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Health Promotion > Quiz 1 > Flashcards

Quiz 1 Flashcards

1
Q

Health promotion vs Health maintenance

A

Health promotion: increase well-being. Strategies that make POPULATIONS reach higher level of wellness. Looks at strengths & goals of individuals, families, populations. E.g., providing housing, promoting oral health

Health maintenance: preserve INDIVIDUAL’S present state of health, prevent disease recurrence. Focus on known risks. e.g., developmental surveillance, IZs, anticipatory guidance

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2
Q

3 levels of disease prevention

A

part of health maintenance
Primary: stop dz from occurring. IZs
Secondary: Stop progression. Screening.
Tertiary: Minimize residual dz. Help live w/residual dz.

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3
Q

Pediatric health promotion: First 5 years

A

focusing HP efforts on first 5 years of life can help reduce incidence of dz in general population

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4
Q

Standard components of pediatric well visit

A 
History (subjective)
Physical exam (obj)
Screening tests - dvptl & physical
Assessment (not just Dx)
Plan of care, anticipatory guidance (diet, IZs, safety, growth & dvpt, screening)
*F/U* & referral
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5
Q

AAP 2014 periodicity schedule

A

gives recommendations for pediatric preventative care

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6
Q

Changes to 2014 AAP periodicity schedule

A

Routine dyslipidemia screening 9-11yo
Depression screening 11-21yo
Screen w/CRAFFT for etoh/drug use
STI & HIV screening 16-18yo
REMOVAL of routing cervical dysplasia screening before 21yo
CHD screening after 24h/age but before hospital discharge
Hgb & Hct at 15 & 30 months (still 12 & 24, but at 15mths they’ve switched to whole milk so can pick up more)

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7
Q

Approaches to health promotion

A

Medical, behavioral, educational, client-centered, societal change

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8
Q

Medical approach to HP

A

Goal: keep ppl free of disease & disability. Focus is on sustaining dz-free state, not on enhancing ability

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9
Q

Behavioral change approach to HP

A

Encourage behaviors that will lead to freedom from dz. “Healthy behavior” is defined by health promoter (disempowering?)

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10
Q

Health Belief Model of HP

A

Person is convinced of necessity of behavior change

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11
Q

Health Belief Model: stages of change

A

Pre-contemplation: no perceived need to change
Contemplation: aware of problem but struggles w/energy/cost of change
Preparation: planning for change, small steps made
Action: Concerted effort, at least 6mths
Maintenance: plans to prevent relapse

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12
Q

Educational approach to HP

A

HCP provides knowledge & understanding. Choice is up to individual.

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13
Q

Client-centered approach to HP

A

Children & young people identify their own needs. Work on equal plane w/HCP.

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14
Q

Societal change approach to HP

A

Modifies physical & social environment to make healthier choices easier to make. E.g., sidewalks.

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15
Q

Family Capacities: definition & 4 categories

A

Definition: resources parents/caregivers bring to tasks of raising kids
4 categories:
Financial resources
Time investments
Psychological resources
Human capital (e.g., level of education, health literacy)

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16
Q

4 core foundations of children’s health

A

Responsive caregiving
safe & secure environments
adequate & appropriate nutrition
health promoting behaviors

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17
Q 
Age Ranges:
Early Childhood
Middle Childhood
Adolescence
Young adulthood
A

Early Childhood: birth - 8yo
Middle Childhood: 6-12yo
Adolescence: 10-19
Young adulthood: 20-24

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18
Q

urination pattern in infants

A

bladder reflexively empties 20x/day

Volume capacity approx 60 cc

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19
Q

urination pattern in toddlers

A

can hold urine for 2 hours
voids 7-12x/day
Volume capacity 300ccs

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20
Q

urination pattern in preschoolers

A

98%+ will have bladder control by 4yo during day

Nighttime control varies. “Accidents” WNL till 6yo for boys & 5yo for girls

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21
Q

Primary enuresis

A

continued involuntary leakage of urine (have never been fully dry)

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22
Q

Secondary enuresis

A

Had bladder control for at least 3 mtgs but not currently.
Diurnal: daytime
nocturnal: nighttime

Requires further evaluation - UTI, diabetes, constipation, sickle cell, CRF, psychosocial stressors, abuse

***common

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23
Q

Primary nocturnal enuresis

A

common (even 1% of 18yo)
more common in boys
family pattern

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24
Q

Why do infants stool after feeding?

