Week 9 Content Flashcards
Sick child history includes gathering what information?
- 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
Patient information to gather for a sick visit- think if you were seeing them in an urgent care setting:
- 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
Pain/ symptom Mnumonic
Onset
Location
Duration
Characteristic
Alleviating factors/ relieving factors
Radiating or Relieving
Timing
Severity
yale observation scale for infants determine what
evaluate febrile status in urgent and nonurgent pediatric critical care (ages 3mo-36mo)
Yale Items
1) observation
2) reaction to parents
3) state variation
4) color
5) hydration
6) social response
Higher score indicates greater concern for bacteremia
when to seek medical attention urgently (11)
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-5)strange or withdrawn behavior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
Acute sinusitis- A bacterial diagnosis requires the presence of one of the following criteria:
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.
When do you prescribe VS wait with Acute Sinusitis?
What is the prefered ABX?
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
AOM diagnostic criteria (2):
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.
preferred ABX for AOM
amoxicillin
Augmentin if recurrent AOM, or conjunctivitis as well.
Pharyngitis Diagnostic criteria:- to decide weather to test or not
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
age of testing for GAS pharyngitis
ages 5-15 (no earlier than 3 years since GAS rarely causes pharyngitis in that age)
first line ABX for strep pharyngitis
amoxicillin
what is a RADT test
rapid antigen detection test
viral cold duration
normal length of cold: 5-7days
can last around 10 days
causative agents range over 200 viruses
bronchiolitis- causes, ages, and sx
usually caused by RSV, or viral in general
children <24 months old
rhinorrhea, cough, wheezing, tachypnea, increased WOB
bronchiolitis course and treatment
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
pyrexia (fever) identified as:
Hyperexia is defined as:
38 degrees or 100 F
40 degrees or 104 F
misconceptions of fever:
- fevers are dangerous
- fevers can cause brain damage
- treatment is always needed
truth about fevers
- most fevers do not lead to long-term complications
- severe cases can be exceptions
- fever management varies
Options for temp taking: RECTAL
Rectal:
GOLD standard for neonates and infants
most accurate but invasive. used when precise measurement is critical. contraindications: neutropenia, bleeding disorders, NEC.
Options and ages for temp taking: Oral
ages 4-5 and older
less accurate than rectal
more accurate than axillary
influenced by mouth breathing and recent food/drink intake
Options for temp taking: axillary
safe for neutropenic patient
typically yields lower readings than rectal