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. A child of 4 years during 5 days is treated because of acute shigellosis, moderate degree. An
effect from the therapy is insignificant; intoxication and dyspepsia still are present. Choose the
adequate treatment.

A. To strengthen oral rehydration

B. To apply parenteral rehydration therapy

C. To appoint netylmycin 7.5 mg/kg per day

D. To apply immune modulators therapy

E. To give enterosorbents

2. At the child of 4 months an acute shigellosis is diagnosed. Name reserve antibiotic which is
applied in treatment of moderate and severe degree dysentery at the children of this age:

A. Nifuroxazid

B. Gentamycin

C. Cefasolin

D. Ceftriaxon

E. Ciprofloxacin

3. At a child with the expressed signs of toxicosis with dehydration the acute severe shigellosis
is clinically suspected. Give feeding recommendations to the mother of her sick 10 months old
child.

A. To decrease the usual volume of meal in the first 2-3 days on 40-50 %, to conduct the
rejuvenation of food

B. Feed only by the strained breast milk

C. To give an advantage to the sour-milk adapted formulas

D. Water-tea pauses during 6-12 hours, and farther usual feeding

E. Frequent feeding by small portions, as a child wants to eat

Real situation to be solved:

1. A child, 5.5 years old, enters the infectious department from the kindergarten, where some cases of acute gastrointestinal infection were noticed. The disease has acute beginning: fever 39.5 °C, vomiting, abdominal pain, liquid feces, and defecation 15 times per day. Objectively: skin pallor, tachycardia, tenderness of abdomen in the left inguinal region, spasms of the sigmoid colon. Feces are in a small amount, predominantly mucus and blood.

1. Name main syndromes of the disease.

2. What infection is suspected?

3. What prophylaxis must be done in the kindergarten?

3. In a child, 7 years old, who is ill for 3 days, shigellosis with often defecation 20-25 times per day is present. A skin is pale, dry, elasticity is reduced, the body temperature is 38.9 °C, repeated vomiting, colicky pain are present.

1. Put the complete clinical diagnosis in this case.

2. When patient can be discharged from the department?

Answers for the self-control

Tests: 1. E; 2. B; 3. E; 4. B; 5. C; 6. C; 7.A; 8. D; 9. C; 10. B. Step: l.C:2.D:3.A. Real-life situation I:

1. Toxic, distal colitis.

2. Shigellosis, acute form.

3. Observation of contacts (thermometry, stools) inspection for 7 days. One feces culture in contacts. Disinfection.

Real-life situation 2:

1. Shigellosis, typical form, severe degree with prevalence of the local manifestations, acute course.

2. Clinically healthy after normalization of complete blood analysis and one negative fecal culture, done in 2 days after course of antimicrobial therapy.

Aids and material tools: Charts "Shigellosis", photo, video.

Result level Students must know:

1. Etiology, epidemiology, pathogenesis of Shigellosis.

2. Clinical features of Shigellosis.

3. Laboratory examination of patient with Shigellosis.

4. Differential diagnosis of Shigellosis.

5. Main treatment of Shigellosis.

6. Prophylaxis of Shigellosis. Students should be able to:

1. Separate anamnesis data which told us about Shigellosis.

2. Find diagnostic criteria of Shigellosis, while examining the patient.

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

4. To learn main tendentions of Shigellosis treatment.

5. To perform prophylaxis of Shigellosis.

Дата добавления: 2015-11-14