Special Conditions Flashcards
(40 cards)
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.
