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406 Cards in this Set
- Front
- Back
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what are the goals of well-child care
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Promotion of biomedical health
Assessment of development and behavior Optimizing family function Anticipatory guidance |
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what are well-child care screens used for
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identifying children at risk for growth parameters
nutrition vision and hearing developmental milestones, school performance population- or risk-based screening: e.g., anemia, lead, urinalysis, tuberculosis parent-child interaction |
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what are some disease and injury preventions
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vaccinations
anticipatory guidance-determine what family already knows, reinforce positive behavior, provide new information |
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how many doctors visits should a child have before age 21
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28
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when do doctors visits taper off for children
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as vaccinations become less frequent
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what are the screens done for infants
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Nutrition/hydration status
Physical growth Sensory/neurological function Achievement of developmental milestones Parenting skills Family resources |
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what is the anticipatory guidance for infants
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Routine baby care
Safety sleep position “baby-proofing” environment vehicle safety Critical milestones, e.g.: teething walking stranger anxiety Child care |
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what are the documented risks when giving vaccinations and what are the increased risks
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Anaphylaxis/allergic reaction – agent vs. suspension medium
Concomitant infection/febrile illness increased risk of febrile seizures Compromised immune function: increased risk for acquisition of infection with live virus incomplete immunity |
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what are the unproven risks for giving vaccinations
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Developmental/neurological sequelae
SIDS Autism exposure to mercury (thimerosal) or other adjuvants Impact on developing immune function |
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what are the routine immunizations for infants
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Hepatitis B (HBV)
Diphtheria/tetanus/pertussis (DTP) Haemophilus influenzae type B (HiB) Polio (IPV) Pneumococcal (PCV) Influenza – yearly for all children > 6 mos. |
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what does the hepatitis B vaccine do
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Reduces risk of fatal consequences later in adulthood
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when should the hep B vaccine be given
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First dose by 2 weeks of age (ideally before newborn is discharged)
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what is the Major developmental vulnerability of infancy due to
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immature biological systems
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what are the major concerns with immature biological systems
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SIDS
acute diarrheal illness/dehydration |
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infants that have immature biological systems are virtually what
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completely dependent on adult caregivers
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what is SIDS
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Sudden unexplained death of infant under 1 year of age
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what is the typical age for SIDS
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less than 6 months
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what is the peak age for SIDS
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2 - 4 months
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there is a greater incidence of SIDS in who
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Native American, African-American, and Hispanic infants & lower SES families
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there is a higher risk of SIDS with what
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premature birth, low APGAR, recent illness
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what are the typical findings seen in SIDS
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previously healthy infant
baby found in position in which s/he had been put to sleep evidence of terminal respiratory & motor activity frothy, serosanguineous discharge from nose/mouth clenched fists skin mottling/post-mortem lividity unrevealing autopsy |
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what are the risk factors for SIDS
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Placed to sleep on stomach or side
Soft bedding, objects in crib Co-sleeping Maternal smoking during pregnancy ETS exposure in infancy |
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what are the preventative factors for SIDS
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supine sleep position
pacifier for sleeping room fan breastfeeding for first 16 weeks vaccinations |
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what are the nursing roles in SIDS
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Prevention and Support and referral for grieving parents
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what is the role of nurses in preventing SIDS
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supine sleeping, “proximate but separate” sleeping environment for first 6 months
reduction of ETS exposure no evidence for use of monitoring devices |
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what is the Leading cause of illness in children < 5 years
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acute diarrheal disease
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what can cause acute diarrheal disease
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infectious or medications
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what can cause infectious acute diarrheal disease
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viral, bacterial, parasitic
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how is acute diarrheal disease spread
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fecal-oral contamination
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what is a major medicine that causes acute diarrheal disease
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antimicrobials
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what do medications do that cause acute diarrheal disease
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malabsorption
secondary infection |
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what does acute diarrheal disease cause
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Increased stool frequency & water content
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what are the consequences of Increased stool frequency & water content
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dehydration, electrolyte disturbance, malnutrition
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what is the primary reason to treat acute diarrheal disease
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dehydration
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what is done to treat acute diarrheal disease
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Oral rehydration therapy
Reintroduction of nutrients |
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what does oral rehydration therapy do
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correction of electrolyte imbalances,
replacement of stool losses |
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what should be done to reintroduce nutrients to the infant
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continue breast feeding
use easily digested foods (BRAT) |
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Specific nutrient/vitamin deficiencies may result from what
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dietary imbalances
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what are specific dietary imbalances that cause nutrient/vitamin deficiencies
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Vitamin D-deficiency rickets
vegetarian diets (www.vrg.org) iron-deficiency anemia |
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what is failure to thrive
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inadequate growth resulting from not obtaining or not effectively using calories required for growth
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how is FTT diagnosed
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a persistent deviation from an established growth curve
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what alone is not diagnostic of FTT
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less than 5th percentile alone
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FTT May be secondary to what
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a known physical cause:
congenital defects chronic illness malabsorption disorder known or unidentified psychosocial factors: inadequate resources/knowledge about nutrition disturbance in parent-child interaction |
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FTT may be related to what
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underlying organic processes
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what are Factors associated with FTT
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diminished head growth
decreased immune function behavioral disturbances |
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what are Consequences for subsequent development
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persistent growth delay
poor psychosocial outcomes cognitive, neurological, and motor deficits |
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what is usually successful For FTT resulting from lack of resources or knowledge
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correcting the underlying problem is usually successful
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what is the treatment of FTT
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Nutritional management: caloric intake to support catch-up growth
Treatment of underlying organic problems Multidisciplinary team addresses specific underlying causes and manifestations |
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what is the assessment for nurses for infants with FTT
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physical growth
developmental status behavioral characteristics parent-child interaction |
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what are the interventions for FTT
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Nutritional management
Family support and education Referral for community resources |
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what are congenital anomalies
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Conditions that arise from genetic abnormalities or abnormal fetal growth/differentiation
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congenital anomalies are specific to what
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Specific to critical periods of fetal development
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when are manifestations of congenital anomalies evident
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at birth
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congenital anomalies have major implications for what
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how children develop and function
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what are the types of congenital anomalies
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Chromosomal abnormalities
