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NURP 532 Test 1 Study Guide @ 2024
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NURP 532 Test 1 Study Guide @2024
When should rectal temperature be used? - Answer in children under age of three,
especially children under 12 months of age.
A toxic-appearing child under age five is more predictive of - Answer a serious bacterial
infection
non-blanching rashes (petechiae or purple rash) concerning for - Answer bacteremia
fever without focus - Answer Acute fever of unknown etiology after a thorough
evaluation of a child less than 24 months of age
higher risk of a serious bacterial infection - Answer children less than 24 months of age,
specially those under 3 months.
one of the more common bacterial infections that cause fever without focus in infants
and children - Answer UTI
Accounts for the cause of most fevers - Answer Viral infections: enterovirus, influenza,
respiratory syncytial virus (RSV), rotavirus, adenovirus, herpes virus-6, or parechovirus
Non-infectous pediatric fever causes - Answer Kawasaki disease; autoimmune or
inflammatory disease, reaction to immunization
pediatric fever red flags (10) - Answer o Ill or toxic appearing, even if no fever is present
o Skin color is ashen blue, mottled, or pale
o Lethargic, weak, high-pitched cry, poor feeding, decreased response
o Tachypnea or tachycardia
o Cap refill more than three seconds
o Decreased urine output
o Bulging fontanel
o Non-blanching skin rash
o Underlying health problem, including prematurity
o Unreliable caretakers
,Infants and children who are ill or toxic appearing regardless of age or presence of
fever require - Answer a sepsis work-up
-CBC with differential
-Serum glucose (to compare with CSF glucose)
-CSF testing -r/o meningitis
-Inflammatory markers (CRP and PCT) (done in combination with WBC count to increase
sensitivity)
-Urinalysis and urine culture (catheterization or suprapubic aspiration)
-Blood cultures
-Chest x-ray
-Stool culture if diarrhea or blood or mucus in stool
Management of neonatal less than 28 days with fever - Answer require a full workup and
hospitalization
well-appearing infants between 29 and 60 days of age with fever require - Answer
-CBC/diff
-Blood culture
-UA and urine culture
-PCT, CRP if available within 60 minutes
-CXR if signs of respiratory symptoms
-Lumbar puncture only if any one of the following:
1)WBC count less than 5,000 microL or greater than 15,000 microL
2)Absolute band count greater than 1,500 microL 3)PCT greater than 0.5 ng/ml
4)CRP greater than 20 mg/L Pneumonia on CXR
Use clinical judgement
Evaluation of infants between 61 to 90 days of age. Infants who are well appearing and
have no focal infection or viral infection, such as flu or RSV - Answer Urinalysis and
urine culture via catheterization
Possible CBC with diff, blood culture, and PCT
Urine testing to r/o UTI is generally recommended for - Answer · infants and children
over three months of age
, females under 12 months of age and uncircumcised males, especially if the fever is
greater than 102.2 degrees Fahrenheit and its duration is longer than 24 to 48 hours
Urinalysis for fever - Answer UA and culture required for all infants less than 90 days
who present with fever
UA and culture also recommended for older infants and toddlers age 3-24 months at
risk; risk factors include temperature greater than 102.2°F, females less than 12 months
of age, uncircumsized males, duration of fever (greater than 24-48 hours) and absence
of another infection
Can also use UTI calculator, which reduces the need for urine sampling and lower rate
of missed UTIs
Criteria for management of fever in infants between 29 and 90 days of age - Answer
-step-by-step approach.
-It identifies low-risk infants who do not require a lumbar puncture. Depends on whether
the child is low-risk Reliable caregivers, ability to return to clinic if symptoms worsen,
and the family feels comfortable
-Low-risk: full-term infant (more than 37 weeks); normal UA, WBC, and PCT; less than
1,500 bands; previously healthy; appears well; no focal bacterial infection; nl CXR if
performed
-If infant is low-risk and has reliable caregivers and follow up, discharge home and close
f/u in 12-24 hours
-If low-risk criteria not met, the child should be admitted and have CSF studies and
receive IV antibiotics
-If low-risk criteria met but unreliable caregivers or follow-up, the child should be
admitted for observation
fever of unknown origin - Answer -Core body temperature greater than or equal to
38.1°C (100.5°F/101) measured at least once daily for 14 (3 weeks textbook) or more
consecutive days and diagnosis not apparent after careful history, physical exam, and
relatively simple, noninvasive tests
-Temperature greater than 38°C (101°F) or greater on several occasions of more than
three-weeks duration, and with failure to reach a diagnosis, despite one week of intense
investigation (Gompf, 2017)
fever of unknown origin history: - Answer ·Same as fever without source in addition to
the following:
-History of the fever pattern How long does it last?
-When does it occur?
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