in the GP Flashcards
what should you look for in the assessment of an unwell child?
appearance: activity or alertness- eye contact or lying limply
could be crying but can see if they look well perfused or poorly perfused and unwell and lethargic
pattern of breathing: not only respiratory illness, sepsis and metabolic also presents with breathlessness- how rapidly?, respiratory distress?
do they look drowsy and lethargic- think of history of presenting complaint
how does respiratory distress present in children?
nasal flaring
tracheal tug
subcostal and intercostal recession
look under childrens clothing, exposing them appropriately to inspect their chest wall
when should you examine for a rash?
when child presents with acute fever or intercurrent illness
think of type of rash: blanching or non-blanching
what is the pediatric assessment triangle?
framework to structure examination
childs general appearance: well or unwell
what is work of breathing, respiratory distress increased work of breathing and general appearance affected
do they look distressed
consider skin perfusion: examine capilary refill time- centrally sternum and peripherally at nail bed , in shock- perfusion will be reduced and general appearance affected
what are the NICE guidelines on feverish children?
use this to learn how to assess unwell patient
temperature
respiratory rate > 60
central capillary refill time prolonged>2 secs
heart rate
clinical observations need to be age specific to provide appropriate clinical interpretation of the use in the context of child in front
18 month old child, mild fever- 37.9 degrees feels warm at times, moderate reduction in oral fluid intake, child present with spots around mouth
what is the differential diagnosis?
hand, foot and mouth disease
commonly seen in children who play in indoor play areas and childcare facilities
what is the cause of hand, foot and mouth disease?
coxsackie A and B , HSV
enterovirus that is highly contagious
what are the symptoms of hand, foot and mouth disease?
(mild) fever, malaise, anorexia, abdominal pain, sore mouth , sore spots around hand, feet and mouth
what is the management for hand, foot and mouth disease?
avoid pregnant women and other children whilst rash present
stay at home while unwell
infant with history of eczema , presents with vesicular spots/ lesions all over body , febrile and lethargic , unwell
what is differential diagnosis?
2 most differential: superficial skin infection in the context of eczema
chicken pox
what are the consequences of chicken pox?
could lead to dangerous secondary bacterial infection
bacteria penetrate body via vesicular lesions and can lead to further infection
what is the incubation period for chicken pox?
2-3 weeks
when do children become infectious in chicken pox?
2-3 days before and continue until 5-6 days after rash or when all spots crusted over
what is chicken pox caused by?
bacterial
strep or staph
what are the symptoms of chicken pox?
redness, unwell, new temperature
