Non-Communicable Diseases

• Non communicable diseases (NCDs), also known as chronic diseases, are not
passed from person to person. These diseases:

– Are of long duration and generally slow progression

– Do not result from an (acute) infectious process

– Are “not communicable”

– Cause premature morbidity, dysfunction, and reduced quality of life

– Usually develop and progress over long periods

– Often initially insidious

– Once manifested there is usually a protracted period of impaired health

 Types of NCDs
 Cardiovascular disease (Coronary heart disease, Stroke)
 Cancer
 Chronic lung disease
 Diabetes
 Chronic neurologic disorders (Alzheimer’s, dementias)
 Arthritis/Musculoskeletal diseases
• In some definitions, NCDs also include:
– Chronic mental illness
– Injuries, which have an acute onset, but may be followed by
prolonged convalescence and impaired function
 Characteristics of NCDs
• Complex etiology (causes)

• Multiple risk factors

• Long latency period

• Non-contagious origin (non-communicable)

• Prolonged course of illness

• Functional impairment or disability

• Incurability

• Insidious onset
 Risk Factors of Non-Communicable
Diseases
• Risk Factors

• A risk factor is an aspect of personal behaviour

or lifestyle, an environmental exposure, or a
hereditary characteristic that is associated
with an increase in the occurrence of a
particular disease, injury, or other health
condition (Principles of Epidemiology, CDC,
2006).
• Modifiable Risk Factor
• A risk factor that can be reduced or controlled by
intervention, thereby reducing the probability of
disease occurrence.

• The WHO has prioritized the following four risk factors:

1. Physical inactivity
2. Tobacco use
3. Alcohol use
4. Unhealthy diets
• Non-Modifiable Risk Factor
• A risk factor that cannot be reduced or
controlled by intervention, for example:
– Age
– Gender
– Race
– Family history (genetics)
Global Burden and Trends of Non
Communicable Diseases
• Non communicable diseases (NCD) are now a global
growing problem including:

– Africa and in low-income countries like Tanzania

• The NCD burden constitutes one of the major

challenges to socioeconomic development:

– It causes a big burden to both the economy and to the

health care systems
• NCDs accounted for an estimated 36 million deaths, or 63% of the 57 million deaths
that occurred globally in 2008, comprising mainly: Cardiovascular diseases (48%),
cancers (21%), chronic respiratory diseases (12%) and diabetes (3.5%) (Alwan et al.,
2010)

• About 80% of all NCD deaths in 2008 occurred in low- and middle-income countries

• About a half of NCD deaths in low- and middle-income countries are under the age
of 70

• Without intervention, NCD deaths will increase by 15% from 36 to 44 million

between 2010 and 2020

• WHO projects that NCD deaths will increase by 15% globally between 2010 and
2020 from 36 to 44 Million deaths
• The highest increase is projected to occur in the African region (WHO, 2008)

• The burden of disease due to NCDs is increasing, as measured by the Disability Adjusted
Life Years (DALYs):

– Calculated as the sum of years of life lost and years lived with disability

• The Global Burden of Disease (GBD) Study showed that in 1990, 47% of DALYs were from:

– Communicable, maternal neonatal and nutritional disorders

– 43% from non-communicable diseases and 10% from injuries

– In 2010 the trend had shifted to 35%, 54% and 11% respectively (Murray et al., 2012)