A

Gastrocolic reflex often causes stool after feeding

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25
Q

Stooling: breastfed infants

A

BF: yellow, seedy, 1-8x/day or 2-4x/week (okay b/c no unbroken down food)
Less than FF, lower percentage of hard stools

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26
Q

Stooling: FF infants

A

FF: brown/green/soft/formed 1-4x/day (no less than every other day)
Higher percentage green stools
Soy –> highest percentage of hard stools

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27
Q

Straining & hard stools in infants

A

Normal to strain, cry & grunt - no coordination of muscles

Hard stools abnormal/ Prunes do work!

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28
Q

Stooling: toddlers

Patterns & barriers to toileting

A

pattern develops w/diet & activity. 1-2x/day or QOD
Increased awareness: may go off alone to poop
Need to learn words to associate w/going
Animation/fear of toilet common
Need to watch others poop (normalize)
Negativism may impede toilet training (if saying “no” to everything - not the right time)
Painful stools will impede toileting process

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29
Q

Stooling: preschoolers, school-age, adolescents

A

Usually 1 stool/day
Diet & activity important to regularity (no scientific evidence)
Witholding pattern can lead to painful stools (can cause megacolon/lack of signals to brain)
Straining UNCOMMON & may indicate constipation

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30
Q

Constipation

A

Decrease in child’s normal frequency WITH difficult or incomplete passage of hard dry stools

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31
Q

Encopresis

A

Stool incontinence after 4yo

usually secondary to constipation (liquid poop around solid poop - so must treat constipation)

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32
Q

Diarrhea

A 
Infection 
Change in diet (excessive fluids/juices)
Protein, lactose, carb intolerance
Stress
Tx: BRAT (bananas, rice, applesauce, toast) - no evidence it works
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33
Q

Toilet training: child readiness cues

A 
walks well
able to sit &  play, dress & undress self partially
Wants to put toys "where they belong"
Likes to imitate
Not in period of negativism
Takes pride in doing things
BM formed at regular time each day
Able to remain dry 2hrs at a time
Has words for urine & stool
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34
Q

Toilet training: length

A

Typically takes 2-3 months

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35
Q

Assisted infant toilet training

A

can begin soon after birth

caregiver recognizes signals that infant is ready & needs assistance to toilet

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36
Q

REM & babies

A 
develops about 29 weeks gestation
Rapid, irregular pulse & RR
Body twitches
active dream state
Ends w/brief awakening but they don't know how to go back to sleep yet
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37
Q

NREM & babies

A 
Non-rapid eye movement
begins 32-35 weeks gestation
HR & RR are lower
Restorative functions of sleep
4 Stages: 
Stage 1: drowsiness, light sleep
Stage 2: deeper but easily aroused
Stage 3: Deeper, body relaxed, shallow breathing. Develops at 3-4mths
Stage 4: Deep sleep. If awakened, confused.
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38
Q

Effect of poor sleep in kids

A 
Poorer health (depression) in parents, esp mothers.
Moderate to severe in 17% infants, 14% preschoolers
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39
Q

Infant sleep cycle

A 
50 - 60 min
more REM: enter REM shortly after sleep onset
Newborns: 50% REM
Premature infants: 80% REM
Preschoolers: 30% REM
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40
Q

Adult Sleep Cycle

A

90-100 min
20% REM
First REM 90min after sleep

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41
Q

Sleep cycle

A

Awake -> Stage 1 NREM -> Stage 2 NREM -> Stage 3 NREM -> Stage 4 NREM -> REM

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42
Q

Newborn pattern of sleep

A

REM w/frequent arousal. 16-17 hours per 24h. No circadian rhythm.

