Microsoft word - guidelines for health worker clinic.doc

Guidelines for a health worker clinic

• Fever is above 37.4oC • Child’s weight in Kg = (age +4) x2. Works from 1 year old to about 10 • All children should be de-wormed every 6 to 12 months. • Children in poor nutrition areas should be given multivits • Drug quantities should be for 5 days generally
Drug doses given as:
od = once daily
bd = twice daily
tds = three times daily
qds = four times daily
prn = as required
Paracetamol (not recommended under 2 months)
• Children under 3 months – 60mg single dose • Children 3 months to 1 year – 60mg 6 hrly • Children up to 5yrs -120mg 6hrly • Children 6-12 yrs – 250mg 6 hrly • Children 13-16 yrs – 500mg 6 hrly • Adult 1gm 6 hrly • Children under 2 – 62.5mg tds • Children under 10 - 125mg tds • Adults - 250mg tds Co-trimoxazole (not recommended under 6 weeks) • Children under 6 months 20/100mg bd • 6 months to 6 years 40/200mg bd • 6 to 12 years 80/400mg bd • Above 12 – 2 tabs bd • Under 2 years 62.5mg qds • 2-10 years 125mg qds • 10-16 years 250mg qds • Adult 500mg qds • Under 12 years give 2 tabs stat, then 5 more doses of 2 tabs at 8 hrs, 24 hrs, • Adults give 4 tabs stat, then then 5 more doses of 4 tabs at 8 hrs, 24 hrs, 36 Ranitidine 150mg bd Ibuprofen 200mg tds with food Ferrous sulphate 200mg bd in adults. Use with extreme caution in children as it is lethal at too high a dose. Warn that stools will be black, that nausea will result (avoided by taking with food) and that the supply must be kept away from children. CONDITIONS AFFECTING ADULTS and CHILDREN

Most is self-limiting. Advise adequate clear fluids. Give oral rehydration sachet to children. If fever is present or there is blood in the stool, treat as infective diarrhoea, and give Adults can take Loperamide 1 per bowel motion – max 8/day 2. Any adult with a cough longer than 3 months especially if the is weight loss, night sweats or fever needs to be advised to attend a government hospital or TB clinic for tests and treatment. NB There may be no abnormal signs in the chest on listening. Coughs only need antibiotics if there are crepitations in the chest. Treat with • Amoxicilin or Co-trimoxazole. Give paracetamol if there is a fever. A history of pain passing urine or frequency suggests cystitis but may also be due to bladder stones. Test the urine. Stones will result in blood and protein. Infection (UTI) will show blood, protein & nitrites. Treat infection with Repeated UTI in children should be investigated with a renal tract ultrasound. 4. Chloramphenicol or tetracycline eye drops/ointment qds Any adult with a very high fever and no other obvious cause especially if been in high risk area treat as possible malaria treat with There will be high fever, and paracetamol will be needed 6. Not serious but cosmetically ugly on dark skin If severe, consider oral Ketoconazole. May become infected – use oral Cloxacillin. Advise Vaseline(petroleum jelly) for minor /dry skin problems and as good emollient/barrier cream especially for people standing in water in rice fields. • Betnovate cream if severe (but never on face) • Hydrocortisone if less severe (or on face) Look at conjunctiva. If v pale or heavily pregnant give iron If a Dentist is present, patients who have extractions will need Sometimes penicillin (or erythromycin if allergic) will be needed. SPECIFIC CHILDHOOD CONDITIONS

Also consider HIV/ISS if in a child above 2 year. May need Ketoconazole. Refer for HIV testing 13. Severe intestinal worm infection The child usually presents with a distended abdomen, marked pallor and often a big spleen. Treat with • Mebendazole and • Ferrous sulphate 14. Fever of unknown origin Look for a cause: a. Viral upper respiratory tract infection , ie cough but clear chest. b. Tonsilitis, ie sore throat with while pus visible on tonsils o Penicillin or Co-trimoxaxole c. Chest infection, ie cough with either ;brown or purulent sputum (not just yellow or light green), added sounds on listening to the chest or fever d. Ear infection, ie discharge from the ear, or child pulling ear with a o As above or local Chloramphenical ear drops o Co-trimoxazole or Amoxicillin or Cefalexin o Paracetamol and fluids. If severe advise hospital o Paracetamol and Lumarten. If severe send to hospital/clinic ADULT CONDITIONS

15. Indigestion
Usually described as “gas pain”
Patient is often tender in epigastrium and likes spicy foods!
Treat with
If the history suggests a longstanding problem and therefore possible ulcer also give 16. Back pain Mostly due to heavy work by farmers. Advise them to do stretching exercises and get a massage each evening if possible! 17. Headache Most are tension type. Often a symptom of underlying stress- consider need to offer prayer. Many are due to dehydration and failure to wear hat in strong sun. Give advice. Some viral headaches are associated with colds.
New Hope Ministries 2009


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