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Fall 2020 Primary Care FNP > School Age Children > Flashcards

School Age Children Flashcards

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1
Q

Erkickson’s Developmental Theory

______ vs. _______

  • B_____, cr____, acc_____
  • Skills of life
    • Re____ to peers, self-d_____
    • ___work, ___ sports
    • Mastering re____ and arith____
A

Industry vs. Inferiority

  • Building, creating, accomplishing
  • Skills
    • Relating, discipline
    • teamwork, team sports
    • reading, arithmetic
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2
Q

Piaget Stage

_____ Operational Stage

  • L_____ thinking
    • Coherently organized _____
    • Seq____ arrangement
  • Conservation
    • M___ and V____ - understanding numbers remain the same despite changes in form

M____ and R_____ are major tasks that need to be master

A

Concrete Operational Stage

  • Logical
    • thoughts
    • Sequential
  • Conservation
    • Mass and Volume

Math and Reading

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3
Q

Social-Emotional Development

  • The school-age years bring new and exciting ch____ and re____ for children
  • Research conducted on school-aged children show that peer ____ have a profound impact on children’s overall development
  • Children who have good relationships with classmates are often less l____, de____, ____ fewer days of school, and en___ school.
A
  • challenges, rewards
  • peer relationships
  • less lonely, depressed, miss fewer days of school, enjoy school
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4
Q

Reasons for Concern

  • Children who have problematic ____ relationships and difficulties with ____ skills
  • Children who struggle with peer acc_____ and repirocal f____ building are at greater risk for increased problems in elementary school
  • These children are at risk for b_____, social _____, s__ness, and school related difficulties
  • As a HCP if you identify signs of difficulty, it is important to consult with cou____ or ps____
A
  • peer relationships, social skills
  • peer acceptance, reciprocal friendship
  • bullying, isolation, sadness
  • counselor, psychologist
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5
Q

6-7y Social, Cognitive, Emotional, Physical Milestones

  • May lose first baby ____
  • Likes to stay b____
  • ____ skills in order to become better
  • They should be able to ____ age-appropriate books
  • Speaks in _____ sentences, understands concept of n_____, differentiates ___ and ___, tells t____
  • During this time they are able to coo____ and sh___, p____ with friends of same gender
  • They like to ____ adults, j_____ of others and siblings
A
  • tooth
  • busy
  • Practice
  • read
  • complete sentences, numbers, right and left, time
  • cooperate, share, play
  • copy, jealous
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6
Q

10-12y Milestones of Age

  • Remainder of adult ___ will develop
  • More in_____, f____ are very important and influential
  • D______ the ability to stick to the r_____
  • Increased interest in _____ of interest
A
  • adult teeth
  • independent, friend important
  • Developing, rules
  • gender
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7
Q

7-12y Social, Cognitive, Emotional Development

  • This is an age where the child spends a great part of the day in s____ and with f____
  • They pick up quite a few new skills and at the same are likelty to have ______ outbursts on a regular basis
  • Milestones are: D_____ ability to stick to the r_____
    • The beginning of the “_____“
A
  • school, friends
  • emotional outburts
  • Developing, rules
    • “LOOK”
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8
Q

Middle and Late Childhood (6-12 y) Physical Development

Growth and Body Changes

  • Children grow more _____
  • Weight __-__ lb/yr
  • Height ___ inch/yr
  • _____ growth patterns (boys vs. girls)
  • Body proportion (th____ and sl____)
  • _____ become bigger and stronger
  • ____ capacity gives greater endurance and speed
A
  • slowly
  • 5-6lb
  • 2 inch
  • Similar
  • thinner, slimmer)
  • Muscles
  • Lung
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9
Q