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43
Q

Infant (3-4mth) sleep pattern

A

NREM increases. 14-15 hrs sleep. Can fall asleep after REM. Circadian rhythm.

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44
Q

Infants (6-12mth) sleep pattern

A

Need for feeding at night less acute. Can sleep 12h, 2 naps during day. Separation anxiety starts (change sleep environment before).

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45
Q

Breastfeeding & infant sleep

A

associated w/increased wakening (sometimes digested faster)

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46
Q

Toddler sleep pattern

A

11-12h at night
No morning nap, keep afternoon nap
Separation anxiety
Rituals important

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47
Q

Preschool sleep pattern

A

11-12h at night
Some stop afternoon nap
Fear of monsters

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48
Q

School age sleep pattern

A

10-11 h at night

sleep problems learned behavior or sign of stress

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49
Q

Adolescent sleep patterns

A

9 hours/night
irregular sleep schedule
Most don’t sleep enough: ETOH (>0.08 –> less REM, >stage2, >awakening), caffeine

50
Q

SIDS vs SUID

A

SIDS: cannot be explained
SUID: explained or unexplained - any sudden death during infancy

51
Q

3 major causes SUID

A

suffocation
asphyxia
entrapment

52
Q

“Back to Sleep” Campaign

A

AAP - only on back, not side or stomach to avoid SIDS

Up to 1 yo

53
Q

Appropriate mattress for infants

A 
Firm crib mattress covered by fitted sheet
No soft materials
Not on shared beds
No bedrails
Not in sitting devices
54
Q

Bed sharing & infants

A

AVOID

room share w/o bedshare –> decrease SIDS by 50%

55
Q

Soft objects in crib

A

AVOID - no soft objects or loose bedding, no bumper pads

56
Q

Prenatal care & SIDS

A

lower risk for SIDS

57
Q

Smoking & SIDS

A

AVOID
2nd hand
sharing bed w/smoker particularly risky

58
Q

ETOH & illicit drugs & SIDS

A

increased risk

59
Q

Breastfeeding & SIDS

A

Reduced risk of SIDS. Increases w/exclusivity of BFing.

60
Q

Pacifiers & SIDS

A

Pacifiers are protective - even if falls out.
Do not hang on neck.
Attach nothing to it
Delay pacifier introduction until BFing firmly established - 3-4weeks

61
Q

Temperature & SIDS

A

Avoid overheating (no standard definition)
Babies need only 1 more layer than adults
Avoid covering face & head/overbundling
No evidence for fan

62
Q

IZs and SIDS

A

No evidence for causative link between IZs and SIDS, more evidence that it’s protective

63
Q

Commercial Marketing devices & SIDS

A

Avoid 0- no evidence

64
Q

Cardiorespiratory monitors & SIDS

A

No evidence they decrease SIDS

65
Q

Awake tummy time & SIDS

A

if supervised, it’s recommended to facilitate development & minimize developmental plagiocephaly

66
Q

Populations w/highest rates of SIDS

A

African-American, American Indian

67
Q

2 common reasons for sleep problems in infants

A

Night waking & night feeding

*put to bed awake, reinforce circadian rhythm with quiet dark room, comfort & change in bed, feed only when necessary

68
Q

Ferber / Controlled Comfort Method

A

Sleep assist method
Baby in crib awake but drowsy. Make sure dry, fed, well.
Return at progressing intervals to comfort but not pick up - 3min, 5min, 12 min
*for infants 6mths of age (can go whole night w/o feeds)

69
Q

Camping out method

A

sit w/infant until falls asleep independently. Parent gradually removes presence from room. First sitting near bed, then door, then outside door.