– From 1990 to 2010 the proportion of all deaths and disability (DALYs) due to NCDs increased from
47% to 54%
Distribution of Deaths by Leading Course
Groups
 STRATEGIES FOR THE PREVENTION AND CONTROL OF
NON-COMMUNICABLE DISEASES
• Principles in the Prevention and Control of NCDs in
Tanzania
– Primary health care approach
– Universal coverage
– Continuum of care
– Life course approach
– Multisectoral approach
– Evidence based
– Empowerment of people
– Integrated approach
– Accountability
Strategic Objectives for the Prevention and
Control of NCDs
 Advocate for NCDs prevention and control as a National
Priority
 To strengthen leadership, governance, multisectoral
collaboration and accountability for prevention and
control of NCDs
 To strengthen and align health systems to address NCDs
though promotive, preventive curative and rehabilitative
services
 To strengthen national capacity for NCDs surveillance,
research for evidence-based planning monitoring and
evaluation
 Expected Outcomes of the Strategies
• Community Interventions plus Legislation
• Community Interventions
• Improved facility care
• Overall Outcome (Mortality)
 Strategic Interventions for the Prevention
and Control of NCDs
• The strategies for interventions for prevention and control include the
following:
– Strengthen NCDs leadership and management capacity
– Strengthen NCDs organization and management capacity
– Develop a framework for multisectoral cooperation and coordination
– Resource Mobilization
– Develop and or strengthen legislation for the prevention and control of NCDs
– Enforce Framework Convention on Tobacco Control (FCTC)
– Increase awareness of NCDs associated risk factors and healthy lifestyles by
involving all sectors
– Strengthen capacity of the health Care system to provide care and treatment
services for NCDs
– To promote research for the prevention and control of NCDs
– Strengthen Monitoring and Evaluation and Surveillance of NCDs
 Continuum of Chronic Care Model for
Prevention and Control of NCDs
• A continuum of chronic disease prevention
and care interventions corresponds to
different population groups:
– People without disease, those at risk of disease,
and people currently coping with chronic disease
– Most importantly, a number of the major chronic
diseases can be prevented, or their onset delayed
• The Chronic Care Model (CCM) identifies the six
essential elements of a health care system that
encourage high-quality chronic disease care.
• These elements are:
1. the community
2. the health system
3. self-management support
4. delivery system design
5. decision support and
6. clinical information systems
 The community

• The first element describes the interventions

for prevention at a population level:
– emphasizing on educating and counselling
individuals, families and community on health
lifestyle
– prevention of tobacco and alcohol use
– eating healthy diet and
– promotion of physical exercises
 The health system

• The second element describes improving

awareness and health literacy among the
population to promote health and well-being.
 Self-management support

• The third element describes screening for

NCDs and risk factors.
 Delivery system design

• The fourth element describes the early

diagnosis of NCDs among the population.
 Decision support
• The fifth element describes accessing a well-
equipped health facility for early treatment
and quality care.
 Clinical information systems

• The sixth element explains secondary

prevention which includes:
 early treatment
 continued monitoring and
 adherence to treatment among patients
• The seventh element is the long-term care and
management:
– This is the tertiary prevention, which includes the
prevention of complications and close follow-up of
clients
 General Principles of Good Chronic Care
 Develop a treatment partnership with your patient

 Focus on your patient’s concerns and priorities

 Use the 5 A’s Assess, Advise, Agree, Assist and Arrange

 Support patient self-management

 Organize proactive follow up

 Involve ‘ expert patients’ peer educators and support staff in your healthy facility

 Link the patient to the community–based resources and support

 Use written information registers, treatment cards and written information for patients to
document, monitor and remind

 Work as a clinical team

 Key Points
• Effective action to prevent and control non-
communicable diseases will require
developing existing capacity including the
organizational capacity and developing
competency for NCDs prevention and control
 Key Points…
• The strategies for interventions for prevention and control include

– Strengthening NCDs leadership, management and organization and

capacity, multisectoral cooperation and coordination, resource
mobilization

– Increasing awareness of risk factors and healthy lifestyle by involving all

sectors, building capacity of the health care system to provide care and
treatment services for NCDs

