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Exam 1 Summer 2014 Part 1 > Exam 1 > Flashcards

Exam 1 Flashcards

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1
Q

Visit Intervals for Infancy

A

newborns 3-5 days after discharge then 1 month. Important issues to address are weight, jaundice and breast feeding

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2
Q

Visit Intervals for early childhood

A

(12m/o to 4y/o) visit 12,15,18,24, and 30 months old then 3 and 4 years. Guideline a minimum of 6 visits till 15 m/o

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3
Q

Visit Intervals for middle childhood

A

(5y/o to 10 y/o) annually

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4
Q

Visit Interval for adolescence

A

(11 y/o to 21 y/o) annually

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5
Q

Health History: determining the type of history needed:

A

Birth, dietary/nutritional, previous illness, injury & surgery, allergies, current medications, immunizations, growth/development, habits, review of systems

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6
Q

Health Assessments: Collecting Data by

A

observing, interviewing the parent and the child and physical exam

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7
Q

Bio-graphic Demographic

A 
Name, age, health care provider,
Parents name age/siblings age
Ethnicity/cultural practices
religion/religious practices
parent occupation
child occupation for adolescent
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8
Q

Past Medical History

A

Allergies, childhood illness, trauma/hospitalizations, birth history, did baby go home with mom/special care nursery, genetics: anything in the family

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9
Q

Current Health Status

A

Immunizations,
any underlying illness/genetic condition,
what concerns do you have today

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10
Q

Review of System

A

Ask questions about each system
Measuring data: growth chart, head circumference, BMI
Nutrition: breast fed, formula, eating habits
Growth & development: How does parent think child is doing

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11
Q

Physical Assessment: General appearance & behavior

A 
Facial expression
Posture/movement
Hygiene
Behavior
Development: grossly fits guidelines for age
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12
Q

Measurements: When to do weights

A

all visits

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13
Q

Measurements: When to do length/ heights

A

all visits

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14
Q

Measurements: when to do BMI

A

2 y/o and older

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15
Q

Measurements: When to do head circumference

A

2 y/o and younger

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16
Q

Measurements: When to do BP

A

3 y/o and older and younger in children with specific risk conditions

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17
Q

Vital signs temperature

A

rectal only when absolutely necessary

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18
Q

vital signs: pulse

A

apical on all children under 1 year

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19
Q

vital signs: respirations

A

infants use abdominal muscles

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20
Q

vital signs: blood pressure

A

admission base line

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21
Q

vital signs: height, weight, head circumference

A

2 years and younger

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22
Q

Newborn Metabolic Screening

A

PKU, Hypothyroidism, Galactosemia, Hemoglobinapthies (sickle cell disease or thalassemias)

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23
Q

Reason for Newborn Metabolic screening

A

allows for early recognition & intervention for condition that may not be apparent at birth but may significantly impact normal growth & development

