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PEDS > Week 4 > Flashcards

Week 4 Flashcards

1
Q

School aged child (6-12) - physical growth (6)

A
  • gain 1.4-2.2kg/year
  • grow 4-6cm/year
  • loss of baby teeth (brushing = important)
  • better metabolism
  • fat gives way to muscle
  • hit growth spurt between 9-11
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2
Q

School aged child (6-12) - sensory (3)

A
  • can read
  • conversion develops
  • able to concentrate for longer periods on activities
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3
Q

School aged child (6-12) - motor skills (General)

A
  • finishing touches on school and sport
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4
Q

School aged child (6-12) - fine motor skills

A
  • enjoys craft projects
  • cards and board games
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5
Q

School aged child (6-12) - gross motor skills

A
  • two-wheeler (training wheels)
  • jump rope
  • ice skates
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6
Q

School aged child (6-12) - stages of play

A
  • cooperative play, learning social component of play
  • when hospitalized, feel the need for socialization
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7
Q

School aged child (6-12) - Communication

A
  • vocab increases
  • cleaning up pronunciations and grammar
  • when hospitalized they need simple vocabulary
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8
Q

School aged child (6-12) - sexuality (4)

A
  • need to learn in the factual information for later age group (9-12)
  • explanation of inappropriate touch
  • need prep for puberty (physical and hormonal) as it starts in late stages of this age group
  • needs to be done by family and school
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9
Q

Puberty/physical growth - females (4)

A
  • 8-13 years (lasts for 3 years)
  • menses 2.5 years into puberty (mean age of 12.5)
  • pubic hair, breasts, fat distribution changes
  • girls hit their sprouts (7-25kg, grow 2.5-20cm)
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10
Q

Puberty/physical growth - males (3)

A
  • age 10-15, lasts for 6 years
  • pubic hair, penis, testes grow, more muscular, fat distribution change
  • growth spurts (7-30kg, grow 11-30 cm)
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11
Q

Adolescence (12-18) - sensory

A

fully developed

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12
Q

Adolescence (12-18) - motor skills fine

A

skills well developed

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13
Q

Adolescence (12-18) - gross motor skills

A
  • muscle development continues
  • lack of coordination common during growth spurt
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14
Q

12-14 years (early adolescence) - psychosocial development (6)

A
  • preoccupation with body changes and images (self conscious)
  • expectations vs self doubt
  • peer group influencial
  • abstract thinker (sense of right and wrong)
  • most interest in present and near future
  • test rules and limits
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15
Q

15-17 years (mid adolescence) psychosocial development (8)

A
  • desire for independence
  • self conscious
  • peer group = life
  • less conflict with parents but sadness due to psychological loss of parents
  • increased ability to care and share so can devlelop intimate relationships
  • improved work habits and sense of right and wrong
  • concern about future plans and intellectual interests
  • unrealistically high expectations of self alternate with poor self-concept
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16
Q

18-21 (late adolescence) - psychosocial development (6)

A
  • identity more firm, including sense of humour, interests, emotional stability
  • able to compromise and develop useful insignt
  • adult appearance, clear sexual identity
  • setting goals, mutual caring, internal control
  • uncertainties about sexuality future relationships and work
  • pride in own works
  • accepts social institutions and cultural traditions
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17
Q

History taking adolescents (10)

A
  • to be kept strictly confidential
  • build rapport - less intrusive to most intrusive
  • do not make assumptions - open ended Q
  • accentuate positive traits (self esteem)
  • write as little as possible (be engaged)
  • sensitively explore sexuality, drugs, school, mental health, violence, family (prob will answer but wont be volunteered)
  • asking what their peer group is like tends to reflect their individual activities and likes are
  • hist is important
  • puberty (record of changes, menstruation pain, bleeding, etc)
  • diet and exercise (meals away form home, allergies, iron, weight bering exercise etc)
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18
Q

Psychosocial evaluation - HEEADSSS

A

H = home environment (family structure, dynamics, etc)
E = education (fav classes, difficulties, employment)
E = eating (foods, concerns with over/under weight, ED)
A = activities that are peer related (extra curricular, exercise, peer relationships)
D = drugs
S = sexuality (age of first sexual activity)
S = suicide/depression
S = safety from injury and violence (include bullying and abuse)

