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Saaliha Part 4 – PM4B > (SYNOPTIC) Neonates + Paediatrics > Flashcards

(SYNOPTIC) Neonates + Paediatrics Flashcards

1
Q

How should pain be assessed when they are unable to tell you verbally, i.e. a neonate?

A

Facial Expression?
0 - relaxed
1 - grimace

Crying?
0 - no
1 - whimper
2 - vigorous crying

Arms?
0 - relaxed
1 - flexed/ extended

Legs?
0 - relaxed
1 - flexed/ extended

Posture?
0 - relaxed
1 - flexed/ extended

State of arousal?
0 - asleep/ awake
1 - restless

Heart rate?
0 - baseline
1 - increase by 10-40BPM
2 - increase by ≥40BPM

Respiratory rate?
0 - baseline
1 - alteration in breathing

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2
Q

When observing pain of a neonate, and having allocated a score, how are the scores interpreted?

A

1-3: Nurse-controlled measure

  • non-nutritive sucking
  • repositioning

4-7: Consider sucrose/ alternative pain relief + nurse-controlled measures

8-10: Review with medical team
- discuss alternative prescription for pain relief

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3
Q

What is FLACC, with regard to pain?

A

Pain assessment score
Face
Legs
Activity
Crying
Consolability

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4
Q

What are some behavioural indicators of pain?

A
  • Irritability
  • Unusual quietness or lethargy
  • Restlessness
  • Sobbing, screaming or whimpering
  • Increased clinging
  • Loss of appetite
  • Laying ‘scared stiff’
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5
Q

What are some physiological indicators of pain?

A
  • heart rate
  • respiratory rate
  • blood oxygen
  • blood pressure
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6
Q

Treatment for mild pain

A

Paracetamol

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7
Q

Treatment for mild to moderate pain

A

Paracetamol + NSAID

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8
Q

Treatment for moderate pain

A

Paracetamol + NSAID + codeine?? look at codeine cards

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9
Q

Treatment for severe and very pain

A

Paracetamol + NSAID + morphine

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10
Q

For what patient age group is codeine considered suitable?

A

Patients older than 12

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11
Q

For what patient age group is codeine contraindicated?

A

All children under 18yrs who undergo removal of tonsils/ adenoids

For the purpose of sleep apnoea

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12
Q

What do you do in suspected asthma?

A

Diagnosis and assessment

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13
Q

What do you do in diagnosed asthma?

A
  • assess symptoms
  • measure lung function
  • check inhaler technique and adherence
  • adjust dose
  • update self-management plan
  • move up and down as appropriate
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14
Q

What is the management of suspected asthma in neonates and paediatrics?

A

Initiation of treatment with very low-> low dose ICS

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15
Q

What is the management ladder of diagnosed asthma in neonates and paediatrics?

A

(1) Regular preventer

(2) Initial add-on therapy
- VERY low dose ICS
- ≥5 add LABA/ LTRA
- <5 add LTRA

(3) Additional controller therapies:
- Consider increasing ICS to low dose
- ≥5 add LABA/ LTRA
- no response to LABA: consider stopping

(4) Refer for specialist care

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16
Q

When would you consider moving up the ladder?

A

If using 3 doses or more a week

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17
Q

If child is at 5 and still have symptoms what would we do?

A

Objective tests
- FeNO
- Spirometry
- Bronchodilator reversibility

Monitor peak flow for 2-4 weeks if there is diagnostic uncertainty

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18
Q

FeNO

A

35ppb or more

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19
Q

Spirometry

A

FEV1/FVC ratio < 70%

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20
Q

What is LTRA treatment?

A

Leukotriene receptor antagonist therapy

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21
Q

What dose of beclometasone dipropionate is considered to be a very low dose for use in children?

A

50 microgram

2 puffs

BD

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22
Q

What dose of beclometasone dipropionate is considered to be a low dose for use in children?

A

100 micrograms

2 puffs

BD

23
Q

What dose of beclometasone dipropionate is considered to be a medium dose for use in children?

A

200 micrograms

2 puffs

BD

24
Q

Why should you use a spacer with your child’s inhaler?

