DI

ARRHEA
PART-
1 GENERALI
NFORMATI
ON
NameandAddr
essoft
hepat
ient
: War
dno:_
___
___
uni
t:
___
__
_
___
___
___
___
___
___
___
___
___
___
___
_IPNO:
_
___
___
___
___
___
___
___
___
___
___
___
_
_
___
___
___
___
___
___
___
___
___
___
___
_
TELEPHONENO:
___
___
___
___
___
___
___
_

I
NDI
VIDUALPROFI
LE
AGE: EDUCATI
ON:
SEX: OCCUPATI
ON:
RELI
GION: I
NCOME:
CASTE:
HABI
TATI
ON:
H/
OMI
GRATI
ON:

BLOODGROUP:
SEROPOSI
TITVI
TY:
DRUGSENSI
TITVI
TY:

Mar
it
alst
atus:
No.
ofl
i
vingchi
l
dren:
I
mmuni
sat
ionst
atus:
I
mpor
tantheal
thev
ent
s:
Longhospi
tal
stay
:
Oper
ati
ons:
Bl
oodt
ransf
usi
ons:
Chr
oni
cdi
seases:
Regul
armedi
cat
ions:
Addi
cti
ont
odr
ugs:
Sui
ci
cdeat
tempt
s:
I
njur
ies/
bur
ns/
acci
dent
s:

Per
sonal
hygi
ene
Cl
othes: or
alhy
giene:
Hai
r nai
l
s:
Bat
h/handwash: f
oot
wearusage:

Li
fest
yle
Di
et:
veg/
nonv
eg/
mixed
Foodhabi
t:
regul
ar/
ir
regul
ar
Phy
sical
act
ivi
ty:
Ot
herhabi
ts:
alcohol
/smoki
ng/
chewi
ngt
obacco

Soci
alr
elat
ionshi
p
Wi
thf
ami
l
ymember
s:
Wi
thsoci
ety
:
Fami
l
ymember
swi
thpat
ient
:

FAMI
LYPROFI
LE

Fami
l
yst
ruct
ure:
AgeIn t
otal
complet
edy
ear
s Number

mal
e f
emal
e

<1y
r

1-
5yr

6-
15y
r

16-
64y
r

>65y
r

Fami
l
ycompost
ion
Sl
.no name Age sex Mari
tal educat
ion occupat
ion i
ncome Medicosoci
al
i
n st
atus
st
atus
yr
s

Percapi
tamont
hlyi
ncome: t
otal
fami
l
yincome÷Noofmember
s
Soci
oeconomi
ccl
ass:
(acct
omodi
fi
edBGPr
asadcl
assi
fi
cat
ion)
Medi
cosoci
alst
atus:
 I
nfant Lepr
osy Di
sabi
l
ity

Chi
l
drenunder5y
rs HI
V/STD Ment
alr
etar
dat
ion

Pr
egnancy Cancer Psy
chi
atr
icpr
obl
ems

Lact
ati
on Di
abet
es Al
cohol
addi
cti
on

Ol
dage BP/
car
diacpr
obl
ems Soci
alev
il
s

LI
VINGCONDI
TIONS(
HOUSI
NG)
SL HOUSI
NGSTANDARDS SCORE:1
SATI
SFACTORY
N
O 0POOR

1 const
ruct
ion:
local
i
ty,
saf
ety
,pr
otect
ion

2 Space:
spat
ial
suf
fi
ciencyt
opr
eventov
ercr
owdi
ng

3 Li
ghtandv
ent
il
ati
on

4 Wat
er:
adequacy
,accessi
bil
i
ty,
andsaf
est
orageofwat
er

5 Sani
tat
ion:
washi
ng

6 Ki
tchen:

7 Env
ironmentDist
urbances:
noi
se,
air
pol
l
ut i
on,
dust
,odor
,opendrai
netc

8 Ani
mal
s:pet
,cat
tl
e,
poul
tr
ykeepi
ng

9 Cl
eanl
i
nessofper
sonsandpr
emi
ses

10 Connect
ivi
ty:
road,
tr
anspor
tat
ion,
communi
cat
ion,
school
s,

soci
al,
recr
eat
ional
,
fir
e,pol
i
ce
Vi
tal
event
sint
hef
ami
l
y
Bi
rt
h:
Adopt
ion:
Mar
ri
age/
div
orce
Deat
hwi
thcause:

