peds1.txt

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adamarine
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102954
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peds1.txt
Updated:
2011-09-19 23:40:50
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ped1
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ped1
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  1. Approach to the pediatric patient
    • they are not miniature adults
    • they are unique
    • tx not the same
  2. Implications of such a statement
    • physical findings are different
    • labs different
    • Dx unique
    • prognosis different=better than adult but if it affects growth & development it could be worse
  3. Major diff btwn children & adults
    • developmental=mental & motor abiltiy
    • emotional resp=to health care & illnesses
    • developmental changes=changes in organ sys=liver still developing enzymes
    • Immunity=disease different b/c they have not been exposed to all germs
    • meds different=preps in liqued & resistantce is different
    • Not the historian so they can't tell what is wrong but sometimes they have to
  4. Preventative Peds is the KEY=Goals
    • promote wellness & optimal health=physical mental emotional & spirt
    • prevent preventalbe diseases
    • early diagnoses of disease=asymptomatic & symptomatic
    • prevent unnescessary disability=physical, educational
  5. Overview WEll child care or health supervision
    well exam is lrg % of visits=1st yr
  6. schedule of visits for the well exam
    • newborn=2days/2wks/1mo
    • 2,4,6,9,12,15,18,24mos
    • yearly
  7. Standards
    varyies based on high vs low risk
  8. Focus is on
    wellness & prevention
  9. HPI/Concerns
    • pmh-birth hx
    • under 5 & perinatal hx
  10. nutrition
    how much are they eating
  11. sleep
    habits & problems=where are they sleeping
  12. Elimination habits
    pooping,potty training
  13. behavior
    discipline problems & look at parenting skills
  14. Developmnent
    denver screening
  15. social & fhx
    • who do they live with
    • exposed to 2nd hand smoke=asthma & ear infections
    • look at family tree
  16. Physical exam includes
    • denver
    • screening tests=hearing, vision, immunizations
  17. Anticipatory Guidance
    troubleshoot problems for the future & special needs
  18. Important to take in the PE
    vital signs=BP
  19. vaccines scheduled updated on CDC
    2*yr
  20. Definition of screening
    presumptive identification of an asymptomatic disease or defect by utilizing a relatively simple test or procedure. Identify a disease prior to the time when the disease is usually dx w/intent to change the final outcome.
  21. Is screening the dx gold standard
    no b/c the test criteria=scientific, reliable, validity, sensitivity is proportion of individuals tested are positive & specificity in that they don't have the disease
  22. Diseases suitable for screening
    • serious
    • common=PKU
    • ability to confirm diagnosis
    • treatable/controllable meaning preventing from progressive froward
    • optimal time for tx must be b4 time of usual dx
    • cost effective for everyone
  23. Examples for screening
    • metabolic screen
    • Ht & Wt
    • vision & hearing
    • denver
    • lead
    • hematocrit
    • sickle
    • cholesterol
    • TB
    • Urinalysis
  24. Hearing screen
    hearing deficits=major contributing factors language delay & global delays=school, learning. Receptive vs Expressive
  25. Risk factors for hearing screen
    • affected family member
    • bilirubing >20mg/dl
    • congenital infection
    • defects skull/ent
    • small birth wt
    • asphyxia
    • infections & abx
  26. Prevention & Anticipatory guidance by age group/visit purpose
    • direct parent & child's attention to issues that may arise=future
    • 3T's=personal TIME, TALK=to the parent & have them listen; TOUCH=hugs, kisses, sitting close to them
  27. Prevention & AG by age group/visit Topics
    • diet
    • injury prevention
    • developmental/behavorial issues
    • instructional/academic issues
    • health promotion/prevention
    • oral & written materials=acceptable & go through it with them
  28. Prenatal
    • maternal health: nutrition, smoking, drugs, breast feeding, care
    • safety: car seats, smoke detectors, CPR, walkers, cribs
  29. Newborn
    • coping w/detection of anomalies
    • safety=safe sleep to shaky baby syndrome
    • infant's nutrition=breast/bottle & what are you feeding them
  30. infancy
    • nutrition
    • developmental changes
    • safety as child develops=accidents will happen
    • immunizations
  31. preschool
    • accicent prevention
    • early detection of disabilities:vision & hearing
    • socail development:family church play & school
  32. School
    • school success=academic & social
    • behavorial concerns & deviations
    • maintain relationship
    • safety
  33. teens
    • sexuality
    • safety: substance abuse, etoh
    • future planning
  34. Discipline=AAP 3 essential elements
    • maintain positive, loving relationship
    • positive reinforcement such as praising them for good things
    • remove reinforcement of undesired behavior such as bad interactions w/mom & dad are better than none at all
  35. Methods
    • time outs=1min per age of life up to 15-18mos
    • remove priveleges
    • punishement=spanking becomes abusive when it is out of control & definately don't want to shame the child; express to them what they did was bad but they aren't a bad person.

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