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Exam 1 Summer 2014 Part 1 > Exam 1 > Flashcards

Exam 1 Flashcards

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
Q

Reasons to retest newborn for metabolic screening

A

discharge prior to 24 hrs
Blood sample collected while baby on special formula or antibiotics
Insufficient sample
Prematurity or under weight

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26
Q

Galactosemia:etiology

A

Galactose-1-phosphate uridyltransferase deficiency

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27
Q

Galactosemia: Clinical features

A

irritability, lethargy, vomiting, hypoglycemia, hepatomegaly, jaundice, brisk hemolysis, FTT, developmental delay, intellectual disability

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28
Q

Galactosemia Eval & Tx

A

UA- dietary exculsion of glactose

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29
Q

Galactosemia pathophysiology

A

If gatactosemic infant is given milk, unmetabolized milk sugars build up & damage the liver, eyes, kidneys & brain

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30
Q

Hemoglobinapathies (thalassemias or sickle cell disease) Etiology, Clinical Features, Evaluation & Treatment

A

varies with condition

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31
Q

Hypothyroidism: Etiology

A

abnormally in the thyroid gland or problem making thyroid hormone

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32
Q

Hypothyroidism: Clinical Features

A

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

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33
Q

Hypothyroidism: Eval & Tx

A

Free T4 & TSH serum sample- replacement dose of levothyroxine sodium

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34
Q

Phenylketonuria: Etiology

A

Deficiency of phenylalanine hydroxylase enzyme (phenylalanine is an amino acid)

35
Q

Phenylketonuria: Clinical Features

A

Irreversible brain damage
Lighter skin and hair for race
Eczematous rash
Musty or Mousy odor

36
Q

Phenylketonuria: Eval & Tx

A

Serum phenylalanine levels- dietary modification to limit phenylalanine intake

37
Q

Foods High in phenylalanine

A

Fish, meat, dairy, nuts, legumes, eggs, wheat, diet soda with aspartame

38
Q

Foods Low in phenylalanine

A

most vegetables, most fruit, sugars, special bread, cookies or crackers, & low protein foods such as special formula

39
Q

Screening levels for hypothyroidism

A

TSH > 9 mU/L and Free T4 < 0.6ng/dL

40
Q

Maple Syrup Urine Disease

A

Defective BCKD protein complex (unable to BCKD into leucine, isoleucine, & valine) this protein complex builds up in the body

41
Q

Sensory Screening-Vision: Ages for physical exam and history

A

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
Q

Sensory Screening-Hearing Newborns

A

before 3 months, screen and document if failed referral needed

43
Q

Sensory Screening- Hearing Ages

A

Age 4,5, & 6 y/o and then every otheryear at age 8 & 10 and then by risk assessment or new patient

44
Q

Risk Factors for Hearing Loss

A

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
Q

Types of hearing loss

A

neurosensory or conductive

46
Q

Reason for diagnostic hearing screening

A

causes delay of speech patterns

47
Q

Screening: Anemia Screening Definition

A

low Hgb, physiologic consequence- inadequate capacity to carry O2

48
Q

Reasons for anemia screening

A

required for normal neurocognitive growth & development

49
Q

Time frames for Screening for anemia

A

breast feed children after 4 months, all children after 1 year on whole milk, and adolsecents, anemia is present with lead poisoning.

50
Q

Terminology RBC

A

erythrocyte

51
Q

Terminology Hemoglobin

A

main functional protein in blood

52
Q

Terminology Hematocrit

A

number of RBCs in a blood sample

53
Q

Terminology MCV

A

the average size of the RBC

54
Q

Terminology MCH

A

the average size of the Hgb within a RBC

55
Q

Terminology MCHC

A

the average concentration of Hgb within a blood sample

56
Q

Terminology Reticulocyte Count

A

“newborn” RBCs

57
Q

Terminology Serum Iron

A

amount of iron in the blood

58
Q

Terminology TIBC

A

ability of the blood to bind to iron

59
Q

Terminology Ferritin

A

the place where the iron is stored in the body for use

60
Q

Terminology Transferrin

A

the escort of iron from one place to the next

61
Q

Jaundice Major Risk Factors

A 
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
Q

Jaundice peak at what day

A

day 5

63
Q

Management of Hyperbilirubinemia

A

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
Q

Developmental /Behavior Screening for 9 month old

A

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
Q

Developmental/ Behavior Screening for 18 month old

A

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
Q

Developmental/Behavior Screening for 24 month old

A

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
Q

Development/Behavior Assessment:

Development Surveillance Components

A 
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
Q

Developmental Screening Tools

A

PEDS
Ages Stages questionnaires (Denver)
MCHAT

69
Q

Immunization: Hepatitis B (Hep B)

A

birth, during 1-2month, during 6-18 months

70
Q

Immunization: Rotavirus (RV)

A

time sensitive-month 2,4,

71
Q

Immunization: Diphtheria, tetanus pertussis (DTaP)

A

2,4,6,during 15-18m/o, during 4-6y/o

72
Q

Immunization: Haemophilus influenza type b (Hib)

A

time sensitive- months 2,4

73
Q

Immunization: Pneumococcal Conjugate (PVC 13)

A

2,4,6, during 12-15 m/o PPSV during 2-6 for high risk groups

74
Q

Immunization: Inactivated poliovirus (IVP)

A

2,4, during 6-18m/o, during 4-6y/o

75
Q

Immunization: Influenza

A

6m/o and older yearly

76
Q

Immunization: Measles, Mumps, Rubella (MMR)

A

live vaccine, given SQ, during 12-15 m/o,during 4-6y/o

77
Q

Immunization: Varicella

A

live vaccine, given SQ, during 12-15 m/o, during 4-6 y/o

78
Q

Immunization: Hepatitis A

A

2 dose series during 12-23 m/o, Hep A series during 2-6 years catch up for high risk groups

79
Q

Immunization: Meningococcal

A

1st dose 11-12 y/o, booster 16y/o

80
Q

Immunization: Human papillomavirus (HPV2 females only, HPV4 males & female)

A

3 dose series 11-12 y/o

81
Q

Immunization: Tetanus, diphtheria, & acellular pertussis (Tdap> or = 7y/o)

A

11-12 y/o

82
Q

Hgb/Hct

A

varies from state to state- mandatory at 1y/o & 2 y/o, based on risk assessment at all time.

83
Q

Lead screening

A

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
Q

Tuberculosis Screening

A

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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