[ { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 18.0\n - Nursing Specialty: pediatric emergency burns\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 18 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 4 year old child presents to the emergency department with second degree burns on the forearm after accidentally touching a hot stove the child was playing in the kitchen when they reached out to touch the stove the burns cover about 5 of the total body surface area the child is alert and crying with redness blisters and swelling on the affected area the burns appear to be superficial to moderate in severity the child is in mild pain and there is no indication of airway or breathing distress no other injuries are noted questions 1 what is the immediate treatment protocol for second degree burns in paediatric patients 2 should any tetanus prophylaxis be considered in this case 3 what follow up care should be recommended for burn healing\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 4 year old with 5 superficial burns no other injuries immediate management paracetamol analgesics to to ensure child has minimal or no pain cleaning and frosting of wound with silver sulpha fizika topical prophylactic can be considered in this case good nutrition high protein diet" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 17.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 17 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 6 year old girl presented to the emergency department with complaints of vomiting and abdominal pains patient is known diabetic on insulin and does not take as scheduled because of lack of funds on assessment the girl is confused having kussmaul breathing and fruity scented breath has dry tongue and reports blurred vision temp 37 pulse 120b m resp 48b m rapid and labored spo2 90 on room air questions what is the diagnosis of the patient what is the most immediate management what health education will be given to the patient and family which investigations will be ordered\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 6 year old present with vomiting and abdominal pains known diabetic on insulin but doesn\u2019t take it as scheduled due to lack of funds he is confused kussmaul breathing fruity scented breath dry tongue blurry vision vitals temp n pulse \u2191 120 bp \u2193 48 rapid laboured spo\u2082 90 diagnosis diabetic ketoacidosis dka in known dm type 1 patient due to insulin insufficiency and uncompliance differentials sepsis in a knon diabetic patient investigations 1 laboratory investigations urinalysis blood gas analysis rbs hba1c uecs cbc management 1 insert iv large bore cannula 2 give normal saline bolus and maintenance fluids 3 check rbs regularly 4 give insulin 0 1 u kg hr iv 5 monitor blood glucose levels 6 check uecs for hypokalemia \u2013 if present add it to the iv fluid 7 treat underlying infection with antibiotics 8 do regular ketone ph and bicarbonate checks" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 12.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya forty seven years old man came to casualty supported by two men screaming because of pain upon inquiry he reported that he had severe abdominal pain upper abdominal pain in the gastric area which had started the previous night he had not slept he also reported that this was not the first time that it was happening and he reported a history of pud this time it was severe so on observations the puds were the vitals were within normal range the questions i had were an analgesic first or this patient was sent for labs or to do a scan first\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 47 year old man presents with severe persistent upper abdominal pain in the gastric area that started the previous night he has a history of peptic ulcer disease vitals are normal patient is in distress problems severe pain history of peptic ulcer disease distress and inability to sleep management administer analgesia for the pain start iv fluids to correct possible volume depletion administer proton pump inhibitor for the gastrointestinal upset administer antibiotics if there are signs of peritonitis investigations complete blood counts to check for leukocytosis ultrasound do an erect abdominal x ray to look for air under the diaphragm provisional diagnosis pdx acute exacerbation of peptic ulcer disease" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 12.0\n - Nursing Specialty: critical care\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 12 years of experience in primary care working in a national referral hospitals in uasin gishu county in kenya er aged 92 years female was brought in with inability to walk abdominal pain generalized body malaise and history of fecal impaction on assessment she is sick with gcs of 4 15 bp 131 82mmhg map 96 hr 92 rr 17b min temp 36 3 sp02 68 questions what emergency care should patient er receive what investigation should be done what is the diagnosis\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 72 year old female with inability to walk abdominal pain generalized body malaise and history of fecal impaction on exam gcs is 14 15 and low oxygen saturation dx constipation altered mental status management assess airway breathing and circulation initiate oxygen therapy if necessary intravenous fluids if hypotensive or with features of shock establish intravenous line access do a random blood glucose test perform a digital rectal examination if fecal impaction evacuate manually and also use enema investigations laboratory full hemogram to identify cytopenias and signs of infection renal function test to identify electrolyte abnormalities and uremia liver function test to identify derangement and possibility of hepatic encephalopathy random blood glucose to identify either hypoglycemia or hyperglycaemia and correct accordingly blood gas analysis to identify electrolyte derangements acid base abnormalities and correct appropriately radiology computed tomography of the head to rule in out space occupying lesions features of meningitis meningoencephalitis chest x ray if patient has respiratory symptoms abdominal pelvic ultrasound to aid in identification of masses" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 16.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 16 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 22 year old female patient is brought in with complaints of headache dizziness weakness and vomiting the patient also has confusion she was using a charcoal jiko to cook in a poorly ventilated room before developing the above symptoms she is pale and disoriented gcs 14 15 temperature 36 2 c pulse 112bpm respirations 26 minute spo2 80 on room air bp 142 92 mmhg questions how do i manage the patient what investigations do i need to carry out why is the patient confused\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 22 year old female presents with headache dizziness weakness and vomiting the patient is also confused she was using a charcoal jiko in a poorly ventilated room before developing the above symptoms on examination is pale and disoriented desaturating and tachypneic how do i manage the patient the case is one of carbon monoxide poisoning secondary to inhalation of carbon monoxide from incomplete carbon combustion management would involve oxygen supplementation to improve oxygen to the deprived brain the investigations to carry out include i a scan of the head to assess for any ischemic injury ii blood tests to check for levels of carbon monoxide why is the patient confused carbon monoxide binds to hemoglobin with higher affinity compared to oxygen this prevents normal delivery of oxygen to the brain which is very sensitive to hypoxia" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 12.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya a 40 year old para 3 0 gravida 4 mother at a gestation of 38 weeks comes for the second antenatal clinic she is already in the intensive phase of anti tb medication how do i manage the baby after delivery and what precautions should the mother take to ensure the baby is not infected\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 40 year old para 3 0 g4 at 38 weeks on intensive phase antitbs differentials pulmonary tb investigations baseline full hemogram renal function tests liver function tests to assess for complication from anti tbs management counsel mother on adherence to medication ensure patient is taking pyridoxine to prevent peripheral neuropathy if during the first 2 weeks of treatment isolate mother from other children at home to prevent cross transmission link patient with obstetrician to assess fetal wellness and make plan for delivery" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 20.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 33year old male client complains of pain in the teeth broken teeth swelling and bleeding he had been involved in a motorbike accident today on examination had lost some teeth obvious lacerations on the gums b p 100 52mmhg p 89 m t 36 question what is the priority management of the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 33 year old male with tooth pain broken teeth swelling and bleeding involved in a motorbike accident clinical examination shows lacerations on the gums he was hypertensive with other normal vital signs priority management admit the patient clear the airway and mobilize the c spine remove the teeth if present in oral jaw cavity administer oxygen via mask prepare for intubation in case of anticipated airway obstruction insert a large bore intravenous cannula and administer fluids intravenously insert a catheter to monitor urine output if severe bleeding administer blood assess the glasgow coma scale score expose the patient and examine other possible injuries investigations include laboratory perform crossmatch blood conduct a full hemogram to check for hemoglobin levels conduct urea electrolytes creatinine tests for kidney function imaging perform a cervical spine x ray chest x ray pelvic x ray conduct a focused abdominal sonography of trauma fast" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: nan\n - Nursing Specialty: child health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse working in a national referral hospitals in uasin gishu county in kenya a 10 year old boy presented with a lump fever and limited range of motion in his left hip after a minor trauma x rays of the pelvis and left hip revealed a lytic lesion t 38 bp 110 60 mmhg p 100 b m r 26 b m what laboratory investigation can be done what is the diagnosis what s the management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 10 year old presenting with lump fever and limited range of motion in his left hip after minor trauma x rays reveal lytic lesions on examination febrile and tachypneic laboratory investigation i erythrocyte sedimentation rate to check for inflammation ii c reactive protein iii full hemogram to check for sepsis what is the management antipyretics for the fever analgesics broad spectrum antibiotics anti inflammatory drug such as ibuprofen prepare for possible incision and drainage" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 16.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: critical care\n\n Prompt from the nurse : i am a nurse with 16 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 21 year old male patient presents with chest pain tightness and shortness of breath for the last 6 hours he reports being asthmatic and uses an inhaler but has not purchased a new one when it is finished as he was busy with school exams at school his breathing is labored and has an obvious wheezing sound temp 37 2 pr 102 b min spo2 86 on room air resp 28 breaths min and bp 141 78 mmhg the patient is not able to complete a sentence question how do i manage the case\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 21 year old male with chest pain tightness and shortness of breath for the last 6 hours he is asthmatic and uses an inhaler labored breathing and wheezing febrile slightly tachycardic spo2 86 on room air tachypneic and hypertensive 141 78 mmhg patient unable to complete sentence management administer high flow oxygen via face mask then gradually wean off nebulize with short acting beta agonist iv corticosteroids monitor vitals to see response to medications educate patient to avoid triggers treat underlying infection with broad spectrum antibiotics differential diagnosis asthma pneumonia pulmonary embolism" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 8.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: critical care\n\n Prompt from the nurse : i am a nurse with 8 years of experience in general nursing working in a sub county hospitals and nursing homes in kakamega county in kenya a patient with burns over the chest and face present in casualty the patient develops difficulty in breathing while at the department vital signs are within normal range except the spo2 which is 89 of oxygen and respiration that is 24 breaths per minute why is the patient having difficulty in breathing what is the appropriate position for this patient should i de blister the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a patient with burns on chest and face develops difficulty in breathing spo2 89 respiratory rate 24 other vitals normal 1 why is the patient having difficulty in breathing inhalation injury may occur when burns affect the face causing difficulty in breathing 2 what is the appropriate position for this patient patients with inhalation injuries are kept in a supine position with oxygen supplied to them via face mask 3 should i de blister the patient yes" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: nan\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse working in a health centres in kakamega county in kenya a 19 year old boy was brought in the facility with the history of having been involved in a road accident on examination the leg was swollen the right leg was swollen and he had a cut wound on the right hand on the head it was also swollen and he complained of severe headache now was i to refer this patient for ct scan or just stitch the wound treat with antibiotics and discharge home\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 19yr old boy involved in rta on examination swollen right leg rt hand cut wound swollen head with severe headache whether to refer for ct scan or just stitch wound treat with antibiotics discharge patient should be stabilized wound stitched to arrest bleeding give initial analgesia and medication immobilize the swollen limbs then do x rays on affected limbs and refer for a head ct scan to rule out intracranial bleeds or fractures of skull differential diagnosis for severe headache could be a hematoma in the brawn look out for worsening condition" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 14.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 14 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 43 year old female comes to the emergency department with a history of high blood pressure she looks very anxious on further assessment pulse is 120 bpm resp 22 bpm bp 155 118 mmhg question what is the immediate management of the above condition\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 43 yr old female with history of high bp anxiety vitals bp 155 95 pr 22 rr 120 management can be managed with oral anti hypertensive calcium channel blockers can be initiated as they are recommended as first line in the african population e g amlodipine nifedipine baseline investigations should be done e g u e lipid profile radiology echo ecg patient should be discharged on antihypertensives and given a clinic date for follow up diagnosis hypertensive urgency" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 16.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 16 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 20 year old male has generalized body swelling and loss of consciousness for the last 3 hours he was harvesting honey when he was attacked by a swarm of bees he is sick looking with evidence of bee stings all over his body glasgow coma scale 7 15 temperature 38 1 degrees celsius pulse 104 bpm spo2 90 on room air blood pressure 160 110 mmhg respirations 12 breaths minute question how do i manage the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 20 year old male with a history of bee stings generalized body swelling sick looking gcs of 7 15 febrile spo\u2082 90 hypotensive 100 11 bradycardia management of patient 1 assess and ensure patent airway 2 intubate patient 3 oxygen administration for ventilation support 4 administer antipyretics for the fever 5 administer epinephrine 6 call physician on duty for review 7 alert intensive care unit for possible admission 8 monitor vitals regularly" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 15.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 15 years of experience in general nursing working in a dispensaries and private clinics in kiambu county in kenya so a 30 year old male was admitted in the ward with the diagnosis of query meningitis so the patient came with complaints of severe headache general body weakness stiff neck for about three days he had also fever hotness of body so an assessment the blood pressure was 130 over 88 temperature of 39 7 respiration of 26 pulse rate of 98 beats per minute so the patient was assessed physically and was noted to have that stiff neck the patient also had red eyes had difficulty in movement so the blood tests had been run and we are waiting for the results however the patient also had been newly tested had been tested hiv positive unknown to the patient so the patient just comes in and during the assessment that s when the hiv was discovered so the question here is why did the patient take long to seek for medical attention because the second day in the ward the patient passed on having received just the initial doses of treatment so there was no adequate time to manage the patient so why did the patient seek for medical attention late number two i would want to ask what really killed this patient what really killed this patient is there something else that could have been done that was not done to have helped this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 3 year old male c o severe headache gbw stiff neck 3 7 hob o e vitals bp 130 85 temp 39 7 rr 26 pr 98 stiff neck red eyes difficulty in movement awaiting lab works newly diagnosed hiv ddx meningitis bacterial or viral cryptococcal meningitis q1 why did this patient seek medical attention late health seeking behaviour varies from one person to another a proper history and evaluation of circumstances would help answer you possible reasons financial constraints distance from hospital support system availability q2 what led to the death of the patient a post mortem would help answer specific cause of death from a number of possible complications evaluate lab works as well to help answer this q3 what else could have been done to help this patient starting patient on iv antifungals and antibiotics early or before lab results symptomatic management of symptoms like antipyretics ivfs oxygen supplementation avoiding hypoglycemia via doing rbs and giving fluids with dextrose diagnosis meningitis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 20.0\n - Nursing Specialty: emergency care mental health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing and primary care working in a health centres in uasin gishu county in kenya during a mobile vct clinic of hiv aids a man aged 16 years came for counselling the boy has been born with hiv aids after being transmitted by his mother he looked quite disturbed and unhappy he has been on arvs throughout his life during counselling he said he had gone through stigma from school neighbors and relatives nobody wanted to be associated with him in class nobody wanted to share a pen or desk with him he feels like committing suicide vital signs bp 120 70 mmhg p 82 b min t 36 2 oc spo2 99 r 16 b min differential diagnosis stigma depression recommendation enhanced counselling to the boy parents and teachers referral to a psychologist for further management questions how can stigma be reduced controlled for clients with hiv aids how can sensitization be increased at community level against stigma\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "16 yr old with hiv experiencing stigma and is now suicidal vitals stable 1 diagnosis hiv associated depressive disorder differential major depressive disorder x0001 x0001 bipolar disorder depressive episode 2 how can stigma be reduced controlled a client patient level extensive psychological counselling group therapy meditation b community based public awareness forums focussed group discussions health campaigns social media campaigns" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: elgeiyo marakwet\n - Health level\t : county hospitals\n - Years of Experience: 1.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 1 years of experience in general nursing working in a county hospitals in elgeiyo marakwet county in kenya a 25 year old man presents to the opd with complains of running nose general body weakness hotness of the body for 3 days he is a known rheumatic heart disease patient on assessment patient is sick looking but alert v signs bp 119 78mmhg pr 104b min spo2 97 on room air rr 20b min and t 37 8oc questions how can this patient be managed what are the investigations required\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 65 year old male presents with severe chest pain radiating to the back described as tearing in nature along with shortness of breath his blood pressure is 200 110 mmhg in the right arm and 180 100 mmhg in the left arm investigations perform a ct angiogram to confirm aortic dissection obtain an ecg to rule out myocardial infarction management plan administer iv beta blockers to reduce heart rate and blood pressure start iv nitroprusside for additional blood pressure control refer urgently to cardiothoracic surgery diagnosis aortic dissection" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: nan\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a health centres in uasin gishu county in kenya a 26 year old female came to the facility with complaints of painful urination swollen vagina pain during sexual intercourse itchy vulva heavy yellowish vaginal discharge with fishy odour for the last one week the patient reports that she has three sexual partners and she always sleeps together and she always performs sex with them without any protection on examination the vagina and vulva are tender and painful there is presence of yellowish vaginal discharge with fishy odour vital signs taken temp 36 40c p 90b m r 24bpm bp 117 68mmhg spo2 98 questions how will this patient be managed the patient could be suffering from which condition\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 26 year old female with complaints of painful urination swollen vagina pain during sexual intercourse itchy vulva heavy yellowish vaginal discharge with fishy odour for one week she has three sexual partners with whom she sleeps with with no protection the vulva and vagina are tender and painful vitals respiratory rate 24 breaths per minute and other vitals are within normal ranges the differential diagnosis are as follows bacterial vaginosis urinary tract infections cervicitis sexual transmitted diseases such as gonorrhea pelvic inflammatory diseases the patient will be managed as follows request for the following labs complete blood count vdrl test provider initiated testing and counselling pitc sexual transmitted diseases screening high vaginal swab for cultures give analgesics for pain management give antibiotics such as ceftriaxone metronidazole give an antifungal such as fluconazole psycho education and counselling offer family planning education" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 23.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 23 years of experience in general nursing working in a dispensaries and private clinics in uasin gishu county in kenya a 2 year old child was brought to the facility with a history of passing loose bloody stools hotness of the body and refusal to feed on observation the child appears sick and irritable on examination the temperature is 38 4\u00b0c pulse rate is 106 beats per minute and respiration rate is 28 breaths per minute the weight is 6 4 kg a blood test for malaria turned out negative questions how should this child be managed what are the investigations to be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary this is a 2 year old child with a history of passing loose bloody stool hotness of body and refusal to feed child is sick and irritable febrile 38 4 the child is underweight and blood test for malaria is negative diagnosis infective gastroenteritis management admit for stabilization the child is malnourished and moderately dehydrated therefore the patient requires rehydration therapy using the standard who ten step approach for malnutrition give analgesia for pain antipyretic for fever check the child s random blood sugar and correct hypoglycemia ensure intravenous access for sample collection and rehydration ask relevant vaccination information and schedule if they missed any avoid hypoglycemia and hypothermia by keeping warm blankets warm fluid radiant warmers treat infectious causes by giving empirical antibiotics investigations to be done random blood sugar full hemogram c reactive protein erythrocyte sedimentation rate stool microscopy culture sensitivity blood culture abdominal ultrasound rule out surgical cases for bloody stool in intussusception" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: nan\n - Nursing Specialty: emergency care gbv\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a health centres in kakamega county in kenya a female born aged 32 years comes to the clinic for a drug briefing and contests that the spouse prohibits her from leaving the home to refill her drugs he denies her food and sometimes pulls her out of the house at night the mother has children from a previous marriage that are not going to school though they are of school going age the mother is requesting the health care provider to assist her in the abusive marriage is it proper for the health care worker to assist the client in the abusive marriage by reporting to the various social and child support services\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 32 year old reports being in abusive marriage management of the patient as a healthcare provider you are required to assist the client by reporting to the appropriate social and child support services healthcare workers have the duty of protecting individuals who are vulnerable they are also advocates of patient safety therefore the steps you should take as a nurse is to engage the patient and ensure confidentiality assess any immediate dangers connect the client to gender based violence support services" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kiambu county in kenya female client aged 36 years old comes in with a child one month old and expresses that the umbilical cord of the baby has never dried up on examination the stunk is wet with pulse what are the possible risks involved in this case what are the possible counselling options to the mother and what are the outcomes of the treatment\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 1 month old baby wet umbilical cord dx omphalitis ddx q1 risks of septic umbilical cord include sepsis peritonitis counsell the mother on good hygiene methods for umbilical cord care promote health education on the risks involved the treatment outcome is good if treated effectively with antibiotics" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 9.0\n - Nursing Specialty: neonatal care\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 9 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a neonate is admitted to the kangaroo room on kangaroo mother care weighing 1 8 kgs suddenly develops difficulty in breathing with a wet chest mother shouted at sister that the baby was not well the baby was found to have aspirated while ngt feeding the vital signs were stable questions what is the ideal immediate care of the patient what should be done to prevent such cases\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a neonate admitted to the kangaroo room weighing 1 8kg presented a sudden onset of difficulty in breathing with a wet chest baby found to have aspirated while ngt feeding normal vitals immediate care oxygen supplementation prophylactic via nasal prongs suction incase of secretions to open airway give intravenous antibiotics including metronidazole what should be done to patient avoid feeding when ng tube is not in situ put mark on ng tube for the mother to know if it is displaced and avoid feeding" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 31.0\n - Nursing Specialty: wound and ostomy care\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 31 years of experience in general nursing working in a sub county hospitals and nursing homes in kakamega county in kenya a 47year old man came with a wound on the right lower limb for 2 months no history of diabetes in the family rbs normal he is for dressing of the wound on alternate days dx chronic wound what could be delaying the healing of the wound and the sugars are normal\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 47 year old man with a wound on the right lower limb for 2 months he has no history of being treated for diabetes mellitus and random blood sugar levels are within normal he usually attends the clinic for dressing on alternate days q some of the factors that could be contributing to a delayed healing of the wound include 1 the advanced age of the patient 2 insufficient nutrient intake e g low protein 3 cigarette smoking 4 use of immunosuppressant medications 5 comorbid medical conditions such as vascular disorders and autoimmune disorders 6 poor moisture control of the wound 7 local infection at the wound site 8 foreign bodies at the site of the wound" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 12.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 12 years of experience in primary care working in a national referral hospitals in uasin gishu county in kenya mz age 18 years male came in with complaints of chest pains headache fever abdominal pains he was diagnosed with aplastic anemia a month ago on assessment he has pallor and reports of bleeding tenderness vitals t 36 7 p 97b min r 20b min bp124 47mmhg spo295 questions what acute care should be given to mz what investigation should be done what is the differential diagnosis\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "18 year old male presents with chest pain headache fever abdominal pain he was diagnosed with aplastic anemia a month ago o e examination shows pale and bleeding vitals hypotensive what acute care should be given analgesia for pain fluid resuscitation for hypotension antibiotics for superimposed infection after blood culture has been done grouping and crossmatch and transfusion if anemic or has thrombocytopenia what investigation should be done full hemogram white blood cell level hemoglobin level platelet level blood slide for malaria parasite peripheral blood film grouping and crossmatch blood culture cardiac biomarkers to investigate for acute coronary syndrome myocarditis endocarditis hematologist hemato oncologist review imaging chest x ray to screen for pneumonic changes electrocardiography and echocardiography to investigate for acute coronary syndrome pericarditis and heart failure dx aplastic anemia" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: 31.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 31 years of experience in general nursing and primary care working in a health centres in kakamega county in kenya a mother presents to hospital with per vaginal bleeding abdominal tenderness no fetal movement in gestational period of 33 weeks she reported of having fallen in the bathroom while bathing bp 90 60 mmhg pulse 124 b m no fetal heart rate diagnosis iufd due to placenta abruption do i contact a medical officer what should i do immediately\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a mother at 33 weeks gestation presents with per vaginal bleeding tenderness and no fetal movements after history of fall in the bathroom blood pressure is normal she is tachycardic no fetal heart rate differential diagnosis intrauterine fetal death due to placenta abruption is made management prompt delivery is essential to prevent complications such as disseminated intravascular coagulation dic infection vaginal delivery is preferred so induction of labour can be done do a complete blood count to asses the hemoglobin level and ascertain whether transfusion is necessary dopamine agonists can be given to stop milk production postpartum psychological counselling to help the mother come to terms with the situation" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a national referral hospitals in uasin gishu county in kenya a 48 years old lady was admitted with complaints of easy fatigue left lower leg swelling early satiety and left lower leg weakness on examination she is pale and jaundiced blood works cbc wbc 19 02 hb 6 0gm dl bp 100 60 mmhg p 102b min questions what investigation can be done what management will be offered to the client\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 48 year old with easy fatigability left leg swelling weakness and early satiety vitals hypotension tachycardia laboratory anemia high white blood cell count dx sepsis anemia management investigation liver function tests to check on albumin indicator of sepsis chronicity take samples for blood microscopy and sensitivity sample for group and cross matching and get blood for transfusion start on antibiotics in view of high white blood cell count in view of anemia peripheral blood film and reticulocyte count a bone marrow aspiration bma may be considered" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: nan\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse working in a national referral hospitals in uasin gishu county in kenya a 46 year old female was rushed into the emergency department with presentation of unresponsiveness with a blood sugar level of 13 00mg dl on examination she has a presentation that is consistent with hypovolemia dry mucosal membranes and tachycardia no ketones in her urine t 37 7 bp 90 60mmhg p 110b min r 24 questions what is the immediate care what is the diagnosis what investigations can be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 70 year old male has difficulty swallowing weight loss and regurgitation of food over three months he also reports episodes of aspiration next steps in management perform endoscopy to evaluate the esophagus and obtain biopsies collaborate with oncology for diagnosis staging and initiating treatment provide guidance on nutritional modifications during therapy diagnosis esophageal cancer" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : community health centers\n - Years of Experience: 24.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 24 years of experience in general nursing working in a community health centers in uasin gishu county in kenya a 24 year old female who lives in rural community was brought in the outpatient clinic with complaints of vomiting abdominal pain and breathing fast she is a known diabetic patient on mixtard insulin 8 i u in the morning and 4 i u in the evening which she had missed for two weeks vital signs temperature pulse 110 beats per minute respiratory rate 20 cycles spo2 96 on room air and random blood sugar 23 0 mmol l questions what is the diagnosis what is the management what heath education can you give this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 24 year old diabetic on mixtard 8iu am and 4iu pm but missed meds vitals rbs 23 mmol l tachycardia otherwise normal diagnosis hyperglycemia management 1 insert catheter to monitor input output 2 take samples for full hemogram urea electrolyte creatinine hba1c and urinalysis 3 start iv hydration" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 5 year old boy admitted with complaints of fever night sweats unexplained weight loss fatigue not eating well coughing and has swollen lymph nodes on the armpit and neck for 3 weeks vitals temp 39 degrees celsius p 126b min rr 26b min spo2 94 weight 12kg questions what is the immediate management investigations to be done what are differential diagnosis from above signs and symptoms\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 5 year old boy fever night sweats unexplainable weight loss fatigue poor feeding and swollen lymphadenopathy for 3 weeks temp 39\u00b0c pulse 126 bpm rr 26 spo2 94 weight 14 kg immediate management admit antibiotic oxygen therapy \u2013 tachypnea and monitor oxygen saturations history of poor feeding \u2013 establish iv access and administer intravenous fluids ringer\u2019s lactate and dextrose 5 chest x ray investigations chest x ray sputum for gene xpert full hemogram renal function test \u2013 poor feeding aki rule out blood cultures liver function test in anticipation for anti tb drugs hiv testing" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: 9.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: critical care\n\n Prompt from the nurse : i am a nurse with 9 years of experience in general nursing working in a health centres in kakamega county in kenya a middle aged man was brought in by good samaritan on a wheelbarrow they reported to have got him along the roadside he was unconscious and could not be able to talk glascow coma scale was low on examination sugars were very low and i heard the smell of alcohol he could lose the alcoholic coma can dextrose 5 helped to boost blood sugars\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a man who is middle aged presents with inability to talk and reduced level of consciousness on examination he has a low gcs low blood sugars and is smelling alcohol concern for alcoholic coma can d5 help boost blood sugars d5 has very low glucose concentration therefore d50 is better in the management of hypoglycemia secure an iv line and give a bolus of d50 check rbs vital signs and gcs quarter hourly to monitor for improvement as the patient has a reduced level of consciousness keep him in a safe position to prevent aspiration a left lateral position is preferred perform necessary investigations to rule out other causes of altered mental status like head injury or stroke do your ct of head mri to confirm hemorrhages blood culture to assess any bacterial infection check uecs to assess hydration status and electrolytes give oxygen if hypoxic impression alcohol induced hypoglycemia alcoholic coma" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 16.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 16 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 6 year old boy was presented to ed accompanied by the mother this morning with severe stomach pain and weight loss on his labs has signs of anemia low calcium and vit d deficiency chest x ray is normal he has several bruises of varying stages on his arms and back mother reports she is clumsy vital signs pulse 94 beats minute rr 24 temperature 36 00c spo2 98 questions what investigations do you need what interventions should i initiate\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 6 year old male presented with severe bone pain and weight loss on assessment he is anemic hypocalcemic and has vitamin d deficiency with various bruises on arm and back he is tachypneic diagnosis rickets work ups full hemogram reticulocyte count peripheral blood film urea electrolyte and creatinines imaging abdominal ultrasound stool for ova and cysts occult blood bone scan interventions 1 address the underlying cause 2 supplement deficiencies such as nutritional supplements 3 pain management with analgesia 4 grade the anemia and transfuse if necessary" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : health centres\n - Years of Experience: 22.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery ent\n\n Prompt from the nurse : i am a nurse with 22 years of experience in general nursing working in a health centres in kiambu county in kenya twenty three years old lady came to the facility with a history of epistaxis nosebleeding on examination bp was 180 105 which was high how to stop the epistaxis\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 23 year old with history of epistaxis she is hypersensitive bp 180 105 differential diagnosis nasal trauma hypertension infections how to stop epistaxis advise the patient to lie forward pinch her nose with the thumb and index finger to control the bleeding apply cold compression over the nasal bridge causing vasoconstriction preventing further bleeding you can do nasal packing also to control bleeding using gauze work up evaluation of the hypertension likely secondary hypertension" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kakamega county in kenya a client age 40 years came to opd complaining of itching rashes on the body no history of hiv testing counselling was done accepted to be tested and results were positive cd4 count was taken and the result was 180 counselled and was initiated on art my question is what other tests will i request how will i manage opportunistic infection\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 40 year old patient presented with body rashes itching he was found to be positive after hiv testing with a low cd4 count of 180 tests requested start with baseline tests 1 full haemogram to check white cell count 2 urea electrolytes and creatinine to check kidney function before starting antiretrovirals and check for any complication eg hiv nephropathy 3 liver function tests to check baseline liver function because antiretrovirals can cause liver damage 4 serum cryptococcal antigen crag test for cryptococcal meningitis 5 triple serology to check for other sexually transmitted infections eg hepatitits b and c 6 sputum test for genexpert acid fast bacili gram staining 7 radiological chest x ray look out for any effusion cavitation and fibrosis ct scan to rule out lung fibrosis part 2 tb start on anti tbs cryptococcal meningitis to amphotericin and flecainide pneumocystis carini pneumonia start high dose septrin kaposi s \u00e7arana chemotherapy candidiasis fluconazole herpes antivirals acyclovir" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 17.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 17 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 5 month old male presents with diarrhea and vomiting for 3 days he was weaned on porridge 4 days ago on assessment he is lethargic pr 30b m bp 60 40mmhg sunken eyes and cold extremities questions 1 what is the child\u2019s diagnosis 2 what is the first step in resuscitating the child\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 5 month old male presents with diarrhea and vomiting for 3 days was weaned on porridge 4 days ago on assessment he is lethargic pr 30b m bp 60 40 sunken eyes and cold extremities this is most likely a case of gastroenteritis with differentials of malaria and urinary tract infection which can also present with vomiting the first step in managing this child is the administration of intravenous fluids to replace deficits give maintenance fluids and to replace any ongoing losses zinc can also be given for 10\u201314 days analgesics for pain relief antiemetics to help relieve vomiting" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 20.0\n - Nursing Specialty: surgical care\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 20 years of experience in primary care working in a national referral hospitals in uasin gishu county in kenya a female patient age 27 years is admitted to the ward after acdf surgery the general condition is stable with vital stable the hb done is at 7g dl blood was ordered for grouping and cross matched and transfusion was done after 15 minutes the patient reported itching in the whole body hotness of the body and palpitations questions x0001 what is the immediate action to be taken x0001 what protocol should be followed if it is a case of blood transfusion x0001 what investigations need to be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 27 year old female admitted after acdf surgery with stable vitals hb done 7g dl blood ordered and transfused after 15 minutes she reported itching in the whole body hotnesso f body and palpitations what is the immediate action to be taken stop the transfusion immediately give antihistamine intravenously stat example hydrocortisone if you have adrenaline it can be given antipyretic for fever analgesic to reduce pain close monitoring of patient vitals report to the lab and redo the cross match for further evaluation what protocol should be followed if it is a case of blood transfusion report to the lab and take the blood back for further evaluation recheck grouping and cross matching investigations grouping and cross matching diagnosis blood transfusion reaction" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: 8.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 8 years of experience in general nursing working in a health centres in kakamega county in kenya a stable client on a multi monitor clinic recently taken vl was 275 000 copies upon interrogating the client he reports to have never missed to take arv even a single day what could have caused high vl is the client hiding something are the results really correct thank you\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a seropositive presented with a high viral load patient is complacent on antiretroviral therapy causes of high viral load a drug resistance to one or more of the agents b suboptimal antiretroviral regime c drug drug interactions that reduce efficacy of antiretroviral agents d co infection e progression of disease f non adherence to medication g hiv reinfection it may be difficult to ascertain drug adherence without collaboration" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 12.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya a four year old preschooler is brought to the clinic by the mother with complaint of not behaving like the age mates and seems low and disinterested in most of the environmental activities on assessment a diagnosis of mental retardation is made how do i reassure this mother and what are the causes of mental retardation\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a four year old preschooler presents with complaints of not behaving like the age mates and seems low and disinterested in most of the environmental activities on assessment a diagnosis of mental retardation is made the causes of mental retardation include genetic conditions such as down syndrome prenatal causes such as infection during pregnancy exposure to harmful substances such as alcohol and maternal malnutrition perinatal causes such as prematurity low birth weight and hypoxia postnatal causes such as infections like meningitis head injury and malnutrition exposure to toxic substances such as lead endocrine or metabolic disorders" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 12.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: surgery paediatrics\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 10 year old boy presents to the ed with a history of accidental poisoning reported to have ingested battery acid during a visit to a car garage three hours ago on examination there are obvious burns from the mouth down to the throat breathing on the skin is peeling off has difficulties in breathing and breathing in severe pain there is no history of hospital emissions or any treatment temperature 36 degrees celsius rr steam pass 150 sdo 285 question what is the immediate management of this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 10 year old boy at ed with accidental poisoning reported to have ingested battery acid during visit to a car garage 3 hours ago history has burns from mouth down to throat skin peeling off has difficulty breathing and severe pain no history of hospital admission or any treatment temp normal immediate management give oxygen via nrms 15l min refer for immediate intubation in icu give analgesics diagnosis accidental poisoning acid" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 14.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 14 years of experience in general nursing working in a dispensaries and private clinics in kiambu county in kenya the mother says that the child has persistent cough and fever for the past three days the mother is concerned because the child has not been feeding well and looks lethargic and weak upon history taking the child has no history of chronic illnesses immunization status is up to date there are no known allergies for medications and the child has been attending a playgroup and she has recently had a running nose and a cough so vital signs temperature is 38 5 indicative of a fever respiration of 28 and a heart rate of 110 saturations of oxygen are 98 the child appears tired but is alert no signs of dehydration the child is not distressed so my question should be done to confirm the diagnosis and should a rapid should a chest x ray be done to rule out any lung infection such as pneumonia and should i give antipyretics and hydrate immediately should this child be referred to a higher level facility\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary child with persistent cough and fever for 3 days baby has not been feeding well and looks lethargic no history of chronic illnesses immunization status upto date recently has had a runny nose and a cough rr 28 hr 110 spo2 98 baby looks tired but is alert concerned for severe pneumonia i would manage the patient as follows admit the patient analgesics antibiotics xpen gentamicin if unable to feed fix nasogastric tube lab full blood count blood slide for malaria parasites c reactive protein procalcitonin urea electrolytes and creatinine liver function tests radiological test chest x ray" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 12.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya a baby is brought to outpatient department by the mother with complaint of hotness of body cough running nose for two days on examination patient had severe chest wall in drawing a diagnosis of pneumonia was made how do i manage pneumonia\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a baby was brought to hospital with complaints of cough running nose and hotness of the body for 2 days the baby also has chest wall indrawing on examination ddx pneumonia upper respiratory tract infection such as rhinitis flu allergy the management of pneumonia involves monitoring of oxygen saturations with supplementation of oxygen to maintain spo2 of 92 prescribe antibiotics e g with i v penicillin and gentamicin prescribe acetaminophen for relief of fever and pain offer nutritional support and ensure adequate feeding ensure adequate hydration close monitoring of other vital signs investigations to confirm a diagnosis of support treatment include chest x ray to visualize the lungs complete blood count to confirm an infection inflammatory marks such as erythrocyte sedimendation rate and c reactive protein blood cultures sputum for gram staining microbiological culture and sensitivity" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 30.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 30 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 22 yr old male presents with abdominal pains vomiting constipation and passing brownish urine for 3 days he travelled to a semi arid area 3 weeks ago where he developed the symptoms gc weak and dehydrated yellow eyes dark palms vitals bp 130 70 mmhg pr 90b min temp 38oc spo2 96 rbs 4 7mmol questions what is his priority care what investigations need to be done what could be his diagnosis and management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 32 year old male with abdominal pain vomiting constipation brownish urine following a semi annual area visit 3 52 ago o e weak dehydrated jaundice dark palms vitals bp 130 70 pr 90 temp 38\u00b0c spo\u2082 96 rbs 4 7 priority care optimizing patient\u2019s fluid status rehydrate with ivf stopping vomiting to limit losses pain control investigations to be done urine test dipstick mcs fhg uecs lfts hepatitis b and c antigen coagulation profile abdominopelvic ultrasound dx leptospirosis dehydration" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kiambu county in kenya a 21 year old male patient is seen in the emergency department with a history of drug induced poisoning the client confirms that he had taken an excessive amount of lorazepam on examination he has a heavy tongue complains of a headache and is confused with a glasgow coma scale gcs of 13 15 vital signs bp 123 78 mmhg pulse 78 bpm respiration rate 24 breaths per minute spo2 96 1 what is the antidote for lorazepam 2 should i do gastric lavage or dialysis 3 should i refer admit or treat as an outpatient 4 what counseling information should i give the client\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 21 year old male with a history of drug induced poisoning he confirms overdose of lorazepam he has heavy tongue headache confused with gcs 13 15 blood pressure 123 78 pulse pressure 78 respiratory rate 24 spo2 96 antidote for lorazepam flumazenil is an antidote for lorazepam should i do gastric lavage or dialysis depends on how long it has been since the overdose if a patient has presented within an hour you can do a lavage if not just observe should i refer admit or treat as outpatient admit patient to observe for respiratory distress cardiovascular effects and central nervous system depression consult a physician if any complications arise counseling information counsel the patient on the effects of drug overdose consult psychologist to counsel the patient in case of suicidal ideation consult psychiatrist" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 27.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 27 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 79 year old female was admitted to the ward complaining of chest pains body weakness and feeling tired all the time for the last one month on exam t 36 60c p 68b m r19b m bp 140 70 mmhg spo2 90 rbs 5 7mmol l on palpation the neck veins were engorged recommendation for senior review questions what investigations are required to arrive at a diagnosis what age related diseases could the patient be suffering from\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 79 year old presents with chest pain body weakness and tiredness for 1 month overall examination temperature 36 6\u00b0c respiratory rate 19 pulse rate 68 blood pressure 140 70 spo2 90 random blood sugar 5 79 engorged neck veins impression congestive heart failure ddx leukemia cll given the age and presentation of general tiredness coronary syndrome given the on and off chest pain pulmonary embolism given that the spo\u2082 is 90 and chest pain investigations cbc pbf uec lfts d dimers cardiac markers imaging echo ecg chest x ray chest ct spirometry age related disease chronic obstructive pulmonary disease" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a relative reports that a patient has hallucination and confusion but is able to ambulate with assistance one week later the patient becomes unconscious and is desaturating a burns patient who has been in the surgical unit for the last one year for extensive burns management the patient is on intravenous paracetamol esose and flagyl assessment spo2 75 questions which investigations should be done what is the recommended management of this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary burns patient in burns unit for 1 year on esose pcm and flagyl o o confusion hallucination but can ambulate unconscious and desaturating 1 52 vitals spo2 75 x0001 investigations \u00b7 cbc to rule out infections \u00b7 blood culture \u00b7 wound swab culture \u00b7 lumbar puncture \u00b7 crp \u00b7 uecs \u00b7 blood gas analysis to check on metabolic state of patient \u00b7 head ct scan to rule out intracranial manifestations of complication \u00b7 chest x ray x0001 management \u00b7 clear the airway \u00b7 patient may need oxygen therapy and mechanical ventilation call for critical care consult \u00b7 monitor vitals fluids and parenteral nutrition \u00b7 start antibiotics broad spectrum \u00b7 antipyretics for fever \u00b7 consult physician diagnosis septicaemia" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: 10.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a health centres in kakamega county in kenya a 15 year old boy is brought to the facility by the father with abdominal distention breathlessness and pain on his retaking the father says after taking supper last night he started complaining of constipation and abdominal fullness on assessment the abdomen was fulls pains on touch and then vomiting could this be an obstruction or food poisoning what kind of investigations can be done and what action can be done to release the pain and distention\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 15 year old with a history of abdominal distension breathlessness and pains that worsened after last night supper has a full tender abdomen with vomiting should this be obstruction or poisoning intestinal obstruction would be the most probable diagnosis in this scenario due to abdominal distension associated with vomiting food poisoning is often associated with diarrhea and constitutional symptoms such as fever muscle pains etc other ddx constipation volvulus severe gastritis investigations 1 imaging a plain abdominal x ray is useful in showing air fluid levels to rule out intestinal obstruction or has sigmoid volvulus ultrasonography abdominal ultrasound to rule out abdominal masses such as lymphomas tumors etc 2 laboratory do a complete blood count urea creatinine and electrolytes and blood grouping and cross match in anticipation for surgical intervention what to be done to relieve the pain and distension 1 prop up the patient in bed 2 analgesics such as paracetamol 3 ng tube insertion to drain gastric contents 4 definitive management of identified diagnosis such as exploratory laparoscopy 5 consider surgical review ddx intestinal obstruction would be the most probable diagnosis in this scenario due to abdominal distension associated with vomiting food poisoning is often associated with diarrhea and constitutional symptoms such as fever muscle pains etc other" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 14.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 14 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 36 year old pregnant mother at 34 weeks p1 0 g2 is brought to the health facility by her husband with complaints of seizure episodes husbands reports that she suddenly collapsed and began convulsing for about 2 minutes followed by confusion and drowsiness prior to the seizure she had been complaining of a headache on assessment patient appears drowsy and anxious bp 160 110 mmhg p 110b m r 20 b m spo2 98 what is the urgent care of the patient what investigations need to be done what is the subsequent care of the client\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary the patient is a 36 year old female para 1 0 g 2 she was brought to the hospital by her husband because she had a seizure she also reports having a headache before the seizure her blood pressure is high 160 110 and her pulse is 100 other vitals are normal management 1 admit the patient 2 lower the bp with iv antihypertensive e g labetalol 3 start magnesium sulphate high dose until 24 hrs after delivery 4 monitor maternal well being and fetal well being the fetal heart rate is important for the mother monitor the blood pressure do urinalysis peripheral blood film complete blood count 5 plan to deliver investigations need to be done 1 complete blood count to check for platelets 2 peripheral blood film to check for hellp hemolysis elevated liver enzymes and low platelet count 3 liver function test to check for bilirubin levels especially if hellp is suspected 4 urinalysis to check for protein levels 5 urea electrolytes and creatinine urea electrolytes creatinine and sugar to check for kidney damage 6 head ct scan to check for any other abnormalities 7 biophysical profile to assess the fetal well being the subsequent care of the client is to deliver the patient" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a national referral hospitals in uasin gishu county in kenya a 26 yr old para 3 0 g4 is admitted in active labour for 3 hours fhr 138b min cervical os 8cm dilated questions how will this mother be managed what interventions can be done to support progress of labour what are the health messages required\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 26 year old multiparous admitted in active labour on examination cervical os 8cm dilated fhr 138 b min how will this mother be managed monitor the fetal status monitor material vitals check of frequency and adequacy of maternal contractions check for fetal engagement check for cervical ripening and dilation what interventions can be done to support labour progress augment labour with oxytocin in normal saline rupture of membranes if still intact buscopan to ripen the cervix health management required advice mother to only push during increased uterine contractions breath via mouth" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 12.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya a 60 year old woman referred from the game opc clinic after having fainted in the doctor s office on my examination her bp is quite stable the pulse rate is way high at 130 beats per minute and she has a history of a heart condition so the question i asked what are the appropriate tests to take so as to know what exactly is causing the palpitations and what procedure would the woman benefit from to fix this problem because it has been on and off on and off yeah\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 60 year old female fainted and was brought in pr 130 bpm bp stable history of heart condition what tests complete blood count urea creatinine and electrolyte liver function test coagulation profile blood culture troponins creatinine kinase c reactive protein echocardiogram electrocardiogram management definitive management depends on the diagnosis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 19.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 19 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya an elderly man brought in by his sons was confused with complaints of not being able to pass urine for 12 hours and verbalizing pain the patient is a 66 year old retired policeman living with his wife known diabetic patient on metformin had a history of abdominal surgery 20 years ago no other known medical history quit smoking cigarettes over 30 years ago patient is confused with a gcs of 13 15 not pale not in respiratory distress placing his hand over the lower abdomen after every few minutes bp 136 74mmhg pr 96 bpm rr 20 bpm spo2 94 on room air rbs 10 3mmol l on abdominal palpation a firm swelling noted over the suprapubic area questions what is the management of this patient which investigations are required\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary an elderly man brought in by his sons was confused with complaints of not being able to pass urine for 12 hours and excruciating pain 66 years old and is a known diabetic on metformin had a history of abdominal surgery 20 years ago quit smoking over 20 years ago patient is confused with a gcs of 13 15 not pale not in respiratory distress placing his hand over the lower abdomen after every few minutes bp 136 74 pr 96 rr 20 spo2 94 on ra random blood sugar 10 3 mmol l on abdominal palpation a firm swelling noted over the suprapubic area this is most likely a case of acute urinary retention with differentials of diabetic neuropathy urinary tract infection bladder outlet obstruction and neurogenic bladder management in this case includes 1 catheterization to relieve pain and handle the retention 2 analgesics to relieve pain 3 address the underlying cause control blood sugars in this case investigations 1 complete blood count 2 urinalysis 3 random blood sugar 4 hba1c 5 prostate specific antigen" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 30.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 30 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 32 yr old male presents with a headache that is not relieved with paracetamols he has been having these headaches on and off especially the temporal region he reports the pain as throbbing and feels like the head is splitting into two generally fair holding his head which he has tied a tie around vitals temp 37oc pr 90b min rr 18b min spo2 96 questions what is the priority care what are the investigations to be done what could be causing the headaches\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 32 year old male with a headache that is unrelieved by paracetamol on off especially in the temporal region o e holding his head tied with a tie diagnosis primary headache disorder e g migraine ddx subarachnoid hemorrhage cluster headaches temporal arteritis intracranial mass lesions hypertension priority care provide analgesia strong opioids if necessary and monitor response monitor vital signs and consciousness level conduct further investigations to identify the cause investigations cbc electrolytes" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 14.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 14 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 25 year old male comes to the emergency department experiencing extreme lower abdominal pain which escalates daily he had abdominal surgery 2 weeks ago and he has never had bowel movements on assessment the abdomen is tender and swollen question what is the immediate management of the above\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 25 year old male with extreme lower abdominal pain which escalates daily history of abdominal surgery 2 weeks ago with no bowel movements ever since o e abdomen is tender and swollen immediate management abcs check airway patency assess for respiratory distress shock iv access with 2 large bore lines for fluid resuscitation and administration of medications give ns lr for correction of dehydration and electrolyte imbalances pain management with iv morphine ngt decompression broad spectrum antibiotics with anaerobic coverage imaging abdominal ultrasound check for bowel obstruction or localized bowel perforation ct abdomen confirm x ray results x ray abdomen air fluid levels bowel loops surgical consultation after lab work full hematologic workup and preparation for surgery urea electrolyte and creatinine check possible electrolyte derangements causing ileus" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 12.