– Promoting research for the prevention and control of NCDs and

strengthening monitoring, evaluation and surveillance of NCDs

– Continuum of care for NCDs is essential as all NCDs are chronic diseases
 UTILIZING EFFECTIVE COMMUNICATION
SKILLS IN THE MANAGEMENT OF NCDS
• Definition of Effective Communication
– Communication is a process in which a message is
conceived, organised, transmitted, received and
responded to.
OR
– Communication is a process of exchanging
information, thoughts, feeling, idea, instructions
or knowledge.
• Effective Communication is the process in
which a message is effectively conceived,
organised, transmitted, received and
responded to.
 Categories of Communication

• Communication can also be categorised according to the nature of the

communication process, as follows:
• Interpersonal communication which involves more than one individual;
it may be between two people or among many people
– For example, in group meetings, interviews, conversations among individuals
or memos to members of staff
• Intrapersonal communication occurs within an individual
– It involves thoughts, feelings, and the way a person looks at himself/herself
– The sender and receiver are the same person
– The channel is the individual’s brain, processing the thoughts and feelings
– There is feedback through discarding certain ideas and replacing them with
new ideas
– Largely influenced by experiences one has gone through and relationships
with other people
 Process of Communication

• The SENDER delivers the information

• The RECEIVER takes in the information

• The MESSAGE is the information, ideas, or feelings being shared

• The CHANNEL is the media or means through which the

information is being sent

• FEEDBACK is the response from the receiver indicating that the

message has been received
Importance of Effective Communication
• Improves quality of care and helps in identifying service quality gaps

• Helps in building a relationship of trust, understanding and empathy

• Showing sensitivity and responsiveness at each level of communication

• Enhances the working relationship among service providers

• Helps patients to feel connected and not isolated

• Keeps patients informed of their condition

• Motivates service providers where there is open communication

• Gives the healthcare providers an opportunity to provide clear directions and effective feedback

• Allows health care providers to share information, feelings, ideas and knowledge during the caring
process
 Principles of Effective Communication

• Listening attentively to the person speaking

or the client:

– Keeping eye contact that is culturally acceptable

– Not interrupting the speaker/client when is talking
• Listening attentively to the person speaking
or the client:
– Assuring that no one will talk to you during the
discussion with the client/patient unless the
client’s permission has been obtained
– Avoiding looking at your watch or moving pieces
of paper or silently showing you are in a hurry
• Establish a two-way communication:

– Encourage the use of open-ended questions

– Paraphrasing the sentence to encourage the other to join in the communication

– Show the client that you care

– Show empathy

– Respect and dignity of the client

– Assure secrecy and confidentiality

• Affirm and acknowledge results:

– Accept the client’s point of view

– Present yourself as expected of a professional

Considerations in Effective Communication
Basic Communication Skills
Active Listening
• Examples of Active Listening Techniques

– Stop talking and listen to the speaker don’t interrupt

– Restate the speaker’s exact words

– Paraphrase in your own words what the speaker said

– Understand and reflect on the underlying feelings of the speaker

(identify the emotion)

– Identify with the speaker’s emotions and state the implications of

those feelings
 CONTD’’
– Make eye contact that is culturally acceptable

– Face the speaker

– Concentrate on the speaker and what he/she is saying

– Demonstrate interest in what is being said

– Avoid distractions, like phone calls, talking to other people, or doing

paperwork

• Note that this is a factor related to the environment in which you are holding a
conversation

• Choose a meeting place that is free from any distractions

 Methods/Modes of Communicating with
Patients
1. Speaking – Verbal

2. Writing – Books, newspapers, reports, instructions, orders, prescription

3. Drawing – Diagrams, illustrations, signals

4. Pictures – Different objects, humans, animals

5. Body language - Non-verbal

6. Sign language – Using fingers, hands, eyes, legs

7. Telephone – Desk phones or landlines, handsets

8. Media – Television, radio, websites, internet

Common Barriers to Communication
 BARRIER FROM SENDER
• Talking too much, not giving the client time to express self

