Special Conditions

Question 1

Types of Child Abuse

Answer 1

Physical abuse, neglect, sexual abuse, emotional abuse, psychological abuse. Occurs regardless of socioeconomic status, gender, age, race

Question 2

What NPs are obligated to do with child abuse

Answer 2

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.

Question 3

Who can do a sexual abuse exam in the ER

Answer 3

pediatric SANE certified RN

Question 4

Is child abuse acute or chronic?

Answer 4

Chronic

Question 5

Examine for this after report of abuse

Answer 5

Shaken Baby Syndrome and Retinal hemorrhages

Question 6

Shaken Baby Sybdrine

Answer 6

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

Question 7

Down Syndrome caused by

Answer 7

Trisomy 21. 3 of chromosome 21 instead of 2.

Question 8

Phenotype of Down Syndrome

Answer 8

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

Question 9

Physiological concerns with Downs

Answer 9

ophthalmology difficulties, higher risk for cardiac abnormalities

Question 10

Fragile X caused by

Answer 10

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.

Question 11

Phenotype Fragile X

Answer 11

almond eyes, large lower placed ears

Question 12

Team approach for Fragile X

Answer 12

Need nutrition, behavior, fine and gross motor with PT/OT, education, family support for genetic counseling. Child is severely mentally handicapped

Question 13

Fetal Alcohol Syndrome versus Fetal Alcohol Effects

Answer 13

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

Question 14

FAS caused by

Answer 14

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

Question 15

Downs, Fragile X and FAS can have comorbid…

Answer 15

Autism

Question 16

Phenotype of FAS

Answer 16

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

Question 17

Autism diagnostic criteria

Answer 17

1) Impaired social interactions 2) problems with verbal and nonverbal communication 3) repetitive activities/limited activities

Question 18

Incidence of Autism

Answer 18

3-4/1,000. NJ is more common, 1 out of 4. Males are 4x likely.

Question 19

Cause of Autism

Answer 19

Unknown, but may be genetic with defects in genes or d/t abnormal levels of neurotransmitters changing how neurons interact, issues in brain development

Question 20

Autistic behaviors

Answer 20

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

Question 21

Asperger Syndrome

Answer 21

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.

Question 22

Asperger usually seen at what age

Answer 22

Between 5 & 9

Question 23

Symptoms of Aspergers

Answer 23

Impaired social interaction, obsessed over one issue like the weather for example

Question 24

ADHD

Answer 24

Persistent inattention, hyperactive and impulsive. Onset before 7. Females usually more inattentive than males but dx later than males.

Question 25

Cause of ADHD

Answer 25

Multifactoral, cause is unknown, influencing neuroanatomical or neurobiologic, may be genetic

Question 26

Dx ADHD

Answer 26

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

Question 27

Team approach with ADHD

Answer 27

Need educational assessment, psychological assessment, ot/pt, behavioral pediatricians

Question 28

Comorbidities with ADHD

Answer 28

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

Question 29

Therapeutic mgmt of ADHD

Answer 29

classroom help, family education and counseling, behavioral therapy and psychotherapy, environmental manipulation, Not all children benefit from meds.

Question 30

ADHD meds

Answer 30

Stimulants: dexedrine, adderall, ritalin. Side effects: insomnia, anorexia, weight loss, hypertension, long term use may suppress growth

Question 31

Depression

Answer 31

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?

Question 32

Clinical depression

Answer 32

2 weeks or more of hopelessness, lethargy, worthlessness.

Question 33

Rumination

Answer 33

Repeatedly think and talk about experiences leads to sadness, angry. Assess at every well visit. More common in girls

Question 34

Suicide ideation

Answer 34

thinking about suicide with emotional and intellectual overtones. Ideation common, completed suicide is not

Question 35

Parasuicide

Answer 35

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.

Question 36

Anorexia

Answer 36

fatal self starvation under eating and over exercising, deprive organs of vital nutrients. Fear of gaining weight, decreased food intake

Question 37

Bulimia nervosa

Answer 37

binge eat and purge, usually by self induced vomiting or laxatives

Question 38

Eating disorder percentage under age of 20

Answer 38

87%

Question 39

Bullying

Answer 39

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

Question 40

Gang violence

Answer 40

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.