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Pediatric Primary Care Exam 1 > Health Promotion > Flashcards

Health Promotion Flashcards

1
Q

How many well child visits should there be from birth to adolescence? (2)

A
  1. 14 well child visits
  2. 31 supervision visits
    * 12 from birth to 3 years old
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2
Q

Routine Hearing Screening Ages (6)

A
  1. Newborn screening
  2. 4 years old
  3. 5 years old
  4. 6 years old
  5. 8 years old
  6. 10 years old
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3
Q

Risk Indicators for Hearing Screening (11)

A
  1. Caregiver concern* regarding hearing, speech, language, or developmental delay.
  2. Family history* of permanent childhood hearing loss.
  3. NICU of more than 5 days* or any of the following regardless of length of stay: ECMO, assisted ventilation, exposure to ototoxic medications (gentamycin and
    tobramycin) or loop diuretics (furosemide/Lasix), and hyperbilirubinemia that requires exchange transfusion.
  4. In utero infections*, such as CMV, herpes, rubella, syphilis, and toxoplasmosis.
  5. Craniofacial anomalies*, including those that involve the pinna, ear canal, ear tags, ear pits, and temporal bone anomalies.
  6. Physical findings, such as white forelock, that are associated with a syndrome known to include a sensorineural or permanent conductive hearing loss.
  7. Syndromes associated with hearing loss or progressive or late-onset hearing loss*, such as neurofibromatosis, osteopetrosis, Usher syndrome, Waardenburg, Alport, Pendred, and Jervell and Lange- Nielson.
  8. Neurodegenerative disorders* such as Hunter syndrome, or sensory motor neuropathies, such as Friedreich ataxia and Charcot-Marie Tooth syndrome.
  9. Culture-positive postnatal infections associated with sensorineural hearing loss*, including confirmed bacterial and viral (especially herpes viruses and varicella) meningitis
  10. Head trauma, especially basal skull/temporal bone fractures that requires hospitalization.
  11. Chemotherapy
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4
Q

AAP Vision Screening Recommendations (3)

A
  1. Routine screening at age 18 has been changed to a risk assessment.
  2. A visual acuity screen is recommended at ages 4 and 5 years, as well as in cooperative 3 year olds.
  3. Instrument based screening may be used to assess risk at ages 12 and 24 months, in addition to the well visits at 3 through 5 years of age.
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5
Q

Clinical Guidelines for Vision Screening: Newborn-6 Months (5)

A
  1. Ocular history
  2. External inspection
  3. Red reflex testing
  4. Pupil exam
  5. Visual acuity and fixate and follow should occur by 6 months
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6
Q

Clinical Guidelines for Vision Screening: 6-12 months AND 1-3 years (8)

A
  1. Ocular history
  2. External inspection
  3. Red reflex testing
  4. Pupil Exam
  5. Ocular motility
  6. Instrument Based screening
  7. Visual acuity and fixate and follow
  8. Visual acuity should occur at age 3
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7
Q

Clinical Guidelines for Vision Screening: 4-5 years old (6)

A
  1. Ocular history
  2. External inspection
  3. Red reflex testing
  4. Pupil Exam
  5. Ocular motility
  6. Instrument Based screening
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8
Q

Clinical Guidelines for Vision Screening: Over 6 years old (7)

A
  1. Ocular history
  2. External inspection
  3. Red reflex testing
  4. Pupil Exam
  5. Ocular motility
  6. Instrument Based screening ONLY if unable to vision screen
  7. Visual acuity (snellen)
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9
Q

Developmental Screening Guidelines (3)

A
  1. Autism Screening should occur at 18 and 24 months
  2. Developmental Surveillance should occur at every primary care visit when not doing developmental screening
  3. Neuromotor screening should occur at 9, 18, 30, and 48 months
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10
Q

What ages should standardized neurodevelopmental screening occur? (3)

A

9, 18, and 30 months

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11
Q

9 month old neurodevelopmental screening (2)

A
  1. Can separate from parents, move around

2. Develop pincer grasp - surrogate for cortical and over all brain development

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12
Q

18 month old neurodevelopmental screening

A

Validated instrument for screening for autistic spectrum disorder *** this should be repeated at 24 months!!!