• Being critical and judgmental

• Laughing at or humiliating the client

• Showing signs of being upset

• Not listening or accepting feedback

• Using an inappropriate channel

• Not listening, not paying attention

• Lack of knowledge on the subject of discussion

• Using difficult or different language

• Giving information which demoralizes the client/patient

• Arguing

• Preaching

• Storytelling

• Showing discomfort and embarrassment if the client is upset

• Contradictory verbal information with non-verbal gestures

 BARRIER FROM RECIEVER
• Using the inappropriate channel

• Not listening, not paying attention

• Interrupting before sender completes the

message

• Not sending feedback

Barriers to communication from healthcare
providers
• Barriers may arise when a healthcare provider is not focused on the client but instead acts based on
their own personal thoughts or beliefs. These actions may include:

• Demoralizing

• Advice giving

• Arguing

• Preaching

• Storytelling

• Showing discomfort and embarrassment if the client is upset

• Not respecting the client’s beliefs and/or way of life

• Not creating trust or rapport

 Barriers to communication from
patient/client
• Language barrier

• Culture

• Negative attitude towards the counsellor

• Patient is too sick to respond

 Overcoming Barriers to Communication

• Senders and Receivers can overcome barriers by:

– Using the appropriate channel

– Creating a good rapport

– Being attentive both verbally and non-verbally

– Using a common language

– Avoiding medical terminology and jargon

– Being self-aware

– Using feedback from each other

– Asking questions for clarification in order to understand feedback

 Key Points

• Effective communication is when the message is effectively conceived,

organized, transmitted, received and responded to

• That is the sender has sent a clear message and the receiver has
understood the message

• Health care providers have to:

– make sure that information sent to patients is relevant, clear and simple

– check whether the patient has understood

– be an active listener who is able to paraphrase and reflect to understand

patients’ problems
COUNSELLING AND HEALTH
EDUCATION FOR PREVENTION
AND CONTROL OF NCDS
 Definition of Counseling

• Counselling is a helping relationship to a person out

of a difficult situation or cope with it.

– It is a way of relating and responding to another person,

so that the person is helped to explore thoughts, feelings
and behaviour, to reach a clearer self-understanding.

– Is helped to find and use own strengths to cope more

effectively with life by making appropriate decisions or
taking relevant action.
• Counselling is not:

– Telling clients what to do

– Criticizing clients

– Forcing ideas or values on clients

– Taking responsibility for clients’ actions or decisions

 Definition of Health Education
• Health education is a process of giving health
information to an individual or group, families,
and community aiming at a behaviour change
e.g., promoting health lifestyle.
Counselling vs. Health Education
 Goals of Counselling
• To help clients discover their own thoughts and feelings,
as well as ways of managing their situations

• To provide emotional support and safety in times of crisis

• To help people explore their emotions and make

appropriate plans for future

• To make informed choices and change their behaviours

based on accurate information
 Benefits of Counselling
• The benefits of counselling are the results or resolutions of
a counselling process so that the client can:

– Make some of the changes that he/she wants in life

– Develop positive relationships and explore his or her potential

– Cope with painful situations, like death, terminal illness and

disability

– Clients can develop an awareness of their problems and create

new responses to old issues
 Goals of Health Education

• The ultimate aim of health education is to change

behaviour in a positive way

• Positively influence the health behaviour of

individuals and communities, as well as living and
working conditions that influence their health

• Promote, maintain, and improve individual,

family, and community health
 Benefits of Health Education
• Improves the health status of individuals, families,
communities, states, and the nation

• Enhances the quality of life for all people

• Reduces premature deaths by focusing on prevention

• Reduces the human and financial costs of medical

care
Four Stages of Counselling Process
• The four stages of counselling include:

1. Relationship Building

2. Exploration

3. Understanding

4. Action Plan
 Relationship Building

• Creation of rapport between the provider and the client

• Very crucial at the beginning of the counselling process

• It puts the client at ease and makes conditions easy for

effective counselling

• In counselling setting relationship building takes on a

more specific meaning
 Exploration

• Collecting and clarifying information related to the client’s reason for seeking
counselling

