Unit Two Part 1.2 - Family Assessment Flashcards
What is the assumption that underlies family assessment
families are central to and inseparable from the health of children
What are the 4 basic elements of the family assessment
- anatomy or structure
- lifecycle or developmental stage
- functioning
- presence of protective factors
What is the standard for assessing family composition
constructing a 3 generation pedigree
provides a valuable visual record of family structure, genetic links, and health-related information. Insights about families are gained, not only because families share genes but also because they also often share environments, behaviors, and culture—all of which contribute to shared health problems
Who is important to include in the family assessment pedigree that may not normally fit in
non genetically linked individuals who are apart of the child’s family
What does a genogram include that a pedigree does not
genogram expands a pedigree to include non genetically linked relatives as well as socialcultural context of family relationships
What is an ecomap
graphic portrayal of the type, number, and quality of relationships or connections individuals have within their family and their community
It provides a snapshot of an individual’s personal/social relationships, as well as how much energy the relationships use, by identifying each relationship as close/distant, strong/weak, mutual/one-sided, positive/negative, nurturing/damaging, and/or secure/plagued by conflict.
It is a valuable tool in determining a family’s strengths, resources, needs, and deficits.
What is a family APGAR
Tool used to assess a family’s
A-adaptation
P-partnership
G-growth
A-affection
R-resolve
It consists of five questions, which make it easy and quick to administer and a popular choice for evaluating family function in busy primary care settings
What is the SCREEM mnemonic
Tool used to identify a family’s
[S] social
[C] cultural
[R] religious
[E] economic
[E] education
[M] medical resources
as well as their absence.
Physical Examination Data
Essential Pediatric Physical Examination Data
* General appearance: Note the child’s general state (e.g., Is the child alert? Active/interactive? Ill appearing?). Note general appearance (e.g., overall nutrition, color, respiratory effort, general body positions and movements). Does the child appear congruent with the stated age? What is the parent/child interaction? Are there any physical signs that may indicate the presence of a syndrome? * Head: Assess size/shape (e.g., micro/macrocephaly, craniosynostosis, positional plagiocephaly), note size/appearance of fontanels, approximation/closure of suture lines. * Eyes: PERRLA, EOMs, red reflex, cover/uncover, abnormal and/or asymmetric eye shape, movements, or color are standard elements. Vision screening begins early, beginning with whether or not the infant can fix/follow and respond to visual stimulation and later to formal vision screening beginning in early childhood. * Ears: Shape/placement of the ear, response to auditory stimuli, and the presence of preauricular sinus/tags should be noted. Check that newborn hearing testing was done. Hearing screening also continues with assessment of an infant’s response to voices/noises and language development. Formal audiometric evaluation begins in early childhood and continues through adolescence. Examination of the TM is one of the most common components of a pediatric exam. * Nose: Newborns are obligate nose breathers. Assess for patency, septum position, and flaring. Note discharge. Infants/young children may explore/placing foreign bodies in nasal passages. * Mouth: Assess for developmentally appropriate tooth eruption/shedding sequences, early/overt caries, abnormal mucosal color/lesions, uvula, intact palate, tonsil size/appearance, and tongue tie. * Neck: Note ROM, noting any abnormalities (e.g., nuchal rigidity, webbed neck, torticollis) motion. Palpate thyroid. Note presence of thyroglossal/branchial cleft cysts/sinus. * Skin: Note color/texture and nature/distribution of congenital/other lesions and/or rashes. Attend to lesions that might indicate the presence of disease or illness risk (e.g., hemangiomas, café au lait spots, acanthosis nigricans) or injury (e.g., color, shape, location of bruises) or are atypical for age (e.g., acne, secondary sexual characteristics). * Lymph nodes: Note size, mobility, pain/tenderness, and warmth. Look for related cause. * Chest: Assess for overall shape, congenital malformations (e.g., shield chest), and thoracic cage variations (e.g., pectus carinatum/excavatum). Note any dyspnea, retractions, and use of accessory muscles. * Breasts: Note placement, discharge, and SMR. * Lungs: Assess for symmetric expansion, air movement, and lung sounds. * Cardiovascular: Assess heart sounds, noting abnormalities/presence murmurs. Note presence/nature of femoral pulses. Check peripheral perfusion/circumoral cyanosis. * Abdomen: Assess for age-appropriate contour, distention/tenderness, organ position size, masses, umbilical hernia/erythema/leakage, inguinal bulging/hernia, and congenital malformations. Most umbilical hernias resolve by 2 years of age, whereas all inguinal hernias require surgical intervention. * Genitalia: Note SMR. Assess for congenital/acquired variations, defects, or malformations (e.g., ambiguous genitalia, hypospadias, cryptorchidism, fused labia, vaginal discharge). * Anus: Assess for patency/placement. Note abnormalities (e.g., bleeding, fissures, rectal prolapse). * Musculoskeletal: Assess for full/symmetric ROM, presence of abnormal movements, joint laxity, abnormal/asymmetric tone/strength, extremity position/symmetry, gross/fine motor development, and presence of congenital/acquired abnormalities (e.g., tibial torsion, equinovarus, pes planus, metatarsus adductus, genu varum/valgum, femoral anteversion). Infants require ongoing hip evaluation (e.g., Barlow, Orotlani). Gait progression evaluation is standard. Careful attention to spine curvatures until growth is complete. * Neurologic: Note presence/persistence of primitive reflexes. Assess overall alertness/interaction with others; cranial nerves, overall tone/abnormalities (e.g., spasticity, hypotonicity), tics, and seizure activity/abnormal movements. Assess for spinal dimple/lesion.
