CLINCO BACTERIOLOGICAL STUDY OF ACUTE GASTRO ENTERITIS IN CHILDREN - format
CLINCO BACTERIOLOGICAL STUDY OF ACUTE GASTRO ENTERITIS IN
CHILDREN
PROFORMA
INFORMANT
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I.P. NO. |
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Name : |
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Age: |
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Sex : |
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Address: |
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Date of Admission : |
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Date of Discharge: |
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Diagnosis : |
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Results : |
Chief Complaints :
History of Present Illness:
1.
Loose Motions
A.
No. of Times
i.
Less than 5
times a day.
ii.
5 – 10 times
a day
iii.
More than 10
times a day.
B.
Color of the
stools:
Yellow,
Greenish, White, Black, Clay, Brown, Rice, Watery, Pea Soup, Watery
C.
Consistency
of stools: Watery, semisolid, pasty
D.
Nature of
stools: Mostly watery or faecal any mucow, blood or frankly bloody, blood and
mucow.
E.
Foul
smelling : Yes / No
F.
Feel of the
stools : Sticky / Greasy
G.
Amount of
stools : Unduly bulky / Large /
Small
H.
Association
with pain abdomen Yes/No
I.
Contents of
Stools : Worms / Undigested food / seeds
2.
VOMITING
Duration
Frequency
Character of Vomitus :
Food recently taken, mucus, bile, blood, faecal material, watery.
Nature of Vomiting :
Regurgitant / Projectile
Child vomits whatever food child takes : Yes/No
3.
FEVER
Duration, Type,
Associated with chills and
rigors, high grade / moderate / low grade
Toxicity – Present
/ Absent
Associated with Malaise or apathy
4.
PAIN
ABDOMEN
Duration Type
acute recurrent
mode of onset sudden
gradual location radiation
5.
ALTERED
SENORIUM
Present / Absent
6.
CONVULSIONS
Present / Absent Generalised
/ Localised
7.
OTHER
SYMPTOMS
PAST HISTORY
H/o
Similar complaints in the past
H/o
Fever : Cough
FAMILY HISTORY
Other
sibilings with similar complaints
SOCIO
ECONOMIC STATUS
Kuppuswamy
Classification
Upper
Class
Upper
Middle Class
Lower
Middle Class
Upper
Lower Class
Lower
Class
BIRTH HISTORY
Ante
Natal
Natal
Full
term : Yes / No Home
Delivery : Yes/No
Weight
of baby If
known size of baby
Small
/ Medium / Large
Post
Natal
IMMUNIZATION
a)
BCG b) OPV c) DPT d) Measles
DIETARY HISTORY
Prelacteal
Feed
Exclusive
Breast Feeds
Breast
Feeds + Top Feeds
Semisolids
Weaning
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Expected Calories |
Intake of Calories |
Deficit of Calories |
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Expected Proteins |
Intake of Proteins |
Deficit of Proteins |
DEVELOPMENTAL HISTORY
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Social Smile |
Head Holding |
Sitting |
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Crawling |
Standing |
Walking |
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Gross motor |
Social |
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Fine motor |
Language |
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GENERAL PHYSICAL EXAMINATION
Constitution
: Well
alert / Unwell / Very sleepy /
Unconscious
Vital
signs : Pulse RR B.P Temperature
Stature
:
Ant.
Fontanelle - Fused / Open - Depressed
/ Buged
Eye
: Normal / Sunken / Very dry
Breathing
: Normal
/ Foot / Very Foot / Deep
Cheeks
: Sunken
/ Normal
Tongue
: Dry
/ Coated / Moist
Skin
: Turger Normal / Lost
Ears
:
Lips
:
Teeth
:
Gums
:
Extremetio
: Normal
/ Cold / Calmy
State
of Dehydration : Mild / Moderate / Swear
Signs
of Aciodosis : Present / Absent
Signs
of Alkalosis : Present / Absent
Signs
of hyper Natraemia : Present / Absent
Signs
of Hypo Natramia : Present / Absent
Signs
of Hyper Kalemia : Present / Absent
Signs
of Hypo Kalemia : Present / Absent
ANTHROPOMETRY
Head
circumference Chest
circumference
Height
weight
Head
to Rump Rump
to Heel
Span
SYSTEMIC EXAMINATION
Per Abdomen
Inspection
: Shape Symetry
Local
Building State of
Skin
Umbilicus Blood vessels
Peristalsis
Palpation
: Feel Oedema
of Abd wall Yes/No
Tenderness
Yes/ No
Organomegally
Liver
Spleen
Kidney
Percussion
: Resonant / Free Fluid
Liver
dullness Other
Organs
Auscultation
: Peristaltit Sound Heard
/ No
CENTRAL NERVOUS SYSTEM
CARDIO VASCULAR SYSTEM
RESPIRATORY SYSTEM
INVESTIGATIONS
BLOOD
STOOL
Macroscopy
Microscopy
No.
of Pus Cells
No.
of Red Blood Cells
Bacteria
Ova/
Cysts
Reducing
Substances
KOH
Preparation
STOOLS FOR CULTURE AND SENSITIVITY
SERUM ELECTROLYTES
USG ABDOMEN
OTHERS
DURATION OF HOSPITALS
Less
than 1 day /
2 days / 3 days / More than 3 days
MANAGEMENT
i.
Only ORS
ii.
ORS, Later
IV Fluids
iii.
IV Fluids
Only
iv.
IV Fluids /
Later ORS
ORS : How
much in 24 Hours Tolerated
/ Not Tolerated
IV Fluids : Type
of Fluids
Amount of
Fluids
Potassium
Chloride
Calcium
Gluconate
Sodium
Bicarbonate
BREAST FEEDING : Stopped /
Continued
If
Stopped when it is started
FEEDING : Type
of Food
FOLLOW UP : 1st
Day 2nd Day 3rd Day 4th Day
No. of Stools :
No. of Vomiting:
Type of Stools :
Weight of Child:
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