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RC Study Cards > Psych/Development/Pharm > Flashcards

Psych/Development/Pharm Flashcards

1
Q

What are the 3 Ps to pain management?

A
  1. Pharmacological
  2. Physical
  3. Psychological
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2
Q

In what 3 circumstances is LET contraindicated?

List 3 topical anesthetics. Which works fastest? Which works for longest?

List 2 non-pharmacological managements to managing fracture pain.

A
  1. < 3 mo
  2. Mucosal surfaces
  3. Large, deep or contaminated wounds

Topical anesthetics

  1. Maxilene (liposomal lidocaine 4%; amide anesthetic)
  2. Ametop (amethocaine 4%/tetracaine; ester anesthetic)
  3. Emla (lidocaine-prilocaine 5%; amide anesthetic)
  4. Pain ease (vapocoolant spray; pentafluoropropane tetrafluoroethane)

Onset: Pain ease → Ametop/Maxilene (30min) → Emla (60min)

Duration: Pain ease (1 min) → Emla (1-2h) → Maxilene → Ametop (4h)

Fracture pain: Immobilize, icing

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3
Q

Provide 3 examples of physical pain management

Provide 3 examples of psychological pain management

How can you minimize injection pain? List 3

A

Physical

  • Skin-to-skin (kangaroo) care
  • Pacifier
  • Swaddling
  • Tucking
  • Sitting upright

Psychological

  • Parental presence
  • Age-appropriate preparation
  • Distraction
  • Deep breathing
  • Hypnosis
  • Music

Injection pain

  • Topical anesthetic
  • Buffered lidocaine: add bicarbonate to lidocaine in 1:10 ratio
  • Inject slowly
  • Use solution warmed to body temperature
  • Small gauge needle (27G-30G)
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4
Q

What are the 4 recommendations from the CPS for pharmacare in Canada

A
  • All governments should:
    • Develop/implement pharmacare plans that mandate universal, comprehensive, portable prescription drug coverage for children/youth
    • Develop a comprehensive, evidence-informed national list of paediatric drugs for inclusion to the pharmacare program
    • Modernize processes for drug approvals to expand access and ensure appropriate paediatric labelling for all medications marketed in Canada
    • Support drug trials, cost-effectiveness research and the development of commercial paediatric drug formulations
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5
Q

What percentage of medications are currently administered “off label” in Canada?

A

80%

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6
Q

Why are children more affected by climate related changes? List 2.

Which children are at greatest risk?

A
  1. Metabolize more water/air/food per kg than adults
  2. Rapid growth/development, physiologically dynamic systems and risk exposure over a longer life course

Greatest risk

  1. Low socioeconomic status
  2. Indigenous
  3. Living with a chronic disease
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7
Q

List 5 specific climate related risks children may face and one example of each.

A
  1. Depletion of ozone → ↑skin cancer
  2. ↑air pollution → ↑respiratory disorders/asthma + cardiovascular illnesses, ↑risk for cancer
  3. ↑natural disaster events →
    • Displacement of home/living in overcrowded shelters
    • Inability to access chronic disease management
    • Loss of possessions/routines
    • Loss of loved ones
  4. Heat/cold injuries → burns/frostbite (due to immature temperature regulation systems)
  5. Contaminated water sources d/t heavy rain/flooding overwhelming sewage treatment facilities → water-borne infections (Salmonella typhi, E coli, Cryptosporidium, amebiasis)
  6. Inset, tick and roden related infections → Lyme disease, Equine encephalitis, RMSF
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8
Q

List 4 risk factors for lead toxicity

A
  1. Live in home built before 1960 for ≥6mo (esp if water supplied by lead pipes, original paint is chipping, under renovation)
  2. Sibling/housemate/playmate with lead poisoning
  3. Pica, lick/mouth painted surfaces or eat paint chips
  4. Emigrated or international adoption from country with higher lead levels
  5. Infant born to mother with lead exposure or mineral deficiency (zinc, calcium, iron, magnesium)
  6. Any above risk factors + known or suspected neurodevelopmental disorder
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9
Q

List 2 low-lead symptoms and 4 toxicity symptoms

A

Low-lead:

  1. Neurodevelopmental signs
    • Inattention
    • Hyperactivity
    • Hearing impairment
    • Poor balance
    • Speech delay
  2. Cognitive delay

Lead toxicity:

  • CNS: headache, clumsiness, somnolence, seizure
  • GI: abdominal pain, constipation, vomiting
  • Heme: anemia (microcytic)
  • GU: renal failure
  • possible death
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10
Q

What are 4 long-term consequences of lead poisoning?

