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CMN 568 - Unit 1 > CMN 568 - Unit 1 > Flashcards

CMN 568 - Unit 1 Flashcards

1
Q

The most common pediatric infectious disease; otherwise known as the “common cold”

A

Acute Viral Rhinitis

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2
Q

Signs and symptoms of Acute Viral Rhinitis

A

Sudden onset of CLEAR or mucoid rhinorrhea, nasal congestion, and fever. May present with a sore throat, cough, and red TM for u[ to 14 days.

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3
Q

Common pathogens for Acute Bacterial Rhinosinusitis

A

S pneumoniae, H influenzae, M catarrhalis, and B-hemolytic streptococci

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4
Q

Signs and symptoms of Acute Bacterial Rhinosinusitis

A

Nasal congestion, PURULENT nasal discharge, facial pain/pressure, cough, headache, fever for less than 30 days

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5
Q

When to diagnose and treat Acute Bacterial Rhinosinusitis with antibiotics

A
  1. If s/sx last for more than 10 days
  2. worsening of symptoms within 10 days after initial improvement in s/sx
  3. s/sx of FOCAL signs. i.e., periorbital edema, severe sinus tenderness, or severe headache.
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6
Q

Treatment considerations for Acute Bacterial Rhinosinusitis

A
  1. Pediatrics - 7 days after symptoms resolves
  2. Adults - 7-10 days, may be longer to prevent relapses
  3. Daycare status, recent antibiotic use, allergies, and age.
  4. NSAIDS/Tylenol for pain and fever control
  5. Nasal decongestants for < 3 days
  6. OTC ORAL deongestants, antihistamines, cough/cold preps are not receommended for children < 4 years old
  7. Intranasal corticosteroid sprays are RECOMMENDED in ALL adults and may be useful for CHILDREN WITH ALLERGIC SINUSITIS
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7
Q

Successive episodes of bacterial infections of the sinuses, each lasting less than 30 days & SEPARATED intervals of at least 10 days

A

Recurrent sinusitis

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8
Q

Episodes of inflammation of the paranasal sinuses lasting more than 90 days

A

Chronic sinusitis

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9
Q

Antibiotic treatment difference between acute sinusitis and chronic/recurrent sinusitis

A

Duration of chronic/recurrent sinusitis treatment is 3 - 4 weeks

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10
Q

Differential diagnosis for chronic/recurrent sinusitis

A
  1. Anatomical problems (septal deviation, polyp, or foreign body)
  2. Cystic fibrosis or immunodeficient
  3. Reflux esophagitis
  4. Anaerobic and Staph organisms
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11
Q

Triad of children with Allergic rhinitis or “hay fever”

A
  1. Allergic rhinitis
  2. Asthma
  3. Eczema

More common in red-haired children

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12
Q

Signs and symptoms of Allergic Rhinitis

A
  1. Rubbing of nose (Allergic Salute sign)
  2. Allergic shiners (Dark circles and swelliing under the eyes)
  3. Clear nasal drainage with pale, swollen and boggy nasal turbinates
  4. Conjunctival injection, tearing, and redness of eyes
  5. Enlarged tonsils
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13
Q

Treatment of Allergic Rhinitis

A
  1. Avoidance of allergic triggers
  2. Nasal irrigations
  3. Non-sedating Antihistamines (Loratidine, Cetirizine)
  4. Intranasal corticosteroids
  5. Mast-cell stabilizers (Cromolyn sodium, Montelukast)
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14
Q

Common causes of Epistaxis

A
  1. Dry nose
  2. Nose rubbing
  3. Picking
  4. Vigorous blowing
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15
Q

Rare cause of Epistaxis

A
  1. Bleeding disorders such as Von Willebrand (Clotting factor VWF deficient)
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16
Q

When to do a full work-up for Epistaxis

A
  1. Family hx of bleeding disorder
  2. Medical hx of easy bleeding
  3. Spontaneous bleeding at any site
  4. Bleeding lasting for over 30 min. or blood that will not clot with direct pressure
  5. Onset before 2 yrs of age
  6. A drop in Hematocrit due to epistaxis
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17
Q

Treatment for Epistaxis

A
  1. Patient up, lean forward and pinch SOFT part of the nose for 5 - 15 minutes
  2. ONE time oxymetazoline spray (Afrin) or Phenylephrine
  3. Application of polysporin to prevent recurrence until all crusting is healed
  4. No NSAIDS or Aspirins
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18
Q

90% of Sorethroat and fever are caused by what?