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: critical care\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya a female patient is brought to the hospital with complaint of shortness of breath upon exhaustion for three days on examination temperature is at 39 4 blood pressure 122 over 80 and spo2 of 80 percent at room air unfortunately the oxygen syringe in the facility is empty how do i manage this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary female sob 3 7 t 39 4 bp 122 80 spo2 80 oxygen is empty how do i manage this patient assess for life threatening conditions administer antipyretics and monitor vitals start fluid therapy perform the following laboratory tests full hemogram liver and renal functions esr and procalcitonin abg and blood culture radiological chest x ray and echo ecg based on physical examination results and investigations consider a physician for further management or referral" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kakamega county in kenya a mother comes to the maternity and successfully goes through labour and gives birth to a premature live infant with 1750 grams since the infant is active and shows normal somatic movement a decision to admit the mother in the kmc room is reached at number one what are some of the considerations of admitting a client in the kmc that is kangaroo mother care and two when do you opt for newborn unit services other than kmc and lastly at what point do you discharge the client from the kmc room\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a mother comes to the maternity ward and successfully goes through labour and gives birth to a premature live infant with 1750 grams since the infant is active and shows normal somatic movement a decision to admit the mother in the kmc room is reached at number one considerations for admission to the kmc low birth weight babies 2000g hypothermia babies with poor suckling reflexes mother with poor support at home criteria for discharging from the kmc room continuous weight gain at least 15 g kg per day for three consecutive days regained weight that is the same as that at birth a baby gained weight of at least 2000g a stable baby" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kiambu county in kenya a forty five year old man was brought with a history of confusion and high blood sugar he is a known diabetic what drugs should i give what lab works do i do and which iv fluids should i give\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 45year old man has a history of confusion and has a high blood sugar he is a known diabetic there is a concern for diabetic ketoacidosis with a differential of hyperglycemic hyperosmolar state the immediate management involves the assessment of his vital signs to determine the need for oxygenation give intravenous fluids normal saline bolus and maintenance over 24 hours give insulin at 1 mg kg and monitor the sugars regularly take blood samples for these investigations correct potassium urinalysis to check for ketones blood gas analysis to check for acidosis urea electrolytes and creatinine to rule out electrolyte imbalances give kcl after the first hour of fluids if potassium is low once the sugar levels are at 10 14 mmols give d5w with the normal saline diagnosis diabetic ketoacidosis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 15.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 15 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya a 75 year old male comes in opd with inability to pass urine for one day on examination the patient is in pain and sweating and has been treated for bph benign prostate hypertrophy before urethral catheterization attempted but failed what can i do to help the patient relieve the bladder since there is no one to do the suprapubic catheterization in the facility\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 75 year old presenting with inability to pass urine for one day patient is in pain and sweating has been treated for benign prostatic hyperplasia urethral catheterization attempted but failed management x0001 \u2022 x0001 suprapubic catheterization \u00b1 referral x0001 \u2022 x0001 pain management non opioid analgesic x0001 \u2022 x0001 antispasmodic smooth muscle relaxant such as buscopan x0001 \u2022 x0001 alpha blockers relax prostate and bladder neck x0001 \u2022 x0001 follow up diagnosis urinary retention" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 15.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 15 years of experience in mental health and psychiatric nursing working in a national referral hospitals in uasin gishu county in kenya a 66 male patients have been in brought in outpatient clinic with complains of sudden onset of severe pain radiating to the back patient is in severe respiratory distress the son report that father is known hypertensive and diabetic patient on follow up recommendation ecg and cardiac markers to be done urgently immediate medical treatment for this patient differential diagnosis for this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 66 year old male with diabetes mellitus dm and hypertension htn on follow up presented with severe pain radiating to the back and severe respiratory distress diagnosis myocardial infarction hypertension diabetes immediate medical treatment 1 assess saturations and put the patient on oxygen if needed 2 vital signs monitoring check vital signs especially heart rate blood pressure bp spo\u2082 respiratory rate and temperature and random blood sugar 3 pain management 4 dual antiplatelet statins anticoagulation and beta blocker 5 anti diabetic agent 6 anti hypertensive diagnostic investigations perform a chest x ray urgently along with an electrocardiogram cardiac markers order the following tests complete blood count cbc c reactive protein crp erythrocyte sedimentation rate esr random blood sugar rbs hba1c blood gas analysis if available perform echocardiography 7 consultation engage a cardiologist for further evaluation" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 20.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a man aged 40 years complaining of severe joint pains the man reports to have been treated in different facilities with no improvement investigation done include asot negative rheumatic test \u2013 negative and serum calcium normal temperature of 36 9 bp 110 70 mmhg pulse 78 bpm and spo2 98 question what could be causing joint pains which investigation should be carried out on this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "40 year old with complaints of severe joint pains has been treated in different facilities with no improvement investigations already done ast negative rheumatoid factor negative serum calcium normal vitals temp 36 9\u00b0c bp 120 70 pulse 78 bpm spo\u2082 80 note possible case of early osteoarthritis or autoimmune disease with manifestations of arthralgia and arthritis investigations to be carried out 1 complete blood count 2 c reactive protein 3 erythrocyte sedimentation rate 4 uric acid level 5 antinuclear antigen as a screening test radiology x ray of the involved joints" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 15.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 15 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya a one year old baby is brought in by a mother with history of having ingested jik of unknown amount two hours ago how do i manage this baby which treatment can i give\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 1 year old baby presenting with ingestion of jik dx jik poisoning management ensure the baby has a patent airway normal breathing and stable vitals do not induce vomiting to prevent further damage to the esophagus and oropharynx do not use milk and vinegar to avoid further damage place the child on the side to prevent aspiration consult a pediatrician for possible endoscopic evaluation give activated charcoal give fluids" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 24.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 24 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 60 year old female was seen in opd with complaints of severe diarrhea she is a known diabetic on treatment she is also on antihypertensive treatment on examination she was weak and had not taken any meal for one day vital signs bp 149 89 mmhg pulse 60 resp \u2013 16 rbs 20mml l she was started on iv fluid but diarrhea didn\u2019t stop questions what is the cause of diarrhea what is the best management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "60 year old female seen in outpatient with complaints of diarrhoea she is a known diabetic and hypertensive on treatment on examination she is weak and had not taken any meal for a day vitals bp 149 89 pr 60 rr 16 rbs 20 mmol started on intravenous fluids but diarrhoea didn t stop diagnosis gastroenteritis what is the best management manage blood sugar give intravenous fluids to the patient treat underlying infection with appropriate therapy assess the medication that the patient is on and see if there is need for change administer loperamide to stop the diarrhea" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a male 44 year old complains of severe pain on the anal area region he can not sit down and sleeping is a problem because of the pain on examination swollen anal area with vessels inflamed around the anal vitals t \u2013 36 2 c resp \u2013 18 r m pulse \u2013 66 b m bp \u2013 140 64 mmhg questions what are the investigations to be done to the patient why is the severe pain at the anal region\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 44 year old male patient presenting with anal pain and engorged vessels in the anal area bp 140 64mmhg investigations to be carried out full haemogram per rectal examination keynote cause of the severe pain is due to the presence of nerve endings below inferior to the dentate line which cause pain when the rectal mucosa is exposed there is a possibility of infection which would cause pain" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : health centres\n - Years of Experience: nan\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: critical care\n\n Prompt from the nurse : i am a nurse working in a health centres in kiambu county in kenya a 42 year old man is brought to the out patient department by people who found him lying unconscious by the road side they had no history about him and so didn t know what his problem was or any history about him he looked clean and well kept and had no obvious cuts or bruises how do i manage this patient what lab works do i do should i refer and how\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 42 year old man brought in unconscious with no further history on him he is well kept and had no obvious cut or bruise how do i manage the patient this is an unconscious patient and thus stabilization is key ensure the airway is patent and is breathing adequately assess for presence of an adequate pulse additionally strictly monitor the vitals investigations to be done include i complete blood count to rule out anaemia ii blood chemistry panel to check for electrolyte derangements iii imaging studies such as ct head should i refer and how once a nurse has clearly documented the patient s history together with clinical findings thus far he should call a higher facility that has icu services in the event that it may be necessary dx coma cause ddx traumatic brain injury intracranial haemorrhage alcohol intoxication poisoning hypoglycaemia hypoxic ischaemic encephalopathy" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kakamega county in kenya i m on the ward there is this child who had been admitted with the history of having been sick for one week and then the hb was done the hb was 5 so diagnosis of severe anaemia was made so she s been transfused she s been on the ward and she has received three units of blood so we are at that but the anemia is not improving the hb is still 5 6 grams per deciliter the question lingering on my mind is this is there any other condition could this child be having leukemia or why is it that she has received blood and the anemia is not improving we refer this child for further management the doctor comes to discuss the issue and then it s agreed that we refer the child to the level 6 for further management and investigations what could have happened if this child remained on the ward\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a child presents with a 1 day history of being sick hb 5g dl diagnosed with severe anemia of unknown cause transfused 3 units hb still at 5 6 g dl impression ddx malaria as possible sickle cell causes of leukemia severe anemia blood disorder coagulopathy e g hemophilia malnutrition investigations as per the possible causes the following investigations are recommended i x0001 peripheral blood film bone marrow aspirate stool for occult blood hb electrophoresis coagulation profile sickling test liver function tests imaging brain ct scan knees ultrasound main reason for lack of improvement is because the underlying cause has not been identified as such the patient could further deteriorate to a point of dying hemato oncologist consult is key" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 15.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 15 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 9 year old girl was brought to the ed with a burn wound in the left hand mother allegedly reported that the girl accidentally fell near a jiko an hour ago the girl lives with the mother and stepfather on assessment the child appears withdrawn dehydrated sp02 94 on ra p 100b m bp 100 80mmhg temp 36 60c had second degree burn on the left hand on the palm also to have noted to have scars on the back and a septic partially healed burn wound on the right thigh the mother also noted to have healed bruises on both wrists on further probing the mother revealed that the step father was abusive to both of them questions 1 x0001 what is the immediate care for this patient 2 x0001 what is the best course of action to help both the mother and the child\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 9 yrs old girl was brought to the emergency department with a burn injury on the left palm upon examination she is withdrawn dehydrated with 2nd degree burns on palms and other old injuries mother discloses that child has been subjected to abuse by stepfather problems dehydration suspicion of ongoing abuse physical injuries and 2nd degree burns on the left hand psychological impact management clean and dress wounds with sterile techniques use topical antibiotics eg silver sulfadiazine for infection prevention administer analgesics for pain relief administer tetanus toxoid if wound contaminated administer iv fluids to rehydrate the child immediate referral of child to a psychologist to assess psychological impact of abuse from stepfather continuous monitoring of vital signs ensure that child and mother are kept safe and involve social worker investigations complete blood count check for signs of infection burn wound culture to identify any bacterial infection urea electrolytes and creatinines to check if kidney is compromised x ray of limbs chest and pelvis to check for any hidden fracture preferred diagnosis x0001 child abuse history of previous scars" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 17.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: critical care\n\n Prompt from the nurse : i am a nurse with 17 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 2 year old girl is brought to the emergency department with burns after the explosion of a gas cylinder on assessment she is awake crying and the vital signs are temp 36 pulse 150b m resp 40 bpm physical examination demonstrates 20 of her body surface after 30 minutes after arriving at the emergency unit the child develops stridor in respiratory distress and drowsy blood gas analysis shows normal pao2 95 mmhg and pac02 of 90 mmhg questions what are the priorities of assessment what types of injuries are likely are external burns the only possible injury what consultations are necessary\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 2yr old is brought in with burns after the explosion of a gas cylinder on assessment she is awake crying and vitals are temperature 36 pulse 150b min resp rate 40 on physical exam 20 burn surface area after 30 minutes of arriving the child develops stridor and respiratory distress and drowsy abg shows normal pao2 95mmhg paco2 90mmhg q1 what are the priorities of assessment airway is the first priority of assessment pain intensity management edema assessment limb and frank assessment general functional mobility assessment q2 what types of injuries are likely inhalation burn and probably caused the respiratory distress and stridor metabolic abnormalities like hypokalemia hypoalbuminemia eschar q3 what consultations are necessary a pediatrician review critical care review" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kiambu county in kenya a baby is brought in by the mother at opd outpatient clinic with history of unable to feed diarrhea weakness of the body and vomiting he is not febrile and is three months old the nurse requests for the immunization card which is not there so the baby has never received any immunization the mother reports that it was a home delivery and she has never attended any clinic number one whose question what is our priority in management and what are the necessary investigations to the baby and to the mother number two how do we administer the vaccines missed\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 3 month old infant presents with a history of inability to feed lethargy body weakness and vomiting sunken fontanels dry mucous membranes possible electrolyte imbalance \u2192 severe dehydration management initial management assess abcs ensure airway patency and breathing adequacy circulation \u2013 iv access assess f e status and give iv fluids for rehydration random blood sugar if less than 3 mmol l give dextrose investigations complete blood count to white blood count for infection crp esr uec for electrolyte imbalance blood culture further steps monitor vitals and look out for complications once stabilized and recovered \u2192 counsel mother on the importance of immunization initiate adjust vaccine schedule" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 18.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 18 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 10 year old female patient was brought to the hospital accompanied by her mother with complaints of pain when passing urine and bruises in her perianal region temperature 36 40c pulse 100 beats minute respiration 21 breaths minute question s what might have caused the bruises what laboratory tests will be requested what referral will be offered to the patient and the mother what is the immediate management of the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 10 year old female was brought in hospital accompanied by mother with complains of pain when passing urine and bruises around the perianal area temp 36 4 pr 100 b min rr 21 b min q1 what might have caused the bruises since the patient is a 10 year old the likelihood cause of the bruises is a streptococcal infection q2 lab baseline tests full hemogram liver function test renal function test bs for mps blood culture since you are in a national referral hospital you can also do a strep test sputum gram stain and culture q3 what referral will be preferred to the patient and mother a pediatric referral q4 immediate management give antibiotics for infection give topical cream to apply on the perianal bruises if the child is in pain give analgesics" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 17.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 17 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 13 year old male is brought in after being found unconscious rat and rat poison was found beside him and was brought to hospital alongside the patient on assessment the patient is unconscious pupils dilated epistasis pain and petechiae temp 40 hr 198b m rr 38bpm spo2 95 on room air question what is the immediate treatment\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 13yr male brought to opd with hx of unconsciousness a bottle of an acaricide found next to him o e unconscious patient pupils dilated has epistaxis vitals temp 40\u00b0c hr 198 bpm rr 38 bpm spo2 95 on room air q1 what is the immediate treatment stabilize set up an iv line large bore get blood samples for bga full haemogram lft renal function test coagulation profile remove contaminated clothings and wash flush the patient with water get set up with an airway give oxygen 7 10 l min set up iv fluids give atropine 0 6mg im stat repeat every 15 minutes till full atropinization give pralidoxime 1g iv slowly set up urinary catheter in icu to monitor kidney functions through fluid input output chart monitor vital signs 2 hourly give iv vitamin k 10mg stat tranexamic acid give activated charcoal via ng tube to bind the ingested poisons in the stomach dx organophosphate poisoning" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 15.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 15 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya a 55 year old man came with his diabetes and hypertension the blood sugar was high and the blood pressure was high so now it s managing the two conditions so he was given insulin to bring the blood sugar down and then he was given the hypertensive drugs but when it came to managing now the question is the two conditions were conflicting because you managed now the diabetes with the insulin and now the fluids when you give the fluids then the blood pressure starts rising so now the question is how do you manage the two conditions together\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "55 year old with diabetes high hypertension pre existing with high bp and high sugars how to manage the high bp and regulate the blood sugars hyperglycemia administer soluble insulin administer intravenous fluids monitor blood sugars hourly with a target random blood sugar 14 mmol l then continue with oral medications the patient is in diabetes ketoacidosis requiring insulin infusion laboratory do urinalysis glycated hemoglobin hba1c and full hemogram lipid profile and thyroid function test hypertension in hyperglycemia administer oral antihypertensive such as nifedipine enalapril intravenous furosemide will help in reducing the fluid overload that would complicate the blood pressure monitor blood pressure levels with a target bp of 140 90 mmhg continue with oral medications" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 15.0\n - Nursing Specialty: neonatal care\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 15 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya a baby is brought in by the mother in the mch clinic for a routine checkup after two weeks post delivery on examination the baby is dehydrated and has yellowness of the eyes the cord is also infected how do you treat neonatal sepsis and how do i go on counselling this mother to avoid the same\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a baby 2 weeks day of life is dehydrated and has yellowness of eyes cord is also infected key concerns dehydrated patient jaundice infected cord diagnosis neonatal sepsis source is the cord late ddx hyperbilirubinemia resulting from hemolytic anemia as a result of the infection explains the jaundice treat as follows fhg check for leukocytosis blood culture check for bacterial growth swab the cord for microscopy culture and sensitivity uecs assess kidney function treatment rehydrate patient if able to suckle encourage suckling start empirical antibiotic broad spectrum as you await culture and sensitivity result advise the mother and teach her proper hygiene keep the card dry and clean apply topical antibiotics" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya 40 years old female was brought to hospital with history of hotness of the body general body weakness no history of travel to malarial endemic areas no signs of flu vital signs temperature 39c pulse 110 min respirations 20 min bp 100 60mmhg spo2 97 cbc done indicated raised wbc questions what is the diagnosis of this patient what is the immediate medical management of this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a case of a 10 year old female complaint history of hotness of body generalized body weakness no travel history to malaria endemic zones no signs of flu vital signs febrile 39\u00b0c otherwise normal complete blood count count raised white blood cell immediate management 1 admit 2 ensure intravenous access 3 give intravenous fluids 4 give antipyretics for the fever 5 nutritional support 6 empirical antibiotics for possible infection 7 blood culture 8 malaria test 9 sputum analysis 10 monitor vitals 11 alert medical officer in charge" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse in general nursing working in a dispensaries and private clinics in kakamega county in kenya a client with a pale skin condition presented like it was a burn wound she says it appeared like that after taking an amoxil antibiotic she started experiencing that two days ago what is it and how and what has caused the rashes\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary patient presents with pale skin looking like a burn 2 day history reports that that appearance started after amoxicillin was taken impression severe drug reaction immediate management stop the medication and refer to the patient to a facility where a physician or dermatologist can review the patient if the facility that the patient will be referred to the patient will be admitted to a speicalised burn unit or icu treatment instituted include fluid replacement wound care administration of corticosteroids administer analgesics dx severe drug reaction" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: maternah and child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kiambu county in kenya a two year old baby was brought to the facility with a history of difficulty in breathing the nasal flaring refusal to feed since two weeks ago on examination the baby s temperature was 38 degrees she had ronchi and spo2 of 75 and mother says that she had been treated she had been given drugs from a chemist for the last five days what are the lab works that should be done which is the best treatment to give to this baby should i nebulize or administer oxygen\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 2 year old baby was brought to the hospital with complaints of difficulty in breathing had nasal flaring refused to feed since 2 weeks ago on examination the baby\u2019s temp was 37\u00b0c she had rhonchi spo\u2082 of 75 and mother says that the baby had been treated was given drugs from the chemist for the last 5 days the diagnosis in this case is most likely bronchiolitis given the age difficulty in breathing nasal flaring and the examination finding of rhonchi and spo\u2082 of 75 differentials can be pneumonia foreign body aspiration asthma early onset congenital heart disease with pulmonary congestion lab work to be done includes cbc crp bs for malaria radiological chest x ray the treatment for bronchiolitis is majorly supportive since the saturations are low i would administer o\u2082 therapy encourage hydration and breastfeeding antibiotics are administered in the presence of pneumonia administer analgesics for pain relief" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kakamega county in kenya a college girl with severe abdominal pains missed her menses suspected she was pregnant was advised by a friend to terminate the pregnancy in a nearby clinic misoprostol was inserted patient in severe abdominal pain pv bleeding and cervix dilated at 3cm should i admit the patient and allow the expulsion process to go on to the end\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "college girl had amenorrhea missed menses suspected pregnancy wanted to terminate took misoprostol now presents with pv bleeding 3cm cervix dilated diagnosis incomplete abortion should i admit and allow expulsion admit iv antibiotics iv fluids analgesia do obstetric ultrasound to ascertain transfer of anemic take sample for urea electrolytes and creatinine complete blood count blood grouping and cross matching" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in uasin gishu county in kenya a female aged 48 years visited the clinic from shauri estate huruma she complaints of a small growth in the left eye not painful lasted 6 months this was the first time to have this assessment this was the first time to have this growth vision is good 6 16 6 16 a growth on the conjunctiva noticed no treatment given question what is the immediate intervention for lilian what can be done to avoid future recurrence if left undone what can it have to the eye\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 48 year old female presents with painless growth in the left eye for the last 6 months on assessment growth on the conjunctiva is noted vision unaffected infections granulomatous disease papilloma 1 this patient should be referred to a hospital with an ophthalmologist for diagnosis and treatment 2 prevention of recurrence depends on the cause of the growth treatment of underlying conditions such as infections co morbidities are important such as hiv as well as lifestyle modification such as cessation of cigarette smoking 3 if left untreated it could progress in growth which will cause visual disturbances metastasis to other sites damage to the other structures of the eye such as the retina and optic nerve which could lead to blindness it will also affect the mental health of the patient due to poor aesthetics" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: emergency care gbv\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kakamega county in kenya a middle aged lady has come to the facility her age is 30 her husband always assaults her every time she has nowhere to go and she has nothing to do she asks me to advise her what to do what can i tell the client\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 30 years old woman presents with a history of being assaulted by her husband dx gender based violence management involvement of gender based violence advocates psychological counseling" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kakamega county in kenya a client was admitted to labour work with low vision severe headache convulsion bp 180 140 protein my question is how will i administer magnesium sulfate how will i manage bp what investigation will i request\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a client is admitted in the labour ward with low vision severe headache and convulsions bp 180 140 protein plus plus q1 how will i administer magnesium sulfate giive 4g intravenous loading dose immediately followed by 10g intramuscularly and then by 5g intramuscularly every four hours in alternating buttocks stop administration of magnesium sulfate after the last episode of convulsion q2 how well will i manage the bp the blood pressure is 180 144 so this is considered to be hypertensive crisis and it is a medical emergency drugs of choice in hypertensive crisis are labetalol hydralazine and nicardipine give 20mg labetalol 4ml undiluted over 2 minutes and then measure the bp after 10 minutes the dose is titrated to blood pressure to a maximum of four doses of 20mg 4ml if two bolus doses of labetalol does not lower the bps then consider for infusion and monitor bp after every 20 minutes q3 what investigations will i request you start with the baseline tests which are full hemogram liver function tests renal function tests and bs for mps do a ct scan of the head to help in finding probable cause of the low vision severe headache and convulsions abdominal ultrasound to check the kidneys to rule out invisible masses" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kakamega county in kenya a 36 year old male comes to opd after treatment of tb he still has chestpains night sweats and weight loss has been on anti tbs with no improvement repeat sputum microscopy genexpert positive for rif resistance bmi 15 9 do i start the client on mdr treatment how do i get the client to do routine sputum tests while on medication\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary x0001 x0001 x0001 x0001 a 36 year old male comes to the out patient department after tb treatment with no improvement has chest pain night sweats and weight loss has repeated sputum microscopy gene xpert ve for rifampicin resistance bmi 15 9 does a nurse start on mdr treatment no because the patient is resistant to only one drug continue management with other anti tbs h z e and supplement rif with a fluoroquinolone how to get client to do routine sputum tests while on rx patient education and involvement in the current course of illness will give them knowledge and empower them to cooperate on follow up diagnosis single drug rifampicin resistance tb" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: nan\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse working in a national referral hospitals in uasin gishu county in kenya a 2 year old baby presented at the sick child clinic with a history of hotness of the body a known chemotherapy patient on follow up with fever unresponsive to paracetamol no history of convulsion has not travelled to malaria endemic zones father could not corroborate birth history on examination irritable febrile questions what other antipyretic could be given could this warrant admission or discharge and if so why\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 2 year old with hotness of body known chemotherapy patient with fever unresponsive to paracetamol on examination irritable febrile a what other antipyretic can be given nsaids like ibuprofen b admit patient as management of neutropenic fever needs close monitoring isolation iv medication and white blood cell count monitoring diagnosis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 22.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 22 years of experience in general nursing working in a dispensaries and private clinics in uasin gishu county in kenya a 38 year old patient presents in the facility with complaints of bloody stool during bowel movement pain and itching around the anus and a small lump felt near the opening the symptoms started 2 weeks ago and takes a lot of processed food on assessment the abdomen looks soft and non tender vital signs bp 118 72mmhg pr 82 b m temp 36 9 rr 20b m questions what is the cause of blood in stool what is the immediate management of this patient what laboratory investigations are needed for this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 38 year old male presents in a dispensary with a history of bloody stool during bowel movement pain and itching around anus and a small lump in the anus has a history of taking a lot of processed food all vital signs are normal a cause of blood in stool hemorrhoids anal fissure colorectal cancer b immediate management of patient give laxatives give analgesics for pain topical antihemorrhoidal advise on diet change and drinking lots of water refer for general surgery review for possible hemorrhoidectomy c lab investigations complete blood count if suspecting infection stool for occult blood blood and cysts tumor markers e g cea if suspecting colorectal cancer" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: 12.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a health centres in kakamega county in kenya a 34 year old mother para 3 0 gravida 4 gestation in weeks 39 weeks came with the following history laps on and off that radiate to the back on examination the vitals are 120 80 respiration 20 pulse 80 fetal heart rate 140 other examinations fundal height 38 out of 40 fetal heart rate 140 lie and presentation is cephalic on vaginal examination the vulva is no his neck vaginal is warm and moist cervix is fully dilated membrane ruptured the liqueur is clear so these are the questions that are was is this just a normal labor what is it that i need to do to prepare is there an assistant that i need to do to have or can i just let the mother go to the nearest facility or can i alert any help from the nearby the rest is that\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 32 year old pregnant woman presents with the onset of labor pain radiating to the back vitals stable on examination the cervix is fully dilated with ruptured membranes and clear liquor fetal heart rate is 140 bpm cephalic presentation with active labor differential diagnosis active labor management prepare for delivery set up necessary equipment for vaginal delivery and neonatal resuscitation insert iv line and take cbc and cross match deliver the baby hand over to assist for apgar score evaluation and neonatal care ensure active management of the third stage of labor oxytocin 10 iu intramuscular examine placenta delivered inspect for complete membranes initiate postpartum care" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 16.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: critical care\n\n Prompt from the nurse : i am a nurse with 16 years of experience in cardiology working in a national referral hospitals in uasin gishu county in kenya patient came in with hypotension diaphoretic initially admitted with lower limb edema easy fatigability blood stained cough and chest pain previously had ge which is now resolved she is 58 year old female who has been well until 2 12 months when she developed above complains and progressively worsened and was brought to hospital no history of smoking alcohol has history of eye surgery cataract removal no history of chronic illnesses she is married and blessed with 8 children who are alive and well no history of chronic illnesses in the family she is a farmer and lives in her farm the patient has bradycardia weak and reports of dizziness cold extremities and also reports of muscle weakness and occasional tremors bp unrecordable heart rate 109 160 min respiration rate 23 min spo2 92 on o2 temperature 36 9c random blood sugar 1 9mmol l questions what is the emergency treatment what is the working diagnosis\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 58 years old female patient who reportedly came in hypertension diaphoretic initially admitted with lower limb edema fatigability blood stained cough and chest pain had gastroenteritis which had been rectified has been unwell for 2 12 when she developed the above complaints which are progressively worsening no history of smoking alcohol has a history of eye surgery no history of stress she is married and blessed with 8 children who are alive and well she had bradycardia weak and reports of dizziness cold extremities muscle weakness and occasional tremor vitals bp unrecordable hr 109 160 min rbs 19 mmol l rr 23 min temp 36 9 spo2 92 on oxygen what is the emergency treatment our concern here is hypertensive hypoglycemic pulmonary embolism shock pneumonia put wide bone cannulas at least 2 quickly give 50 dextrose ivfluid maslin at least 2 times in 1 hour as you monitor the patient and maintain her on oxygen following the above and proceed to do investigation laboratory full hemogram liver function test crp coagulation profile radiological chest x ray echo ecg no cardiac diseases ct pulmonary angiogram diagnosis diabetes ketoacidosis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya an 18 years old male came to the emergency department with a complaint of undescended testis on palpation scrotal testicles are absent questions what is management which investigations are needed to confirm the diagnosis\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "3 year old male with complaints of undescended testis or palpation testicle are absent what s the management for cryptorchidism definitive orchidopexy bilateral requires urologists expertise investigations to confirm scrotal ultrasound to confirm absence of scrotal sac abdominopelvic ultrasound to locate testis dx cryptorchidism differential ddx testicular agenesis bilateral inguinal hernia" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 12.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya sarah ten years of age presented to the emergency department with a complaint of headache and is now unable to walk for one week he was treated in a clinic nearby with antibiotics without improvement the temperature is 37 8 degrees celsius spo2 98 ra pulse 120 rr 28 deep and rapid bp 90 60mmhg questions what is the immediate management what investigations are required\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 24 year old male presents with fever altered mental status and generalized seizures lasting two minutes on examination he is febrile and lethargic with a positive kernig\u2019s sign no rash or focal neurological deficits are observed investigations perform a lumbar puncture for cerebrospinal fluid analysis to confirm bacterial meningitis management plan start iv ceftriaxone and dexamethasone immediately administer anticonvulsants to control seizures monitor closely for signs of increased intracranial pressure diagnosis bacterial meningitis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: emergency care burns\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 15 years old female presents at an urgent care center after burning her hand while cooking presents with burn wound redness and blisters cover the arm posteriorly wound cause of bleeding and exposure of muscles t \u2013 37 5 c resp \u2013 20 r m pulse \u2013 68 b m bp \u2013 110 60 mmhg questions 1 what is the management of the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 15 year old female presents with burn wound after an accident while cooking the wound has redness and blisters covering the arm posteriorly vitals bp 110 60 other vitals are within normal ranges management of the patient admit give iv fluids 4mls kg total burn surface area to prevent shock give analgesics do debridement of wounds mechanical debridement using gauze give antibiotics apply topical antibiotics and topical antifungals on wound give anti parasitics give antihistamines give hematinics deworm your patient refer to a plastic surgeon for further management differential diagnosis thermal burns drug allergy chemical burns" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 20.0\n - Nursing Specialty: emergency care gbv\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 34 year old lady who comes to the emergency department with a stab wound on the chest she reports that she was stabbed by her husband with a knife on examination she is in pain she is not pale there is profuse bleeding from the site she was stabbed temp 36 90c p 116b m bp 100 60mmhg spo2 97 questions what is the emergency management of this patient what investigations will be done to assist in patient management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 34 year old lady brought at emergency with a stab wound on the chest stabbed by husband with a knife o e in pain not pale profuse bleeding from stab site bp 100 60 pulse 116 spo2 normal q1 what is the emergency management of this patient give oxygen give analgesics apply pressure dressing to the wound site give anti tetanus and anti rabies prophylaxis give broad spectrum antibiotics give iv fluids q2 what investigations will be done to assist in patient management chest x ray anterior posterior and lateral diagnosis hemopneumothorax hemorrhagic shock" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 9.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 9 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya 40 years old male was brought to the hospital for dialysis he was weak and sick looking vital signs bp 60 40 mmhg pulse 120 min temperature 36 4c spo2 96 min patient collapsed questions what could be the cause of the death what is the immediate care that could have been given before dialysis\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 40 year old male brought to the hospital for dialysis weak and sick looking vitals bp 60 40 mmhg hypotension pulse 120 tachycardic temperature 36 20c normal the patient collapsed q1 what could be the cause of death q2 what is the immediate care that could have been given before dialysis oxygen via non rebreathable mask 15l min iv access iv fluids via large bore cannulas iv antibiotics iv analgesics diagnosis cardiac arrest" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: 13.0\n - Nursing Specialty: emergency care gbv\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 13 years of experience in general nursing working in a health centres in kakamega county in kenya a 13 year old girl was brought in by the teacher having a complaint of lower abdominal pain pv discharge i took the history and the lady reports that the problem has there for a period of two months and when i further probed she reports to have been abused sexually by the mother s side guy while the mother had gone to buy a credit in the evening and the man took advantage of her and he abused her on palpation there was lower abdominal pain on a vaginal examination they found that there was a discharge creamy which i sent to lab to do a urine analysis hiv test and pregnancy test i suspected a sgbv with pid is this is a sgbv case what am i supposed to do after the results are out maybe they can be treated for the sti where am i supposed to refer this sgbv case\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 13 year old girl a suspected victim of sexual based violence by someone known to her lower abdominal pain per vaginal discharge for 2 months now problems lower abdominal pain per vaginal bleeding psychologic tauma management start broad spectrum antibiotic anti fungal pessaries take samples for pregnancy test hiv syphilis from the patient consider taking hiv test from suspect if suspect is not around consider starting pep post exposure prophylaxis psychological counselling and involve relevant sexual gender based violence advocates at sexual gender based violence centre if syphilis is present start an antibiotic if pregnant consider talking to the patient on whether to keep the baby or do an individual abortion" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 2.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 2 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 65 year old female presents to the facility with complaints of difficulty breathing for the past two days has a history of htn and smoking for 40 years on assessment she appears mildly distressed with tachypnea vitals bp 140 90 spo2 92 rr 22 pr 95 t 37 question what could be the diagnosis of the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 65 year old female presents to the sub county hospital with complaints of difficulty in breathing for the past 2 days hx of smoking for the past 40 years and hypertension on exam appears mildly distressed with tachypnea rr 22 pr 82 bp high at 140 90 other vitals are normal a what could be the diagnosis of the patient congestive cardiac failure copd pneumonia investigations complete blood count kidney and liver function tests random blood sugar electrocardiogram echocardiography chest x ray" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kiambu county in kenya a 35 year old male is brought to the emergency department with a history of a road traffic accident rta and complains of pain in the left lower limb on examination bruising is seen on the knee region and there is an open wound on the left tibia fibula bone observations bp 90 66 mmhg pulse 114 bpm respiration rate 24 breaths per minute temperature 36 4\u00b0c he is noted to have a fracture of the tibia fibula region how do i perform fracture mobilization and what should i use to immobilize the limb what is the best painkiller to administer which fluid should i give as a plasma expander for blood loss\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 35 year old male patient presents with pain in the left lower limb bruising on the knee following a road traffic accident there is an open wound on the left tibia fibula bone on exam patient is tachycardic tachypneic other vital signs are normal a x0001 diagnosis tibiofibular fracture b immediate management \u00b7 \u00b7 immobilization of the limb using a splint after which an x ray is done stop active bleeding \u00b7 pain management using analgesics \u00b7 assess extent of the blood loss and manage \u00b7 if patient is hypotensive start on iv fluids \u00b7 start broad spectrum antibiotics b x0001 investigations \u00b7 complete blood count to check the hb levels \u00b7 urea electrolytes and creatinines to check renal function \u00b7 x ray on the fracture site c orthopedic team to review with results and plan for surgery" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 27.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 27 years of experience in general nursing working in a health centres in uasin gishu county in kenya an adult female 29 years old came to the clinic accompanied by her mother who gave hx that the pt had delivered 7 weeks ago and started behaving funny including not wanting to breastfeed the baby mood swings and abnormal sleep patterns no family hx of psychosis 37 00c p 72b m r 20b m bp 120 70 mmhg recommendation refers to mhu for management questions at what stage does puerperal psychosis set in are there other underlying factors apart from puerperal psychosis\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 29 year old female came to the clinic with a history of giving birth 7 weeks ago presents with a history of behaving funny has mood swings not wanting to breastfeed the child and abnormal sleep pattern vital signs are normal at what stage does puerperal psychosis set in immediately post delivery up to 6 weeks postpartum any other underlying factors apart from peripheral psychosis 1 postpartum depression 2 eclampsia 3 metabolic disturbances" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kakamega county in kenya 6 months was brought in having been chocked by cooked bananas she was being fed by elder sister crying and irritable what is the best management for this child\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "6 month old brought after being choked by cooked bananas the infant is crying and irritable diagnosis dx foreign body aspiration aspiration pneumonia management assessment of airway to ensure it is secure and patent maneuvers to remove the foreign body \u2013 young infant\u2019s back blows and chest thrusts educate the mother or caretaker on appropriate ways to feed the child" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : county hospitals\n - Years of Experience: 1.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 1 years of experience in general nursing working in a county hospitals in uasin gishu county in kenya 28 year old female para 2 0 gravida 3 come into labor ward accompanied by her sister in 2nd stage of labor delivered via spontaneous vaginal delivery to live female infant baby at birth did not cry and blue in color apgar at one minute 6 questions 1 how do you resuscitate this baby 2 what can cause this poor outcome\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 28 year old para 2 0 gravida 3 comes into the labor ward in the second stage of labor she was delivered via spontaneous vaginal delivery to a male infant the baby did not cry immediately apgar score 6 a how do you resuscitate this baby 1 clear the airway by removing secretions 2 pat the baby 3 put on oxygen b causes of poor score 1 premature birth 2 fetal distress 3 prolonged labor" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: nan\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse working in a national referral hospitals in uasin gishu county in kenya an 8 year old boy was brought in by the mother with history of generalized weakness painful joints headache abdominal pain loss of appetite and growth failure this is the 3rd admission with the same complaints on assessment the boy appeared wasted with growth failure and weak there is history of sickle cell in the family vital signs t 39 9\u00b0c pr 104 bpm spo 94 questions 1 x0001 what could be the diagnosis 2 x0001 what would be the best health messages to the family\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "patient summary 8 year old male symptoms generalized weakness painful joints headaches abdominal pain loss of appetite growth failure third admission with the same complaint appears wasted with growth failure family history of chronic obstructive pulmonary disease vitals temperature 39 9\u00b0c pulse rate 104 spo\u2082 94 1 diagnosis sickle cell disease 2 best health message to family educate about sickle cell disease explain autosomal recessive inheritance both parents must carry the gene for the child to have the disease advice on lifestyle modifications emphasize adherence to medication and follow up importance 1 diagnosis sickle cell disease" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 15.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 15 years of experience in mental health and psychiatric nursing working in a national referral hospitals in uasin gishu county in kenya a 8 year old boy is brought to the emergency department with complaints of pain on the right hand below the elbow complaints of having been bitten by a snake 3 hours ago on examination there is mild edema around the area of the wound there are visible fang marks vital sings p 96 t 37 1 rr 26 spo2 96 questions what is the acute management for the patient which investigation can be done for the client\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 8 year old boy with right hand pain following a snake bite on examination there are visible fang marks and mild edema around the area of the wound vital signs are normal part i acute management insert intravenous cannula take samples for full haemogram urea creatinine and electrolytes liver function tests give antivenom if suspected to be a poisonous snake administer analgesics e g intravenous paracetamol or tramadol clean the wound administer antibiotics to prevent soft tissue infection admit for observation administer maintenance intravenous fluids investigations full haemogram baseline tests urea creatinine and electrolytes blood gas analysis in case of respiratory compromise" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 20.0\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 53 year old woman presents at the hospital with complaints of a left breast wound which is painful and fungating she reports that the wound started 1 \u00bd years ago and has been increasing in size progressively she sought herbal medication which she has been using for the last 6 months with no improvement on examination the lady is in fair general condition not pale not jaundiced she has a large wound on her left breast the nipple can\u2019t be located temp 37 8oc p 110b m spo2 93 bp 110 72mmhg questions 1 x0001 what is the immediate management of this patient 2 x0001 what test will be carried out to help come up with the diagnosis\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "53 year old woman presenting with complaints of a left breast wound which is painful and fungating and it started 1 1 2 yrs ago and has been increasing in size progressively she sought herbal medication which she has been using for the last 6 months with no improvement on examination in fair general condition not pale not jaundiced she has a large wound on her left breast the nipple cant be located vitals t 37 8\u00b0c pr 110 bpm spo2 93 bp 110 72 mmhg diagnosis breast malignancy immediate management will be give antipyretics for fevers give analgesics for pain give fluids give antibiotics to prevent treat infection cleaning and dressing of the wound surgical review for further management investigations full hemogram c reactive protein liver function test tumor markers biopsy of the lesion radiology mammogram breast ultrasound chest abdominal ct scan" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: child health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kakamega county in kenya a patient aged 15 years comes with history of hotness of the body dizziness diarrhea and vomiting from the past two days ago he also reports history of convulsion and fall from a tree bp 120 60 pulse rate of 98 temperature of 36 2 he also reports history of convulsion and fall from a tree can i do malaria test what may cause convulsion\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 15 year old male presents with a history of fever hotness of the body dizziness diarrhea and vomiting for the past two days along with convulsions and a history of a fall from a tree on examination bp is 120 60 pulse rate is 98 bpm and temperature is 36 2\u00b0c based on this scenario can we do a malaria test there is concern for malaria to rule out traumatic brain injury the differential diagnosis include meningitis space occupying tension infection sepsis the causes of convulsions may include vascular disease infections like malaria tuberculosis trauma metabolic diseases electrolyte imbalance and rarely in this case malisnary" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a health centres in uasin gishu county in kenya a 30 year old male came into the facility with complaints of inflamed joints presence of scales on the joint the skin is itchy and peels easily for the last two weeks he has been using applying a cream on the skin and taking painkillers at home without improvement on examination the skin is dry with scales vital signs taken temp 360c p 88b m r 22 bpm bp 120 80mmhg spo2 98 questions what is the immediate care for this patient why is the patient not responding to treatment the patient could be suffering from which condition\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "case summary a 20 year old male presents with complaints of inflamed joints scaly skin itching and peeling for the last two weeks vitals stable on exam skin is dry and scaly diagnosis reactive arthritis differential diagnosis psoriatic arthritis eczema management 1 corticosteroid creams for inflammation 2 nsaids for inflammation if not contraindicated 3 consider dmards for systemic inflammation 4 identify triggers or aggravating factors 5 refer to a rheumatologist or dermatologist for further management" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a health centres in kakamega county in kenya a primigravida sustains a tear after delivery on assessment the extend of the tear is noted as second degree the woman had strong uterine contractions and perineum was not well supported am concerned that the uterus might also had sustained a tear due to profuse bleeding should i give fluids after repairing the peroneal tear which type of fluid is suitable for the mother i request her to do check hb\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a primigravida who sustained a tear after delivery and on assessment the extent of the tear is noted as second degree concern second degree perineal tear anemia uterine rupture hypotension management give iv fluids correct possible hypotension analgesics pain management antibiotics prevent infections transfuse if the hemoglobin level is low repair the tears using local anaesthetics do a vaginal examination to check for clots and remove them educate the mother on the care of wounds investigations full hemogram blood grouping and crossmatching for transfusion urea creatinine and electrolytes abdominopelvic ultrasound" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: 2.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 2 years of experience in general nursing working in a health centres in kakamega county in kenya a one year baby brought to hospital with the history of having been taken paraffin which was in drinking bottle on exam the baby was smelling paraffin question can this paraffin affect the baby and what can i use to dilute the paraffin in the paraffin in the body\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 1 yr old baby brought to hospital after ingesting paraffin from a drinking bottle upon examination baby has a distinct paraffin odor problems paraffin poisoning gastrointestinal tract irritation management avoid inducing vomiting due to risk of aspiration start oxygen therapy if there are signs of respiratory distress administer intravenous fluids to maintain hydration and blood pressure monitor vital signs closely keep the child in observation for signs of respiratory distress if ingestion was within a short time consider using activated charcoal administer empiric antibiotics if aspiration pneumonia is suspected refer to a pediatrician for further management investigations arterial blood gas check for respiratory acidosis chest x ray check for aspiration pneumonia complete blood count monitor for any signs of infection liver and renal function tests to assess for any signs of systemic toxicity paraffin cannot be diluted in the body paraffin effects on baby include vomiting abdominal pain aspiration pneumonia preferred diagnosis dx hydrocarbon poisoning" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: mental health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kakamega county in kenya a male client aged 45 is brought to the facility by the facility with complains of being violent past 3 weeks there is a history of schizophrenia in the family unkempt hallucinations and illusions present although vital signs are within normal limits what treatments should i administer to calm the patient should i simply reffer to a psychiatrist\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 45 year old male brought to the facility with complaints of being violent in the past 3 weeks there is positive history of schizophrenia in the family unkempt hallucinations and illusions present although vital signs are within normal what treatment should i administer to calm the patient benzodiazepines should i simply refer to a psychiatrist yes refer to a psychiatrist after calming the patient down" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 16.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 16 years of experience in cardiology working in a national referral hospitals in uasin gishu county in kenya a patient is admitted as self referral from home with c o lower limb edema easy fatigability and generally feeling unwell patient was in nairobi at the sister\u2019s place and reports of being out of meds for an unspecified length of time not compliant to follow up at the cardiology clinic and today comes in an acute state he has been on follow up at cardiology clinic and had travelled to nbi when he became sick was taken to knh and treated but not sure what meds were prescribed he didn\u2019t improve and decided to travel back to eldoret for treatment in moi teaching and referral hospital cardiology unit no history of other chronic illness has history of several admissions here in mtrh and bungoma crh no history of blood transfusion of surgery further history shows that he had gone to some church and was prayed for then stopped taking meds the patient is very sick started on o2 therapy via nrm reports of dizziness even at rest has a fast pulse blood pressure 100 60 mmhg heart rate 156 min respiration rate 25 min spo2 82 room air random blood sugar 6 2mmol l questions q1 what is the diagnosis q2 what is the emergency care\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a patient known to be on cardiology follow up presented with complaints of lower limb edema easy fatigability and general malaise the patient has a history of several admissions and is currently decompensated vital signs show an elevated respiratory rate 25 min and a blood sugar level of 6 2 the patient has a history of deviating from medication post religion diagnosis acute heart failure differential diagnoses arrhythmia acute respiratory distress syndrome nephrotic syndrome leg edema religious indoctrination management emergency care administer oxygen insert intravenous lines for sample collection and therapy catheterize to monitor output regulate fluid and salt intake to prevent fluid overload alert the physician for review and further management advise on religious beliefs emphasize the importance of social responsibility and scientific medicine" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 29.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 29 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 16 year old female walked into the clinic complaining of a severe headache which started 3 days ago getting worse each day she is also said to be gravid 1st pregnancy and ln her 3rd trimester complains of swollen lower limbs on palpation fundal height 36 weeks cephalic presentation on auscultation fetal heart rate 138 pitting oedema in lower limbs vital b p 140 100 pulse 124 respirations 20 spo2 92 questions what is the diagnosis what investigation can be done what is the cause of edema\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 16 year old female severe headache getting worse each day for 3 days gravid primigravida in the 3rd trimester lower limb swelling pitting edema fundal height 36 weeks in cephalic presentation fhr 138 bp 140 100 pulse 124 resp 20 sp02 92 causes of edema preeclampsia kidney failure liver failure investigations liver function test he end organ damage full hemogram platelet count hellp syndrome kidney function test urinalysis proteinuria obstetric ultrasound echo ecg management 1 prepare for delivery cesarean section delivery refer it to higher level facility with obstetrician and theatre vaginal delivery 2 induced labour 3 antihypertensives labetalol dose 4 prophylactic anticonvulsants magnesium sulfate 5 monitor blood pressure and vitals 6 monitor fetal status heart rate movement" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 12.