70
Q

Night terrors in children

A

during NREM
Don’t try to wake but keep safe and back to bed
Can try to wake up at point before it usually happens - after few weeks may stop

71
Q

Sleep disordered breathing

A

Has health consequences, e.g., ADHD, asthma & allergies
Physical exam: TMs (r/o OM), neuro, nasopharyngeal structures
Possible referral to ENT

72
Q

“Sexually reactive youth”

A

better term than “youth sex offenders”

73
Q

Factors that affect frequency & type of sexual behavior

A 
Childcare- more interaction
Preschool age - inquisitive
Exposure to nudity
Family environment
Access to porn
Abuse
Developmental disabilities
74
Q

Normal sexual behaviors: common

A 
Transient, few, distractible
touching/masturbating in public/private
Viewing/touching others' genitals
Showing genitals
Standing/sitting too close
Trying to view adult nudity

*assess situational factors

75
Q

Normal sexual behaviors: less common

A

Transient, moderately responsive to distraction
Rubbing body against others
Trying to insert tongue while kissing
touching peer/adult genitals
crude mimicking of sexual acts
sexual behaviors that are occasionally but persistently disruptive

*assess situational factors

76
Q

Sexual behaviors: uncommon

A

Persistent & Resistant to parental distraction
Asking peer/adult to engage in specific sexual act
Inserting objects into genitals
Explicitly imitating intercourse
Touching animal genitals
Sexual behaviors that are frequently disruptive

*assess situational factors

77
Q

Sexual Behaviors: Rarely Normal

A

Involve children 4+ years apart
Variety displayed on daily basis
results in emotional distress or physical pain
associated w/other physically aggressive behavior
involve coercion
child becomes angry if distracted

*assess situational factors

78
Q

3 considerations in giving care for adolescents r/t sexuality

A

Consent (“mature minor doctrine”), Confidentiality, Payment

79
Q

Adele Hoffman Models of Adolescent Care

A

Model I: Parent adolescent collaborative
Model II: Patient Primary - Parent Secondary (purpose reviewed together, parent leaves and returns at end, confidentiality w/teen)
Model III: Patient Alone - Parent Optional

80
Q

When to ask about sex

A

Bright Futures: 11-14yo

81
Q

STIs and screening recommendations for adolescents

A

All sexually active: GCCT
If requesting
HIV/AIDS - if treated for STI, unprotected w/multiple partners, high risk, IVDU, MSM, sex for $, etc

82
Q

Pregnancy intention & ambivalence

A

If ambivalent, more likely to get pregnant or STI (less likely to use condom)

83
Q

Age of Consent

A

16 years: in general
18 yo: if partner in position of power (NON school teacher, athletic coach)
13-15 yo: can consent to sexual relations w/anyone up to 3y older
12yo and younger: cannot legally consent
NO age of consent if partner is school teacher, psychologist, or therapist

84
Q

Growth rate of infants

A

Weight doubles by 5-6 months, Triples by 12 months

85
Q

Challenges to nutritional needs

A

small size of stomach

immaturity of digestive system

86
Q

Nutritional needs of infants from birth to 1year of age

A

exclusive BFing for 6mths followed by continued BFing as complementary foods are introduced = best
Breast milk as PRIMARY food for first year

Vitamin & mineral supplementation:
400 U oral vit D drops for BF prior to discharge
Iron supplementation may be needed
Fluoride 6mths to 3 years if <0.3 ppm

Solids: begin at 6mo depending on development and interest

87
Q

How long to breastfeed?

A

First year of life and as long as mutually desired after that

88
Q

Advantages of breastfeeding r/t medical conditions

A

decreased risk of OM, URI, LRI, asthma, RSV bronchiolitis, NEC, atopic dermatitis, gastroenteritis, IBD, obesity, DM, etc

89
Q

The specificity of human milk

A

50% of baby’s genetic material
Not static
Virtually every component plays a nutritional role

90
Q

Anatomy & Physiology: stages of lactation***

A

Mammogenesis (dvpt of breast tissue): embryogenesis to puberty. estrogen & progesterone: Proliferation of ducts and glands.