A
  1. Hypertension
  2. Vascular disease
  3. Renal impairment
  4. Aberrant behaviour/cognitive delay
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11
Q

You want to order a screen for suspected lead exposure.

What tests do you order?

A
  • Serum lead level (venous)
  • CBC
  • Ferritin
  • Calcium, protein, albumin
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12
Q

What are the 3 ranges for management of serum lead levels?

When do you need to repeat testing?

What intervention is recommended?

A
  1. 5-14 mcg/dL
    • Repeat in 1-3 months, if stable - 3 months
    • Nutrition counselling (fruit with every meal, encourage iron containing foods)
    • Supplement if iron deficient
    • Contact public health for guidance
    • Full neurodevelopmental assessment and follow-up
    • PEHH for sources of exposure
  2. 15-44 mcg/dL
    • ABOVE, except repeat in 1-4 weeks
    • AXR to r/o foreign body
    • If asymptomatic, no chelation
  3. >44 mcg/dL
    • ABOVE, except repeat in 48h
    • Admit to hospital
    • Chelation therapy with Poison control centre
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13
Q

What are the 4 Ms for promoting healthy screen use in school-aged children + adolescents?

A
  • Monitor for problematic screen use
    • Complaints about being bored/unhappy without access
    • Oppositional behaviour in response to screen limits
    • Screen use that interferes with sleep, school, face-to-face interactions, offline play or physical activities
    • Negative emotions following interactions or video games or while texting
  • Model
    • Review your own media habits, plan time for alternative hobbies, outdoor play and activities
    • avoid screens 1h before bedtime
    • Discourage recreational bedroom use
  • Meaningful
    • Prioritize face-to-face interaction, sleep and physical activity over screens
    • Choose educational, active or social activities on screens
  • Manage
    • Family media plan
    • Co-view and talk about content whenever possible
    • Review acceptable/unacceptable behaviours proactively
    • Get passwords
    • Discourage multitasking during homework
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14
Q

When does educational TV use peak?

When does entertainment TV + social medial take up more leisure time?

A

Preschool

By 8 years

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15
Q

List 4 benefits of screen use in school-aged children

List 4 benefits of screen use in adolescents

A

School-age Benefits

  • ​​Improve academic performance → enrich knowledge + literacy skills
  • Develop positive relationships with teachers and peers
  • Increased math proficiency + reduced learning gaps
  • Cooperative or competitive video games can offer opportunities for identify, cognitive and social development
  • Increase sense of well-being, prosocial behaviour
  • Lower depression risk vs no screen time if 1h/day
  • help make and maintain friendships (more diverse and gender-inclusive)

Adolescents (moderate use 2-4h/d)

  • Improves self-concept
  • Validating
  • Affirming
  • Increased cognitive skills with game-specific, short-term action video games (especially in executive function and visual spatial working memory)
  • Enhanced well-being
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16
Q

List 4 risks of digital media in school-aged children.

