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Peds Newborn- Adolescents > Week 9 Content > Flashcards

Week 9 Content Flashcards

1
Q

Sick child history includes gathering what information?

A
  • understand main concern
  • at minimum, there are 2 historians (7 years or older) at least
  • how LONG has the child been sick?
  • Exposure?
  • PMH?
  • Immunization status
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2
Q

Patient information to gather for a sick visit- think if you were seeing them in an urgent care setting:

A
  • age, sex/gender
  • accompanying adult and who they are to the patient
  • highlight of parental concerns
  • date that the child was last WELL
  • Interval Hx of the illness
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3
Q

Pain/ symptom Mnumonic

A

Onset
Location
Duration
Characteristic
Alleviating factors/ relieving factors
Radiating or Relieving
Timing
Severity

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4
Q

yale observation scale for infants determine what

A

evaluate febrile status in urgent and nonurgent pediatric critical care (ages 3mo-36mo)

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5
Q

Yale Items

A

1) observation
2) reaction to parents
3) state variation
4) color
5) hydration
6) social response

Higher score indicates greater concern for bacteremia

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6
Q

when to seek medical attention urgently (11)

A

1) newborns and infants younger than 3 months with a fever above 100.4
2) significant change from normal behavior
confusion or delirium
-3) child is less responsive or alert or unconscious
4) seizure or abnormal shaking or twitching
-5)strange or withdrawn behavior
uncontrolled bleeding
6) cant stand or is unsteady when walking
7) breathing problems
skin or lips look blue
trouble feeding or eating
8) pain that gets worse, is persistent or is severe
9) severe headache or vomiting in injured head
10) fever that is persistent >3days
11)widespread rash

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7
Q

Acute sinusitis- A bacterial diagnosis requires the presence of one of the following criteria:

A

1) Persistent symptoms without improvement: nasal discharge or daytime cough >10 days.
2) Worsening symptoms: worsening or new onset fever, daytime cough or nasal discharge after initial improvement of a viral upper respiratory tract infection (URI).
3) Severe symptoms: fever ≥39°C, purulent nasal discharge for at least 3 consecutive days.

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7
Q

When do you prescribe VS wait with Acute Sinusitis?

What is the prefered ABX?

A

1) watchful wait for 3 days with persistent symptoms
2) prescribe ABX if sx are worsening or severe
3) ABX of choice- Amoxicillin or Augmentin

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8
Q

AOM diagnostic criteria (2):

A

1)Moderate or severe bulging of tympanic membrane (TM) or new onset otorrhea not due to otitis externa.

2) Mild bulging of the TM AND recent (<48h) onset of otalgia (holding, tugging, rubbing of the ear in a nonverbal child) or intense erythema of the TM.

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9
Q

preferred ABX for AOM

A

amoxicillin

Augmentin if recurrent AOM, or conjunctivitis as well.

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10
Q

Pharyngitis Diagnostic criteria:- to decide weather to test or not

A

sore throat plue 2 of the following sx:
- Absence of cough
- Presence of tonsillar exudates or swelling
- History of fever
- Presence of swollen and tender anterior cervical lymph nodes
- Age < 15 years

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11
Q

age of testing for GAS pharyngitis

A

ages 5-15 (no earlier than 3 years since GAS rarely causes pharyngitis in that age)

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12
Q

first line ABX for strep pharyngitis

A

amoxicillin

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13
Q

what is a RADT test

A

rapid antigen detection test

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14
Q

viral cold duration

A

normal length of cold: 5-7days
can last around 10 days

causative agents range over 200 viruses

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15
Q

bronchiolitis- causes, ages, and sx

A

usually caused by RSV, or viral in general

children <24 months old

rhinorrhea, cough, wheezing, tachypnea, increased WOB

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16
Q

bronchiolitis course and treatment

A

worsents day 3-5 after sx started and then improves

-nasal suctioning, no deep
-no abx
-albuterol or racemic epi can be used in clinic

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17
Q

pyrexia (fever) identified as:
Hyperexia is defined as:

A

38 degrees or 100 F
40 degrees or 104 F

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18
Q

misconceptions of fever:

A
  • fevers are dangerous
  • fevers can cause brain damage
  • treatment is always needed
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19
Q

truth about fevers

A
  • most fevers do not lead to long-term complications
  • severe cases can be exceptions
  • fever management varies
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20
Q

Options for temp taking: RECTAL

A

Rectal:
GOLD standard for neonates and infants
most accurate but invasive. used when precise measurement is critical. contraindications: neutropenia, bleeding disorders, NEC.