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya a 85 year old woman present to the emergency department with complaint of worsening shortness of breath swelling in her legs persistent productive cough and reports difficulty sleeping due to breathing difficulty when lying flat she is a non hypertensive patient and diabetic patient on examination she has peripheral edema a bp of 160 over 95 radon blood sugar of 14 3 mmol per litre a heart rate of 120 beats per minute has cold extremities and an echocardiogram shows reduced ejection fraction what is appropriate medical management to this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary an85 year old with complaints of worsening shortness of breath swelling in her legs persistent productive cough report of difficulty sleeping orthopnea diabetic patient long standing hypertension exam peripheral edema bp 160 95 rbs 14 3 pulse 120 cold extremities echo shows reduced ejection fraction the patient likely has acute decompensated heart failure with a background of diabetes and hypertension q what is the appropriate medical management x0001 \u2022 x0001 initiate supplemental oxygen x0001 \u2022 x0001 fix iv cannula \u2013 initiate opioids for pain and reducing anxiety x0001 \u2022 x0001 diuretics x to reduce fluid overload and pulmonary and peripheral edema this will mitigate shortness of breath diuretics may cause bp to drop x0001 \u2022 x0001 control sugars initiate insulin therapy to achieve glycemic control x0001 \u2022 x0001 close monitoring of vital signs x0001 \u2022 x0001 monitoring of labs ues lfts fhg x0001 \u2022 x0001 refer to cardiologist for further management diagnosis decompensated heart failure" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: bungoma\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 1.0\n - Nursing Specialty: neonatal care\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 1 years of experience in general nursing working in a sub county hospitals and nursing homes in bungoma county in kenya a 2 day old neonate is brought to the nbu with complaints of difficulty in feeding turning bluish in colour while feeding and crying the baby appears lethargic cyanosed cool extremities and capillary refill 3 secs pulse 165 beats per minute respiratory rate 55 breaths per minute spo2 82 room air temperature 37 0oc questions what is the immediate management of the neonate what is the differential diagnosis what investigations should be done what is the prognosis and management plan how should the feeding difficulties be managed\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 2 day old in newborn unit with complaints of difficulty in feeding bluish discolouration while feeding and crying on examination the baby is lethargic cyanosed cool extremities and normal capillary refill tachypnoea afebrile with oxygen saturations of 82 this is concerning for a cyanotic congenital heart disease management assessment and initial stabilization of the baby initiate oxygen therapy establish intravenous fluids hydration establish intravenous line access and obtain samples perform a random blood glucose keep the baby warm monitor vitals of the baby inform pediatrician for review and further management investigations full hemogram urinalysis urine microscopy culture and sensitivity blood gas analysis acute phase reactants such as c reactive proteins imaging chest x ray urgent echocardiography to assess the cardiac structure differentials congenital cardiac disease cyanotic neonatal sepsis respiratory distress syndrome" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 31.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 31 years of experience in general nursing working in a sub county hospitals and nursing homes in kakamega county in kenya a 69 yr old male presents at opd withfever chest pains haemoptsis which have been on and off for the last 3 months no chronic illness no tb contact has been treated with different antibiotics for the same for the last 3 months gene xpert neg bp 140 70 temp37 2 what condition could this be what investigations can be done what is the best management for the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 60 year old male presents with a two month history of progressive difficulty swallowing solids and liquids he reports unintentional weight loss and occasional regurgitation of undigested food no history of smoking or alcohol use vitals bp 135 80 mmhg hr 85 bpm rr 16 breaths min temperature 36 7\u00b0c spo2 98 on room air lab tests and radiology lab tests full hemogram and liver function tests radiology barium swallow and upper gi endoscopy to assess for esophageal strictures or malignancy diagnosis esophageal cancer" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kakamega county in kenya a 20 year old is brought to the opd by relatives tied up presenting with a barking sound and biting people at any chance she gets she has a history of dog bites twice but received anti rabies treatment on both occasions no other significant history she has difficulty swallowing hydrophobia and severe dehydration vital signs blood pressure 80 60 mmhg why was the anti rabies treatment not effective how can i manage the patient will the patient recover\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 20 yr old tied up presenting with a barking sound and biting people on every chance she gets has history of dog bites twice but received anti rabies treatment on both occasions has difficulty in swallowing hydrophobia severe dehydration bp 80 60 reasons why the anti rabies treatment is not effective there was probably a delay with initiating the anti rabies vaccination hence it crossed the blood brain barrier when the vaccine was given rabies had reached the brain and the vaccine is impervious to the blood brain barrier management will the pt recover check for new wounds or presence of a new dog bite place large bore intravenous cannulas and give fluids for maintenance give prophylactic antibiotics call physician for further consult monitor vitals restrain the patient to reduce further injuries to other patients and people the prognosis is poor once the rabies antigen enters the brain as the virus neutralizing vaccine doesn t pass the blood brain barrier" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatric neurology\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a twelve year old girl brought in on a wheelchair with complaints of wounds on the buttocks for 3 weeks history of paraplegia 2 years ago caused by unconscious condition on exam has deep pressure ulcers on the gluteal region bilaterally wounds are septic and dirty with exudates and escar vitals t 38 4 degrees celsius p 108b min rr 20b min spo2 99 on room air weight 28 kg questions what is the immediate management what are the investigations to be done what is the long term care for this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 12 year old brought on a wheelchair with complaints of a wound on buttocks for 3 weeks paraplegic 2 years ago due to unconscious condition o e deep pressure ulcers on gluteal region bilaterally wound is dirty with exudate and necrotic tissue vitals temp hyperthermia pulse tachycardia bp 90 60 rr 28 min spo2 99 ra q1 what is immediate management admit fix iv line get samples for full hemogram urea electrolytes and creatinine and esr give iv fluids give antibiotics broad spectrum wound debridement obtain blood culture pus swab culture give analgesics clean the wound and dress on a ripple mattress nutritional counselling investigations to be done full hemogram to assess complete blood count anemia platelets esr blood culture pus swab culture and sensitivity mri of the lumbosacral spine diagnosis spine injury with pressure sores" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: nan\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine cardiology\n\n Prompt from the nurse : i am a nurse working in a national referral hospitals in uasin gishu county in kenya 50 years old lady presents with complaints of difficulty in breathing easy fatigability and chest pains for 1 week she has bilateral lower limb swelling cold extremities and palpitations she s a known heart failure patient who defaulted clinic follow up and drugs due to financial challenges vitals t 36 0 c bp 100 60 mmhg r 24 b m p 60 b min spo2 85 room air questions what is the immediate care what investigation needs to be done what healthcare teaching is needed for the client\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 50 years old lady with complaints of difficulty in breathing easy fatigability and chest pains for 1 week has bilateral lower limb swelling cold extremities and palpitations known heart failure patient has defaulted clinic follow up other vitals except 100 60 r 24 b mm spo2 85 the top in my list of concerns is acute decompensated heart failure i would therefore manage the patient as follows for immediate management i would give diuretics like iv lasix supplement oxygen analgesics for pain management the investigations i would do are laboratory investigation full hemogram x0001 x0001 x0001 x0001 cardiac markers like nt probnp troponins kidney and liver function tests radiological investigations echocardiogram ecg chest x ray chest ct scan health care teaching needed on patient is as follows patient should be compliant to medication and be on followup reduce salt diet other considerations for cardiologist review" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : health centres\n - Years of Experience: 22.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 22 years of experience in general nursing working in a health centres in kiambu county in kenya a 48 years old man came to to the facility complaining of high bp of 174 112 was on medication which was not working for him i gave nifelat and hctz stat after one hour repeated the bp which was still high 164 110 ques which medication will he respond with do i need to refer to a higher facility\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 48 year old male known hypertensive on medication but with uncontrolled hypertension on assessment blood pressures are 174 112 mmhg repeat blood pressure is 161 110 mmhg after nifedipine and hydrochlorothiazide administration this patient presents with a hypertensive urgency and requires an urgent admission for blood pressure control this should be done in consultation with the physician differentials include hypertensive encephalopathy medications for hypertensive control in this situation would include intravenous labetalol a combined beta blocker intravenous nitroglycerin blood pressure control should be gradual to prevent the risk of hypoperfusion target levels of 150 100 mmhg are aimed at and thus strict blood pressure monitoring is essential upon initiating therapy refer the patient for regular follow up by a physician" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 16.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 16 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a19 year old patient comes with headache vomiting and dizziness she reports experiencing the symptoms after she fell from a double decker bed in school 2 weeks ago the symptoms have now worsened assessment vital signs temperature 36 9c pulse 98bpm spo2 97 bp 119 71 mmhg questions why is the patient vomiting why does the patient feel dizzy which are the most suitable investigations in this case\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "19 y o female with headache vomiting and dizziness after falling from a height 1 week ago differentials i head injury ii haematoma epidural subdural the patient had trauma to the head and thus bleeding into the cranial cavity she is experiencing the dizziness and vomiting due to the space occupying lesion in the brain which is pushing on the brain tissue investigations labs i full hemogram ii kidney function tests imaging i brain ct scan" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 2.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 2 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 30 year old female was brought to the facility unconscious following a road accident on assessment she appears unconscious unresponsive and possible head injury due to bleeding on the head and deformity vitals bp 137 86 mmhg t 37 4 pr 123 rr 10 oxy sat 84 question what could be the immediate management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary road traffic accident 30 y o involved in a road traffic accident presents in an unconscious state unresponsive with possible head injury and deformity blood pressure is normal low respiratory 10 breaths per min spo\u2082 at 84 management cervical spine stabilization with a collar assess airway for patency and suction secretions assess breathing and initiate oxygen therapy establish intravenous cannulation for circulatory compromise and initiate iv fluids with appropriate drop rate intravenous fluid should be controlled stabilize pelvis with a pelvic binder blood transfusion if needed ct scan and neurosurgical referral if head trauma is suspected investigations full hemogram renal and liver function tests ddx severe traumatic brain injury intracranial haemorrhage lung contusion haemothorax pneumothorax" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 18.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 18 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 45 year old male presents with complaints of rectal bleeding and discomfort during bowel movements for the past week the patient reports experiencing mild anal pain and itching with occasional bright red blood on toilet paper after defecation he has a history of chronic constipation but no previous surgical history on examination there is a small external hemorrhoid visible at the anal verge the patient appears otherwise well with no signs of systemic infection or anaemia questions 1 what are the first line treatment options for managing the patient s symptoms 2 is there any indication for further diagnostic workup or specialist review\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 45 year old male with a history of per rectal bleeding mild anal pain and itching with a history of chronic constipation but no history of post surgical history on examination there is a small external hemorrhoid at the anal verge investigations show no systemic infections or anaemia differentials hemorrhoids anal fissures colorectal cancer first line treatment for managing the patients symptoms laxative to help with the constipation analgesics to help with the anal pain topical anaesthetic e g lidocaine is there any indication for further diagnostic work up or specialist review for chronic constipation we can consult a nutritionist to help advise on the right diet consult a general surgeon if suspecting colorectal cancer given the age of the patient or for possible hemorrhoidectomy" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: nan\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse working in a health centres in kakamega county in kenya a three year old child is brought to opd with a history of cut scratch on the arm a day ago there were no visible marks on the child s arm how do i manage this child should the child get anti rabies\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "complaint of a 3\u00bd year old child presenting with a cat scratch from a day ago on the arm no visible marks assess for risk of rabies exposure is the scratch from a stray cat with an unknown vaccination history depth of injury if the scratch is from a stray cat of unknown vaccination history with a deep wound consider rabies post exposure prophylaxis if no visible scratch and was from a domestic pet with known vaccination there is no need for rabies post exposure prophylaxis reassure parents" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 15.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 15 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 5 year old boy was brought with complaints of nasal blockage breathing from the mouth and snoring while sleeping mother reports that they started after he got a cold on assessment temp 38 0oc p 100 b m spo2 94 on ra breathing from the mouth respiratory chest clear questions how can the child be managed what investigations can be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "5 year old boy brought with complaints of nasal blockage mouth breathing and snoring while sleeping diagnosis adenoid hypertrophy what investigations can be done complete blood count c reactive protein erythrocyte sedimentation rate culture of nasal discharge head and neck x ray what is the immediate management administer antipyretics for fever administer empirical antibiotics encourage hydration once stable call for ear nose and throat review" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 20.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a mother brings a 10 old boy with complains of rash and intense itching that is worse at night for 2 weeks on examination the rash are small raised blisters they appear between fingers genital area buttocks and feet thin wavy lines on the skin t 36 0 p 72bpm rr 20bpm treatment at dispensary was given antihistamine and pain killers question what is immediate care of the patient what would be long time management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 10 year old boy presents with rashes and intense itching worse at night for 2 weeks on examination the rashes are small raised blisters between fingers feet genital area and buttocks tiny wavy lines on skin vitals stable diagnosis scabies differential diagnosis atopic dermatitis diagnosis is mostly clinical management 1 anthelmintics ivermectin single dose repeat after 7 14d 2 consider topical permethrin cream scabizol 3 antihistamine for relieving itching 4 counseling and avoidance of reinfection 5 follow up meeting to confirm resolution 6 monitor for complications" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 14.0\n - Nursing Specialty: mental health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 14 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 33 years old male is brought by a guardian to the clinic with a history of decline work performance poor concentration and motivation feels fatigue and difficulty sleeping reports feeling hopeless despite having a stable job assessment bp 138 74mmhg res 22 b m p 84 b m temp 36 8 degrees celsius questions what psychological assessment can be done what is the management which support system can be offered to the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 32 years old male brought to the clinic by the guardian with a history of decline work performance poor concentration and motivation feels fatigue and difficulty sleeping reports feeling hopeless despite having a stable job bp 138 74 ps 4 rr 22 diagnosis acute depressive illness differentials major depressive disorder bipolar disorder depressive episode management as follows take a detailed history to establish what might be affecting the patient any stressors history of alcohol social and marital life psychological treatment therapy for the patient psychological counselling on coping mechanisms give antidepressants link the patient to support groups follow up the patient by psychiatrist investigations" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 20.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 4 year old girl was brought into the facility with complaints of diarrhea and vomiting the condition started 4 days ago and was taken to a facility nearby and treated with no improvements the child is sick looking temperature 36 9 spo2 94 pulse 60 bpm investigation done malaria test negative stool for ova and cyst nothing detected question what is the cause of gastroenteritis what investigation test to be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 4 year old c o acute loose stool and vomiting x 4 7 no response to medication o e sick looking vitals temp 36 9 spo2 94 pulse 60 investigations done b s for mps negative stool got o c normal dx acute gastro enteritis ddx food poisoning infections e coli shigellosis typhoid fever question 1 cause of gastro enteritis likely infectious causes question 2 what investigations a stool gor culture and sensitivity b salmonella antigen test c full hemogram d renal function test e liver function test f stool analysis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 15.0\n - Nursing Specialty: mental health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 15 years of experience in mental health and psychiatric nursing working in a national referral hospitals in uasin gishu county in kenya a 26 year old male patient is admitted with bipolar mood disorder and was done appendicectomy 7 days ago comes with complaints of abdominal pain refusal to feed aggressive behavior on examination the patient is irritable uncooperative for the assessment vital signs bp 125 80 spo2 98 pr 100 t 39 8 tenderness at epigastric region questions what is causing the spiking fevers could the patient be developing complication relating to appendicectomy why which investigation can be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 28 year old patient is admitted with bipolar disorder and was done appendectomy 7 days ago comes with complaints of abdominal pain refusal to feed aggressive behavior on examination he is irritable uncooperative assessment bp 125 80 spo2 98 pr 100 t 39 8\u00b0c tenderness at epigastric region what is causing the spiking fevers possible cause of the spiking fever is an infection probably from the surgical site investigations done to be done baseline full hemogram liver function tests blood for malaria parasite smear abdominal blood culture diagnosis surgical site infection" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a national referral hospitals in uasin gishu county in kenya a 25 year old woman came into the clinic complaining of frequent urination and pain when urinating but no blood in her urine fevers chills flank pain or vaginal discharge she has had similar symptoms in the past that went away with antibiotics t36 p 75b min bp 110 60 questions what investigation can be done what is the diagnosis what treatment is anticipated\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 25 year old woman came to the clinic complaining of frequent urination and pain when urinating but no blood in her urine what investigations can be done 1 urine test to rule out infection check for nitrates pus cells 2 blood test white blood cell count kidney function 3 vaginal swab to check for sexually transmitted infections differential diagnoses ddx 1 upper urinary tract infection 2 lower urinary tract infection 3 pelvic inflammatory disease what treatment is anticipated antipyretics for fever antibiotics for infection painkillers encourage oral hydration" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 20.0\n - Nursing Specialty: surgical care\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya mother brought a 4 year girl having rectal prolapse who had been seen in another facility the mother reported the same condition several times and had been taking the child to a hospital for management now the prolapse persisted despite being managed in the hospital vital signs temperature 37o spo2 98 pulse 70 bpm question what could be causing the rectal prolapse what\u2019s the immediate care management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 4 year old referred with rectal prolapse has occurred severally and persistent on this episode vital signs temperature 37 celsius spo2 98 pr 70 b min immediate care management manual reduction gently reduce the prolapse to prevent further complications advice the mother to prevent straining during defecation ensure the child is well hydrated and nourished refer the patient to a referral facility where the patient can be managed by a pediatric surgeon or gastroenterologist" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a national referral hospitals in uasin gishu county in kenya a 60 year old male patient presenting with fever cough abdominal pain chest pain breathlessness that worsens with exertion of work nausea and vomiting he s a known diabetic and hypertensive client for 5 years on glimepiride metformin and lasix bp 150 95 p 105 r 26 questions 1 what is the diagnosis 2 what management is required\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 60 year old male with fever cough chest pain breathlessness nausea and vomiting history diabetic hypertensive for 5 years assessment diagnosis myocardial infarction management stabilize patient oxygen therapy if saturation 90 pain management with analgesics empiric antibiotics after collecting samples antiemetics for nausea vomiting dual antiplatelets anticoagulation statins beta blocker investigations full hemogram urea electrolyte and creatinines liver function test c reactive protein red blood cells hba1c troponins brain natriuretic peptide echocardiogram electrocardiogram chest radiograph definitive management dependent on diagnosis refer to an internal medicine specialist" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 9.0\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 9 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 55 year old lady presents with complains of post coital bleeding foul smell puss discharge for 6 12 p v bleeding for 4 12 and back pains for 4 12 on assessment the patients look weak and emaciated bp 110 64mmhg p 100b min t 37 1c spo2 98 hb 4 9 g dl questions what could be the diagnosis what could be the management what could be the differential diagnosis\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 55 year old female complains of post coital bleeding foul smelling discharge for 6 12 pver vaginal bleeding for 4 12 and back pain for 4 12 exam patient looks weak and emaciated with normal vitals hb 4 9g dl diagnosis likely diagnosis of cervical cancer differentials endometrial cancer vaginal cancer metastatic disease what could be the diagnosis cervical cancer post coital bleeding vaginal discharge severe anemia hb 4 9 what could be the management stabilization of patient admit patient take hx physical exam fix iv line and collect samples cbc uecs lfts gxm coagulation profile crp transfusion prbcs ivf hydration stop active bleeding tranexamic acid pain management paracetamol initiate antibiotics broad spectrum foul smelling discharge ceftriaxone iv metronidazole nutrition what additional work up do a speculum to assess bleeding discharge mass get a pap smear get a biopsy of mass request for pelvic imaging pelvic ultrasound ct abdominopelvic ct cxr consult with an expert to for future management" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 20.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 42 year old lady who comes to the clinic with a history of confession general body weakness she is a client who is on follow up at an oncology clinic for cancer of the urinary bladder she received her 2nd cycle of chemotherapy 4 days ago on examination the pattern is confused weak lab test u e c\u2019s sodium is 110 temp 36 40c p 70b m r 24bpm bp 90 52mmhg spo2 92 questions what is the emergency management of this patient what could be the cause of low sodium levels in this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 42 year old with urinary bladder cancer on chemotherapy and cycle 4 days ago comes with confusion vital signs indicate hypotension they also have hyponatremia dx hypotension secondary to dehydration hyponatremia investigations full hemogram to rule out anemia renal function tests management supplementation of sodium with hypertonic saline in view of hypotension post chemotherapy rehydration with iv fluids" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kiambu county in kenya a client comes in at 34 weeks pregnant in maternity with complaints of bleeding on examination bright red clots are bleeding and query fetal heart rates is the baby alive or dead which is the most appropriate mode of delivery and what are the possible outcomes\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 34 week pregnant mother presents with bright red vaginal bleeding and possible fetal distress upon examination there were clots and concern for fetal heart rate problems bright red vaginal bleeding possible fetal distress presence of clots management initiate iv fluids to stabilise the mother and transfuse if severe anemia noted ensure continuous fetal monitoring by a cardiotocogram admit the patient if vitals are not stable prepare for emergency cesarean section if baby is alive and vaginal delivery if baby is deceased prepare for neonatal care by administering corticosteroids and also administer magnesium sulfate for neuroprotection possible outcomes of mother include recovery after delivery or risk of hemorrhagic shock possible outcomes for the baby include survival if timely cesarean section is performed preterm complications such as sepsis or demise investigations do a abdominal and transvaginal ultrasound to assess placenta location fetal viability do cardiotocography to monitor fetal heart rate to confirm if baby is alive do a complete blood count to check for hemoglobin level do a blood grouping and cross matching in preparation of transfusion do a coagulation profile to rule out disseminated intravascular coagulation do a urinalysis to rule out potential cause of bleeding diagnosis placenta previa" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 16 year old boy was brought in with hx of trauma from a school locker when he was playing with classmates 1 7 was injured on the groin area and is now in so much pain especially the testicles temp 37 2oc p 100 b min rr 20 b min spo2 97 bp 120 80mmhg questions what is the immediate management which investigations should be carried out\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 16 year old male presenting with testicular pain following trauma on the groin area from a school locker has elevated pulse at 100 bpm vitals normal immediate management the concerns in the above patient would be a testicular injury with a differential of epididymal or vascular injury the immediate management includes assessment for open injuries or bleeding arising from trauma and manage appropriately analgesics such as paracetamol antispasmodics such as buscopan or nsaids investigations full haemogram due to bleeding concerns urea creatinine and electrolytes blood grouping and cross match in preparation for any surgeries scrotal and pelvic ultrasound to assess the inguinal area scrotum and testis refer to urological center for surgical scrotal exploration" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: 8.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 8 years of experience in general nursing working in a health centres in kakamega county in kenya 14 years old girl came with malaise fever chills she completed al full dose one day ago investigation done bs for mps was negative salmonella type 3 not done pregnancy test negative the lmp started 2 days ago how can i manage the patient should i refer the patient for more investigation\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 14 year old female presents with malaise fever chills completed al full dose 1 day ago for malaria treatment last menstrual period started 2 days ago investigations bs for mps negative pregnancy test negative salmonella type 3 not done management administer iv fluids for hydration antipyretics for fever investigate thoroughly to find cause blood slide for malarial parasites salmonella cultures blood culture if malaria antimalarials ensure compliance if typhoid antibiotics referral if symptoms persist" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 2.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 2 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 45 year old male presents to the facility with complaints of severe lower back pain that started 3 days ago he describes the pain as a sharp stabbing sensation in the lower back which radiates down to the right leg and worsens with movement on assessment the patient appears uncomfortable and irritable vitals bp 130 85 mmhg pr 84 spo2 98 t 37 resp rate 16 bpm question what is the immediate management of the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 45 yr old male with complaints of severe lower back pain stabbing that radiates down to the right leg and worsens on movement patient uncomfortable and irritable has fever immediate management administer analgesics for pain management such as nsaids advise the patient to avoid heavy work and rest involve the physical therapist to help the patient" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: bungoma\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 1.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: surgery paediatrics\n\n Prompt from the nurse : i am a nurse with 1 years of experience in general nursing working in a sub county hospitals and nursing homes in bungoma county in kenya a 2 month old baby male is brought in with complaints of a curved penis downwards and urethral opening located on the underside vital signs are temperature 36 4\u00b0c pulse rate 120 breaths per minute respiratory rate70 breaths per minute and spo2 95 questions what investigations should be done what is the management plan for the baby what support should the parents receive\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 2 month old male brought with displaced urethral meatus vitals tachycardia tachypnea other vitals normal a what investigations should be done \u2713 investigate for sepsis given tachycardia and tachypnea do a septic screen to include urinalysis urine culture full hemogram urea electrolytes creatinine c reactive protein \u2713 grouping and crossmatching screen for cross matching as this case is surgical \u2713 kidney ureter and bladder ultrasound assess normal anatomy and function of kidney ureters and bladder b management plan for baby will require surgical intervention by a urologist c what support should parents receive \u2713 health education to parents \u2713 explain the condition of the patient \u2713 explain a course of management \u2713 explain possible complications with without treatment \u2713 address any concerns they may have diagnosis congenital malformation with urinary tract infection" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 18.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 18 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a female patient aged 16 years came to the hospital with chief complaints of passing hard melena stools swelling in the anal region she works in a petrol station as a pump attendant temperature 36 30c pulse 91 beats minute respiration 20 breaths minute blood pressure 123 79mmhg question s what might have caused the bleeding what radiological examinations will be done what is the immediate management for this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 16 year old female patient with a complaint of passing hard melena stool swelling in the anal region the vitals are normal bleeding could be from distended haemorrhoidal veins radiological examinations include perform an exam rectal endoscopic ultrasound to characterize the swelling and see whether it is cystic or solid perform magnetic resonance imaging of the pelvis to visualize the tissues perform a rectosigmoid endoscopy to help visualize perform a colonoscopy to visualize the colon for possible pathology perform a sigmoidoscopy conduct an anorectal exam including anoscopy management give the patient stool softeners give the patient rectal applications and astringents advise the patient to do sitz bath perform sclerotherapy perform rubber band ligation of note surgical review will be necessary for further surgical management in addition perform complete blood count to check for haemoglobin levels and white cell count if an infection is suspected" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 8.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 8 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 17 year old girl in the company of her mother presents to the emergency department with a history of fainting attacks for the past 3 days vital signs bp 120 80mmhg pulse 86 beats per minute temperature 36 2 0 c spo 2 98 question what could be the cause of the attacks\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 17 year old presents with a history of fainting attacks for the past 3 days vitals within normal range what could be the cause of the attacks" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kiambu county in kenya a 28 year old woman presents herself at the maternity with complaints of low abdominal pains pv bleeding and has amenorrhea for six months on examination the client is gravid bleeding is evident on the pant she reports that the laps started three days ago and she was not worried since she was not due for delivery but now the pain has increased with intensity and more bleeding on examination fundal height is six months longitudinal lie cephalic presentation all other parameters appear normal question one what is the priority treatment for this client question two is ultrasound a priority for treatment and diagnosis question three what are the available counselling options for the mother in case of premature delivery question four what are the available referral options for nbu care question five what are the possible outcomes\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 28 year old at 28 gravid patient presenting with lower abdominal pains and per vaginal bleeding which has progressively been worsening this is a care of antepartum hemorrhage which could be due to trauma to the abdomen abortion which is spontaneous placenta previa placenta abruptio vasa previa is ultrasound a priority for treatment and diagnosis yes to check the viability of the fetus and to rule out possible causes of bleeding what are the available counselling options for the mother in case of premature delivery counsel the mother on a long possible stay for the baby and need for new born unit care what is the priority treatment give dexamethasone to promote lung maturity fluid resuscitation to replenish blood volume give tocolytics to delay labor what are the available referral options for new born unit care refer to a county referral or a national referral what are the possible outcomes \u2170 premature delivery and preterm baby ii death of mother in case hemostasis is not achieved iii death of the baby due to apnea" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: 21.0\n - Nursing Specialty: emergency care adult\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 21 years of experience in general nursing working in a health centres in kakamega county in kenya a female 28 year old lady was brought to the casualty department in an unconscious state history reveals that she is a teacher in a nearby school she came from home with complaints of general body malaise then she suddenly fell down and drifted into unconsciousness observations of vital signs were within normal range what could be the cause of her condition what type of investigations are required to make her diagnosis what can we do to stabilize her condition before referral\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 28 year old lady unconscious with complaints of generalized body malaise and loss of consciousness normal vitals differentials postural hypotension can cause sudden loss of consciousness due to sudden postural changes pre existing or underlying cardiac abnormalities such as aortic stenosis cardiac arrhythmias can result in loss of consciousness vasovagal syncope can also lead to sudden loss of consciousness convulsion space occupying lesion intracranially will lead to loss of consciousness sepsis early pregnancy symptoms with easy fatigability anaemia investigations laboratory full hemogram malarial blood slide pregnancy test renal function test imaging computerized tomography of the brain or magnetic resonance imaging of the brain to identify potential space occupying lesions meningitis meningoencephalitis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: emergency care adult\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kakamega county in kenya a patient aged 42 years came to out patient with history of having fainted the blood pressure was 70 over 60 the patient was unconscious and could only respond slightly to pain mrdt was done and was negative it was hard to identify the cause of unconsciousness because he was not able to do rbs so the question was do i refer this patient to another level which i did but i didn t get the feedback because he just went\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 42 year old came with a history of having fainted bp 90 60 hypotensive unconscious and only responding to light pain stimuli mrdt negative hgb hard to identify the cause of unconsciousness because he wasn\u2019t able to do random blood sugar q1 refer to another level no resuscitate the patient investigate and refer q2 immediate management fix an iv line run 50 dextrose do a full hemogram to rule out anemia and sepsis catheterize give analgesic give antibiotics then refer for ct scan brain etc diagnosis altered level of consciousness cause" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 18.0\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 18 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 20 year old female patient came to the hospital with complaints of severe lower abdominal for 2 days she is nulliparous she had been in marriage for 2 years without a baby she bought medicines in a clinic and she was told they are fertility drugs vital signs temperature 36 60c pulse 121 beats minute respiration 16 breaths minute question s what is the differential diagnosis what investigations can be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 20 year old female patient with complaints of severe lower abdominal pain for 1 2 days she is nulliparous and has been in marriage for 2 years without a baby she bought medicine which were fertility drugs vitals 36 6 temp pulse 121 bpm resp 16 bpm lab investigations to be done complete blood count urea creatinine and electrolytes urinalysis pregnancy diagnostic test blood grouping and crossmatching radiological abdominopelvic ultrasound erect abdominal x ray" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 12.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya a mother brought her child to mch clinic for bcg immunization after having a home delivery five days ago on examination the baby is severely dehydrated has a weak cry and a temperature of 39 2 should i give the bcg immunization how should i manage this baby what health talk do i give to this mother\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a mother brought her child to mch for bcg after having a home delivery 5 days ago o e baby severely dehydrated weak cry temp 37 2\u00b0 1 should i give the bcg immunization no hold bcg until the fluid condition is treated for the dehydration and fever 2 weeks 2 how should i manage this baby fix an iv line do random blood sugar and give 10 dextrose give iv ringers lactate give antibiotics take samples for bs for malaria parasite slide and full hemogram keep warm treat for malaria if so transfuse if low haemoglobin admit under neonatologist 3 health talk to the mother sleep under an insecticide treated net deliver at hospital facility during next pregnancy maintain hygiene exclusive breastfeeding cord care keep warm diagnosis neonatal sepsis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 2.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 2 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 58 year old male complains of intentional weight loss fatigue and persistent abdominal pain for the past 2 months history of hypertension which is well controlled and chronic alcohol use disorder family history of colon cancer from the dad and breast cancer from the mom on assessment the patient appears fatigue with mild jaundice and slightly thin vitals bp 130 80 mmhg pr 85 t 36 1 spo2 94 resp rate 16 question what could be the diagnosis of the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 58 year old male presents to a sub county hospital with a history of intentional weight loss fatigue persistent abdominal pain for the past 2 months he has a history of htn well controlled and a family history of colorectal cancer father and breast cancer mother on examination patient is mildly jaundiced but vital signs are normal possible diagnosis pancreatic cancer colorectal cancer hepatocellular carcinoma investigations full hemogram urea creatinine and electrolytes liver function test carcinogenic embryonic antigen stool for occult blood colonoscopy" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 29.0\n - Nursing Specialty: surgical care\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 29 years of experience in general nursing working in a health centres in uasin gishu county in kenya an adult male 40 years of age came into the clinic complaining of severe headache and gradual loss of vision which started 3 days ago on examination visual acuity right eye 6 out of 60 left eye 6 out of 60 bp on 140 110 pulse 80 respirations 20 spo2 95 questions 1 what could have caused the loss of vision 2 could the high bp have been caused by the loss of vision\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 40 year old male comes with a 3 day history of severe headache and gradual loss of vision in both eyes examination reveals visual acuity of 6 6 in both eyes blood pressure of 140 110 mmhg other vitals were normal problems severe headache bilateral visual loss elevated blood pressure 140 110 management administer antihypertensive medications to stabilize the blood pressure administer analgesics to relieve the headache refer urgently to a specialist for further evaluation that is ophthalmologists and neurologists investigations complete blood count to assess for infections blood glucose to check for diabetes mellitus lipid profile if available to check dyslipidemia urea electrolytes creatinine to check for renal function urinalysis to check for proteinuria possible cause of vision loss hypertensive retinopathy optic nerve damage retinal vascular occlusion high blood pressure causes vision loss hypertension can cause hypertensive retinopathy preferred diagnosis dx hypertensive retinopathy" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 12.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: psychiatry\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a dispensaries and private clinics in uasin gishu county in kenya a 3 year old female is brought with complaints of increased thirst frequent urination hunger fatigue and blurred vision which has been persistent for more than one week temp 36 8 spo2 97 pr 96b m questions what investigations are to be done what is the immediate management of the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 19 year old male presents with auditory hallucinations disorganized speech and social withdrawal over the past 3 months he denies substance use or medical history investigations conduct urine toxicology to rule out substance induced psychosis perform mri of the brain to exclude organic causes schedule a psychiatric evaluation management plan initiate antipsychotic medication such as risperidone provide psychosocial therapy and family support monitor for side effects and ensure adherence to treatment diagnosis schizophrenia" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 12.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a dispensaries and private clinics in kakamega county in kenya a child 5 years is brought to the facility for routine immunization and growth monitoring the child looks wasted the mother reports of lack of appetite and passing of intestinalworms two days ago weight is 10kgand stunted growth noted signs of marasmus noted how do i handle the case should i contact a nutritionist\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 5 year old child was brought to kakamega dispensary for routine immunisation and growth monitoring the child looks wasted mother reports lack of appetite and passing of intestinal worms 2 days ago weight is 10kg and stunted growth noted signs of marasmus noted 1 how do i handle the situation give deworming medications such as albendazole according to immunisation history and protocol administer vitamin a being a dispensary let the immediate concerns that you are able to if hypoglycemic give dextrose intravenous fluids if hypothermic keep child warm warm blankets refer to a facility for admission where marasmus can be handled appropriately 2 should i contract a nutritionist yes contact a nutritionist and for further management especially on the diet which is probably lacking for the baby" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: 2.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 2 years of experience in general nursing working in a health centres in kakamega county in kenya a 32yrs old lady comes in with weakness of the right side of the body has a history of having been strike by lightning bp 100 60mm hg she is conscious and talking what is the treatment of lightning strike should i admit the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 32 year old lady comes with weakness in the right side of her body has a history of being struck by lightning bp 100 60 management admit the patient primary survey analgesics iv fluids monitor vitals catheterize physiotherapy lab workups fhg uecs lfts radiology echo ecg" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kakamega county in kenya a 30yr old lady presents with c o foul smelling feet the patient has been exhibiting the symptoms for the past 3yrs despite using the antifungal cream the feet are clean and dry what is the management of the client\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "surgery 30 yr old lady with complaints of foul smelling feet for 3 years persistent despite using antifungal cream foot clean and dry only dx poor hygiene bacterial infection fungal infection resistant management for this client foot hygiene patient to wash her feet regularly with soap and water antifungal medication topical antifungal medications shown topical antibacterial medications the patient changes socks and shoes daily referral to a dermatologist for further management" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a man was brought to the emergency department after a big tree fell on his abdomen the patient is oriented and able to verbalize the patient rates abdominal pain at 9 10 patient is not able to ambulate and reports vomiting bloody vomit twice questions which investigations need to be done how should the patient be managed\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary male with abdominal trauma pain score 9 10 unable to ambulate hemoptysis noted patient is alert assessment diagnosis splenic rupture management investigations full hemogram urea electrolyte and creatinines blood group and cross matching focused assessment by sonography of trauma ultrasound abdominopelvic x ray priority care check for open bleeding and apply pressure establish intravenous access with large bore intravenous lines giving crystalloids check hemoglobin transfuse packed red cells whole blood if needed administer antifibrinolytics perform focused assessment by sonography for trauma to localize hemorrhage address airway and breathing give oxygen if hypoxic monitor gcs manage hypoglycemia with dextrose prepare for surgical intervention" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 20.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: critical care\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 12 year old boy came in with fever restlessness lack of appetite drooling redness and inflammation of the throat known patient with autism temperature 39 3 degrees celsius pulse 90 beats min respiration 22 breaths min rbs 5 3mmol l questions 1 what is the differential diagnosis 2 what is the immediate management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 12 year old boy presents to a health centre with fever restlessness lack of appetite drooling redness and drooling vitals t 7 39 3 pr 90 rp 22 min immediate management follow the abcde approach obtain saturation and administer oxygen if saturation is 95 administer antipyretics initiate iv fluids after obtaining iv access examine the throat and take a throat swab for culture start the patient on a broad spectrum antibiotic refer the patient to a facility where investigation such as complete blood count urea electrolytes and creatinine blood culture can be done impression pharyngitis differentials epiglottitis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 23.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 23 years of experience in general nursing working in a dispensaries and private clinics in uasin gishu county in kenya a 17 year old girl came to the facility with severe vomiting she is a form two from a nearby secondary school the girl looks weak and dehydrated on observation temperature 38 4 degrees celsius resp 18 b min pulse of 70b min bp 102 60mmhg questions what is the immediate care of this girl what is the possible cause of vomiting what are the investigations to be done on this girl\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 17 year old girl with severe vomiting looks weak and dehydrated with fevers dx gastroenteritis ddx malaria hyperemesis gravidarum septicemia management iv access for iv fluids take blood samples for investigations cbc pdt crp esr uecs urinalysis analgesia for pain coverage antiemetics iv ondansetron antibiotic coverage after results antipyretics cover for the fever nutritional support" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 12.0\n - Nursing Specialty: neonatal care\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya the 2 days old baby is brought to an newborn unit with complaint of irritability and refusal to breastfeed on assessment baby had cleft lip and palate how do i manage this condition at the moment and which method of feeding is the most appropriate\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 2 day old baby with a cleft lip and palate presenting with irritability and refusal to breastfeed the management of the baby at this point will involve 1 x0001 stabilize the patient by ensuring the airways breathing and circulation are adequate 2 x0001 check blood sugar levels and address hypoglycemia with a dextrose infusion appropriately 3 x0001 provide warmth to the baby 4 x0001 ensure the hydration status is adequate 5 x0001 involve a nutritionist to help meet the nutritional demands of the baby question the most appropriate method of feeding is through the expression of breast milk and use of special feeding tubes and bottles to deliver the milk this is because the baby is unable to coordinate suckling of breast milk it may also be required to feed the baby in specific positions to prevent the risk of aspiration" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 30.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 30 years of experience in general nursing working in a health centres in uasin gishu county in kenya a female 59 years old patient complains of oral sores for the last 2 days chest pains and fever for the last 3 months history of night sweats loss of weight no history of coughing temperature \u2013 37 7 c pulse \u2013 68b min respiration rate 18b min blood pressure \u2013 130 70 mmhg and sp02 \u2013 90 room air questions what is the possible diagnosis what differential diagnosis what is the immediate management what investigations can be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 59 yrs old female presents with complaints of oral sores for the last 2 days accompanied by chest pain fever for the past 3 months night sweats and weight loss vitals show patient is febrile low saturation levels of 90 problems chronic fever chest pain weight loss oral sores low spo2 management administer antipyretic for fever administer analgesics for chest pain relief ensure oral care for the oral sores such as topical antiseptics start oxygen therapy for the low spo2 regular monitoring of vital signs refer to a specialists pulmonologist cardiologist administer broad spectrum antibiotics if infection is suspected investigations chest x ray to assess lung pathology e g tb sputum culture evaluate for mycobacterium tuberculosis hiv test complete blood count check for signs of infection c reactive protein erythrocyte sedimentation rate check inflammation oral swab culture preferred diagnosis dx tuberculosis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a health centres in kakamega county in kenya a couple comes to mch for first antenatal visit on abdominal examination done fundal height with palpable mass felt and then the first anc profile was done blood group o positive urinalysis nothing no abnormality detected hb 5 4 the vdrl negative and then pmtct the wife found to be positive the testing was done also for the husband it turned out to be negative now the mother comes to me and says she doesn t want the husband to know that she is hiv positive she is on treatment but the husband doesn t know now how do i tell or disclose the result to spouse will it lead to any medical legal issues in future do i need transfusion because of low hb or do i give him a treatment or advice on diet could the arvs that the mother is taking lead to low hb in pregnancy\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 1st anc fh palpable mass blood group o hb 5 4pmtct mother does not want husband to find out about the results should i tell or disclose result to spouse medical legal issues in future do i need transfusion give treatment or advice on diet could arvs lead to low hb this is a case of medical dilemma but of importance is adhering to patients rights if the mother does not want her hiv status to be disclosed it is important to respect patients privacy however educate the patient on the repercussions of poor adherence and the impact on her and her spouse this is a case that can attend medical legal issues breach of patient rights to confidentiality by disclosing her hiv status without her consent can attract legal pursuit this is a case of severe anemia in pregnancy to optimize mother and child well being it is vital to transport the mother to a better facility advise on diet and give iron rich vegetables protein and iron supplements as prescribed by a doctor arvs in some cases may lead to low anemia as a side effect of some arts therapy and a review with an infectious diseases team is important" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 22.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 22 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya opd a 30 years old man came to the facility complaining of pain on the right side of the abdomen for the last 2 days question what was the cause of the pain on the right side of the abdomen after giving analgesics do i refer him to a higher facility for abdominal x ray to rule out acute appendicitis\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "case summary a 30 year old man with a diagnosis of pain in the abdomen for 2 days differential diagnosis cholelithiasis cholecystitis cholangitis appendicitis perforated gastric ulcer management yes after giving analgesics administer prophylactic broad spectrum antibiotics with anaerobic coverage i e ceftriaxone and metronidazole iv rehydrate him with iv fluids i e ns and d10 alternating or ringers alone request for lab work ups i e to check hb and wbcs anaemia and bacterial infection type and crossmatch in preparation for surgery urea electrolytes and creatinine to rule out electrolyte imbalances and then refer him to higher facility for abdominal x ray to r o acute appendicitis and also for further management" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: mental health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kiambu county in kenya a 30 year old man was brought by relatives with history of agitation beating people and chasing them and loitering in the streets he looked unkept and had incoherence of speech he is a known psychiatric patient who has been in follow up but has not taken his medication for the last two months which is the best treatment for this man should we refer for psychiatric review\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 26 year old male presents to mtrh with high grade fever severe headache and confusion he recently returned from a malaria endemic region and reports a history of missed antimalarial prophylaxis examination reveals jaundice and hepatosplenomegaly vitals t \u2013 39 5 degrees bp normal pr 90bpm management start iv artesunate immediately provide supportive care with iv fluids and antipyretics perform blood smear for malaria parasites and initiate hematological monitoring monitor for complications like cerebral malaria diagnosis severe malaria" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 15.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 15 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 5 year old child was brought to the emergency department with complaints of loss of consciousness and weakness for one hour guardian reports that the child was playing outside but went quiet after entering the granary the child was found lying down near an open hand sprayer that had been used to spray cattle on assessment avpu at p pupil is pinpoint spo2 88 on room air p 60b m r 166 bpm temp 35 6oc rbs 6 7mmol l bp 80 50mmhg extemities are cold questions what is the priority care for this patient what investigations can be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 5 y o child brought to ed complaining of loss of consciousness weakness for one hour found lying down near a hand sprayer used to spray cattle avpu pinpoint pupils desaturating bradycardic tachypneic hypothermic cold extremities but bp is normal a priority care for patient remove clothes as might be contaminated with poison change them irrigate eyes ensure airway patency and adequate breathing provide o\u2082 administer atropine pralidoxime for organophosphate poisoning reversal iv fluids continuously monitor vitals urine output perform gastric lavage to suction any ingested poisons administer activated charcoal via ng tube if patient presents with seizures give anticonvulsants keep patient warm take samples for investigations ensure to continue administering atropine until full atropinization is achieved by monitoring for increased pulse pupil dilation clear bilateral lung fields b investigations 1 laboratory tests cbc rule out other causes of syncope like anemia crp esr wbc check for sepsis uecs correct derangements blood slide for malaria parasite toxicology screening 2 radiology eeg rule out seizures echo ecg rule out congenital heart conditions that can cause syncope dx organophosphate poisoning" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: emergency care rape\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kakamega county in kenya 7 years old girl was brought in by the an uncle with the complain of having been assaulted sexually by grandfather uncle reports that his grandfather has been calling her his wife because she was named after the late grandmother little did they now he was meaning it laceration were observed around the vagina and there was pv bleeding what is the priority treatment for this little girl can this be categories under gbv should i sign p3 forms\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 7 year old female is sexually assaulted by the grandfather lacerations around the vagina and perivaginal bleeding priority management of the patient sign a p3 form and notify the police collect samples vaginal swab for semen analysis skin swab blood and all other available evidence for police including the child\u2019s clothes take samples for testing vaginal swabs for cultures blood for cbc uecs triple serology urine for urinalysis start post exposure prophylaxis as you await triple serology results analgesics for the pain give antibiotics if the wounds are infected clean and dress the wounds counsel the child and the family of the child keynote this case is categorized under gender based violence and a p3 form should be signed since it is a police case diagnosis defilement" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 19.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 19 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a female neonate is brought in with gasping respirations 2 hours after birth she was born via emergency caesarean section to a mother with one previous scar at 39 weeks of gestation apgar score was 8 1 9 5 10 10 birth weight was 3400 grams and is saturating at above 94 on room air she is floppy dusky and has a heart rate of 45bpm rbs 4 5mmol l temp 36 6 and spo2 unrecordable question what is the immediate management of this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary neonate referred to a national referral hospital 2 hours post delivery via cesarean section delivered at 37 weeks apgar score 8 at 1 9 at 5 10 at 10 birth weight 3400 grams spo2 94 assessment findings floppy dusky heart rate 45 bpm rbs 4 5 mmol l vitals t 36 6\u00b0c impression respiratory failure immediate management position the head in neutral position and start suction provide positive airway pressure to maintain spo2 at \u2265 94 start chest compressions if the heart rate remains at a figure of less than 60 after ventilating provide a radiant warmer to maintain temperature at 36 5\u00b0c to 37 5\u00b0c check random blood sugar frequently monitor vitals investigations arterial blood gas to assess oxygenation septic screen complete blood count c reactive protein procalcitonin urea electrolytes and creatinine to check metabolic derangements once stable the patient can be transferred to nicu" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 1.