Acute Illness Flashcards
Conditions with Fever:
-Influenza (high)
-Acute Rhinosinusitis (high)
-COVID-19
Infections with rapid Onset:
-Acute Pharyngitis
-Influenza
-Gastroenteritis (stomach flu)
-Acute Otitis Media
-Urinary Tract Infection
-COVID-19 (differs by variant)
What is a possible outcome of untreated Urinary Tract
Infection?
Infection of the kidney and back pain
Patient Presentation: Fever
-higher than the normal core temperature of 100˚F (97.5˚F – 98.9˚F) -> variation: 4-6 PM, low between 4-6 AM
-Symptoms: Headache, sweating, generalized malaise (discomfort), chills, tachycardia, arthralgia (joint stiffness), myalgia (muscle pain), irritability, anorexia (loss of appetite)
-Complications: febrile seizures in kids, dehydration
Patient Presentation: Urinary Tract Infection
-Predisposing conditions: pregnancy, diabetes, urinary stones,
urinary obstruction, presence of urinary catheters, history of UTIs
-Pain on urination (dysuria)
-Sensation of the urgent need to urinate and frequent urination
-Urinary hesitancy
-Blood in the urine (hematuria)
-Changes in urine color (blood) and odor (bacteria)
-Lower abdominal pain/discomfort (could be due to the kidney)
What are the ways to measure a patient’s fever?
Rectal, Oral, Temporal, Tympanic (eardrum), Axillary
Accurate: Skin- Temporal, Tympanic - ear, rectal (gold-standard) -> get the core temperature
less accurate: oral, axillary -> away from core temperature, color-changing strips inaccurate (kids head is warm, leaning on mum, interferences)
What are the ways to measure a patient’s fever?
Rectal, Oral, Temporal, Tympanic (eardrum), Axillary
Accurate: Skin- Temporal, Tympanic - ear, rectal (gold-standard) -> get the core temperature
Fever range: 100.4 F
less accurate: oral, axillary -> away from core temperature, color-changing strips inaccurate (kids head is warm, leaning on mum, interferences), pacifier thermometer (oral)
Fever range: oral: 99.5 F, axillary 99 F
How do home UTI test work?
-sense nitrate shaded by bacteria -> highly specific but low sensitivity
-Contact a healthcare provider with (+) test, Contact a healthcare provider with a (-) test if symptoms persist
-Example: UTI Home Test: nitrite; AZO Test Strips: nitrite and leukocyte esterase
Infections treated with OTC and prescribed drugs:
-OTC: Common Cold, Stomach Flu (gastroenteritis), Vaginal Yeast infections, Fungal infections
-Antibiotics/prescribed/need assessment: Strep Thorat, Flu, Ear infection, sinus infection, COVID, UTI
When to treat a fever?
There is no evidence, in general treatment only when there is discomfort
Nonpharmacologic Therapy:
-Rehydration, lightweight clothing, avoiding overexertion, keeping room temperature, sponge bath
Difference between children’s MOTRIN (ibuprofen) VS infant’s MOTRIN?
-same dose, but a different device and different concentration, different color
-higher concentration for infants, so a high volume is not needed for infants (up to 2y)
How to use the correct dose if the age and weight don’t match?
Use weight for the correct dose
Why is the concentration for children and infants Tylenol the same?
-Avoid dosing errors -> hepatic toxicity
-Different devices: Syringe for infants (up to 2y), cups for kids
Pharmacologic Options -> Antipyretics
PEDIATRICS dosing
-Aspirin: Only for children ≥ 15 years of age
-Acetaminophen (Tylenol): 10-15mg/kg q 4-6hrs, Max= 5 doses/day
-Ibuprofen: 5-10mg/kg q 6-8hrs; Max = 4 doses/day
Pharmacologic Options -> Antipyretics
Adult dosing
-Aspirin: Generally, avoid in favor of safer options
-Acetaminophen (Tylenol): 325-650mg q 4-6 hours; Max= 4000mg/day
-Ibuprofen: 200-400mg q 4-6 hour; Max = 1200mg/day
After taking meds:
How long does it take to see a reduction of temperature?
30- 60 min after taking the med
-> Contact PCP (primary care physician) if fevers remain elevated (>103-104˚F) longer than 2hrs after OTC treatment or if it gets higher
How long to use OTC regimen without seeing the physician?
No longer than 3 days without improvement in fever
How to treat symptoms like:
Headache, Body Aches, Sore throat, and fatigue
Pain meds
How to treat symptoms like:
Nasal Discharge & Congestion and Cough
Antihistamines
a lot of cough and cold products have Antihistamines, some might have Decongestants in them (Oxymetazoline, Naphazoline, Phenylephrine)
How to treat Urinary Urgency and Discomfort
-It is bacterial -> Antibiotics, it could infect kidneys which is harder to treat
-there are some OTC products to treat the symptoms but they go WITH ANTIBIOTICS
-Example: AZO
What is the API of AZO?
- phenazopyridine -> treating the symptoms of UTI alongside the antibiotics
-Symptoms: urinary burn, pain after urologic procedures
-only short-term: for 2 days
-it passes the kidney -> caution in patients with renal insufficiency, safe for geriatrics?
Side effects and counseling on administration:
-Side effects: upset stomach, headache, discoloring of the urine (warn patient, don’t wear white underwear (staining)
-Administration: with a glass full of water, it gets washed by the kidney -> stay hydrated
OTC product for UTI: Cystex (combo product)
API
API: methenamine (antibiotic but not enough to resolve the infection and sodium salicylate (impact on paint)
Symptoms: symptomatic relief of urinary burning, pain,
frequency/urgency associated with UTIs
Cystex: Warnings
-limited to 3 days
bc of salicylate avoid in geriatrics, children, pregnant women, patients with GI problems,
patients on anticoagulant (warfarin) - bleed risk, or on NSAIDS -> Drug interaction !!; Antihypertensive drugs
patients drinking alcohol (3 or more a day) - bc of renal impairment?
patients allergic to Aspirin
Side effects: stomach upset, nausea, vomiting
take it with a glass full of water and after a meal
