CONTENTS :

TOPIC 1 Assessment of Growth Anthropometry

TOPIC 2 History Taking and Physical Examination
in Thyroid Disease
TOPIC 3 Drug Prescription
TOPIC 4 Procedure for administering
intradermal,subcutaneous and intramuscular
injection
TOPIC 5 Diabetic Foot Care in DM
TOPIC 6 Diabetic Counseling (Hypoglicemia)

TOPIC 1

: MEASUREMENT OF GROWTH ANTHROPOMETRY

MODULE OF SKILL LABORATORIUM PRACTICE

BLOCK
TOPIC

I.

: ENDOCRINE AND METABOLISM SYSTEM

: MEASUREMENT OF GROWTH ANTHROPOMETRY

GENERAL OBJECTIVE
After finishing skill practice, the students will be able to
performed measurements of weight, height and body proportion
in children

II. SPECIFIC OBJECTIVES

At the end of skill practice, the students will be able to :
1. Measure height and weight
2. Measure sitting height
3. Calculate body proportion
4. Record the measurements on appropriate growth charts
5. Interpretation of the results
III. SYLLABUS DESCRIPTION
1. Expected Competencies
a. Students are capable to demonstrate procedure of height and
weight measurements
b. Students are capable to determine body proportion
c. Students will be able to record growth measurement on a
growth chart
2. Methods
a. Presentation
b. Demonstration
c. Coaching
d. Self practices

a.
b.
c.
d.
e.
f.

3. Laboratory facilities
a. Skill Laboratory
Trainers
Models
Student Learning Guide
Standardized patients
Trainers Guide
Growth chart references
4. Venue
Skills Laboratory

5. Evaluation
a. Point nodal evaluation
b. OSCE
IV. EQUIPMENT
1. Presentation : Audiovisual
2. Demonstration and coaching
2.1. Measurement of weight
Beam Balance
2.2. Measurement of height/sitting height
a.Stadiometer and microtois
b.A stool
3. Growth recording
Growth chart (CDC)
Chart of upper to lower body proportion
Straightedge
Calculator
4. Models
Mannequin,
Standardized patient
1. INTRODUCTION
This module is guide for measuring and recording weight, height,
sitting height, and body proportion
The purpose of these measurements are :
To present accurate techniques for measuring weight and stature
for children and adolescents
The measurement process has two steps:
1. measure
2. record
If measures are in error, then the foundation of the growth
assessment is also in error. It is important to have the date, age,
and actual measurements recorded so the data may be used by
others or at a later point in time.
1. Many clinical decisions and clinical interventions are based on
physical measurements
2. Accurate and reliable physical measures are used to:
monitor the growth of an individual
detect growth abnormalities
monitor nutritional status
track the effects of medical or nutritional intervention
Accurate weighing and measuring have three critical components.
These are: technique, equipment, and trained measurers.
Technique :Standardized
Equipment :Calibrated, accurate
Trained measurers: Reliable, accurate

Appropriate technique for each measure must be utilized. The

techniques should be very similar to those used to obtain data to
develop the growth charts. These measures should be performed
by a trained measurer so they are both accurate and reliable
Learning Guide
NO

STEP

A. PREPARATION
1
Greet the child & introduce yourself
2
Identify infants data : Name, sex, date of birth,
address
3
Explain the procedure to the patient
B. WEIGHING CHILDREN AND ADOLESCENT
4
Child or adolescent wears lightweight
undergarments, gown, or lightweight outer
clothing
5
Calibrate beam balance or mechanic scale
6
Child must be able to stand without assistance.
Ask the child to stand the center of scale
platform
C. MEASURING OF THE HEIGHT
7
Ask the child to take off the shoes
Calibrate the stadiometer or microtois
8
The child is measured on standing position with
heels, buttocks, shoulders and head
touching a flat upright surface with heels
together, legs straight, arms at sides,
shoulders relaxed
The head should be positioned in the Frankfort
9
plane (most inferior point of the orbital
margin at same level as tragion)
10 Ask the child to take a deep breath, then let it
out to relax his shoulders
11 Bring the perpendicular headpiece down to
touch the crown of the head
12 Examiner eyes are same level with th e scale to
be read
13 Record to the nearest 0.1 cm in the chart
14 Record on the growth chart appropriate for age
and gender
D. SITTING HEIGHT
15 Ask the child to sit on a stool
(stool height 60 cm)

PERFORMANCE
SCALE
1
2
3

16
17
18
19
20
21
22

The back of the head, thoracic spine and buttock

should rest against the wall
The head should be positioned in the Frankfort
plane
Ask the child to take a deep breath, then let it
out to relax his shoulders
Bring the perpendicular headpiece down to
touch the crown of the head
Record to the nearest 0.1 cm
The sitting height (upper body segment) =
Height measured on the scale height of the
stool (60 cm)
Lower body segment = Standing height sitting
height

23
Calculate the upper to lower segment ratio
24
Record the ratio on the appropriate curve
E. PLOTTING MEASUREMENT
25 Plot the measurement on the growth chart
appropriate for age and sex (for accurate
plotting use a plotting aid such as a
straightedge)
26 Share the information with the family (i.e.,
translate into a form that is useful to them)
REFERENCES
1. Identification and Quantification of Sources of Error in Weighing
and Measuring Children, CDC, PHS, DHEW, 1976.
2. Lohman, TG, Roche, AF, and Martorell, R. Anthropometric
Standardization Reference Manual, Human Kinetics Books,
Champaign, IL, 1988.
3. NHANES III Anthropometric Procedures, a video from the
National Center for Health Statistics, Centers for Disease Control
and Prevention.
4. Pediatric Anthropometry, from Ross Laboratories, 2000.
5. Weighing and Measuring Children: A Training Manual for
Supervisory Personnel, Nutrition Division, CDC, PHS, DHHS, and
Bureau of Community Health Services, HHS, 1980.
6. Styne D. Growth.In Greenspan FS and Gardner DG.eds. Lange
Medical Books/McGrow Hill 2004; 176 - 214