School Age Children Growth and Development

  • Body systems mature
    • ____ portion grows faster than _____ portion
    • Bones _____, muscles are more fl_____ - increased strength and heart and lung capacity give the child the ____ to perform increased skills
    • Movements are more coo_____
    • More aware of ____ and development of secondary ____ characteristics
  • Prepubescence begins __ yrs before onsent of puberty
  • Puberty Average Age
    • Girls ___ y
    • Boys ___ y
  • Have an expanded ______ span
A
  • Body systems
    • lower
    • lengthen, flexible, endurance
    • coordinated
    • body, sex characteristics
  • 2y
  • Puberty
    • 12
    • 14
  • attention span
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10
Q

Physical Development

Participation in Activities (4)

  • Gross Motor Skills
    • _____ muscles of the body: W____, R_____, Cl_____
  • Fine Motor Skills
    • Gross: Th_____, C_____
    • Fine: P____, Dr____, Using a kn___ and f___, Wr____, T____ shoes
A

Baseball, Football, Swimming, Running

  • Gross Motor
    • Large muscles: Walking, Running, Climbing
  • FIne Motor
    • Throwing, Catching
    • Painting, Drawing, knife/fork, Writing, Tying
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11
Q

Influences on Physical Growth and Health

  • Hereditary and Hormones
    • (2) hormones
  • N______
  • Infectious disease
    • ___nutrition
    • imm______
  • Childhood in_____
A
  • Hereditary and Hormones
    • Growth hormone
    • Thyroid stimulating hormone
  • Nutrition
  • ID
    • Malnutrition
    • Immunization
  • injuries
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12
Q

History-What to Ask?

  • Review previous n_____
  • Importance of a complete history
    • Pre____
    • Bi____
    • Fa____
    • Ill____ (review what common medical/surgical for age group)
    • Ho_____/ _ _ visits
    • Imm_____
    • Nut_____
    • School P_____
    • Developmental _____
    • M____ history - LMP
  • Do you have a ______ card?
A
  • notes
  • complete history
    • Prenatal
    • Birth
    • Family
    • Illness
    • Hospitalizations/ER
    • Immunizations
    • Nutrition
    • Performance
    • Milestones
    • Menstrual - Last Menstrual Period
  • Vaccine Card
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13
Q

History-What to Ask?

  • Also include
    • Exer_____
    • Ac____
    • Saf____
    • After school _____
    • S____ use?
    • Substance ex____?
    • S_____ experimentation
    • D_____ scale (patient and parent)
A
  • Exercise
  • Activity
  • Safety
  • activities
  • Substance
  • exposure
  • Sexual
  • Depression
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14
Q

School Age - Physical Exam

  • ____ signs, especially __ ___*
  • H_/W_/B _ _
  • All components of a normal ___ in a younger child
  • T____ staging
  • NY state ____ forms
A
  • VS, Blood pressure*
  • HT/WT/BMI
  • PE
  • Tanner
  • school
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15
Q

Anticipatory Guidance

  • ______: growth spurt, prepare pt and parent for puberty - “the look”
  • E_____
  • In_____: lo____ and lang____, concrete to ____ reasoning
  • S____ Development: community and sexual identity
  • S____ Readiness: School performance
  • H____ Patterns: Nutrition, Sleep, Exercise
  • S____: accident prevention- leading cause of death; teach prevention planning, confirm emergency plan
    • Safety, violence exposure, cohesion and sexual act
A
  • Physical
  • Emotional
  • Intellectual: logic and language, concrete to abstract reasoning
  • Social
  • School
  • Health
  • Safety
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16
Q

Anticipatory Guidance

  • Health Maintenance
    • Imm_____ remember/___ Shot - MEMORIZE
    • _ _ _ screening - school entrance
  • PPD can be applied ____ or ____ that MMR vaccine is given. However if MMR vaccine given on the previous day or earlier, the PPD should be _____ for at least?
  • Live _____ vaccine given prior to the application of PPD can ____ the reactivity of the skin test bc of mild ____ of the immune system
  • www.___.gov/vaccines
A
  • Health Maintenance
    • Immunizations/FLU
    • PPD
  • before or same day, but MMR before = PPD delayed one month
  • Measles, reduce reactivity of PPD bc of mild suppression of immune system
17
Q

