cd /home/daytona/workspace && python3 -c " import pdfplumber # Extract Physical Examination PDF text1 = [] with pdfplumber.open('/home/daytona/workspace/attachments/7425e621-3ba4-4336-9c00-afea01ee75af/Physical Examination.pdf') as pdf: print(f'Physical Examination.pdf - Pages: {len(pdf.pages)}') for i, page in enumerate(pdf.pages): t = page.extract_text() if t: text1.append(f'--- PAGE {i+1} ---\n{t}') with open('/home/daytona/workspace/pe_text.txt', 'w') as f: f.write('\n'.join(text1)) print('PE extracted, chars:', sum(len(t) for t in text1)) "

cd /home/daytona/workspace && python3 -c " import pdfplumber # Extract Physical Assessment PDF text2 = [] with pdfplumber.open('/home/daytona/workspace/attachments/7425e621-3ba4-4336-9c00-afea01ee75af/Physical Assessment.pdf') as pdf: print(f'Physical Assessment.pdf - Pages: {len(pdf.pages)}') for i, page in enumerate(pdf.pages): t = page.extract_text() if t: text2.append(f'--- PAGE {i+1} ---\n{t}') with open('/home/daytona/workspace/pa_text.txt', 'w') as f: f.write('\n'.join(text2)) print('PA extracted, chars:', sum(len(t) for t in text2)) "

python3 -c " import fitz # PyMuPDF doc = fitz.open('/home/daytona/workspace/attachments/7425e621-3ba4-4336-9c00-afea01ee75af/Physical Examination.pdf') print('Pages:', len(doc)) # Try extracting text with PyMuPDF for i in range(min(3, len(doc))): page = doc[i] text = page.get_text() print(f'Page {i+1} ({len(text)} chars):', text[:300]) "

# Convert PDFs to images and run OCR via pdf2image + pytesseract python3 -c " from pdf2image import convert_from_path import pytesseract, os pdf1 = '/home/daytona/workspace/attachments/7425e621-3ba4-4336-9c00-afea01ee75af/Physical Examination.pdf' images = convert_from_path(pdf1, dpi=200) print('Pages converted:', len(images)) text_all = [] for i, img in enumerate(images): t = pytesseract.image_to_string(img) text_all.append(f'--- PAGE {i+1} ---\n{t}') print(f'Page {i+1}: {len(t)} chars') with open('/home/daytona/workspace/pe_ocr.txt', 'w') as f: f.write('\n'.join(text_all)) print('Done PE OCR') "

python3 -c " from pdf2image import convert_from_path import pytesseract pdf2 = '/home/daytona/workspace/attachments/7425e621-3ba4-4336-9c00-afea01ee75af/Physical Assessment.pdf' images = convert_from_path(pdf2, dpi=200) print('Pages converted:', len(images)) text_all = [] for i, img in enumerate(images): t = pytesseract.image_to_string(img) text_all.append(f'--- PAGE {i+1} ---\n{t}') print(f'Page {i+1}: {len(t)} chars') with open('/home/daytona/workspace/pa_ocr.txt', 'w') as f: f.write('\n'.join(text_all)) print('Done PA OCR') "

# Try lower DPI, just first few pages of PE python3 -c " from pdf2image import convert_from_path import pytesseract, os pdf1 = '/home/daytona/workspace/attachments/7425e621-3ba4-4336-9c00-afea01ee75af/Physical Examination.pdf' # Only first 3 pages, low DPI images = convert_from_path(pdf1, dpi=100, first_page=1, last_page=3) print('Converted:', len(images)) for i, img in enumerate(images): img.save(f'/home/daytona/workspace/pe_p{i+1}.png') print(f'Saved pe_p{i+1}.png') print('done') " 2>&1 | head -20

# Convert remaining pages of both PDFs at low DPI python3 -c " from pdf2image import convert_from_path pdf1 = '/home/daytona/workspace/attachments/7425e621-3ba4-4336-9c00-afea01ee75af/Physical Examination.pdf' pdf2 = '/home/daytona/workspace/attachments/7425e621-3ba4-4336-9c00-afea01ee75af/Physical Assessment.pdf' # Pages 4-12 of PE images = convert_from_path(pdf1, dpi=100, first_page=4, last_page=12) for i, img in enumerate(images): img.save(f'/home/daytona/workspace/pe_p{i+4}.png') print(f'PE pages 4-12 done: {len(images)}') # All 13 pages of PA images2 = convert_from_path(pdf2, dpi=100, first_page=1, last_page=13) for i, img in enumerate(images2): img.save(f'/home/daytona/workspace/pa_p{i+1}.png') print(f'PA all pages done: {len(images2)}') " 2>&1

python3 -c " import pytesseract from PIL import Image all_text = [] for i in range(1, 13): img = Image.open(f'/home/daytona/workspace/pe_p{i}.png') t = pytesseract.image_to_string(img) all_text.append(f'=== PE PAGE {i} ===\n{t}') with open('/home/daytona/workspace/pe_ocr.txt', 'w') as f: f.write('\n'.join(all_text)) print('PE OCR done, total chars:', sum(len(x) for x in all_text)) " 2>&1

python3 -c " import pytesseract from PIL import Image all_text = [] for i in range(1, 14): img = Image.open(f'/home/daytona/workspace/pa_p{i}.png') t = pytesseract.image_to_string(img) all_text.append(f'=== PA PAGE {i} ===\n{t}') with open('/home/daytona/workspace/pa_ocr.txt', 'w') as f: f.write('\n'.join(all_text)) print('PA OCR done, total chars:', sum(len(x) for x in all_text)) " 2>&1

mkdir -p /home/daytona/workspace/nursing-pe-pdf && cat > /home/daytona/workspace/nursing-pe-pdf/generate_pdf.py << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.units import cm, mm from reportlab.lib.colors import HexColor, white, black from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable, KeepTogether, PageBreak) from reportlab.lib.enums import TA_LEFT, TA_CENTER, TA_JUSTIFY from reportlab.platypus import BaseDocTemplate, Frame, PageTemplate # Colors NAVY = HexColor('#1a3a5c') TEAL = HexColor('#1d7874') LIGHT_BLUE = HexColor('#e8f4f8') LIGHT_TEAL = HexColor('#e0f2f0') ACCENT = HexColor('#f0a500') LIGHT_GREY = HexColor('#f5f5f5') DARK_GREY = HexColor('#444444') MED_GREY = HexColor('#888888') WHITE = HexColor('#ffffff') OUTPUT = '/home/daytona/workspace/nursing-pe-pdf/Physical_Examination_Nursing_Guide.pdf' def header_footer(canvas, doc): canvas.saveState() w, h = A4 # Header bar canvas.setFillColor(NAVY) canvas.rect(0, h - 25*mm, w, 25*mm, fill=1, stroke=0) canvas.setFillColor(WHITE) canvas.setFont('Helvetica-Bold', 13) canvas.drawCentredString(w/2, h - 14*mm, 'PHYSICAL EXAMINATION — COMPREHENSIVE NURSING GUIDE') canvas.setFont('Helvetica', 8) canvas.drawRightString(w - 20*mm, h - 21*mm, 'Nursing Reference 2024') # Footer canvas.setFillColor(NAVY) canvas.rect(0, 0, w, 12*mm, fill=1, stroke=0) canvas.setFillColor(WHITE) canvas.setFont('Helvetica', 8) canvas.drawCentredString(w/2, 4*mm, f'Page {doc.page} | Physical Examination — Nursing Reference Guide') canvas.restoreState() doc = BaseDocTemplate( OUTPUT, pagesize=A4, rightMargin=2*cm, leftMargin=2*cm, topMargin=3.2*cm, bottomMargin=2*cm, ) frame = Frame(doc.leftMargin, doc.bottomMargin, doc.width, doc.height, id='main') template = PageTemplate(id='main', frames=frame, onPage=header_footer) doc.addPageTemplates([template]) styles = getSampleStyleSheet() def style(name, **kw): s = ParagraphStyle(name, **kw) return s H1 = style('H1', fontSize=16, textColor=WHITE, backColor=NAVY, fontName='Helvetica-Bold', spaceAfter=6, spaceBefore=14, leftIndent=-10, rightIndent=-10, leading=22, borderPadding=(6,10,6,10)) H2 = style('H2', fontSize=13, textColor=NAVY, fontName='Helvetica-Bold', spaceAfter=4, spaceBefore=10, leading=18, borderPadding=(4,0,4,0)) H3 = style('H3', fontSize=11, textColor=TEAL, fontName='Helvetica-Bold', spaceAfter=3, spaceBefore=7, leading=16) BODY = style('BODY', fontSize=10, textColor=DARK_GREY, fontName='Helvetica', spaceAfter=4, spaceBefore=2, leading=15, alignment=TA_JUSTIFY) BULLET = style('BULLET', fontSize=10, textColor=DARK_GREY, fontName='Helvetica', spaceAfter=3, spaceBefore=1, leading=14, leftIndent=18, bulletIndent=6) NOTE = style('NOTE', fontSize=9, textColor=HexColor('#555555'), fontName='Helvetica-Oblique', spaceAfter=3, spaceBefore=2, leading=13, leftIndent=10, borderPadding=(4,8,4,8), backColor=LIGHT_TEAL) COVER_TITLE = style('COVER_TITLE', fontSize=30, textColor=WHITE, fontName='Helvetica-Bold', spaceAfter=10, alignment=TA_CENTER, leading=36) COVER_SUB = style('COVER_SUB', fontSize=14, textColor=HexColor('#cce8ff'), fontName='Helvetica', spaceAfter=6, alignment=TA_CENTER, leading=20) COVER_DETAIL = style('COVER_DETAIL', fontSize=11, textColor=WHITE, fontName='Helvetica', spaceAfter=4, alignment=TA_CENTER, leading=16) def h1(text): return Paragraph(f'<b>{text}</b>', H1) def h2(text): return Paragraph(text, H2) def h3(text): return Paragraph(text, H3) def body(text): return Paragraph(text, BODY) def bullet(text): return Paragraph(f'\u2022 {text}', BULLET) def note(text): return Paragraph(f'<i>{text}</i>', NOTE) def sp(n=1): return Spacer(1, n*4*mm) def hr(): return HRFlowable(width='100%', thickness=1, color=TEAL, spaceAfter=4, spaceBefore=4) def info_box(rows, col_widths=None, header=None): """Create a styled info table.""" data = [] if header: data.append([Paragraph(f'<b>{h}</b>', ParagraphStyle('th', fontSize=10, textColor=WHITE, fontName='Helvetica-Bold', alignment=TA_CENTER)) for h in header]) for row in rows: data.append([Paragraph(str(c), ParagraphStyle('td', fontSize=9.5, textColor=DARK_GREY, fontName='Helvetica', leading=13)) for c in row]) cw = col_widths or [doc.width/len(data[0])]*len(data[0]) style_cmds = [ ('BACKGROUND', (0,0), (-1,0), NAVY if header else LIGHT_BLUE), ('TEXTCOLOR', (0,0), (-1,0), WHITE if header else DARK_GREY), ('ROWBACKGROUNDS', (0, 1 if header else 0), (-1,-1), [WHITE, LIGHT_GREY]), ('GRID', (0,0), (-1,-1), 0.5, HexColor('#cccccc')), ('TOPPADDING', (0,0), (-1,-1), 5), ('BOTTOMPADDING', (0,0), (-1,-1), 5), ('LEFTPADDING', (0,0), (-1,-1), 8), ('RIGHTPADDING', (0,0), (-1,-1), 8), ('VALIGN', (0,0), (-1,-1), 'TOP'), ] t = Table(data, colWidths=cw) t.setStyle(TableStyle(style_cmds)) return t story = [] # ─── COVER PAGE ─────────────────────────────────────────────────────────────── from reportlab.platypus import Flowable class ColorBlock(Flowable): def __init__(self, w, h, color): self.w, self.h, self.color = w, h, color def draw(self): self.canv.setFillColor(self.color) self.canv.rect(0, -self.h, self.w, self.h, fill=1, stroke=0) def wrap(self, *args): return self.w, self.h story.append(Spacer(1, 2*cm)) story.append(Paragraph('<b>PHYSICAL EXAMINATION</b>', COVER_TITLE)) story.append(Paragraph('Comprehensive Nursing Guide', COVER_SUB)) story.append(sp(2)) story.append(HRFlowable(width='60%', thickness=3, color=ACCENT, spaceAfter=10, hAlign='CENTER')) story.append(sp()) story.append(Paragraph('Compiled from two authoritative nursing textbooks', COVER_DETAIL)) story.append(Paragraph('Physical Examination (12 pages) &amp; Physical Assessment (13 pages)', COVER_DETAIL)) story.append(sp(4)) cover_table_data = [ ['Topics Covered'], ['Definition &amp; Objectives of Physical Examination'], ['Types of Physical Examination'], ['Methods / Techniques of Examination'], ['Equipment Required'], ['Nurse\'s Role — Environment, Patient, Assistance'], ['General Observations &amp; Head-to-Toe Assessment'], ['Systemic Examination (Head to Genitalia)'], ['Vital Signs &amp; Anthropometric Measurements'], ['Neurological Assessment (Reflexes, Sensation, Coordination)'], ['Symptoms Classification &amp; Observation Guide'], ['Positioning &amp; Draping'], ] ct = Table([[Paragraph(r[0], ParagraphStyle('cov', fontSize=10.5, textColor=DARK_GREY, fontName='Helvetica', leading=15))] for r in cover_table_data[1:]], colWidths=[12*cm]) ct.setStyle(TableStyle([ ('BACKGROUND', (0,0), (-1,-1), LIGHT_BLUE), ('ROWBACKGROUNDS', (0,0), (-1,-1), [LIGHT_BLUE, WHITE]), ('GRID', (0,0), (-1,-1), 0.3, HexColor('#aaccdd')), ('LEFTPADDING', (0,0), (-1,-1), 12), ('TOPPADDING', (0,0), (-1,-1), 5), ('BOTTOMPADDING', (0,0), (-1,-1), 5), ])) story.append(ct) story.append(PageBreak()) # ═══════════════════════════════════════════════════════════════════════════════ # SECTION 1 — DEFINITION & OBJECTIVES # ═══════════════════════════════════════════════════════════════════════════════ story.append(h1('1. DEFINITION & OBJECTIVES OF PHYSICAL EXAMINATION')) story.append(sp()) story.append(h2('1.1 Definition')) story.append(body( 'A <b>physical examination</b> is a thorough inspection or a detailed study of the entire body ' 'or some part of the body to determine the general physical condition, or the conditions of ' 'some parts of the body or its function. It is the systematic collection of objective information ' 'that is observed or elicited through examination techniques. Physical examination involves the ' 'use of one\'s senses to obtain information about the structure and function of the area being ' 'observed or manipulated.' )) story.append(sp()) story.append(h2('1.2 Objectives / Purposes')) for obj in [ 'To detect disease in its early stage.', 'To determine the cause and extent of disease.', 'For periodic health check-up.', 'To find out whether a person is physically fit.', 'To understand the physical and mental well-being of the client.', 'To understand any changes in the condition — any improvement or regression.', 'To determine the nature of treatment or nursing care required.', 'To protect the community, especially in case of a communicable disease.', 'To find out whether the person is medically fit for a particular task.', ]: story.append(bullet(obj)) story.append(sp()) # ═══════════════════════════════════════════════════════════════════════════════ # SECTION 2 — TYPES # ═══════════════════════════════════════════════════════════════════════════════ story.append(h1('2. TYPES OF PHYSICAL EXAMINATION')) story.append(sp()) types_data = [ ['Type', 'Description'], ['Periodic Health Examination', 'Done at definite intervals to see that the individual is healthy and fit. ' 'It is the foundation stone of preventive medicine. The more complete the ' 'examination, the greater its value as a preventive measure. Includes inspection ' 'of the entire body; also done as a follow-up to watch progress.'], ['Examination for Diagnostic Purpose', 'A medical examination by the physician according to the patient\'s symptoms ' 'when illness occurs. Aimed at identifying the cause and extent of disease.'], ] story.append(info_box(types_data[1:], header=types_data[0], col_widths=[5.5*cm, 11*cm])) story.append(sp()) # ═══════════════════════════════════════════════════════════════════════════════ # SECTION 3 — METHODS / TECHNIQUES # ═══════════════════════════════════════════════════════════════════════════════ story.append(h1('3. METHODS / TECHNIQUES OF EXAMINATION')) story.append(sp()) story.append(note( 'The four basic techniques of physical examination are: Inspection, Palpation, ' 'Percussion, and Auscultation. A fifth technique — Manipulation — is also used.' )) story.append(sp()) methods = [ ('Inspection', 'INSP', 'The systematic visual examination of the client through deliberate, purposeful ' 'observation using the sense of sight. It involves observation of colour, shape, ' 'symmetry, size, movement, texture, and other physical characteristics. Involves ' 'observation of the colour, contour, and condition of surfaces or structures with ' 'the naked eye or with the aid of a light source.'), ('Palpation', 'PALP', 'Feeling with the hands to note the size, position, texture, and temperature of ' 'organs. The soft tissues are examined by applying gentle or firm pressure on the ' 'body surface. The various organs of the abdomen can be felt by applying pressure ' 'on the abdomen. Used to assess tenderness, consistency, pulsations, and masses.'), ('Percussion', 'PERC', 'Examination by tapping with fingers on the body to determine the conditions of ' 'internal parts by the sounds produced. Done by placing a finger of the left hand ' 'firmly against the part to be examined (chest, abdomen) and tapping with the ' 'fingertips of the right hand. Two types: (1) Direct percussion — tapping directly ' 'with the fingertip; (2) Indirect percussion — involves two hands. Allows ' 'discrimination among five different tones.'), ('Auscultation', 'AUSC', 'The process of listening to sounds generated within the body. Usually done with a ' 'stethoscope (discovered by Laennec in 1819). The heart and blood vessels are ' 'auscultated for circulation of blood; the lungs for air movement (breath sounds); ' 'the abdomen for bowel sounds. Four characteristics of sound assessed: ' '(1) Pitch — high to low; (2) Loudness — soft to loud; (3) Quality — e.g. gurgling, ' 'swishing; (4) Duration — short or long.'), ('Manipulation', 'MANIP', 'Moving certain parts of the body to note its flexibility or limitation in movement. ' 'Testing of reflexes — the response of tissues to external stimuli is tested by means ' 'of a percussion hammer, safety pin, wisp of cotton, or hot and cold water. Limitation ' 'of movement is discovered by this method.'), ] for name, tag, desc in methods: story.append(KeepTogether([ h3(f'{tag} — {name}'), body(desc), sp(), ])) # ═══════════════════════════════════════════════════════════════════════════════ # SECTION 4 — EQUIPMENT # ═══════════════════════════════════════════════════════════════════════════════ story.append(h1('4. EQUIPMENT REQUIRED FOR PHYSICAL EXAMINATION')) story.append(sp()) story.append(h3('Standard Tray / Bedside Equipment')) equip = [ ['General Equipment', 'Specialised Instruments'], ['Sphygmomanometer\nStethoscope\nTongue depressor\nFlashlight / Adjustable light\nTape measure and skin pencil\nPercussion hammer\nSafety pin\nTuning fork\nCotton applicators\nSpecimen bottles / Test tubes\nCulture bottles\nSlides\nKidney tray\nWeighing machine\nThermometer', 'Ophthalmoscope (eye examination)\nOtoscope / Ear speculum (ear examination)\nNasal speculum (nostril examination)\nHead mirror\nLaryngoscope\nLaryngeal mirror\nVaginal speculum (female genitalia)\nProctoscope (rectal examination)\nGloves (rubber gloves / finger stall)\nMackintosh\nVaseline (lubricant)\nSterile specimen bottles\nSlides and cotton applicators\nHot and cold water in test tubes (sensation testing)'], ] story.append(info_box(equip[1:], header=equip[0], col_widths=[7.5*cm, 9*cm])) story.append(sp()) # ═══════════════════════════════════════════════════════════════════════════════ # SECTION 5 — NURSE'S ROLE # ═══════════════════════════════════════════════════════════════════════════════ story.append(h1('5. ROLE OF THE NURSE IN PHYSICAL EXAMINATION')) story.append(sp()) story.append(note( 'The nurse\'s role has three main components: (A) Preparation of the Environment & Equipment, ' '(B) Preparation of the Patient, (C) Assistance with the Examination.' )) story.append(sp()) story.append(h2('A. Preparation of the Environment & Equipment')) for item in [ 'Maintain good ventilation and privacy — use a screen if examination is in a general ward.', 'Provide adequate light (natural or artificial).', 'Arrange a separate examination room whenever possible.', 'Provide a special examination table with mattress and pillow, or an ordinary cot with sheets for draping.', 'Arrange all articles conveniently at the bedside before the examination begins.', 'Ensure all instruments are clean, sterile (where required), and in working order.', ]: story.append(bullet(item)) story.append(sp()) story.append(h2('B. Preparation of the Patient')) story.append(h3('Physical Preparation')) for item in [ 'Clean and shave the part if necessary.', 'Keep the client in a comfortable position convenient for the doctor to examine.', 'Ask the client to empty the bladder prior to examination.', 'Empty the bowels by an enema if required.', 'Remove garments and change into hospital dress if it is the custom.', 'Drape the client with extra sheets and expose only the areas needed; avoid unnecessary exposure.', ]: story.append(bullet(item)) story.append(sp()) story.append(h3('Mental / Psychological Preparation')) for item in [ 'The client may be anxious about illness and may have false ideas about medical examination.', 'The nurse\'s duty is to allay anxieties and fears by proper explanation.', 'Explain the sequence of the procedure to gain the client\'s confidence and cooperation.', 'As far as possible, a nurse should remain with a female client during physical examination.', 'Obtain the confidence and co-operation of the patient by proper explanation before procedures such as rectal examination.', ]: story.append(bullet(item)) story.append(sp()) story.append(h2('C. Assistance with the Examination')) for item in [ 'Be ready for examination and assist the physician; hand over instruments needed for the examination.', 'Handle the patient from the opposite side of the examiner.', 'Place the patient in the proper position for the part being examined.', 'Ensure comfort of the patient throughout the examination.', 'Record the examination findings, specimens taken, and any significant observations.', 'After the examination, keep the patient comfortable, clean and sterilise equipment, and replace items.', ]: story.append(bullet(item)) story.append(sp()) # ═══════════════════════════════════════════════════════════════════════════════ # SECTION 6 — GENERAL OBSERVATIONS # ═══════════════════════════════════════════════════════════════════════════════ story.append(h1('6. GENERAL OBSERVATIONS ON THE PATIENT')) story.append(sp()) story.append(body( 'General observations are made as the client walks in or as the nurse approaches. ' 'Systematic observations include:' )) story.append(sp()) gen_obs = [ ['Observation Area', 'What to Assess'], ['General Appearance', 'Well-nourished or under-nourished; thin or obese; healthy or unhealthy; ' 'active or dull/tired; facial expression (anxious, worried, depressed, in pain).'], ['Level of Consciousness', 'Conscious, unconscious, delirious; speaking coherently or incoherently; ' 'alert, drowsy, stuporous, or comatose.'], ['Posture & Body Curves', 'Lordosis (inward curve of lumbar spine), Kyphosis (outward curve), Scoliosis (lateral ' 'curvature). Any limp in gait or unusual posture or attitude.'], ['Height & Weight', 'Measured using appropriate scales. Skull circumference measured from above the eyes ' 'to the occipital protuberance. Baby\'s length measured on a hard surface from heel to vertex.'], ['Skin', 'Colour: pallor, jaundice, cyanosis, flushing. Texture: dryness, flaking, wrinkling, ' 'excessive moisture. Temperature: warm, cold, clammy. Lesions: macules, papules, vesicles, ' 'wounds, abrasions, pressure sores, ulcers.'], ['Motor Activity', 'Muscle tone, any rigidity of body, difficulty or disability in movement, unnatural movements.'], ['Breathing', 'Rate and depth of respiration, movements of chest and abdomen, any sounds, ' 'any difficulty in breathing, any cyanosis; mouth-open breathing.'], ['Eating & Drinking', 'Signs of appetite or lack of it; likes and dislikes; whether eating and swallowing is painful.'], ['Elimination', 'Amount, frequency, and nature of elimination; any unusual characteristics or abnormalities ' 'in excretions; any discharges.'], ['Mental / Emotional State', 'Whether delirious, unconscious, anxious, worried, happy, or unhappy; emotional response to ' 'family, friends, and strangers; states of anxiety, fear, irritability; soundness of mind; ' 'any difficulties in thought or sensations such as loss of memory.'], ] story.append(info_box(gen_obs[1:], header=gen_obs[0], col_widths=[4.5*cm, 12*cm])) story.append(PageBreak()) # ═══════════════════════════════════════════════════════════════════════════════ # SECTION 7 — HEAD-TO-TOE SYSTEMIC EXAMINATION # ═══════════════════════════════════════════════════════════════════════════════ story.append(h1('7. HEAD-TO-TOE SYSTEMIC EXAMINATION')) story.append(sp()) systems = [ ('Head & Face', [ 'Shape of the skull and fontanelles (especially in the newborn).', 'Skull circumference (measured at greatest diameter from above eyes to occipital protuberance).', 'Scalp: cleanliness, condition of hair, presence of pediculi, infections (e.g. ringworm).', 'Face: pale, flushed, puffiness, signs of fatigue, pain, or anxiety.', ]), ('Eyes', [ 'Look for pallor, jaundice (icterus), cyanosis, redness, or discharge.', 'Check pupillary reaction to light (PEARL — Pupils Equal And Reactive to Light).', 'Assess visual acuity; use ophthalmoscope to examine inner part of eye.', 'Note any swelling, discharge, or abnormality of the lids and cornea.', ]), ('Ears', [ 'Examine the external ear for shape and any discharge.', 'Examine the tympanic membrane using an otoscope.', 'Test hearing using a tuning fork (Rinne and Weber tests).', 'Note any pain, hearing impairment, or discharge.', ]), ('Nose', [ 'Examine external nares using a nasal speculum and head mirror; autoscope may also be used.', 'Note any discharge from the nose.', 'Assess for impairment in sense of smell or difficulty in nose breathing.', ]), ('Mouth & Pharynx', [ 'Examine with a tongue depressor and good light; client seated with head resting against chair back.', 'Inspect lips, teeth, gums, tongue, and mucosa for colour, ulceration, or white patches.', 'Note any odour of the mouth.', 'Examine tonsils and posterior pharyngeal wall for redness, exudate, or enlargement.', 'Check for hoarseness or difficulty in speaking.', ]), ('Throat & Neck', [ 'Examine the throat for any abnormalities.', 'Neck palpated for lymph nodes (lymphadenopathy).', 'Assess the thyroid gland — ask client to swallow saliva while palpating.', 'Note any swelling, growth, or restricted movements; check if neck veins are distended.', 'Any abnormality in size and shape of structures.', ]), ('Chest', [ 'Anterior chest examined with client in horizontal recumbent (supine) position.', 'Percussed to detect presence of fluid or congested areas.', 'Auscultated (stethoscope) for breath sounds; posterior chest examined with client in sitting position.', 'Heart examined by auscultation for murmurs and other sounds.', 'Breasts examined by inspection and palpation for lumps or growths; axillary lymph nodes palpated.', 'Note rate and depth of respiration, type of breathing, any cough or expectoration.', 'Check for presence of any lumps or growth; note nipple condition (normal or inverted in females).', ]), ('Abdomen', [ 'Client in supine (dorsal recumbent) position with knees slightly flexed to relax abdominal muscles.', 'Inspect for distension, rigidity, bulging in certain areas; skin marks, discolouration, or shiny appearance.', 'Percussed, auscultated (bowel sounds), and palpated to detect any abnormalities.', 'Assess appetite, fluid intake; note any emesis associated with abdominal disturbances.', ]), ('Genitalia & Rectum', [ '<b>Female Genitalia:</b> Client in dorsal recumbent or lithotomy position. Clean rubber gloves, ' 'vaginal speculum, good light source, and lubricant needed. Abnormalities of vulva, vagina, ' 'cervix, uterus, and ovaries detected. Inguinal region palpated for enlarged lymph nodes.', '<b>Rectal Examination:</b> Client in dorsal recumbent or left lateral position. Examined for ' 'haemorrhoids, fissures; client asked to bear down as if to defecate. Proctoscopic examination ' 'done when proctoscope is used. An enema is given beforehand and rectum should be empty. ' 'Indicated before rectal surgery, during labour, or to remove foreign bodies.', ]), ('Extremities (Arms & Legs)', [ 'Extremities inspected, palpated, and moved in all directions.', 'A fine tremor suggestive of hyperthyroidism can be observed if client holds arms out in front for a few minutes.', 'Assess for pitting oedema at the ankle joint by pressing skin against the bone.', 'Observe posterior calf for varicose veins.', 'Joints moved in all directions to assess range of movement.', 'Fingers: long, tapering, or clubbing. Nails: pale, cyanotic, brittle, broken.', 'Hands: moist, dry, oedematous, trembling; any inability to move or pain.', 'Feet: deformities, corns, symptoms of circulatory disturbance (cyanotic).', 'Legs: varicose veins, deformities, oedema.', ]), ('Spine', [ 'Examined in standing position for abnormal curvatures (lordosis, kyphosis, scoliosis).', 'Fingers moved over the spine to detect spina bifida, especially in newborn infants.', ]), ] for sys_name, items in systems: story.append(KeepTogether([ h3(sys_name), *[bullet(i) for i in items], sp(), ])) # ═══════════════════════════════════════════════════════════════════════════════ # SECTION 8 — NEUROLOGICAL ASSESSMENT # ═══════════════════════════════════════════════════════════════════════════════ story.append(h1('8. NEUROLOGICAL ASSESSMENT')) story.append(sp()) story.append(h2('8.1 Level of Consciousness')) story.append(body( 'Consciousness is the awareness of self and environment. It is a complex entity requiring ' 'many of the brain\'s functions to be intact. Altered states of consciousness indicate some degree ' 'of brain dysfunction. Assessment of consciousness may be done by "neuro-checks" — examining ' 'the level of consciousness, respiratory patterns, pupillary reactions, motor responses, and vital signs.' )) story.append(sp()) story.append(h3('Levels of Consciousness')) loc_data = [ ['Level', 'Description'], ['Alert', 'Fully awake, oriented to person, place, and time. Responds promptly to stimuli.'], ['Drowsy / Lethargic', 'Excessive sleepiness; responds to verbal stimuli but may drift back to sleep.'], ['Stupor', 'Unresponsive except to vigorous and repeated stimulation.'], ['Coma', 'No voluntary movement; no response to painful stimuli. Complete unconsciousness.'], ['Delirium', 'State of confused excitement; speaks incoherently; may be disoriented.'], ] story.append(info_box(loc_data[1:], header=loc_data[0], col_widths=[4*cm, 12.5*cm])) story.append(sp()) story.append(h2('8.2 Reflexes')) story.append(body( 'Reflexes are tested using a percussion hammer, safety pin, wisp of cotton, or hot and cold water. ' 'The following reflexes are routinely assessed:' )) story.append(sp()) reflexes = [ ('Biceps Reflex', 'Client\'s arm is placed in a relaxed semi-flexed position. The doctor places a finger over ' 'the biceps tendon and gently taps with the percussion hammer. Contraction of the biceps muscle is noted.'), ('Triceps Reflex', 'Client\'s arm is supported in a relaxed position; tapped with a hammer just above the olecranon ' 'process. Normally the forearm will straighten.'), ('Patellar (Knee-Jerk) Reflex', 'Client is seated with legs dangling freely. The area just below the patella is tapped. ' 'Normally the lower leg will kick forward.'), ('Achilles Reflex', 'In the same sitting position, the foot is supported with one hand and the Achilles tendon is tapped. ' 'Normal response is a downward jerk of the foot (plantarflexion).'), ('Plantar Reflex (Babinski)', 'The sole of the foot is stroked with a sharp instrument (pin). Normal response: all toes bend ' 'downward (negative Babinski). Abnormal response (positive Babinski): toes spread outward and ' 'the big toe moves upward — indicates upper motor neuron lesion in adults.'), ] for name, desc in reflexes: story.append(h3(name)) story.append(body(desc)) story.append(sp()) story.append(h2('8.3 Sensation Tests')) story.append(body( 'Sensation is tested with the client\'s eyes closed. The following modalities are assessed:' )) for item in [ '<b>Touch:</b> Tested with a wisp of cotton touched to the skin. Client identifies the location touched.', '<b>Pain:</b> Tested using a safety pin (sharp vs. dull discrimination).', '<b>Temperature:</b> Tested using hot and cold water in test tubes. Client identifies whether the stimulus feels hot or cold.', '<b>Vibration:</b> Tested using a tuning fork placed on bony prominences.', ]: story.append(bullet(item)) story.append(sp()) story.append(h2('8.4 Coordination Tests')) story.append(h3('Finger-to-Nose Test')) story.append(body( 'Client is asked to abduct and extend the arms at shoulder height and rapidly touch the nose, ' 'alternating index fingers. In abnormal response, the client will miss the nose.' )) story.append(sp()) story.append(h3('Heel-to-Shin Test')) story.append(body( 'Client runs the heel of one foot along the shin of the other leg. Inability to perform this ' 'smoothly indicates cerebellar dysfunction.' )) story.append(sp()) story.append(h2('8.5 Equilibrium (Romberg Test)')) story.append(body( 'Client is asked to stand with feet together and eyes open; then eyes are closed. ' 'Abnormalities of gait or posture may be noted. If the client does not lose balance with eyes open ' 'but does so with eyes closed (positive Romberg), sensory ataxia is indicated. ' 'The nurse must be prepared to help the client if they start to fall.' )) story.append(sp()) story.append(h2('8.6 Muscle Strength')) story.append(body( 'Muscle strength is tested by asking the client to move a joint through its full range, ' 'while the examiner applies opposing resistance. Strength is graded 0-5 ' '(0 = no contraction, 5 = normal full strength against resistance).' )) story.append(sp()) # ═══════════════════════════════════════════════════════════════════════════════ # SECTION 9 — SYMPTOMS # ═══════════════════════════════════════════════════════════════════════════════ story.append(PageBreak()) story.append(h1('9. SYMPTOMS — CLASSIFICATION & SIGNIFICANCE')) story.append(sp()) story.append(body( 'A symptom is any evidence of disease or change in condition. The nurse should observe signs ' 'and symptoms of the patient so that the physician can be notified to adjust medication and treatment.' )) story.append(sp()) story.append(h2('9.1 By Perception')) for item in [ '<b>Subjective symptoms:</b> Apparent only to the patient; known through complaint (e.g. pain, dizziness).', '<b>Objective symptoms:</b> Readily perceptible to others and to the patient (e.g. pallor, redness, rashes).', ]: story.append(bullet(item)) story.append(sp()) story.append(h2('9.2 Cardinal Symptoms')) story.append(body( 'Variations from normal in <b>temperature, pulse, respiration, and blood pressure</b>.' )) story.append(sp()) story.append(h2('9.3 By Background/Cause')) for item in [ '<b>Familial symptoms:</b> Peculiar to certain families; may indicate a definite predisposition to certain conditions (e.g. TB, cardiac conditions).', '<b>Social symptoms:</b> Those ruled by economic status and environmental factors (e.g. poor housing, lack of proper food).', ]: story.append(bullet(item)) story.append(sp()) story.append(h2('9.4 By Extent and Body Part')) for item in [ '<b>General symptoms:</b> Affecting the whole body (e.g. fever).', '<b>Local symptoms:</b> Confined to one part or area (e.g. swelling, redness).', '<b>Physical symptoms:</b> Pertaining to physical sensations (e.g. hunger, thirst).', '<b>Mental symptoms:</b> Originating from the mind (e.g. fear, worry, anxiety).', ]: story.append(bullet(item)) story.append(sp()) story.append(h2('9.5 Common Symptom Terminology')) terms = [ ['Term', 'Definition'], ['Tenderness / Pain', 'Sensation produced by stimulation of nerve endings or over a diseased organ; the most common and important symptom.'], ['Pallor', 'Abnormal paleness of the skin, mucous membranes, or conjunctivae; indicates anaemia or poor circulation.'], ['Cyanosis', 'Bluish tint of the lips, nail beds, and skin due to inadequate oxygenation of the blood.'], ['Jaundice', 'Yellowish discolouration of skin and sclera due to elevated bilirubin.'], ['Oedema', 'Abnormal accumulation of fluid in the interstitial tissue; detected by pressing skin against bone (pitting oedema).'], ['Clubbing', 'Enlargement of fingertip phalanges associated with chronic hypoxia.'], ['Aphasia', 'Loss of ability to speak, understand language, read, or write due to dysfunction of brain centres.'], ['Tremor', 'Involuntary rhythmic movement; fine tremor of outstretched hands may suggest hyperthyroidism.'], ] story.append(info_box(terms[1:], header=terms[0], col_widths=[4.5*cm, 12*cm])) story.append(sp()) # ═══════════════════════════════════════════════════════════════════════════════ # SECTION 10 — POSITIONING & DRAPING # ═══════════════════════════════════════════════════════════════════════════════ story.append(h1('10. POSITIONS & DRAPING FOR PHYSICAL EXAMINATION')) story.append(sp()) positions = [ ['Position', 'Description', 'Used For'], ['Horizontal Recumbent\n(Supine)', 'Lying flat on back, limbs extended.', 'General examination; chest (anterior); abdominal examination.'], ['Dorsal Recumbent', 'Supine with knees flexed and separated.', 'Abdominal examination; pelvic and rectal examination.'], ['Lithotomy', 'Supine, thighs flexed on abdomen, legs on stirrups.', 'Female genitalia examination; rectal examination.'], ['Left Lateral\n(Sims\' Position)', 'Lying on left side, left leg slightly flexed, right knee drawn up.', 'Rectal examination; proctoscopic examination.'], ['Sitting', 'Patient seated upright at edge of table/bed.', 'Posterior chest examination; neurological assessment; ENT examination.'], ['Standing', 'Patient standing upright.', 'Spinal curvature assessment; equilibrium testing; gait analysis.'], ['Knee-Chest', 'Patient on knees with chest on table, buttocks raised.', 'Proctoscopic and sigmoidoscopic examination.'], ] story.append(info_box(positions[1:], header=positions[0], col_widths=[3.5*cm, 6.5*cm, 6.5*cm])) story.append(sp()) story.append(note( 'Draping Principles: Always expose only the area required for examination. Maintain the ' 'patient\'s dignity and privacy at all times. Use adequate sheets for draping and provide ' 'a screen if examination is in a shared ward area. Keep the patient warm.' )) story.append(sp()) # ═══════════════════════════════════════════════════════════════════════════════ # SECTION 11 — VITAL SIGNS & ANTHROPOMETRIC # ═══════════════════════════════════════════════════════════════════════════════ story.append(h1('11. VITAL SIGNS & ANTHROPOMETRIC MEASUREMENTS')) story.append(sp()) story.append(body( 'Vital signs are cardinal measurements that reflect physiological status. Variations from ' 'normal in any of these are classified as cardinal symptoms.' )) story.append(sp()) vitals = [ ['Parameter', 'Normal Adult Range', 'Clinical Significance'], ['Temperature', '36.5 – 37.5°C (97.7 – 99.5°F)', 'Fever (>38°C) may indicate infection; hypothermia (<35°C) is a medical emergency.'], ['Pulse', '60 – 100 beats/min', 'Tachycardia (>100) or bradycardia (<60); rhythm, volume, and character also assessed.'], ['Respiration', '12 – 20 breaths/min', 'Rate, depth, rhythm, and breath sounds assessed. Cyanosis noted if oxygenation is inadequate.'], ['Blood Pressure', '< 120/80 mmHg', 'Hypertension >140/90 mmHg; hypotension <90/60 mmHg.'], ['Oxygen Saturation', '≥ 95% (SpO₂)', 'Values <90% indicate hypoxaemia requiring intervention.'], ['Height', 'Adults: varies by age/sex', 'Measured using stadiometer; in infants, from heel to vertex on hard surface.'], ['Weight', 'BMI 18.5 – 24.9 kg/m²', 'Weighed without shoes; infants weighed unclothed on baby scale.'], ['Skull Circumference', 'Adult: ~55 cm\nNewborn: 33–35 cm', 'Measured at greatest diameter from above eyes to occipital protuberance.'], ] story.append(info_box(vitals[1:], header=vitals[0], col_widths=[3.5*cm, 5.5*cm, 7.5*cm])) story.append(sp()) # ═══════════════════════════════════════════════════════════════════════════════ # SECTION 12 — INFORMATION SOURCES # ═══════════════════════════════════════════════════════════════════════════════ story.append(h1('12. SOURCES OF INFORMATION FOR NURSING ASSESSMENT')) story.append(sp()) story.append(body( 'Before and during physical examination, the nurse uses multiple sources of information to ' 'build a complete clinical picture:' )) story.append(sp()) sources = [ ['Source', 'Information Obtained'], ['Patient\'s Chart / Records', 'Name, age, sex, occupation, past illness history, previous examinations, ' 'laboratory results, progress reports made by the attending physician.'], ['Doctor\'s Orders', 'Each new order for medication and treatment provides further information helpful ' 'in observing the patient.'], ['Patient & Family Interview', 'Already-obtained information may be enriched by tactful questioning. ' 'During conversation, signs and symptoms such as fear, worry, anxiety, pain, and restlessness can be detected.'], ['Health History', 'Past medical history, surgical history, family history (diabetes mellitus, cancer, ' 'heart diseases), obstetrical history, lifestyle/high risk behaviour (smoking, alcoholism, substance abuse), ' 'food habits, sleep patterns, exercise patterns.'], ['Physical Examination', 'Objective findings from inspection, palpation, percussion, auscultation, and manipulation.'], ['Laboratory / Diagnostic Results', 'Blood tests, urine tests, imaging, and other investigations that ' 'support the clinical findings.'], ] story.append(info_box(sources[1:], header=sources[0], col_widths=[4.5*cm, 12*cm])) story.append(sp()) # ─── BUILD ──────────────────────────────────────────────────────────────────── doc.build(story) print(f'PDF created: {OUTPUT}') PYEOF python3 /home/daytona/workspace/nursing-pe-pdf/generate_pdf.py

ls -lh /home/daytona/workspace/nursing-pe-pdf/Physical_Examination_Nursing_Guide.pdf

cat > /home/daytona/workspace/nursing-pe-pdf/generate_simple_pdf.py << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib.styles import ParagraphStyle from reportlab.lib.units import cm from reportlab.lib.colors import HexColor from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable, PageBreak) from reportlab.lib.enums import TA_LEFT, TA_CENTER, TA_JUSTIFY from reportlab.platypus import BaseDocTemplate, Frame, PageTemplate NAVY = HexColor('#1a3a5c') TEAL = HexColor('#1d7874') LT_BLU = HexColor('#e8f4f8') LT_GRY = HexColor('#f5f5f5') DGREY = HexColor('#333333') WHITE = HexColor('#ffffff') OUTPUT = '/home/daytona/workspace/nursing-pe-pdf/Physical_Examination_Simple.pdf' def header_footer(canvas, doc): canvas.saveState() w, h = A4 canvas.setFillColor(NAVY) canvas.rect(0, h-18*mm, w, 18*mm, fill=1, stroke=0) canvas.setFillColor(WHITE) canvas.setFont('Helvetica-Bold', 11) canvas.drawCentredString(w/2, h-11*mm, 'Physical Examination — Nursing Guide') canvas.setFillColor(NAVY) canvas.rect(0, 0, w, 8*mm, fill=1, stroke=0) canvas.setFillColor(WHITE) canvas.setFont('Helvetica', 7.5) canvas.drawCentredString(w/2, 2.5*mm, f'Page {doc.page}') canvas.restoreState() from reportlab.lib.units import mm doc = BaseDocTemplate(OUTPUT, pagesize=A4, rightMargin=2*cm, leftMargin=2*cm, topMargin=2.5*cm, bottomMargin=1.8*cm) frame = Frame(doc.leftMargin, doc.bottomMargin, doc.width, doc.height, id='main') doc.addPageTemplates([PageTemplate(id='main', frames=frame, onPage=header_footer)]) def S(name, **kw): return ParagraphStyle(name, **kw) H1 = S('H1', fontSize=12, textColor=WHITE, backColor=NAVY, fontName='Helvetica-Bold', spaceAfter=5, spaceBefore=10, leading=18, borderPadding=(5,8,5,8)) H2 = S('H2', fontSize=10.5, textColor=NAVY, fontName='Helvetica-Bold', spaceAfter=3, spaceBefore=7, leading=15) BD = S('BD', fontSize=9.5, textColor=DGREY, fontName='Helvetica', spaceAfter=3, spaceBefore=1, leading=14, alignment=TA_JUSTIFY) BL = S('BL', fontSize=9.5, textColor=DGREY, fontName='Helvetica', spaceAfter=2, spaceBefore=1, leading=13, leftIndent=14, bulletIndent=4) def h1(t): return Paragraph(f'<b>{t}</b>', H1) def h2(t): return Paragraph(t, H2) def bd(t): return Paragraph(t, BD) def bl(t): return Paragraph(f'• {t}', BL) def sp(n=1): return Spacer(1, n*3*mm) def hr(): return HRFlowable(width='100%', thickness=0.5, color=TEAL, spaceAfter=3, spaceBefore=3) def tbl(rows, hdr, cw): data = [[Paragraph(f'<b>{c}</b>', S('th', fontSize=9, textColor=WHITE, fontName='Helvetica-Bold', leading=12)) for c in hdr]] for row in rows: data.append([Paragraph(str(c), S('td', fontSize=9, textColor=DGREY, fontName='Helvetica', leading=13)) for c in row]) t = Table(data, colWidths=cw) t.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,0), NAVY), ('ROWBACKGROUNDS',(0,1),(-1,-1),[WHITE, LT_GRY]), ('GRID',(0,0),(-1,-1),0.4,HexColor('#cccccc')), ('TOPPADDING',(0,0),(-1,-1),4), ('BOTTOMPADDING',(0,0),(-1,-1),4), ('LEFTPADDING',(0,0),(-1,-1),6), ('RIGHTPADDING',(0,0),(-1,-1),6), ('VALIGN',(0,0),(-1,-1),'TOP'), ])) return t W = 16.5*cm # usable width story = [] # ── 1. DEFINITION & OBJECTIVES ────────────────────────────────────────────── story += [h1('1. Definition & Objectives'), sp()] story += [bd('A <b>physical examination</b> is a thorough, systematic inspection of the entire body ' '(or part of it) to assess general health and detect disease.'), sp()] story.append(h2('Objectives')) for o in [ 'Detect disease in its early stage', 'Determine the cause and extent of disease', 'Conduct periodic health check-ups', 'Assess physical and mental well-being', 'Determine the nature of treatment or nursing care needed', 'Protect the community (especially in communicable disease)', ]: story.append(bl(o)) story.append(sp()) # ── 2. TYPES ──────────────────────────────────────────────────────────────── story += [h1('2. Types of Physical Examination'), sp()] story.append(tbl( [['Periodic Health Examination', 'Done at regular intervals to confirm the individual is fit and healthy. Foundation of preventive medicine.'], ['Diagnostic Examination', 'Performed by the physician when illness occurs to identify cause and extent of disease.']], ['Type', 'Description'], [5*cm, 11.5*cm] )) story.append(sp()) # ── 3. TECHNIQUES ─────────────────────────────────────────────────────────── story += [h1('3. Techniques of Examination'), sp()] story.append(tbl( [['Inspection', 'Systematic visual observation — colour, shape, symmetry, size, movement.'], ['Palpation', 'Feeling with hands — size, position, texture, temperature, tenderness.'], ['Percussion', 'Tapping fingers on body surface to detect internal conditions by sound (dull, resonant, tympanic).'], ['Auscultation', 'Listening with a stethoscope — heart, lungs (breath sounds), bowel sounds. Assess pitch, loudness, quality, duration.'], ['Manipulation', 'Moving body parts to assess flexibility, range of motion, and reflexes.']], ['Technique', 'What It Assesses'], [3.5*cm, 13*cm] )) story.append(sp()) # ── 4. EQUIPMENT ───────────────────────────────────────────────────────────── story += [h1('4. Equipment Required'), sp()] story.append(tbl( [['General', 'Sphygmomanometer, stethoscope, thermometer, tongue depressor, flashlight, tape measure, percussion hammer, safety pin, tuning fork, cotton applicators, kidney tray, weighing machine'], ['Specialised', 'Ophthalmoscope (eye), otoscope/ear speculum (ear), nasal speculum (nose), laryngoscope, vaginal speculum (female), proctoscope (rectal), rubber gloves, lubricant, sterile specimen bottles, slides']], ['Category', 'Items'], [3*cm, 13.5*cm] )) story.append(sp()) # ── 5. NURSE'S ROLE ────────────────────────────────────────────────────────── story += [h1("5. Nurse's Role"), sp()] story.append(h2('A. Environment & Equipment')) for i in ['Ensure privacy, good ventilation, and adequate lighting.', 'Arrange examination table/cot with sheets for draping.', 'Set up all equipment at bedside before starting.']: story.append(bl(i)) story.append(sp()) story.append(h2('B. Patient Preparation')) for i in ['Ask client to empty bladder (and bowel if required).', 'Change into hospital gown; expose only the area being examined.', 'Explain the procedure to reduce anxiety and gain cooperation.', 'A nurse should stay with female clients throughout.']: story.append(bl(i)) story.append(sp()) story.append(h2('C. Assistance During Examination')) for i in ['Hand instruments to the physician; stand on opposite side.', 'Position the patient correctly for each part examined.', 'Record findings, specimens, and any changes observed.', 'After: make patient comfortable; clean and sterilise equipment.']: story.append(bl(i)) story.append(sp()) # ── 6. HEAD-TO-TOE ASSESSMENT ──────────────────────────────────────────────── story += [h1('6. Head-to-Toe Assessment'), sp()] story.append(tbl( [['Head & Face', 'Skull shape; fontanelles (newborn); scalp hygiene; pediculi; facial pallor/puffiness.'], ['Eyes', 'Pallor, jaundice (sclera), cyanosis, discharge; pupil reaction (PEARL); visual acuity.'], ['Ears', 'External ear shape; tympanic membrane (otoscope); hearing (tuning fork); discharge.'], ['Nose', 'Discharge; smell impairment; nasal obstruction (nasal speculum).'], ['Mouth & Throat', 'Lips, teeth, gums, tongue, mucosa; ulcers, odour, hoarseness; tonsils, pharynx.'], ['Neck', 'Lymph nodes (palpation); thyroid (ask to swallow); jugular vein distension; range of motion.'], ['Chest', 'Respiratory rate/depth; percussion for fluid; auscultation (breath & heart sounds); breasts for lumps.'], ['Abdomen', 'Distension, rigidity; bowel sounds (auscultation); palpation for organs/masses; skin marks.'], ['Genitalia', 'Female: lithotomy position; vulva, vagina, cervix, uterus. Rectal: left lateral; haemorrhoids, fissures.'], ['Extremities', 'Oedema (pitting); varicose veins; joint ROM; clubbing; cyanosis of nails; tremor.'], ['Spine', 'Lordosis, kyphosis, scoliosis (standing); spina bifida (newborn — run fingers along spine).'], ], ['Body Area', 'Key Points to Assess'], [3.5*cm, 13*cm] )) story.append(sp()) # ── 7. NEUROLOGICAL ASSESSMENT ─────────────────────────────────────────────── story += [h1('7. Neurological Assessment'), sp()] story.append(h2('Level of Consciousness')) story.append(tbl( [['Alert','Fully awake, oriented.'], ['Drowsy','Responds to voice, drifts to sleep.'], ['Stupor','Responds only to vigorous stimulation.'], ['Coma','No voluntary movement; no response to pain.'], ['Delirium','Confused, incoherent speech, disoriented.']], ['Level', 'Description'], [3.5*cm, 13*cm] )) story.append(sp()) story.append(h2('Reflexes (tested with percussion hammer)')) story.append(tbl( [['Biceps', 'Tap biceps tendon — contraction of biceps.'], ['Triceps', 'Tap above olecranon — forearm straightens.'], ['Patellar', 'Tap below patella (legs dangling) — lower leg kicks forward.'], ['Achilles', 'Tap Achilles tendon — foot jerks downward (plantarflexion).'], ['Babinski', 'Stroke sole — normal: toes curl down. Positive (abnormal): big toe up, others fan out.']], ['Reflex', 'Normal Response'], [3*cm, 13.5*cm] )) story.append(sp()) story.append(h2('Sensation & Coordination')) for i in ['Touch: wisp of cotton (eyes closed — locate stimulus).', 'Pain: safety pin (sharp vs. dull).', 'Temperature: hot/cold water in test tubes.', 'Finger-to-nose test: rapid alternating touching — abnormal if nose is missed.', 'Romberg test: stand with feet together, eyes closed — positive if client sways/falls.']: story.append(bl(i)) story.append(sp()) # ── 8. VITAL SIGNS ─────────────────────────────────────────────────────────── story += [h1('8. Vital Signs & Measurements'), sp()] story.append(tbl( [['Temperature', '36.5 – 37.5 °C', 'Fever >38 °C; hypothermia <35 °C'], ['Pulse', '60 – 100 bpm', 'Tachycardia >100; bradycardia <60'], ['Respiration', '12 – 20 /min', 'Note rate, depth, rhythm, sounds'], ['Blood Pressure','< 120/80 mmHg', 'HTN >140/90; hypotension <90/60'], ['SpO₂', '≥ 95%', 'Hypoxaemia if <90%'], ['Weight/Height', 'BMI 18.5–24.9', 'Infant: naked, on baby scale; adult: standing scale, no shoes'], ], ['Parameter', 'Normal Range', 'Clinical Note'], [3.5*cm, 4.5*cm, 8.5*cm] )) story.append(sp()) # ── 9. SYMPTOMS ────────────────────────────────────────────────────────────── story += [h1('9. Symptoms — Classification'), sp()] story.append(tbl( [['Subjective', 'Felt only by patient (pain, dizziness, nausea).'], ['Objective', 'Visible to others (pallor, rash, jaundice, redness).'], ['Cardinal', 'Changes in temperature, pulse, respiration, BP.'], ['General', 'Affect whole body (fever, fatigue).'], ['Local', 'Confined to one area (swelling, redness).'], ['Mental', 'Fear, worry, anxiety.'], ], ['Type', 'Description'], [3*cm, 13.5*cm] )) story.append(sp()) # ── 10. POSITIONS ──────────────────────────────────────────────────────────── story += [h1('10. Common Examination Positions'), sp()] story.append(tbl( [['Supine (Horizontal Recumbent)', 'Flat on back', 'General, chest (anterior), abdomen'], ['Dorsal Recumbent', 'Supine, knees flexed & apart', 'Abdomen, pelvis, rectal'], ['Lithotomy', 'Supine, legs on stirrups', 'Female genitalia, rectal'], ['Left Lateral (Sims\')', 'On left side, right knee drawn up', 'Rectal, proctoscopy'], ['Sitting', 'Upright at edge of table', 'Posterior chest, neuro, ENT'], ['Standing', 'Upright, feet together', 'Spine, gait, Romberg test'], ], ['Position', 'Description', 'Used For'], [4*cm, 5.5*cm, 7*cm] )) story.append(sp()) story.append(bd('<b>Draping:</b> Always expose only the area needed. Maintain dignity and privacy. ' 'Keep the patient warm and use a screen in shared wards.')) doc.build(story) print('Done:', OUTPUT) PYEOF python3 /home/daytona/workspace/nursing-pe-pdf/generate_simple_pdf.py

ls -lh /home/daytona/workspace/nursing-pe-pdf/Physical_Examination_Simple.pdf

python3 -c " from pdf2image import convert_from_path pdf = '/home/daytona/workspace/attachments/7425e621-3ba4-4336-9c00-afea01ee75af/Photo.pdf' images = convert_from_path(pdf, dpi=150) print('Pages:', len(images)) for i, img in enumerate(images): img.save(f'/home/daytona/workspace/photo_p{i+1}.png') print(f'Saved photo_p{i+1}.png - size: {img.size}') " 2>&1

python3 -c " import pytesseract from PIL import Image all_text = [] for i in range(1, 19): img = Image.open(f'/home/daytona/workspace/photo_p{i}.png') t = pytesseract.image_to_string(img) all_text.append(f'=== PAGE {i} ===\n{t}') with open('/home/daytona/workspace/photo_ocr.txt', 'w') as f: f.write('\n'.join(all_text)) print('OCR done, chars:', sum(len(x) for x in all_text)) " 2>&1

# Upscale key pages for better analysis, save as higher quality python3 -c " from PIL import Image import os # Save key pages at higher res for visual analysis for i in [1,2,3,4,5,6,7,8]: img = Image.open(f'/home/daytona/workspace/photo_p{i}.png') # Upscale 2x w, h = img.size img2 = img.resize((w*2, h*2), Image.LANCZOS) img2.save(f'/home/daytona/workspace/photo_big_p{i}.jpg', quality=90) print(f'p{i}: {img2.size}') " 2>&1

python3 -c " import pytesseract from PIL import Image # Run OCR on the bigger images all_text = [] for i in range(1, 19): try: img = Image.open(f'/home/daytona/workspace/photo_big_p{i}.jpg') except: img = Image.open(f'/home/daytona/workspace/photo_p{i}.png') t = pytesseract.image_to_string(img, config='--psm 6') all_text.append(f'=== PAGE {i} ===\n{t}') with open('/home/daytona/workspace/photo_ocr2.txt', 'w') as f: f.write('\n'.join(all_text)) print('OCR done') for i, t in enumerate(all_text): print(f'Page {i+1}: {len(t)} chars') " 2>&1

cat > /home/daytona/workspace/nursing-pe-pdf/ttn_care_plan.py << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib.styles import ParagraphStyle from reportlab.lib.units import cm, mm from reportlab.lib.colors import HexColor, black, white from reportlab.platypus import (BaseDocTemplate, Frame, PageTemplate, SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable, PageBreak, KeepTogether) from reportlab.lib.enums import TA_LEFT, TA_CENTER, TA_RIGHT, TA_JUSTIFY from reportlab.pdfgen import canvas as pdfcanvas W, H = A4 MARGIN = 1.8*cm # ── colours matching a handwritten nursing care plan aesthetic ─────────────── DARK_BLUE = HexColor('#1a2f5a') MID_BLUE = HexColor('#2c5282') LIGHT_BLUE = HexColor('#dbeafe') PALE_BLUE = HexColor('#eff6ff') TEAL = HexColor('#0d7377') LT_TEAL = HexColor('#e0f2f1') PINK = HexColor('#fce4ec') PURPLE = HexColor('#4a235a') LT_PURPLE = HexColor('#f3e5f5') ORANGE = HexColor('#e65100') YELLOW = HexColor('#fff9c4') GREY = HexColor('#f0f0f0') DGREY = HexColor('#333333') MED_GREY = HexColor('#666666') WHITE_C = HexColor('#ffffff') RED = HexColor('#c62828') GREEN = HexColor('#1b5e20') LT_GREEN = HexColor('#e8f5e9') OUTPUT = '/home/daytona/workspace/nursing-pe-pdf/TTN_Care_Plan.pdf' # ── styles ─────────────────────────────────────────────────────────────────── def S(name, **kw): return ParagraphStyle(name, **kw) COVER_INST = S('ci', fontSize=15, textColor=WHITE_C, fontName='Helvetica-Bold', leading=20, alignment=TA_CENTER, spaceAfter=2) COVER_DEPT = S('cd', fontSize=12, textColor=HexColor('#cce4ff'), fontName='Helvetica', leading=16, alignment=TA_CENTER, spaceAfter=2) COVER_TITLE = S('ct', fontSize=26, textColor=WHITE_C, fontName='Helvetica-Bold', leading=32, alignment=TA_CENTER, spaceAfter=6) COVER_SUB = S('cs', fontSize=14, textColor=HexColor('#ffecb3'), fontName='Helvetica-Bold', leading=18, alignment=TA_CENTER, spaceAfter=4) COVER_COND = S('cc', fontSize=18, textColor=HexColor('#fff176'), fontName='Helvetica-Bold', leading=24, alignment=TA_CENTER, spaceAfter=4) SEC_HEAD = S('sh', fontSize=11.5, textColor=WHITE_C, fontName='Helvetica-Bold', backColor=DARK_BLUE, leading=16, spaceBefore=8, spaceAfter=4, borderPadding=(4,8,4,8)) FIELD_LABEL = S('fl', fontSize=9, textColor=MID_BLUE, fontName='Helvetica-Bold', leading=12, spaceAfter=1) FIELD_VAL = S('fv', fontSize=9.5, textColor=DGREY, fontName='Helvetica', leading=13, spaceAfter=2) BODY = S('bd', fontSize=9.5, textColor=DGREY, fontName='Helvetica', leading=14, spaceAfter=3, alignment=TA_JUSTIFY) BULLET = S('bl', fontSize=9.5, textColor=DGREY, fontName='Helvetica', leading=13, leftIndent=14, spaceAfter=2) TABLE_HDR = S('th', fontSize=9, textColor=WHITE_C, fontName='Helvetica-Bold', leading=12, alignment=TA_CENTER) TABLE_CELL = S('tc', fontSize=9, textColor=DGREY, fontName='Helvetica', leading=12, alignment=TA_LEFT) TABLE_CELL_C = S('tcc', fontSize=9, textColor=DGREY, fontName='Helvetica', leading=12, alignment=TA_CENTER) DIAG_HEAD = S('dh', fontSize=10, textColor=WHITE_C, fontName='Helvetica-Bold', backColor=TEAL, leading=14, borderPadding=(3,6,3,6)) SMALL = S('sm', fontSize=8.5, textColor=MED_GREY, fontName='Helvetica-Oblique', leading=12, spaceAfter=2) def h(t, style=SEC_HEAD): return Paragraph(f'<b>{t}</b>', style) def b(t): return Paragraph(f'• {t}', BULLET) def bd(t): return Paragraph(t, BODY) def sp(n=1): return Spacer(1, n*3*mm) def hr(color=MID_BLUE): return HRFlowable(width='100%', thickness=0.7, color=color, spaceAfter=3, spaceBefore=3) W_INNER = W - 2*MARGIN # ~16.4 cm def tbl(data_rows, header_row, col_widths, hdr_bg=DARK_BLUE, alt=True): data = [[Paragraph(f'<b>{c}</b>', TABLE_HDR) for c in header_row]] for row in data_rows: data.append([Paragraph(str(c), TABLE_CELL) for c in row]) cmds = [ ('BACKGROUND', (0,0), (-1,0), hdr_bg), ('GRID', (0,0), (-1,-1), 0.4, HexColor('#bbbbbb')), ('TOPPADDING', (0,0), (-1,-1), 4), ('BOTTOMPADDING', (0,0), (-1,-1), 4), ('LEFTPADDING', (0,0), (-1,-1), 5), ('RIGHTPADDING', (0,0), (-1,-1), 5), ('VALIGN', (0,0), (-1,-1), 'TOP'), ] if alt: for i in range(1, len(data)): cmds.append(('BACKGROUND', (0,i), (-1,i), PALE_BLUE if i%2==0 else WHITE_C)) t = Table(data, colWidths=col_widths) t.setStyle(TableStyle(cmds)) return t def field_row(pairs, widths=None): """pairs = list of (label, value) side by side""" n = len(pairs) w = widths or [W_INNER/n]*n cells = [] for lbl, val in pairs: cells.append(Paragraph(f'<font color="#2c5282"><b>{lbl}:</b></font> <font color="#333333">{val}</font>', S('fr', fontSize=9.5, fontName='Helvetica', leading=14))) row = [[c] for c in cells] # lay side by side flat = [c for (l,v) in pairs for c in [ Paragraph(f'<b><font color="#2c5282">{l}</font></b>', S('lbl',fontSize=9,fontName='Helvetica-Bold',leading=12,textColor=MID_BLUE)), Paragraph(str(v), S('val',fontSize=9.5,fontName='Helvetica',leading=13,textColor=DGREY)) ]] # actually build as 2-col per pair row_data = [] label_cells = [] val_cells = [] for lbl, val in pairs: label_cells.append(Paragraph(f'<b><font color="#2c5282">{lbl}</font></b>', S('l2',fontSize=9,fontName='Helvetica-Bold',leading=12))) val_cells.append(Paragraph(str(val), S('v2',fontSize=9.5,fontName='Helvetica',leading=13,textColor=DGREY))) interleaved = [] ws = [] for i,(lbl,val) in enumerate(pairs): interleaved.append(Paragraph(f'<b><font color="#2c5282">{lbl}:</font></b>', S(f'lx{i}',fontSize=9,fontName='Helvetica-Bold',leading=12))) interleaved.append(Paragraph(str(val), S(f'vx{i}',fontSize=9.5,fontName='Helvetica',leading=13,textColor=DGREY))) lw = widths[i*2] if widths and len(widths)>i*2 else 2.5*cm vw = widths[i*2+1] if widths and len(widths)>i*2+1 else (W_INNER/n - lw) ws += [lw, vw] t = Table([interleaved], colWidths=ws) t.setStyle(TableStyle([ ('TOPPADDING',(0,0),(-1,-1),3),('BOTTOMPADDING',(0,0),(-1,-1),3), ('LEFTPADDING',(0,0),(-1,-1),4),('RIGHTPADDING',(0,0),(-1,-1),4), ('BACKGROUND',(0,0),(-1,-1),PALE_BLUE), ('BOX',(0,0),(-1,-1),0.4,HexColor('#bbbbbb')), ('INNERGRID',(0,0),(-1,-1),0.3,HexColor('#dddddd')), ('VALIGN',(0,0),(-1,-1),'MIDDLE'), ])) return t def section_box(title, content_rows, bg=LIGHT_BLUE): """A labelled box with a coloured header and content rows.""" header = [[Paragraph(f'<b>{title}</b>', TABLE_HDR)]] rows = [[Paragraph(r, S('sb',fontSize=9.5,fontName='Helvetica',leading=14,textColor=DGREY))] for r in content_rows] data = header + rows t = Table(data, colWidths=[W_INNER]) t.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,0), DARK_BLUE), ('BACKGROUND',(0,1),(-1,-1), bg), ('GRID',(0,0),(-1,-1),0.4,HexColor('#aaaaaa')), ('TOPPADDING',(0,0),(-1,-1),4),('BOTTOMPADDING',(0,0),(-1,-1),4), ('LEFTPADDING',(0,0),(-1,-1),8),('RIGHTPADDING',(0,0),(-1,-1),8), ('VALIGN',(0,0),(-1,-1),'TOP'), ])) return t # ═══════════════════════════════════════════════════════════════════════════════ # BUILD STORY # ═══════════════════════════════════════════════════════════════════════════════ def build_pdf(): story = [] # ── PAGE 1: COVER ───────────────────────────────────────────────────────── from reportlab.platypus import Flowable class Rect(Flowable): def __init__(self, w, h_, color, radius=0): self.w=w; self.h_=h_; self.color=color; self.radius=radius def wrap(self,*a): return self.w, self.h_ def draw(self): self.canv.setFillColor(self.color) if self.radius: self.canv.roundRect(0,0,self.w,self.h_,self.radius,fill=1,stroke=0) else: self.canv.rect(0,0,self.w,self.h_,fill=1,stroke=0) story.append(sp(2)) story.append(Paragraph('COLLEGE OF NURSING', COVER_INST)) story.append(Paragraph('Govt. Medical College & Hospital', COVER_DEPT)) story.append(sp(3)) story.append(HRFlowable(width='80%',thickness=2,color=HexColor('#ffecb3'), hAlign='CENTER',spaceAfter=10,spaceBefore=10)) story.append(Paragraph('CHILD HEALTH NURSING', COVER_DEPT)) story.append(sp())) story.append(Paragraph('NURSING CARE PLAN', COVER_TITLE)) story.append(sp(2)) story.append(Paragraph('ON', COVER_SUB)) story.append(sp()) story.append(Paragraph('NEWBORN', COVER_SUB)) story.append(sp(2)) story.append(HRFlowable(width='60%',thickness=2,color=HexColor('#fff176'), hAlign='CENTER',spaceAfter=10,spaceBefore=10)) story.append(Paragraph('TRANSIENT TACHYPNEA OF THE NEWBORN', COVER_COND)) story.append(Paragraph('(TTN)', COVER_COND)) story.append(sp(4)) # Submitted by / to box sub_data = [ [Paragraph('<b>Submitted By</b>', TABLE_HDR), Paragraph('<b>Submitted To</b>', TABLE_HDR)], [Paragraph('Baby of Kavitha\nNewborn / Male\nNICU, Bed No. 3', TABLE_CELL), Paragraph('Mrs. Hemalatha, M.Sc(N)\nAssistant Professor\nDept. of Child Health Nursing', TABLE_CELL)], ] sub_t = Table(sub_data, colWidths=[W_INNER/2, W_INNER/2]) sub_t.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,0),MID_BLUE), ('BACKGROUND',(0,1),(-1,-1),PALE_BLUE), ('GRID',(0,0),(-1,-1),0.5,HexColor('#aaaaaa')), ('TOPPADDING',(0,0),(-1,-1),6),('BOTTOMPADDING',(0,0),(-1,-1),6), ('LEFTPADDING',(0,0),(-1,-1),10),('RIGHTPADDING',(0,0),(-1,-1),10), ])) story.append(sub_t) story.append(PageBreak()) # ── PAGE 2: NURSING CARE PLAN — Patient Details ──────────────────────────── story.append(h('NURSING CARE PLAN')) story.append(sp()) pd_data = [ ['Name of Patient', 'Baby of Kavitha', 'IP No.', 'NB-2024-0381'], ['Age', '2 days (Newborn)', 'Ward', 'NICU / Neonatal Ward'], ['Sex', 'Male', 'Bed No.', '3'], ['Date of Admission', '10/07/2024 at 08:45 AM', 'Religion', 'Hindu'], ['Address', 'Manali Nagar, Theni', 'Informant', 'Mother'], ['Diagnosis', 'Transient Tachypnea of the Newborn (TTN)', 'Blood Group', 'B +ve'], ] pd_t = Table(pd_data, colWidths=[3.8*cm, 4.8*cm, 3.2*cm, 4.6*cm]) pd_t.setStyle(TableStyle([ ('BACKGROUND',(0,0),(0,-1),LIGHT_BLUE), ('BACKGROUND',(2,0),(2,-1),LIGHT_BLUE), ('ROWBACKGROUNDS',(1,0),(1,-1),[WHITE_C,PALE_BLUE]), ('ROWBACKGROUNDS',(3,0),(3,-1),[WHITE_C,PALE_BLUE]), ('GRID',(0,0),(-1,-1),0.4,HexColor('#bbbbbb')), ('FONTNAME',(0,0),(0,-1),'Helvetica-Bold'), ('FONTNAME',(2,0),(2,-1),'Helvetica-Bold'), ('FONTSIZE',(0,0),(-1,-1),9.5), ('TOPPADDING',(0,0),(-1,-1),5),('BOTTOMPADDING',(0,0),(-1,-1),5), ('LEFTPADDING',(0,0),(-1,-1),6),('RIGHTPADDING',(0,0),(-1,-1),6), ('TEXTCOLOR',(0,0),(0,-1),MID_BLUE), ('TEXTCOLOR',(2,0),(2,-1),MID_BLUE), ('SPAN',(1,4),(1,4)), ('SPAN',(1,5),(3,5)), ])) story.append(pd_t) story.append(sp(2)) story.append(h('REASON