• The counsellor is finding out client’s problems, needs, misinterpretations and

behaviours

• Client shares own feelings and views about problem at hand

• Provider encouraging the client to express his or her central concerns

• Provider assesses the client’s readiness to engage in behaviour change steps

• Provider explores with the client the pros and cons of making change decisions
 Understanding
• At this stage of understanding or checking understanding, the skills used are:

– Warmth

– Trust

– Respect

– Genuineness

– Concreteness

– Questioning

– Summarization

– Self-disclosure, a reflection of feelings

– Minimal encouraging, immediacy

 Action Plan

• Action plan is the last stage where the counsellor and his/her client sum
up what has transpired throughout the session. At this stage, a client can
make a decision towards his/her problem.

• The following issues can be agreed upon:

– To proceed with counselling

– To postpone the session to another date

– To refer the client to another counsellor

– To terminate the process

The 5As Tool for Behavioral Change Support

• The 5As Is a tool used for brief interventions

• It summarizes what a health worker can do to help someone

who is ready to change

• The 5As include:

– ASK, ADVISE, ASSESS, ASSIST, ARRANGE

• Can be integrated into regular visits by health providers of

any level, either at the community or facility level
 Ask

• Ask the patient about the relevant risk factor(s) at

every visit

• Ask in a friendly way, without being judgmental

– Keep the questions simple

– Record the information in the patient’s medical

record/notes
 Advise

• Provide information, key messages and advice in a clear,

simple, and personalized manner. Link the advice to
something that is relevant for the person. For example:

– A person with hypertension may be interested in the benefits of

reducing salt intake

– People with young children may be concerned about the effects

of second-hand smoke

– Parents may be interested in breastfeeding and child feeding

 Assess

• Assess the patient’s readiness to start making a change by asking two

questions:

– Are you ready to have a diet that includes more healthy options? Be more physically
active? Be a non-smoker? Be a lower-risk drinker?

– Do you think you will be able to make the change?

• If the answer is “Not sure/No” it indicates that the person is not yet ready to
change. In this case, an effort needs to be made to increase motivation for
change

• If the answer is YES, suggest that you and the patient can move on to the
next step
 Assist
• Help the person to develop a plan that can increase the chance of success

• Provide practical counselling that focuses on:

– provision of basic information about the risk factor

– identification of situations that could trigger relapse

– ways of coping with trigger situations

• Provide social support including:

• providing encouragement and communicating interest and concern

• encouraging the person to talk about the change process with family and friends

• Provide and ensure availability of health education materials and details about
additional resources, such as support groups, quit-lines
 Arrange
• Arrange a follow-up contact, by phone or in person. Discuss the timing of follow-up with patients

• At follow-up for all patients:

– Identify present problems as well as new ones that could arise

– Remind them of the additional support that is available

– Schedule the next follow-up visit

– Refer to specialist services if needed and available

• For those who have made the planned changes:

– Congratulate them on their success

• For those who have challenges:

– Remind them to view this as a learning experience

– Review their circumstances and motivate them to re-commit

– Link to more intensive support, if available

 Roles and Qualities of an Effective
Counsellor
• The counsellor’s role is to facilitate the client’s work in ways that
respect the client’s values, personal resources and capacity for self-
determination.

• Counselling is not:

– Telling clients what to do

– Criticizing clients

– Forcing ideas or values on clients

– Taking responsibility for clients’ actions or decisions

 Qualities of an Effective Counsellor
• Effective counsellors should:

– Show competence

– Can be trusted

– Demonstrate self-awareness

– Are in good psychological health

– Build rapport

– Show warmth and sensitivity

– Show empathy

– Remain objective and open-minded

 Counsel and Educate Patient to Adhere to
Treatment
• If the patient is prescribed medication:

