Study Guide Midterm NR602 PEDs
Primary Care Foundations in Pediatric and Women's Health
Social determinants of health
Biosocial circumstances, or social determinants of child health, are
shaped by economics, social policies, and politics in each region and
country.
Marginalized populations
Human trafficking
Physical Indicators—Nonspecific:
Pain on urination; vaginal or penile discharge; vaginal, rectal, or penile
bleeding
Enuresis and encopresis
Urethral or lymph gland inflammation; genital or perianal rashes; labial
adhesions
Pain in anal, gastrointestinal, pelvic, and urinary areas
Genital injuries or signs, such as bruising, scratches, bites, grasp
marks, or swelling of the genitalia that are unexplained or inconsistent
with history
Physical Indicators—Specific:
Blunt-force trauma (lacerations, bruising, abrasions, tears) to the
genital or rectal areas, or both, that is inconsistent with the history or
these same findings with a history of sexual contact or penetration
Commonly encountered STIs:
Diagnostic of sexual abuse—gonorrhea (by culture) and syphilis if not
perinatally acquired, nondelivery-related or nonpregnancy-related
Chlamydia (culture is the only reliable diagnostic method), HIV, and
herpes type 2
Highly suspicious: Trichomonas vaginalis
Suspicious: Condyloma acuminatum (appearing after 3 years old and
not perinatally acquired)
Possible: Herpes type 1 and nonvenereal warts (may be due to
autoinoculation in the genital or anogenital area)
Uncertain: Bacterial vaginosis and Mycoplasma
Pregnancy, sperm, and semen are certain indicators of sexual abuse in
young children
Pediatric Health Promotion and Prevention
, Indicators of child health
Principle 1. Growth and development are orderly and sequential.
Although children differ in rates and timing of developmental
changes, they generally follow certain predictable stages or phases.
Specific examples include the rapid growth during the first year of
life, progress toward independence throughout childhood, and the
development of secondary sex characteristics during adolescence.
Principle 2. Growth and development pacing varies considerably
between children. Some children demonstrate early skill in motor
coordination, and others demonstrate early skill in language
acquisition. These changes are unique to each child.
Principle 3. Development occurs in a cephalocaudal and
proximodistal direction. An example of this principle is seen as
infants develop increasing motor coordination, gaining head control
before sitting and walking. Similarly, developmental progress occurs
with controlled movements that first occur near the body’s midline,
such as rolling over, progress to distal coordination of the hands,
such as mastery of the pincer grasp.
Principle 4. Growth and development increasingly integrates.
Behavior that is taken for granted, such as self-feeding, occurs as a
result of the acquisition of numerous small changes and skills.
Simple skills and behaviors integrate into more complex behaviors
as the child grows and develops.
Principle 5. Developmental abilities increasingly organize and
differentiate. As a result of increasing maturation and experience,
children’s behaviors and responses to internal and external cues
become more regulated, organized, and differentiated. The infant
who cries and moves because of hunger is different from the
hungry toddler who walks to the refrigerator and points.
Principle 6. The child’s internal and external environments affect
growth and development. Opportunities for play, societal norms,
cultural values, family traditions, and family beliefs all influence
child development. Similarly, children influence their environment
to achieve desired experiences and opportunities.
Principle 7. Certain periods are critical to growth and development.
Critical periods are points of time when developmental advances
occur and are particularly susceptible to alterations due to internal
and external influences. For example, fetal exposure to certain
viruses during the first trimester of pregnancy increases the risk of
congenital abnormalities.
Principle 8. Development is a continual process, often without
smooth transitions. Developmental phases are marked by periods
of change, growth, and stability plateaus.
, Immunizations
Diphtheria-Tetanus-Acellular Pertussis Vaccine
DTaP vaccines are used for children younger than 7 years old; Tdap
is given to those 7 years old or older. Tetanus prophylaxis as part of
wound management is based on age.
Polio Vaccine
Only inactivated polio vaccine (IPV) is available for use in the United
States; seroconversion to each of the three serotypes of polio
ranges from 99% to 100% after three doses.
