Assisting in Pediatrics

Assisting in Pediatrics
40 Assisting in Pediatrics

Learning 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.

Introduction Pediatrics Pediatrician Medical Assistant Specialty
Healthcare of children Pediatrician Monitors development Diagnose and treat Medical Assistant Parent education Adhering to immunization schedules Recognizing special health concerns Liaison between parent and physician Learning Outcome: Identify the role of the medical assistant during pediatric examinations. Pediatrics is a specialty area of medicine that involves the care of children up to the age of 18, and in some cases 21. The pediatrician specializes in the healthcare of children, monitoring their development and diagnosing and treating their illnesses. There are also subspecialties in pediatrics You must like children of all ages to be able to relate to them and to communicate with them effectively. Medical assistant’s primary areas of responsibility include: Parent or caregiver education Adherence to immunization schedules Recognizing special health concerns Assisting with the pediatric patient’s physical exam and treatment.

Developmental Stages and Care
Developmental milestones for each stage Physical development Intellectual-cognitive development Psycho-emotional development Social development Learning Outcome: Relate growth and development to pediatric patient care. Understanding the child's stages of growth and development will improve your skills. Physical development – the bodily changes that occur. Intellectual-cognitive development – thinking skills the child is developing. Psycho-emotional development – changes in feelings experienced during a particular period. Social development – how a person relates to others. As you explore each stage, you will also review the related aspects of care to help you provide the necessary care and patient education.

Neonate Birth to one month Physical development Umbilical cord Head
Jaundice Yellowish color Bilirubin Reflexes Vision and hearing Birth to one month Physical development Head ¼ the length Fontanels Skin Loose, wrinkled, red Peels during 1st week Learning Outcome: Relate growth and development to pediatric patient care. The full-term infant usually weighs between 7 and 9 pounds and is 18 to 22 inches in length. Fontanels – soft spots of tough cartilage. The baby’s pulse can sometimes be seen at the fontanels. The baby is unable to hold up his head – must be supported. Part of the umbilical cord still attached and usually falls off around the tenth day of life. Neonatal jaundice – a yellowish color of the skin in the first few days of life. This is caused by an accumulation of bilirubin. Babies have large numbers of red blood cells at birth. Their immature liver is unable to handle the breakdown of these cells. Reflexes can be observed in the newborn. Some are protective and others are due to the infant’s immature nervous system. Infants can see objects within eight inches of their eyes. They probably detect brightness rather than color. Their eyes tend to turn outward or may even cross. Infants seem to prefer high-pitched tones.

Neonate (cont.) Intellectual-cognitive development Social development
Responds to stimulation Establishes an activity pattern Responds to a soft, gentle voice Tries to focus on voice and face Can show excitement and distress Learning Outcome: Relate growth and development to pediatric patient care. Intellectual-Cognitive Development. Become calm when picked up and held firmly. Tune out disturbing stimulation by sleeping.

Neonate (cont.) Aspects of care Jaundice treatment Hygiene
Tepid sponge baths Avoid oil, lotions, and powders Feeding instructions Jaundice treatment Hydration Ultraviolet light or bili-blanket Blood tests Learning Outcome: Relate growth and development to pediatric patient care. Sponge baths with tepid water and limited amounts of mild infant cleansing soap are given until the cord has fallen off. Breastfeeding – parents are given instruction about frequency of feedings, duration of feedings, and care of the mother and her breasts. Bottle-feeding – parents must be given instruction about the type of formula and how to prepare it correctly. Parents should be taught about bowel movements and spitting up. The treatment for jaundice in the newborn is keeping the infant well hydrated with breast milk or formula. With treatment by ultraviolet light, make sure that the infant’s eyes are protected. May be treated using a bili-blanket. Blood tests are done to ensure that the bilirubin level does not become dangerously high.