– Teach the patient how to take it at home

– Explain the difference between medicines for long-term control (e.g. blood pressure)
and medicines for quick relief (e.g. for wheezing)

– Tell the patient the reason for prescribing the medication

– Show the patient the appropriate dose

– Explain how many times a day to take the medication

– Label and package the tablets

– Check the patient’s understanding before the patient leaves the health centre
• Explain the importance of:

– Keeping an adequate supply of the medication

– The need to take the medication regularly as

advised even if there are no symptoms
 Adherence Versus Compliance
• The term “compliance” is defined as acting in
accordance with a command

– In healthcare it is often perceived as obeying a

provider's instructions
• Adherence is perceived as a patient agreeing to make
behaviour changes that will improve his or her health.
Adherence involves taking medication:

– in the correct amount,

– at the correct time, and

– in the way they are prescribed

– as agreed, upon through a shared decision-making process

between the client and the healthcare provider
 Goals of Counselling
• To help clients discover their own thoughts and feelings,
as well as ways of managing their situations

• To provide emotional support and safety in times of crisis

• To help people explore their emotions and make

appropriate plans for future

• To make informed choices and change their behaviours

based on accurate information
 Benefits of Counselling
• The benefits of counselling are the results or resolutions of
a counselling process so that the client can:

– Make some of the changes that he/she wants in life

– Develop positive relationships and explore his or her potential

– Cope with painful situations, like death, terminal illness and

disability

– Clients can develop an awareness of their problems and create

new responses to old issues
 Factors Influencing Adherence
• Everyone has trouble taking medication and adherence to drug regimens is poor across all populations and diseases in every
disease

• Adhering to medicine is a lifelong process because

• Once a person begins taking medicines for chronic diseases like heart diseases and diabetes no stopping unless advised by a
doctor

• Adherence is considered successful for most chronic diseases when the patient takes medications > 80% of the time

• The average adherence to self administered treatment is 50%

• Adherence is one of the most important factors in the success of chronic disease treatment

• High levels of adherence are critical to prevent resistance and improving health

• Low levels of adherence lead to drugs not being effective and linked to increased risk of complications

• Adherence is hard to predict, factors that impact adherence must be identified and addressed

• Adherence in most patients will decrease over time (initiation period versus maintenance) as new problems and side effects
arise and pill fatigue sets in
 Factors Related to the Drug Regimen
• Cost of the regimen

• Complexity of the regimen

• Storage of drugs, e.g. refrigeration

• Duration of the therapy, (lifelong)

• Extent to which the regimen interferes with the patient’s daily life

• Model of regimen delivery

• Side effects associated with the regimen

 Factors Related to the Patient and/or the
Provider
• Provider not familiar with regimen, side effects, drug to drug interactions and
mechanism

• Lack of understanding by patient/provider of relationship between adherence

and resistance

• Poor communication between provider and patient

• Lack of trust between patient and provider/health care system

• Lack of self-efficacy (belief in self and therapy)

• To assess possible barriers to adherence in a non-judgmental way helps the

client develop an adherence plan with concrete objectives
 Benefits of the Adherence Counselling
• Help patients develop an understanding of their treatment and its
challenges

• Prepare patient to initiate treatment

• Provide ongoing support for patient to adhere to treatment over the

long term

• Help patient develop good treatment taking behaviour

• Help clients/patients set goals for their treatment

• Develop a positive patient-provider relationship

 Outcome of Adherence
• Through adherence, patients and providers can:

– Prevent opportunistic infections

– Diagnose complications early

– Improve outcomes of treatment and care

– Delay emergence of drug resistance

 Key Points
• Counselling is an interpersonal communication through which a person
is helped to assess