List 4 risks of digital media in adolescents

A
  • Poor sleep duration and quality
    • Inhibit melatonin release → emotional arousal, disrupted sleep rhythms
  • ↑ sedentary time + obesity risk

School-aged

  • Conduct problems by 7yo if ≥3h/day at 5yo
  • ↑depressive symptoms
  • ↓ physical activity
  • ↑exposure to harmful/negative content if not superfised
  • Multitasking
    • Impairs problem solving
    • Undermines confidence in ability to do homework
    • Disrupts reading efficacy
  • Being economically disadvantaged or minority/marginalized is associated with more media use

Adolescent

  • No use or excessive use → feelings of alienation and social exclusion
  • Depression risks
    • Receiving negative content in instant messages (also anxiety)
    • Excessive use (>6h/d)
    • Passively surfing internet when one has few or no close friends
  • Lower English + math scores
  • Weaker working memory
  • Lower sustained attention
  • Greater impulsivity
  • If >50% free time is spent on gaming → hyperactivity, conduct problems, peer issues and emotional problems
    *
17
Q

What approach should you use to strength relationships with and within families you see.

List 2 ways to increase family engagement and build trust

A
  • Ask questions
  • Build on family’s relational strenghts
  • Counsel with family-centred guidance
  • Develop plans for changing behaviours related to sleep or discipline PRN
  • Educate about positive parenting strategies

Engagement

  • Ask parent about their childhood (“how did your parents help you deal with emotions”)
  • Screen relational issues/social isolation (“who do you turn to for support”)
  • Motivational interviewing
  • Reframe negative exchanges (“I wonder if there’s a more helpful way to think about this behaviour”)
18
Q

What are the issues that parents most often seek advice from health care providers regarding?

A
19
Q

How should parents approach disciplining their children?

A
  • ‘Positive discipline’
    • Teaches child appropriate behaviour rather than punishing them for inappropriate behaviour
    • Uses “I statements” “ I don’t like it when you do that”
    • Purpose: foster independence and communication skills, problem solve, take responsibility for behaviour

Be consistent without being rigid

Wait until both child and parent are emotionally ready to re-engage

“Redirect”

  • Reduce words
  • Embrace emotions
  • Describe (without lecturing)
  • Involve the child in discipline
  • Reframe a ‘no’ into a ‘yes’ (with conditions)
  • Emphasize the positive
  • Creatively approach a disciplinary situation
  • Teach
20
Q

When does a baby develop normal circadian rhythm cycle?

List 3 healthy strategies to promote self-soothing at bedtime for babies

What should be the first line strategy to prevent sleep problems in infants and young children?

A

At least 6 months of age

  1. Consistent, calming sleep routines (“bath, book, bed”)
  2. Settling babies into their cribs drowsy, but still awake
  3. Putting babies to bed without a bottle
  4. Waiting a few minutes to see if they settle to sleep on their own after waking
  5. Avoiding overstimulation during night-time feeds or diaper changes

Gradually withdraw parental attention while maintaining a presence at bedtime (lying near but not interacting with children until they fall asleep) or leaving room and not returning for 2-5 minutes before responding to crying, then lengthening that interval

21
Q

How can paediatricians help parents with problem behaviours? What approach should you take?

A

ABCs

  • Antecedants (what events precede the behaviour and how are parents responding)
    • Time-ins: Connect then redirect
  • Behaviours
  • Consequences

Environmental factors (may be contributing to stress but can be modifiable): living conditions, transitions, scheduling, possible interferences

Serious, disruptive or intractable child behaviours - early clinical recognition, connect with evidence-based Parent Management Training program

22
Q

Provide guidance regarding crying behaviours for a mother that has a baby with infantile colic

A
  • Crying is a form of communication - how they call for help, physical closeness or to have their basic needs met
  • Responding consistently, quickly and warmly helps develop secure attachment
    • Episodes become shorter when parents learn to anticipate and respond to early cues
  • Cannot “spoil” an infant with warmth and comforting
  • Parents need regular social/emotional support
    • Feelings of frustration are normal
    • If feeling overwhelmed, stress or exhausted, take regular brief breaks or ask partner, trusted family member or frient to some child care
  • Share evidence-based informaiton on soothing strategies
23
Q

List 2 protective parenting factors

A
  1. Consistent care provider
  2. Healthy routines
  3. Being read to
  4. Using community resources
  5. Parent’s social network
  6. Positive work-life balance
  7. Limited family screen time
  8. Healthy bedtime routine

RC Study Cards (20 decks)

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