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Approach to the pediatric patient
- they are not miniature adults
- they are unique
- tx not the same
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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
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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
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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
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Overview WEll child care or health supervision
well exam is lrg % of visits=1st yr
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schedule of visits for the well exam
- newborn=2days/2wks/1mo
- 2,4,6,9,12,15,18,24mos
- yearly
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Standards
varyies based on high vs low risk
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Focus is on
wellness & prevention
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HPI/Concerns
- pmh-birth hx
- under 5 & perinatal hx
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nutrition
how much are they eating
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sleep
habits & problems=where are they sleeping
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Elimination habits
pooping,potty training
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behavior
discipline problems & look at parenting skills
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Developmnent
denver screening
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social & fhx
- who do they live with
- exposed to 2nd hand smoke=asthma & ear infections
- look at family tree
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Physical exam includes
- denver
- screening tests=hearing, vision, immunizations
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Anticipatory Guidance
troubleshoot problems for the future & special needs
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Important to take in the PE
vital signs=BP
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vaccines scheduled updated on CDC
2*yr
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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.
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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
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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
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Examples for screening
- metabolic screen
- Ht & Wt
- vision & hearing
- denver
- lead
- hematocrit
- sickle
- cholesterol
- TB
- Urinalysis
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Hearing screen
hearing deficits=major contributing factors language delay & global delays=school, learning. Receptive vs Expressive
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Risk factors for hearing screen
- affected family member
- bilirubing >20mg/dl
- congenital infection
- defects skull/ent
- small birth wt
- asphyxia
- infections & abx
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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
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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
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Prenatal
- maternal health: nutrition, smoking, drugs, breast feeding, care
- safety: car seats, smoke detectors, CPR, walkers, cribs
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Newborn
- coping w/detection of anomalies
- safety=safe sleep to shaky baby syndrome
- infant's nutrition=breast/bottle & what are you feeding them
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infancy
- nutrition
- developmental changes
- safety as child develops=accidents will happen
- immunizations
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preschool
- accicent prevention
- early detection of disabilities:vision & hearing
- socail development:family church play & school
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School
- school success=academic & social
- behavorial concerns & deviations
- maintain relationship
- safety
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teens
- sexuality
- safety: substance abuse, etoh
- future planning
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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
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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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