Y khoa - Dược - Chapter 40: Assisting in pediatrics

40Assisting in PediatricsLearning Outcomes (cont.)40.1 Relate growth and development to pediatric patient care.40.2 Identify the role of the medical assistant during pediatric examinations.40.3 Discuss pediatric immunizations and the role of the medical assistant.Learning Outcomes (cont.)40.4 Explain variations of pediatric screening procedures and diagnostic tests.40.5 Describe common pediatric diseases and disorders and their treatment.40.6 Recognize special health concerns of pediatric patients.IntroductionPediatrics Specialty Healthcare of childrenPediatricianMonitors developmentDiagnose and treatMedical AssistantParent educationAdhering to immunization schedulesRecognizing special health concernsLiaison between parent and physicianDevelopmental Stages and CareDevelopmental milestones for each stagePhysical developmentIntellectual-cognitive developmentPsycho-emotional developmentSocial developmentNeonateBirth to one monthPhysical developmentHead ¼ the lengthFontanels Skin Loose, wrinkled, redPeels during 1st weekUmbilical cordJaundiceYellowish colorBilirubin ReflexesVision and hearingNeonate (cont.)Intellectual-cognitive developmentSocial developmentResponds to stimulationEstablishes an activity patternResponds to a soft, gentle voiceTries to focus on voice and faceCan show excitement and distressNeonate (cont.)Aspects of careHygieneTepid sponge bathsAvoid oil, lotions, and powdersFeeding instructionsJaundice treatmentHydration Ultraviolet light or bili-blanketBlood testsThe Infant: One Month to One Year (cont.)Physical developmentRapid growthDevelops head to footLarger groups of muscles develop before smaller groupsEye-hand coordinationIntellectual-cognitive developmentRecognition and understanding developAt 12 months ~ follows simple directionsThe Infant: One Month to One Year (cont.)Psycho-emotional developmentAddress physical needs quickly and calmlyPhysical contact and cuddling importantSocial DevelopmentOccurs quicklyIncreasing interaction with familyThe Infant: One Month to One Year (cont.)Aspects of careRegular checkups and immunizationProvide physical contactIntroduce solid foodsEnsure safetyThe Toddler: One to Three YearsPhysical developmentWeight gain slowsArms and legs lengthenBegins walkingToilet trained by three years of ageThe Toddler: One to Three Years (cont.)Intellectual-cognitive developmentLearn through playDevelop independenceSpeech progressesThe Toddler: One to Three Years (cont.)Psycho-emotional developmentGain control over expression of feelingsNeed consistent limitsBecome sensitive to feelings of others Social developmentProgress to sharing and playing with othersAdult guidance to learn appropriate behaviorThe Toddler: One to Three Years (cont.)Aspects of carePromote the development ofFine motor skillsLanguage skillsSet limits Provide a safe environmentThe Preschooler: Three to Five YearsGrowth rates varyRespiratory and heart rates slow downRequire adequate calcium intakeAchieve of nighttime continenceDevelop fine motor skillsThe Preschooler: Three to Five YearsIntellectual-cognitive developmentVocabulary at three years ~ 900 wordsVocabulary at five years > 2000 wordsPsycho-Emotional DevelopmentProgresses from pleasant to negative to self-assuredCapable of accepting some responsibility by five years oldThe Preschooler: Three to Five YearsSocial development – able to take turns and play with other childrenAspects of careDevelopmental assessment and physicalReceive appropriate immunizationsMaintain nighttime routinesThe Elementary School Child: Six to Ten YearsPhysical developmentGirls may be larger than boysMuscles continue to developNeed regular exerciseIntellectual-cognitive developmentAttention span increasesBetter able to separate fantasy from realityDevelop sense of right and wrongThe Elementary School Child: Six to Ten Years (cont.)Psycho-emotional developmentPeer influencesGender-related rolesSensitive to criticismSocial developmentAvoid overwhelming childOutdoor activities Appropriate social behaviors learnedThe Elementary School Child: Six to Ten Years (cont.)Aspects of careStructure and scheduleMonitor physical activitiesBe consistent in activities and disciplineRegular health and dental checksThe Middle School Child: Eleven to Thirteen YearsPhysical developmentOnset of puberty Girls – 12 to 13 years of ageBoys – around 14 years of ageSkin problems and acneIntellectual-Cognitive DevelopmentGrades may slipTend to exaggerate The Middle School Child: Eleven to Thirteen Years (cont.)Psycho-Emotional DevelopmentCrave independenceSexualityTemperamental Take on behaviors of peersSocial developmentRelationshipsNeed a trusted adult to talk toThe Middle School Child: Eleven to Thirteen Years (cont.)Aspects of careProvide assurance that the child is valued and lovedDiscipline consistentlyDo not be hypercriticalMonitor friendships and associationsDo