Neonatal Sepsis Flashcards
(16 cards)
You are the doctor on call in the pediatrics unit when a mother brought her 4 day old baby to the hospital because he has been refusing to feed, has had intermittent fever,
and developed convuisions earlier .
Take a focused history from the mother.
GRIP
Greet: Good day Sir.. Good day Ma Rapport: how are you doing today
Introduce : My name is “insert name “ I am a candidate of the ongoing mdcn exam, for the purpose of the exam, I have been tasked to ask you some questions
Permission: please may I proceed
BIODATA (NASORATI)
Name: what is this child’s name
Age: how old is he
Sex please confirm that this is a male child
Occupation : what do his parents do for a living
Religion: what religion do the parents practice
Accress . where do the parenis live
Tribe: What tribe are the parents
Informant: can you confirm your relationship to this child
5C
Presenting complain
What bought you to the hospital
I see here that you are complaining that your baby has refused to feed, also had intermittent fever and convulsion, is that correct? Which one started first?
GRIP
Greet: Good day Sir.. Good day Ma Rapport: how are you doing today
Introduce : My name is “insert name “ I am a candidate of the ongoing mdcn exam, for the purpose of the exam, I have been tasked to ask you some questions
Permission: please may I proceed
BIODATA (NASORATI)
Name: what is this child’s name
Age: how old is he
Sex please confirm that this is a male child
Occupation : what do his parents do for a living
Religion: what religion do the parents practice
Accress . where do the parenis live
Tribe: What tribe are the parents
Informant: can you confirm your relationship to this child
5C
Presenting complain
What bought you to the hospital
I see here that you are complaining that your baby has refused to feed, also had intermittent fever and convulsion, is that correct? Which one started first?
History of presenting complain
Refusal to feed ( DOCTOR)
Duration: how long has he been refusing to feed
Onset: did it start suddenly or gradually
Character: is the baby completely refusing to feed or just taking less than usual
Time: is the feeding difficulty worse at certain times or persistent through out the day
Other symptoms: has there been excessive crying, weakness
Related: any vomiting or difficulty sucking
Fever ( DOCTOR)
Duration: when did first notice the fever
Onset: did it start suddenly or gradually
Character: is it low grade or high grade? Did you confirm with a thermometer what were the values ?
Time: is the fever constant? Does it get worse at any specific time
Other symptoms : chills. shaking or excessive sweating
Related: any rash, any diarrhea or vomiting
Convulsion ( DOCTOR)
Duration: how many episodes has he had so far? How long did they last
Onset: did it start suddenly
Character
Preictal: where there warning signs like abnormal movement or irritability
Ictal: were the convulsions generalized ( affecting the whole body ) or localized affecting one part of the body ). Did the baby stop breathing or turn blue during the convulsion
Postictal: was there excessive sleepiness or weakness afterwards. Did the baby defecate or urinate immediately after.
Causes
1) meningitis: any stiffness, excessive crying or irritability or swelling on their head
2) Pneumonia: any fast breathing, grunting, chest retractions
3) Congenital malaria: did you have malaria close to your delivery, did you take your preventive medication for malaria
4) Cord Sepsis - has there been any foul smelling umbilical discharge. has here been any rashes or pustules around the umbilical stump
5) Chorioamnionitis :Did you have any infection close to your delivery. how long did the labor last Was there any drainage of fluid days or hours before labor
6) Metabolic causes : ( hypoglycemia) how often do you feed the baby?
7) Birth asphyxia : did the child cry immediately after birth
8) Congenital infections: did you attend your
ANC for this pregnancy. Did you do all your prenatal investigations
were they all negative? Did you have any fever, rash, or illness during your pregnancy
9) Traditional practice : were there any scarification marks made on the baby or any local concoction given?
Complications
complications
1) Septic shock: has the been excessively cold or sweaty have vou noticed reduced urination or excessive weakness
2) Hydrocephalus: is his head size rapidly increasing
3) Jaundice: any discoloration of the skin or eyes
4) Respiratory failure : any signs of bluish lips, grunting or difficulty breathing
5) Disseminated
Any unusual bleeding? From umbilical cord or other sites?
Care so far
what have you done so far for this condition have you taken any herbal concoction or medication
have you visited any prayer house. pharmacy or hospital
have you done any investigations
Pregnancy history
Was this pregnancy booked for antenatal
Did you have any infections during your pregnancy
Was the delivery at term
Was it via vaginal or cesarean section
If vaginal was it spontaneous or induced
Did the baby cry immediately after birth
Was the baby admitted immediately after birth
Nutritional history
(Is this child been exclusively breastfed, how often do you feed him? are you making enough breast mIlk? Do you extract your breast milk and
use the feeding bottle to feed
Did you give your baby breast milk only for the first six month
When did you introduce other foods
Frequency- now many times does he eat in a day
Adequacy - does he eat and ask for more
Density - does his meal contain all the classes of food in the right proportion
Utility: do you think your child is growing well
Immunization history
Immunization history
Has the child received all his immunization for his age
Do you have his vaccination card with you? Can see IT
Did he have any reaction to the vaccine?
Developmental history
DIa he cry immediately after birth
Does he suckle well, does he move all his limbs properly, did he open his eyes,
when did he start smiling
When did he start smiling
When did he start siting or standing without support
When did he start walking or talking what class is he in,
what is his performance at school.
how does he relate to this school mates-older child
Past medical history
Was he hospitalized after birth
Any resuscitation after birth
Any oxygen therapy or blood transfusions
Any medication given after birth
Social history
What kind of house do you live in
what is your source or water supply
Who takes care of his feeding bottle
Where do you store your food or water
What kind of toilet do you use
What kind of house do you live in? how many occupants in each room, how many windows
What is your highest level of education, what do you do for a living
Drug history
Is he on any long term medication
Is he on any current medication
Does he have any drug allergy
REVIEW OF SYSTEM
CnS: any loss of consciousness, irritability
Endo : any neck swelling, any excessive sweating
Respiratory: difficulty breathing, bluish lips
Cardiovascular : leg edema, cough, fast breathing
Digestive: diarrhea abdominal bloating, blood in stool
GUS: blood in urine , pus in urine, no urination
MSS: joint swelling joint stiffness
