Special Conditions Flashcards
Types of Child Abuse
Physical abuse, neglect, sexual abuse, emotional abuse, psychological abuse. Occurs regardless of socioeconomic status, gender, age, race
What NPs are obligated to do with child abuse
Report and do a detailed history and physical. Write clean legible notes. Refer to ER for SANE exam and forensic evidence collection. Advocate. Prevent long term sequelae – behavioral issues, absences from school, issues if taken from home, living with grandparents, etc.
Who can do a sexual abuse exam in the ER
pediatric SANE certified RN
Is child abuse acute or chronic?
Chronic
Examine for this after report of abuse
Shaken Baby Syndrome and Retinal hemorrhages
Shaken Baby Sybdrine
d/t weakened neck muscles the head will fling out of control. Impact is 30x that of gravity causing permanent or fatal damage. The dura membrane blood vessels can rupture – need CT to see this. Nerves can sever causing brain swelling –> cutting off oxygen –> blindness and brain damage. Damaged optic nerve –> blindness
Down Syndrome caused by
Trisomy 21. 3 of chromosome 21 instead of 2.
Phenotype of Down Syndrome
eyes slanting upward, small ears that fold at top, mouth is smaller making the tongue appear larger, small nose with flat nasal bridge, short necks, small hands with short fingers, decreased muscle tone – hypotonic, floppy like a ragdoll, small for age - shorter stature
Physiological concerns with Downs
ophthalmology difficulties, higher risk for cardiac abnormalities
Fragile X caused by
Genetic disorder of a mutation on the X chromosome. Girls have 2 Xs, if one is broken the other can compensate so the symptoms are more mild.
Phenotype Fragile X
almond eyes, large lower placed ears
Team approach for Fragile X
Need nutrition, behavior, fine and gross motor with PT/OT, education, family support for genetic counseling. Child is severely mentally handicapped
Fetal Alcohol Syndrome versus Fetal Alcohol Effects
Different from fetal alcohol effects as FAS has phenotype features, fetal alcohol effects/alcohol related birth defects are harder to dx since behavioral pattern is present by not phenotypical symptoms making FAS obvious, moms may not admit to using alcohol while pregnant either
FAS caused by
Fetal brain vulnerable to changes in glucose variations which cause an oxygen deficit, causes a defect in placental functioning. Once damage is done there is no way to reverse it, child will remain impaired
Downs, Fragile X and FAS can have comorbid…
Autism
Phenotype of FAS
short palpebral fissures, flat midface, short nose, indistinct philtrum, thin upper lip. Associated features: epicanthal folds, lower nasal bridge, inner ear anomalies, micrognathia - small jaw
Autism diagnostic criteria
1) Impaired social interactions 2) problems with verbal and nonverbal communication 3) repetitive activities/limited activities
Incidence of Autism
3-4/1,000. NJ is more common, 1 out of 4. Males are 4x likely.
Cause of Autism
Unknown, but may be genetic with defects in genes or d/t abnormal levels of neurotransmitters changing how neurons interact, issues in brain development
Autistic behaviors
Impaired ability to make friends, sustain conversation, absent social play, repetitive or unusual language, restrictive patterns of interest, preopccupation with certain objects or subjects, adherence to rituals – diet, sensory. Ex baby not smiling during milestones, not making friends at school, repetitive words/phrases
Asperger Syndrome
Neurobiological disorder as part of a group of conditions called autism spectrum disorder. May not need special education courses – can be mainstreamed into regular classes.
Asperger usually seen at what age
Between 5 & 9
Symptoms of Aspergers
Impaired social interaction, obsessed over one issue like the weather for example
ADHD
Persistent inattention, hyperactive and impulsive. Onset before 7. Females usually more inattentive than males but dx later than males.
Cause of ADHD
Multifactoral, cause is unknown, influencing neuroanatomical or neurobiologic, may be genetic
Dx ADHD
Ask teachers since they are with them all day. Need 6 of the 9 criteria at significant levels more than expected age. Persists for more than 6 months. Seen in more than 2 settings like school and home. Impairs social, occupational, academics
Team approach with ADHD
Need educational assessment, psychological assessment, ot/pt, behavioral pediatricians
Comorbidities with ADHD
Learning disabilities, neurological conditions, medical conditions, emotional/psych conditions, speech/communication issues, academic learning. Can have either super high IQ or very low. With High IQ if school tests it will not meet need for services that are actually warranted
Therapeutic mgmt of ADHD
classroom help, family education and counseling, behavioral therapy and psychotherapy, environmental manipulation, Not all children benefit from meds.
ADHD meds
Stimulants: dexedrine, adderall, ritalin. Side effects: insomnia, anorexia, weight loss, hypertension, long term use may suppress growth
Depression
Dip in self esteem at puberty r/t body image, peer groups. Drugs/Depression are the two D’s in HEADDSS. Do you sometimes feel sad, how often are you sad, all day? Do certain things make you sad?
Clinical depression
2 weeks or more of hopelessness, lethargy, worthlessness.
Rumination
Repeatedly think and talk about experiences leads to sadness, angry. Assess at every well visit. More common in girls
Suicide ideation
thinking about suicide with emotional and intellectual overtones. Ideation common, completed suicide is not
Parasuicide
doesnt result in death, but does inflict harm like OD on tylenol –> liver damage or cutting higher on the wrist. More common in girls. Males 4x higher with suicide.
Anorexia
fatal self starvation under eating and over exercising, deprive organs of vital nutrients. Fear of gaining weight, decreased food intake
Bulimia nervosa
binge eat and purge, usually by self induced vomiting or laxatives
Eating disorder percentage under age of 20
87%
Bullying
Social isolation and poor social and emotion adjustment for victims. School attendence issues come in to office for headache and stomach ache only happens in AM before school
Gang violence
Screen at well child visits, do you know anyone in a gang? Pregnant young girls can be gang related pregnancies. Also screen for drug use in teens.