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13
Q

30 month old neurodevelopmental screening (2)

A

1, Majority of children have isolated delay in expressive language
2. At 24 months, can screen language 20% will be delayed

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14
Q

Type of Development Standardized Tests (4)

A
  1. Ages and Stages
  2. Denver II
  3. Peds
  4. Language: Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS)
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15
Q

Type of Behavioral Standardized Tests (2)

A
  1. Pediatric Symptom checklist: 35 questionnaire for children 4 to 16 years of age
  2. Modified checklist for Autism in Toddler (M-CHAT)
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16
Q

Newborn Screening

A

Should be done 24 hours post feeding

*Also do critical congenital heart defect screening

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17
Q

Dyslipidemia Screening

A

Screen between 9-11 years old AND 16-18 years old

dyslipidemia=high cholesterol

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18
Q

Hematocrit and Hemoglobin Screening

A

15-30 months risk assessment

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19
Q

Trichimosis Vaginalis Screening (6 risks)

A 
Unnecessary unless child is at risk
Risks:
1. New or multiple partners
2. History of STI
3. NAAT for T vaginalis
4. Point of care tests
5. DNA probe
6. Culture -- Microscopic is less sensitive (51% to 65% in females and less sensitive in males
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20
Q

Routine syphilis evaluation

A

No routine syphilis evaluation
*Only MSM annually or every 3-6 months if high risk or
behaviors that put them at high risk

**No routine syphillis unless adolescent/adult males having sex with one another

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21
Q

STI/HIV Screening (4)

A
  1. HIV screening: 16 and 18 years.

STI screening
2. All sexually active adolescents should be screened for chlamydia and gonorrhea annually

  1. Use of highly sensitive nucleic acid amplification tests (NAATs) to test urine, urethral, vaginal (provider or patient collected cervical, and liquid cytology specimens
  2. Not approved for oral or rectal swab specimens
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22
Q

Cervical Dysplasia (2)

A
  1. Adolescents should no longer be routinely screened for cervical dysplasia until age 21.
  2. If immunocompromised or immunosuppressed, yearly PAP tests should begin with onset of sexual activity
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23
Q

Flouride Varnish (6)

A
  1. Dental home referral starting at age 1 year
    * Dental home should start at age 1 but insurance doesn’t cover it until age 3
  2. Fluoridated toothpaste is recommended for all children starting at tooth eruption, regardless of caries risk.
  3. A smear (the size of a grain of rice) of toothpaste should be used up to age 3. After the 3rd birthday, a pea sized amount may be used.
  4. Parents should dispense toothpaste for young children and supervise and assist with brushing.
  5. Fluoride varnish is recommended in the primary care setting every 3–6 months starting at tooth emergence.
  6. Over-the counter fluoride rinse is not recommended for children younger than 6 years due to risk of swallowing
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24
Q

Indications for Pelvic Exams Prior to Age 21 (9)

A
  1. Persistent vaginal discharge
  2. Dysuria or urinary tract symptoms in a sexually active female
  3. Dysmenorrhea unresponsive to nonsteroidal antiinflammatory drugs
  4. Amenorrhea
  5. Abnormal vaginal bleeding
  6. Lower abdominal pain
  7. Contraceptive counseling for an intrauterine device or diaphragm
  8. Suspected/reported rape or sexual abuse
  9. Pregnancy
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25
Q

How much flouride should be used from birth-6 months?

A

None

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26
Q

How much flouride should be used from 6 months-3 years?

A

0.25mg/d of <3ppm

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27
Q

How much flouride should be used from 3-6 years old?

A

0.50mg/d of <3ppm

OR

0.25mg/d of 0.3-0.6ppm

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28
Q

How much flouride should be used 6-16 years old?

A

1.0mg/d of <3ppm

OR

0.50mg/d of 0.3-0.6ppm

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29
Q

What is done vs. what is not done at well-child visit?

