COUNSELLING

Pamela Franco
IMMUNISATION
Pamela Franco
 1

GP, 6 months old boy, referred by nurse bcs noticed no vaccines bcs mother
doesn’t want immunization.

Task:
Hx
Counselling

http://www.mif-ua.com/media/uploads/article_images/41_glav_4.jpg.300x300_q85.jpg
1. HOPC: No

2. DDs: Symptoms? (fever, vomiting…)

3. Well being

4. BINDS

- I: WHY?
 a. Convulsion: unfortunately but rare febrile seizure. Observation after vaccination by
professionals

b. Autism: Is a misconception, no scientifically evidence of a link

c. Fever: Panadol

d. Produce low immunity: receiving multiple vaccines on the same day will not overwhelm
the immune system. We are helping the body to improve the immune system.

e. I have never heard of those diseases: As vaccine-preventable diseases become less

common and parents have little familiarity with the devastating effects of vaccine-
preventable diseases, some parents may believe that vaccines are not necessary. It is
thanks to the successful vaccination program that you have never hear about it. Example:
measles.

J Boom, C Healy. (Feb 2020) Mary M Torchia (ed). Standard childhood vaccines: Parental hesitancy or refusal. Retrieved March 2020, from https://www.uptodate.com/contents/standard-
childhood-vaccines-parental-hesitancy-or-refusal
Jan E Drutz . M Torchia (ed). (Feb 2020). Standard immunizations for children and adolescents: Overview. Retrieved March 2020, from https://www.uptodate.com/contents/standard-
immunizations-for-children-and-adolescents-overview
 Counselling:

1. Explain how vaccines works

2. Adverse effects

3. Contraindications

4. How to do it

5. No jab No play

Danchin M, Nolan T. A positive approach to parents with concerns about vaccination for the family physician. Aust Fam Physician 2014;43(10):690–94. Available at
https://www.racgp.org.au/download/Documents/Good%20Practice/2015/July/GP2015-July-Anti-vax.pdf [Accessed 24 March 2020]
 1. Explain how vaccines works:
Immune system is made up of cells and chemicals (AnTiBodies) that fight
infections. We can create ATB against diseases by catching an illness or
through vaccines. Vaccines are made up of a weakened or
dead version of the germ, and the body makes antibodies to destroy it,
without catching the illness.

2. Adverse effects: Shoulder pain (painkiller), skin reaction (ice), fever

(Panadol), febrile seizure/syncope/allergy (observation).

- J Boom, C Healy. (Feb 2020) Mary M Torchia (ed). Standard childhood vaccines: Parental hesitancy or refusal. Retrieved March 2020, from https://www.uptodate.com/contents/standard-
childhood-vaccines-parental-hesitancy-or-refusal
- Jan E Drutz . M Torchia (ed). (Feb 2020). Standard immunizations for children and adolescents: Overview. Retrieved March 2020, from https://www.uptodate.com/contents/standard-
immunizations-for-children-and-adolescents-overview
- Danchin M, Nolan T. A positive approach to parents with concerns about vaccination for the family physician. Aust Fam Physician 2014;43(10):690–94. Available at
https://www.racgp.org.au/download/Documents/Good%20Practice/2015/July/GP2015-July-Anti-vax.pdf [Accessed 24 March 2020]
 3. Contraindication: Anaphylaxis, MMR immunocompromised, pertussis
encephalopathy 1w following DTP. Delay if fever or chemo treatment.

4. How to do it: Vaccine under supervision, with a modify catch-up

vaccination schedule.

5. No jab No play: for enrolling a child in education program or care

services, you need to obtain evidence that the child is up to date with all
vaccinations that are due for their age.

- Kroger AT, Duchin J, Vázquez M. General best practice guidelines for immunization. Best practices guidance of the Advisory Committee on Immunization Practices (ACIP). Available at:
https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html (Accessed on March 20, 2020).
- Kirby T. No jab, no play: Australia and compulsory vaccination. Lancet Infect Dis. 2017;17(9):903.
 2

GP, kid with Hx asthma, eczema and egg allergy. Mother wants to discuss
influenza vaccine.

Task:
Hx
Counselling

http://www.mif-ua.com/media/uploads/article_images/41_glav_4.jpg.300x300_q85.jpg
1. HOPC:
- Asthma
- Eczema
- Egg allergy: what exactly happened? (anaphylaxis?)