Cholesterol Screening

  • NHLBI/AAP guidelines strongly recommend universal cholesterol screening between ages of? (2)
  • This screening should occur in the context of ___ child and health ____ visits
  • Lipid screening can be performed with a ___ fasting lipid profile or __-fasting lipid levels

D______ in children: Definition, screening, and diagnosis

A
  • 9-11 and again between 17-21
  • well child, health maintenance
  • full fasting or no-fasting

Dyslipidemia

18
Q

Cholesterol Intervention

For pediatric patients who are _____ or obese have high _____ concentration or low ____ concentration, (1) is the primary treatment, which includes improvement of ____ with nutrition _____ and increased (1) to produce improved energy balance.

A

overweight, high triglyceride, low HDL, weight management, diet, nutrition counseling, physical activity

19
Q

Lead Poisoning is Preventable

  • ___ exposure
    • ​Report _____ or damanged paint to building owner. Building owners are ____ to safely fix peeling paint. If they do not fix peeling paint, or if work is being done in unsafe manner (ie dust), you should ____ them online or by calling ___. or NYCHA residents concerned about their home or their children can call 718-707-7771
    • Keep children away from (2) - Wash f____ and w______ often. Wash childrens h___ and t___ too. Remove ____ before entering your home.. Wash work clothes separate from family laundery if someone is in _____. Learn more about avoiding products that may contain lead, such as imported ____, f___ and cos____, and traditional m_____.
A
  • Avoid
    • ​Peeling, required, report, 311
    • peeling paint and home renovations, floors and windowsills, hands and toys, shoes, construction, pottery, food, cosmetics, medicines
20
Q

Lead Testing

  • In New York State, children must be tested for lead poisoning at ages ___ and ___, and screened for risk up to age ___.
  • Ask your pcp about testing _____ children if you think they’ve been exposed to lead.
  • _____ women should be assessed for lead exposure at first ____ visit
  • Call ___ for help finding a clinic
    • When to retest
      • 5 - <15 =
      • 25-45 =
A
  • 1-2, screening up to age 6
  • older
  • Pregnant, first prenatal visit
  • 311
    • Q1-3 months till <5
    • Q3 months till <15 then like above
21
Q

Lead NYC >45

  • Arrange hospitalization and ch_____ according to “Recommended Chelation Protocol for Children With BLLs > 45 ug/dL
  • Perform complete _______ exam
  • Confirm BLL with ______ specimen processes as an emergency test before providing chelation, unless symptoms of ______ are present
  • Obtain ______ to look for paint chips/other solid lead ingestion; if radio-opaque particles are found or recent ingestion is witnessed, use a cathartic
  • Monitor e______ protoporphyrin (EP) levels to assess timing of exposure
  • Do not discharge the child until the NYC _____ ______ inspects the home
    • Inform the NYC Healht department of hospital admission by calling 646-632-6002
    • The NYC Health Department can provide: R_____ to providers with expertise in lead poisoning for consultation onevenings on evenings and weekends, call the Poison control center at 212-POISONS (764-7667)
A
  • chelation
  • neurologic
  • venous, encephalopathy
  • abdominal x-ray
  • erythrocyte
  • Health Department
    • Referrals
22
Q

Lead NYC 20 - <45

  • All actions for BLL __ and __ AND
  • Evaluate for ____-deficiency ______, often associated with lead poisoning
  • Consider _____ if paint chips or other solid lead ingestion is suspected
  • If radio-opaque partles are found or recent ingestion is witnessed, use a ______
A
  • 5, 20
  • iron deficiency anemia
  • abdominal x-ray
  • cathartic
23
Q