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19
Q

Adolescents - sexuality

A
  • 30% teens 15-17 reported having sex (68% 18-19)
  • 39% of sexually active males had intercourse with more than one partner (25% of females)
  • percent of more than one sexual partner was higher among 15-17 than 20-24
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20
Q

Sexual health - adolescents

A
  • related physical and psychosocial development
  • sexual function
  • attitudes and behaviours
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21
Q

Importance of scripted verbiage in sexual health

A
  • part of my role is… no right and wrong answer… no judgment
  • 3 exceptions (you say you are abused, you might hurt yourself or someone else, if you are diagnosed with disease that needs to be reported
  • is it okay to ask you some questions about sexual health?
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22
Q

Sexual health questions (6)

A
  • do you use drugs
  • are you currently having sex or have you ever had sex
  • have you ever experienced something sexually that you didn’t want to experience
  • do you have symptoms that make you think you have an STI
  • if female when was first day of your last period? pap test? HPV
  • any questions for me?
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23
Q

Safe sex and teens (7)

A
  • condoms for safer sex (don’t prevent viral STI like herpes and HPV)
  • pre exposure hepatitis, A, B, HPV
  • STI info about transmission, s/s, risk factors, safer sex
  • increased STI with use of spermicides
  • partner testing
  • contraception
  • pre-conceptual folic acid
  • emergency contraception for females
24
Q

Sexual health - LGBT

A
  • young gay men are at high risk for HIV
  • HIV ans STI testing offered at every visit
  • gay + lesbian ahve higher rates of al and drug, depression
25
Q

Hormonal contraception

A
  • most effective nonsurgical method for preventing pregnancy in adolescents
  • 3 months after initiation, 76% teens remain on oral contraceptives after 12 months 50% continue
    • family pressure, poor compliance, adverse effects
26
Q

combined oral contraceptives benefits

A
  • menstrual cycle regulation
  • decreased menstrual flow
  • decreased dysmenorrhea
  • decreased acne
  • decreased hirsutism (body hair)
  • decreased risk of endometrial and ovarian cancer
27
Q

Risks of oral contraceptives (6)

A
  • venous thromboembolism
  • myocardial infarction
  • stroke
  • gallbladder disease
  • breast cancer
  • cervical cancer
    .
    slim risks, but it does happen
28
Q

Emergency contraception

A
  • progestin only - plan B
    • low incidence of side effects, pelvic exam not required
  • if an adolescent has had unprotected sex within 5 days
    • sooner better (95% first 24, 85% 24-48, etc)
29
Q

Teenage pregnancy (2)

A
  • 4 times higher for indigenous Canadian youth, 18 time higher for those aged under 15 times living on reserves
  • teen pregnancy is an important public health concern for aboriginal communities because an adolescent’s lack of readiness for pregnancy and parenthood
30
Q

When to suspect pregnancy in a teen (7)

A
  • irregular menses
  • unusual vaginal bleeding
  • acute or chronic abdominal pain
  • unreliable menstrual history
  • amenorrhea
  • nausea/vomiting
  • fatigue
31
Q

If pregnancy is diagnosed (4)

A
  • ask patients knowledge of options and their feelings about them
  • enquire about family, cultural, community concerns and partner’s role
  • determine extent of support system (who told, how they reacted)
  • assess for other health concerns or complications (ex bleeding)
32
Q

Teenage pregnancy - more assessment (5)

A
  • current substance use
  • enquire where she lives
  • enquire about personal goals
  • ask about school
  • ask if she is taking multivitamin with folic acid and iron
33
Q

Follow up - teen pregnancy

A
  • keep in contact with all individuals who were pregnant (edu and guidance)
  • assessment and counselling for drug and alc abuse
34
Q

teenage pregnancy - risk to infant (14)

A
  • poor prenatal care
  • poor nutrition (intrauterine growth retardation)
  • smoking
  • use of alcohol
  • use of illicit drugs
  • associated STIs
  • anemia
  • pregnancy-induced hypertension
  • prematurity
  • poor parenting
  • separation from child’s father
  • low income
  • low educational attainment
  • unemployment
35
Q

Sexually transmitted diseases

A
  • females = 49% increase in chlamydia, 75% increase in honorrhea
  • males = 94% increase in chlamydia, 80% increase gonnorhea

15-19 have highest risk of contracting chlamydia or gonorrhoea of any age group

36
Q

Behaviours increasing STI risk (17)

