Clinico social case Presentation
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The document presents a clinico-social case of a 29-year-old female patient with HIV infection and acute gastritis, detailing her personal, social, and clinical history. Key aspects include her low income and education level, as well as the impact of her illness on family dynamics and community health. Management recommendations focus on immediate psychological support, family counseling, and long-term health education and social support measures.
Clinico social case Presentation
- 1. CLINICO-SOCIAL CASE PRESENTATION University of Medicine (1),Yangon PSM Posting Group 5, Sub-groupA Roll No. 1 – 30
- 2. FORTHIS CLINICO-SOCIAL CASE, Case taking: Done by the whole sub-group Presenter: Kyaw San Lin (RN - 21) Computer: KayYu San (RN- 4) KKThwe Sunn (RN - 1) Kyaw San Lin (RN - 21) Pamphlet: KKThwe Sunn (RN - 1)
- 3. CONTENTS Personal Characteristics Summary of Relevant Social & Community Aspect Summary of Clinical Aspects Analysis of the Problem Management Summary of the Case
- 4. PERSONAL CHARACTERISTICS Age 29 Sex Female Race and Religion Myanmar, Buddhist Education 4th Standard Marital status Married Number of children 2 Occupation Selling rice & pickled tea (La-phat) at Thein Phyu Night Bazaar
- 5. PERSONAL CHARACTERISTICS Date ofAdmission 24th August, 2014 HospitalWard Unit 3, B Block, Central Woman Hospital Father Name U Sein Win Occupation ManualWorker Education Read &Write Mother Name Daw Shwe Mi Occupation ManualWorker Education Read & Write
- 6. SUMMARY OF RELEVANT SOCIAL & COMMUNITY ASPECT Personal History Occupational History Family History Attitude towards her illness Social Environmental History
- 7. PERSONAL HISTORY Well conscious and can respond to questions Hobby - WatchingTV, mainly movies Doesn’t have any ambition
- 8. HER LIFE EVENTS Childhood life at Zwe Htaw village Moved to Yangon Life after Marriage
- 9. CHILDHOOD LIFE AT ZWE HTAW VILLAGE • Parents - poverty • Many siblings Born from a poor family • Only Elementary school present • Both parents can only read and write Primary education at the village • Far from town • An hour drive by motorcycle to nearest town Thone khwa For higher levels of education…
- 10. LIFE EVENT AFTER MOVINGTO YANGON CITY Moving to Yangon to her elder brother at the age of 19 Assist household works for her brother’s family No further Education and health knowledge gained Met her husband-to-be while hiring Trishaw
- 11. MARRIAGE LIFE Age of marriage – 21 yrs After 3 yr (age of 24) – 1st child After another 2 yr (age of 26) – 2nd child Now, after another 3 yr (age of 29) - 3rd child pregnant and income becomes insufficient Lead her to sell goods at the night bazzare
- 12. OCCUPATIONAL HISTORY Working hours From 10 pm to 4 am Abnormal sleeping pattern Hours of sleep per day 4 hours Insufficient hours of sleep • Selling rice & pickled tea (La-phat) at Thein Phyu Night Bazaar
- 13. FAMILY HISTORY • 4 members • Nuclear type Her husbandPatient 2nd child1st child
- 14. HER HUSBAND Age – 33 years Education – 4th Standard Occupation – trishaw driver Daily income – 5000 kyats
- 15. HER CHILDREN First child - 5 years old, lives with her grandparents at Zwe Htaw village since 2012. Second child – 3 ½ years old, sent to her grandparents since she have the present pregnancy
- 16. ATTITUDETOWARDS HER ILLNESS According to her… She has never worked as sex worker No pre-marital sexual activity No extra-marital sexual activity Never transfused blood before So,… Realised that she got this disease from her beloved husband. Already known the chances of exposure to premarital and extramarital sexual exposure during his working period and environment.
- 17. ATTITUDETOWARDS HER ILLNESS But,… She understands her husband’s situation Still loves him… Wants to take medication regularly together with her husband. To get be able to live with her family happily as normal people.
