Back to AI Flashcard MakerNursing /Simmons NURP 502 Exam 1 1: Fever without Focus Part 2
_____ is not common in bacterial meningitis.
Nuchal rigidity is not common in bacterial meningitis.
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Key Terms
Term
Definition
_____ is not common in bacterial meningitis.
Nuchal rigidity is not common in bacterial meningitis.
What assessments suggest serious bacterial infections?
1. Ill appearance 2. Fever 3. Vomiting 4. Tachypnea with retractions 5. Delayed cap refill
Abdominal auscultation may reveal signs of _____ or _____.
Abdominal auscultation may reveal signs of ileus or hyperactivity.
What are 2 global assessment red flags for serious infection in children older than 1 month?
1. Parental concerns 2. Physician instinct
What are 4 child behavior red flags for serious infection in children older than 1 month?
1. Changes in crying pattern 2. Drowsiness 3. Inconsolability 4. Moaning
What are 6 circulatory / respiratory red flags for serious infection in children older than 1 month?
1. Crackles 2. Cyanosis 3. Decreased breath sounds 4. Poor peripheral circulation 5. Rapid breathing 6. Shortness of breath
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| Term | Definition |
|---|---|
_____ is not common in bacterial meningitis. | Nuchal rigidity is not common in bacterial meningitis. |
What assessments suggest serious bacterial infections? | 1. Ill appearance 2. Fever 3. Vomiting 4. Tachypnea with retractions 5. Delayed cap refill |
Abdominal auscultation may reveal signs of _____ or _____. | Abdominal auscultation may reveal signs of ileus or hyperactivity. |
What are 2 global assessment red flags for serious infection in children older than 1 month? | 1. Parental concerns 2. Physician instinct |
What are 4 child behavior red flags for serious infection in children older than 1 month? | 1. Changes in crying pattern 2. Drowsiness 3. Inconsolability 4. Moaning |
What are 6 circulatory / respiratory red flags for serious infection in children older than 1 month? | 1. Crackles 2. Cyanosis 3. Decreased breath sounds 4. Poor peripheral circulation 5. Rapid breathing 6. Shortness of breath |
What are 6 other factors red flags for serious infection in children older than 1 month? | 1. Decreased skin elasticity 2. Hypotension 3. Meningeal irritation 4. Petechial rash 5. Seizures 6. Unconsciousness |
T/F All urine specimens should be sent for formal urinalysis and culture. | True. Urine dipstick testing has a 12 percent false-negative rate. Urine culture: Collected in urine bag and has 85 percent false-positive rate. |
When are UTIs more common in boys than girls? | First 3 months of life; Uncircumcised |
What is the normal range for WBCs? | 5,000-15,000 |
The band count should be less than _____. | 1500 |
WBC count alone has poor and for identifying young infants with bacteremia and meningitis. Sepsis workup should not be based on the WBC count alone. | WBC count alone has poor sensitivity and specificity for identifying young infants with bacteremia and meningitis. Sepsis workup should not be based on the WBC count alone. |
What 2 inflammatory markers are better indicators than WBC counts? | 1. C-reactive protein 2. Procalcitonin |
What levels of C-reactive protein indicate inflammation? | 2+ |
What should levels of procalcitonin be? | Less than 0.5 |
When is a lumbar puncture recommended? | All febrile neonates. Infants and young children with clinical signs of meningitis (i.e. nuchal rigidity, petechiae, or abnormal neurologic findings). |
Lumbar punctures are not recommended for children older than 3 months unless _ are present. | Lumbar punctures are not recommended for children older than 3 months unless neurological signs are present. |
Two guidelines suggest that a lumbar puncture may be omitted for well-appearing, previously healthy young infants with no _____, a WBC count between _____, and no _ on urinalysis. | Two guidelines suggest that a lumbar puncture may be omitted for well-appearing, previously healthy young infants with no focal signs of infection, a WBC count between 5,000 and 15,000, and no pyuria or bacteriuria on urinalysis. |
T/F Rapid viral testing that is positive for RSV is unlikely to have a serious bacterial infection. | False. Positive for influenza are unlikely to have a coexistent serious bacterial infection. Positive for respiratory syncytial virus may still have a significant risk of UTI. |
What signs indicate the need for a CXR? | Young children older than one month demonstrating respiratory symptoms (tachypnea, retractions, focal auscultatory findings, oxygen saturation level in room air of less than 95%).; Fever of more than 102.2°F (39°C).; WBC count of more than 20,000. |
Do viruses or bacteria cause most pediatric pneumonias? | Viruses |
These lab results are suggestive of serious bacterial infections. Urinalysis (unspun) _____. WBC _____. ANC _____. CRP _____. Procalcitonin _____. | Urinalysis (unspun): WBCs/HPF 10+, bacteria in any of 10 HPFs, or positive leukocyte esterase and nitrite findings; WBC: 15,000+; ANC: 10,000+ neutrophils; CRP level: 40+; Procalcitonin level: 0.5+ |
When would you perform a urine culture in these populations: All males? Uncircumcised males? All females? Older female children? | All males younger than 6 months; All uncircumcised males younger than 12 months; All females younger than 24 months; Older female children if symptoms suggest a urinary tract infection (UTI) |
When do you collect stool for WBC counts and guaiac? | If diarrhea present; Blood or mucus present (child doesn't appear toxic) |
What criteria must be met for febrile children (2-36 months) to not be admitted to the hospital? | 1. Healthy prior to onset of fever 2. Fully immunized 3. No significant risk factors 4. Appears nontoxic and otherwise healthy 5. Parents (or caregivers) appear reliable and have access to transportation if the child's symptoms should worsen |
When the child does not appear toxic and is not hospitalized, when should f/u occur? | Within 24-48 hours or sooner if the condition worsens.; Admission occurs if condition worsens or evaluation indicates serious infection. |
How do you manage a child who does appear toxic? | Admit child for further treatment.; Pending culture results, administer parenteral antibiotics.; Initially administer ceftriaxone, cefotaxime, or ampicillin/sulbactam (50 mg/kg/dose). |