Transcript Pediatric Diagnosis - Caangay Family Site

Pediatric Diagnosis
• Observation
– Eye contact
– Establish rapport with the parents & the child
• History taking
– Investigation
– Asking “relevant” questions
Personal History Taking
• Active listening
– silence
– non-verbal indications of interest
• facilitation
– “door openers”
– “rocking”
– “repeating”
• Questioning
– probe & seek clarification
• reflection
• confrontation
History taking
– Outline of history
• General Data
• Chief complaint
• History of present illness
• Past medical history
• Family history
• Maternal & perinatal history
• Developmental history
• Nutritional history
• Immunization history
• Personal & Social history
Pediatric Diagnosis
– Review of the Systems
– Physical Examination
– Assessment
General Data:
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Patient’s name
Religion
Date of birth
Age of the patient
Sex
Patient’s address
Birth place
Nationality
Admission (First, 2nd, or third)
Informant
Reliability
Chief Complaint:
– What is the problem of the patient?
Respiratory
– Cough?
– Colds?
– Difficulty of breathing
CNS
Dizziness?
Headache?
Drowsy?
Gastrointestinal disorders
– vomiting?
– Difficulty of swallowing?
– diarrhea
General
Fever?
Loss of appetite?
History of Present Illness:
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Nature and date of onset
time of manifestations
describe the signs and symptoms
occurrence and progression
inquire about recent exposure to infectious
disease
Past Medical History
– State the previous illnesses of the patient
– Age of occurrence
• Example:
– Had measles at 2 years old
– Previous hospitalization
• Example:
– He was admitted at fatima medical center due to bronchial
asthma on August 8, 2005
Family History:
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Birth order of the patient
Number of living siblings
Total number of siblings
Heredo-familial disease
• (+) PTB-father
(+) diabetes-mother
– Are parents alive and healthy?
– Size of the family?
– Health and problems of the other children
• To known if there’s any history of associated
congenital/genetics disorder in the family
Maternal & Perinatal History:
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Chronological order of pregnancies
Illnesses during pregnancy
X-ray exposure during pregnancy
Drug intake during pregnancy
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Age of gestation – full term? Pre-term? Post-term?
Place of delivery – hospital? Home?
Type of delivery?
Complications?
Apgar?
Birth weight?
Developmental History
• Developmental milestone of the patient
– At what age the patient started to
Sit? Walk? Talk?
– Secondary sexual characteristics (adolescent)
Nutritional History
• Type of feedings
– Breast feeding?
– Artificial feeding?
– Supplementary feeding?
• Example: Patient was breastfed until 6 months old
then shifted to Promil Gold at 1:2 dilution up to 1
year old
Immunization History
• Type of immunization
• Age immunized
Example:
Patient received 1 dose of BCG at birth,
3 doses of DPT, 3 doses of TOPV at 2, 4 & 6
months old & 1 dose of measles vaccine at 9
months old.
Personal & Social History
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Living condition
Housing condition
Educational attainment of the parents
Family income
Example:
The family lived in a 10 X 8 sq meter house. Water
supply by MWSS. Electricity by Meralco. Family income
of 8,000 per month.
Review of System
Occurrence
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Skin
HEENT
Chest & Lungs
Heart
Abdomen
Genitalia
Extremities
Duration
jaundice
1 month
eye discharge
3 days
wheezing
2 days
chest pain
5 days
epigastric pain
yellowish discharge
joint pain
Examining a Pediatric Patient
Keen Observation
Physical Examination:
• General Survey
– ? Level of consciousness
– ? Respiratory distress
• Vital signs
– Wt. (% percentile) Expected body wt. (EBW)
– Ht. (% percentile) Temp.
– CR
RR BP
• HEENT
– ? Color of conjunctivae
• pinkish/pale
– ? Nasal/aural discharges
– ? Cervical masses/lymphadenopathy
– ? Conditions of the throat
• color & sizes of the tonsils
– congestion/pectechiea/swelling
• Lungs
– retractions
– breath sounds-wheezes, rhonchi, rales
• Heart
– precordium-? bulging, adynamic/dynamic
– heart sounds- ? Rate, rhythms, murmur
• Abdomen
– Symmetrical- ? Bulging
– bowel sounds - normoactive, hypoactive,
hyperactive
– organomegaly
• liver span, spleen & other palpable masses
• Genitalia
– ? Testis descended
– ? Ambiguous genitalia
• Extremities
– ? Pulses e.g. full & equal
– ? Capillary refill - </> 2 sec
– ? Clubbing
• Neurologic Examination
Assessment
• Diagnosis?
• Impression?