TOPIC 2

: THYROID DISEASE CLINICAL EXAMINATION

MODULE OF SKILL LABORATORIUM PRACTICE

BLOCK
TOPIC

: ENDOCRINE AND METABOLISM SYSTEM

: HISTORY TAKING AND PHYSICAL EXAMINATION IN
THYROID
DISEASE

General Objectives:
After completion of skill laboratory practice the student will be able to
perform clinical examination of thyroid disease in order to make a
proper diagnosis.
Specific Objectives:
At the end of skill laboratory practices, the student will be able to
understand the evolving of systematic information gathering from:
a. History taking
b. Systematic physical examination Thyroid disease.
Syllabus Description
Sub Model Objective
After finishing skill practice of clinical examination, the students will
be able to perform history taking and physical examination the
patient of thyroid disease.
Expected Competencies
a. Student will be able to demonstrate procedure of history taking
the patient with thyroid disease.
b. Student will be able to demonstrate procedure of physical
examination to the patient with Thyroid disease
Methods
a. Presentation
b. Demonstration
c. Coaching
d. Self practices
Laboratory Facilities:
a. Class Room
b. Standardized patient
c. Reading Material
d. Trainers
e. Audiovisual Aids (LCD, OHP, Video)
f. Student Learning Giude
Venue
Training room( Skills Laboratory) / Jatinangor/ Hasan sadikin
Hospital

Evaluation
a. Written test
b. Observed testing.
LEARNING GUIDE
THYROID DISEASE EXAMINATION
Procedure for Clinical Examination
I
INTRODUCTION HISTORY TAKING
0
1 Greet the patient and introduce the examiners self,
develop a good rapport with the patient
2 Ask the patients identity
- The patients name
- The patients age
- The patients work
- The patients residence
II CHIEF COMPLAINT
3 Ask the patient why she/he come to clinic
4 Ask the date of onset
- Whether the onset was sudden or insidious
- Whether the patient were :
Thyroid Hyper function:
- palpitations
- heat intolerance
- nervousness
- easy fatigability
- restlessness
- diarrhea.
- excessive sweating.
- preference to cold.
- weight loss without loss appetite.
- emotional instability.
Thyroid Hypo function :
coldness
weight gain
constipation
menstrual irregularities
muscle cramps.
Malaise
Fatigue
III
1.

GENERAL EXAMINATION
Assess the patients level of consciousness, blood

pressure, pulse rate, respiration, temperature,

height, body weight and BMI
As
2. Assess the Face and Eyes examination :
Lid retraction, Periorbital Edema, Exophthalmos, puffy
face, a hoarse, husky voice
3.
Assess the Thyroid and pretracheal lymph nodes
examination:
Examination of thyroid gland :
Observe the neck, especially as the patient
swallows.
Examine from front of patient:
a. To palpate the right lobe: palpate with your left
thumb while fixating the left lobe with your right
thumb.
b. Rotate the gland slightly with one thumb while
palpating the other lobe with the other thumb.
c. Same principle for the other lobe.
Examine from behind of the patient:
a. Ask the patient to flex the neck slightly forward
to relax the sternocleidomastoid muscles
b. Place the three fingers of both hands on the
patients neck so that your index fingers are
just below the cricoid cartilage.
c. Ask the patient to sip and swallow water as
before. Feel for thyroid isthmus rising up under
your fingers pads.
d. Displace the trachea to the right with fingers of
left hand; palpate lateral part of thyroid gland
with the fingers of the right hand; palpate in the
space between the displaced trachea and the
relaxed sternocleidomastoid muscle, find the
lateral margin. In similar fashion, examine the
left lobe. The lobes are somewhat harder to
feel than the isthmus.
e. If the thyroid is enlarged, auscultation for listen
bruit by placing bell stethoscope above the
lateral part of thyroid gland.
The size of thyroid nodules can be measured by
first drawing and outline on the skin.
4.

Assess the cardiac condition :

bradycardia and tachycardia

Assess the pulmonary condition :

slow respiration, shortness of breath .
5.
6.

7.

8.

Assess the Abdominal condition : slowed or rapid

peristaltic
Assess the extremities condition :
Tremor
thyroid dermopathy
moist hand, warm
dry skin
myxedema
Assess the Neuromuscular System:
slow reflexes
hyper reflexes
Assess the Musculoskeletal System:

muscular weakness

II Signs & Symptoms of hyperthyroidism-Wayne Index0

1
2
Ask the patient whether she/he has any of symptoms below and count the
score:
Score
A. Symptoms
Present
Not present
1
Dyspneu on effort
+1
0
2
Palpitation
+2
0
3
Easy fatigability
+3
0
4
Preference to warm
-5
0
5
Preference to cold
+5
0
6
Sweating
+3
0
7
Nervousness
+2
0
8
Increasing appetite
+3
0
9
Decreasing appetite
-3
0
10 Weight gain
-3
0
B. Signs
1
Palpable thyroid
+3
-3
2
Vascular bruit on thyroid
+2
-2
gland
3
Exopthalmos
+3
0
4
Lid lag
+2
0
5
Lid retraction
+1
0

6
7
8
9
10

11

III

Hyperkinetics
Fine Tremor
Warm hand
Moist hand
Pulse rate
< 80 bpm
80 90 bpm
> 90 bpm
Atrial Fibrillation
Total score (from A + B)
Interpret the total score
a. > 19
b. 11 19
c. < 11

= toxic
= equivocal
= non-toxic

+4
+1
+2
+1

-2
0
-1
-1

-3
0
+3
+4

0
0
0
0

Attachment:
Scenario for History taking in thyroid disorder:
A medical doctor is in charge at the Outpatient clinic at Hasan Sadikin
Hospital. A young woman came complaining of palpitation.
Pay attention to demonstration in the session.
You are about to practice the history taking based on the frame work below:
I
1

INTRODUCTION HISTORY TAKING

Greet the patient and
Dr
Selamat pagi ibu, perkenalkan nama
introduce the examiners
saya dr. Silahkan duduk.
self, develop a good
rapport with the patient Ps
Terima kasih dok

Ask the patients identity Dr

(Name,
age,
work,
residence)
Ps

Baik
sekarang
saya
mau
menanyakan nama ibu siapa?
Nama saya

Dr

Berapa umur ibu?

