LEARNING GUIDE SKILL TMS

2020/2021

HT FEVER

COLD CHAIN
BLOCK : Tropical Medicine System
TOPIC : History taking of fever in adult

I. GENERAL OBJECTIVE
After completing skill practice, the student will be able to perform history taking.

II. SPECIFIC OBJECTIVE

At the end of skill practice, the student will be able to understand the procedure of history taking of fever
systematically

III. SYLLABUS DESCRIPTION

3.1 Sub Model Objective

After finishing skill practice of clinical examination, the student will be able to perform history taking
of fever in adult.

3.2 Expect competencies

Student will be able to demonstrate the procedure of history taking of fever in adult

3.3. Method
a. Presentation
b. Demonstration
c. Coaching
d. Self practice

3.4 Laboratory facilities

a. Skills laboratory
b. Trainers
c. Student learning guide
e. Trainer’s guide
f. References

3.5 Venue
Skills laboratory

3.6. Evaluation

No Step / Ask 0 1 2

1 Introduction was conducted properly, ask identity, occupation,

politely with empathy
2 Give attention to the patient, not writing while listening
3 Use of open question at the beginning and the first 3 questions in
anamnesis
4 Provide guidance to the patient and not interrogative
5 Focus the conversation to specific topic, (like the symptoms of fever)
6 Onset of fever was inquired and concluded correctly
7 Type of fever was inquired and concluded correctly
8 Timing (when, duration and frequency) was inquired and concluded
correctly
9 Have acquired at least 2 other events or setting when fever occurred
10 Have acquired at least 3 accompanying symptoms (ex chills, headache,
sweating, ptechiaeetc)
11 Have acquired at least 3 additional information (history of traveling,
previous illness, medicine history and occupational history)
12 Able to name at least 2 diseases that is relevant to the type of fever
encountered.
Total

ROLE PLAY FOR HISTORY TAKING OF TROPICAL MEDICINE

Problem 1:

This exercise is a role play. One student act as a patient, the other one try to anamnesis and describe his fever
type and the important information regarding the complaint or possible disease. Try to use all the description,
but besides this, you can also be creative about the additional story to make up.

Identity : Adin, 25 years old, male, occupation student of art.

Chief complaint: Fever

General appearance: Patient look weak, pale, and apathetic

Description of complaint:
Since 1 week ago patient felt cold and slight fever, this symptom persisted and even increasingly felt
worse and become very high. Patient lost his appetite. Every day fever is felt, especially at night, there was
only slight rigors, and sweating 1 hour after taking parasetamol tablet. He has been weak actually for 10
days. Before fever is felt, he has the feeling of weakness, dizzy and headache. It was difficult for him to
study, so he missed several classes. Since a week he did not go to school.

He went to a doctor and was prescribed parasetamol tablet, which was taken for 3 days, but the fever
kept on coming.

He is a student in Bandung, and actually he came from Jakarta but since childhood never travel outside of
Java, the farthest journey was to Cirebon last year.

Answer for problem 1:

No Step / Ask Correct answer

1 Introduction was conducted properly, ask identity, According to observation of the tutor
occupation, politely with empathy
2 Give attention to the patient, not writing while listening According to observation of the tutor
3 Use of open question at the beginning and the first 3 According to observation of the tutor
questions in anamnesis
4 Provide guidance to the patient and not interrogative According to observation of the tutor
5 Focus the conversation to specific topic, (like the symptoms According to observation of the tutor
of fever)
6 Onset of fever was inquired and concluded correctly Gradual onset
7 Type of fever was inquired and concluded correctly Continuous or remittent
8 Timing (when, duration and frequency) was inquired and 1 week, fever always
concluded correctly
9 Have acquired events or setting when fever occurred Night time fever become worse (only one
setting is enough)
10 Have acquired at least 3 accompanying symptoms (ex chills, Any 3 from: Shivering, sweating, headache,
 headache, sweating, ptechiaeetc) dizziness, weakness
11 Have acquired at least 3 additional information (history of No traveling history outside of Java, he is a
traveling, previous illness, medicine history and occupational student, only parasetamol was taken
history)
12 Able to name at least 2 diseases that is relevant to the type of Typhoid, TB milier (extra pulmonary),
fever encountered. Leptospirosis, Ricketsia.

