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Pediatric Presentation

Transcript: Presented by Marisa and Kate Mitchell Preschool (ages 3-5) Pulse- 80-110 Blood Pressure- Sys: 82-110 Dia: 50-... Normal Vital Signs Pulse- 80-110 Blood Pressure- Sys: 82-110 Dia: 50-78 Respirations- 22-34 Temperature- 98.6-99 Normal Growth and Development Normal Growth and Development Physical: Builds on motor and verbal skills developed as a toddler. Develops a more active imagination. Becomes more sexually curious. More curious in general and asks more questions. Cognitive Cognitive Develops rivalries with siblings and forms greater attachments to the father or alternate caregiver. Grows less reliant on the mother. Begin to recognize their position as members of the family unit. Social-Emotional Social-Emotional Common Illnesses/Disorders Common Illnesses/Disorders Fifth Disease Strep throat Pink eye Endocrine Disorders Constipation Ear infections Diarrhea ADLs ADLs ~This is the stage where you should encourage the child to do more ADLs themselves. Have them dress themselves and brush their teeth on their own. ~By this time they should not be wearing diapers or pullups. They are in the process of starting school, they should be able to use the restroom on their own. Reading to the preschooler is very important, they enjoy stories and it is a good way to teach them new words. Story Time Story Time You should start working on their home skills, picking up around the house, doing small chores. If you are doing something such as yard work, have them help you. It is a good teaching moment and good way to bond. Home Skills Home Skills ~Before going to school, you should prepare your child by making sure they can read/write their own name. ~Before the starting school year, you should set a morning and bedtime routine, this will make everything much easier. ~As said before, make sure they can use the restroom on thier own. Preparing for School Preparing for School ~Set up and consistently enfore rules and limits. ~Teach basic safety rules and precautions such as using a seat belt, wearing a helmet, and that ovens can cause burns. ~Take safety measures around the house, store poisonous products out of reach and use saftey covers on electrical outlets. ~Stranger danger!! Teach them the dangers of bad people. Safety Concerns Safety Concerns Keep toys from cluttering walkways Keep toys from cluttering walkways Keep side rails on the bed up at night Keep side rails on the bed up at night Keep beds in low position Keep beds in low position Keep a night light on Keep a night light on ~Maintain a safe envirnoment ~Apply standard precautions ~Collect and test specimens ~Provide warmth, affection, and security. Responsibilities when caring for a preschooler Responsibilities when caring for a preschooler

Pediatric Oral Health

Transcript: Trends in Oral Health children as young as one can have untreated tooth decay. Analysis of data from NHANES indicates that children ages 2-5 from families with low incomes were five times more likely to have untreated tooth decay than their peers from families with higher incomes. Children with Special Healthcare Needs most prevalent unmet health need among children with special health care needs is oral health care. Poor oral health can profoundly affect an infant’s or child’s health and well-being. Difficulty chewing Oral Health, General Health and Well-Being Key points Reduced self-esteem Dental Caries is the process leading to tooth decay. Dental caries is the most common chronic childhood disease and five times more common than asthma. missed opportunities for learning Health professionals can promote the oral health of infants and children by learning about oral development, oral disease, oral hygiene, fluoride, nutrition, and injury and violence prevention and by sharing information with parents and working in partnership with oral health professionals. Access to Oral Health care is difficult for children that come from families that have low income, families with no dental insurance, and other with special healthcare needs. 66 percent of children ages 2-4 from families with annual incomes of less than $10,000 had not had a dental visit the preceding year. Access to care Conclusion Poor oral health can profoundly affect an infant’s or child’s health and well-being. Pediatric Oral Health Untreated Tooth Decay Understanding how infants’ and young children’s oral health is related to their general health will help health professionals interpret the possible causes of oral health problems and their affect on general health. Difficulty sleeping Tooth Decay Oral health problems can lead to impaired speech development, inability to concentrate on important early learning experiences, and absences from school or child development programs. How does severe oral disease affect a child?

