Module 2 CANVAS Info + PP Flashcards
What developmental element begins during adolescence? When does it end?
Puberty
Adulthood
What is the age range for adolescence?
10-19yrs
Adolescent thinking moves from ________ to __________.
Concrete to abstract
What occurs during adolescence in regards to family?
Independent identity and separation
Do you take a BP on all children? What would be the position?
Yes, but they need to be cooperative. Seated in a quiet room.
Correct BP cuff size
Width covers 40-50% circumference of the limb
How to diagnose HTN in children: how many separate readings need to occur for dx?
3 separate readings separated over time
What frequently causes pediatric HTN?
-Renal issues
-Obesity
Stages of pediatric HTN
- Stage 1: 95-99th percentile plus 12mmHg
- Stage 2: >99th percentile plus 12mmHg
What medications commonly given during middle/adolescent stages can raise blood pressure?
-Steroids
-Oral contraceptives
What is the best method to take a blood pressure? What is the difference?
-Automated is not the better way to take a BP; manual is!
-BP readings from automated BP devices are 5mmHg higher for diastolic and 10mmHg higher for systolic
BP varies by what two components of the individual?
Height and weight
Labs that should be ordered when HTN is dx? (8)
CBC, serum nitrogen, creatinine, electrolytes, lipid panel, glucose, urinalysis, renal ultrasound
Indications for pharmacological therapy include: (5)
- Symptomatic HTN
- Stage 2 HTN w/o a clearly modifiable factors (eg. obesity)
- Chronic kidney disease
- Diabetes (types 1 and 2)
- Persistent HTN despite nonpharmacologic measures
Nonpharmacological interventions to help with HTN
Diet
Exercise
Weight management
Enuresis
-Repeated urination into clothing during the day and into bed during the night by a child who is chronologically and developmentally older than 5
How many times must a child urinate into clothing during the day and night (who is chronologically AND developmentally older than 5yrs) to be considered for the dx of enuresis?
at least twice a week x3 months
Encopresis
-repeated passage of stool into inappropriate places by child who is chronologically OR developmentally older than 4yrs
How often must encopresis occur for patient to receive dx?
-Must occur each month at least 3 months and is not attributed to physiologic effects of substance or another medical condition except to the mechanism of constipation
What most often causes encopresis?
Constipation
Etiology of ADD/ADHA
Can be genetics, fetal alcohol syndrome, CNS trauma/infections, prematurity/neonatal brain injury and hyperthyroidism
What is the most common neurodevelopmental disorder?
ADD/ADHA
Does ADD/ADHD occur alone or with comorbidities?
BOTH; includes learning disabilities, anxiety disorders and depression
What is the most common comorbidity of ADD/ADHD?
Anxiety disorders
How often does ADD/ADHD occur in children and adults?
-7-8%
-1.5%
Triad of symptoms and characteristics of ADD/ADHD?
-Hyperactive-impulsive: interrupting, taking risks, “bugs” people, hyperactive
-Inattentive: messy, not organized, no time management, fails deadlines, can occur with OSA
-Combined
What six symptoms classifies ADD/ADHD?
- persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by: inattention and/or hyperactivity and impulsivity
- Several inattentive or hyperactive-impulsive sx were present prior to age 12 yrs
- Several inattentive or hyperactive-impulsive sx are present in two or more settings (i.e. at home, school, or work; with friends, or relatives in other activities)
- There is clear evidence that the sx interfere with, or reduce the quality of social, academic, or occupational functioning
- Sx do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (i.e. mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal)
What improves outcomes for ADD/ADHD patients?
Early dx and treatment
What are the major factors of treatment failure for ADD/ADHD?
Improper dx and failure to recognize comorbidities
At what age do sx need to be present before to diagnose ADD/ADHD?
Before age 12 and in more than 1 setting
What are different modalities of management for ADD/ADHD?
Treat comorbidities (if applicable)
Behavior modification techniques
Social skill training
Counseling
**Some or all may be beneficial
ADD/ADHD medications: stimulants
-Which schedule?
-Abuse risk?
High potential for abuse and dependence
-Assess abuse risk before prescribing
-Monitor for signs of abuse and dependence during tx
Contraindications for ADD/ADHD medications (stimulants)
-Do not use in patients with serious heart problems or in those for whom an increase in BP or HR would be problematic
What are the monitoring parameters for ADD/ADHD patients about to start stimulant medications?
-with prolonged treatment, what labs should be drawn?
-baseline cardiac evaluation in patients
-if risk factors present, BP and HR at baseline, after dose increase, and periodically
-Height and weight at baseline and periodically
-with prolonged treatment, consider CBC w/ diff and annual platelets if prolonged tx
What is something you as the practitioner should always do when prescribing ADD/ADHD medications (or any medications for that matter)?
