step 2 CS FEVER CHILD

（ROS)review of system for pediatric -

FEVER CUD SAD+ABD SYMPTOMS+PAM IF BIG DEALS

F ever

E ye discharge & redness/ear pulling

V omit

E ar discharge/pain

R ash , R hinorhea (runny nose)

Cry ,Chest symptoms

C old (cough,Recent URI?, sore throat,difficulty swallowing,dysphagia,sob)

U rinary changes (frequency,urgency,burning,dysuria,hematuria, color,odor ,content,consistency,how mny wet diapers? )

D iarrhea (amount,blood,color,consistency,content,mucus, frequency)

Sleep

Seizure

Activty (awake,playful, how does he looks?)

Dehydrated (dry mouth, shrunken eyes?

Pediatric (PMH) past medical history

PAM IF BIG DEALS

PMH -childhood illness and infection? has ur child had any serious illness or infection?does the child have dm,asthma,seizure?

PSH- have ur child had any surgey before

Hospitalize? -
Allergy- does ur child have any allergies?
Medication- is ur child taking any medication

Ill contact- have u heard of any sick contact?anybody else sick at home?

Family history- does anyone in ur family have a similar problem/other medical problem?

Birth history

-was ur pregnancy full term(40weeks or 9months?)

- did u have routine checkup during pregnancy?how often?

-did u have any complications during ur pregnancy/during ur delivery/after delivery?

-was an ultrasound performed during your pregnancy?

- did u smoke,drink or use drugs during pregnancy?

- was it a vaginal delivery or C-section?

-did ur child have any medical problems after birth?

-when did ur child have her/his first bowel movement? 

-how long did u stay at hospital after delivery?any complication? 

Imunization - are ur child immunization utd?

Growth development
- is ur child develepment on track for their given age?

- when did ur child first smile?first sit up? first crawling?start talking?start walking? learn to dress himself?start using short sentense? 

Day care- accommodation / main carer / who lives with child?/any sick contact?

Eating habits - did u notice any changes of ur child's eating habits?

did u breast feed ur child?hw long? hw mnt times per day? is he feeding/sucking  well?

Appetite- how is ur child appetite?

Last check up - when was the date of your child's last routine checkup?was it normal?

 

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·         Hello, are u mother of josh white?

·         Is it ok if I address u as mrs white?

·         Well miss white I am dr.chong the doctor on duty today. How can I help u?

·         May I sit down and take a few note while with we talk?

·         Can u clarify the age of child?

·         Boy/girl?

·         Now tell me more about the problem of ur child?

·         Im so sorry to hear that I’ll do my best to help him get better

HPI:

·         Onset- When did the fever start?

·         Sudden/gradual?

·         How high is the fever?

·         How did u measure his temperature?(thermometer in mouth,axilla,anus?)

·         Any chills or night sweats?

DOC PA FAA

·         Progression – since it started how does it progress, is it getting better/worst?

·         Settings- do u have any idea,what might have caused ur child fever to start?

·         Constant – does ur child’d fever comes and go or constant?

·         AA- does anything pain the fever better/worst?

·         S- any other symptoms?

GEnral

·         Does ur child’s fver affect his activities?

·         Is he still playful and ac tive like before?

·         Any rash in his body? If yes – when/whr did it start – can u describe the rash for me. – what is the size ?- how about the color? – flat/swollen?

HEENT

• ·         Does he have any discharge from his ears/eye?
• ·         Any red eye?
• ·         Does ur child pulls his ears?
• ·         Des he cx of fullness in ears(older kids)
• Respiratory system
• Does he have runny nose
• Does he have any sore throat/difficulty swallowing
• Any pain around his cheek bone/ forehead
• Any cough/breathlessness
• How about wheezing

Nervous system

• -          Do u think he is sensitive to light /around light
• -          Is white holding his neck stiff?
• -          Any abnormal jerks/movement of limbs?

GIT

• -          Does he have any nausea/vomiting/any changes in appetite or weight
• -          Do u think that the stomach is distended.bloated
• -          Does he cry when passs stools
• -          Any changes in his bowel habits(diarrhea/constipate)
• -          Can u describe his stool for me any foul smell blood mucus

URINARY SSYTEM

• -          Does he passes any urina
• -          Any changes in urinary habits
• -          Can u describe ur child’s urine for me
• -          When was the last time he peed
• -          Do u think his mouith skin is dry
• -          How many diapers do u need to change

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history
HPI; hostory obtained from mother. the patient is a 7 month old M with fever x1 day. temperature recorded by forehead thermometer at home reached 101 F yesterday. the child has been tired,irritated,and breathing rapidly for the past day. the mother denies any abdominal retractions or nasal flaring . the mother also notes rhinorrhea and refusal of breast and baby food. the child has a history of sick contact with his 3 yo brother ,who had a URI 1 week ago that has since resolved. he attends day care. no cough,ear pulling,ear discharge or rash.
ROS: negative except as above
allergies : NKDA
MEDICATION ;TYLENOL
PMH jaundice in the first week of life
PSH NONE
BIRTH HISTORY: 40 week vaginal delivery with no complications
dietary history: breast feeding and supplemental vitamins.
immunization historu:UTD.
Developmental history: last checkup was 2 weeks ago and showed normal weight ,height,and developmental milestone
physical examination: none

differential diagnosis 
diagnosis 1; viral URI
fever
rhinorrhea
siblings with URI
day care attendance
increased breathing rate

diagnosis 2 pneumonia
fever
day care attendance
siblings with uri
increase BR

diagnosis 3 : otitis media
fever 
irritability
day care attendance 

diagnostic workup:
cbc with differential
blood culture
UA and urine culture
CXR
respiratory viral panel
pneumatic otoscopy