2. Well being

3. BINDS
 Counselling:

1. Explain asthma: People with asthma are at high risk of developing serious flu complications, even
if their asthma is mild or their symptoms are well-controlled by medication. Bcs flu can cause
further inflammation of the airways and lungs. Flu infection in the lungs can trigger asthma
attacks and a worsening of asthma symptoms. It also can lead to pneumonia. Asthma is the most
common medical condition among children hospitalized with flu.

2. Explain egg in influenza: Most flu vaccines today are produced using an egg-based manufacturing
process and thus contain a minimum amount of egg protein called ovalbumin

3. How to do it: If hives in any center but if more sever needs to be observed by professionals

4. Adverse effects and contraindications of vaccinations

5. Every year: the influenza virus change every year. Preventing seasonal flue needs to get vaccine
every year.

- CDC. (Nov 2019). Flu and People with Asthma. Retrieved March 2020, from https://www.cdc.gov/flu/highrisk/asthma.htm
- CDC. (2020). Flu Vaccine and People with Egg Allergies. Retrieved March 2020, from https://www.cdc.gov/flu/prevent/egg-allergies.htm
SEPTIC WORKUP
(RASH)
Pamela Franco
 1

ED, 10 months girl, rash today.

Task:

Hx
PEFE card
Counselling

March

http://www.mif-ua.com/media/uploads/article_images/41_glav_4.jpg.300x300_q85.jpg
 +

URTI FOR 1 WEEK WITH TODAY RASH DECREASE EATING AND IRRITABLE
FEVER NUMBER OF WET NAPPIES

T 39.5 NON-BLANCHABLE PURPLE COLD HANDS/FEET +/- STIFF NECK

RASH
 5C:

Condition: Meningococcemia

Cause: a bug (Neisseria meningitidis) spread in the blood (sepsis) including the cover of
the brain (meningococcemia).
REASSURE

Common: uncommon

Complication: Death (life threating). Long term deafness, learning difficulties, most of
these after-effects get better with time. REASSURE.

Could also be: DDs

The Royal Children's Hospital Melbourne. (2017, June). Acute meningococcal disease . Retrieved March 2020, from
https://www.rch.org.au/clinicalguide/guideline_index/Acute_meningococcal_disease
 Mx
Now Future

Admission Tertiary Hospital • Why vaccine did

not work? →
Ix Septic profile cover 5 types +
decrease severity
Treatment AB IV + Fluids +/- inotropic

Notification Yes • Reading

Exclusion Yes

Prophylaxis Yes

The Royal Children's Hospital Melbourne. (2017, June). Acute meningococcal disease . Retrieved March 2020, from
https://www.rch.org.au/clinicalguide/guideline_index/Acute_meningococcal_disease
 To confirm the diagnosis is necessary to perform Ix in TERTIARY hospital so I will call the ambulance.
In the meanwhile, I will talk with my superior and:

1. Septic profile: 2. I will notify health department and once

confirmed we need to inform childcare
• Put an IV canula for:
- Take blood for:
- FBC, ESR/CRP, UEC, LFT, Coags, group 3. Prevent possible infection in contacts by
and hold given prophylaxis (Rifampi/cipro) within 24H
to all contacts in last 7 days.
- VBG with lactate and glucose
- Culture
4. Vaccine: It only cover 5 types and not all of
- Start IV fluids, empiric AB, +/- them, also do not prevent the disease 100%
inotropes but decrease the severity of it
• Urinary catheter for uranalysis and
culture
• CXR
• LP
- The Royal Children's Hospital Melbourne. (2020, March). SEPSIS – assessment and management. Retrieved March 2020, from
www.rch.org.au/clinicalguide/guideline_index/Acute_meningococcal_disease
- The Royal Children's Hospital Melbourne. (2017, June). Acute meningococcal disease . Retrieved March 2020, from
www.rch.org.au/clinicalguide/guideline_index/Acute_meningococcal_disease
 2

GP in small town 50Km from city, 2 yo boy, upset parent, child lethargic and
febrile for last 4 hours. Kid has URTI for last 3 days.

Task:
Hx
PEFE
Dx-DDs (meningococcemia)
Mx

http://www.mif-ua.com/media/uploads/article_images/41_glav_4.jpg.300x300_q85.jpg
 3

Intern, suburban hospital, 2 yo boy, upset parent, URTI 3 days but now does
not eat and is irritable. Looks unwell, non blanchable rash, cold pale skin. VS
T40, RR40, PR 150, BP 90/60, no neck stiffens.

