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CMN571 > Module 2 CANVAS Info + PP > Flashcards

Module 2 CANVAS Info + PP Flashcards

1
Q

What developmental element begins during adolescence? When does it end?

A

Puberty
Adulthood

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2
Q

What is the age range for adolescence?

A

10-19yrs

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3
Q

Adolescent thinking moves from ________ to __________.

A

Concrete to abstract

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4
Q

What occurs during adolescence in regards to family?

A

Independent identity and separation

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5
Q

Do you take a BP on all children? What would be the position?

A

Yes, but they need to be cooperative. Seated in a quiet room.

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6
Q

Correct BP cuff size

A

Width covers 40-50% circumference of the limb

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7
Q

How to diagnose HTN in children: how many separate readings need to occur for dx?

A

3 separate readings separated over time

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8
Q

What frequently causes pediatric HTN?

A

-Renal issues
-Obesity

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9
Q

Stages of pediatric HTN

A
  1. Stage 1: 95-99th percentile plus 12mmHg
  2. Stage 2: >99th percentile plus 12mmHg
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10
Q

What medications commonly given during middle/adolescent stages can raise blood pressure?

A

-Steroids
-Oral contraceptives

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11
Q

What is the best method to take a blood pressure? What is the difference?

A

-Automated is not the better way to take a BP; manual is!
-BP readings from automated BP devices are 5mmHg higher for diastolic and 10mmHg higher for systolic

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12
Q

BP varies by what two components of the individual?

A

Height and weight

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13
Q

Labs that should be ordered when HTN is dx? (8)

A

CBC, serum nitrogen, creatinine, electrolytes, lipid panel, glucose, urinalysis, renal ultrasound

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14
Q

Indications for pharmacological therapy include: (5)

A
  1. Symptomatic HTN
  2. Stage 2 HTN w/o a clearly modifiable factors (eg. obesity)
  3. Chronic kidney disease
  4. Diabetes (types 1 and 2)
  5. Persistent HTN despite nonpharmacologic measures
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15
Q

Nonpharmacological interventions to help with HTN

A

Diet
Exercise
Weight management

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16
Q

Enuresis

A

-Repeated urination into clothing during the day and into bed during the night by a child who is chronologically and developmentally older than 5

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17
Q

How many times must a child urinate into clothing during the day and night (who is chronologically AND developmentally older than 5yrs) to be considered for the dx of enuresis?

A

at least twice a week x3 months

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18
Q

Encopresis

A

-repeated passage of stool into inappropriate places by child who is chronologically OR developmentally older than 4yrs

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19
Q

How often must encopresis occur for patient to receive dx?

A

-Must occur each month at least 3 months and is not attributed to physiologic effects of substance or another medical condition except to the mechanism of constipation

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20
Q

What most often causes encopresis?

A

Constipation

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21
Q

Etiology of ADD/ADHA

A

Can be genetics, fetal alcohol syndrome, CNS trauma/infections, prematurity/neonatal brain injury and hyperthyroidism

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22
Q

What is the most common neurodevelopmental disorder?

A

ADD/ADHA

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23
Q

Does ADD/ADHD occur alone or with comorbidities?

A

BOTH; includes learning disabilities, anxiety disorders and depression

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24
Q

What is the most common comorbidity of ADD/ADHD?

A

Anxiety disorders

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25
Q

How often does ADD/ADHD occur in children and adults?

A

-7-8%
-1.5%

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26
Q

Triad of symptoms and characteristics of ADD/ADHD?

A

-Hyperactive-impulsive: interrupting, taking risks, “bugs” people, hyperactive
-Inattentive: messy, not organized, no time management, fails deadlines, can occur with OSA
-Combined

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27
Q

What six symptoms classifies ADD/ADHD?

A
  1. persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by: inattention and/or hyperactivity and impulsivity
  2. Several inattentive or hyperactive-impulsive sx were present prior to age 12 yrs
  3. Several inattentive or hyperactive-impulsive sx are present in two or more settings (i.e. at home, school, or work; with friends, or relatives in other activities)
  4. There is clear evidence that the sx interfere with, or reduce the quality of social, academic, or occupational functioning
  5. Sx do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (i.e. mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal)
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28
Q

What improves outcomes for ADD/ADHD patients?