A
  1. Viral infections.
  2. Only 5-15% is caused by Bacterial infections. (No Antibiotics)
  3. Viral infections most commonly presents with cough and rhinorrhea
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19
Q

Different Viral infections of the Throat

A
  1. Infectious Mononucleosis
  2. Herpangina
  3. Pharyngoconjuctival fever
  4. Hand, Foot, & Mouth Disease
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20
Q

Large exudative tonsillitis, Generalized POSTERIOR cervical adenitis, fever, palpable SPLEEN or axillary adenopathy

A

Inf. Mononucleosis. Palpate for the SPLEEN!

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21
Q

2-3 mm ulcers on the anterior pillars and soft palate and uvula and is caused by Coxsackie virus

A

Herpangina

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22
Q

If presenting with exudative tonsillitis, CONJUCTIVITIS, lymphadenopathy and fever.

A

Pharyngoconjuctival fever. Consider viral infections of negative for Rapid Strep such as Adenovirus

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23
Q

Ulcers on the tongue and oral mucosa; vesicles, pustules, & papules on the palms, soles, interdigital areas, and buttocks and is caused by enteroviruses

A

Hand, Foot, & Mouth Disease

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24
Q

What is the most common bacterial cause of Acute Bacterial Pharyngitis

A

Group A Beta-Hemolytic Streptococcus (GABHS)

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25
Q

Centor Criteria

A
  1. Fever
  2. Lack of Cough
  3. Exudates on Tonsills
  4. Adenopathy of ANTERIOR Cervical

2 out of 4; do rapid strep
3 out of 4 has a sensitivity of 90% for GABHS (Empiric)

Do C&S if sending home patient without Antibiotics

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26
Q

Treatment for Acute Bacterial Pharyngitis

A
  1. Oral Penicillin V or IM Penicillin if compliance issues
  2. Amoxicillin
  3. If allergic to PCNs then Erythromycin / Azithromycin or Cephalosporins
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27
Q

Complications of Tonsillitis

A
  1. Peritonsillar Cellulitis or Abscess - UNILATERAL with high fever and soft palate and uvula DISPLACED
  2. Retropharyngeal Abscess - GABHS with Respiratory symptoms AND neck hyperextension, dysphagia, drooling, dyspnea, and gurgling respirations
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28
Q

Most common pathogens of Acute Otitis Media (AOM)

A
  1. Strep Pneumoniae
  2. HIB - not the bacteria in HIB vaccine (unencapsulated and non-typeable)
  3. Moraxella Catarrhalis
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29
Q

Signs and Symptoms of AOM

A
  1. Fever, Otalgia, Insomnia, Anorexia
  2. EFFUSION (OEM or SOM) for up to 3 months. If longer than 3 months, refer for hearing tests and consider PE tubes
  3. Erythematous, retracted (early) or BULGING (late), immobile/decreased mobility of TM and decreased light reflex
  4. Loss of bony landmarks and light reflex (cone of light) on otoscopic examination
  5. Purulent discharge for perforated TM
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30
Q

What kind of hearing loss is present with OEM?

A

Conductive hearing loss (Hearing loss over 20 decibels after 3 months is considered significant)

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31
Q

When should you refer an AOM?

A
  1. If patient is less than 3 months

2. If OEM for more than 3 months

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32
Q

What should be assessed and possible complications for AOM with or without fever?

A
  1. Nucchal rigidity - Meningitis (Common the younger the child is)
  2. Pneumonia
  3. Mastoiditis - Palpate behind the ear
  4. Tympanosclerosis - scarring of TM and middle ear stuctures resultin into conductive hearing loss
  5. Perforation of TM - drainage of ear
  6. Cholesteatoma - granulation tissue develops near perforation - refer for surgery
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33
Q

Flat tympanogram

A

OEM / SOM

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34
Q

Flat tympanogram with negative peak pressure

A

Obstructed Eustachian tube

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35
Q

Helpful in identifying ear pathogen

A

Nasal swab

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36
Q

First line treatment for AOM

A
  1. Amoxicillin 90mg/kg/day up to 4g/day for:
    - 5-7 days in children > 2 yrs
    - 10 days in children < 2 yrs
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37
Q