Total

Problem 2:

This exercise is a role play. One student act as a patient, the other one try to anamnesis and describe his fever
type and the important information regarding the complaint or possible disease. Try to use all the description,
but besides this, you can also be creative about the additional story to make up.

Identity :YeniWunungga, 23 years old, female, occupation student of nursing.

Chief complaint: Fever

General appearance: Patient look weak, pale, and apathetic.

Description of complaint:
Since 2 week ago patient felt cold but then followed by fever. This has happened about 3 to 4 times, but
several days was without any fever, she couldn’t quite remember how many days. But the last fever went
since yesterday, and 2 days before this there was no fever for two days. She felt shivering with a lot of
sweating when the fever subsided. Now patient is becoming weak, lost appetite and nauseated. Headache
is felt during the fever, especially the high ones. It was difficult for her to study, so he missed several
classes in the last 1 weeks and several days leaving earlier in the week before.

She went to a doctor and was prescribed parasetamol tablet and amoxicillin last week, which was taken
for 4 days, but the fever kept on reapearing.

He is a nursing student in UNPAD Bandung, and came from Jayapura since 6 month ago.

Answer for problem 2:

No Step / Ask Correct answer

1 Introduction was conducted properly, ask identity,
occupation, politely with empathy
2 Give attention to the patient, not writing while listening
3 Use of open question at the beginning and the first 3
questions in anamnesis
4 Provide guidance to the patient and not interrogative
5 Focus the conversation to specific topic, (like the
symptoms of fever)
6 Onset of fever was inquired and concluded correctly
7 Type of fever was inquired and concluded correctly
8 Timing (when, duration and frequency) was inquired and
concluded correctly
9 Have acquired at least 2 other events or setting when
fever occurred
According to observation of the tutor
According to observation of the tutor
According to observation of the tutor
According to observation of the tutor
According to observation of the tutor
Both gradual or abrupt is possible
Intermitent
2 weeks ago, for 1-2 days, with 2 days
without fever, frequency every 3 days
No specific events that the patient can now
of
10 Have acquired at least 3 accompanying symptoms (ex
chills, headache, sweating, ptechiaeetc)
11 Have acquired at least 3 additional information (history
of traveling, previous illness, medicine history and
occupational history)
12 Able to name at least 2 diseases that is relevant to the
type of fever encountered.
Chills, sweating, shivering, headache,
weakness, lost appetite, nauseated
Nursing student in UNPAD, came from
Papua 6 month ago, have taken
parasetamol and antibiotics amoxicillin
Most likely: Malaria, less likely: Typhoid,
urinary tract infection

Total

Problem 3:

This exercise is a role play. One student act as a patient, the other one try to anamnesis and describe his fever
type and the important information regarding the complaint or possible disease. Try to use all the description,
but besides this, you can also be creative about the additional story to make up.

Identity : Dina, 32 years old, female, occupation secretary of a factory.

Chief complaint: Fever

General appearance: Patient look weak

Description of complaint:
Four days ago patient felt cold and then fever is felt. It was a high fever, especially at night time. Her
friends told that his skin felt like fire. Actually in the morning before, she felt OK and still went to work in
the factory until the afternoon. This symptom persisted for the next two days even increasingly felt worse
and become very high. There was no shivering or sweating, however she felt thirsty and nauseated. She
also felt dizzy and have a headache every-time fever is felt. Fever subsided this morning. There is a red-
dish rash in her arms and lower leg / foot. Her room mate observed this only today.

She has not come to the doctor

He is a secretary in Bandung, and never went traveling too far, except Bali in the last year.

Answer for problem 3:

No Step / Ask Correct answer

1 Introduction was conducted properly, ask identity,
occupation, politely with empathy
2 Give attention to the patient, not writing while listening
3 Use of open question at the beginning and the first 3
questions in anamnesis
4 Provide guidance to the patient and not interrogative
5 Focus the conversation to specific topic, (like the
symptoms of fever)
6 Onset of fever was inquired and concluded correctly
7 Type of fever was inquired and concluded correctly
8 Timing (when, duration and frequency) was inquired and
concluded correctly
9 Have acquired at least 2 other events or setting when
fever occurred
10 Have acquired at least 3 accompanying symptoms (ex
chills, headache, sweating, ptechiaeetc)
According to observation of the tutor
According to observation of the tutor
According to observation of the tutor
According to observation of the tutor
According to observation of the tutor
Abrupt onset
Continuous
4 days ago, for 4 days until this morning, no
frequency
Night time; only one event that patient can
recall
Thirsty, nauseated, dizzy, headache, skin
rash
11 Have acquired at least 3 additional information (history Working as a secretary, never been outside
of traveling, previous illness, medicine history and of Java and Bali. Never visited doctor.
occupational history)
12 Able to name at least 2 diseases that is relevant to the Dengue, chikungunya and other non specific
type of fever encountered. acute viral infections

