Exam (elaborations)
NURP 532 Exam 1 Latest Update @ 2024
- Course
- Institution
NURP 532 Exam 1 Latest Update @ 2024 ...
[Show more]
Content preview
NURP 532 Exam 1 LatestUpdate @ 2024
What is the standard temperature method for children under 3 years ago? How about
older children? What is the least accurate forms? - Answer - rectal- most accurate, but
invasive
- can use oral temperature afterwards
- axillary and tympanic not as accurate
T/F: the general appearance of the child/infant is a stronger indicator of an SBI (serious
bacterial infection) vs the degree of temperature elevation - Answer true
T/F: response to antipyretics should not be used to differentiate between serious and
non-serious illness; appearance should be used - Answer true
T/F: pts with viral infections tend to feel and look better than those with bacterial
infections - Answer true
What immunizations can prevent bacteremia? - Answer HiB or pneumococcal vaccines;
those without these will be at higher risk of bacteremia
What are s/sx of fever without focus? - Answer fever >100.4 F with no other localized
s/sx associated with it
How is fever without focus evaluated/diagnosed or evaluated? What are the special
groups that should get these evaluations as well? - Answer - acute fever of unknown
etiology/cause after thorough evaluation of a child less than 24 months
- infants and children who are ill or toxic appearing regardless of age or presence of
fever require sepsis work up
- those under 3 months old with fever (with or without source) needs (sepsis) full work
up despite known/unknown etiology due to high risk of serious bacterial infection
- rule out other diseases
What does the work up labs look like for those of fever without source for those under 3
months? What about those 3 months or older? What are the exceptions to the work up? -
Answer for those under 3 months:
- CBC with diff
,- serum glucose*
- CSF testing (to rule out meningitis)
- inflammatory markers (CRP and PCT)
- urinalysis/UA and urine culture- required for all infants under 3 months
- blood cultures
- chest x-ray if resp s/sx
- stool culture if diarrhea or blood or mucus in stool*
- for those 3 months or older: UA and urine culture is recommended for those with fever
>102.2 F, females less than 1 year, uncircumcised males, duration of fever greater than
24-48 hours, and absence of another infection; all other labs can be based on clinical
presentation and risk for SBI
exception to labs or work-up is not needed:
- when pt has viral infection like flu or RSV, no work up is needed for RSV; for flu, UA and
urine culture is recommended
- if infant had received an immunization within the past 24 hours and temperature is less
than 38.6 C/101.5 F
- monitor with close follow-up
if fever lasts more than 48 hours then further work up is needed
What are differential dx of fever without focus? - Answer - bacterial infections-
bacteremia, bacterial meningitis, bacterial pneumonia, skin infection, osteomyelitis,
bacterial gastroenteritis, septic arthritis, or UTI
- viral infections- enterovirus, influenza, RSV, rotavirus, adenovirus, herpes virus 6 or
parechovirus
- non-infectious disease- kawasaki disease, autoimmune/inflammatory disease related
to immunization.
How do you manage/treat fever without focus for children under 3 months? - Answer -
after labs- if child is low-risk (non-problematic labs like PCT under 1500 bands and
healthy) with reliable caregivers and follow up, then discharge home and close f/u in
12-24 hours; instruct parents to administer acetaminophen 10-15 mg/kg every 4-6 hours
as needed
- if not low risk (bad labs), child should be admitted and have CSF studies and receive IV
antibiotics
- if low risk, but unreliable caregiver or follow up, child should be admitted for
,observation; do CSF studies and antibiotics if it worsens
What are the red flags for a serious bacterial infection in an infant or child? Which age of
pediatric patients are at greatest risk for serious complications? - Answer - ill or toxic
appearing with or without fever
- skin is blue, mottled, or pale
- lethargic, weak, high-pitched cry, poor feeding, decreased response
- tachypnea or tachycardia
- cap refill more than 3 seconds
- decreased UO/urine output
- bulging fontanel
- non-blanching skin rash
- underlying health problem/prematurity
- unreliable caretakers
- greatest risk for SBI is under 3 months
What are the s/sx of fever of unknown origin (FUO)? - Answer temperature >100.4 F for
more than 2-3 weeks with failure to reach a diagnosis despite one week fo intensive
investigation via hx, physical exam, and noninvasive tests/labs
What hx do you collect for fever without source and unknown origin (FUO)? - Answer -
immunizations
- medical hx and meds
- ill contacts
- travel
- hx of fever pattern
- family hx of autoimmune dz or hereditary fever syndrome
- family pets or exposure to animals
- eating habits
- hx of pica (eating things that are not food) or travel
- insects
An 18-month-old male presents to your office with a temperature of 102.4. The parent
, says he has been feverish for the past few days with a slightly decreased appetite and
energy level, but otherwise no complaints. What are 5 differential diagnoses you would
consider as a common reason for fever in this age of patient? - Answer - enterovirus,
UTI, influenza, bacterial gastroenteritis, RSV
What diagnostic tests will you consider in a patient with fever of unknown origin? What if
labs come back normal? - Answer - CBC with diff
- blood culture
- BMP/CMP
- LFT*
- erythrocyte sedimentation rate (ESR) *
- C-reactive protein
- UA and urine cultue
- chest X-ray
(basically the same as fever without focus except for these *)
If normal, then further work-up required with infectious disease referral/consult- more
specific labs and imaging like ux, CT, or MRI
What treatments do you give for fever without source? Which is drug of choice? empiric
tx? what are tx contras? - Answer - empiric tx with antibiotics not recommended- can
delay and mask dx
fever management:
- acetaminophen is drug of choice 10-15 mg/kg every 4-6 hours, not to exceed 5 doses in
24 hours
- ibuprofen- use in children 6 months to 12 years old; every 6-8 hours of dose 5-10mg/kg
due to longer duration of action
- adequate hydration
Contraindications:
- do not bundle
- cold/tepid water bath should not be used due to increased shivering and temp risk
- no aspirin due to risk of Reyes syndrome
What are the indications for hospitalization in an infant or child with fever? - Answer - if
labs are abnormal and pt is not low risk, send to hospital
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Flat. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $10.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
75619 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now