- 18. HER CURRENT ENVIRONMENT Lives only with her husband in a 10 square feet room Shared with other families. Share bathrooms and toilets. Transportation - easy from her house. Bazaar - near her house and she can go easily. Water supply - from the Gyo Phyu water pipeline. Latrine - sanitary with septic tank attached. Refuse disposal - in a nearby public bin. Clinics and hospitals - situated near her house
- 19. SUMMARY OF CLINICAL ASPECT History Physical Examination Investigations Provisional Diagnosis
- 20. HISTORY Admitted to the CentralWomen Hospital (CWH) On 24th August, 2014 For acute gastritis and PMCT programme
- 21. MENSTRUAL HISTORY Age of menarche - 13 years. 28-week cycle, lasts for 3 days, regular, moderate amount, no dysmenorrhoea. LMP - 3rd January, 2014 (not sure) MBD - 33 wks 6 days EDD - 10th October, 2014
- 22. PAST OBSTETRIC HISTORY The age of marriage - 21 years. Single marriage. G 3, P 2+0. Her 1st child - 5 years old, born at term by urgent LSCS d/t APH d/t placenta praevia. No 3rd stage & puerperal complications. Her 2nd child - 3 ½ years old, born at term by elective LSCS d/t previous LSCS. No 3rd stage & puerperal complications.
- 23. HISTORY OF PRESENT PREGNANCY Unplanned but wanted pregnancy. Dx of pregnancy by UCG on March. Signs and symptoms of pregnancy such as morning sickness, and amenorrhoea are also present. Took AN care at 6th month of pregnancy at CWH.
- 24. HISTORY OF PRESENT ILLNESS acute onset dull aching pain in epigastrium 1 day duration aggravated by taking food relieved by taking antacid not severe No radiation
- 25. PAST MEDICAL & SURGICAL HISTORY No past history of H/T, DM, IHD, epilepsy,TB, renal diseases or other diseases. No history of hospitalization. No past surgical history.
- 26. PAST GYNAECOLOGICAL HISTORY No past gynaecological diseases, operations or treatment. Screening of cervical smear has not been done before.
- 27. FAMILY, DRUG & PERSONAL HISTORY No family history of H/T, DM, PE, or twin pregnancy. No other genetic diseases present. No regular taking of drug. No known drug allergy. No smoking, alcohol drinking, betel chewing or drugs addiction.
- 28. CLINICAL EXAMINATION General CNS CVS Respiration Lymphatics Breast Abdomen
- 29. GENERAL EXAMINATION Well alert, well orientated, lying comfortably in the bed, no fever, slightly thin. Eyes: Pallor present. No Jaundice. Mouth:Teeth and gum are healthy. No tonsillar enlargement. Neck: No visible swelling in the neck. Extremities Upper limbs: NAD Lower limbs: No clubbing, no peripheral cyanosis, bilateral pitting petal oedema present.
- 30. CNS EXAMINATION Well alert, well orientated. Normal cranial nerves, sensory, motor and peripheral nerves functioning.
- 31. CVS EXAMINATION BP- 110/70 mmHg PR – 70 beats/min Apex beat - located at the left 5th ICS within the mid-clavicular line Normal 1st and 2nd heart sound No added sound
- 32. RESPIRATORY SYSTEM EXAMINATION Normal vesicular breath sound No added sound RR – 16/min
- 33. LYMPHORETICULAR SYSTEM No lymph node enlargement. No liver enlargement. No splenic enlargement.
- 34. BREAST EXAMINATION Well developed. Nipple is protruded. On palpation of the four quadrants, no abnormal lump is palpated.
- 35. ABDOMINAL EXAMINATION (SUMMARY) Fundal Height - 38week size SFH- 35 cm Single foetus Longitudinal lie Head presentation Not engaged. FHS is 160 beats/min, strong and regular.
- 36. INVESTIGATIONS Blood for CP – RBC,WBC, & platelet are normal in both count and morphology Chemical Pathology – Alkaline Phosphatase↑ Infection screening HBs Ag - negative, HCV Ab - negative, Blood for VDRL – non-reactive HIV screening test – reactive, 1st confirmation test – reactive, 2nd confirmation test – Positive HIV screening test of the husband - reactive, 1st confirmation test – reactive, 2nd confirmation test – Positive CD4 count - 284 cells/𝜇L (Normal - >400 cells/𝜇L)
- 37. INVESTIGATIONS USG Date of present report 2nd July, 2014 No. of foetus: Single Presentation: Head Lie: Longitudinal Placental Localization: Anterior, upper Amniotic fluid volume: Normal Radiologist Comments Single viable foetus 27 week at EGA
- 38. PROVISIONAL DIAGNOSIS 29 years old G 3, P 2+0 at 34+6 weeks of pregnancy with HIV infection and acute gastritis
- 39. ANALYSIS OFTHE PROBLEM From 3 Aspects: 1. Social Etiology 2. Diagnoses – Clinical & Social 3. Social Implications
- 41. PREDISPOSING FACTORS Poverty Husband’s daily income - 5 thousand kyats Low Education Level passed only the 4th Standard Poor Health Knowledge not interested in seeking health knowledge Weak Guardianship d/t the large size of her family needs personality formation and moral teachings
- 42. ENABLING FACTORS Low education Level of Husband Occupation of Husband Morality of Husband, Premarital Sexual Exposure, Unsafe Sex Lack of Premarital Counselling
- 43. PRECIPITATING FACTORS Pregnancy increases HIV infection progression, progression to AIDS and the chance of death. Nature of her Occupation weakens her health and worsens her condition.
