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Complaints and anamnesis taking in toddlers and preschoolers (children aged from 1 to 6 years)
Algorithm of practical students' work Complaints and anamnesis taking in newborns and infants 1. Friendly facial expression and smile. 2. Gentle tone of speech. 3. Greeting and introducing. 4. Tactful and calm conversation with the parents of sick child. 5. Explanation of future steps concerning the child (hospitalization, some methods of examination, etc.). Complaints and anamnesis taking in toddlers and preschoolers (children aged from 1 to 6 years) 1. Friendly facial expression and smile. 2. Gentle tone of speech.
3. Greeting and introducing. 4. By means of game playing find a contact with a child. 5. Tactful and calm conversation with the parents of sick child. 6. Explanation of future steps concerning the child (hospitalization, some methods of examination, etc.). Complaints and anamnesis taking in school age children 1. Friendly facial expression and smile. 2. Gentle tone of speech. 3. Greeting and introducing. 4. Tactful and calm conversation with sick child his/her parents. 5. Explanation of further steps to child and his/her parents (hospitalization, some methods of examination, etc.).
1. To collect complaints: subfebrile, febrile temperature, rashes on the skin, near the orifices, on mucose membranes of oral cavity, genitals, along the sensitive nervs (intercostal, trigeminal) acompanying with pain, itching; weakness, bad appetite, vomitimg, seisures, visual disturbances. 2. To collect anamnesis of the disease, epidemiological anamnesis: • an acute beginning of the disease from hyperthermia, toxic syndrome, pain before rashes appears, rashes on the lst-2nd day; • in 11 -21 days before the disease contact with a patient who had chicken pox (rare - herpes Zoster), contact with a patient who had herpes simplex; • relapsed character of the disease. • Conversation accomplishment.
3. To inspect a patient: Physical methods of examination of newborns and infants 1. Friendly facial expression and smile. 2. Gentle tone of speech. 3. Greeting and introducing. 4. Explain to the parents what examination should be performed and obtain there informed consent. 5. Prepare for examination(clean and warm hands, warm phonendoscope, etc.). 1. Friendly facial expression and smile. 2. Gentle tone of speech. 3. Greeting and introducing. 4. Explain to the parents what examination should be performed and obtain there informed consent. 5. Find a contact with a child; try to gain his/her confidence. 6. Prepare for examination(clean and warm hands, warm phonendoscope, etc.). Physical methods of examination of school age children 1. Friendly facial expression and smile. 2. Gentle tone of speech. 3. Greeting and introducing. 4. Explain to the parents what examination should be performed and obtain there informed consent. 5. Find a contact with a child; try to gain his/her confidence. 6. Prepare for examination (clean and warm hands, warm phonendoscope, use the screen if necessary etc.). A. Examination: •rashes on the skin (spots, papules, vesicles, crusts, pigmentation), localized in groups, near the orifices, on mucose membranes of oral cavity, genitals, along the sensitive nervs (intercostal, trigeminal) acompanying with pain, itching; • rashes in the mouth - papules, vesicles, erosions; • purulent conjunctivitis, keratitis; • irritability, hyperesthesia, meningeal pose; B. Palpation: • positive Kering, Brudzinsky signs, nuchal rigidity, tender trigeminal points, hyperesthesia; • painful damage of skin and mucosa. Conversation accomplishment. Informing about the results of examination
1. Friendly facial expression and smile. 2. Gentle tone of speech. 3. Greeting and introducing. 4. Explain to a child and his/her parents what examinations should be performed and obtain their informed consent. 5. Involve adolescent and his/her relatives in to the conversation (compare present examination results with previous ones, clarify weather your expectations are clear for them or not). 6. Conversation accomplishment. 4. To estimate the results of additional researches: • Complete blood analysis: normal or leucopenia with relative lymphocytosis. • Virology inspection: selection of virus and its' antigen from the vesicles, nasopharyngeal smear, CSF, IF method, PCR. • Serologic reactions: CBR, PHAR, NR with 4 times or more increasing of the antibody tytre in dynamics. • Explaining the results of examination to child's parents. • Conversation accomplishment.
