Unit Two Part 1- Health History

Question 1

What is the first priorty of any child/infant visit

2

Answer 1

assess for distress or decompensation

once you determine child is stable enough to be in primary care you can continue

Question 2

What is the purpose of taking a hollistic health history at a well child visit?

2

Answer 2

• Assess patterns
• Evaluate risk factors

that may impede normal growth and development

Question 3

What is important information to collect during the health hisotry of patients up to age 6?

3

Answer 3

• any prenatal complications
• issues with labour and delivery
• newborn hospitalizations

Question 4

Why is it important to gather information about growth parameters and attainment of developmental milestones?

Answer 4

To identifying underlying pathology in the pediatric patient

Question 5

What is the definition of growth?

2

Answer 5

• An icrease in number and size of cells
• An increase in size and weight of the whole or any of its parts

Question 6

What is the definition of development

Answer 6

• gradual change and expansion in capabilities –> represents advancement from lower to more advanced stages of complexity

Question 7

What is the definition of maturation?

Answer 7

an increase in competence and adaptability

Question 8

Growth and development have a ___ and ____ progression

Answer 8

cephalocaudal (head to toe)
proximodistal (midline to periphery)

Question 9

During infancy ___ paced growth is experienced, mostly affecting the ____

Answer 9

rapid growth
head

Question 10

During toddler/preschoolhood ___ paced growth is experienced, mostly affecting the ___

Answer 10

slow
trunk

Question 11

During the school-age ___ paced growth is experienced, mostly affecting the ___

Answer 11

slow
limbs

Question 12

During adolescence ___ paced growth is experienced, mostly affecting the ___

Answer 12

rapid
sexual maturation

Question 13

Because each child progresses at their own pace, growth and development occurs on a ____ with a _____ of normal physical, social, emotional, and cognitive growth during infancy, childhood, and adolescence.

Remember to view deviations from the expected in the context of the whole child.

Answer 13

spectrum
range

Question 14

What is the purpose of growth charts

Answer 14

tools to help form an overall clinical impression of the child

• not intended to be used as a sole diagnostic instrument

serial measurements are used to assess patterns and identify aberrations.

Question 15

What is the difference in length and height on growth charts

Answer 15

length - the normal values are based on laying down measurements

height- based on standing up

Question 16

In what position should head circumference be measured

Answer 16

upright position

normal values are based on upright position

Question 17

Why are ongoing health supervision (well-child) visits important

Answer 17

allows opportunity to assess health and function of child and family

Question 18

What are the 4 components to well child visits

HPSG

Answer 18

• history
• physical exam
• screening
• guidance

focusing on health promotion and anticipatory guidance, disease prevention, and disease detection

Question 19

What is health surveillance

in terms of well child visits

Answer 19

systematic collection, analysis, and interpretation of data for the purpose of prevention

Question 20

What does health surveillance guide?

Answer 20

primary prevention measures

Surveillance is a continuous, long-term process, which may/may not include screenings.

Question 21

What level of prevention is screening?

Answer 21

seconday

surveillance is primary

Question 22

When is screening recommended

Answer 22

when the individual will benefit from early treatment or intervention

Question 23

What is universal vs selective screening in children

Answer 23

Universal screening - conducted on all children at defined time intervals or ages

Selective screening - conducted only on those children for whom a risk assessment suggests follow-up

Question 24

What is the difference in the routine well-child visits, ill-child visit, and foused, single-purpose visit

Answer 24

routine - goal is screening for growth/developmental abnormalities
ill - acute or chronic illness/injury
focused - sports physical, sexual abuse exams etc

Question 25

What are the nine elements of a well-child visit

Answer 25

• Patient-identifying statement
• reason for visit
• date of last visit
• pmhx
• prior screening/results
• ROS
• Current health
• Fam hx
• household/environment

• Patient-identifying information/statement
  * Identify if this is a new or established patient/family
  * Child age, sex/gender
  * Accompanying adult(s)
  
  • Reason for the visit
    
    • Highlight parental (and child) concerns/priorities
  • Date of last visit
    
    • Interval history (with an established patient/family, seek an “update” of the comprehensive history on record)
  • Past health/medical history
    
    • Prenatal/birth/neonatal history
    • Childhood illness/injury
    • Hospitalization/surgery/procedures
    • Allergies (food, medication, environment)
    • Immunizations
    • Medications (prescription, OTC, folk/herb, complementary/alternative therapies)
  • Prior screening/results
  • Review of systems—begin with global questions in each system; pursue areas of concern in further detail
  • Current health
    
    • General habits/day-to-day functioning—nutrition, sleep, activity, elimination
    • Development/milestones—affective, cognitive, physical
    • Preventative health history—screenings, immunizations, health protection activities
  • Family history
    
    • Family structure/function
      
      • Parenting
    • Family health history
    • Family ethnic/cultural beliefs/practices
    • Family health habits (e.g., literacy, smoking, seatbelts, helmets, guns)
  • Household/environment
    
    • Family function—identify family members, role strain, or significant family changes.
    • Safety/risks—injury, exposure to violence, adverse childhood experiences, toxic exposures, social determinants of health, housing, and food security

Question 26

What are the 8 parts of a ill child visit

Answer 26

• patient identifying statement
• reason for visit
• date child was last well
• HPI
• Focused pmhx
• ROS
• focused fam hx
• environment

• Patient-identifying information/statement
  • Identify if this is a new or established patient/family
  • Child age, sex/gender
  • Accompanying adult(s)
• Reason for the visit
  • Highlight parental (and child) concerns/priorities
• Date child was last well
• Interval/history of the present illness—chronologic description for each concern
  • Symptom analysis (onset, duration, course, symptom characteristics, aggravating/alleviating factors, exposure to illnesses/other causative factors, similar problems in close contacts, previous episodes of similar illnesses/symptoms, previous diagnostic measures, pertinent negative data, and the meaning of the concern for the family and child)
• Focused past health/medical history
  • Prenatal/birth/neonatal history
  • Illness/injury
  • Radiograph/lab tests/procedures
  • Hospitalization/surgery
  • Allergies (food, medication, environment)
  • Immunizations
  • Medications (prescription, OTC, folk/herb, complementary/alternative therapies)
• Review of systems
• Focused family history
  • Family health history
  • Family ethnic/cultural beliefs/practices
• Environment
  • Social determinants of health
  • Environmental aggravating/alleviating factors
  • Caregiver strain