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)
(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)