• The current situation, explore own feelings, and arrive at a solution to

cope with the problem

• Counselling is different from health education

• Counselling for adherence to treatment is essential in helping the

process of healing

• Health education on the prevention of risk factors to NCDs and advise

on healthy lifestyle
PATIENT ASSESSMENT FOR POSSIBLE NCDS

• Definition of Patient Assessment

• Is a complete health assessment which include
gathering information about a person’s:
1. Medical, family, socio-economic status, etc
history and lifestyle, physical examination and
doing laboratory tests, and screening for disease
2. It involves everything we do in history taking,
physical examination and investigations to
screen or diagnose a problem/disease
 Patient Assessment
• A Patient assessment consists of:

– Making an initial assessment and building rapport

– Taking a focused history to get symptoms

– Performing physical examination to identify signs

– Interpreting lab results

– Making a diagnosis and identifying a differential diagnosis

– Creating a treatment plan

 Importance of Patient Assessment
• The importance of a patient assessment is for the
provider to:

• Determine the patient’s symptoms

• Assess socio-economic status, risk behaviours, and

available support

• Guide in making a clinical diagnosis and differential

diagnosis
 Taking Comprehensive History of Patients
Suspected to Have NCDs
• History taking is a process of collecting information from clients who
come to health facilities for services. Usually, the information is
collected following these aspects:
1. Chief Complaint: a brief statement of the complaint or incident that
prompted to come for service
2. Present Medical History: a detailed narrative, as much as possible in the
patient's own words, of the development of the current health problem
from its onset to the present
3. Past Medical History: prior illnesses, their treatment and trend
4. Socio-economic History: marital status, past and present occupations,
travel, hobbies, stresses, diet, habits, and use of tobacco, alcohol, or drugs
5. Family History: present health or cause of death of parents, brothers, and
sisters, with particular attention to FGM practices in the family
consequences
 The Technique of History Taking
• Among the components of history taking, date and time of
history are always important

• Be sure to document the time you evaluate the patient,

especially in situations of emergency

• Collect demographic data (identifying data) such as age,

gender, occupation, marital status

• Source of the history, usually the patient but can be the family
member or friend or letter of referral or medical record
 The Process of Interviewing and History
Taking
• Getting ready

• Record all information correctly and vividly what you

collect from the interview

• Write down specific phrases, specific dates or words

• NOTE: Most patients are accustomed to notes taking,

for those who find it uncomfortable, explore their
concerns and explain your need to.
Conducting Physical Examination for NCDs
• Physical Examination or clinical examination is the process by which a healthcare provider
investigates the body of a patient for signs of disease

• It generally follows the taking of the medical history (an account of the symptoms as experienced
by the patient)

• Together with the medical history, physical examination aids in determining the correct diagnosis
and devising the treatment plan

• This data then becomes part of the medical record

• The detail of a physical examination will depend very much on the

– magnitude and severity of the patient’s problems,

– your need for thoroughness

– the clinical setting (inpatient or outpatient) and time available

Techniques of Physical Examination
• The physical examination is based on four aspects:

1. Inspection

2. Palpation

3. Percussion

4. Auscultation
 Conducting Physical Examination
• Before you begin physical examination, take some time to prepare for the task ahead

– Reflect your approach to the patient

– Prepare the environment

– Prepare and check your equipment

– Make the patient comfortable

– Place patient in a comfortable position

– Make a rapid assessment of the patient status

• Measure the vital signs BP, Pulse, Respiration and body temperature

• Perform a systematic examination and focus on the major patient’s complain

 Performing Laboratory Investigations for
Diagnosing NCDs
• Laboratory investigations ordered depend on
clinical impression and availability.
• Fasting blood glucose

• Random blood glucose

• HbAIC

• Serum potassium

• Serum creatinine

• Serum urea

• Total Cholesterol

• Urine protein

• Fundus examination

• Foot examination

• Cervical cancer screening

Risk Factors for Chronic Non-Communicable
Diseases
 Key Points
• The patient assessment involves:

• Making an initial assessment, building rapport

• Taking a focused history and identifying risk factors for NCDs

• Examining and assessing signs, symptoms

• Interpreting lab results

• Making a diagnosis