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ID_AJCPI | I am a nurse with 30 years of experience in General nursing working in a Health Centres in Uasin Gishu county in Kenya. A 24 year old female, with complains of PV bleeding and lower abdominal pain for one day. History passing blood clot per vigina associated with excruciating pain. Pains are contraction in nature. No history of fever or headache. Last menstrual period was on 13/9/2024. Reports to have been given some meds to put under her tongue at a chemist. On examination she is afebrile, sick looking, no pallor nor jaundice. Vitals: blood pressure- 120/70, temperature 36, pulse 70, respiration- 20b/min. other systems are normal. Viginal examination not done. Diagnosis: incomplete abortion. Plan: patient referred for MVA and related management. For obstetric ultrasound and CBC. Questions: How could this patient been managed at a primary health facility? which investigations could have been done? | Summary:
24 year old female with per vaginal bleeding and lower abdominal pain for 1 day. History of passing clots per vaginal associated with excruciating pain that is contracting in nature. Last period was 13/9/2024 12/40, reported to have been given a drug to put under her tongue at a chemist.
She is afebrile, sick looking, no pallor, no jaundice.
Vitals are, BP of 120/70, temperature of 35, pulse of 70 and RR-20bpm..
She was referred for MVA and related management
Q1.How could this patient have been managed at a primary health facility?
Fix an IV line, 2 large bore and give IV fluids
Give IV analgesics to reduce the pain.
Give IV antibiotics to prevent infections.
Q2. Which investigations could have been done?
Full hemogram to rule out severe anemia and sepsis with white blood cell count
Diagnosis: Induced Incomplete abortion |
ID_VELKR | I am a nurse working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 26 yr old para 3+0 G4 is admitted in active labour for 3 hours. FHR-138b/min, cervical os-8cm dilated
Questions
How will this mother be managed?
What interventions can be done to support progress of labour?
What are the health messages required? | Summary
26 year old multiparous admitted in active labour. On examination, cervical Os - 8cm dilated, FHR 138 b/min
How will this mother be managed
Monitor the fetal status
Monitor material vitals
Check of frequency and adequacy of maternal contractions
Check for fetal engagement
Check for cervical ripening and dilation
What interventions can be done to support labour progress
.Augment labour with oxytocin in normal saline
Rupture of membranes if still intact
Buscopan to ripen the cervix
Health management required
Advice mother to only push during increased uterine contractions
Breath via mouth |
ID_ZRHBT | I am a nurse working in a Health centres in Kakamega county in Kenya. A primigravida sustains a tear after delivery. On assessment, the extend of the tear is noted as second degree The woman had strong uterine contractions and perineum was not well supported.Am concerned that the uterus might also had sustained a tear due to profuse bleeding. Should I give fluids after repairing the peroneal tear?.Which type of fluid is suitable for the mother?.I request her to do check hb. | Summary
A primigravida who sustained a tear after delivery and on assessment, the extent of the tear is noted as second degree.
Concern
Second degree perineal tear
Anemia
Uterine rupture
Hypotension
Management
Give IV fluids - correct possible hypotension
Analgesics - pain management
Antibiotics - prevent infections
Transfuse - if the hemoglobin level is low
Repair the tears using local anaesthetics
Do a vaginal examination to check for clots and remove them
Educate the mother on the care of wounds
Investigations
Full hemogram
Blood grouping and crossmatching -for transfusion
Urea, creatinine and electrolytes
Abdominopelvic ultrasound |
ID_JFGYQ | I am a nurse with 12 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Kiambu county in Kenya. The 2 days old baby is brought to an newborn unit with complaint of irritability and refusal to breastfeed. On assessment, baby had cleft lip and palate. How do I manage this condition at the moment and which method of feeding is the most appropriate? | A 2 day old baby with a cleft lip and palate, presenting with irritability and refusal to breastfeed.
The management of the baby at this point will involve:
1)_x0001_Stabilize the patient by ensuring the airways, breathing and circulation are adequate
2)_x0001_Check blood sugar levels and address hypoglycemia with a dextrose infusion appropriately
3)_x0001_Provide warmth to the baby
4) _x0001_Ensure the hydration status is adequate
5)_x0001_Involve a nutritionist to help meet the nutritional demands of the baby.
Question:
The most appropriate method of feeding is through the expression of breast milk and use of special feeding tubes and bottles to deliver the milk. This is because the baby is unable to coordinate suckling of breast milk.
It may also be required to feed the baby in specific positions to prevent the risk of aspiration |
ID_NLPCS | I am a nurse with 24 years of experience in General nursing working in a Health centres in Uasin Gishu county in Kenya. A 24-year-old female was brought to the facility complaining of severe vomiting and abdominal pain. She was restless. She said the vomiting has been on and off but the abdominal pain started in the morning before they came to the hospital. Last menses was 2 months ago. Vital signs: Temp 35.6 30 c, Pulse – 80, Resp – 20.
Questions: What could be the diagnosis? What is the immediate management? | Summary
24 year old female presenting with vomiting and abdominal pain. Last menses 2 months ago.
Concerns
Delayed menses
Vomiting
Abdominal pain
Dx
Hyperemesis gravidarum
DDX
Ectopic pregnancy
Gastroenteritis
Appendicitis
Management
Pregnancy test
Monitor vital signs
Analgesics for pain
IV fluids to prevent dehydration
Prepare for possible surgery incase of ectopic pregnancy, or appendicitis
Monitor signs of shock
Consult obstetrician and gynaecologist |
ID_GWVCW | I am a nurse working in a Sub-county Hospitals and Nursing Homes in Kakamega county in Kenya. A mother comes to the maternity and successfully goes through labour and gives birth to a premature live infant with 1750 grams. Since the infant is active and shows normal somatic movement, a decision to admit the mother in the KMC room is reached at number one, what are some of the considerations of admitting a client in the KMC, that is kangaroo mother care? And two, when do you opt for newborn unit services other than KMC? And lastly, at what point do you discharge the client from the KMC room? | SUMMARY
A mother comes to the maternity ward and successfully goes through labour and gives birth to a premature live infant with 1750 grams. Since the infant is active and shows normal somatic movement, a decision to admit the mother in the KMC room is reached at number one
CONSIDERATIONS FOR ADMISSION TO THE KMC
Low birth weight , babies <2000g
Hypothermia
Babies with poor suckling reflexes
Mother with poor support at home
CRITERIA FOR DISCHARGING FROM THE KMC ROOM
Continuous weight gain at least 15 g/kg per day for three consecutive days
Regained weight that is the same as that at birth
A baby gained weight of at least 2000g
A stable baby |
ID_ORTBP | I am a nurse with 22 years of experience in General nursing working in a Dispensaries and Private Clinics in Uasin Gishu county in Kenya. A 38-year-old patient presents in the facility with complaints of bloody stool during bowel movement, pain and itching around the anus and a small lump, felt near the opening. The symptoms started 2 weeks ago and takes a lot of processed food. On assessment, the abdomen looks soft and non-tender. Vital signs: BP 118/72mmHg, PR 82 b/m, Temp 36.9, RR 20b/m.
Questions
What is the cause of blood in stool?
What is the immediate management of this patient?
What laboratory investigations are needed for this patient? | A 38-year-old male presents in a dispensary with a history of bloody stool during bowel movement, pain, and itching around anus and a small lump in the anus. Has a history of taking a lot of processed food. All vital signs are normal.
(A) Cause of blood in stool
Hemorrhoids
Anal fissure
Colorectal cancer
(B) Immediate management of patient
Give laxatives
Give analgesics for pain
Topical antihemorrhoidal
Advise on diet change and drinking lots of water
Refer for general surgery review for possible hemorrhoidectomy
(C) Lab investigations
Complete blood count (if suspecting infection)
Stool for occult blood (blood and cysts)
Tumor markers (e.g. CEA) if suspecting colorectal cancer |
ID_DHNNE | I am a nurse with 12 years of experience in Primary care working in a National Referral Hospitals in Uasin Gishu county in Kenya. Patient was admitted as a referral for Cardiothoracic review. With chief complaints of Chest pain, fevers. She had been admitted for two weeks and She has bilateral chest drains which are active. On auscultation she has reduced air entry on the right side, dull on percussion. VITALS; BP-140/75mmHg, P-110b/min, T-37.2, RR 16b/min, SPO2-92 % on oxygen via nasal prongs.
Questions: What investigation should be done? What is acute management? What is the differential diagnosis? | SUMMARY
A female patient was admitted for cardiothoracic review. She presented with chest pain and fever. After 2 weeks, bilateral chest drains are active. She is hypertensive.
DDX: - Bilateral pleural effusions
Investigations
* full hemogram
* C-reactive protein
* Urea, electrolyte and creatinine
* Sputum for culture
* Sputum for Gene X-pert
* Blood cultures
* Chest X-ray
* Tumor markers - PCR for malignancy
* Pleural fluid analysis - by Light's Criteria
* Biopsy for Immunohistochemistry
Autoimmune screen
Acute management
* Supportive care
* Pain management with analgesia
* Fluid therapy with Intravenous fluids
* Assess chest tube regularly and drain if full
* Follow-up diagnostic results to have a definitive diagnosis
* Antibiotic therapy - Empiric antibiotics
* Definitive treatment depends on diagnosis. |
ID_WZVWA | I am a nurse with 12 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Kiambu county in Kenya. A 24 year old patient is brought to the emergency department after he was rescued while trying to commit suicide by hanging. On assessment there are lacerations on the neck. What is the management of this patient and what reassurance do I give the relatives? | summary
A 29-year-old pt is brought to the facility after attempted suicide by hanging.
Differential Diagnosis
Suicide attempt.
Manage your patient as follows:
1. Monitor vital signs.
2. Ensure airway patency.
3. Administer oxygen if needed.
Imaging CT or MRI may be needed.
Consider psychiatric evaluation.
Explain the patient’s condition to the relatives.
Offer information about support resources, hotlines.
Encourage them to seek professional counseling for them to cope with the situation. |
ID_GDLPG | I am a nurse with 1 years of experience in General nursing working in a County Hospitals in Elgeiyo Marakwet county in Kenya. A 4 year old boy is brought by her mother to the emergency with complains of profuse nose bleeding on left nostril that started 3 hours ago.
On examination, patient is alert, not pale, the left nostril is packed with a small cloth fully soaked with blood.
V/signs: BP 90/58 mmhg, PR 65 b/m, RR 25 b/m, T 36.6oc, PR 65 b/min, SPO2 98% on room air
Questions:
How can this patient be managed?
What are the laboratory investigations required? | a 7-year-old boy presents with profuse nose bleeding on the left nostril that took 3 hours to stop at home. On examination, the patient appears pale but not cyanotic. Packed with blood, hypovolemic shock. Hypotensive, tachypneic.
Other vitals are essentially normal.
Dx:
epistaxis
Dx:
Hematological malignancy
Trauma
How can this patient be managed
Pack the nostril with gauze soaked with adrenaline.
Give intravenous tranexamic acid to stop
Emergent ear nose and throat specialist review
Intravenous fluid resuscitation
Laboratory investigations required:
Hemoglobin levels
Platelet levels
Blood group and crossmatch in preparation for transfusion |
ID_DELOK | I am a nurse with 20 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A patient 42-year old female complains of cold intolerance, weight gain, fatigue constipation and depression in 1 week. He had been done thyroidectomy 3 weeks ago. Medicine- levothyroxine. On assessment, P 50/m T 35 B/P 100/50 SPO2 90%, hair looks thin. Questions: What could be causing the symptoms? What is the immediate management of the patient? | Summary:42 year old female with complaints of cold intolerance, fatigue, constipation, and depression for 1 week. Had a thyroidectomy 3 years ago. On levothyroxine. Pulse 50 (bradycardia)
Temp normal, BP 100/50 (Hypotension)
SPO2 98% RA
Q1: What could be causing the symptoms?
* Hypothyroidism following thyroid surgery or drugs
Q2: What is the immediate management of the patient?
* Give Levothyroxine for supplementation.
* Fix an IV line for fluids.
* Draw a sample for Full hemogram, FT4, TSH to rule out anemia and hypothyroidism.
* Urea, Creatinine, and electrolytes to assess kidney status.
* Do a thyroid function test to assess the level of thyroid hormones.
* Give IV antibiotics.
* Refer to Endocrinologist
Diagnosis:
Hypothyroidism |
ID_CNBFW | I am a nurse with 17 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 12 year old girl is brought to the emergency unit with sudden onset of difficulty in breathing. Patient is a known asthmatic patient on inhaler and follow up.
On assessment there is audible wheezing, shallow breathing, retractions and use of accessory muscles. HR 130b/m, Resp 50b/m, BP 110/50 mmHg, Temp 36, SPO2 88% on room air. Patient is given prednisolone, nebulized and started on oxygen therapy via nasal prongs.
Questions
What are the predisposing factors for asthma?
Is the treatment effective?
Which medications are required? | Summary
A 12-year-old female patient presents with difficulty in breathing. Known asthmatic on inhaler. On assessment wheezing was noted, shallow breathing, and use of accessory muscles. Patient is tachycardic, tachypneic and desaturating on room air. Patient has been treated with prednisolone, nebulized, and started on oxygen therapy.
Diagnosis - acute asthmatic attack
The predisposing factors:
Genetic factors (family history)
Allergens
Air pollution
Exposure to smoke while cooking in a poorly ventilated area or cigarette smoke
Chronic respiratory infections
The treatment
Ensure underlying causes of the exacerbation are treated such as co-infection.
Dosages are adjusted based on symptomatology.
Medications required are short-acting beta agonists
Add inhaled corticosteroids and anticholinergics
Give oxygen therapy where necessary.
Antibiotics in bacterial co- infections |
ID_TPBIB | I am a nurse with 10 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Uasin Gishu county in Kenya. An 18 year old lady was brought into the facility with a history of having fallen into fire while cooking. The patient is a known epileptic on treatment. They reside at Kahoya.