A

What is done: counseling on nutrition and physical activity (usually done from 2-5 years old)

What is not done:

  1. Inquiries about domestic violence
  2. 50% addressed parent depression
  3. 2/3 asked about alcohol and substance abuse
  4. 50% asked about social support
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30
Q

Effectiveness of Preventative Care (3)

A
  1. Support optimal nutrition – Breastfeeding and Monitoring weight/height/head circumference
  2. Safety promotion
    - Bicycle safety monitoring
    - Other safety issues are more problematic: Guns, Prevention of burns, Substance abuse
  3. Early recognition of behavioral issues
    - ADHD
    - Autism screening at 18 month and 24 months
31
Q

Reach out and Read (5)

A

A promotion of literacy; children get to bring home books for every child visit

  1. Starts at 6 month child visit through 5 years
  2. Encourage the parent/guardian to read
  3. Increases reading aloud at home
  4. Improved expressive and receptive language skills
  5. Effective in lower and middle income families
32
Q

Health Belief Model (5)

A
  1. Rational appraisal of balance between the barriers and benefits of action; attempts to explain and predict health behaviors by focusing on attitudes/beliefs
  2. Perceived seriousness of and susceptibility to a disease influences an individual’s perceived threat of disease
  3. Demographic and socio-psychological influences
  4. High perceived threat, low barriers, and high perceived benefit to action increase likelihood of engaging in recommended behavior
  5. Perceived severity may not be as important as perceived susceptibility
33
Q

Transtheoretical Model (3)

A
  1. Hypothesizes a number of qualitatively different discrete stages and process of change; how you move through periods of maybe or maybe not
  2. People move through changes, relapsing and revisiting earlier stages of success
  3. Bandura criticizes this theory as he feels that human functioning is too multifaceted to fit so nicely into stages
34
Q

Stages of transtheortical model (6)

A
  1. Pre contemplation –> No/Denial
  2. Contemplation –> Maybe/Ambivalence
  3. Determination/Preparation –> 0-3 months; Yes/Motivated
  4. Action –> 3-6 months; Doing it/Go
  5. Maintenance –> Over 6 months; living it
  6. Relapse/Recycle
35
Q

Tenets of Shared Decision-Making (7)

A
  1. Develop a partnership
  2. Establish/review the patient’s preference for information and their role in the decisions/uncertainty about the course of action to take
  3. Respond to patient’s ideas, concerns and expectations
  4. Identify choices and evaluate research evidence in relation to the individual patient
  5. Present or direct the patient to the evidence; help patient make alternative decisions
  6. Make or negotiate a decision in partnership and resolve conflict
  7. Agree on a plan and arrange a follow-up
    * Internet has made patients more involved in medical decisions and demand accountability
36
Q

Patient’s use of internet (5)

A
  1. Shift of power – internet information can empower family and patient; patient asks for interpretation of information
  2. Changes their decisions about how to treat illnesses
  3. Helps families/patient’s ask questions or obtain second opinion
  4. Influences decision about whether to visit a provider
  5. Improves the way the person takes care of themselves
37
Q

Traditional Medical Model of Patient relationship of acquisition of health information

A

Source –> Dissemination (spreads information) –> user

38
Q

Health Care Consumer Model of Patient relationship of acquisition of health information

A

User –> access, search –> Source

39
Q

Information Sharing Model of Patient relationship of acquisition of health information

A

Interactive

Source user

40
Q

Paternalistic Model (3)

A

Information transfer: one way provider to patient; minimum necessary for informed consent

Deliberation: physician alone or with other physicians

Decision about implementing treatment: physician

41
Q

Shared-Decision Making Model (5)

A
  1. Information transfer: two way provider provides medical information needed for decision and patient provides info about preference
  2. Deliberation: physician and patient (plus potential others)
  3. Decision about implementing treatment: physician and patient
  4. SDM is based on trust and mutual respect
  5. Initiatives only base outcome may hinder the use of SDM, encouraging provider to act on patient’s preferences
42
Q

Informed Patient Model (3)

A

Information transfer: one way from doctor to patient; all medical information needed for decision making

