CMN 568 FINAL QUESTIONS & ANSWERS WITH COMPLETE SOLUTIONS | LATEST UPDATE

CMN 568 FINAL QUESTIONS & ANSWERS WITH COMPLETE SOLUTIONS | LATEST UPDATE Incidence of Fever - ANSWER One of most common reasons for parents to seek medical care. Preschoolers have an average 6-8 febrile illnesses a year. Definition of fever - ANSWER Rectal temperature ≥ 100.4°F Tympanic temperature - ANSWER Not accurate in infants under 3 months Fever Causes - ANSWER Most common Benign viral illness, can also caused by bacterial or fungal infections, drug reactions including immunizations, malignancies, autoimmune or metabolic disorders, CNS disorders, excessive environmental temperatures. Factors that increase likelihood of serious bacterial illness - ANSWER Age under 3 months, history of prematurity, chronic medical conditions such as immunosupression or aspenia, previous hospitalizations, daycare. Toxic appearance Non-Toxic appearance - ANSWER Strong cry Consolable Alert and easy to arouse Pink skin tones Good hydration; good turgor, tears, moist mucous membranes Smiles, responsive to environment Toxic appearance - ANSWER Weak or high pitched cry Inconsolable Difficult to arouse Pale, ashen, cyanotic, or mottled skin tones Poor hydration; poor turgor, dry mucous membranes, no tears No smile, listless, dull, infant won't alert to environment Signs of serious illness - ANSWER Fever greater than 40 (105) Nuchal rigidity Petechial skin rash Seizure activity Stridor or increased WOB Physical exam signs of serious infection: Skin - ANSWER Petechiae, rashes Physical exam signs of serious infection: head/neck - ANSWER Sunken or bulging fontanelles, nuchal rigidity Physical exam signs of serious infection: ears - ANSWER Bulging TM, AOM, mastoiditis Physical exam signs of serious infection: Chest - ANSWER Tachypnea, wheezing, rales, rhonchi Physical exam signs of serious infection: Heart - ANSWER Murmurs Physical exam signs of serious infection: Abdomen - ANSWER Tenderness, distension Physical exam signs of serious infection: Musculoskeletal - ANSWER Refusal to bear weight or use an extremity, erythema/warmth over joint Diagnostic tests for fever in infant and young child - ANSWER CBC w/ Diff (WBC > 15,000 may indicate SBI. Child with overwhelming sepsis my have WBC <5,000) UA/ C&S: R/O UTI CXR: R/O Pneumonia Lumbar Puncture: R/O meningitis Blood cultures: R/O Bacteremia Stools for C&S: R/O Infectious diarrhea Management of fever in infant < 4 weeks - ANSWER Refer to pediatrician Hospitalization Full septic workup IV antibiotics pending culture results Management of fever in infant 4 weeks - 3Mo - ANSWER Toxic appearance: Refer to pediatrician Hospitalization Full septic workup IV antibiotics pending culture results Non-Toxic appearance/No risk factors for SBI: Full septic workup Specific treatment for any diagnosed conditions Empiric antibiotics after cultures: Rocephin 50mg/kg/day (up to 1 gm max) Must have reliable caregiver with phone and transportation Close followup in 24 hours Management of fever in 3Mo to Preschool - ANSWER Toxic appearance: Septic work up Consider hospitalization and IV antibiotics, especially if no focal source of fever can be identified Non-Toxic appearance: Lab work up guided by H&P CBC with Diff CXR if cough or dyspnea Stool C&S if diarrhea UA: all girls under 2yo, all males under 6Mo, uncircumcised males under 12Mo Non-Toxic appearance: Fever <39 (102) no obvious source: Antipyretics, close followup by visit or phone Fever >39 (102) antipyretics, consider empiric antibiotics, close followup by visit or phone Antipyretic - ANSWER Acetaminophen: 10-15mg/kg Q 4-6 Hrs (Max 5 doses in 24 hours) Ibuprofen: 5-10mg/kg Q 6-8hrs (max 40mg/kg/day) Never use aspirin Educate parents on risk of overdosing and review concentration information. Fever-Home Care - ANSWER Increased fluids to maintain hydration Light clothing/bla