Total

Problem 4:

This exercise is a role play. One student act as a patient, the other one try to conduct anamnesis and describe
his fever type and the important information regarding the complaint or possible disease. Try to use all the
description, but besides this, you can also be creative about the additional story to make up.

Identity :Abdulah, 67 years old, male, retired office clerk.

Chief complaint: Fever

General appearance: Patient look weak, pale, and apathetic.

Description of complaint:
Since 1 month ago patient felt fever which comes and go. This has happened often almost every day there
is fever. Sometimes it subsides in the morning, but never felt normal, because he still felt cold and weak.
At night usually is higher. He has no appetite and loose his weight. Headache is felt during the fever,
especially the high ones. It was difficult for him to work in the garden where he usually like to spent his
time.

He went to a doctor 3 times and was prescribed parasetamol tablet and antibiotic for 3 times. Has his
blood checked but he never felt better. If he takes parasetamol, fever only normalized for 2-3 hours and
then it comes back.

He has no history of traveling. Smoke 1 box per day until he felt sick.

Answer for problem 4:

No Step / Ask Correct answer

1 Introduction was conducted properly, ask identity,
occupation, politely with empathy
2 Give attention to the patient, not writing while listening
3 Use of open question at the beginning and the first 3
questions in anamnesis
4 Provide guidance to the patient and not interrogative
5 Focus the conversation to specific topic, (like the
symptoms of fever)
6 Onset of fever was inquired and concluded correctly
7 Type of fever was inquired and concluded correctly
8 Timing (when, duration and frequency) was inquired and
concluded correctly
9 Have acquired at least 2 other events or setting when
fever occurred
10 Have acquired at least 3 accompanying symptoms (ex
chills, headache, sweating, ptechiaeetc)
11 Have acquired at least 3 additional information (history
According to observation of the tutor
According to observation of the tutor
According to observation of the tutor
According to observation of the tutor
According to observation of the tutor
Gradual
Remittent
1 month, for 1 -2 days, every day
When he takes parastamol fever subsided
for 3 hours but then come again.
Difficult to work, weak, cold, no appetite,
loose weight.
No history of traveling, went to doctor, got
 of traveling, previous illness, medicine history and parasetamol and antibiotics, smoking
occupational history) history, no other hazardous working
condition
12 Able to name at least 2 diseases that is relevant to the Most likely: Tuberculosis, malignancy,
type of fever encountered. lymphoma,

Total

LEARNING GUIDE
COLD CHAIN
 BEFORE SESSION

LOADING COLD-CHAIN EQUIPMENT

Refrigerators
- Jauhkan kulkas lebih dari 10 -15 cm dari dinding dan kulkas lain Jaga listrik tetap
dalam mode pada Jauhkan dari matahari secara langsung Jaga sirkulasi yang baik
Jangan membuka dan menutup pintu lebih dari dua kali sehari

Load a vaccine into refrigerator :

1. Bekukan dan simpan paket es beku di kompartemen freezer
2. Letakkan termometer dan label beku di rak kedua (dekat vaksin sensitif beku)
3. Semua vaksin dan pengencer harus disimpan di kompartemen lemari es.
4. Susun kotak vaksin dalam tumpukan di mana udara dapat bergerak di antara mereka (1-2
cm/2 jari).
5. Simpan vial vaksin OPV, DTP, Td, TT, Liquid Hib, hepatitis B dan DTP-HepB yang sudah
dibuka dalam kotak “gunakan dulu” untuk penggunaan pertama pada sesi berikutnya.
6. Simpan vial dengan VVM yang menunjukkan lebih banyak paparan panas daripada yang
lain di dalam kotak berlabel "gunakan dulu". Gunakan botol ini terlebih dahulu di sesi
berikutnya.
7. Simpan hanya vial yang baik untuk digunakan di lemari es.
8. Simpan kantong es berisi air dingin di rak paling bawah dan di pintu lemari es.
9. Simpan vaksin di tempat yang sesuai dengan lemari es yang Anda gunakan.