Lactogenesis I (initiation of milk production): mid pregnancy to day 2 PP.
Progesterone: Lobular formation
Prolactin: lobular, alveolar dev, colost.
Placental lactogen: Increases prolactin
Estrogen: Ductular sprouting.

Lactogenesis II (onset of copious production of milk). Day 3-8. A switch from endocrine to autocrine (local) control.
Progesterone down: Lactogenic trigger prolactin: supportive/permissive
glucocorticoids: assists in milk production
insulin, cortisol: supports milk production

Galactopoeisis (aka lactogenesis III, maintenance of milk production): Day 9 to beginning of involution.
Prolactin, cortisol, & insulin: Stimulates transcription of genes that encode milk proteins
Oxytocin: Facilitates milk transfer- MER
Thyroid, PTH and GHs (?): increase responsiveness of mammary cells to prolactin

91
Q

Effect of retained placenta on BFing

A

can inhibit w/drawal of progesterone & subsequent release of prolactin

92
Q

Conditions that affect prolactin secretion

A

hypothyroidism, DI (vasopressin secretion is supressed, impedes prolactin release), PCOS, pituitary surgery
On dopamine agonists: ergot alkaloids (carbergoline, ergotamine
OCPs with estrogen

93
Q

Human Milk vs cow: protein, fat, carbs

A

less protein: 1.1g
More fat: 4.2g
More carbs: 7g
*per 100g fresh milk

94
Q

Infant feeding cues

A

Early: stirring, mouth opening, turning head & rooting
Mid: stretching, increasing physical movement, hand to mouth
Late: crying, agitated body movements, turning red

95
Q

C/Is to BFing

A

PCP, cocaine, connabis
Methadone (unless adequately nourished and in maintenance program)
ETOH: minimize intake < 0.5 g alcohol/kg body weight. Wait 2 hours. Does not increase milk production.
Smoking: strongly discouraged.

96
Q

Maternal diet & BFing

A

increased calorie needs 450-500 kcal/day

Risk of mercury in fish - read recs

97
Q

Breast Milk storage

A 
Room temp 3-4 h (6-8 h if very clean)
Refrigerator 72h (5-8 daysif very clean)
Freezer 6mths (12 acceptable)
98
Q

Vitamin D in infancy***

A

BF & partially BF: 400 IU/day beginning in first few days of life
Continue supplementation unless infant is weaned to 1 L/day or 1 qt/day of bit D fortified formula or whole milk
*if non-BF and receiving less than 1000mL day of vit D supplemented formula/milk, same guidelines.

99
Q

Iron supplementation in BF infant

A

High levels of lactose & bit C in breast milk facilitates iron absorption
Reserves laid down in utero - not affected by mom’s iron intake during BFing
Iron supplementation before 6mths may be detrimental
Longer BFing - less likely to be anemic

Gradual introduction of iron rich foods around 6mths - cereals, meats, dark green veggies, oatmeal, grains

100
Q

Infants who may require early iron supplementation

A

Preterm
LBW
Hematologic D/Os
Born w/inadequate stores

101
Q

Fluoride supplementation in BF infant

A

from 6mo to 3 yo - decision based on fluoride concentration in water supply, food, fluid, and toothpaste sources
Too much fluoride: brown and white spots under enamel. Hard to repair.