Ps

tahun

Dr

Ibu tinggal dimana?

Ps

Saya tinggal di

Dr

Ibu masih bekerja atau tidak?

Ps

Saya .

Dr

Maaf, ibu sudah menikah?

Ps

Dr

(Jika sudah
berapa?

Ps

Anak saya ada

menikah)

Anak

ibu

II
3

CHIEF COMPLAINT
Ask the patient why sheDr
comes to the clinic
Ps
Dr

Ask the date of onset

Ps
Dr

Ask whether the onset wasPs

sudden or insidious

Ask whether the patient

Dr
were: heat intolerance,
nervourness,
easy
fatigability, restlessness,
Ps
diarrhea,
excessive
sweating, preference to
cold, weight loss without
loss appetite, emotional
instability
Dr

Apa yang ibu rasakan saat ini? Apa

yang membuat ibu datang ke
klinik saya?
Saya merasa jantung saya berdebardebar
Sejak kapan ibu merasa jantung
berdebar-debar?
Kurang lebih sejak 1 bulan terakhir
ini
Apakah
keluhan
berdebar
ini
timbulnya mendadak atau adakah
aktifitas
yang
menyebabkan
keluhan ini?
Keluhannya timbul tiba-tiba dan tidak
dipengaruhi
aktifitas,
kadang
timbul saat istirahat.
Apakah ibu ada keluhan lain yang
dirasakan selain berdebar-debar?
Hmm, saya juga merasakan selalu
kegerahan, saya menjadi lebih
enak bila berada di kamar yang
berAC.
Jadi ibu senang di ruangan yang
lebih dingin daripada di tempat
yang berhawa panas?

Ps

Ya

Dr

Apakah
tangan
berkeringat?

Ps

Ya dok tangan saya sering basah

dan kadang-kadang di tempat
dingin
pun
saya
gampang
berkeringat

Dr

Apakah ibu merasakan ada keluhan

lain selain yang ibu sebutkan?
Apakah ibu merasakan adanya
benjolan di leher?

ibu

sering

Ps

Ya dok, sejak 3 bulan yang lalu saya

merasakan ada benjolan di leher
yang makin lama makin besar.

Dr

Mula-mula benjolan
sebesar apa?

Ps

Mula-mula sebesar telur

sekarang ya segini dok.

Dr

Selain di leher, apakah ada bagian

tubuh lain yang ibu rasakan ada
perubahan?

Ps

Ada dok, kata teman-teman saya

mata saya makin lama tampak
lebih melotot dok.

Dr

Selain itu, apakah ibu merasakan

keluhan yang lain? Apakah emosi
ibu agak terganggu akhir-akhir
ini? Apakah ibu menjadi gampang
tersinggung?

Ps

Ya betuk sekali dok, saya menjadi

gampang marah dan cepat
tersinggung.
Apakah
itu
berhubungan dengan penyakit
saya dok?

Dr

Ya, ada hubungannya. Lalu apakah

ibu menjadi susah tidur akhir-akhir
ini?

Ps

Ya, saya menjadi susah tidur bahkan

sudah 2 hari ini saya tidak bisa
tidur, mungkin karena berdebardebar ya dok?

Dr

Ya mungkin, lalu bagaimana dengan

buang air besar? Lancar?

Ps

Sudah 2 minggu ini saya diare.

Dr

Berapa kali sehari ibu buang air

di

leher

itu

ayam,

besar?
Ps

Wah hampir 5 kali sehari dok,

sampai lemas badan saya.

Dr

Lalu bagaimana
makan ibu?

Ps

Nafsu makan saya sangat baik dok,

bahkan teman-teman saya bilang
kalau saya makan lebih banyak
dari biasanya.

Dr

Lalu bagaimana dengan berat badan

ibu? Apakah naik?

Ps

Ya itu anehnya dok berat badan saya

kok turun.

Dr

Apakah ada di keluarga ibu yang

menderita sakit kelenjar gondok
atau yang sama seperti ibu
keluhkan saat ini?
Agaknya tidak ada dok

Ps
Dr

TOPIC 3

dengan

nafsu

Baik kalau gitu mari saya periksa

dulu ibu, sillahkan naik ke tempat
tidur.

: WRITING PRESCRIPTION
MODULE OF SKILL LABORATORIUM PRACTICE

BLOCK

: Endocrine and Metabolism System (EMS)

TOPIC

: Writing Prescription

Tutor guide SL 2013

ASSIGNMENT WRITING OF PRESCRIPTION ORDER
WOULD YOU WRITE GOOD PRESCRIPTIONS FOR PATIENTS BELOW :