Birth defects (congenital malformations) |
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what are the birth defects seen with congenital anomalies
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Cardiac
Central nervous system Craniofacial Skeletal Gastrointestinal Genitourinary |
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what are chromosomal syndromes
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Abnormality in the amount of genetic material
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what are autosomal abnormalities
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Trisomy 21 (Down Syndrome)
Partial chromosomal deletions, e.g., Prader-Willi Syndrome (15q11-q13) |
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what do most autosomal abnormalities represent
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“spontaneous mutations” rather than inherited disorders
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autosomal abnormalities may be incompatible with what
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life, e.g., Trisomy 13 or 18
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Sex chromosome abnormalities
may affect who |
May affect exclusively females, exclusively males, or both
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what do Sex chromosome abnormalities typically affect
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sexual characteristics, reproduction, and/or other developmental dimensions
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what are some Sex chromosome abnormalities
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Kleinfelter’s (47,XXY), Turner’s (45,X), Fragile X
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down syndrome is the most common what
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chromosomal abnormality leading to a generalized syndrome
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what is seen in the chromosomes of down syndrome
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Trisomy 21 - extra chromosome
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what is the cause of down syndrome
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unknown
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what is down syndrome associated with
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advanced maternal age
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down syndrome has considerable variation in what
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phenotypic expression
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what are the common characteristics of down syndrome
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upward slanted eyes
flat nasal bridge protruding tongue hypotonia |
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what is required to confirm down syndrome diagnosis
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Chromosomal analysis
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what are the manifestations of down syndrome
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Cognitive impairment: mental retardation ranges from mild to moderate
Social development delayed; easy temperament and sociability common Physical growth: linear growth reduced, particularly height – problems with obesity and related conditions sexual development delayed sensory problems: ocular abnormalities, impaired vision |
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down syndrome increases the risk for what
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structural congenital anomalies and childhood leukemia
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what are structural congenital anomalies that down syndrome can cause
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Congenital Heart Disease (CHD)
Tracheoesophageal fistula (TEF) skeletal defects |
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down syndrome can cause alterations in what
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immune function
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alterations in immune function can cause what
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respiratory infections
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respiratory infections are primarily problematic with whom
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particularly problematic in children with CHD
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what is the nursing role in down syndrome
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Education and support for parents coming to terms with diagnosis
Address physical problems hypotonia feeding problems upper respiratory abnormalities Promote developmental intervention Support parents in decisions about genetic counseling and subsequent pregnancies |
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what kind of anomalies are neural tube defects
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CNS
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what are neural tube defects
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Failure of embryonal neural tube closure during first month post conception
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50% of neural tube defects are associated with what
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nutritional deficiency
Folic acid |
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what is anencephaly
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Both cerebral hemispheres are absent
Brainstem is intact so basic functions (respirations, heart beat) are maintained for short period, but incompatible with sustained life |
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anencephaly is detected how
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fetal ultrasound; family faces decision whether to terminate pregnancy or continue to term delivery
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what is hydrocephalus
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Disturbance in the dynamics of CSF
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hydrocephalus can be what
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congenital or acquired
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what causes congenital hydrocephalus
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altered development of structures affecting ventricular and subarachnoid spaces
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what causes acquired hydrocephalus
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variety of causes including infection, tumor, etc.
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hydrocephalus problems result from what
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impaired absorption
obstruction of flow |
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hydrocephalus may be seen on what
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fetal ultrasound
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what are the manifestations of hydrocephalus
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abnormal head growth
bulging fontanels lethargy/irritability |
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what is the management for hydrocephalus
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surgical intervention to correct or compensate for abnormality
Ventriculoperitoneal (VP) shunt most common Shunt malfunction/infection problematic |
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hydrocephalus management is directed toward what and what are they
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complications of shunt malformation
increased intracranial pressure (ICP) from obstruction and/or infection abdominal complications |
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what should be monitored for hydrocephalus
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increased ICP/infection
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what are developmental implications for hydrocephalus
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Cognitive: with early detection and treatment, risk of brain damage is small
Physiological? Social? |
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what is spina bifida
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Midline defects resulting from failure of spine to close
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what does spina bifida degree of deficit depend on
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on anatomical level and degree of defect
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what is SB occulta and what is seen
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not externally visible
Gap in bony structures of the spinal column |
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SB occulta is commonly what
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lumbosacral
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where are the indications for SB occulta
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Superficial cutaneous
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what are some rare problems seen with SB occulta
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neuromuscular problems, including bowel/bladder problems, scoliosis, back pain, etc.
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what is SB cytica
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external protrusion of neural sac
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what are the types of SB cystica
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Meningocele
Myelomeningocele |
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what is Meningocele
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- meninges and CSF without neural elements; neurological defect uncommon
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what is Myelomeningocele
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nerves herniate into sac as well, causing varying degree of neurological problems
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what are the characteristics of Myelomeningocele and what is it associated with
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most common in lumbar & lumbosacral areas
unprotected neural sac can tear and leak CSF 80 - 85% associated with hydrocephalus |
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what are the manifestations of Myelomeningocele
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lower extremity involvement in lesions below 2nd lumbar vertebra
degree of deficit may be unequal bilaterally sensory disturbance parallels motor dysfunction incontinence/decreased anal sphincter tone |
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what is the Prenatal diagnosis for Myelomeningocele
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elevated alpha-fetoprotein (AFP) levels, ultrasound
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what can be done if a prenatal diagnosis is found
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Caesarian delivery
prenatal surgery |
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what is the management for Myelomeningocele
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Early surgical closure
multi-specialty surgical teams monitoring for/aggressive treatment of infection Evaluation of musculoskeletal involvement Ongoing, multi-disciplinary evaluation and rehabilitation |
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what are the nursing considerations for Myelomeningocele
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Meticulous care of neural sac pre-operatively
Skin care diaper area pre-closure areas of sensory/motor impairment Monitoring for complications r/t hydrocephalus Neurogenic bladder - may require intermittent catheterization Bowel training Prevention/management of latex allergy |
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what is the family education and support for Myelomeningocele
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Transition from parent-care to self-care
clean catheterization techniques skin care managing sensory impairment close monitoring for tissue injury early detection of UTI guidance for developmental expectations referral for services and support |
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what are the developmental implications for Myelomeningocele
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Physical (growth, motor, sexual, etc.)
