Always paint a clear picture of the patient's symptoms in your documentation. Be sure to include medical history, allergies to medication, and current medications related to the symptoms. Any nurse or provider should be able to see exactly why you landed on your chosen disposition based off your documentation.
Warning Signs in Babies (click for video/sound)
Click links below to hear
Rapid respiratory rates apply to children who are not crying.
The following RR are abnormally fast:
Under 2 months: > 60 breaths per minute
2 to 12 months: > 50 breaths per minute
1 to 5 years: > 40 breaths per minute
6 to 11 years: > 30 breaths per minute
12 years or older: > 20 breaths per minute
When counting respirations over the phone, explain that 1 respiration is an inhale and exhale, set your timer, and ask caller to count for one full minute
Is the patient working harder to breathe? Do they appear to be struggling?
Any blueness to lips or face?
Is the patient awake/alert, normal cry?
Are their any respiratory noises when they breathe? Does it clear when they cough?
If patient can cough and the sound clears it is likely congestion, not wheezing
Ask caller to put patient to phone for you to listen
Is there any stridor (mimic this sound for the caller)?
Is the skin sucking in between their ribs when they breathe?
Are they feeding well, having to take breaks?
Is there any nasal congestion? Have you tried to suction prior to feeding or sleep?
Although high fevers can cause small increases in RR, there is no reliable conversion factor.
If the fever is above 103 F (39.5 C) and the RR is slightly increased above abnormal (and not associated with any increased work of breathing or trouble feeding), a nurse may elect to provide a follow-up call in 1 hour.
All infants birth to 1 year with a suspected BRUE (brief resolved unexplained event) need to be referred to an ED now for an evaluation.
Lethargy - usually due to a serious illness such as sepsis
Is patient feeding and sucking well?
Alert when Awake? Watching tablet or looking at a book?
Little spontaneous movement
Decreased eye contact
Doesn’t seem to recognize the parent; minimal response to stimulation or touch
Doesn’t interact with the parent or environment; does not play
Decreased spontaneous talking or babbling
Doesn’t respond to questions
Doesn’t follow simple commands
Location - where does it hurt
Level - mild/moderate/severe
Does it wake from sleep?
Are they consolable?
Does pain improve with Tylenol or Motrin?
Characteristic - sharp, dull, achy, throbbing, etc.
Duration - when did the pain start, how long does it last
Consistency - does it come and go or is it constant
Difficulty breathing or swallowing? Rule out anaphylaxis first.
Taking any medications?
Duration - when did it start
Color - pinkish, red, purple or blood colored, pale center
Description - raised, flat, smooth, splotchy, welts, hives (pale red bumps that resemble mosquito bites), blistered, peeling
Size - pinpoint, tip of pen or eraser, coin size, palm of hand
Does it itch?
Is it painful to touch?
Alteration in Skin integrity (lump, bruise, laceration, abscess, etc)
Location - where is the area located
Size - coin size, tip of an eraser, pea, grape, marble, lemon, golf ball, etc.
Pain - tender to touch, can you move normally (see above)
Redness - surrounding skin, is there a red streak
Swelling - mild/moderate/severe - double in size, noticeable difference, puffy
Drainage - see above
Color - black, white, red, bruised/discolored, blue
Rash - see above
The only colors to worry about are red, black (not dark green) and white.
"Bloody" stools: 90% of red stools are not caused by blood
Foods: red Jell-O, red or grape Kool-Aid, red cereals, red cake frosting, red candy, tomato juice or soup, cranberries, beets, red peppers, red licorice, Fire Cheetos, rhubarb, paprika, red food coloring
Medicines: Amoxicillin or Rifampin and Omnicef or cefdinir
Medicines: iron, bismuth (e.g., Pepto-Bismol)
Having the caller smear a piece of stool on white paper and looking at it under a bright light often confirms that the color is actually dark green.
White or grey stools
Foods: milk-only diet
Medicines: aluminum hydroxide (antacids), barium sulfate from barium enema
Liver disease or bile duct obstruction: Newborns with blocked bile ducts (biliary atresia) have stools that are light gray or pale yellow