Week2 R

What are 5 questions you would ask the mother next?

1. How high was the temperature and how was it taken (eg, rectal, temporal, axillary, or not taken at all, just by touch)?

2. Any home meds given for fever or is the patient taking any medication OTC or prescribed?

3. How much is the patient feeding and wetting diapers daily?

4. Any recent exposure to anyone sick or does patient attend daycare?

5. How many times did the patient have diarrhea in a day and describe stool for any blood and color?

What additional signs/symptoms would alert you that this infant may need to be transferred to the ER?

-Dehydration

– Failure to Thrive

-Continuous vomiting and labs as indicated

-Any child with fever and petechiae and who appears very ill.

According to Burns ,Dunn, Brady, Starr, Blosser, & Garzon (2017) symptoms that would prompt emergency care include: a change in or new rash, duskiness, cyanosis, or mottling of the skin. Coolness of the extremities, poor feeding or vomiting, irritability, cries with positional changes, difficulty in comforting or arousing, seizure activity and bulging anterior fontanelle.

What are your top 3 differential diagnoses

1. Rotavirus

2. Acute Gastroenteritis

3. Bacterial Gastroenteritis

Rotavirus has an acute onset of fever, vomiting and watery diarrhea occur 2 to 4 day later in children <5 years old, especially those between 3 to 24 months old (Burns et al., 2017).

Reference

Burns, C. E., Burns, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (2017). Pediatric primary care(6th ed.). St. Louis, MO: Elsevier.

Week 2 Discussion Question

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Shana Henderson posted Mar 12, 2019 3:06 PMSubscribe

A 6 month old male patient presents to your clinic with his mother. The mother’s chief complaint is that the baby has had a fever and diarrhea for several days and is not nursing as much as usual. The infant is quiet and warm, lung sounds are clear, heart sounds normal. No medical history, born healthy at 39 weeks 5 days via uncomplicated vaginal delivery, he is exclusively breast fed and is up-to-date on his vaccinations.

5 questions to you would ask the mother?

1. How high was the temperature and what have you been giving to treat the temperature?

2. Anyone else in the family sick?

3. Does the child attend daycare?

4. How many episodes of diarrhea does the child have per day? Is there any blood in the diarrhea?

5. How many wet diapers per day are you changing?

What additional signs/symptoms would alert you that this infant may need to be transferred to the ED?

Additional signs and symptoms that would alert me that the infant may need to be transferred to the ED would include a high fever >39C, the infant is lethargic or difficult to arouse, the infant is not producing any tears/dry mucus membranes, persistent vomiting, tachycardia, increased or decreased respirations, decreased urine output, poor muscle tone, delayed capillary refill, pale cool skin, irritability, sunken eyes and sunken fontanelles.

Top 3 differential diagnosis:

1. Viral gastroenteritis

2. Bacterial gastroenteritis

3. Parasitic gastroenteritis

Gastroenteritis in children is a major cause of morbidity in the United States (Churgay, C., & Aftab, Z., 2012). It is defined as the onset of diarrhea in the absence of chronic disease, with or without fever or pain. It is common in children under the age of 5. The rotavirus is the number one cause of diarrhea and hospitalization in young children. After rotavirus, bacteria such as salmonella and shigella are also responsible for acute gastroenteritis in children under 5 years of age. A small percentage of gastroenteritis are caused by parasites such as Giardia intestinalis and Cryptosporidium. It is important that children who are suffering from acute diarrhea be treated as soon as possible to prevent dehydration. Oral rehydration should be the initial treatment if the child is mildly dehydrated. If oral hydration can be tolerated, commercially prepared oral hydration would be appropriate, as long as the child is not vomiting. The caregiver should start out by giving small amounts of liquid then increase as the child tolerates it. In cases where the child has severe dehydration, the infant should be taken to the ER where intravenous fluids can be administered and the child can be monitored for hemodynamic stability (Cochran, W., 2017). Prevention of gastroenteritis starts with proper hand washing. It is important to teach children and caregivers how to properly wash their hands and inform them to avoid improperly stored food as well as contaminated water.

Reference:

Gastroenteritis in Children – Children’s Health Issues. (n.d.). Retrieved from https://www.merckmanuals.com/home/children-s-health-issues/digestive-disorders-in-children/gastroenteritis-in-children

Gastroenteritis in Children: Part 1. Diagnosis. (n.d.). Retrieved from https://www.aafp.org/afp/2012/0601/p1059.pdf

Compare Physical Assessment Of A Child To That Of Adult

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