin
2. Injection gentamycin
3. Injection ceftriaxone
4. Injection hydrocortisone
5. Paracetamol tabs
6. Syrup paracetamol
7. Ped zinc
8. Infusion RL and NS
9. ORS
10. Injection X pen

TOP TEN DISEASES IN PEDIATRIC WARD

 11. Severe Pneumonia
12. Upper respiratory infections
13. Anemia
14. Burn
15. Urinary tract infections
16. Pneumonia
17. Fracture
18. Neonatal sepsis
19. Moderate malnutrition
20. Diarrhea

A CASE PRESENTATION FROM PAEDIATRIC DEPARTMENT

NAME: Zainab Justine

AGE: 3 days

Sex: Female

Religion: Muslim

Tribe: Pare

Address: Same

Informant: Biological mother

Chief complaint:

A three days baby with no complains.

HISTORY OF PRESENTING ILLNESS

The mother reported her child to have not complained. She is a three days neonate
breastfeeding well and has no problem.

Post natal, the baby was born through a c/section due to CPD but was delivered at term.
Mother reports the child to have cried immediately after birth and was born with 3.5 kgs
and also breastfed after 4hours.

Prenatally; Mother started attending RCH clinic when the pregnancy was 4 months old and
was screened for HIV and syphilis and tested for malaria and the results were all negative,
the mother also reported to have been given mebendazole for deworming 4 times, tetanus
toxoid 2 times, sp for malaria prophylaxis 3 times and fefo 4 times. The mother denies to
have encountered any complications during pregnancy.
However both the mother and child are doing well under nursing care and observation.

REVIEW OF SYSTEMS

EAR NOSE AND THROAT

Ear: There was no history of ear tagging, ear discharge or bleeding from the ear

Nose: No history of nasal bleeding or nasal congestion

Throat: There was no history of discomfort in swallowing

MUSCULOSKELETAL SYSTEM

There is no history of joint swelling

PAST MEDICAL HISTORY

This is the first admission to Same hospital. There is no history of blood transfusion or any
surgical intervention. No history of food or drug allergies reported so far and also not
attending any special clinic.

FAMILY AND SOCIAL HISTORY

She is the first born in her family. There is a history of Asthma in their family on father’s
side, however no history of Diabetes, hypertension or cancer. She is living with both her
mother and father in a block house well ventilated, and they use tap water for drinking and
domestic activities. They use pit latrine. Both her parents drink alcohol about two beers per
day, for more than ten years now.

GENERAL EXAMINATION;

An alert pink baby girl not jaundiced, not pale and not
cyanosed with stable vitals of temp. 37 degrees of centigrade,
RR 58, occipital frontal circumference 28cm,

And has 3kgs.

REGONAL EXAMINATION;

Head and neck.

Anterior posterior fontanels are present and pulsating not bulging, normal
symmetrical lines in alignment with the ears, normal nose with no deformity, normal lips
with no cleft palate and no any deformity. Normal neck with no deformity.

Chest and abdomen.

 Normal chest which moves with respiration and with normal symmetrical
breasts and with no deformity. Normal abdomen moving with respiration and with no
deformity. Normal back with no spinal bifida and no any other deformity.

Extremities.

Normal extremities with no extra digit and no deformity.

Perineum.

Normal perineum with normal labia majora and menorah and normal vagina
with no deformity.

SUMMARY:

This is a neonatal case of baby Zainab 3 days old female, whose

informant is biological mother was born 3 days ago and has no complain and was
born at the hospital through NSVD, at term with 3.5kgs and cried immediately
after delivery and had no complications after delivery.
DIAGNOSIS

3 days neonate with no complain

MANAGEMENT

❖ Advice mother on child hygiene especially with the umbilical stump

❖ Advice mother to keep the baby warm
❖ Advice mother on exclusive breast feeding of the baby
❖ Advice mother to attend RCH clinic for the baby’s follow up
❖ Advice on the child’s immunization and arrange for next
immunization.

MEDICAL DEPARTMENT
OBJECTIVES:

17. Take history thoroughly

18. Perform physical examination to the patients thoroughly
19. Perform relevant laboratory investigations to help in making diagnosis
20. Formulation of diagnosis
21. Treat the patients appropriately and refer patients for proper management
22. Conduct health education
23. Plan proper care and treatment for people living with HIV/AIDs
24. Counsel clients on HIV testing
TOP TEN DRUGS USED IN MEDICAL DEPARTENT

1. Salbutamol
2. Amoxicillin
3. Glibenclamide
4. Ferrous sulphate and folic acid
5. Metformin
6. Artmether lumefrantin
7. Cotrimoxazle
8. Ciprofluoxacin
9. Metrondazole
10. nifedipine

TOP TEN DISEASES IN MEDICAL DEPARTMENT

11. Hypertension
12. DM
13. Pneumonia
14. HIV/AIDS
15. TB
16. Anemia
17. Heart failure
18. UTI
19. Bronchial asthma
20. PUD

A CASE PRESENTATION FROM MEDICAL DEPARTMENT

Name: Zaina Nassoro

Age; 78 years

Sex: Female

Tribe: Pare

Occupation: Farmer

Religion: Christian

Marital status: Married

Address: Same

Has been in the ward for three months

Informant: Patient’s biological daughter

CHIEF COMPLAINT

Known diabetic patient for 2 years and not on medications, came with the main complain
of wound on the right toe for three months.

HISTORY OF PRESENTIING ILLNESS:

The patent was well until three months prior to admission when she started experiencing a
gradual onset of wound on her right foot that was painful with pus discharge and foul
smelling.

However currently the patient’s condition is good.

REVIEW OF OTHER SYSTEMS:

EAR, NOSE AND THROAT

7. Ear: There is no history of ear pain , ear discharge o ear bleeding

8. Nose: There is no history of nasal bleeding, nasal congestion or runny nose
9. Throat: There is no history of painful during swallowing or difficulty in swallowing

CARDIO VASCULAR SYSTEM

No history of heart beat awareness, No history of chest tightness, chest pain

PAST MEDICAL HISTORY:

Has one history of admission during 2018 due to DKA where she was managed and got well

Has a history of blood transfusion

Has no history of food or drug allergy

Has no history of surgical intervention

Has no history of attending to any special clinic or use of long term medications.

FAMILY AND SOCIAL HISTORY:

She is the sixth child out of six children where 3 are male and 3 female and all are well and
alive.

She lives with her children in a block house well ventilated and use a pit latrine

They use tap water for domestic uses and drinking.

Also the patient had a history of drinking alcohol and smoking but no longer does that.

well ventilated block house using tap water for drinking tap water which was un boiled and
for domestic purpose. Neither himself nor his wife using alcohol or smoking cigarette

PHYSICAL EXAMINATION:

GENERAL EXAMINATION;

An alert old lady not ill looking with normal hair color, texture, and distribution. Not pale not
jaundiced and not cyanosed with no peripheral lymphadenopathy with no palmar pallor and
normal capillary refill and no finger clubbing with stable vital signs of BP 140/80mmHg TEMP
36 degrees of centigrade and no lower limb edema.

Comment: The vital signs are stable

SYSTEMIC EXAMINATION:

PER ABDOMEN EXAMINATION

On inspection:
The abdomen is flat
Moving with respiration
Umbilicus is inverted
No any distended veins and no any traditional or therapeutic mark
seen.

