Student Manual Tropis 2012

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Collection Manual

CLINIC & LABORATORY SKILLS

TROPICAL MEDICINE

Presented at The Grade VI

Student of Medical Faculty Hasanuddin University

MEDICAL FACULTY

HASANUDDIN UNIVERSITY

2012


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CONTENTS

1. Preface:

2. List authors

3. Order

4. 1st Manual Anamnesis of patches on the skinpatient

Learning objectives

Description of activities

Step of activities

Examples of patient status

Checklist

5. 2nd Manual Physical examination of patches on the skin patients

Learning objectives

Description of activitiesStep of activities


Checklist

6. 3rd Manual Skin Scratch

Learning objectives


Step of activities


Checklist

7. 4th Manual Skin Liquid Smear

Learning objectives


Step of activities


Checklist

8. 5th Manual Peripheral Blood Smear

Learning objectives


Step of activities


Checklist

9. 6th Manual Feces Smear

Learning objectives


Step of activities


Checklist 2


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PREFACE

Manual collection of clinical and laboratory skills is given to the students who take a

course in Tropical Medicine in the sixth semester and the instructors who accompany

students on these skill activities. General instructional purposes and specificinstructional objectives are presented in each module intended for students and

instructors to know the learning objectives of each manual in order to achieve the

expected minimum competencies.

Description of activities to be conducted at each skills training is equipped with time

allocation, so that the use of 90 minutes for each exercise can be used as efficiently as

possible. Step of activities is a step by step activity that should not be exchanged one

another so that the consistency of the flow of skills is chieftained.

Each manual is equipped with work sheet so students can record the activities which

are undertaken during the skills training, instructors are expected to check this work

sheet at the end of activities. Students Attendance in the skill training will be

equipped with assessment column.

Some things related to activities such as orderliness, schedule of activities, division of

space, and instructor's name are also attached to this set of manual skills.

This manual collection is still far from perfection, a construction criticism is needed

very much

Makassar, April 1th

2010

Tropical Medicine

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Editor

1 st Manual

Anamnesis patient patches on the skin

Editor: Sri Vitayani & Sitti Wahyuni

2nd Manual

Anamnesis patient patches on the skin

Editor: Sri Vitayani & Sitti Wahyuni3rd Manual

Scratch SkinEditor: Muh. Nasrum Massi, Baedah Madjid

& A.R. Sultan

4thManual

Skin fluid smear

Editor: Muh. Nasrum Massi, Firdaus Hamid & Baedah Madjid

5th Manual

Peripheral blood smear

Editor: Sitti Wahyuni

6th ManualFaeces smear

Editor: Sitti Wahyuni

RULE OF CLINICAL SKILLS & LABORATORIUM

Students who follow this activity are required:

1. Reading the manual skills of the previous clinical and laboratory.

2. Attending on time.

3. Can prove his identity during the exercise took place (the entire face visible)4. Wearing a lab coat and appropriate signage absenteeism

5. Neatly dressed and polite.

6. Actively participate in skills training activities.

7. Do not do activities that have not relation with skills training activities.

8. Do not put other items on the table except manual labor and skills training

materials

9. No damage to materials and skills training tools. Any damage must be

replaced within a maximum period of one week.

10. Leaving skills training room in neat and clean condition.

11. The above rules are applied since entering the corridor of an integrated

laboratory skills lab at the first and second floors.

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MANUAL 1

ANAMNESIS SKILL

PATIENTS WITH MAJOR COMPLAINTS IN PATCHES ON THE SKIN

LEARNING OBJECTIVES

General Instructional Objectives

At the end of the exercise of these skills, students are expected to do anamnesis thatled to the diagnosis of tropical diseases in patients with major symptoms of patches

on the skin.

Specific Instructional Objectives

1. Capable and skilled to communication with patients

2. Capable and skilled to foster a sense of connection and provide a sense of

empathy.

3. Capable and skilled to get information about patches on the skin is experienced

by patients.

4. Capable and skilled to conduct guided anamnesis that lead to the diagnosis of

tropical diseases with major complaints of patches on the skin

5. Capable and skilled to provide information to patients regarding further action

will be carried out based on the anamnesis has been collected.

6. Capable and skilled to make a resume of all information obtained in the

anamnesis with the chief complaint of patches on the skin.

INDICATIONS

Patients with symptoms of patches on the skin with suspect :

- Leprosy

- Bacterial infection of non leprosy

- Fungal infections

- Viral infection

- Parasitic infection

- Non-specific skin disorders

MATERIALS AND TOOLS

- Desk

- Chair of patient

- Chair of doctor

- Status Book of patients with anamnesis sheet.

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ACTIVITY DESCRIPTION

Activity Time Description

l. Introduction 5 minutes Introduction

- The instructor explained about the objectives ofthese skills

- The instructor show materials and tools for theseSkills

2.

Demonstration

20 minutes 1. A student acts as patients2. Mentor shows how to get information about the

patches on the skin experienced by patients

3. Mentor shows how to do anamnesis that lead todiagnosis of tropical diseases with a chief complaint

of patches on the skin.

4. Mentor shows how to inform to the patient regarding

further action will be done based on the results of

anamnesis have been collected.

5. Mentor shows how to create resumes from allinformation obtained in the anamnesis with the chief

complaint of patches on the skin6. Students are required to ask about the things which

are not clear related to the these skills activities

3. Practice role

playing with

feedback

55 minute

s

1. Students are divided into pairs, one of them acts as adoctor and another one has a role as a patient

2. Person who acts as the doctor performed the followingactivities: get information about the patches on the skin

experienced by the patient, performing anamnesis that

lead to the diagnosis of tropical disease with a chiefcomplaint of patches on the skin, inform the patientabout further action to be performed based on

anamnesis results have been collected and make a

resume of all information obtained in the anamnesiswith the chief complaint of patches on the skin

3. Role exchange4. Mentor rounds among students and does a supervision5. Mentor corrects the things which are not perfect

Brainstormig

andDiscussion

10 minutes Students are given the opportunity to put opinions about

the activities undertaken

Total time 90 minutes

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STEP OF ACTIVITY

NO. Activities undertaken

Preparation of patients

1 Please let the patient came into the room.

2 Greet patients and their families with great familiarity.

3 Introduce yourself while shaking the patients hand.

4 Please let the patients and their families to sit down.5 Show empathy for patients.

6 Provide general information on the patient or family about the anamnesis you are going to do,objectives and benefits to the patient anamnesis.

7 Provide assurance to patients and their families about the confidentiality of all informationobtained on the anamnesis.

8 Tell us about the patients rights to the patient or his family, for example the right to refuse toanswer questions which he considers one does not need to answer.General Anamnesis

9 Ask patient's personal data: name, age, address, and occupation

10 Ask what is causing the patient comes to the doctor (chief complaint).

For heteroanamnesis, ask the patient relationship with the people who accompany themGuided anamnesis

11 Ask any skin abnormalities began to appear, whether arising lost, settled, where a locationinitially and then where they appear.