A

Early dx and treatment

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29
Q

What are the major factors of treatment failure for ADD/ADHD?

A

Improper dx and failure to recognize comorbidities

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30
Q

At what age do sx need to be present before to diagnose ADD/ADHD?

A

Before age 12 and in more than 1 setting

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31
Q

What are different modalities of management for ADD/ADHD?

A

Treat comorbidities (if applicable)
Behavior modification techniques
Social skill training
Counseling
**Some or all may be beneficial

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32
Q

ADD/ADHD medications: stimulants
-Which schedule?
-Abuse risk?

A

High potential for abuse and dependence
-Assess abuse risk before prescribing
-Monitor for signs of abuse and dependence during tx

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33
Q

Contraindications for ADD/ADHD medications (stimulants)

A

-Do not use in patients with serious heart problems or in those for whom an increase in BP or HR would be problematic

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34
Q

What are the monitoring parameters for ADD/ADHD patients about to start stimulant medications?
-with prolonged treatment, what labs should be drawn?

A

-baseline cardiac evaluation in patients
-if risk factors present, BP and HR at baseline, after dose increase, and periodically
-Height and weight at baseline and periodically
-with prolonged treatment, consider CBC w/ diff and annual platelets if prolonged tx

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35
Q

What is something you as the practitioner should always do when prescribing ADD/ADHD medications (or any medications for that matter)?

A

Check for drug interactions

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36
Q

Non-stimulant ADD/ADHD drugs
-used alone or with stimulants?

A

Can be used alone or with stimulants

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37
Q

By age 6, how many Dtap vaccinations should be given?

A

5

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38
Q

By age 6, how many IPV vaccinations should be given?

A

4

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39
Q

When do children begin with their first dose of Tdap?

A

Ages 11-12 yrs

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40
Q

When do children begin with their first HPV vaccine?

A

ages 11-12yrs
-can start at age 9 years

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41
Q

If HPV is given in a 2 dose series, how often is it given?

A

Age 9-14 is the initial vaccination, then 6-12 months after first vaccine (minimal interval: 5 months)
*have to repeat dose if given too soon

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42
Q

If HPV is given in a 3 dose series, how often is it given?

A

Age 15 years or older is the initial dose.
-First dose: 0
-Second dose: 1-2 months later
-Third dose: 6 months
(minimal intervals: dose 1-2 = 4 weeks; dose 2-3 = 12 weeks; dose 1-3 = 5 months. Repeat if given too soon)

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43
Q

If HPV vaccination schedule is interrupted, does the series need to be restarted?

A

No

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44
Q

Meningococcal vaccine (MenACWY-D; MenACWY-CRM; MenACWY-TT)
-routine vaccination timeline

A

-2 dose series at ages 11-12yrs, 16yrs

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45
Q

Meningococcal serogroup B vaccination (MenB-4C, Bexsero; MenB-FHbp, Trumenba)
-routine vaccination timeline

A

-Adolescents not at increased risk: 16-23 years (preferred ages 16-18) based on clinical decision making
*Bexsero: 2 dose series at least 1 month apart
*Trumenba: 2 dose series at least 6 months apart (if dose 2 adminstered earlier than 6 months, administer 3rd dose at least 4 months after dose 2)

46
Q

Are Bexsero and Trumenba interchangeable?

A

No

47
Q

Dengue (DEN4CYD)
When is it given?

A

Only given if seropositive in endemic dengue areas
-given at age 9-16yrs

Ages 9-16 years living in areas with endemic dengue (frequent or continuous) AND have laboratory confirmation of previous dengue infection

-three dose series: 0. 6. 12 months (given 6 months apart)

Endemic areas: Puerto Rico, American Samoa, US Virgin Islands, Federated States of Micronesia, Republic of Marshall Islands, and Republic of Palau

**Do not need to administer to children traveling to or visiting endemic dengue areas

48
Q

What is the age range for people to utilize the live-attenuated influenza vaccine? (LAIV4)

A

2-49 years

49
Q

Tdap: how often is this vaccination given during adulthood?