On superficial palpation:
There is no any area of tenderness, and no any palpable mass

On deep palpation:
No any intra-abdominal organ palpable such as kidney, liver and
spleen

On percussion:
Tympanic note heard
On Auscultation:
Normal bowel sounds heard

CARDIOVASCULAR SYSTEM
On inspection:

There is no visible hyperactivity or bulging on pericardial area

There is no any traditional or therapeutic mark seen
Jugular venous pressure not elevated
On Palpation:
 The apex beat is located at the 5th inter costal space along the left mid clavicular line
No any area of tenderness and no any palpable mass
On Auscultation:

Both heart sounds S1 and S2 heard with no additional heart sounds

NEVOUS SYSTEM EXAMINATION

7. Higher centers:
The patient is oriented to people place and time, concentration is intact and both
short and long term memory are intact.
8. Cranial nerves:
All cranial nerves are intact
9. Long tract
Normal muscle bulkness
Normal muscle tone
Normal muscle tone and normal muscle power (grade 5/5)
Coordination is intact (Hell sheen test) and
Patella, ankle and supinator and biceps reflexes are intact

RESPIRATORY SYSTEM

On inspection:

The chest is bilaterally symmetrical moving with respiration

No any traditional or therapeutic mark seen on chest
No chest deformity seen
On palpation:

Trachea is centrally located, tactile vocal fremitus is normal, and

No any palpable mass or any area of tenderness
Normal tactile vocal fremitus felt
Chest expand equally with respiration
On Percussion:

Normal resonant note heard

On Auscultation:

Normal vesicular breath sounds heard

SUMMARY:
A medical case from medical ward of a female patient with initials Z.M 78 years, a known
Diabetic for 3 years now and not on medication. The patient came with the main complain
of wound on the left foot that was painful and foul smelling discharge. The patient reports a
history of blood transfusion and on examination she’s not pale, not jaundiced and not
cyanosed with stable vital signs.

DIAGNOSIS:

1. Diabetic mellitus with diabetic foot.

DIFFERENTIAL DIAGNOSIS

3. Septic wound
4. Foot gangrene

MANAGEMENT

Investigations:
✓ RBG
✓ FBP
✓ Urinalysis
✓ RFT
✓ LFT
✓ Doppler ultrasound of the foot

TREATMENT:

Non Pharmacological:

-Encourage the patient on proper nutrition and counsel on diabetic plate

Pharmacological:

IV metronidazole 500mg tds 7/7

Metiformin 500mg bd 1/12

Glibenclamide 5mg od 1/12
COMPLICATIONS

✓ Retinopathy
✓ Nephropathy
✓ Encephalopathy
✓ Neuropathy
✓ Stroke
✓ Foot gangrene

PREVENTION;

Proper diet lifestyle

PROGNOSIS

Is good under proper adherence of medication.

OBSTRETICS AND GYNECOLOGY DEPARTMENT

OBJECTIVES:

➢ Take thorough history from patients

➢ Perform physical examination thoroughly
➢ Perform relevant laboratory investigations
➢ Formulate the diagnosis
➢ Treat and manage cases properly
➢ Provide referrals when necessary
➢ Record labor, maternal and fetal parameters using a patograph
➢ Interpret findings and recordings on patograph
➢ Conduct normal delivery
➢ Conduct post-delivery examination
➢ Manage post-partum conditions
➢ Educate mothers about breastfeeding of infants
➢ Provide proper HIV/AIDs care

10. TOP TEN DISEASES AND CONDITIONS IN OBSTRETICS AND GYNECOLOGY

DEPARTMENT

1. Anemia in pregnancy
2. UTI
3. APH
4. PPROM
5. PIH
6. PID
7. Vaginal candidiasis
8. Malaria in pregnancy
9. PPH
10. Obstructed labor
TOP TEN DRUGS USED IN OBSTETRICS AND GYNECOLOGY.

1. Oxytocin
2. Magnesium sulphate
3. Nitrofurantoin
4. Ferrous sulphate
5. Folic acid
6. Metronidazole
7. Amoxycilin
8. Ampicillin
9. Ceftriaxone
10. Clotrimazle cream.

A CASE PRESENTATION FROM OBSTRETIC AND GYNAECOLOGY DEPARTMENT

Name: Angelina Godfrey

Age: 28 years

Sex: Female

Tribe: Pare

Occupation: Teacher

Religion: Christian

Address: Same

Date of admission: 11th July 2020

Date of history taking: 14th July 2020

Referral mode: From kighare dispensary

Informant: Patient herself

Gravida; 5

Para; 0

Living; 0

Gestation age (GA); 24 weeks

Last normal menstrual period (LNMP): 31st Jan 2020,

Expected date of delivery was (EDD):6th Nov 2020

CHIEF COMPLAINT:

Bilateral lower limb edema for 2 weeks

Headache for 5 days

HISTORY OF PRESENTING ILLNESSC

The patient was apparently well until 2 weeks ago when she started experiencing the
gradual onset of bilateral lower limb swelling which was worsening as time went on
associating with general body weakness, relieved upon walking, aggravated upon resting
and sitting down for a long time with no history of pain of lower limbs

Also the patient she was complaining if headache which was of gradual onset for 5 days
which was generalized, throbbing in nature, with no radiating factor where it was associated
with heart beat awareness, and dizziness where the condition was aggravated during a day
and when performing physical activities and relieved by resting

However there is no history of muscle pain, no history of joint pain, no history of abdominal
pain, no history of vomiting, no history of passing loose stool, no history of blurry vision, no
history of epigastric pain, no history of convulsion, no history of loss of consciousness, no
history of difficulty in breathing, no history of fever. The mother also reports to feel the
foetal kicks.

REVIEW OF OTHER SYSTEMS

EAR, NOSE AND THROAT

7. Ear: There is no history of ear discharge, ear pain or ear bleeding

8. Nose: there is no history of nasal bleeding, nasal congestion or runny nose
9. Throat: There is no history of difficulty in swallowing and no history of hoarseness of
voice

ENDOCRINE SYSTEM:

There is no history of excessive hunger, excessive thirsty of heat and cold intolerance

MUSCULOSKELETAL SYSTEM:

There is no history of muscle pain, joint pain or joint swelling

RESPIRATORY SYSTEM:

There is no history of chest pain, chest tightness or difficulty in breathing

PAST MEDICAL HISTORY

The patient has no any history of previous admissions as hospital, no any history of
blood transfusion, surgical intervention, and food or drug allergies so far.
OBSTRETIC HISTORY:

This mother is gravid 5, Para 0, living 0

The mother reported that her fist baby died at term when she was in labor and
experienced elampsia.
Her second baby as the mother reports, died when the pregnancy had 6 months due
to the same cause that’s eclampsia
The mother reports that hr third baby died when the pregnancy had 5 months but
she was not told the reason or cause of death
And lastly her child died when the pregnancy was of three months due to
hypertension

However the mother reports that during all her previous pregnancy she had a
normal and stable blood pressure but the condition occurs too suddenly and the
pressure rises then she loses her baby.
INDEX PREGNANCY:

She started attending Reproductive and child health (RCH) clinic when the pregnancy
was 13 weeks, and she has attended 4 times until now. She was screened for
malaria, syphilis and HIV and all the results were negative. She was given folic acid
and ferrous sulphate, sulphadoxine pyrimethamine for malaria prophylaxis and
mebendazole for deworming, she was also given a single dose of tetanus toxoid (TT),
and she did not suffer from any illness since she conceived until today presenting
with this illness.
Comment: I was able to confirm all these information from the RCH card number 4.