Check for drug interactions
Non-stimulant ADD/ADHD drugs
-used alone or with stimulants?
Can be used alone or with stimulants
By age 6, how many Dtap vaccinations should be given?
5
By age 6, how many IPV vaccinations should be given?
4
When do children begin with their first dose of Tdap?
Ages 11-12 yrs
When do children begin with their first HPV vaccine?
ages 11-12yrs
-can start at age 9 years
If HPV is given in a 2 dose series, how often is it given?
Age 9-14 is the initial vaccination, then 6-12 months after first vaccine (minimal interval: 5 months)
*have to repeat dose if given too soon
If HPV is given in a 3 dose series, how often is it given?
Age 15 years or older is the initial dose.
-First dose: 0
-Second dose: 1-2 months later
-Third dose: 6 months
(minimal intervals: dose 1-2 = 4 weeks; dose 2-3 = 12 weeks; dose 1-3 = 5 months. Repeat if given too soon)
If HPV vaccination schedule is interrupted, does the series need to be restarted?
No
Meningococcal vaccine (MenACWY-D; MenACWY-CRM; MenACWY-TT)
-routine vaccination timeline
-2 dose series at ages 11-12yrs, 16yrs
Meningococcal serogroup B vaccination (MenB-4C, Bexsero; MenB-FHbp, Trumenba)
-routine vaccination timeline
-Adolescents not at increased risk: 16-23 years (preferred ages 16-18) based on clinical decision making
*Bexsero: 2 dose series at least 1 month apart
*Trumenba: 2 dose series at least 6 months apart (if dose 2 adminstered earlier than 6 months, administer 3rd dose at least 4 months after dose 2)
Are Bexsero and Trumenba interchangeable?
No
Dengue (DEN4CYD)
When is it given?
Only given if seropositive in endemic dengue areas
-given at age 9-16yrs
Ages 9-16 years living in areas with endemic dengue (frequent or continuous) AND have laboratory confirmation of previous dengue infection
-three dose series: 0. 6. 12 months (given 6 months apart)
Endemic areas: Puerto Rico, American Samoa, US Virgin Islands, Federated States of Micronesia, Republic of Marshall Islands, and Republic of Palau
**Do not need to administer to children traveling to or visiting endemic dengue areas
What is the age range for people to utilize the live-attenuated influenza vaccine? (LAIV4)
2-49 years
Tdap: how often is this vaccination given during adulthood?
-Given with each pregnancy (27-36weeks)
-Given 1 dose Td/Tdap for wound management
*minor wound: give if not administered w/i last 10 years
*other wounds: give if not administered w/i last 5 years
-Given 1 dose Tdap, then Td or Tdap booster every 10 years
*start giving after 11 years old
Adulthood: MMR
-pregnancy considerations
-severe immunocompromising conditions
-healthcare personnel
-do not give during pregnancy (can give afterward)
-MMR contraindicated
-Born before 1957 w/o immunity: consider 2 dose series at least 4 weeks apart
-Born in 1957 or later w/o immunity: 2 dose series at least 4 weeks apart
Adult: VAR
-no evidence of immunity
-evidence of immunity
-2 dose series 4-8 weeks apart; if already received 1 dose, 1 more dose needed at least 4 weeks after first dose
-US born before 1980 with documentation of 2 doses VAR vaccine at least 4 weeks apart, diagnosis or verification of hx of varicella or herpes zoster, lab evidence of immunity or disease
Adult: Zoster vaccination
-age
-how many doses
-timing of doses
-50 years or older
-2 dose series recombinant zoster vaccine
-2-6 months apart (minimum interval: 4 weeks; repeat dose if administered too soon) regardless of previous herpes zoster or hx of zoster vaccine live vaccination
Adult: pneumococcal vaccine
-19-64 years
->64yrs
-1. PCV15 or PCV20; if PCV15 then + PPSV23 given 1 year afterward; minimal 8 weeks between
2. PCV13 + PCV20 given 1 year afterward, or complete PPSV23 series
3. PPSV23 + PCV15 or PCV20 at least 1 year after PPSV23 done
4. PCV13 and PPSV23, but not completed series: add 1 dose PCV20 at least 5 years after last vaccine or recommended PPSV23 series
-1. unvaccinated or unknown: PCV15 or PCV20; if PCV15 follow with PPSV23 1 years after (minimum 8 weeks)
2. PCV13: follow with PCV20 1 year after OR complete PPSV23 series
3. PPSV23: PCV15 or PCV20 at least 1 year after
4. PCV13 and PPSV23 but NO PPSV23 was received at age >equal 65 years: 1 dose PCV20 at least 5 years after last pneumococcal vaccine dose or complete recommended PPSV23 series
> 12 yrs, which COVID19 booster is available?