A

-Given with each pregnancy (27-36weeks)
-Given 1 dose Td/Tdap for wound management
*minor wound: give if not administered w/i last 10 years
*other wounds: give if not administered w/i last 5 years
-Given 1 dose Tdap, then Td or Tdap booster every 10 years
*start giving after 11 years old

50
Q

Adulthood: MMR
-pregnancy considerations
-severe immunocompromising conditions
-healthcare personnel

A

-do not give during pregnancy (can give afterward)
-MMR contraindicated
-Born before 1957 w/o immunity: consider 2 dose series at least 4 weeks apart
-Born in 1957 or later w/o immunity: 2 dose series at least 4 weeks apart

51
Q

Adult: VAR
-no evidence of immunity
-evidence of immunity

A

-2 dose series 4-8 weeks apart; if already received 1 dose, 1 more dose needed at least 4 weeks after first dose
-US born before 1980 with documentation of 2 doses VAR vaccine at least 4 weeks apart, diagnosis or verification of hx of varicella or herpes zoster, lab evidence of immunity or disease

52
Q

Adult: Zoster vaccination
-age
-how many doses
-timing of doses

A

-50 years or older
-2 dose series recombinant zoster vaccine
-2-6 months apart (minimum interval: 4 weeks; repeat dose if administered too soon) regardless of previous herpes zoster or hx of zoster vaccine live vaccination

53
Q

Adult: pneumococcal vaccine
-19-64 years
->64yrs

A

-1. PCV15 or PCV20; if PCV15 then + PPSV23 given 1 year afterward; minimal 8 weeks between
2. PCV13 + PCV20 given 1 year afterward, or complete PPSV23 series
3. PPSV23 + PCV15 or PCV20 at least 1 year after PPSV23 done
4. PCV13 and PPSV23, but not completed series: add 1 dose PCV20 at least 5 years after last vaccine or recommended PPSV23 series

-1. unvaccinated or unknown: PCV15 or PCV20; if PCV15 follow with PPSV23 1 years after (minimum 8 weeks)
2. PCV13: follow with PCV20 1 year after OR complete PPSV23 series
3. PPSV23: PCV15 or PCV20 at least 1 year after
4. PCV13 and PPSV23 but NO PPSV23 was received at age >equal 65 years: 1 dose PCV20 at least 5 years after last pneumococcal vaccine dose or complete recommended PPSV23 series

54
Q

> 12 yrs, which COVID19 booster is available?

A

-bivalent booster (not monovalent) mRNA

55
Q

Is COVID19 vaccine dosage based on age, height/weight?

A

Age on day of vaccination

56
Q

At what age can children receive COVID19 booster?

A

6 months if eligible

57
Q

Children at increased risk for severe illness from COVID19

A

obesity, diabetes, asthma, chronic lung disease, sickle cell disease, or immunosuppression

58
Q

What do some children develop after a dx of COVID19 that is a rare and serious illness?

A

Multisystem inflammatory syndrome in children (MIS-C)

59
Q

How much more likely are children and teens ages 18 years and younger who have had COVID-19 to be newly dx with diabetes?

A

2.5x more likely
-30 days or more after infection

60
Q

Varicella vaccine specifics

A
61
Q

Vaccines due when entering school (K or 1)

A
62
Q

Vaccines due at ages 11 or 12

A
63
Q

Vaccines due at college age

A
64
Q

Know reasons for delaying vaccine

A

Moderate to severe febrile illness

65
Q

Anorexia nervosa
-functionally, body has:
-tachycardia or bradycardia can develop?
-S/S
-hypotension or hypertension?
-how is QT involved?
-impact on peripheral circulation? Lanugo? GI sx?
-what is the main goal of an anorexic patient?