GYNAECOLOGICAL HISTORY:

The patient attended menarche when she was 13 years old, where she has been
having a menstrual cycle of 28 days, and flow of 4 days in which she changes pads, 3
times a day which are not totally soaked with blood. She does not have any history
of severe pain during menstruation,
She has never used any contraceptive methods.
There is no any history of sexually transmitted or genital tract diseases,
There is no any history of gynecological surgery

FAMILY HISTORY

She is the third born out of five children in her family where three are boys and two
are girls. All her siblings are alive and well. There is no any history of inherited
diseases running in her family such as, hypertension, diabetes mellitus, asthma,
epilepsy and cancer. Both her parents are also alive and well.

SOCIAL HISTORY:
 She is married, living with her husband in a block house which is well ventilated,
using pit latrine and tap water for drinking and domestic activities without boiling
drinking water. Neither herself nor her husband drink alcohol or smoke cigarette.

PHYSICAL EXAMINATION

GENERAL EXAMINATION:

Adult woman, fairly looking, alert with normal hair color texture and distribution
Not cyanosed
Pallor on conjunctiva
Not dehydrated
No finger clubbing
Not jaundiced
No peripheral lymph nodes enlargement
Capillary refill is normal
Lower limb pitting edema
VITAL SIGNS:

✓ Blood pressure 130/80mmHg

✓ Pulse rate: 100 beats per minute, strong , non -collapsing, synchronized with
femoral pulse, with regular rhythm
✓ Respiratory rate: 20 breaths per minute
✓ Body temperature: 36.8OC
Comment: These are stable vital signs .

SYSTEMIC EXAMINATION
Per abdominal examination:
On inspection:

The abdomen is ovoid in shape, slightly distended with no any traditional or

therapeutic marks seen, and the abdomen moves with respiration, linear negra seen,
umbilicus is averted

On palpation:

The fundal height is 30cm

Abdominal circumference is 84cm
Lie; longitudinal
Presentation; cephalic
Position; Right occipital anterior (ROA)
Head level was 5/5
Auscultation;

Fetal heart rate 142 beat per min

PER VAGINAL EXAMINATION:

On inspection:

Normal hair distribution around the perineum area

Normal vulva and vaginal
Clitoris is present
Labia majora and minora are present
On Palpation:

There is no tenderness at the vulva or vagina

Sacral promontory not easily reached
Sacral curve is rounded
Ischial spine is blunt
Cervix closed
Vaginal outlay angle admit 4 knuckles
CARDIOVASCULAR SYSTEM:

On inspection:

There is no bulging or hyper activity on the pericardial area

No any traditional or therapeutic mark seen on the pericardial area
On Palpation:

The apex beat is located on the 5th intercostal space along the left midclavicular line
No any area of tenderness and no any palpable mass on the pericardial area
On Auscultation:

Both heart sounds S1 and S2 are heard without additional sounds

RESPIRATORY SYSTEM
On inspection:

The chest is bilaterally symmetrical, with no any traditional or therapeutic mark seen
The chest moves with respiration, no chest deformity seen
On palpation:

There is no any area of tenderness and no any palpable mass

Tactile vocal fremitus is normal and trachea is centrally located
 No any palpable mass, chest expand equally with respiration
On percussion:

Normal resonant note heard;

On Auscultation:

Norma vesicular breath sounds heard

Nervous examination;
7. Higher centers
The patient is alert, oriented to people place and time; both short term and long
term memory are intact
Concentration is also intact
8. Cranial nerves
All cranial nerves are intact
9. Long tract
Normal muscle bulkiness, normal muscle tone and normal muscle power
(grade5/5)
Coordination is intact, and all tested reflexes are intact

SUMMARY:

This is an obstetric case of a patient who goes by the named Angelina Godfrey ,
28 year old, gravid 5, Para 0, living 0, with last normal menstrual period of 31st
/January/2020, expected date of delivery 29th /November/2020 and gestation
age of 24 weeks plus 1 day who came with main complain of bilateral lower limb
swelling for two weeks and headache for five days where it was associated with
general body weakness, heartbeat awareness, dizziness and on examination was
pallor on conjunctiva, lower limb pitting edema with stable vital signs.

DIAGNOSIS:

Pre-eclampsia; due to elevated blood pressure and edema

DIFFERENTIAL DIAGNOSIS

Congestive Cardiac Failure

Imminent eclampsia
MANAGEMENT:

Investigations:
✓ Hemoglobin level estimation, to know the level of Hemoglobin and rule
out anemia
✓ Obstetric abdominal pelvic ultrasounds scan to confirm check gestation
age, fetal presentation and amount of amniotic fluid
 ✓ Urinalysis to rule out proteinuria
✓ Blood slide for malaria
✓ Random blood glucose
✓ Renal function test

TREATMENT:

Non pharmacological management

❖ Have enough resting

❖ Avoid salt intake to avoid elevation of blood pressure
❖ Encourage taking vegetables and fruits to help to correct anemia

Pharmacological management

➢ Nifedipine 20mg per oral od for a month

➢ Paracetamol 1g per oral 8 hourly for 3 days
➢ Close monitoring of the patient’s blood pressure

COMPLICATIONS:

❖ Eclampsia
❖ Heart failure
❖ Intrauterine fetal death

PREVENTION:

Early and regular attendance of antenatal clinic

Early diagnosis and treatment
PROGNOSIS:

Prognosis of this patient is good under close and proper nursing observation and
management.

SURGICAL DEPARTMENT
OBJECTIVES:

➢ Take surgical history from the patients thoroughly

➢ Perform physical examination thoroughly
➢ Perform relevant laboratory investigations to aid in formulating the proper diagnosis
 ➢ Formulate diagnosis properly
➢ Provide provider initiated testing and counseling (PITC)
➢ Practice safety techniques and aseptic techniques in performing surgical procedures
➢ Assist major surgery

TO TEN DISEASES IN SURGICAL DEPARTMENT

11. Fractures
12. Breast lumps
13. Appendicitis
14. BPH
15. Road traffic accidents
16. Peritonitis
17. Hernia
18. Hydrocele
19. Haemorrhoids
20. wound

TOP TEN DRUGS USED IN SURGICAL DEPARTMENT

20. Cloxacillin
21. Paracetamol
22. Ceftriaxone
23. Metronidazole
24. Ampicilin
25. Tramadol
26. Soluble asprin
27. Gentamycin
28. Injection diclofenac
29. manitol

A CASE PRESENTATION FROM SURGERY DEPARTMENT

Name: Praygod Samwel

Age: 21 years

Sex: Male

Tribe; Pare

Occupation: Business
Religion: Christian

Address: Same Gonja

Date of history taking: 19th July 2020

Referral from Home

Informant: Patient himself

Chief complaint: Loss of consciousness for 2hours

HISTORY OF PRESENTING ILLNESS

The patient was well until 4 days ago when he experienced a sudden onset of loss of
consciousness following a motor vehicle accident which he sustained when he lost control
of himself because he was drunk and did not know what he was doing since he was not in
his real sense. The patient reports falling on a rough surface causing several facial and hands
bruises and a cut wound on his abdomen and loss of consciousness for 2 hours and when he
woke up he found himself at the hospital not knowing who took him there or what was
done when he got there.