Assessment: On examination, the patient's skin had profound blisters leaking fluids, she looked pale, weak, cyanotic at the lips and fingernails. Vital signs, BP 90/70, respiration 16, SPO2 85%.
Questions
1. What is the urgent management of the patient?
2. What investigations can be done to the patient?
3. What other specialized care will the patient require? | Summary:
· 18-year-old epileptic patient with deep burns and suspected inhalation injuries.
1. Urgent Management:
· Stabilize the patient by:
Securing the airway by introducing an airway device.
Setting up an intravenous line for hydration.
Administering oxygen via a non-rebreather mask.
Empirical antibiotics
2. Investigations:
· Full blood count .
· Renal function tests (e.g., urea and electrolytes).
· Liver function tests .
3. Specialized Care:
· Refer to a burns unit for advanced management.
4. Treatment:
· Antibiotics as per culture sensitivity.
· Analgesics to manage pain.
· Anticonvulsants if seizures are present.
· Tetanus toxoid vaccination as prophylaxis. |
ID_JZNZW | I am a nurse with 12 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Kiambu county in Kenya. Forty-seven years, old man, came to Casualty, supported by two men, screaming, because of pain. Upon inquiry, he reported that he had severe abdominal pain, upper abdominal pain, in the gastric area, which had started the previous night.
He had not slept. He also reported that this was not the first time that it was happening, and he reported a history of PUD. This time it was severe.
So on observations, the PUDs were, the vitals were within normal range. The questions I had were, an analgesic first? or this patient was sent for labs? or to do a scan first? | Summary
A 47-year-old man presents with severe persistent upper abdominal pain in the gastric area that started the previous night. He has a history of peptic ulcer disease. Vitals are normal. Patient is in distress.
Problems:
Severe pain
History of peptic ulcer disease
Distress and inability to sleep
Management:
Administer analgesia for the pain.
Start IV fluids to correct possible volume depletion.
Administer proton pump inhibitor for the gastrointestinal upset.
Administer antibiotics if there are signs of peritonitis.
Investigations:
Complete blood counts to check for leukocytosis.
Ultrasound.
Do an erect abdominal X-ray (to look for air under the diaphragm).
Provisional Diagnosis (Pdx):
Acute exacerbation of peptic ulcer disease |
ID_VBWWP | I am a nurse with 18 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Uasin Gishu county in Kenya. A 4-year-old child presents to the emergency department with second-degree burns on the forearm after accidentally touching a hot stove. The child was playing in the kitchen when they reached out to touch the stove. The burns cover about 5% of the total body surface area. The child is alert and crying, with redness, blisters, and swelling on the affected area. The burns appear to be superficial to moderate in severity. The child is in mild pain, and there is no indication of airway or breathing distress. No other injuries are noted.
Questions:
1. What is the immediate treatment protocol for second-degree burns in paediatric patients?
2. Should any tetanus prophylaxis be considered in this case?
3. What follow-up care should be recommended for burn healing? | Summary:
A 4 year old with 5% superficial burns. No other injuries
Immediate Management:
* Paracetamol analgesics to to ensure child has minimal
or no pain
* Cleaning and frosting of wound with silver sulpha-fizika
* Topical prophylactic can be considered in this case
* Good nutrition - high protein diet |
ID_ZMMYN | I am a nurse with 1 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Uasin Gishu county in Kenya. 24 years old boy was admitted in the ward with complains of talking a lot he says he is a prophet of God he is sleeping a lot and gets irritated easily on assessment he is restless, I cannot obtain the vitals since he was violent
Questions
Which therapy will work best for him?
What are the antipsychotics to be administered?
Whom do I call for assistance? | summary
A 24 year old, boy, talking a lot, irritable, restless, sleeps a lot, violent
Which therapy will work best for him?
Management of the patient;
This is a concern for bipolar disorder with differential of schizophrenia
Therapy;
- psychoeducation
-Psychotherapy
-Therapeutic alliance
-Biopsychosocial approach.
b) What are the antipsychotics to be administered?
- Second generation antipsychotics
c) Whom do I call for assistance?
- A psychiatrist |
ID_BKPAH | I am a nurse working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 40-year-old female presented with symptoms of Addison's disease, including depression, fatigue, weight loss, salt craving, and skin hyperpigmentation.
V/signs: T 36, BP 110/60 mmHg, P 70 b/m
Questions:
Which investigation can be done?
What management will be offered to the client?
What health teachings are needed for the client? | Summary
A 40 yr old female with addison's disease symptoms; depression, fatigue, weight loss and skin hyperpigmentation.
Vital signs are normal
Diagnosis
Addison's disease
DD
Cushing's disease
Hypothyroidism
Malnutrition
Investigations to be done
Take samples for cortisol levels
Thyroid function tests
Random blood sugars
Renal function tests
ANA screen
Hiv test
What management for the patient?
Give a corticosteroid IM hydrocortisone or prednisolone
If there's hypothyroidism, manage with hormonal replacement therapy e.g levothyroxine
Correct hypoglycemia if low sugars
Increase vitamin C uptake and other vitamins
Diagnosis
Addison's disease |
ID_NSTRJ | I am a nurse with 22 years of experience in General nursing working in a Health centres in Kiambu county in Kenya. A 48 years old man came to to the facility complaining of high BP of 174/112 , was on medication which was not working for him. I gave Nifelat and HCTZ stat, after one hour, repeated the BP which was still high, 164/ 110 .Ques, which medication will he respond with? Do I need to refer to a higher facility? | A 48-year-old male, known hypertensive on medication but with uncontrolled hypertension. On assessment, blood pressures are 174/112 mmHg. Repeat blood pressure is 161/110 mmHg after nifedipine and hydrochlorothiazide administration.
This patient presents with a hypertensive urgency and requires an urgent admission for blood pressure control.
This should be done in consultation with the physician.
Differentials include hypertensive encephalopathy.
Medications for hypertensive control in this situation would include:
Intravenous labetalol, a combined beta-blocker.
Intravenous nitroglycerin.
Blood pressure control should be gradual to prevent the risk of hypoperfusion.
Target levels of 150/100 mmHg are aimed at, and thus strict blood pressure monitoring is essential upon initiating therapy.
Refer the patient for regular follow-up by a physician. |
ID_ZUXZW | I am a nurse with 20 years of experience in General nursing and Primary care working in a Health Centers in Uasin Gishu county in Kenya. A 21 year old female patient comes to the clinic complaining of dizziness, some headache, and blurred vision for 1 week. On examination, the palms of the hands are fairly pale and also the eyes. The headache is mild. There is no nausea /vomiting or diarrhoea. Other medically alright. She says her favorite is chips and soda. Vital Signs- BP 119/64 mmhg Pulse 79/min Sp02 96% Resp- 16/min Temp-36.1°C Questions: Which Investigations should be done? How can she be managed? | A 21 year old female with complaints of dizziness, headache, blurred vision for 1 week. Exam pallor: Vitals - Normal
Diagnosis:anemia
Which investigations should be done:
Full hemogram
Blood group and crossmatch
Peripheral blood film,blood slide for malaria
Urinalysis
Iron studies
Stool for ova and cyst
Folate and Vit B12 levels
How can she be managed:
Take the above samples and follow up the results..
Transfuse if needed, initiate hematics
Deworming - anthelmintic meds
Supplement and increase iron, folate and Vitamin B12 in diet
Involve a nutritionist for counseling and dietary recommendation.
Rule out other causes such as malaria, blood loss/hemorrhage/bleeding diathesis.
Pain management: Analgesia for headache - paracetamol
Ensure the patient is well hydrated.
Consult with a specialist for further care |
ID_CBLIG | I am a nurse with 30 years of experience in General nursing working in a Health centres in Kakamega county in Kenya. A male client in the outpatient department with history of severe abdominal pain. Pain that started for the last 14 hours. The pain started while he was on duty lifting bags of cement.
He has not taken any premedications. On examination the blood pressure is 90 /60, pulse 100, temperature 36.8. The abdomen is soft. On auscultation there is reduced bowel movement.
There is evidence of irreducible right inguinal hernia. My question is, is there any investigation that I am supposed to do for this client before referral? Is it right if I give a sedative because he is in much pain? Is it also alright if I give analgesics before referral? Or what else can be done? | SUMMARY
A 60-year-old male patient presented to the OPD with severe abdominal pain that worsened over 14 hours.
Physical Examination:
Abdomen: Tender, with reduced bowel sounds, and is irreducible.
Diagnosis:
Incarcerated inguinal hernia
Q1: What investigations should be done before referral?
Full blood count
Renal function test
Abdominal ultrasound
Abdominal X-ray (plain erect)
Q2: Role of sedatives?
No use of sedatives because it will mask the clinical findings and worsen the vital signs, especially the respiratory rate.
Q3: Is it right to give analgesia?
Yes, the pain is severe, so analgesia can be given.
Q4: What else can be done?
Refer the patient for urgent surgical intervention - herniorrhaphy
Intravenous fluids
Empirical antibiotics |
ID_ECNQI | I am a nurse with 22 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Kiambu county in Kenya. OPD, A 30 years old man came to the facility complaining of pain on the right side of the Abdomen for the last 2 days.Question: What was the cause of the pain on the right side of the Abdomen? After giving analgesics, do I refer him to a higher facility for Abdominal x-ray to rule out acute Appendicitis? | Case Summary
A 30 year old man with a diagnosis of pain in the abdomen for 2 days.
Differential Diagnosis
Cholelithiasis
Cholecystitis
Cholangitis
Appendicitis
Perforated gastric ulcer
Management
Yes, after giving analgesics, administer prophylactic broad spectrum antibiotics with anaerobic coverage{I.e ceftriaxone and metronidazole iv }, rehydrate him with IV fluids I.e NS and D10 alternating or Ringers alone , request for lab work ups I.e to check Hb and WBCs [anaemia and bacterial infection ] , Type and Crossmatch in preparation for surgery , Urea, Electrolytes and Creatinine to rule out electrolyte imbalances and then refer him to higher facility for Abdominal X ray to r/o acute appendicitis and also for further management. |
ID_DFPCN | I am a nurse with 9 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Uasin Gishu county in Kenya. A 60 years old female brought to the hospital with hx of swollen lower limbs; unable to pass urine itchy skin for 1/52 she is a known DM/HTN patient for 10 years on medication and follow-up. On assessment, BP-180/94mmHg, P-92b/min,T-38.5c ,R-36b/min,there is generalized body oedema , the skin is dry peeling
Questions
What could be the possible diagnosis of the patient?
What investigations could be done to aid in diagnosis? | SUMMARY
a 60 year old female known DM/HTN for the last 10 years on medication presented with 52 history of swollen lower limbs pass urine with itchy skin. On exam to high BPS of 180/94, febrile, in severe respiratory distress, Generalised Body edema.
possible Diagnosis
Acute Kidney failure
Investigations.
Lab - Full Hemogram to check for leukocytosis and Hemoglobin levels.
• Urinalysis to check for urinary infections.
• HBA1c to check for drug compliance
• Kidney function tests to check for electrolytes and urea, creatinine levels to assess the kidney failure
• Blood gas analysis to check for levels of CO2 and O2 in blood.
Radiology - 1) Chest xray to check lung pathologies
2) KUB scan to check for any obstructive uropathy
3) ECHO + ECG to look for heart function to rule out heart failure
4) Bilateral lower limb doppler ultrasound to rule out clots
5) Abdominal pelvic ultrasound scan. |
ID_HSJLG | I am a nurse with 20 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Uasin Gishu county in Kenya. A man aged 40 years complaining of severe joint pains. The man reports to have been treated in different facilities with no improvement. Investigation done include ASOT-negative, rheumatic test – negative and serum calcium normal. Temperature of 36.9, Bp 110/70 mmHg, pulse 78 bpm and spo2 98%.
Question:
What could be causing joint pains?
Which investigation should be carried out on this patient? | 40-year-old with complaints of severe joint pains. Has been treated in different facilities with no improvement.
Investigations already done:
AST negative.
Rheumatoid factor negative.
Serum calcium normal.
Vitals: Temp 36.9°C, BP 120/70, Pulse 78 bpm, SpO₂ 80%.
Note: Possible case of early osteoarthritis or autoimmune disease with manifestations of arthralgia and arthritis.
Investigations to be carried out:
1. complete blood count.
2. c-reactive protein.
3. Erythrocyte sedimentation rate
4. Uric acid level.
5. Antinuclear antigen (as a screening test).
Radiology:
X-ray of the involved joints. |
ID_JRROQ | I am a nurse with 10 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. an 18 years old male came to the emergency department with a complaint of undescended testis. On palpation scrotal testicles are absent.
Questions
What is management?
Which investigations are needed to confirm the diagnosis? | 3 year -Old male with complaints of undescended testis .Or palpation testicle are absent.
What's the management for cryptorchidism
Definitive Orchidopexy (Bilateral), requires urologists expertise
Investigations to confirm
Scrotal ultrasound to confirm absence of scrotal sac
Abdominopelvic ultrasound to locate testis
Dx: Cryptorchidism
Differential / DDx
Testicular agenesis
Bilateral inguinal hernia |
ID_NGZJA | I am a nurse with 20 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 34-year-old lady who comes to the emergency department with a stab wound on the chest. She reports that she was stabbed by her husband with a knife. On examination she is in pain, she is not pale, there is profuse bleeding from the site she was stabbed. Temp-36.90C, p-116b/m, BP-100/60mmHg, SpO2-97%.
Questions:
What is the emergency management of this patient?
What investigations will be done to assist in patient management? | Summary:
34 year old lady brought at Emergency with a stab wound on the chest. Stabbed by husband with a knife.
O/E- In pain, not pale, profuse bleeding from stab site
BP 100/60 Pulse 116.
SPO2 normal.
Q1: What is the emergency management of this patient?
* Give oxygen.
* Give analgesics.
* Apply pressure dressing to the wound site.
* Give anti-tetanus and anti-rabies prophylaxis.
* Give broad spectrum antibiotics.
* Give IV fluids.
