Complaints and anamnesis taking in newborns and infants

Algorithm of practical students' work

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Tactful and calm conversation with the parents of sick child.

5. Explanation of future steps concerning the child (hospitalization, some methods of examination, etc.).

Complaints and anamnesis taking in toddlers and preschoolers (children aged from 1 to 6 years)

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. By means of game playing find a contact with a child.

5. Tactful and calm conversation with the parents of sick child.

6. Explanation of future steps concerning the child (hospitalization, some methods of examination, etc.). Complaints and anamnesis taking in school age children

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Tactful and calm conversation with sick child his/her parents.

5. Explanation of further steps to child and his/her parents (hospitalization, some methods of examination, etc.).

1. To collect complaints: fever, weakness, headache, insomnia, poor appetite, nausea, vomiting, diarrhea, nasal congestion, sore throat, dry barking or moist cough, hoarseness of the voice, dyspnea, purulent exudates from ocular slots.

2. To collect anamnesis of disease, epidemiological anamnesis:

• an acute beginning of the disease from catarrhal, toxic syndrome;

• predominance of catarrhal phenomena above the intoxication;

• 2-7 days before the disease contact with a patient who had the same disease;

• the same disease in relatives. Conversation accomplishment.

3. To inspect a patient:

Physical methods of examination of newborns and infants

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Explain to the parents what examination should be performed and obtain there informed consent.

5. Prepare for examination(clean and warm hands, warm phonendoscope, etc.).

Physical methods of examination of toddlers and preschoolers

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Explain to the parents what examination should be performed and obtain there informed consent.

5. Find a contact with a child; try to gain his/her confidence.

6. Prepare for examination(clean and warm hands, warm phonendoscope, etc.).

Physical methods of examination of school age children

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Explain to the parents what examination should be performed and obtain there informed consent.

5. Find a contact with a child; try to gain his/her confidence.

6. Prepare for examination (clean and warm hands, warm phonendoscope, use the screen if necessary etc.).

A. Examination; hyperemia of the face, conjunctiva, injection of sclera's vessels, purulent exudates from ocular slots. Hyperemia and edema of palatal arch, back pharyngeal wall, graininess of back pharyngeal wall, tonsillitis with small effusion on tonsils. Great mucus and

purulent nasal discharge. Inspiratory dyspnea with the involvement of additional breathing muscles.

B. Palpation: enlarged cervical, submandibular, axillar, inguinal lymph nodes (in Adenovirus infection).

C. Percussion: bandbox sound, dullness.

D. Auscultation: harsh breathing, dry dissipated wheezes, tachypnea, tachycardia, arrhythmia, accentuation of the heart tones.

Conversation accomplishment.

Informing about the results of examination

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Explain to a child and his/her parents what examinations should be performed and obtain their informed consent.

5. Involve adolescent and his/her relatives in to the conversation (compare present examination results with previous ones, clarify whether your expectations are clear for them or not).

6. Conversation accomplishment.

4. To estimate the results of additional researches:

• Complete blood analysis: leucopenia, lymphocytosis with shift to the left, the ESR

acceleration.

• Virology inspection: selection of the viruses' antigens from the nasopharyngeal smears.

• Serologic reactions, RIF, IEA.

• Explaining the results of examination to child's parents.

• Conversation accomplishment.

5. To substantiate the diagnosis.

Planning and prediction of conservative treatment results

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Explain to child's parents the necessity of further treatment directions correctly and accessibly.

5. Discuss with parents and their child the peculiarities of drug intake, duration of usage, side effects and find out whether they understand your explanations.

6. Conversation accomplishment.

6. To prescribe treatment: regime, diet, etiologic treatment, antihistamines, detoxication, corticosteroids, and symptomatic treatment.

Informing about treatment prognosis

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Correct and clear explanation of expected results of treatment.

5. Discuss with the parents and their child the importance of continuous treatment, following the treatment scheme; make sure that your explanations are properly understood.

6. Conversation accomplishment.

Step

1. The child is 2 years old. Mother complains of nasal congestion, dry cough, increasing of the body temperature to 38 °C. The breathing is harsh, diffuse dry wheezes and moist small rales in both lungs. On chest x-ray - signs of emphysema. What is the most probable diagnosis?

A. Adenoviral infection

B. Rhinoviral infection

C. Influenza

D. Parainfluenza

E. Respiratory-syncitial infection

2. At a child the typical form of adenoviral infection is diagnosed clinically. At the objective inspection: temperature of body 3 8,3-3 8,7 °C, laboring nasal breath through the presence of mucous-purulent excretions in lower nasal ways, moderate hyperemia and edema of soft palate, tonsils, back pharyngeal wall is red with enlarged, bright follicles, moderately enlarged anterior and posterior cervical lymph nodes, hepatosplenomegaly. Name diagnostic criterion, which is absent here to put diagnosis of adenoviral infection.

A. Pneumonia

B. Mesadenitis

C. Conjunctivitis

D. Encephalitis

E. Nephritis

3. The child, 1 year old, is treated in infectious department with diagnosis Parainfluenza. On the 2nd day of the disease his condition became worse. The child is excited, inspiratory dyspnea, tachypnea, tachycardia, cyanosis of the lips, tip of the nose and fingers, cool perspiration has appeared. Intercostals' involvement is noted at breathing. What degree of larynx stenosis is present?

A. I

B. II

C. III

D. IV

E. V

Real situations to be solved:

1. A boy, 8 years old, has upper respiratory tract viral infection. On the 4-th day body temperature has increased to 39 °C. Dry cough became wet and more often, dyspnea has appeared. Lung sound is dull in lower parts of both lungs; during auscultation - crepitaton is present. Breathing rate is 32 per minute, cardiac rate - 126 per minute.

1. What is the cause of status worsening?

2. What must be done?

2. The child, 5 years old, is ill for 3 days. Body temperature increased to 39 °C; nasal discharge, eyes itching had appeared. Objectively: mild hyperemia of the nasal mucous membranes, back pharyngeal wall. Exists the palpebral edema, ocular slots are narrowed, tearing is present.

1. What is the most possible diagnosis?

2. Prescribe local treatment of conjunctivitis.

Answers for the self-control:

Tests: 1. B; 2. D; 3. C; 4. E; 5. C; 6. B; 7. A; 8. D; 9. B; 10. C.

Step: l.E2.C:3.C.

Real-life situation 1:

1. ARVI complicated by pneumonia.

2. Hospitalize and treat patient by antibiotics.

Real-life situation 2:

1.Adenoviral infection, typical pharyngoconjunctival form, moderate severity.

2. 0.05 % Desoxyrhibonuclease sol. 1-2 drops into the conjunctiva for 4-5 days.

Aids and materials tools: charts "Viral upper respiratory tract infections", photo, video "Croup syndrome".

Result level

Students must know:

1. Etiology, epidemiology and pathogenesis of ARVI.

2. Clinical diagnostic features of parainfluenza, RS-infection, rhinoviral, adenoviral infection.

3. Laboratory examination of patients with ARVI.

4. Differential diagnosis of ARVI in children.

5. Main treatment of ARVI.

6. Prophylaxis ofARVI.

Students should be able to:

1. Separate anamnesis data, which told us about risk factors ofARVI.

2. Find diagnostic clinical criterions ofARVI during examination of the patient.

3. To perform differential diagnosis among diseases, which have the identical clinical features.

4. To learn the main tendentions ofARVI treatment.

5. To perform prophylaxis ofARVI.

Дата добавления: 2015-10-29