However the patient denies a history of convulsion, headache or vomiting after the
accident.

Currently the patient’s condition is improving under proper management and nursing care.

REVIEW OF OTHER SYSTEMS

THROAT

There is no history of difficulty in swallowing or pain during swallowing

CARDIOVASCULAR SYSTEM

There is no history of lower limbs swelling, heart beat awareness, difficulty in

breathing on lying flat or air hunger during the night

RESPIRATORY SYSTEM

There is no history of chest pain, chest tightness, or difficulty in breathing

ENDOCRINE SYSTEM

There is no history of excessive sweating, excessive hunger, or excessive thirsty

GASTROINTESTINAL SYSTEM

There is no history of passing lose stool, abdominal pain, abdominal discomfort,

nausea or vomiting
GENITALURINARY SYSTEM
 There is no history of increased frequency in urination, painful urination, or urgency
in urination
PAST MEDICAL HISTORY

This is his second admission at this hospital due to a motor cycle accident which led
him to fracture which was treated and went on well. There is no history of blood
transfusion, no history of any food or drug allergies so far. There is also no history
long term use of medication or attending any special clinic.
FAMILY HISTORY

He is the sixth born out of six children in his family whereby all his siblings are alive
and well, but his father died due to unknown cause. There is no any history of
inherited diseases running in his family such as hypertension, diabetes mellitus,
epilepsy, asthma or cancer.
SOCIAL HISTORY

He lives with his wife. He lives in a block house well ventilated and they use tap
water for drinking and domestic purposes without boiling drinking water. He uses
alcohol which is bear four bottles per day for more than 15 years now. He has no
history of using cigarette. He is married and living with his wife and his two children.
His wife neither drinks alcohol nor smokes cigarette.

PHYSICAL EXAMINATION
General examination:
He is an adult man, alert and oriented, not ill looking with normal hair color texture
and distribution.
Not pale
Not jaundiced
Not cyanosed
No peripheral lymph nodes enlargement
Not dehydrated
No finger clubbing
Capillary refill is normal
Not edematous
VITAL SIGNS:

✓ Blood pressure: 135/85mmHg

✓ Pulse rate 89 beats per minute, strong, regular rhythm, non -collapsing,
synchronized with femoral pulse,
✓ Respiratory rate: 18 breaths per minute
✓ Body temperature: 36.8oC
Comment: these are stable vital signs
LOCAL EXAMINATION:

Inspection:
 Multiple bruises on the chicks of the face and the lower lip and a stitched wound on
the abdomen.
Not discharging or bleeding
Well dressed
Palpation:

Still some tenderness on the bruises.

SYSTEMIC EXAMINATION

MUSCULOSKELETAL SYSTEM:
On inspection: There is no swelling on any other parts than the affected limb

No visible joint swelling

On Palpation: there is no area of tenderness on the muscles on palpation except the
affected part of left limb

GASTROINTESTINAL SYSTEM

On inspection:

The abdomen is flat, with no distended veins, no any traditional or therapeutic mark
seen, the abdomen moves with respiration
On Superficial palpation:

There is no any area of tenderness, and no any palpable mass

On deep palpation:

There is no any intra-abdominal organ enlarged such as kidney, liver

and spleen

On percussion:

Normal tympanic note heard

On Auscultation:

Normal bowel sounds heard

RESPIRATORY SYSTEM:

On inspection:

The chest is bilaterally symmetrical, moves with respiration, no any traditional or

therapeutic mark seen
On Palpation:

There is no any area of tenderness, no any palpable mass

Trachea is centrally located,
Tactile vocal fremitus is normal
 Chest expands equally with respiration
On percussion:

Normal resonant note heard

NERVOUS SYSTEM

7. Higher centers: The patient is oriented to people place and time

Short and long term memory is intact
Concentration is intact
8. Cranial Nerves: All cranial nerves are intact except cranial nerve number 8 in
vestibule part which was not tested due to the patient being unable to walk
9. Long Tract: Normal muscle bulkiness, normal muscle tone and normal muscle
power in all other limbs except the affected one.
Sensation is intact
CARDIOVASCULAR SYSTEM

On inspection:

There is no bulging or hyper activity on the pericardial area

On palpation:

There is no area of tenderness and no any palpable mass

The apex beat is located at the 5th intercostal space along the left midclavicular
line
On Auscultation:

Normal heart sounds S1 and S2 heard with no any additional sound

SUMMARY:

A male patient from same with the initials of P.S 21 years old brought to the hospital 4 days
ago due to the history of loss of consciousness following a motor cycle accident and led to
several facial bruises and a cut wound on his abdomen. Currently the patient is doing
well and with stable vital signs.

DIAGNOSIS:

• Head injury due to the loss of consciousness

• Soft tissue injury due to the several facial bruises
• Cut wound due to the wound on the abdomen.

DIFFERENTIAL DIAGNOSIS:

Skull fracture
Orbital trauma
Intracranial hemorrhage
MANAGEMENT

Investigations:
1. Hemoglobin level estimation to rule out anemia
2. X-ray of the skull
3 .Full blood picture
TREATMENT:

• Ensure ABC
• IV fluids that is preferable ringers lactate
• Iv diclofenac 75mg 8hrly 24hrs
• Iv cloxacillin 500mg tds for 5 days
• Daily wound dressing

COMPLICATION

• Septicemia
• Haemorrhagic shock
• Hematoma
• scars

PREVENTION;

Avoid alcohol drinking when driving or using motor vehices

CONCLUSION AND RECOMMENDATIONS

I thank my all might God for giving me strength during the course of my field work,
hence I was able to learn different things that would help me in my medical field
currently and for my future among of those things are to be hard worker, cases
management, caring of malnutrition in pediatric, increase my skills in assisting
surgical procedure, management of emergency cases, HIV/AIDS in pediatric and in
adult patient and learn new management knowledge that would help me in the
course of this field work.
It has been a matter of immense pleasure, honor and challenge to have opportunity
to take up this project and complete it successful.
I conclude by contented all people who helped me to succeed to conduct my field
work GOD bless you all.
RECOMMENDATIONS
My recommendations towards this field attachment are as follows:

➢ The college should check preferably the time of conducting this field work
because is short time to conduct and learn new ideas.

➢ The principal of college should assign the student to their home nearby
hospital to apply their knowledge and skills so that they can improve.

➢ I recommend that there should be good follow-up of students in their field

work to make sure all students participated equally.

➢ The college should also help their students to increase the money to use for
their field project including stationary fee which would help them on
preparation and writing their field work report.

NAME: Nosim Toima

AGE: 32 years old

SEX: Female

LEVEL OF EDUCATION: Standard VII

MARITAL STATUS: Married

TRIBE: Maasai

OCCCUPATION: Peasant

RELIGION: Christian

ADDRESS: majengo

DATE OF HISTORY: 16th july 2020

Main complaints:- Abdominal pain for one month.

-Passing black stool for two days.

History of presenting illness.

The patient was doing well until one month ago when she developed a gradual onset of
abdominal pain at the upper part above umbilicus,the pain was burning in nature radiating to the
[Link] pain worsened as time went on and became more severe three ago before coming to
hospital where the patient was not able walk upright the pain was associated with with heart burn
and vomiting which was after taking meal in which the vomitus contained food particles,no foul
smell,not blood stained,the patient vimited four times before coming to [Link] pain was
aggreviated by taking sour foods and relieved by vomiting.