102
Q

B-12 supplementation in BFing

A

vegetarian mothers and those w/gastric bypass - if mom doesn’t supplement (4mg/day), then infant should

103
Q

Types of infant formula/concentrations***

A

Ready to feed
Concentrate (1 can water, 1 can formula)
Powder (1 scoop formula, 2 oz water)

*discard unused after feeding! Refrigerate after mixing

104
Q

Calorie considerations in infant formula and infant needs***

A

20kcal/oz in regular calorie formulas
Some specialized brands have 22-24kcal/oz
Babies need minimum 100-115 kcal/kg/day to gain weight

105
Q

Protein hydrolysate formula

A

“hypoallergenic formula”
useful for babies w/milk or soy protein allergies
Easier to digest
less likely to cause allergic reactions

106
Q

Soy infant formula - use

A

Medical indications: galactosemia & hereditary lactase deficiency (ONLY)
May be used for milk allergy
Vegetarian (not vegan)
Gastroenteritis if secondary lactose intolerance
NOT recommended for preterm

107
Q

Soy infant formula: controversy

A

Safety
in vivo & in vitro study raise possibility of estrogenic effects of isoflavones in SIF
Isoflavone levels higher in infants fed SIF
Animal studies show isoflavones decrease fertility
No human studies w/adverse effects

108
Q

Goat’s milk vs cow’s milk: infant nutrition

A

similar weight gain

More BMs in GM

109
Q

Whole cow’s milk: infant nutrition

A

NOT before 1 yo: can cause anemia by irritating gut and leading to small but consistent blood loss from GI tract (micro bleeds)
Interferes w/absorption of nutrients
High solute load which kidneys have trouble excreting

110
Q

Rice milk: infant nutrition

A

insufficient protein for <2yo
hypoalbuminemia & poor weight gain
Increased arsenic levels

111
Q

Almond milk: infant nutrition

A

Insufficient protein source for <2yo

No difference ingrowth rate (increment, length, head circumference) as compared to soy or hydrosylate

112
Q

Formula additives: pre/probiotics

A

Nothing to say for or against

113
Q

DHA and ARA

A

docosahexaenoic acid & arachidonic acid
omega-3 FAs found in breast milk and certain foods, such as fish and eggs
Some studies suggest adding to formula may help infant eyesight and brain development. Some shows no benefit.

114
Q

Unpasteurized milk: infant nutrition

A

possible health hazard

pasteurization does not change nutritional value

115
Q

When to introduce solids

A

4-6 mths of age (from spoon/bowl, not bottle)
Developmentally, at 4-6mths, extrusion (tongue thrust) reflex diminishes and infant begins to sit well with support

6-12 mths solids are in addition to, not replacing essential nutrients from milk

116
Q

First complementary food

A

Often rice cereal
Provides iron when prenatal iron stores are decreasing
Easily digested
rarely causes allergic reaction
1-2 tablespoons of cereal once or twice daily before milk feeding

117
Q

Introducing finger foods

A

after 6mths age
avoid hot dogs hard veggies, whole grapes, chunks PB
Supervise eating
Parents should be familiar w/techniques of airway obstruction removal
Introduce meats early (6mths)
Delay introduction of honey until after 1 year (infantile botulism before 1yo)

118
Q

Effects of delayed introduction of solids

A

associated w/reduced odds of childhood overweight/obesity
Assoc w/increased risk of allergic sensitization to food and inhalant allergens
Findings support introduction from 4-6mo, no later than 6mo!

119
Q

Weaning guidelines

A

Between 8-9mths, offer baby a cup w/assistance (discourage non spill- just like sucking)
By one year, bottles should be slowly withdrawn
BFing can continue, but water/juice from cup
Cup @snack/mealtime to accustom child to drinking when thirsty and not as comfort (will decrease dental caries & caloric intake)

120
Q

Iron levels in infancy: infant nutrition***

A

Newborns have maternal stores
iron in breastmilk has high bioavailability
Iron stores decrease by 4-6mo = need more dietary iron
6-12 mo 11 mg/day iron. Formula contains 10-12mg/L of iron

121
Q

Weight gain/loss in first weeks: newborns

A

Normal to lose up to 10% weight in first week. Start to gain again around day 4/5. Expect all back in 1-2 weeks (closer to 2 for breastfed).

Health Promotion (1 decks)

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