Cognitive Psychosocial |
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what are some GI malformations of infants
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Cleft Lip/Palate
Tracheoesophageal fistula (TEF) Biliary atresia Abdominal wall defects Hirschprung Disease Anorectal malformations |
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what is a cleft lip
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incomplete fusion of the structures forming the primitive oral cavity
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a cleft lip can be what
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unilateral or bilateral
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a cleft lip typically involves what
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nasal structures
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what abnormalities are common in a cleft lip
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dental abnormalities common on side of cleft
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what is a cleft palate
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failure of fusion of 1o and 2o palatal plates
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what are the types of cleft palate
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soft palate only vs. extension into hard palate
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where is a cleft palate seen
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may be midline or extend to nostril on one or both sides
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severe clefts involve what
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may involve nasal septum defects - communication between oral and nasal cavities
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what is the cause of clefts
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Probably both genetic & environmental
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a cleft lip is more commonly what
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cleft lip (alone or as CL/CP) more likely to be inherited than isolated cleft palate
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what are some possible causative factors of clefts
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teratogenic drugs (thalidomide, phenytoin)
folic acid deficiency smoking or alcohol ingestion during pregnancy |
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what is the management for clefts
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Surgical closure – often multi-step procedures
lip repair before palate repair on-going revisions Orthodontics to correct malposition of teeth and maxillary arches Speech therapy required secondary to problems with: musculature tooth alignment hearing loss |
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how do you meet infants nutritional needs with a cleft and what is common
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breast feeding challenging but not impossible
special nipples and feeding devices nasal discharge of oral intake common frequent burping spoon feeding |
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what is important to develop with clefts
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structures that support speech – “non-nutritive sucking”
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clefts have an increase risk for what
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middle ear infections
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what psychosocial support should be given for clefts
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parent distress at visible defect
promote positive self-image |
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what is a Tracheoesophageal Fistula
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Failure of the trachea and esophagus to separate into distinct structures early in embryonal development
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a Tracheoesophageal Fistula is often accompanied by what
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esophageal atresia
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TEF may present as what
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as part of a syndrome of associated anomalies
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what are the most common defects of TEF
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proximal segment of esophagus terminates in blind pouch
distal segment connects to respiratory structures |
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Perinatal period may be complicated by what with TEF
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maternal polyhydramnios, low birth weight, prematurity
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what are the manifestations of TEF
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Severe respiratory compromise:
excessive, frothy saliva coughing choking nasal return of fluid aspiration leading to cyanosis/apnea Gastric distention with air |
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what is the respiratory management for TEF
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maintenance of patent airway
prevention of pneumonia |
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what is the GI manegment for TEF
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nutritional support
non-nutritive sucking |
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what is the family support for TEF
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intensive intervention at birth
feeding problems on-going medical interventions |
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what kind of repair can be done for TEF
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surgical
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what is Biliary Atresia
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inflammatory process causing bile duct fibrosis and resulting in obliteration of the biliary tract
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what are the types of biliary atresia
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Embryonic/congenital
Perinatal/acquired |
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what is embyonic biliary atresia
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dysregulated development of biliary system, associated with other congenital anomalies
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what is prenatal BA
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bile ducts presumably develop normally
undergo fibrotic changes during perinatal period lead to ductal obliteration |
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what is the cause of prenatal BA
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etiology unknown but most likely involves auto-immune pathway
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what are the manifestations of BA
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persistence or re-emergence of neonatal jaundice
abnormal stool and urine color hepatomegaly +/- splenomegaly failure to thrive |
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what improves outcomes for BA
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Early diagnosis and intervention
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further follow-up recommended in BA is seen when
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ductal dilatation on fetal US
persistent conjugated hyperbilirubinemia |
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surgical interventions for BA are directed at what
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directed at restoring biliary drainage
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what is the surgical interventions for BA
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Kasai procedure (primary portoenterostomy) – best outcomes if performed before 8 weeks of age
Some evidence that long-term antibiotic prophylaxis prevents recurrent cholangitis (infection of the hepatic ducts) and improves outcomes post-Kasai procedure |
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80% of BA patients require what despite kasai procedure
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liver transplants
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what is an Omphalocele
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herniation of abdominal contents through umbilical ring
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what happens in the Peritoneal sac with Omphalocele
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containing bowel +/- other viscera
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what is Gastroschisis
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herniation of abdominal contents through defect in abdominal wall
No membrane covering exposed bowel |
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Omphalocele is usually associated with what
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with other anomalies
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abdominal wall defects have a potential for what
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long-term nutritional problems
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what is Hirschsprung Disease
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Congenital aganglionic megacolon
absence of ganglion cells in an area of the intestine |
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Hirschsprung Disease may involve what
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the entire colon; distal colon (inc’ing rectum) most common
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what is lost in Hirschsprung Disease
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rectosphincteric reflex
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inadequate mobility of the intestine results in what with Hirschsprung Disease
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mechanical obstruction
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when are manifestations for HD usually detected
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neonatal period
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what are the manifestations for HD
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abdominal distention
vomiting constipation failure to pass meconium within first 48 hours |
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what are the signs of HD in later childhood
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history of failure to thrive, GI dysfunction
chronic constipation and abdominal distention |
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what happens in the rectum with HD
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Rectum remains empty of feces although leaking may occur
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how is HD diagnosis confirmed
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rectal biopsy and/or anorectal manometry
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what is the medical management for HD
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disimpaction
diet high in protein and calories, LOW in fiber TPN |
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what is the surgical management for HD
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removal of aganglionic bowel
temporary ostomy allows dilated bowel to return to normal |
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what is Developmental Dysplasia of the Hip (DDH)
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Abnormality in conjunction of structures of the hip (acetabulum, femoral head)
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DDH varies by what
