HIV Councelling (OSCE) Pre-Test Counselling

HIV Councelling (OSCE)
Pre-test counselling
Hi. I would like to advice you to take a HIV test. Do you know what is HIV infection? It is a slow developing disease
caused by human immunodeficiency virus (HIV) that destroys the body's defense against diseases and if left untreated
may result in acquired immunodeficiency syndrome (AIDS). HIV infection passes from a person to another by exchange
of body fluids such as blood and semen. Therefore, it can be transmitted through transfusions of infected blood,
exchange of needles in injection drug users and unprotected sexual intercourse. It may also pass from mother to baby
during pregnancy and breast feeding. Since your husband has tested positive for HIV infection, you are at risk of
contracting it from him. (Since you have a history of having unprotected sex with numerous partners, you are at risk of
contracting the infection from one of them.) There are a few methods in reducing the risk of transmission during sexual
intercourse such as avoiding penetration and using condoms (and reducing the number of sexual partners) but they are
not foolproof. Up till now, do you have any questions? In this HIV test, we are going to test your blood for HIV antibody
which will be produced by your body if you have the disease. However, there is a chance that the result of this HIV test
is false. If you tested positive, we will proceed with a confirmatory test. If you tested negative, we recommend you to
take another test later because your body may not produce the HIV antibody yet. I would like to assure you that this
HIV test is confidential and we will give the result directly to you after 3 days. If you agree, please sign this form.
Thank you.
Post-test counselling
Test result negative

Hi. I have your HIV test result. Would you like to know the result? It is good news, you tested negative. However,
there is a small chance that you may be in what we call as the window period in which although already infected by
HIV, your body may not produce the HIV antibody yet. Therefore, we recommend you to take another test in 3 months.
As you may already know, HIV infection can be transmitted through transfusions of infected blood, exchange of needles
in injection drug users and unprotected sexual intercourse. It may also pass from mother to baby during pregnancy and
breast feeding. You are at risk of contracting this disease as your husband has tested positive for it. (You are at risk of
contracting this disease as you have a history of having unprotected sex with numerous partners.) In this case the best
method to prevent HIV transmission is by abstaining from sexual intercourse. If this is not possible, other methods such
as avoiding penetration during sexual intercourse and using condoms (and reducing the number of sexual partners)
may lower the risk of transmission. Since you are repeatedly exposed to this disease, I would advice you to have
repeated HIV tests and to take prophylactic medications - I will refer you to a HIV specialist. I will also refer you to an
obstetrician to advice you on contraception and pregnancy. Do you have any questions? Thank you.
Test result positive

Hi. I have your HIV test result. Would you like to know the result? I assure you that this is confidential and we will not
tell anyone else about it. Unfortunately, you tested positive for HIV infection. It is good that we know that you are
infected with HIV early in the disease process. The HIV weakens your ability to fight illness. However, the process is
slow and may take upto 10 years or more before symptoms appear. Medical treatments and earlier use of medications
can help your body resist HIV. They do this by slowing the growth of HIV and delaying or preventing certain life-
threatening conditions including AIDS. I will immediately refer you to a HIV specialist. I will also refer you to an
obstetrician to advice you on contraception and pregnancy. There are a few precautions that you must take to reduce
the risk of transmitting it to other people. Use condoms everytime you do any type of sexual intercourse from beginning
to end. (and try to reduce the number of sexual partners that you have.) You cannot donate blood or any other parts of
your body. However, contrary to popular belief, HIV infection cannot be transmitted by holding hands, hugging, kissing
or sharing spoons, forks and glasses. I would like to again assure you that this is confidential. (However, you have to
tell your sexual partners that you tested positive so that they can get tested too.) If you need any help please call this
number. Thank you.
Commed [osce]
scenario: miss x has been given a salbutamol inhaler. pls explain the correct procedure for administering this drug.
introduction/consent
reason for carrying out this procedure
explain procedure with demonstration
1. should sit up straight or stand

2. remove the cap, hold the inhaler between the index finger and the thumb then shake it
* if the inhaler has not been used for a long time, spray 1 puff into the air
3. inhale fully & slowly and exhale through the mouth
4. engulf the mouth of the inhaler tightly and extend the neck a little
5. press on the inhaler and "suck" for 5-10 seconds
6. remove the inhaler and exhale through the nose slowly while keeping the mouth close
7. wait for 1 min before repeating the 2nd dosage
8. rinse the mouth after using the inhaler
observation of procedure by pt,check understanding + any corrections

ask if pt has any questions and stress on the importance of correct technique
benefits: fast relieve, less side effects in comparison with tablets, improve quality of life, using a prophylactic inhaler
consistently helps in the control of asthma
wrong technique leads to: poor control of the disease, high cost, affects productivity, hosp admission
reference for the steps 1-8 above : unit pendidikan pesakit, MGH and some added points from books here and there
scenario: 30 year old male presented with persistent nocturnal cough for a month. Take her PEFR recording.
introduction
explain procedure
consent
wash hands
demonstrate:
1.obtain the peak flow meter and disposable mouth piece
2.stand upright
3.reset pointer to "0"
4.hold the peak flow meter in horizontal position and ensure your fingers are not obstructing the scale
5.repeat procedure 2 more times and record the highest of 3 readings
6.compare the readings to the chart ( varies fr person-person by age,height and gender)
7.offer to take full history and do examination
8. advice pt to keep a diary and perform this procedure 3x/day
9. address any concerns
some points about PEFR:

- measures the maximum flow rate in the first 2ms of expiration
- cheap and simple test
- estimates airway calibre
- monitor and assess response to t/t
- PEFR>80% normal
<50% acute severe asthma
<33% severe life threatening asthma

HIV Councelling (OSCE) Pre-Test Counselling

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HIV Councelling (OSCE)

Test result negative

Test result positive

1. should sit up straight or stand

observation of procedure by pt,check understanding + any corrections

some points about PEFR:

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