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 1 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya 21 years old mother comes to the facility with a 2 year old baby with complain of having frequent attacks of cold cough the baby has been to the facility for several times and was attended to on observation the baby was weak and having watery eyes vital signs temp 37 2c pulse rate 82b min spo2 94 questions what might be causing frequent attacks of cold cough how can the baby be generally managed\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 2 year old baby with frequent attacks of cold cough body is weak with a history of wheezing age temperature is normal respiratory rate is slightly reduced management monitor symptoms reassess vital signs for any changes supportive care administer oral rehydration if baby can feed if not administer iv fluids administer nasal decongestants investigations perform spirometry to check lung function perform a chest x ray to check for lung abnormalities perform a delayed type hypersensitivity test to confirm allergy note physical examination should be done to check for wheezes if asthma is suspected laboratory investigations perform a complete blood count to check for white cell count perform a genexpert test to rule out tuberculosis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : community health centers\n - Years of Experience: 24.0\n - Nursing Specialty: neonatal care\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 24 years of experience in general nursing working in a community health centers in uasin gishu county in kenya a 3 day old neonate is brought into the new born unit with yellowing skin and sclera on assessment the baby appears lethargic and pale the vital signs are temperature 38 5 c respirations 18 cycles and pulse 80bets per minute questions what could be the cause of the yellow skin and sclera what is the immediate management of the neonate which tests could be important in the diagnostic process what complications risks is the neonate likely to experience what is the role of the mother in the management of this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 3 day old neonate with neonatal jaundice low resp rate of 18 and bradycardia and hyperthermia dx neonatal jaundice ddx sepsis hemolytic disease of the newborn uti cholestasis malaria causes of jaundice in a newborn breast milk jaundice hemolytic disease of newborn neonatal sepsis congenital jaundice investigations cbc lfts uecs bilirubin levels direct and indirect management iv fluids give antibiotics and antipyretics admit in the nbu or refer to the nearest higher facility talk to the mother for psychological support" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 27 year old female complains of back pain abdominal pain and headaches for 3 7 vitals t 36 8oc p 100b min rr \u2013 19b min spo2 \u2013 99 questions what is the management for this patient which investigations should be done for this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 27 year old female with complaints of back pain abdominal pain headache for 3 days vitals normal management of the patient admit administer analgesics for pain and headache administer intravenous fluids encourage rest and posture to reduce pain alert physician imo on duty for review ensure intravenous access for drawing of samples and fluids investigations complete blood count urea creatinine and electrolytes liver function tests blood gas analysis urinalysis pregnancy diagnostic test blood slide for malaria radiological tests abdominal ultrasound spine mri ct endoscopy" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 20.0\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 21year old college girl complains of vaginal bleeding abdominal cramps and aches and blood clots for a day she is primigravida lmp 3 months ago medications zulu mr assessment t 36degrees celsius p 93b m rr 20b m bp100 60 spo2 94 question what is the priority management of the lady what are the investigations that should be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 21 years with vaginal bleeding abdominal cramps and passing clots primigravida at 12 weeks blood pressure of 100 60 this is early pregnancy bleeding which has many causes it is concerning ectopic pregnancy management iv line and initiate iv fluids administer empiric iv analgesics perform sterile speculum and examine administer iv analgesia prefer pelvic ultrasound and inform doctor to proceed with management as per findings investigations laboratory full hemogram pregnancy test radiology obstetric ultrasound diagnosis incomplete abortion" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : community health centers\n - Years of Experience: 24.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 24 years of experience in general nursing working in a community health centers in uasin gishu county in kenya a 64 year old female comes to the health facility with complaints of hotness of the body blurred vision and confusion she has a history of recurrent urinary tract infection that was last diagnosed 48 hours ago she has an indwelling catheter with little volume of urine in a urine bag vital signs blood pressure 79 50 mmhg temperature 390 c pulse 100 beats per minute spo2 91 on room air questions what could be the immediate intervention what is the diagnosis what investigations should be requested what is the best management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 64 year old female with a history of recurrent urinary tract infection last diagnosed 48 hours ago she has indwelling catheters with little volume present with hotness of body blurry vision and confusion patient is hypotensive febrile tachycardic with spo2 of 91 diagnosis septic shock investigations urea electrolytes and creatinine full hemogram blood and urine culture malaria blood slide random blood sugar radiological abdominal pelvic ultrasound management initial assessment stabilization of patient initiate oxygen therapy assess circulation and establish intravenous access preferably 2 large bore cannulas initiate intravenous fluids crystalloids to maintain intravascular volume perform random blood sugar and give intravenous 50 dextrose if less than 3 mmol l empiric antibiotics broad spectrum intravenous antipyretics evaluate the catheters and change monitor urine output and chart plan for urgent referral to a hospital with high dependence unit monitor vitals of the patient continually other complications that can arise include acute kidney injury cerebral oedema" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kakamega county in kenya a 8year old presents to the facility with complains of running nose fever and headaches he has history of travelling to malaria endemic region and walking through rains on malaria test the results are negative an impression of urti is made which antibiotic is best suitable for the child\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "8 year old presents with fever headaches and running nose with history of travelling to malaria endemic zone although the malaria test is negative dx upper respiratory tract infection q1 give empirical broad spectrum antibiotics to cover both gram ve and gram ve causative organisms give anti malaria medication empirically with suspicion of malaria infection differential diagnosis upper respiratory tract infection sepsis malaria enteric fever upper respiratory tract infection" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 15 years old male is brought to the emergency department with an amputated penis the patient is bleeding profusely from the penis stump the vital signs bp 70 40mmhg pulse 126 bpm rr 22 minute temp 36 c question how should the client and the family be handled\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 15 year old male brought in to the emergency department with amputated penis bleeding profusely from stump vitals bp 70 40 pr 22 min temp 36 0 how should they be handled in this case due to profuse loss of blood my main concern is hypovolemic shock start by stabilizing the patient as he is profusely bleeding control the bleeding first to stop bleeding apply a dressing around stamp with pressure place 2 large bore cannulas on either arms get a sample of blood for lab investigations transfuse iv crystalloids to prevent hypovolemic shock check for airway patency and if the patient is breathing check gcs if less than 8 intubate and call icu on blood sample collected perform full hemogram to see levels of hb hct and wbc for infection of stump perform blood grouping and cross matching if hb 7 transfuse 3 units of blood packed rbc do urea electrolyte and creatinine to check for electrolyte as well as for kidney injury as acute blood loss can lead to aki give tetanus toxoid and prophylactic antibiotics as you await lab results once airway breathing and circulation has been secured clean the wound extremeties the urethra dress wound monitor vitals as you await surgical team review" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a health centres in kakamega county in kenya patient came with severe cough which was productive with chest pain on examination she looks weak sputum for gene xpert what drug should i give before results\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a patient presenting with productive cough chest pain and genexpert results awaited the history around this patient is not complete we would have liked to know how long the cough has been there any weight loss and contact with anyone with chronic cough and occupation of the patient history of smoking diagnosis query tb ddx copd pneumonia lung cancer heart failure radiology tests will include a chest x ray and a ct scan drug treatment will depend on the vital signs if the patient is desaturating you give oxygen pain medications" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 22.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 22 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a middle aged female went to hospital with a cut wound on the calcaneal region after she was at toilet 2 hours ago on examination deep cut wound with torn achilles\u2019 tendon investigations x ray revealed cut tendon questions what\u2019s the best intervention for the patient what are the complications of unrepaired tendon\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary female presents with a cut wound on the calcaneal region deep cut on the achilles tendon imaging showed cut tendon diagnosis cut calcaneal tendon management stop any active bleeding on the leg by applying pressure administer intravenous fluids to prevent hypotension analgesics prophylactic antibiotics tetanus toxoid dress the wound in sterile dressing refer to trauma surgeon for further management complications of unrepaired tendons hemorrhage infection immobility ankle stiffness re rupture inability to regain strength scar tissue improper healing" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 8.0\n - Nursing Specialty: neonatal care\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 8 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 3 weeks old baby boy is brought to the emergency department by the mother with history of yellowness of the eyes and hotness of the body for the past 4 days the child is reported not to breastfeed for one week on assessment the conjunctiva is yellow vital signs indicate temperature of 38 0 c pulse 120 beats per minute spo2 96 and respiratory rate 32 per minute question what is the immediate management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 29 year old female presents with sudden sharp unilateral lower abdominal pain radiating to the back pain started after vigorous physical activity examination reveals localized tenderness in the right adnexa with no rebound tenderness investigations perform transvaginal ultrasound to confirm ovarian torsion order a cbc to assess for leukocytosis management plan initiate iv fluids and analgesics for pain control refer urgently for diagnostic laparoscopy perform detorsion or oophorectomy based on findings diagnosis ovarian torsion" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kakamega county in kenya an anc mother came in mch with a history of low abdominal pains itching of the vulva and headache on examination she was 30 weeks gestation and was i to do urinalysis on i sent her to the laboratory for urinalysis and there was pus cells b s was negative was i to give antibiotics or refer the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a female who is pregnant at 30 weeks gestation has a history of lower abdominal pain and vulva itching and a headache urinalysis done showed pus cells blood slide for malaria parasites was negative diagnosis vulvovaginal candidiasis ddx bacterial vaginosis vulvovaginal warts urinary tract infection give antibiotics because the woman is pregnant and has urinary tract infection depending on the physical evaluation of the patient and the vulval itching if they have a typical whitish discharge or a history of a whitish curd like discharge manage as vulvovaginal candidiasis a fungal infection warranting the use of clotrimazole pessaries diagnosis vulvovaginal candidiasis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 16.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 16 years of experience in cardiology working in a national referral hospitals in uasin gishu county in kenya a patient came walking from the clinic accompanied by his cousin with chief complain of cough abdominal distention and edema on lower limbs the patient is 38 year old who was well until last month where he started presenting with the above complains he went to private clinic at trans nzoia where he was given furosemide and other medications patient did not show improvement he decided to go to another private clinic with no much improvement patient is a farmer no history of smoking nor alcohol consumption patient is married living with his wife and three children two sons and one daughter both alive he is sick looking has distended abdomen with moderate distress and started on o2 vial nasal cannula blood pressure 120 90 mmhg pulse rate 85 b min respiration rate 21b min spo2 96 room air temperature 36 7c questions q1 what investigations should be done q2 what is the diagnosis and treatment\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a male patient presents to the clinic with cough abdominal distension and lower limb edema he is 33 years old and was last well 1 month ago treated for the above symptoms with furosemide and other medications with no improvement he has no history of smoking or alcohol use on examination he is sick looking with a distended abdomen has moderate respiratory distress on o2 via nasal prongs vitals are normal investigations laboratory urea electrolyte creatinine assess the renal function and electrolytes full hemogram rule out infections that precipitate decompensation in heart failure lfts assess heart function thyroid function test check t3 and t4 levels radiological chest x ray echocardiogram q2 what is the diagnosis heart failure management supportive elevate the limbs and prop up the bed at 450 paracentesis to reduce the respiratory distress from the ascites definitively diuretics while monitoring input and output sodium glucose transporters a beta blocker and angiotensin receptor blockers diagnosis heart failure" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kakamega county in kenya patient h 30 years old comes to antenatal clinic for her 7th visit on examination she is gravid 34 weeks 68 kgs blood pressure 130 70mmhg pulse 70 beats per minute on examination the abdomen looks bulged and enlarged pregnancy test to be repeated which is positive ultrasound done nothing in the uterus is it an hyatid mole how do i tell her that all this time she has not been pregnant should i discontinue her from the antenatal clinic what do i do\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 30 year old comes for the first anc visit on examination she is gravida 1 at 24 weeks weighing 68 kg normal vitals on examination distended abdomen pregnancy test repeat positive ultrasound done nothing in utero is it a hydatid mole yes differential diagnosis blighted ovum how do i tell her that all this time she has not been pregnant counsel the patient and take time to explain the possible causes of this allow the patient to ask questions and answer should i discontinue her from the anc yes what do i do refer to obstetrician for further management example evacuation" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: 30.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 30 years of experience in general nursing working in a health centres in kakamega county in kenya a male client in the outpatient department with history of severe abdominal pain pain that started for the last 14 hours the pain started while he was on duty lifting bags of cement he has not taken any premedications on examination the blood pressure is 90 60 pulse 100 temperature 36 8 the abdomen is soft on auscultation there is reduced bowel movement there is evidence of irreducible right inguinal hernia my question is is there any investigation that i am supposed to do for this client before referral is it right if i give a sedative because he is in much pain is it also alright if i give analgesics before referral or what else can be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 60 year old male patient presented to the opd with severe abdominal pain that worsened over 14 hours physical examination abdomen tender with reduced bowel sounds and is irreducible diagnosis incarcerated inguinal hernia q1 what investigations should be done before referral full blood count renal function test abdominal ultrasound abdominal x ray plain erect q2 role of sedatives no use of sedatives because it will mask the clinical findings and worsen the vital signs especially the respiratory rate q3 is it right to give analgesia yes the pain is severe so analgesia can be given q4 what else can be done refer the patient for urgent surgical intervention herniorrhaphy intravenous fluids empirical antibiotics" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 3.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 3 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 26 year old female patient comes with complaints of headache and visual disturbance for 2 days on assessment bp 121 67 mmhg pr 78 beats per minute spo2 98 questions what is the possible diagnosis what is the management for this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "26 year old female with headache and visual disturbance for 7 7 vitals bp 121 67 pr 78 spo2 98 dx migraine ddx tension headache eye condition such as refractive errors management of the patient refer to a higher facility for physician and ophthalmology review and other management give an analgesic if available" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 20.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 20 years of experience in primary care working in a national referral hospitals in uasin gishu county in kenya a 14 year old boy was seen with gapping of the operation site following a laparotomy done 5 days ago secondary to trauma avpu at a not in pain question 1 what is the management of the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 14 year old boy seen with gapping of an operation site following laparotomy 5 days ago secondary to trauma avpu is at a not in pain the diagnosis wound dehiscence management evaluate extent of wound separation check for signs of infection sterile wound coverage to prevent further contamination prepare for possible surgical intervention debridement broad spectrum antibiotics wound culture sensitivity testing monitor vital signs nutritional support hydration" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kakamega county in kenya rose 20 years old female client comes to the routine antenatal clinic on examination her blood pressure is 160 100 pulse 80 beats per minute all of a sudden she started convulsing before anything else now is she epileptic is she developing pt is she having severe malaria what is causing the convulsions suddenly\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 29 year old came for a routine antenatal clinic blood pressure 160 110 pulse 80 convulsions management admit shout for help abc approach \u2013 secure the airway go to a safe place ensure patient safety position patient in lateral position to prevent aspiration monitor blood pressure give antihypertensives intravenous labetalol control the convulsions with magnesium sulfate stat dose consider delivery of the child prepare for delivery give steroids if the gestation is less than 34 weeks e g dexamethasone monitor urine output by catheterization assess for organ damage liver function tests hellp syndrome full hemogram platelet count kidney function tests check for fetal well being e g fetal heart rate non stress test consult an obstetrician for further management and referral" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 17.0\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 17 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a mother comes with an ultrasound report done 1 week ago it shows intrauterine foetal growth retardation at 14 40 her gestational age is 30 weeks she was treated for anaemia at 8 weeks and is a known hypertensive patient who has been on medication for the last 2 years assessment vital signs bp 139 90mmhg pulse 80 min respiration 18 min temp 36 0 rbs 4 0mmol l fhr 122 min fundal height 16 40 questions what could be the cause of iugr what investigations and management will be appropriate for this client\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary mother who has an ultrasound report showing intrauterine growth restriction at 30 weeks gestation yet she is at 35 weeks gestation by dates she was managed for anemia at 8 weeks and follow up for hypertension her b p is 130 90 and fundal height is at 16 40 what are the causes for intrauterine growth restriction maternal factors chronic hypertension or preeclampsia anemia or malnutrition smoking alcohol or substance abuse placental factors placental abruption or previa fetal factors chromosomal abnormalities congenital infections e g torch multiple gestation what investigations should be done investigations labs full hemogram kidney function tests liver function tests blood sugars imaging obstetric ultrasound scan" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: 20.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing and primary care working in a health centres in kakamega county in kenya a nine year old male comes to the hope facility after having been involved in rta he has a deep cut wound on the head that is bleeding profusely he is in a semi conscious state vital signs are within normal range am i to put iv fluids am i to refer the client am i to stitch the cut wound\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary age 9 years old gender male presenting complaint head injury post road traffic accident vital signs within normal range management 1 \u2060 \u2060initial assessment and resuscitation airway maintain airway apply cervical collar breathing administer oxygen assess for chest injury circulation control bleeding establish intravenous access disability assess neurological status using glasgow coma scale or avpu exposure remove clothing to assess for other injuries 2 \u2060 \u2060secondary survey collect data about the nature of the accident and mechanism of injury perform a detailed physical examination 3 \u2060 \u2060investigations laboratory tests complete blood count urea creatinine and electrolytess glasgow coma scale coagulation profile head ct scan abdominal ultrasound 4 \u2060 \u2060immediate interventions intravenous fluids to maintain hydration and reduce brain edema analgesics for pain relief antibiotics to prevent infection 5 \u2060 \u2060treatment treatment will depend on the severity of the head injury and the findings of the investigations if no brain injury is identified the patient may be discharged with regular follow up if brain injury is suspected the patient may require admission to the icu for neurological monitoring" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 22.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 22 years of experience in general nursing working in a dispensaries and private clinics in uasin gishu county in kenya a 43 year old male came to the facility with complaints of chest pain reported the pain started 25 minutes ago while climbing stairs then it resolved after some minutes when he sat down on history taking reports sudden onset of shortness of breath no current medications no past medical history but he reports experiencing the same complaint 2 months ago which subsided on examination the patient looks alert and anxious vital signs temperature 37 0\u00b0c bp 128 90 mmhg pulse 80b min respiration 18b min questions what might be the cause of the chest pain what is the immediate treatment for this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 43 year old male presented with chest pain after exertion which resolved on rest this presentation is recurrent for 2 months on examination he is alert and hypertensive diagnosis stable angina immediate management control hypertension administer antihypertensives antiplatelet therapy with aspirin statins may should be administered lifestyle modification reduction of smoking and alcohol use balanced diet minimize salt in food investigations electrocardiogram echocardiography stress test coronary angiography based on risk stratification chest x ray cardiac enzymes \u2013 beta natriuretic peptide troponins hbaic lipid profile diagnosis stable angina hypertensive heart disease gastro esophageal reflux disease" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 60 years old male with complaints of wound on the foot involving toes and plantar region reports no pain and no sensation for 3 weeks on examination the toes are gangrenous wound is exudating a lot of pus and the wound has no sensation not known diabetic and has no hypertension vital signs t 38c p 100b min r 20b min bp 180 110mmhg rbs 16mmol l questions what is the immediate management what are investigations to be done how can the loss of sensation be assessed and managed to avoid further risk of injury\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 60 year old male with a complaint of wound on the foot involving toes and plantar region reports no pain and no reaction for 3 weeks on examination the toes and gangrenous wound exuding pus wound has no sensation not known diabetic vitals t 38\u00b0c p 100 bpm rr 20 bpm bp 180 110 mmhg rbs 16 mmol l from description most likely diabetic foot given absence of pain and sensation infected wound with pus and uncontrolled sugar immediate management 1 optimize blood sugar controls for better outcomes 2 antibiotics for infection with pus 3 administer antipyretics for fever 4 wound debridement for faster healing investigations include 1 cbc 2 rbs 3 hba1c 4 crp" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: bungoma\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 1.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 1 years of experience in general nursing working in a sub county hospitals and nursing homes in bungoma county in kenya a 54 year old woman presents at the facility with a cough general body weakness and loss of appetite for the past 1 week she appears weak and pale with oedema of the lower limbs blood pressure 93 52 mmhg pulse rate 102 beats per minute respiratory rate 24 breaths per minute spo2 90 and temperature 36 9oc questions what investigations should be done what is the management plan for the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 54 y o old woman presents with cough general body weakness and loss of appetite for one week on examination appears catabolic pale lower limb edema and is hypertensive tachycardic tachypneic hypoxemic spo\u2082 90 and afebrile differential diagnosis anemia high output cardiac failure secondary to anemia investigations complete blood count to check hb blood group and cross matching urea electrolyte creatinine to assess kidney function reticulocyte count imaging chest x ray pulmonary edema echo evaluate heart function management 1 supplement o\u2082 2 transfusion if anemic follow required guidelines 3 review with results and findings 4 ivf in moderation 5 consider iron supplementation" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 20.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing and primary care working in a health centres in uasin gishu county in kenya a 24 year old female came to clinic with a history of voice hoarseness running nose with heavy mucus headache and nose bleeding x1 she is also having productive cough for the last 3 days she has no chest pains she has been managing the problem with honey and lemon juice vis bp 121 79 mmhg p 88 min temp 37 1\u00b0c resp 22 min spo2 94 she has no underlying condition questions which investigations should be done how can she be managed\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 24 year old female with hoarseness of voice running nose with heavy mucus headache and nose bleeding for one day and a productive cough for three days with no chest pains she managed it locally using honey and lemon juice vitals rr 22 breaths per minute and others all normal no underlying conditions investigations to be done complete blood count a white cell count may point to possible causes of symptoms and help differentiate a viral from a bacterial cause there may also be no change on the cbc direct laryngoscopy will help visualize the vocal cords and the pharynx to confirm diagnosis management of the patient rest the vocal cords by avoiding talking a lot and singing take warm fluids medications to relieve symptoms like analgesics for headache paracetamol nsaids antihistamines to reduce mucus production like levocetrizine cough suppressant may reduce coughing and rest the vocal cords broad spectrum antibiotics can be given if indicated from cbc but if viral self resolution will occur with supportive management differential diagnosis acute laryngitis bacterial or viral acute pharyngitis bacterial or viral" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 20.0\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 34 years old lady comes with complains of itching and irritation at vaginal area for 12 days she has been having dyspareunia saying its on off for long time on assessment thick white cottage cheese like discharge noted redness and swelling around the vagina bp 120 96 p 110bpm t 38 0 random blood sugar 12mmol l question what could be causing the candidiasis what is the management for the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 34 year old old female with vaginal irritation for 12 days on and off dyspareunia on examination there is thick white cottage cheese like discharge redness and swelling around the vagina blood pressure 120 96 mmhg pulse 110 temperature 38\u00b0c rbs12mmol l cause of candidiasis hyperglycemia undiagnosed type 2 diabetes mellitus management of the patient detailed history previous polyuria polydipsia polyphagia weight loss then general head to toe physical examination get iv access give iv fluids normal saline give antipyretics start antifungal per vaginal investigations hbalc for confirmation of diabetes mellitus uecs lfts to check on organ damage cbc and c reactive protein to check on sepsis differential diagnosis bacterial vaginosis sexually transmitted infections" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 15.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 15 years of experience in primary care working in a sub county hospitals and nursing homes in uasin gishu county in kenya a client presents to the facility with complaints over intense pain from rashes that developed across the chest 2 days ago she feels severe pain that doesn t allow her to sleep she is an hiv positive client diagnosed a month ago but was not started on medication due to tb infection the client looked restless blood pressure 104 65 mmhg pulse 62 beats minute respiration 20 breaths minute body weight 56 kgs questions what is the diagnosis how can this be managed what prevented the client from beginning antiretroviral\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a patient reports intense pain from chest rashes for 2 days hiv positive diagnosis a month ago not started medication due to active tuberculosis looks wasted and vitals are normal diagnosis herpes zoster in hiv how can the disease be managed give analgesics for the pain caused by the rashes nutritional review and support psychological support and counselling consult infectious disease and physician antiviral medication start anti tuberculous medication and haart after 2 weeks investigations full hemogram inflammatory markers viral load cd 4 count serum cryptococcal antigen test if cd4 less than 200 what prevented the patient from beginning antiretroviral iris immune reconstitution inflammatory response that occurs when the immune system starts to recover by giving the antiretrovirals" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 10.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya an 18 year old lady was brought into the facility with a history of having fallen into fire while cooking the patient is a known epileptic on treatment they reside at kahoya assessment on examination the patient s skin had profound blisters leaking fluids she looked pale weak cyanotic at the lips and fingernails vital signs bp 90 70 respiration 16 spo2 85 questions 1 what is the urgent management of the patient 2 what investigations can be done to the patient 3 what other specialized care will the patient require\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary \u00b7 18 year old epileptic patient with deep burns and suspected inhalation injuries 1 urgent management \u00b7 stabilize the patient by securing the airway by introducing an airway device setting up an intravenous line for hydration administering oxygen via a non rebreather mask empirical antibiotics 2 investigations \u00b7 full blood count \u00b7 renal function tests e g urea and electrolytes \u00b7 liver function tests 3 specialized care \u00b7 refer to a burns unit for advanced management 4 treatment \u00b7 antibiotics as per culture sensitivity \u00b7 analgesics to manage pain \u00b7 anticonvulsants if seizures are present \u00b7 tetanus toxoid vaccination as prophylaxis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a neonate is born in the labor ward with an apgar score of 8 1 10 5 10 10 the neonate has both the male and the female genitalia question how should the family and the neonate be taken care of\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a neonate brought in apgar 8 10 10 neonate has both male and female genitalia how should family and the neonate be taken care of management of the patient refer to a urologist for expert management psychological counselling on parents in case of distress continue breastfeeding and other infant care because the child is otherwise stable" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 8.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 8 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya an elderly female patient is brought to the emergency department by her relatives with complains of chest pains and a history of angina on assessment the vital signs are blood pressure 110 70 mmhg spo2 98 pulse 102 beats per minute temperature 36 5 0 c questions what is the appropriate intervention what radiological investigation would the patient benefit from\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary an elderly female with complaints of chest pain and a history of angina vitals are normal momentum probable localization this presentation is concerning for 1 myocardial infarction interventions include 1 primary interventions a administer oxygen via non rebreather mask b analgesia morphine is the best option c administer thrombolytics like alteplase if the 3 hour bracket has not been exceeded d administer aspirin 325 mg e monitor vital signs closely radiological interventions include 1 echocardiogram rule structural heart disease 2 electrocardiogram rule out cardiac muscle problems 3 chest x ray rule out pneumonia 4 esophagogastroduodenoscopy ogd rule out peptic ulcer disease" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kakamega county in kenya a three year old child is brought at opd with history of convulsions for three times and fever there is no history of trauma and the child has been given panadol syrup at home on examination the baby is febrile with a temperature of 39 degrees celsius an mrdt is done and it is negative is this severe febrile illness which medication should i administer should i refer the child for admission and further investigations\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a three year old presents with hx of convulsions and fever no hx of trauma and has received panadol syrup at home on examination is febrile malaria test is negative diagnosis febrile convulsions which medication should i administer this is likely a bacterial infection management involves administration intravenous broad spectrum antibiotics such as ceftriaxone administer antipyretics to manage the fever administer anticonvulsants such as diazepam expose child to lower temperature should i refer to the child yes the child would need blood work up to identify the possible causative agent for this a blood culture and sensitivity would be required admissions would be required since intravenous medications together with close examination is warranted" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 20.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 63year old man comes to the clinic with complains of having pain on the tongue and difficulty in pronouncing words he says that he has experienced bleeding and difficulty swallowing for a year he has been on and off the district in his county treatment morphine on examination he looks malnourished t36 0 degrees celsius p 91b min bp 90 60mmhg hypotension questions what investigations can be done what is the priority care of the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 63 year old man comes presenting complaints of pain in the tongue and difficulty in pronouncing words reports of bleeding and difficulty in swallowing for 1 year treatment morphine examination malnourished vitals are normal investigations lab complete blood count urea electrolytes and creatinine random blood sugar radiology endoscopy priority care hydrate with fluids correct electrolyte imbalances follow up on the imaging" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 19.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 19 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 25 year old man complained of painless swollen scrotum for a week the patient was well until a week ago when he noticed the swelling he works in an academy as a driver has no history of trauma no known medical or surgical history history of hypertension in the family not married doesn\u2019t drink alcohol or smoke cigarettes patient is alert not pale bp 112 72mmhg pr78bpm rr 18 bpm spo2 97 temperature 36 80 c rbs 4 5mmol l on physical examination left scrotum swollen and hard on palpation no color change no urethral discharge no dysuria questions what could be the cause of the disorder what is the management of this patient which investigations will be required\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 25 year old man complains of painless swollen scrotum for a week no history of trauma on examination the left scrotum is swollen and hard on palpation investigations 1 full haemogram 2 c reactive protein 3 kidney function test imaging 1 scrotal ultrasound management 1 refer to a urologist for further management" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : community health centers\n - Years of Experience: 24.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 24 years of experience in general nursing working in a community health centers in uasin gishu county in kenya a 41 year old female client on dialysis with an arteriovenous fistula for hemodialysis insitu and being used she states that she woke up this morning and found herself in a pool of blood on assessment the fistula is ruptured and blood flushing out profusely vital signs taken were 80 54 mmhg pulse 137 beats per minute respiratory rate 28 breaths per minute temperature 36 1 0 c spo2 84 questions what is the priority care for this patient are there any investigations that are required for this patient if yes what are they what is the diagnosis and management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 41 year old female on dialysis arterio venous fistula reports finding herself in a pool of blood this morning on assessment arterio venous fistula ruptured blood gushing out vitals bp 80 54 mmhg pulse 137 bpm rr 28 bpm temp 36\u00b0c spo2 84 assessment ruptured arteriovenous fistula consider coagulopathy trauma as differential diagnosis priority care control bleeding apply pressure or tourniquet administer tranexamic acid to control bleeding ensure the patient is hemodynamically stable iv fluids give analgesics to control pain investigations complete blood count hematocrit vbg blood grouping and cross matching coagulation profile dx ruptured arteriovenous fistula definitive management surgical consult vascular surgeon for fistula repair ligation" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 24.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: critical care\n\n Prompt from the nurse : i am a nurse with 24 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 34 year old is brought to the clinic accompanied by his girlfriend with complaints of having fainted after eating supper there is no history of such an incident before vital signs temp 36 00 c rr \u2013 24 hr 100 spo2 \u2013 98 questions what is the cause of him fainting what could be the diagnosis which investigation could be carried out\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 34 year old brought by girlfriend with complaints of having fainted after taking supper tachypneic dx hyperglycemic hyperosmolar state cardiac arrhythmia causes of fainting syncope cardiac arrhythmia orthostatic hypotension investigations lab tests blood glucose level random blood sugar blood pressure monitoring imaging electrocardiography and echocardiography" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 26.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: critical care\n\n Prompt from the nurse : i am a nurse with 26 years of experience in general nursing working in a sub county hospitals and nursing homes in kakamega county in kenya a three year old baby came to outpatient department accompanied by the mother with history of having ingested poison on examination the child was unconscious but not smelling poison and not responding to stimuli observations that were taken temperature was 36 2 degrees centigrade pulse was 134 respiration was 30 might this be poison or is it another condition which test should i do should i give this child iv fluids to resuscitate her should i do gastric lavage or should i just refer this patient to a pediatrician for further management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "3 years old baby with history of long prison ingestion child is unconscious and unresponsive vitals 36 2 pulse rate 143 respiratory rate 30 diagnosis dx ingestion of unknown poison ddx organophosphate poisoning immediate management \u2013remove any clothing follow the abcde approach obtain oxygen saturations of 95 start oxygen get intravenous access and get samples for the labs start intravenous fluids perform any random blood sugar collect any evidence of the poison ensure that the child is stable before referral position the child laterally to prevent aspiration gastric lavage is recommended when the ingestion of poison occurrences within 2 hours and if the chemical on the poison ingested is known in the referral facility the following investigations will be done toxicology screen to identify the toxin through blood and urine tests urea electrolyte creatinine" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 38.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 38 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 10 month old baby is brought to the level 3 facility emergency room after having a seizure at home the mother states the child was about to eat a meal on assessment the temperature was elevated at 39 2 degrees celsius the respirations 38 breathes min pulse rate 138 bpm and saturations of oxygen at 92 questions what could be wrong with the child what should the nurse anticipate as the immediate care plan for the baby\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 10 month old baby brought to a level 3 facility after having a seizure at home while about to have a meal o e hyperthermia 39 9\u00b0c respiratory rate 35 tachypnoea pulse rate 160 blood pressure 138 84 and po\u2082 normal q1 what could be wrong with the child febrile convulsions acute bacterial meningitis q2 what should the nurse anticipate as the immediate care plan for the baby admit seizure protection glucose control fix iv line and give iv fluids anticonvulsants anti pyretic analgesia turbid sponging take samples for full hemogram crp and bs for malaria parasite slide give high dose antibiotics for severe illness diagnosis febrille convulsions" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 1.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 1 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 65 year old male is brought to the facility with complains of worsening shortness of breath fatigue and lower extremity edema for the past 3 days he has history of chronic heart failure with non compliance to medications and dietary restrictions on assessment bp 160 90mmhg hr 112b min resp 25b min spo2 82 lung auscultation crackles heard questions what is the immediate management what is the pathophysiology of chronic heart failure what is the health education for the patient on drug compliance\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 65 year old male with history of chronic heart failure with non compliance presents with dyspnea fatigue and lower limb edema he is hypertensive tachycardic tachypneic saturating at 92 with crackles on auscultation diagnosis acute exacerbation of heart failure management prop up patient monitor input output start the patient on diuretics to manage fluid overload start guideline directed medical therapy for management of heart failure with a reduced ejection fraction manage hypertension with antihypertensives advise the patient on compliance" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 20.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 20 years of experience in primary care working in a national referral hospitals in uasin gishu county in kenya a 41 year old male presents to the emergency department with epigastric pain and vomiting the pain began suddenly 2hrs ago followed by bilious vomiting the patient is a smoker and a chronic alcoholic upon assessment the patient was sweating and comfortable while lying still vital signs bp 170 90mmhg p 116 t 37 5 the upper abdomen is tender and rigid on palpation question how should this patient be managed\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 41 year old male presents to a national referral hospital with epigastric pain and vomiting which started 2 hours prior vomitus bilious patient is a known smoker o e patient is diaphoretic vitals bp 170 90 pr 116 t 37 5\u00b0c exam upper abdomen is tender and rigid on palpation management follow abcde approach 1 ensure airway is patent suction any secretions 2 obtain spo2 if less than 85 supplement oxygen appropriately 3 get iv access and start on iv fluids 4 administer analgesia 5 administer antiemetics 6 start patient on proton pump inhibitors investigations complete blood count serum amylase liver function tests urea electrolytes and creatinines abdominal x ray consult general surgery once the lab results from investigations have been obtained impression acute pancreatitis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 30.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 30 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 64 year old man came to the facility with a history of cough for 1 month headache and fever for 2 days cough is dry with associated night sweats coughs mostly at night wheezing but no history of difficulty in breathing headache is generalized and throbbing in nature with no relieving or aggravating factors has fevers on and off with no chills no history of contact with a person with tuberculosis patient is a known diabetic on meds has a history of loss of weight despite feeding well he has easy fatigability sick looking and febrile vitals blood pressure \u2013 130 90 mmhg respiration rate 22b min temperature 36 7 degrees celsius spo2 95 pulse rate 70b min on examination respiration rhonchi marked on the left lower lobe harsh breath sounds fine crepitation cardiovascular system regular s1 and s2 heard no added sounds apex beat at 5th intercostal space other systems are normal questions what are the possible diagnoses what investigations need to be done which medications should be used to treat the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "case summary 64 year old male with non productive cough associated with right sweat for 1 12 headache and fever for 7 7 cough predominant at night has wheezing known dm on medication easy fatigability and weight loss despite feeding well o e sick looking febrile rhonchi on left lower lobe fine crepitation no cardiac murmurs vitals bp 130 90 pulse 70 rr 22 temp 36 7 spo2 95 dx heart failure diabetic cardiomyopathy known t2 dm investigations to be done labs fbc u e lfts esr crp hba1c abg imaging cxr chest ct scan ecg echo medications to treat patient give routine dm medication antitussive antipyretic schedule nebulization with salbutamol empirical antibiotics for community acquired pneumonia maintenance intravenous fluids dx heart failure diabetic cardiomyopathy known t2 dm" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 1.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 1 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 15 year old boy was brought to the facility with complains of coughing and shortness of breath he is a known asthmatic patient who\u2019s currently on meds temp 36 4 degrees celsius questions what are the differential diagnoses what will i teach the patient on management of asthma what other investigations can be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 15 year old boy was brought to the facility with complaint of coughing and shortness of breath he is a known asthmatic patient who is currently on medication t36 4\u00b0c a x0001 what are the differential diagnosis acute asthma exacerbation pneumonia pulmonary tuberculosis b x0001 what will i teach the patient on management of asthma educate the patient to be compliant on medication given by a doctor educate the patient on the techniques of using an inhaler do that the drugs can well demerged and utilized educate the patient to avoid potential triggers of his condition e g pets pollen c x0001 what investigation can be done for this patient the following investigations can be done laboratory investigations full hemogram to check for signs of infections renal function tests to check for fluid and electrolyte balance acute phase inflammatory markers i e crp sputum for microscopy culture sensitivity and gene x part radiology test chest x ray" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 20.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya mother brought a 4 year old boy with tearing eyes which lasted for a month the baby has been treated in an eye clinic several times with no improvement vital signs temperature 36 8 spo2 98 pulse 60 bpm investigation done complete blood count with no abnormality question what could be the cause of tearing eyes why is the child not responding to treatment what other investigation tests to be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 4 year old brought in with complaints of tearing a lot vitals within normal range has been repeatedly treated before without improvement complete blood count normal what could be causing the tearing of eyes differentials include allergies keratitis conjunctivitis ectropion styes exposure to irritants like smoke why is the child not responding to treatment inappropriate diagnosis non compliance to treatment incorrect dosages of the drug what other investigations need to be done proper ocular exam on a slit lamp may be helpful for diagnosis consult an ophthalmologist for proper workup and management" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 1.0\n - Nursing Specialty: mental health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 1 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya 24 years old boy was admitted in the ward with complains of talking a lot he says he is a prophet of god he is sleeping a lot and gets irritated easily on assessment he is restless i cannot obtain the vitals since he was violent questions which therapy will work best for him what are the antipsychotics to be administered whom do i call for assistance\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 24 year old boy talking a lot irritable restless sleeps a lot violent which therapy will work best for him management of the patient this is a concern for bipolar disorder with differential of schizophrenia therapy psychoeducation psychotherapy therapeutic alliance biopsychosocial approach b what are the antipsychotics to be administered second generation antipsychotics c whom do i call for assistance a psychiatrist" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 15.0\n - Nursing Specialty: mental health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 15 years of experience in mental health and psychiatric nursing working in a national referral hospitals in uasin gishu county in kenya a 48 years old male patient is brought to the emergency department by neighbors with complaints of self isolation loading rubbish neglect of personal hygiene and not feeding this is a known patient with schizophrenia who lost follow up stays alone physically weak emaciated and looks malnourished poorly kept with foul body odor a septic wound on the right lower limb at the ankle region draining pus vitals signs bp 108 70 p 82 rr 21 and t 36 0 questions what is the immediate management of this patient which investigation can be conducted for this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "48 year old male known schizophrenic patient who was lost to follow up brought in with a septic wound on the right lower limb immediate management of concern is the septic wound swab the wound for microscopy culture and sensitivity draw blood for full hemogram creative protein blood culture administer appropriate antibiotics for the wound imaging x ray the patient s hygiene and nutrition should be considered a social worker should be involved for the follow up of the patient next of kin to be involved in the management patient to be discharged on olanzapine" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 12.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a dispensaries and private clinics in uasin gishu county in kenya a mother walks into the child welfare clinic with a male baby six weeks old for immunization she also reports that the baby is not feeling well on history she reports the baby to have had fever for two days poor feeding and a cough on assessment the mother seems to be hiding something hiv test done and turned positive mother denied having been tested vital signs temp 37 9\u00b0c spo 91 pr 142 bpm questions 1 x0001 what could be the immediate management for both the mother and baby 2 x0001 how can this patient client be better assessed 3 x0001 how best can this mother be counseled and given adequate health information\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a mother comes to the child welfare with her 6 week old male baby for immunization she reports baby is not feeding and has had a fever for two days baby is hyperthermic and tachycardic mother is hiv positive issues of concern is that the child might also be hiv positive immediate management of the baby emergency stabilization hyperthermia antipyretics tachycardia evaluate for signs of sepsis dehydration or hypoxia empiric antibiotic therapy can be initiated after samples for culture and full hemogram resuscitation assess the airway and circulation for any life threatening conditions provide oxygen therapy and maintain saturation between 92 96 establish intravenous or intraosseous for fluid resuscitation and administer isotonic fluids investigations labs full hemogram blood culture c reactive protein cerebrospinal analysis to rule out meningitis imaging chest x ray hiv testing polymerase chain reaction test to determine hiv status if positive the mother should be counselled and child initiated on zidovudine and nevirapine immediate management of the mother hiv care review haart regimen and ensure adherence viral load and cd 4 count counselling and education on the management of hiv monitoring and followup admit the baby for close monitoring until stable frequently follow up on both the mother and the baby kindly refer to the answer given prior it elaborates on how best patients can be assessed counselling should be done in a safe environment the mother should not be exposed to any social stigma from the healthcare workers she should be given information in sections and information should be reinforced prior to giving new information" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: nan\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse working in a health centres in kakamega county in kenya a mother came in the facility with a complaint of swollen mass on the breast it was tender and yellowish the problem has lasted for three months she is feeling hotness of the body on investigation what investigation can we do to the client can we perform breast exam can i refer the patient to gynecologist for review\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a mother presents with a 3 month hx of swollen mass on the breast which on examination is tender and yellowish and has a fever diagnosis chronic mastitis the investigations that can be done include full hemogram to check the white blood count c reactive protein can we perform a breast exam yes clinical examination of the breast is important to evaluate the extent of the disease and to rule out possible signs of malignancies can i refer the patient yes the patient should be referred to a general surgeon for possible incision and drainage of the breast mass or abscess" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: neonatal care\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kakamega county in kenya a 1 7old neonate in postnatal ward is drooling coupious saliva the neonate was delivered one day ago through c s due to prolonged 2nd stage stage of labor the apgar score was 9 in 1 min 10 in 5 min and 10 in 10 min 0 spo2 98 p 120bm rr 48bm temp 36 5 what is the the cause and management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 1 day old neonate in the postnatal ward is drooling copious saliva delivered via cesarean section due to prolonged second stage of labor normal vital signs management position the patient well to avoid aspiration suctioning of the saliva and other secretions put the patient nil per oral administer iv fluids to maintain hydration the patient is concerning for esophageal atresia cause of copious saliva esophageal atresia tracheoesophageal fistula" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in uasin gishu county in kenya a lady of 32 years comes to the postnatal clinic 2 weeks after normal delivery with complaints of pelvic pain fever foul smelling vagina discharge and delayed reduction of uterine size on assessment temperature 360c pulse 90 beats minute respiration 26 breaths minute blood pressure 130 85mmhg and spo2 98 questions what is the diagnosis what is the immediate management of this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 32 year old 2 weeks postpartum with pelvic pain fever foul smelling vaginal discharge and delayed reduction of uterine size tachypnea q diagnosis postpartum sepsis q management admission iv line iv antibiotics fluids investigations lab full haemogram uec gxm crp imaging pelvic scan to rule out retained placenta or endometritis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 17.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 17 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 12 year old girl is brought to the emergency unit with sudden onset of difficulty in breathing patient is a known asthmatic patient on inhaler and follow up on assessment there is audible wheezing shallow breathing retractions and use of accessory muscles hr 130b m resp 50b m bp 110 50 mmhg temp 36 spo2 88 on room air patient is given prednisolone nebulized and started on oxygen therapy via nasal prongs questions what are the predisposing factors for asthma is the treatment effective which medications are required\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 12 year old female patient presents with difficulty in breathing known asthmatic on inhaler on assessment wheezing was noted shallow breathing and use of accessory muscles patient is tachycardic tachypneic and desaturating on room air patient has been treated with prednisolone nebulized and started on oxygen therapy diagnosis acute asthmatic attack the predisposing factors genetic factors family history allergens air pollution exposure to smoke while cooking in a poorly ventilated area or cigarette smoke chronic respiratory infections the treatment ensure underlying causes of the exacerbation are treated such as co infection dosages are adjusted based on symptomatology medications required are short acting beta agonists add inhaled corticosteroids and anticholinergics give oxygen therapy where necessary antibiotics in bacterial co infections" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 12.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya 6 old presented to the emergency department with c o diarrhoea vomitin2 7 now unresponsive rbs low a referral from a health centre had been given ivf paracetamol and amoxil syrup the symptoms started when they started introducing new feeds to the child temperature38oc p 180b min spo2 \u2013 72 ra rr 58b min dry mucous membrane skin turgor 2 sec recommendation iv access o2 administration antipyretics questions what led to the diarrhoea and vomiting what can be done in fur to prevent diarrhoea and vomiting\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a six months old presented with a history of diarrhea and vomiting for two days now is unresponsive and rbs is low a referral from a health center where he had been given iv paracetamol and amoxicillin syrup the symptoms started when new feeds were being introduced to the child vitals temperature 38\u00b0c pulse rate 180 oxygen saturation 72 respiratory rate 58 dry mucous membrane skin turgor 2 seconds what could have led to the diarrhea and vomiting the probable cause of diarrhea and vomiting in this patient is gastroenteritis what can be done to prevent vomiting and diarrhea since the symptoms started after introducing new feeds the symptoms would have been prevented by o food being stored properly away from contamination" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 12.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a dispensaries and private clinics in uasin gishu county in kenya a 74 year old female walks in the hospital with complains of headache blurred vision and general bosy weakness for 2 days she is a known hypertensive patient she reports not to have taken her antihypertensive medication for one week she does not attend her routine clinic but buys her medication over counter on examination patient is sick looking and in pain vital signs bp 188 112mmhg pr 94b m temperature 37 recommendation patient to be counselled on drug adherence questions what is the diagnosis of this patient what further management could be done for this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 70 yr f known htn with blurred vision and general body weakness x3 7 hasn\u2019t taken anti htn x2 7 o e bp 188 112 rmity pr 94 btsimin q2 further management 1 set up an iv line 2 collect blood samples a u e c b haemogram c urinalysis d lipid profile e rbs 3 add diuretic 4 analgesic 5 give ace inhibitors for high bp 6 monitor bp then refer for echo and discharge home with normal medications 7 refer for cardiologist review q1 diagnosis \u2192 hypertensive urgency" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 14.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 14 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 78 year old female who came to the emergency department due to a fall has compression fractures on assessment she has a back pain level of 7 10 temp 37 2\u00b0c pulse 101 bpm bp 123 97 oxygen saturation 99 question what management will be effective for the above situation\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 78 yr female fall fractures back pain t372 pulse 101 bp 123 97 spo2 99 1 what management will be effective for the above situation manage any life threatening conditions check for airway breathing and circulation monitor vitals for sign of shock oxygen saturation respiratory rate catheterize to monitor input and output perform a full neurological exams laboratory tests full hemogram renal function tests coagulation profile triple studies blood groups and cross matching radiological tests x ray of the spinal column chest x ray fast scan mri spinal column based on the above investigation results consult a spine surgeon for decompression surgery and further management" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a national referral hospitals in uasin gishu county in kenya a 40 year old female presented with symptoms of addison s disease including depression fatigue weight loss salt craving and skin hyperpigmentation v signs t 36 bp 110 60 mmhg p 70 b m questions which investigation can be done what management will be offered to the client what health teachings are needed for the client\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 40 yr old female with addison s disease symptoms depression fatigue weight loss and skin hyperpigmentation vital signs are normal diagnosis addison s disease dd cushing s disease hypothyroidism malnutrition investigations to be done take samples for cortisol levels thyroid function tests random blood sugars renal function tests ana screen hiv test what management for the patient give a corticosteroid im hydrocortisone or prednisolone if there s hypothyroidism manage with hormonal replacement therapy e g levothyroxine correct hypoglycemia if low sugars increase vitamin c uptake and other vitamins diagnosis addison s disease" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 15.