Q2: What investigations will be done to assist in patient management?
* Chest X-ray (Anterior, Posterior and Lateral)
Diagnosis:
Hemopneumothorax
Hemorrhagic shock |
ID_MIAYN | I am a nurse with 16 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 21-year-old male patient presents with chest pain tightness and shortness of breath for the last 6 hours. He reports being asthmatic and uses an inhaler but has not purchased a new one when it is finished as he was busy with school exams at school. His breathing is labored and has an obvious wheezing sound. Temp. 37.2, PR- 102 b/min, SPO2- 86%, on room air, Resp 28 breaths/min and BP 141/78 mmHg. The patient is not able to complete a sentence.
Question:
How do I manage the case? | Summary
21 year old male with chest pain, tightness and shortness of breath for the last 6 hours. He is asthmatic and uses an inhaler. Labored breathing and wheezing, febrile, slightly tachycardic,SPO2 86% on room air. Tachypneic and hypertensive 141/78 mmHg. Patient unable to complete sentence.
Management
Administer high flow oxygen via face mask then gradually wean off
Nebulize with short acting beta agonist, IV corticosteroids
Monitor vitals to see response to medications
Educate patient to avoid triggers
Treat underlying infection with broad spectrum antibiotics
Differential diagnosis
Asthma
Pneumonia
Pulmonary embolism |
ID_GKEQL | I am a nurse with 24 years of experience in General nursing working in a Community Health Centers in Uasin Gishu county in Kenya. A 3 day old neonate is brought into the new born unit with yellowing skin and sclera. On assessment, the baby appears lethargic and pale, The vital signs are temperature 38.5 C, respirations 18 cycles and pulse 80bets per minute. Questions: What could be the cause of the yellow skin and sclera? What is the immediate management of the neonate? Which tests could be important in the diagnostic process? What complications/risks is the neonate likely to experience? What is the role of the mother in the management of this patient? | Summary
A 3 day old neonate with neonatal jaundice, low resp rate of 18 and bradycardia and hyperthermia
Dx: Neonatal jaundice
DDx: Sepsis, hemolytic disease of the newborn, UTI ,cholestasis ,malaria
Causes of jaundice in a newborn
Breast milk jaundice
Hemolytic disease of newborn
Neonatal sepsis
Congenital jaundice
Investigations
CBC, LFTs, UECs, Bilirubin levels(direct and indirect).
Management
IV fluids.
Give antibiotics and antipyretics.
Admit in the NBU or refer to the nearest higher facility.
Talk to the mother for psychological support. |
ID_WHQPD | I am a nurse with 12 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Kiambu county in Kenya. A 60-year-old woman referred from the Game OPC clinic after having fainted in the doctor's office. On my examination, her BP is quite stable. The pulse rate is way high at 130 beats per minute and she has a history of a heart condition.
So the question I asked, what are the appropriate tests to take so as to know what exactly is causing the palpitations? And what procedure would the woman benefit from to fix this problem? Because it has been on and off, on and off, yeah. | A 60-year-old female fainted and was brought in. PR 130 bpm. BP stable. History of heart condition.
What tests?
Complete blood count
Urea,creatinine,and electrolyte
Liver function test
Coagulation profile
Blood culture
Troponins
Creatinine kinase
C reactive protein
Echocardiogram
Electrocardiogram
Management:
Definitive management depends on the diagnosis. |
ID_ISTWZ | I am a nurse with 16 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. This is Mr. Julius, a 29-year-old businessperson with a background of alcohol dependence, who was brought in by ambulance after being found unconscious in the street. Was witnessed to have a full-body fits lasting 5 minutes and later becoming unconscious. Had an episode of urine incontinence and bit his tongue. He reports to have had 2 episodes before. The mother was epileptic. He lives in a storey building. The vital signs are normal.
Questions
How can we confirm if the convulsions are of metabolic or infectious cause?
How can he be managed? | SUMMARY
25 year male with loss of consciousness. History of alcohol dependence and prior seizures.
Diagnosis - brain hematoma
Management:
Evaluation:
History and physical exam to identify probable causes.
Investigations: full hemogram, blood gas analysis, C-reactive protein, Random blood glucose ,urea electrolytes and creatinine
Emergency Care:
Check airway, immobilize cervical spine.
Administer oxygen if saturation <90%.
Establish intravenous access; provide intravenous fluids if hypotensive.
Check GCS score, administer dextrose if hypoglycemic.
Conduct trauma evaluation.
Medical Therapy:
Administer anticonvulsants for seizures.
Provide sedatives if agitated. |
ID_EBYMV | I am a nurse with 26 years of experience in General nursing working in a County Hospitals in Kakamega county in Kenya. A two-year-old baby was brought to outpatient department with history of having swallowed a coin. On examination, the patient had difficulty in breathing, not able to swallow saliva. Observations were taken and temperature was 36 degrees centigrade, pulse was 1.3 per minute and respiration was 28 per minute.
An impression of respiratory blockage was made. What should I do to this child? If I give oxygen, will she benefit or should I just refer this patient to the next level for further management? | Summary
2-year-old baby presents with a history of swallowing a coin.
On examination, difficulty in breathing, inability to swallow saliva.
Vitals are normal.
Impression of respiratory blockade was made.
IMMEDIATE MANAGEMENT
1. Do an X-ray to confirm the position of the coin.
2. Suction any drooling.
3. Put on nasal prongs supplemental oxygen.
4. Call physician and surgeon for emergency review.
5. Try abdominal thrusts to dislodge the coin upwards.
6. May require bronchoscopy for removal.
7. Give analgesics for the pain.
8. Give prophylactic antibiotics (broad spectrum). |
ID_XITDZ | I am a nurse with 18 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 10 year old female patient was brought to the hospital accompanied by her mother with complaints of pain when passing urine and bruises in her perianal region. Temperature 36.40c, Pulse 100 beats/minute, respiration 21 breaths/minute.
Question(s):
What might have caused the bruises?
What laboratory tests will be requested?
What referral will be offered to the patient and the mother?
What is the immediate management of the patient? | SUMMARY
a 10 year old female was brought in hospital accompanied by mother. With complains of pain when passing urine and bruises around the perianal area Temp - 36.4 , PR - 100 b/ min, RR 21 b/ min.
Q1
What might have caused the bruises
Since the patient is a 10 year old the likelihood cause of the bruises is a streptococcal infection.
Q2
Lab
Baseline tests -Full hemogram , liver function test , renal function test , BS for MPs
Blood culture
Since you are in a national referral hospital you can also do a strep test
Sputum gram stain and culture
Q3
What referral will be preferred to the patient And mother
A pediatric referral
Q4
Immediate management
Give antibiotics for infection
Give topical cream to apply on the perianal bruises
If the child is in Pain give analgesics |
ID_LFILK | I am a nurse with 24 years of experience in General nursing working in a Health centres in Uasin Gishu county in Kenya. A 67-year-old female came to our facility with complaints of gradually becoming unable to walk upright. The spine is bent and now she walks holding a stick. She reports that there are other old men and women in their village like her. She says the problem started 3 years ago, but there was nobody to complain to since she lives alone. Vital signs: BP- 100/60 mmHg, Pulse – 70, RR – 18. Investigations: RBS 0 7.9mmol/l.
Questions: What is the diagnosis? What might be the cause of the curving spine? | SUMMARY
67-yr old female with inability to walk upright for past 3 yrs. Vitals normal.
What causes the curving of the bone:
Caused by common spine degeneration due to osteoporotic changes leading to osteoarthritis of the joint in the vertebra, decreased bone space, with the body weight leading to curvature.
Diagnosis: Kypho-scoliosis. |
ID_DOIOO | I am a nurse working in a Health centres in Kakamega county in Kenya. A 9 year old girl is brought with complaints of headache,GBM, vomitting and HOB The patient was treated for malaria with oral anti malarial a week ago but the mother reports there's no improvement noted The patient looks weak and lethargic and is not feeding well. Temp 37.9°c BS for MPs done and was positive. Which type of treatment should i use now that the first one failed? | Summary
A 9 year female with headache, general body malaise, vomiting, fever for 1 month.
Recently treated for malaria. No Improvement noted
On examination: sick looking, Temp- 37.90
Repeat bs for Mps + ve
Which Type of treatment should be used after 1st treatment failure:
Admit.
Give anti malarial
Give lV antipyretics/ analgesic.
Give IV fluids - 100% dextrose alternative with saline |
ID_DROFS | I am a nurse with 7 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Kakamega county in Kenya. A patient on blood transfusion has been on the ward and the transfusion started. The caretaker increases the speed of blood without the consent of the nurse. The nurse comes after 30 minutes and finds the blood over.
Vital signs, blood pressure is 120/74 ,pulse of 84, respiration of 18 breaths per minute. The patient is alert, is conscious, is no danger sign noted. What is the nurse supposed to do? | Summary
A patient on blood transfusion has been on the ward and the transfusion started. The caretaker increased the speed of blood without the consent of the nurse. The nurse comes after 30 minutes and finds the blood over.
Vital signs: BP 120/74, P 85, respirations 18 bpm. The patient is alert, conscious, and has no danger signs noted.
This is a case of rapid blood transfusion, which is not a standard practice in the medical field.
For this patient:
Monitor vital signs very closely.
Perform a second physical exam to pick out any signs such as crackles.
It’s also important to educate the caretaker about the standard practice and complications that can arise from the procedure. |
ID_NKDJE | I am a nurse with 12 years of experience in General nursing working in a Dispensaries and Private Clinics in Uasin Gishu county in Kenya. A 1 and half year-old male child was brought with complains of having been burned with hot water some few minutes ago. The burnt surface is exposed, mother reports to have poured cold water to the site (left lower limb). On assessment the child is in pain, The burns are estimated to be 2nd degree with parts of the skin broken while others have blisters. Vital signs Temperature 35.6, SPO2 96%, pr 126b/m. Question: What is the immediate care management of the patient? | Summary:
1 ½-year-old male presents with burns from hot water. Skin broken with blisters.
Dx: Second-degree burn.
Management:
Ensure airway is clear.
Monitor breathing and SpO₂.
Administer fluid resuscitation and pain relief.
Irrigate burn areas with saline.
Dress burn areas with sterile dressing.
Apply silver sulfadiazine.
Provide tetanus prophylaxis. |
ID_VUBWB | I am a nurse with 23 years of experience in General nursing working in a Dispensaries and Private Clinics in Uasin Gishu county in Kenya. A 25-year-old female at 30 weeks gestation came to the outpatient clinic with elevated blood pressure of 160/110 mmHg. She complained of headache and swelling of the hands and feet for the last week. She has no past medical history. On examination, temperature: 36°C, pulse: 96 beats per minute, respiration rate: 18 breaths per minute.
Questions:
What is the immediate management?
What are the investigations to be done?
What might cause the elevated pressure? | A 25 year old female patient at 30 weeks gestation presenting with elevated blood pressure of 160/110 mmHg. She also complains of headache and swelling of the hands and feet for 1 week.
The immediate management of this patient is to:
1)_x0001_Stabilize the blood pressure by administering intravenous antihypertensives such as labetalol to gradually lower the BP
2)_x0001_Provide bed rest and nursing in a quiet room
3)_x0001_Administer magnesium sulphate for prevention of eclamptic seizures.
4)_x0001_Monitor maternal well being by regularly taking vital signs.
5)_x0001_Monitor fetal wellbeing by fetal heart rate movement
Some of the Investigations to be done for this patient include:
1)_x0001_Complete blood count to check anemia/infection/platelet levels
2)_x0001_Liver function test to check bilirubin levels to rule out hemolysins/end organ damage
3)_x0001_Urea electrolyte creatinine to assess for end organ damage
4)_x0001_Urinalysis to check for protein in urine
5)_x0001_Obstetric ultrasound to evaluate fetal growth
6)_x0001_Umbilical doppler studies to monitor fetal wellbeing
7)_x0001_Non stress test to check for any signs of a non-reassuring fetal status
The possible cause of the elevated blood pressure for this patient is:
-A poor implantation of the placenta causing remodelling of the spiral arteries within the uterus
leading to ischemia and the release of inflammatory mediators that cause a dysfunction of the blood vessels.
Other possible causes include genetic inheritance, underlying systemic disorder such as a kidney disease among other conditions |
ID_MDILB | I am a nurse working in a Sub-county Hospitals and Nursing Homes in Uasin Gishu county in Kenya. A 56-year-old female came in the facility with complains of forgetting things easily, poor appetite and is worried about her children. She lives with the husband and her two children. Vital signs 35.9, PR 101b/m, bp 136/77mmhg. On assessment, there is no obvious history of trauma or injury. Questions: 1.What further investigation can be done to the patient? 2.Why does the patient present with vomiting and loss of appetite? | A 56-year-old female reports with a history of forgetting things easily, poor appetite, and is worried about her children. Vitals show hypothermia of 35.9°C, tachycardia of 101, and BP of 126/77.
(A) What further investigations could be done?
Investigations:
CT scan of the head → Intracranial bleeding
Complete blood count → signs of sepsis (↑ leukocytes)→Septic shock
C-reactive protein, Erythrocyte sedimentation rate → inflammatory markers.
Blood culture.
Urea, electrolytes and creatinine, Liver function tests → metabolic course, electrolyte disturbances.
Psychiatric illness → Psychiatric review.
Why does the patient present with vomiting and loss of appetite?
Could be due to increased intracranial pressure. |
ID_EWEXZ | I am a nurse with 2 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Uasin Gishu county in Kenya. A 65 year old female presents to the facility with complaints of difficulty breathing for the past two days. Has a history of HTN and smoking for 40 years. On assessment she appears mildly distressed with tachypnea. Vitals: BP 140/90, SPO2 92%, RR 22, PR 95, T 37.
Question: What could be the diagnosis of the patient? | SUMMARY
A 65 year old female presents to the sub county hospital with complaints of difficulty in breathing for the past 2 days.
Hx: of smoking for the past 40 years and hypertension.
