OSPE

Objective structured practical examination.

 ORS preparation
Steps:-Clean Utensil
Clean hands – wash hand with soap and water before
preparation.
Clean water – cool boiled water or use filtered water.
Measure 1 lit. of water and pour in the utensil.
Put 1 packet of ORS powder in the water and prepare
solution.
Keep the ORS covered in the utensil.
Use ORS within 24 hrs.
Wash hands before handling ORS in the utensil.
 Measurement of height
Steps:-Use stadiometer for measuring height.
Ask the subject to remove shoes/chappal.
Stand over the stadiometer without support.
Both the ankle should be joined and both the great toe
being apart making an angle.
Scale of stadiometer should be behind the ankle.
Subject should be standing erect and looking forward.
Assess the Frankfurt’s plane.
Take reading by gently pressing the hair by marker.
Three readings should be taken and average calculated.
Height should be measured early morning.
 Measurement of weight
Steps:-Use beam balance to measure weight.
Set zero error.
Ask the subject to remove shoes and dress
to minimum clothing.
Ask the subject to stand over the weighing
pedestal without support and erect.
Take reading. Three readings should be
taken and average calculated.
Weight should be measured early morning.
 Hand-washing
Steps:- Remove rings, watch or bracelets from the hand.
Wet the hand with clean water and apply soap.
Rub both palms vigorously facing each other.
Rub the back of both hands.
Interlace fingers and rub hands together.
Interlock fingers and rub the back of fingers of both hands.
Rub thumb in a rotating manner followed by the area between
index finger and thumb for both hands.
Rub fingertips on palm for both hands.
Rub both wrists in a rotating manner.
Wash hands with clean running tap water.
Dry hands with a clean towel/dryer.
Steps of Hand-washing.
 Measurement of MUAC
Steps:-Explain the procedure to parents/guardian.
Flex the upper-arm(900)
Properly mark the olecranon and acromian process
and measure the distance with non-stretchable tape.
Marking the mid-point between the above two
points.
Straighten the arm.
Measure MUAC by Shakir’s tape at the mid-point.
Interpretation of MUAC results.
Advise the parents/guardian.
 Measurement of B.P.

Steps:- Explain the procedure.

Checking of the apparatus( attachment, cracks and leakage in
the bulb/cuff, mercury column knob is in open mode.
Ask to subject to sit on a chair/ lie down on flat surface.
Place the apparatus on horizontal surface at the persons heart
level.
Mercury column is at the observers eye level.
Tie the cuff 1 inch above the elbow placing both the tubes in
front.
Measure B.P. by palpatory method.
Measure the B.P. by auscultatory method.
Deflate and remove the cuff, close the mercury column knob.
Interpret, inform, advise regarding the finding.
 Measurement of waist-hip ratio
Steps:- 1. Explain the procedure to the subject.
2. Measurement with a non-stretchable measuring tape.
3. Subject should be relaxed.
4. Subject should stand straight with minimum clothing and weight
equally distributed.
5. Both the arms should be on the side and feet close together.
6. Measurement taken at the end of normal respiration.
7. Waist measurement- midpoint between lowest palpable rib and
top of iliac crest.
8. Hip measurement- over widest part of the buttock with tape
parallel to floor.
9. Take two measurements for each entity. If variation is within 1 cm
calculate the average. If variation is more than 1 cm, repeat the two
readings.
10. Calculate – ( W in cm/H in cm ) and comment.
 COUNSELLING MOTHER FOR COMPLEMENTARY FEEDING OF SIX MONTH OLD CHILD.

GATHER APPROACH.
GREET
The mother and ask her to sit down. Inquire about the age of the
child. Make mother comfortable so that she can explain her problem
easily.