A

-hypothyroid symptoms (euthyroid sick): hair things, brittle nails, dry skin, temperature decreases
-bradycardia (in supine position)
-dizziness, light-headedness, syncope (orthostasis)
-hypotension: secondary to impaired cardiac fx (left ventricular systolic dysfunction)
-can develop prolonged QTc syndrome and increased QT dispersion (irregular QT intervals) –> risk for cardiac arrythmias
-reduced; lanugo can develop; GI tract has inability to take in normal quantities of food, early satiety and GER can develop - gastrocolic reflex may be lost causing delayed gastric emptying, bloating, constipation
-drive for thinness

66
Q

Diagnosis for anorexia nervosa

A

-restriction of energy intake relative to requirements leading to low body weight in context of age, physical health, sex, and developmental trajectory
-strong fear of gaining weight even though underweight
-disturbance in way one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of seriousness of current low body weight
-weight loss leading to body weight <15% below expected
-females: absence of 3 consecutive menstrual cycles

67
Q

Types of anorexia nervosa

A
  1. restricting
  2. binge-eating/purging
    *can have combination
    *can have atypical type - is within or above normal weight
68
Q

Labs connected to diagnosis of anorexia nervosa

A

TSH, electrolytes, LFTs, cholesterole, CBC w/ diff, BUN, creatinine, phosphorus, calcium, magnesium, u/a; EKG and Bone density

69
Q

What is a red flag that can lead to diagnosis of anorexia nervosa?

A

weight loss below a normal body weight

70
Q

What is a complication of anorexia nervosa, especially in females?

A

Osteoporosis, esp. in females with amenorrhea

71
Q

Screening questions regarding dx of anorexia nervosa

A

-how do you feel about your body?
-are there parts of your body you might change?
-when you look at yourself in the mirror, do you see yourself as overweight, underweight, or satisfactory?
-if overweight, how much do you want to weight?
-if your weight is satisfactory, has there been a time when you were worried about being overweight?
-if overweight (underweight), what would you change?
-have you ever been on a diet?
-what have you done to help yourself lose weight?
-have you ever made yourself vomit to get rid of food or lose weight?

72
Q

bulimia nervosa
-factors that contribute
-more common in boys or girls?
-when does this activity usually begin (at what stage of life?)

A

-genetics, biology, emotional health, social expectations
-girls/women
-late teens/early adulthood

73
Q

what eating disorder is characterized as the person losing control over eating?

A

bulimia nervosa
-eating large amounts of food with a loss of control over eating and then purge, trying to get rid of the extra calories in an unhealthy way

74
Q

labs to check if patient dx with bulimia nervosa?

A

electrolytes and amylase (may increase d/t chronic parotid stimulation)

75
Q

S/S of bulimia nervosa

A

-being preoccupied with body size/shape/weight
-fear of gaining weight
-feels out of control while eating and is unable/unwilling to recognize satiety signals
-eating unusually large amounts of food
-forcing vomiting and/or exercising too much and/or laxative use to keep weight off
-using laxatives, diuretics, and/or enemas when not necessary
-fasting or restricting certain foods to avoid calories

76
Q

How do people with bulimia get rid of calories and prevent weight gain?

A

-vomiting
-using medicines: diuretics, diet pills, cathartics & supplements to promote weight loss

77
Q

how often does someone participate in bulimic activities usually?

A

-binge eating and inappropriate compensatory behaviors occur at least once a week x3 months on averages

78
Q

treatment for bulimia nervosa

A

depends on severity and etiology
-psychotherapy averages 6-9 months; input and output

79
Q

medications to utilize on patient diagnosed with bulimia nervosa

A

-SSRI, anti-reflux meds
-heat application and sucking tart candy can help with pain and swelling associated with enlarged parotid gland

80
Q

what is the goal of treatment regarding bulimia patients?

A

interrupt the binge/purge cycle
-goal to reach remission

81
Q

what factors are associated with binge-eating disorder (BED)?

A

combination of psychological, social, and environmental factors

82
Q

definition of binge-eating disorder

A

eating disorder consuming unusually large amounts of food and unable to stop

83
Q

S/S BED
(also, when do sx tend to develop?)

A

-most often overweight/obese
-depression, substance abuse
-eating when not hungry, eating past being full, secret alone eating
-feeling upset/guilty/ashamed/ or depressed after eating
-frequently dieting w/o weight loss
**does not vomit after eating large amounts
-associated with marked distress
-sx develop during adolescence

84
Q

labs to check when diagnosing binge-eating disorder?

A

thyroid, cholesterol, triglycerides

85
Q

treatment for BED

A

psychotherapy

86
Q

medication associated with treatment of BED

A

Topamax, antidepressants, Vyvanse, nutritional supplements if indicated

87
Q

how often does BED occur in order to dx this condition?

