CMN 568 STUDY GUIDE | Module 1 material
Patient/family counseling which includes information, advice, and
anticipatory guidance
suggestions about expected health-related life occurrences, health
maintenance, and preventive plans.
where should pediatric history both patient and parent; obtain as much as possible from patient to
information be obtained from? give child a degree of control over a potentially threatening
situation
1. inspection first, from afar; examine skin color and work of
order of pediatric physical breathing before beginning exam; establish trust; allow child to sit
examination in parents lap; defer otoscopic exam until last
when should eyes and ears be during every health visit
examined?
- visual inspection of eyes/eyelids
3 components of vision assessment - alignment of eyes
- visual acuity
- eye history
- vision assessment
- inspection of eyelids and eyes
birth to age 3 ophthalmic exam
- pupil examination
includes:
- ocular mobility
- red reflex check
- eye history
- vision assessment
- inspection of eyelids and eyes
- pupil examination
age 3 and up ophthalmic exam
- ocular mobility
includes:
- red reflex check
visual acuity test with eye chart; classes should be worn if
prescribed and record data as "corrected"
, should be able to briefly track mother's face or brightly colored
assessing newborn visual acuity object within an hour after birth (fixation reflex not developed for
several weeks); dont talk while assessing vision, baby may look
toward sound rather than visual stimulus
when patient presents with eye visual acuity; UNLESS there is chemical injury to eye, then you
condition (infection, injury, etc), should irrigate first and refer to ophthalmologist; when there is
what do you check first? decreased acuity, also refer to ophthalmologist
what is the visual acuity of a 20/200-20/400; acuity reaches adult level of 20/20 by age 5
newborn?
- 3-5yr: if acuity is less than 20/40 in either eye, or if theres a
difference in two lines in acuity between eyes
when to refer child to - 6yr and older: if acuity is less than 20/30 or if theres a difference in
ophthalmologist two lines in acuity between eyes
when to assess red reflex birth until the child can read eye chart
when should you start to 2 months; refer out if fixation and following are poor by 3 months
assess fixation and following?
when to test corneal light reflex 3 months- 5 years; refer out for asymmetry in light reflex
(hirschsbergs test)?
when to start cover testing for 6 months- 5 years
strabismus
when to start a fundoscopic exam 3 years
when to start preliterate eye chart 3-4 years
testing
minimal visual acuity at age 3-5 20/40
minimal visual acuity greater 20/30
than 6 years old
downs syndrome children have refractive error, strabismus, cataracts
increased risk of what eye
disorders?
conventional screening audiometry (raise your hand if you can hear
hearing screening after age 4 the noise); each ear tested and referred for discrepancy greater
than 20 dB; hearing screening should be part of attention
problem workup
what percentage dose acute care 30%
visits account for in a primary
care office?
document events related to presenting problem (describe them in
medical record), including supporting physical data/ diagnostics;
clinician documentation of acute treatment, follow up instructions (when to return to work or school);
Patient/family counseling which includes information, advice, and
anticipatory guidance
suggestions about expected health-related life occurrences, health
maintenance, and preventive plans.
where should pediatric history both patient and parent; obtain as much as possible from patient to
information be obtained from? give child a degree of control over a potentially threatening
situation
1. inspection first, from afar; examine skin color and work of
order of pediatric physical breathing before beginning exam; establish trust; allow child to sit
examination in parents lap; defer otoscopic exam until last
when should eyes and ears be during every health visit
examined?
- visual inspection of eyes/eyelids
3 components of vision assessment - alignment of eyes
- visual acuity
- eye history
- vision assessment
- inspection of eyelids and eyes
birth to age 3 ophthalmic exam
- pupil examination
includes:
- ocular mobility
- red reflex check
- eye history
- vision assessment
- inspection of eyelids and eyes
- pupil examination
age 3 and up ophthalmic exam
- ocular mobility
includes:
- red reflex check
visual acuity test with eye chart; classes should be worn if
prescribed and record data as "corrected"
, should be able to briefly track mother's face or brightly colored
assessing newborn visual acuity object within an hour after birth (fixation reflex not developed for
several weeks); dont talk while assessing vision, baby may look
toward sound rather than visual stimulus
when patient presents with eye visual acuity; UNLESS there is chemical injury to eye, then you
condition (infection, injury, etc), should irrigate first and refer to ophthalmologist; when there is
what do you check first? decreased acuity, also refer to ophthalmologist
what is the visual acuity of a 20/200-20/400; acuity reaches adult level of 20/20 by age 5
newborn?
- 3-5yr: if acuity is less than 20/40 in either eye, or if theres a
difference in two lines in acuity between eyes
when to refer child to - 6yr and older: if acuity is less than 20/30 or if theres a difference in
ophthalmologist two lines in acuity between eyes
when to assess red reflex birth until the child can read eye chart
when should you start to 2 months; refer out if fixation and following are poor by 3 months
assess fixation and following?
when to test corneal light reflex 3 months- 5 years; refer out for asymmetry in light reflex
(hirschsbergs test)?
when to start cover testing for 6 months- 5 years
strabismus
when to start a fundoscopic exam 3 years
when to start preliterate eye chart 3-4 years
testing
minimal visual acuity at age 3-5 20/40
minimal visual acuity greater 20/30
than 6 years old
downs syndrome children have refractive error, strabismus, cataracts
increased risk of what eye
disorders?
conventional screening audiometry (raise your hand if you can hear
hearing screening after age 4 the noise); each ear tested and referred for discrepancy greater
than 20 dB; hearing screening should be part of attention
problem workup
what percentage dose acute care 30%
visits account for in a primary
care office?
document events related to presenting problem (describe them in
medical record), including supporting physical data/ diagnostics;
clinician documentation of acute treatment, follow up instructions (when to return to work or school);