On exam: Appears mildly distressed with tachypnea (RR 22), PR 82, BP high at 140/90. Other vitals are normal.
(A) What could be the diagnosis of the patient?
Congestive cardiac failure.
COPD.
Pneumonia.
Investigations
Complete blood count
Kidney and liver function tests
Random blood sugar
Electrocardiogram
Echocardiography
Chest X ray |
ID_UGIEB | I am a nurse with 27 years of experience in General nursing working in a Health centres in Uasin Gishu county in Kenya. A 7-year-old boy was brought to the facility by his mother with complaints of body temperature, headache, photophobia, loss of appetite, and a high-pitched cry. On examination, the child had a bulging fontanelle and mild dehydration. Observations: temperature 38.9°C, pulse 80 beats per minute, respiration rate 26 breaths per minute, SPO? 94%.
Recommendation:
Mother advised to loosen and expose child’s clothes to lower the temperature.
Referred for further management.
Questions!
a) How does a child with meningitis present?
b) What is the immediate care? | Summary
7-Year-old boy with complains of headache, hotness of body and photophobia. Associates high pitched cry. On examination, bulging fontanelles and mild dehydration.
The patient is febrile and tachypneic.
The presentation is concerning for meningitis with differentials of:
I. Malaria
II. Pneumonia
Meningitis typically presents with;
- Headaches, Fever, Neck stiffness, Photophobia.
On physical examination;
- Positive Brudzinski’s sign
- Positive Kernig’s sign
- Signs of raises intracranial pressure maybe present.
The patient requires referral and admission.
Assess the patient’s airway for patency.
Administered oxygen therapy to support ventilation.
Obtain intravenous access and draw samples for blood work.
Access circulation status and rehydrate as necessary.
Assess for disabilities by performing a Glasgow comma.
Scale score and observing pupillary reactions.
Administer empiric antibiotics therapy after drawing blood and Cerebrospinal Fluid for gram staining and culture.
If signs of intracranial hypotension present, avoid lumbar puncture.
Administer antipyretics.
Administer dextrose as part of the IV fluids to cover up for the nutritional deficiency.
Lab investigations
- Perform a full hemogram for signs of infection.
- Microscopy, culture and sensitivity of cerebrospinal fluid or blood to isolate micro-organisms.
- Perform Acute Phase Reactants assay if available e.g., C-reactive protein levels.
If signs of raised intracranial pressures persist, a head CT scan is preferred to rule out any space occupying lesions.
Diagnosis- meningitis |
ID_GERAA | I am a nurse with 27 years of experience in General nursing working in a Health centres in Uasin Gishu county in Kenya. A 9-year-old boy was brought by the mother with complaints of pain on the left ear and not being able to hear for 3 days Temp 36°C pulse 80 bpm, resp. 34b/Min, Spo2, 93%
On examination there was a bean which had blocked the whole opening
Recommendation.” Patient sent to ENT department for further management.(TRAUMA-FB) | Summary:
A 9 year old male presents with pain on left ear and inability to hear on left ear for 3 days.
Examination: Bean stuck in left ear.
Vitals: Temp - 36°C, PR - 80 bpm, Resp - 34, SPO2 - 93%.
Impression:
Foreign body in left ear.
Management:
1. Attempt to remove the foreign body by flushing it out with water for injection.
2. If need be, tweezers can be used instead.
3. If unable to remove the foreign body, refer to the ENT department for removal of the foreign body. |
ID_KZJWX | I am a nurse with 10 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A patient is brought to the Theatre with intestinal obstruction. This is his first admission. Patient complains of inability to pass stool for one and half weeks and abdominal distension. There is no history for chronic diseases in the family. Vital sign at the time of receiving the patient in Theatre BP 130/70 mmHg, Pulse 100 bpm, RR 21/minute, SPO2 96%. Upon opening the abdomen all the intestines had become necrosed.
Question
How should the patient be managed intraoperatively and postoperatively? | Patient brought to the theater with intestinal obstruction; complaints of inability to pass stool and abdominal distension. Vitals critical. Upon opening abdomen, all intestines were necrosed
Q: How should the patient be managed intra-operatively and post-operatively
Intra-operation:
Resection and anastomosis.
Construction of a stoma.
Peritoneal washout.
Placement of a drain.
Anesthesia team: Manage anesthesia, antibiotics, IV fluids, and monitor vitals. Manage complications: Hemodynamic instability.
Post-operation:
Monitor vital signs.
Antibiotics.
Nil per oral: Then gradual transition to full feeds.
Nutrition counseling.
Pain management.
Ambulation.
Education and counseling.
Diagnosis; necrosis of the intestines |
ID_WJZHZ | I am a nurse with 20 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 34 years old lady comes with complains of itching and irritation at vaginal area for 12 days. She has been having dyspareunia, saying its on off for long time. On assessment thick white, cottage cheese like discharge noted, redness and swelling around the vagina. BP 120/96, P 110bpm, t 38.0, Random blood sugar 12mmol/L.
Question:
what could be causing the candidiasis?
What is the management for the patient? | SUMMARY
34 year-old old female with vaginal irritation for 12 days, on and off dyspareunia
On examination, there is thick white cottage cheese-like discharge, redness and swelling around the vagina. Blood pressure 120/96 mmHg, pulse 110 temperature 38°c , RBS12mmol/L
Cause of candidiasis
Hyperglycemia- Undiagnosed type 2 diabetes mellitus
Management of the patient:
Detailed history;
Previous, polyuria, polydipsia, polyphagia, weight loss then general head to toe physical examination
Get IV access; give IV Fluids (Normal saline)
Give antipyretics
Start antifungal per vaginal
Investigations
HbAlc for confirmation of diabetes mellitus
UECS, LFTs to check on organ damage.
CBC and C-reactive protein to check on sepsis
Differential Diagnosis
Bacterial Vaginosis
Sexually Transmitted Infections |
ID_IZKNZ | I am a nurse with 2 years of experience in General nursing working in a Health centres in Kakamega county in Kenya. A 32yrs old lady comes in with weakness of the right side of the body. Has a history of having been strike by lightning BP 100/60mm/hg, she is conscious and talking What is the treatment of lightning strike, should I admit the patient? | Summary
A 32-year-old lady comes with weakness in the right side of her body. Has a history of being struck by lightning. BP 100/60.
Management
Admit the patient, Primary survey, analgesics, IV fluids, monitor vitals, catheterize, physiotherapy
Lab workups: FHG, UECs, LFTs
Radiology: ECHO< ECG |
ID_SFTVB | I am a nurse with 14 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Uasin Gishu county in Kenya. A 24-year-old, comes in second stage of labor with cord presentation. Para 1+0 with a history of precipitate labor. Assessment: Upon examination there is cord prolapse and continuous urge to push. A fresh still birth is delivered thereafter. Questions: What is the relationship between precipitate labor and cord prolapse? What is the benefit of emergency caesarian section in this case? | Summary:
A 24-year-old in the second stage of labor with cord prolapse and precipitate labor. Stillbirth delivered.
Differential Diagnosis
Still birth
Cord prolapse
Precipitate labour
Question:
Is there a relationship between cord prolapse and precipitate labor?
Assessment: No relationship exists. The cause could be amniotomy or prolonged labor.
Management:
Emergency cesarean section minimizes oxygen deprivation to the fetus, reducing complications and improving survival. |
ID_TEFMS | I am a nurse working in a Dispensaries and Private Clinics in Kakamega county in Kenya. A three year old child is brought at OPD with history of convulsions for three times and fever. There is no history of trauma and the child has been given Panadol syrup at home. On examination the baby is febrile with a temperature of 39 degrees Celsius.
An MRDT is done and it is negative. Is this severe febrile illness? Which medication should I administer? Should I refer the child for admission and further investigations? | A three year old presents with Hx of convulsions and fever.No hx of trauma and has received Panadol syrup at home
On examination is febrile.Malaria test is negative
Diagnosis:febrile convulsions
Which medication should I administer?
This is likely a bacterial infection ,management involves;
-Administration intravenous broad spectrum antibiotics such as ceftriaxone
-Administer antipyretics to manage the fever
-Administer anticonvulsants such as diazepam
-Expose child to lower temperature
Should I refer to the child?
Yes
The child would need blood work up to identify the possible causative agent.For this a blood culture and sensitivity would be required
Admissions would be required since intravenous medications together with close examination is warranted |
ID_MWHSU | I am a nurse with 10 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 15 years old female presents at an urgent care center after burning her hand while cooking. presents with burn wound, redness and blisters cover the arm posteriorly wound cause of bleeding and exposure of muscles.T – 37.5 ?C Resp – 20 r/m Pulse – 68 b/m BP – 110/60 mmHg
Questions:
1.What is the management of the patient? | SUMMARY
A 15 year old female presents with burn wound after an accident while cooking. The wound has redness and blisters covering the arm posteriorly. Vitals BP 110/60, other vitals are within normal ranges
MANAGEMENT OF THE PATIENT
Admit
Give IV fluids(4mls/kg/ total burn surface area) to prevent shock
Give analgesics
Do debridement of wounds - mechanical debridement using gauze
Give antibiotics
Apply topical antibiotics and topical antifungals on wound
Give anti-parasitics
Give antihistamines
Give hematinics
Deworm your patient
Refer to a plastic surgeon for further management
DIFFERENTIAL DIAGNOSIS
Thermal burns
Drug allergy
Chemical burns |
ID_FKBJZ | I am a nurse working in a Health centres in Kiambu county in Kenya. A two-month-old baby was brought by a police officer after having been abandoned in a thicket. The baby was crying a lot. He had cold extremities and was malnourished.
Do I keep the baby? Where will I take this baby? Should I report to the children's department office? What is the HIV status of the baby? | SUMMARY
A 2 month old baby abandoned brought in irritable with cold extremities and malnourished
Do l Keep the baby?
Yes, do baselines test to assess baby's health Status.
Tests such as blood slide for malaria parasite, HIV status, mid-upper arm circumference, random blood sugar in case of any derangements, intervene
Should I report to the children's department?
Yes
What is the HIV state of the baby?
This will be guided by the baseline tests. |
ID_XOAYI | I am a nurse with 17 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 20 year old male is brought to the emergency department with severe headache for the last 2 days. There is a history of a fall during rugby game.
On examination patient is in pain, right orbital oedema, right red eye. Vitals: Temp 36.2, Resp 12b/m, Pulse 94b/m, BP 130/70 mmHg, pain 8.
Questions
What is happening to the patient?
What is the immediate management?
Who should be consulted on the management of the patient?
Which laboratory tests and radiological investigations will aid in the management? | Summary
A 20 year old male with a severe headache for the last 2 days . There is a history of a fall. On examination, patient is in pain, right orbital edema, right red eye vitals-stable.
Concerning for head injury
I would therefore manage the patient as follows
1st pur a cervical collar
Analgesics for pain management
Mannitol
If SPO2 <90% give O2
Elevate heat at 30 degrees
Phenytoin
Laboratory investigations_x0001__x0001__x0001_Radiological investigation
UECs_x0001__x0001__x0001__x0001__x0001__x0001_Head CT Scan
LFTs
FHG
A Neurosurgeon should be consulted. An ophthalmologist should also review the right red eye. |
ID_VWAIT | I am a nurse with 30 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 50 yr old female presents with complaints of right hand numbness (fingers and palm) for 5 days(2nd episode) . A known hypertensive on amlodipine. On examination, there is sudden speech slurring and drooling of saliva. Vitals: BP- 150/110 mmHg. PR-50b/min, RR-10b/min, Temp- 36.1oc, spo2—78%, RBS- 1.0mmol.
Questions
What is her emergency care?
What investigations need to be done?
What is the subsequent management? | A 50 year old female presents with complaints of right hand numbness for 5 days. She is a known hypertensive patient on amlodipine. On examination: Vitals: BP- Hypertension 150/110, pulse 50b/min - bradycardia RR-10 reduced. Temp normal 36.1°C; Desaturating at 78%. Sudden speech slurring and drooling of saliva. RBS-1.0mmol.
Hypertensive patient with features suggestive of stroke with underlying severe hypoglycemia and hypoxia.
Q: What is her emergency care?
Primary survey and patient stabilization. ABCs.
Ensure airway is patent, suction secretions (drooling); position and secure airway - Guedel/Intubation.
Assess breathing - supplemental O2 via NRM 10L O2 high flow targeting for saturations > 90%.
Circulation- Fix 2 bore IV Cannulas; collect blood samples and correct hypoglycemia - D50% bolus then D10% to have correct hypoglycemia.
Administer iv labetalol # presses as required.
Fix a urinary catheter to monitor Input/output.
Fix ecg lead to continuously monitor for arrhythmias eg. Atrial fibrillation
Get an urgent non-contrast head CT - ischemic vs hemorrhagic stroke
Ischemic stroke - thrombolysis eg IV alteplase if meets criteria; initiate antiplatelet therapy eg aspirin.
Hemorrhagic stroke - neurosurgical review, control BP,
initiate AVT prophylaxis if no bleeding risk e.g. LMW.
Fix NGT for feeding.
Review with specialist
Consider ICU care.
Investigations:
CBC
GXM
UEC/LFTs
ABG
RBC
Lipid profile
Coagulation profile
Radiological:
Non-contrast head CT
ECG
Chest x ray
Subsequent management:
Managing hypoglycemia - dextrose
Monitoring and controlling BP
Managing type of stroke
Rehabilitation - speech therapy, physical therapy
DVT prophylaxis
Lifestyle modification
Close follow-up in clinic
Differentials
Stroke in a hypertensive patient with hypoglycemia and
Transient ischemic attack |
ID_CQUSC | I am a nurse with 20 years of experience in Primary care working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 14-year-old boy was seen with gapping of the operation site following a laparotomy done 5 days ago secondary to trauma. AVPU at A. Not in pain Question: 1. What is the management of the patient? | Summary
A 14 year old boy seen with gapping of an operation site following laparotomy 5 days ago secondary to trauma. AVPU is at A. Not in pain.