Antibiotic treatment for AOM if patient developed a RASH from PCN

A
  1. Cephalosphorin
    - Cefuroxime (Ceftin)
    - Cefpodoxime (Vantin)
    - cefdinir (Omnicef)
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38
Q

Antibiotic treatment for AOM if patient developed an URTICARIA / HIVES or OTHER SERIOUS ALLERGIC REACTION from PCN

A
  1. Trimethoprim-sulfamethoxazole (Bactim)

2. Azithromycin (Zithromax)

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39
Q

If unable to take orally or compliance issues with antibiotic treatment, what should be considered?

A
  1. single IM Ceftriaxone (Rocephin)
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40
Q

Second line treatment for AOM and used when no improvement after 48-72 hours after Amxocillin or has had antibiotics in the past month

A
  1. Amoxicillin-clavulanate (Augmentin) - Dose so that Amoxicillin is dosed at 90mg/kg/day
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41
Q

Augmentin is effective for what organisms?

A
  1. Drug-resistant Strep. Pneumoniae (DRSP)
  2. Beta-lactamase positive strains of M. Cat and H.Flu

Alternatives are Cefuroxime or IM Ceftriaxone

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42
Q

What Antibiotics should not be given for H. Flu and S. pneumoniae?

A
  1. Macrolides (Azithromycin)
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43
Q

What can be given to penicillin allergic children?

A
  1. Erythromycin
  2. Clarithromycin
  3. Azithromycin
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44
Q

Pain management for Otalgia?

A
  1. Tylenol or Motrin

2. Topical anesthetic drops (Auralgan) - Only if TM is intact

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45
Q

Discuss observation of AOM for 6 years and older

A

Allow 6 years older patients to go home and observe s/sx for 48 hours and instruct parents to fill safety net antibiotic prescription (SNAP) if symptoms does not improve in 48 hours or if it worsens

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46
Q

What are the risk factors and how to prevent AOM

A
  1. Second hand smoke (inflames eustachian tibes and impedes drainage)
  2. Pacifier use or Bottle feeding - Avoid use after 6 months pacifier
  3. Daycare
  4. Promote breast feeding
  5. Immunizations (Pneumococcal / HIB )
  6. Eustachian tube dysfunction common in infants (shorter, wider, floppier and more horizontal)
  7. Craniofacial disorders such as down’s syndrome
  8. Winter months
  9. Immunocompromised
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47
Q

Extreme case of OME

A

Glue ear - Immobile TM even with positive or negative pressure

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48
Q

What causes OME

A
  1. Allergies causing swelling and inflammation of Eustachian tube
  2. AOM and residual for up to 16 weeks
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49
Q

Signs and symptoms of OME

A
  1. Usually asymptomatic
  2. Feeling of fullness in the ear
  3. Popping with swallowing
  4. Air travel complaints
  5. Air-fluid line / bubbles
  6. Dullness and interrupted light reflex with protrusion of incus d/t negative pressure behind TM
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50
Q

How is OME diagnosed?

A

Pneumatic Otoscopy

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51
Q

Infection / Cellulitis of the ear canal with bacteria or fungus?

A

Otitis Externa

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52
Q

Risk Factors for Otitis Externa

A
  1. Overzealous removal of ear wax
  2. Water stasis in the ear canal
  3. Trauma to external canal (Hearing aids, Q-tips, etc.)
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53
Q

Signs and symptoms of Otitis Externa

A
  1. Pain / Itching in the ear
  2. Swelling of ear canal
  3. Minimal thick (Purulent) drainage
  4. Tenderness on tragus and pinna
  5. Unable to visualize TM
  6. Possible pre-auricular or cervical lymphadenpathy
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54
Q

Treatment of Otitis Externa

A
  1. Topical Antibiotics (Flouroquinolone drops) with steroid (Ciprodex)
  2. If TM can’t be visualized, assume perforated TM and use only drops safe for the middle ear and do NOT irrigate.
  3. Pope ear wick (insert dry wick then instill drops) to ensure drops entering into the canal
55
Q