- 44. REINFORCING FACTORS Poor Nutrition does not eat any meat other than small fish. commonly eats vegetables → low protein diet. Lack of Family Support Currently, only her husband staying with her insufficient as family support.
- 45. CLINICAL DIAGNOSIS 29 years old, G 3, P 2+0, at 33+6 weeks of pregnancy with HIV infection and acute gastritis
- 46. SOCIAL DIAGNOSIS Poverty Poor education Lack of health knowledge especially reproductive health
- 47. SOCIAL IMPLICATIONS Social Implications Individual Level Family Level Community Level National Level
- 48. INDIVIDUAL LEVEL Psychological Stress others might ignore her socially isolated loss of support from family & friends emotional breakdown fear of opportunistic infections, anticipatory grief, shame, helplessness, and discrimination
- 49. FAMILY LEVEL Increased risk of transmission of HIV from mother to child during pregnancy, birth or lactation Financial problems Inability to work during pregnancy Increase in expenditure of healthcare and health facilities Family Burden care given to her during gestation period → take effort and time of family members. Reduction of care for other children
- 50. COMMUNITY LEVEL Increased risk of transmission Increased workload for doctors and medico- social workers
- 51. NATIONAL LEVEL Decreasing Human resources Increased incidence and prevalence of HIV infected person Increased workload of health sector
- 52. Predisposing factors Poverty Low Education Level Poor Health Knowledge Weak Guardianship Enabling Factors Low education Level of Husband Occupation of Husband Morality of Husband Premarital Sexual Exposure, Unsafe Sex Lack of Premarital Counselling Precipitating factor Pregnancy Nature of Occupation Reinforcing factors Poor Nutrition Lack of Family Support Clinical diagnosis 29 years old, G 3, P 2+0, at 33+6 weeks of pregnancy with HIV infection & acute gastritis Social diagnosis Poverty Poor education Lack of health knowledge especially in reproductive health Individual Level Psychological stress Community Level Increased risk of transmission Increased workload for doctors and medico-social workers Family Level • Increased risk of transmission of HIV • Financial problems • Family Burden • Reduction of care for other children National Level Decreasing Human resources Increased incidence and prevalence of HIV infected person Increased workload of health sector Social Etiology Social Implication
- 53. CLINICO-SOCIAL MANAGEMENTS Mangements Immediate Management Individual Level Family Level Long-term Management Individual Level Family Level Community Level National Level
- 54. IMMEDIATE MANAGEMENTS Individual Level Psychological support and counselling PMCT Nutrition Treatment for acute gastritis Family Level Counselling Sterilization ARV Prophylaxis to Baby
- 55. LONG-TERM MANAGEMENTS Individual Level Social support and ART treatment Rest Safe water and Food Avoid handling pets Safe Sex Family Level Health Education Prevention of HIV transmission
- 56. COMMUNITY LEVEL HE about blood transfusion, drug abuse, sexual promiscuity and their disease HE to sex workers about safe sex Encouraging the community to help patients by giving psychological support Cooperation and collaboration with social welfare services such as NGOs
- 57. NATIONAL LEVEL Promoting literacy Creating job opportunities Promoting national health care services and facilities National HIV/ AIDS Control Program (NAP) Implementing PMCT programme Surveillance against STD in community Identify missing cases Cooperation and collaboration with INGOs, local NGOs and services Supervision, monitoring and evaluation
- 58. SUMMARY OFTHE CASE A female patient, aged 29, G 3, P 2+0, came to CWH for acute gastritis and AN Care. HIV testing done as part of the AN Care package - positive result Admitted to CWH, B Block, Unit 3 on 24th August, 2014 for PMCT. Her husband tested for HIV - positive. Both - low income, poor educational status and lack of reproductive health education.
- 59. SUMMARY OFTHE CASE CD4 count - <350 cells/mm ART treatment Her husband - referred toTharketa STI Hospital for ART treatment. Counselling - HIV, PMCT, delivery and infant feeding