The diagnosis
Wound dehiscence.
Management
- Evaluate extent of wound separation.
- Check for signs of infection.
- Sterile wound coverage to prevent further contamination.
- Prepare for possible surgical intervention - debridement.
- Broad spectrum antibiotics.
- Wound culture & sensitivity testing.
- Monitor vital signs.
- Nutritional support.
- Hydration. |
ID_UFAIG | I am a nurse with 12 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Kiambu county in Kenya. A para 2+0 Gravida 3 mother came for first ANC visit at 34 weeks gestation. On examination, the PITC and VDRL turned positive. Which medication should immediately be initiated to the mother? what medication should the infant given immediately after delivery? | A mother, para 2 + 0 gravida 3 at 34 weeks gestation, presents for her first antenatal clinic visit. On exam, PITC and VDRL turned positive.
Management:
Medication to be initiated:
Benzathine penicillin IM for syphilis
Antiretroviral medication
Medication for the infant:
Antiretroviral drugs or penicillin for congenital syphilis |
ID_HQOIZ | I am a nurse with 27 years of experience in General nursing working in a Health centres in Uasin Gishu county in Kenya. A 22-year-old female patient comes to the clinic with complaints of epigastric pains, nausea and vomiting for 3 days. She has had a diagnosis of Peptic ulcers for the last 2 years. She has been on omeprazole and antacids on and off. She cannot retain anything orally. She is a student and is single. On examination. She has rebound tenderness at the epigastric region. Vital Signs- BP-114/71 mmhg Pulse - 79/min Temp-32.1°c Spo2 - 96%.
Questions Other systems are okay
a) What Investigations should be done?. B) How can she be managed? | Summary:
A 22 year old female patient with complaints of epigastric pain, nausea and vomiting for 3 days. Had PUD for 2 years. Has been on Omeprazole and antacids on and off. Cannot retain anything orally. On examination- Has rebound tenderness at the epigastric region.
BP-116/71 _x0001_P-76/min _x0001_SPO2-96%
Other systems- Unremarkable
Concerning for: Acute gastritis
Management is as follows:
* Antiemetic.
* Analgesics - Avoid Non steroidal anti-inflammatory drugs.
* Proton pump inhibitors
* Antibiotics - Flagyl/Clarithromycin.
Investigations:
* H.pylori antigen
* Pregnancy test
* Stool for occult blood.
* Full hemogram
* Urea, electrolyte and creatinine
* Liver function tests |
ID_MLHTC | I am a nurse working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 48 years old lady was admitted with complaints of easy fatigue, left lower leg swelling, early satiety and left lower leg weakness.
On examination: She is pale and jaundiced. Blood works: CBC -WBC 19.02, Hb 6.0gm/dl. Bp 100/60 mmhg P 102b/min
Questions:
What investigation can be done?
What management will be offered to the client? | SUMMARY
48-year-old with easy fatigability, left leg swelling, weakness, and early satiety.
Vitals: Hypotension, tachycardia.
Laboratory: Anemia, high white blood cell count
Dx:
Sepsis
Anemia
Management/Investigation:
Liver function tests to check on albumin - indicator of sepsis chronicity
Take samples for blood microscopy and sensitivity.
Sample for group and cross-matching and get blood for transfusion.
Start on antibiotics in view of high white blood cell count
In view of anemia, Peripheral blood film and reticulocyte count: A bone marrow aspiration (BMA) may be considered. |
ID_GTWCL | I am a nurse with 30 years of experience in General nursing working in a Health centres in Uasin Gishu county in Kenya. A female, 59 years old patient complains of oral sores for the last 2 days. Chest pains and fever for the last 3 months. History of night sweats, loss of weight. No history of coughing. Temperature – 37.7 ?C, pulse – 68b/min, respiration rate 18b/min, blood pressure – 130/70 mmHg and SP02 – 90% room air.
Questions:
What is the possible diagnosis?
What differential diagnosis?
What is the immediate management?
What investigations can be done? | Summary
A 59 yrs old female presents with complaints of oral sores for the last 2 days accompanied by chest pain, fever for the past 3 months, night sweats and weight loss. Vitals show patient is febrile, low saturation levels of 90%.
Problems
* Chronic fever
* Chest pain
* Weight loss
* Oral sores
* Low SpO2
Management
* Administer antipyretic for fever
* Administer analgesics for chest pain relief
* Ensure oral care for the oral sores such as topical antiseptics
* Start Oxygen therapy for the low SpO2
* Regular monitoring of vital signs
* Refer to a specialists (pulmonologist, cardiologist)
* Administer broad-spectrum antibiotics if infection is suspected.
Investigations
* Chest X-ray - to assess lung pathology e.g TB
* Sputum culture - evaluate for mycobacterium tuberculosis
* HIV test
* Complete blood count check for signs of infection
* C-reactive protein & Erythrocyte sedimentation rate check inflammation
* Oral swab culture
Preferred diagnosis (Dx)
* Tuberculosis |
ID_DWGSV | I am a nurse with 10 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 66 years old female is in the orthopaedic ward, 3rd post-operative day. She was done right knee replacement. She is complaining of right calf pain on movement. Vitals; Temp. 36.20C, Pulse – 76b/min, Resp. – 20 b/min, BP 136/60mmHg. Questions: What type of investigations should be done to the patient? What is the management of the patient? | A 36 year old female with right knee replacement 3 days ago presents with right calf pain on movement.
Dx: Deep Venous Thrombosis
DDx: Compartment Syndrome
Sepsis
Management
Proper physical exam to assess for paresthesia, pulselessness, swelling to check for compartment syndrome
Doppler ultrasound to check for deep vein thrombosis.
Analgesia to manage pain.
If compartment syndrome confirmed, inform orthopedic team for fasciotomy
If Deep Vein Thrombosis is confirmed, inform the physician, anticoagulation team to start on blood thinners.
Blood works to check for sepsis: Full hemogram and C-Reactive Protein |
ID_YRTKV | I am a nurse with 38 years of experience in General nursing working in a Health centres in Uasin Gishu county in Kenya. A 48 year old male client is escorted to the level 3 health facility by his spouse with complaints of dizziness, and falls for a duration of three days. The patient has a history of atrial fibrillation and is taking warfarin tablets. On assessment small bruises are noted on his left arm, pulse 58 beats/minute, blood pressure 130/80 mmHg, temperature 36.4 degrees Celsius, spo2 90%. The patient reports feeling weak and has a pale conjunctiva.
Questions
What could be wrong with the patient?
Which priority nursing action should be taken?
What diagnostic investigations should be considered first? | Summary
A 48 year old male with a hx of dizziness and frequent falls on warfarin tablets due to atrial fibrillation. On exam noted small bruises on left arm vitals are normal with slight bradycardia ,noted to be pale and lethargic
Diagnosis:warfarin side effects
Immediate nursing care
Put the patient in a couch and elevate the head at 45 degrees
Do cleaning and dressing on the bruises
Urgently refer the patient to a cardiologist for further evaluation and management
Thyroid function test
Full hemogram
Urinalysis
RBS
urea,electrolytes and creatinine
liver function test
doppler ultrasound to rule out blood clots |
ID_UKYNV | I am a nurse in General nursing working in a Dispensaries and Private Clinics in Kakamega county in Kenya. A female client presents with history of coughing up blood for 1 week,loss of body weight and hoarseness of the voice. She has been loosing weight with no apparent reason. Weight 55 KGS,coughing, lymphadenopathy.Lung cancer diagnosed. Where do I reffer the client to?which basic care do I give before referral? | Summary:
A female client presents with a history of coughing blood for 1 week, loss of body weight, and hoarseness of voice. History of weight loss.
Weight - 55 kg, coughing, lymphadenopathy.
Diagnosis:
Pulmonary TB
Pneumonia
Lung cancer.
Management:
I would manage the patient as follows:
Immediate care:
Assess if the patient has any life-threatening condition.
Do vital signs, including RBS.
Primary survey ABCDE:
Airway patency and c-spine.
Breathing - look, listen, feel. If SPO2 < 90% - oxygen supplementation.
Circulation - IV cannula, IV fluids; RBS < 4 mmol - give D50.
Analgesics - pain management.
Cough syrup.
Nutritional support.
Labs:
FHG, UEC, LFT., gene expert
Tumour marker.
Radiology:
Abdominal-pelvic, chest CT scan.
Chest X-ray. |
ID_IVWZD | I am a nurse with 10 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. 40 years old female was brought to hospital with history of hotness of the body ,general body weakness, no history of travel to malarial endemic areas ,no signs of flu, Vital signs Temperature- 39C, pulse-110/min,Respirations-20/min,bp-100/60mmHg, spo2 -97%, CBC done indicated raised WBC. Questions: What is the diagnosis of this patient? What is the immediate medical management of this patient? | A case of a 10-year-old female.
Complaint: History of hotness of body.
Generalized body weakness.
No travel history to malaria-endemic zones.
No signs of flu.
Vital signs: Febrile (39°C), otherwise normal.
Complete blood count count: Raised white blood cell
Immediate Management:
1. Admit.
2. Ensure intravenous access.
3. Give intravenous fluids.
4. Give antipyretics for the fever.
5. Nutritional support.
6. Empirical antibiotics for possible infection.
7. Blood culture.
8. Malaria test.
9. Sputum analysis.
10. Monitor vitals.
11. Alert medical officer in charge |
ID_LXLCR | I am a nurse working in a Sub-county Hospitals and Nursing Homes in Uasin Gishu county in Kenya. A lady of 32 years comes to the postnatal clinic 2 weeks after normal delivery with complaints of pelvic pain, fever, foul smelling vagina discharge and delayed reduction of uterine size. On assessment; temperature 360c, pulse 90 beats/minute, respiration 26 breaths/minute, blood pressure 130/85mmHg and SPO2 98%.
Questions
What is the diagnosis?
What is the immediate management of this patient? | SUMMARY
32-year-old, 2 weeks postpartum, with pelvic pain, fever, foul-smelling vaginal discharge, and delayed reduction of uterine size. Tachypnea
Q: Diagnosis:
Postpartum Sepsis
Q: Management:
Admission
IV line
IV antibiotics + Fluids
Investigations:
Lab: Full Haemogram, UEC, GXM, CRP
Imaging: Pelvic scan to rule out retained placenta or endometritis |
ID_ZDYDI | I am a nurse with 19 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A female neonate is brought in with gasping respirations 2 hours after birth. She was born via emergency caesarean section to a mother with one previous scar at 39 weeks of gestation. APGAR score was 8/1, 9/5, 10/10. Birth weight was 3400 grams and is saturating at above 94% on room air. She is floppy, dusky and has a heart rate of 45bpm, RBS 4.5mmol/l, Temp 36.6, and SPO2 unrecordable. Question: What is the immediate management of this patient? | Summary
Neonate referred to a national referral hospital 2 hours post-delivery via cesarean section delivered at 37 weeks. Apgar score 8 at 1, 9 at 5, 10 at 10. Birth weight 3400 grams.
SPO2 >94%
Assessment findings: Floppy, dusky, heart rate 45 bpm.
RBS 4.5 mmol/l Vitals T. 36.6°C
Impression:Respiratory failure
Immediate Management:
Position the head in neutral position and start suction.
Provide positive airway pressure to maintain SPO2 at ≥ 94%.
Start chest compressions if the heart rate remains at a figure of less than 60 after ventilating.
Provide a radiant warmer to maintain temperature at 36.5°C to 37.5°C.
Check random blood sugar frequently.
Monitor vitals.
Investigations
Arterial blood gas to assess oxygenation
Septic screen: Complete blood count, C-Reactive protein/Procalcitonin
Urea, electrolytes and creatinine to check metabolic derangements.
Once stable, the patient can be transferred to NICU. |
ID_OFPVA | I am a nurse with 15 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Kiambu county in Kenya. A one-year-old baby is brought in by a mother with history of having ingested jik of unknown amount two hours ago. How do I manage this baby? Which treatment can I give? | SUMMARY
1-year-old baby presenting with ingestion of Jik.
Dx: Jik poisoning
Management:
Ensure the baby has a patent airway, normal breathing, and stable vitals.
Do not induce vomiting to prevent further damage to the esophagus and oropharynx.
Do not use milk and vinegar to avoid further damage.
Place the child on the side to prevent aspiration.
Consult a pediatrician for possible endoscopic evaluation.
Give activated charcoal.
Give fluids. |
ID_NNZOK | I am a nurse with 8 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Uasin Gishu county in Kenya. An elderly female patient is brought to the emergency department by her relatives with complains of chest pains and a history of Angina.
On assessment the vital signs are, Blood pressure 110/70 mmHg, SPO2 98%, pulse 102 beats per minute, Temperature 36.5 0 C.
Questions:
What is the appropriate intervention?
What radiological investigation would the patient benefit from? | Summary
An elderly female with complaints of chest pain and a history of angina.
Vitals are normal.
Momentum: Probable localization.
This presentation is concerning for:
1. Myocardial infarction
Interventions include:
1. Primary interventions:
a. Administer oxygen via non rebreather mask.
b. Analgesia - Morphine is the best option.
c. Administer thrombolytics like alteplase if the 3-hour bracket has not been exceeded.
d. Administer aspirin 325 mg.
e. Monitor vital signs closely.
Radiological Interventions include:
1. echocardiogram - Rule structural heart disease.
2. Electrocardiogram - Rule out cardiac muscle problems.
3. Chest X-ray - Rule out pneumonia.
4. Esophagogastroduodenoscopy (OGD) - Rule out Peptic ulcer disease. |
ID_QTNQH | I am a nurse working in a Dispensaries and Private Clinics in Kakamega county in Kenya. A middle-aged mother came to our facility with a history of severe chest pain radiating at the back for two days. The mother says she bought some drugs from the chemist which she used but the pain still persists. The question is, should I send this mother for chest X-ray? Could this be pneumonia? | Summary:
A 70-year-old female presents with progressive neck pain, difficulty walking, and numbness in both hands. Vitals normal except elevated pulse rate.
