Week 4: Paediatrics 1 (consultation and immunisation) Flashcards
1
Q
Challenges when consulting with children
A
- Extra people in the room
- Different range of problems
- Communication
- Lack of confidence
- Different illnesses
2
Q
Tips do good consultation etiquette with children and teenagers
A
- Direct questions to child, but do include parent
- Ask questions about child to get to know them better
- Don’t use jargon- age appropriate
- Use active listening and empathy
- Respect the knowledge patients may have
- Make environment relaxed and informal
- Involve teenagers in decision making
- Ask young people if they’d like to speak on their own if they have come with a parent/guardian
- Talk mental health
- Check children’s understanding
- Recap what the patient saying
- Check if anything’s happening at school e.g. bullying
3
Q
Structure of child consultation
A
- Check name, DoB, PMH. Safeguarding issues
- Greet the child by name and check who is with them
- If the child is over 4 ask them the first question ‘do you want to tell me why you’re here’
- Usually the child will ask the parent to talk on their behalf
4
Q
3 minute toolkit – acutely ill children
A
Children symptoms tend to be vague e.g. vomiting or temp. Need to examine a child to find the focus of infection.
- Children decompensate later in their illness, so important to look for physiological signs of serious diagnosis
Top to toe assessment tool
- A-E and checks childs physiology
- Order may vary depending on child
- Carried out after history
5
Q
Airway
A
- Secretions (bronchiolitis) or stridor (croup)
- Childs airw ay an become blocked easily because small
- Foreign body
- Unprotected airway
- Decrease conscious level
- Useful test is a gag reflex – trying to insert oropharyngeal airway → if child coughs = good → if child allows airway = call an anaesthetist
6
Q
Breathing
A
-
Resp rate
- Measure of distress or more systemic problems
- Count each breathe over 30s and x2
- Try and do when child calm
- Normal range changes with age of child
-
Recession and accessory muscle use
- Represents difficulty in breathing
-
Oxygen sat
- Pulse oximeter
- Place on childs finger
- Useful because children can be close to decompensating even with low sats
- Cyanosis will only appear when oxygen sats are <85% - early warning
- Children <10 different equipment
- If child moves the reading may be artificially low (hold limbs still)
- Should be at least 96%
-
Auscultation
- Children may be sacred of stethoscope, if children crying catch the breathe sounds as they breathe in
- Warm stethoscope if warm
- Could turn it into a game
- Finding’s less valuable since smaller chest so noises tend to transmit across chest
7
Q
Circulation
A
-
Colour
- If child pale ask parent what normal colour is
- Look for mottled arms or legs (this may be normal) – could be a sign of poor perfusion
- Heart rate
- When child is calm
- If crying will increase HR
- Measure RP at wrist for 30 x2
- In babies <60 use brachial pulse
-
Capillary refill
- Shows if child has compromised circulation
- Press for 5 second on Childs skin and count until normal colour <2s
- Can be measured centrally by pressing on the sternum and peripherally by pressing on the fingers, toes, hands or feet
- Early sign of decompensation
-
Temperature of hands and feet
- Compare hands and feet to the chest basically comparing if difference in peripheral and central perfusion e.g. sepsis
-
Blood pressure
- Difficult to measure in children because they can get upset when cuff goes on arm
- Not worth measuring unless children very drowsy late sign of decompensation
- Cuff should measure 2thirds of the length of the upper arm
- Could use thigh
8
Q
Disability
A
-
Pupils
- Usually always normal in a child awake and orientated
- May be sluggish after a fit or drug overdose
- Changing pupils sizes may be due to ongoing seizure
- Asymmetrical pupil size means a space occupying lesion in brain
- E.g. extradural haemorrhage
-
Limb tone and movement
- Compare movement of limbs i-mportant if worried about SoL
- Only likely to find symptoms if patient is not alert and orientated
-
AVPU score/ GCS
- Note child’s behaviour and how alert
- Ask some questions
- Ask parent if normal behaviour
- Irritablity may indication raised intracranial pressure or meningitis
- Will not be easy to calm
- Drowsiness also common when child has high temp
- Persistent drowsiness very worrying
- Note child’s behaviour and how alert
9
Q
Ears, nose and throat
A
- Needs examining in any child with a fever
- Should be left to the end in case the child gets upset
10
Q
Ears
A
- Have a firm grip on the child to prevent otoscope damaging ear
- TM often pink if they are hot
11
Q
Throat
A
- Do after ear examination
- Hold child like this
- Use tongue depressor
- Children often have large tonsils that look red due to increased blood supply
- True tonsilitis= covered in exudate
12
Q
Temperature assessment
A
- Using ear thermometer (tympanic thermometer)
- Children may not want this- do this as quick as poss
- Paper strips such as tempa dots can be placed in mouth or arm pit
- Axillary temp recommended in babies (ears too small)
13
Q
Tummy assessment
A
- Best examined lying flat
- May have to make do on parents lap if too upset
- Ensure child is relaxed and trusts you
- Feel around abdomen gently and ask for pain
- Once child is relaxed you can do firmer palpation
- Palpation of liver and spleen same as adults
- Examine testicles
- Look for strangulated hernias in groin
- Urine sample tested at bedside
14
Q
Blood glucose assessment
A
- Most commonly check using blood drop on a reagent strip- BM stix
- Should be measured in confused or drowsy child
- Finger or toe prick
- Occurs in children quite easily
- Hypoglycaemia
- Alcohol
- Haven’t eaten for a day or so
- DKA
genetic abnormality
- Blood glucose assessed through blood gas machine (3-5 mmol/l normal)
15
Q
Environment
A
- Provide child friendly environment putting the child at ease
- Relaxing them will make assessment more accurate and quicker
- Provide toys and books
- Calming child down is medically important e.g. in asthma attack