Lead NYC 5 - <20

  • Assess potential sources of exposure by asking the Recommended Lead Risk Assessment _______
  • Provide Recommended ______ Message
  • Evaluate for adequate intake of (2). Adequate stores may decrease GI ______ of lead
  • If a fingerstick specimen, confirm with _____ specimen within time frame specified in recommended follow-up blood lead test schedule below. Venous specimens are ____ accurate than fingerstick specimens.
  • Report BLL to NYC _____ ____ within __ hrs via Online registry
  • In analyzing specimens in your office using a point of care device, remember to _____ BLLS
A
  • Questions
  • Educational
  • Calcium, iron, absorption
  • venous, more accurate
  • Health Department within 24 hrs
  • REPORT!
24
Q

Common Problems Otitis Externa

  • Otitis externa =
    • S/S = ____ in ear aggravated by ____ the auricle, ex_____ in ear canal
    • Tx = P_____ - keep instruments ____
      • Keep w____ out
      • Medication: ____/____ drops
A
  • Inflammation of external auditory canal
    • pain, moving, exudate
    • Prevention, out
      • water
      • antibiotic/steroid drops
25
Q

Asthma

An average of __/10 school age children has asthma

  • Subjective: D___ H_____ cough, Dys_____, Wh______, T___ chest
  • Exam: B/L inspiratory _______, tachy____, tachy_____, _____ muscle use. P____ flow meter
  • Differential: Br_____, Foreign _____, Pn______
  • PLAN: D_____, Th______. Ed_______
    • Asthma ed_____
    • F___ shot
A

1/10

  • Dry Hacking, Dyspnea, Wheezing, Tight
  • wheezing, tachypnea, tachycardia, accessory muscle use, Peak flow
  • Bronchities, body, pneumonia
  • Diagnostic, Therapeutic, Education
    • education
    • Flu shot
26
Q

Common Problem: Childhood Asthma

  1. S/S =
  2. Acute Attack =
  3. F____ and S_____ History
  4. Differential D_____
A
  1. (Note pattern, frequency, precipitating factors and duration)
    • Coughing, SOB, wheezing on exhalation
    • Chest congestions and tightness, sputum production
    • Insomnia rt SOB, coughing, or wheezing at night
    • Bouts of coughing/wheezing that increases with resp infection
    • Delayed recovery after resp infection
    • Fatigue and dyspnea upon exertion (exercise induced asthma)
  2. Tachycardia, Diaphoresis, Chest pain, use of accessory muscle while breathing, flaring of nares while breathing, use of abdominal muscles while breathing
  3. Family, Social
  4. Diagnosis
27
Q

Common Problems: Childhood Asthma

  • Diagnostic Tests (2)
  • Medication (3)
  • Patient Education
    • ​s___ e____ of medication
    • Avoiding all_____
    • Notifying child’s _____ personnel
    • Give parent written ______
  • Follow up
    • ​R____ to office if not well controlled
    • Routine follow up every ___ months
A
  • Spirometry, Exhaled Nitric Oxide Tests
  • Long term control, Rescue meds (short acting), Allergy desens shots -immunotherapy
  • Education
    • SE
    • allergens
    • school
    • instructions
  • Follow up
    • Return
    • Q6 m
28
Q

Tinea Corporis

=

  • Superficial _____ infection involving what parts of the body (3)
  • S/S =
  • Topical meds =
  • Oral meds keep in mind what t____?
  • Education - don’t share cl____, t_____
A

“Ringworm” of nonhairy skin

  • fungal, face, trunk, limbs
  • red, scaly, oval patch usually asx or mildly itchy
  • Antifungal QD for two weeks
  • teaching
  • no sharing clothing, towels
29
Q

Tinea Capitus

=

  • _____ infection of the s____
    • S/S = same as tinea corporis, may have + anterior/posterior cervical n____
    • Tx = M_____, Sh_____, O___ meds (LFT’s)
    • Education = _____ of hats, towels
A

“ringworm” of the head

  • Fungal, scalp
    • nodes
    • medication, shampoo, oral meds (check LFTs)
    • No sharing
30
Q