1. Juandi 40 years-old man given Metformin, 500 mg taken with breakfast for one
week. Actually euglycaemic level cant be achieved and GI discomfort did not
occur, so the dose adjusted with 500 mg Metformin taken with evening meal.
Duration of therapy is ten days. Available Metformin tablet and Glucophage
tablet contains 500 mg Metformin
2. Mrs Riana 42 years-old woman given Rosiglitazone 4 mg twice
daily for one week. Available Avandamet tablet contains 2 mg
Rosiglitazone.
3. Rizkiana 45 years-old woman will be given Insulin lispro 100 IU
subcutaneous injection 30 minute before meal.. Three times a
day for one day. Available Humulin R 100IU/ml Vial 3 ml.
4. Johny 5 years boy was diagnosed thypoid will be given antibiotic
Thiamphenicol Syrup 125 mg four times a day for 7 days on
empty stomach and
Paracetamol 120 mg three times a day for three days. Available
Comthycol syrup contains 125 mg/cth thiamphenicol volume 60
ml and Cupanol
Syrup contains 120 mg/cth Paracetamol volume 60 ml.
Parasetamol tablet
contains 500 mg paracetamol.
5. Julia a 3 years-old girl was diagnosed febrile convulsion. This
patient will be given diazepam 5 mg per rectal and repeated given
every 8 hours for one day. Available preparation is Stesolid rectal
solution tube contain 5 mg diazepam.
6. Erika a 4 years-old girl was diagnosed cough with upper
respiratory tract. infection. Will be treated with Amoxycillin 125
mg three times a day for 5 days, Paracetamol 125 mg if needed
Chlortrimeton (CTM) 1 mg, Glyceril guaiacolas 10 mg three times a
days for 3
days.
Available preparation are :
Amoxycillin Caps 250 mg,
Caplet 500 mg,
Syrup 125 mg/Cth Volume 60 ml.
Paracetamol Syrup 120 mg/cth
Paracetamol tablet 500 mg
CTM
tablet
4 mg
Glyceril guaiacolas 50 mg

7. Bimo, 4 years old

Symptom
: Body temperature 38,5 0 C, mild dyspnoe caused by
obstructive rhinitis, mild productive cough
Diagnose
: Allergic rhinitis and pharyngeal infection
Medicament treatment
: Antibiotic, antipyretic, antihistamin,
mucolytic
Would you write a prescription for this patient
8.Janet 10 years old with similar symptom and diagnose above
She has allergy to Penicillin derivates
Would you write a prescription for this patient
Adult Doses :
Amoxycillin
Erythromicin

: 500 mg 3 times daily

500 mg 3 times daily

Acetaminophen
CTM
Bromhexin

: 500 mg 3 times daily

: 4 mg 3 daily
: 8 mg 3 times daily

5 days
if needed
3 days

Available preparations are :

Amoxicillin Caps. 250 mg ; Caplet 500 mg
Amoxilin Syr. 125 mg/Cth 60 ml,
Amoxillin Syr. 250 mg/Cth 60 ml
Erythromycin caps. 250 mg
Erythromycin Syrup 125 mg/Cth 60 ml
Paracetamol Tab. , Panadol tab.500 mg
Paracetamol Syr. 120 mg/Cth, Panadol Syr. 160 mg/Cth
CTM Tab. 4 mg
Bromhexin Tab. 8 mg
Bisolvon Syr. Contains bromhexin 4 mg/Cth 60, 120 ml
TUTOR GUIDE :
1. R/ Metformin 500 mg tab. No.VII
VII
S. m Tab .I dc
.............................

or

R/ Glucophage 500 mg Tab. No. XX

XX
S. 2 dd Tab. I pagi dan sore dc
.............................

R/ Metformin 500 mg tab. No.

S. 1 dd Tab I pagi dc
.............................
R/ Glucophage 500 mg Tab. No.
S m et vesp. Tab I dc
.............................

2. R/ Avandamet 2 mg Tab.No.XXVIII or R/ Avandamet 2 mg Tab. No.XXVIII

S. 2 dd Tab II
S. b dd Tab. II
............................. ttd
.............................tdt
3. R/ Humulin R 100 IU/ml inj. 3 ml Vial No. I
S imm / S 3 dd 1 ml sc inj. h ac
...............................
4.. R/ Comthycol 125 mg/Cth Syr. 60 ml Flc.No. III
S. 4 dd Cth I 1 h ac/ 2 h pc
.............................
R/ Cupanol 120 mg/Cth Syr. 60 ml Flc No.I or R/ Parasetamol 125 mg
S. prn. Cth I max tdd
Sach.lactis
qs
.............................
mf Pulv dtd No. IX
S prn Pulv I max tdd
5. R/ Stesolid 5 mg rectal sol. Tb.No. III
S. 0 8 h tb I pro-rectal
.............................

R/ Stesolid 5 mg rectal sol. Tb.No. III

S. tiap 8 jam Tb.I pro-rectum
.............................

6 .A.R/ Amoxycillin syr.125 mg/Cth Syr. 60 ml Flc No.II

S.t dd Cth I
.............................
or R/ Amoxycillin 125 mg
mf pulv dtd No. XV
S.t dd pulv I
.
...................
B.

R/ Parasetamol 120 mg/cth syr.60 ml Flc. I

S prn Cth I max tdd
.............................
R/ CTM
1 mg
Glyceril guaiac. 10 mg
Mf pulv dtd No. IX
S. t dd. Pulv I
.............................

R/ CTM
Glyceril guaiac.
Mf pulv No. IX
S. t dd. Pulv I
.............................

9 mg
90 mg

7. Bimo, 4 th
Prep. ; Syrup, pulv.
Dosis :
-

FI
ISO
Hitung : n/(n+12 ) x adult dose

Amox ; n/(n+12) x adult dose

= 4/(4 +12) x 500 mg = 125 mg

syrup amox

R/ Amoxycilin 125 mg/cth Syr. 60 ml Flc II

S. t dd Cth I

Tdd
Symptomatic :
Prep. :
-

Pulveres
Syrup

Paracetamol Dosis : n/(n+12) x adult dose

CTM
Bromhexin

x 500 = 125 mg
x 4
=
1 mg
x8
=
2 mg

R/ P arasetamol 120 mg/cth Syr. 60 ml Flc. I

S prn Cth I max tdd

Tdd
R/ CTM
1 mg
Bromhexin
2 mg
Mf pulv dtd No. IX
S t dd pulv I
Tdd
8. Janet 10 years old
Prep. ; Syrup, Capsul, tablet
Dosis : n/20 x Dosis dewasa
R/ Erythromycin 250 mg Caps. No. XV
S.t dd Caps I
..................... or
R/ Erythromycin 125 mg/Cth Syr. 60 ml Flc III
S t dd Cth II
.......................

