health promotion and well child care Flashcards
pediatric History taking: PQRST
P-promoting, preventing, precipitationg, palliating factors
Q- quality or quantity
R- region or radiation
S- Severity, setting, simulataneous symptoms
T- temporal factors, onset/durationg, frequency, course over time, have symptoms occured before
Pediatric history taking: OLDCARTS
Onset
Location
Duration
Characteristics
Associated symptoms/aggrevating factors
Relieving
Timing- worse/better day or night
Severity, sequence
birth weight red flag at initial visit
loss of >7-10% of bw
Vit D supplement
400IU/day initiat4ed iwthin first 2 mos for exclusively bf infants
Adolescent History (HEADS)
Home-family dynamics, living arrangements
Education/employment:
Activites/peers: screen time, sleep, activities of daily living
Disabilities/drugs: safety, suicide risk, firearm risk, self image, sexuality
CRAFFT
C- Car- riden in car with someone using d/a
R- do you ever us d/a to relax
A- use D/A when by yourself
F- do you forget things while using
F- do family/friends tell you that you should cut down
T- ever gotten into trouble while using
PHQ-9
Depression screening tool
Stranger anxiety timing
starts 6/7 mos
Separation anxiety
starts 8/9 months
Toddler developmental considerations
- striving for independence
- temper tantrums common
-magical thinking
-fear of separation from parents, instrusion of body orifices loss of control and pain
Preschool children
role play with equipment
allow choices when possible
inform chid of what you are going to do
praise child for helping
teach child about body
school age children
concrete thinking
desires to act brave
enjoys gathering scientific information
modesty
fear of death beginning at age 9
explain use of equipment
adolescent
striving for independence and congtrol
formal operational thinking
bodily concerns
concerns about being different
fears- changes in body, separation from peers, loss of control, death
examine without parent unless desired by patient
cover body part not currently being seen
teach about body
provide assurance of “normalcy” during exam
normal temp and fever
normal newborn 36.5-37.5 rectal
38 degrees C and above
pulse
birth to 10 days: 95-160
1-4 wks: 105-180
1-6 mos: 100-150
6-12 mos: 90-130
1-3 yrs: 80-125
3-6 yrs: 70-115
6-12 yrs 60-100
>12 yrs: 60-100
causes of increased pulse
temp, anxiety/stress, exercise, severe anemia, hyperthroidism, hypoxia, heart disease
Respiratory rates
Neonate: 40-60
up to 12 mos: 30-40
1-3 yrs: 20-30
3-6 yrs: 20-25
6-12 yrs 14-22
>12 yrs: 12-18
increased RR
temp, anxiety/stress, pain, respiratory conditions, heart disease
Blood pressure
bladder width: 40% Circumference of mid bicep
bladder length: cover 80-100% circumference of arm
bp measured at heart level and arm should be supported
- begin to measure at well child visits starting at 3 yrs old
hypertension
average systolic and/or diastolic bp 95th percent for age an sex on 3 separate occasions using same arm, cuff and position
+ taller/heavier children have higher BP than smaller
pulse pressure
difference between systolic and diastolic BP (normal is 20-50mmHg)
WIDE due to high systolic: fever, exercise or excitement
WIDE due to low diastolic: PDA, aortic regurg, heart disease
Sexual/Reproductive History guidelines
- “When was the first time you had intercourse”, date of last intercourse
- date of 1st menarch
- frequencey, length, quanity of menses and sx
- use of tampons or pads
- sexual preference
- types of sexual practices
- reasons for sexual activity
- pregnancies and outcomes
- concurrent contraception, contraceptive history, condom usage
- hx of STI, name each disease (knowledge
- discharge?
- date of last pelvic exam
- performancec of self breast/testicular exam
- history of sexual abuse
measurement of growth parameters
- weight for GA
- length- first 24 mos, height per gestational age
- head circumference- first 24 mos per gestational age
- BMI
- CDC Growth charts for childrn with special healthcare needs
a. premature
b. VLBW
c. genetic/congenital chromosomal conditions
Head circumference
2cm larger than chest during 1st year of life, head and chest circ is equal at 1 yr, during childhood, chest is 5-7cm larger than head
Fontanel
- assess while infant sitting up and not crying
- Posterior font- closes by 2 mos of age
- anterior fontanel should be no larger than 4-5 cm
- Anterior fontant. closes by 18 mos
a. early closure leads to synostosis
b. late closure seen in increaed ICP, hypothyroid, rickets, syphilis, down syndrome, Ost. Imperfecta - large font: chronic increased ICP, subdural hematoma, rickets, hypothyroid,, O.I.