Deliberation: patient (plus potential others)

Decision about implementing treatment: patient

43
Q

Potential Advantages of Informed Patient Model (7)

A
  1. Better informed patients; online recourses help patient partner with patient
  2. More likely to comply with treatment if using internet
  3. improved communication
  4. Help patients seek care for problems they may have ignored
  5. Participatory decision making model fosters informed decision making
  6. Internet may help patient feel more comfortable with their decision
  7. Patient may be able to access their own records
44
Q

Disadvantage of Informed Patient Model (5)

A
  1. Variability of internet information
  2. Limited access by socioeconomic and ethnic groups further exacerbating health care disparities
  3. Adults with low literacy
  4. Use of internet health info sites may impact liability with providers being responsible to conform to standard of care
  5. Could interfere with provider-patient relationships (optimism tends to prevail)
45
Q

Triangulation Response (3)

A
  1. Effective communication
  2. Positive reinforcement
  3. praising efforts to take role in decision making and self care management

(triangulation –> internet at top, patient and provider connected at base)

46
Q

Shared Decision Making in Primary Care Disadvantages (3)

A
  1. Time constraint
  2. Multiple problems to be handled in a short period of time
  3. What provider wants to focus on may not be what the patient is truly concerned about
47
Q

Developmental Perspective in teen brain: changes in pre-frontal cortex (5)

A
  1. Increase in white matter (insulated and myelinated); increased number of connections between prefrontal cortex- crucial component of complex behaviors and decision making
  2. Increased sensitivity to dopamine in the brain
  3. Increased sensation-seeking behaviors and goal directed activity
  4. Decrease in number of DA receptors; redistributed from rewards and behavior pathway as adolescent hits adulthood
  5. Outside forces (poverty, discrimination, trauma, nutrition, etc.) change the brain at a level of signaling molecules - serotonin and dopmaine
48
Q

Developmental Perspective (2)

A
  1. Early teens can look like children; puberty has variable onset
  2. Early maturing and late maturing adolescents face social challenges and unique individual challenges
49
Q

How to identify development (5)

A

What we see:

  1. Shifting peer groups
  2. challenging parents
  3. changing hair colors and fashion
  4. declining or growth in spiritual development
  5. sexual experimentation

*Experimentation may help in coping mechanism

50
Q

5 C’s

A

Rick Little and Richard Lerner
*Assessment to strength-based care

  1. Confidence
  2. Competence
  3. Character
  4. Connection
  5. Contribution
51
Q

Strength Based Approach vs. Risk Based Approach (5)

A
  1. Not competing paradigms
  2. Look for the best in both
  3. Reframe adolescence
    * Youth get message that they are troublesome and dangerous (esp. for minority and marginalized youth)
  4. Resilience theory - youth live up or down to our expectations of them
  5. We illuminate the problems of youth in data we have about them
52
Q

Core Principles in Positive Youth Development (4)

A
  1. Young people need to feel valued
  2. Youth are often the best teachers and role models of other youth
  3. Adults can be supportive and instructive from the sidelines—allow them to carry out activities as independently as possible
  4. The feared adolescent behaviors of substance use, self-mutilation, eating disorders, Internet addiction and others are coping strategies for youth to manage stressors
53
Q

Storm and Stress (3)

A
  1. Coined by Stanley Hall in 1904

2. 3 key elements of adolescent development: conflict with parents, mood disruption, risky behavior

54
Q

Erikson Adolescent Stage

A

Confusion or diffusion of identity versus achieving a stable identity

55
Q

7 C’s Model of Resilience

A
  1. Confidence
  2. Competence
  3. Character
  4. Connection
  5. Contribution (Lerner and Colleagues)
  6. Coping
  7. Control
56
Q

Three principles used to engage youth as their own expert

A
  1. Self-determination theory
  2. Nururant-authoritative approach
  3. Mindfulness
57
Q

Self-determination theory (2)

A
  1. Sense of autonomy and competence is critical
  2. Interaction with adults support emerging sense of autonomy and confidence
    * The adolescent knows what is best for them (strength-based)
58
Q