EOM, extraocular movement; PERRLA, pupils equal round reactive to light accommodation; SMR, sexual maturity rating.
Approaches to the physical exam
Physical Examination Approaches With Children
General: Infants/young children often dislike being placed on the examination table. Infants/toddlers can be easily examined on a parent’s lap and/or knee to knee with the provider, creating a human “exam table.” Young children are often easily distracted and/or enjoy simple playful interactions. Older children and adolescents can be modest/self-conscious and will do best if allowed to stay in street clothes with a drape if a more complete exam is needed.
Developmental considerations: Approach children at their eye level. Start examining peripherally (hands/feet) because this is often less threatening. Engage children, making the exam fun. A toy may help—either one that the child has brought or a penlight, or even an ear speculum rattling in a urine container can be a useful distraction. Make sure the child is comfortable and that hands and stethoscope/instruments are warm. Ask parents to assist with dressing/undressing young children. Be aware of sensitivities. Engage older children/teens throughout the process, make the exam informative, and allow child/teen to maintain control.
Deterring fears: Avoid predictable conflicts if possible (e.g., separating child/parent). Make parents your allies. Pay attention to your body language, voice, gaze, and touch. Maximize the child’s cognitive ability (e.g., if a child has object permanence, you can play peek-a-boo or explaining each instrument and having the child assist during the exam). Use what the child already enjoys/is doing as part of your exam. Avoid repetition of previous frightening experiences if possible or defer them to the end of the encounter.
Integrate play/books: Come prepared. Have age-appropriate and child-friendly toys, puppets, lights/gizmos, and books readily available. Be playful in the interaction when appropriate (e.g., pretending to blow out a light to initiate a deep breath). Enlist them as an assistant (e.g., holding the tongue depressor) or engage them in fun activities (e.g., see how long they can stand on one foot or if they can walk like a duck or penguin). Let them tell you a joke. Remember to smile.
Preparation: It is helpful to know what the parent understands, as well as what the parent has told the child will happen before you begin an exam or procedure. Clarify misconceptions. Have a trial run/role play with puppets or dolls. Encourage the child to ask questions before/during the process. Explain the exam or procedure step by step, focusing on what the child will experience (e.g., feel, taste, see, and/or smell) rather than solely on technical information. Pay attention to the child’s comfort. Allow choices that are real (i.e., do not offer choices if there are not any).
What are protective factors
conditions or attributes of individuals, families, communities, or the larger society that promote optimal child development, improve child resiliency, and reduce the likelihood of child abuse and neglect.
Which protective factors are a childs mental and physical health grounded in
2
- parent-child realationship
- parental developmentally approatie teaching about interactions with others
parent-child relationship –> involves active, reciprocal, and nurturing interaction between parent and child
parental developmentally appropriate teaching about social, emotional, and physical interactions with others
It includes loving opportunities to experience success and failure in ways that promote resiliency.
What does the ACES family health history and health appraisal questionnaire look for
tool to collect info on child abuse, neglect, household challenges, other sociobehavioural factors
What is the Parents assessment of protective facctors tool?
tool to measure the presence, strength, and growth of 5 protective factors
- parental resilience
- social connections
- concrete support in times of need
- children’s social/emotional competence
- knowledge of parenting and child development
What is the Three-Talk Model of Shared-Decision Making?
Tool that provides pathway to applying shared decision making in practice