What to assess in eye newborn assessment

A
  1. Clarity of Cornea
  2. Presence of red reflex (Indicates intactness not vision)
  3. Drainage
56
Q

What medication causes chemical conjunctivitis with horrible drainage

A

prophylactic silver nitrate (Also not effective against chlamydia; leading cause of opthalmia neonatorum)

57
Q

Partial nasolacrimal duct obstruction with continuous tearing and yellowish discharge and swelling

A

Dacryocystitis

58
Q

Treatment for Acute Dacryocystitis

A
  1. Massage lacrimal sac 6 times a day for chronic dacryocystitis
  2. If infected; use oral Augmentin
  3. Topical Antibiotics
  4. IV antibiotics for severe infection or evidence of periorbital cellulitis
59
Q

What treatment of eye disorders do NP never prescribe?

A

Steroid eye drops!

60
Q

Patient has dacryocystitis that persisted for 8 months now with inflammation of lacrimal sac

A

Refer to ophthalmology

61
Q

What are used for assessing the alignment of eyes and diagnosis of strabismus?

A
  1. Hirschberg test
  2. Corneal light reflex
  3. Cover test
62
Q

Treatment for Strabismus

A

Refer to ophthalmologist for possible patching or surgery

63
Q

Up to what month is brief periods of strabismus normal for newborn? Unless strabismus is very obvious and persistent

A

6 months

64
Q
  1. Esotropia
  2. Exotropia
  3. Hypotropia
  4. Hypertrpia
A
  1. Inward turn of eyes
  2. Outward turn of eyes
  3. Downward turn of eyes
  4. Upward turn of eyes
65
Q

Caused by brain trying to suppress the off center image and can result in permanent blindness; considered the most common and serious complication of strabismus

A

Amblyopia

66
Q

How to check visual acuity in newborn?

A
  1. Newborns are able to BRIEFLY visually track mother’s face or brightly colored object within an hour after birth (fixation reflex not developed for several weeks so fixation is brief)
  2. Don’t talk to baby when assessing vision – he may look toward sound rather than visual stimulus
  3. Older babies should show increased body motion or reach when interesting object (like bottle, pacifier or toy) is presented
  4. Children who can talk can be given eye charts with pictures to identify
  5. Snellen E chart or blackbird chart may be used if child can talk and follow directions
67
Q

Visual Acuity development in children

A

Newborn - 20/200 to 20/400
6 months - 20/60 to 20/100
1st grader (5-6 yo) - 20/20 to 20/25

68
Q

How often to check vision for children

A

Every 1 to 2 years

69
Q

Patient has 20/40 in Left eye and 20/100 on Right eye. What is the next plan of action?

A

Refer! One is for less than 20/40 in either eye and the other is a difference of more than 1 line in acuity between eyes

70
Q

Visual Acuity is almost always done first in all eye conditions except for what?

A
  1. Chemical injury
  2. Foreign body

Irrigate affected eye profusely first. Refer if decreased acuity.

71
Q

Itchy, red, watery eyes with WHITISH AND STRINGY discharge with usual history of allergies

A

Allergic “Vernal” conjuctivitis

72
Q

Treatment of Allergic conjunctivitis

A
  1. Mast cell stabilzers (Cromolyn sodium (Opticrom)
  2. H2 receptor antagonist such as Levocabastine (Livostin)
  3. Non-steroidal anti-inflammatories such as Ketorolac tromethamine (Acular)
  4. Combination drops such as Olopatadine (Patanol) with mast cell stabilizer and H2 receptor antagonist
  5. AVOID steroid eye drops: risk of glaucoma and cataracts, refer to ophthalmologist for those.
  6. Systemic antihistamines such as Benadryl are helpful
73
Q

Signs and symptoms of Viral conjunctivitis

A
  1. Redness, watery eyes with CLEAR discharge usually

2. Preauricular lymph node often enlarged

74
Q

Organism causing Viral conjunctivitis

A
  1. Associated with pharyngitis caused by Adenovirus
  2. Herpes Simplex Virus
  3. Measles virus.
75
Q

Treatment for Viral conjunctivitis

A
  1. Self-limiting / resolving
  2. Prophylaxis antibiotic eyedrops to avoid secondary bacterial infections
  3. Very contagious so practice good hand hygiene
  4. Children should stay out of school until redness and tearing resolves
76
Q

Treatment for HSV-related eye disorders

A

Refer to opthalmologist!

