Lecture Two (pediatric Physical Diagnosis-DR.M)-Exam 1 Flashcards
What are the different age groups?
- Infants (0 -12 months)
- Toddlers (13 months - 2 years)
- Preschool-aged children (3 - 5 years)
- School-aged children (6 -12 years)
- Adolescents (≥13 years)
- How many kids have had contact with a health care professional in the past year?
- How many ED visits were by kids under 15 and the age group 15-24 year olds?
- 93.9% so that is a lot of kids
- Under 15: 17.6%
- 15-24: 12.6%
How should you do the introduction with children?
- During any visit you should introduce yourself and give your patient a warm welcome, but you may need to modify your approach based on the age of the patient.
- Take cues from your pediatric patients.
- When you enter the examination room, look for clues about your patient’s approachability.
- A child who buries their head under the caregiver’s elbow requires a different approach from one who’s comfortably playing with toys.
- If your pre-school age patient prefers to be ignored, talk to the adult(s) in the room instead. However, if your pediatric patients show interest in interacting with you, focus on the child.
During the different age groups, where are the children during the visit?
What must you did every single visit?
You need to identify who you are interviewing
* Parent, Step-parent, Adoptive parent
* Grandparent and Other Relatives
* Caregiver- Foster Parent
* Nanny
* Friend of family Patient
You must document in the chart who the history is being taken from at each visit.
- Who is a minor?
- Who has the power to consent when minors need medical care?
- A minor is any person under the age of 18 who is not married and has not been emancipated
- Natural parents, adoptive parents, legal custodians and legal guardians have the power to consent when minors need medical care
What happens when a parent or legal guardian is not available for ordinary medical care and treatment?
- If a parent is not available, then the medical provider can first look to a step-parent, then a grandparent, adult sibling, or adult aunt or uncle (HAVE TO BE 18 YEARS OR OLDER)
- If the child is in the custody of the Department of Children and Families or the Department of Juvenile Justice, then the caseworker, probation office or the administrator of the state residential facility where the individual resides can consent to medical treatment when the parent or guardian cannot be reached
What is ordinary medical care and treatment? What does it not include?
- Medical or dental examinations
- Blood testing, tuberculin testing
- Preventative care
- Well-child visits and immunizations
Ordinary medical care does not consist of surgery, anything requiring general anesthesia, provision of psychotropic medications or other extraordinary procedures.
What can a parent do so the providers do not have to track them down and get consent from only them?
What happens when a parent or legal guardian is not available in emergent care?
- A Medical Provider is permitted to provide care to minors without parental consent in emergent situations
- Situations are considered emergent when a minor has been in an accident or when a minor is suffering from an acute event wherein a delay in the provision of care would endanger the health or well-being of the minor.
- Nevertheless, prior to providing care there must be an attempt to contact the parent at home or work (if a parent can be identified).
What needs to happen if a HCP needs to provide care that was not consented to ?
- If a health care provider needs to provide care that was not consented to by either a parent or guardian, it is essential to document in the medical record a detailed statement by the Medical Provider that the treatment was medically necessary for the patient’s well-being.
- A parent should be advised of medical treatment as soon as possible
When can a minor seek medical care for himself/herself without parental consent? (think about emancipated minors)
Emancipated minors:
* A minor over the age of 16 can be emancipated either by a judge or common law in most states.
* A judicial emancipation occurs when a minor, his/her legal guardian or an independent representative petitions the court asking for the individual to be declared independent and be viewed as an adult in the eyes of the law.
* A minor can also be considered emancipated if she has “[broken ] the bonds of subjection of the child to the parent,” which may include living independently, supporting herself, maintaining a job for self-support and being liable for her own debts.
* A minor who is married or has been married is given the same legal status as an adult in the eyes of the law
Emancipated minors laws differ how?
laws differ in terms of age limits, circumstances surrounding the request, and court procedures
When is a minor not considered emancipated?
not considered emancipated merely by giving birth and becoming a parent
When can a minor seek care without consent? (7)
- Sexually Transmitted Diseases
- Birth Control
- Pregnancy and the child
- Substance Abuse
- Physical or Sexual Abuse
- Crisis Intervention
- Mental health diagnostic or evaluative services: age 13+ (can not give medication without consent)
Issue is with billing with insurance
What is the normal pediatric vital signs (only trends)?
The younger you are: faster breathing and pulse and the lower your BP is
What does not change with age?
temperature
Temperature:
* When can it fluctuate?
* What is normal temp?
* What is a fever?
- Body temperature may fluctuate depending upon the time of day
- Normal temperature may range between 97.0 F (36.1 C) and 100.3 F (37.9 C)
- A rectal temperature of 100.4 F (38.0 C) or higher is considered a fever ⭐️
- What is the pulse oximetry for pediatric vitals?
- What is a concern?
- 95%-100% on room air
- Normal pediatric pulse oximetry (SPO2) values have not
been firmly established in literature - SPO2 is lower in the immediate newborn period
- SPO2 of <92% should be a cause of concern and may suggest a respiratory disease or cyanotic heart disease
What curves do we look and what are the age ranges?
- Birth-36 months: Length, weight and head Circumstance
- 2-20 years old: BMI and stature for age and weight for age percentiles
FOR BOYS AND GIRLS
- For children and teens, BMI is what?
- In children, a high amount of body fat can lead to what?
- For children and teens, BMI is age- and sex-specific and is often referred to as BMI-for-age.
