Block 10 (GNK 481) wEBSITE : MBChB IV (2006)

OUTCOME INDICATORS and LEARNING THEMES

Week 1: Evaluation of the sick child

1.1Outcome Indicators

Specific outcomes / Knowledge / L / Skill / L / Assessment
Can conduct an interview
Can obtain a complete history regarding a sick child
Can do a complete physical examination on a child
Can recognize abnormal features on clinical examination
Can assess the severity of illness and decide on emergency, hospital or domiciliary care of a sick child
Can diagnose shock and organ dysfunction or failure
and initiate cardiopulmonary resuscitation
Can prepare a problem list for active management / Know the barriers to communication
Know preventative and promotive aspects of health care
Know the age-related normal ranges of vital signs
Know and recognise signs of:
-respiratory distress
-cardiac failure
-convulsions and coma
-shock
-dehydration
-upper airway obstruction
-lower airway obstruction
-meningeal irritation
-raised intracranial pressure
-acute abdomen
-acidosis
-hypoglycaemia
-malnutrition and nutritional deficiency
Know the indications for hospital care
Know the causes of:
-cyanosis
-respiratory distress
-cardiac failure
-oedema
-coma
-convulsions
-short stature and poor growth
-pallor
-bleeding tendency
-polyuria/oliguria
-vomiting and diarrhoea
-failure to thrive
-developmental retardation
-developmental regression
-fever
-fever and rash
-pain
-loss of weight
Know the normal daily fluid and food requirements for different ages / 4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4 / Communication skills
-Building up trust
-Listening
-Non-directive questioning
Take blood pressure:
-Flush method
-Baumanometer
-Doppler principle
Count pulse rate
Count respiratory rate
Estimate capillary filling time
Estimate modified Glasgow coma scale
Use pulse oximeter
Take fingerprick blood for:
-Haemoglobin
estimation
-Dextrostix estimation
-Glucometer reading
Oxygen administration:
-Face mask
-Nasal prongs/catheter
-Ambu-Bag
-Endotracheal
intubation
Cardiorespiratory resuscitation
Bladder catheterisation
Urine dipstix examination
Urine sediment microscopy
Measurement of body temperature
-axillary
-rectal
-sublingual
Assessment of severity of dehydration
Assessment of nutritional state
Screening assessment of developmental state
Clinical examination of systems
Measurement of length, head circumference, weight
Plotting on growth chart and interpretation of the curve
Observe the child for evidence of illness
Organise referral and transport
Prescribe fluid therapy and
set up a drip infusion for resuscitation or rehydration / 4
4
4
4
4
4
4
4
4
3
3
4
4
4
4
4
4
2
4
4
4
4
2
4
4
4
4
4
4
4
4
4
4
4
4 / Simulated interview
Case presentation and report
Logbook for competency certificate
MCQ
OSCE

1.2 Learning Themes

1.2.1 The patient/family interview and clinical examination

  • Making an early diagnosis of treatable conditions
  • Assessing physical, intellectual and emotional normality
  • Identifying children who are especially at risk
  • Appropriate counselling of parents

1.2.2 What is normal and healthy in childhood?

  • Age-related normal values of vital signs
  • Normality of growth and development

1.2.3Integrated Management of Childhood Illness

  • Evaluating the degree of illness for appropriate management
  • Triage for treatment or referral

1.2.4Sudden infant death syndrome, Cardiac arrest

  • Categories

Life-threatening condition present, death unexpected at this time

Medical condition present, death unexpected

Medical condition unrecognised, found at autopsy

No disorder/disease known or found

  • Risk factors for SIDS
  • Supporting the family and facing the problem
  • Medico-legal implications

1.4.5The ill child

  • Subjective evaluation

Appearance and facial expression

Reactions and behaviour

Skin colour and feel

Mother’s opinion

  • Objective measurements

Vital signs

Temperature

Fluid balance

  • Signs of organ system dysfunction

Chronic

Acute

  • Scoring systems

Paediatric Coma scale

1.4.6Manifestations of disease in infancy and childhood

The unconscious child

  • The convulsing child

The cyanosed child

  • The oedematous child

The short child/ Child with poor growth

  • The child who is not thriving

The pale child

1.2.7The chronically ill child

Diagnostic evaluation

Impact of chronic disease on child and family

1.2.8 The role of the laboratory in evaluation

Diagnosis or support

Function, pathology, aetiology

Results for action

True, valid, significant?

Screening