77
Q

Signs and symptoms of Bacterial conjunctivitis

A
  1. Redness
  2. PURULENT discharge
  3. May have symptoms of URI
  4. Usually NO adenopathy
78
Q

Organisms causing Bacterial Conjunctivitis

A
  1. Haemophilus Influanzae, 2. Strep pneumoniae
  2. Moxarella catarrhalis
  3. Straph Aureus
79
Q

Treatment for Bacterial Conjunctivitis

A
  1. Warm compress
  2. Hand washing and no sharing of towels
  3. Refer if no improvement in 48-72 hours
  4. Antibiotics
80
Q

Antibiotics for Bacterial Conjunctivitis. Drops if concerned about vision. Ointment if concerned about prolonged contact with ocular surface and soothing effect

A
  1. Erythromycin ophthalmic ointment: Apply 0.5-in ribbon QID for 5-7d
  2. Polymyxin-trimethoprim ophthalmic solution: Instill 1-2 drops QID for 5-7d
  3. Sulfacetamide ophthalmic solution: Instill 1-2 drops QID for 5-7d
  4. Azithromycin ophthalmic solution: Instill 1-2 drops BID for 2d, then 1 drop for 5d
  5. Ciprofloxacin ophthalmic solution: Instill 1-2 drops every 2h while awake for 2d, then 1 or 2 drops every 4h while awake for the next 5d
  6. Levofloxacin ophthalmic solution: Instill 1-2 drops in affected eye(s) every 2h while awake (up to 8 times daily) on days 1-2; instill 1-2 drops in affected eye(s) every 4h while awake (up to 4 times daily) on days 3-7
  7. Ofloxacin ophthalmic solution: Instill 1-2 drops in affected eye(s) every 2-4h on days 1-2; instill 1-2 drops QID on days 3-7
81
Q

When to give systemic (Oral/parenteral) antibiotics for bacterial conjunctivitis?

A
  1. If caused by Chlamydia trachomatis

2. N. Gonorrhea (Ophtalmia neonatorum)

82
Q

A teenager presents to the clinic with possible bacterial conjunctivitis. What is the next plan of action?

A

Culture eyes in sexually active teenagers to rule out STD

83
Q

Patient presents to the clinic with Eye pain. What is the next plan of action?

A
  1. Visual Acuity (except for foreign body and chemical substance: Irrigation first)
  2. Pupillary reaction
  3. Anesthetic drops prior examination or removal of foreign body

Refer immediately if abnormal or presence of imbedded objects

84
Q

Patient presents with sudden severe unilateral eye pain with tearing and redness. What do you suspect?

A
  1. Corneal abrasion
85
Q

How to diagnose and examine a possible corneal abrasion?

A

Flourescein dye and woods or cobalt blue lamp

Corneal abrasion will appear as bright yellow / greenish collection of dye on surface of eye

86
Q

Treatment for corneal abrasion

A
  1. Antibiotic drops or ointment
  2. Patching is not recommended
  3. No contact lenses until healed
  4. No anesthetic eye drops for home use
  5. Topical cyclopegic drops (Atropine opthalmic)
  6. NSAID / Tylenol or narcotics for pain management
  7. Follow-up in 24 hours
87
Q

Signs and symptoms of Blepharitis

A
  1. Redness and irritation of eyelid margins
  2. May present with dry eyes and conjunctivitis
  3. Crusting
88
Q

Redness and irritation of eyelid often caused by bacterial overgrowth (Staph Aureus) and meibomian gland obstruction

A

Blepharitis

89
Q

Treatment for Blepharitis, Hordeolum and Chalazion

A
  1. Eyelid scrubs with baby shampoo
  2. Warm compress
  3. Topical antibiotic ointment (Polysporin or Sulamyd ointment)
  4. I & D for Chalazion if slow to resolve
90
Q

Redness and localized eyelid NODULE / GRANULOMA often caused by obstruction of meibomian glands

A

Chalazion

91
Q

Redness, swelling, warm and PAPULE on eyelid specifically in the glands of Zeis usually by Staph Aureus

A

Hordeolum “Stye”

92
Q

Redness and swelling of both eyelids with pain and FEVER usually caused by staph aureus and strep pyogenes

A

Periorbital Cellulitis

93
Q

Treatment for Periorbital cellulitis

A

Refer for hospitalization and systemic antibiotics

94
Q

Most common intraocular malignancy of childhood, usually presenting before age of 3

A

Retinoblastoma

95
Q

Patient presents to the clinic with sign of Leukocoria (white reflex in pupil), strabismus, red eye, and glaucoma. What is the next course of action?