- In children, a high amount of body fat can lead to weight-related diseases and other health issues and being underweight can also put one at risk for health issues.
What is the BMI calculation?
LY
.
What are the weight status categories with the corresponding percentile range?
How are pain scales used in pediatrics?
- Faces Pain Scale – Revised (FPS-R): More often used for ages 3 and above
- Verbal Numerical Rating Scale: More often used ages 8 and above
What is this?
Lanugo: The downy hair seen over shoulder is lanugo. Although this is present to much greater degree in preture infants, term babies also have variable amounts of lanugo present at birth
What is this?
- Normal peeling: a dry, flaky, peeling appearance of the skin is very common in newborns
What is this?
Normal skin pigment: Increased pigment seen at the base of the nails in African american infant. In some areas, though, the increased melanin can be seen–around the nails, over the helix of the external ear, around the umbilicus and over the genitalia
What is this? What is the most common spot?
Slate grey patches (mongolian spots): Dark blue-grey lesions most commonly seen in darker-skinned infants. The sacrum is the most commonly affected area. These lesions tend to fade over several years but may not completely disappear
What is this?
Left: salmon patch (100% goes away)
Right: Stork bite (same as salmon patch but may stay)
* Pink patches also known as nevus simplex or “angel kisses”, these are a common capillary malformations that are present at birth.
THESE WERE PRESSURE POINTS WHEN IN UTERO
What is this?
Hemangioma: Lesions often start flat, circular area (halo) of pallor with central area of telangiectasia. Later develop raised red appearance
* Grow up to 6 months then stays for years as the body breaks them down
What is this?
Milia: White papules on the skin that are keratin filled epithethial cysts which occur in up to 40% of newborns. Spontaneous exfoliation and resolution is expected within a few weeks.
What is this?
Sebaceous hyperplasia: The lesions are more yellow than milia and are the result of maternal androgen exposure in utero. Sebaceous hyperplasia is a benign finding and spontaneously resolves with time.
What is this?
Neonatal acne: Rash has an inflammatory component which is caused by maternal hormones, does not generally appear until after 2 weeks of age.
DOES NOT MEAN TEENAGE ANCE
What is this?
ERYTHEMA TOXICUM: Generally starts on day 1 or 2 and increase in number over the next several days, followed by spontaneous resolution in about a week.
LOOKS LIKE BUG BITE; WHEN HOT LOOKS WORSE
What is this?
TRANSIENT NEONATAL PUSTULAR MELANOSIS: Hyperpigmented spots that remain after the fragile pustules have resolved. Because the rash starts in utero, lesions may be in any stage at birth. Etiology is unknown, it has been observed that African Americans infants are more frequently affected with this condition, occurring in up to 4%.
GET IN UTERO
What is this?
Acrocyanosis: Painless condition where the small blood vessels in your skin constrict, turning the color of your hands and feet bluish. The blue color comes from the decrease in blood flow and oxygen moving through the narrowed vessels to your extremities.
VASCULAR IS DIFFERENT FIRST BORN
What is this?
Mottling: Transient lacy erythema that occurs commonly in newborns particular visible when the infant is cold and disappears with warming.
What is this?
JUNCTIONAL MELANOCYTIC NEVUS: The lesion is completely flat and is medium to dark brown in color. It may become slightly raised as the infant grows and may become a compound nevus if intradermal melanocytes develop. It is considered a benign lesion.
ROUNDER BOARDERS
What is this?
Cafe au lait spot: Lighter in color than melanocytic nevi and caused by an increased amount of melanin in both melanocytes and epidermal cells and may increase in number with age.
CRAZY SHAPES
What is this?
Sucking bilster: Sucking blisters are solitary lesions that occur only in areas accessible to the infant’s mouth. The blister may still be intact at the time of delivery but often appears as a flat, scabbed, healing, area. They are benign and resolve spontaneously.
What is this?
fingernail scratches
What is this?
Forceps mark (to pull baby out)
What is this?
Vacuum mark
more brusing
What is this?
Scalp electrode site: Scalp electrodes are used for internal monitoring prior to delivery and can cause a small circular scab at the site where the monitor was inserted.
What is this?
facial bruising
* due to the baby being bigger
* happens over a few hours
What is this?
Jaundice: Yellowing of the skin. When assessing jaundice comparisons are useful. Follows a cephalo- caudal progression in the newborn.
What is this?
Harlequin color change: Well-demarcated color change, with one half of the body displaying erythema and the other half pallor. Usually occurring between two and five days of age in 10% of infants. The condition is benign, and the change of color fades away in 30 seconds to 20 minutes. It may recur when the infant is placed on her or his side.
What is this?
Normal umbilical cord process: A normal cord has two arteries (small, round vessels with thick walls) and one vein (a wide, thin-walled vessel that usually looks flat after clamping).
What is this?
Meconium stained umbilical cord: indicates that meconium has been present in the amniotic fluid for some time.
What is this?
Meconium staining: The yellow tint is meconium staining. This suggests that the meconium was present in utero for some time prior to delivery. Staining may also be seen on the umbilical cord and the skin.
What is this?
Paronychia: an infection of the skin around a fingernail or toenail. The infected area can become swollen, red, and painful, and a pus-filled blister may form.
PRONE until 2
What is this?
Hair tourniquet: The hair is wrapped around the digit by a repetitive movement of the appendage in a confined area. More common in children four days to 19 months old and usually present to doctors inconsolably crying and in obvious distress.
USE NAIR TO GET OFF