Soci
alst
atusoft
hef
ami
l
y
Educat
ion
Occupat
ion
Li
vi
ngcondi
ti
ons
Soci
alr
elat
ionshi
p:
Soci
oeconomi
cst
atus:
Nut
ri
ti
onal
int
akeoft
hef
ami
l
y
Foodi
tems I
ntakeoft
he RDA fort
he Remar
ks/
inf
erence
f
ami l
y fami
l
y

cer
eal
s

pul
ses

Greenleaf
y
veget
ables

Rootsand
tuber
s

Other
veget
abl
es

f
rui
ts

oi
l
s

Sugarand
j
aggery

mi
l
k

Meat
/fi
sh

Coef
fi
cientuni
trequi
redbyt
hef
ami
l
y

Heal
thst
atusoft
hef
ami
l
y(i
nbr
ief
)
1.
phy
sical
heal
th:
2.
ment
alheal
th:
3.
soci
alheal
th:
4.
spi
ri
tual
heal
th:
HI
STORYOFPRESENTI
LLNESS
CHI
EF ONSET DURATI
ON DESCRI
PTI
ON
COMPLAI
NT OFSYMPTOMS

Di
arr
hea

Vomi
ti
ng

Thi
rst

Lowur
ineout
put

Fev
er

ot
her
s

PASTHI
STORY
h/
opr
evi
ousi
l
lness/
hospi
tal
i
zat
ionf
orsi
mil
arcompl
aint
s
t
imeofi
l
lness:
nat
ure:
hospi
tal
i
zat
ion:
compl
i
cat
ion:
t
reat
ment
:
h/
olowbi
rt
hwei
ght
f
eedi
ngpr
act
ices-
breast
/bot
tl
e
weani
ngpr
act
ices
i
mmuni
zat
ion
poorl
i
vingst
andar
dsandpoorsoci
oeconomi
cst
atus

DI
ETHI
STORY
h/
ofoodandwat
eri
ntakei
npast15day
s
Epi
demi
ologi
cal
hist
ory
Anysi
mil
arcasei
nthef
ami
l
y/nei
ghbour
hood
Anycont
actwi
thsi
mil
arcase

Gener
alexami
nat
ion
Bui
l
t:
hei
ght
:
wei
ght
:
anemi
a:
cl
ubbi
ng:
cy
anosi
s:
nour
ishment

t
emper
atur
e

pul
se

bl
oodpr
essur
e

r
espi
rat
ion

j
aundi
ce

l
ymphadenopat
hy

edema

SYSTEMI
CEXAMI
NATI
ON:

RS

CNS:

CVS:

ABDOMEN:
 EPI
DEMI
OLOGI
CALDI
AGNOSI
S

Assessmentofdehy
drat
ion

Sl
.no par
ti
cul
ars

NO SOME SEVERE

Byhi
stor
y(ask)

1 St
ool
sperday

2 Vomi
ti
ng

3 Thi
rst

4 Ur
ineout
put

5 t
ear
s

By
exami
nat
ion(
look)

1 Gener
alcondi
ti
on

2 mout
handt
ongue

3 ey
e

4 ski
npi
nch

5 pul
se

6 BP

7 Br
eat
hing

8 t
emper
atur
e
9 Ant
eri
orf
ront
anel
l
e

10 Consci
ousness

11 i
rr
it
abi
l
ity

LABI
NVESTI
GATI
ONS

Sl
.no Exami
nat
ionr
equi
red r
epor
t

1.
stool Nakedey
e
exami
nat
ion

2.
uri
ne Micr
oscopic
examinat
ion

3.
blood El
ect
rol
ytes.
osmol
ali
ty

ELI
SA

CLI
NICALDI
AGNOSI
S

cr
it
eri
afordi
agnosi
s

1.
ACUTEWATERYDI
ARRHEA

2.
DYSENTARY-

3.
PERSI
STANTDI
ARRHEA-

MEDI
COSOCI
ALDI
SCUSSI
ON
Agentf
act
ors Hostf
act
ors

Env
ironment
alf
act
ors Soci
alf
act
ors

Lev
elsofpr
event
ion:
Levelsof Whichl
evel
has Howitcoul
dbe
prevent
ion f
ail
ed pr
event
ed

pr
imar
y Heal
th
pr
omotion

Speci
fi
c
prot
ect
ion

secondar
y Earl
ydetect
ion
andprompt
tr
eatment

t
ert
iar
y Di
asabil
i
ty
l
imi
tati
on

Rehabi
l
itat
ion

Assessmentofknowl
edge,
att
it
ude,
andpr
act
icet
owar
dst
hedi
sease
par
ti
cul
ars knowl
edge at
ti
tudes pr
act
ice

Cause

Tr
eat
ment

Pr
event
ion

Heal
thser
vices

ot
her
s

MANAGEMENT:
ADVI
CE: