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Simmons NURP 502 Exam 1 > 1: Fever without Focus > Flashcards

1: Fever without Focus Flashcards

1
Q

What percent of childhood fevers have no apparent cause?

A

20%

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2
Q

Who is at the greatest risk of having a serious bacterial infection in the case of a fever without focus?

A

Febrile infants and children younger than 36 months

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3
Q

T/F Consider fever documented at home by a reliable parent or caregiver the same as fever found upon presentation.

A

True

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4
Q

T/F Parents are often poor historians and reports of maximum temperatures should not be accepted without clinical confirmation.

A

False. Accept parental reports of maximum temperature.

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5
Q

T/F If an infant has been excessively bundled and repeat temperature taken 15-30 minutes after unbundling is normal, the infant should be considered afebrile.

A

True

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6
Q

T/F Always remember that normal or low temperature precludes serious, life-threatening, infectious disease.

A

False. Always remember that normal or low temperature does not preclude serious, even life-threatening, infectious disease.

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7
Q

Why is a family hx of a previous death in a young infant from infection important?

A

It can be suspicious for congenital anomalies and primary immunodeficiencies.

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8
Q

In 3 months to 3 years assessment hx, which immunizations are important?

A

Check for incomplete immunization to Streptococcus pneumoniae or Haemophilus influenzae type b.

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9
Q

What is particularly important when assessing young children and infants?

A

Pay particular attention to assessing hydration status and identifying the source of infection.

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10
Q

What is the standard location for checking temperature in infants and young children?

A

Rectal. Temperature obtained via tympanic, axillary, or oral methods may not truly reflect the patient’s temperature.

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11
Q

What is a sensitive predictor of pulmonary infection in patients of all ages, especially in infants and young children?

A

Pulse Ox

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12
Q

When is it mandatory to get a pulse ox with a sick child?

A
  1. Abnormal lung examination findings
  2. Respiratory symptoms
  3. Abnormal respiratory rate
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13
Q

What are alternatives to an actual weight in emergency situations?

A

Estimating methods: Broselow tape, weight based on age.

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14
Q

Toxic appearance is associated with what?

A
  1. Lethargy
  2. Poor perfusion
  3. Hypoventilation
  4. Hyperventilation
  5. Cyanosis (Shock)
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15
Q

What are petechial or purpuric rashes associated with?

A

Bacteremia. Purpura is associated more often with meningococcemia than is the presence of petechiae alone.

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16
Q

This is a reliable method for determining degree of illness.

A

Yale Observation Scale

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17
Q

What 6 variables are considered in the Yale Observation Scale?

A
  1. Quality of cry
  2. Reaction to parent stimulation
  3. State variation
  4. Color
  5. Hydration
  6. Response
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18
Q

What score on the Yale Observational Scale indicates a 92% risk of serious bacterial infection?

A

16+

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19
Q

What score on the Yale Observational Scale indicates only a 2.7% risk of serious bacterial infection?

A

10-

20
Q

T/F Lack of a circumcision should be noted in males.

A

True

21
Q

_____ is not common in bacterial meningitis.

A

Nuchal rigidity is not common in bacterial meningitis.

22
Q

What assessments suggest serious bacterial infections?

A
  1. Ill appearance
  2. Fever
  3. Vomiting
  4. Tachypnea with retractions
  5. Delayed cap refill
23
Q

Abdominal auscultation may reveal signs of _____ or _____.

A

Abdominal auscultation may reveal signs of ileus or hyperactivity.

24
Q

What are 2 global assessment red flags for serious infection in children older than 1 month?

A
  1. Parental concerns
  2. Physician instinct
25
Q

What are 4 child behavior red flags for serious infection in children older than 1 month?

A
  1. Changes in crying pattern
  2. Drowsiness
  3. Inconsolability
  4. Moaning
26
Q

What are 6 circulatory / respiratory red flags for serious infection in children older than 1 month?

A
  1. Crackles
  2. Cyanosis
  3. Decreased breath sounds
  4. Poor peripheral circulation
  5. Rapid breathing
  6. Shortness of breath
27
Q

What are 6 other factors red flags for serious infection in children older than 1 month?

A
  1. Decreased skin elasticity
  2. Hypotension
  3. Meningeal irritation
  4. Petechial rash
  5. Seizures
  6. Unconsciousness
28
Q

T/F All urine specimens should be sent for formal urinalysis and culture.

A

True. Urine dipstick testing has a 12 percent false-negative rate. Urine culture: Collected in urine bag and has 85 percent false-positive rate.

29
Q

When are UTIs more common in boys than girls?

A
  • First 3 months of life
  • Uncircumcised
30
Q

What is the normal range for WBCs?

A

5,000-15,000

31
Q

The band count should be less than _____.

A

1500

32
Q

WBC count alone has poor _____ and _____ for identifying young infants with bacteremia and meningitis. Sepsis workup should not be based on the WBC count alone.

A

WBC count alone has poor sensitivity and specificity for identifying young infants with bacteremia and meningitis. Sepsis workup should not be based on the WBC count alone.

33
Q

What 2 inflammatory markers are better indicators than WBC counts?

A
  1. C-reactive protein
  2. Procalcitonin
34
Q

What levels of C-reactive protein indicate inflammation?

A

2+

35
Q

What should levels of procalcitonin be?

A

Less than 0.5

36
Q

When is a lumbar puncture recommended?

A
  • All febrile neonates.
  • Infants and young children with clinical signs of meningitis (i.e. nuchal rigidity, petechiae, or abnormal neurologic findings).
37
Q

Lumbar punctures are not recommended for children older than 3 months unless _____ are present.

A

Lumbar punctures are not recommended for children older than 3 months unless neurological signs are present.

38
Q

Two guidelines suggest that a lumbar puncture may be omitted for well-appearing, previously healthy young infants with no _____, a WBC count between _____, and no _____ on urinalysis.

A

Two guidelines suggest that a lumbar puncture may be omitted for well-appearing, previously healthy young infants with no focal signs of infection, a WBC count between 5,000 and 15,000, and no pyuria or bacteriuria on urinalysis.

39
Q

T/F Rapid viral testing that is positive for RSV is unlikely to have a serious bacterial infection.

A

False. Positive for influenza are unlikely to have a coexistent serious bacterial infection. Positive for respiratory syncytial virus may still have a significant risk of UTI.

40
Q

What signs indicate the need for a CXR?

A
  • Young children older than one month demonstrating respiratory symptoms (tachypnea, retractions, focal auscultatory findings, oxygen saturation level in room air of less than 95%).
  • Fever of more than 102.2°F (39°C).
  • WBC count of more than 20,000.
41
Q

Do viruses or bacteria cause most pediatric pneumonias?

A

Viruses

42
Q

These lab results are suggestive of serious bacterial infections.

  • Urinalysis (unspun) _____.
  • WBC _____.
  • ANC _____.
  • CRP _____.
  • Procalcitonin _____.
A
  • Urinalysis (unspun): WBCs/HPF 10+, bacteria in any of 10 HPFs, or positive leukocyte esterase and nitrite findings
  • WBC: 15,000+
  • ANC: 10,000+ neutrophils
  • CRP level: 40+
  • Procalcitonin level: 0.5+
43
Q

When would you perform a urine culture in these populations:

  • All males?
  • Uncircumcised males?
  • All females?
  • Older female children?
A
  • All males younger than 6 months
  • All uncircumcised males younger than 12 months
  • All females younger than 24 months
  • Older female children if symptoms suggest a urinary tract infection (UTI)
44
Q

When do you collect stool for WBC counts and guaiac?

A
  • If diarrhea present
  • Blood or mucus present (child doesn’t appear toxic)
45
Q

What criteria must be met for febrile children (2-36 months) to not be admitted to the hospital?

A
  1. Healthy prior to onset of fever
  2. Fully immunized
  3. No significant risk factors
  4. Appears nontoxic and otherwise healthy
  5. Parents (or caregivers) appear reliable and have access to transportation if the child’s symptoms should worsen
46
Q

When the child does not appear toxic and is not hospitalized, when should f/u occur?

A
  • Within 24-48 hours or sooner if the condition worsens.
  • Admission occurs if condition worsens or evaluation indicates serious infection.
47
Q

How do you manage a child who does appear toxic?

A
  • Admit child for further treatment.
  • Pending culture results, administer parenteral antibiotics.
  • Initially administer ceftriaxone, cefotaxime, or ampicillin/sulbactam (50 mg/kg/dose).

Simmons NURP 502 Exam 1 (32 decks)

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