Revolta Flashcards
Approach to general paediatrics
Holistic multi system approach is essential - more than one problem may exist, more than one system involved
Start with the age- different approach (exam, history taking) depending on age, conditions manifest different at different age
Difference in paeds than other specialisations
Parent are there
Play is essential and clinically helpful
Nursing staff is specialised
Great differ by weight and age
Taking good history in children
It is a key step in making diagnosis
It can rule out significant pathology
Helps examination to be more targeted
We need to be calm and emphatetic
Show interest in what they are saying
Deal with anxieties
Consider the age and developmental stage, language and intellectual skills
Some questions directed to child some to parents
Key stages in history taking
Introduce yourself
Generate rapport
Presenting complaint( what we already know)
History of complaint (onset, progress, variation, effects, observations)
Birth history
Past medical history
Immunisations
Development (what can they do and they age)
Drugs and allergies
Family and social history - siblings etc
Schools and nursery (common source of infections
Parental social history-smoking, alcohol, drugs
Addressing concerns and closure
What made them come today
Concerns
Summaries key features
Check understanding
Document history and discussions
Note date, time, who was present with them/helped with history
Phases of childhood
Neonate (less than 4 weeks)
Infant (less than 1 y)
Toddler (1-2y)
Pre school (2-5y)
School age
Teenager
Main childhood objectives
To grow, develop, attain optimal health, develop independence, be safe, be cared for, to be involved
Key developmental fields
Gross motor, fine motor, social and self help, speech and language, hearing and vision
Influencing factors for development
Genetics
Environment
Positive early childhood experience
Abuse/neglect
Adverse environmental factors
Antenatal (infections, toxins)
Postnatal (infections, toxins , trauma, malnutrition, metabolic, maltreatment)
Developmental assessment -why is important
Reassurance
Early diagnosis
Discuss positive stimulation
Improving outcomes
Main components of healthy child progamme
Health promotion (smoking, alcohol, nutrition, dental and mental health, support services, hazards and safety)
Developmental screening including hearing
Immunisation
Examining child
Start with observation
Think about each system and each area
Appropriate for they age
Rapport is essential
Signs of hypoglycemia
Shaking
Sweating
Anxiety
Dizziness
Hunger
Fast heartbeat
Impaired vision
Fatigue
Headache
Irritable
Risk reduction in pt with diabetes/risk of hypoglycemia
Check if they have testing kit and hypo treatment
Staff training and awareness
Small snack pre appointment
Treatment for tonic clonic seizure
Lie flat, comfortable, remove sharps, hazards
Keep mouth clear
Administer buccal midazolam if lasting more than 5 min
Call ambulance if seizure more than 10 min
Things in dental setting-triggers for asthma exacerbation
Rosins in varnish
Enamel dust
Methametachylate
LA
NASIDs
Opioids
Questions to identify the risk
What symptoms they have while having attack
How severe attacks are
How frequently they come
Do they have relief treatment with you and have you taked your normal dose before
Anything in dental surgery causing exacerbation
Assessing chocking and severity
Ineffective cough- unconscious -open airway-5 breaths, CPR
Conscious -5back blows, 5thrusts
Effective cough- check for relief of cough or deteriorating
Asthma treatment
Step 1 inhaled beta agnostist, blue, Salbutamol
Step 2 inhaled corticosteroids, brown, beclomethasone
Step 3 increased inhaled corticosteroids, long acting beta agonist (green), tablets
Step 4 high dose inhaler corticosteroids , purple
Step 5 oral steroids, specialist referal