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 15 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 3 year old girl is brought by the mother with complaints of fever and abdominal pain mother reports the girl had been treated 4 days ago for urinary tract infection uti but noted that the girl was getting worse on assessment lethargic pale temp 37 80c p148 b m r 30bpm spo2 95 on ra questions what is the immediate care of the patient what investigations can be done to the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "3 year old girl treated for uti 4 7 days ago now has fever and abdominal pain getting worse o e pale lethargic vitals temp 37\u00b0c pulse 148 rr 30 spo2 95 dx uti ddx acute gastritis malaria immediate care call for urgent pediatrician review start admission process get iv access and give fluids and analgesic antipyretic draw samples for fbc u e lft crp bf for malaria urinalysis and urine for mcs blood culture investigations to be done abdominal ultrasound cxr dx uti" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 31.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 31 years of experience in general nursing working in a sub county hospitals and nursing homes in kakamega county in kenya a 2 year old is brought to the opd with worsening earache and discharge for the last 5 days this is the second incidence immunization is up to date mucopurulent ear discharge wounds on the pinna redness behind the ear swelling at the back of the ear temperature 39 2 degrees celsius could this be mastoiditis or otitis media what could be the best treatment what are the possible complications\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 2 year old presents with ear ache and discharge for the last five days discharge is mucopurulent this is the second episode he has wounds on the pinna redness and swelling behind the ear vitals temperature 39 2 celsius impression otitis media differentials superimposed mastoiditis best treatment ensure the child\u2019s other vitals are within normal range get and iv io access and administer an antipyretic as well as iv fluid bolus normal saline or ringer\u2019s lactate start broad spectrum antibiotics awaiting swab culture and sensitivity urgent referral to a facility with an ent specialist for further assessment and management possible complications bacterial meningitis hearing loss deafness" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: 30.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 30 years of experience in general nursing working in a health centres in kakamega county in kenya i have received a girl who is eight years old and the mother gives a history of her not being able to pass stool for the last one week she has no abdominal pain the abdomen is soft the vital signs are normal how do i manage this client do i give a soap enema or do i prescribe laxatives or do i refer\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 9 year old girl at kakamega health center was brought in by her mother who reports the child has not passed stool for the past one week the child has no abdominal pain but presents with a soft abdomen vitals are normal 1 how do i manage this patient administer oral or rectal laxatives to soften the stool give an enema to force the stool out if needed adjust the child s diet to include more fiber rich foods vegetables fruits and increase fluid intake refer to a pediatrician if there is no improvement conduct a digital rectal examination dre to check for stool impaction dx constipation" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 57 year old female came with complaints of a wound on the left leg where it had been amputated 1 month ago due to diabetic foot on examination has a stamp on the leg whereby below knee amputation was done and now the wound has opened up and is septic vitals temp 37 8oc p 100b min rr 20b min spo2 94 on room air questions what is the immediate management what are the discharge instructions for this client\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 57 yr female with complaints of a wound on left leg that had been amputated 1 month ago as a complication of diabetes on examination temp 37 8 c a what s the immediate management check random blood sugar and control sugar levels thoroughly examine wound size depth discharging sinuses necrotic tissue erythema edema take swab for culture wound debridement and removal of nonviable tissue to promote healing and give analgesics thorough wound irrigation with normal saline can administer local anaesthetic during this process give topical antiseptic like iodine properly dressed wounds give broad spectrum antibiotics with coverage of gram positive negative anaerobes and fungi give analgesics and antipyretics call a physician for further review b discharge instructions i proper medication good adherence ii proper clinic follow up to monitor disease progression iii regular check up to assess macro microvascular compromise retinopathy nephropathy neuropathy cardiomyopathy iv do not walk barefoot v use a mirror to visualize limbs and treat wounds" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: elgeiyo marakwet\n - Health level\t : county hospitals\n - Years of Experience: 1.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 1 years of experience in general nursing working in a county hospitals in elgeiyo marakwet county in kenya a 44 year old male patient presented with complaints of joint pains radiating to the ears vomiting blood hoarseness and difficulties in swallowing he is a known alcoholic and cigarette smoker on assessment he had foul breath labored breathing and enlarged cervical nodes v s bp 107 72mmhg pr 117b m spo2 85 pr 39b m t 36 00c questions what is the immediate management of the patient what could be causing the enlarged cervical nodes which investigation should be ordered for the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 44 year old male complains of joint pain radiating to the ear bloody vomitus hoarseness and difficulty swallowing he is a known alcoholic and smoker on examination he has a foul breath labored breathing and enlarged cervical nodes he is tachycardic 117 bpm and has a low spo2 85 immediate management includes administration of analgesics start on antibiotics empirically give ondansetron to manage the vomiting give oxygen via nrm to manage the hypoxia note the enlarged cervical nodes could be caused by an infection investigations include a complete blood count to look for signs of infection crp to check the inflammatory levels imaging" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a national referral hospitals in uasin gishu county in kenya sb aged 38 year old female patient came to the hospital with complaints of chronic chest pain radiating to the back sore throat and general body malaise on assessment she has reduced air entry bilaterally vitals bp 100 60 mmhg t 36 9 p 110 b min spo2 89 on room air rr 24 br min questions what acute care should the patient receive what are the investigations to be done what is the diagnosis\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 38 year old female presents with chronic chest pain radiating to the back sore throat and general body malaise on assessment she has reduced air entry bilaterally vitals he is hypotensive tachycardic desaturating and tachypnea acute care for the patient involves i oxygen supplementation to improve saturation ii analgesia to manage chronic chest pain iii antibiotics to treat the sore throat and the probable lung infection investigations include i full hemogram to check for white blood cells level ii chest x ray to check for evidence of consolidation iii c reactive protein levels to assess degree of inflammation what is the diagnosis this is most likely a case of community acquired pneumonia as evidenced by chronic chest pain radiating to the back and reduced air entry on examination" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 26.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 26 years of experience in general nursing working in a sub county hospitals and nursing homes in kakamega county in kenya a young lady walks into the facility accompanied by the mother with complaints of restlesness and low abdominal pain it started six hours ago on examination the os closed rather the fundal light is at 28 weeks gestation and the os is closed and the presentation is cephalic the companion asserts that she behaves like that even with minor conditions or issues such as common flu the nurse decides to refer them to another facility for ultrasound and urinalysis by use of public means a few minutes later the relative to the client who is one of the county bosses in the county calls notably furious because ambulance services was not considered during the referral despite it being free so the main question is what is the protocol for engaging ambulance services for a pregnant woman\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a young lady at 28 weeks gestation presents with abdominal pain and restlessness on examination the cervix is closed the companion reports hysteria the nurse refers the patient diagnosis urinary tract infection procedure for making a referral entails write a referral note for the patient stating the working diagnosis tests that have been done so far and any interventions done indicate the reason for referral contact the hospital to which the patient is being referred to and inform them that you have made the referral if available and if the patient is in a critical condition that requires close monitoring take the patient in a well equipped ambulance with qualified medical personnel" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: nan\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse working in a health centres in kakamega county in kenya a child is brought to mch with a bulging anterior fontanelle the child is two years old and has a fever and a shrill cry could this be meningitis what are the differential diagnoses\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 2 year old child brought to the mother child clinic with a bulging anterior fontanelle she also has a fever and a shrill cry concern for meningitis with increased intracranial pressure sepsis encephalitis would manage as follows fix a cannula and administer iv fluids antipyretics for fever analgesics for pain antibiotics for suspected infection nb all doses according to pediatric protocol after stabilizing the patient refer to a higher facility with head ct scan and for further management investigations full hemogram erythrocyte sedimentation rate urea electrolytes and creatinine liver function tests blood slide for malarial parasites lumbar puncture for cerebrospinal fluid analysis radiology head ct scan" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 15.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 15 years of experience in primary care working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 15 year old boy was brought to the health facility with convulsions the boy had a fight with another boy and sustained injury to the head through hitting and falling down on assessment blood pressure 90 50mmhg temperature 36 10c spo2 86 gcs 7 15 oxygen was given but feared to give intravenous fluids and painkillers ambulance was contacted but was far away questions how could the patient be managed in the emergency unit as referral is awaited\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 15 year old boy was brought to the health facility with a history of convulsions there was a history of fighting with another boy where he was hit and sustained injury to the head on examination he had a low blood pressure of 90 50 and low spo2 of 86 but had a normal temperature of 36 1 celsius diagnosis head trauma differentials intracranial bleeding subdural bleeding epidural bleeding intracerebral bleeding cerebral edema meningitis for this patient start with addressing the most life threatening conditions secure the airway jaw thrust chin lift make sure to rule out basal skull fracture before placing oropharyngeal airway and place a cervical collar for breathing supplemental oxygen with non rebreather mask check the chest if it is moving with respiration auscultate the chest for bilateral air entry circulation place two large bore cannulas and start giving hypotonic saline collect blood for investigations urea electrolytes and creatinine complete blood count toxicology tests place catheter and monitor input and output disability check glasgow coma scale score and observe for changes in the glasgow coma scale score do a random blood sugar test exposure expose the patient adequately and examine other areas for injury head trauma" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 19.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: critical care\n\n Prompt from the nurse : i am a nurse with 19 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 14 year old girl brought in by the teachers had collapsed in class after lunch the girl has been well with no known medical or surgical history she is a day schooler who lives with her parents she is a quiet girl who doesn\u2019t mingle much with other girls she hasn\u2019t had any disciplinary issues in school on assessment the girl is unresponsive to verbal stimulation not in respiratory distress not pale and not dehydrated pr 84 bpm rr 16 bpm spo2 95 on room air temperature 36 80 c rbs 4 7mmol l physical examination findings normal questions what is the management of this patient which investigations are needed\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 14 year old girl presents with loss of consciousness previously well normal vitals random blood sugar 4 7mmol differential diagnosis vasovagal syncope cardiovascular disease arrhythmias neurological disorders ensure airway breathing and circulation are intact put patient in recovery position monitor vitals monitor progression of symptoms laboratory investigations complete blood count kidney toxicology screen rapid pregnancy test b hcg" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: surgical care\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 48 year old female is admitted 48 hours after thyroidectomy she complains of numbness and tingling of the toes and fingers she has an upper arm and facial muscles twitching vitals temperature 36 2 pulse \u2013 78b min blood pressure \u2013 112 62 mmhg respiration rate \u2013 20b min spo2 96 room air questions what has caused the upper and facial twitching what is the management of this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 48 year old female 48 hrs post thyroidectomy has numbness and tingling of toes and fingers has upper arm and facial muscle twitching vitals are normal concern for hypoglycemia i would therefore manage the patient as follows calcium supplementation monitor vitals thyroid hormone replacement lowering thyroid hormones according to thyroid function tests tfts investigations to be done extended urea electrolytes and creatinine uecs thyroid function tests full hemogram additional information monitor vitals" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 15.0\n - Nursing Specialty: mental health\n - Clinical Panel Focus: internal medicine psychiatry\n\n Prompt from the nurse : i am a nurse with 15 years of experience in mental health and psychiatric nursing working in a national referral hospitals in uasin gishu county in kenya a 20 year male patient is brought to the emergency department with allegation of violence walking with a panga and threatening neighbor and destroying properties has been using cannabis and was on medication which he defaulted alleging that he experienced bad side effects t 36 6 p 104 rr 18 and bp 122 61 while assessing the patient he took out a roll of cannabis from pocket and threatened to smoke questions what is immediate management of this how can the patient be motivated to accept rehabilitation\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 20 yr old male with a history of cannabis use presented with allegations of violence with destruction of properties has defaulted medication vitals are normal immediate management admit to the mental health unit do verbal de escalation escalation and if it does not work give tranquilizer do baseline lab workups full blood count to rule out infections lft\u2019s to rule out liver disease incase of hepatotoxicity due to medications uec\u2019s check for kidney function incase of medication toxicity bs for malaria parasite to rule out cerebral malaria doa brain ct scan to rule out any organic causes space occupying lesion start on antipsychotics do a psychotherapy motivational interviewing which includes effects of drug abuse ways of cutting down stopping" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kakamega county in kenya a 35 year old woman presents to the facility with complaints of pv bleeding and weight loss she says there is history of fibroids in the family on assessment there is some signs of abdominal muscle felt i m concerned that the woman might be having fibroids which appropriate drug should i give should i refer the woman for gynecological review\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 35 year old woman presents with vaginal bleeding and weight loss has a history of fibroids in the family on assessment abdominal mass felt i\u2019m concerned the woman might be having fibroids which appropriate drug would i give there is no drug of choice for fibroids however combined oral contraceptives cocs have shown the most benefit differentials of per vaginal bleeding in non pregnant woman endometriosis adenomyosis malignancy e g cervical cancer pelvic inflammatory disease polycystic ovarian syndrome uterine polyps in pregnancy ectopic pregnancy molar pregnancy abortion should i refer for a gynecologic review per vaginal bleeding is a worrying symptom and needs to be managed by a gynecologist refer to a gynecologist" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 8.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: critical care\n\n Prompt from the nurse : i am a nurse with 8 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 21 year old lady is brought to the facility with complains of chest tightness tingling sensation and palpitation on assessment deep rapid breathing and carpal spasms are noted question which is the priority action to be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 21 yr old lady with complains of chest tightness tingling sensation and palpitation deep rapid breathing and carpal spasms concern for asthma pneumonia cardiac disease neuromuscular disease immediate management airway make sure it is intact breathing check spo2 and supplement oxygen if needed drugs nebulize the patient iv hydrocortisone iv antibiotics iv anaelgesics investigations fhg esr sputum for aafbs cxr echo tfts" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 17.0\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 17 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a mother who is being managed in an active phase of labour on oxytocin she starts complaining of excessive abdominal pains which are continuous she is sweating profusely vomiting and has a headache she is a para 2 0 gravida 3 vital signs bp 90 62mmhg pulse 88b min temp of 36 0 contractions are strong and continuous oxytocin infusion has ended one hour before time questions what should be the immediate intervention what should the managing team watch out for\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary gravida 3 para 2 mother in acute labor she reports excessive abdominal pain and also vomiting symptoms headache mild hypertension and altered contractions diagnosis active labor but pre eclampsia ddx ruptured uterus hyperemesis gravidarum management manage for preeclampsia with magnesium sulphate position mother in lateral position monitor vital signs and provide iv fluids consult surgical team for possible cesarean section administer analgesics for pain relief investigate further with cbc coagulation profile and cross matching" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 12.0\n - Nursing Specialty: neonatal care\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a dispensaries and private clinics in kakamega county in kenya a newborn baby brought to clinic by her mother with high fevers restlessness weight is 2 9kg malaria for parasites are negative could this be sepsis what treatment should i give\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary newborn male brought with fever restlessness weight 2 9kg bs for mps negative diagnosis neonatal sepsis treatment \u2713 admit \u2713 antipyretics administration \u2713 analgesics \u2713 antibiotics benzylpenicillin gentamicin \u2713 iv fluids \u2713 monitor glucose \u2713 monitor vitals" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 16.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 16 years of experience in cardiology working in a national referral hospitals in uasin gishu county in kenya a patient had chest pain feeling of own heartbeat abdominal fullness and generalized body pains for one week born 2005 known rhd patient on cardiac follow up at mtrh compliant on drugs this is her index admission to the facility she is a form 2 drop out last born in a family of six siblings she lives with her parents both parents are farmers a has tachycardia and irregular appears pale and and on o2 via n cannula at 4l min has cold clammy skin questions q1 what is the possible diagnosis q2 which is the best approach\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 19 year old male rheumatic heart disease patient on follow up and compliant to drugs presents with palpitations and chest pain abdominal fullness and general body pains for 1 week patient is a lastborn in a family of six and a form 2 dropout and lives with both parents on examination the patient has irregular tachycardia is pale with cold and clammy skin he is started on oxygen via nasal cannula at 4l min management take further history and ask about urine output and fevers connect patient to monitor and obtain vitals obtain iv access and take samples complete blood count urea electolytes creatinine liver function test c reactive proteins troponins monitor airway spo2 provide oxygen if needed check vitals bp hr if overhydrated initiate diuresis check glasgow coma scale check for wheezing crackles perform an electrocardiogram expose the patient do a secondary survey cardiology review dx arrhythmia congestive heart failure cardiogenic shock" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 24.0\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 24 years of experience in cardiology working in a national referral hospitals in uasin gishu county in kenya a 28 year old female presents to the maternal and child health clinic with complaints of lower abdominal pain painful intercourse and spotting for one month the woman is married and has two children she is using an iucd as a contraceptive method vitals temp 360 c resp \u2013 24 pulse \u2013 80 bp \u2013 120 70 mmhg questions what is the cause of the symptoms what is the possible diagnosis what interventions are appropriate for this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 28 year old female comes with complains of lower abdominal pain painful intercose and spotting for one month she is using an intrauterine device has stable vital signs the concerns for this patient are lower abdominal pain painful sexual intercose and spotting management of the patient do a pelvic exam to check for signs of an infection administer analgesic for pain management administer broad spectrum antibiotics while awaiting culture results check for intrauterine device placement and complications if possible refer for further gynaecological evaluation or ultrasound imaging to assess for structural issues follow up care of the patient investigations to be done pelvic examination pelvic ultrasound cervical swabs to test for bacterial infection pregnancy test endometrial biopsy differential diagnosis pelvic inflammatory disease endometriosis cervicitis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kakamega county in kenya a postnatal mother is brought to the mch ministry of having had fits at home she delivered to the facility one week ago on examination she is semi conscious her vitals are normal except for the blood pressure that is elevated at 130 over 100 a diagnosis of eclampsia is made what treatment should i give should i refer the mother for further management and investigation\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary postnatal mother who delivered at the facility one week ago presents with fits that started at home she is semi conscious bp 130 100 a diagnosis of eclampsia was made diagnosis the patient is concerning for postnatal eclampsia differentials seizures sepsis management of the patient refer to a tertiary facility lower the blood pressure using antihypertensives prevent or treat seizures using magnesium sulphate keynote eclampsia can occur from 20 weeks gestation to six weeks postnatal" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 1.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 1 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya 56 year old female came to the health facility with history of burning sensation on the sole of the foot she says it has lasted for one year on assessment no edema or discoloration of the foot vital signs bp 186 92mmhg temperature 36 8c pulse 60 min questions what might be the cause of burning sensation tingling paresthesia what is the diagnosis of this patient what is the management of this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 56 year old female patient presents with paresthesia on the sole of the foot for one year she is hypertensive bp 186 92 comment i would like to get further history on her past medical history what medications she is on and whether she has ever been diagnosed with diabetes diagnosis paresthesia in an hypertensive patient ddx nerve entrapment radiculopathy diabetic neuropathy investigations laboratory investigations fhg blood glucose levels inclusive of hba1c uecs management administer antihypertensives treat the cause of the paresthesia accordings to the results on investigation" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kiambu county in kenya a 10 year old boy is brought to the hospital having consumed an amount of paraffin which was put in a water bottle on examination the child s breath is smelling paraffin all the other parameters are normal what is the best treatment for this child what is the possible cause of this accident\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 10 year old boy is brought in to the hospital having consumed an amount of paraffin which was put ina water bottle on examination the child s breath is smelling paraffin all the other parameters are normal what is the best treatment for this child the best treatment for this child is respiratory support check for airway patency corrosion by the paraffin inflammatory process exudative material or any material that can obstruct the airway monitor for signs of respiratory distress or respiratory collapse or failure then emergency intubation is required check for ventilation status o2 saturation signs of hypoxia do not induce vomiting administer iv fluid and concern for fluid overload give dextrose to prevent hypoglycemia after the child is stable admit to the pediatric ward therefore the counselor and psychiatrist of the same cause accidental ingestion of paraffin due to improper storage the paraffin was placed in a water bottle which is a common error that leads to confusion and accidental ingestion especially by children diagnosis paraffin poisoning" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 3.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 3 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 36 yr old male patient to comprehensive care clinic to pick his antiretroviral medication on routine check bp 110 68mmhg pr 76b m spo2 96 rr 20b m rbs 5 6mmol l asked the patient of his marital status and confirms married but the wife not aware of his status and is taking medication although is wife knowledge the patient insists the wife should never find out despite several attempts of convincing by the counselor for him to disclose the information to his wife in order for her to get help he refused question what is the approximate measure to take as a nurse now that the wife should also be started on medication\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 36 year old male with hiv attending comprehensive care clinic to pick up his antiretroviral medication his vital signs are stable he is married but his wife unaware of hiv status despite being on art he insists his wife should not know about his status problems non disclosure of hiv status limited support system patient mental health stigma management continued counseling to address patient concern encourage patient to seek support from peers advice that disclosure is essential not just for his own health but health of his wife provide patient with education on importance and risks of not disclosing his status if he refuses remind that his confidentiality is guaranteed continue to monitor the patient hiv progression through viral load testing encourage use of condoms during sexual intercourse to prevent transmission investigations hiv testing of wife cd4 count viral load testing sti screening routine blood tests eg liver function tests urea electrolytes creatinine complete blood count preferred diagnosis dx hiv infection" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 22.0\n - Nursing Specialty: neonatal care\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 22 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya mch a two weeks baby boy was brought to the facility had foul smelling ambilicus high temp of 39 degrees crying and refusal to breastfeed a diagnosis of neonatal sepsis was made question what is the immediate treatment for this baby is it due to poor personal hygiene do i refer\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 2 week old baby boy with neonatal sepsis secondary to infection umbilical cord is febrile and irritable the immediate treatment is as follows to manage the hypothermia expose the baby feed the baby with expressed breast milk administer fluids intravenous antibiotics benzyl penicillin and gentamicin cleaning of the cord using sterile technique is it due to poor hygiene yos could be due to poor handling of umbilical cord with dirty hands or soiling do i refer yes the baby should be referred to a neonatologist for further care" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: elgeiyo marakwet\n - Health level\t : county hospitals\n - Years of Experience: 1.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 1 years of experience in general nursing working in a county hospitals in elgeiyo marakwet county in kenya a 15 year old male patient admitted to the medical ward with a diagnosis of meningitis 4 days ago starts having convulsions global in nature with lots of secretions and movement of extremities vital signs bp 110 78 mmhg pr 85 b min spo 98 on room air question what is the urgent care of the patient what are the health education for this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 17 year old male with convulsions for 4 days diagnosis of meningitis made diagnosis meningitis management urgent care perform lumbar puncture therapeutic and diagnostic pain management with analgesics empirical antibiotics high dose empirical antifungal antituberculosis therapy if indicated investigations cerebrospinal analysis full hemogram cryptococcal antigen testing blood cultures random blood sugar patient care ensure hygiene adherence to medications and educate on danger signs encourage ambulation and a balanced diet" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 17.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: critical care\n\n Prompt from the nurse : i am a nurse with 17 years of experience in general nursing working in a dispensaries and private clinics in kakamega county in kenya a client age 24 years a male came in unconscious accompanied with a cook he was a kmtc student who had a history of having only one meal per day rbs done sugars were 2 mrdt was negative and vital signs were normal what can i do to raise sugars can i do guiding and counselling on feeding practices\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 24 year old male presented unconscious history of having only 1 meal rbs done 2 mmol l normal vitals mrdt is negative management 1 oral glucose if the patient is conscious you can dissolve sugar or give any sugary drink to the patient 2 intravenous dextrose administer 10 or 5 dextrose via an iv access 3 consider counselling on feeding practices regular meals balance diets recognition of early warning signs diagnosis hypoglycemia" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 22.0\n - Nursing Specialty: emergency care rape\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 22 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 16 year old female is brought to a level 5 hospital by relatives with complains of rape by unknown person to her in a maize plantation while going home 30 minutes ago she is crying uncontrollably on examination small bruise on external genitalia around the perineum speculum examination whitish fluid accumulated in deep vaginal wall the under pant was wet and torn around the waist line questions what is the immediate intervention what is the follow up plan\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 16 year old complaints of rapes on examination external genitalia has a small bruise speculum reveals whitish fluids accumulated in the deep vaginal wall underpant is wet and bra is above the waist what is the immediate intervention proper vaginal exam assessing bleeds if lacerations present stop the bleeding by applying pressure and if laceration is too big stitching might help during vaginal exam collect samples around the cervix samples of the whitish fluid and also around the vagina for forensics do not discard the clothes like underpants as it may be useful for forensics administer post exposure prophylaxis for hiv screen for stis investigations such as elisa vdrl cervical swab cultures may be useful administer an emergency contraceptive involve law makers and fill appropriate forms if the patient is overly anxious an anxiolytic may be given to tackle panic anxiety involve a psychologist for psychological support what is the follow up plan psychological counselling as it takes a long time to process the assault follow up pregnancy test after 2 weeks may be appropriate if initial test was negative if any of the stis were positive treat with appropriate antibiotics and ensure adherence if initial sexually transmitted screen was negative another test maybe be done" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 20.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing working in a health centres in uasin gishu county in kenya 31 year old female para 3 0 gravida 4 admitted with nausea severe vomiting up to 10 episodes bloodstained general weakness shortness of breath when assessed she is very weak and frail bp 90 54mmhg pulse 124 beats min respirations 20 breaths min spo2 94 rbs 5 7mmol l questions 1 how best can i manage the patient 2 what has caused the severe vomiting\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 31 yr old para 3 0 gravida 4 is admitted with nausea and vomiting up to 10 episodes blood stained has general weakness and shortness of breath hypotensive at 90 54 mmhg tachycardic at 124 bpm spo 94 rbs 5 7 mmol l concerns 1 how to best manage the patient 2 what has caused severe vomiting differential diagnosis hyperemesis gravidarum with differentials of gastroenteritis peptic ulcer disease appendicitis manage as follows 1 iv fluids therapy electrolyte saline 2 antacids antiemetics plasil doxylamine 3 dietary changes small frequent meals avoid citrus fruits 4 consult a gastroenterologist and a maternal fetal specialist 5 continuously monitor vital signs 6 investigate \u2013 full hemogram hb causes are many it may be unknown or due to rapid rise of the hormone hcg other risk factors are obesity and twin pregnancies" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 9.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 9 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 60 years old female brought to the hospital with hx of swollen lower limbs unable to pass urine itchy skin for 1 52 she is a known dm htn patient for 10 years on medication and follow up on assessment bp 180 94mmhg p 92b min t 38 5c r 36b min there is generalized body oedema the skin is dry peeling questions what could be the possible diagnosis of the patient what investigations could be done to aid in diagnosis\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 60 year old female known dm htn for the last 10 years on medication presented with 52 history of swollen lower limbs pass urine with itchy skin on exam to high bps of 180 94 febrile in severe respiratory distress generalised body edema possible diagnosis acute kidney failure investigations lab full hemogram to check for leukocytosis and hemoglobin levels \u2022\u2060 \u2060urinalysis to check for urinary infections \u2022\u2060 \u2060hba1c to check for drug compliance \u2022\u2060 \u2060kidney function tests to check for electrolytes and urea creatinine levels to assess the kidney failure \u2022\u2060 \u2060blood gas analysis to check for levels of co2 and o2 in blood radiology 1 chest xray to check lung pathologies 2 kub scan to check for any obstructive uropathy 3 echo ecg to look for heart function to rule out heart failure 4 bilateral lower limb doppler ultrasound to rule out clots 5 abdominal pelvic ultrasound scan" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse in general nursing working in a dispensaries and private clinics in kakamega county in kenya a female client presents with history of coughing up blood for 1 week loss of body weight and hoarseness of the voice she has been loosing weight with no apparent reason weight 55 kgs coughing lymphadenopathy lung cancer diagnosed where do i reffer the client to which basic care do i give before referral\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a female client presents with a history of coughing blood for 1 week loss of body weight and hoarseness of voice history of weight loss weight 55 kg coughing lymphadenopathy diagnosis pulmonary tb pneumonia lung cancer management i would manage the patient as follows immediate care assess if the patient has any life threatening condition do vital signs including rbs primary survey abcde airway patency and c spine breathing look listen feel if spo2 90 oxygen supplementation circulation iv cannula iv fluids rbs 4 mmol give d50 analgesics pain management cough syrup nutritional support labs fhg uec lft gene expert tumour marker radiology abdominal pelvic chest ct scan chest x ray" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 15.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 15 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya the patient is brought in outpatient department complaining of abdominal pain abdominal distension vomiting and not able to pass stool for the last one week on the examination the patient is in distress in severe pain in respiratory distress because of the distension and a diagnosis of intestinal obstruction is made how do i manage intestinal obstruction and which drugs do i give to relieve the constipation and also the abdominal distension and which surgical intervention is needed for this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary abdominal pain abdominal distention vomiting and not passing stool for one week on examination distressed dx this is concerning for intestinal obstruction management this patient requires inpatient care keep patient nil per oral establish intravenous cannulation and draw samples for laboratory work up initiate intravenous fluid rehydration insert catheter and monitor urine output insert a nasogastric tube for gut decompression administer antibiotics broad spectrum empirically after blood culture samples have been obtained administer intravenous analgesics to manage the pain perform a digital rectal exam and evacuate in case of fecal impaction monitor vitals closely inform surgical team to review investigations radiological investigation an erect abdominal x ray will show multiple air fluid levels laboratory full hemogram to identify hemoglobin levels and features of infection renal function tests to identify electrolyte abnormalities for correction before infection" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 22.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 22 years of experience in general nursing working in a dispensaries and private clinics in kiambu county in kenya a one year three month baby was brought to the mch cannot stand on support or grasp a fist information malnourished why the delayed milestones is the baby feeding enough and the right diet where i refer to occupational therapy for further management where i refer to the nutritionist\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary this is a case of a 1 year and 3 month old baby cannot stand on support or grasp a fist is malnourished brought to the dispensary diagnosis malnutrition with delayed milestones refer to a higher facility that has the following services pediatric physician to assess for signs of child abuse and abandonment and treat any illness nutritionists for review and support speech therapist to ensure milestone attainment occupational therapy to help achieve highest level of motor functioning physiotherapies to prevent contractures social support for parents to reassure psychiatric child support to assess neurodevelopmental conditions ddx delayed milestones neurodevelopmental disorders motor disorders like cerebral palsy bone diseases e g osteogenesis imperfecta malnutrition failure to vaccinate causing poor growth due to constant infections regressed milestone of development due to acute conditions such as infections dehydration child abandonment poor nutrition status metabolic or endocrine disorders of acute onset child abuse" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kiambu county in kenya a 60 year old lady comes to the facility for follow up she reports to have been receiving chemotherapy at knh on examination she has pallour reports of dizziness vomiting and weakness of the body she was sent for hemoglobin check which was 5 1 the wbcs were 8 2 now the question should i admit the mother for transfusion then refer back to knh number two should i administer the antiemetic and some fluids and transfuse the mother\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 40 year old female on chemotherapy at kenyatta national hospital presents with dizziness vomiting and body weakness on examination the patient is pale full haemogram was done which showed haemoglobin of 5 4 and white blood cell count of 8 2 1 admit the patient for transfusion if blood is available at the facility and refer back to continue chemotherapy 2 take vital signs if blood pressure is normal transfuse the patient but if pt is in shock administer crystalloids eg normal saline while awaiting transfusion take samples for full haemogram urea creatinine and electrolytes blood grouping and cross matching if a patient is noted to have electrolyte imbalance appropriate fluids may be administered" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 17.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 17 years of experience in general nursing working in a dispensaries and private clinics in kakamega county in kenya groaning in pain after being stung by bees no history of chronic illness or allergies swollen face and arms with visible bee stings should i give an analgesic and a steroid\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary groaning in pain after being stung by bees no history of chronic illness or allergies swollen face and arms with visible bee stings should i give an analgesic and a steroid this is a concern for bee stings management of the patient as follows administer analgesic and antihistamine in case of severe anaphylactic reactions like oedema and stridor of airway obstruction administer epinephrine and set up a cardiac monitor electrocardiogram in severe cases administer steroids hydrocortisone admit severe cases of anaphylaxis for monitoring" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kakamega county in kenya a 30 year old mother reported to the opd was brought in by the husband and relatives reports with multiple cuts and profuse bleeding on examination there is multiple cuts on the head back of the body so stitching was made to arrest the bleeding and cleaning and dressing was also done so the mother reports to have been cut by external cuts but when taking history when in the absence of the relatives and the husband the mother reports to have been assaulted by the husband after a disagreement at home so a diagnosis of multiple cut wounds secondary to assault was made so the biggest question is how good will we help them to solve issues at home how can we admit the mother and do the consultation to the husband three can we report the matter to the relevant authorities or not thank you\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a lady brought in with multiple cuts and profuse bleeding on the head back of the body the bleeding was stopped by stitching the lacerations and clean dressing applied she discloses privately it was the husband who assaulted her after a disagreement how do we help them solve issues at home involve a psychologist counsellor if they are willing to talk through things can we admit the mother and do consultation with the husband since the patient is stable avail the best options for her prioritizing her safety these include reporting to the law makers for domestic violence consulting psychologist can we report to the relevant authorities it is entirely dependent on the lady assaulted to report the cause we can support her in her decision and offer reassurance advise the mother in whatever decision consult the patient before attempting to report including a psychologist may help her gain clarity" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 15.0\n - Nursing Specialty: mental health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 15 years of experience in mental health and psychiatric nursing working in a national referral hospitals in uasin gishu county in kenya a 78 year old female is admitted to the unit with complaints of drooling of saliva and drowsiness which lasted for 3 days the patient has been on management for schizophrenia and is on haloperidol nocte on examination the is still drooling saliva appears sleepy and does not maintain eye contact she is unable to stand upright vital signs bp 110 60 p 60 spo2 96 t 36 0 chest clear questions what could be causing the drooling of saliva and drowsiness what is the acute management for this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 78 year old female admitted to the mental health unit with complaints of drooling saliva and drowsiness for three days she is on management for schizophrenia with haloperidol nocte on examination she is sleepy does not maintain eye contact she is unable to stand upright diagnosis extrapyramidal side effects of haloperidol acute management of the patient administration of trihexyphenydine or any available anticholinergic to counter the extrapyramidal side effects the definitive management is to have the patient switched to an atypical antipsychotic in consultation with a psychiatrist" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 29.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 29 years of experience in general nursing working in a health centres in uasin gishu county in kenya a child 5 years of age brought in by the mother complaining of the child being restless unable to breathe and not able to sleep at night on examination the child was very restless sternum receding indrawing of the sternum and chest labored breathing vital signs pulse 128 respirations 28 spo2 78 questions 1 what could have caused the labored breathing 2 what is the cause of the low spo2\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a child 5 years old complains of restlessness difficulty in breathing and unable to sleep at night on exam there is sternum receding indrawing of the sternum and chest child is tachycardic tachypneic and has low oxygen saturation q1 what could have caused the labored breathing differentials include severe pneumonia tuberculosis adenotonsillar hypertrophy asthma q2 what is the cause of low spo\u2082 differentials similar to those of labored breathing include severe pneumonia tuberculosis adenotonsillar hypertrophy asthma" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 19.0\n - Nursing Specialty: emergency care rape\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 19 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 17 year old boy brought in by neighbors having been sexually assaulted by men while herding the boy works as a herd boy no known medical and surgical history no known chronic illness in the family anxious with a limping gait not in respiratory distress pr 68 bpm rr 18 bpm spo2 96 on room air temperature 36 80 c on physical assessment anal area bloodstained with lacerations questions what is the immediate management of this patient what investigations are needed which specialist consultation is needed for the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 17 year old male sexually assaulted by men while hearding presents anxious with a limping gait on examination anal area is blood stained with lacerations vitals are within normal ranges immediate management of the patient stop anal bleeding apply pressure on any laceration admit and administer analgesics clean and dress the anal area administer iv fluids administer anxiolytics administer prophylactic antibiotics administer hiv post exposure prophylaxis psychological counselling if consent is obtained administer rape kit administer tetanus toxoid vaccine investigations needed full hemogram check the hemoglobin levels and any signs of infection blood grouping and crossmatching incase transfusion is needed hiv elisa test venereal disease research lab test for any sexually transmitted infection special consultations needed the police or law to report the assault child protection services because he is a minor psychiatrist or psychologist to help in processing the trauma general surgeon to assess the extent of injury" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 7.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 7 years of experience in general nursing working in a sub county hospitals and nursing homes in kakamega county in kenya a 35 year old mother rhesus negative para 0 3 gravida 4 is admitted to maternity with inevitable abortion at 12 weeks the abortion is complete and mother taken to postnatal check hb before discharge is 5 1 grams per deciliter and she reports of reacting with blood the previous transfusion ranferon is out of stock in the facility and patient is unable to purchase due to financial constraints at the moment what can i do to save this mother\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "35 year old female po 3g4 now po 4 rhesus negative came with inevitable then complete abortion 12 weeks concerns hb 5 1 g dl previous transfusion ranferron out of stock financial constraints patient how to save the mother revoke discharge repeat grouping and cross matching test source for blood get iv ferrous sulphate refer to a higher facility for further management with ferrous sulphate or blood available involve social workers if within or at the referral facility" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kiambu county in kenya so an expectant mother comes to maternity with one previous car in labour it is during a doctor s strike and she is in active phase of labour at 8cm dilatation and it is a rural facility without a maternity theatre you call the referral facility and they say doctors are on strike so they are not receiving patients and the mother says she doesn t have money to go to a private facility so what should you do in such a scenario\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a case of expectant mother with one previous scar in active phase of labour dilated at 8cm what should you do in such scenario admit the patient to labour room insert two large bore intravenous lines administer uterotonics to enhance contractions oxytocins conduct 2nd stage and third stage of labour if no complications with delivery discharge home via child health clinics if complications with delivery refer to health specialist" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 3.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 3 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 2 year old girl is brought in and the mother reports poor feeding cold extremities and difficulty in breathing for 6 months on assessment pr 106 beats per minute spo2 90 temperature 36 1\u00b0c questions what is the possible diagnosis what are the investigations to be done what is the management for this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 2 year old girl was brought to the hospital by the mother complaining of poor feeding cold extremities and dib for 6 12 vitals pr 106 spos 90 t 136 106 diagnosis congenital heart disease investigations full hemogram chest x ray echocardiogram management if the echocardiogram confirms to be congenital heart disease then refer to a cardiologist for definite management supportive nutrition oxygen supplementation treatment of infections with antibiotics" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: mental health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 56 year old female came in the facility with complains of forgetting things easily poor appetite and is worried about her children she lives with the husband and her two children vital signs 35 9 pr 101b m bp 136 77mmhg on assessment there is no obvious history of trauma or injury questions 1 what further investigation can be done to the patient 2 why does the patient present with vomiting and loss of appetite\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 56 year old female reports with a history of forgetting things easily poor appetite and is worried about her children vitals show hypothermia of 35 9\u00b0c tachycardia of 101 and bp of 126 77 a what further investigations could be done investigations ct scan of the head \u2192 intracranial bleeding complete blood count \u2192 signs of sepsis \u2191 leukocytes \u2192septic shock c reactive protein erythrocyte sedimentation rate \u2192 inflammatory markers blood culture urea electrolytes and creatinine liver function tests \u2192 metabolic course electrolyte disturbances psychiatric illness \u2192 psychiatric review why does the patient present with vomiting and loss of appetite could be due to increased intracranial pressure" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 30.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 30 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 60 years old patient complains of retrosternal pain pain is stabbing in nature and is long standing relieve with pain killers but now intensified blood pressure 150 60 mmhg questions what is the possible diagnosis what is the immediate management what is the long term management what investigations could be performed\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 60 year old patient has retrosternal pain the history given is not adequate however the causes of retrosternal pain would include this patient should be referred for investigation" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kakamega county in kenya a 55yrs old man on the ward with septicaemia and severe anaemia patient has been sick for 1 12 while using otc at home hb is 3 8gdl fhg elevated wbcs noted patient is weak and sick looking can both blood and antibiotics be administered concurrently or which one to be administered first\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "case summary a 55 year old man on the ward with septicaemia and severe anaemia patient has been sick for 1 month while using over the counter medication at home hb 3 8 g dl can both blood and antibiotics be administered concurrently antibiotics are to be administered first as septicaemia is a more urgent problem and would most likely be addressed first dx severe anaemia septicaemia" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : health centres\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse working in a health centres in kiambu county in kenya a two month old baby was brought by a police officer after having been abandoned in a thicket the baby was crying a lot he had cold extremities and was malnourished do i keep the baby where will i take this baby should i report to the children s department office what is the hiv status of the baby\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 2 month old baby abandoned brought in irritable with cold extremities and malnourished do l keep the baby yes do baselines test to assess baby s health status tests such as blood slide for malaria parasite hiv status mid upper arm circumference random blood sugar in case of any derangements intervene should i report to the children s department yes what is the hiv state of the baby this will be guided by the baseline tests" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centers\n - Years of Experience: 20.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing and primary care working in a health centers in uasin gishu county in kenya a 21 year old female patient comes to the clinic complaining of dizziness some headache and blurred vision for 1 week on examination the palms of the hands are fairly pale and also the eyes the headache is mild there is no nausea vomiting or diarrhoea other medically alright she says her favorite is chips and soda vital signs bp 119 64 mmhg pulse 79 min sp02 96 resp 16 min temp 36 1\u00b0c questions which investigations should be done how can she be managed\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 21 year old female with complaints of dizziness headache blurred vision for 1 week exam pallor vitals normal diagnosis anemia which investigations should be done full hemogram blood group and crossmatch peripheral blood film blood slide for malaria urinalysis iron studies stool for ova and cyst folate and vit b12 levels how can she be managed take the above samples and follow up the results transfuse if needed initiate hematics deworming anthelmintic meds supplement and increase iron folate and vitamin b12 in diet involve a nutritionist for counseling and dietary recommendation rule out other causes such as malaria blood loss hemorrhage bleeding diathesis pain management analgesia for headache paracetamol ensure the patient is well hydrated consult with a specialist for further care" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 38.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 38 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 48 year old male client is escorted to the level 3 health facility by his spouse with complaints of dizziness and falls for a duration of three days the patient has a history of atrial fibrillation and is taking warfarin tablets on assessment small bruises are noted on his left arm pulse 58 beats minute blood pressure 130 80 mmhg temperature 36 4 degrees celsius spo2 90 the patient reports feeling weak and has a pale conjunctiva questions what could be wrong with the patient which priority nursing action should be taken what diagnostic investigations should be considered first\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 48 year old male with a hx of dizziness and frequent falls on warfarin tablets due to atrial fibrillation on exam noted small bruises on left arm vitals are normal with slight bradycardia noted to be pale and lethargic diagnosis warfarin side effects immediate nursing care put the patient in a couch and elevate the head at 45 degrees do cleaning and dressing on the bruises urgently refer the patient to a cardiologist for further evaluation and management thyroid function test full hemogram urinalysis rbs urea electrolytes and creatinine liver function test doppler ultrasound to rule out blood clots" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 27.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 27 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 9 year old boy was brought by the mother with complaints of pain on the left ear and not being able to hear for 3 days temp 36\u00b0c pulse 80 bpm resp 34b min spo2 93 on examination there was a bean which had blocked the whole opening recommendation \u201d patient sent to ent department for further management trauma fb\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 9 year old male presents with pain on left ear and inability to hear on left ear for 3 days examination bean stuck in left ear vitals temp 36\u00b0c pr 80 bpm resp 34 spo2 93 impression foreign body in left ear management 1 attempt to remove the foreign body by flushing it out with water for injection 2 if need be tweezers can be used instead 3 if unable to remove the foreign body refer to the ent department for removal of the foreign body" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: elgeiyo marakwet\n - Health level\t : county hospitals\n - Years of Experience: 1.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 1 years of experience in general nursing working in a county hospitals in elgeiyo marakwet county in kenya a 4 year old boy is brought by her mother to the emergency with complains of profuse nose bleeding on left nostril that started 3 hours ago on examination patient is alert not pale the left nostril is packed with a small cloth fully soaked with blood v signs bp 90 58 mmhg pr 65 b m rr 25 b m t 36 6oc pr 65 b min spo2 98 on room air questions how can this patient be managed what are the laboratory investigations required\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 7 year old boy presents with profuse nose bleeding on the left nostril that took 3 hours to stop at home on examination the patient appears pale but not cyanotic packed with blood hypovolemic shock hypotensive tachypneic other vitals are essentially normal dx epistaxis dx hematological malignancy trauma how can this patient be managed pack the nostril with gauze soaked with adrenaline give intravenous tranexamic acid to stop emergent ear nose and throat specialist review intravenous fluid resuscitation laboratory investigations required hemoglobin levels platelet levels blood group and crossmatch in preparation for transfusion" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 14.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 14 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 32 year old female patient came to the facility with a history of experiencing severe headaches for the past one year which occurs approximately 2 3 times per month patient reports nausea and vomiting during the headache attack she also has blurred vision on assessment temp \u2013 36 8 degrees celsius p \u2013 76 b m r \u2013 18b m bp \u2013 130 80 mmhg questions what is causing a severe headache what laboratory and radiological investigation can be done what is management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 32 y o old female presents with severe headache for one week nausea and vomiting assessment vitals normal 2 investigations these are aimed at ruling out other differential diagnoses e g migraine headache vs tension headache vs cluster headache radiological imaging studies e g ct scan mri lab tests e g cbc esr fbc 3 management the drug recommended for migraines are triptans e g sumatriptan these however are likely to be unavailable expensive i can supplement with nsaids combined with a muscle relaxant one is also advised to avoid triggers e g physiological stress certain foods like chocolate ensure adequate hydration as dehydration is also a trigger diagnosis migraine headache" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : community health centers\n - Years of Experience: 24.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: critical care\n\n Prompt from the nurse : i am a nurse with 24 years of experience in general nursing working in a community health centers in uasin gishu county in kenya a 49 year old male is admitted with a history of dizziness weakness and inability to walk the patient has a hemoglobin level of 3 2gm dl and is for transfusion and management of anaemia vital signs blood pressure 70 50 mmhg pulse 112 beats per minute respiratory rate 27 breaths per minute spo2 77 blood is put up and after 10 minutes the patient develops fever of 38 0 c shivering and itchiness of the whole body questions what is the diagnosis what is the management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 49 year old male admitted history of dizziness weakness inability to walk hb 3 2g dl due for transfusion vitals bp 70 50 pr 112b min rr 27b min spo2 77 10 minutes into blood transfusion tenny 38 shivering body itchiness differential diagnosis acute transfusion reaction management 1 stop the transfusion 2 clear the airway 3 ensure patient is an oxygen supplementation and nrm with saturation above 92 4 give iv antipyretic e g paracetamol 5 rehydrate with crystalloid solutions about 3 liters of third over 24 hrs 6 antihistamines to control the anaphylaxis generalized itchiness e g diphenhydramine and chlorpheniramine 7 osmotic diuretics e g mannitol which helps to chillness destroyed hemoglobin and prevent aki that may result 8 consider use of adrenaline for blood pressure control 9 physician consult 10 inform hospital management and blood bank" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 12.