lecture to junior doctors

1. By Dr Hisham Mukhtar Alrabty
Pediatrics consultant and pulmonologist at Tripoli children hospital.
Senior lecturer at pediatrics department/ Tripoli university.
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2. index:
1. Introduction.
2. Purpose of follow up.
3. Criteria for admission.
4. Basics of daily patient follow up.
5. Who is responsible for follow up.
6. Special cases follow up.
7. Conclusion message.
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3. Introduction:
What is meant by follow up?
It is to check the inpatient health status on
regular basis at certain time intervals which
could be 4 or 6 or 12 hourly or daily.
Looking for any new event ,results of
requested investigations and clinical
condition of patient whether improving or
regressing or static.
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4. Purposes:
to know and recognize the following:
 the clinical progress of patient and the affect of
treatment planned for the patient .
 Diagnosis being true or no.
 Patient given his treatments or missed.
 Results of investigations or asking for new
investigation.
 If the inpatient is in need of further consultation
or imaging.
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5. Admission criteria:
1. Severe respiratory distress.
2. Severe dehydration.
3. Uncontrolled seizures.
4. Poisoning.
5. Heart failure.
6. Acute kidney injury.
7. Bleeding.
8. Uncontrolled hypertension.
9. Shock of any type.
10. Severe infection like meningitis or UTI.
11. Unrecognized skin rash.
12. Coma patients.
And generally when patient life is jeopardized.
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6. Basics of follow up:
O Looking for any new events like seizures
or spikes of fever.
O Daily measurement of vital signs.
O Daily measurement of weight.
O Input and output chart.
O Oral intake (appetite of patient ).
O Treatment chart checking.
O Collecting results of requested
investigations.
O Finishing any further consultations.
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7. Who is responsible for follow up?
Generally all doctors are in charge of
daily follow up.
It is being done by junior doctors
under supervision of senior registrars.
And then finished in ward round by on
call specialist or consultant.
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8. Respiratory case:
O Counting respiratory rate over complete
one minute in quiet child.
O Oxygen saturation measurement.
O Checking for signs of respiratory distress
like central cyanosis.
O Checking for fever spiking.
O Oral intake.
O Any new auscultation findings.
O Check for frequency of nebulized
medicines.
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9. Dehydration:
O Frequency of vomiting and diarrhea.
O Oral intake.
O Input and output chart.
O Daily weight.
O Check for signs of dehydration.
O Check for results of urea and electrolytes.
O Blood pressure measurement.
O Be sure of intravenous fluid type and rate.
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10. Meningitis:
ODaily ofc measurement by same
doctor.
OAssessment of tone and reflexes
daily.
OPalpation of AF.
OAsking about new events like
convulsions or behavioral changes
and fever.
OCollection of csf culture.
OAssessment of following by baby.8/23/2019dr hisam alrabty 2017 10

11. Henoch sholein purpura:
ODaily measurement of blood
pressure.
ODaily urine for RBCS and albumin.
OAssessing the child for abdominal
pain.
ORash evolution and new one.
OJoint involvement and weight of
child.
OTracking any new complication like
scalp edema.
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12. Convulsions:
O Any new fits and its time and frequency.
O Consciousness level and child orientation.
O Dose of anticonvulsants and being given
or no.
O Collections of requested investigations
like blood sugar or calcium or drug level.
O Results of EEG or CT.
O Neurological consultation.
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13. Conclusion:
Inpatient follow up is responsibility
of all medical staff doctors and
nurses.
Inpatients are friable and subject to
many complications like nosocomial
infection.
So please we should all take care of
them very cautiously and efficiently.
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14. 8/23/2019dr hisam alrabty 2017 14
Thanks for
attention