Paediatric-History taking & Physical examination of Dengue viral infection

Paediatric-History taking & Physical examination of Dengue viral infectionCreated OnApril 23, 2020Last Updated OnApril 23, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination of Dengue viral infection < All Topics Table of Contents History taking: Ask about patient’s data: name, age, gender Ask about history of presenting illness Fever Sudden onset High grade Associated with chills and rigors? Rash Typically during first 24-48hours of fever Involving face, trunk, abdomen and extremities (generalized) URTI symptoms: cough, nasal congestion, sore throat Joint, muscle pain Child appears to be less active? Retroorbital pain Reduced oral intake Vomiting Diarrhoea Reduced urine output Lethargy, confusion, restlessness Abnormal bleeding/ bruising Abdominal pain/ distension Ask about vaccination history All vaccinations are up to date Ask about past medical history History of dengue infection Ask about drug history Any drug allergy? Ask about family history Any similar symptoms seen in family members? Chronic familial diseases? Ask about social history Living environment? – dengue hotspot? Recent travel to dengue endemic area? Physical examination: Anthropometric measurement: weight, height, BMI, head circumference Assess for failure to thrive General Vital signs Temp: elevated (in febrile phase), normal (in critical and recovery phase) Pulse: rate (increased with fever/ shock), volume (low volume in hypovolemic shock), rhythm BP: hypotensive if in shock Respiratory rate Cold extremities, capillary refill time < 2s – if in shock Conscious? Alert? Orientated? Altered mental status? Any palpable lymph nodes Generalized maculopapular rash, blanch with pressure, described as “isles of white is sea of red” Any visible bruising, petechiae or ecchymoses seen on skin? Any bleeding from mucous membrane Conjunctival injection Inflamed pharynx Hydration status Thread pulse, tachycardia Hypotensive Sunken eyes Sunken anterior fontanelle Poor skin turgor Tourniquet test – to determine capillary fragility Blood pressure cuff inflated to midpoint of systolic and diastolic pressure for 5 minutes Remove cuff and raise arm for 1 minute Positive: 10 – 20 petechiae per square inch Gastrointestinal examination Inspection May have distended abdomen Palpation May have tender hepatomegaly Percussion Shifting dullness/ fluid thrill...

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