R/ Parasetamol 500 mg tab. No. III

S. prn Tab max tdd
...........................
R/ CTM
2 mg
Bromhexin
4 mg
Mf pulv dtd No. IX
S t dd p I
......................

TOPIC 3

: WRITING PRESCRIPTION
MODULE OF SKILL LABORATORIUM PRACTICE

BLOCK

: Endocrine and Metabolism System (EMS)

TOPIC

: Writing Prescription

I. GENERAL OBJECTIVE
After finishing skill practice of Prescription, the student will be able to perform
writing the prescription order properly

II. SPECIFIC OBJECTIVES

At the end of skill practices, the student will be able to:

a. perform writing semisolid and liquid dosage form prescription correctly
b. perform writing medical equipment prescription correctly
III. SYLLABUS DESCRIPTION

3.1

Sub Model Objective

After understanding the purpose and the role of administration of each drug
should be given ,the student will be able to perform writing prescription of semi
solid and semi liquid and medical equipment .

3.2

Expected Competencies
a. Students demonstrate how to write the prescription of liquid dosage
form ( cream, ointment, drop, solution ) .
b. Student demonstrate how to write the prescription of medical equipment
( disposable syringe, infusion set )

3.3

Methods
a. Presentation
b. Demonstration
c. Coaching
d. Self practices

3.4

Laboratory Facilities
1. Skills Laboratory
2. Trainers
3. Student Learning guide
4. Trainers guide
5. References
6. Prescription paper

3.5

Evaluation
a. Skill demonstration
b. Point nodal evaluation
c. OSCE

V. References
1. Edward L and Roden M., Principles of Prescription order Writing and patient
compliance,The Pharmacological Basis of Therapeutics, Goodman and
Gilmans, 2001, 1903-1914,
2. Lofholm PW, Katzung Bg, Rational prescribing & prescription writing, Basic
and Clinical Pharmacology, The Mc Graw-Hill Company, 2001, p. 1552
1559.
3. Howard C.Ansel, The Prescription, Remington Pharmaceutical Sciences,
18th ed., Mack Publishing Company, 2000
4. Farmakope Indonesia III

The component part of prescription order :

- Prescriber information
- Date, include place = city ; Bandung, September 17th
- Superscription = R/ symbol = recipe = you take)
- Inscription = medication prescribed
- Subscription = direction to pharmacist
- Signa = direction for patien
- Refill information (if needed)
- Prescriber signature
- Patient information ; name, age, address

Name
:
Specilalist :
Address
:
License of Practice :

prescriber
information
Bandung, .....-.....-..2013

ITER 1x
R/

superscription
Amoxicillin 500 mg caps No. XV

inscription
Subscription

S.t.dd . Caps I a.c.

Signa

......... .............

Signature
aditional signa

Name
:
Age
:
Address :

patient information

Latin abreviation :
a.c.
p.c.
1 h.a.c.
M.f. pulv.

ante coenam
post coenam

D.t.d.
Iter
Iter 1x
Epith
No. X
S.
Om
O1/2 h
O8h
b.d.d.
t.d.d
t.i.d.
Garg.
Pulv. I
Cth
C
S.u.e
Vesp

da tales doses
iteratur

misce fac. Pulveres

epithema
nomero decem
Signa
omni mane
omni dimidia hora
omni 8 hora
bis de die
ter de die
ter in die
gargle
pulveres unum
cohlear teae
Cohlear cibarum
signa usus externus
vespere

before meal
after meal
one hour before meal
mix and make divided
powder
such doses be given
Repeat
repeat 1 x
obat kompres
number 10
mark
every morning
every half an hour
every 8 hours
twice a day
three times a day
= three times a day
mouth wash
one powder
teaspoon = 5 ml
tablespoon = 15 ml
external use
every night

VI. LEARNING GUIDE OF WRITING THE PRESCIPTION

No.

Step
0

1
2
3.
3
4
5
6
7
8
9
10
11.
12

Preparation
Explain the drugs you should given and the purpose of each
drugs
Explain the role of administration of each drugs .
Name of prescriber, no license, address
Place and date
R/
Name of drug
Strength of drug
Dosage form
Numero (NO) and amount
Signa
Frequentation of administration & dosage form
Dosage
Time of administration

11
12
13
14
15
16

Close line and signature

R/
Name of drug
Strength of drug
Dosage form
No and amount of drugs

17
18
19
19
20

Signa
Frequentation of administration & dosage form
Dosage
Time of administration
Close line and signature

Paracetamol 125 mg, Chlortrimeton (CTM) 1 mg, Glyceril guaiacolas

10 mg three times a days for 3 days.