FOR HOSPITALISATION')) story.append(sp()) story.append(bd( 'Baby of Kavitha, a 2-day-old male newborn, born by normal vaginal delivery at 38 weeks of gestation, ' 'was admitted to the NICU with complaints of <b>rapid breathing (tachypnea)</b>, ' '<b>grunting</b>, and <b>mild chest retractions</b> noted since birth. ' 'Respiratory rate was 78 breaths/min at admission. SpO₂ was 92% on room air. ' 'Baby was admitted for management of Transient Tachypnea of the Newborn (TTN).' )) story.append(PageBreak()) # ── PAGE 3: HISTORY TAKING ──────────────────────────────────────────────── story.append(h('HISTORY TAKING')) story.append(sp()) story.append(h('PRESENTING COMPLAINTS', SEC_HEAD)) story.append(sp()) for item in [ 'Rapid breathing (respiratory rate >60/min) since birth', 'Audible grunting on expiration', 'Mild subcostal and intercostal retractions', 'Nasal flaring', 'Mild cyanosis — improved with supplemental oxygen', 'Reduced feeding (weak suck reflex due to respiratory distress)', ]: story.append(b(item)) story.append(sp()) story.append(h('HISTORY OF PRESENT ILLNESS', SEC_HEAD)) story.append(sp()) story.append(bd( 'Baby of Kavitha was born at 38 weeks of gestation by normal vaginal delivery. ' 'Within 2 hours of birth, the baby developed rapid breathing and grunting. ' 'The baby was shifted to NICU for further evaluation and management. ' 'There was no history of maternal fever or prolonged rupture of membranes. ' 'Mother had an elective caesarean section planned but delivered vaginally. ' 'Chest X-ray showed perihilar streaking and fluid in the horizontal fissure, ' 'consistent with TTN. Baby was placed on supplemental oxygen and IV fluids.' )) story.append(sp()) story.append(h('PAST HISTORY', SEC_HEAD)) story.append(sp()) for item in [ 'No previous history of illness (newborn)', 'No previous hospitalisation', 'No history of any drug or food allergy', 'No previous surgeries', ]: story.append(b(item)) story.append(sp()) story.append(h('ALLERGIES', SEC_HEAD)) story.append(sp()) allergy_t = tbl( [['Food', 'Nil'],['Medication', 'Nil'],['Product/Environment', 'Nil'],['Others', 'Nil']], ['Category', 'Details'], [4*cm, W_INNER-4*cm], hdr_bg=MID_BLUE ) story.append(allergy_t) story.append(sp()) story.append(h('FAMILY HISTORY', SEC_HEAD)) story.append(sp()) for item in [ 'Type of family: Nuclear family', 'No family history of respiratory disorders or congenital heart disease', 'No family history of diabetes mellitus, hypertension, or tuberculosis', 'Mother: 24 years, healthy, no chronic illness', 'Father: 28 years, healthy, non-smoker', ]: story.append(b(item)) story.append(PageBreak()) # ── PAGE 4: FAMILY PEDIGREE ─────────────────────────────────────────────── story.append(h('FAMILY PEDIGREE CHART')) story.append(sp()) story.append(bd('<b>Legend:</b> □ = Male ○ = Female ■/● = Affected × = Deceased')) story.append(sp()) # Simple pedigree table ped_data = [ ['Relation', 'Name / Age', 'Sex', 'Health Status'], ['Paternal Grandfather', '65 yrs', 'Male', 'Healthy'], ['Paternal Grandmother', '60 yrs', 'Female', 'Healthy'], ['Maternal Grandfather', '62 yrs', 'Male', 'Healthy'], ['Maternal Grandmother', '58 yrs', 'Female', 'Healthy'], ['Father', 'Karthik, 28 yrs', 'Male', 'Healthy, employed'], ['Mother', 'Kavitha, 24 yrs', 'Female', 'Healthy, housewife'], ['Patient (Index Case)', 'Baby of Kavitha, 2 days', 'Male', 'TTN — Under treatment'], ] ped_t = tbl(ped_data[1:], ped_data[0], [4*cm, 4*cm, 2.5*cm, W_INNER-10.5*cm], hdr_bg=PURPLE) story.append(ped_t) story.append(sp(2)) story.append(bd( '<b>No consanguineous marriage.</b> No family history of respiratory or cardiac illness. ' 'No history of neonatal deaths in the family.' )) story.append(PageBreak()) # ── PAGE 5: BIRTH / PERINATAL HISTORY ───────────────────────────────────── story.append(h('BIRTH / PERINATAL HISTORY')) story.append(sp()) pn_data = [ ['Period of gestation', '38 weeks (Late Pre-term / Early Term)'], ['Type of delivery', 'Normal Vaginal Delivery (NVD)'], ['Place of delivery', 'Govt. Medical College Hospital, Theni'], ['Birth weight', '2.9 kg'], ['Length at birth', '48 cm'], ['Head circumference', '33 cm'], ['Cry at birth', 'Immediate cry'], ['Breastfeeding initiated', 'Delayed — due to respiratory distress; IV fluids started'], ['APGAR Score', '1 min — 6/10 | 5 min — 8/10'], ['Resuscitation', 'Suction of airway; supplemental O₂ administered'], ['Colour at birth', 'Initially cyanosed; improved with O₂'], ['Maternal antenatal care', 'Regular ANC — 8 visits; no complications detected'], ['Maternal fever / PROM', 'No'], ['Maternal GBS status', 'Not tested'], ['Corticosteroid given', 'No (not indicated; delivered at 38 wks)'], ['Meconium in liquor', 'No'], ] pn_t = tbl(pn_data, ['Parameter', 'Details'], [5.5*cm, W_INNER-5.5*cm], hdr_bg=TEAL) story.append(pn_t) story.append(PageBreak()) # ── PAGE 6: IMMUNISATION ────────────────────────────────────────────────── story.append(h('IMMUNISATION CHART')) story.append(sp()) imm_data = [ ['BCG', '0.05 mL', 'Intradermal (left arm)', 'At birth', 'Given ✓'], ['OPV-0 (Birth dose)', '2 drops', 'Oral', 'At birth', 'Given ✓'], ['Hepatitis B (Birth dose)', '0.5 mL', 'Intramuscular (right thigh)', 'At birth', 'Given ✓'], ] imm_t = tbl(imm_data, ['Vaccine', 'Dose', 'Route', 'Schedule', 'Status'], [2.5*cm, 2*cm, 4.5*cm, 2.5*cm, 4.9*cm], hdr_bg=MID_BLUE) story.append(imm_t) story.append(sp(2)) story.append(bd('<b>Note:</b> Remaining vaccines (DPT, OPV, Hib, PCV, Rotavirus, etc.) to be ' 'given as per National Immunisation Schedule after discharge.')) story.append(sp(2)) # ── SOCIOECONOMIC HISTORY ───────────────────────────────────────────────── story.append(h('SOCIOECONOMIC HISTORY')) story.append(sp()) soc_data = [ ['Place of residence', 'Rural — Manali Nagar, Theni'], ['Type of house', 'Pucca house'], ['No. of rooms', '3 rooms'], ['No. of windows', '4 windows (adequate ventilation)'], ['Source of water', 'Tap water (municipal supply)'], ['Latrine facility', 'Indoor toilet'], ['Source of income', 'Father — daily wage labourer'], ['Monthly income', '₹ 8,000 – 10,000 (below poverty line)'], ['Diet pattern', 'Vegetarian'], ['Sleeping pattern', 'Normal for gestational age'], ['Recreational activities', 'Not applicable (newborn)'], ['Health care facility', 'Govt. Medical College Hospital, Theni'], ] soc_t = tbl(soc_data, ['Parameter', 'Details'], [5*cm, W_INNER-5*cm], hdr_bg=ORANGE) story.append(soc_t) story.append(PageBreak()) # ── PAGE 7: PHYSICAL EXAMINATION ───────────────────────────────────────── story.append(h('PHYSICAL EXAMINATION')) story.append(sp()) story.append(h('GENERAL APPEARANCE', S('gah', fontSize=10, textColor=TEAL, fontName='Helvetica-Bold', spaceBefore=4, spaceAfter=3, leading=14))) story.append(sp()) gen_data = [ ['Build', 'Appropriate for gestational age (AGA)'], ['Nutrition', 'Adequate'], ['Consciousness', 'Active, crying'], ['Colour', 'Mildly cyanotic — improving with supplemental O₂'], ['Activity', 'Slightly reduced due to respiratory distress'], ['Cry', 'Vigorous cry initially; mild grunting noted'], ['Posture', 'Normal flexed posture of newborn'], ] gen_t = tbl(gen_data, ['Assessment', 'Finding'], [4.5*cm, W_INNER-4.5*cm], hdr_bg=TEAL) story.append(gen_t) story.append(sp()) story.append(h('VITAL SIGNS', S('vsh', fontSize=10, textColor=MID_BLUE, fontName='Helvetica-Bold', spaceBefore=4, spaceAfter=3, leading=14))) story.append(sp()) vs_data = [ ['Temperature', '36.8°C', 'Normal (36.5–37.5°C)'], ['Pulse / Heart Rate', '148 bpm', 'Normal (120–160 bpm)'], ['Respiratory Rate', '78 breaths/min', 'Elevated (Normal: 30–60/min) — Tachypnea'], ['Blood Pressure', '68/42 mmHg', 'Normal for newborn'], ['SpO₂ (room air)', '91–92%', 'Low — supplemental O₂ required'], ['SpO₂ (with O₂)', '97–98%', 'Acceptable'], ['Weight', '2.9 kg', 'Normal (>2.5 kg = not LBW)'], ['Length', '48 cm', 'Normal'], ['Head Circumference', '33 cm', 'Normal (33–35 cm)'], ] vs_t = tbl(vs_data, ['Parameter', 'Value', 'Interpretation'], [4.5*cm, 3.5*cm, W_INNER-8*cm], hdr_bg=MID_BLUE) story.append(vs_t) story.append(PageBreak()) # ── PAGE 8: HEAD-TO-TOE EXAMINATION ────────────────────────────────────── story.append(h('HEAD-TO-TOE EXAMINATION')) story.append(sp()) htt_data = [ ['Head', 'Normocephalic; fontanelle flat and soft; no caput or cephalhaematoma'], ['Eyes', 'Bilaterally symmetrical; no discharge; sclera — white; conjunctiva — pink'], ['Ears', 'Well-formed pinnae; ear cartilage firm (indicates ≥36 wks); no discharge'], ['Nose', 'Nasal flaring present (sign of respiratory distress); nares patent'], ['Mouth & Lips', 'Lips — mildly cyanotic initially; mucosa — moist; palate intact; suck reflex — weak'], ['Neck', 'Short; no palpable lymph nodes; no webbing; trachea midline'], ['Chest', 'Subcostal and intercostal retractions present; tachypnea; grunting on expiration; ' 'bilateral air entry — decreased; percussion — dull at bases; breath sounds — decreased'], ['Cardiovascular', 'Heart rate 148 bpm; regular rhythm; S1S2 heard; no murmur'], ['Abdomen', 'Soft; liver palpable 2 cm below costal margin (normal); spleen not palpable; ' 'umbilical stump — clean and dry; no abdominal distension'], ['Genitalia', 'Male; testes descended bilaterally; normal male external genitalia'], ['Spine', 'No spina bifida; no sacral dimple; midline intact'], ['Extremities', 'All four limbs well-formed; normal tone; capillary refill <2 sec; ' 'no oedema; peripheral pulses palpable'], ['Skin', 'Mildly cyanotic at birth; improving; vernix caseosa present; no rash; lanugo hair present'], ] htt_t = tbl(htt_data, ['System / Area', 'Findings'], [3.5*cm, W_INNER-3.5*cm], hdr_bg=DARK_BLUE) story.append(htt_t) story.append(PageBreak()) # ── PAGE 9: NEONATAL REFLEXES ───────────────────────────────────────────── story.append(h('NEONATAL REFLEXES')) story.append(sp()) ref_data = [ ['Rooting Reflex', 'Weakly Present', 'Reduced due to respiratory distress'], ['Sucking Reflex', 'Weakly Present', 'Reduced — IV fluids initiated'], ['Moro Reflex', 'Present', 'Symmetrical response bilaterally'], ['Grasp Reflex (Palmar)', 'Present', 'Normal'], ['Plantar