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degree of severity
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what are the types of DDH
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Acetabular dysplasia (preluxation
Subluxation Dislocation |
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what is Acetabular dysplasia (preluxation
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hypoplasia of the acetabular roof but femoral head stays in the acetabulum
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what is Subluxation
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incomplete dislocation, stretched capsule and ligaments allow partial displacement
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what is Dislocation
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femoral head not in contact with acetabulum
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what are predisposing factors of DDH
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maternal estrogen (higher incidence in females)
uterine positioning positive family history |
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what are the manifestations of DDH
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abnormalities of posture and gait
instability of hip on weight bearing tendency to dislocate outright dislocation |
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what can early detection and treatment of DDH do
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preserve linear growth and function
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what is the goal of DDH treatment
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establish and maintain normal hip joint
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what are the types of DDH treatment
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splinting
casting bracing surgical reduction |
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what are the nursing considerations for DDH
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detection: unequal gluteal and thigh folds
counsel parents re feeding, hygiene, safety during casting |
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what is Congenital Clubfoot
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Bony deformity or foot/ankle with soft tissue contracture
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half of Congenital Clubfoots are what
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bilateral
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what are the causes of congenital clubfoot
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likely genetic and environmental
familial tendency |
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what are the types of congenital clubfoot
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syndromic (tetralogic)
congenital (idiopathic) |
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what is syndromic (tetralogic) club foot associated with
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associated with other anomalies
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when is congenital clubfoot diagnosed
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prenatally or at birth
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what are the characteristics of congenital clubfoot
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obvious deformity/shortening of foot
with/without calf atrophy |
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what is the management of congenital clubfoot
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serial casting – gradual stretching of structures on medial aspect
surgery – not entirely restorative |
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what screening is done in early childhood
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Physical growth
Oral health Age-based risk assessment: anemia, lead, +/- TB Vision/hearing Communication/language |
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what behavior and disipline problems might occur during early childhood
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temper tantrums
night terrors |
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what developmental transitions occur in early childhood
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finger foods, moving from bottle to cup
readiness to toilet school |
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what home safety anticipatory guidance is done in early childhood
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risks r/t increased mobility
accidental ingestion access to guns water safety |
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what is vehicle safety in early childhood
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transition to forward facing car seat at about 20 lbs - but keep child in the back
car seat for children up to 80 lbs |
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what are early childhood immunizations
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MMR (measles, mumps, rubella)
Varicella – first visit after 12 mos. [DTP, Hib, IPV, PCV, influenza] Meningococcal for high-risk groups > 2 years |
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Expanding social network increases likelihood of what
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communicable diseases
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Improving gross & fine motor control increases what
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environmental risks – accidental ingestion
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Continued dependency on adult caregivers in early childhood can lead to what
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child maltreatment
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Incidence and complication rates of communicable disease have declined with what
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vaccination & antimicrobial agents
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what spread easily among groups of children
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contagious diseases
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why do Contagious diseases spread easily among groups of children
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Hand-to-mouth activities
Proximity in classrooms, play activities Caregivers moving between children in hospital and child care settings |
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symptoms of communicable disease may initially be what
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initially be non-specific
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what are the early symptoms of communicable diseases
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rash
sore throat fever diarrhea/vomiting |
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what should you do for patients with signs of communicable diseases
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Assess possible exposures, history of vaccination/ previous infection
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who is at higher risks for complications of communicable disease
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Immune compromised
children Cancer therapy Steroids HIV infection Primary immunological disorder |
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what is Varicella zoster
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chicken pox
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what has reduced the incidence of chicken pox
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immunization
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what increases with age with chicken pox
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morbidity and mortality
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what is shingles
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reactivation of latent virus
can transmit live virus and cause chicken pox in someone without immunity (active or passive) |
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what is giardia
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intestinal parasites
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where are giardia seen mostly
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day care centers
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how are giardia most commonly spread
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fecal-oral route
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what are the common symptoms of giardia in infants
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diarrhea, vomiting, anorexia, FTT
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what are the common symptoms of giardia in school aged children
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cramping, intermittent diarrhea/constipation
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what is a common symptoms of giardia in all children
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Malodorous stools
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how is giardia treated
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antibiotics (metronidazole)
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what are the developmental predispositions to accidental digestion
|
oral exploration of environment
less discriminatory sense of taste curiosity and independence imitation |
|
|
what are house hold risks for accidental digestion
|
cosmetics
cleaning products OTC medications houseplants |
|
|
what is the Emergency Response for Accidental Ingestion
|
Identify substance
Contact Poison Control Center If gastric decontamination indicated, head to ER for medical management/monitoring – DO NOT ATTEMPT TO INDUCE VOMITING AT HOME |
|
|
what is done if gastric decontamination occurs
|
induction of vomiting (syrup of Ipecac)
activated charcoal gastric lavage cathartics specific antidotes |
|
|
where does lead exposure come from
|
75% of existing homes built before 1980
interior and exterior paint as sources disrepair/renovation increases exposure Lead-based paints still used commercially in other countries |
|
|
lead exposure can be what
|
ingestion or inhalation
paint chips, soil, dust, contaminated objects |
|
|
why is the biological risk of lead poisoning higher in children and what system is most vulnerable
|
greater gastrointestinal absorption than adults
lower threshold for toxic effects rapidly developing neurological system most vulnerable |
|
|
what is a Developmental risk of exposure to lead
|
oral exploration of environment
|
|
|
what are the social risk factors for lead poisoning
|
poverty, older housing
|
|
|
what blood levels of lead are considered harmful
|
Blood lead levels > 10 mcg/dL
|
|
|
Blood lead levels > 10 mcg/dL of lead are 3 times more likely in whom
|
Medicaid-eligible children
|
|
|
when is targeted screening for lead poisoning
|
9-12 mo and 2 yrs
|
|
|
what effects does lead toxicity have on the neurological system
|
Interferes with synapse formation, neurochemical development, myelinization, and neuronal growth
|
|
|
what are neurological symptoms of High levels (>45 mcg/dL) of BLL
|
seizures, encephalopathy, death
|
|
|
what are neurological symptoms of Low to moderate levels (> 10 mcg/dL)
|
developmental disabilities, learning disabilities, decreased intelligence, fine motor disturbance, emotional and social problems
|
|
|
what are some possible effects of BLL around 5
|
reduced academic performance, ADHD
|
|
|
what are hematologic symptoms of lead
|
microcytic anemia
iron-deficiency increases susceptibility to lead poisoning and severity of resulting anemia |
|
|
Other organ systems (cardiovascular, renal, muskuloskeletal, etc.)