12 Ask whether or not accompanied by fever

13 Ask whether or not accompanied by itching.

14 Ask if there are patches on the skin with an insect bite or injury (trauma)

15 Ask whether this was accompanied by cramps, patches on the skin or sore. If there is, ask:- When these things begin to happen, whether or not happen suddenly.- Nature of pain or cramping: mild, moderate, severe; intermittent or continuous; higher in the

morning, afternoon or evening; attack with a certain interval; only at one place or feels like

ants moving.- Is there pain bones, artralgia, myalgia, anorexia and malaise.- Tenderness in the arms and legs.- Wounds in the palms of the hands or feet

16 Ask whether or not the patient had experienced similar complaints in the past.

17 Ask a history of the same disease in the family or the neighborhood where one lived.

18 Ask a history of contact with the victims of the disease with similar symptoms

19 Ask your medical history has ever been received from a doctor and purchased his ownmedicine by a patient without a prescriptionEnding anamnesis

20 Explain to patients that this phase is just the beginning phase of a series of checks to know thepatient's illness: and physical examination is still needed to refine the diagnosis.

Create a resume of the results of anamnesis

21 Divide up all the results obtained in a tabulation

22 Create one chief diagnosis and differential diagnosis of the anamnesis result

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Student activity sheets

EXAMPLES OF PATIENT STATUS SHEET

No Register:

Name:Sex:

Age:

Ocupation:

Address:

Date/hour: /

ANAMNESIS (relationships with patients ..................................... if

heteroanamnesis)

Chief complain :

Guided Anamnesis:


Summary:

Diagnosis anamnesis:

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CHECKLIST MANUAL 1

ANAMNESIS SKILL

PATIENT WITH MAJOR COMPLAINTS IN PATCHES ON THE SKIN

NO. Activities which are appraised

Check up Preparation

1 Perform a sense of connection with patients and their families.

2 Make an informed concent to the client and his family.

General anamnesis

3 Exploring the client's personal data: name, age, address & occupation

4 Asking four chief reasons to come to the doctor

Guided anamnesis

5 Exploring the history of the disease based on five chief complaints.

6 Exploring other symptoms that accompany the chief complaints

7 Exploring the history of similar illness in the family or neighborhood environment.

8 Exploring the history of contact with patients with symptoms of patches on the skin

9 Exploring the history of medicine has ever been received / used

Ending the anamnesis and creating a resume

10 Explaining to the client that this phase is just the beginning phase of a series of examinations to be

able to know the illnesses is suffered by patients: and physical examination is still needed to refine

the diagnosis.

11 Composing the results of anamnesis and make its resume.

Note: The above list contains activities will be assessed on the skills test in which the instructor was asked for

giving assessments to students for eleven checklist above (see sheets of student assessment)

Score: 0 if not done 1 if it is done but yet satisfying

2 if satisfactory

Examples of student assessment sheets for the manual first

ActivitiesNo Name Studentnumber 1 2 3 4 5 6 7 8 9 10 11

Total

1 Aminah 2007000C4 2 2 2 1 2 2 2 1 2 2 2 20

23

4

20

Scoring for the first manualTotal value of the lowest 0, highest value 22Score 0-11: unskilledScore 12-22: skilled (graduate CSL, this value will still be scored to C,B &A )

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MANUAL 2

SKILL OF PHYSICAL EXAMINATIONCHIEF COMPLAINT OF PATIENT WITH PATCHES ON THE SKIN

LEARNING OBJECTIVES

General instructional objectives

At the end of this skills exercise, the students are expected to perform physical

examinations that led to the diagnosis of tropical diseases with chief complaints of

patches on the skin

Specific Instructional objectives

7. Capable and skilled to communicate with patients.

8. Capable and skilled to explain the physical examination will be conducted.

9. Capable and skilled to prepare patients before physical examination.

10. Capable and skilled to assess patient status in general and measuring vital

signs.

11. Capable and skilled inspection done in a systematic physical examination to

diagnose a patient with a chief complaint among other patchess on the skin by

checking:

a. Skin effloresensi.b. Signs of dryness and cracked skin.

c. Sensitivity on the part of skin lesions

d. Palpability peripheral nerves in a symmetrical right and left, to see the

existence of nerve enlargement, its consistence, there is tenderness and

dysfunction nerve.

12. Capable and skilled to inform results found, required investigation and

treatment plan to patient / family.

13. Capable and skilled to make a resume for patient records

INDICATIONS

Patients with suspect:

1. Leprosy

2. Fungal infection

3. Bacterial infection

4. Viral infection

5. Parasitic infections

6. Non-specific skin disorder


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MEDIA AND LEARNING TOOLS

Water flow

Liquid Soap

small towel

Thermometer

Stethoscope

Tensimeter

magnifying glass

Tape measure height and weight

Cotton which is sharpened in one its edge.

Sterile needle immersed in alcohol

Two reactions tubes, each containing hot water and cold water

Video, slides or drawings to show typical clinical signs in some tropical

diseases that give a patches on the skin.

medical and non-medical tpatches can

Status book of the patient to record the results of physical examination



1. Introduction 5 minutes Introduction

- The instructor explained the purpose of this skill. Instructors

demonstrate the materials and tools necessary to perform these skills.

2. Demonstration 15 minutes 7. A student acts as patients.

8. Mentor shows how to prepare patients before physical

examination.9. Mentor shows how to conduct assessment of patient

status and measuring vital signs.

10. Mentor shows how to conduct examination

systematically to physical diagnosis to the patient with

the chief complaint of patches on the skin such as by

examining:

- Skin effloresensi.

- The signs of dryness and cracked on skin.

- Sensitivity on the part of the skin lesions.

- Peripheral nerves in a symmetrical right and left, to

see the existence of nerves enlargement, its

consistency, there is tenderness and neurological

dysfunction (mentor shows the audiovisual how

examination of peripheral nerves).

11. Mentor shows you how to inform the results

found, investigation

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required and a treatment plan to patient / family

12. Mentor shows how to create a resume for

patient records

13. Students are required to ask the things which are

unclear in relation to skill activity.

3. Practice role playing

with feedback

55 minutes

6.Students are divided into some pairs , one

person acts as a doctor and one personacts as a patient.

7. Person who acts as the doctor performed the followingactivities: explains the physical examination will be done,

prepare the patient before physical examination, assessingpatient status in general, and measuring vital signs, performphysical examination in a systematic physical examination to

diagnose patients with complaints of the chief patchess on theskin (skin effloresensi, signs of dryness and cracked skin,sensitivity on the part of the skin lesions, peripheral nerves aresymmetrical right and left, to see the existence of nerve

enlargement, its consistency, tenderness and neurological

dysfunction), inform results are found, the investigationrequired and a treatment plan to patient / family and make a

resume for archives patient

8. Role exchange9. Mentor walk rounds among students and do a supervision10. Mentor corrects the things which are not perfect

4.Brainstorming and

discussion

10 minutes Students are given the opportunity to put forward opinions about theactivities undertaken.


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STEP OF ACTIVITIESS

No. Activities undertaken

Preparation of patients

1 Explains the physical examination will be conducted, its purpose and benefits

2 Giving assurance to patients and their families about the confidentiality of all information obtained

on the physical examination.

3 Explaining about the rights of patients or their families, for example concerning the right to refuseto be examined.

4 Please the patient to put off all the clothes and make sure the patient gets good light during the

physical examination.

5 Standing on the right side of patient.

Assessment of overall patient status and vital signs

6 View and record the general condition of patients: mild pain, moderate pain or severe pain.

7 Determine the nutritional status: height and weight measurement (in accordance with the manual to

determine the status of a nutrient).8 Measure and assess patient vital signs: blood pressure, pulse, respiration and temperature.