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya a mother aged 40 years para 3 0 gravida 4 with gestation of 38 weeks is brought by relative with complaint of lower abdominal pain and ruptured membrane on exam a diagnosis of occipital posterior position was made what are the possible outcome of occipital posterior position and their management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "40 year old mother para 3 0 gravida 4 at 38 weeks gestation presents with lower abdominal pain and ruptured membrane on examination a diagnosis of occipitoposterior position made dx fetal malpresentation ddx compound presentation inadequate pelvis what are the possible outcomes of occipital posterior position severe birth asphyxia delayed second stage shoulder dystocia obstructed labor management emergency cesarean section vacuum assisted delivery admit neonate to newborn intensive care unit" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 14.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 14 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 58 year old female presents to a health facility with increased shortness of breath chest discomfort and fatigue over the past two weeks the patient reports to be hypertensive but well controlled with medication assessment bp 138 88mmhg p 88 b m res 22 b m spo2 94 temp 36 7 degree celsius questions what is the likely cause of shortness of breath chest pain and fatigue what laboratory and radiological investigation can be done what is the management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 58 year old female with a history of well controlled hypertension presents with increased shortness of breath chest discomfort and fatigue for two weeks on assessment there is mild tachypnea blood pressure is 138 88mmhg diagnosis myocardial infarction management the patient needs admission at a facility with a cardiac care system stabilize the patient and start oxygen therapy to support ventilation obtain intravenous access and obtain samples for lab tests analgesics for chest discomfort antibiotics to cater for possible infections imaging to be done o check x ray to assess lung and heart morphology o echocardiography and electrocardiography to assess heart morphology and cardiac activity laboratory investigations full hemogram c reactive protein erythrocyte sedimentation rate urea electrolyte and creatinine troponin cardiac markers cardiology consults" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 23.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 23 years of experience in general nursing working in a dispensaries and private clinics in uasin gishu county in kenya a female child of 4yrs was brought in by the grandmother with history of fever and cough her mother passed 2 years ago no immunization history the child has features of wasting with fever of 39 degrees celsius pulse 124b min pso2 88 weight of 7 2kg questions what are the investigations to be done on this child what are the referrals to be made\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 4 year old child with a history of fever and cough and has not had any immunization done the child is wasted with fever of 39\u00b0c tachycardia with a low spo2 of 88 the baby is also underweight diagnosis pneumonia investigations full hemogram c reactive protein and erythrocyte sedimentation rate chest x ray to rule out pneumonia management start the patient on oxygen therapy give antipyretics administer antibiotics to manage the pneumonia manage the malnutrition as follows assess for hypoglycemia and manage administer vitamin a supplements give ready to use therapeutic foods nutritional counselling is needed" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: nan\n - Nursing Specialty: mental health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a health centres in kakamega county in kenya a 34 year old lady brought in by the mother in law she s a few days postpartum 10 days ago she looks unkempt not feeding not breastfeeding the baby since discharge from hospital vitally she s stable now could this be postpartum psychosis should i refer this mother for psychiatrist review do i call cancler to have a session with her now which medication can i give now\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 34 yr old lady 10 days postpartum brought to health center she is unkempt not feeding and has not breastfed the baby since discharge from hospital normal vital signs problems unkempt not feeding not breastfeeding baby management immediate mental health assessment then consider referral to a psychiatrist for review ensure that patient is well supported emotionally and physically by engaging with family ensure safety of both the patient and the baby offer breastfeeding counseling and educate the mother on importance of breastfeeding administer antidepressants e g fluoxetine if suspicion of postpartum depression administer antipsychotics e g haloperidol if suspicion of postpartum psychosis administer anxiolytics lorazepam if patient is anxious investigations thyroid function tests to rule out thyroid disorders that can cause mood changes complete blood count to exclude anemia preferred diagnosis dx postpartum depression or postpartum psychosis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse working in a national referral hospitals in uasin gishu county in kenya a 40 year old man presented with a lump in his neck and chronic voice hoarseness has no difficulty in swallowing he has been a chain cigarette smoker for 20 years t 37 5 p 95b min bp 110 60 mmhg questions what investigation needs to be done what is the diagnosis and possible differential diagnosis what different forms of treatment should the client expect\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary the 40 year old presents with a neck lump and hoarse voice he is a known smoker for 20 years vital signs are normal a differentials goitre laryngeal carcinoma thyroid cancer b investigations labs complete blood count to rule out infection anemia in case of cancer c reactive protein erythrocyte sedimentation rate thyroid function tests fine needle aspiration imaging ultrasound of the neck mass endoscopy c what different forms of treatment should the client expect medical 1 analgesics to help with pain 2 proton pump inhibitors in case suspecting gerd 3 corticosteroids in case airway obstruction is suspected surgical intervention thyroidectomy lumpectomy psychological intervention in case it is cancerous" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 17.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 17 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 5 month old infant is brought to the emergency department unresponsive the infant was well until 2 hours ago when he was lethargic on assessment the infant has gasping respirations weak rapid pulse hr 250b m resp 18bpm bp 90 40 mmhg temp 36 8 resuscitation commenced via bag mask ventilation and code blue pediatric team was initiated questions what is the likely diagnosis what is the most important step who is to do what and when\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 5 year old baby who was brought to emergency department unresponsive reported to have been well 2 hours prior lethargic examination gaspic respiration weak and rapid pulse tachycardic resuscitation was commenced via bag mask ventilation and a code blue pediatric team was initiated what s the most important thing to do securing the airway who is to do what and when have a team leader to coordinate and assign roles 1 person to do a finger technique cardiorespiratory resuscitation and the other be on airway giving rescue breaths at a ratio of 15 2 have an intravenous access and samples taken have child connected to the monitor continue with the above as you monitor the child" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 27.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 27 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 22 year old female patient comes to the clinic with complaints of epigastric pains nausea and vomiting for 3 days she has had a diagnosis of peptic ulcers for the last 2 years she has been on omeprazole and antacids on and off she cannot retain anything orally she is a student and is single on examination she has rebound tenderness at the epigastric region vital signs bp 114 71 mmhg pulse 79 min temp 32 1\u00b0c spo2 96 questions other systems are okay a what investigations should be done b how can she be managed\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 22 year old female patient with complaints of epigastric pain nausea and vomiting for 3 days had pud for 2 years has been on omeprazole and antacids on and off cannot retain anything orally on examination has rebound tenderness at the epigastric region bp 116 71 x0001 p 76 min x0001 spo2 96 other systems unremarkable concerning for acute gastritis management is as follows antiemetic analgesics avoid non steroidal anti inflammatory drugs proton pump inhibitors antibiotics flagyl clarithromycin investigations h pylori antigen pregnancy test stool for occult blood full hemogram urea electrolyte and creatinine liver function tests" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kakamega county in kenya a 20 year old comes to the opd wuth blurred vision severe pain and swollen red left eye was hit by a splinter when choping firewood splinter in the eye tearing should i attempt to remove the foreign body what first aid should i give\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary this is a 20 year old patient who was pierced by a piece of wood and developed blurred vision this is a serious penetrating injury to the eyeball and its structures it is painful experience management administer pain medication tetanus toxoid and iv antibiotic irrigate with saline pad the eye this patient should be referred to a larger facility with ability to do a ct scan mri specialist review and surgery" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kakamega county in kenya a schoolgirl was brought by a school bus on a mattress came in carried by four men matron reports that the girl had been on antimalarial treatment and last dose had just been taken at 8 a m now she has stiffness of the neck and feels hot and unable to sit or stand observations blood pressure was 110 70 pulse of 100 beats and respiration of 26 with a temperature of 40 degrees centigrade can i do cunning test can i do lp for csf but we don t have reagents to test for meningitis can we repeat malaria test can we change antimalarials to iv treatment can it be hypoglycemia\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary school girl brought in with history of hotness of body weakness with prior history of antimalarial treatment on exam neck stiffness febrile with normal bps in respiratory distress q1 do repeat blood slide for malaria parasites and start on 2nd line treatment of complicated malaria do lumbar puncture for csf biochemistry check sugars to rule out hypoglycemia and correct accordingly child needs admission for further evaluation and care diagnosis malaria differentials meningitis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 1.0\n - Nursing Specialty: surgical care\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 1 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya 68 year old female who underwent total right leg amputation was admitted due to severe gangrene she has a history of hypertension and was on antihypertensives on assessment bp 140 90mmhg hr 87b min resp 18b min drainage of bloody pus from the incision site questions what are the priority nursing diagnoses how can i assist the patient with impaired physical mobility what can i include in education and discharge planning\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 68 year old underwent amputation was admitted due to severe gangrene a hypertensive patient on antihypertensives vitals are normal on examination pus from incision site what is the priority nursing diagnosis impaired mobility activity intolerance cellulitis how do you assist the patient with impaired mobility crutches wheel chair have a caregiver around what can i include in education and discharge pus proper wound cleaning and dressing at nearest clinic adherence to antibiotics attend regular clinics for diabetes and hypertension educate on delaying or preventing complications include psychologists due to recent amputation to be processed" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 24.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 24 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 27 year old male is brought to the clinic complaining of constipation he says he took a mixture of maize and beans \u2013 \u2018githeri\u2019 \u2013 for lunch he is a casual laborer in a construction company vital signs temp 360 c pulse \u2013 90 resp \u2013 28 questions what is the diagnosis what is the treatment what investigations are necessary for him\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 27 year old male brought to uasin gishu clinic presenting with constipation he took githeri for lunch he is a casual labourer in a construction company vitals temperature 36oc pulse rate 90 respiratory rate 28 breath per minute what is the diagnosis food poisoning respiratory rate of 28 breath per minute may be due to sepsis constipation secondary to food diet lacking fibers vegetables water what investigations are necessary for him full haemogram to assess white blood cell status abdominal ultrasound to assess bowel movements erect abdominal x ray to rule out gas levels stool for widal slide agglutination test and helicobacter pylori stool test" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kiambu county in kenya a 30 year old woman para 2 0 gravida 3 comes in the maternity ward with complaints of lower abdominal pains on examination fundal height is 30 weeks over 40 cephalic presenting longitudinal lie right occipital anterior and no engagement on ascaultation no fetal heart heard pv bleeding bright red blood is visible on the pad no previous history of aph in the previous deliveries bp is 100 60 temperature 35 degrees pulse is 90 respiration 20 what is the most urgent action to be taken on this client question 2 what is the most appropriate mode of delivery question 3 what is the possible outcome question 4 consider emergency and explore referral options\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 30 year old woman multigravida presenting with lower abdominal pain and per vaginal bleeding on examination fundal height 30 40 cephalic presentation longitudinal lie and no engagement is hypotensive diagnosis placenta abruptio ddx placenta previa what is the most urgent action to be taken a priority in this came would be to resuscitate the mother through administration of intravenous fluids such as normal saline this should be done alongside with attempts to stop bleeding with tranexamic acid an obstetric ultrasound should be performed to further identify the cause of the bleed which would further aid in better management what is the most appropriate mode of delivery \u2022\u2060 \u2060a cesarean section would be ideal in this case since the mother is most likely sick and thus unable to exert beating down efforts another reason is that better hemostasis is likely to be achieved with this approach what are the referral options once the patient is stabilized they should be transported to a higher facility with theatre facilities in anticipation of premature delivery diagnosis placenta abruptio" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : health centres\n - Years of Experience: nan\n - Nursing Specialty: mental health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a health centres in kiambu county in kenya a young man was brought with a history of talking a lot not sleeping eating excessively and not well kept he was also not coherent in speech he has a history of abusing drugs since three years ago what medication do i give how do i counsel the patient and also the family\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary young man presenting with disorganized behavior excessive eating and poor self care he exhibits incoherent speech suggesting drug use diagnosis drug induced mood disorder ddx drug induced mania diabetes affective disorder medication mood stabilizers e g lithium valproate benzodiazepines e g diazepam antipsychotics e g olanzapine quetiapine counseling for family advise on discontinuation of drug abuse encourage seeking a rehabilitation program for better control educate about the effects of drug abuse counsel family members to support the patient in treatment and rehabilitation" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 12.0\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya a young lady para 1 0 plus 0 gravida 2 para 1 para 1 0 para 1 plus 0 gravida 2 means the second pregnancy she has another child the lnp of 1st 9th 23rd the edd of 10th 10th 2024 she is 38 weeks she comes in to the facility emergency department with complaints of body malaise or body weakness muscle ache lack of appetite nausea and vomiting she physically looks sick and she states that she has a history of travelling to kakamega two weeks ago the bp was 100 60 pulse of 88 hb of 9 8 and random blood sugar of 6 3 fetal heart rates were present i requested for an mps which was not done due to unavailability of the slides refer for investigations and further management start on antimalarials and hematins\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a para 1 gravida 2 with 38 weeks gestation prevents with body weakness hb is 12 management consider antimalarias haematinics deworming drugs and hospital delivery advised diagnosis moderate anemia at term anaemia in pregnancy is a relatively common phenomena and may be due to iron deficiency malaria worms this could contribute the general body weakness however because of the nausea and vomiting the ddx will be" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a national referral hospitals in uasin gishu county in kenya a 40 year old mother para 4 1 g 6 during delivery the shoulders got stuck questions what should be the immediate management what should be the management for her baby\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 32 year old female presents with dysuria urgency and lower abdominal discomfort for two days she denies fever or flank pain examination reveals suprapubic tenderness but no costovertebral angle tenderness investigations perform urinalysis and urine culture to confirm urinary tract infection uti management plan prescribe oral nitrofurantoin or fosfomycin advise hydration and urinary hygiene practices monitor for resolution of symptoms within 48\u201372 hours diagnosis uncomplicated uti" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 16.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 16 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya mrs p in room 4 private wing 1 admitted 4 days ago currently has complaints of crushing chest pains rating it at 9 10 bp 90 51mmhg hr 123 beats minute rr 36 breaths minute spo2 87 on room air the pain started an hour ago she is being managed for malaria the pain radiates to the back and her left jaw no pain medications were administered has had similar chest pain without a heart attack in the past i have placed her on oxygen 2l she is deteriorating on my assessment ecg shows no st changes questions what medications can we give for her pain which investigations should be done how do you plan to inform the family about her change in condition\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary mrs p in room 4 private wing 1 admitted 4 days ago currently has complaints of crushing chest pain rating it at 9 10 bp 90 51 mmhg hr 123 beats minute rr 36 breaths minute spo\u2082 87 on room air the pain started an hour ago she is being managed for malaria the pain radiates to the back and her left jaw no pain medications were administered has had similar chest pain without a heart attack in the past i have placed her on oxygen 2l she is deteriorating on my assessment ecg shows no st changes a what medication can we give for her pain give morphine for the chest pain administer nitroglycerin to improve perfusion and also help with the chest pain aspirin can also be given to help with thrombolysis give supplemental oxygen b which investigations should be done electroencephalogram echo cardiogram cardiac enzymes chest x ray complete blood count kidney function tests c how do you plan to inform the family about her change in condition be calm and composed even if the family is emotional or upset tailor the information to the family\u2019s level of understanding be ready to repeat or clarify information as needed differentials myocardial infarction angina pulmonary edema severe malaria" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 68 years old female with complaints of abdominal pains and bleeding per vaginal for the last 2 months has dizziness on and off and weak reports that menopause set in at 48 years has 12 children all alive and well she resides in the village and does a lot of work on palpation has abdominal mass abdomen is tender vitals temp 37 0 degrees celsius p 90b min r 18 bp 130 90mmhg spo2 96 questions what is the immediate management which is the most appropriate radiological should be done how can the patient be assisted to understand and participate in her care and recovery\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 50 year old female reports a week of fever abdominal pain and frequent watery diarrhea she recalls eating undercooked poultry three days before the symptoms began examination reveals mild abdominal tenderness and dry mucous membranes investigations perform stool and blood cultures to confirm typhoid fever plan administer iv fluids to address dehydration start antibiotics such as ceftriaxone and azithromycin monitor for complications including intestinal perforation or sepsis diagnosis typhoid fever" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 30.0\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 30 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 24 year old female with complains of pv bleeding and lower abdominal pain for one day history passing blood clot per vigina associated with excruciating pain pains are contraction in nature no history of fever or headache last menstrual period was on 13 9 2024 reports to have been given some meds to put under her tongue at a chemist on examination she is afebrile sick looking no pallor nor jaundice vitals blood pressure 120 70 temperature 36 pulse 70 respiration 20b min other systems are normal viginal examination not done diagnosis incomplete abortion plan patient referred for mva and related management for obstetric ultrasound and cbc questions how could this patient been managed at a primary health facility which investigations could have been done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 24 year old female with per vaginal bleeding and lower abdominal pain for 1 day history of passing clots per vaginal associated with excruciating pain that is contracting in nature last period was 13 9 2024 12 40 reported to have been given a drug to put under her tongue at a chemist she is afebrile sick looking no pallor no jaundice vitals are bp of 120 70 temperature of 35 pulse of 70 and rr 20bpm she was referred for mva and related management q1 how could this patient have been managed at a primary health facility fix an iv line 2 large bore and give iv fluids give iv analgesics to reduce the pain give iv antibiotics to prevent infections q2 which investigations could have been done full hemogram to rule out severe anemia and sepsis with white blood cell count diagnosis induced incomplete abortion" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 15.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 15 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya this is a man 40 years old he came to the hospital has been diagnosed with hiv and he defaulted drugs and now he has come with a temperature of 40 and has difficulty in breathing and productive cough then he was done investigations of sputum he s having tb then he said that he s not going to take any drug so how can you deal with it the question is this patient is very sick and he has refused to take drugs how do you deal with that patient from there onwards\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 40 year old male diagnosed with hiv and defaulted drugs presented with dfficulty in breathing and and productive cough sputum analysis confirmed pulmonary tb insists he will not take nay drugs diagnosis pulmonary tuberculosis in a newly diagnosed hiv patient non compliant to medications the initial management determine whether the patient requires admission in the active setting there is a positive history of difficulty in breathing so a baseline sp02 to determine whether 02 supplementation is required should be done secondly whether as in patient or outpatient isolation protocol should be initiated to prevent further spread this should be accompanied by contact tracing and public health department involvement as we approach medication for such a patient counseling should be initiated on the need for therapy for him including consequences for not taking said medication in terms of this specific case this is a newly diagnosed hiv patient with concurrent ptb as we begin counselling on importance of therapy priority should be put on initiating anti tb\u2019s first for at least 2 weeks before initiating arvs due to risk of iris immune reconstitution inflammatory syndrome the psychological counselling should include next of kin and should be continuous to increase chances of success" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 14.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 14 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 21 year old para 1 0 g2 comes to the maternity with a history of reduced fetal movements on assessment she has generalized edema bp 152 110mmhg pulse 92 b min and temperature 36 1 c questions what is the immediate management for the client which investigations will be performed to confirm the diagnosis\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 21 year old para 1 gravida 2 with a history of reduced fetal movements on assessment she has generalized edema with a hypertension of 152 110 mmhg other vital signs are normal this presentation is consistent with a hypertensive disorder in pregnancy the presentation necessitates management by an obstetrician admit the patient urgently ensure the airway is patent and suction any visible secretions monitor oxygen saturations and administer oxygen therapy if oxygen saturation is below 92 obtain intravenous access and draw samples for blood catheterize the patient and chart urine output determine the patient s gestation as this wasn t included and classify the specific disorder if a patient is a chronic hypertensive patient continue antihypertensive if a diagnosis of pre eclampsia is reached administer intravenous antihypertensives such as intravenous labetalol if severe features are present administer intravenous magnesium sulfate for seizure prophylaxis and monitor for magnesium sulfate toxicity depending on the gestation administer zinc for fetal neuroprotection administer intravenous corticosteroids if severe features persist and delivery is imminent before 34 weeks gestation monitor the fetus well being restrict fluid intake administer anticonvulsants in the event seizures occur laboratory investigations perform serial complete blood count to evaluate for features of hemolysis or low platelets perform liver function tests to check involvement of the liver perform renal function test by checking urea electrolytes and creatinine levels perform urinalysis to evaluate for proteinuria imaging perform an obstetric ultrasound to evaluate fetal well being in case convulsions occur an electroencephalogram may be needed to rule out other causes of convulsions" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: nan\n - Nursing Specialty: mental health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a national referral hospitals in uasin gishu county in kenya a 38 years old lady brought in history of confusion agitation hallucinations and convulsions has a history of chronic alcohol use but stopped 2 weeks ago bp 130 80 mmhg p 85 t37 rr 20 questions what s the diagnosis what immediate management is required\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 38 year old lady brought in with a history of confusion agitation hallucination and convulsions has a history of chronic alcohol use but stopped 2 weeks ago blood pressure 130 80mmhg pulse rate 85 temperature 37 respiratory rate 20 the main concerns in this case are alcohol withdrawal syndrome convulsive disorder hypoglycemic and electrolyte disturbances differential dx alcohol withdrawal syndrome the immediate management includes the patient should be on continuous vital signs monitor and ensure a random blood sugar test is done and managed as per result if hypoglycemic give 50ml of 50 dextrose bolus early thiamine supplementation before glucose administration if available we need to manage the convulsions benzodiazepines are the gold standard after initiating parenteral benzodiazepines once convulsions are settled transition to oral benzodiazepines to manage the agitation and possible tremors if present correct any electrolyte disturbances once stable refer for psychotherapy and rehabilitation" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 30.0\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 30 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 32yr old female presents with lower abdominal pains and backache for 2 weeks has been treated for urinary infections but the pain persists on examination tenderness on palpation and vaginal discharge temp \u2013 36 1oc pr 90b min rr 18b min bp 110 70 mmhg spo2 \u2013 98 questions what would be causing the abdominal pains what investigations need to be done what is the appropriate management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 32 year old female with 2 week history of lower abdominal pains and back ache for two weeks has been treated for uti but pain persists on examination tenderness on palpation and vaginal discharge vitals are normal differential diagnosis pregnancy which might be normal or ectopic recurrent uti pelvic inflammatory disease bacterial vaginosis candidiasis i would like to manage the patient as follows analgesics for pain management iv fluids catheterization monitor input and output antibiotics antifungals clotrimazole pessaries if ectopic pregnancy surgical intervention by gynecologist investigations as follows labs urinalysis pregnancy test serum beta hcg fhg uecs ltfs vdrl gxm radiological investigation abdominopevic ultrasound kub ultrasound" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 1.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 1 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 14 year old was referred to a facility for treatment of hepatic failure and hypertension he had a 3 days history of fever up to 400c malaise mild headache and few episodes of non projectile vomiting he was under medication ibuprofen on assessment bp 75 46mmhg temp 38 1c questions what nursing intervention will i implement what do i do as call for the clinician\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 14 year old referred for treatment of hepatomegaly and hypertension had a history of fever t 40 malaise mild headache and few episodes of non projectile vomiting on ibuprofen on exam bp 75 46 t 38 1 i would manage the patient as follows analgesia avoid paracetamol iv fluids to treat shock as you monitor blood pressure electrolyte imbalance correction give antiemetic lactulose rifaximin lab full hemogram peripheral blood film liver function tests triple serology urea electrolytes and creatinine radiology abdominal pelvic ct scan echocardiography" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: nan\n - Nursing Specialty: surgical care\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse working in a health centres in kakamega county in kenya a 45 year old man was brought to the opd urgently with a distended abdomen it reportedly started 2 days ago and has been increasing in size with so much pain on assessment the abdomen is distended with a non tender consistency and very painful diagnosis intestinal obstruction an abdominal ultrasound will be done to confirm the diagnosis an ambulance was called for urgent referral to a higher level for investigation and subsequent management what might have caused the abdominal obstruction what other investigations are needed to make a diagnosis will the patient benefit from laparotomy\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 45 year old man with a 2 day history of abdominal distension and severe abdominal pain problems abdominal distension abdominal pain management intravenous fluid resuscitation to prevent dehydration correction of electrolyte imbalance with intravenous potassium insertion of nasogastric tube to decompress and relieve symptoms of distension and vomiting administration of analgesics to manage pain immediate referral to a higher level hospital for further evaluation including imaging monitor vital signs especially heart rate blood pressure and assess for signs of shock investigations abdominal ultrasound abdominal x ray to check for air fluid levels complete blood count to check for signs of infection renal function test to check for kidney involvement differential diagnoses intestinal obstruction peritonitis acute pancreatitis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 14.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 14 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 30 year old woman who came to the maternity wing has severe abdominal pains after a fall she reports per vaginal bleeding she is pale dizzy bp 90 50 mmhg pulse 98 bpm spo2 88 question how could this case be handled\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a case of a 30 year old brought to maternity severe abdominal pain after a fall reports per vaginal bleeding she is pale and dizzy hypotensive how to handle the case this is a gynecological emergency stabilize patient abcs airway breathing circulation stop the bleeding ensure intravenous access for samples and therapy administer intravenous fluids monitor vital signs progressively insert catheter give analgesics for pain investigation blood tests complete blood count coagulation profile cross match blood grouping abdominal pelvic ultrasound urgent alert a higher facility for possible referral" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: nan\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse working in a health centres in kakamega county in kenya a mother brought in a child six months old with the issue of diarrhea and vomiting for the last four days diarrhea is greenish in color today morning he has diarrhea four times but breastfeeding well on examination no pallor no jaundice no dehydration temperature within normal ranges b s for m p s negative was i to treat diarrhea with no dehydration was i to treat with antibiotics or just treat with the zinc plus ors then come back after seven days to refer the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 6 month old child is brought in with diarrhea and vomiting for the last four days the diarrhea has been greenish in color today he has four episodes of diarrhea but is breastfeeding well normal vitals blood slide for malaria parasites is negative was i to treat diarrhea with no dehydration yes the baby is losing a lot of water and would most likely start losing weight was i to treat with antibiotics or just treat with zinc plus ors the diarrhea is most likely non infectious and thus management should involve zinc sulfate and oral rehydration solution dx gastroenteritis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kiambu county in kenya a mother comes in with a baby two years old with complains of cough fast breathing and slight fever mother reports it s a recurrent condition on this baby on examination fever is 37 6 degrees centigrade pulse is 124 beats per minute respiration is 28 beats per minute all other parameters appeared normal question 1 what is the priority treatment for this baby question 2 what is the most appropriate health message for the mother question 3 what are the vaccines advised in this case\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a mother comes in with a baby two years old with complaints of cough fast breathing and slight fever mother reports it s a recurrent condition on the baby on examination vitals temp 37 6\u00b0c pr 124 rr 28 all other parameters are normal diagnosis pneumonia a what is the priority treatment for this child 1 administer antipyretics to curb the fever 2 administer intravenous fluids 3 administer antibiotics for suspected infection 4 administer oxygen b what is the most appropriate health message to this mother 1 to be able to recognize danger signs such as difficulty in breathing elevated temperature etc and rush to the hospital 2 make sure she completes the drug dosages administered in the hospital 3 she should also be told to avoid triggers such as exposure to cold 4 the mother should also be given nutrition advice" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 5.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 5 years of experience in general nursing working in a sub county hospitals and nursing homes in kakamega county in kenya an 18 year old pregnant gravida was brought in second stage of labour on examination the abdomen is normal and the pelvis is adequate she had stayed in second stage for over one hour and still has not delivered should i try assisted delivery or should i prepare for cs\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 18 year old pregnant gravida was brought in a sub county hospital in a second stage labor on examination the abdomen has normal findings and the pelvis is adequate she has been in second stage of labor for over 1 hour and has not delivered yet dx prolonged 2nd stage labor management reassure the patient give iv fluids to help increase the contractions give oxytocin to increase the strength of the contractions ask the mother to push only when she has contractions to prevent her from getting tired plan for assisted vaginal delivery since her passage is adequate we can try assisted vaginal delivery you can do an episiotomy and vacuum to help with delivery" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 26.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 26 years of experience in general nursing working in a sub county hospitals and nursing homes in kakamega county in kenya a 60 year old man came to outpatient department with history of inability to urinate for one day on examination the bladder was distended and tender observations taken temperature was 36 4 degrees pulse was 90 blood pressure was 110 over 80 an impression of bph was made so what should i do to confirm the diagnosis should i catheterize the patient first before i send the patient for ultrasound or should i refer this patient to a higher facility for further management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "60 yr old inability to urinate how to confirm diagnosis of bph other than a leading history and rectal exam that reveals enlarged prostate the following is done prostatic ultrasound psa rules out cancer of the prostate a patient who has urine retention requires catheterization of the ultrasound a spicot may be used if the sonographers wish to perform the test o a full bladder diagnosis urine retention due to bph" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 14.0\n - Nursing Specialty: obstetrics emergency\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 14 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 24 year old comes in second stage of labor with cord presentation para 1 0 with a history of precipitate labor assessment upon examination there is cord prolapse and continuous urge to push a fresh still birth is delivered thereafter questions what is the relationship between precipitate labor and cord prolapse what is the benefit of emergency caesarian section in this case\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 24 year old in the second stage of labor with cord prolapse and precipitate labor stillbirth delivered differential diagnosis still birth cord prolapse precipitate labour question is there a relationship between cord prolapse and precipitate labor assessment no relationship exists the cause could be amniotomy or prolonged labor management emergency cesarean section minimizes oxygen deprivation to the fetus reducing complications and improving survival" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 15.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 15 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya a middle aged man comes in the clinic with complaint of severe chest pain and left shoulder pain acute on onset for the last three hours on examination the patient is restless in severe pain and difficulty in breathing he is a known hypertensive patient for the last five years non compliant to the treatment the bp at that time was 170 over 100 saturating 90 percent in room air can this patient be suffering from myocardial infarction due to the non compliance of the drug and which is the best drug to start the patient on and if i m not able to get an urgent ecg to roll out what else can i do to this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a middle aged male patient has presented at the clinic with severe chest pain and left shoulder pain he has been hypertensive for the past five years and is on medication on examination he is restless in severe pain and has difficulty in breathing bp is 170 100 mmhg spo2 is 90 on room air investigation labs troponin full haemogram urea creatinine and electrolytes echocardiogram electrocardiogram chest x ray management this patient is concerning for myocardial infarction he has angina pectoris the severe left sided chest pain the best drug to start the patient on is analgesics dual antiplatelets anticoagulants beta blockers statins refer to a cardiologist" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 16.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 16 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya this is mr julius a 29 year old businessperson with a background of alcohol dependence who was brought in by ambulance after being found unconscious in the street was witnessed to have a full body fits lasting 5 minutes and later becoming unconscious had an episode of urine incontinence and bit his tongue he reports to have had 2 episodes before the mother was epileptic he lives in a storey building the vital signs are normal questions how can we confirm if the convulsions are of metabolic or infectious cause how can he be managed\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 25 year male with loss of consciousness history of alcohol dependence and prior seizures diagnosis brain hematoma management evaluation history and physical exam to identify probable causes investigations full hemogram blood gas analysis c reactive protein random blood glucose urea electrolytes and creatinine emergency care check airway immobilize cervical spine administer oxygen if saturation 90 establish intravenous access provide intravenous fluids if hypotensive check gcs score administer dextrose if hypoglycemic conduct trauma evaluation medical therapy administer anticonvulsants for seizures provide sedatives if agitated" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : county hospitals\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a county hospitals in uasin gishu county in kenya a 30 year old gravid woman para 2 0 was brought to ante natal clinic with complains of lower abdominal pain radiating to the back for two days gestation by date 38 weeks she also reported watery discharge two days ago the mother weighs 102kg b p 139 80 mmhg pulse rate of 99 b min spo2 92 on assessment vaginal dilatation 6 cm pulsating cord present just above the vagina questions what was the immediate care to the mother what is the relationship between cord presenting and the watery discharge\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 30 year old female with a cord prolapse at 30 weeks gestation ddx cord prolapse cors presentation spontaneous rupture of membranes may lead to the umbilical cord rushing out of the uterus and being the presenting part at the cervical canal this is a concern since the head of the baby may push against the umbilical cord thus cutting off its blood supply this is an obstetric emergency the patient should be asked to be on her fours with her chest on the bed and a healthcare worker to support the umbilical cord the patient should immediately be rushed to the theatre for an emergency caesarean section" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 12.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine psychiatry\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya a 24 year old patient is brought to the emergency department after he was rescued while trying to commit suicide by hanging on assessment there are lacerations on the neck what is the management of this patient and what reassurance do i give the relatives\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 29 year old pt is brought to the facility after attempted suicide by hanging differential diagnosis suicide attempt manage your patient as follows 1 monitor vital signs 2 ensure airway patency 3 administer oxygen if needed imaging ct or mri may be needed consider psychiatric evaluation explain the patient\u2019s condition to the relatives offer information about support resources hotlines encourage them to seek professional counseling for them to cope with the situation" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 20.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 2year old male child comes to the clinic escorted by his mother with complains of having hotness of the body rashes all over the body and scratching a lot for 2 days the mother had given him paracetamol on examination febrile t 39 p 120bpm r 22bpm eyes looking red question what is the priority care of the boy how can we prevent complications of the diagnosis\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 2 yr old male comes with hotness of body rashes all over body and scratching a lot for 2 days with redness of eyes patient is febrile tachycardic diagnosis sepsis problems hotness of body fever scratching a lot itchiness rashes redness of eyes management administer antipyretic for the hotness of the body administer antihistamine for the rashes and scratching refer to the ophthalmologist for checking the eye problem refer to a dermatologist for checking up the skin irritation investigations do a full hemogram to rule out infection do a blood slide of malaria due to hotness of body do a renal function test to rule out sepsis due to the hotness of body and tarchycardia do a liver function test to rule out liver injury do a crp do a stool for ova and cyst because anthelmintic can cause allergy" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 15.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 15 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya an 8 year old boy is brought in by the mother in the occupational department for routine check up and assessment mother reports the boy has been having cerebral palsy since birth and of late she has been having congested chest with no cough and convulsions on and off and has been on treatment how do you manage convulsive disorder in a cerebral palsy patient and how do we counsel this mother to be able to live with this child which other treatments how do you manage cerebral palsy\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary an 8 year old brought in for a routine check up in the occupational department history of cerebral palsy since birth with recent of chest congestion with no cough or convulsions a management of convulsive disorder in a cerebral palsy patient 1 assess for life threatening signs check airway breathing and circulation intravenous anticonvulsants therapy for seizure control like diazepam phenytoin levetiracetam 2 tracking of seizure frequency duration and characteristics for management plan 3 identification and rx of potential triggers i e fever infection sleep deprivation medication non compliance stress e t c 4 follow up with neurology after relevant investigations like head ct scan and mri b counselling of the mother 1 explain to the child the condition adequately including etiology prognosis and management 2 acknowledge her concerns and emphasize with her challenge 3 refer to psychologist for family therapy 4 encourage mother to practice self care as well c other management vaccinations especially with influenza vaccine nutritional support with adequate hydration d management of cerebral palsy assess respiratory status chest physiotherapy and postural drainage for clearance of secretions monitor for aspiration as risk of aspiration pneumonia is present in cp on account of swallowing difficulties refer to nutritionist if there are swallowing difficulties physical therapy to improve muscle strength flexibility and coordination occupational therapy to increase child independence speech therapist speech swallowing difficulties orthopaedic referral for deformities in posture botox injections in kids with muscle stiffness" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 12.0\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a dispensaries and private clinics in kakamega county in kenya a 45 yr old client request for fp services history of breat cancer on hormonal treatment mastectomy done 2 years ago client request for long term method which is the best fp method to administer\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 45 year old client requesting for family planning services has a history of breast cancer on hormonal treatment mastectomy was done two years ago the patient is interested in a long term family planning method what is the best method hormonal contraceptives are a risk factor for breast cancer hence not appropriate for a patient with a history of breast cancer non hormonal methods of contraception will therefore be recommended such as copper iud differential diagnosis hormonal choices" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kiambu county in kenya 20 year old woman comes to the facility and has been on depo provera as a family planning method had complaints of intermittent pv bleeding for the last six months how do i manage the hormonal imbalance should i counsel for an alternative method\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 20 year old woman on depo provera with intermittent pv bleeding for 6 months a management of hormonal imbalance progesterone therapy for endometrial stabilization and reduction of irregular bleeding if depo provera is the proven cause of imbalance manage any other cause of hormonal imbalance i e thyroid disorders or other endocrine disorders accordingly give methimazole or propylthiouracil for any hyperthyroidism treat any pelvic infections that would be the cause of bleeding manage any endometrial pathology i e fibroids malignancy polyps adenomyosis etc b yes counsel on depo provera alternatives i e barrier methods i e condoms copper intrauterine device \u2192 non hormonal methods combined oral contraceptives \u2192 regular bleeding is restored with a predictable menstrual cycle" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 30.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 30 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 30 years old male patient complains of swollen right foot tender and warm to touch temperature 36 c respiration rate 20b min sp02 \u2013 98 room air blood pressure \u2013 110 20 mmhg questions how can this patient be managed what is the differential diagnosis what is the preferred diagnosis what investigations should be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 30 year old male presents with swelling in the right foot tender and warm on palpation management 1 perform complete blood count urea electrolytes creatinine c reactive protein and x ray of the foot 2 if fracture is confirmed apply plaster of paris 3 if cellulitis is confirmed administer antibiotics 4 provide analgesics for pain relief dx cellulitis abscess fracture of foot bones" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 2.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 2 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 3 year old child presents with hotness of the body pain on swallowing and neck pain on assessment there is bilateral tonsil enlargement and inflammation temperature 38 2 pr 121b m spo2 93 rr 18 question what could be the possible diagnosis of this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 3 year old child presenting with hotness of the body pain on swallowing and pain in the neck the child has bilateral tonsil enlargement on physical assessment dx acute tonsillitis which is an inflammation of the tonsils mostly caused by viral and bacterial infections" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 36 year old is in the emergency c o severe abdominal pain and loose diarrhea after feeding in a party four hours ago the patient has diarrhea after 10 minutes nonstop on examination pt has dry mouth dry skin sunken eyes lethargic and requests a diaper because she can\u2019t hold the loose stool vitals t \u2013 36 2 c resp \u2013 18 r m pulse \u2013 116 b m bp \u2013 98 64 mmhg questions what is the immediate management of the condition what is the management of the patient what are the investigations to be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 36 year old patient presents to the emergency department with severe abdominal pain and profuse diarrhea patient exhibits dehydration including dry skin sunken eyes and lethargy patient is tachycardic and hypotensive problems severe dehydration sunken eyes lethargy dry skin tachycardia hypotension profuse diarrhea abdominal pain management start iv fluids to replace ongoing loss add potassium administration to iv fluids once urine output adequate to correct hypokalemia administer empiric antibiotics if bacterial gastroenteritis is suspected encourage oral rehydration solution as soon as the patient can tolerate oral intake avoid antimotility agents e g loperamide initially as they may worsen toxin mediated diarrhea investigation stool analysis for microscopy cultures stool tests for ova cyst urea electrolytes and creatinines complete blood count to check for signs of infection blood cultures to rule out septicemia abdominal ultrasound to rule out other causes of pain such as appendicitis provisional diagnosis acute gastroenteritis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 24.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 24 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 67 year old female came to our facility with complaints of gradually becoming unable to walk upright the spine is bent and now she walks holding a stick she reports that there are other old men and women in their village like her she says the problem started 3 years ago but there was nobody to complain to since she lives alone vital signs bp 100 60 mmhg pulse \u2013 70 rr \u2013 18 investigations rbs 0 7 9mmol l questions what is the diagnosis what might be the cause of the curving spine\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 67 yr old female with inability to walk upright for past 3 yrs vitals normal what causes the curving of the bone caused by common spine degeneration due to osteoporotic changes leading to osteoarthritis of the joint in the vertebra decreased bone space with the body weight leading to curvature diagnosis kypho scoliosis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: elgeiyo marakwet\n - Health level\t : county hospitals\n - Years of Experience: 1.0\n - Nursing Specialty: neonatal care\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 1 years of experience in general nursing working in a county hospitals in elgeiyo marakwet county in kenya a 6 day old male neonate is brought by her mother and presents with a distended abdomen feeding intolerance green colored vomiting for 3 days on assessment neonate is lethargic sick looking there is blood in stool with dry mucous membrane v signs t 35 5oc spo2 96 on room air rr 45b min rbs 1 8 mmol l questions how can the baby be managed what investigations would be required\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary an 8 day old neonate presents with abdominal distension feeding intolerance bilious vomiting lethargy blood stool and hypoglycemia differential diagnosis necrotizing enterocolitis neonatal sepsis intestinal atresia labs 1 complete blood count rule out infection 2 urea electrolytes and creatinine assess kidney function and electrolyte imbalances 3 blood cultures imaging 1 abdominal x ray rule out atresia management 1 broad spectrum antibiotics 2 intravenous fluids 3 dextrose for hypoglycemia 4 keep npo 5 pediatric surgery review" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 17.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery opthalmology\n\n Prompt from the nurse : i am a nurse with 17 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 20 year old male is brought to the emergency department with severe headache for the last 2 days there is a history of a fall during rugby game on examination patient is in pain right orbital oedema right red eye vitals temp 36 2 resp 12b m pulse 94b m bp 130 70 mmhg pain 8 questions what is happening to the patient what is the immediate management who should be consulted on the management of the patient which laboratory tests and radiological investigations will aid in the management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 20 year old male with a severe headache for the last 2 days there is a history of a fall on examination patient is in pain right orbital edema right red eye vitals stable concerning for head injury i would therefore manage the patient as follows 1st pur a cervical collar analgesics for pain management mannitol if spo2 90 give o2 elevate heat at 30 degrees phenytoin laboratory investigations x0001 x0001 x0001 radiological investigation uecs x0001 x0001 x0001 x0001 x0001 x0001 head ct scan lfts fhg a neurosurgeon should be consulted an ophthalmologist should also review the right red eye" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 17.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 17 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 8 year old girl presents with anorexia tachypnea and vomiting one week ago she had low grade fever cough and runny nose on assessment the patient is fatigued with abdominal pain vitals temp 36 resp 36 hr 140b m bp 70 30 mmhg chest radiograph shows massive cardiomegaly questions what is the diagnosis and differential diagnosis which treatment strategies take priority what laboratory tests or other studies should be ordered\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 8 year old girl presents with anorexia tachypnea and vomiting one week ago she had low grade fever cough and runny nose on assessment the patient is fatigued with abdominal pain on examination is hypotensive tachycardic and tachypnoeic chest radiograph shows cardiomegaly what is the diagnosis and differential diagnosis this is most likely rheumatic fever with features of left sided heart failure due to rheumatic heart disease the differential diagnosis is infective endocarditis which treatment strategies take priority fluid resuscitation to improve the blood pressure ondansetron to prevent vomiting investigations to be done include full hemogram to assess infection urea electrolytes and creatinine to assess for features of acute kidney injury" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 16.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 16 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 40 year old female comes with headaches joint pains chest pain running nose dry cough and general body weakness for 3 days she reports sudden onset she has been on acetaminophen with no relief temperature 37 8 degrees celsius pulse 94 bpm spo2 94 on room air blood pressure 121 79 mmhg respirations 20 breaths minute question what is the diagnosis\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 40 year old female has a 3 day history of headache joint pain and chest pain she also has an associated running nose dry cough and general body weakness for 3 days she\u2019s been on acetaminophen with no relief the vitals are normal the likely diagnosis is pneumonia with differentials of pulmonary tuberculosis and malaria the immediate management involves the administration of analgesics to relieve the pain preferably nsaids take samples for complete blood count \u2013 to check for signs of infection crp bs for mps treat definitively based on the results of the investigations" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 23.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 23 years of experience in general nursing working in a dispensaries and private clinics in uasin gishu county in kenya a 25 year old female at 30 weeks gestation came to the outpatient clinic with elevated blood pressure of 160 110 mmhg she complained of headache and swelling of the hands and feet for the last week she has no past medical history on examination temperature 36\u00b0c pulse 96 beats per minute respiration rate 18 breaths per minute questions what is the immediate management what are the investigations to be done what might cause the elevated pressure\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 25 year old female patient at 30 weeks gestation presenting with elevated blood pressure of 160 110 mmhg she also complains of headache and swelling of the hands and feet for 1 week the immediate management of this patient is to 1 x0001 stabilize the blood pressure by administering intravenous antihypertensives such as labetalol to gradually lower the bp 2 x0001 provide bed rest and nursing in a quiet room 3 x0001 administer magnesium sulphate for prevention of eclamptic seizures 4 x0001 monitor maternal well being by regularly taking vital signs 5 x0001 monitor fetal wellbeing by fetal heart rate movement some of the investigations to be done for this patient include 1 x0001 complete blood count to check anemia infection platelet levels 2 x0001 liver function test to check bilirubin levels to rule out hemolysins end organ damage 3 x0001 urea electrolyte creatinine to assess for end organ damage 4 x0001 urinalysis to check for protein in urine 5 x0001 obstetric ultrasound to evaluate fetal growth 6 x0001 umbilical doppler studies to monitor fetal wellbeing 7 x0001 non stress test to check for any signs of a non reassuring fetal status the possible cause of the elevated blood pressure for this patient is a poor implantation of the placenta causing remodelling of the spiral arteries within the uterus leading to ischemia and the release of inflammatory mediators that cause a dysfunction of the blood vessels other possible causes include genetic inheritance underlying systemic disorder such as a kidney disease among other conditions" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 27.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 27 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 7 year old boy was brought to the facility by his mother with complaints of body temperature headache photophobia loss of appetite and a high pitched cry on examination the child had a bulging fontanelle and mild dehydration observations temperature 38 9\u00b0c pulse 80 beats per minute respiration rate 26 breaths per minute spo 94 recommendation mother advised to loosen and expose child\u2019s clothes to lower the temperature referred for further management questions a how does a child with meningitis present b what is the immediate care\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 7 year old boy with complains of headache hotness of body and photophobia associates high pitched cry on examination bulging fontanelles and mild dehydration the patient is febrile and tachypneic the presentation is concerning for meningitis with differentials of i malaria ii pneumonia meningitis typically presents with headaches fever neck stiffness photophobia on physical examination positive brudzinski\u2019s sign positive kernig\u2019s sign signs of raises intracranial pressure maybe present the patient requires referral and admission assess the patient\u2019s airway for patency administered oxygen therapy to support ventilation obtain intravenous access and draw samples for blood work access circulation status and rehydrate as necessary assess for disabilities by performing a glasgow comma scale score and observing pupillary reactions administer empiric antibiotics therapy after drawing blood and cerebrospinal fluid for gram staining and culture if signs of intracranial hypotension present avoid lumbar puncture administer antipyretics administer dextrose as part of the iv fluids to cover up for the nutritional deficiency lab investigations perform a full hemogram for signs of infection microscopy culture and sensitivity of cerebrospinal fluid or blood to isolate micro organisms perform acute phase reactants assay if available e g c reactive protein levels if signs of raised intracranial pressures persist a head ct scan is preferred to rule out any space occupying lesions diagnosis meningitis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 27.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 27 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 20 year old female patient came to the clinic complaining of abdominal fullness and discomforts blood stained diarrhoea and nausea since last night she says she had taken supper at a nearby kiosk after which the pains began she has had diarrhoea x5 on examination she has poor skin turgor sunken eyes and dry lips she verbalizes abdominal pains vital signs bp 111 73 mmhg p 78 min sp02 98 temp 36 9\u00b0c resp 22 min questions what could be the differential diagnosis how can she be managed\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "case summary a 20 year old female presents with abdominal fullness discomfort bloody diarrhea nausea and vomiting symptoms followed meals ingested at a hotel diarrhea persisted for 12 hours examination findings poor skin turgor sunken eyes dry lips vitals bp 112 73 mmhg p 78 bpm spo\u2082 98 r 22 min t 36 9\u00b0c diagnosis dysentery with dehydration management iv fluids to correct dehydration administer pain medication full hemogram stool analysis review results and treat according to the case findings" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 1.