-bivalent booster (not monovalent) mRNA
Is COVID19 vaccine dosage based on age, height/weight?
Age on day of vaccination
At what age can children receive COVID19 booster?
6 months if eligible
Children at increased risk for severe illness from COVID19
obesity, diabetes, asthma, chronic lung disease, sickle cell disease, or immunosuppression
What do some children develop after a dx of COVID19 that is a rare and serious illness?
Multisystem inflammatory syndrome in children (MIS-C)
How much more likely are children and teens ages 18 years and younger who have had COVID-19 to be newly dx with diabetes?
2.5x more likely
-30 days or more after infection
Varicella vaccine specifics
Vaccines due when entering school (K or 1)
Vaccines due at ages 11 or 12
Vaccines due at college age
Know reasons for delaying vaccine
Moderate to severe febrile illness
Anorexia nervosa
-functionally, body has:
-tachycardia or bradycardia can develop?
-S/S
-hypotension or hypertension?
-how is QT involved?
-impact on peripheral circulation? Lanugo? GI sx?
-what is the main goal of an anorexic patient?
-hypothyroid symptoms (euthyroid sick): hair things, brittle nails, dry skin, temperature decreases
-bradycardia (in supine position)
-dizziness, light-headedness, syncope (orthostasis)
-hypotension: secondary to impaired cardiac fx (left ventricular systolic dysfunction)
-can develop prolonged QTc syndrome and increased QT dispersion (irregular QT intervals) –> risk for cardiac arrythmias
-reduced; lanugo can develop; GI tract has inability to take in normal quantities of food, early satiety and GER can develop - gastrocolic reflex may be lost causing delayed gastric emptying, bloating, constipation
-drive for thinness
Diagnosis for anorexia nervosa
-restriction of energy intake relative to requirements leading to low body weight in context of age, physical health, sex, and developmental trajectory
-strong fear of gaining weight even though underweight
-disturbance in way one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of seriousness of current low body weight
-weight loss leading to body weight <15% below expected
-females: absence of 3 consecutive menstrual cycles
Types of anorexia nervosa
- restricting
- binge-eating/purging
*can have combination
*can have atypical type - is within or above normal weight
Labs connected to diagnosis of anorexia nervosa
TSH, electrolytes, LFTs, cholesterole, CBC w/ diff, BUN, creatinine, phosphorus, calcium, magnesium, u/a; EKG and Bone density
What is a red flag that can lead to diagnosis of anorexia nervosa?
weight loss below a normal body weight
What is a complication of anorexia nervosa, especially in females?
Osteoporosis, esp. in females with amenorrhea
Screening questions regarding dx of anorexia nervosa
-how do you feel about your body?
-are there parts of your body you might change?
-when you look at yourself in the mirror, do you see yourself as overweight, underweight, or satisfactory?
-if overweight, how much do you want to weight?
-if your weight is satisfactory, has there been a time when you were worried about being overweight?
-if overweight (underweight), what would you change?
-have you ever been on a diet?
-what have you done to help yourself lose weight?
-have you ever made yourself vomit to get rid of food or lose weight?
bulimia nervosa
-factors that contribute
-more common in boys or girls?
-when does this activity usually begin (at what stage of life?)
-genetics, biology, emotional health, social expectations
-girls/women
-late teens/early adulthood
what eating disorder is characterized as the person losing control over eating?
bulimia nervosa
-eating large amounts of food with a loss of control over eating and then purge, trying to get rid of the extra calories in an unhealthy way
labs to check if patient dx with bulimia nervosa?
electrolytes and amylase (may increase d/t chronic parotid stimulation)
S/S of bulimia nervosa
-being preoccupied with body size/shape/weight
-fear of gaining weight
-feels out of control while eating and is unable/unwilling to recognize satiety signals
-eating unusually large amounts of food
-forcing vomiting and/or exercising too much and/or laxative use to keep weight off
-using laxatives, diuretics, and/or enemas when not necessary
-fasting or restricting certain foods to avoid calories
How do people with bulimia get rid of calories and prevent weight gain?
-vomiting
-using medicines: diuretics, diet pills, cathartics & supplements to promote weight loss
how often does someone participate in bulimic activities usually?