Haemophilus Influenzae Type B Vaccine
Of the six serotypes, Hib is the most virulent, accounting for
pneumonia, bacteremia, meningitis, epiglottitis, septic arthritis,
cellulitis, otitis media, purulent pericarditis, and other less common
infections, notably in those younger than 4 years of age.
Hepatitis A Virus Vaccine
The primary HAV vaccine initiative focuses on children in order to
prevent transmission to adults in whom the illness is likely to be
serious. Current guidelines include universal vaccination for those 1
to 18 years old and for other subsets of the population. HAV is
currently given as a two-dose series.
• Those traveling to countries where HAV is endemic
• Those residing in and in contact with others from communities
with a high HAV incidence or outbreak
• Children in diapers in day care centers with high rates of HAV
• Men who have sex with men
• Individuals with severe illness (e.g., chronic liver disease)
• Illicit-drug users (using injectable or noninjectable drugs)
• Those with blood-clotting disorders (e.g., hemophiliacs)
• Unvaccinated persons 1 year old or older who are household
members and/or close contacts (including babysitters) of an
international adoptee from a country of high or intermediate
endemicity within 60 days after the adoptee’s arrival.
Hepatitis B Virus Vaccine
Two recombinant HBV vaccines, composed of hepatitis B surface
antigen (HBsAg) protein, are licensed in the United States. This
vaccine is safe during pregnancy and lactation. Preterm infants
weighing less than 2000 g should be immunized when they are 1
month old, while all newborns weighing 2000 g or more should be
vaccinated prior to hospital discharge.
• Hemophiliac patients and other recipients of certain blood
products
• Intravenous (IV) drug users
• Individuals with HIV, chronic liver disease, or on hemodialysis
, • Heterosexual persons with a history of multiple sex partners in
the previous 6 months or with recent sexually transmitted infections
• Men who have sex with men
• Household and sexual contacts of those who are HBsAg positive
• Foreign-born individuals (including adoptees) from countries with
HBsAg prevalence
• Susceptible child who bit a person with chronic HBV infection
• Staff and residents of residential institutions for the
developmentally disabled
• Staff and attendees of nonresidential day care and school
programs for the developmentally delayed if an identified HBV
carrier is known to attend or poses risk of infecting others
• Healthcare workers and others with occupational risk
• International travelers who travel to areas where endemicity for
HBV is 2% or greater and who otherwise may be at risk
• Inmates in juvenile detention and other correctional facilities if
unimmunized or under-immunized
• Individuals with diabetes mellitus between the ages of 19 and 59
years old
Human Papillomavirus Vaccine
Gardasil-9 (9vHPV) was licensed for use in 2014 and is
recommended for males and females 9 through 26 years old. The 9-
valent HPV vaccine provides protection against the HPV types
contained in the previous HPV4—6, 11, 16, 18—and an additional
five HPV types—31, 33, 45, 50, and 58—that are responsible for the
most common causes of cervical cancer worldwide. A 2-dose HPV
schedule is approved for individuals who receive their first dose on
or before 15 years of age, with a minimum of 5 months between
the 2 doses.
Influenza Vaccine
The influenza vaccine is formulated yearly based on epidemiologic
forecasts. Usually one or two influenza A virus strains are changed
based on the dominant influenza strain(s) projected to infect the
population in the approaching flu season. The ACIP recommends
annual, universal vaccination for those 6 months old and older,
unless contraindicated. Influenza disease rates are highest among
children younger than 2 years old, in those 65 years old and older,
and in those with high-risk medical conditions.
Meningococcal Vaccine
Of the 13 serotypes of Neisseria meningitidis, serogroups B, C, Y,
and W135 cause 90% of the meningococcal diseases in the United
States. Most infections in children younger than 5 years old are
attributed to serogroup B, whereas C, Y, and W135 cause three-
fourths of infections in those 11 years old and older. Infections due
to serogroup A are rare.