The Infant: One Month to One Year (cont.)
Physical development Rapid growth Develops head to foot Larger groups of muscles develop before smaller groups Eye-hand coordination Intellectual-cognitive development Recognition and understanding develop At 12 months ~ follows simple directions Learning Outcome: Relate growth and development to pediatric patient care. Physical Development Infants triple their birth weight by their first birthday. They develop in a cephalocaudal fashion with the earliest development starting at the head and moving down. Infants first gain control of the head, neck, and shoulders, and then the arms, torso, and legs. Changes are seen in reflexes and in the development of coordinated movement and eye-hand coordination. See text for specific types of physical development in infants. Intellectual-Cognitive Development At one month of age, an infant can make contact which progresses to recognition of familiar faces and then to “making faces” at four to five months. Around six months of age, the child is making babbling sounds and by nine months is able to play games like peek-a-boo. The infant begins to understand cause and effect. At 12 months, an infant can follow simple directions.

Psycho-emotional development Address physical needs quickly and calmly Physical contact and cuddling important Social Development Occurs quickly Increasing interaction with family Learning Outcome: Relate growth and development to pediatric patient care. Psycho-Emotional Development By three months, the infant smiles spontaneously and displays pleasure in making sounds. At four months, the infant can vocalize a mood and, at six months, there may be abrupt mood changes. At nine months, the infant displays pleasure in playing simple games, and by one year has learned to express many emotions. Physical contact and cuddling helps infants develop a sense of security and trust. Social Development By one month of age, infants are able to smile. At three months, the infant responds to voices. At six months, the baby “babbles” and is interested in his or her own voice. Imitative play becomes an important part of the infant’s interaction with others. At nine months, the first development of words can be observed. This leads to increased interaction with family and others.

Aspects of care Regular checkups and immunization Provide physical contact Introduce solid foods Ensure safety Learning Outcome: Relate growth and development to pediatric patient care. Regular health checkups and immunizations should be followed Infants need tactile stimulation for growth and development. Physical contact and cuddling and prompt attention to their needs help infants develop a sense of security and trust, which is necessary for them to thrive. In the first six months, the mother’s breast milk or infant formula meets the growing infant’s needs. The physician, with your assistance, will provide guidance about the introduction of solid foods to the diet. Ensure infant safety. See the Patient Education feature Keeping Infants and Toddlers Safe.

The Toddler: One to Three Years
Physical development Weight gain slows Arms and legs lengthen Begins walking Toilet trained by three years of age Learning Outcome: Relate growth and development to pediatric patient care. Children from the age of one to three years need constant attention. Weight gain slows and the arms and legs grow more than the trunk and head, and now seem to be in proportion to the child’s overall size. Growth charts are used to determine a child’s growth in relation to average rates. Refer to Procedure 40-2 Maintaining Growth Charts for documenting growth. Most toddlers will walk independently by 15 months of age. At 18 months, a toddler can squat, kneel and remain upright, and precisely perform the pincer grasp and may use a spoon for self-feeding. By two years of age, the child can run, throw a ball, and scribble with a pencil. At three years, the child is very active. Children of this age can dress themselves, ride a tricycle, throw a ball, draw simple shapes, and use a pair of child’s scissors. Many children are toilet-trained between two and three years of age.

The Toddler: One to Three Years (cont.)
Intellectual-cognitive development Learn through play Develop independence Speech progresses Learning Outcome: Relate growth and development to pediatric patient care. Intellectual-Cognitive Development Children enjoy imitating sweeping, raking, and making things Toddlers are curious about their world, and play may involve experimenting. Progresses with speech Speaks a few single words at 12 to 15 months. Makes sentences containing six to 20 words at two years. Repeats nursery rhymes at three years.

Psycho-emotional development Gain control over expression of feelings Need consistent limits Become sensitive to feelings of others Social development Progress to sharing and playing with others Adult guidance to learn appropriate behavior Learning Outcome: Relate growth and development to pediatric patient care. Psycho-Emotional Development They gain some control over ways of expressing their feelings. A child of 15 months may respond to “No,” but by the time the toddler approaches 18 to 21 months, he or she is resisting authority and is the one who is saying “No!” As toddlers approach three years of age, they become sensitive to the feelings of others and may be characterized as affectionate. Social Development Between one and two years, the toddler is unlikely to be able to play with another child. Between two and three years, children become able to share and play with others. Adult guidance is necessary for the toddler to develop an awareness of appropriate behavior when playing with other children.

