Paeds Flashcards
Introduction
- *W**ash hands
- *I**ntroduce yourself
- *P**atient’s consent
- *E**xplain procedure/purpose for Hx
Clarification of who speaking to (checks she is mum) and confirmation of name of child
PC
“What brought you in today?” / “Why have you booked an appointment today?” (if over the phone)
HPC
Temperature – asks for measurement and how it was taken - “Have you measured his/her temperature? How high was it?”
Treatments tried so far and response to them - “What treatments have you tried so far? How did he/she respond to them?”
Elicits specific clinical details, including:
RS enquiry – cough / cold/breathing - “has he/she got any cough?”, “any recent colds?”, “how’s their breathing? Are they short of breath?”
GIS enquiry – “is he/she eating / drinking?”, “any sickness or vomiting?”, “any diarrhoea?”
GU – wet nappies - “how many wet nappies have they had today?”, “is this different to usual?” (more wet nappies = diarrhoea, less = possible dehydration)
CNS – alertness -“what is he/she doing now?”, “is he/she sleepy/irritable?”, “how is he/she if you move him?”
Rashes - “has he/she got any rashes?”, “did it fade when you placed a glass tumbler over it?” (if the patient had rashes)
ICE
Explores mother’s ideas, concerns and expectations:
Ideas - “what do you think could have caused your child’s symptoms?”
Concern - “is there anything that your worried about regarding your child’s symptoms?”
Expectation - “what were you hoping we would do for you today?”
Offers appointment / home visit - “would you like an appointment to come into the GP surgery?”/”would doctor to come to your house and examine your child?”
SH
Home situation - “who does your child live with at home?”, “do they have siblings?”, “are they going at the same rate as their siblings were at their stage?” (if they are any developmental concerns)
Parents smoking/drinking - “do you or any other adults at home smoke or drink?”
School and education - “Is your child currently in school?”, “how is school going for them?”
Recent contacts - “was anyone else in the house or in their school sick recently?”
Involvement of social services - “have social services ever been involved in the care of your child?”, “is your child on a child protection plan?”
PMH
Enquires after previous serious illness and immunisation history
- “Have they been ill in the past?”, “have they had any hospital admissions? What for?”, “Is there anything they see their doctor regularly for?”*
- “Are they up to date with all their childhood immunisations?”*
DH
- “Are they on any medications that have been prescribed by your doctor?”, “do they take any over the counter medications?”*
- “Do they have any allergies to any medications? What happens when they take the medication?”*
FH
“Do you have any FHx of asthma, cystic fibrosis or any other lung/heart conditions?”
DDx
Discussion of diagnosis – likely to be viral, should get better within a few days
“It’s likely that your child currently has a viral infection. This normally resolves itself without any further treatment.”
Counselling
Discussion of management plan – to include:
Offers to see child - “would you like me to see/examine your child?”
Giving paracetamol and/or ibuprofen if distressed or unwell - “if your child continues to be unwell you can give them some Calpol (paracetamol), or some ibuprofen which you can get over the counter”
Check whether she has some or can access some - “do you have any Calpol or ibuprofen at home?”, “have you got a local shop/pharmacy nearby where you can buy some Calpol or ibuprofen?”
Advise neither undressing nor over wrapping - “As a practical advice, try not to underdress or over wrap your child”
Advises on fluid intake (considers dioralyte for rehydration) - “make sure that your child is drinking enough fluids and you can also try dioralyte to rehydrate your child”
Safety-netting
- “Call 999 if your child:*
- -develops breathing difficulties*
- -becomes floppy or have a fit*
- -has a non-blanching rash on glass test*
- -persistent vomiting”*
- “You can come back to the surgery if your child:*
- -Has poor urine output*
- -Has a fever that lasts longer than 5 days*
- -Deteriorates or you are worried”*
Close consultation
“Thank you so much for speaking with me today. Before you go I’d like to give you a patient information leaflet. A great website to go to is NHS choices, which I’ll write on a piece of paper for you to take home with you.”