ASK
Ask the mother about her problem.
Ask the mother whether the child was exclusive breastfed or not.
Ask her about the immunization status of the child.
Ask her about any episodes of illness of child in the recent past.
TELL
• Appreciate her for her efforts to rear the child.
• Tell her about the importance of Exclusive breast feeding.
• Tell her that after the age of 6 months complementary feeding should
be started along with the breast feeding.
• Tell her that child needs for energy and protein after the age of 6
months is increased and it cannot be met with breast milk only and
additional food should be added to the childs diet.
• Tell mother that after 6 months of age the complementary feeding
gives stimulus to the dentition development in the child.
• Tell mother about the various foods used in complementary feeding
like mashed potato, thick dal, mashed dal & rice, boiled apple, mashed
banana, paste like sooji in milk or any locally available food made
edible or the child.
• Tell her to add little oil 1 tea spoon or ghee to make the food palatable
and to increase the calorie content.
• Half katoori should be given three times daily or as much as till the
child is satisfied.
HEAR
Listen to what the mothers have to say. Be all ears to her so that she will be
satisfied that you are sincerely helping her and she will tell the problems she
is facing with the child.

EXPLAIN
Explain the mother about the importance of food hygiene and hygienic
feeding practice.
Washing hands before preparation of food with soap and water.
Washing hands before feeding the child.
Using clean water and clean utensils to prepare the food.
Covering the food after preparation and if stored for sometime.
Ensure that mother understand the concept of complementary feeding,
hygiene and healthy child.
RETURN
Ask her to return if she doesn’t understand any part or faces any difficulty in
following that which has been explained.
COUNSELLING OF MOTHER OF AN INFANT SUFFERING WITH RECURRENT DIARRHOEA.

GATHER APPROACH
GREET
Greet mother and ask her to sit down. Ask about her child. Make her
comfortable.

ASK
Ask the mother about her problem and how you can help her.
Ask the mother how many episodes of diarrhea the child is having.
Ask mother whether associated with fever or not.
Ask her whether the child if feeding or not.
Ask her whether the child on ORS or not.
Ask her about the food hygiene and hygienic feeding practice.
TELL
Assure her that her child will be well after treatment.
Tel l her about the common sources of infection.
Contaminated drinking water, contaminated food, PICA, not hand
washing before preparation and feeding of child, eating outside
food.
Tell mother about the danger signs in diarrhea- signs of
dehydration.
Tell mother how ORS helps in diarrhea.
How frequently ORS should be given.
Continue feeding in diarrhea to provide energy to child.

HEAR
Listen what the mother has to say regarding the problem.
Listen with intent to identify the cause and alleviate the cause.
EXPLAIN
Explain her about hygienic food and hygienic feeding.
Handwashing with soap and water before preparation of food and
feeding of child.
Using clean utensil and clean water.
Proper storage of cooked food.
ORS preparation.
Giving ORS to child.
How feeding during diarrhea helps the child.
Adhere to treatment.
Danger signs of diarrhea – signs of dehydration worsening.

