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RRPA Clinical Med II > Pediatric Fever (Exam 2) > Flashcards

Pediatric Fever (Exam 2) Flashcards

1
Q

A fever is a temp greater than?

A

100.4

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2
Q

Can bundling or teething cause a fever?

A

No, maybe elevated, but not over 100.4

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3
Q

Are tympanic temps just as accurate as rectal?

A

No, must get rectal temp

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4
Q

T/F The higher the fever the sicker the infant.

A

False, fever is a fever

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5
Q

What is the cause of a majority of serious bacterial infections SBI’s?

What is the causative organism?

A

UTI, most commonly from E. Coli

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6
Q

T/F breastfed infants are immunocompetent?

A

False, they have immature opsonin capabilities, decrease macrophage and neutrophil function, poor Ig response to encapsulated bacteria

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7
Q

T/F The older the kid, the higher the chance of SBI.

A

False, <4 weeks 15% SBI, 4-8wks <5% SBI

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8
Q

Does a fever over 100.4 require a work-up for bacterial illness regardless of PE?

A

Yes

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9
Q

What are the 5 common pathogens in neonatal fever?

A

GBS, E. Coli, Listeria, Klebsiella, Herpes

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10
Q

What labs should you order for neonatal fever?

A

UA
CBC
BCx (blood culture)
LP (lumbar puncture)

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11
Q

How should you treat neonatal fever?

A

systemic Abx and admit

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12
Q

What is the most likely cause of pediatric fever, bacteria or virus?

A

Virus

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13
Q

Neonates are what age (in days)?

A

<28 days

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14
Q

Protocol eligible Infants are what age (in days)?

A

29 days to 59 days

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15
Q

What age are infants (in days)?

A

> 60 days

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16
Q

Is a parents gestalt predictive of infection?

A

Yes, have to listen to parent

17
Q

Protocol eligible infants (age 29-59 days) assumes what?

A

They are term babies (>38 weeks + 6 days) Early term is 37wks to 38wks6days. Ross says for test purposes FULL TERM is 40weeks
PE that is benign (check eyes, ears, mouth,d iaper) and CHILD MUST BE CONSOLABLE
Non-toxic
No previous abx

18
Q

What are the 3 protocols?

A

Philadelphia
Rochester
Boston

19
Q

What 4 things do all the protocols suggest you do?

A 
1. Get a WBC count 
Positive WBC is <5,000 or >15,000 and/or absolute neutrophil count ANC >1500
2. Do a UA
Positive if >10wbc/hpf
3. CXR if resp sx
4. Lumbar puncture (LP)
Positive if >10 wbc/mm3
20
Q

If any of the 4 things for the 3 protocols are positive, such as WBC, UA, CXR, or LP, what should you do?

A

Admit and empiric abx

21
Q

If protocol tests are negative, what are your 2 choices?

A
  1. No abx, d/c and f/u in 24hrs

2. Abx and LP and d/c and f/u in 24hrs

22
Q

Your peds pt has low risk labs, but they have obvious bronchiolitis, what do you need to do?

A

UA

F/u in 24hrs

23
Q

If your peds pt has a fever but you can’t identify the source, and they are w/in protocol age 29-59 days, what are your abx choices?

A
  1. Ceftriaxone or cefotaxime covering Strep pneumo, H influ, and E coli
  2. Ampicillin (up to 6 weeks of age) for Listeria and GBS
  3. Vanco for MRSA
  4. Acyclovir for all
24
Q

If you give abx to your peds pt with no source of fever who is within protocol age, what do you HAVE to do?

A

LP

25
Q

What 3 bugs does ceftriaxone or cefotaxime cover?

A

Strep pneumo
H influ
E coli

26
Q

What 2 bugs does ampicillin cover for?

A

Listeria

GBS

27
Q

What bug does vanco cover?

A

MRSA

28
Q

What is acyclovir for?

A

Herpes infections

29
Q

Should you give azithromycin?

A

No, the road to hell is paved with azithro

30
Q

If peds pt is >59 days old and has fever, what should you ask the parent?

A

What is their immunization status?

31
Q

For a peds pt >59 days, what should you strongly consider ordering even if they have bronchiolitis?

A

UA

32
Q

If your >59 days peds pt with a fever has elevated wbc on cbc, what should you do next?

A

LP

33
Q

Your peds pt has been vaccinated, has a fever, but they don’t appear ill. If they just received their 1st round of vaccinations they are 6wks and w/in protocol age. If the fever is w/in 72 hours, what is all you need to do?

A

UA

34
Q

If the child is unvaccinated?

A

Ignore everything I just said for all previous slides

35
Q

Unvaccinated infants less than 60 days old. What should you think?

A

Pneumococcus
Can kill in 24 hours, so worry about the fever on day 1
Lab values have greater importance, elevated cbc is really ominous
Very aggressive work-up and probably admission

36
Q

New protocol for 29 to 90 days “step by step”. What are the steps for the algorithm?

A

-Well appearing with normal pediatric assessment triangle (Appearance, Work of Breathing, Circulation to skin)
-age >28 days old
-Leukocyturia
-Procalcitonin <0.5ng/ml
-CRP <= 20mg/L
-ANC (absolute neutrophil count) <= 10,000
If all these present, low risk patient

37
Q

If infant is positive for any of the “step by step” protocol steps then they fail the protocol and need a work-up. What should you do?

A

Abx
LP
BCx
Admit

38
Q

Do not give abx unless you do what?

A

LP

RRPA Clinical Med II (45 decks)

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