This study guide is designed to support your preparation for the midterm examination in the Primary Care of the Childbearing Family course. It covers essential topics, organized by weeks and chapters, with a focus on the most critical concepts and clinical guidelines you need to know.
Week 1 – Chapter 14: Introduction to Health Promotion and Health Protection
Key Topics:
- Nurse Practitioner Roles
- Pediatric Nurse Practitioner (PNP): Focuses on health promotion, protection, and disease prevention in children.
- Primary Care Nurse Practitioner (PCNP): Manages well-child care, prevention, and common pediatric acute illnesses.
- Acute Care Nurse Practitioner (ACNP): Specializes in caring for acutely, chronically, or critically ill children, including those who are medically fragile or tech-dependent.
Levels of Prevention:
- Primary Prevention: Aims to prevent diseases from being established. It involves health promotion (e.g., lifestyle changes, nutrition) and specific protection (e.g., immunizations, environmental modifications).
- Secondary Prevention: Focuses on early diagnosis and prompt treatment to interrupt the disease process, often through screening and early detection.
- Tertiary Prevention: Involves specialized care and equipment to improve survival and quality of life. It includes disability limitation and rehabilitation.
- Quaternary Care: Requires highly specialized expertise and equipment for rare and complex conditions.
Week 1 – Chapter 20: Sleep
Sleep in Pediatric Patients:Sleep is vital for a child’s physical and mental development. Common sleep disorders include insomnia, sleep apnea, parasomnias, restless legs syndrome (RLS), and narcolepsy. Management involves behavioral interventions, pharmacotherapy, and sometimes surgical options, tailored to the specific disorder.
Week 1 – Chapter 22: Immunizations
Immunization Guidelines:
- Barriers to Vaccination: Include concerns about safety, autism, immune overload, and lack of perceived risk. Effective communication and education are key to addressing these barriers.
- Live Vaccines: Should not be administered before 1 year of age or to pregnant women. Examples include the MMR (Measles, Mumps, Rubella) and Varicella vaccines.
- Killed (Inactivated) Vaccines: Provide systemic protection but may not prevent local infections. Common examples include DTaP, polio, and hepatitis vaccines.
Week 1 – Chapter 44: Common Pediatric Injuries and Toxic Exposures
Pediatric Injuries:
- Abrasions: Superficial injuries often managed at home unless severe. Proper wound cleansing and care are essential.
- Puncture Wounds: May require radiographic evaluation if a foreign object is suspected. Antibiotic prophylaxis is necessary for high-risk wounds.
- Bites and Stings: Require immediate care, including wound cleansing, antibiotic administration, and possibly tetanus prophylaxis.
Toxic Exposures:
- Prevention Strategies: Include safe storage of medications, chemicals, and household items. Educate families on the risks of poisoning, especially in children under 6 years old.
Week 2 – Chapters 9-13, 21, 32, 45
Newborn Assessment:
- APGAR Score: Assesses a newborn’s health at 1 and 5 minutes after birth, focusing on Activity, Pulse, Grimace, Appearance, and Respiration.
- Physical Examination: Includes vital signs, skin assessment, head circumference, and screenings for congenital conditions. Proper newborn nutrition and growth monitoring are crucial.
Well-Child Visits:
- Regular check-ups at specific intervals (2 weeks, 2 months, 4 months, etc.) ensure ongoing health and development. Key aspects include screening for social determinants of health, immunizations, and developmental milestones.
Developmental Milestones:
- By Two Months: Infants begin to follow movement and react to sound.
- By Six Months: They start babbling, may roll over, and sit with support.
- By One Year: They can stand, take steps, and follow one-step commands.
Pediatric Physical Examination:
- Comprehensive Exam: A thorough head-to-toe assessment is essential, including growth measurement, immunization status, and anticipatory guidance.
- Sports Physicals: Focus on identifying conditions that may impact a child’s ability to participate in sports safely. The history and physical assessment target cardiovascular, neurological, and orthopedic health.
Pediatric Assessment – Health History:
- Social and Family History: Includes details about the child’s living environment, family dynamics, and any risk factors like smoking or low socioeconomic status.
- Eye and Hearing Screening: Recommended at specific ages to detect early vision or hearing problems that could impact development.
HEADSS Assessment:
- A psychosocial assessment tool used for adolescents, covering Home, Education, Activities, Drugs, Sexuality, Suicide/Depression, and Safety.
Growth and Development – Age Groups:
Infants (Birth to 1 Year):
- Physical Development: Rapid growth, with birth weight tripling and height increasing by 50% by one year.
- Cognitive Development: By six months, infants start babbling; by nine months, they recognize their name.
Toddlers (1 to 4 Years):
- Physical Development: Steady growth with improved motor skills, from walking to running and climbing.
- Cognitive Development: Language development progresses, with toddlers speaking in sentences by age two.
Children (5 to 10 Years):
- Physical Development: Growth continues at a steady pace, with enhanced strength and coordination.
- Cognitive Development: Children become more logical and capable of complex learning.
Adolescents (11 Years to Adult):
- Physical Development: Puberty brings significant changes, with variations in the age of onset.
- Cognitive Development: Adolescents develop the ability to think abstractly and consider future consequences.
Adolescent Sexuality, Gender Identity, and Gender Expression:
- Gender Identity: Typically established by age 5 to 7. It involves an internal sense of being male, female, or another gender.
- Gender Expression: Outward expression of gender, which may not align with sex assigned at birth. Supportive environments are crucial for LGBTQ+ youth.
Endocrine/Metabolic Disorders:
- Common Disorders: Include adrenal insufficiency and hypothyroidism. Early signs may include deviations from normal growth patterns or specific physical findings.
- Adolescent Sexuality: Providers must build trust with adolescents to discuss sensitive topics like sexual orientation and gender identity confidentially.
Genetic Testing and Counseling:
- Fetal Alcohol Spectrum Disorder (FASD): Preventable but can cause a range of physical and cognitive impairments. Early diagnosis and intervention are crucial.
Down Syndrome:
- Common Features: Include brachycephaly, midface hypoplasia, and congenital heart defects. Ongoing screening and care are necessary to manage associated health issues.
Week 3 – Chapters 31, 33-37
Infectious Diseases:
- Fever: A common reason for pediatric visits. Immediate evaluation is required for high-risk patients, including infants under three months or those with severe symptoms.
- GI Disorders: Include enteroviruses and poliomyelitis. These viral infections require supportive care and preventive measures like vaccination.
Dermatologic Disorders:
- Contact Dermatitis: A hypersensitive reaction to various substances, managed with appropriate skin care and avoidance of triggers.
- Seborrheic Dermatitis: Common in infants (cradle cap) and adolescents (dandruff). Treatment includes antifungal agents and topical steroids.
- Pityriasis Rosea: A benign, self-limited skin condition with a characteristic “Christmas tree” pattern. It typically resolves within 6 to 12 weeks.