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 1 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya 67 years old female came to the facility having dysponea and bilateral lower limb swelling that was gradual for one week she had been to a health centre and was discharged with some antibiotics but not known questions whom can i consult what is the treatment regime for such a patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 67 year old presents to a sub county hospital with dyspnea and bilateral lower limb swelling for 1 week whom to consult cardiologist to evaluate the patient and manage congestive heart failure nephrologist to assess renal injury physician to address treatment for the patient supportive management oxygen \u226495 therapy if the patient has a dyspnoea spo\u2082 of diuretics to address the lower limb swelling investigation complete blood count to rule out infectious processes urea electrolytes and creatinines to assess renal function echocardiography electrocardiograph to assess the heart and the lungs impression congestive heart failure" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 20.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 40 year old female complains of chest tightness coughing especially evening and morning times she is known asthmatic patient on franol inhaler on examinations patients has wheezing sound during auscultation and shortness of breaths questions what should i immediately do to relief the symptoms should be there be adjustment change of medications\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 14 year old female with complaints of chest tightness and coughing especially in the evening or mornings known asthmatic on franol inhaler presents with wheezing sound and shortness of breath concerns 1 chest tightness coughing 2 relieve symptoms 3 what adjustment should be done to their medication differential diagnosis controlled asthma immediate management requires 1 relievers short acting beta 2 agonists salbutamol or terbutaline 2 add an inhaled corticosteroid 3 monitor vital signs reassess the patient consider the following adjustments 1 combination therapy long acting bronchodilators inhaled corticosteroids 2 add leukotriene receptor antagonists 3 avoid triggers 4 regular follow up consult a physician to determine the best course of action" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 18.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 18 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 45 year old female presents to the emergency department with dizziness and light headedness her blood pressure is 85 55 mmhg she has a history of hypertension treated with lisinopril she reports a 2 day history of vomiting and diarrhoea after eating at a restaurant no recent changes to medications assessment the patient appears pale capillary refill is delayed at 4 seconds heart rate is 115 bpm and she is afebrile questions should we initiate iv fluids immediately if so what type and rate are additional diagnostics e g bloodwork ecg required at this stage\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 45 yr old hypertensive on lisinopril comes in with 2 day hx vomiting after eating in a restaurant bp 85 55 mmhg cap refill 4 sec hr 115 diagnosis shock hypovolemic secondary to acute gastroenteritis question should we initiate fluids yes iv fluids additional diagnostics \u2713 urea electrolytes and creatinine \u2713 full hemogram \u2713 c reactive protein \u2713 echocardiogram \u2713 electrocardiography" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in uasin gishu county in kenya neonate 1 week old from langas brought in the eye clinic mother complains of severe yellow discharge sticky swollen eyes and baby not opening the eyes assessment the baby of home delivery not clean environment vital signs were good pulse 120 beats minute temperature 38 8 degree celsius the baby looked sick questions what could have been the cause what could be the acute immediate intervention what could this complicate to\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "1 week old neonate brought to the eye clinic with severe yellow sticky discharge swollen eyes and unable to open eyes home delivery has fever sick looking differential diagnosis infection from mother during delivery gonorrhoea chlamydia trauma from birth immediate management stabilize patient by antipyretics empiric antibiotics eye drops swab of discharge for microscopy culture and sensitivity administer anti inflammatory medication for swollen eyes examine mother to locate source of infection possible complications vision loss keratitis orbital cellulitis bacteremia sepsis meningitis hearing loss from complicated otitis media" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 22.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 22 years of experience in general nursing working in a dispensaries and private clinics in uasin gishu county in kenya a 14 year old female is brought to the dispensary with complains of severe left upper quadrant pain that is worsening over the last one day and vomiting yellow in color no past medical history and not on any medication vital signs temperature 38 bp 132 78mmhg and pr 92 b m question 1 what investigations can be to this client 2 what is the possible management for this client\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 14 year old female was brought to the dispensary with complaints of left upper quadrant pain that worsened over the last one day and vomiting yellowish colored vomitus no history of using any medications or taking any meals has a fever of 38\u00b0 other vitals are normal differentials malaria intestinal obstruction sickle cell crisis investigations do a blood sample for malaria and rapid diagnostic test for malaria do a peripheral blood film and sickling test do an erect abdominal x ray if available to check for any obstruction abdominal ultrasound if available to check for liver enlargement management depends on the cause could refer for further management if suspecting intestinal obstruction or hepatitis antimalarials \u2192 if suspecting malaria supportive management 1 give iv fluids \u2192 ringer\u2019s lactate combine with dextrose if not feeding well 2 give analgesics e g paracetamol rule out hepatitis first 3 give antipyretics for the fever" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 20.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing and primary care working in a health centres in uasin gishu county in kenya a 32 year old male comes to the clinic with a history of severe piercing pains in the left eye for 1 day he has no history of eye problems before there are no pains in the right eye he cannot see well with the left eye due to pain there s no history of trauma in the eyes vital signs bp 111 69mmhg p 78 min temp 37 0\u00b0c sp02 98 resp \u2013 20b min questions what is the immediate intervention how can he be managed\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 32 year old male with a history of unilateral severe piercing pain in the left eye for 1 day associated with a visual disturbance on that eye no history of eye trauma or any eye problems before vital signs are unremarkable diagnosis acute glaucoma management obtain the intraocular pressures if elevated start iv medication with drugs for glaucoma such as beta blockers elevate the head of the bed administer intravenous analgesics for the severe pain administer empirical antibiotics administer cycloplegics to minimize corneal irritation and reduce intraocular pressure pad the eye to provide relief from photophobia refer to ophthalmologist investigations that can be carried out include further evaluation of the optic nerve via fundoscopy and visual field examination should be done by a specialist notably the right eye should also be evaluated for any features of raised intraocular pressure by tonometry examination of the degree of angle closure by gonioscopy" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 15.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 15 years of experience in primary care working in a sub county hospitals and nursing homes in uasin gishu county in kenya an expectant mother was sent to the lab for an anc profile her tests were normal except that hepatitis b results were positive her gestation is 24 weeks and is known to have hiv on treatment questions can this condition be transmitted to the infant how can this be managed\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary an expectant mother was sent to the laboratory for anc profile her tests were normal except that hepatitis b was positive her gestation is 24 weeks and is known to be on treatment for hiv can hepatitis be transmitted to the baby hepatitis b is primarily transmitted to the baby during delivery through exposure to infected maternal blood or fluids the risk of transmission is higher if the mother has a high viral load of hbv for management in this case 1 the mother during pregnancy should consider antiretroviral from gestational age of 28 32 weeks after looking at the viral load if high ensure mother takes medication for hiv cart 2 during delivery for the baby a prophylaxis for the hiv is recommended administer art e g nevirapine b vaccination for hepatitis b can be given within 12 hours of birth 3 post partum i ensure mother continues art for hiv treatment and educate for antiviral therapy for hepatitis b virus ii for the baby ensure hepatitis b vaccine series is completed perform hb ag and anti hb tests also conduct hiv testing at 6 weeks for the infant" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: nan\n - Nursing Specialty: neonatal care\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse working in a national referral hospitals in uasin gishu county in kenya a 1 day old baby is brought to the clinic with c o crying a lot not passing stool since birth on examination abdomen is distended tender anal excaudate noted patency of anus present\u2019 temp 36 4oc questions what could be making the baby not to open bowels what are the possible differential diagnoses how well the baby should be managed what are the investigations required\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 1 day old baby presenting with complaints of having not passed stool since birth and crying a lot the baby has distended tender abdomen with a confirmed patency of the anus question differential diagnosis that could be making the baby not to pass stool include hirschsprung s disease that is a congenital disorder presenting with constipation due to an impaired development of the gut duodenal atresia meconium ileus management of the baby should involve ensure the baby is stable by addressing complications such as hypothermia hypoglycemia and dehydration therefore provide warmth fluids and nutritional support attempt stimulation of the rectum e g with a gloved finger to encourage bowel movements monitoring of vital signs give oxygen if abdominal distension is causing respiratory embarrassment investigations to work up the patient such as routine laboratory tests including complete blood count electrolyte levels liver function tests an abdominal ultrasound to look out for any anatomic abnormalities within the gastrointestinal tract refer to a pediatrician paediatric surgeon for further management" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 10 year old male child referred with a diagnosis of intestinal obstruction for 2 days child is in pain anxiety and restless abdomen is distended not passing stool or flatus npo vital t 38 degrees celsius p 116b min r 28 spo2 92 rbs 5 0mmol l weight 28kgs questions what is the immediate management what could have caused the obstruction which investigations should be carried out\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 10 year old male with a diagnosis of intestinal obstruction since 2 days ago in pain anxiety and restlessness on examination abdomen distended febrile tachypneic tachycardic currently npo immediate management fluid resuscitation with ringer s lactate maintain nil per oral nasogastric tube for decompression broad spectrum antibiotics and analgesics prepare patients for possible explorative laparotomy antipyretics what could have caused the obstruction parasitic worms such as ascaris lumbricoides tumors within the small intestine inguinal hernias what investigations should be carried out blood for culture and sensitivity full hemogram for infection urea electrolytes and creatinine to nile out hypokalemia imaging erect abdominal x ray abdominal ultrasound" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: nan\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse working in a health centres in kakamega county in kenya a 9 year old girl is brought with complaints of headache gbm vomitting and hob the patient was treated for malaria with oral anti malarial a week ago but the mother reports there s no improvement noted the patient looks weak and lethargic and is not feeding well temp 37 9\u00b0c bs for mps done and was positive which type of treatment should i use now that the first one failed\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 9 year female with headache general body malaise vomiting fever for 1 month recently treated for malaria no improvement noted on examination sick looking temp 37 90 repeat bs for mps ve which type of treatment should be used after 1st treatment failure admit give anti malarial give lv antipyretics analgesic give iv fluids 100 dextrose alternative with saline" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kiambu county in kenya a two week old baby brought the history of dry skin yellow discoloration of the skin and eyes and refusal to breastfeed should i refer or tell the mother to expose the baby to sun\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 2 week old baby with dry yellow skin and eyes with refusal to breastfeed should you refer the baby or tell mother to expose child to sun 1 already child has refused to breastfeed hence intervention is required immediately if available lab tests for blood group and crossmatching to rule out abo and rh incompatibility that can cause jaundice bilirubin levels on lfts cbc 2 initiate phototherapy if not available refer child to the nearest hospital with nbu facilities diagnosis neonatal sepsis differentials neonatal jaundice" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 24.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 24 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 10 month old male child was brought to cwc with complaints of not being able to lift right arm up but can hold things the history from the mother was that it started 3 days after measles vaccination injection on the deltoid muscle in one of the facilities she was advised to do physiotherapy in the referral hospital vital signs are within normal range questions what is the diagnosis what caused the arm weakness what other investigations can be done what medications can be given to the child\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 10 month old male presented with a history of inability to lift right arm up but can hold things which started 3 days after measles vaccine injection on the deltoid muscle she was advised to do physiotherapy vitals are within normal ranges causes of arm weakness injection site infection injection related nerve injury muscle injury investigations lab complete blood count imaging x ray of the shoulder joint and upper arm ultrasound of the shoulder region nerve conduction studies medications to be given to the patient administer analgesics for pain administer anti inflammatory medication to reduce inflammation physiotherapy can be done refer the patient to a specialist preferably neurologist" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 26 years old female post delivering svd very stable two hours post delivery complains of wet bed and feels weak vitals temperature \u2013 36 degrees celsius respiration \u2013 18b min spo2 \u2013 92 room air blood pressure \u2013 94 48 mmhg and bed linen is soiled with a pool of blood why is the patient in a pool of blood what is the immediate management of this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 28 years old female post vaginal delivery 2hrs ago complaints \u2192 wet bed feels weak on examination \u2192 temp 36\u00b0c rr 86 min spo2 72 on ra bp 94 48 soiled linen with a pool of blood why is patient in a pool of blood she is bleeding excessively per vagina immediate management 1 get iv access and start fluid resuscitation with crystalloids 2 blood grouping and crossmatch for urgent blood transfusion 3 identify causes of pph check for any bruises lacerations or tears in cervix \u2192 suture any that require suturing check for uterine involution give uterotonics \u2192 if not involuting appropriately intensive massages identify other possible causes of bleeding and arrest them 4 give supplemental oxygen if in respiratory distress 5 persistent bleeding may necessitate a surgical intervention diagnosis postpartum hemorrhage pph" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 12.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya emmy 25 yrs old female presented with a swollen neck suspected to be goitre she also complained of a lump on the anterior neck he eats a lot and has lost weight and now reports diarrhoea bp \u2013 140 90 mmhg pulse 82 b min rr 28 temp 37 80 c pulse question what are the investigations to be done what is the management of the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 25 year old emily presents with swelling in the anterior neck suspected to be goiter complaints of a lump on the anterior neck and associated weight loss despite eating a lot and now reports of diarrhea o e bp 140 90 mmhg hypertension rr 28 breaths min temperature 37 8\u00b0c question 1 what are the investigations to be done lab tests thyroid function tests tfts full hemogram blood sugar urea creatinine electrolytes calcium levels fna imaging anterior neck ultrasound neck mri question 2 what is the management for this patient the fix iv line give iv fluids give antipyretic give analgesic start antibiotics refer to ent surgeon diagnosis hyperthyroidism" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in uasin gishu county in kenya a mother brought a 16 year old boy to the outpatient department with complaints of severe pain in the lower right part of the abdomen belly vomiting and loss of appetite on assessment temperature 38\u00b0c pulse 88 beats minute respiration 20 breaths minute and spo2 96 no medication was given questions what is the immediate care of this patient what investigation will he require to be done what is the differential diagnosis\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 16 yr old boy was brought with severe lower right abdominal pain vomiting and loss of appetite rebound tenderness ddx acute appendicitis diverticulitis gastroenteritis immediate care administer iv fluids to maintain hydration administer analgesics administer antiemetics empiric antibiotics investigations labs complete blood count urea electrolytes and creatinine imaging abdomen pelvic ultrasound" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 30.0\n - Nursing Specialty: neonatal care\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 30 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 2 day old term baby weighing 3 kgs is irritable with a high pitched cry had been breast feeding well spo2 \u2013 96 temp 37 8oc pr 138b min rr 30b min questions what is the priority care what investigations need to be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 2 day old term baby weighing 3 kgs is irritable with high pitched cry had been breast feeding well vitals spo2 96 temp 37 8 pr 158b min rr 30b min diagnosis neonatal sepsis what investigation should be done complete blood count c reactive protein urea electrolytes and creatinine blood culture lumbar puncture with cerebrospinal studies management start empirical anti biotics monitor glucose levels and administer glucose if necessary administer analgesics maintain warmth" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: 21.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 21 years of experience in general nursing working in a health centres in kakamega county in kenya a patient comes in the outpatient clinic with a smelling septic wound that was covered with a dirty rag on examination the wound has a lot of dead tissue and head maggots the patient reported to have been pricked by a sharp object that caused a swelling which later developed into a wound he has not used any medication ever since he was injured one week ago can this patient benefit from the normal wound dressing alone can we prescribe antibiotics to help in the recovery of the wound is surgical required in this situation how often will the patient be coming for review of the wound\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 7 year old girl presents with fever sore throat and difficulty swallowing for three days examination shows swollen tonsils with exudates steps to manage prescribe oral amoxicillin and paracetamol for symptom relief encourage hydration and a soft diet monitor for complications like peritonsillar abscess diagnosis acute tonsillitis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 12.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a dispensaries and private clinics in kiambu county in kenya a 25 year old patient is brought in the emergency department in a semi conscious state following a road traffic accident on examination there is urine incontinence reduced sensation of touch and on x ray imaging shows spinal cord fracture question 1 how do i stabilize this patient to prevent further damage 2 what other imaging tests should i request to determine the extent of the injury\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "case summary a 25 year old patient semi conscious after a road traffic accident presenting with urine incontinence reduced sensation of touch and spinal cord fracture on x ray diagnosis spinal cord injury and head injury this patient requires urgent admission to a facility with theatre and intensive care management to stabilize the patient check the airway for any signs of airway obstruction suction any visible secretions establish an oropharyngeal airway if the patient cannot maintain airway patency stabilize the cervical spine with a rigid collar monitor the patient\u2019s breathing for any signs of respiratory distress and administer oxygen therapy and monitor oxygen saturation obtain iv access with 2 large iv cannulae and obtain samples for lab work start iv fluids and administer analgesics for pain management catheterize the patient to address incontinence and monitor output after ruling out injury to urethral meatus perform a disability assessment checking for the gcs score if less than 8 consider intubation adequately expose the patient while keeping them warm to assess for any other possible injuries if there is a need to turn the patient log rolling should be the only way check for features of cerebral edema if present elevate the head of the patient administer osmotic drugs such as mannitol to reduce intracranial pressure a head ct scan should be done to aid assessment of any herniations or intracranial bleeds imaging to be done head ct scan to check for any intracranial abnormalities chest x ray to evaluate for any possible chest trauma abdomino pelvic x ray to check for injuries in the abdomino pelvic region focused abdominal sonography for trauma to assess for soft tissue injuries x rays of the limbs to evaluate for any fractures" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: surgical care\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a patient is brought to the theatre with intestinal obstruction this is his first admission patient complains of inability to pass stool for one and half weeks and abdominal distension there is no history for chronic diseases in the family vital sign at the time of receiving the patient in theatre bp 130 70 mmhg pulse 100 bpm rr 21 minute spo2 96 upon opening the abdomen all the intestines had become necrosed question how should the patient be managed intraoperatively and postoperatively\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "patient brought to the theater with intestinal obstruction complaints of inability to pass stool and abdominal distension vitals critical upon opening abdomen all intestines were necrosed q how should the patient be managed intra operatively and post operatively intra operation resection and anastomosis construction of a stoma peritoneal washout placement of a drain anesthesia team manage anesthesia antibiotics iv fluids and monitor vitals manage complications hemodynamic instability post operation monitor vital signs antibiotics nil per oral then gradual transition to full feeds nutrition counseling pain management ambulation education and counseling diagnosis necrosis of the intestines" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 15.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 15 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya a 28 year old mother visited antenatal clinic with complaint of per vaginal bleeding on history taking she states that she had fallen while washing her house on assessment patient has active pv bleeding what investigation should i do and how should i manage this patient till delivery of the baby\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 28 year old gravid female presenting with per vaginal bleeding secondary to trauma active bleeding noted on assessment diagnosis antepartum hemorrhage management stabilization ensure hemodynamic stability with intravenous access large bore ivs administer intravenous fluids crystalloids check hemoglobin levels transfuse packed red cells or whole blood if needed obstetric management obtain obstetric history perform abdominal exam to assess fundal height conduct a speculum exam to visualize the cervix perform an ultrasound to assess fetal health empiric therapy administer empiric antibiotics manage pain with analgesics follow up ensure viability of pregnancy monitor vitals bleeding and educate patient to seek medical attention for worsening symptoms or recurrence of bleeding" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 18.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 18 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 24 year old male patient came to the facility with complaints of injuries sustained by hyena attack the wounds were deep and actively bleeding temperature 36 00c pulse 98 beats minute respiration 23 breaths minute blood pressure 100 78mmhg question s what is the immediate management of the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 24 year old male with complaints of injury after sustaining a hyena attack wounds were deep actively bleeding t 36 p 98 rr 23 min bp 100 78 i would manage the patient as follows primary survey abcde circulation fix a large bore iv cannula and give fluid arrest the bleeding apply pressure on bleeding points analgesics for pain wound cleaning and dressing tetanus toxoid vaccine anti rabies vaccine prophylactic antibiotics fhg if hb 7g dl transfuse lab full hemogram urea electrolytes and creatinine liver function tests" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 12.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a dispensaries and private clinics in uasin gishu county in kenya a 1 and half year old male child was brought with complains of having been burned with hot water some few minutes ago the burnt surface is exposed mother reports to have poured cold water to the site left lower limb on assessment the child is in pain the burns are estimated to be 2nd degree with parts of the skin broken while others have blisters vital signs temperature 35 6 spo2 96 pr 126b m question what is the immediate care management of the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 1 \u00bd year old male presents with burns from hot water skin broken with blisters dx second degree burn management ensure airway is clear monitor breathing and spo\u2082 administer fluid resuscitation and pain relief irrigate burn areas with saline dress burn areas with sterile dressing apply silver sulfadiazine provide tetanus prophylaxis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kiambu county in kenya describe situation background and assessment so a known mdr tb patient has come for treatment it is a patient who is on follow up then they come into the room you have given information about use of the surgical mask but the patient enters the injection room without a surgical mask and you as the health worker also you don t have a mask so the health care any request of guidance so the guidance i would require to know is how do i handle the situation do you tell the patient to go to leave the room and come with a mask or do you proceed to give the treatment and reinforce the information about the mask putting in mind when you send the patient away maybe you are risking the life of many others who will interact with the patient and when you retain the patient in the room you yourself are putting yourself at risk\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a known multi drug resistant tb patient coming in for treatment on follow up he comes in without a mask and the health worker also has no mask guidance firstly maintain the patient at least 1 meter away from you as you acquire your mask and inform the patient about the importance of wearing a surgical mask while in the hospital or around other people should the patient cough advise him to cover his mouth with his hand sanitize his hands with an alcohol based sanitizer thereafter hand washing with a soap is also an option instruct the patient to wear a mask continue with treatment as the protocol for mdr tb management" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 38.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 38 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 51 year old female client reports from a level 6 hospital with laboratory results which was done there on enquiry why he did not take back the lab results back to the prescribing physician he said that the queue was too long and he was not willing to wait and opted to bring the results to the level 3 facility which was less populated with the patients on assessment he gave a history of diminished urinary output he presented with pedal pitting oedema bp 170 100 mmhg pulse 68 b min respirations \u2013 16 breaths per minute temperatures 37 8 degrees celsius spo2 91 his lab results from the level 6 hospital indicated elevated potassium of 6 8 meq l he also had a medical record that indicated end stage renal disease esrd and was scheduled for haemodialysis in 2 hours\u2019 time questions what priority action should the nurse ensure take before referring the patient back to the level 6 hospital\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 51 year old with a history of diminished urine output bilateral pedal edema the blood pressure is elevated and oxygen saturation of 91 potassium 6 8 meq l diagnosis end stage renal disease and is due for hemodialysis due to the impaired renal function the concern for this patient is congestive cardiac failure and hyperkalemia with hypertensive urgency in hypertensive retinopathy urgent referral is essential but essential measures can be taken initial stabilization of the patient assess the breathing and initiate high flow oxygen therapy establish iv line access and obtain samples for laboratory work up catheterize the patient and monitor the urine output in a chart there are many methods of lowering the potassium levels but there need to be implemented cautiously under guidance by a nephrologist such as potassium binding drugs and potassium shifting with use of insulin administer iv analgesia in case there is pain urgent referral to a facility with provision for dialysis nephrology review and possible high dependency unit admission investigation that can be done a random blood glucose to assess glucose levels renal function tests level can be repeated top asses the level of damage urinalysis urine microscopy culture and sensitivity to check for any infection blood gas analysis to evaluate to evaluate for any compensatory mechanisms radiological investigations like an abdominal pelvic ultrasound to assess kidney structure" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 12.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya a 12 year old girl is brought in the out patient department with complains of a toothache the pain is constant and gets worse while eating their is a sore on the jaw of the affected tooth there is a cavity on observation tender on touch refuses for me to touch the tooth and has temp of 38 9\u00b0c reffer to a dentist\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 12 year old presents with a tooth ache associated with fever diagnosis dental abscess this is a patient who requires full blood count malaria xray of the jaw and admit for tooth extraction administer iv and antibiotics antipyretics and analgesics" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 27.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 27 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 37 year old lady comes to the facility complaining of toothache headache and a painful neck on examination the patient had difficulty in turning her neck and there was bilateral swelling noticed on palpation temp 38 6c resp 24b min pulse 80 bpm bp 150 90 mmhg spo2 94 recommendation sent for dental review questions what is the cause of slight increase in temp bp and pulse what extent has the dental infection spread\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 37 year old lady with complaints of headache toothache and a painful neck she has difficulty in turning her neck and bilateral nodes swelling on palpation she has a fever of 38 5\u00b0c is tachypneic bp is elevated pulse and spo2 one within range a diagnosis ludwig s angina b the fever could be secondary to infection c management check airway and ensure it is secure start the patient on antipyretics for the fever start the patient on broad spectrum antibiotics corticosteroids can be used to reduce inflammation treat the dental infection" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : health centres\n - Years of Experience: 22.0\n - Nursing Specialty: mayernal and child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 22 years of experience in general nursing working in a health centres in kiambu county in kenya a three year old child was brought to the facility with history of coughig running nose hotness of the body on a dose has been treated with antibiotics like amoxicillin dt augmentin and the problem is still persisting what is the best medication for this child do i refer the child to the physician for more investigations and treatments\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 3 year old child with coughing running nose hotness of the body and history of oral antibiotic use e g augmentin without improvement there are features of ongoing infection despite oral treatment could be due to poor dosage drug resistance reinfection or viral causes not responsive to antibiotics management admit the patient establish iv line access and obtain samples for culture and sensitivity initiate iv fluid therapy administer iv antipyretics to manage fever analgesics for pain consider switching to a different class of antibiotics once investigations are out investigations laboratory full hemogram c reactive protein malaria blood slide sputum for microscopy culture and sensitivity imaging chest x ray" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 30.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 30 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 25 yr old p 2 0 g3 at 28 weeks came for normal anc normal previous deliveries general condition good vitals bp 150 100 mmhg pr 80b m rr19b min spo2 96 palpation fh 38 weeks fhr 140b min cephalic presentation has edema of both lower limbs which she reports has been there since 2 days ago questions what evaluations are recommended what are the differential diagnoses what is the management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 25 yr old para 2 0 gravida 3 at 28 weeks came for normal anc normal previous deliveries and generally good condition apart from elevated bp all other vital signs are normal on palpation fh is at 38 wks fhr at 140 b m presentation is cephalic bilateral lower limb edema seen for 2 days recommendation for evaluations urinalysis check for proteinuria a sign of pet coagulation profile uecs lfts to rule out hellp syndrome characterized by low platelets elevated liver enzyme urine collection to monitor daily proteinuria fetal assessment with biophysical profile non stress test ultrasound for intrauterine growth retardation check management admin antihypertensives if bps remain sustained fetal monitoring for full hemogram and cardiotocography changes magnesium sulphate to administer to prevent eclampsia regular assessment of urine electrolytes urinalysis limb elevation to alleviate edema loop diuretics" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 17.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: critical care\n\n Prompt from the nurse : i am a nurse with 17 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 16 year old boy who is admitted in the oncology ward started having confusion appears grey and molted the patient is receiving chemotherapy and 3 days ago he started complaining of pain on the intravenous access redness and arm swelling the intravenous access was removed immediately vitals temp 40 bp 70 30 mmhg resp 46b m hr 150b m questions what type of shock does the patient have what is the immediate management what monitoring is needed on the intravenous access which laboratory tests are required\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 16 year old boy is confused appears grey and mottled received chemo 3 days ago complained of pain in intravenous access site redness and swelling hyperthermia hypotension tachycardia and tachypnea dx septic shock management airway breathing high flow oxygen to spo2 94 circulation aggressive fluid resuscitation monitor for respiratory failure use vasopressors if no response to fluids antibiotic therapy broad spectrum antipyretics analgesics source control clean intravenous site establish new intravenous site monitoring needed for intravenous access regular assessment inspect for redness swelling or pain use sterile technique when cannulating documentation of any reactions investigations blood culture complete blood count lactic acid level c reactive protein procalcitonin urea electrolytes and creatinine coagulation profile arterial blood gas culture iv access" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 2.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 2 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 20 year old male presents to the facility with complaints on the ankle and swelling after twisting his ankle while playing basketball on assessment the pain is severe and unable to bear weight on the affected ankle bp 126 87 mmhg hr 72 rr16 t 36 7 spo2 95 question what is the immediate management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 20 year old male with pain at the ankle joint after a basket match this is concerning for trauma in the ankle joint diagnosis tendon injuries following blunt trauma ddx fracture of tibia fibula sprain haemarthrosis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kakamega county in kenya a middle aged mother came to our facility with a history of severe chest pain radiating at the back for two days the mother says she bought some drugs from the chemist which she used but the pain still persists the question is should i send this mother for chest x ray could this be pneumonia\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 70 year old female presents with progressive neck pain difficulty walking and numbness in both hands vitals normal except elevated pulse rate investigations mri cbc crp management prescribe nsaids and recommend physical therapy for symptom relief refer to orthopedic surgery for decompression and stabilization monitor for worsening neurological symptoms diagnosis cervical myelopathy" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 12.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a dispensaries and private clinics in uasin gishu county in kenya a 73 year old female came with complaints of headache on and off blurred vision for 3 days now neck pain and general body weakness the patient is in a generally sick looking condition bp 154 101 mmhg temp 36 4 questions what is the immediate care of the patient what investigations are to be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 73 year old female presents with headache which is on and off blurred vision for 3 days neck pain and general body weakness on examination sick looking vitals bp 154 101 immediate care assess the patient\u2019s breathing and sp02 levels and manage accordingly target sp02 is 95 assess the patient\u2019s neurological status to establish the gcs as that will guide on need for urgent airway protection or not offer nifedipine 40 mg sublingual stat urgent referral to a higher facility for physician assessment urgent full hemogram urea electrolyte and creatnine s liver function tests coagulation profile csf analysis for biochemistry and microbiology detailed neurological examination inpatient monitoring imaging tests such as brain ct echo ecg effective blood pressure control within the acceptable time length" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 1.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: critical care\n\n Prompt from the nurse : i am a nurse with 1 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya an ambulance with a siren on arrives at the emergency unit carrying 6 pupils reported to have drowned in a dam while on their picnic on assessment 3 of the pupils are unconscious while the other 3 are restless and confused parents and other people arrive in vehicles and motor bikes jamming up the whole unit questions what do i prioritize what is the status of the 6 pupils who are alive what emergency care to i give to the 6 pupils\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 6 pupils present to the clinic after drowning in a dam while on a picnic on exams 3 pupils are unconscious while 3 are restless and confused parents and other people arrive in vehicles and motorbikes jamming up the whole place priorities first triage the pupils call for help assess the status of the pupils 3 unconscious 3 restless and confused emergency care to the pupils categorize the pupils assess the unconscious pupils airway \u2013 clear the airway and suction if necessary breathing and ventilation \u2013 ensure it is adequate if not give oxygen via face mask circulation \u2013 obtain iv access draw blood samples and administer iv fluids for resuscitation disability \u2013 evaluate their neurological status exposure \u2013 warm the pupils with blankets or warm fluids monitor all the pupils" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : health centres\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a health centres in kiambu county in kenya so a male client of 57 years is admitted to the wards with severe pneumonia the client is well oriented but with an spo2 of 84 and with a plan of care for oxygen administration you start the patient on oxygen and the patient pulls out the oxygen says they do not need assistance in breathing you try cancelling the client but the client still declines oxygen therapy so the question is how should you handle such a patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 57 y o male with pneumonia and spo2 of 87 who refuses oxygen this is a patient who lacks insight to the importance of oxygen to his management regimen the idea would be to counsel the patient in the presence of a counsellor and close family members the patient s understanding should be assessed his fears and anxieties should also be addressed and his close family should be involved in the patient s management" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 29.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 29 years of experience in general nursing working in a health centres in uasin gishu county in kenya an old man 65 years of age visited the facility with complaints of progressive loss of vision which started 3 years ago on examination visual acuity right eye 6 out of 60 left eye 6 out of 60 blood pressure 100 60 pulse 80 respirations 18 spo2 99 referred for management in the eye clinic questions 1 what investigations could be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "65 years old with progressive vision loss visual acuity is 6 60 bilaterally vitals stable what investigations could be done clinical blood pressure for hypertensive encephalopathy lab hba1c heavy metal screening triple serology lipid profile autoimmune markers radiological fundoscopy mri of the orbit and brain ddx cataracts diabetic retinopathy hypertensive retinopathy glaucoma heavy metal poisoning infections hiv syphilis toxoplasmosis ocular orbital tumors cranial nerve palsies" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 30.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 30 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 50 yr old female presents with complaints of right hand numbness fingers and palm for 5 days 2nd episode a known hypertensive on amlodipine on examination there is sudden speech slurring and drooling of saliva vitals bp 150 110 mmhg pr 50b min rr 10b min temp 36 1oc spo2\u201478 rbs 1 0mmol questions what is her emergency care what investigations need to be done what is the subsequent management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 50 year old female presents with complaints of right hand numbness for 5 days she is a known hypertensive patient on amlodipine on examination vitals bp hypertension 150 110 pulse 50b min bradycardia rr 10 reduced temp normal 36 1\u00b0c desaturating at 78 sudden speech slurring and drooling of saliva rbs 1 0mmol hypertensive patient with features suggestive of stroke with underlying severe hypoglycemia and hypoxia q what is her emergency care primary survey and patient stabilization abcs ensure airway is patent suction secretions drooling position and secure airway guedel intubation assess breathing supplemental o2 via nrm 10l o2 high flow targeting for saturations 90 circulation fix 2 bore iv cannulas collect blood samples and correct hypoglycemia d50 bolus then d10 to have correct hypoglycemia administer iv labetalol presses as required fix a urinary catheter to monitor input output fix ecg lead to continuously monitor for arrhythmias eg atrial fibrillation get an urgent non contrast head ct ischemic vs hemorrhagic stroke ischemic stroke thrombolysis eg iv alteplase if meets criteria initiate antiplatelet therapy eg aspirin hemorrhagic stroke neurosurgical review control bp initiate avt prophylaxis if no bleeding risk e g lmw fix ngt for feeding review with specialist consider icu care investigations cbc gxm uec lfts abg rbc lipid profile coagulation profile radiological non contrast head ct ecg chest x ray subsequent management managing hypoglycemia dextrose monitoring and controlling bp managing type of stroke rehabilitation speech therapy physical therapy dvt prophylaxis lifestyle modification close follow up in clinic differentials stroke in a hypertensive patient with hypoglycemia and transient ischemic attack" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 3.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 3 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 17 year old female presents with complaints of severe joint pains of sudden onset that have lasted for one day her vital signs are as follows blood pressure 138 78 mmhg pulse rate 98 beats per minute temperature 37\u00b0c respiratory rate normal and spo2 98 the patient also reports an inability to stand for more than a couple of minutes questions what are some of the diagnostic evaluations to be done for this patient what is the possible diagnosis how is the patient supposed to be managed\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 17 year old presents to a health centre with severe joint pain of sudden onset that started a day prior vital signs bp 138 78 pr 98 t 37 8\u00b0c rr normal spo2 98 diagnostic evaluations complete blood count assess for inflammation infection erythrocyte sedimentation rate c reactive protein identify if there is inflammation streptococcal throat culture joint x ray management provide analgesia such as nsaids which can relieve pain and reduce inflammation physical therapy to help improve function impression trauma" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 12.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya a para 2 0 gravida 3 mother came for first anc visit at 34 weeks gestation on examination the pitc and vdrl turned positive which medication should immediately be initiated to the mother what medication should the infant given immediately after delivery\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a mother para 2 0 gravida 3 at 34 weeks gestation presents for her first antenatal clinic visit on exam pitc and vdrl turned positive management medication to be initiated benzathine penicillin im for syphilis antiretroviral medication medication for the infant antiretroviral drugs or penicillin for congenital syphilis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 15.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 15 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 3 year old girl was brought by the mother having chewed five tablets of 500mg paracetamol she reports having caught the daughter chewing the fifth tablet and was sure of the count on assessment bp 100 60mmhg temp 36 8oc p 100b m spo2 95 avpu at a questions what is the immediate care of the patient what laboratory investigations can be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 3 year old chewed 5 tablets of paracetamol 500mg normal vital signs diagnosis paracetamol overdose immediate care rehydration ivf to normal saline proton pump inhibitors such as esomeprazole activated charcoal to reduce absorption do not induce vomiting monitor liver function tests coagulation profile full hemogram antidote is acetylcysteine to prevent liver damage manage patient as inpatient" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kakamega county in kenya okay a 59 year old female is brought in supported with the reasons of not able to talk feeling thirsty passing a lot of urine then dizziness on examination bp check blood pressure is 180 over 100 then rbs random blood sugars is 20 1 grams per deciliter now i put up an iv line but my question is do i put normal saline to stabilize the sugars or do i put the insulin first because the normal saline obviously it will raise the bp as well that is the question okay that s the end of this\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 59 yr female brought to opd with complaints of associated vertigo fatigue polydipsia excessive thirst polyuria o e sick looking bp 180 100mmhg rbs 20 mmol l tk 4 5 nb an iv line has been set up q1 should i give normal saline or insulin first i d manage the high bp first by giving an anti hypertensive target bp 140 90 mmhg await lab results especially renal function tests spot potassium levels to initiate insulin therapy when normal potassium levels start on iv soluble insulin 10 iu mixtaard 10 iu give as you take rbs every 2 hours do bga and correct any electrolyte imbalance or dka if present refer for admission and physician to review and manage dx diabetes mellitus" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 10.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 20 year old school going boy came to the facility with a history of pain while passing urine with pus like discharge from the penis blister like wounds around the pubic region for the last one week the boy has not taken any medication on further probing the boy reports to be sexually active with several girlfriends and does not use protection resides in pemughi assessment on examination the boy appeared sick on inspection there are sores around the genitalia with discharge from the penis and pain at the groin vital signs temperature 38 pulse 88 respirations 20 spo2 90 questions 1 what investigations can be done to the patient 2 what is the management of the patient 3 what other information can the patient benefit from on behavior changing\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 20 year old boy presents with dysuria with pus like discharge noticed 6 hours ago unmarried and reports multiple sexual partners but no use of protection denies other symptoms assessment sick looking does complain of pain in the genital area no noted discharge normal vitals diagnosis urinary tract infection 1 what investigations can be done full hemogram urinalysis vdrl pus swab culture and sensitivity 2 what is the likely management for the patient antibiotics analgesics 3 what other information can the patient benefit from on behavior change to be told on changes of having multiple partners use of protection complications of sti call partner for testing" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 20.0\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 45 year old lady presents at the clinic with complaints of lower abdominal pains foul smelly vaginal discharge for five days she is married and stays with her family her lmp is one week old she has an intrauterine device for family planning which was inserted two years ago her last delivery was 10 years ago on examination she is in fair general condition appears anxious on palpitation she has tenderness of the lower supra pubic region temp 36 90c p 94b m r 18 bpm bp 110 70mmhg questions what is the immediate management of this patients which investigation will be done on this patient what are the possible causes of lower abdominal pains and foul smelly vaginal discharge\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 45 year old lady complains of lower abdominal pains and foul smelling discharge for 5 days lmp is one week old has an iud for family planning inserted 2 years ago examination appears anxious on palpation tenderness of suprapubic region vitals normal q1 immediate management of this patient pain management pelvic examinations speculum to examine vagina cervix pelvic ultrasound to assess iud placement salpingitis q2 what investigation will be done on this patient laboratory full hemogram urinalysis high vaginal swab for culture and microscopy renal function test visual inspection using lugol\u2019s iodine cervix radiology pelvic ultrasound transvaginal q3 possible causes of lower abdominal pains and foul smelly vaginal discharge urinary tract infection pelvic inflammatory disease cervical cancer" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 17.0\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 17 years of experience in general nursing working in a dispensaries and private clinics in kakamega county in kenya there is pain on the left labia minora with a small rash a mother complains it started a week ago with mild pain foul smelling and slight itching has had no treatment a dimple like pimple that has pain on touch no foul smell could this just be a pimple or a chance what treat ment should be given prior to that what other tests can be done on her\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "pain on left labia minora with small rash for 1 week mild pain foul smell slight itch pimples are painful on touch pimple or chancre likely folliculitis bartholin\u2019s cyst genital herpes lymphogranuloma venereum treatment topical antibiotics e g gvl syphilis warm compress drainage of abscess bartholin s cyst antiviral rx e g acyclovir for herpes tests microscopy swab high vaginal for gram stain and culture vaginal ph test rule out bacterial vaginosis viral culture pcr for herpes full hemogram neutrophilia for bacterial infection hiv sti screen" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 16.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 16 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya calling from the medical surgical unit about a 65 year old female in room 105 experiencing pain and redness at her surgical incision site her recent vital signs are temperature 36 80c bp 148 72mmhg hr 90 beats minute and respiration 22 breaths minute she was admitted yesterday post hip replacement awaiting physiotherapy this morning the incision site is clean and dry but has an 8 cm redness around it it s warm and tender to touch questions what can be done for the swelling on the surgical site\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "65 year old female post hip replacement surgery complaining of surgical site pain vitals stable haemodynamically dx surgical site infection differential sepsis swelling on the surgical site \u2022 x0001 give iv nsaids \u2022 x0001 effective wound care full hemogram random blood sugar wound swab for culture and microscopy \u2022 x0001 if swelling worsens do ultrasound" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a national referral hospitals in uasin gishu county in kenya a 60 year old man comes to the follow up clinic after being discharged from the hospital 2 weeks ago due to right sided heart failure on examination he has difficulty in breathing diminished lung sounds with crackles in bilaterial bases he represents a productive greenish cough and he has been a smoker for 35 yrs question what is the immediate care what laboratory radiology needs to be done what treatment prescription needs to be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 60 year old man with a history of right sided heart failure presents with difficulty in breathing and productive greenish cough on examination he has difficulty in breathing diminished lung sounds and bilateral crackles at the base of the lungs he has smoked for 35 years immediate care the immediate care to this patient involves the check of his vitals particularly his spo2 and give o2 if the spo2 is less than 90 monitor his input output admit the patient and investigate by doing the following complete blood count for signs of infection c reactive protein levels for monitoring imaging chest x ray echocardiogram the definitive management antibiotics empirically as you await the laboratory and imaging results nebulization with salbutamol a beta agonist and a steroid anti tb if the genexpert is positive" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : health centres\n - Years of Experience: 8.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 8 years of experience in general nursing working in a health centres in kakamega county in kenya 17 years old girl came in the facility two weeks post delivery she reports to having fresh pavaginal bleeding on examination speculum vaginal examination was done there s a moderate fresh bleeding she reports to have not been involved in extraneous chores at home she reports that the bleeding has just been continuous and by this time she had changed her three pads since morning now the request should this girl be referred to a gynecological for review and what else should we do at our level what else can i do at my level 3 facility now that she s still having fresh moderate pv bleeding\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 17 year old female post delivery svd now with vaginal bleeding speculum examination moderate to fresh bleeding reports no extraneous chores at home has changed 3 pads dx pph q1 should patient go for gynae review yes q2 management set up an iv line for iv fluids and blood transfusion give tranexamic acid and vitamin k give analgesics do labs gxm got transfusion full hemogram level of hb ht rbc platelets coagulation profile to r o clothing disease renal function state of kidney consult and refer patient to level iv facility for gynae review" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in uasin gishu county in kenya mary a 27 year old came into the antenatal clinic with complaints of severe lower abdominal pain on one side vaginal bleeding and missed her period for 10 weeks on examination temperature 370c pulse 85 beats minute respiration 24 breaths minute spo2 98 and blood pressure 120 70 mmhg questions what is the acute management of mary what is the diagnosis what investigations will she require what is the differential diagnosis\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "case summary mary a 27 yr old presents with severe localized abdominal pain on one side vaginal bleeding she has missed her period for 10 weeks on examination all vitals are normal except respiratory rate 24 tachypneic what is the acute management of the patient ensure the patient is stable by ensuring the airway is patient and they are breathing adequately ensure the patient is hemodynamically stable by giving intravenous fluids or blood in case hb is low proper vaginal examination sterile can be done perform an abdominal ultrasound to assess for any abnormality or check for any signs of a fetus pregnancy test is mandatory b hcg urine should be done to assess pregnancy if not confirmed by ultrasound give analgesics to relieve pain collect samples for lab investigations blood monitor vitals regulary once stable obtain a proper history what is the diagnosis diagnosis entirely depends on further investigations such as ultrasounds possible differentials include ectopic pregnancy complicated abortion incomplete urinary tract injection pelvic inflammatory disease molar pregnancy what investigations will she require complete blood count to assess for infection and hemoglobin level renal function tests to assess for kidney function as there is risk for acute kidney injury in hemodynamically unstable patients liver function tests to assess liver function coagulation profile to assess bleeding disorders septic screen blood urine cultures and urinalysis b hcg to rule out pregnancy ultrasound to assess uterus cervix and any abnormality" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: surgical care\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a patient complains of swelling on the right upper limb and the right side of the trunk patient received post splenectomy vaccines one day before swelling in the surgical ward splenectomy was done following a road traffic accident where he sustained ruptured spleen assessment on palpation of the swelling there is air leak below the skin vitals bp 128 70 mmhg pulse 90 bpm respirations 18 minute spo2 80 questions what caused the air leakage to the subcutaneous tissue what is the management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary air leak on the right side of the chest associated with desaturation dx subcutaneous empysema ddx hemothorax pneumothorax causes iatrogenic injury to the right bronchus during intubation by the anaesthetic injury to the diaphragm during surgery put on oxygen do a an xray of the chest put a ngt management surgery to repair the injury" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 12.0\n - Nursing Specialty: critical care\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 12 years of experience in primary care working in a national referral hospitals in uasin gishu county in kenya patient was admitted as a referral for cardiothoracic review with chief complaints of chest pain fevers she had been admitted for two weeks and she has bilateral chest drains which are active on auscultation she has reduced air entry on the right side dull on percussion vitals bp 140 75mmhg p 110b min t 37 2 rr 16b min spo2 92 on oxygen via nasal prongs questions what investigation should be done what is acute management what is the differential diagnosis\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a female patient was admitted for cardiothoracic review she presented with chest pain and fever after 2 weeks bilateral chest drains are active she is hypertensive ddx bilateral pleural effusions investigations full hemogram c reactive protein urea electrolyte and creatinine sputum for culture sputum for gene x pert blood cultures chest x ray tumor markers pcr for malignancy pleural fluid analysis by light s criteria biopsy for immunohistochemistry autoimmune screen acute management supportive care pain management with analgesia fluid therapy with intravenous fluids assess chest tube regularly and drain if full follow up diagnostic results to have a definitive diagnosis antibiotic therapy empiric antibiotics definitive treatment depends on diagnosis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: bungoma\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 1.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 1 years of experience in general nursing working in a sub county hospitals and nursing homes in bungoma county in kenya a 2 year old female is brought by the mother with complaints of irritability fever and foul smelling urine for the past 4 days the infant appears weak temperature 37 3\u00b0c respiratory rate 56 breaths pulse rate 110 beats per minute spo 98 questions what is the management plan for the baby what investigations should be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 2 year old brought with complains of irritability fever and foul smelling urine for 4 7 assessment weak vitals temperature 37 3 respiratory rate 56 min pulse rate 110 spo2 98 dx urinary tract infection ddx sepsis malaria immediate management admit the patient follow the abcd approach get intravenous access and start intravenous fluid draw samples for labs complete blood count urea electrolyte creatinines liver function test urine for urinalysis blood slide for malaria parasites blood culture c reactive protein monitor vital signs start on broad spectrum antibiotic investigations urinalysis dipstick and microscopy check for pus cells on microscopy and nitrites on dipstick indicative of urinary tract infection c reactive protein elevated in infection blood culture to check for infection" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 12.