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21
Q

Options and ages for temp taking: Oral

A

ages 4-5 and older
less accurate than rectal
more accurate than axillary
influenced by mouth breathing and recent food/drink intake

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22
Q

Options for temp taking: axillary

A

safe for neutropenic patient
typically yields lower readings than rectal

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23
Q

Options and ages for temp taking: infrared

A

includes: tympanic and forehead
tympanic accuracy can be dependent on positioning and ear conditions
temporal reading can be influenced by environmental factors

24
Q

RED flags for Fever

A
  • age <1 month of age
  • toxic appearance regardless of age or fever degree
  • unreliable caregiver/historian
  • decreased urinary output
  • capillary refill >3 seconds
  • non blanching skin rash
25
Q

immunizations to look for in Hx when assessing fever

A

Hib and Pneumococcal

26
Q

benefits of a fever

A

decreases pathogen replication
enhances effectiveness of antimicrobial treatment
often self limited

27
Q

teaching points about fever

A
  • no damage to the brain below 107.8
  • fever itself is not dangerous
  • its a normal response to infection
28
Q

when to give medication VS when to NOT give medication for fever?

A
  • in a HEALTHY KID- fevers do not need medication less that 102 unless other symptoms are present
  • antipyretics may be needed for underlying conditions
29
Q

AAP guidelines and treatment for Infant Temp >38 who are “well appearing”- age 8-21 days

A

infants should receive the standard workup, including blood, urine, and CSF studies
- tx- not concerned for meningitis: ampicillin and gentamicin or ampicillin and ceftazidime
- concerned for meningitis: ampicillin and ceftazidime
- Admission to the hospital while BC grow

30
Q

AAP guidelines and treatment for Infant Temp >38 who are “well appearing”- 22-28 days

A
  • blood, urine, culture
  • infants should also be tested for abnormal inflammatory markers, which include height
    of fever, procalcitonin, absolute neutrophil count, and C-reactive protein. These tests can help
    determine the need for a lumbar puncture
  • infants can be sent home after a dose of ceftriaxone if CSF studies and inflammatory
    markers are normal
31
Q

AAP guidelines for Infant Temp >38 who are “well appearing”- 29-60 days

A
  • infants can avoid lumbar puncture entirely with normal inflammatory markers.
32
Q

urine workup details

A
  • UA interpretation: + leuk esterase, +nitrites, WBC>5 cells.
  • Bac UTI DX cannot be made until UA and Urine cultures are both +
33
Q

elevated inflammatory markers are defined as

A

Temp: >38.5
ANC > 4000-5200
CRP >20 mg/L

34
Q

fever of unknown origin definition and criteria

A
  • 38 degrees or greater on SEVERAL occasions
  • more than 3 weeks duration with failure to dx with 8 days of investigation
35
Q

common causes for fever of unknown origin (school age and adolescents)

A

school: infections , rheumatologic disease (arthritis), rarely leukemia

Adolescents: TB, IBS, autoimmune Dx, abscess, STD

36
Q

there is a range of low risk to high risk for fevering kids- what is one way you can determine risk right away?

A

almost always- child under 28 days of life is considered high risk.

37
Q

some odd questions to ask during history intake when there are RECURRENT fevers in kids:

A
  • family history: IBD, genetic conditions
  • pet/domestic animal exposure and their vaccine status
  • unusual diets including exotic meats
  • PICA?
  • travel details
38
Q

AOM defined

A

acute infection in the middle ear

39
Q

eustatian tube dysfunction

A
  • short, small and flat in kids causing issues from adenoids to middle ear
40
Q

key viruses and bacteria that cause AOM

A

V: RSV and influenza
B: S Pnumoniae, H influ., moraxella catatthalia, and s pyogens

41
Q

Dx requirments AOM

A

1) acute onset of middle ear inflammation and effusion
2)presence of middle ear effusion
3) signs and symptoms of middle ear inflammation

42
Q
A
42
Q

use of pneumatic otoscopy

A

if the membrane is bulging, no need for pneumatic otoscopy- Dx AOM

if the TM is RED with minimum other symptoms, perform pneumatic otoscopy.

If it moves, its probably red from crying and or fever

if no mobility, DX AOM

43
Q

treat VS observe

A
44
Q

aom ABX

A

amoxacillin 80-90mg/kg/day

45
Q

AOM failed 48-72 hrs of tx

A

augmentin THEN ceftriaxone IM 3d

46
Q

AOM and conjunctivitis combined ABX tx

A

augmentin

47
Q

penincill allergy options AOM

A

cefdinir, cefuroxime, cefpodoxime

failure- then ceftriaxone IM 3d

48
Q

dosing lengths for AOM

A
49
Q

MEE dx

A

middle ear effusion is fluid in the middle ear with NO signs of infection

50
Q

MEE treatment

A

saline rinse and symtom tx and then reevaluate in 3 months. if not resolved, can refer to ENT

51
Q

ENT refferal with MEE or AOM

A
52
Q

when would you consider adenoid hypertrophy for AOM/MEE causation?

A

> 4 years with recurrent occurance

53
Q

URI: most contagious, when should resolve

A

first three days, shedding up to 2 weeks, should resolve by the end of 10 days of sx.

54
Q

age for cough medication

A

no younger than 4 years

55
Q

conjunctivitis prevention in the newborn

A

erythromycin ointment at birth, within the 1st hour to prevent gonorrhea in the eye

56
Q

bacterial conjunctivitis

A

starts unilateral, becomes bilateral

yellow/green discharge

crusted eyelids

57
Q

allergic rhinitis

A

severe itching and tearing

Peds Newborn- Adolescents (12 decks)

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