9 Look at the entire patient body from top to toe:

- whether there is thinning of scalp hair and eyebrows.

- whether there lagophthalmia in the eyelid.

- whether the patient's nose dropped (sadle nose).

- areas where patchess are located

10 Check there is any enlargement of the liver, edema of the legs, wounds in the legs

Examination of patches on the skin

11 Where these patchess location are

12 Look at the effloresence type: erythema, hypopigmentation, hyperpigmentation, vesicles nodules,

blister, macular papules, squama, urtika, ulceration, crusting

13 If the entire surface of lesions is flat, note whether the skin surface is dry or wet, and the presence offine hair.Sensitivity test

14 Using a sharpened tip of cotton:

- Touch the skin of normal patients with a sharpened tip of the cotton, and a little bent.

Allow the patient to see what and where you do it.

- Ask the patient to see to another direction and do the touch with cotton at first on a normal

region, and in the regions are alternating patches. Ask whether or not the patient felt the

touch.

- Ask patients to showed part of her body touched. Record whether or not in accordance with

section which is touched.

- Take the assessment test results of the touches.

15 Doing lightly puncture with the tip of the needle:

- Do the same test with lightly puncture by using a sterile needle, firstly on

normal skin area. Allow the patient to see what and where you do it.

- Close the patients eye and do lightly puncture in normal area first , then in

alternating patches area.

- Do the assessment results of puncture tests.

16 Using hot and cold tubes:

- Do the same test using two tubes where each using two tube contain cold

and warm water. Doing first at normal skin area and ask for the patient to

see what and where you do it

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- close the patients eyes and put alternating both tubes to normal area first,

then at patches area.

- Doing result assessment of tube test you have done.

Examination of peripheral nerves

17 N. Auricularis magnum:

- Ask the patient to turn his face into the direction opposite from the side whichwill be checked, while looking toward the shoulder.

- Keep a notice whether visible or absence of enlargement of N. Auricularmagnum.

- If the enlargement of the nerve is not visible, do remain palpation by maintaininga position like that, scan the area with palpability upper neck of the patient,from craniolateral to caudomedial direction.

- Feel the presence or absence of this nerve thickening.

18 Inspection N. Radialis:- Ask the patient to bend his arm so as to form an angle of 60 C at the elbow.- Calm the patient down and instruct him to relax his muscles.- Touch and trace the lateral third of the upper arm area roughly between meeting

area. Triceps brachii caput longum and lateral.- Feel the presence or absence of this nerve enlargement. Look at the expressionon the patient to know the sensitivity of this nerve

19 Inspection N. Ulnaris:- Hold the bottom of the right arm of patient with your right hand.- Put elbows slightly bent so that the patient's arm will be relaxed.- Use the index finger and middle finger left hand to search while touching N.

ulnaris in nervi ulnaris sulcus (indentation between the bones bulge elbow and asmall bulge in the medial = medial epicondylus)

- Feel whether or not there is nerve enlargement.- Give a little light pressure on N. Ulnar while tracing it to top direction smoothly,

see the expression whether or not looks pain.

20 Inspection N. Medianus- Ask for the patient to clench his hands (not too tight), while slightly difleksikan.- Scan the area between the tendo m. Palmaris longus tendon and m. Flexor carpi

radialis longus with your fingertips.

- Feel if there is enlargement. While touchinglook at the patients expression

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21 Inspection N. Peroneus communis (lateral popliteal nerve)

- Have the patient sit on the edge of the bed with legs dangling relaxed.

- Sit in front of the patient with a right hand checks the left foot of the patient and

left hand checks the right foot of the patients.

- Put middle finger and your index finger on the outside of the mid-calf patients.

- Touch slowly upward until it finds a lump of bone, (caput fibula).

- After that Touch peroneus nerve approximately 1 cm from the lump into bones

the rear top.

- Rolling the nerve with mild pressure to the left and right are interchangeably.

- Feel the absence of enlargement.

- While touching look at the expression of the patient.

- Patients were asked to sit idly dangling.

- Touch N. Posterior tibial artery at the bottom of the rear side of ankle deep.

- Feel the absence of enlargement.

- While touching look at the expression of the patient.

22 Mapping neural disorders:

Make a picture in the paper that has been provided, all found in nerve abnormalities.

23 Examination of nerve function impairment:- Inspect the patient's eyelids to see any disruption of motor N. Facialis-Check the feet to see the motor and sensory disturbances.

24 Helping the patient to wake up, to put on clothing and to allow one to re-sit.

Informing results found, investigation and treatment plan

25 Explain to the patient's family about the patient's examination results found.

26 Explain that for a definite diagnosis some supporting investigation are required.

27 Explain about the disease diagnosis, treatment plan, prognosis and complications.

28 Doing counseling by explaining about the disease (according to diagnosis), especially the one about

the success of therapy.29 Explain the rules of treatment and make sure the patient or his preface to comply with a rule that will

be receiving treatment.

30 Say goodbye to the patient by giving hope to patients

Creating a resume for patient records

31 Write your resume in its entirety (the anamnesis, physical examination, a

temporary treatment given and the requested investigation) as

patient records.

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EXAMPLES OF PATIENT STATUS

No Register:Name:

Sex:

Age:

Occupation:

Address:

Date / hour: / /

ANAMNESIS (the relationship with the patient.......................... if

heteroanamnesis)

The main complaint:

The guided Anamnesis:

Resume:

GENERAL CONDITIONS:

Vital signs: Blood pressure......mmHg; Nadi....../min, Respiratory:.... minutes;

Temperature.......oC

General conditions: pain mild / moderate / heavy

Nutritional status: height.......cm; weight.......kg; nutrition less/better/more

PHYSICAL EXAMINATION:

1. Skin patches:

Effloresensi Type:

Surface:

Student activities sheets

2. Sensitivity test

Cotton test:

Needle puncture test:

Test tube:

3. Nerve circumstances:

Thickening N. Auricularis magnum:

Thickening N. Radialis:

Thickening N. Ulnaris:

Thickening N. Medianus:

Thickening N. Peroneus communis (lateral popliteal nerve):

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Map of neurological disorders:

Disfunction of nerve :

Summary :


Diagnosis:

Differential diagnosis :

Management: Th/

Editional examination :

Nerve facialis

Nefrve medianus

Nerve peroneus

Nerve tiabialis

Nerve radialis

Nerve auricularis

magnus

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EXAMINATION REFERENCE OF LEPROSY SUSPECT PATIENTS

A. Basic diagnosis of leprosy (leprosy)

Leprosy or leprosy diagnosis can only be enforced if found in one of the cardinal

sign (major symptoms).The main symptoms of leprosy are:

1. Numbness of skin lesions

Abnormalities of the skin in leprosy can be in the shape of patches of

hypopigmentation or reddish (eritrematous), which was numb. May be less flavor

(hipestesi) or do not feel at all (anesthesia).

2. Significant thickening of nerve is followed by nerve function impairment

Thickening of the nerve occurs as a result of peripheral nerve inflammation

(peripheral neuritis). Neuritis in leprosy can be accompanied with or without a

neurological dysfunction.Functions nerve disorders that can occur:

a. Sensory dysfunction: anesthesia / hipestesi,b. Motor dysfunction: parese or paralise,

c. autonomic function disorders: dry skin, cracking, edema, etc..