-binge eating and inappropriate compensatory behaviors occur at least once a week x3 months on averages
treatment for bulimia nervosa
depends on severity and etiology
-psychotherapy averages 6-9 months; input and output
medications to utilize on patient diagnosed with bulimia nervosa
-SSRI, anti-reflux meds
-heat application and sucking tart candy can help with pain and swelling associated with enlarged parotid gland
what is the goal of treatment regarding bulimia patients?
interrupt the binge/purge cycle
-goal to reach remission
what factors are associated with binge-eating disorder (BED)?
combination of psychological, social, and environmental factors
definition of binge-eating disorder
eating disorder consuming unusually large amounts of food and unable to stop
S/S BED
(also, when do sx tend to develop?)
-most often overweight/obese
-depression, substance abuse
-eating when not hungry, eating past being full, secret alone eating
-feeling upset/guilty/ashamed/ or depressed after eating
-frequently dieting w/o weight loss
**does not vomit after eating large amounts
-associated with marked distress
-sx develop during adolescence
labs to check when diagnosing binge-eating disorder?
thyroid, cholesterol, triglycerides
treatment for BED
psychotherapy
medication associated with treatment of BED
Topamax, antidepressants, Vyvanse, nutritional supplements if indicated
how often does BED occur in order to dx this condition?
occurs at least once a week over 3 months
avoidant-restrictive food intake disorders (ARFID)
-hallmark feature
-definition
-avoidance or restriction of oral food intake in the absence of criteria for AN (body image disturbance, fear of weight gain/body fat)
-can have limitations in the amount and/or types of food
-AN without distress of body shape or size or fears of fatness
S/S ARFID
lack of interest in eating, avoidance to sensory characteristics of food
-concern for aversive consequences of eating, inadequate nutritional/energy needs met
**there is a lack of drive for thinness with AFRID
what can ARFID be associated with?
-weight loss or failure to gain
-nutritional deficiency
-dependence on enteral feeding or oral nutritional supplement
-interference with psychosocial functioning
treatment associated with ARFID
brief medical hospitalizations
long psychiatric or residential hospitalization
How are youth screened for substance abuse?
-what are the goals of this screening tool?
SBIRT (screening, brief intervention, and referral to treatment)
-a quick, effective technique to manage SUD in adolescents during routine health supervision visits
-goals: determine whether teens have used any alcohol or drugs; determine where adolescents are on the substance use spectrum; for healthcare provider to initiate a brief discussion with the teenage patients about substance use and provide them with education, advice, and referrals within a motivational interviewing model
what are the three levels of substance use disorder risk
-no reported use
-lower risk
-higher risk
what is substance abuse often associated with?
sexual and physical abuse
false negatives/positives can occur
-poppyseed can cause + morphine
etc.
how long can cannabinoid be detected after use?
-5 days with moderate use
-10-20 days with habitual use
CAGE screening
-what does it screen for?
-what does acronym stand for?
-alcohol abuse
-1. have you ever felt you should Cut down on your drinking? 2. have people Annoyed you by criticizing your drinking? 3. have you ever felt bad or Guilty about your drinking? 4. have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye opener)?
*if Yes >2, at risk.
how to screen for alcohol and drugs?
-CAGE-AID
-1. have you ever felt you should Cut down on your drinking or drug use? 2. have people Annoyed you by criticizing your drinking or drug use? 3. have you ever felt bad or Guilty about your drinking or drug use? 4. have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye opener)?
*if Yes >2, at risk.
*severe alcohol level = >0.3g/dL
definition of substance abuse
chronic, progressive disease typically initiated with tobacco/alcohol (gateway drugs) while trying out a variety of behaviors; experimenting while putting their health and safety at risk
prevention of substance abuse
-primary level
-secondary level
-tertiary level
-has been a Public priority since 1980’s as with DARE
-targets at-risk populations like Alateen (children of alcoholic parents0
-to prevent morbid consequence like Safe Ride Home (substance user)
etiology of substance abuse
genetics, social, environmental, mental/behavioral
labs associated with substance use diagnosis
urine and blood tests; breath tests; hair tests (can have false positives, so be aware)
alcohol
-more common substance abuse in women or males?
-more common in what race?
-males
-whites
what is associated with early and frequent marijuana use during asolescence?
psychiatric problems
Tobacco
-when to screen?
-why is it a gateway drug?
-each visit?
-tends to lead to other substance abused items
What are nicotine dependent smokers more likely to develop?
psychotic disorders, anxiety, and delirium
Is nicotine physically, psychologically, or physically & psychologically addictive?
physically and psychologically addictive
how quickly does addiction occur with nicotine use?
1 month
five A’s of tobacco cessation:
Ask
Advise
Assess
Assist
Arrange
medications associated with helping smoking cessation
sustained release antidepressants, bupropion, clonidine, nortriptyline help decrease release after cessation by 5-fold
types of referrals related to smoking cessation
low intensity
out-patient
school-based
residential
hospital-based
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