MSN 572 WEEK 2 COMPLILED NOTES FOR TEST (AUTORECOVERED).

MSN 572 WEEK 2 COMPLILED NOTES FOR TEST (AUTORECOVERED). Week 2 Special Populations: Dr. Porter Blocks in book (blue or grey) focus on those important points Child development Tanner staging- go up to stage 5- stages of development that lead up to puberty (i.e. Breast buds) Pubic hair is tanner staging 3 Sexual maturity ratings- breast buds stage 2 (Bright Futures pg 123) Well child visit- start with looking (eyes) – Look listen feel Developmental milestones are important and ages Startle reflex (surprise reaction) develops in utero (birth) and last until 3-6 mths Incurvation- rub baby spine and turn towards way you are rubbing it Red eye reflex- related to retinoblastoma; if not present it is abnormal Failure to thrive- assess weight, height, head circumference, length Gestational diabetes babies are large Moms are high risk if they have gestational diabetes and can develop diabetes after birth – 50% rate Contraindications of vaccines- fever over 105, cry for 3 hrs. after vaccine, seizure after vaccine, allergy to components Flublok- does not have egg components in it Wait 4 weeks between live vaccines; don’t give 2 live vaccines at same time because immune system will be down before going up Mild illness at last vaccine is fine; and okay to vaccinate Immunoglobulins- IgG – Stays the longest; had it and now Gone (needs to ensure it goes up to ensure protection) IgM- immediate; have now 12-year-old PPD skin test- positive if induration, if active TB in the house you will need a chest x-ray and always refer to specialist; and you can still vaccinate What vaccine given every 10 years? Toxoid vaccine Working with adolescent- ask if sexually active; invite parent to leave to ask personal questions; offer privacy BCG vaccine can cause positive reaction with PPD Pregnant women- Baby heart rate is higher than adult- 60 is abnormal; heart rate of 160 is normal in a baby Presumed signs of pregnancy- breast tenderness, increased urination, amenorrhea, If pregnant- cervix exam would be soft and cyanotic Round ligament pain- hormonal change cause this Diastasis recti - when abdominal muscles spread- you don’t treat Normal expected weight gain in pregnancy- 20-25 lbs. healthy is 27 lbs average Mom feels baby move at weeks G- # pregnancies T- # carry to term P- # preterm before 20- 37 weeks L- born alive Vaccines that protect patient and newborn- DTP (diphtheria, pertussis, tetanus) Hypoglossal nerve – cranial nerve 12 – pinch the nose and open mouth Geriatrics- What elevates first in aging population? Diastolic Most common heart valve goes bad as we age? Aortic- due to build up calcium buildup aortic stenosis (right sternal border) Circadian rhythm- lose sleep patterns as we age because we no longer have a schedule Falls- number 1 risk as we age- best thing is to keep them active- walking Number 1 referred pain for hip fracture is knee pain Intimacy questions-highest rate of STI is in retirement communities Vaginal atrophy (occurs most after menopause)- painful intercourse Beers criteria- criteria/guidelines used to improve the safety of prescribing medications to geriatric population Four principles of child development 1. child development proceeds along a predictable pathway 2 the range of normal development is wide 3 various physical, social, and environmental factors, as well as diseases, can affect child development and health 4 the child's developmental level affects how you conduct the history and physical examination Key components of pediatric health promotion 1. age appropriate developmental achievement of the child physical such as maturation growth and puberty Motor such as gross and fine motor skills Cognitive such as developmental milestones, language, school performance Emotional such as self regulation, mood, temperament, self efficiency, self esteem, independence Social such as social competence, self responsibility, integration with family and community, peer interactions 2 . health supervision visits Periodic assessment of clinical and oral health next time more frequent health supervision visits for children with special health care needs 3. integration of physical examination findings with health promotion 4 immunizations 5. Screening procedures 6 anticipatory guidance Health habits Nutrition and healthy eating Safety and prevention of injury Physical activity Sexual development and sexuality Self responsibility, efficiency, and healthy self esteem Family relationships such as interactions strengths and supports Positive parenting strategies Oral health Emotional and mental health Recognition of illness Sleep Screen time Prevention of risky behaviors such as tobacco, alcohol and drug use, unprotected sex School and vocation Peer relationships Community interactions 7. partnership among health care provider, adolescent child and family Tips for examining a newborn examine the newborn in presence of parents Swatow and then undressed the newborn as the examination proceeds Dim the lights and rock the newborn to encourage the eyes to open Observed feeding, if possible, particularly breast feeding A typical sequence for the examination of the newborn; Careful observation before and during the examination Heart Lungs Head, neck, and clavicles Ears and mouth Hips Abdomen and Gu system Lower extremities, back Eyes , whenever they are spontaneously open or at the end of the examination Skin, as you go along Urological system Apgar score Five components that classify the newborns neurological recovery from stress of birth an immediate adaptation to extrauterine life Score each newborn at one in five minutes after birth Scoring is based on a 3 point scale, (0, 1 , or 2) If the apgar score at 5 minutes is 8 or more proceed to a more complete examination Clarification by gestational age in birth weight Gestational age pre term :less than 34 weeks Late preterm: 34 to 36 weeks Term :37 to 42 weeks Post term: greater than 42 weeks Birth weight classification: Extremely low birth weight; Less than 1000 grams Very low birth weight; Less than 1500 grams Low birth weight less than 2500 grams Normal birth weight; greater than or equal to 2500 grams Newborn classifications Small for gestational age ; SGA; Less than 10th percentile appropriate for gestational age; AGA; 10th to 90th percentile Large for gestational age; LGA; greater than 90th percentile What a newborn can do Core elements: Do you born she's all five senses, for example they will look at human faces and turn to appearance voice Newborns are unique individuals. Marked differences exist in temperaments, personality, behavior, and learning Newborns interact dynamically with caregivers a two way St Examples of complex newborn behavior Habituation ; Ability to selectively and progressively shut out negative stimuli such as repetitive sound ; It reciprocal, dynamic process of interacting and bonding with the caregiver State regulation; Ability to modulate the level of arousal in response