have symptoms when |
symptoms rarely seen except in acute poisoning
|
|
|
what is done for BLL > 45 mcg/dL
|
Chelation
|
|
|
what is done for BLL > 70 mcg/dL
|
IV/IM chelation
|
|
|
what are some Environmental measures to reduce exposure
to lead |
decontamination
keep children/pregnant women away from renovation frequent cleaning to reduce dust prevent contact with bare soil in play areas frequent hand-washing |
|
|
what are some dietary considerations for lead poisoning
|
good nutrition reduces absorption
small, frequent meals increase intake of zinc, iron, calcium, vitamins A & D vitamin C to increase iron absorption |
|
|
what do you do for lead excreted in breast milk
|
calcium supplementation for lactating moms
|
|
|
what is the definition of child maltreatment
|
Action or failure to act that puts child at imminent risk of serious harm
At the hands of an adult responsible for the child’s welfare |
|
|
what are the classifications of child maltreatment
|
Neglect
Abuse physical emotional sexual |
|
|
what is the incidence of child maltreatment in US
|
Maltreatment reported in 3,000,000 children/yr
1,000,000 confirmed cases |
|
|
what are the classifications of confirmed cases
|
60% neglect
25% physical abuse 10% sexual abuse 5% emotional abuse |
|
|
who is at highest risk for a fatality in childhood maltreatment
|
young children at highest risk
40% < 1 yr 85% < 6 yrs |
|
|
what are parent factors for maltreatment
|
history of childhood abuse/neglect
poor control of aggressive impulses tolerance of violence low self-esteem/mental illness substance abuse |
|
|
what are child factors to maltreatment
|
temperament/activity level
personality or characteristics that remind perpetrator of problematic relationship physical/developmental disability singled out as “identified victim” |
|
|
what are environmental factors to maltreatment
|
chronic stress
poverty/crowded living conditions limited psychosocial support social isolation |
|
|
presence of risk factors is what
|
NOT diagnostic
Framework for assessment, not judgment |
|
|
what is the definition of child neglect
|
failure to provide for a child’s basic needs (including emotional)
|
|
|
child neglect accounts for how many deaths from maltreatment
|
1/3
|
|
|
child neglect may reflect what
|
ignorance
poor preparation for parenting lack of resources |
|
|
what kind of neglect is more easily recognized than other forms of maltreatment
|
physical
|
|
|
what can emotional neglect result in
|
FTT
Behavioral manifestations: vary from withdrawal to acting out |
|
|
what is the definition of physical abuse
|
deliberate infliction of physical injury
|
|
|
the Pattern of injury is more suggestive than what
|
any specific type of injury
|
|
|
physical abuse poses as a risk of mis diagnosis of what
|
unintentional injuries, medical conditions
|
|
|
what are potential clues to physical abuse
|
child and/or parent report doesn’t fit physical findings
parent exhibits inappropriate response - concern out of sync with injury, defensiveness and/or protection of privacy |
|
|
what are suggestive physical findings of physical abuse
|
injuries to face, head, buttocks, back
patterned burns spiral fractures dislocations lack of reaction to pain/frightening events |
|
|
what is Munchausen Syndrome by Proxy
|
One person (parent) fabricates or induces illness in another (child)
|
|
|
Munchausen Syndrome by Proxy is considered what
|
child maltreatment but also indicative of psychiatric condition in perpetrator-
pathological desire for attention |
|
|
Induced illness typically results in what
|
repeated medical visits, procedures, hospitalization
|
|
|
symptoms of Munchausen Syndrome by Proxy may be what
|
fabricated/imitated or actually result from infliction of injury
|
|
|
condition resulting from Munchausen will eventually seem what
|
implausible
|
|
|
symptoms of Munchausen may resolve when
|
child in someone else’s care
|
|
|
what do children usually believe in Munchausens
|
Children usually believe they are ill and that parent’s care is essential
|
|
|
what is emotional abuse
|
deliberate attempt to undermine child’s self-esteem or self-worth
|
|
|
emotional abuse often accompanies what
|
other forms of maltreatment
|
|
|
what is verbal assault
|
persistent criticism and negative labelling
belittling terrorizing |
|
|
what are the forms of emotional abuse
|
verbal assault, rejection, isolation
|
|
|
what is sexual abuse
|
Coercion, persuasion, inducement, enticement of a child to engage in sexually explicit conduct
includes commercial exploitation |
|
|
sexual abuse is committed by whom
|
person responsible for child’s care
|
|
|
what is the difference between sexual abuse and sexual assault
|
sexual assault perpetrator is stranger
|
|
|
what is incest
|
physical sexual activity between family members
Blood relationship implied but not necessary |
|
|
what is Pedophilia
|
preference for children as sexual partners
|
|
|
pedophiles’ crimes are considered sexual abuse if they are what
|
committed with children known to the perpetrator
|
|
|
