Paediatric-History taking & physical examination of patient with dehydration

Paediatric-History taking & physical examination of patient with dehydrationCreated OnApril 22, 2020Last Updated OnApril 22, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & physical examination of patient with dehydration < All Topics Table of Contents History taking: History taking is important to assess the severity of dehydration clinically and to determine the etiology of the child’s condition Ask about patient’s identification – name, age, gender Age <3 years risk for dehydration Ask about chief complaint May be causes of dehydration (most common cause – diarrhoea, vomiting) May be symptoms of dehydration (lethargy, drowsy, shortness of breath) Ask about history of presenting illness Regarding vomiting Onset Frequency Amount Content of vomiting – blood, bile, mucus Characteristic – projectile/ non-projectile Regarding diarrhoea (more than 3 watery stool/day) Onset Frequency Stool consistency – watery, soft stool Presence of blood or mucus – suggest bacterial pathogen Associated symptoms Fever – gastroenteritis Abdominal pain – common in gastroenteritis, small bowel obstruction, and intraabdominal haemorrhage Lethargy, shortness of breath – correlate with degree of dehydration Urine output Oliguria/anuria in severe dehydration Polyuria in diabetes insipidus Increase urine output, sweet smell (diabetic ketoacidosis) Number of diapers changed compared with normal Weight change – compare to recent weight prior to illness Activity of the child – lethargy/drowsy in dehydration Possible ingestion that cause vomiting Heat and sunlight exposure – insensible fluid loss History of trauma – haemorrhage can lead to shock and hypovolemia Thirst – prompt investigation of hyperosmolar state Ask about birth history – any disease or abnormalities diagnosed Ask about developmental history – as part of general history taking Ask about immunisation history Immunisation against rotavirus Ask about past medical history Underlying medical condition Diabetes type I – DKA Diabetes insipidus Intestinal obstruction History of recent infection History of burn – burn over 10% of the body surface area cause significant losses through skin Ask about drug history History of diuretic Recent use of antibiotic Ask about feeding history Lack of breastfeeding – risk factor for viral age History of poor oral intake – risk for dehydration Amount of fluid intake Ask about social history Day-care – exposure to people with gastroenteritis Poor personal hygiene Travel history Sick contact at home History of vigorous or prolonged exercise – in adolescent Socioeconomic status Physical examination: General examination Assess mental status –alert/irritable/drowsy/coma Body weight Vital signs Pulse – heart rate, volume, quality of pulse Blood pressure – reduce in shock Breathing – rate, characteristic (eg. Kussmaul breath in acidosis) Temperature – fever in infection Pain score Capillary...

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