Also complained of passing black stool for two days which was of sudden onset,it is soft,non
mucoid and passes stool two times per [Link] no history of passing loose stool,eating black
coloured meal,yellowish colouration of skin,or loss of appetite.

Review of other systems.

o Ear:-No history of ear bleeding or ear itching.

o Nose:-No history of nasal pain or nasal bleeding.
o Throat:-No history of hoarseness of voice or difficult in swallowing.
o Endocrine system:-No history of excessive hunger or excessive sweating.
o Musculoskeletal system:-No history of joint pains or muscle pains.
o Cardiovascular sytem:-No history of cough,difficult in breathing on lying
flat,heartbeat awareness or lower limb swelling.
o Respiratory system:-No history of chest tightness,chest pain or difficult in
breathing.
o Nervous system:-No history of headache,fever,convulsion,loss of
consciousness.

Past medical history.

There is history of one previous admission at Same district hospital due to malaria
in 2011,she was treated by intravenous fluids and oral medication that she doesn’t know
their names and she was [Link] no history of food/ drug allergy so far and no surgical
intervention done or blood transfusion.

Gynaecological history.
 She attained her menarch when she was 15 years with a cycle of 28 days and flow
of 5 days,she changes pieces of khanga 3 times a day which are not totally soaked with
[Link] no history of contraceptives use,sexual transmitted infections or gynaecological
surgeries.

Family and social history.

She is the first born out of four children,married with three children all alive and well with
all her [Link] no history of cigarette or alcohol consumption though her husband has
history of alcohol consumption 2 bottles of Serengeti beer per [Link] is a peasant and
children are in primary school where they live in a well ventilated house using tap water for
drinking and domestic purposes.

PHYSICAL EXAMINATION.
Generel examination. Adult woman,ill looking,fully conscious oriented to people,place,time,some
pale not jaundiced,not cyanosed,not dehydrated,no finger finger clubbing,no lymph node
enlargement with normal capillary refill.

Vitals signs;Blood pressure-𝟏𝟎𝟎⁄𝟔𝟎mmHg. Temperature- 36.5°C,Respiratory rate-20 breath/min,

Pulse rate-76 beats/min.

SYSTEMIC EXAMINATION.
PER ABDOMEN.

15. Inspection:-Scaphoid abdomen moves with respiration,inverted umbilicus,no visible

veins or peristalsis with traditional marks on the epigastric region.
16. Palpation:-No palpable mass/intra-abdominal organ on superficial and deep
palpation but tenderness on epigastric region during deep palpation.
17. Percusion:-Normal tympanic note heard.
18. Auscultation:-Normal bowel sounds heard.

PER CHEST.

CARDIOVASCULAR SYSTEM.

4. Inspection:-No bulging or hyperactivity at the precordial area,no surgical or

therapeutic marks seen on the chest.
5. Palpation:-Apex beat located at 5th intercoastal space along the left mid-clavicular
line.
6. Auscultation:-First and second heart sounds heard with no additional sounds.

RESPIRATORY SYSTEM.
 21. Inspection:-Chest is bilateral symmetry moves with respiration,no
surgical/therapeutic mark seen and no visible swelling.
22. Palpation:-No area of tenderness,no palpable mass,trachea centrally located with
normal tactile vocal fremitus and expands equally with respiration.
23. Percusion:-Normal resonant note heard.
24. Auscultation:-Normal vesicular breath sounds and vocal resonance heard.

NERVOUS SYSTEM.

➢ Higher centres:-Fully conscious oriented to people,place and time with intact

coordination with both long and short memory intact.
➢ Long tracts:-Reduced muscle bulkiness,normal muscle tone and muscle power(5⁄5)
with intact coordination and sensation.
➢ Cranial nerves:-All cranial nerves are intact.
➢ Reflexes:-Superficial and deep tendon reflexes are intact.

SUMMARY. I’ve been presenting to you Nosim Toima a female patient of 32 years from
SAME Juu admitted with complain of abdominal pain for one month and passing black stool
for two days with heart burn,loss of appetite and non-projectile vomiting after meals with
some pale and tender epigastric region with scaphoid abdomen with stable vital signs on
examination.

Impressions:-

21. Bleeding peptic ulcer disease due to epigastric pain,heart burn and passing black
stool.
21. Anaemia secondary to bleeding peptic ulcer disease due to some paleness and
history of passing black stool.

Differential diagnosis:-

22. Pancreatitis due to abdominal pain and inability to walk upright.

23. Gastric carcinoma due to passing black stool and vomiting soon after meals.
24. Worm infestation due to wasting and passing black stool.
25. Gastroenteritis due to vomiting and abdominal pain.

Investigations:

➢ Haemoglobin level estimation – 8.9g/dl.

➢ Stool analysis for occult blood and ova.
➢ Oesophagealgastroduodenoscopy.

MANAGEMENT:
Non-pharmacological treatment:
 • Stop using food(citric fruits and sour foods)that aggreviate the condition.
• Avoid staying hungry for a long period of time.
• Avoid stress.

Pharmacological treatment:

✓ Metronidazole tablets 400mg PO 8 hourly for 7 days.

✓ Amoxicilline capsules 500 mg PO 8 hourly for 7 days.
✓ Omeprazole capsules 20 mg PO once daily for 14 days
✓ Haemovit syrup 15 mls PO 8 hourly for 1 month.
✓ Vitamin B Complex 2 tablets PO 12 hourly for 1 month.
✓ Mebendazole tablets 500 mg PO stat.

Complications:

xii. Gastric perforation.

xiii. Peritonitis.

Prevention:

1. Early diagnosis and treatment to prevent complications.

2. Improve good hygiene on food handling and personal hygiene.
3. Avoid citric fruits and juices,sour foods,pepper or spicy foods.
4. Avoid stress.

Follow up:

❖ Daily follow up in the ward and seven days post discharge.

Prognosis:

❖ Is good as the diseases can be cured.

 TOP TEN DISEASES IN PAEDIATRICS AND
CHILD HEALTH.
[Link].

[Link] PNEUMONIA.

[Link] TRACT INFECTION.

[Link].

[Link] WATERY DIARRHOEA.

[Link].

[Link]/AIDS.

[Link].

[Link].

[Link].
NAME:-Lengai Pumba.

AGE:-1 year and 3 months.

SEX:-Male.

TRIBE:-Maasai.

RELIGION:-Christian.

ADDRESS:-same

INFORMANT:-Biological Mother.

Main complaints:-Cough for five days,

-Fever for three days,

-Running nose for one day.

History of presenting illness:-

The mother reported the child to be well until 5 days ago when the child developed a gradual
onset of cough which was wet in nature more severe during night hours and morning. The condition
worsened as time went on which made the child not to breath well. The condition was associated
with difficulty in breathing and was aggreviated by cold weather and relieved in warm condition.
However no history of night sweat no history of weight loss no history of lower limb swelling no
history of Tb contact

The mother also reported that the child to develop a gradual onset of fever which was
persistent and worsened as time went on. Had no aggreviating factor but was relieved by giving
paracetamol syrup. However no history of convulsion no history of loss of consciousness no
discomfort on urination no history of vomiting or passing loose stool.