Nurturant-Authoritative Approach (2)

A
  1. Nurturance supporting the youth’s emotional experience
  2. Authoritative not authoritarian
    * Support emotions w/o knocking what they are doing; be mindful and aware of their feelings
59
Q

Mindfulness Approach (4)

A

Reflection and self awareness by the HCP to look at

  1. Be mindful of the adolescent’s system and values
  2. Deal with strong feelings
  3. Have a beginners mind
60
Q

Active Listening

A

What the patient says –> what the practitioner hears

*Asking/reiterating what the patient said; reflective listening

61
Q

Patient Centered Approach

A
  1. Simple open questions
  2. Listening and encouraging with verbal and nonverbal prompts
  3. Clarify and summarize
  4. Reflective listening - making statements, the aim of which is to understand the patient’s meaning
62
Q

Three topics to talk about in behavior change

A
  1. Importance - why is it important? is it worthwhile to change?
  2. Confidence - how? Can I change?
  3. Readiness - when? should I do it now?
63
Q

Ingredients of Readiness to Change (3)

A
  1. Importance – why should I change? personal values and expectations of the importance of change
  2. Confidence - how will I do it? Self eficacy

these lead to readiness

64
Q

Motivational Interviewing (5)

A
  1. Belief that the responsibility for change lies with the client and that respect for the client’s autonomy is crucial
  2. Opposite would be telling a client what needs to be done
  3. Model to describe HOW people change; helps people with problem behaviors change their behaviors
  4. Leads to improvement in client’s health outcome
  5. Identifies client’s own fears and difficulties and helps to resolve the issues
    * YOU CAN ONLY CHANGE ONE BEHAVIOR AT A TIME
65
Q

Tools for motivational interviewing (2)

A
  1. Readiness ruler
    - How ready is the patient for change?
    - Scale of 0-10, 0 being not at all, 10 being very
  2. Confidence ruler
    - How confident is the patient that he/she will be successful in making the change?
    - Scale of 0-10
66
Q

DARN CAT

A

Pneumonic for motivational interviewing; how to remember questions to ask the patient about change

Desires
Abilities
Reasons
Need
Commitment
Action to 
Take change
67
Q

Skills to explore patients feelings about change (4)

A

OARS

Open ended questions
Affirmations
Reflections
Summarization

68
Q

Drowning Deaths (4)

A
  1. Youngest children and African American children are at high risk with African American teens between 15-19 at highest risk
  2. Fresh water lakes and pools
  3. Portable pools at the highest risk
  4. Swimming lessons don’t make the child drown-proof
    * But swimming lessons in 1-4 years is associated wtih decrease risk of drowning
69
Q

AAP Drowning Questionnaire (3)

A
  1. Backyard dangers - chain link fence and open gates
  2. Proper supervision around water - close enough to touch child
  3. When to leave child alone in bathtub: Around 6 years old
70
Q

Risk Factors of Pedestrian Injuries (5)

A
  1. Highest risk for 5-9 year old boys
  2. Low income
  3. 4-9pm at night is period of greatest risk
  4. Absence of supervision
  5. Crossing the street mid-block
71
Q

Physical Risks for Pedestrian Injuries (4)

A
  1. Smaller size
  2. Poor peripheral vision and depth perception
  3. Poor localization of sound
  4. Difficulty judging speed on oncoming care
72
Q

Developmental Contributions to Pedestrian Injuries (4)

A
  1. Egocentrism (I see the car so the car sees me)
  2. Magical thinking
  3. Inability to interpret traffic symbols
  4. Peer pressure
73
Q

Issues with Clinical Decision Making (4)

A
  1. Avoid indiscriminate use of diagnostic test
  2. Risk of adverse outcome because of inappropriate management
  3. Costs and possible harmful effects of nonbeneficial therapeutic intervention
  4. PROBLEM- Single disorder can produce a wide spectrum of signs and symptoms; many disorder produce similar signs and symptoms

Pediatric Primary Care Exam 1 (7 decks)

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