not over schedule the child’s time.The Adolescent: Fourteen to Nineteen YearsPhysical developmentCentered on normal sexual changeMay develop unhealthy habits leading to health problems as an adultIntellectual-Cognitive DevelopmentDeveloping own valuesDo not always see the consequences of behaviorsThe Adolescent: Fourteen to Nineteen YearsPsycho-emotional developmentPressure of adolescence may lead to angry outburstsAnxiety and depression may be presentSocial developmentFriendships are importantProblems include eating disorders, substance abuse, STIs, suicide and violenceThe Adolescent: Fourteen to Nineteen YearsAspects of careTeens should know the risks of engaging in sexual activityNeed people toListen and give them the factsTrust them Provide discipline and consistencyEducate them to be independentSet good examplesApply Your KnowledgeWhat are the four developmental milestones that are part of each life stage from birth through the teen years?ANSWER: The developmental milestones for each stage are: Physical developmentIntellectual-cognitive developmentPsycho-emotional developmentSocial developmentVery Good!Pediatric ExaminationsDiscussions should be appropriate for the child's developmental stage Relieve fearExplain proceduresAllow child to examine instrumentsSpeak in terms appropriate to age levelInfants need seven well-baby examinations during their first year 2 weeks1 month2 months4 months Well Child Examination6 months9 months1 year Well Child Examination (cont.)Children in the second and third year 15 and 18 months24 and 30 monthsAnnually after 3 years oldPrepare for exam as you would for an adultFollow Standard Precautions Apply Your KnowledgeKris who is 2 yrs old is due for his well child exam. When you try to take his temperature he starts to cry and tries to hide behind his mother. What can you do to gain his cooperation?ANSWER: You could let him examine the thermometer while explaining what you will be doing. You might also take his mother’s temp so he can see it doesn’t hurt. Pediatric ImmunizationsProvide protection from infectious diseasesVaccination Weakened strain of a virusKilled virusToxoid ~ weaken toxinPediatric Immunizations (cont.)Medical assistant roleScheduling appointments based on immunization scheduleEducating parentsAdministering the vaccineKeeping careful immunization recordsEnsuring proper vaccine storage and handlingPediatric Immunizations (cont.)Immunization recommendations Informed consentExplain benefits and risksReview the Vaccine Information StatementAdministering immunizationsInjection or oralCheck for contraindicationsPediatric Immunizations (cont.)Immunization recordsRequire specific informationInstruct parents to maintain up-to-date recordsVaccine Storage and HandlingCorrect temperatureRotation of stockPreparation for administrationInfections control guidelinesApply Your KnowledgeANSWER: The medical assistant should be sure that vaccines are stored properly, administer vaccines correctly (if within scope of practice), maintain careful immunization records, educate parents, follow recommended immunization schedule for follow-up appointments.What are the responsibilities of the medical assistant relating to immunizations?Super!Pediatric Screening and Diagnostic TestsComparison to national averagesMedical assistant roleVital signs and measurementsVision and hearing testsCollecting specimensAdministration of medications and immunizationVital SignsTake temperature last – no oral temperature in children less than five years oldBlood pressureCuff sizeDo not use palpatory methodDocument where heartbeat becomes muffledBody MeasurementsDone at each office visitWeightLength or heightHead circumferenceGeneral Eye and Vision ExamGeneral eye and vision examPediatrician examines interior of the eyeVisual acuity testing General ear examTest a child in the same way as an adultInfant or toddler ~ check for response to soundsDiagnostic TestingThroat culturesRapid test for streptococcal bacteriaConfirm with throat cultureUrine specimensBlood specimensApply Your KnowledgeHow often are pediatric measurements taken?ANSWER: At each appointment.CORRECT!Pediatric Diseases and DisordersDo not make assumptions regarding diagnosis or treatmentDo not recommend aspirin for fever in childrenIf complaint includes a high fever, notify the physicianCommon Diseases and DisordersHead liceHerpes simplex virusImpetigoInfectious conjunctivitis PinwormsRingwormStreptococcal sore throatLess Common Diseases and DisordersConditionDescriptionAIDSMost cases are transmitted mother-to-child during pregnancy, labor, delivery, or breastfeeding. All babies born to HIV-positive mothers, test positive for HIV antibodies, but not all remain permanently infected.Juvenile rheumatoid arthritisAutoimmune disease of the joints; occurs in children 16 years or younger. Severity of the disease ranges from mild to severe and may affect the eyes and internal