Load front-loading refrigerator with freezer on top

1. Vaksin hidup/Vaksin peka panas: Campak, MR, MMR, BCG dan OPV di rak paling atas
(dekat evaporator)
2. Vaksin sensitif beku: vaksin DTP, DT, Td, TT, HepB, DTP-HepB, Hib, DTP-HepB+Hib,
meningokokus, demam kuning, dan JE di rak tengah; dan
3. Pengencer di sebelah vaksin yang diberikan (jangan dibekukan)

Loading ice-lined refrigerators

1. Campak, MR, MMR, BCG dan OPV di bagian bawah saja; dan

2. Vaksin sensitif beku (vaksin DTP; TT; HepB, Hib, DTP-HepB, Hib; DTP-HepB+Hib,
meningokokus, demam kuning, dan JE) di bagian atas saja.Cold boxes and vaccine carriers
Load vaccine into cold boxes and vaccine carriers:
1. Di awal atau hari sesi, ambil semua bungkus es beku yang Anda butuhkan dari freezer lalu
tutup pintunya
2. Kondisikan kantong es beku dengan benar, dengan membiarkan kantong es berada pada
suhu kamar sampai es mulai mencair dan air mulai terbentuk.
3. Letakkan kantong es berkondisi pada masing-masing dari keempat sisi kotak dingin atau
pembawa vaksin dan di bagian bawah kotak dingin jika diperlukan.
4. Letakkan termometer di salah satu sisi kotak dingin.
5. Letakkan vaksin dan pengencer di tengah kotak dingin atau wadah.
6. Sertakan indikator pembekuan dalam kemasan dengan vaksin
7. Dalam wadah vaksin, letakkan bantalan busa di atas kantong es yang telah dikondisikan.
Dalam kotak dingin, letakkan kompres es berkondisi di atas vaksin.
8. Tutup kotak dingin atau tutup wadah dengan rapat.
9. Tempatkan kantong es terkondisi dalam jumlah yang cukup di dalam kotak dingin atau
wadah vaksin.
10. Simpan kotak dingin atau pembawa vaksin di tempat teduh
11. Tutup rapat-rapat.
12. Gunakan bantalan busa untuk menampung vial selama sesi imunisasi.

MONITOR AND ADJUST THE TEMPERATURE

Monitoring the temperature in vaccine refrigerators

If the temperature is too LOW (below +2° C)
 1. Putar kenop termostat sehingga panah menunjuk ke angka LOWER. Ini akan membuat
lemari es lebih hangat.
2. Periksa apakah pintu freezer menutup dengan benar. Segel mungkin rusak.
3. Periksa vaksin yang peka terhadap beku (DTP; DT; Td: TT; HepB; DTP-HepB, vaksin Hib cair
dan DTP-HepB+Hib) untuk melihat apakah vaksin tersebut telah rusak karena pembekuan
dengan menggunakan uji kocok.
Jika suhu terlalu TINGGI (di atas +8° C):
1. Pastikan kulkas berfungsi; Jika tidak, periksa apakah ada minyak tanah, gas, atau catu daya.
2. Periksa apakah pintu lemari es atau kompartemen pembekuan tertutup dengan benar.
3. Periksa apakah embun beku menghalangi masuknya udara dingin di kompartemen
pembekuan ke dalam kompartemen kulkas.
4. Putar kenop termostat sehingga panah menunjuk ke angka TINGGI.
5. Jika suhu tidak dapat dipertahankan antara +2°C dan +8°C, simpan vaksin di tempat lain
sampai lemari es diperbaiki.

SHAKE TEST (to determine whether vaccine has been frozen )

1. Siapkan sampel kontrol beku
2. Pilih sampel uji
3. Kocok kontrol dan sampel uji selama 10-15 detik
4. Biarkan istirahat
5. Bandingkan vial, Jika laju sedimentasinya sama, vial mungkin telah rusak karena
pembekuan dan tidak boleh digunakan.