- sunken AF seen with sever dehydration (more than 10%)
Microcephaly
head circ more and 2 standard deviations below the mean for age, sex, gestation.
Causes: intrauterine infection, genetic defects, drug usage during preg (esp alcohol)
Macrocephaly
head circ >2 standard deviations above mean
causes: hydrocephalous, masses, increased ICP, skeletal dysplasias, familial tendency
Head tilt causes
strabismus, CNS lesions, short sternocleidomastoid muscle (congenital torticollis)
Caput succedaneum
diffuse edema of the soft tissue of th escap that crossess suture lines, may be seen with bruisin due ot traumatic vaginal birth, seen at birth, no specific treatment usually resolves in 2-3 days
Cephalohematoma
suberpiosteal collection of blood that does not cross suture lines, does not appear until severl hours or over 24hrs, no specific treatment, resolves over a few weeks to months, observation for hyperbilirubinemia
Craniosynostosis
premature or irregular closure of sutures, causes unusual head shape
Frontal bossing
bulging of frontal area associated with rickets, prematurity, and preamture closing of sutures
Plagiocephaly
flattening or asymmetry of cranium
(brachycephaly, scaphocephaly)
Head control
4 mos of age- head held erect and in midline
6 mos- no head lag when pulled to sitting, if present may indicate nueromuscular disorder, 1st sign of cerebral palsy
Torticollis
restriction of motion, can result from birth trauma ( inury to sternocleidomatoid muscle with bleeding into the muscle), muscle spasm, viral infection or drug ingestion
Turner’s syndrome
webbed neck, 99% in females, banormal ears, micronathia, lymphedema of hands and feet
Thyroglossal duct cyst
filled with fluid from epithelial cells, seen near midline of neck, cyst moves up and down with protrusion of tongue, may become infected, and present as abscess, surgical excision recommended
Brachial cleft cyst
can appear as swelling anterior to sternocleidomastoid muscle or as opening along anterior border of scm, may drain and become infected
hematoma of SCM muscle
common in breech deliveries
eyes and visual acuity exam if:
- Preterm infant risk for ROP
- infant who doesn’t track, absent blink in response to bright lights/sudden mvmt
- children younger than 6 yrs of age: who rub eyes excessively, squint, photophobia, difficulty reaching for or picking up small objects, engage in head tilting, hold objects close to face, presence of retinal hemorrhage
- school age children who sit to close to TV, poor progress in school
- any child who has white area in pupil visible in photographs (retinoblastoma), any white, gray-white, yellow colored material in cornea/lens (congenital cataracts), complains of headache that progresses throughout day (not present in morning), excessive tearing, sstrabismus, drooping eyelid/head tilting, papilledema
dacrosynostenosis
blocked tear duct, may lead to infection *dacrocystitis
“stork bite”
telangiectatic nevi- disappears by 12 mos
periorbital edema
soft swelling around eye
may be related to renal or cardiac problems or sinusitis
acute onset, unilateral eyelid edema with erythma tenderness- periorbital cellulitis
Hearing Screen: initial
EOAE testing is the universal screening tool for the newborn; however, the EOAE does not quantify hearing deficit and may not identify auditory nerve dysfunction. Evoked otoacoustic emission
VRA: VISUAL REINFORCED AUDIOMETRY
VRA testing is a type of behavioral test that measures the response of the child to speech and frequency-specific stimuli. It is generally performed on a child between 5-24 months old.
TYMPANOMETRY
Tympanometry is of little use in children younger than 7 months of age because their ear canals are hypercompliant in response to pressure from the tympanometer.
Auditory brainstem response
ABR measures the initiation of sound-induced electrical signals in the cochlea and the functioning of the peripheral auditory system and neurologic pathways related to hearing. It is a physiological test that averages the number of brainstem responses to brief tones or clicks. It does not require an audiologist for interpretation; the results are pass/fail, and inferences can be made about hearing thresholds. For this reason, it is often used in newborn hearing screening. Since the infant must remain still, it is often performed during sleep or occasionally under sedation