Pediatric Oral Hygiene

Transcript: By: Brionna Dwyer Why???? My product is a children's book I made myself. It is about Oral hygiene, and shows kids how important it is in thier lives. What I was going to do? Getting all the supplies Writing the Book Would I finish in time? Self-Growth Children's teeth start to develop before birth. Caring for a child's teeth from a early age will help him/her to grow up with healthy teeth an gums. 2 sets of teeth: Milk Teeth: A usually has 20 of them, and they push through the gums around 2 or 3 yrs. old. Permanent Teeth: Usually pop up around 6 yrs. old. Adults should have up to 32 permanent teeeth. I was obsessed with brushing my teeth when I was little, just liked to take care of my teeth, and I want others, especailly little kids to see how important it is to do so. Did You Know!! Base of my Project Conclusion Taking good care of one's teeth is one of the smartest investments a person can make towards thier health, and helping to ensure that teeth will remain strong, healthy & white for a lifetime. Good Benefits are: Eating a balanced diet Brushing your teeth Going to the dentist Learning Stretches My future Plans Time Mangament Clean & Fluoride Applications Root Canal Treatment Orthodontics Extractions Use of Resources is important too The average woman smiles about 62 times a day! A man? Only 8! Kids laugh around 400 times a day. Grown-ups just 15:-( Smilers in school yearbooks are more likely to have successful careers and marriages than poker faced peers Problem solving About your child's Teeth It basically specializes in child and early teen care. The pediatric dentsit are specialist in both preventive and restorative dental care for infants, kids, and adolescents. Benefits of Good Oral Hygiene Difficulties Just for a thought; are teeth are like jewels, thier fragile and we need to take care of them especailly the "little ones'", just as we take care of our jewerly good, we need to take care of our teeth good as well. My Research Pediatric Dentistry Subject 2 The three main points : What is Pediatric Dentistry About Your child's Teeth Benefits of Good Oral Hygiene PROSCATINATION Communictating with ohters Speacking in front of people better Seeing my advisor more Services Include: is here Pediatric Oral Hygiene

