Child with Fever and Respiratory or Skin issues

Child with Fever and Respiratory or Skin issues

Kayla brings Riley, now 18 months, in for complaint of fever and rash. The fever began 3 days ago and is of normal levels in the morning then gets as high as 100 to 101 degrees in the afternoons. Riley has also had clear rhinorrhea and in the last 24 hours he has developed a red, diffuse rash to the torso and abdomen that does not itch and a barking cough in the last day. Mother reports he is drinking, but not as well as usual. He did have a good wet diaper this morning and at least four diapers yesterday, but is not really eating much and is not playing.

Medications: Mother has stopped the Zyrtec. She is giving Robitussin cough and cold at 2.5 ml last night and this morning. Liquid Tylenol 7.5 ml last night and this morning.

She is very concerned about the level of the fever and the fact that after 3 days he is not improving.

Discussion Questions Part One: We will begin by focusing on gathering history in an ill child.

What ‘red flags’ did you note in the historical data?

What data is most important to include in this particular case and which historical data that might be gathered on a well-child exam can be left out of this ill visit?

What are your differential diagnoses?

What parts of the physical exam will you focus on today to rule in or out your differentials