Neuritis in leprosy can be symptomatic pain, but sometimes there is no pain,

known as

silent neuritis.

3. Positive acid resistant bacillus

Examination materials to notice a smear taken from a liquid preparation made by

direct skin (skin smear). This material is usually taken from the ear lobe or from

the active part (edge) of a lesion on the skin. Sometimes the material was taken

with a skin or nerve biopsy.

B. Diagnosis

For the diagnosis of leprosy was found in a person must be at least one of the

cardinal sign above. If one cardinal sign is not found, it should only be diagnosed

as a suspected leprosy = leprosy. Such patients should be observed and

reexamined after 3-6 months until the diagnosis of leprosy can be enforced or

removed.

C. Clinical symptoms

a. Early Signs of Leprosy Disease (leprosy)

1. Skin disorders Changes in skin color such as white spot like white blotches,

Can be infiltrates shape Can be nodules shape

2. Nerve Disorders Edge

Real nerve enlargement accompanied by numbness, and / or muscle

weakness in areas that are supplied (eyes, hands, feet), or sometimes in the

form of tender.

b. Signs of Leprosy Disease (Leprosy) Continue.If untreated leprosy early is not medicated or found lately, it will be found

a more severe clinical symptoms.

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1. Skin disorders

The number of patches on the skin grow much, much thicker and red

spots. The skin becomes more dry.

2. Nerve Disorders

Thickened nerves with nerve function impairment, and tenderness, may

occur on one or more peripheral nerves. Therefore, peripheral nervefunction is disrupted, the skin is numb when taxable collision will causewounds (ulcers on the palms of the hands or feet), dry skin can crack.

Further disruption muscles moving the fingers and toes (kiting / clawing).Symptoms continued: Nose to collapse, gynecomasty madarosis and

lagophthalmus. \

PHYSICAL EXAMINATION OF LEPROSY SUSPECTED PATIENTS

Doing an examination in a room that gets enough sunlight lighting.

Examination must be done systematically in which the patient sits facing theexaminer. Beginyour examination from head to toe, then the rear body start from

neck, shoulders, rear body, arms and legs.

Examination of skin on the entire surface of the client body by paying attention tothe client privacy.

Inspection numb

Inspection of anesthesia (numbness), or sensitivity testing using the following:- Cotton and patients were asked for indicating the direction of movement of

cotton.

- Pick a light sterile needle to determine the pain experienced by patients.

- Hot and cold reaction Tubes to determine the response to temperature.

- Compare between one lesion with other lesions.

Sensitivity test conducted alternately in the area of normal skin and skin

lesions

Make sure the patient does not see the area is touched or punctured.

Sensitivity test used to assess how much nerve damage that occurs in

patients. While the enlargement of the nerve test to assess how much of the

peripheral nerve fibers involved and damaged in the disease. Both these tests are

often performed in patients suspected of leprosy. Ballpoin or bike bars, can be used

to assess peripheral nerve disorders based on its nerves area.

Examination of peripheral nerve enlargement

Peripheral nerve examination should be conducted systematically and carried out on

the rightlimb and left.

Feeling nervous or palpation should be conducted in such a way that does not hurt

patient or not a good impression on patients. Fingernail examiner should not be long.

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In this examination the patient should be in calm condition with attenuated muscle.

Find a place that will be examined peripheral nerves. Then rubbed and Taste

referred to the enlargement of peripheral nerves.

Check as many as possible peripheral nerves are frequently involved in leprosy.

Make the picture on the paper has been provided.

1. Inspection N.Auricular magnus

In addition to the palpability, in most cases, the enlargement N. Auricular magnus

can be found by inspection.

2. Inspection N.Radialis

Is the most difficult Nerve to be touched because it was not superficial palpable as

other nerves that are often involved in leprosy. To feel it browse the lateral third of

the upper arm about a meeting between regional m. Tricep brachii caput longum and

lateral.

3. Inspection N. Ulnaris

This nerve is difficult to touch from the outside, because it required proficiency of

the examiner to be able to feel it.

4. N. Median Inspection

This nerves is rather difficult to Palpated because lie between the deep and two

tendon (M.Palmaris longus and M.Flexor carpi radialis longus).

To be able to distinguish easily the thickened / enlarged nerve, it is required a

normal nerve palpation experience on healthy people.

CHECKLIST MANUAL 2

PHYSICAL EXAMINATION SYSTEMATIC

COMPLAINTS OF PATIENTS WITH SKIN SPOT ON

NO. Activities that are considered

Preparatory examination

1 Do connect with patients and their families feel.

2 Take through the informed concent to patients and their families.

Assessment of general condition and skin

3 Perform thorough skin examination.4 Examination of other organs such as eyes, nose and heart patients.

5 Verifying the existence of thinning hair and eyebrows.

Examination of skin patches

6 Location and type of effloresensi.

7 How is lesions surface: dry, wet, presence or absence of fine hair.

Sensitivity test

8 With a cotton tip

9 With the tip of the needle

10 With tube

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MANUAL 3

SKILLS OF TAKING, MAKING AND CHECKING WET PREPARATION

AND PREPARING SKIN SCRATCH DELIVERY

LEARNING OBJECTIVESGeneral instructional objectives

After completing this training, students are expected to perform retrieval and

delivery of skin scratch properly, correctly and efficiently.

Specific instructional objectives

After doing the exercises these skills, students are expected to be able to:1. Do preparation of patients correctly

2. Prepare equipment / materials correctly3. Make good relation with patients

4. Give inform concent to patients correctly.

5. conduct regular hand washing and asepsis correctly

6. Install sterile gloves correctly, and release them after the work is completed.

7. Perform capture of the scratch skin correctly

8. Make preparation and delivery of skin scratch correctly

INDICATIONS

Patients with skin lesions which is suspected to suffer dermatomikosis.

TOOLS AND MATERIALS REQUIRED

Flow water Spiritus Lights

Liquid Soap Paper sterile Petri dish or is a minimum size 10

x 10 cm Antiseptic solution small towel or tissue in a folded state.

Cotton Sterile gloves

Scalpel (knife handles size 2 pcs Lisol solution containing 5%

No.3 and the blade no. 15) Medical trash

Alkohol70% Non-medical trash

REFERENCE

Scratch up ward with a slope of 30 - 45 using a sterile scalpel.Locations scraped the edge of the lesion which is part of the most active

part and covered with scales.

TOOLS AND MATERIALS ARE REQUIRED FOR MAKING &

EXAMINING DIRECT BLOOD SMEAR OF SKIN SCRATCH

Flow water Inoculated Needles

Liquid Soap 10% KOH solution

Antiseptic solution Pipette

Small towel or tissue Fold the paper sterile / sterile petri dish

Cotton Binocular microscope

70% Alcohol 2 pcs khlorin0 basin containing solution 5%

Lights spiritus Cover glass

Glass Objects permanent markers

Medical trash Non-medical trash

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ACTIVITY Time DESCRIPTION

1.Introduction 5 minutes Introduction

2. Demonstration 20 minutes 1. Organize students seated position

2. Two instructors give examples how to retrieve, create

and examining wet preparat (blood smear), and

preparing skin scratch delivery. Students pay attention /

watched a demonstration by using learning manual.