Aspects of care Promote the development of Fine motor skills Language skills Set limits Provide a safe environment Learning Outcome: Relate growth and development to pediatric patient care. Allow a child to increase independence in a safe environment. Toddlers need opportunities to work on their fine motor skills. Toddlers are developing their language skills, so simple explanations provide a positive environment for development. Setting limits helps the child to develop boundaries in relationships and behavior. At the same time, the environment should not be one in which the child is constantly told “No.” Refer to the Patient Education feature Keeping Infants and Toddlers Safe.

The Preschooler: Three to Five Years
Growth rates vary Respiratory and heart rates slow down Require adequate calcium intake Achieve of nighttime continence Develop fine motor skills Learning Outcome: Relate growth and development to pediatric patient care. The child of three to five years is preparing to go out into the world. Physical Development It is best not to compare the preschooler’s size to that of another preschooler. Each child’s growth should be monitored and compared to the size documented on his or her ongoing growth chart. The respiratory rate and the heart rate begin to slow down, coming closer to the adult range. Children should be active in their play and need adequate calcium intake for the development of strong bones. Most children will have achieved nighttime bowel and bladder control by the time they are three or four years of age. If lack of bowel and/or bladder control persists beyond four or five years, this should be brought to the physician’s attention. Many skills are achieved, including going up and down stairs using an alternating step approach, riding a tricycle, skipping, hopping on one foot, and throwing a ball. Girls are usually about a year ahead of boys in small muscle coordination and fine motor skills.

Intellectual-cognitive development Vocabulary at three years ~ 900 words Vocabulary at five years > 2000 words Psycho-Emotional Development Progresses from pleasant to negative to self-assured Capable of accepting some responsibility by five years old Learning Outcome: Relate growth and development to pediatric patient care. Intellectual-Cognitive Development Language grows by quickly. The imaginative child of three years forms simple sentences, and can tell simple stories that may be very “I”-oriented. At four years of age, sentences are complete, and the favorite question is “Why?” At age five, the stories the child tells involve more detail. At this age, the child has learned the difference between telling stories and lying. Psycho-Emotional Development The three-year-old child is very easy and pleasant and has an increasing sense of self. Imagination may lead the child to have unfounded worries and fears, especially at night. At four years of age, negativity may increase. The child is testing limits and needs guided opportunities for freedom. At five years the child is more self-assured, well-adjusted, and home-centered. At this age, the child likes to follow the rules, may want to “play by the rules,” and is capable of accepting some responsibility.

Social development – able to take turns and play with other children Aspects of care Developmental assessment and physical Receive appropriate immunizations Maintain nighttime routines Learning Outcome: Relate growth and development to pediatric patient care. Social Development Three-year-old children know their gender. They know how to take turns and may enjoy brief activities in a group with other children. They like to “help.” Four-year-old children are very social and enjoy playing simple group games, like tag and hide-and-seek. At five years, the child continues to be very social, enjoys playing with other children, and likes games in which the “rules” are observed. Aspects of Care The child of five years should receive a complete preschool developmental assessment and physical including an evaluation of hearing and vision. Immunizations must be up to date when the child enters kindergarten. Children of about three years may have night terrors. Parents should discuss these with the pediatrician if they are severe or persistent. Children may use delaying tactics at bedtime and may need to be shown repeatedly that there is nothing in the closet or under the bed. A night-light is useful. Nighttime routines are important in helping a child feel secure.

The Elementary School Child: Six to Ten Years
Physical development Girls may be larger than boys Muscles continue to develop Need regular exercise Intellectual-cognitive development Attention span increases Better able to separate fantasy from reality Develop sense of right and wrong Learning Outcome: Relate growth and development to pediatric patient care. Physical Development Girls may be taller and heavier than boys. Bones continue to ossify. Permanent teeth replace “baby teeth.” Muscles continue to develop. Regular exercise is needed to encourage strength and coordination. At nine and ten years of age, the reproductive system will also be developing. Intellectual-Cognitive Development The six-year-old child has a brief attention span. By ten years old, she or he is able to focus for longer periods of time. Most children of this age like to talk. As children move from five or six years of age toward nine and ten years, they are better able to separate fantasy from reality. They develop a sense of what is right and wrong, of honesty and fairness.