what are Characteristics of the “typical” sexual abuser:
|
most often male
known to victim if not parent, step-parent works closely with children |
|
|
More reported victims of sexual abuse are what
|
female
|
|
|
what are Behavioral manifestations of sexual abuse
|
age-inappropriate sexual activity/play
bed-wetting mood changes phobias/fears |
|
|
behavioral manifestation are not what of sexual abuse
|
diagnostic
|
|
|
what are physical findings of sexual abuse
|
perineal bruising
torn or absent hymen pain, swelling, and itching of external genitalia recurrent UTI’s |
|
|
what are problems with children reporting sexual abuse
|
risks of disclosure
confusion r/t multiple instances of abuse limited language skills susceptible to suggestion repeated interrogation leading questions |
|
|
what are interventions for child maltreatment
|
Nurses are “mandated reporters”
Protect child from further abuse Evaluate risk for other children in home Support for child child values relationship with abusive parent(s) limit interrogation address physical, developmental, and play needs Support for non-abusing parent(s) feelings of anger, guilt, shame guidance for interacting with child Support for abusing parent(s) component of successful treatment programs recognize and address deficits in knowledge, resources, sources of emotional support referral to professional & self-help services |
|
|
what is done for the prevention of child maltreatment
|
Educating children about safety, assertiveness
Educating parents about potential signs sudden behavioral/emotional change unexplained physical findings reluctance to be with particular adults Promoting disclosure - anticipatory guidance reassuring child that abuse is not their fault provide children with language for talking about maltreatment/unwanted contact |
|
|
what is the well-care screening done in middle childhood
|
mental health/behavioral issues
vision/hearing annually diet and exercise risk-based assessment: dyslipidemia emerging sexuality HPV vaccine recommended well before sexual activity begins |
|
|
what is anticipatory guidance for middle childhood
|
School issues (achievement, bullying, positive peer relationships
Healthy lifestyle behaviors diet & exercise tobacco, alcohol, street drugs Sports and injury prevention Developmental transitions increasing independence after school supervision onset of puberty |
|
|
what causes developmentally based conditions in middle childhood
|
Disconnect between developmental timing and social expectations
|
|
|
what are the types of developmentally based conditions seen in middle childhood
|
delayed continence = enuresis, encopresis
Attention Deficit Disorder (ADHD) Emergence of identifiable mental health/ emotional disorders |
|
|
what are the characteristics of enuresis
|
intentional or involuntary
beyond “age of voluntary bladder control” - > 5 yrs old unrelated to identified physiological cause > twice/week for at least 3 months |
|
|
what are the classifications of enuresis
|
primary: continence never established
secondary: follows period of established continence |
|
|
enuresis is more common in whom
|
boys
|
|
|
what is commonly seen with enuresis
|
positive family history
|
|
|
when does enuresis Become most socially problematic
|
when children begin staying away from home
|
|
|
what are some possible causes of enuresis
|
sleep problems
diminished functional bladder capacity spontaneous bladder muscle contraction nocturnal polyuria insufficient ADH leads to failure to concentrate urine during sleep |
|
|
what interventions are done for enuresis
|
May improve/resolve without intervention
|
|
|
temporary regression of enuresis may be due by what
|
stress
|
|
|
what does a distractible temperament lead to
|
ignoring physiological cues, forgetting to toilet which leads to occasional “accidents”
|
|
|
what deserves assessment and intervention with enuresis
|
Persistence, interference with social confidence, self-esteem deserves assessment and intervention
|
|
|
what are the medications for enuresis
|
Anticholinergics, Nighttime DDAVP
|
|
|
what do anticholinergics do
|
inhibit urination
|
|
|
what are the problems with anticholinergics
|
side effects
|
|
|
what does DDAVP do
|
increases urine concentration and decreases urine output
|
|
|
what is the problem with DDAVP
|
expensive
|
|
|
High relapse rate occur when with enuresis
|
when meds are discontinued
|
|
|
the management of enuresis is what
|
Multi-faceted behavioral approach
|
|
|
what is the Multi-faceted behavioral approach for enuresis
|
Retention control training (bladder training)
Conditioning therapy (wetness alarm) Behavioral motivation |
|
|
what is Retention control training
|
Kegels, stream interruption, scheduled voiding
|
|
|
what is Conditioning therapy
|
wakes child with initial wetness, gets them to bathroom to complete voiding, eventually wakes to sensation of micturation
|
|
|
what are behavioral motivations for enuresis
|
positive (reward) for goal achievement
negative (consequences) – increased self-care responsibility |
|
|
what is never indicated with enuresis. Why?