Pediatric Presentation

Transcript: Vaccines: 2. Clinical findings in an epidemic of herpangina with myalgic, neurological and gastro-enteritic features. FRASER Can Serv Med J. 1957 Jul;13(7):407-19. Management Higher fever 102-104 Throat: hyperemia and yellow/greyish-white papulovesicular lesions Lack of skin involvement Note... Following acute infection, enteroviruses are shed from the stool (6wks-several months) and throat (4 wks) for prolonged periods and the isolated virus may or may not be responsible for the current symptoms. Oral Enanthem 24 h Presentation: -Fever 103 and vomited after taking Motrin that morning -Decreased PO intake due to new, painful blisters in mouth -Painful blisters appeared on palms and soles papules vesicles ulcerations Everyone, but particularly younger than 5-7 years old Wide spectrum of severity Minor vs Major (Stephens Johnson) The papules become target or iris lesions within a 72-hour period and begin on the extremities. Remain ~ 7 days and then begin to heal. Precipitating factors: herpes simplex virus (HSV), Epstein-Barr virus (EBV), and histoplasmosis. Pediatric Presentation --Pt received MIVF and placed on PCA pump for pain control due to the intense pain pt experienced associated to the lesions. --Multiple swabs consistently neg for HSV, but due to biopsy + for EM, placed pt on suppressive dose of Acyclovir with IV steroids. --Ophthalmology rec erythromycin ointment for eyes until lesions around eyes improved -Clinical diagnosis -Laboratory tests (e.g., HSV-1 and -2, immunoglobulin M and G) -Skin biopsy PLAN: Direct admit to W&C for decreased PO intake and pain control Brief Hospital Course: Diagnosis: 50% of cases are related to medication use Rofecoxib (Vioxx) Candesartan cilextil (Atacand) Ciprofloxacin (Cipro) Metformin (Glucophage) Bupropion (Wellbutrin) Adalimurab (Humira) When fever is gone usually in 2 to 3 days. If widespread blisters, stay home until the blisters dry up ~ 7 days When to return to school?? Diagnosis: Erythema Multiforme 24 h Incubation period... Tests: Rapid Mycoplasma IGM positive Viral Diatherix: +enterovirus Pt returns to clinic: Not tolerating PO intake and vomiting ; increased throat pain and unable to keep pain meds down Increased # of blisters and lesions on palms and soles; Fever resolved WBC: 24K; negative HSV 8. Ayangco L, Rogers RS III. Oral manifestations of erythema multiforme. Dermatol Clin 2003;21:198 Parasites: 3. HAND, FOOT, AND MOUTH DISEASE"IN CHILDREN; AN EPIDEMIC ASSOCIATED WITH COXSAKIE VIRUS A-16. RICHARDSON HB Jr, LEIBOVITZ AJ Pediatr. 1965 Jul;67:6-12. Treatment: Exam: Causes... May be painful/nonpruitic hands feet buttocks trunk face fingernails Bacterial Drugs: The case... 7. Erythema Mulforme. Jose A Plaza, MD Director of Dermatopathology, emedicine.medscape.comarticle/1122915overviewpa=o5E4EWcGjoT4Zvrrm1pZgG1sYhB8kDqSfi76cBhc2di7QH4%2B7VT98f0kNJ%2BIQF3pLfpFASqy1cuE0D5oYYijQPzf93FVBcPwXD4yvpU7Ryc%3D#a2 macular, maculopapular, vesicular (1-10mm) Exam: 6. Neurologic complications in children with enterovirus 71 infection. Huang CC, Liu CC, Chang YC, Chen CY, Wang ST, Yeh TF N Engl J Med. 1999;341(13):936. Coxsackievirus A2, A4 to A10, A16, B2, B3, B5 Echovirus 1, 4, 7, 19 Enterovirus A71 Tetanus-Diptheria Smallpox Hep. B HFMD: supportive tx and Norco 7.5/325mg q6hrs PRN pain; HSV by rapid PCR, CBC Oral thrush: fluconazole Trichomonas species and Toxoplasma gondii Herpangina A/P: Eyes: BL Hyperemia with mucoid DC Oropharynx: white patches, erythematous papules, inflamed tonsils BL Resp/Card: CTAB/RRR Abd: NT, ND +BS Skin: no rashes, warm/dry References 7 year old male with PMH of hand, foot, mouth 3 months prior, presents to clinic c/o: -fever 102F past two days -stringy, mucoid eye discharge -congestion and sore throat A/P: Adenovirus, coxsackievirus B5, cytomegalovirus (CMV), echoviruses, enterovirus, Epstein-Barr virus (EBV), hepatitis A / B / C viruses (HAV / HBV / HCV), HSV, influenza, measles, mumps, paravaccinia, parvovirus B19, poliomyelitis, varicella-zoster virus (VZV), and variola. 1. Herpangina; clinical studies of a specific infectious disease. PARROTT RH, ROSS S, BURKE FG, RICE EC SON Engl J Med. 1951 Aug;245(8):275-80. Most common: HSV 1 &2, then Mycoplasma species Strep + pharyngitis: Keflex x 10 days Acute bacterial conjunctivitis: Ofloxacin drops x 5 days Ingestion/contact: fecal material, oral secretions, vesicle fluid or, for some serotypes, respiratory secretions. Usually supportive Indications for hospitalization: ●Inability to maintain adequate hydration ●Neurologic or cardiovascular complications, such as: ●The inability to differentiate eczema coxsackium from eczema herpeticum (for HFMD only) Prevention: Hand hygiene Child care Isolation Vaccines 5. Clinical and laboratory differentiation between herpangina and infectious (herpetic) gingivostomatitis. PARROTT RH, WOLF SI, NUDELMAN J, NAIDEN E, HUEBNER RJ, RICE EC, McCULLOUGH NB Pediatrics. 1954;14(2):122. buccal mucosa tongue uvula lips tonsils -Flavorings: benzoic acid and