A

Perform Red reflex (Buckner test) to consider Retinoblastoma - Positive Bruckner test is a difference in the quality of the red reflex between eyes. Refer if positive!

96
Q

Risk factors of Acute Closed-angle Glaucoma (ACAG)

A
  1. Age
  2. Farsightedness
  3. Family History
  4. Medications
97
Q

Signs and symptoms of ACAG

A
  1. Rapid onset of severe unilateral eye pain
  2. Blurred vision WITH halos around lights
  3. Nausea / Abdominal pain
  4. Redness and cloudy appearing cornea
  5. Dilated, non-reactive pupil
  6. Eye feels har don palpation
98
Q

Treatment for ACAG

A

Refer urgently to opthalmologist

99
Q

Common etiology of Keratitis

A
  1. Bacterial (Pseudomonas Aeruginosa, M. Cat, Gram-negative bacilli, staph)
  2. Viral ( HSV)
  3. Contact lense left overnight
  4. Corneal trauma (Surgery)
100
Q

Signs and symptoms of Keratitis

A
  1. Blurred vision from Hazy cornea, may have central ulcer
  2. HYPOPYON (pus in the anterior chamber)
  3. Diffuse erythema
  4. Eye pain
  5. Photophobia
  6. Grittiness
    (foreign body sensation)
101
Q

Treatment for Keratitis

A

Refer to an Opthalmologist

102
Q

Signs and symptoms of Uveitis

A
  1. Unilateral eye pain
  2. Photophobia
  3. Blurred Vision from cloudy cornea
  4. PERILIMAL ERYTHEMA (Redness at border of cornea and sclera)
  5. Reactive and small pupil
103
Q

Treatment for Uveitis

A

Referral to an ophthalmologist

104
Q

Common organisms causing Otitis Externa

A
  1. Pseudomonas Aeruginosa - Foul-smell
  2. Staphylococcus Aureus
  3. Aspergillus or other fungi - Common in Diabetics
105
Q

Differential Diagnosis for Otitis Externa

A
  1. Furunculosis of the ear canal
  2. Mastoiditis
  3. AOM with TM perforation
  4. Patent PE tubes (Draining)
106
Q

First line treatment for Otitis Externa

A
  1. Flouroquinolone drops (Covers Pseudomonas and Staph)
    - Ciprofloxacin/dexamethasone (Ciprodex) 4ggts BID for 7 days (Can be used even if TM is perforated or with PE tubes (safe)
    - Neomycine/Polymixin B/Hydrocortisone (Cortisporin otic) 3-4 gtts TID_QID for 7-10 days (NOT SAFE for use with perforated TM or PE tubes - CAN CAUSE HEARING LOSS)
107
Q

Prevention of Otitis Externa

A
  1. Avoid vigorous ear cleaning
  2. Avoid Q-tips
  3. After swimming, use 2-3 gtts of 1:1 sol’n of vinegar and ethyl alcohol, or swim ear drops.
108
Q

When should you always treat with antibiotic therapy for AOM?

A

less than 6 months and severe AOM WITH otorrhea

109
Q

When can you suggest observation for AOM?

A

more than 6 months for unilateral AOM WITHOUT otorrhea or more than 2 years for bilateral AOM WITHOUT otorrhea

110
Q

First line treatment for children with tympanostomy tubes and otorrhea but no systemic symptoms (pain, fever)?

A

Flouroquinolone otic drops (cipro otic) 4 gtts BID x 7 days

111
Q

Child presents to clinic with history of AOM for more than 4 weeks. What is next plan of action?

A

Likely a new pathogen, start with Amoxicillin or other first line treatments

112
Q

What are some reasons for antibiotic failure?

A
  1. Drug-resistant pathogen (Macrolides for H. Flu and Strep Pneumoniae for Amxocillin failure)
  2. Non-compliance - IM Ceftriaxone
  3. Vomiting of medications - improve with flavoring
113
Q

Fluid remains in ear after AOM for how many weeks?