3. Give opportunities for students to ask questions and

instructors give explanations about important aspects

3. Practice role playing

with feedback

55 minutes 2. Students are divided into pairs. An Instructor is needed

to observe every step taken by each spouse.

3. Simultaneously, each pair of practices take steps to

capture and scratch delivery skin preparation

4. Instructors around between pairs of students who are

doing practice to conduct supervision and use a

checklist to assess student work.

5. If there are errors instructor, immediately work

procedures shows again pass up the right way.

6. Instructors provide questions and feedback back to each

pair

4. discussion 10 minutes 1. Brainstorming / Discussion: Which one is easy? Which

one is difficult? Ask about students feelings at the time

of scratching the skin. What can be done by doctor to

patient feel more comfortable?2. Instructors make conclusions by answering the last

question and clarify things are still not understood.


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LEARNING GUIDE

SKILLS OF TAKING, MAKING AND CHECKING WET PREFARAT, AND PREPARING

DELIVERY OF SKIN SCRATCH

NO. STEP / ACTIVITY

PATIENT PREPARATION

1. Greet clients or their families friendly and introduce yourself, and ask their conditon.

2. Please clients and their families to sit

3. Give general information on the client or his family about making scratch, purpose and the benefit to

the client circumstances.

4. Give assurance to the client or his family about the security checks performed

5. Give assurance to the client or his family about the confidentiality required by the client

6. Explain to the client about the rights of clients or their families, for example the right to refuse takingskin scratch.

7. Ask your client's willingness to oral examination of skin scratch

PREPARATION OF MAKING SKIN SCRATCH

8. Prepare all the necessary tools and materials on a table near the patient

9. Write the register number / patient data on the back of the glass objects, petri dish or on the outside of

the sterile paper folds.

10. Ask the patient to sit or lie down (depending on the location of specimen collection)

11. Wash your hands regularly

12. Put sterile gloves

MAKING SKIN SCRATCH

13. Check the location of specimens well14. Do disinfection of the skin defect with alcohol 70% starting from the middle of an abnormal area in a

circle to the edge of the skin disorder that would be scratched.

15. Take a new alcohol cotton and do skin disinfection in the area around the lesion started from the

outside to the inside.

16. Making scratch with a sterile scalpel lesion edges upward with a slope of 30 - 45

17. Open the folded paper cup or lid

18. Knock scalpel at the base of the Petri dish or on the surface of sterile paper that had been prepareduntil all the scales and the flake of skin scratch falls on the surface of paper or a petri dish .

19. Insert a scalpel which has been used in the basin contains 50-10% lisol

MAKE AND CHECK WET TABLET FROM SKIN SCRATCH

20. Put one glass flat objects with Register number / patient data on the back.

21. Drop 1-2 drops of 10% KOH solution

22. Dampen the tip of the needle inoculation with KOH solution and then take one or more bits of skin onthe bottom plate dish, and insert in KOH solution on the surface of glass objects

23. Cover a glass cover on the liquid droplets with caution, so that no air between the glass objects andglass cover.

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24. Fit horizontally on the microscope table.

25. Close the microscope diaphragm as small as possible and derive the microscope condenser (if any) as

low as possible.

26. Look under the microscope with an objective lens 10 times. Rotate macrometer to obtain a clear

image.

27. Find the object by looking at the edge of the liquid droplets.28. After finding the object, change the object lens to 45 times magnification.

29. Record what you see: epithelial skin, spores, hyphae.

AFTER WORK OUT

30. Wipe the desk with a cloth dampened with a solution of 50-10% lisol

31. Take inventory and write this directly in a bowl lisol

32. Wash hands who still wear gloves with a solution of 5% lisol

33. Open up the gloves and throw into medical trash.

34. Do wash your hands asepsis.

35. Say thank you and goodbye to patients with good wishes recovery soon

PREPARATION SKIN SCRATCH DELIVERY

36. Check the security of the skin scratch: stick cap with a folded paper tape Sello.

37. Write the introduction of the skin scratch delivery for laboratory containing:

- Personal data of patients,

- Examination request: microscopic or / and culture

- An explanation of the local use of anti-fungal or other drugs: what drugs are

used and when to stop.

38. The folding of paper inserted in an envelope and sent in room temperature together with a letter

envelope of introduction to the laboratory.


EXAMPLES OF SKIN SCRATCH EXAMINATION SHEET RESULTS

No:

Date:

Name:

Sex:

Age:

Address:Occupation:

The main complaints:

The result of skin scratch examination:

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EXAMPLE REFERENCE GAZETTE

Dr. Sanusi Perangin Angin

Praktice permission No. 1234567Practice address: Kebangkitan street no. 27Telephone No.: 0411-275634

Makassar,

Designation:

At........................

In Sincerely,

Sent patient's skin scratch:

Name:

Sex:

Age:

Address:

Occupation:The main complaints:

Thank you,


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CHECK LIST

TAKE, MAKE AND CHECK WET PREPARAT AND PREPARE SKIN

SCRATCH DELIVERY

Instructions : Put an (V) in the appropriate box.

Give Score : (0) if not done, (1) if it is done but still not satisfactory, (2) if

satisfactory

NO. ASSESSED ASPECTS SCORE

PREPARATION 0 1 2

1. Capable of connecting with patients and their families feel.

2. Able to give informed concent well.

3. Able to prepare the patient for retrieval and examination of

skin sctrach

4. Able to adjust lighting

5. Prepare all the necessary tools

6. Perform routine hand washing and wear gloves correctly

MAKE & CHECK SKIN SCTRACH 0 1 2

7. Conduct any skin sctrach

8. Saving the skin sctrach on the right folded paper

9. Doing the manufacture of wet preparat skin sctrach

10. Checking the wet prefarat in the microscope correctly

MAKING OUT AFTER SKIN SCTRACH 0 1 2

11. Conducting medical garbage disposal properly12. Perform cleanin and disinfeksi ob field correctl13. Making a delivery preparation examination material

correctly.14. Separate well with the Patients .

Commment / Summary : Recommendation:

Instructor Signature .......................................... Date:..

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MANUAL 4

SKILLS OF TAKING AND MAKING SKIN SMEAR PREFARAT

LEARNING OBJECTIVES

General Instruction Objectives

After having this training, students are expected to be able to perform skin fluid intake and

make prefarat skin liquid (skin smears) well, correct and efficient.

Specific Instructional Objectives

After doing these exercises skills, students are expected to be able to:

1. Prepare equipment / materials properly.

2. Make sense of connection with the patient and or family well.

3. Make inform concent to patients and / or their families properly.

4. Conduct regular hand washing and asepsis correctly.

5. Wearing sterile gloves correctly, and put it out after the work is completed.

6. Perform skin fluid intake.

7. Making and store prefarat liquid of the skin (skin smears) correctly.

8. Prepare a prefarat skin liquid delivery properly.

TOOLS AND MATERIALS REQUIRED

Water flow 70% Alcohol

Liquid soap Lights spiritus

Antiseptic solution to clean Objects glass

Small towel or tissue The basin contains a 5% solution Lisol

Cotton Plasters

scalpel (knife handle No.3 and blade no.15) medical trash

non-medical trash

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INDICATIONS

Patients who have anaestesi skin patches (numbness) or with enlargement of one

peripheral nerves.

