Appendix D Screening Instruments

Appendix D Screening Instruments

Publication Details

Symptoms Checklist

Table

Symptoms Checklist.

Amsler Grid Test

This instrument is an effective screening tool for early detection of cytomegalovirus. An Amsler grid can help you monitor your central visual field. It can detect early and subtle visual changes resulting from several macular diseases such as age-related macular degeneration and diabetic macular edema. It is also helpful in tracking changes in vision once they have been discovered. The Amsler grid tests each eye separately. This helps you to recognize visual symptoms that are only in one eye.

Figure

The above are examples of two different Amsler grids. Both are useful for monitoring central vision. The grid on the right is a modified Amsler grid (Yannuzzi card) intended to be carried in the wallet or purse for daily self-assessment.

Instructions

▪: Test your vision with sufficient lighting.

▪: Wear your reading glasses or look through the reading portion of your bifocals (if you normally read with spectacles).

▪: Hold the Amsler grid at normal reading distance (about 14 inches).

▪: Cover one eye at a time with the palm of your hand.

▪: Stare at the center dot of the chart at all times.

▪: Do not let your eye drift from the center dot.

Ask yourself the following questions as you check each eye separately:

▪: Are any of the lines crooked or bent?

▪: Are any of the boxes different in size or shape from the others?

▪: Are any of the lines wavy, missing, blurry, or discolored?

Note: If using a rectangular card like the one on the right above (Yannuzzi card), you should check each eye with the card held both vertically and horizontally.

If the answer to any of these questions is “yes” (and this is a new finding for you), you should contact your doctor immediately for an examination. Sometimes these changes may mean that there is leakage in the back of the eye causing swelling of the retina.

Examples of Abnormal Amsler Grids

Figure

Publication Details

Copyright

This is an open-access report distributed under the terms of the Creative Commons Public Domain License. You can copy, modify, distribute and perform the work, even for commercial purposes, all without asking permission.

Publisher

Substance Abuse and Mental Health Services Administration (US), Rockville (MD)

NLM Citation

Substance Abuse Treatment for Persons With HIV/AIDS [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2000. (Treatment Improvement Protocol (TIP) Series, No. 37.) Appendix D Screening Instruments.

Symptoms Checklist

Symptom	Question/Action
▪ Fever ▪ Loss of appetite ▪ Weight loss ▪ Night sweats ▪ Nausea ▪ Diarrhea ▪ Lymph node swelling	▪ HIV positive? Ask about the possibility of HIV. Get an HIV test. ▪ Ask about change in diet. ▪ Active drug use? Injection-related bacterial infections, cocaine use, and heroin withdrawal are possible causes. ▪ Ask about tuberculosis (suggest the Mantoux Purified Protein Derivative [PPD] test). ▪ Ask if the client is taking any new illicit drugs or medications; some symptoms may be side effects. See the medical professional before stopping medicines. ▪ Is there another infection? See medical professional for diagnosis and treatment, especially if the CD4+ T cell count is low (< 200).
▪ Cough ▪ Chest pain ▪ Shortness of breath	▪ HIV positive? Ask about the possibility of HIV. Get an HIV test. ▪ Smoking of tobacco or drugs? ▪ Exposure to TB? Cough lasting more than 3 weeks should be checked. ▪ Fever and night sweats? Pneumonia usually causes these symptoms along with a fever, with or without chills and night sweats.
▪ Forgetfulness ▪ Psychosis ▪ Seizures	▪ HIV positive? Ask about the possibility of HIV. Get an HIV test. ▪ Intoxication with drugs or alcohol? Withdrawal? ▪ Head injury? Immediate medical attention may be needed. HIV-related infection or cancer in the brain may occur, especially if the CD4+ T cell count is low (< 200). ▪ Ask about a history of depressive or dissociative symptoms. ▪ Ask about a history of psychotic symptoms.
▪ Numbness or tingling in the limbs	▪ HIV positive? Ask about the possibility of HIV. Get an HIV test. ▪ Is didanosine (Videx), zalcitabine (Hivid), or stavudine (D4T) being taken? Contact medical professional immediately. ▪ Is there long-term alcohol use or diabetes? See a medical professional. ▪ If HIV positive, are antiretroviral medicines working well, are they being taken correctly? Medication resistance or failure to take medicines can make HIV symptoms worse. ▪ If there is any numbness or tingling in the limbs, the client should see a medical professional.
▪ Rash ▪ Itching	▪ Itching ▪ HIV positive? Ask about the possibility of HIV. Get an HIV test. ▪ Hepatitis from drug or alcohol use? See a medical professional. ▪ Injection site cellulitis? See a medical professional. ▪ Ask if the client is taking any new medications; some symptoms may be side effects. See the medical professional before stopping medicines.