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Ama - Part 4 PM4B > (SYNOPTIC) Neonates + Paediatrics COPY > Flashcards

(SYNOPTIC) Neonates + Paediatrics COPY 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
Q

Management of moderate asthma in A+E: 1st line

A
  • Give b2 bronchodilator (e.g. salbutamol) via spacer
  • Oral prednisolone 30-40mg
  • Reassess within 1 hour
26
Q

Management of acute severe asthma in A+E: 1st line

A
  • 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
Q

Main treatments to give when someone presents to emergency room with acute asthma (asthma attack)

A
  • Oxygen
  • B2 agonist
  • Oral steroids
  • Ipratropium
28
Q

What is the treatment for mild atopic eczema in children?

A
  • emollients: ensure SLS free. Thought to irritate skin by stripping natural oils
  • mild topical CS: HC
29
Q

What is the treatment for moderate atopic eczema in children?

A
  • emollients
  • moderate topical corticosteroids (betamethasone/ clobetasone)
  • topical calcineurin inhibitors (tacrolimus, pimecrolimus)
  • bandages
30
Q

What is the treatment for severe atopic eczema in children?

A
  • emollients
  • potent topical CS (betamethasone/ mometasone)
  • topical calcineurin inhibitors
  • bandages
  • phototherapy
  • systemic treatment
31
Q

Name some side effects of systemic corticosteroid use.

A
  • impairment of growth and healing
  • fluid retention
  • osteoporosis
  • weight gain
  • peptic ulcers
  • altered mood/ psychosis
  • electrolyte imbalances
  • blood glucose increase
32
Q

Name some side effects of topical corticosteroid use.

A

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
Q

When should oral antihistamines be offered to children with eczema?

A

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
Q

What is the first line treatment for secondary infections of eczema in children?

A
  1. Flucloxacillin, Erythromycin
    - if penicillin allergy
  2. Topical treatment with Abx only if infection is localised (max 2 weeks)
35
Q

What is the treatment for a meningitis infection in children?

A

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
Q

What is a potential complication of this drug when used in children?

Chloramphenicol

A

Neonates liver is not mature enough to metabolise correctly.

Can result in grey baby syndrome

37
Q

What is a potential complication of this drug when used in children?

Sulfonamides

A

Kernicterus in neonates

- Brain damage due to high levels of bilirubin in blood

38
Q

What is a potential complication of this drug when used in children?

Ceftriaxone

A

Kernicterus in neonates
- Brain damage due to high levels of bilirubin in blood

Forms precipitate with calcium

39
Q

What is a potential complication of this drug when used in children?

Nitrofurantoin

A

Haemolytic anaemia in children <3 months

40
Q

What is a potential complication of this drug when used in children?

Tetracyclines

A

Bind to calcium in growing bones + teeth

Causes discolouration

41
Q

What is a potential complication of this drug when used in children?

Quinolones

A

Arthopathy in children

- joint disease

42
Q

What are some common reasons for having to admit term babies?

A
  • Hypoglycaemia
  • Hyperbilirubinaemia
  • Infection
  • Poor feeding
  • Asphyxia during birth
43
Q

What are some common issues for preterm babies?

A
  • 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
Q

Newborn respiratory distress Syndrom (NRDS)

A
  • baby’s lungs are not fully developed
  • cannot provide enough oxygen
  • causing breathing difficulties
  • usually affects premature babies.
45
Q

Curosurf

A
  • 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
Q

Why is vitamin K injection prescribed to all babies

A
  • 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
Q

Why is vitamin K given IM?

A
  • 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
Q

Why might maternal breastmilk not be nutritionally sufficient for preterm babies - PHOSPHATE

A
  • 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
Q

Why might maternal breastmilk not be nutritionally sufficient for preterm babies - VITAMIN D

A
  • 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
Q

Why might maternal breastmilk not be nutritionally sufficient for preterm babies - IRON

A
  • 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
Q

Why might maternal breastmilk not be nutritionally sufficient for preterm babies - SODIUM

A
  • Sodium is required for consistent linear growth
  • Preterm beenfits may need sodium supplementation, either IV or oral
52
Q

Abidec

A

Multivitamin containing vit D
pre-term 0.6mL
term 0.3mL
daily

53
Q

Sytron

A

Sodium feredate
1mL daily start 4-6 weeks after birth

Ama - Part 4 PM4B (69 decks)

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