week 3 content Flashcards
AAP periocity table of timing of well child visits
- 3-5 days of age (when home from hospital)
- 1 month
- 2,4,6,9,12,15,18,24, and 30 months
- annually beginning age 3
start the visit: 3 things
- review VS and anthropometrics before you enter the room
- greet the family and patient
- ask about concerns
first step of the data collection
history
when does the head to toe PE start?
preschool
interval history
allergies, ER visits, illnesses, injuries, hospitlaizations
other components of the history
- medications
- nutritional history
- physical activity hisotry
- elimination
- safety
- sleep
- social history
- developmental history
- mental health assessment
temp taking regulations
- no axillary temps (except for newborn)
- no typmanic temps less than 6 mo
- oral temp at age 4-5 years
apicle pulse should be taken when
ages 6 years and younger
bp should be taken when
ages 3 years and older
length measured until when
2 years, then the height is started
when switching over, there can be a change in length becuase when they are laying down they can be “stretched” a bit
head circ is measured when
3 years and younger
BMI calculated at age
2 and older
notes about wt measuring
- infant weighed naked, no diaper
- toddlers weighed in diaper only
- preschool and older weight with no shoes or jacket
absent red reflex
indicative of a retinoblastoma
weak or absent femoral pulses
coarc of the aorta
undecended testes
need to have happened and if not, should be refered to urology by 6 mo of age
hip click
look for it in every exam for the first whole YOL (ortolani and barlow)
strabismus
- intermittment si normal for first 4 mo
- finding can be cover uncover test OR unequal light reflexes
- if not fixed, what can happen: amblyopia
umbilical hernia
can resolve on own
scoliosis
assessed via forward bending beginning at age 9-10 for girls and 11-12 for boys. refer if >25 degrees
aap recommendations for PPD screening
1,2,4,6 mo visits
use Edinburg of PHQ9
if depression is found, sent to therapy, provider or ER if self harm is evident
CCHD screening
pulse ox on R arm, and R or L lower extremity
pass : difference between them is less than 3% and both are between 95-100%
school hearing tests ages
4,5,6,8,10 and then 1 time between ages 11-14, and another time between 15 and 17
iron deficincy
- risk assessment: 4 mo
- preemie: higher risk for iron deficiency
- risk assessment measure H and H at 12,15,18,24, and 30 mo
dental screening and oral health
- 6 months: screening starts
- 1 year: refer to dental home
- first semi-annual cleaning starts at 3 years
latent TB
1,6,12 and 24 mo risk assessment
reasons to check blood pressure before age 3
- SGA
- birth weight <1500g
- born at < 32 weeks
- neonatal complications that require intensive care or umbilical artery catheterization
-CHD
screening for dyslipidemia
kids with risk factors: begins after the age of two
kids without risk factors: screen 2x during childhood, once between age 9-11, one between 17-21
screening for alcohol, nicotine and substance abuse starts when
age 11. start the conversation of dangers at age 9
depression screen
annual 12-21
girls reach full height when?
1-2 years after menarche
first female sign of puberty, then what follows?
breast development or thelarchy, 6 months later then there is pubic hair
average age of menarche
12.5 years (usually 1.5-2.5 years after breast bud development, takes 18-24 mo to establish reg. cycles
primary amenorrhea
- no menarche by 16 years
- no breast buds by 14 years
earlist puberty change for males is? what happens 6 months later?
growth of the testes, grow pubic hair (adrenarche), then elongation/widening of the penis.
which teste hangs lower
L
3 causes of death in adolecents
1) unintentional injuries (MVA)
2) suicide (last 15 years)
3) homicide
situations to breech confidentiality
danger to self
danger to others
child abuse
resportable STI’s
gunshot/knife wound
billing 3rd party payers
sensitive questions to ask with parents out of the room
BI-HEADSS
Bi- body image
do you ever feel bad about your weight? does anyone else make you feel bad about your weight?
H-home situation
Do you feel safe at home?
E-education/employment
do you have a job? how are things going at school?
A- activities
are you in sports?
D- dating/drugs
have you ever tried any frugs? marijuana? pills? have you tried alcohol?
S-sexuality
do you have a girlfriend/boyfriend or both? are you sexually active? what types of sexual acitvity are you engaed in? do you use protection? have you ever been made to do seomthing you are uncomfortable with doing?
S- suicide
testing/screening for STI’s
sexually active: screen annually for chlamidia and gonorrea
HIV: once between ages 15-18 per periocidity table
difference between PE and WCC
- does not replace a WCC
stats on sports physical
65-75% detection rate of conditions
history that is connected to CHD
- alcohol exposure in utero
- fam h/o
- maternal diabetes
- h/o rhumatic fever or Kawasaki
-genetic
timing of sports physical
4-6 weeks before the season starts
s1 sound
closure of the mitral and tricuspud valve
inaudible: VSD< atrioventricular valve regurgitation, PDA, and occasionally Pulm valve stensosis
pathological murmurs
higher than a grade 3- when a thrill is present
venous hum
not pathalogical- no referral
functional murmur identifier
stills murmur decreases in intensity when the child stands up
what are we worried about when the murmur increases when the patient stands up?
hypertrophic cardiomyopathy- associated with sudden death in athletes
thrills are felt with what
blood flow from high to low pressure
innocent murmur VS ASD
- precordial activity is increased in ASD
- S2 splits and moves with respiration in an innocent murmur wharas it is “fixed” and non effected by inspiration in an ASD
- patient stands up- innocent increases in intensity, ASD does not