5. To substantiate the diagnosis. Planning and prediction of conservative treatment results 1. Friendly facial expression and smile. 2. Gentle tone of speech. 3. Greeting and introducing. 4. Explain to child's parents the necessity of further treatment directions correctly and accessibly. 5. Discuss with parents and their child the peculiarities of drug intake, duration of usage. 6. Side effects and find out weather they understand your explanations. 7. Conversation accomplishment. 6. To prescribe treatment: regime, diet, (in severe cases, immune compromised patients -acyclovir), locally - antiseptic fluids, antiviral ointments, 20 % albucid into conjunctiva, antihystamines, detoxication, corticosteroids (in severe cases), and symptomatic treatment, antibiotics in case of complication. Informing about treatment prognosis 1. Friendly facial expression and smile. 2. Gentle tone of speech. 3. Greeting and introducing. 4. Correct and clear explanation of expected results of treatment. 5. Discuss with the parents and their child the importance of continuous treatment, following the treatment scheme; make sure that your explanations are properly understood. 6. Conversation accomplishment.
Step 1. In a child, 2 years old, with oral mucose damage as vesicles, that ruin, forming erosions, acompanied by the pain, febril body temperature was diagnosed Herpetic stomatitis. What changes in complete blood analyses are most probable? A. Leucocytosis, lymphopenia B. Leucopenia, lymphocytosis C. Leucocytosis, neutrophilia D. Leucopenia, monocytosis E. Leucocytosis, monocytosis, atypical mononuclear cells 2. The boy, 4 years old, became ill acutely: low-grade fever, small catarrhal phenomena, rash on skin. The rash as firmly grouped papuls on the red base (on the 2nd day their evolution to small vesicles with the transparent content) was localised along left trigeminal nerve branches. Herpes Zoster was diagnosed. For what period must be isolated ill person? A. For the whole rash period +15 days since the rash has appeared B. For the whole rash period +10 days since the rash has appeared C. For the whole rash period + 5 days since the rash has appeared D. For 11 days E. For 21 days 3. In a child, 6 years old, who has Herpetic infection, on the 6 day of the disease has increased body temperature, appeared the headache, vomiting. During examination stiff neck was found. Meningitis was diagnosed. What change in cerebro-spinal fluid is the most probable? A. Lymphocyte pleocytosis B. Neutrophyl pleocytosis C. Protein more than 1 g/1 D. Normocytosis E. Glucose level is increased A real life situations to be solved 1. A girl, 5 years old, has herpes simplex infection, localized form (labial's herpes), relapsed duration. 1. What laboratory methods will prove this diagnose? 2. Prescribe treatment to this child. 2. A boy, 10 years old, complains of pain, rashes on left lateral surface of the chest. 3 days ago body temperature had increased to 38.7 °C, pain in the same region had appeared. Rashes has appeared today. During examination: in left lateral surface of the chest, along the 4th intercostal space: hyperemia, infiltration of the skin with group of vesicles on it. General condition is satisfactory. 1. What disease must be suspected? 2. What evolution of rashes in this case? Answers for the self-control: Tests: 1. C; 2. C; 3. D; 4. C; 5. B; 6. D; 7. B; 8. C; 9. B; 10. A. Stepil.B;2.C;3.A. Real - life situation 1: 1. Serologic examination, virologic examination of vesicles' content. 2. Unguent of acyclovir on damaged region 5-6 times per day. Group B vitamins (B1, B2). Real - life situation 2:
1. Herpes zoster infection 2. Grouped along nerves' branches: spot → papule → vesicle with transparent then cloud content → crust → pigmentation. Result Level Students must know 1. Etiology, epidemiology, pathogenesis, pathomorphology of Herpes virus infection. 2. Classification of Herpes virus infection. 3. Main diagnostic criteria of Herpes simplex infection. 4. Main diagnostic criteria of Herpes zoster infection. 5. Complications of Herpes virus infection. 6. Differential diagnosis of Herpes virus infection. 7. Main principles of Herpes virus infection treatment and prophylaxis. Students should be able to do:
1. To diagnose Herpes virus infection. 2. Interpret results of laboratory and instrumental examination of the child in case of Herpes virus infection. 3. Perform differential diagnosis of Herpes virus infection. 4. Prescribe treatment to children with this pathology and its prophylaxis.
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