A
  • sexual activity with a person with known STI
  • sexually active and age under 25
  • a new sexual partner or more than 2 partners in last year
  • no contraception
  • no use of barrier contraception
  • serial one-partner relationships
  • substance use (esp with sexual contact under influence)
  • injection drug use
  • sex with blood exchange
  • sharing sex toys
  • sex workers and their clients
  • sex for food money shelter drugs
  • homeless, impoverished, etc
  • partnering with anonymous individuals
  • sexual abuse or assault victims
  • previous STI
  • men who have sex with men
  • travel
37
Q

Vaccinations and STIs

A
  • all adolescents should be considered to be given hepatitis B virus and human papillomavirus vaccines (HPV)
38
Q

Substance abuse

A
  • 3/5% grade 7-12 have used ecstasy one/more times, 2.6% using cocaine
  • increased number of hallucinogens, cannabis, cocaine, stimulants
    • FNMI = more likely
  • linked to increasing availability and changing attitudes twd drug use
39
Q

Screening for substance use

A
  • any friends use tobacco, alcohol, others
  • ever fell pressured to use any of these in social situations?
40
Q

Assess substance

A

crafft mnemonic

41
Q

CRAFFT mneumonic

A

C - ever rode in a Car driven by someone using drugs or alc
R - ever use drugs or alc to Relax, increase self-esteem, fit in with peers
A - ever use drugs or alcohol when Alone
F - Forget activities done while using drugs or alc
F - Family or Friends ever tell you to cut down on alc or drug use
T - ever been in Trouble while using drugs or alc

42
Q

Goals of treatment - substance abuse

A
  • client tells their parent about their substance abuse
  • behaviour change (ex facilitate treatment prevent relapse)
  • assess for and treat co-morbid conditions including medical and mental health
43
Q

Non-pharmacologic interventions (even if they do not use substances) (6)

A
  • explain how substances can affect things important to teens (ex body image)
  • explain risks and consequences of using substances, that everyone can develop a drug use problem
  • help them plan to handle scenarios when peer pressure may take place
  • counsel about tobacco use, under age drinking, drug use
  • advise teens to avoid binge drinking and smoking
  • support adult role models and provide age appropriate guidance about supervision
44
Q

Obesity (2)

A
  • obese children are more likely to become obese adults (associated health and social consequences)
  • age and gender-specific BMI at or above 95th percentile for children of same age and sex
45
Q

Complications of obesity - physical (4)

A
  • insulin resistance and type 2 diabetes
  • fatty liver disease
  • pulmonary complications (sleep apnea, exercise intolerance, asthma)
  • musculoskeletal and abnormal growth acceleration
46
Q

Complications of obesity - psychological and social (3)

A
  • discrimination
  • low self esteem
  • bullying and victimization
47
Q

Obesity treatment (6)

A
  • diet
  • physical activity
  • behaviour modification (focus social and behavioural aspects of food)
  • family involvement
  • drugs (orlistat)
  • PREVENTION
48
Q

Acne

A
  • chronic inflammatory disorder of hair follicles on face and trunk
    • most common skin disorder
    • 85% population 12-25
    • 1:1 female to male, more severe in males
  • 20% of neonates
    • response to maternal androgen hormones
    • develops in first month
    • resolves spontaneously
49
Q

Acne - mild

A

non-inflammatory comedones (no colour)

50
Q

acne - moderate

A
  • inflammatory papules, pustules, comedones
  • mild disease on chest and back
51
Q

acne - moderately severe

A
  • inflammatory, numerous papules, localized cysts or nodules,
  • face, chest, back
52
Q

acne - severe

A
  • nodular and cystic acne on face back chest
  • numerous cystic lesions that may connect
  • pustules may be present
53
Q

Treatment of acne

A
  • treatment = suppress lesions until condition is outgrown (prevent scaring, minimize psychological distress)
  • maintenance with topical retinoids-
  • isotretinoin (Acutane) for severe acne not responsive to other therapies (4-6 months, severe birth defects)
54
Q

Pandemic teens -

A
  • July 2020 # girls admitted to ED for suspected suicide attempts has increased 26.2% over a year
    • February 2021 has increased to 50%
  • boys increased to 3.7%
  • second leading cause of death youth aged 10-17
  • tele-health
  • COVID took away coping strategies = neg impact on depression, anxiety
  • remote learning provided some protection for teens against bullying
55
Q
A

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