The Elementary School Child: Six to Ten Years (cont.)
Psycho-emotional development Peer influences Gender-related roles Sensitive to criticism Social development Avoid overwhelming child Outdoor activities Appropriate social behaviors learned Learning Outcome: Relate growth and development to pediatric patient care. Psycho-Emotional Development They may be more influenced by their peers than by their parents. Children are beginning to develop a sense of self and also learn gender-related roles School-age children may be very sensitive to criticism and to what they see as failure. Social Development Avoid allowing the child to become overwhelmed with too many organized activities at this time Outdoor activities help to use up some of the child’s energy Appropriate social behaviors are learned during this stage.

The Elementary School Child: Six to Ten Years (cont.)
Aspects of care Structure and schedule Monitor physical activities Be consistent in activities and discipline Regular health and dental checks Learning Outcome: Relate growth and development to pediatric patient care. Structure and a schedule help to maintain order and discipline. Monitor physical activities to prevent injury. The American Academy of Pediatrics advises against elementary school-age children participating in contact sports. Consistency in daily activities and in discipline help the child to develop intellectually, emotionally, and socially. Regular health and dental care and maintenance of immunizations are required. Communicable diseases are common.

The Middle School Child: Eleven to Thirteen Years
Physical development Onset of puberty Girls – 12 to 13 years of age Boys – around 14 years of age Skin problems and acne Intellectual-Cognitive Development Grades may slip Tend to exaggerate Learning Outcome: Relate growth and development to pediatric patient care. Physical Development Puberty – the physiological changes that make a person capable of sexual reproduction. By the time a girl reaches middle school, a significant occurrence may be the onset of menstruation (menarche). It is important for everyone to remember that even though her body may be maturing, she is still only between 9 and 12 years old Hormonal changes may contribute to development of skin problems and acne. Intellectual-Cognitive Development Physical growth is taking place and so many physiological changes are occurring that less energy is available to concentrate on academics. Preadolescents may tend to exaggerate and “bend the truth.”

The Middle School Child: Eleven to Thirteen Years (cont.)
Psycho-Emotional Development Crave independence Sexuality Temperamental Take on behaviors of peers Social development Relationships Need a trusted adult to talk to Learning Outcome: Relate growth and development to pediatric patient care. Psycho-Emotional Development Although preadolescents crave independence, they are also very unsure of themselves. They are experiencing a wide range of physical changes and are learning the roles of sexuality. Preadolescents must receive accurate information about their changing bodies and feelings. Parents may find that the preadolescent is easily annoyed and temperamental. The preadolescent child will often take on the behaviors of his or her peer group. Social Development. Girls express an earlier interest in male-female relationships than do boys. Children of this age need to be able to turn to an adult with whom they are comfortable, so they can ask personal and intimate questions.

The Middle School Child: Eleven to Thirteen Years (cont.)
Aspects of care Provide assurance that the child is valued and loved Discipline consistently Do not be hypercritical Monitor friendships and associations Do not over schedule the child’s time. Learning Outcome: Relate growth and development to pediatric patient care. Consistency in discipline is very important. Parents should not be hypercritical or make too many demands.

The Adolescent: Fourteen to Nineteen Years
Physical development Centered on normal sexual change May develop unhealthy habits leading to health problems as an adult Intellectual-Cognitive Development Developing own values Do not always see the consequences of behaviors Learning Outcome: Relate growth and development to pediatric patient care. Tremendous physiological changes may cause internal conflicts that can turn into external clashes. The process of developing independence, a personal identity, and future plans is important during this stage. Physical Development Females attain their adult height and weight while males may continue to grow in height until 25 years of age. Physical growth and development in the teenage years are centered on normal sexual change. Weight control can be a concern. Some health problems of adulthood can be traced back to lifelong habits of poor dietary choices and lack of exercise begun in adolescence. Intellectual-Cognitive Development The teen asks questions and needs to work out answers that fit into his or her values. Adolescents often do not see the connection between behavior and consequences.

Psycho-emotional development Pressure of adolescence may lead to angry outbursts Anxiety and depression may be present Social development Friendships are important Problems include eating disorders, substance abuse, STIs, suicide and violence Learning Outcome: Relate growth and development to pediatric patient care. Psycho-Emotional Development An adolescent knows the socially acceptable and appropriate ways to express feelings. Anger that is directed inward can be harmful. Social Development Teens become more comfortable with their parents and outgrow the attitude of “not wanting to be seen dead” with their parents. Teen years are wonderful and difficult at the same time.