Investigations: MRI, CBC, CRP
Management:
Prescribe NSAIDs and recommend physical therapy for symptom relief.
Refer to orthopedic surgery for decompression and stabilization.
Monitor for worsening neurological symptoms.
Diagnosis: Cervical Myelopathy. |
ID_ZOSEH | I am a nurse working in a Dispensaries and Private Clinics in Kiambu county in Kenya. A two week old baby brought the history of dry skin, yellow discoloration of the skin and eyes and refusal to breastfeed. Should I refer or tell the mother to expose the baby to sun? | summary
2 week old baby with dry yellow skin and eyes with refusal to breastfeed.
SHOULD YOU REFER THE BABY OR TELL MOTHER TO EXPOSE CHILD TO SUN
1. Already child has refused to breastfeed hence intervention is required immediately.
If available:
> Lab tests for: Blood group and crossmatching to rule out ABO and Rh incompatibility that can cause jaundice. Bilirubin levels on LFTS. CBC
2. Initiate phototherapy, if not available refer child to the nearest hospital with NBU facilities.
Diagnosis; Neonatal sepsis
Differentials; Neonatal jaundice |
ID_GULKY | I am a nurse working in a Dispensaries and Private Clinics in Kiambu county in Kenya. Female client aged 36 years old comes in with a child one month old and expresses that the umbilical cord of the baby has never dried up. On examination, the stunk is wet ++ with pulse. What are the possible risks involved in this case? What are the possible counselling options to the mother? And what are the outcomes of the treatment? | SUMMARY
1 month old baby wet-umbilical cord
Dx: omphalitis
Ddx: Q1 Risks of septic umbilical cord include
sepsis
peritonitis
Counsell the mother on good hygiene methods for umbilical cord care.
Promote health education on the risks involved.
The treatment outcome is good if treated effectively with antibiotics. |
ID_OUECW | I am a nurse working in a Dispensaries and Private Clinics in Kakamega county in Kenya. A1yr old child has hx of not being able to walk well following the immunization that was done. At 3/12 the baby was given the vaccines that caused paralysis of the lower limb , so the mother has been using warm water to massage the limb. The baby has lower limb deformity making him not to stand well. Was the baby born with deformities or was caused by the vaccine immunization? How can l reassure the mother that by bringing the child for physiotherapy it will be well? | Summary
a 4 yr old child has a history of not being able to walk since immunization at 3 months. The baby has lower limb deformity making him unable to stand well.
Was the baby born with deformities or was caused by the vaccine immunization?
It is possible the baby had skeletal deformity such as club foot upon birth that was only realized at 3 months.
Differentials
Contractures
Polio
Malnutrition
Metabolic bone disorders
How can I reassure the mother that by bringing the child for physiotherapy it will be well?
As much as the physiotherapy is going to improve the child's ability to walk, the nurse cannot say for certain that the child is going to recover fully and be well. |
ID_QRYLO | I am a nurse with 8 years of experience in General nursing working in a Health centres in Kakamega county in Kenya. 14 years old girl, came with malaise, fever, chills. She completed AL full dose one day ago. Investigation done, BS for MPS was negative. Salmonella type 3, not done.
Pregnancy test, negative. The LMP started 2 days ago. How can I manage the patient? Should I refer the patient for more investigation? | SUMMARY
14 year old Female presents with malaise, fever, chills. Completed AL full dose 1 day ago for malaria treatment. Last menstrual period started 2 days ago.
Investigations: BS for MPS negative, pregnancy test negative, Salmonella Type 3 not done.
Management:
Administer IV fluids for hydration.
Antipyretics for fever.
Investigate thoroughly to find cause:
Blood slide for malarial parasites.
Salmonella cultures.
Blood culture.
If malaria: Antimalarials, ensure compliance.
If typhoid: Antibiotics.
Referral if symptoms persist. |
ID_YOMUU | I am a nurse with 22 years of experience in General nursing working in a Health centres in Kiambu county in Kenya. A three-year-old child was brought to the facility with history of coughig, running nose, hotness of the body on a dose has been treated with antibiotics like Amoxicillin DT, augmentin and the problem is still persisting.
What is the best medication for this child? Do I refer the child to the physician for more investigations and treatments? | Summary
A 3-year-old child with coughing, running nose, hotness of the body, and history of oral antibiotic use (e.g., Augmentin) without improvement.
There are features of ongoing infection despite oral treatment. Could be due to poor dosage, drug resistance, reinfection, or viral causes not responsive to antibiotics.
Management:
Admit the patient.
Establish IV line access and obtain samples for culture and sensitivity.
Initiate IV fluid therapy.
Administer:
IV antipyretics to manage fever.
Analgesics for pain.
Consider switching to a different class of antibiotics once investigations are out.
Investigations:
Laboratory:
Full hemogram.
C-reactive protein.
Malaria blood slide.
Sputum for microscopy, culture, and sensitivity.
Imaging:
Chest X-ray. |
ID_FSIJY | I am a nurse with 20 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Uasin Gishu county in Kenya. A 4-year-old girl was brought into the facility with complaints of diarrhea and vomiting. The condition started 4 days ago and was taken to a facility nearby and treated with no improvements. The child is sick looking, temperature 36.9, spo2 94%, pulse 60 bpm.Investigation done, malaria test negative, stool for ova and cyst- nothing detected.
Question:
What is the cause of gastroenteritis?
What investigation test to be done? | Summary:
4 year old
C/o Acute loose stool and vomiting x 4/7
No response to medication
O/E:
Sick looking
Vitals - Temp 36.9, SpO2 - 94%, Pulse - 60
Investigations done:
B/S for mps - negative
Stool got o/c - Normal
Dx:
Acute gastro-enteritis
Ddx: -Food poisoning
Infections:
E. coli
Shigellosis
Typhoid fever
Question 1: Cause of gastro-enteritis?
* Likely infectious causes
Question 2: What investigations?
a) Stool GOR culture and sensitivity
b) Salmonella antigen test
c) Full hemogram
d) Renal function test
e) Liver function test
f) Stool analysis |
ID_RQPAU | I am a nurse with 10 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 60 years old male with complaints of wound on the foot involving toes and plantar region reports no pain and no sensation for 3 weeks. On examination; the toes are gangrenous ,wound is exudating a lot of pus and the wound has no sensation, not known diabetic and has no hypertension, vital signs T-38c,P-100b/min,R-20b/min, BP-180/110mmHg, RBS- 16mmol/L
Questions
What is the immediate management?
What are investigations to be done?
How can the loss of sensation be assessed and managed to avoid further risk of injury? | Summary
A 60-year-old male with a complaint of wound on the foot involving toes and plantar region. Reports no pain and no reaction for 3 weeks. On examination, the toes and gangrenous wound exuding pus. Wound has no sensation. Not known diabetic.
Vitals:
T: 38°C, P: 100 bpm, RR: 20 bpm, BP: 180/110 mmHg, RBS: 16 mmol/L
From description:
Most likely diabetic foot, given absence of pain and sensation, infected wound with pus and uncontrolled sugar.
Immediate Management:
1. Optimize blood sugar controls for better outcomes.
2. Antibiotics for infection with pus.
3. Administer antipyretics for fever.
4. Wound debridement for faster healing.
Investigations include:
1. CBC.
2. RBS.
3. HbA1C.
4. CRP. |
ID_YVQUD | I am a nurse with 20 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. An 8-year-old is brought to the hospital by the parents with complaints of general body weakness, hotness of the body for two days. Parents report that she treated to acute lymphocytic leukemia 1 year ago and was taken abroad for bone marrow transplant. On examination, the girl is weak and sick looking, febrile, pale++, temp-39.4oC, p-138 b/m, r-28 bpm.
Questions:
What is the emergency management of this pattern?
What investigation will be done on this patient? | Summary:
A 36-year-old male presents with sudden onset of severe right lower quadrant abdominal pain associated with nausea and vomiting. The pain began 6 hours ago and has progressively worsened. Examination reveals tenderness and guarding in the right lower quadrant with rebound tenderness.
Investigations:
Perform an abdominal ultrasound to assess for appendicitis.
Order a complete blood count (CBC) to evaluate for leukocytosis.
Management Plan:
Admit for IV fluids and nil by mouth (NPO).
Administer IV antibiotics, such as ceftriaxone and metronidazole.
Prepare for emergency appendectomy.
Diagnosis: Acute Appendicitis. |
ID_JYLRR | I am a nurse with 18 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 24 year old male patient came to the facility with complaints of injuries sustained by hyena attack. The wounds were deep and actively bleeding. Temperature 36.00c, Pulse 98 beats/minute, respiration 23 breaths/minute, blood pressure 100/78mmHg.
Question(s):
What is the immediate management of the patient? | Summary
A 24 year old male with complaints of injury after sustaining a hyena attack. Wounds were deep, actively bleeding.
T-36 P-98 RR-23/min BP-100/78
I would manage the patient as follows:
Primary survey- ABCDE-
Circulation- Fix a large bore IV cannula and give fluid.
Arrest the bleeding- apply pressure on bleeding points.
Analgesics for pain
Wound cleaning and dressing
Tetanus toxoid vaccine
Anti-rabies vaccine
Prophylactic antibiotics
FHG- If Hb <7g/dl- transfuse
Lab
Full hemogram
Urea, electrolytes and creatinine
Liver function tests |
ID_WEFUI | I am a nurse working in a Dispensaries and Private Clinics in Kakamega county in Kenya. A middle-aged lady has come to the facility. Her age is 30. Her husband always assaults her every time.
She has nowhere to go and she has nothing to do. She asks me to advise her what to do, what can I tell the client. | Summary
A 30 years old woman presents with a history of being assaulted by her husband.
Dx: Gender-based violence
Management:
Involvement of gender-based violence advocates.
Psychological counseling. |
ID_HZLJV | I am a nurse working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 60 year old man comes to the follow up clinic after being discharged from the hospital 2 weeks ago due to right sided heart failure. On examination he has difficulty in breathing, diminished lung sounds with crackles in bilaterial bases. He represents a productive greenish cough and he has been a smoker for 35 yrs Question: What is the immediate care? What laboratory radiology needs to be done? What treatment prescription needs to be done? | SUMMARY
A 60-year-old man with a history of right-sided heart failure.
Presents with difficulty in breathing and productive greenish cough.
On examination, he has difficulty in breathing, diminished lung sounds, and bilateral crackles at the base of the lungs.
He has smoked for 35 years.
IMMEDIATE CARE
The immediate care to this patient involves the check of his vitals, particularly his SPO2, and give O2 if the SPO2 is less than 90%.
Monitor his input/output.
Admit the patient and investigate by doing the following:
Complete Blood Count for signs of infection.
C-reactive Protein levels for monitoring.
Imaging:
Chest X-ray.
Echocardiogram.
The definitive management:
Antibiotics: empirically as you await the laboratory and imaging results.
Nebulization with Salbutamol, a beta agonist, and a steroid.
Anti-TB, if the GeneXpert is positive |
ID_QOQTK | I am a nurse with 12 years of experience in Primary care working in a National Referral Hospitals in Uasin Gishu county in Kenya. ER, aged 92 years, female was brought in with inability to walk, abdominal pain, generalized body malaise and history of fecal impaction. On assessment she is sick with GCS of 4/15. BP-131/82mmHg, MAP-96 , HR-92, RR-17b/min, Temp-36.3 , SP02-68%.
Questions: What emergency care should patient ER receive? What investigation should be done? What is the diagnosis? | SUMMARY
72-year-old female with inability to walk, abdominal pain, generalized body malaise, and history of fecal impaction.
On exam GCS is 14/15 and low oxygen saturation.
Dx:
constipation
Altered mental status
Management:
Assess airway, breathing and circulation
initiate oxygen therapy if necessary, intravenous fluids if hypotensive or with features of shock
Establish intravenous line access.
Do a random blood glucose test
Perform a digital rectal examination. If fecal impaction, evacuate manually and also use enema
Investigations:
Laboratory:
Full hemogram to identify cytopenias and signs of infection
Renal function test to identify electrolyte abnormalities and uremia
Liver function test to identify derangement and possibility of hepatic encephalopathy
Random blood glucose to identify either hypoglycemia or hyperglycaemia and correct accordingly
Blood gas analysis to identify electrolyte derangements, acid/base abnormalities and correct appropriately
Radiology:
Computed tomography of the head to rule in/out space occupying lesions, features of meningitis/meningoencephalitis
Chest x-ray if patient has respiratory symptoms
Abdominal-pelvic ultrasound to aid in identification of masses |
ID_BQFXW | I am a nurse with 12 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Kiambu county in Kenya. A young lady Para 1 +0 plus 0. Gravida 2. Para 1? Para 1 +0. Para 1 plus 0. Gravida 2 means the second pregnancy. She has another child. The LNP of 1st, 9th, 23rd, the EDD of 10th, 10th, 2024, she is 38 weeks.
She comes in to the facility emergency department with complaints of body malaise or body weakness, muscle ache, lack of appetite, nausea and vomiting. She physically looks sick and she states that she has a history of travelling to Kakamega two weeks ago. The BP was 100 /60, pulse of 88, HB of 9.8 and random blood sugar of 6.3. fetal heart rates were present.
I requested for an MPS which was not done due to unavailability of the slides. refer for investigations and further management, start on antimalarials and hematins | Summary:
A para 1 gravida 2 with 38 weeks gestation prevents with body weakness, HB is 12
Management:
consider antimalarias, haematinics, deworming drugs, and hospital delivery advised
Diagnosis:
moderate Anemia at term
Anaemia in pregnancy is a relatively common phenomena and may be due to iron deficiency, malaria, worms. This could contribute the general body weakness. However , because of the nausea and vomiting, the DDX will be: |
ID_SVUKM | I am a nurse with 3 years of experience in General nursing working in a Health Centres in Uasin Gishu county in Kenya. A 13yr old girl in the ward with a diagnosis of spindle cell carcinoma already done with chemotherapy and radiotherapy sessions and now being managed for anaemia with Hb of 4g/dl goes into coma and is unresponsive to surrounding. The vitals are Bp 84/40mmhg Pulse rate-92/m SPO2 96% but on Oxygenvia nasal prongs at 3l/24hrs. RBS- High despite being started on insulin injection. Questions: 1. What can be done to this patient to reduce the blood sugars? 2. What might caused the patient move into coma? | Summary
13 year in the ward with a diagnosis of spindle cell carcinoma.Done with chemotherapy and radiotherapy sessions Being managed for anemia ,Hb 4 g/dl goes into coma.Hypotensive 84/40MmHg, SPO2 96 % on oxygen via nasal prongs.