RETURN
Return to health centre if the condition of child deteriorates.
Return if unable to understand any part explained.
 Counselling for Personal prophylaxis
measures for malaria
Steps:- GATHER approach.
G – Greet, the person with a smile. To generate confidence and establish cordial
environment for counseling.
A – Ask the person about himself, his problem and how you can help.
T – Tell about drugs and protection methods.
Drugs:-
Short term Chemoprophylaxis (upto 6 weeks).
Doxycycline – 100mg once daily
Children 1.5 mg/kg .
To be started 2 days before and continued 4 weeks after leaving.
Contraindicated in pregnant women and children less than 8 years.
Long term Chemoprophylaxis ( more than 6 weeks).
Mefloquine – 250mg weekly for adults.
To be started 2 days before and continued 4 weeks after leaving.
Contraindicated in H/o convulsion, neuro-psychiatric disorders, cardiac
disorders, screening before prescription.
Personal protection:-
Mosquito nets – ITN, LLINs.
Mosquito repellant creams.
Mosquito repellant coils and vaporizers.
Full sleeve clothing.
H – Help, the person to understand the importance of
chemoprophylaxis and the drugs used.
E – Explain, the dosage, the contraindication and adverse effects.
R – Return, report immediately if any adverse effect or any
doubt.
 Counselling for Accidental needle-stick
injury
Steps:- GATHER approach.
G – Greet, the person with a smile. To generate confidence and establish
cordial environment for counselling.
A – Ask, the person about himself, his problem and how you can help.
T – Tell
Various diseases can be transmitted through needle-stick injury
like HIV, Hepatitis B, Hepatitis C, Malaria, Dengue, Syphilis,
Gonorrhea, Brucellosis, Herpes, Diphtheria, Staph. aureus, Strep.
pyogenes.
Hepatitis B, Hepatitis C and HIV are of concern.
Risk of transmission:-
Hepatitis B – 6% to 30%
Hepatitis C – 1.5% to 2.7%
HIV - 0.3% to 5.0%
Identify the source patient who should be tested for Hep B, Hep C and
HIV.
Window period:-
Time between the potential infection and development of
accurate test result.
HIV – 10 days to 3 months.
HepB & HepC – 3 to 5 months.
PEP currently available against these infections effectively
either prevent the risk of transmission or delay the
development of disease if started within 2 hrs of injury.
Confidential follow-up post-exposure testing at 6 weeks, 3
months, 6 months and 1 year.
Precautions to prevent exposure to others till follow-up
testing is complete.
H – Help
Alleviate fear, Assure the person that not everyone exposed
develops the disease. Risk of transmission.
Assure PEP is effective.
Guide to nearby ICTC centre.
Guide to nearby PEP centre.
Hear and answer queries if any.
E – Explain
Adherence to PEP.
ICTC testing.
Prevention of exposure to others.
R – Return
Follow-up testing.
PEP collection.
Any query.
 Counselling for Post-exposure prophlyaxis
in HBsAg needle-stick injury
Steps:- GATHER approach.
G – Greet, the person with a smile. To generate confidence and
establish cordial environment for counselling.
A – Ask, the person about himself, his problem and how you can help.
T – Tell
Risk of transmission:-
Hepatitis B – 6% to 30%
Get tested immediately and confidentially for HepB, HepC and HIV.

Window period:-
Time between the potential infection and development of
accurate test result.
HepB & HepC – 3 to 5 months.
 PEP currently available against these infections effectively
either prevent the risk of transmission or delay the
development of disease if started within 2 hrs of injury.
If Vaccinated: no treatment needed.
If unvaccinated: Hepatitis B immunoglobulin should be
given immediately. Followed 3 doses of vaccine at 0, 1 &
6 months.
Confidential follow-up post-exposure testing at 6 weeks, 3
months, 6 months and 1 year.
Precautions to prevent exposure to others till follow-up
testing is complete.
H – Help
Alleviate fear, Assure the person that not everyone exposed develops the
disease. Risk of transmission.
Assure PEP is effective.
Guide to nearby ICTC centre.
Guide to nearby PEP centre.
Hear and answer queries if any.
E – Explain
Adherence to PEP.
ICTC testing.
Prevention of exposure to others.
R – Return
Follow-up testing.
PEP collection.
Any query.
Counselling for Post-exposure prophylaxis in
HIV needle-stick injury.
Steps:- GATHER approach.
G – Greet, the person with a smile. To generate
confidence and establish cordial environment for
counselling.
A – Ask, the person about himself, his problem and
how you can help.
T – Tell
Risk of transmission:-
HIV - 0.3% to 5.0%
Get tested immediately and confidentially for HIV.
Window period:-
Time between the potential infection and development of accurate test
result.
HIV – 10 days to 3 months.
PEP currently available against these infections effectively either prevent
the risk of transmission or delay the development of disease if started
within 2 hrs of injury.

HIV PEP:
Four weeks regimen of either-
Zidovudine + lamivudine or
Lamivudine + Stavudine or
Stavudine + Didanosine.
Confidential follow-up post-exposure testing at 6 weeks, 3 months, 6
months and 1 year.
Precautions to prevent exposure to others till follow-up testing is
complete.
H – Help
Alleviate fear, Assure the person that not everyone exposed develops
the disease. Risk of transmission.
Assure PEP is effective.
Guide to nearby ICTC centre.
Guide to nearby PEP centre.
Hear and answer queries if any.
E – Explain
Adherence to PEP.
ICTC testing.
Prevention of exposure to others.
R – Return
Follow-up testing.
PEP collection.
Any query.
Thank You.