Also the mother reported that the child developed a gradual onset of running nose for 1 day
which worsened as time went on, associated with difficult in breathing and nasal congestion, no
history of nasal bleeding.

Review of other systems.

 ❖ Ear and throat:-No history of abnormal ear discharge or history of hoarseness of voice when
crying.
❖ Musculoskeletal system:-No history of joint swelling.

Past medical history: he has history of one previous admission in may 2020 due to the same
complain and was diagnosed to have severe pneumonia. He was treated at SAME district hospital
with injections that the mother doesn’t remember. He got better and was discharged.

However no history of any surgical intervention, no history of blood transfusion no history

of food or drug allergy.

Antenatal history;-the mother did not suffer from any disease during pregnancy. She started
attending ANC when the pregnancy was of 5 months where she attended 3 times where she was
screened for HIV, syphilis, and Malaria where all the result were negative. She was given Folic acid ,
mebendazole for de-worming and SP for anti malaria .I confirmed this information from RCH card
No 4.

Natal history; it was a full term pregnancy where the mother delivered at the hospital through
spontaneous vaginal delivery , membranes ruptured spontaneously. The baby did not cry
immediately after delivery but cried after 5 minutes when he was helped to breath by oxygen. Then
the child was breastfed after 2hours after being stable. The child weighed 3.2kg

Postnatal history; the child did not suffer from any complication after delivery like yellowish
discolouration of the skin or mucous membrane. He did not suffer from sepsis of the cord or bluish
colouration of the body.

Immunization history; the child is fully immunized according to his age basing on the expanded
programme of immunization in Tanzania. And i was able to confirm this information from RCH card
No1 and the BCG scar at the right shoulder.

COMMENT; THIS IS GOOD IMMUNIZATION HISTORY AND THE CHILD IS TO COMPLETE THE
MEASLE 2 VACCINE AT THE AGE OF 18 MONTHS

Dietary history; the child was exclusively breasted for 6 months, then after 6 months the mother
started giving the child mashed potatoes and cows milk and continue breastfeeding and the child
was fed 8 times a day and on need. Now the child can feed on the food that is prepared for the
family example ugali, rice, meat plus vegetables. But now due to the illness the child has decreased
feeding.

COMMENT; THIS IS GOOD DIETARY HISTORY SINCE THE CHILD HAS BEEN EXCLUSIVELY
BREASTFED FOR 6 MONTHS AND THE CHILD FED 8 TIMES A DAY

Developmental milestone; the child started to smile at 4 weeks, respond to name at 3 months also
control the neck at 3 months ,grab object to mouth at 4 months, sit with support at 5 months, sit
without support at 6 months. Stands with support at 8 months , without support at 9 months. and
walk without support at 9 months . now the child is able to run and play with other kids.

COMMENT; it’s a good developmental milestone.

Family and social history; he the second born out of 2 children where both are boys and his brother
is alive and well and both his parents are alive and well, he lives with his family (parents and brother)
in a well ventilated block house, uses tap water for domestic purpose not boiling water for drinking ,
they use pit latrine and there is no history of any hereditary disease running in their family like
hypertension, asthma, epilepsy or diabetes mellitus.

PHYSICAL EXAMINATION;

General examination; young child, ill looking, alert ,not pale, not cyanosed, not dehydrated, no
finger clubbing, normal capillary refill, not oedematous.

Vital sign;-Temperature- 38.1o C,Respiratory rate -53breath/min,Pulse rate- 102beats/min

COMMENT; all vital sign are stable with exception of temperature which is high.

Anthropometric measurements;-Height- 76 cm,Weight -10.3kg,OFC- 46 cm,MUAC-14.6 cm

COMMENT; -Weight for height is normal,Weight for age is normal,OFC and MUAC are normal
according to the age.

SYSTEMIC EXAMINATION;

PER CHEST:

11. Inspection:-lower chestwall in drawing,no surgical marks seen,chest bilateral symmetrical,no

visible swelling.
12. Palpation:-No area of tenderness and Chest expands equally with respiration.
13. Percussion:-Normal resonant note heard.
14. Auscultation:-bilateral basal crepitations heard.

PER ABDOMEN.

ix. Inspection:-abdomen is flat ,moves with respiration ,umbilicus is flat,no traditional or

surgical marks seen,no visible peristalsis,no visible distended veins.
x. Palpation:-No area of tenderness,No intra abdominal organ palpable.
xi. Percussion:-Normal tympanic note heard.
xii. Auscultation:-Normal bowel sound heard.

CARDIOVASCULAR SYSTEM.

9. Inspection:-No hyperactivity or bulging of precordial area,No any surgical or therapeutic

marks seen.
10. Palpation:-Apex beat located at 4th intercostals space along the left mid clavicular
line.
11. Auscultation:-1st and 2nd heartbeat sound heard with no murmurs.
NERVOUS SYSTEM.

• Higher centres:-the child is alert.

• Cranial nerves:-I was able to perform only cranial nerve no.2,3,4,6 and 7which were intact.
• Long tract:-Normal muscle tone,Normal muscle bulkiness.
• Reflexes:-Knee, ankle, bicep, and tricep reflexes were intact.

SUMMARY. This was a paediatric case of the patient named Lengai Pumba a male child of 1 year
and 2 months who was brought by his mother with the main complain of cough for 5 days, fever for
3 days and running nose for 1 day with difficult in breathing, no Tb contact on examination severe
lower chestwall in drawing with bilateral basal crepitation with stable vita sign except respiratory
rate 53 breath/min which is high and temperature 38.1oC.

Diagnosis.

• Severe pneumonia due to chest in drawing, bilateral basal crepitations

Fast breathing and fever.

Differential diagnosis.

• Uncomplicated malaria.
• Urinary tract infection.

Investigation.

• Malaria rapid diagnostic test-negative.

• Urinalysis-2-3 leu/puss cells/HPF.

MANAGEMENT.

Non pharmacological.

16. Ensure warmth to the child

17. Improve hygiene to the child.

Pharmacological.

❖ Ampicillin 250mg 8hourly IV for 5 days.

❖ Gentamycin Injection 50mg Od IV for 5 days.
❖ Paracetamol syrup 2.5mls PO 8hourly for 3days.

Complications.

• Lung abscess.
• Pleural effusion.
• Pneumothorax.
 • Lung collapse.
• Cor pulmonary.

Prevention.

✓ Ensure warmth to the child

✓ Early diagnosis and treatment..
✓ Close windows during cold weather.

Follow up.

11. Daily follow up in ward round for the progress of the condition.

Prognosis.

➢ The prognosis is good due to the condition is treatable.

TOP TEN DISEASES IN OBSTRETRICS AND GYNAECOLOGY.

[Link] TRACT INFECTIONS IN PREGNANCY.
[Link] IN PREGNANCY.

[Link] INDUCED HYPERTENSION.

[Link] SEPSIS.

[Link]-MATURE RUPTURE OF MEMBRANES.

[Link] PARTUM HAEMORRHAGE.

[Link] ECLAMPSIA.

[Link] PSYCHOSIS.

[Link] IN PREGNANCY.

[Link].

NAME; Rehema Mollel.

AGE; 20years.

MARRITAL STATUS; Married.

SEX; Female.

TRIBE; Maasai.

OCCUPATION; Peasant.

RELIGION; Christian.

ADDRESS; Lashaine.
DATE OF HX TAKING; 18/07/2020

GRAVIDITY; Prime Gravida.