RBS- High despite being on insulin.
What can be done to reduce the blood sugars?
Increase insulin dose.
Correct hypokalemia if there.
Check if the patient is using corticosteroids because they cause excessive hyperglycaemia.
Administer intravenous fluid to the patient.
Causes of coma in the patient.
Hyperglycemia
Severe anaemia
Tumour progression
Sepsis
Diabetic ketoacidosis |
ID_RAMZU | I am a nurse with 29 years of experience in General nursing working in a Health centres in Uasin Gishu county in Kenya. A teenage boy aged 22 years walked into the clinic complaining of loose motions which
Started one day ago.
On examination the boy looked weak with sunken eyelids. Vitals 90/50, pulse 120,
respirations 18, temperature 35, SPO2 95%.
Questions:
1. What could have caused the diarrhoea?
2. What investigations could be done to make a diagnosis? | SUMMARY
22 year old boy complaining of loose motions for one day.
On examination: weak
Sunken eyelids
Vitals; BP 90/50
Pulse 120
Other vitals normal
1.CAUSE OF DIARRHEA
Food poisoning
Infection eg cholera
2.INVESTIGATIONS
Full hemogram-check white cell count for infection
Stool analysis-culture,microscopy for sensitivity
Blood culture |
ID_KMYZY | I am a nurse with 2 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Uasin Gishu county in Kenya. A 20 year old male presents to the facility with complaints on the ankle and swelling after twisting his ankle while playing basketball.
On assessment the pain is severe and unable to bear weight on the affected ankle. BP 126/87 mmhg, HR 72, RR16, T 36.7, SPO2 95%.
Question: What is the immediate management? | Summary
20 year old male with pain at the ankle joint after a basket match.
This is concerning for trauma in the ankle joint
Diagnosis
Tendon injuries following blunt trauma
DDx:
Fracture of tibia Fibula
Sprain
Haemarthrosis |
ID_WABQX | I am a nurse with 17 years of experience in General nursing working in a Dispensaries and Private Clinics in Kakamega county in Kenya. Groaning in pain after being stung by bees. No history of chronic illness or allergies. Swollen face and arms with visible bee stings Should I give an analgesic and a steroid? | Summary
Groaning in pain after being stung by bees. No history of chronic illness or allergies. Swollen face and arms with visible bee stings. Should I give an analgesic and a steroid?
This is a concern for bee stings.
Management of the patient as follows;
Administer analgesic and antihistamine.
In case of severe anaphylactic reactions like oedema and stridor of airway obstruction administer epinephrine and set up a cardiac monitor electrocardiogram.
In severe cases, administer steroids (hydrocortisone).
Admit severe cases of anaphylaxis for monitoring. |
ID_USIEY | I am a nurse with 12 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Kiambu county in Kenya. A mother aged 40 years para 3+0 gravida 4 with gestation of 38 weeks is brought by relative with complaint of lower abdominal pain and ruptured membrane. On exam a diagnosis of occipital posterior position was made. What are the possible outcome of occipital posterior position and their management? | 40-year-old mother, para 3+0, gravida 4 at 38 weeks gestation, presents with lower abdominal pain and ruptured membrane. On examination, a diagnosis of occipitoposterior position made.
Dx: fetal malpresentation
Ddx
Compound presentation
Inadequate pelvis
What are the possible outcomes of occipital posterior position?
Severe birth asphyxia.
Delayed second stage.
Shoulder dystocia.
Obstructed labor
Management:
Emergency cesarean section.
Vacuum assisted delivery.
Admit neonate to Newborn intensive care unit . |
ID_DDTPK | I am a nurse with 30 years of experience in General nursing working in a Health centres in Uasin Gishu county in Kenya. A 60 years old patient complains of retrosternal pain. Pain is stabbing in nature and is long standing relieve with pain killers but now intensified. Blood pressure -150/60 mmhg
Questions:
What is the possible diagnosis?
What is the immediate management?
What is the long term management?
What investigations could be performed? | summary:
60 year old patient has retrosternal pain.
The history given is not adequate, however, the causes of retrosternal pain would include;
This patient should be referred for investigation |
ID_CEGVK | I am a nurse with 18 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 20 year old female patient came to the hospital with complaints of severe lower abdominal for 2 days. She is nulliparous. She had been in marriage for 2 years without a baby. She bought medicines in a clinic and she was told they are fertility drugs. Vital signs; Temperature 36.60C, pulse 121 beats/minute, respiration 16 breaths/minute.
Question(s):
What is the differential diagnosis?
What investigations can be done? | A 20 year old female patient with complaints of severe lower abdominal pain for 1-2 days. She is nulliparous, and has been in marriage for 2 years without a baby. She bought medicine which were fertility drugs. Vitals: 36.6 temp, pulse 121 bpm, resp 16 bpm
Lab investigations to be done
Complete blood count
Urea creatinine and electrolytes
Urinalysis
Pregnancy diagnostic test.
Blood grouping and crossmatching
Radiological
Abdominopelvic ultrasound
Erect abdominal X-ray |
ID_ONVGJ | I am a nurse with 10 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A man was brought to the emergency department after a big tree fell on his abdomen, the patient is oriented and able to verbalize. The patient rates abdominal pain at 9/10. Patient is not able to ambulate and reports vomiting bloody vomit twice.
Questions
Which investigations need to be done?
How should the patient be managed? | SUMMARY
Male with abdominal trauma. Pain score: 9/10, unable to ambulate, hemoptysis noted. Patient is alert
Assessment:
Diagnosis - Splenic rupture
Management:
Investigations:
full hemogram, Urea, electrolyte and creatinines, blood group and cross matching.
Focused Assessment by Sonography of Trauma ultrasound, abdominopelvic X-ray.
Priority Care:
Check for open bleeding and apply pressure.
Establish intravenous access with large bore intravenous lines, giving crystalloids.
Check hemoglobin, transfuse packed red cells/whole blood if needed.
Administer antifibrinolytics
Perform Focused Assessment by Sonography for Trauma to localize hemorrhage.
Address airway and breathing, give oxygen if hypoxic.
Monitor GCS, manage hypoglycemia with Dextrose.
Prepare for surgical intervention. |
ID_OFZHH | I am a nurse with 20 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Uasin Gishu county in Kenya. Mother brought a 4-year girl having rectal prolapse who had been seen in another facility. The mother reported the same condition several times and had been taking the child to a hospital for management, now the prolapse persisted despite being managed in the hospital. Vital signs temperature 37o, spo2 98, pulse 70 bpm.
Question:
What could be causing the rectal prolapse
What’s the immediate care management? | Summary
A 4 year old referred with rectal prolapse has occurred severally and persistent on this episode. Vital signs: Temperature - 37 celsius, SpO2 - 98 %, PR 70 b/min
Immediate care management
Manual reduction
Gently reduce the prolapse to prevent further complications
Advice the mother to prevent straining during defecation
Ensure the child is well hydrated and nourished
Refer the patient to a referral facility where the patient can be managed by a pediatric surgeon or gastroenterologist |
ID_LNEJH | I am a nurse with 14 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Uasin Gishu county in Kenya. A 32 year old female patient came to the facility with a history of experiencing severe headaches for the past one year, which occurs approximately 2-3 times per month. Patient reports nausea and vomiting during the headache attack. She also has blurred vision.
On assessment: Temp – 36.8 degrees Celsius, P – 76 b/m, R – 18b/m, BP – 130/80 mmHg.
Questions
What is causing a severe headache?
What laboratory and radiological investigation can be done?
What is management? | Summary:
32 y/o old female presents with severe headache for one week, nausea and vomiting.
Assessment: Vitals normal.
2. Investigations:
These are aimed at ruling out other differential diagnoses, e.g., migraine headache vs. tension headache vs. cluster headache.
Radiological imaging studies, e.g., CT scan/MRI.
Lab tests, e.g., CBC, ESR, FBC.
3. Management:
The drug recommended for migraines are Triptans e.g., Sumatriptan. These, however, are likely to be unavailable & expensive.
I can supplement with NSAIDs combined with a muscle relaxant.
One is also advised to avoid triggers, e.g., physiological stress, certain foods like chocolate.
Ensure adequate hydration as dehydration is also a trigger.
Diagnosis:
Migraine headache. |
ID_VSHPC | I am a nurse with 10 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A patient complains of swelling on the right upper limb and the right side of the trunk Patient received post splenectomy vaccines one day before swelling in the surgical ward. Splenectomy was done following a road traffic accident where he sustained ruptured spleen Assessment: On palpation of the swelling there is air leak below the skin. Vitals BP 128/70 mmHg, Pulse 90 bpm, Respirations 18/minute & SPO2 80% Questions: What caused the air leakage to the subcutaneous tissue? What is the management? | Summary
Air leak on the right side of the chest associated with desaturation.
Dx
Subcutaneous empysema
DDx
Hemothorax
Pneumothorax
Causes
Iatrogenic injury to the right bronchus during intubation by the anaesthetic
Injury to the diaphragm during surgery
Put on oxygen
Do a an Xray of the chest.
Put a NGT
Management
Surgery to repair the injury. |
ID_NIACK | I am a nurse with 2 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Uasin Gishu county in Kenya. A 3 year old child presents with hotness of the body, pain on swallowing and neck pain. On assessment there is bilateral tonsil enlargement and inflammation. Temperature 38.2, PR 121b/m, SPO2 93%, RR 18. Question: What could be the possible diagnosis of this patient. | Summary
A 3-year-old child presenting with hotness of the body, pain on swallowing, and pain in the neck. The child has bilateral tonsil enlargement on physical assessment.
Dx:* Acute tonsillitis, which is an inflammation of the tonsils mostly caused by viral and bacterial infections. |
ID_VZVPQ | I am a nurse with 19 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 14-year-old girl brought in by the teachers had collapsed in class after lunch.
The girl has been well with no known medical or surgical history. She is a day schooler who lives with her parents. She is a quiet girl who doesn’t mingle much with other girls. She hasn’t had any disciplinary issues in school.
On assessment the girl is unresponsive to verbal stimulation. Not in respiratory distress, not pale and not dehydrated. PR 84 bpm, RR 16 bpm, Spo2 95% on room air, Temperature 36.80 C. RBS 4.7mmol/L. Physical examination findings normal.
Questions
What is the management of this patient?
Which investigations are needed? | SUMMARY
A 14 year old girl presents with loss of consciousness. Previously well.
Normal vitals
Random blood sugar-4.7mmol
Differential Diagnosis
Vasovagal syncope
Cardiovascular disease, arrhythmias
Neurological disorders
Ensure airway,breathing and circulation are intact.
-Put patient in recovery position
-Monitor vitals
-Monitor progression of symptoms
Laboratory Investigations
Complete Blood Count
Kidney
Toxicology screen
Rapid pregnancy test /b-hcg |
ID_PFRFC | I am a nurse with 19 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. An elderly man brought in by his sons was confused with complaints of not being able to pass urine for 12 hours and verbalizing pain.
The patient is a 66-year-old retired policeman living with his wife. Known diabetic patient on metformin. Had a history of abdominal surgery 20 years ago. No other known medical history. Quit smoking cigarettes over 30 years ago.
Patient is confused with a GCS of 13/15. Not pale, not in respiratory distress. Placing his hand over the lower abdomen after every few minutes. BP 136/74mmHg, PR 96 bpm, RR 20 bpm, Spo2 94% on room air, RBS 10.3mmol/L. on abdominal palpation, a firm swelling noted over the suprapubic area.
Questions
What is the management of this patient?
Which investigations are required? | Summary
An elderly man brought in by his sons was confused with complaints of not being able to pass urine for 12 hours and excruciating pain.
66 years old and is a known diabetic on metformin. Had a history of abdominal surgery 20 years ago. Quit smoking over 20 years ago.
Patient is confused with a GCS of 13/15. Not pale, not in respiratory distress. Placing his hand over the lower abdomen after every few minutes. BP: 136/74, PR: 96, RR: 20, SPO2: 94% on RA. random blood sugar: 10.3 mmol/L. On abdominal palpation, a firm swelling noted over the suprapubic area.
This is most likely a case of acute urinary retention with differentials of diabetic neuropathy, Urinary tract infection, bladder outlet obstruction, and neurogenic bladder.
Management in this case includes:
1. Catheterization to relieve pain and handle the retention.
2. Analgesics to relieve pain.
3. Address the underlying cause, control blood sugars in this case.
Investigations:
1. complete blood count
2. Urinalysis
3. random blood sugar
4. HBA1C
5. Prostate specific antigen |
ID_ZQLRI | I am a nurse with 15 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 5 year old child was brought to the emergency department with complaints of loss of consciousness and weakness for one hour. Guardian reports that the child was playing outside but went quiet after entering the granary. The child was found lying down near an open hand sprayer that had been used to spray cattle. On assessment AVPU at P, pupil is pinpoint, SpO2- 88% on room air, p-60b/m, r- 166 bpm, temp-35.6oC, RBS-6.7mmol/L, BP-80/50mmHg.extemities are cold.
Questions:
What is the priority care for this patient?
What investigations can be done? | Summary
5 y/o child brought to ED complaining of loss of consciousness & weakness for one hour. Found lying down near a hand sprayer used to spray cattle.
AVPU: Pinpoint pupils. Desaturating, bradycardic, tachypneic.Hypothermic, cold extremities but BP is normal.