A

occurs at least once a week over 3 months

88
Q

avoidant-restrictive food intake disorders (ARFID)
-hallmark feature
-definition

A

-avoidance or restriction of oral food intake in the absence of criteria for AN (body image disturbance, fear of weight gain/body fat)
-can have limitations in the amount and/or types of food
-AN without distress of body shape or size or fears of fatness

89
Q

S/S ARFID

A

lack of interest in eating, avoidance to sensory characteristics of food
-concern for aversive consequences of eating, inadequate nutritional/energy needs met
**there is a lack of drive for thinness with AFRID

90
Q

what can ARFID be associated with?

A

-weight loss or failure to gain
-nutritional deficiency
-dependence on enteral feeding or oral nutritional supplement
-interference with psychosocial functioning

91
Q

treatment associated with ARFID

A

brief medical hospitalizations
long psychiatric or residential hospitalization

92
Q

How are youth screened for substance abuse?
-what are the goals of this screening tool?

A

SBIRT (screening, brief intervention, and referral to treatment)
-a quick, effective technique to manage SUD in adolescents during routine health supervision visits
-goals: determine whether teens have used any alcohol or drugs; determine where adolescents are on the substance use spectrum; for healthcare provider to initiate a brief discussion with the teenage patients about substance use and provide them with education, advice, and referrals within a motivational interviewing model

93
Q

what are the three levels of substance use disorder risk

A

-no reported use
-lower risk
-higher risk

94
Q

what is substance abuse often associated with?

A

sexual and physical abuse

95
Q

false negatives/positives can occur

A

-poppyseed can cause + morphine
etc.

96
Q

how long can cannabinoid be detected after use?

A

-5 days with moderate use
-10-20 days with habitual use

97
Q

CAGE screening
-what does it screen for?
-what does acronym stand for?

A

-alcohol abuse
-1. have you ever felt you should Cut down on your drinking? 2. have people Annoyed you by criticizing your drinking? 3. have you ever felt bad or Guilty about your drinking? 4. have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye opener)?
*if Yes >2, at risk.

98
Q

how to screen for alcohol and drugs?

A

-CAGE-AID
-1. have you ever felt you should Cut down on your drinking or drug use? 2. have people Annoyed you by criticizing your drinking or drug use? 3. have you ever felt bad or Guilty about your drinking or drug use? 4. have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye opener)?
*if Yes >2, at risk.
*severe alcohol level = >0.3g/dL

99
Q

definition of substance abuse

A

chronic, progressive disease typically initiated with tobacco/alcohol (gateway drugs) while trying out a variety of behaviors; experimenting while putting their health and safety at risk

100
Q

prevention of substance abuse
-primary level
-secondary level
-tertiary level

A

-has been a Public priority since 1980’s as with DARE
-targets at-risk populations like Alateen (children of alcoholic parents0
-to prevent morbid consequence like Safe Ride Home (substance user)

101
Q

etiology of substance abuse

A

genetics, social, environmental, mental/behavioral

102
Q

labs associated with substance use diagnosis

A

urine and blood tests; breath tests; hair tests (can have false positives, so be aware)

103
Q

alcohol
-more common substance abuse in women or males?
-more common in what race?

A

-males
-whites

104
Q

what is associated with early and frequent marijuana use during asolescence?

A

psychiatric problems

105
Q

Tobacco
-when to screen?
-why is it a gateway drug?

A

-each visit?
-tends to lead to other substance abused items

106
Q

What are nicotine dependent smokers more likely to develop?

A

psychotic disorders, anxiety, and delirium

107
Q

Is nicotine physically, psychologically, or physically & psychologically addictive?

A

physically and psychologically addictive

108
Q

how quickly does addiction occur with nicotine use?

A

1 month

109
Q

five A’s of tobacco cessation:

A

Ask
Advise
Assess
Assist
Arrange

110
Q

medications associated with helping smoking cessation

A

sustained release antidepressants, bupropion, clonidine, nortriptyline help decrease release after cessation by 5-fold

111
Q

types of referrals related to smoking cessation

A

low intensity
out-patient
school-based
residential
hospital-based
day

CMN571 (8 decks)

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