LNMP;11/10/2019.

EDD;18/07/2020

GA; 40weeks and 0 days (by date).

Main complain:-Heartbeat awareness for 1 week,

-Headache for three days.

History of presenting illness.

The patient was apparently well until one week ago when she started to experience the
gradual onset of heart beat awareness which more severe during walking or stressed and even when
doing daily activities at home but condition was relived upon resting. The condition worsens as time
went on and made the patient unable to perform her daily activities and the condition is associated
with dizziness . however there no history of cough ,no history of air hunger during the night , no
history of difficult breathing when lying flat , no history of lower limb swelling

Also the patient complained of headache which was of gradual onset for 3 days localized at
the lateral aspect of the head not radiating to any part of the head ,the condition was persistent all
the time aggreviated when the patient is walking and upon bending down. But was relived upon
taking paracetamol and was mostly associated with general body weakness, fever non projectile
vomiting where she vomited once ,vomitus contains food particles approximately half cup of tea and
has no foul smell. however there was no history of convulsion ,no history of loss of consciousness.

Review of other systems.

➢ Genital urinary system:-No history of frequent micturation or history of vaginal discharge .

➢ Ear:-No history of ear itching or history of ear bleeding.
➢ Nose:-No history of nasal bleeding or history of nasal congestion.
➢ Throat :-No history of difficult on swallowing or history of hoarseness of voice.
➢ Endocrine system:-No history of excessive thirsty or excessive hunger.

Past medical history. this is the first admission , no history of blood transfusion, no history of food or
drug allergy, no history any surgical intervention.

Obstetric history; she is prime gravida , she started booking when the pregnancy was 5 months, in
which she attended 3 times , she was screened for HIV , syphilis , and malaria where the result were
negative . she was given folic acid, Sulphadoxine pyremethamine for anti- malaria, tetanus toxoid
and mebendazole for de-worming.

COMMENT; i was able to confirm this information from RCH card no 4.

Gynaecological history; she attained her menarch at the age of 14 years with a cycle of 28 days
which is regular with flow of 3 days where she changes pieces of khanga 3 times per day which are
not totally soaked with [Link] has no history of suffering from sexually transmitted disease and
no history of use of contraceptives.

Family and social history; She is the last born out of 7 children where 3 are boys and 4 are girls. All
her siblings are alive and well too. She is married and lives with her husband in a well ventilated
block house ,they use tap water for domestic purpose but they don’t boil water for drinking. neither
of them smoke cigarette nor drink alcohol. However no history of hereditary disease run in their
family such as asthma ,hypertension, diabetes mellitus.

PHYSICAL EXAMINATION;

General examination; Adult woman, fully conscious oriented to people place and time, some pale,
capillary refill normal, no lymph nodes enlarged, no finger clubbing, not oedematous not
dehydrated.

Vital signs:-Blood pressure-100/60mmhg,Pulse rate-79 beats/min,Respiratory rate-

79beats/min,Temperature 37.1oC

SYTEMIC EXAMINATION.

CARDIOVASCULAR SYSTEM.

o Inspection:-No bulging or hyperactivity of pre-cordial area or traditional marks seen.

o Palpation:-Apex beat located at 5th intercoastal space along the left mid-clavicula line.
o Auscultation :-1st and 2nd heartbeat sound heard in all auscultatory areas.

NERVOUS SYSTEM.

• Cranial nerves:-All cranial nerves intact except vestibular cochlear which is cranial nerve
number 8 since the patient was unable to walk in a straight line because of the illness.
• Higher centre:-Fully conscious,Oriented,long and short memory intact.
• long tract:-normal muscle tone, normal muscle power(5/5),sensation was intact.
• Reflexes:-patella , ankle, biceps, triceps, and supinator reflexes were intact

RESPIRATORY SYSTEM.

• Inspection:-Chest is bilateral symmetrical,moves with respiration,No surgical or therapeutic

marks seen.
• Palpation:-Trachea centrally located,Chest expand equally with respiration,No palpable
mass felt,Normal tactile vocal fremitus felt.
• Percussion:-Normal resonant note heard.
• Auscultation:-Normal vesicular breath sound heard,Vocal resonant note heard.

PER ABDOMEN.
 • Inspection:-Abdomen uniformly distended ovoid in shape,Linear nigra seen and striae.
gravidulum seen,Traditional marks seen at the hypochondriac region and at the right and
left lumber region.
• Palpation:-Fundal height -36cm,Longitudinal lie,Cephalic presentation with the head level of
5/5,Abdominal circumference-96cm,Approximated expected birth weight -3.4kg.
• Auscultation:-Foetal heart rate -142beats/min.

[Link] is the obstetric case of the patient who goes by name Rehema Mollel a female of 20
years from Lashaine, a prime gravida with LNMP of 11/10/2019 EDD of 18/07/2020 and gestation
age of 40weeks who came with the main complain of heartbeat awareness for 1 week and headache
for 3 days with dizziness ,general body weakness fever loss of appetite whitish vaginal discharge and
non projectile vomiting . on examination she is pale with fundal height of 36cm, longitudinal lie,
cephalic presentation, approximated birth weight of 3.4kg, foetal heart rate 142beat/min with stable
vital signs.

Diagnosis.

8. Anaemia in pregnancy due to heartbeat awareness,dizziness,some pale and general body

weakness.
9. Urinary tract infection in pregnancy due to frequent urination,burning sensation during
and vaginal itching,fever.
10. Vaginal candidiasis due to whitish curdy like discharge.

Differential diagnosis.

5. Uncomplicated malaria in pregnancy.

MANAGEMENT.
Investigation

i. Haemoglobin level-7.9 g/dl.

ii. Malaria rapid diagnostic test-negative.
iii. Obstetric ultra sound
iv. Urinalysis-many pus cells.

Treatment

❖ Haemovit syrup 15mls 8hrly PO for four weeks.

❖ Clotrimazole pessaries 100mg od noct vaginally 6 days.
❖ Amoxicillin capsules 500mg 8hrly PO for 5 days.

Non pharmacological.

✓ Encourage patient to take plenty of water

✓ Encourage eating food rich in iron
✓ Proper hand wash before and after visiting the toilet
Complication;

12. Intrauterine foetal growth restriction

13. Intrauterine foetal death
14. Heart failure
15. Post parturm haemorrhage

Prevention .

• Regular attendance to antenatal clinic.

• Improve hand hygiene and toilet hygiene.
• Ensure adherence to the medication given during ANC.
• Drinking plenty of water.
• Eating plenty of green vegetable.

Follow up .

11. I will follow up the patient daily in the ward to check on the progress.

Prognosis;

12. The prognosis is good since the condition can be managed at hospital and the
patient is already at hospital for management with close observation .

TOP TEN DISEASES IN SURGICAL DEPARTMENT.

[Link].

[Link].

[Link].

[Link].

[Link].

6. FRACTURES.

[Link] TISSUE INJURY.

[Link].
[Link].

[Link] PROSTATE HYPERPLASIA.

NAME; Judica Kisongwe.

AGE;33 years.

MARRITAL STATUS; Married.

SEX; Female.

TRIBE; Maasai.

OCCUPATION; Livestock Keeper.

RELIGION; Christian.

ADDRESS; Arkatan.

DATE OF HX TAKING; 28/07/20.

Main Complain; -Abdominal pain for 2 weeks.

History of presenting illness.