A) Priority Care for Patient:
Remove clothes as might be contaminated with poison & change them. Irrigate eyes.
Ensure airway patency and adequate breathing; provide O₂.
Administer atropine & pralidoxime for organophosphate poisoning reversal & IV fluids. Continuously monitor vitals & urine output.
Perform gastric lavage to suction any ingested poisons.
Administer activated charcoal via NG tube.
If patient presents with seizures, give anticonvulsants.
Keep patient warm.
Take samples for investigations.
Ensure to continue administering atropine until full atropinization is achieved by monitoring for:
Increased pulse.
Pupil dilation.
Clear bilateral lung fields.
B) Investigations:
1. Laboratory Tests:
CBC: Rule out other causes of syncope like anemia.
CRP, ESR, WBC: Check for sepsis.
UECs: Correct derangements.
Blood slide for malaria parasite.
Toxicology screening
2. Radiology:
EEG: Rule out seizures.
ECHO/ECG: Rule out congenital heart conditions that can cause syncope.
Dx: Organophosphate poisoning. |
ID_VITYK | I am a nurse with 18 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A female patient aged 16 years came to the hospital with chief complaints of passing hard melena stools, swelling in the anal region. She works in a petrol station as a pump attendant. Temperature 36.30c, pulse 91 beats/minute, respiration 20 breaths/minute, blood pressure 123/79mmHg.
Question(s):
What might have caused the bleeding?
What radiological examinations will be done?
What is the immediate management for this patient? | SUMMARY
A 16-year-old female patient with a complaint of passing hard melena stool, swelling in the anal region. The vitals are normal.
Bleeding could be from distended haemorrhoidal veins
Radiological examinations include:
Perform an exam & rectal endoscopic ultrasound to characterize the swelling and see whether it is cystic or solid.
Perform magnetic resonance imaging of the pelvis to visualize the tissues.
Perform a rectosigmoid endoscopy to help visualize.
Perform a colonoscopy to visualize the colon for possible pathology.
Perform a sigmoidoscopy.
Conduct an anorectal exam including anoscopy.
Management:
Give the patient stool softeners.
Give the patient rectal applications and astringents.
Advise the patient to do sitz bath.
Perform sclerotherapy.
Perform rubber band ligation.
Of note: Surgical review will be necessary for further surgical management.
In addition, perform complete blood count to check for haemoglobin levels and white cell count if an infection is suspected. |
ID_GDOBT | I am a nurse with 10 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 5 year old boy admitted with complaints, of fever, night sweats, unexplained weight loss, fatigue, not eating well, coughing and has swollen lymph nodes on the armpit and neck for 3 weeks. Vitals; Temp-39 degrees celsius, P-126b/min, RR-26b/min, SPO2- 94%,weight-12kg
Questions
What is the immediate management?
Investigations to be done?
What are differential diagnosis from above signs and symptoms? | SUMMARY
5-year-old boy. Fever, night sweats, unexplainable weight loss, fatigue, poor feeding, and swollen lymphadenopathy for 3 weeks. Temp: 39°C, pulse: 126 bpm, RR: 26, SpO2: 94%, weight: 14 kg.
Immediate Management:
Admit.
Antibiotic
Oxygen therapy – tachypnea, and monitor oxygen saturations.
History of poor feeding – establish IV access and administer intravenous fluids (Ringer’s Lactate and dextrose 5%).
Chest X-ray.
Investigations:
Chest X-ray.
Sputum for gene xpert.
Full hemogram.
Renal function test – poor feeding: AKI rule out.
Blood cultures.
Liver function test in anticipation for anti-TB drugs.
HIV testing. |
ID_HHPZM | I am a nurse with 7 years of experience in General nursing working in a Sub-county Hospitals and Nursing Homes in Kakamega county in Kenya. 23 years old came to MCH/FP clinic with history of headache, flank pains,blurred vision, dizziness ,History of hypertension 3 years back, she is using depo as Family Planning method. Diagnosis of hypertension was made BP 215/ 109, temperature 36.9° , weight 89kg. What is the best management for this client? Should I refer for gynaecological review? Should I start her on antihypertensive? | Summary
A 23 year old female reports of headache, flank pain, blurred vision, dizziness; Hypertension known hypertensive;
BP 215/109mmHg
Management of the patient;
Assess ABC and TM stabilizing the patient.
Monitor vital signs closely.
Fix a large bore IV cannulas; collect blood samples: CBC, UEC, LFTS, lipid profile, RBS, HbAIC.
Fix a urinary catheter, collect urine for analysis; monitor input/output.
Initiate IV labetalol/Hydralazine, even BP is gradually lowered.
Access labs to check for features suggestive of end-organ damage.
IV analgesia - PCM/Trandol.
Refer to a specialist.
Diagnosis - hypertensive emergency elevated BP >180/110 with features suggestive of end-organ damage.
Differential diagnosis :secondary hypertension. |
ID_PNIPE | I am a nurse with 12 years of experience in General nursing working in a Dispensaries and Private Clinics in Uasin Gishu county in Kenya. A mother walks into the child welfare clinic with a male baby, six weeks old, for immunization.
She also reports that the baby is not feeling well. On history, she reports the baby to have had fever for two days, poor feeding, and a cough. On assessment the mother seems to be hiding something. HIV test done and turned positive. Mother denied having been tested. Vital signs Temp: 37.9°C, SPO?: 91%, PR: 142 bpm.
Questions
1._x0001_What could be the immediate management for both the mother and baby?
2._x0001_How can this patient/client be better assessed?
3._x0001_How best can this mother be counseled and given adequate health information? | Summary
A mother comes to the child welfare with her 6 week old male baby for immunization. She reports baby is not feeding and has had a fever for two days. Baby is hyperthermic and tachycardic. Mother is HIV positive
Issues of concern is that the child might also be HIV POSITIVE
Immediate management of the baby
Emergency stabilization
Hyperthermia - antipyretics
Tachycardia- evaluate for signs of sepsis, dehydration or hypoxia
Empiric antibiotic therapy can be initiated after samples for culture and full hemogram
Resuscitation
Assess the airway and circulation for any life threatening conditions
Provide oxygen therapy and maintain saturation between 92 - 96%
Establish intravenous or intraosseous for fluid resuscitation and administer isotonic fluids
Investigations
Labs
Full hemogram, blood culture, c-reactive protein
Cerebrospinal analysis to rule out meningitis
Imaging
Chest x ray
HIV testing, Polymerase chain reaction test to determine HIV status. If positive the mother should be counselled and child initiated on zidovudine and nevirapine
Immediate management of the mother
Hiv care. Review HAART regimen and ensure adherence
Viral load and CD 4 count
Counselling and education on the management of HIV
Monitoring and Followup
Admit the baby for close monitoring until stable
Frequently follow up on both the mother and the baby
Kindly refer to the answer given prior. It elaborates on how best patients can be assessed
Counselling should be done in a safe environment . the mother should not be exposed to any social stigma from the healthcare workers
She should be given information in sections and information should be reinforced prior to giving new information |
ID_NVGKJ | I am a nurse with 17 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 16 year old boy who is admitted in the oncology ward started having confusion, appears grey and molted. The patient is receiving chemotherapy and 3 days ago he started complaining of pain on the intravenous access, redness and arm swelling.
The intravenous access was removed immediately. Vitals: Temp 40, BP 70/30 mmHg, Resp 46b/m, HR 150b/m.
Questions
What type of shock does the patient have?
What is the immediate management?
What monitoring is needed on the intravenous access?
Which laboratory tests are required? | SUMMARY
16-year-old boy is confused, appears grey and mottled. Received chemo 3 days ago, complained of pain in intravenous access site, redness and swelling. Hyperthermia, Hypotension, Tachycardia and Tachypnea.
Dx - Septic shock
Management
* Airway & Breathing: High flow oxygen to SpO2 >94%.
* Circulation: Aggressive fluid resuscitation, monitor for respiratory failure, use vasopressors if no response to fluids.
* Antibiotic therapy: Broad-spectrum.
* Antipyretics.
* Analgesics.
* Source control: Clean intravenous site, establish new intravenous site.
Monitoring needed for intravenous access
* Regular assessment: Inspect for redness, swelling or pain.
* Use sterile technique when cannulating.
* Documentation of any reactions.
Investigations
* Blood culture
* Complete Blood count
* Lactic acid level
* C-reactive protein & Procalcitonin
* Urea, electrolytes and creatinine
* Coagulation profile
* Arterial blood gas
* Culture IV access |
ID_DRKUX | I am a nurse with 15 years of experience in Primary care working in a Sub-county Hospitals and Nursing Homes in Uasin Gishu county in Kenya. A man reports to the facility with a history of frequent urination, and pain when urinating with hesitation. He has been having the problem for 4 days and now not able to perform sexual intercourse due to pain and erectile dysfunction. On assessment, there was urethral discharge (yellowish) and pimples around the shaft. Blood pressure 120/78 mmHg, pulse 76 beats/minute and respiration 20 breaths/minute.
Questions
Why yellow discharge?
What causes the symptoms?
What’s the management? | Summary
Male patient with complaints of dysuria, pyuria and dribbling on micturition for 4 days. Also reports erectile dysfunction
Impression
Urethritis
DD
Urethral strictures
Bladder outlet obstruction’ sexually transmitted infection (STIs)
Why yellow discharge?
Its an inflammatory exudate due to inflammation of the urethra
What causes discharge?
Type of infection/bacteria e.g gonococcal urethritis
extent/severity of the infection
Management
Give empiric antibiotics combined with flagyl
Analgesics for the pain
Encourage fluid intake’ treat sexual partner
Investigations
PSA to rule out BPH
Urinalysis with early morning urine
Urethral swab for microscopy and culture
Do KUB( kidney, ureter and bladder ultrasound)
Do micturating cystourethrography |
ID_WQWTC | I am a nurse with 17 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 5 month old infant is brought to the emergency department unresponsive. The infant was well until 2 hours ago when he was lethargic.
On assessment the infant has gasping respirations, weak, rapid pulse. HR 250b/m, Resp 18bpm, BP 90/40 mmhg, Temp 36.8. Resuscitation commenced via bag mask ventilation and code blue pediatric team was initiated.
Questions
What is the likely diagnosis?
What is the most important step?
Who is to do what and when? | Summary
A 5 year old baby who was brought to emergency department unresponsive. Reported to have been well 2 hours prior. Lethargic
Examination
Gaspic respiration, weak and rapid pulse.tachycardic
Resuscitation was commenced via bag mask ventilation and a code blue pediatric team was initiated.
What's the most important thing to do?
Securing the airway
Who is to do what and when?
Have a team leader to coordinate and assign roles
1 person to do a finger technique cardiorespiratory resuscitation and the other be on airway giving rescue breaths at a ratio of 15:2
Have an intravenous access and samples taken
Have child connected to the monitor
Continue with the above as you monitor the child |
ID_NMRKV | I am a nurse with 22 years of experience in General nursing working in a Dispensaries and Private Clinics in Uasin Gishu county in Kenya. A 14-year-old female is brought to the dispensary with complains of severe left upper quadrant pain that is worsening over the last one day and vomiting yellow in color. No past medical history and not on any medication. Vital signs Temperature 38, BP 132/78mmhg and PR 92 b/m. Question: 1.What investigations can be to this client? 2. What is the possible management for this client? | SUMMARY
A 14 year old female was brought to the dispensary with complaints of left upper quadrant pain that worsened over the last one day and vomiting yellowish colored vomitus. No history of using any medications or taking any meals. Has a fever of 38°. Other vitals are normal.
Differentials:
Malaria
Intestinal obstruction
Sickle cell crisis
Investigations:
Do a blood sample for malaria and rapid diagnostic test for malaria
Do a peripheral blood film and sickling test
Do an erect abdominal X-ray if available to check for any obstruction
Abdominal ultrasound if available to check for liver enlargement
Management:
Depends on the cause:
Could refer for further management if suspecting intestinal obstruction or hepatitis
Antimalarials → if suspecting malaria
Supportive management:
1. Give IV fluids → Ringer’s lactate, combine with dextrose if not feeding well
2. Give analgesics e.g., Paracetamol (rule out hepatitis first)
3. Give antipyretics for the fever |
ID_VMUTI | I am a nurse with 12 years of experience in General nursing working in a National Referral Hospitals in Uasin Gishu county in Kenya. A 49-year-old man is brought to the ED by paramedics after being reported to have collapsed during a vigorous exercise at a local gym. No significant history was reported. He was rushed in after the accident. On examination. He is unresponsive with shallow breaths, threads pulse, and. unrecordable Bp. pulse-47, Spo2 62% RA RR-24 b/min, Bp-- unrecordable
QUESTIONS
What will be the immediate management?
What investigations are needed to be done? | SUMMARY-a 49 year old man is brought to the emergency department by the paramedics after being reported to have collapsed during a vigorous exercise at a local gym.No significant history was reported.He was rushed in after the accident.O/E unresponsive with shallow breaths,thread pulse,unrecordable BP PULSE 47 SPO2 62% RR 24.
a)What will be the immediate management?
for immediate management on this patient:
check for airway and cervical spine instability.check for any secretions,foreign body,breath sound,perform a head tilt and chin lift maneuver.
check for breathing and ventilation.check for breath sounds if you can hear the sounds.any abnormal sounds from airway,chest movement,oxygen saturation.
initiate oxygen via a non rebreather mask.check for circulation and hypovolemic instability.
insert two large IV bores start hydration therapy and dextrose to the patient.
perform a random blood sugar levels.
Diagnosis
This is a concern for cardiac arrhythmias with differentials of hypoglycemia,spinal injury,heat stroke,drugs/toxins.
perform routine laboratory investigation and an emergency echo and ECG for this patient.It will guide in definitive management of the patient.
b)What investigations are needed to be done?
laboratory-random blood sugar,full hemogram,liver function test,renal function test,drug toxicology
Radiological-echo ECG to check for cardiac structure and conduction, CT scan of the head |
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