Pediatric Presentation

Transcript: What would you Do? Does this Patient need a lumbar puncture? Does this patient need antibiotics? What if he was 4 weeks older or younger? Should the ED have sent this Patient Home? Pediatric Case Presentation HPI :2 month-old previously healthy female who presents to ED with a 3 day history of fevers. T max 103. Was evaluated in ED 1 day prior to admission for fevers, had normal CXR, RSV and Influenza swabs. Was sent home to follow up with PCP the next day thinking that this was a viral URI. No antibiotics were started. Fever continued. Feeding decreased from 5 to 2 oz Q3-4 hrs and has had minimal stool over last 4 days. UOP normal. Patient is fussy. Urine Culture: Negative Blood Culture: Negative, CSF Culture Negative CSF glucose 45, CSF Protein 47 CSF Cell count 93 WBC 23 segs 31 lymphs and 46 monos Enterovirus RNA negative Influenza swab Negative, RSV swab Negative Body PMH: Born NSVD. Mom was GBS negative and had no HSV history. Born full term NSVD. There was meconium aspiration for which the child was treated. no other complications. pt was born 3625 gms. Feeding history : Breast fed Start 2 oz q 3 hrs, nothing for the last 15 hrs surgeries none Social History: The patient lives at home with her mother, father and brother. not in daycare. no smokers in the home. no pets. meeting developmental milestones. Brother has been sick recently Immunizations: has not received her 2-month-old well-child check immunizations yet, was to have appointment the next day. Allergies: None Medications: Children's Tylenol last dose a few hrs before admission Body Body Well appearing children Must decide if low risk for SBI WBC 5000 to 15000 with less than 1500 bands Normal urinalysis Normal CSF pleocytosis have reliable follow up within 24 hrs Age 30-60 days - If low risk and well appearing, get CSF culture, Blood Cultures, Urine culture, may send home with one dose of empiric ceftriaxone and close f/u Age 60-90 days - If low risk and well appearing may get blood cultures, Urine culture and skip the LP. Pt is ill appearing Maternal history of genital HSV If pt has mucocutaneous vesicles Or if it is in the first 14-21 days Any temp of 38 C or greater warrants: CSF culture, Blood Culture, Urinalysis and Urine Culture If pulmonary symptoms get a chest X-Ray Consider HSV culture of Vesicles, conjuctiva blood, csf, oropharynx, urine and stool (Automatic in first 14 days) Neonatal period of 30-90 days Neonatal Period 0-28 days CC: Fever In the first 7 days: Most likely to be vertical transmission PPROM, Maternal Fever, GBS positive, HSV outbreak, premature delivery, or history of STDs 7-90 days of life: Most likely to be from the environment prolonged hospital stay, premature delivery, Formerly of the UW-Green Bay Mens Cross-Country team Smitherman, H. et. al. 2012, Evaluation and management of fever in the neonate and young infant (less than three months of age). Accessed online at Empiric Antibiotics should Include: Risk Factors For Serious Bacterial Infection Body Physical Examination: Vitals T 101.2 pulse 160, respirations 29 and pulse ox 99% on RA General: listless and fussy, nontoxic HEENTnormocephalic, PERRL, Fontanelle is full, resisting flexing of the neck Cardiovaascular: Tachycardic no murmurs Lungs: clear to auscultation bilaterally, no crackles or wheezes Abdomen: Soft, nontender and nondistended. Bowel sounds are present Extremities: Warm. deceased movement, does have a startle response Skin: acyanotic. No rash Neuro: good tone, no focal findings, preference for turning head to the right ROS : No rash’s currently however there was a red splotches all over body one week ago, evaluated at a residency clinic (obviously not as good as ours), and was told it was allergies vs viral in nature. No other symptoms until today Body Spark Back to our Case Body Labs on Admission: WBC 16.4 HGB 11.9 PLT 500 UA: trace blood CSF Gram Stain: negative Labs From previous ED visit: RSV: Neg Influenza A and B: Neg CXR: Neg Neonatal Fever: Fever in the First 30 Days of life If child has temp over 38.5 or is ill appearing they have a high chance of SBI Culture blood, CSF, and Urine Chest X-Ray if there are any respiratory symptoms Ceftriaxone empirically Ampicillin up through 6-8 weeks to cover listeria Ill appearing children 30-90 days of age: By Seth Bodden MD Body Fever of Unknown source: Fever in the first 90 days of life. Body Fever of unknown source Body Antiviral Therapy if: Body Most Common Source of Meningitis in this age are: Group B strep, E.Coli, GNRs, Enterococcus Listeria Body What would you Do? Because neonates have impaired immune systems. There immune cells cannot rapidly multiply like ours, plus they are not immunized yet. They also do not have a fully intact Blood Brain Barrier. All These leads to pretty serious outcomes In the first week of life 12% of children presenting with fever have a serious bacterial infection Ages 30-90 if ill-appearing 45% may have serious bacterial infections Hospital Course: Why

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