Pneumococcal Vaccines
Primary Care Foundations in Pediatric and Women's Health
Social determinants of health
Biosocial circumstances, or social determinants of child health, are
shaped by economics, social policies, and politics in each region and
country.
Marginalized populations
Human trafficking
Physical Indicators—Nonspecific:
Pain on urination; vaginal or penile discharge; vaginal, rectal, or penile
bleeding
Enuresis and encopresis
Urethral or lymph gland inflammation; genital or perianal rashes; labial
adhesions
Pain in anal, gastrointestinal, pelvic, and urinary areas
Genital injuries or signs, such as bruising, scratches, bites, grasp
marks, or swelling of the genitalia that are unexplained or inconsistent
with history
Physical Indicators—Specific:
Blunt-force trauma (lacerations, bruising, abrasions, tears) to the
genital or rectal areas, or both, that is inconsistent with the history or
these same findings with a history of sexual contact or penetration
Commonly encountered STIs:
Diagnostic of sexual abuse—gonorrhea (by culture) and syphilis if not
perinatally acquired, nondelivery-related or nonpregnancy-related
Chlamydia (culture is the only reliable diagnostic method), HIV, and
herpes type 2
Highly suspicious: Trichomonas vaginalis
Suspicious: Condyloma acuminatum (appearing after 3 years old and
not perinatally acquired)
Possible: Herpes type 1 and nonvenereal warts (may be due to
autoinoculation in the genital or anogenital area)
Uncertain: Bacterial vaginosis and Mycoplasma
Pregnancy, sperm, and semen are certain indicators of sexual abuse in
young children
Pediatric Health Promotion and Prevention
, Indicators of child health
Principle 1. Growth and development are orderly and sequential.
Although children differ in rates and timing of developmental
changes, they generally follow certain predictable stages or phases.
Specific examples include the rapid growth during the first year of
life, progress toward independence throughout childhood, and the
development of secondary sex characteristics during adolescence.
Principle 2. Growth and development pacing varies considerably
between children. Some children demonstrate early skill in motor
coordination, and others demonstrate early skill in language
acquisition. These changes are unique to each child.
Principle 3. Development occurs in a cephalocaudal and
proximodistal direction. An example of this principle is seen as
infants develop increasing motor coordination, gaining head control
before sitting and walking. Similarly, developmental progress occurs
with controlled movements that first occur near the body’s midline,
such as rolling over, progress to distal coordination of the hands,
such as mastery of the pincer grasp.
Principle 4. Growth and development increasingly integrates.
Behavior that is taken for granted, such as self-feeding, occurs as a
result of the acquisition of numerous small changes and skills.
Simple skills and behaviors integrate into more complex behaviors
as the child grows and develops.
Principle 5. Developmental abilities increasingly organize and
differentiate. As a result of increasing maturation and experience,
children’s behaviors and responses to internal and external cues
become more regulated, organized, and differentiated. The infant
who cries and moves because of hunger is different from the
hungry toddler who walks to the refrigerator and points.
Principle 6. The child’s internal and external environments affect
growth and development. Opportunities for play, societal norms,
cultural values, family traditions, and family beliefs all influence
child development. Similarly, children influence their environment
to achieve desired experiences and opportunities.
Principle 7. Certain periods are critical to growth and development.
Critical periods are points of time when developmental advances
occur and are particularly susceptible to alterations due to internal
and external influences. For example, fetal exposure to certain
viruses during the first trimester of pregnancy increases the risk of
congenital abnormalities.
Principle 8. Development is a continual process, often without
smooth transitions. Developmental phases are marked by periods
of change, growth, and stability plateaus.
, Immunizations
Diphtheria-Tetanus-Acellular Pertussis Vaccine
DTaP vaccines are used for children younger than 7 years old; Tdap
is given to those 7 years old or older. Tetanus prophylaxis as part of
wound management is based on age.
Polio Vaccine
Only inactivated polio vaccine (IPV) is available for use in the United
States; seroconversion to each of the three serotypes of polio
ranges from 99% to 100% after three doses.
