Physical methods of examination of school age children

Complaints and anamnesis taking in newborns and infants

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, chills, weakness, headache in frontal-temporal areas and areas of superciliary arcs, insomnia, muscular pain, pain in joints, in eyeballs, tearing, photophobia, poor appetite, nausea, nasal congestion, sore throat, dry hocking cough.

2. To collect anamnesis of disease, epidemiological anamnesis:

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

• predominance of intoxication above the catarrhal phenomena;

• 1-2 days before the disease contact with a patient who had flu;

• presence of the flu epidemic.

• 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. Hyperemia and edema of palatal arch, back pharyngeal wall, graininess of back pharyngeal wall. Petechia on pharyngeal mucosa, face, bleeding from mucosa. Cold.

B. Percussion: dilation of cardiac dullness borders.

C. Auscultation: harsh breathing, dry dissipated wheezes, tachypnea, tachycardia, arrhythmia,
deafness of the heart tones, systolic murmur on the apex.

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, relative lymphocytosis, the ESR acceleration.

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

• Serologic reactions: RIF, 1EA, BHAR, CBR.

• 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.

Steps

1. The child is 7 years old. He has influenza for 5 days. The condition of the child sharply worsened. Breathing - 30 in 1 min.; cyanosis of perioral triangle; in lower parts of the lungs, more in the right, dullness of the lung sound, moist small rales. What complication of influenza is possible?

A. Croup syndrome

B. Pneumonia

C. Meningitis

D. Myocarditis

E. Obstructive bronchitis

2. The child, 2 years old, is treated from influenza. His condition suddenly became worse: the body temperature has increased to 39.8 °C, has appeared rough barking cough, hoarseness of the voice, expressed inspiratory dyspnea. What complication of influenza has developed?

A. Pneumonia

B. Bronchiolitis

C. Croup syndrome

D. Obstructive bronchitis

E. Pharyngitis

3. The child is 10 years old. He has influenza for 4 days. The body temperature is 40.2 °C. The child complains of headache, expressed weakness, vomiting. Objectively: child is faded, positive meningeal signs, denominated hemorrhagic syndrome. What form of the influenza does this child have?

A. Typical, catarrhal

B. Typical, subtoxic

C. Typical, toxic

D. Atypical, hypertoxic

E. Atypical, fulminant

Real situation to be solved:

1. Aboy, 10 years old, is hospitalized with diagnose of acute respiratory disease. Body temperature is 39.8 °C. The boy complains of headache, myalgia and malaise, pain with eye movement, dry cough. During examination: flashing face, tearing, photophobia, and hemorrhages on face, neck. At night he had nasal bleeding.

1. How to prove the etiology of the disease?

2. What antiviral treatment should be performed?

2. In the child, 7 years old who is ill for 3 days, disease has acute beginning, with increasing of the body temperature to 39 °C. Objectively: hyperemia of the face, injection of sclera vessels, moderate cyanosis of the lips. During examination of the oral cavity exists maculous exanthema on soft palate, graininess of the back pharyngeal wall. The skin is clean, pale; tachycardia is present.

1. What disease is most probable in this case?

2. How to differentiate it from measles (by the clinical features)?

Answer for the self-control:

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

Steps: l.B;2.C;3.D.

Real -life situation 1:

1. By immunofluorescence or ELISA -method.

2. Remantadine 50 mg per mouth 2 times daily for 4-5 days.

Real -life situation 2:

1. Influenza, typical toxic form, moderate degree.

2. Absence of conjunctivitis, laryngotracheitis and Koplick's spots in the patient.

Aids and material tools: Charts "Influenza", photos, video. Result level

Students must know:

1. Etiology, epidemiology and pathogenesis of influenza.

2. Clinical diagnostic features of influenza.

3. Laboratory data in patient with influenza.

4. Differential diagnosis of influenza in children.

5. Main treatment of influenza.

6. Prophylaxis of influenza. Student should be able to:

1. Separate anamnesis data, which told us about influenza.

2. Find diagnostic clinical criteria of influenza during examination of patients.

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

4. To learn main tendentions of the influenza treatment.

5. To perform prophylaxis of influenza.

Date: 2015-12-24; view: 879