Aspects of care Teens should know the risks of engaging in sexual activity Need people to Listen and give them the facts Trust them Provide discipline and consistency Educate them to be independent Set good examples Learning Outcome: Relate growth and development to pediatric patient care. Teens need adequate amounts of calcium and weight-bearing exercise for strong bone development. Teens should know the risks of early, unplanned pregnancy and sexually transmitted infections when engaging in sexual activity. The adolescent needs to spend time enjoying friendships, sporting events, and social events. People who are caring for teens should: Listen Give them the facts Trust them Provide them with firm and friendly discipline Be consistent Educate them with their independence in mind Set limits and stick to them Set examples of good behavior and good taste Remember how it feels to be an adolescent

Apply Your Knowledge What 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 development Intellectual-cognitive development Psycho-emotional development Social development Learning Outcome: Relate growth and development to pediatric patient care. Very Good!

Pediatric Examinations
Discussions should be appropriate for the child's developmental stage Relieve fear Explain procedures Allow child to examine instruments Speak in terms appropriate to age level Learning Outcome: Identify the role of the medical assistant during pediatric examinations. You may discuss with the parent, caregiver, or child topics such as eating habits, sleep patterns, daily activities, immunization schedules, and toilet training. Discussions should be appropriate for the child's developmental stage. This discussion will provide important clues to possible abnormal physical, cognitive-intellectual, psycho-emotional, and social development. You can help relieve a child’s fear by calmly explaining procedures before they occur, giving the reason for each procedure, and being cheerful and mindful of a child’s feelings. Allowing a child to examine some of the blunt instruments may also lessen fear. Treat the child with respect and provide positive reinforcement when a child is cooperative. Adolescents and preadolescents often feel awkward and self-conscious about being examined. They may also prefer to dress alone and to be alone with the doctor.

Well Child Examination
Infants need seven well-baby examinations during their first year 2 weeks 1 month 2 months 4 months 6 months 9 months 1 year Learning Outcome: Identify the role of the medical assistant during pediatric examinations.

Well Child Examination (cont.)
Children in the second and third year 15 and 18 months 24 and 30 months Annually after 3 years old Prepare for exam as you would for an adult Follow Standard Precautions Learning Outcome: Identify the role of the medical assistant during pediatric examinations. Infants and toddlers Ask parent to remove all clothing except diaper, then cover child until physician arrives. If child cries during exam, encourage parent to allow pacifier to quiet the child Do not allow feeding during exam; stomach sounds interfere with clear auscultation. Refer to Table 40-1 Recommendations for Preventive Pediatric Healthcare and the Points on Practice feature Assisting with an Exam for an Infant or Child

Excellent! Apply Your Knowledge
Kris 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. Learning Outcome: Identify the role of the medical assistant during pediatric examinations. Excellent!

Pediatric Immunizations
Provide protection from infectious diseases Vaccination Weakened strain of a virus Killed virus Toxoid ~ weaken toxin Learning Outcome: Discuss pediatric immunizations and the role of the medical assistant. Immunizations The administration of a vaccine or a toxoid (a weakened toxin) to protect susceptible individuals from infectious diseases. Reduce the susceptibility of the host to infection. When vaccinated with a weakened strain of a virus, the patient’s lymphocytes manufacture antibodies that remain in the body and make it immune to that virus in the future. Killed-virus vaccines, which are used to immunize against influenza, do not provide protection for as long a period as live-virus vaccines. Toxoids are used to produce active immunity against diseases such as tetanus and diphtheria.

Pediatric Immunizations (cont.)
Medical assistant role Scheduling appointments based on immunization schedule Educating parents Administering the vaccine Keeping careful immunization records Ensuring proper vaccine storage and handling Learning Outcome: Discuss pediatric immunizations and the role of the medical assistant. Immunizations are usually given during regular check-ups and include hepatitis B, diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella, chickenpox, and Haemophilus influenzae type B vaccinations. Many vaccines have largely eliminated the threat of once-prevalent, life-threatening diseases. The medical assistant role includes Scheduling appointments and follow-up visits at the appropriate time based on the immunization schedule. Educating parents about the benefits and risks of vaccines and obtaining informed consent. Administering the vaccine correctly. Keeping careful immunization records, including the vaccine type, the date of vaccination, and the vaccine lot number. Ensuring proper vaccine storage and handling, including checking the temperature of the refrigerator and freezer daily.