The patient was well until 2 weeks ago when she started experiencing the gradual onset of
sharp pain at the lower right side of the abdomen. The pain was radiating to the whole abdomen
and at the right leg, aggreviated by coughing or when the patient walks upright and is relieved by
slightly bending to the right side.

However, there is no history of vomiting, passing loose stool constipation loss of appetite or
passing blood in stool no history of yellowish colouration of skin or mucous membrane, no history of
skin itching, no history history of irregular menstrual bleeding with her last normal menstrual period
on 29th june 2020, there is no history of painful micturation, frequent or urgent urination, no history
of abnormal vaginal discharge, no history of fever

Review of other system.

✓ Ear:-No history of ear pain or ear itching.

✓ Nose:-No history of nasal congestion or nasal pain.
✓ Throat:-No history of pain on swallowing or history of horseness of voice.
✓ Cardiovascular system:-No history of difficult in breathing on lying flat,No history of
heartbeat awareness.
✓ Respiratory system :-No history of cough,No history of chest pain.
✓ Endocrine system:-No history of excessive hunger,No history of excessive thirst.
✓ Musculoskeletal system:-No history of joint pain,No history of joint swelling.

Past medical history:- she has no history of admission, this is the first admission, no history of blood
transfusion, no history of any food and drug allergy, no history of using long standing medication, no
history of attending any special clinic.

Gynaecological history ;she attained her menach when she was 16 years old with regular cycle of 28
days flow of 3 days per day, she change pads 3 times per day not totally soaked with blood .no
history of using contraceptive no history of STIs.

Family and social history; she is the 1st born out of 5 children, 2girls and 3 boys all alive and well.
They use tap water for domestic purpose and she is the livestockkeeper while the husband is the
teacher, neither her husband or her drink alcohol or smoke cigarette . no history of hereditary
disease run in their family such as hypertension, asthma or diabetes mellitus.

PHYSICAL EXAMINATION.

General examination; adult woman,ill looking,well oriented to people,time and place,fully

conscious, not pale,not cyanosed,not jaundiced,no finger crabbing,normal capillary refill,not
oedematous.

Vital signs:-Blood pressure -120/70mmhg,Temperature-36.6oC,Pulse rate -70beats/min,Respiratory

rate-18 breath/min.

SYSTEMIC EXAMINATION.

PER ABDOMEN.

10. Inspection:-Obese abdomen,moves with respiration,Umbilicus inverted,No surgical or

therapeutic marks seen.
11. Palpation:-Tenderness at right iliac fossa on superficial palpation,No any enlarged intra
abdominal organ is palpable on deep palpation.
12. Percussion:-Normal tympanic note heard.
13. Auscultation:-Normal bowel sounds heard.

Special signs.
 ✓ Obtrurator sign was positive.
✓ Psoas sign was positive.
✓ Pointing sign positive.
✓ Roving sign positive.

CARDIOVASCULAR SYSTEM

ix. Inspection:-No bulging or hyperactivity of precordial area,No traditional marks seen.

x. Palpation:-Apex beat located at 5th intercoastal space along the left midclavicular line.
xi. Auscultation :-1st and 2nd heartbeat sound heard in all auscultator areas.

RESPIRATORY SYSTEM.

4. Inspection:-Chest is bilateral symmetrical,moves with respiration,No surgical or therapeutic

marks seen.
5. Palpation:-Trachea centrally located,Chest expand equally with respiration,No palpable
mass felt,Normal tactile vocal fremitus felt.
6. Percussion:-Normal resonant note heard.
7. Auscultation:-Normal vesicular breath sound heard,Vocal resonant note heard.

NERVOUS SYSTEM EXAMINATION.

✓ Higher centres:-Fully conscious,Orientated to people place and time,Concentration

intact,Memory intact.
✓ Cranial nerves:-All cranial nerves were intact.
✓ Long tract:-Muscle bulkness normal,Muscle power normal 5/5,Muscle tone normal,Co-
ordination was intact,Sensation was intact.
✓ Reflexes:-Patella, ankle, supinator, biceps, and triceps reflex wee intact and normal.

SUMMARY;This is the surgical case of the patient who goes with the name Judica Kisongwe a female
of 33 years from Arkatan who came with the main complain of abdominal pain at the right iliac fossa
for 2 weeks. On examination tenderness on the right iliac fossa with positive psoas, obturator
,roving and pointing sign with stable vital signs.

Diagnosis.

❖ Acute appendicitis.

Differential diagnosis.

❖ Right ovarian cyst.

❖ Appendicular abscess..
❖ Pelvic inflammatory disease
Investigation.

➢ Full blood picture

➢ Abdominal ultrasound
➢ Blood grouping and cross matching

Treatment.

10. Nothing per oral.

11. Resuscitation with IV fluids normal saline alternating with dextrose normal saline 500mls
8hrly for 3 days.
12. Catheterizing the patient.
13. Metronidazole 500mg IV 8hrly for 3 days.
14. Ampicillin 1g 6hrly IV for 3 days.
15. Diclofenac 75mg IM stat then continue 12hrly then prepare for appendectomy.

Non pharmacological treatment.

11. Reassure the patient.

Complication.

3. Strangulation.
4. Peritonitis.

Prevention.

4. Early diagnosis and treatment.

Follow up.

5. This should be done daily to monitor the condition of the patient.

Prognosis.

6. The prognosis is good since the patient is getting medication and is at the hospital.
CHAPTER THREE.
 CHALLENGES IN PROVISION OF MEDICAL CARE AT
SAME DISTRICT HOSPITAL.
Most of the patient come to the hospital too late to get proper treatment and
that is mostly because , they first use local herbs at home, hoping that they will
get cured and when the condition get worse and develop complications is
when they come to the hospital as the last resort. This makes provision of
health care difficultly since some patients come in terminal illness.

Language barrier; this is also major setback in the provision of care , since
most of people in the hospital catchment area are pare, and most of them
speak only their language hence making it difficult,the health providers who do
not know the traditional language this set back is affecting students equally as
hospital staff. Hence provision of care would require someone to interpret for
the patient unreported, due to issue of privacy and confidentiality.

Some medications were not available in the hospital pharmacy, and patients
were reluctant to buy drugs from the neighbor’s pharmacy since they are
under impression that the health worker owned those pharmacies.

Also the government policy of free health services for the elderly, children and
pregnant women is proving difficult to implement since patients in those
category did not understand when they are told to buy medicines that are
unavailable to the hospital.

RECOMMENDATIONS.
In order to improve the health care delivery system at SAME Hospital, the
following are our recommendations;
 7. To build the hospital intensive care unit for serious patients who
needs close monitoring
8. To increase number of wards and beds so as to meet the patients
demand in order to avoid the tendency of two patients sharing the
bed
9. To administer vaccines to hospital workers in order to prevent them
from acquiring infections for example; hepatitis B
[Link] improve orthopedic unit in order to manage patients with
orthopedic cases instead of referring them
[Link] government should provide more medications to SAME Hospital
which are not in the SAME District Hospital Pharmacy.

CONCLUSION.
The time we have spent at SAME district hospital during our field work has
been very productive and essential in sharpening us into a best medical
personnel as we are on the edge of completing our first step into this field.
It has given us confidence and experience as we will need both of them in the
near future when we will officially take up the job as junior medical
practitioner.

we would like to thank God and everyone who made it possible for us to come
this far.