Acute Ilness Inclass (no panopto) Flashcards
(44 cards)
When should children seek medical care for dehydration?
-Dry mucous membranes
-crying without tears
-no UOP for 4-6 hours
-sunken eyes
-blood in stool
-abdominal pain
-vomiting for >24hrs
-fever > 103
-lethargy
-polyuria (DKA)
How to treat dehydration in children?
Oral rehydration/fluid replacement
-Pedialyte®, Rehydralyte®, Enfalyte®, CeraLyte®
contains electrolytes and some sugar (enhances water and sodium absorption)
What is the common dose of IV bolus for dehydration?
IV bolus 20 ml/kg of 0.9%, max 1000 ml
up to 30-60 min
Fluid doses by weight
<10 kg: 100 ml/kg
maintenance: 4 ml/kg/hr
11-20 kg: 1000ml + 50 ml/kg for each kg > 10
-> maintenance: 40 ml/hr + 2 ml/kg/hr
> 20 kg: 1500ml + 20 ml/kg for each kg > 20
-> maintenance: 60 ml/hr + 1 ml/kg/hr
Calculating fluid deficit (in Liters)
% dehydration x weight (Kg) = #Liters needed
Drugs for acute pain
strong pain: Strong opioids (morphine, fentanyl) -> weaker opioids (Morphine)
weak pain: NSAIDs or Tylenol
At what age does a newborn have the PK/PD activity as an adult?
age of 1
Which drugs for pain are restricted by the FDA in children?
-codeine
-cough medicine
-tramadol
What are the treatment goals for the common cold in children?
-Symptomatic relief (congestion and cough)
-Hydration
What are the non-drug therapy options for the common cold?
-Vaporizer (cool mist only)
-Warm juice or lemonade
-Honey (in those > 1 year)
-Nasal aspiration
Pharmacotherapy for the common cold
-Antihistamines, antitussives, decongestants,
expectorants, and analgesics
Babies of which age should NOT use cough and cold meds?
not recommended for babies under 6 years
-lack of data supporting use
-parents overdosing
-ADE: CNS stimulation/depression, lethargy, tachycardia, hallucination, hyperactivity
OTC products to recommend in the common cold
-Suctioning of nasal secretions with a bulb syringe
-Saline nose drops or spray
-topical decongestants
-Honey for cough only in kids > 1 year of age (due to infant botulism -> weakness, constipation)
-Tylenol or NSAIDs for pain
Cough in babies is usually NOT treated, when should treatment be considered?
-Cough leading to consecutive nights of poor
sleep and/or vomiting
-Cough leading to rib fractures
-Cough severe enough to lead to hypoxia
Treatment for irritant cough
-Nasal saline
-Increased humidification
-Honey (older than 1)
-Vapor rub (not in asthmatics bc menthol, and eucalyptus can trigger asthma)
-Antihistamines (for post-nasal drip)
-Albuterol/inhaled corticosteroids
-Dextromethorphan, guaifenesin, benzonatate (>10)
When is a patient considered constipated?
<3 bowel movements a week
>1 episode of fecal incontinence
-history of excessive stool retention
-painful bowel movement
-large fecal mass
-large diameter stool blocking the toilet
must meet 2 of these criteria for 1 month or longer
Definition of Encopresis and Soiling
Encopresis: Involuntary or voluntary passage of stool at regular intervals
Soiling: Involuntary passage of stool
Which diseases can cause constipation in children?
-Hirschprungs disease (segment of the colon without peristalsis)
-high Ca+
-low thyroid
-cows milk allergy
-anatomic (perianal fistula)
-CF (cystic fibrosis)
Which drugs cause constipation?
Opiates, Phenobarbital, Antacids
What helps for constipation in children?
-Toilet training methods
-behavioral
Drugs:
Miralax: 17 g PO Q1H while awake for “cleanouts”
Golytely if severe
OTC: senna, sorbitol, bisacodyl, docusate, rectal suppositroies, enemas
What temperature is considered a fever?
-rectal temperature: >100.4° F (38°C)
-Ear temperature: >100.4° F (rectal mode), >99.5°F (37.5°C) in oral mode
-Oral temperature: >99.5°F (37.5°C)
-Temporal artery: >100.4° F (38°C)
Which temperatures are considered core temperature?
Rectal, ear, temporal artery -> if over 100°F it is fever
rectal is more accurate
What is the most common cause of fever in children?
Infections, UTIs most common
sometimes with vaccines
How to use different thermometer
rectal:
-apply petroleum jelly on the thermometer
-Gently insert the thermometer into the child’s anus ¼ to ½ inch
-hold for 2 minutes (glass thermometer), or 1 minute (digital)
Oral: don’t use if they had a hot or cold drink, place it under the tongue and close your mouth for 3 minutes (glass thermometer), 1 minute (digital)
Temporal: uses an infrared scanner to measure the temperature of the temporal artery on the forehead (may be better than ear thermometer)
Axillary: place under the armpit for 4-5 minutes
Ear: keep inside the ear for 15 minutes (not reliable for children under 6 months)
When should treatment for fever in children be considered?
-Underlying medical problem
-History of febrile seizures
-Child is uncomfortable
if the child has a high temperature (>100°F) but looks fine do NOT treat