A
  • Spacers help get medicine into the lungs more effectively
  • Stop meds from sticking to the back of the mouth
  • Reduces risk of thrush and sores
25
Management of moderate asthma in A+E: 1st line
- Give b2 bronchodilator (e.g. salbutamol) via spacer - Oral prednisolone 30-40mg - Reassess within 1 hour
26
Management of acute severe asthma in A+E: 1st line
* Give O2 via face masks/nasal pongs to achieve SpO2 94-98% * B2 bronchodilator via nebuliser (pref oxygen-driven), salbutamol 5mg (or via spacer if nebuliser unavailable) * Oral prednisolone 30-40mg or IV HC 4mg/kg if vomiting Poor response: - add nebulised 0.25mg ipratropium to every nebulised B2-bronchodilator and repeat every 20 mins for 2 hours according to response
27
Main treatments to give when someone presents to emergency room with acute asthma (asthma attack)
* Oxygen * B2 agonist * Oral steroids * Ipratropium
28
What is the treatment for mild atopic eczema in children?
- emollients: ensure SLS free. Thought to irritate skin by stripping natural oils - mild topical CS: HC
29
What is the treatment for moderate atopic eczema in children?
- emollients - moderate topical corticosteroids (betamethasone/ clobetasone) - topical calcineurin inhibitors (tacrolimus, pimecrolimus) - bandages
30
What is the treatment for severe atopic eczema in children?
- emollients - potent topical CS (betamethasone/ mometasone) - topical calcineurin inhibitors - bandages - phototherapy - systemic treatment
31
Name some side effects of systemic corticosteroid use.
- impairment of growth and healing - fluid retention - osteoporosis - weight gain - peptic ulcers - altered mood/ psychosis - electrolyte imbalances - blood glucose increase
32
Name some side effects of topical corticosteroid use.
TOPICAL * may thin skin if very potent SYSTEMIC * Osteoporosis * weight gain * peptic ulcers | - if used on younger children, may get systemic exposure via skin
33
When should oral antihistamines be offered to children with eczema?
Not to be used routinely Offer 1 month trial of NON-SEDATING to children with SEVERE atopic eczema/ severe itching Offer 7-14 day trial of SEDATING if ≥6 months with sleep disturbance
34
What is the first line treatment for secondary infections of eczema in children?
1. Flucloxacillin, Erythromycin - if penicillin allergy 2. Topical treatment with Abx only if infection is localised (max 2 weeks)
35
What is the treatment for a meningitis infection in children?
Broad spectrum ABx (1) Cephalosporin: use does in hgih end of range to ensure effective treatment - ceftriaxone - cefotaxime (2) Add amoxicillin for babies <3 months
36
What is a potential complication of this drug when used in children? Chloramphenicol
Neonates cannot metabolise Can result in grey baby syndrome Liver is not mature enough to metabolise correctly
37
What is a potential complication of this drug when used in children? Sulfonamides
Kernicterus in neonates | - Brain damage due to high levels of bilirubin in blood
38
What is a potential complication of this drug when used in children? Ceftriaxone
Kernicterus in neonates - Brain damage due to high levels of bilirubin in blood Forms precipitate with calcium
39
What is a potential complication of this drug when used in children? Nitrofurantoin
Haemolytic anaemia in children <3 months
40
What is a potential complication of this drug when used in children? Tetracyclines
Bind to calcium in growing bones + teeth Causes discolouration
41
What is a potential complication of this drug when used in children? Quinolones
Arthopathy in children | - joint disease
42
What are some common reasons for having to admit term babies?
- Hypoglycaemia - Hyperbilirubinaemia - Infection - Poor feeding - Asphyxia during birth
43
What are some common issues for preterm babies?
- hypoglycaemia - electrolyte imbalance - hyperbilirubinaemia - infection/ necrotising colitis - respiratory distress syndrome - patient ductus arteriosus ø condition where blood flows back to lungs from heart - intraventricular haemorrhage
44
Newborn respiratory distress Syndrom (NRDS)
* baby's lungs are not fully developed * cannot provide enough oxygen * causing breathing difficulties * usually affects premature babies.
45
Curosurf
- Poractant alfa - Reduces initial oxygen and ventilation requirements - Most babies are born with surfactant that lines the lungs and stops them from sticking together, making normal breathing possible. - Curosurf given to babies that don't have this
46
Why is vitamin K injection prescribed to all babies
- All babies, not just premature ones - Babies have low levels of vitamin K at birth which can lead to bleeds in the brain - Vitamin K protects them from this risk of high bleeding
47
Why is vitamin K given IM?
* Vitamin K is a fat soluble vitamin * IM it will act as a depot * Provide longer term protection than oral or IV * Works better IM but can be given orally if parents wishes
48
Why might maternal breastmilk not be nutritionally sufficient for preterm babies - PHOSPHATE
* Phosphate essential for bone growth and mineralision; deficinecy frequent in preterm infants * Preterm infants fed exclusively on breast milk, which is relatively phosphate poor * Should recieve PO phosphate supplementation * Plasma phospahte levels should be checked regularly to guide supplementation
49
Why might maternal breastmilk not be nutritionally sufficient for preterm babies - VITAMIN D
- Vitamin D important for bone mineralisation - In preterm neonates, all vit D obtained from dietary sources - Most infants receiving milk feeds will require some form of vit D supplementation, normally administered in a combination multivitamin product (eg, Abidec). - e.g. Abidec
50
Why might maternal breastmilk not be nutritionally sufficient for preterm babies - IRON
* For preterm babies w/ symptomatic anaemia iron supplementation is used infrequently as these babies often recieve blood transfusions * However, breast-fed preterm infants will commonly be discharged home on oral iron supplements (eg, Sytron – sodium feredetate) to prevent iron deficiency anaemia developing at home during the first year of life. * Formula milk is manufactured with additional iron content so ex-preterm babies discharged on formula feeds generally do not need supplementation
51
Why might maternal breastmilk not be nutritionally sufficient for preterm babies - SODIUM
* Sodium is required for consistent linear growth * Preterm beenfits may need sodium supplementation, either IV or oral
52
Abidec
Multivitamin containing vit D pre-term 0.6mL term 0.3mL daily
53
Sytron
Sodium feredate 1mL daily start 4-6 weeks after birth

Saaliha Part 4 – PM4B (73 decks)

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