|
punishment
shaming, anger contribute to psychological burden unlikely to work |
|
|
what is Encopresis
|
bowel incontinence
|
|
|
what are the characteristics of encopresis
|
intentional or involuntary
passage of stool in inappropriate location > 4 years old > once/month for 3 months |
|
|
encopresis is more common in who
|
boys
|
|
|
what are the classifications of encopresis
|
primary – more likely to reflect neglect, family issues
secondary – critical to R/O underlying physiological cause |
|
|
what is the etiological cycle of encopresis
|
change in routine, dietary intake, etc. leads to constipation and/or fecal impaction
painful elimination leads to fear, voluntary retention constipation/impaction worsens periodic passage of hard, large-bore stools can lead to incontinence intermittent watery diarrhea and/or small, hard stools = partial evacuation around impaction |
|
|
what are the Social consequences of encopresis
|
shame
derision by peers, teachers parental rejection social isolation |
|
|
Over time, voluntary retention becomes what
|
behavioral problem
|
|
|
what is the management of encopresis
|
Rule out underlying physiological causes
Bowel disimpaction/evacuation Multi-disciplinary team to deal with social, emotional, and behavioral aspects assessment/counseling/support for child guidance for parents – punishment NEVER indicated, reinforcement techniques same as for enuresis Bowel retraining: |
|
|
what is done for bowel retraining
|
stool softeners/dietary bulk to relieve constipation
regular toileting |
|
|
there is an overlap in what issues in middle childhood to adolescence
|
Behavioral, Emotional, and Academic Issues
|
|
|
starting school represents a what
|
critical transition for children & families
|
|
|
attending school can precipitate what
|
precipitate problems or bring new attention to existing conditions
|
|
|
what is the definition of ADHD
|
condition of the brain that makes it difficult for children to control their behavior in school and social settings
|
|
|
ADHD is manifested as what
|
Manifested as developmentally inappropriate levels of inattention, impulsiveness, AND/OR hyperactivity
|
|
|
ADHD is a what that requires what
|
Chronic condition that requires long-term management
|
|
|
symptoms of ADHD may improve when
|
somewhat in late adolescence, but more likely will persist into adulthood
|
|
|
what are the long term outcomes of ADHD
|
unclear
|
|
|
ADHD is more common in whom
|
boys
|
|
|
what component of ADHD is evident at an early age
|
Behavioral component evident at early age
|
|
|
when do educational/social implications of ADHD become clear
|
at school entry
|
|
|
ADHD occurs in whom
|
children of all intelligence levels
|
|
|
ADHD behaviors are not what
|
abnormal behaviors, but they are developmentally inappropriate
|
|
|
what is the cause of ADHD
|
Exact etiology unknown; combination of organic, genetic, and environmental factors likely
Strong family history ADHD in close relative Substance abuse, conduct disorders, learning disabilities, personality disorders Disregulated neurotransmission |
|
|
ADHD patients have a high co-morbidity of what
|
of psychiatric co-morbidity
|
|
|
what are the most common co-morbitities seen with ADHD
|
anxiety, depression, ODD
|
|
|
why is ADHD diagnosis controversial
|
Issues of medication use, burden on schools
|
|
|
what is the diagnostic criteria of ADHD
|
symptoms present before age 7
present in at least 2 settings (usually school and home) |
|
|
what are the 3 subtypes of ADHD
|
inattention
hyperactivity/impulsivity combined |
|
|
what are the cognitive manifestations of ADHD
|
distractability
disorganization impaired executive function (e.g., ↓ working memory) |
|
|
what are the behavioral manifestations of ADHD
|
motor restlessness
impulsiveness reactive aggression |
|
|
what are the consequences of ADHD
|
Academic underachievement
Problematic social relationships difficulties with sharing, cooperating, turn-taking fewer reciprocal friendships higher rate of teenage pregnancy, STD’s Problematic family relationships – high levels of parenting stress, conflict Diminished self-esteem Compromised QOL (important marker for intervention success) |
|
|
management of adhd is what kind of approach
|
Multimodal
|
|
|
what is the multimodal approach of ADHD
|
pharmacological intervention
behavioral intervention psychotherapeutic approaches |
|
|
what is critical with ADHD management and why
|
Timing
increase incidence of medication s.e.’s < age 5 potential to manage behavior and reduce impact on other life domains |
|
|
what are the medications of ADHD
|
Short-acting stimulants (e.g., Ritalin, Adderall, dexedrine)
Long-acting stimulant preparations (patches, ER capsules, etc.) Strattera SSRI antidepressants (Prozac, Wellbutrin, etc.) |
|
|
what is the problem with short acting stimulants
|
may affect appetite, growth, cardiovascular function
|
|
|
what is the good thing with long acting stimulants
|
can avoid stigma of taking meds at school
|
|
|
what is the problem with strattera
|
lower abuse potential, but less effective
|
|
|
what is the goal of a behavioral intervention for ADHD
|
goal is to prevent undesirable behaviors
|
|
|
what are the behavioral interventions for ADHD
|
rewarding desirable behaviors
consequences for failure to achieve goals strategies to improve success organizational charts social skills |
|
|
what is the environmental management of ADHD
|
decreasing distraction
increasing structure tools for enhanced performance consistency between school & home |
|
|
what are parenting skill interventions for ADHD
|
positive parenting (praise, attention, affection)
consistent limit setting skills for helping kids focus |
|
|
what is a psychotherapy intervention of ADHD
|
focused on helping children manage emotional consequences and promote self-esteem
address issues of parental/family stress |
|
|
First signs of significant mental illness may manifest in what age period
|
middle childhood
|
|
|
rare for emotional syndromes to meet diagnostic criteria before what age
|
7
|
|
|
what may hamper diagnosis of emotional disorders
|
Developmental changes in cognitive, behavioral, and language skills
|
|
|
emotional disorders cause a major disruption in what
|
developmental potential
|
|
|
what is the genetic/family history etiology of emotional disorders
|
emerging evidence serotonin-transporter gene variant
may operate via increased vulnerability to environmental stress |
|
|
what are the environmental etiologies of emotional disorders
|
maternal depression/anxiety
chronic stress exposure (e.g., domestic or neighborhood violence, concentrated disadvantage) traumatic event(s) peer relationships (bullying, rejection, contagion) |
|
|
Many adults with mood disorder experienced first major episode when
|
in adolescents
|
|
|
what is the challenge of screening for depression in childhood
|
must be distinguished from “subclinical minor misery”
|
|
|
childhood depression may be what
|
May be situation-specific and transient
reaction to loss chronic illness |
|
|
childhood depression may represent what
|
onset of chronic mood disorder persisting into adulthood
|
|
|
there is a Strong association of childhood depression with what
|
bullying-victims and perpetrators
|
|
|
there is an increased risk of what what depression in childhood
|
Increased risk of suicide, substance abuse
|
|
|
childhood depression has a significant impact on what
|
Significant impact on academic and social functioning
|
|
|
what is commonly seen with depression
|
Co-existing disorders common (anxiety, conduct disorders, OCD, etc.)