REFERENCE

Abnormalities of skin disorders in leprosy is usually a skin spot that can be red or whiter

than normal skin (hypopigmentation). This defect usually experienced anesthesia.

Good taking area is skin defect on the ear lobe or lobes nose. Or on the skin in other

places that show signs of leprosy.

Skin incision with a scalpel on the skin defect is only efforted up to the layer of dermis, in

case achieve coating subdermis because there are many blood vessels and nerve fibers in

that area. Blood on the stocks is very difficult to the discovery of acid resistant bacillus.

Leprosy bacillus usually gathered a lot at the ends of sensory nerves in the lining

dermis.

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l.Introduction 5 minutes Introduction

2. Role playing &

answer question

20 minutes 4. Organize students seated position

5. Two instructors give example of how toretrieve and made directly from a liquid

dosage form skin. Students pay attention

to demonstration by using Learning

manual.

6. Give opportunities to students to askquestions and instructors provide an

explanation about important aspects

3. Role playing

practice with

feedback

55 minutes 7. Students are divided into pairs, couples.

An instructor is required to observe every

step is taken by each couples.8. Simultaneously, each pair practice these

steps taking and making skin liquidprefarat (skin smear).

9. Instructors walk around between coupleof students who practice to conduct

supervision and use a checklist to assess

students work

10. If there are errors work procedures

instructor shows again pass up the right

ways soon.

11.The instructor gives questions andfeedback to each pair

4. Brainstorming /

Discussion

10 minutes 3. Brainstorming / Discussion: What is

perceived easy? What is difficult?

Asking how the students feel when they

slice skin. What can be done by doctor

so that the patient feels more

comfortable?

4. Instructors make conclusions

by answering the last question

and clarify the things are not yet

understood

Total times 90 minutes

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LEARNING GUIDE

SKILL OF TAKING AND MAKING SKIN

SMEAR PREFARAT

NO. STEPS / ACTIVITIES

PATIENT PREPARATION

1. Greet clients or their families with friendly and introduce yourself, and ask theircondition

2. Please clients and their families to sit3. Give general information to the client or his family about making the skin

liquid, objectives and benefits for client condition.

4. Give assurance to the client or his family about the security check upperformed.

5. Provide assurance to the client or his family about the confidentiality requiredby the client.

6. Explain to the client about the rights of clients or their families, for examplethe right to refuse taking action skin liquid

7. Ask your client's willingness orally to take skin fluids

PREPARATION OF TAKING SKIN LIQUID8. Prepare all the necessary tools and materials on a table near the patient.9. Wipe the glass objects and write the lab number / patient data on the back of the

glass object

10. Ask the atient to sit in bri ht locations11. Wash our hands re ularl12. Wear loves DDT .

MAKING SKIN SMEAR13. Choose the area for suspicious skin lesion, for example on the ear lobes or

nostrils

14. Take asepsis action by brushing cotton with alcohol 70% in the area to be used

as place-making, ranging from local to regional play edges.15. Pinch the area strongly between finger and left thumb, so that the surface of the

skin becomes pale.

16. Make incisions with a sterile scalpel along the 0.5 cm with a depth of 1 2mm (top layer only reaches the dermis).

17. Rotate the scalpel 90 with curry base side and wound up a kind of pulp tissueobtained from the epidermis and dermis to be attached to the surface of thescalpel.

18. Make a smear prefarat, with drops of examination material evenly on thesurface of lass ob ects.

19. Dry prefarat and then fication with the flame20. Press the cut wound with cotton and cover it with laster alcohol

AFTER FINISHING TO MAKING PREPARAT21. Put off our loves and throw into medical trash can22. Do wash hand ase sis.23. Put a rack of preparations in preparations or wrap the preparations with

tissue paper and put in envelope.

24. Write a letter reference to the laboratory

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EXAMPLES OF RESULTS SKIN SMEAR PREFARAT

No :

Date :

Name :

Sex :

Age :

Address :

Occupation :

The main complaints :

The result of skin smear examination

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EXAMPLE REFERENCE GAZETTE

Dr. Sanusi Perangin AnginPractice permission no. 1234567Address practice: Kebangkitan street No. 27

No. Phone: 0411-275634_______________________________________________________________________

___

Makassar,

Designation:

At..................

Sincerely,

Sent liquid of skin smear ..................

From a patient:

Name :Sex :

Age :

Address :

Occupation :

The main complaints :

Thank you


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CHECKLIST

SKILLS OF TAKING AND MAKING SKIN SMEAR PREFARAT

Instructions: Put an (V) in the appropriate box.

Give Score: (0) if not done, (a) if it is done but still not satisfactory, (2) if satisfactory

NO. ASSESSED ASPECTS SCORE

PREPARATION 0 1 2

1. Capable of connecting with patients and their families feel.

2. Able to give good informed concent.

3. Able to prepare patients for making skin smear

4. Able to regulate lighting5. Prepare all the necessary equipment

6. routinely hands properly

MAKING SKIN LIQUID

7.. Determining the location of the specimen and disinfection

8. Perform specimen collection correctly .

9. Doing the manufacture of liquid dosage form of skin (skinsmear)

10. Perform decontamination of equipment which has been used

AFTER TAKING

11. Making a preparation of delivering apus stocks.

Comment / Summary : Recommendation :

Coordinator signature/Instructure ............................. Date:..

Student Name : Stambuk number :

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SKILL

DOING PERIPHERAL BLOOD TAKING,

MAKE A PERIPHERAL BLOOD SMEAR, MAKE

GIEMSA STAIN FOR PERIPHERAL BLOOD SMEAR

AND MICROSCOPIC EXAMINATION FOR PERIPHERAL

BLOOD SMEAR

EDITORS:

SITTI WAHYUNI

PRESENTED IN SEMESTER 6

TROPICAL MEDICINE SUBJECT

MEDICAL FACULTY HASANUDDIN UNIVERSITY

2012


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SKILL

DOING PERIPHERAL BLOOD TAKING,

MAKE A PERIPHERAL BLOOD SMEAR, MAKE

GIEMSA STAIN FOR PERIPHERAL BLOOD SMEAR

AND MICROSCOPIC EXAMINATION FOR PERIPHERAL BLOOD SMEAR

LEARNING OBJECTIVES

General instructional objectives

After completion of this skills training, students are expected to be capable and

skilled bleeding edge, making the peripheral blood smear (thin and thick), made for

Giemsa staining peripheral blood smear and microscopic examination for peripheral

blood smear well and right.

Specific Instructional objectives

After doing the exercises these skills, students:

1. Capable and skilled to give explanations on the patient or family about what will be

done, tools are used, how to do, what are the benefits, and what possible risks & the

right of patients to refuse.

2. Capable and skilled to make a preparation of patients correctly.

3. Capable and skilled bleeding edge by using the Lancet.

4. Capable and skilled to do a thick blood smear.

5. Capable and skilled to do thin blood smear.

6. Capable and skilled to make Giemsa colouring.

7. Capable and skilled to do microscope inspection to identify parasites found on

blood smear prefarat.

8. Capable and skilled to calculate the intensity of Plasmodium infection

9. Capable and skilled to clean laboratory after completion of these skills.

INDICATIONS

1. Patients with suspected malaria fever, dengue infection or infection of filaria

2. Patients with symptoms of lethargic / weak

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DESCRIPTION OF ACTIVITIES

Activities Time Description

1. Introduction 10 minutes Introduction- Instructor explain about the skill objectives- Instructor shows material and tools

needed to perform this skill.

