PACES paeds Flashcards
1
Q
Neonatal jaundice counselling
A
- explain that neonatal jaundice is common
- if <1 or >14 days you will investigate cause
- if physiological explain why happens
- treatment = light therapy
- explain light therapy is not harmful but eyes will be protected and blood samples taken regularly
- encourage frequent breastfeeding (every 3 hours) and wake baby to feed
- need to stay in after phototherapy has stopped to check rebound hyperbilirubinamia
- resources: NHS Choices neonatal factsheet, Breastfeeding network, Bliss (for premature and sick babies)
2
Q
Asthma counselling
A
- explain is a condition where airways are very sensitive and can tighten suddenly making it difficult to breath
- explain step in treatment (whether steroids are needed)
- discuss asthma action plan (carry blue inhaler everywhere, use up to 10 puffs every 30-60 seconds when breathless)
- if no response = ambulance
- explain how to use peak flow meter
- advise on identifying triggers
- support: Asthma UK and itchywheezysneezy.co.uk
- F/U within 2 days
3
Q
Bronchiolitis counselling
A
- explain is common chest infection that affects 1 in 3 children <1 year
- usually gets better by itself over 2 weeks
- advise to maintain good hydration and use paracetamol if child >3 months and distressed
- safety net to call ambulance or come to A&E if significant resp distress or apnoea
- refer to NHS webpage on bronchiolitis
4
Q
cows milk protein allergy counselling
A
- explain that is allergic reaction to some of proteins in milk
- is common (5-15% of infants)
- treatment is simple: mum to avoid cows milk if breastfeeding or hypoallergenic formula in bottle feeding
- consider Ca and Vit D supplement
- takes 2-3 weeks to eliminate cow milk out of breast milk
- many children will grow out of it
- review in 6-12 months, consider reintroducing using steroid ladder
- advise regular growth monitoring
- Support: British Dietetic Association has fact sheet
5
Q
croup counselling
A
- common infection of the airways
- gets better over 48 hours and steroids given to help that
- if gets worse, come back
- if child becomes blue/very pale for more than a few seconds, more sleepy, breathing difficulties = call ambulance
- paracetamol or ibuprofen if distressed
- advise good fluid intake
- regularly check on child at night as cough is worse then
6
Q
CF counselling
A
- lifelong condition characterised by recurrent infections and malabsorption
- management requires MDT approach
- referred to specialist CF centre to discuss ongoing management
- outlines of Mx
Pulmonary = physio, mucolytics
Infection = prop Abx, monitoring
Nutrition = high calorie, enzyme tablets, monitor growth
Psychosocial = support for child and carer - info on genetic counselling if having more children
7
Q
food allergy counselling
A
- body’s immune system reacts to substances that are not harmful to other people
- mainstay of treatment is strict avoidance of allergen
- allergy action plan
- some children grow out of allergies
- use of non-sedating antihistamines and adrenaline
- nuts/seafood more likely to persist through adulthood
8
Q
pneumonia counselling
A
- explain is a chest infection
- explain whether admission needed
- treat with antibiotics
- use paracetamol if distressed
- ensure adequate fluid intake
- advice against parental smoking
- check child regularly during day and night
- seek medical advice if child deteriorates (inc resp distress, reduced responsiveness)
9
Q
tonsillitis counselling
A
- explain is tonsillitis
- importance of taking abx for 10 days even if symptoms get better in that time
- avoid school until 24 hours after starting Abx and child feeling well
- advice on use of paracetamol, lozenges, saltwater, difflam
10
Q
viral induced wheeze counselling
A
- narrowing of airways due to viral chest infection causes difficulty breathing
- inhaled medications help open up airways and make you breathe easier
- child monitored for 4 hours to see whether they can be symptom free for 4 hours after episode
- discharge with salbutamol and spacer
- 10 puffs through spacer max of every 4 hours
- if no response after 10, seek help
- if symptomatic 48 hours after discharge seek help
11
Q
whooping cough counselling
A
- cough that lasts for reasonably long time
- explain that isn’t seen very often because of immunisation programme (discuss concerns about immunisation with parent)
- explain that having it once does not mean you can’t have it again
- explain that antibiotics can help treat condition but cough often persists for long time
- exclude from school until 49 hours after starting antibiotics
12
Q
coeliac disease counselling
A
- explain caused by inability to digest gluten (present in barley, rye, wheat)
- reassure that is common condition (1 in 100) and treat is straight forward (gluten-free diet)
- we will put you in touch with dietician
- importance of keeping to strict gluten free diet (complications include malnutrition and cancer)
- F/U necessary every 6-12 months
- advise regular measurements of height and weight on centile charts
- support: coeliac
13
Q
Chron’s counselling
A
- explain disease with unknown cause that causes inflammation of digestive system leading to malabsorption and bloody diarrhoea
- life-long condition, always risk of relapse
- many medications can be used to settle down inflammation any time it flares up
- seen by gastroenterologist
- complications = malabsorption and bowel cancer
- no special diet but find certain foods will make it worse
- support: Chron’s and Colitis UK
14
Q
GORD counselling
A
- explain due to immaturity of gullet leading to food coming back back the wrong way
- is common and gets better with time
- breastfeeding: offer assessment –> alignate therapy
- formula: review feeding history –> smaller, more frequent feeds –> thickeners –> alignate therapy
- safety net: keep eye on vomit (if blood stained or green seek medical help)
15
Q
intussusception counselling
A
- caused by telescoping of bowel and typically occurs in young children
- if needed reduction, explain
- NG tube aspiration may be needed
- supportive treatment (fluids and antibiotics)
- explain possibility of needing operation if rectal air insufflation is unsuccessful (75% success)
- 5% risk of recurrence (usually within couple days of treatment)
16
Q
UC counselling
A
- condition with unknwon cause that leads to inflammation of bowel, leads to symptoms
- isn’t common but is well known
- there is no cure but is it a condition that tends to come and go in flare ups every so often
- medications that can be used to reduce likelihood of flare ups and treat flare ups when they happen
- complications = growth issues, bowel cancer
- seen by a gastroenterologist
- Support: Chron’s and Colitis UK
17
Q
meningitis counselling
A
- explain is infection of tissues surrounding brain
- serious condition but we have effective antibiotics that can treat infection
- require hospital admission to administer Abx and monitoring
- sometimes be long term complications, most common hearing loss and offer formal audiological assessment as F/U
- F/U with paediatrician in 4-6 weeks
- offer ciprofloxacin prophylaxis for contatcs
- support: meningitis Now
18
Q
atopic eczema counselling
A
- characterised by dry, itchy, skin
- very common, many children grow out of it
- management (use of topical steroids that are topical and short course needed)
- encourage frequent liberant use of emollients and soap substitiute
- association with other atopic conditions
- advise avoidance of triggers
- safety net about signs of infection (oozing, red, fever)
- information and support: itchywheezysneezy.co.uk, explain how to apply emollients
19
Q
ADHD counselling
A
- explain is a condition that affects people’s behaviour. People with ADHD can seem restless, may have trouble concentrating and may act on impulse.
- characterised by difficulties in social interaction, language impairment and ritualistic behavioural tendencies
- management: psychological interventions to reduce ritualistic behaviours, speech and language therapy, educational assessment and plan
- carer’s needs will be attended to and link them to support websites e.g. National Autistic society
20
Q
cerebral palsy counselling
A
- damage to brain that would have occured in early developemnt
- damage to brain doesn’t get worse but way it manifests will change as child gets older
- refer to paediatrician specialising in this
- long term mangaement: physio, SALT, special educational needs
- medications can be given to help with symptoms