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya a para 0 0 gravida 1 mother comes to mch for the first anc clinic at a gestation of 30 weeks she is a known rheumatic heart disease patient and complains of easy fatigability on examination she is dyspneic with spo2 of 80 in room air and a heart rate of 120 beats per minute how do i manage this patient antenatally till delivery\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 60 year old known diabetic woman presents with redness swelling and foul smelling discharge from the left foot examination shows necrosis of the toes and surrounding cellulitis vitals normal steps to be followed start broad spectrum iv antibiotics optimize glycemic control with insulin debride necrotic tissue and consider amputation if necessary investigations perform wound culture and sensitivity cbc to rule out infection rbs doppler ultrasound ct angiogram to investigate venous insufficiency diagnosis diabetic foot ulcer with gangrene" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 2.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 2 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 40 year old male complains of shortness of breath and a productive cough with green sputum for 3 days he has a history of smoking for the past 12 years on assessment the patient has a mild wheezing also with shortness of breath vital signs bp 135 85 mmhg rr 22 bpm t 36 0 spo2 92 question what could be the diagnosis of the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary patient 40 year old male history complaints of shortness of breath productive cough and sputum production for three days history of smoking for several years examination findings mild wheezing with shortness of breath bp 133 85 rr 25 temp 36 0\u00b0c spo2 92 management plan 1 oxygen therapy provide supplemental oxygen to maintain spo2 above 94 2 bronchodilators administer short acting beta agonists e g salbutamol via nebulizer or inhaler 3 steroids consider oral or intravenous corticosteroids to reduce inflammation 4 antibiotics prescribe broad spectrum antibiotics if bacterial infection is suspected 5 sputum culture collect sputum for culture and sensitivity to guide antibiotic therapy 6 chest x ray perform imaging to rule out pneumonia or other lung pathology 7 smoking cessation counseling provide support and education on quitting smoking to prevent further lung damage 8 follow up schedule regular follow up to monitor respiratory function and response to treatment this plan addresses both acute symptoms and underlying risk factors diagnosis chronic bronchitis with an acute exacerbation" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kiambu county in kenya describe the situation background and assessments a mother comes to the cwc clinic with a two month old baby who is due for 10 weeks vaccines and on assessment the baby had fever when we took the temperature it was 38 2 and the mother reported that the baby has had running nose since the previous day do you go ahead and give the vaccine then the child be treated or do you postpone the vaccine so that the child can be treated first then after the fever has gone down and the child is healed now they can come back for the vaccine\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 2 month old presenting for 10 week vaccine noting to have 38 2 fever with cough and runny nose question if the vaccine administration has been delayed can the child be vaccinated post period when the child is treated for fever and cold the clinical protocol is if a child has a mild infection with fever of less than 38\u00b0c they can likely receive vaccines after they recover for children with severe infections and fever of greater than 38\u00b0c it is advised to delay the vaccine for about 72 hours while taking antibiotics and antipyretics the high fever is believed to denature vaccine proteins and child might also be at risk of getting an infection due to low immunity during treatment diagnosis upper respiratory tract infection" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 9.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 9 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya 21 years old female is brought to the health facility in unconscious state no history of previous illness but had initially presented with confusion and general malaise vital signs bp 180 110mmhg pulse 102 min spo2 80 respirations 40 min rbs \u2013high temperature 38 4c questions what is the immediate management of the patient what are the probable investigations that should be ordered to aid in diagnosis\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 21 year old female with altered level of consciousness vital signs bps 180 110 pulse 102 min spo2 80 respiration rate 40 min temp 38 5 and random blood sugar is elevated ppe atls protocol to assess patient and intervene a airway may be compromised due to the altered level of consciousness patient will need suction and an oropharyngeal airway b assess patient\u2019s breathing and put patient on oxygen because she is desaturating c the patient is hypertensive administer antihypertensives 2 wide bore canulas blood for grouping and cross matching blood for other investigations d assess the gcs score e assess the patient\u2019s environment patient requires to be done for a trauma series for further investigations ct head chest x ray fast pelvic x ray investigations toxicology cbc uecs bga blood glucose levels pdt patient requires admission and insert a urethral catheter to monitor output if patient\u2019s gcs score is less than or equal to 8 she will require admission ddx patient with low gcs hypertension hyperglycemia low oxygen saturation levels and tachypneic patient requires referral to a higher facility for further management patient may require surgery depending on the trauma series findings" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kakamega county in kenya a1yr old child has hx of not being able to walk well following the immunization that was done at 3 12 the baby was given the vaccines that caused paralysis of the lower limb so the mother has been using warm water to massage the limb the baby has lower limb deformity making him not to stand well was the baby born with deformities or was caused by the vaccine immunization how can l reassure the mother that by bringing the child for physiotherapy it will be well\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 4 yr old child has a history of not being able to walk since immunization at 3 months the baby has lower limb deformity making him unable to stand well was the baby born with deformities or was caused by the vaccine immunization it is possible the baby had skeletal deformity such as club foot upon birth that was only realized at 3 months differentials contractures polio malnutrition metabolic bone disorders how can i reassure the mother that by bringing the child for physiotherapy it will be well as much as the physiotherapy is going to improve the child s ability to walk the nurse cannot say for certain that the child is going to recover fully and be well" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 20.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a patient 42 year old female complains of cold intolerance weight gain fatigue constipation and depression in 1 week he had been done thyroidectomy 3 weeks ago medicine levothyroxine on assessment p 50 m t 35 b p 100 50 spo2 90 hair looks thin questions what could be causing the symptoms what is the immediate management of the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 42 year old female with complaints of cold intolerance fatigue constipation and depression for 1 week had a thyroidectomy 3 years ago on levothyroxine pulse 50 bradycardia temp normal bp 100 50 hypotension spo2 98 ra q1 what could be causing the symptoms hypothyroidism following thyroid surgery or drugs q2 what is the immediate management of the patient give levothyroxine for supplementation fix an iv line for fluids draw a sample for full hemogram ft4 tsh to rule out anemia and hypothyroidism urea creatinine and electrolytes to assess kidney status do a thyroid function test to assess the level of thyroid hormones give iv antibiotics refer to endocrinologist diagnosis hypothyroidism" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 12.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 40 year old female presented to the ed with a complaint of increased body weight she is a known nephrotic patient on clinical follow up on examination there was obvious body swelling with a moon face and hair in the body the patient is compliant with treatment but looks worried bp \u2013 160 120mmhg pulse 126 b min temp 36 20 c pulse spo2 92 ra question what is the immediate management what are the possible complications\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 40 year old female in the emergency department presenting with increased body weight known nephrotic patient on clinical follow up on examination obvious body swelling moon face hair on the body patient compliant on treatment but looks worried vitals bp 160 120mmhg pr 126 bpm temp 36 2 spo2 92 diagnosis nephrotic syndrome what is the immediate management admit the patient body weight measuring chart fluid input output monitoring by fixing urinary catheter diuretics antihypertensives lab work e g urinalysis for proteinuria liver function test rule out hypoalbuminemia full hemogram recurrent infections what are the possible complications chronic kidney disease secondary to prolonged kidney damage hypertension heart failure secondary to volume overload recurrent infection secondary to loss of immunoglobulins in urine hyperlipidemia which may lead to coronary artery disease" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 14.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 14 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 67 yrs old male brought to health facility with complaint of progressive difficulty swallowing for 2 months patient experience is regurgitation and chest pain changes in voice or persistent cough the patient also his a smoker or consumes alcohol on examination tenderness or mass on palpation of chest or abdomen questions what initial imaging or test can be considered what management can be provided\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 60 year old male brought to sub county hospital complaints \u2192 progressive difficulty in swallowing for 2 12 regurgitation and chest pain changes in voice and persistent cough smoker and consumes alcohol on examination \u2192 tenderness and mass on palpation of chest or abdomen initial imaging or test full hemogram concern for anemia due to poor feeding urea electrolyte creatinine likely electrolyte rule out count kidney injury electrolyte imbalances due to malnutrition poor feeding analysis of blood gas \u2192 poor metabolic state random blood sugar \u2192 hypoglycemia endoscopy to assess oesophagus check for cause of symptoms possible location of tumor and biopsy if indicated metastatic workup \u2192 chest x ray abdominal ct scan management resuscitate with iv fluids \u2013 crystalloids treat hypoglycemia with dextrose 50 treat anaemia with medication or transfusion depending on severity correct electrolyte imbalance and acid base imbalance nutritional management with tolerated feeds enteral feeds or parenteral if necessary surgical consult for possible surgical excision of tumor oncology consult for chemotherapy or radiation therapy diagnosis esophageal carcinoma ddx esophageal stricture chronic esophagitis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 20.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: critical care\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 68 year old man came with fatigue chest pain radiating to the arms jaw left arm and shoulder blades has clammy skin shortness of breath abnormal heartbeat anxiety pain in the epigastric region patient is a known hypertensive history of hypertension and obesity in the family on assessment the patient is anxious and restless bp 80 45mmhg pulse 102 beats min spo2 88 temperature 35 3 degrees celsius questions 1 what is the immediate management of the patient 2 does the patient have an underlying condition 3 should we refer the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 68 year old male presents with fatigue chest pain radiating to the arms jaw and shoulder blades known hypertensive family history of and obesity on examination clummy skin shortness of breath anxiety bp 80 45 pp 102 spo2 88 t 35 3\u00b0c impression \u2060myocardial infarction in a patient with hypertensive cardiomyopathy immediate management follow abcde approach supplement oxygen target 2 95 give the patient aspirin to chew get iv access and give bolus of iv fluid normal saline assess neurological status urgent referral to a higher facility with ccu icu services where the patient will get cardiology review cbcs uecs cardiac markers d dimers lfts done blood gas analysis echo ecg ctpa chest x ray nitroglycerin sublingual administration inotropic support should hypotension persist" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kakamega county in kenya a female patient came in complaining of discharge from the eyes headache and blurred vision it started 3 weeks ago when she visited a relative in isiolo vital signs normal which eye condition can this be\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary woman comes in complaining of discharge from eyes headache and blurred vision that started 3 weeks ago after visiting a relative in isiolo which eye condition could this be diagnosis conjunctivitis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kiambu county in kenya patient complained of earache pain when swallowing headache and chills for 3 7days temp 37 8 celsius premed ibrufen 400mg at home with no much difference on inspection tonsillitis inflammed with white patches on both tonsils treatment for recurring tonsillitis guidance q1whether to give per oral pain killer or im or iv\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary patient complained of earache pain when swelling headache and chills for 3 days temp 37 8 premedications given is ibuprofen 400mg at home with no improvement on inspection tonsillitis inflamed with white patches on both tonsils diagnosis tonsillitis is the most likely diagnosis here otitis media is another differential given the earache for treatment of tonsillitis penicillins are preferred augmentin is a good choice to go with i would also ask which antibiotics were given before so as to change antibiotics and monitor improvement i would also refer the patient to an ent specialist as recurring tonsillitis can be an indication for tonsillectomy as for whether we give the medication orally or through iv im this depends on whether the patient can tolerate oral painkillers if not i would admit the patient for 2 3 days and give iv medications when the patient can feed orally i would transition to oral medications" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kiambu county in kenya a mother comes to the cwc clinic for growth monitoring with a baby who is four years old and on examination the child has never received any vaccines we checked the anc booklet the mother didn t have the anc booklet and she said that the child has never been vaccinated since birth any requests or guidance for the patient a child who is four years and has never been vaccinated which vaccines do you give and what dosage do you give the same dosage as the under one year olds or there s a different dosage for the above one year olds and which ones do you start with then how do they follow each other and is the child given all the vaccines or there are some vaccines that the child is not going to be given\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 34 year old female presents with sudden severe pelvic pain and heavy vaginal bleeding she has a history of secondary infertility and a positive urine pregnancy test vital signs indicate hypotension 100 62 and tachycardia 89bpm management stabilize with iv fluids and transfuse if necessary perform urgent pelvic ultrasound to confirm ectopic pregnancy prepare for emergency laparotomy or laparoscopy counsel the patient on future fertility options diagnosis ruptured ectopic pregnancy" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 29.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: critical care\n\n Prompt from the nurse : i am a nurse with 29 years of experience in general nursing working in a health centres in uasin gishu county in kenya a teenage boy aged 22 years walked into the clinic complaining of loose motions which started one day ago on examination the boy looked weak with sunken eyelids vitals 90 50 pulse 120 respirations 18 temperature 35 spo2 95 questions 1 what could have caused the diarrhoea 2 what investigations could be done to make a diagnosis\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 22 year old boy complaining of loose motions for one day on examination weak sunken eyelids vitals bp 90 50 pulse 120 other vitals normal 1 cause of diarrhea food poisoning infection eg cholera 2 investigations full hemogram check white cell count for infection stool analysis culture microscopy for sensitivity blood culture" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 23.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 23 years of experience in general nursing working in a dispensaries and private clinics in uasin gishu county in kenya a 30 year old man came to the facility with history of chills fever and headache for the last 4 days patient reports having travelled to kisumu county history of taking panadol and amoxyl 2 days ago with no change on examination t \u2013 38 2 c pulse \u2013 94 b min respiration rate \u2013 22 b min blood pressure \u2013 120 76 mmhg questions what are the investigations to be done to the patient what is the immediate management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 30 year old male came to the facility with a history of chills fever and headache for the last four days patient reports having travelled to kisumu county history of taking panadol and amoxil 2 days ago with no change he is febrile at 38 2\u00b0c tachypneic at 22 bpm and other vitals are within normal range what are the investigations to be done to the patient complete blood count urea creatinine and electrolytes blood slide for malaria parasite random blood sugar malaria rapid diagnostic test if bs for mp is not available what is the immediate management insert cannula for intravenous access administer antipyretics and encourage exposure to light clothing administer analgesics for the headache depending on random blood sugar results supplementation with dextrose may be considered initiate anti malarial drugs depending on results from blood slide for malaria encourage feeding and hydration for the patient alert the doctor on duty counsel and reassure the patient" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 18.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 18 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 25 year old male presents with a 5 day history of high grade fever headache abdominal pain and constipation the patient returned from a rural area two weeks ago where clean water was scarce no history of vaccination against typhoid on examination febrile 39 5\u00b0c with mild abdominal tenderness and hepatomegaly questions 1 should a blood culture or widal test be prioritized for immediate confirmation 2 what is the preferred empirical antibiotic until culture sensitivity results are available\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 60 year old male presents with a non healing ulcer on his left foot for two months he has a history of diabetes and peripheral neuropathy examination reveals a 3 cm ulcer with surrounding erythema and foul smelling discharge investigations obtain a wound swab for culture and sensitivity order an x ray of the foot to rule out osteomyelitis management plan start iv antibiotics such as piperacillin tazobactam debride necrotic tissue and dress the wound regularly optimize glycemic control with insulin therapy diagnosis diabetic foot ulcer with infection" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 14.0\n - Nursing Specialty: mental health\n - Clinical Panel Focus: internal medicine psychiatry\n\n Prompt from the nurse : i am a nurse with 14 years of experience in general nursing working in a dispensaries and private clinics in kiambu county in kenya an old woman presents to a facility with chief complaint of fatigue lack of interest in daily activity feelings of hopelessness and feelings of self love and feelings of like she lacks self care she doesn t have self care she lacks self care so on assessment she s unkempt she s apathetic but she can communicate very well she s oriented on place and time yeah so upon inquiring more she tells me she has no prior history of a mental illness but she has been facing financial difficulty and is recently separated from her children and husband so she has an ongoing case with the courts on custody of the children so my question now here is does she require counselling first or should we refer her for psychiatric review yeah\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary an old woman with fatigue lack of interest in daily activities hopelessness no self love no self care apathetic and unkempt she is able to communicate well oriented to place and time q1 this patient seems to be going through a depressive episode she could have major depressive disorder with differentials of mood disorder this would be concerning as she could have developed suicidal tendencies counselling would help the patient but she also requires psychiatric review so yes counsel the patient and then refer psychiatric evaluation" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 15.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 15 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya an 18 year old boy was brought by the school nurse complaining of right testicular pain for 1 day the patient reported that the pain started gradually but progressively worsened over the day on assessment bp 120 70mmhg p 100b m temp \u2013 36 6\u00b0c sp02 98 on ra pain on a scale of 9 right scrotum swollen tender and warm on touch questions 1 x0001 what is the immediate care of the patient 2 x0001 what investigation can be done 3 x0001 which specialty can the patient be referred to\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary an 18 y o male presented with a history of night testicular pain that started 1 day ago it started gradually and progressively worsened over the day on examination was normal vitals nut had right scrotal swelling that was tender and warm on touch differentials ddx testicular torsion epididymo orchitis trauma what is the immediate care of the patient manage the patient with appropriate analgesics such as paracetamol if the pain worsens consider stronger analgesics like tramadol start on iv fluids eg ringers lactate put npo if he is to go to theatre consult a urologist for possible surgical repair what investigations can be done complete blood count check for leukocytosis if suspecting epididymoorchitis scrotal ultrasound blood grouping and cross matching baseline investigation before surgery urea electrolytes and creatinine baseline investigation before surgery what specialty can the patient be referred urology referral" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 3.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 3 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 13yr old girl in the ward with a diagnosis of spindle cell carcinoma already done with chemotherapy and radiotherapy sessions and now being managed for anaemia with hb of 4g dl goes into coma and is unresponsive to surrounding the vitals are bp 84 40mmhg pulse rate 92 m spo2 96 but on oxygenvia nasal prongs at 3l 24hrs rbs high despite being started on insulin injection questions 1 what can be done to this patient to reduce the blood sugars 2 what might caused the patient move into coma\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 13 year in the ward with a diagnosis of spindle cell carcinoma done with chemotherapy and radiotherapy sessions being managed for anemia hb 4 g dl goes into coma hypotensive 84 40mmhg spo2 96 on oxygen via nasal prongs rbs high despite being on insulin what can be done to reduce the blood sugars increase insulin dose correct hypokalemia if there check if the patient is using corticosteroids because they cause excessive hyperglycaemia administer intravenous fluid to the patient causes of coma in the patient hyperglycemia severe anaemia tumour progression sepsis diabetic ketoacidosis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 7.0\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 7 years of experience in general nursing working in a sub county hospitals and nursing homes in kakamega county in kenya 23 years old came to mch fp clinic with history of headache flank pains blurred vision dizziness history of hypertension 3 years back she is using depo as family planning method diagnosis of hypertension was made bp 215 109 temperature 36 9\u00b0 weight 89kg what is the best management for this client should i refer for gynaecological review should i start her on antihypertensive\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 23 year old female reports of headache flank pain blurred vision dizziness hypertension known hypertensive bp 215 109mmhg management of the patient assess abc and tm stabilizing the patient monitor vital signs closely fix a large bore iv cannulas collect blood samples cbc uec lfts lipid profile rbs hbaic fix a urinary catheter collect urine for analysis monitor input output initiate iv labetalol hydralazine even bp is gradually lowered access labs to check for features suggestive of end organ damage iv analgesia pcm trandol refer to a specialist diagnosis hypertensive emergency elevated bp 180 110 with features suggestive of end organ damage differential diagnosis secondary hypertension" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 20.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 20 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya an 8 year old is brought to the hospital by the parents with complaints of general body weakness hotness of the body for two days parents report that she treated to acute lymphocytic leukemia 1 year ago and was taken abroad for bone marrow transplant on examination the girl is weak and sick looking febrile pale temp 39 4oc p 138 b m r 28 bpm questions what is the emergency management of this pattern what investigation will be done on this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 36 year old male presents with sudden onset of severe right lower quadrant abdominal pain associated with nausea and vomiting the pain began 6 hours ago and has progressively worsened examination reveals tenderness and guarding in the right lower quadrant with rebound tenderness investigations perform an abdominal ultrasound to assess for appendicitis order a complete blood count cbc to evaluate for leukocytosis management plan admit for iv fluids and nil by mouth npo administer iv antibiotics such as ceftriaxone and metronidazole prepare for emergency appendectomy diagnosis acute appendicitis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 20.0\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 20 years of experience in primary care working in a national referral hospitals in uasin gishu county in kenya a 32 yr old female received with a history of per vaginal bleeding for 3 weeks bleeding is not associated with menses avpu at a pale temp 36oc pr 82b m rr 20b m bp 101 68mmhg question what is causing the vaginal bleeding in this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 32 year old female with a history of pv bleeding for 3 52 bleeding is not associated with menses avpu at alert pallor observed other vitals are normal" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 12.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine surgery\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya daniel a 53 year old male patient presented the ed with a penetrating object from the front to the back of the truck they are reported to have been fighting with the neighbour over unpaid loans he is alone diabetic on treatment but deferred two months ago due to financial constraints on examination there is no bleeding on the insertion site and the abdomen is distended temp 36 degrees celsius rr 32 breaths min pr 160 beats min he is crying for help question what is the immediate management what investigations are needed\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 53 year old patient injured with a penetrating object front to back following a fight and with known t2dm on treatment o e no bleeding on insertion site abdominal distension crying for help vitals temp 36\u00b0c pr 32 bpm pr 160 dx penetrating thoraco abdominal injury ddx liver laceration spleen rupture concern for developing hypovolemic shock immediate management follow abcde protocol of managing a trauma patient ensure airway is patent and maintain it as such assess breathing and support as needed get iv access draw samples for basic labs and administer ivf bolus assess patients\u2019 gcs pupillary response reassess patient after each intervention call for urgent general surgery review monitor vitals and input output needed investigations labs fhg uec lft gxm coagulation profile imaging fast ultrasound cxr abdominal ct scan dx penetrating thoraco abdominal injury" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 9.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 9 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 38 years old female presented with left ear pain and swelling that started 4 days prior as a small pimple and progressed over the course of 4 days to the point that the patient is unable to lie on her left side due to pain and swelling no history of trauma to that area on examination the patient appeared uncomfortable due to pain and swelling bp 120 80mmhg p 80b min and t 35 9c questions what could be the diagnosis what investigations could be done to aid in diagnosis what is the management of the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 38 year old female presented with left ear pain and swelling which started 4 days prior as a small pimple and progressed over 4 days making the patient unable to lie on her left side due to pain and swelling no history of trauma on examination the patient appeared uncomfortable due to pain and swelling bp and pr were normal temperature slightly low at 35 9 celsius investigation complete blood count urea electrolyte and creatinine management administer analgesic advise patient to avoid lying on affected side refer to ent for otoscope examination" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 1.0\n - Nursing Specialty: neonatal care\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 1 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya the new born was admitted into the new born unit after failure to initiate breathing after birth on assessment apgar 3 6 8 spo2 26 pulse \u2013 106b min temp 34 5c respirations not clear question what is the immediate management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "newborn with poor apgar score in nbu spo2 26 pulse 106 temp 34 5 respirations not clear dx birth asphyxia dd prematurity immediate management call for help initiate resuscitation as per pals protocol" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : community health centers\n - Years of Experience: 24.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 24 years of experience in general nursing working in a community health centers in uasin gishu county in kenya a two year old girl presents in the facility with a packing cough and stridor for five days she had been premedicated with piriton and amoxil but no improvement no history of any other underlying condition on examination mild inspiratory stridor heard no cyanosis vital signs temperature 37 9 c pulse 126 beats respiratory rate 45 breaths per minute and spo2 96 questions what investigations should be done what is the diagnosis what is the management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 2 year old with barking cough tachypnea x1 7 and respiratory distress vitals temp 37 9\u00b0c tachycardia 126 bpm rr 44 spo2 96 investigations lab nasopharyngeal swabs for bordetella pertussis culture or pcr radiological cxr mx management oxygen therapy if spo2 92 administer broad spectrum antibiotics e g azithromycin add analgesics and antipyretics for symptom relief nebulization e g salbutamol for respiratory improvement steroid use e g parenteral dexamethasone may help reduce inflammation the patient needs isolation as the condition is highly contagious contact tracing is also key to limit further spread diagnosis whooping cough" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 29.0\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 29 years of experience in general nursing working in a health centres in uasin gishu county in kenya a girl aged 10 years brought in by her mother came with complaints of pain in the mouth not able to eat especially salty food and some juices on examination the tongue was ulcerated and red and oral thrush on the roof of the pallet pulse 128 respirations 24 temperature 38 8 spo2 98 questions 1 how do we treat this client 2 what caused the rise in temperature\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 10 year old girl brought by her mother with complaints of pain in the mouth not able to eat especially salty food and some juices on examination the tongue was ulcerated and red and oral thrush on the roof of the paller p128 rr 24 t 38 8\u00b0c spo 98 dx oral thrush differentials sepsis oral sores management as follows fix a cannula give iv fluids child not eating give antipyretics for fevers give analgesics for pain give antibiotics to treat infections give antivirals two nystatin drops investigate for the cause of oral thrush do hiv test full haemogram advice the patient on the importance of oral hygiene investigations fhs bs for mps erythrocyte sedimentation rate hiv test" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: elgeiyo marakwet\n - Health level\t : county hospitals\n - Years of Experience: 1.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 1 years of experience in general nursing working in a county hospitals in elgeiyo marakwet county in kenya a 15 year old boy 7 days post circumcision presented to causality with complaints of painful swollen gland penis pungent blood stained discharge on the surgical site hotness of the body and vomiting he underwent traditional circumcision on assessment the gland penis was enlarged pungent thick discharge with stinge smell lower abdomen was fender and mildly distended reports difficulties and pain in urination vital signs bp 117 79mmhg pr 100bpm spo296 t 38 9\u00b0c rr 19bpm questions how could the patient be managed which investigations should be done which health education messages should the patient receive\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 15 year old boy 1 52 post traditional circumcision presents with dysuria swollen penis pungent blood stained penile discharge hotness of body and vomiting on examination lower abdominal tenderness and mild distension bp 117 79 pulse 100 bpm spo 96 pr 19 temp 38 9 differential diagnosis sepsis post circumcision management of this patient get iv access start iv fluids and get samples for cbc and blood culture give tetanus toxoid injection clean the penile wound give antiemetics antipyretic analgesic start on broad spectrum antibiotics available attempt urethral catheterization organize referral to a higher facility where the patient can be managed further in terms of general surgery review given the concerns of pentonitis acute abdomen urologist\u2019s review for round care and further management extensive septic screen for possible suprapubic catheterization should intra urethral catheterization fail for effective input output monitoring availability of hdu icu should the systemic sepsis worsen appraisal of parents on aseptic techniques for circumcision employed in hospitals" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: surgical care\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in uasin gishu county in kenya a young man of 24 years was brought to the outpatient referred from a dispensary complaints a fish bone was stuck on the throat as he was eating fish and tried all measures to swallow it or remove it in vain patient was very anxious and restless on assessment temperature 360c pulse 80 beats minute and respiration 20 breaths minute spo2 98 questions what is the immediate care of the patient what investigations is he likely to be done what complication is likely to occur\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "case summary 24 yr old brought to outpatient in sub county hospital referred from a dispensary in distress complaints of fish bone stuck on the throat he was eating fish and tried all measures to remove it himself or swallow vitals spo2 98 pr 80 bpm rr 20 bpm t 36\u00b0 patient was anxious and restless what is the immediate care of the patient try maneuvers that will remove the fb foreign body causing the choking heimlich maneuver try swallowing compacted with boiled rice refer to ent specialist to try removing it endoscopically calm and reassure the patient what investigations are likely to be done esophagogastroduodenoscopy egd to check for the extent and severity of the injury what complications are likely to occur esophageal trauma esophageal perforation secondary to tb dysphagia dx foreign body oesophogus" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 17.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 17 years of experience in general nursing working in a dispensaries and private clinics in kakamega county in kenya a patient is brought in with signs of knee dislocation history of injury during football on assement the left knee is dislocated what drug can i give before i refer for xray\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary patient brought in with signs of knee dislocation history of falling during a football game but knee is dislocated q1 what drugs can i give before i refer for x ray tramadol or morphine need for a strong painkiller diagnosis dislocation knee with neurovascular compromise" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : county hospitals\n - Years of Experience: 26.0\n - Nursing Specialty: emergency care pediatric\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 26 years of experience in general nursing working in a county hospitals in kakamega county in kenya a two year old baby was brought to outpatient department with history of having swallowed a coin on examination the patient had difficulty in breathing not able to swallow saliva observations were taken and temperature was 36 degrees centigrade pulse was 1 3 per minute and respiration was 28 per minute an impression of respiratory blockage was made what should i do to this child if i give oxygen will she benefit or should i just refer this patient to the next level for further management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 2 year old baby presents with a history of swallowing a coin on examination difficulty in breathing inability to swallow saliva vitals are normal impression of respiratory blockade was made immediate management 1 do an x ray to confirm the position of the coin 2 suction any drooling 3 put on nasal prongs supplemental oxygen 4 call physician and surgeon for emergency review 5 try abdominal thrusts to dislodge the coin upwards 6 may require bronchoscopy for removal 7 give analgesics for the pain 8 give prophylactic antibiotics broad spectrum" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: 17.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 17 years of experience in general nursing working in a dispensaries and private clinics in kakamega county in kenya a mother aged 30 years old a gravida 2 para 1 0 at 38 weeks gestation has intrauterine fetal death induction with misoprostol failed fhr absent bp 110 70 temperature 37 and no contractions how many times are you supposed to try induction should l refer for c s\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary mother 30 years para 1 0 g3 39 40 with intra uterine fetal death induction with misoprostol failed fhr absent bp110 70 temp 38 no contractions q1 how many times are you supposed to induce up to 4 times q2 should i refer for c section no let the mother rest for 24h then retry diagnosis iufd intrauterine fetal death" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 2.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse with 2 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 38 year old male presents with a complaint of painless lump on his left neck unexplained fatigue for the past 2 months family history of prostate cancer from the dad and type 2 diabetes and hypertension from the mother on assessment the patient appears visibly fatigued vitals bp 118 75 mmhg pr 80 t 36 7 rr 16 spo2 94 question what could be the diagnosis of the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 38 year old male with painless lump on left neck unexplained fatigue for 2 months family history of prostate cancer dad and type 2 diabetes mellitus and hypertension mother on examination visibly fatigued vitals are all normal 1 diagnosis the diagnosis would depend on a comprehensive history and physical examination of the patient as well as investigation results for both laboratory as well as radiological investigations done differentials would be ddx lymphadenopathy secondary to bacterial infection of the nodes a reaction to a nearby infection eg a sore throat or systemic infection cancerous neck mass e g cancer of the mouth throat lymph node lymphoma cyst eg epidermoid cyst goiter panel internal medicine 4607 summary a 10 year old presented with a headache and is now unable to walk for 1 week treated at a peripheral facility with antibiotics without improvement temperature 37 8\u00b0c spo2 92 on room air pulse rate 130 bpm rr 28 deep and rapid blood pressure 90 60 mmhg 1 immediate management 2 investigations 1 my key concern in this case would be central nervous system lesions such as space occupying lesions eg tumor upper motor neuron and lower motor neuron lesions stroke central nervous system infections or trauma to the head i would also be concerned about shock hypovolemia or sepsis due to the abnormal vitals immediate treatment would include intravenous fluids get blood samples for testing complete blood count urea creatinine and electrolytes liver function tests intravenous antibiotics broad spectrum e g cephalosporin 3rd gen once hemodynamically stable do mri brain to find cause of symptoms refer to a neurologist urgently 2 laboratory complete blood count urea creatinine and electrolytes for electrolytes and kidney function liver function tests for liver function lumbar puncture \u2192 cerebrospinalfluid for microscopy culture and sensitivity gram stain afb blood for microscopy culture and sensitivity blood slide for malaria pcr for viral infections radiological brain mri echocardiogram electrocardiogram" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kakamega county in kenya mr kalembe 42 years old is brought to outpatient with complaint of edema continuous cough that worsens at night the abdomen is distended and shiny on examination blood pressure is 90 over 40 pulse of 40 beats irregular he is very dyspneic and talks with difficulty he prefers being propped up in bed every edematized site is pitting on pressure could this be ccf could i refer to physician or could it be liver related which medication can i give to relieve\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 42 year old was brought in to an outpatient with coughing and bilateral edema on examination the abdomen is distended and shiny has a low pulse rate that is irregular and low blood pressure 90 management 1 admit the patient 2 give supplemental oxygen via face mask 3 give iv restrict fluid and salt 4 give diuretics in case of congestive cardiac failure 5 call physician for review 6 monitor input and output and ensure that output input 7 daily weights should be taken investigations complete blood count urea electrolytes and creatinines liver function tests electrocardiography echocardiography chest x ray hepatitis b and c tests" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: nan\n - Nursing Specialty: child health\n - Clinical Panel Focus: paediatrics\n\n Prompt from the nurse : i am a nurse working in a national referral hospitals in uasin gishu county in kenya a 1 year old boy brought in by the mother with complaints of fever and vomiting for the last 3 days had been admitted before with similar problems 2 months ago he is the 2nd born in the family the other sibling is on follow up for cerebral palsy fully immunized has normal milestones vital signs temp 38 9\u00b0c pr \u2013 91b m spo2 98 questions what could be causing recurrent fever and vomiting how about the investigations before the next follow up\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 1 year old boy with vomiting and fever for 3 days with treatment of the same 3 months fully immunized and normal milestones vitals fever dx \u00b7 malaria \u00b7 sepsis investigations \u00b7 a full blood count \u00b7 crp \u00b7 blood slide for malaria" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 11.0\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 11 years of experience in general nursing working in a sub county hospitals and nursing homes in kakamega county in kenya a 22 year old nulliparous lady presents in the clinic for preconception counselling on history she previously used fp method that is jadel and during the period there was a history of amenorrhea removal was done one year ago and her menses resumed three months later though irregular do i refer for hormonal tests do i wait for the menses to resume at least six months later or do i give combined oral pills to regulate the menses\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 22 year old nulliparous lady coming to hospital for preconception counselling she has a history of having irregular menses after removal of an implant jadelle that allegedly caused her to have amenorrhea management the patient s symptoms are expected to be undesired effects of contraceptive use ideally you could wait for 6 months for menses to normalize however to rule out other differential for abnormal uterine bleeding the patient should be sent for various laboratory tests including hormonal tests may be necessary to prescribe combined oral pills to regulate the menses until the root cause of the abnormal uterine bleeding is established" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: nan\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a national referral hospitals in uasin gishu county in kenya 28 year old woman is admitted at 38 weeks 2 days gestation as per 3rd trimester ultrasound anc profile blood group b rh negative never got anti d at 28 weeks serology non reactive hb 13g dl reports with complains of lower abdominal pains no backache no bleeding vitals normal per abdomen cephalic 34 40 fhr 138b m no contractions vaginal examination tip of a finger discharge plan admit dexamethasone 6mg bd for 5 7 nitrofurantoin 100mgbd for 5 days clotrimazole pessaries 500mg stat for cord blood sampling for direct coombs test after delivery questions 1 is it recommended to do ict test to all the rhesus negative mothers at or after 28 weeks before admitting 2 if a mother runs an ict positive before delivery what is the management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 28 year old woman admitted at 38 weeks 2 days gestation as per 3rd trimester ultrasound anc profile blood group b rh negative never gotten anti d at 28 weeks serology nr hb 13 complaints of heavy abdominal pain no backache bleeding no contractions vitals normal per abdomen presentation cephalic fh 37 40 fhr 138 m plan admit rehydration dexamethasone abdominal pessary take cord blood sampling for direct coombs test after delivery diagnosis rhesus isoimmunization q1 is it recommended to do ict test to all rh negative mothers or after 28 weeks before delivery yes you can do ict to them but before 28 weeks q2 if a mother turns an ict positive before delivery what is the management this means that the mother has already developed antibodies against the rhesus monitor the fetus doing ultrasounds do amniocentesis and measure bilirubin levels close monitoring during delivery preferably through cls if the fetus develops anaemia do intrauterine transfusion" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 16.0\n - Nursing Specialty: mental health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 16 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya i am calling for a 40 year old female and in neuro ward bed 3 scheduled for ct scan head tomorrow was admitted for observation following a fall at home she has a fractured humerus and a deep laceration on the left of her forehead on my hourly neuro checks she has a repeat ct scan ordered for tomorrow she has some decline since the last check she is confused dizzy with a headache she takes coumadin 5mgs daily question what are your thoughts on doing the scan now\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 40 yr old female admitted following a fall at home due to which she fractured a humerus and has a deep laceration on the left of her forehead repeat ct is ordered for tommorow she is confused dizzy and has a headache she is on coumadin 5 mg daily i am concerned about a traumatic head injury what are your thoughts on doing the scan now go ahead and do the ct as there are no contraindications and it would also help access the extent of the injury diagnosis severe head injury fractured humerus ddx x0001 intracranial hemorrhage alcohol intoxication fractured humerus hypoglycemia recommendation x0001 urgent ct scan of the brain blood glucose level icu care" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : health centres\n - Years of Experience: 24.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 24 years of experience in general nursing working in a health centres in uasin gishu county in kenya a 24 year old female was brought to the facility complaining of severe vomiting and abdominal pain she was restless she said the vomiting has been on and off but the abdominal pain started in the morning before they came to the hospital last menses was 2 months ago vital signs temp 35 6 30 c pulse \u2013 80 resp \u2013 20 questions what could be the diagnosis what is the immediate management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 24 year old female presenting with vomiting and abdominal pain last menses 2 months ago concerns delayed menses vomiting abdominal pain dx hyperemesis gravidarum ddx ectopic pregnancy gastroenteritis appendicitis management pregnancy test monitor vital signs analgesics for pain iv fluids to prevent dehydration prepare for possible surgery incase of ectopic pregnancy or appendicitis monitor signs of shock consult obstetrician and gynaecologist" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 10.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a sub county hospitals and nursing homes in uasin gishu county in kenya a 25 year old mother came for routine antenatal checkup with complaints of mild headache on and off for the last 2 weeks on examination fundal height 32 weeks edema of the lower limbs noted vital signs blood pressure 140 100 pulse 98 questions what test can be done what education can we give the client\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "25 year old with headache for 2 52 noted to have high bps with lower limb edema fundal height 32 weeks dx pre eclampsia investigation an obstetric ultrasound for biophysical profile of fetus placental attachment and adequacy urinalysis patient usually has increased protein in urine liver function test will reveille and increase in liver enzymes full hemogram will have a reduction in platelets count management start on hypertensive medication and stress on need for compliance and complications of not therein refer to an obgyn for close monitoring dx diagnosis pre eclampsia" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : dispensaries and private clinics\n - Years of Experience: nan\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse working in a dispensaries and private clinics in kakamega county in kenya a 26 year old client comes to the family planning clinic with complaints of having had prolonged heavy menses lasting for three weeks on examination she is stable no pallor no abdominal pain or tenderness she is on a long term family planning method that is jadel what could be the cause of the prolonged bleeding is this menorrhagia secondary to fp method what medication should i give her should i refer her for senior review and management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 26 year old came to the clinic with prolonged heavy menses on examination stable no pallor no abdominal pain no tenderness family planning method used was jadelle causes hormonal imbalance caused by the jadelle management remove the jadelle give ibuprofen 800mg three times a day for five days give tranexamic acid 1g stat then 500mg three times a day do full haemogram to determine the level of haemoglobin" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 10.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: surgery\n\n Prompt from the nurse : i am a nurse with 10 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 66 years old female is in the orthopaedic ward 3rd post operative day she was done right knee replacement she is complaining of right calf pain on movement vitals temp 36 20c pulse \u2013 76b min resp \u2013 20 b min bp 136 60mmhg questions what type of investigations should be done to the patient what is the management of the patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 36 year old female with right knee replacement 3 days ago presents with right calf pain on movement dx deep venous thrombosis ddx compartment syndrome sepsis management proper physical exam to assess for paresthesia pulselessness swelling to check for compartment syndrome doppler ultrasound to check for deep vein thrombosis analgesia to manage pain if compartment syndrome confirmed inform orthopedic team for fasciotomy if deep vein thrombosis is confirmed inform the physician anticoagulation team to start on blood thinners blood works to check for sepsis full hemogram and c reactive protein" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 12.0\n - Nursing Specialty: maternal and child health\n - Clinical Panel Focus: obstetrics and gynaecology\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya a 24 years old lady brought by the mother in law referred from another facility to our facility with a history of vagina bleeding she reports that she was pregnant but she s having an abortion an inevitable abortion so the vitals are within normal but she s bleeding though not profusely so on my questions would this lady need a scan first or should the clinician go ahead and do an mva and what is the psychological impact of this condition to this lady\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "a 24 year female who has an inevitable abortion we are not told of the full history of this patient would this be the first pregnancy any underlying medical conditions like diabetes rhesus status any medical conditions like hypertension this would be useful for counselling purposes however since this patient has an inevitable abortion and the vitals are normal one would go ahead and do a pelvic scan followed by mva this way the clinician would be medically covered and would help in counselling later this is a patient who will require a follow up in an obstetrics and gynaecology clinic after the mva diagnosis inevitable abortion" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 12.0\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: critical care surgery\n\n Prompt from the nurse : i am a nurse with 12 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 49 year old man is brought to the ed by paramedics after being reported to have collapsed during a vigorous exercise at a local gym no significant history was reported he was rushed in after the accident on examination he is unresponsive with shallow breaths threads pulse and unrecordable bp pulse 47 spo2 62 ra rr 24 b min bp unrecordable questions what will be the immediate management what investigations are needed to be done\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 49 year old man is brought to the emergency department by the paramedics after being reported to have collapsed during a vigorous exercise at a local gym no significant history was reported he was rushed in after the accident o e unresponsive with shallow breaths thread pulse unrecordable bp pulse 47 spo2 62 rr 24 a what will be the immediate management for immediate management on this patient check for airway and cervical spine instability check for any secretions foreign body breath sound perform a head tilt and chin lift maneuver check for breathing and ventilation check for breath sounds if you can hear the sounds any abnormal sounds from airway chest movement oxygen saturation initiate oxygen via a non rebreather mask check for circulation and hypovolemic instability insert two large iv bores start hydration therapy and dextrose to the patient perform a random blood sugar levels diagnosis this is a concern for cardiac arrhythmias with differentials of hypoglycemia spinal injury heat stroke drugs toxins perform routine laboratory investigation and an emergency echo and ecg for this patient it will guide in definitive management of the patient b what investigations are needed to be done laboratory random blood sugar full hemogram liver function test renal function test drug toxicology radiological echo ecg to check for cardiac structure and conduction ct scan of the head" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kiambu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 22.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 22 years of experience in general nursing working in a sub county hospitals and nursing homes in kiambu county in kenya a 45 years old lady came to the clinic complaining of epigastric pains for the last one month a diagnosis of hyperacidity was made what was the cause of excess acidity how do you prevent it from happening in future what is the best treatment\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 45 yr old with epigastric pain x 1 12 diagnosis of hyperacidity made diagnosis gastritis treatment proton pump inhibitors antacids h2 blockers antibiotics if caused against a h pylori prevention regular meals don t skip meals don t sleep on pillows avoid night meals avoid reflux sleep on pillows reduce reflux weight loss reduce reflux caffeinated drinks avoid spicy foods fatty foods caffeinated drinks" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 7.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 7 years of experience in general nursing working in a sub county hospitals and nursing homes in kakamega county in kenya a patient on blood transfusion has been on the ward and the transfusion started the caretaker increases the speed of blood without the consent of the nurse the nurse comes after 30 minutes and finds the blood over vital signs blood pressure is 120 74 pulse of 84 respiration of 18 breaths per minute the patient is alert is conscious is no danger sign noted what is the nurse supposed to do\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a patient on blood transfusion has been on the ward and the transfusion started the caretaker increased the speed of blood without the consent of the nurse the nurse comes after 30 minutes and finds the blood over vital signs bp 120 74 p 85 respirations 18 bpm the patient is alert conscious and has no danger signs noted this is a case of rapid blood transfusion which is not a standard practice in the medical field for this patient monitor vital signs very closely perform a second physical exam to pick out any signs such as crackles it\u2019s also important to educate the caretaker about the standard practice and complications that can arise from the procedure" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: nan\n - Nursing Specialty: sexual and reproductive health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a national referral hospitals in uasin gishu county in kenya a 38 yr old para 3 presented to clinic with c o spotting between menstrual cycles bleeding post coitus watery vaginal smelly discharge abdominal pains never done a pap smear questions what evaluations will be significant at this point how should the mother be managed\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 68 year old male presents with fever altered mental status and neck stiffness for one day examination reveals photophobia and positive brudzinski\u2019s sign investigations perform a lumbar puncture for cerebrospinal fluid analysis obtain blood cultures to identify causative organisms management plan start iv ceftriaxone and vancomycin immediately administer dexamethasone to reduce inflammation monitor closely for signs of raised intracranial pressure diagnosis acute bacterial meningitis" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: 15.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 15 years of experience in primary care working in a sub county hospitals and nursing homes in uasin gishu county in kenya a man reports to the facility with a history of frequent urination and pain when urinating with hesitation he has been having the problem for 4 days and now not able to perform sexual intercourse due to pain and erectile dysfunction on assessment there was urethral discharge yellowish and pimples around the shaft blood pressure 120 78 mmhg pulse 76 beats minute and respiration 20 breaths minute questions why yellow discharge what causes the symptoms what\u2019s the management\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary male patient with complaints of dysuria pyuria and dribbling on micturition for 4 days also reports erectile dysfunction impression urethritis dd urethral strictures bladder outlet obstruction\u2019 sexually transmitted infection stis why yellow discharge its an inflammatory exudate due to inflammation of the urethra what causes discharge type of infection bacteria e g gonococcal urethritis extent severity of the infection management give empiric antibiotics combined with flagyl analgesics for the pain encourage fluid intake\u2019 treat sexual partner investigations psa to rule out bph urinalysis with early morning urine urethral swab for microscopy and culture do kub kidney ureter and bladder ultrasound do micturating cystourethrography" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: uasin gishu\n - Health level\t : national referral hospitals\n - Years of Experience: 18.0\n - Nursing Specialty: adult health\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse with 18 years of experience in general nursing working in a national referral hospitals in uasin gishu county in kenya a 67 year old male patient came to the hospital with history of coughing blood stained sputum difficulty in breathing sweating at night loss of appetite and dizziness temperature 36 70c pulse 108 beats minute respiration 23 breaths minute blood pressure 100 56mmhg spo2 91 at room air question s what could ailing the patient where does the patient stay what radiological examinations can be requested what laboratory tests can be requested what is the immediate management for this patient\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary 67 year old male with cough hemoptysis dyspnea night sweats anorexia dizziness vitals 100 56 91 on ra 108 bpm 36 7 c radiological investigations cxr echo eeg ctpa lab tests complete blood count urea electrolyte and creatnine s liver function tests esr sputum gene xpert gram stain coagulation profile immediate management \u00b7 admit for management in medical ward \u00b7 oxygen supplementation via nrm target spo2 \u2265 95 \u00b7 check random blood sugar and manage accordingly \u00b7 connect patient on cardiac monitor get iv access and give iv fluid bolus normal saline \u00b7 inform physician and request urgent review" }, { "Prompt": "\n You are a professional clinician assistant. Based on the following information, generate a clinical response that reflects the background and expertise of the nurse:\n\n - County: kakamega\n - Health level\t : sub county hospitals and nursing homes\n - Years of Experience: nan\n - Nursing Specialty: general emergency\n - Clinical Panel Focus: internal medicine\n\n Prompt from the nurse : i am a nurse working in a sub county hospitals and nursing homes in kakamega county in kenya a 40 year old man is brought in outpatient with history of difficulty in breathing cough at night he s done an examination and sputum was taken for check the man says he s a known asthmatic do we still give aminophylline iv if we don t have a nebulizer at the unit or do we admit the patient in the ward\n\n Based on this profile, generate a professional and realistic clinical response as if the nurse is answering a patient or colleague's medical question regarding surgical or ENT care. Keep the tone clinical yet empathetic.\n\n ", "Answer": "summary a 40 year old man is brought to outpatient with history of difficulty in breathing cough at night known asthmatic patient examination done and sputum taken for check 1 do we still give aminophylline iv if we don t have a nebulizer at the unit or do we admit the patient in the ward give aminophylline and ask patient to continue with inhaler put patient at outpatient under observation until breathing gets better before discharging dx exacerbation of asthma" } ]