Available preparation are :

Amoxycillin Caps 250 mg,
Caplet 500 mg,
Syrup 125 mg/Cth Volume 60 ml.
Paracetamol Syrup 120 mg/cth
Paracetamol tablet 500 mg
CTM
tablet
4 mg
Glyceril guaiacolas 50 mg
.11. Bimo, 4 years old
Symptom
: Body temperature 38,5 0 C, mild dyspnoe caused by
obstructive rhinitis, mild productive cough
Diagnose
: Allergic rhinitis and pharyngeal infection
Medicament treatment
: Antibiotic, antipyretic, antihistamin,
mucolytic
Would you write a prescription for this patient
12.Janet 10 years old with similar symptom and diagnose above
She has allergy to Penicillin derivates
Would you write a prescription for this patient
Adult Doses :
Amoxycillin
Erythromicin

: 500 mg 3 times daily

500 mg 3 times daily

Acetaminophen
CTM
Bromhexin

: 500 mg 3 times daily

: 4 mg 3 daily
: 8 mg 3 times daily

5 days
3 days

Available preparations are :

Amoxicillin Caps. 250 mg ; Caplet 500 mg
Amoxilin Syr. 125 mg/Cth 60 ml,
Amoxillin Syr. 250 mg/Cth 60 ml
Erythromycin caps. 250 mg
Erythromycin Syrup 125 mg/Cth 60 ml
Paracetamol Tab. , Panadol tab.500 mg
Paracetamol Syr. 120 mg/Cth, Panadol Syr. 160 mg/Cth
CTM Tab. 4 mg
Bromhexin Tab. 8 mg
Bisolvon Syr. Contains bromhexin 4 mg/Cth 60, 120 ml

TOPIC 4

: PROCEDURE FOR ADMINISTERING INTRADERMAL,

SUBCUTANEOUS AND INTRAMUSCULAR INJECTIONS
MODULE OF SKILL LABORATORIUM PRACTICE

BLOCK

: Endocrine and Metabolism System (EMS)

TOPIC: PROCEDURE FOR ADMINISTERING INTRADERMAL,

SUBCUTANEOUS AND INTRAMUSCULAR INJECTIONS
I.

GENERAL OBJECTIVE
After finishing skill practice of administering injection procedure, the student will be
able to administer injections by using appropriate technique
II.

SPESIFIC OBJECTIVES
At the end of skill practices, the student will be able to :
a. Demonstrate procedure of administering intradermal (intracutaneous)
injection
b. Demonstrate procedure of administering subcutaneous injection
c. Demonstrate procedure of administering intramuscular injection

III.

SYLABUS DESCRIPTION
3.1. Sub Model Objective
After finishing skill practice of administering injection procedure, student will be
able to administering all of various type of injection
3.2. Expected Competencies
Student demonstrate procedure of administering intradermal, subcutaneous, and
intramuscular injection.
3.3. Topics
Procedure for administering intradermal, subcutaneous, and intramuscular
injection.
3.4 Methods
a. Presentation
b. Demonstration
c. Coaching
d. Self practices on anatomic model
3.5 Laboratory Facilities
a. Skills Laboratory
b. Trainers
c. Anatomic Model for Administering Injections
d. Student Learning Guide
e. Trainers guide
f. References
g. Injections sets
3.6. Venue
Skills Laboratory

3.7. Organizer
Block of dermatomusculoskeletal system of clinical Skills Program, Medical
School Padjadjaran University, Hasan Sadikin Hospital
3.8 . Evaluation
a. Skill demonstration in model unit
b. Point nodal evaluation
c. OSCE

IV. INJECTIONS SET ARRENGEMENT

Preparing Equipment :
a. Medication tray
b. Alcohol wipes
c. Vials or ampules of medications
d. Bottle of diluent (when necessary)
e. Syringe with appropriate needles
intramuscular injections : 23 25-gauge, 5/8 needle
subcutaneous injections : ______________________
f. Dry 2 x 2 gauze pad

V. LEARNING GUIDE OF PROCEDURE

FOR ADMINISTERING INJECTION

A. PROCEDURE FOR ADMINISTERING INJECTIONS

Performance Scale
No.

Procedure

Comment
1

Assessment
1.
Assess medication record to identify whether any
medications are to be given to an individual patient
2.
Check medications listed against physicians orders
3.
Review information regarding the medication
4.
Assess size and general build of patient (include patients
weight if necessary)
Planning
6.
Determine appropriate needle and syringe to be used
7.
Gather (set up) the equipment
8.
Wash your hand and use the gloves
Implementation
9.
Read name of medication to be given from record
10.
Check label on medication and take from shelf or drawer
11.
Check label again (how to give the medicine (IM/ID or
SC), check the expired date), before calculating and
preparing dosage
12.
Draw up correct dosage of medication
a. From vial :
1) Clean top of vial with alcohol swab and allow it to dry
2) Discard alcohol swab
3) Prepare syringe and needle
4) Remove needle guard
5) Insert needle into vial through rubber stopper
6) Pick up vial with non dominant hand and
withdraw correct volume of medication
7) Examine for air bubbles and expel them
8) Recheck volume of medication for accuracy
9) Remove needle from vial
10) Replace needle guard
11) change the needle with the new one
b. From ampule
1) Get all medication into lower part of ampule
2) Clean neck ampule with alcohol swab
3) Prepare syringe and needle
4) Wrap neck of ampule and break off the top, away
from yourself
5) Remove needle guard
6) Hold ampule in nondominant hand and insert
needle into ampule
7) Aspirate medication into syringe

8) Withdraw needle from ampule

9) Point needle vertically and pull back slightly
10) Expel air from syringe
11) Make sure that you have the exact volume of
medication needed
12) Replace needle guard
13.
14.
15.
16.
17.
18.
19.

Reexamine vial or ampule to check the label third time

and recalculate the dosage
Place syringe, needle, and alcohol swab on cart
Place patient identification card with medication
Approach and identify patient
Explain to the patient about the procedure & the
medication will be given and verify appropriate site
Provide privacy
Select the appropriate site for injection by identifying
anatomical landmark
a. For intradermal : inner aspect of forearm or scapular
area of back

b. For subcutaneous : abdomen, lateral aspect of

upper arm or thigh

c. For intramuscular :
- lateral aspect of thigh (vastus lateralis):
divide thigh into 3 equal parts. Give the injection into
the middle third

- buttocks (dorsogluteal/gluteus maximus):

Gluteus maximus is the large muscle in the backside.
Divide one buttock into quadrants, halfway down the
middle and halfway across. Give the injection in the
outer, upper quadrant, toward the hip. This is safe from
injuring the sciatic nerve.