Lice/Scabies: Pediculosis

  • Pediculosis and Scabies are caused by _______. _____ is the most common presenting symptom
  • Head and pubic lice infestations are diagnosed with ______ of live lice. ___ (lice eggs or egg casings) are ___ sufficient to diagnose a currest infestation
  • First line pharmacologic tx for pedulosis is p______ 1% lotion or shampoo. Newer tx are available but costly, and resistance patterns are generally unknown.
  • Body lice infestation should be suspected in pts with pruritis who live in _____ conditions or have poor h____
  • Clothing and bedding should be _____ in ___ water and dried in ____ dryer
  • Counseling regarding appropriate diagnosis and correct use of effective therapies is key to reducing the burden of lice
A
  • ectoparasites. Pruritis
  • visualization. Nits not sufficient to diagnose
  • Permetherin
  • crowded, hygiene
  • washed, hot, hot
31
Q

Sexual Abuse

What to do, when to refer?

  • Police
    • ​If you believe the child is in ______ danger of being harmed, call the police at 911 or your local police department
  • Child Abuse Hotline
    • ​Reports of ________ child abuse or maltreatment should be made immediately to the NY Statewide Central Register of Child Abuse and Maltreatment, commonly known as the Child Abuse Hotline, at: 1800 342 3720
    • This hotline operates ___ hrs/day, 7 days a week, 365 days a year
A
  • Police
    • Immediate danger
  • Child Abuse Hotline
    • ​suspected
    • open 24 hrs/everyday all year
32
Q

Risk Factors/Watch For

  • 6-9 yo: poor s_____ adjustment, using agg______ to gain attention, frequent i_____, t_/c____ overuse - development of self attitude: should have ______ role model: family, school, community taking responsibility for child’s development. If lacking, refer.
  • 9-12 yo: ___happy, ____ school performance, ____ of adult role model and opportunity for responsibility; over d_____ on family; too much __/____ games; ____ behavior
  • Always watch for child _____ abuse
  • I______ - know the normal values and variations
  • S______ information
A
  • poor school, aggression, illness, tv/computer, positive
  • unhappy, poor, lack, dependence, tv/video games, antisocial
  • sexual
  • immunizations
  • school
33
Q

School Problems

  • H_____ of problem….Across settings?
  • B____ History
  • F____ History
  • De______ History
  • M_____ History
  • Clinician must do complete __ including v____ and h_____
  • Labs: ____ screening? _ _ _
  • Other labs: Review Guidelines for age group
A
  • History
  • Birth
  • Family
  • Developmental
  • Medical
  • PE, vision, hearing
  • Lead, CBC
34
Q

2019 Recommended Immunizations for Children 7-18

  • When to get the flu shot?
  • When to get Tdap?
  • When to get HPV?
  • When to get Meningococcal A?
  • When to get Meningococcal B?
A
  • Everyone 6 months and older should get a flu vaccine every year.
  • All 11-12 year olds should get one shot of Tdap
  • All 11-12 year olds shoud get a 2 shot series of HPV. A 3 shot series needed for those with weakend immune system and thos who start the series at 15 y or older.
  • All 11-12 yo should get one shot of Men ACWY. A booster shot is recommended at 16 yo
  • Teens 16-18 may be vaccinated wtih MenB vaccine
35
Q

Free Homeschool Curriculum and Educational Resources

  • www.thoughtco.com/free-homeschool-resources-4151635Home
  • lifeinthenerddom.com/free-complete-homeschool-curriculum/
  • www.homeschoolbuyersco-op.org/free-curriculum
  • Find free homeschool curriculum and educational resources with our free and fully searchable database. Discover thorusands of resoursces from ___, the Library of ______, the US Dept of ______
  • What grades?
A
  • PBS, Congress, Dep of Education
  • K-12

Fall 2020 Primary Care FNP (11 decks)

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