2. Demonstration 20 minutes 1. A student acts as patients.2. Instructors demonstrate how to perform peripheral bloodtaking by using the Lancet.3. Instructors demonstrate how to create thick and thin blood

smear.4. Instructors demonstrate how to create Giemsa Stain5. The instructor shows way of microscope examination to

identify parasites found on blood smear preparations.6. The instructor explains how to calculate the intensity of

infection Plasmodium.

7. Students are required to ask for things are unclear inconnection with the activities of these skills

3. Practice of roleplaying withfeedback

60 minutes 1. Students were divided into four groups2. Each group engaged in activities of peripheral bloodtaking, make thick and thin blood smear, making Giemsa

Stain for blood smear and microscopic examination forsimultaneous blood smear

3. Mentors walk around among students and do a supervision4. Mentor corrects things which are not perfect yet

4.Brainstormingand discussion

10 minutes Students are given the opportunity to express opinions aboutthe activities undertaken

Total time 100minutes

MATERIALS AND EQUIPMENT

(for each student)

- 2 pieces of glass objects

- Lancet or sterile needles

- Gloves

- Permanent markers/ markers

- Cotton alcohol

- Dry Cotton

- Methanol Solution

- 3% Giemsa solution in phosphate buffer solution (pH 7.2)

- Bottled water containing

- glass objects Rack

- medical trash can

- Oil emersi binocular microscope

- Tissue lens

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STEPS / ACTIVITIES

A Preparation

1 Explaining to patients about the purpose of inspection and asked for approval.

2 Prepare all the necessary tools.

B Peripheral blood-making activities

3 With a marker, write the patient's identity on the first glass objects

C How to perform the peripheral blood sampling

4 Clean the ring finger or middle finger with cotton alcohol, let it dry.

5 Puncture the clean Finger with sterile Lancet

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6 Wipe the first drop with sterile dry cotton.

7 Press the fingers gently until blood came out

8 In a glass object which has been given an identity, drops blood approximately 1

cm from the left edge of the glass object the size of 3 mm for a thick bloodsmear and a drop more of the same dimensions for a thin blood smear of about 1

cm adjacent to the thin trickle of blood

D Making a thin blood smear

9 Place the glass object of blood on the table

10 Tap the blood on the surface of a glass object with the tip of the other glass

objects that has a function as the catalyst so that the blood spread to all the tip ofa glass object

11 Make a 45 degree angle between the object glasses containing the droplets of

blood and glass objects booster.

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12 Push the second glass object towards the front while maintaining a 45 degree

angle and the driving end of the object glass is never separated from the glassobject containing a droplet of blood

A good smear is a smear-shaped tip of the tongue are more narrowed

Let the smear is dry

Reference

Thin blood smear can be used for:

Identification of Plasmodium and the degree of

parasitemia

See cell and the morphology of cells are in blood for

example to view hipokrom microcytic anemia due to

hookworm infestation.

Calculating the platelet count in patients with DHF

E Making a thick blood smear

13 Place the glass objects that are filled with approximately equal to ,

Take another glass object which has a function as a spreader, and spread out theblood on an object glass by using sharp angles of the spreader object glass until

approximately

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And let dry

Reference

Thick blood smear can be used for:

Identification of Plasmodium and the degree of

parasitemia/mm3 blood

Identification of filaria

F Giemsa staining activity

14 Put a glass object containing a dried blood smear on a glass shelf object

15Dipping into the thin blood smear methanol solution, be careful not to come

thick blood smear fixed. Allow to dry.

16Drop the water above the thick blood smear for hemolysis of erythrocytes, let

a few minutes

17

Drops two object glasses with Giemsa solution 3% and let stand for 30

minutes.

18 Flush with running water until clean.

19 After it is clean place in slanting condition and let it dry.

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G The identification of parasites on thin blood smear

20 Put binocular microscope on a flat work table

21 Check the cleanliness of the microscope. if it is dirty, clean it with xylol and

wipe lightly with lens tissue22 Put dawn preparat on the object table.

23 First look at the object with the objective lens 10 until you can see the red

blood Cells clearly.

24 If the object has been focus, drop to preparat with a drop of oil emersi

25 Replace the lens objective lens with 100 times and turn the micrometer to

focus.

26 Find erithrocyt containing schizont, trophozoit, gametocytes at all field of

view, do a zigzag way, record what you getIdentification reference for thin blood smear

Parasite Plasmodium which can be found located within erithrocyt Plasmodium will appear with a red chromatin and pale bluish

purple-stained cytoplasm. Normal erithrosit grayed somewhat pale purple

Neuthrophil same color but with a core of dark purple and

have granules in their cytoplasm

Erithrocyt containing Plasmodium will be different in shape

and size.

Wall of normal erythrocytes. Chromatin from Plasmodium reddish purple with purple-blue

cytoplasm. Spot of Schiiffher's is seen in erythrocytes containing P. vivax or

P. Ovale Maurer spots visible on the large rings erythrocytes containing

P.falciparum. In P.vivax and P.ovale Schuffher's spots can be seen

Preparations declared negative if no plasmodium was found in 100

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H Seeing the thick blood smear (Erythrocyte lysis was so red blood cells did not

appear anymore

28 Look at the object with the objective lens 10 times.

29 If the object has been focus, drop to the preparat with a drop of oil emersi

30 Replace the lens objective lens with 100 times and turn the micrometer until

the focus of which will show the background looks clean and Plasmodium will

appear with a red chromatin and cytoplasm pale bluish purple

31 Perform inspection at the 100 field of view and take note of what was found

Reference to identify parasites in thick blood smear

Plasmodium will appear with a red chromatin and cytoplasm

pale bluish purple.

In P.vivax and P.ovale Schuffher's spots can be seen

Microfilaria can also appear with thick blood tests 10 x

magnification

Calculating the intensity of infection (parasitemia)

For each field of view (LP) count the amount of leukocyte and Plasmodiumuntil the amount of leukocyt achieves 200

For example:

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field of

view

Amount

eritrocyt/field of view

Amount

Plasmodium/field of view

1 23 0

2 27 2

3 16 0

4 17 1

5 15 0

6 23 0

7 15 0

8 20 0

9 17 010 15 1

11 12 1

Total 200 5

After 11 field of view, 200 leukocyt and five Plasmodium are found.

In 1 mm3 blood there are 5000-10000 leukocyt, or taken as many as 8000 the

average

Then the intensity of infection are:8000 x 5 = 200 parasit/mm3

200

The results stated above there are a number of 200 parasit/mm3 blood

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CHECKLIST

No Assesced Aspect

1

23

4

5

6

7

8

Knowledge of these skills training purposes.

Ability and skills to act in patients asepsisAbility and skills to do the blood sampling using the Lancet

Ability and skills to make a thin blood smear

Skills Ability to make a thick blood smear.

Ability and skills to make Giemsa staining

Ability and skill to determine the intensity of infection in a thick blood smear.