A
  1. 2 weeks - 60-70% for OME
  2. 4 weeks - 40% for OME
  3. 3 months - 10-25% for OME
114
Q

Treatment for OME

A
  1. Have child come back after 4 weeks for evaluation
  2. Refer for Audiology evaluation if present for more than 3 months
  3. Refer to ENT for hearing loss for possible tympanostomy (PE) tube placement
115
Q

Preschoolers get an average of how many febrile illness per year?

A

6 to 8

116
Q

Core (rectal) temperature of more than 38 C or 100.4 F

A

Fever

117
Q

Most accurate temperature measurement

A

Rectal Temperature

118
Q

When not to use a tympanic temperature?

A
  1. Children under 3 months

2. Ear wax / Cerumen impaction - blocking ear canal

119
Q

Most common cause of fever

A

Viral infections

120
Q

Mom of patient asks if teething causes fever?

A

No it does not

121
Q

What is the main challenge in diagnosing fever?

A

Differentiate viral and serious bacterial infections (SBI)

122
Q

Risk factors for Serious bacterial illness

A
  1. Less than 3 months old
  2. History of prematurity
  3. Previous hospitalizations
  4. Immunodeficient (Asplenia)
  5. Daycare or household contact
  6. Not fully immunized infants
123
Q

Signs of serious illness

A
  1. Fever of more than 40 C / 105 F
  2. Nuchal rigidity
  3. Petechial skin rash
  4. Seizures
  5. Respiratory problems
  6. AOM / Mastoiditis
  7. Murmurs
  8. Abdominal distension / tenderness
  9. Joint issues
124
Q

Diagnostic testing for Fever

A
  1. CBC with differential - WBC >15,000 or <5,000
  2. UA/C&S - poss. UTI
  3. CXR - poss. Pneumonia
  4. Lumbar puncture - poss. Meningitis
  5. Blood cultures: poss. Bacteremia
  6. Stools for C&S - poss. infectious diarrhea
125
Q

A 4-week old infant presents to the clinic for fever. What is the next plan of action?

A
  1. Refer for hospitalization, full septic work-up and IV antibiotics pending culture
126
Q

Plan of action for NON-TOXIC looking, no risk factors of SBI with fever for 4 weeks to 3 months

A
  1. Full septic work-up
  2. Treatment for underlying conditions
  3. Empiric antibiotics after cultures
  4. ROCEPHIN 50mg/kg/day
  5. Reliable caregiver with phone and transportation
  6. Close follow-up in 24 hours
127
Q

Plan of action for TOXIC looking OR WITH risk factors of SBI with fever for 4 weeks to 3 months

A
  1. Refer
  2. Hospitalizations
  3. Full septic work-up
  4. IV antibiotics pending culture results
128
Q

Plan of action for NON-TOXIC looking with fever for more than 3 months to pre-school

A
  1. Diagnostic testing guided by underlying conditions. (UA for all girls less than 2 years old and all males less than 6 months, uncircumcised < 12 months)
  2. Antipyretics
  3. Fever of LESS THAN 39 C (102 F) - Close follow-up by visit or phone
  4. Fever of MORE THAN 39 c (102 F) - Consider empiric antibiotics with close follow-up
129
Q

Plan of action for TOXIC looking with fever for more than 3 months to pre-school

A
  1. Septic work-up
  2. Consider hospitalization
  3. IV antibiotics if no focal source of fever
130
Q

When can aspirin be used for children?

A

NEVER! causes Reye’s syndrome

131
Q

Dosing of Acetaminophen (used for patients more than 2 months)

A

15 mg / kg every 4-6 hours NTE 5 doses in 24 hours

132
Q

Dosing of Motrin / Advil (used for patients more than 6 months)

A

10 mg / kg every 6-8 hours NTE 40 mg/kg/day total dose

133
Q

Home instructions for parents with children with fever

A
  1. Increase OFI
  2. Light clothing
  3. TSB
  4. No alcohol or cold water baths
  5. Monitor temp, activity level, oral intake, change in condition every 4 hours
  6. Follow-up in 24 hours by visit or phone

CMN 568 - Unit 1 (2 decks)

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