Immunization recommendations Informed consent Explain benefits and risks Review the Vaccine Information Statement Administering immunizations Injection or oral Check for contraindications Learning Outcome: Discuss pediatric immunizations and the role of the medical assistant. Immunization recommendations Check published immunization schedules for children New guidelines, methods, and vaccines are constantly being developed. Refer to Figure for the birth to age 6 and the age 7-18 immunization schedules. Informed Consent Explain that the side effects of immunizations are usually mild and of short duration. Review with the parent the Vaccine Information Statement. Advise parents that the benefits of immunity greatly outweigh the risks. Obtain informed consent for the child’s immunization. Administering Immunizations In many states, medical assistants may administer immunizations. Most immunizations are given as injections. Some are given orally. The physician will make the decision to vaccinate a child who is ill. Check for any contraindications.

Immunization records Require specific information Instruct parents to maintain up-to-date records Vaccine Storage and Handling Correct temperature Rotation of stock Preparation for administration Infections control guidelines Learning Outcome: Discuss pediatric immunizations and the role of the medical assistant. Immunization Records The National Childhood Vaccine Injury Act of 1988 requires documentation of The vaccine’s type, manufacturer, and lot number The date of administration The name, address, and title of the healthcare professional who administered the vaccine The administration site and route The vaccine’s expiration date Instruct the parents to keep the form and bring it with the child for each subsequent immunization so that you can update the record. Vaccine Storage and Handling Store vaccines at the recommended temperatures. Rotate the supply of vaccines. Prepare vaccines just prior to administration to the patient. Follow infection control guidelines when preparing and administering vaccines.

Super! Apply Your Knowledge
What are the responsibilities of the medical assistant relating to immunizations? ANSWER: 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. Super!

Pediatric Screening and Diagnostic Tests
Comparison to national averages Medical assistant role Vital signs and measurements Vision and hearing tests Collecting specimens Administration of medications and immunization Learning Outcome: Explain variations of pediatric screening procedures and diagnostic tests. Physicians look for signs that the child is in the appropriate stage of growth for her age by comparing a child’s physical, cognitive-intellectual, psycho-emotional, and social signs to charts showing national averages. Medical assistant’s role is similar to that during adult patient exams.

Vital Signs Take temperature last – no oral temperature in children less than five years old Blood pressure Cuff size Do not use palpatory method Document where heartbeat becomes muffled Learning Outcome: Explain variations of pediatric screening procedures and diagnostic tests. Refer to Table 37-1 Normal Ranges for Vital Signs. Some variations in technique and results for pediatric vital signs. Measure pulse, respiration, and blood pressure (if ordered) before you take the temperature to avoid elevations due to agitation. For children younger than 5 years of age, take axillary, rectal, tympanic, or temporal temperatures. Blood pressure in children or infants is not routinely measured at each visit. Use the correct cuff size Do not attempt to estimate an infant's blood pressure using the palpatory method Note when the strong heartbeat becomes muffled.

Body Measurements Done at each office visit Weight Length or height
Head circumference Learning Outcome: Explain variations of pediatric screening procedures and diagnostic tests. Children and infants are weighed and measured at each office visit. Measurements include The height of children and the length of infants. The circumference of an infant's head – an important measure of growth and development Refer to Procedure 40-1 Measuring Infants and the chapter Vital Signs and Measurements

General Eye and Vision Exam
Pediatrician examines interior of the eye Visual acuity testing General ear exam Test a child in the same way as an adult Infant or toddler ~ check for response to sounds Learning Outcome: Explain variations of pediatric screening procedures and diagnostic tests. General Eye and Vision Exam The pediatrician examines the interior of the child’s eyes with an ophthalmoscope. If the caregiver brought the child in specifically for a vision test, record in the child’s chart whatever symptoms the caregiver mentions. Follow the procedure in Assisting With Eye and Ear Care and use modifications listed when performing vision screening on a pediatric patient. General Ear and Hearing Exam Fluid collects more easily in a child’s Eustachian tubes and can promote bacterial growth Children are more susceptible to ear infections For children use the procedure found in Assisting in Eye and Ear Care. When performing a hearing test on an infant or toddler follow steps listed in text.