Ability to answer a question from the examiner

Check list above contains the activities which will be assessed on the skills test in

which the instructor was asked for giving assessments to students for twelve checklist

above (see sheets of student assessment)

Score:

0 if not done

1 if it is done but unsatisfying yet

2 if satisfactory

Examples of student assessment sheets for manual 8

No Name Stambuk Activities Total1 2 3 4 5 6 7 8

1

2678910

Scoring for the manual 8

Total value of the lowest 0, highest value 16

Value = 12: ski

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28

SKILL

TABLET MAKING DIRECT FECES,

IDENTIFYING PARASITES CONTAINED

IN THE FECES AND WAY OF PRESERVATION AND

DELIVERY OF FECES SAMPLES

Created by

SITTI

WAHYUNI

PRESENTED IN GRADE 6

TROPICAL MEDICINE SUBJECT

MEDICAL FACULTY HASANUDDIN UNIVERSITY

2012


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SKILL

TABLET MAKING DIRECT FECES, PARASITES IDENTIFYING

CONTAINED IN FECES AND WAY OF PRESERVATION AND

FECES SAMPLES DELIVERY

LEARNING OBJECTIVESGeneral instructional objectives

After completion of this skills training, students are expected to be capable and

skilled to make feces direct preparations, identified the parasites found in stool

specimens as well as preserving and delivering specimens of faeces properly and

correctly.

Special Instructional objectives

After doing the exercises these skills, students:

1. Capable and skilled to give explanations to the patient or family about what to do,

tools are used, how to do, what the benefits are, risks and what might happen. And

the right to refuse

2. Capable and skilled in preparing patients correctly.

3. Capable and skilled to prepare equipment / materials properly.

4. Capable and skilled to make smear feces on a glass object

5. Capable and skilled to color feces samples for direct examination.

6. Capable and skilled to identify the parasites contained in stool samples.

7. Capable and skilled to perform preservation of feces samples to be sent to

reference

laboratories.

8. Capable and skilled to clean laboratory after finishing skill exercise.

INDICATIONS

1. Patients with diarrhea.

2. Patients with a dysentery.

3. Patients with gastrointestinal complaints without diarrhea or dysentery.

4. Patients with symptoms of fever complaint or weakness with a suspected infection

of the gastrointestinal tract.

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1. Introduction 10

minutes

The instructor explained the purpose of this skills

training

Instructors show materials and tools required

2. Demonstration 20

minutes

1. Instructors demonstrate how to make preparations

Feces direct.

2. Instructors demonstrate how to identify parasite found

in stool specimens.

3. Instructors demonstrate how to preserve Feces

specimens and how to refer.

4. Students were asked for asking about unclear thingsrelated to this activity

3. Practice of role

playing with

feedback

60

minutes

11.Students were divided into four groups

12. Being supervised by instructors, each group of students

make direct preparations feces, dentify parasites found

on feces specimens and stool specimens preserved forreference laboratory simultaneously

13. Instructors walk around among students and do asupervision

14. The instructor corrects the things which are not perfect

4. Disscusion 10

minutes

Students are given the opportunity to express their opinion

about the activities undertaken

Total times 100

minutes

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TOOLS AND MATERIALS

1. Gloves

2. glass Object and the glass cover

3. Disinfection solution

4. Pots containing feces

5. Solution and saline solution and Lugol's iodine solution (1% solution)

6. Tissue paper

7. Microscope

8. Wooden applicators

9. Marker pen10. Pots with a volume of 20 ml of feces that have a tight lid

11. Formalin (formaldehyde) 10%

12. Scotch tape

13. Paper labels

14. Preparat to remove faeces

15. Reference letter

STEP/ACTIVITY

A Preparation

1 Prepare all the necessary tools.

2 Explaining to patients about the purpose of inspection

B Make a direct preparations feces

3 With a marker, write the patient's identity on a glass object

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4 Place the glass objects are flat on the table

5 Drop a drop of saline solution on the middle left glass and 1 drop of lugol iodine

solution on the right middle of the glass object

6Take a little faeces (part slimy) using a wooden applicator, put on drop saline solution, mix

until blended

Note:

- Hard Faeces: take a part that is located outside and inside the specimen.

- Mixed Faeces or blood: taken from the slimy or bloody area

Dilute Faeces: take a section anywhere.

7Same as the third step: Take a little faeces, put on lugol iodine drop, mix until evenly

distributed

8 Close the two drops each with a glass cover

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9 Suction with blotting paper and which is outside the glass cover

10 Put the stocks on the microscope object table, ready for inspection

C Identifying parasites which are found on fecal preparations

11 Place the glass object on an objective table under the microscope

12 Lower the condenser and arrange the light through the diaphragm.

13 Look at the object by using an objective lens 10 times, turn macrometer until the

object is visible

14 Clear the focus by turning the micrometer slowly

15 Increase the magnification to 45 times if necessary

16 Perform the systematic examination with zigzag method.

17 Perform identification of parasites:

Protozoa worm eggs and larvae: the form of trophozoites and cysts

amoebae and flagella

Reference

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Eggs and larvae of worm in a saline solution and iodine lugol

Worm eggs and larvae can be identified easily in the saline solution. They look

colorless and easily seen with magnification 10 x

Protozoa in saline solution

- Forms of trophozoites and cysts of amoebae and flagellate may be seen

- Cysts look round or oval with a clear wall

- Trophozoit will look round or oval with irreguler wall.

- In fresh faeces (faeces of no more than two hours after being expelled),

trophozoit movement can be seen especially in the flagella.

- At first look at the object with the enlargement of an Ox, to see more clearly a part

of parasites such as the nucleus, chromatoid bodies, sucking discs, spirals

grooves, or filaments of the parasite, increase gradually enlarged.

Protozoa in Lugol Iodine

- Trophozoit or cytoplasm of the cyst will look yellow or brown and the nucleus

will look dark brown.

- In Entamoeba cysts karyosome peripheral chromatin and the position can be seen

(if not visible, not Entamoeba). Peripheral chromatin look pale yellow.

Sometimes the young cysts still contain glycogen, glycogen will look dark brown.- Cysts and flagella filaments are also visible with iodine staining lugol.

D Preserve Feces

18 Label the pot with the patient's identity

19 Fill the pot with 10% formalin until the middle of pot

20 With a wooden applicator take feces approximately as much as a teaspoon, put into

pots that are filled with preservatives, stir until feces and its preservative mixed

properly.

E Send to a reference laboratory

21 Cover pot well and use masking tape to prevent leakage at the mouth of the pot.

22 Write the introduction of these specimens include: name, age and sex of patients, a

major complaint and the date of delivery

23 Clean the table after the completion of this activity

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CHECK LIST

No. Aspects assessed

1

2

3

4

5

Knowledge of these skills training purposes.Abilities and skills of doing preparation materials and tools are used

correctly.

Ability and skills to make smear feces on an object glass for immediate

inspection.

Ability & skill to identify the parasites contained in stool samples.

Ability and skills to do the stool sample preservation

Ability & skill to send stool samples to a reference laboratory

check list above contains the activities that will be assessed on the skills test

where the instructor was asked for giving assessments to students for eight

checklist above (see sheets of student assessment)

Score:

0 if not done

1 if it is done but unsatisfying yet

2 if satisfactory

Examples of student assessment sheets for manual 9

ActivitiesNo Name Stambuk1 2 3 4 5

Total

1234567

Scoring for manual 9

Documents

Student Manual Tropis 2012