Task:
Explain Dx (meningococcemia)
Counselling

http://www.mif-ua.com/media/uploads/article_images/41_glav_4.jpg.300x300_q85.jpg
 4

Intern, 7 days or 7 weeks old boy, not feeding well and sleepy.

Task:
Hx (cover infection head to toe)
PEFE (child move only when pocked him)
Dx (sepsis)
Mx

http://www.mif-ua.com/media/uploads/article_images/41_glav_4.jpg.300x300_q85.jpg
HERNIA (VOMITING)
Pamela Franco
 1

GP, 7 months old boy, with umbilical hernia, inguinal hernia and undescended
testis.

Task:
Hx
Counselling

http://www.mif-ua.com/media/uploads/article_images/41_glav_4.jpg.300x300_q85.jpg
 1. HOPC
- Umbilical/inguinal hernia: where? Since when? Can you see it
all the time or on-off? Vomiting? Crying (pain)?
- Undescended testis: change in number of wet nappies or
smell? Change in color of the testis?

2. DDs: No

3. Rx Factors: chronic cough or constipation? Hypothyroidism?

4. Well being + BINDS (premature, low weight, meconium)

Murtagh J, Rosenblatt J, Coleman J, Murtagh C. eds. Murtagh's General Practice: Surgical problems in children. 7e New York, NY: McGraw-Hill.
 Condition: DRAW
- Umbilical/inguinal hernia: protrusion of organs, such as intestines,
through a weakened section of the abdominal wall.
- Undescended testis: go down at 3 months of age.
Testicles missing from the scrotum and are in the groin or lower
tommy.

Cause:
- Umbilical/inguinal hernia: can be present at birth or because chronic
cough, constipation (hypothyroidism, Hirschsprung).
- Undescended testis: premature, low weight.

Murtagh J, Rosenblatt J, Coleman J, Murtagh C. eds. Murtagh's General Practice: Surgical problems in children. 7e New York, NY: McGraw-Hill.
 Common: Not umcommon

Complication:
- Hernias: Strangulation
- Cripto: infertility, hormones deficiency, cancer, rx of trauma and poor
self image.

Mx

Murtagh J, Rosenblatt J, Coleman J, Murtagh C. eds. Murtagh's General Practice: Surgical problems in children. 7e New York, NY: McGraw-Hill.
 Mx

Murtagh J, Rosenblatt J, Coleman J, Murtagh C. eds. Murtagh's General Practice: Surgical problems in children. 7e New York, NY: McGraw-Hill.
DOWN Sx (VOMITING)
Pamela Franco
 1

GP, 24 hours old M, country hospital, vomiting green, not passed meconium. X-
ray Double Bobble.

Task:

PEFE (Dysmorphic features for Down)

Counselling (duodenal atresia with Down sx. Ix genetic test, unfortunately the
screening test during pregnancy is not 100% accurate)

http://www.mif-ua.com/media/uploads/article_images/41_glav_4.jpg.300x300_q85.jpg
 2

GP, midwife said baby might have Down Sx, mom is concerned.

Task:
PEFE
Counselling

http://www.mif-ua.com/media/uploads/article_images/41_glav_4.jpg.300x300_q85.jpg
https://www.physio-pedia.com/images/d/de/DS_features.jpg
 SPIKES → K
Condition: Down syndrome is a common Could be: Other genetic malformations (trisomy 18,
trisomy 13, hypothyroidism, genetic Sx)
Cause: genetic condition caused by an extra
chromosome 21. Mx:
- Ix: basic + ecocardio, TFT, X ray abdomen and
Common spine
- MDT. Children with Down syndrome attend
childcare, kinder, primary and high school
Complication: alongside other children of their age. Adults with
Down syndrome attend post-school training,
- Learning disability with delay in reaching participate in the workforce and lead full lives as
developmental milestones, speech and productive and valued members of the
language take more time. The extent and community. An increasing number of people with
specific areas of delay vary from one person Down syndrome are achieving independent living,
to another. with some level of support, within the
- Problems in hearth, thyroid, GIT, spine. community.
- Support group.

Down Syndrome Victoria. Down Syndrome Today. Retrieved March 2020, from https://es.scribd.com/doc/56260741/Down-Syndrome-Today
Murtagh J, Rosenblatt J, Coleman J, Murtagh C. eds. Murtagh's General Practice: Genetic conditions. 7e New York, NY: McGraw-Hill.