Health Supervision Flashcards
Principles of Health Supervision
- providing services proactively
- optimizing child’s level of functioning
- ensuring child is growing and developing appropriately
- promoting best possible health
- preventing injury and illness through child teaching
Medical Home
physician or nurse practitioner who has a long term and comprehensive relationship w/ the family, leading to comprehensive, continuous, coordinated, and cost effective care
What is considered vital for a child with a chronic illness?
effective partnership among the child’s medical home, family, and community
What will enhance the quality of life and health of a child with a chronic illness?
Coordination of specialty care, community agencies, and family support networks
Special Issues in Health Supervision
- cultural influences
- community influences
- health supervision and the chronically ill child
- health supervision and the internationally adopted child
What issues are covered in a psychosocial assessment?
- health insurance coverage
- transportation to health care facilities
- financial stressors
- family coping
- school’s response to the chronic illness
Chronic Illnesses require what?
- repeated assessments
- need to determine health maintenance needs
- frequency of visits
- types of interventions
For international adoption the child will need a comprehensive screening for?
- infectious diseases
- disorders of G&D
- vision/hearing
- any testing bases on diseases prevalent in their country of origin
When does the screening need to be done?
within the first few weeks of arrival
Universal Screening
- intestinal parasites
- hepatitis A,B,C
- varicella
- HIV
- syphilis
- tuberculosis
The health supervision visit will include what?
- history and physical assessment
- developmental/behavioral assessment
- sensory screening
- appropriate at risk screening
- immunizations
- health promotion/anticipatory guidance
Health promotion/anticipatory guidance may include:
injury prevention
violence prevention
nutrition counseling
Appropriate At-Risk screening may include:
lead anemia TB test HTN cholesterol
What are the 3 components of Health Supervision?
- developmental surveillance and screening
- injury and disease prevention
- health promotion
Health supervision should be viewed as what?
Viewed as part of a continuum of care and NOT as the accomplishment of isolated tasks
Components of Developmental Surveillance
- noting and addressing parental concerns
- obtaining a developmental history
- making accurate observations
- consulting w/ relevant professionals
What may indicate warning signs or identify risks for developmental delay?
Historical information obtained from the parent or primary caregiver about developmental milestones
Any child who “loses” a developmental milestone needs what?
An immediate full evaluation
Why does a child who “loses” a developmental milestone need an immediate full evaluation?
Because this indicates a significant neurological problem
To increase cooperation you can do what?
set up a reward system
Ways to increase cooperation are:
- stamp/sticker on hand
- decorating tongue blade for vision screening
- copy a design and let them color
- let them play with tools
Risk Assessment
includes objective and subjective data to determine likelihood child will develop a condition
Universal Screening
screening of an entire population regardless of child’s individual risk
Selective Screening
done when a risk assessment indicates the child has one or more risk factors for a disorder
What are some specific types of screening performed?
- metabolic
- hearing
- vision
- iron-deficiency anemia
- lead
- hypertension
- hyperlipidemia
If a metabolic screening is not done before 48 hours of age when should it be done?
At first visit
What ages is universal hearing recommended?
4-8 and 10 years old
Criteria for Risk Assessment for Hearing Loss (3 mo- 5 yrs)
- auditory skill monitoring
- developmental surveillance
- assessment of parental concerns
- older than 4 yrs
- difficulty hearing on phone, in noisy background
- frequently asking others to repeat themselves
- turn tv up too loud
Using a vision screening chart
- place chart at eye level
- place mark on floor 20 ft from chart
- align child’s heels w/ mark
- have child read each line w/ one eye covered
- have child read w/ both eyes
At what ages should you screen for iron-deficiency anemia?
4, 15, 18, and 30 months
The child’s Hgb/Hct should be taken at how old?
12 months
What is an elevated blood lead level?
5 ug/dL
At what ages should you screen for elevated blood lead levels?
6,9,12,18,24 months and 3,4,5,6 years
When does the universal hypertension screening begin?
3 years
When do you screen for hyperlipidemia?
Once between 9-11 years and again between 18-21 years old
What happens when the immune system recognizes an antigen?
It responds by producing antibodies or directing special cells to destroy and remove the antigen
Immunity
ability to destroy and remove a specific antigen from the body
Passive Immunity
produced when the immunoglobulins of one person are transferred to another
Active Immunity
acquired when a person’s own immune system generates the immune response
Intramuscular Vaccines
DTap, DT, Tdap Hepatitis A,B Hib Influenza Pneumococcal conjugate vaccine HPV MCV-4 IPV
Subcutaneous Vaccines
IPV
MMR
Varicella
MPSV4
IM injection Birth-28 days and 1-12 months
anterolateral thigh
IM injection 1-2 years and 3-18 years
anterolateral thigh and deltoid muscle
SubQ injection 1-12 months
fatty tissue over anterolateral thigh
SubQ injection >12 months
fatty tissue over anterolateral thigh or triceps
Which vaccines are live virus vaccines?
MMR and Varicella
If the MMR and Varicella vaccine are not given on the same day how far apart should they be given?
28 days
What are no longer contraindications for MMR vaccine?
Egg allergies or pregnancy
LAIV should not be given to who?
Anyone who will be in contact w/ an immunosuppressed patient
The Influenza vaccine is contraindicated for who?
- child w/ large amounts of nasal drainage
- child w/ underlying medical condition
- child < 5 w/ recurrent wheezing in last 12 mo
- immunocompromised children
- taking aspirin
- have been given other live vaccine in last 4 weeks
The Rotavirus Vaccine is contraindicated for who?
- children with SCID
- history of intussusception
HPV is how many doses?
2
What do we chart for immunizations?
- date the vaccine was administered
- name of vaccine
- lot number and expiration date of vaccine
- manufacturers name
- site and route
- edition date of VIS given to parents
- Name and address of the facility administering vaccine
- Name of person administering immunization
What are significant causes of inadequate immunization?
- parental concerns about vaccine safety
- multiple physicians
Topics for Anticipatory Guidance
- promoting oral health care
- healthy weight
- healthy activity
- personal hygiene
- safe sun exposure
Contraindications
- anaphylactic or systemic allergic reaction to vaccine component
- pertussis immunization, encephalopathy w/o an identified cause within 7 days of immunization
