In health, the body temperature is maintained within a range of 36.5- 37.oC despite extreme variations in the environment and physical activities. That is starting from a problem and working it out until you establish what is wrong with your patient and then solving it. This page has been accessed 11,702 times. a) What history would you elicit? Malnutrition? If you are the one to take the temperature and you decide to use this method, do it at the end of the examination. d) Auscultation: Use a stethoscope to detect sounds in the thoracic and abdominal cavities. When you have taken the patient’s history and conducted a physical examination, you may find it necessary to confirm your suspicion with some sort of investigations. Otitis media: Check ear drums for signs of infection. Refer appropriately. An accurate history is the first and most important step in making a correct diagnosis and will direct further investigations as well as the management of an illness. https://wikieducator.org/index.php?title=Lesson_3:_Clinical_Problem_Solving&oldid=68141, Creative Commons Attribution Share Alike License, Can follow an object with eyes, claps with hands, Grasps objects actively, makes loud noises, Understands a few words and tries to use them, Grasps small objects with thumb and fingers. Explain the reasons for carrying out investigations. Disclaimer: The CPSolvers provides information for educational purposes only. 5. If you have any difficulty completing any activity, study the section again and if you still cannot do.the activity write to your tutor for assistance. Satisfying some authorities such as churches, governments, etc. It should precede both physical examination and treatment of all except extremely ill patients like those with convulsions or coma. Make sure the child is moving all four limbs normally. The ultimate goal of problem-solving is to overcome obstacles and find a solution that best resolves the issue. The physical examination you perform will vary depending on the child’s presenting symptom. POINTS TO NOTE WHEN TAKING CHILDRENS HISTORY: Once this is identified then you need plan how to manage the problem (ie. Describe investigations commonly carried out at a health unit; Discuss the common causes of fever in children. You should then present these complaints in order beginning with the one that came first. Now that you have read the section on physical examination, you are ready to complete the next activity. Answer all the questions. Were there any complications during or after delivery? Always greet the mother appropriately and ask her to sit with her child. Ordinarily, it is the mother that brings her child to the clinic, so we will refer only to the mother in our discussion. When a child is sick, the caretaker feels worried and may be impatient about getting treatment. This means asking questions like: Find out when each symptom began and whether it seems to be getting better or worse. Sometimes parents think fever is synonymous with malaria and therefore treat their children unnecessarily with antimalarial tablets. What is Clinical Problem Solving. Actively playing, is clear in climbing and jumping. Complete the following activity before proceeding with the reading material. Problem-solving is a mental process that involves discovering, analyzing, and solving problems. Is the child able to drink or breastfeed? For instance, it may be: It is important to establish the duration of each complaint. Any other family diseases, such as sickle cell disease, asthma, etc. d) Severe dehydration/Acidosis: Rapid, deep breathing in a clear chest. Inspect the ears using an auriscope. Inspect (look at) how the child is breathing. Reasons for Hb estimation are: 5. Urinary tract infections: Check urine for protein and pus cells. level was 12.4 mg per deciliter (normal range, 0.020. to 0.800), and the lactate dehydrogenase level was. Briefly describe how you have been managing fever. If they are obviously dehydrated, they need rehydration urgently and if they have collapsed give intravenous fluids. 4. You can improve your problem-solving skills by familiarizing yourself with common issues in your industry and learning from more experienced employees. Did the child breathe spontaneously at birth? If a sick child seems to be sleeping, awaken the child to make sure he or she is not unconscious at the end of your examination. You have now come to the end of this unit. ………………………………………………………………………………………………………………. a. Look at the immunization card to ascertain which immunization the child has received and has not received. A mother brings her 30-month-old boy Steven to your clinic because he has a cough. Outline the main steps in carrying out a physical examination. Parents have a right to know about the condition of their child as well as the required treatment. It addresses a breadth of mental, emotional and behavioral disorders, integrating the science of psychology with the prevention, assessment, diagnosis and treatment of a wide variety of complicated human problems. This process refers to the skills and techniques one uses to search for solutions and applying these skills to find the best solutions available. In the space provided, outline the main components of history taking for a child: Conducting a physical examination is the next step after history taking. ……………………………………………………………………………………………………………… However, note that paracetamol overdose may cause liver damage. Over the last decade, clinical reasoning has come to prominence as a subjec… Problem solving in clinical nursing practice is the essence of good care delivery. In this position, you can then easily begin examining the child while he or she is sitting on the mother’s lap. Next, we shall discuss a common complaint that children present with in our health facilities, that is Fever. You must also decide on management and follow up. b) Asthma: Recession between and below the ribs plus wheezing, in children above 2 years of age. Therefore it is important to find out: Whatever interferes with a child’s nutrition has a direct bearing on the child’s health and should be dealt with. It is therefore important that as a health worker you understand what fever is, its causes, and how to management. From: Mosby's Field Guide to Occupational Therapy for Physical Dysfunction, 2013 Finally, if the child is unable to sit, stand, walk or if the child’s movements do not seem normal, first rule out neck stiffness. Notice what the child is doing while you talk to the mother. List down some of the common complications of fever? Look for chest indrawing. Remittent fever, in which the fever falls each day but does not reach normal Levels. How can you prevent fever in a child? Typhoid: Look for a history of fever rising slowly over a week, with loss of appetite, headache and increasing toxaemia. If the fever is high (38.5 oC), give paracetamol either as tablets (500mg) or as a suspension (125 mg in 5 mls). However, one negative blood slide does not always rule out malaria. Search our database for more, Full text search our database of 145,100 titles for. It involves using things like logic, reasoning, and creativity, to draw conclusions and generally understand things better. A child comes to you with a high fever of 38.7° c. Is he/she lively, playing, interested in its surroundings? Rheumatoid arthritis: Peripheral joint pains and swelling not fleeting, lymph node enlargement, splenonegaly, rash. Palpate for tenderness or swelling of bones or joints. The average body temperature is 37 oC. Identify a clinical problem Before translating any research or evidence into practice, it is important to understand why you are undertaking a TRIP project. Wearing warm clothes can worsen the fever. A body temperature above 40 oC is called hyperpyrexia. Based on the challenges that clinicians face daily, we have developed a teaching-learning strategy that addresses five central issues: (a) learning to perceive or identify relevant clinical problems; (b) learning to address the limits of formalism by situating clinical problem solving according to the most relevant goals and intents; (c) learning to reason in transition about the particular clinical situation; (d) learning the … The best strategy for solving a problem depends largely on the unique situation. 14. When writing down the patient’s history, always use the caretaker’s words. Before you begin to read this section, do this question: ……………………………………………………………………………………………………………… What are the components of a child's history? Problem Definition Maintaining Factors Goals for Problem Resolution . This is called fever of unknown origin (FUO) or pyrexia of unknown origin (PUO). Respiratory rate is very important. Define the terms: history taking, physical examination, investigations and diagnosis. There are various causes of fever in children. She may answer in the positive or negative. October 28, 2020. Do a blood culture. Urinalysis. If the father or another guardian brings the child, the procedure remains the same. c) What would you look for an examination? Background: Clinical reasoning remains a central skill of the successful clinician.
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