organs. The disease has periods of remission and flare-up.Less Common Diseases and DisordersConditionDescriptionADHD and Learning DisabilitiesADHD – all conditions identified as hyperactivity, hyperkinesis, and attention deficit.LD – a wide rand of conditions that interfere with learningCerebral palsyBirth-related disorder of nerves and muscles; caused by brain damage occurring before, during, or after birth or in early childhoodDiseases and Disorders (cont.)ConditionDescriptionCongenital heart diseaseCardiovascular malformations in the fetus before birth; causes include genetic mutations, maternal infections, maternal alcoholism, or maternal insulin-dependent diabetesDown syndromeGenetic disorder due to one extra chromosome in all cells formed during fetal development; characteristic facial featuresDiseases and Disorders (cont.)ConditionDescriptionHepatitis BInfection of liver; virus can be transmitted from the mother before or during birth; immunization availableRespiratory Syncytial Virus (RSV)Major cause of lower respiratory infections; highly contagious; difficult to treat; antibiotics only treat any secondary infectionsSudden Infant Death SyndromeUnexplained sudden death of an infant during sleep; usually occurs between 2 and 4months old; “back to sleep” Diseases and Disorders (cont.)ConditionDescriptionSpina bifidaDefect of spinal development occurring during the first trimester of pregnancy; the spinal cord is not fully protectedViral gastroenteritisInflammation of stomach and intestines; can cause dehydration and electrolyte imbalance due to fluid lossApply Your KnowledgeMatching: virus that causes cold sore blisters highly contagious dermatologic  disease an autoimmune disease of the  joints birth-related disorder of nerves and  muscles genetic disorder from one extra  chromosome cause of lower respiratory disease in infants and young childrenDown syndromeCerebral palsyRSVJRAImpetigo Herpes simplex virusANSWER:ABCDEFPediatric Patient Special ConcernsDetecting child abuse or neglectWatch for problems in relationship between child and parent/caregiverObserve for physical injuries and signs of neglectDocument and report to physicianPediatric Patient Special Concerns (cont.)Physician will examine forInternal injuriesMalnutritionLack of cognitive abilitySome risk factorsStress Financial problemsAbuse or neglect must be reported by lawPediatric Patient Special Concerns (cont.)Eating disordersAdolescents Anorexia nervosaBulimia nervosaDepression, substance abuse, and addictionDifficult to distinguishFamily should be aware if issuePediatric Patient Special Concerns (cont.)Violence SuicideBe aware of warning sidesAlways take suicide threats seriouslySTIs and birth control information available from SchoolsLocal health departmentsTV and the internetCDCApply Your KnowledgeANSWER: They are: Frequent physical fightingIncreased or serious use of drugs or alcoholIncrease in risk-taking behaviorGang membership or strong desire to be in a gangTrouble controlling feelings such as angerWithdrawal from friends and usual activitiesFeeling rejected or aloneHaving been a victim of bullyingFeeling constantly disrespectedFailing to acknowledge the feelings or rights of othersList the warning signs of potential violence?Superb!In Summary40.1 Growth and development occur in stages throughout life, including neonate, infant, toddler, preschooler, elementary school child, middle school child, and adolescent. Each stage of development occurs through physical, cognitive-intellectual, psycho-emotional, and social milestones. 40.2 The medical assistant must be able to communicate with pediatric patients of all stages, gather and provide educational information to the parent or caregiver, assist with diagnostic and screening procedures, and serve as a liaison between the patient and the physician.In Summary40.3 Immunizations provide patients with protection from infectious diseases. The medical assistant may schedule appointments, provide education, obtain informed consent, administer the medication, maintain the immunization record, and properly handle and store the immunizations.40.4 Screening procedures and diagnostic tests for pediatric patients vary depending upon the age and size of the child. When performing procedures and diagnostic tests, follow the specific guidelines for the procedure and child. In Summary40.5 Some childhood diseases include chickenpox, influenza, measles, mumps, rubella, scarlet fever, and tetanus. Other diseases are outlined in Table 40-2.40.6 The medical assistant should be alert to signs of special health concerns of pediatric patients, including child abuse and neglect, eating disorders, depression, substance abuse and addiction, violence, suicide, and sexually transmitted infections.The End of Chapter 40There are only two things a child will share willingly: communicable disease and his mother’s age.- Benjamin Spock