Haemophilus Influenzae Type B Vaccine
Of the six serotypes, Hib is the most virulent, accounting for
pneumonia, bacteremia, meningitis, epiglottitis, septic arthritis,
cellulitis, otitis media, purulent pericarditis, and other less common
infections, notably in those younger than 4 years of age.
Hepatitis A Virus Vaccine
The primary HAV vaccine initiative focuses on children in order to
prevent transmission to adults in whom the illness is likely to be
serious. Current guidelines include universal vaccination for those 1
to 18 years old and for other subsets of the population. HAV is
currently given as a two-dose series.
• Those traveling to countries where HAV is endemic
• Those residing in and in contact with others from communities
with a high HAV incidence or outbreak
• Children in diapers in day care centers with high rates of HAV
• Men who have sex with men
• Individuals with severe illness (e.g., chronic liver disease)
• Illicit-drug users (using injectable or noninjectable drugs)
• Those with blood-clotting disorders (e.g., hemophiliacs)
• Unvaccinated persons 1 year old or older who are household
members and/or close contacts (including babysitters) of an
international adoptee from a country of high or intermediate
endemicity within 60 days after the adoptee’s arrival.
Hepatitis B Virus Vaccine
Two recombinant HBV vaccines, composed of hepatitis B surface
antigen (HBsAg) protein, are licensed in the United States. This
vaccine is safe during pregnancy and lactation. Preterm infants
weighing less than 2000 g should be immunized when they are 1
month old, while all newborns weighing 2000 g or more should be
vaccinated prior to hospital discharge.
• Hemophiliac patients and other recipients of certain blood
products
• Intravenous (IV) drug users
• Individuals with HIV, chronic liver disease, or on hemodialysis
, • Heterosexual persons with a history of multiple sex partners in
the previous 6 months or with recent sexually transmitted infections
• Men who have sex with men
• Household and sexual contacts of those who are HBsAg positive
• Foreign-born individuals (including adoptees) from countries with
HBsAg prevalence
• Susceptible child who bit a person with chronic HBV infection
• Staff and residents of residential institutions for the
developmentally disabled
• Staff and attendees of nonresidential day care and school
programs for the developmentally delayed if an identified HBV
carrier is known to attend or poses risk of infecting others
• Healthcare workers and others with occupational risk
• International travelers who travel to areas where endemicity for
HBV is 2% or greater and who otherwise may be at risk
• Inmates in juvenile detention and other correctional facilities if
unimmunized or under-immunized
• Individuals with diabetes mellitus between the ages of 19 and 59
years old
Human Papillomavirus Vaccine
Gardasil-9 (9vHPV) was licensed for use in 2014 and is
recommended for males and females 9 through 26 years old. The 9-
valent HPV vaccine provides protection against the HPV types
contained in the previous HPV4—6, 11, 16, 18—and an additional
five HPV types—31, 33, 45, 50, and 58—that are responsible for the
most common causes of cervical cancer worldwide. A 2-dose HPV
schedule is approved for individuals who receive their first dose on
or before 15 years of age, with a minimum of 5 months between
the 2 doses.
Influenza Vaccine
The influenza vaccine is formulated yearly based on epidemiologic
forecasts. Usually one or two influenza A virus strains are changed
based on the dominant influenza strain(s) projected to infect the
population in the approaching flu season. The ACIP recommends
annual, universal vaccination for those 6 months old and older,
unless contraindicated. Influenza disease rates are highest among
children younger than 2 years old, in those 65 years old and older,
and in those with high-risk medical conditions.
Meningococcal Vaccine
Of the 13 serotypes of Neisseria meningitidis, serogroups B, C, Y,
and W135 cause 90% of the meningococcal diseases in the United
States. Most infections in children younger than 5 years old are
attributed to serogroup B, whereas C, Y, and W135 cause three-
fourths of infections in those 11 years old and older. Infections due
to serogroup A are rare.
Pneumococcal Vaccines