- ventral gluteal:
Place the heel of the hand of the greater trochanter of the
femur with fingers pointing towards the patient's head.
The left hand is used for the right hip and vice versa.
While keeping the palm of the hand over the greater
trochanter and placing the index finger on the anterior
superior iliac spine, stretch the middle finger dorsally
palpating for the iliac crest and then press lightly
below this point. The triangle formed by the iliac
crest, the third finger and index finger forms the area
suitable for intramuscular injection.

- upper arm (deltoid)

The deltoid muscle located laterally on the upper arm.
Originating from the Acromion process of the scapula
and inserting approximately one-third of the way
down the humerus, the deltoid muscle can be used
readily for IM injections if there is sufficient muscle
mass to justify use of this site

20.

Give the injection :

a. Clean area with alcohol wipe, using circular motion,
clean from inside outwards
b. Allow site to dry
c. Remove needle guard
d. Express any bubbles from syringe
e. Insert the needle :

1) for intradermal :
i.

insert the needle into the

skin at the side of
injection at a10 15 degree angle with the bevel
of needle facing up
b) Inject the medication slowly.
c) observe for wheals and blanching (normal
finding) at the site
d) withdraw the needle, wiping area gently with a
dry 2 x 2 pad
2) for subcutaneous
a) insert the needle into the subcutaneous
area at a 45 degree angle while forming a
cushion of subcutaneous tissue by gently
pinching the tissue
b) pull back on plunger to check if needle is a blood vessel
c) inject the medication slowly
d) withdraw needle quickly, and massage area with
alcohol wipe to aid absorption, put on band aid if
needed

3) for intramuscular
a) insert the needle into the muscle at a 90 degree angle
b) pull back on plunger. If blood return, you know you
have entered the blood vessel and need to reposition
the needle and aspirate again
c) inject the medication slowly
d) withdraw needle quickly and massage the area
with alcohol wipe. Put on a band aid if needed
Return patient to a comfortable position

21.

Evaluation
22.
Evaluate the patients condition 15 minutes after
administering medication :
Documentation
22.
Documentation the following :
a. Date and time of administering medication
b. Dosage and type of injection
c. Patients response to medication
d. Name and signature of operators

VI. CRITERIA OF PERSONAL PERFORMANCE EVALUATION

SCALE
1.
2.

3.
4.

PERFORMANCE ACHIEVEMENT
If students are doing the task that only fill less
than 35% of whole items for each step
precisely
If students are doing the task that only fill more
than
35% - 60% of whole items for each step
precisely
If students are doing the task that only fill 60% 79% of whole items for each step precisely
If students are doing the task that fill 80% of
whole items for each step precisely

VII. SKILL LABORATORIUM PRACTICE ARRANGEMENT

SCHEDULE OF PRACTICE
No.
Subject
Allocated Time
1.
Brief description about administering
30 minutes
injection :
a. Purpose of procedure
b. Type of injection
c. Location of each type injection
2. Administering
injection
demonstration
30 minutes
:Intramuscular
3.
Tutorial Practice for each student
@ 15 minutes x

COMMENT
LOW
MILD

MODERATE
EXCELENT

Tutor
4 person

4 person
4 person

7
105 minutes
Anatomical Model

TOPIC 5 : DIABETIC FOOT CARE

MODULE OF SKILL LABORATORIUM PRACTICE
BLOCK : ENDOCRINE AND METABOLISM SYSTEM
TOPIC : DIABETIC FOOT CARE
I. GENERAL OBJECTIVE
After finishing skill practice of diabetic foot care, the students should be able to
perform diabetic foot care to support management in patient with diabetic.
II. SPESIFIC OBJECTIVE
At the end of skill practices, the student will be able to give :
Education about diabetic foot
III. SYLLABUS DESCRIPTION
3.1
Objective
After finishing skill practice of diabetic foot care, the students will be able to
perform diabetic foot care.
3.2

Expected Competencies
a. Students will be able to give education about diabetic foot care

3.3

Methods
a. Presentation
b. Demonstration
c. Coaching
d. Self practices

3.4

Laboratory Facilities

a. Trainers guide
b. Students Learning guide
c. Trainers
3.5

Venue
Skills Laboratory

3.6

Evaluation
a. OSCE

LEARNING GUIDE
Diabetes Mellitus Diabetic Foot Care
A patient with a diabetic foot is referred to you.
You are expected to do diabetic footcare.
I.
1.

2.

II.
A.

PHYSICAL EXAMINATION
Sign and symptoms you have to note: (to confirm the diabetic foot)
Examine the foot patients whether :
Warmth
Swelling
Numbness
Have a good pulsation of dorsalis pedis artery or not
Have an ulcer
Have a focal callus or any other deformities (like Charcot Joint)
Categorize the diabetic foot (Wagner Classification)
Grade 0 : no open lesion, bony deformity may be noted
Grade 1 : superficial ulcer without penetration into deeper layers
Grade 2 : deep ulcer leading to tendon, bone, joint capsule or ligament
Grade 3 : tendinitis, osteomyelitis, or deep abscess
Grade 4 : gangrene of toe or fore foot
Grade 5 : gangrene of the whole foot
EDUCATION FOR DIABETIC FOOT
FOOT CARE EDUCATION
1. Check your feet every day, find out if there is any swelling, redness,
blister, callus or other signs/abnormalities on the top, sides, soles,
heels, and between the toes. If obesity prevents you from being
physically able to inspect your feet, ask a family member, neighbor,
or a visiting nurse to perform this important check.

