Complaints and anamnesis taking in school age children

Algorithm of practical students' work

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: subfebrile, febrile temperature, rashes on the skin, mucous membranes, weakness, poor appetite, vomiting, arthralgias.

2. To collect anamnesis of the disease, epidemiological anamnesis:

? an acute beginning of the disease from hyperthermia, toxic syndrome, rashes appears on

the l^s,-2?^d day, gradually in several pushes;

? in 11-21 days before the disease contact with a patient who had the same disease (rare -

herpes zoster).

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 inforw 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:

? rashes on the skin (spots, papules, vesicles, crusts), their localization, color, color of the

surrounding skin. In case of complication - pustules, bullae, hemorrhagic vesicles and bullae, gangrene, phlegmon, abscess;

? rashes on hard and soft palate - papules, vesicles, erosions;

? purulent conjunctivitis;

? irritability, hyperesthesia, meningeal pose, instable in Romberg pose;

? signs of arthritis (tumor, rubor, calor, dolor et functio laesa).

B. Palpation:

? positive Kiering, Brudzinsky signs, nuchal rigidity, tender trigeminal points, hyperesthesia;

? painful passive movements in case of arthritis;

? enlarged cervical, occipital lymph nodes. 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: normal or leucopenia with relative lymphocytosis.

? Virology inspection: selection of virus and its' antigen from the vesicles, IF test, PCR.

? Serologic reactions: CBR with 4 times or more increasing of the antibody titre in dynamics.

? 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.

6. Side effects and find out whether they understand your explanations.

7. Conversation accomplishment.

6. To prescribe treatment: regime, diet, (in severe cases, immune compromised patients, congenital or complicated by CNS damage or hepatitis, thrombocytopenia, pneumonia - acyclovir), local antiseptic fluids, fever control, detoxication, corticosteroids (in severe cases), and symptomatic treatment, antibiotics in case of Bacterial complication.

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. In a child, 9 years old, who has Chickenpox, on 7^th day of the disease again has increased body temperature to 39.2 ?C, has appeared headache, vomiting, existed the shaky gait, declaimed speech. During examination was noted remaining elements of the rash (crusts), nuchal rigidity; the child is falling in Romberg pose. What complication is possible?

A. Polyneuropathy

B. Meningitis

C. Meningoencephalitis

D. Encephalomyelitis

E. Ventriculitis

2. The child, 4 years old, is ill for the 3^rd day. On the skin he has polymorphic rash: spots, papules, vesicles, some of them have purulent content, crusts. Body temperature has increased. Was diagnosed Chickenpox, complicated by pyodermia. What from enumerated medicine should be prescribed to tins child?

A. Genthamycin

B. Nifuroxazid

C. Gancyclovir

D. No one

E. Laevomycetin

3. The boy, 2 years old, became ill acutely. The disease has began from increasing of the temperature to 37.9 ?C, skin rash. On the third day physician has noted the rash on the face, scalp, trunk, arms, legs in the manner of spots, papules, vesicles with transparent content, crusts. What is the probable diagnosis?

A. Herpes simplex

B. Herpes zoster

C. Smallpox

D. Chickenpox

E. Lyell syndrome

Real situation to be solved:

1. To 5-year old girl was diagnosed: chickenpox, typical form, moderate degree. Before this twice a year she had viral upper respiratory tract infection.

1. Does she need acyclovir for the treatment?

2. What complications of chickenpox do you know?

2. The Physician is called to the boy, 5 years old. Patient is ill during 4 days: increased the temperature to 3 8.2 ?C, rash has appeared on skin since the first day of the disease. During examination is noted polymorphic rash (the papules, vesicles, crusts) on the whole body, there are several vesicles with purulent contents and hyperemia around them. He visits kindergarten.

1. Put clinical diagnosis.

2. What is the duration of quarantine in a group?

Answers for the self-control:

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

Real - life situation 1:

1. No, she is normal child.

2. Viral: pneumonia, croup, encephalitis, meningitis, myelitis;

Secondary: abscess, pustules, phlegmon, otitis, pneumonia.

Real - life situation 2:

1. Chickenpox, typical form, moderate degree, complicated by pustullosis.

2. From 9^th till 21^th day after the contact with ill boy.

Aids and material tools: charts "Chickenpox", photo, video.

Result level

Students must know:

1. Etiology, epidemiology and pathogenesis of chickenpox.

2. Clinical diagnostic features of chickenpox.

3. Laboratory examination of patients with chickenpox.

4. Differential diagnosis of chickenpox.

5. Main treatment of chickenpox.

6. Prophylaxis-of chickenpox. Students should be able to:

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

2. Find diagnostic features of chickenpox during examination of the patient.

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

4. To learn main tendentions of chickenpox treatment.

5. To perform prophylazis of chickenpox.

Date: 2016-06-13; view: 6