Reflex', 'Present', 'Normal (toes fan out)'], ['Tonic Neck Reflex', 'Present', 'Normal fencing posture'], ['Babinski Reflex', 'Present', 'Normal — toes dorsiflex'], ['Stepping Reflex', 'Present', 'Normal'], ['Blinking Reflex', 'Present', 'Normal response to light'], ['Gag Reflex', 'Present', 'Normal'], ] ref_t = tbl(ref_data, ['Reflex', 'Status', 'Remarks'], [4.5*cm, 4*cm, W_INNER-8.5*cm], hdr_bg=PURPLE) story.append(ref_t) story.append(PageBreak()) # ── PAGE 10: INVESTIGATION CHART ───────────────────────────────────────── story.append(h('INVESTIGATION CHART')) story.append(sp()) inv_data = [ ['10/07/2024', 'Chest X-ray (AP view)', '—', 'Perihilar streaking, fluid in horizontal fissure — consistent with TTN', 'Ordered'], ['10/07/2024', 'Hemoglobin (Hb)', '17.2 g/dL', '14–22 g/dL', 'Normal'], ['10/07/2024', 'WBC count', '12,800 /mm³', '9,000–30,000', 'Normal'], ['10/07/2024', 'Platelet count', '1,98,000 /mm³', '1,50,000–4,00,000', 'Normal'], ['10/07/2024', 'Blood glucose (RBS)', '52 mg/dL', '45–120 mg/dL', 'Normal'], ['10/07/2024', 'Blood culture', 'No growth', 'No growth', 'No infection'], ['10/07/2024', 'CRP', '<6 mg/L', '<10 mg/L', 'Normal — No sepsis'], ['10/07/2024', 'ABG (Arterial Blood Gas)', 'pH 7.32, PaCO₂ 48, PaO₂ 62', 'pH 7.35–7.45', 'Mild respiratory acidosis'], ['10/07/2024', 'Blood Group', 'B +ve', '—', '—'], ['10/07/2024', 'Serum electrolytes', 'Na 138, K 4.2, Cl 102','Normal range', 'Normal'], ['11/07/2024', 'SpO₂ monitoring', '97–98% on 0.5 L O₂', '≥95%', 'Improving'], ] inv_t = tbl(inv_data, ['Date', 'Investigation', 'Value Obtained', 'Normal Value', 'Remarks'], [2.3*cm, 4*cm, 3.5*cm, 3*cm, 3.6*cm], hdr_bg=RED) story.append(inv_t) story.append(PageBreak()) # ── PAGE 11: NURSING DIAGNOSIS & CARE PLAN TABLE ───────────────────────── story.append(h('NURSING CARE PLAN — NURSING DIAGNOSES')) story.append(sp()) ncp_data = [ # ND 1 [ '1', 'Ineffective Breathing Pattern\nrelated to retained lung fluid\nas evidenced by RR 78/min,\ngrunting, and retractions.', '• RR will decrease to\n 40–60/min within 24 hrs\n• SpO₂ ≥ 95% with O₂\n• No signs of respiratory\n distress within 48 hrs', '• Position in 30–45° head-up tilt\n• Administer O₂ via hood/nasal prongs\n as ordered (0.5–1 L/min)\n• Monitor RR, SpO₂ every 1–2 hrs\n• Avoid unnecessary stimulation\n• Assess for retractions, grunting, flaring\n• Suction only if needed; avoid oral feeds\n until RR <60/min\n• Document all observations', '• RR decreased to\n 52/min by 24 hrs\n• SpO₂ 97–98% with O₂\n• Retractions resolved\n by 36 hrs', ], # ND 2 [ '2', 'Impaired Gas Exchange\nrelated to inadequate lung fluid\nclearance as evidenced by\nSpO₂ 91–92% on room air,\nmild cyanosis, ABG: pH 7.32.', '• SpO₂ ≥ 95% maintained\n• Cyanosis resolved\n• ABG normalises within\n 48 hours', '• Administer supplemental O₂\n as prescribed; titrate to SpO₂\n• Continuous pulse oximetry monitoring\n• Position: prone or slight head elevation\n• Prepare for CPAP if O₂ requirement\n increases (FiO₂ >40%)\n• Assess colour, capillary refill, ABG\n• Notify physician if SpO₂ <90%', '• SpO₂ 97–98% on O₂\n• Cyanosis resolved by\n hour 36\n• ABG improving:\n pH 7.38 by day 2', ], # ND 3 [ '3', 'Imbalanced Nutrition:\nLess than Body Requirements\nrelated to restricted oral feeds\nsecondary to tachypnea, as\nevidenced by weak suck and\nIV fluid dependency.', '• Baby tolerates\n breastfeeds when\n RR < 60/min\n• Adequate weight gain\n• No aspiration episodes', '• Withhold oral feeds while\n RR >60/min; give IV fluids\n• Initiate expressed breast milk\n (EBM) via orogastric tube once\n RR <60/min\n• Initiate breastfeeding when\n RR normalises\n• Monitor blood glucose every 6 hrs\n• Monitor urine output ≥1 mL/kg/hr\n• Weigh daily; monitor intake/output', '• RR normalised by\n day 2; EBM via\n NG tube initiated\n• Breastfeeding by\n day 3; tolerating well\n• Blood glucose normal', ], # ND 4 [ '4', 'Risk for Infection\nrelated to invasive procedures\n(IV line, NG tube, O₂ therapy)', '• No signs of infection\n during hospital stay\n• WBC within normal\n range\n• Blood culture sterile', '• Strict hand hygiene before\n any procedure\n• Maintain aseptic technique\n for IV line and NG tube care\n• Change IV site every 72 hrs\n• Monitor temperature, WBC, CRP\n• Inspect IV site for redness/swelling\n• Ensure proper O₂ equipment hygiene\n• Educate parents on hand hygiene', '• No infection signs\n during hospital stay\n• Blood culture: no\n growth\n• CRP remained <6', ], # ND 5 [ '5', 'Anxiety of Parents\nrelated to newborn\'s illness\nand NICU admission', '• Parents verbalise\n understanding of TTN\n• Parents demonstrate\n confidence in caring\n for the baby', '• Explain TTN — cause,\n treatment, and prognosis\n• Reassure parents TTN is\n self-limiting (resolves in 24–72 hrs)\n• Encourage parents to visit NICU\n• Allow skin-to-skin contact when baby\n is stable (Kangaroo Mother Care)\n• Teach parents signs to watch for\n after discharge', '• Parents verbalized\n understanding; anxiety\n reduced\n• Mother initiated\n breastfeeding', ], ] ncp_t = Table( [[Paragraph(f'<b>{h}</b>', TABLE_HDR) for h in ['#', 'Nursing Diagnosis', 'Expected Outcome', 'Nursing Interventions', 'Evaluation']]] + [[Paragraph(str(r[i]), S(f'nc{i}', fontSize=8.5, fontName='Helvetica', leading=12, textColor=DGREY)) for i in range(5)] for r in ncp_data], colWidths=[0.6*cm, 3.8*cm, 3*cm, 5.5*cm, 3.5*cm] ) ncp_t.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,0), DARK_BLUE), ('ROWBACKGROUNDS',(0,1),(-1,-1),[WHITE_C, PALE_BLUE, LT_TEAL, YELLOW, PINK]), ('GRID',(0,0),(-1,-1),0.4,HexColor('#aaaaaa')), ('TOPPADDING',(0,0),(-1,-1),5),('BOTTOMPADDING',(0,0),(-1,-1),5), ('LEFTPADDING',(0,0),(-1,-1),5),('RIGHTPADDING',(0,0),(-1,-1),5), ('VALIGN',(0,0),(-1,-1),'TOP'), ('FONTNAME',(0,1),(0,-1),'Helvetica-Bold'), ('ALIGN',(0,0),(0,-1),'CENTER'), ])) story.append(ncp_t) story.append(PageBreak()) # ── PAGE 12: DEVELOPMENTAL ASSESSMENT ──────────────────────────────────── story.append(h('DEVELOPMENTAL ASSESSMENT')) story.append(sp()) story.append(bd( '<b>Patient Age:</b> 2 days (Newborn). Development assessed per neonatal milestones.' )) story.append(sp()) dev_data = [ ['Gross Motor', 'Lies with all four limbs in flexed position; moves limbs when stimulated', 'Normal'], ['Fine Motor', 'Palmar grasp reflex present; fist closure', 'Normal'], ['Language', 'Vigorous cry; responds to loud sounds by startle', 'Normal'], ['Social / Personal','Regards face; responds to mother\'s voice', 'Normal'], ['Cognitive\n(Piaget)', 'Sensorimotor stage — Stage 1 (Reflexive)', 'Normal'], ['Psychosocial\n(Erikson)', 'Trust vs. Mistrust — dependent on caregiver for all needs', 'Normal'], ['Psychosexual\n(Freud)', 'Oral stage — satisfaction through sucking', 'Normal (feeding delayed due to TTN)'], ] dev_t = tbl(dev_data, ['Domain', 'Assessment Finding', 'Status'], [3.5*cm, 7.5*cm, 5.4*cm], hdr_bg=GREEN) story.append(dev_t) story.append(sp(2)) story.append(h('DISCHARGE PLANNING & HEALTH EDUCATION')) story.append(sp()) disc_data = [ ['Breastfeeding', 'Encourage exclusive breastfeeding; ensure proper latch and positioning'], ['SpO₂ monitoring', 'Ensure SpO₂ ≥95% on room air before discharge'], ['Signs of relapse', 'Teach parents: fast breathing >60/min, chest retractions, cyanosis — return immediately'], ['Follow-up', 'Review in 1 week; check weight and feeding adequacy'], ['Immunisation', 'Continue National Immunisation Schedule — next visit at 6 weeks'], ['Warmth', 'Maintain warmth (28–32°C); avoid cold stress; kangaroo mother care advised'], ['Hygiene', 'Hand hygiene before handling baby; umbilical cord care — keep dry and clean'], ] disc_t = tbl(disc_data, ['Area', 'Instructions'], [4*cm, W_INNER-4*cm], hdr_bg=TEAL) story.append(disc_t) # ── BUILD ───────────────────────────────────────────────────────────────── def on_page(canv, doc): canv.saveState() pw, ph = A4 # Header canv.setFillColor(DARK_BLUE) canv.rect(0, ph-16*mm, pw, 16*mm, fill=1, stroke=0) canv.setFillColor(WHITE_C) canv.setFont('Helvetica-Bold', 10) canv.drawCentredString(pw/2, ph-10*mm, 'Nursing Care Plan — Transient Tachypnea of the Newborn (TTN)') canv.setFont('Helvetica', 7.5) canv.drawRightString(pw-18*mm, ph-14*mm, 'Child Health Nursing') # Footer canv.setFillColor(DARK_BLUE) canv.rect(0, 0, pw, 9*mm, fill=1, stroke=0) canv.setFillColor(WHITE_C) canv.setFont('Helvetica', 8) canv.drawCentredString(pw/2, 3*mm, f'Page {doc.page} | Govt. Medical College & Hospital | Child Health Nursing') canv.restoreState() doc = BaseDocTemplate(OUTPUT, pagesize=A4, rightMargin=MARGIN, leftMargin=MARGIN, topMargin=2.2*cm, bottomMargin=1.8*cm) frame = Frame(doc.leftMargin, doc.bottomMargin, doc.width, doc.height, id='main', showBoundary=0) # Cover page has no header/footer def on_cover(canv, doc): canv.saveState() pw, ph = A4 canv.setFillColor(DARK_BLUE) canv.rect(0, 0, pw, ph, fill=1, stroke=0) # decorative band top canv.setFillColor(MID_BLUE) canv.rect(0, ph-3*cm, pw, 1.2*cm, fill=1, stroke=0) # decorative band bottom canv.setFillColor(MID_BLUE) canv.rect(0, 0, pw, 1.2*cm, fill=1, stroke=0) canv.setFillColor(WHITE_C) canv.setFont('Helvetica', 8) canv.drawCentredString(pw/2, 0.4*cm, 'Child Health Nursing | Govt. Medical College & Hospital') canv.restoreState() cover_frame = Frame(MARGIN, 1.4*cm, W-2*MARGIN, H-4*cm, id='cover', showBoundary=0) doc.addPageTemplates([ PageTemplate(id='cover', frames=cover_frame, onPage=on_cover), PageTemplate(id='main', frames=frame, onPage=on_page), ]) story.insert(0, None) # placeholder # Switch template after page 1 from reportlab.platypus import NextPageTemplate story[0] = NextPageTemplate('cover') story.insert(2, NextPageTemplate('main')) doc.build(story) print('PDF built:', OUTPUT) build_pdf() PYEOF python3 /home/daytona/workspace/nursing-pe-pdf/ttn_care_plan.py 2>&1

sed -i 's/story.append(sp()))/story.append(sp())/' /home/daytona/workspace/nursing-pe-pdf/ttn_care_plan.py python3 /home/daytona/workspace/nursing-pe-pdf/ttn_care_plan.py 2>&1

~/nursing-pe-pdf/ttn_care_plan.py

python3 /home/daytona/workspace/nursing-pe-pdf/ttn_care_plan.py 2>&1

ls -lh /home/daytona/workspace/nursing-pe-pdf/TTN_Care_Plan.pdf