|
|
|
depression in childhood treatment should address what
|
address both the causes and consequences of depression
for child for family |
|
|
what is the goal of childhood depression treatment
|
promote optimal functioning in all domains
emotional social academic |
|
|
what is the medication management for childhood depression
|
recommended when symptoms are severe or fail to respond to psychological treatment
controversial data about increased suicide risk strongest evidence is for SSRI’s in bipolar disorder (FDA-approved SSRI for use in kids – prozac only) Overall effectiveness ~ 50% |
|
|
what is the psychotherapy management for childhood depression
|
must address family as context and family as mechanism for intervention
take into account prevalence of interpersonal issues for adolescents |
|
|
what are the Cognitive-behavioral skills training for childhood depression
|
emotional regulation
problem solving cognitive reframing social skills |
|
|
when should you refer a child with depression
|
severity of symptoms - disturbances in sleep, weight, or activity levels
presence of situational stressors family dysfunction interference with social, emotional, and/or academic development suicidal thoughts |
|
|
what is the goal of Wellness Focus during Adolescence
|
preparing adolescents for successful transition to adulthood
|
|
|
who are a are a critical source of social influence and social support in adolescents
|
peers
|
|
|
what is the screening done in adolescents
|
Physical growth and development
Social and academic competence Emotional well-being Violence and injury prevention Risk-based assessment: dislipidemia, blood glucose, STI’s, pregnancy, alcohol/drug use, suicide ideation/attempt |
|
|
what is the anticipatory guidance of adolescents
|
Transition to responsibility for own health
Peer relationships – positive and negative Sexual activity and personal safety Vehicle safety Addressing and resolving family conflict Vocational aspirations |
|
|
Boys should be encouraged to report what
|
abnormalities/changes in their reproductive anatomy
trauma to foreskin/penis pain testicular torsion lesions testicular masses -tumors rare but usually malignant |
|
|
Gynecological exam indicated for what
|
onset of sexual activity
amenorrhea primary – no menses > 2 years beyond first pubertal changes or by age 17 secondary – absence > 6 mo once established dysmenorrhea unexplained abdominal pain by age 18? Goals are to promote reproductive health and encourage self-care |
|
|
what brings reproductive issues to forefront in adolescents
|
Pubertal development
|
|
|
Cognitive/social developmental processes promote what in adolescents
|
risk taking
|
|
|
Drive for independence can outpace what in adolescents
|
outpace emotional resources and experience
|
|
|
Early sexual activity is generally more what
|
risky
|
|
|
there is a disconnect between what in early sexual activity
|
psycho-emotional and physical development
|
|
|
Physical risks to mother and fetus are from what is adolescent pregnancies
|
delayed or inadequate prenatal care
|
|
|
what are the social consequences of adolescent pregnancies
|
school drop-out, poverty, prolonged dependency on parents
|
|
|
highest risk of adolescent pregnancy in who
|
girls with poor school performance
|
|
|
Father involvement in adolescent pregnancy is influenced by what
|
by mother & mother’s family
|
|
|
sexually active teens have a high risk for what
|
STIs-physiologically increased susceptibility
|
|
|
Gay and lesbian youth at higher risk for what
|
depression
peer and family rejection victimization/violence suicide |
|
|
~50% of rape victims are what
|
less than 18
|
|
|
there is a Higher risk of sexual assault with who
|
any physical or developmental disability
|
|
|
Non-stranger (acquaintance) rape
has a higher risk with what |
much higher risk with alcohol and drug use
|
|
|
Consequences to physical and social well-being with substance misuse
|
legal ramifications
physiological dependence time and $$ social alienation impact on present and future goal achievement |
|
|
Most commonly misused drugs in adolescence are what
|
alcohol (80-90% by age 18)
Tobacco (36% and rising) Marijuana (experimentation 50%) |
|
|
what is the definition of dependence
|
maladaptive pattern of substance abuse, leading to significant impairment/distress; characterized by:
Physiological dependence (tolerance/withdrawal) Persistent desire or failure to control use Time spent obtaining, using, and recovering from use Interference with social, occupational, recreational activities |
|
|
what is the percent of teen smokers will continue to smoke as adults
|
75%
|
|
|
what is the Influence of family members on adolescent tobacco use
|
parents who smoke
parents who tolerate smoking |
|
|
what is the Influence of peers on adolescent tobacco use
|
peers who smoke
association of smoking with thinness, maturity |
|
|
what is the Influence of medical professionals on adolescent tobacco use
|
Much less likely to be assessed and advised to quit than adults
|
|
|
what are direct consequences of adolescent drinking
|
medical
social |
|
|
what are indirect consequences of adolescent drinking
|
MVA’s
accidental injury homicide/suicide sexual risk-taking |
|
|
what is inhalant use
|
Volatile substances containing chemical solvents
|
|
|
what happens with inhalant use
|
Mind-altering experience, mild euphoria
|
|
|
inhalants are what
|
Gateway drug experience for young children
inexpensive available unaware of dangers |
|
|
what place adolescents at increased risk for suicide attempts/ completion
|
developmental changes
|
|
|
what are the developmental changes that place adolescents at increased risk for suicide attempts/ completion
|
Capacity for introspection/future orientation
Reality of adulthood looms Strong emotional reactions Vulnerability to rejection/loss Limited experience with coping with major problems Ambivalent connections to family/social institutions |
|
|
what are the risk factors for adolescent suicide
|
Active psychiatric disorder
Substance abuse Academic problems/failure Humiliation/rejection/loss Family dysfunction Incarceration |
|
|
what are the protective factors for adolescent suicide
|
Positive peer relationships
Social support/participation Vocational/career options |
|
|
Suicidal act may be what
|
impulsive or carefully thought out
Long-standing stressors Acute precipitating event |
|
|
what is the nursing role in preventing adolescent suicide
|
Assessment & referral
Specifically ask about suicidal ideation, suicide plan, availability of means Contract for short-term safety or immediate treatment Re-affirm hope Promote self-esteem and emotional expression Educational programs for families and peers Recognizing risks and symptoms How to respond |