2. Test the temperature of the water before putting your feet in with
your elbow joint, because the normal ability to sense hot
temperature in hands is usually impaired in diabetics. Burns can
easily occur.
3. Wash your feet every day with lukewarm water and mild soap.
Strong soaps may damage the skin. If there is any callus, soften the
callus with foam coral by gentle rubbing
4. Gently and thoroughly dry the feet, particularly between the toes,
because infections can develop in moist areas.
5. Because of skin changes linked with diabetes, the feet may become
very dry and may crack, possibly causing an infection. After bathing
the feet, soften dry skin with lotion, petroleum jelly, lanolin, or oil. Do
not put lotion between your toes.
6. Cut your toe-nails once a week. Soak your feet in lukewarm water to
soften the nail before trimming. Cut the nail straight across, since
curved nails are more likely to become ingrown.

B.

FOOT WEAR EDUCATION

1. Wear use slipper or shoes with closed toebox shoes at all times to
protect your feet from injury. Otherwise, if you have poor vision and
less ability to feel pain, you may not notice minor cuts or bumps.
Avoid wearing thong sandals or stockings with seams that can cause
pressure points.
2. Wear comfortable, well-fitting shoes. Fit shoes on both feet while
weight bearing. Never buy shoes that do not fit properly, expecting
the shoes to stretch with time. Nerve damage may prevent you from
being able to sense pressure from improperly fitting shoes.
3. Check fot the proper width, allowing adequate room across the ball of
the foot. Check for the proper position of the first metatsophalangeal
joint. It should be in the widest part of the shoe.
4. Check for the correct length. Allow 3/8 to in. etween the end of the
shoe and the longest toe.
5. Look for a snug fit around the heel.
6. Check the inside of your shoes for rough areas or torn pieces that
can cause irritation.
7. Change your shoes after 5 hours of wearing during the day to
alternate pressure points.
8. Wear clean dry socks or non-binding panty hose every day. Socks
may provide an additional layer of protection between the shoe and
your foot.
9. Wear socks to bed if your feet are cold. In cold weather, wear warm
socks and limit your exposure to the cold to prevent frostbite. Avoid
applying a heating pad or hot water bottle to the feet.

C.

GENERAL EDUCATION
1. Tell your doctor immediately if you feel any problem with your foot.
Report sores, changes, or signs of infection to your doctor

2.
3.
4.
5.

immediately. Report all blisters, bruises, cuts, sores or areas of

redness.
Ask your doctor to check your foot every time you do the check up.
Remove shoes and socks during visits to your health care provider.
This is a reminder that you need a foot exam.
Avoid sitting with legs crossed or standing in one position for
prolonged periods of time.
Stop smoking because it decreases blood flow to the feet.
Only use medicine recommended by your doctor. Avoid using
antiseptic solutions on your feet since these can burn and can injure
skin. Never attempt to treat a corns or calluses yourself using overthe-counter remedies.

IV. LEARNING GUIDE

The BATHE technique in counseling
Step of Counseling
Within the counseling, please keep these 3 notions:
I.

Verbal Communication
Low Intonation
Soft not loud
Clear including when emphasizing
II.
Non-verbal communication
Eye contact
Active listening
Body language

III.

Accept that every person is similar as a human,

without looking at skin color, economic status,
ethnic, and religion differences. Thus, understand
clients problem as if it was all human problem is
substantial (Empathy)

Now, start the counseling:

A. Building rapport
1. Greeting and ask the clients name
2. Introduce yourself and explain the goal of counseling
3. Ask for clients agreement and respect his/ her

B. Exploration and understanding

4. Assessing what is the background situation
(Background)
5. Ask about common areas generating strong feelings
(Affect)
6. Elicits the clients emotional response (Affect)
7. Ask how much the clients problems bother him or
her (Troubling)
8. Assess the clients coping with his/herproblems
(Handling)

C. Rational discussion
9. Making the client understand his or her problem
by defining his/her problem (e.g. knowledge,
perception, behavior and environment problems)
and relates it to the disease of the client.
10. Checking clients understanding with his/her
problem
11. Management goal setting and implementation by
discussing several alternatives of solutions
including each solutions benefit and barriers
12. Ask clients to decide (choose) at least one of the
solutions, and ask to participate in
13. Ask the clients for next counseling appointment
14. Termination of this counseling session

Note:
0 = Student does not perform the step
1 = Student perform the step incompletely
2 = Student perform the step completely

ROLE PLAY FOR COUNSELING

Problem 1:
This exercise is a role play that comprises two players. One student acts as a
patient (client) and the other one actsas a counselor.
Client:
Identity
Adin, 54 years old, male, an administrative goverent employee.

Chief complaint: follw up of diabetic patient

Description of complaint:
Mr Adin is a diabetic patient for the last 2 years. He takes regular anti diabetic drug
(Glibenclamid) but his blood glucose level, body weight and BMI are never
normal. He complained of paresthesia on his fingers.
Psychosocial problems:
He lives with his wife and 2 adult children. He will face his retired period next year.
General appearance: Compos Mentis, slightly ill
Vital signs:
Blood Pressure: 120/80 mmHg
Pulse: 88 times/minute; strong, equal, regular
Respiration: 20 times/minute
Temperature: 36,5 C
Physical Examination:
Head:
Conjunctivae
within normal limit
Sclera

:
:

within normal limit

Eye sac
within normal limit
Faring
within normal limit
Neck
within normal limit

:
:
:

Thorax:
Lung
:
within normal limit
Heart
:
within normal limit

Abdomen
Flat, abdominal sound slightly increasing

Liver and Spleen

within normal limit

Extremity
:
within normal limit
Laboratory
Fasting blood glucose level: 150 mg/dL
2hpp: 200 mg/dl
Ureum: 45 mg/dl
Creatinin: 1.5 mg/dl
HbA1C: 10 %
Others within normal limit
Clinical Diagnosis:
Diabetic melitus type 2
Management Therapy:
Non-pharmacologic:
Diabetic Counseling
Pharmacologic:
Glibenclamide 500 mg/dl 2x1 early ante coanam

NOTES:

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