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Pediatric Diagnosis

Pediatric Diagnosis

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Pediatric Diagnosis

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Presentation Transcript

  1. Pediatric Diagnosis • Observation • Eye contact • Establish rapport with the parents & the child • History taking • Investigation • Asking “relevant” questions

  2. Personal History Taking • Active listening • silence • non-verbal indications of interest • facilitation • “door openers” • “rocking” • “repeating”

  3. Questioning • probe & seek clarification • reflection • confrontation

  4. 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

  5. Pediatric Diagnosis • Review of the Systems • Physical Examination • Assessment

  6. General Data: • 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

  7. Chief Complaint: • What is the problem of the patient? Respiratory CNS • Cough? Dizziness? • Colds? Headache? • Difficulty of breathing Drowsy? Gastrointestinal disorders • vomiting? General • Difficulty of swallowing? Fever? • diarrhea Loss of appetite?

  8. History of Present Illness: • Nature and date of onset • time of manifestations • describe the signs and symptoms • occurrence and progression • inquire about recent exposure to infectious disease

  9. 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

  10. Family History: • 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

  11. Maternal & Perinatal History: • Chronological order of pregnancies • Illnesses during pregnancy • X-ray exposure during pregnancy • Drug intake during pregnancy • Age of gestation – full term? Pre-term? Post-term? • Place of delivery – hospital? Home? • Type of delivery? • Complications? • Apgar? Birth weight?

  12. Developmental History • Developmental milestone of the patient • At what age the patient started to Sit? Walk? Talk? • Secondary sexual characteristics (adolescent)

  13. 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

  14. 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.

  15. Personal & Social History • 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.

  16. Review of System Occurrence Duration • Skin jaundice 1 month • HEENT eye discharge 3 days • Chest & Lungs wheezing 2 days • Heart chest pain 5 days • Abdomen epigastric pain • Genitalia yellowish discharge • Extremities joint pain

  17. Examining a Pediatric Patient Keen Observation

  18. Physical Examination: • General Survey • ? Level of consciousness • ? Respiratory distress • Vital signs • Wt. (% percentile) Expected body wt. (EBW) • Ht. (% percentile) Temp. • CR RR BP

  19. 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

  20. 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

  21. Genitalia • ? Testis descended • ? Ambiguous genitalia • Extremities • ? Pulses e.g. full & equal • ? Capillary refill - </> 2 sec • ? Clubbing • Neurologic Examination

  22. Assessment • Diagnosis? • Impression?