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24
Q

reason for state to added extra testing for Newborn metabolic screening

A

Depends on state situations and population

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25
Reasons to retest newborn for metabolic screening
discharge prior to 24 hrs Blood sample collected while baby on special formula or antibiotics Insufficient sample Prematurity or under weight
26
Galactosemia:etiology
Galactose-1-phosphate uridyltransferase deficiency
27
Galactosemia: Clinical features
irritability, lethargy, vomiting, hypoglycemia, hepatomegaly, jaundice, brisk hemolysis, FTT, developmental delay, intellectual disability
28
Galactosemia Eval & Tx
UA- dietary exculsion of glactose
29
Galactosemia pathophysiology
If gatactosemic infant is given milk, unmetabolized milk sugars build up & damage the liver, eyes, kidneys & brain
30
Hemoglobinapathies (thalassemias or sickle cell disease) Etiology, Clinical Features, Evaluation & Treatment
varies with condition
31
Hypothyroidism: Etiology
abnormally in the thyroid gland or problem making thyroid hormone
32
Hypothyroidism: Clinical Features
Prolonged jaundice, constipation, umbilical hernia, large anterior and posterior fontanelle, macroglossia, decreased muscle tone, poor feeders, respiratory distress, poor peripheral circulation, cool & cyanotic extremities, FTT, Intellectual disability
33
Hypothyroidism: Eval & Tx
Free T4 & TSH serum sample- replacement dose of levothyroxine sodium
34
Phenylketonuria: Etiology
Deficiency of phenylalanine hydroxylase enzyme (phenylalanine is an amino acid)
35
Phenylketonuria: Clinical Features
Irreversible brain damage Lighter skin and hair for race Eczematous rash Musty or Mousy odor
36
Phenylketonuria: Eval & Tx
Serum phenylalanine levels- dietary modification to limit phenylalanine intake
37
Foods High in phenylalanine
Fish, meat, dairy, nuts, legumes, eggs, wheat, diet soda with aspartame
38
Foods Low in phenylalanine
most vegetables, most fruit, sugars, special bread, cookies or crackers, & low protein foods such as special formula
39
Screening levels for hypothyroidism
TSH > 9 mU/L and Free T4 < 0.6ng/dL
40
Maple Syrup Urine Disease
Defective BCKD protein complex (unable to BCKD into leucine, isoleucine, & valine) this protein complex builds up in the body
41
Sensory Screening-Vision: Ages for physical exam and history
3,4,5 & 6 y/o and every 2 years there after, or by risk assessment or new patient check for blocked tear ducts with clear drainage from eye or conjunctivitis
42
Sensory Screening-Hearing Newborns
before 3 months, screen and document if failed referral needed
43
Sensory Screening- Hearing Ages
Age 4,5, & 6 y/o and then every otheryear at age 8 & 10 and then by risk assessment or new patient
44
Risk Factors for Hearing Loss
Family hx of sensorineural hearing loss In utero Infections (TORCH) Craniofacial anomalies-cleft lip or palate Hyperbilirubinemia Post natal bacterial meningitis- Gentamycin Findings indicative of a syndrome with hearing loss Neurodegenerative disorders Sensory motor neuropathies Parental concerns for hearing head trauma recurrent/persistent otitis media-conductive loss
45
Types of hearing loss
neurosensory or conductive
46
Reason for diagnostic hearing screening
causes delay of speech patterns
47
Screening: Anemia Screening Definition
low Hgb, physiologic consequence- inadequate capacity to carry O2
48
Reasons for anemia screening
required for normal neurocognitive growth & development
49
Time frames for Screening for anemia
breast feed children after 4 months, all children after 1 year on whole milk, and adolsecents, anemia is present with lead poisoning.
50
Terminology RBC
erythrocyte
51
Terminology Hemoglobin
main functional protein in blood
52
Terminology Hematocrit
number of RBCs in a blood sample
53
Terminology MCV
the average size of the RBC
54
Terminology MCH
the average size of the Hgb within a RBC
55
Terminology MCHC
the average concentration of Hgb within a blood sample
56
Terminology Reticulocyte Count
"newborn" RBCs
57
Terminology Serum Iron
amount of iron in the blood
58
Terminology TIBC
ability of the blood to bind to iron
59
Terminology Ferritin
the place where the iron is stored in the body for use
60
Terminology Transferrin
the escort of iron from one place to the next
61
Jaundice Major Risk Factors
``` Jaundice observed in 1st 24 hrs of life blood group incompatibility (Coombs Test) gestational age 25-38 weeks or < 38 wks Previous sibling requiring phototherapy Cephalohematoma or significant bruising poor feeding exclusive breast feeding mother is East Asian race ```
62
Jaundice peak at what day
day 5
63
Management of Hyperbilirubinemia
Promote & support successful breastfeeding visual estimation of degree of jaundice is not reliable closely monitor the <38 week, breastfeeding Assess before leaving the hospital provide appropriate follow up based on time of discharge and risk factors Treat, when indicated with phototherapy or exchange transfusion hyperbilirubinemia is eliminated from the body through the stool and urine
64
Developmental /Behavior Screening for 9 month old
Gross Motor -pivots when sitting, crawls well, pulls to stand, cruises Visual Motor/problem solving- uses immature pincer grasp, probes with forefinger, hold bottle, throws objects. Language- says "mama", "dada" indiscriminately, gestures, waves bye-bye, understands "no" Social/Adaptive- starts exploring environment, plays gesture games- pat-a-cake. Behavioral issues- stranger anxiety/ separation anxiety & developmental night waking.
65
Developmental/ Behavior Screening for 18 month old
Gross Motor- Runs, throws objects from standing without falling Visual-Motor/Problem solving- Language-Scribbles spontaneously, builds tower of 3 blocks, turns 2 or 3 pages at a time. Social/Adaptive- mature jargoning (includes intelligible words), 7-10 word vocabulary knows 5 body parts. Behavioral Issues- Temper tantrums
66
Developmental/Behavior Screening for 24 month old
Gross Motor- walks up & down steps without help. Visual-Motor/Problem Solving- imitates stroke with pencil, builds tower of 7 blocks, turns pages one at a time, removes shoes, pants, etc. Language- Uses pronouns (I, you, me) inappropriately, follows 2-step commands, 50 word vocabulary, uses 2-word sentences. Social/Adaptive- parallel play. Behavioral Issues- toilet training and/or new siblings
67
Development/Behavior Assessment: | Development Surveillance Components
``` Elicit & attend to the parents Document & maintain a developmental history Make accurate observation Identify the risk & protective factors Documentation maintain accurate records document the process and findings ```
68
Developmental Screening Tools
PEDS Ages Stages questionnaires (Denver) MCHAT
69
Immunization: Hepatitis B (Hep B)
birth, during 1-2month, during 6-18 months
70
Immunization: Rotavirus (RV)
time sensitive-month 2,4,
71
Immunization: Diphtheria, tetanus pertussis (DTaP)
2,4,6,during 15-18m/o, during 4-6y/o
72
Immunization: Haemophilus influenza type b (Hib)
time sensitive- months 2,4
73
Immunization: Pneumococcal Conjugate (PVC 13)
2,4,6, during 12-15 m/o PPSV during 2-6 for high risk groups
74
Immunization: Inactivated poliovirus (IVP)
2,4, during 6-18m/o, during 4-6y/o
75
Immunization: Influenza
6m/o and older yearly
76
Immunization: Measles, Mumps, Rubella (MMR)
live vaccine, given SQ, during 12-15 m/o,during 4-6y/o
77
Immunization: Varicella
live vaccine, given SQ, during 12-15 m/o, during 4-6 y/o
78
Immunization: Hepatitis A
2 dose series during 12-23 m/o, Hep A series during 2-6 years catch up for high risk groups
79
Immunization: Meningococcal
1st dose 11-12 y/o, booster 16y/o
80
Immunization: Human papillomavirus (HPV2 females only, HPV4 males & female)
3 dose series 11-12 y/o
81
Immunization: Tetanus, diphtheria, & acellular pertussis (Tdap> or = 7y/o)
11-12 y/o
82
Hgb/Hct
varies from state to state- mandatory at 1y/o & 2 y/o, based on risk assessment at all time.
83
Lead screening
Varies from state to state- mandatory at 1 y/o & 2 y/o, always give screening give screening questionnaire until age 6, but questionnaire does not count for lead testing
84
Tuberculosis Screening
at risk assessment is required at 1,6, 12, & 18 m/o and then annually beginning at 24 m/o

Exam 1 Summer 2014 Part 1 (3 decks)

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