Diagnostic Testing Throat cultures Urine specimens Blood specimens
Rapid test for streptococcal bacteria Confirm with throat culture Urine specimens Blood specimens Learning Outcome: Explain variations of pediatric screening procedures and diagnostic tests. The pediatrician basically uses the same laboratory tests and radiologic tests as for adults. Throat Culture Perform a rapid test for the presence of streptococcal bacteria To confirm a negative test result, physicians may also do a throat culture. Refer to Procedure 46-1 Obtaining a Throat Culture Specimen Pediatric Urine Specimen Involve the child (if age-appropriate) and the parents or guardians. Ask questions listed in text. When you collect a urine specimen from a child who is toilet-trained, follow the same procedures as for an adult. If the child is an infant or not toilet-trained, refer to Procedure 40-3 Collecting a Urine Specimen from a Pediatric Patient Blood Drawing Procedures and Children Refer to the chapter Processing and Testing Blood Specimens Your primary concern when working with infants is to complete tests accurately. When working with children, address them directly. A parent, guardian, or coworker should hold a very young child during a venipuncture or dermal puncture to prevent the child from moving.

Apply Your Knowledge How often are pediatric measurements taken?
ANSWER: At each appointment. Learning Outcome: Explain variations of pediatric screening procedures and diagnostic tests. CORRECT!

Pediatric Diseases and Disorders
Do not make assumptions regarding diagnosis or treatment Do not recommend aspirin for fever in children If complaint includes a high fever, notify the physician Learning Outcome: Describe common pediatric diseases and disorders and their treatment. Many common disorders found in children are not specific diseases. Upper respiratory infections occur frequently among children. Any number of conditions could be the cause of a child’s symptoms. Encourage the parent to bring the child to the office. Do not recommend aspirin use in children, It is associated with Reye syndrome, a potentially fatal disease of the central nervous system (CNS) and liver.

Common Diseases and Disorders
Head lice Herpes simplex virus Impetigo Infectious conjunctivitis Pinworms Ringworm Streptococcal sore throat Learning Outcome: Describe common pediatric diseases and disorders and their treatment. Refer to Table 40-2 Common Pediatric Diseases and Disorders.

Less Common Diseases and Disorders
Condition Description AIDS Most 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 arthritis Autoimmune 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. Learning Outcome: Describe common pediatric diseases and disorders and their treatment. Juvenile Rheumatoid Arthritis As a medical assistant, your role in caring for children with JRA includes emphasizing the value of exercise and physical therapy, stressing the importance of taking medications as directed, and offering assistance by providing patient education brochures and information regarding local support groups and organizations.

Less Common Diseases and Disorders
Condition Description ADHD and Learning Disabilities ADHD – all conditions identified as hyperactivity, hyperkinesis, and attention deficit. LD – a wide rand of conditions that interfere with learning Cerebral palsy Birth-related disorder of nerves and muscles; caused by brain damage occurring before, during, or after birth or in early childhood Learning Outcome: Describe common pediatric diseases and disorders and their treatment. Attention Deficit Hyperactivity Disorder and Learning Disabilities. These disorders can cause gross motor disability, inability to read or write, hyperactivity, distractibility, impulsiveness, and generally disruptive behavior. ADHD – difficult to diagnose correctly Learning disorders: Dyslexia – reading problems Dysgraphia – writing problems Dyscalculia – math problems Cerebral Palsy Spastic cerebral palsy is the most common form and characterized by hyperactive tendon reflexes, rapid alteration between muscular contraction and relaxation, permanent muscle shortening, and underdevelopment of extremities. There is no known cure, but the effects of the disorder can be alleviated with physical therapy, speech therapy, orthopedic surgery, splints, skeletal muscle relaxants, and anticonvulsant medication.

Diseases and Disorders (cont.)
Condition Description Congenital heart disease Cardiovascular malformations in the fetus before birth; causes include genetic mutations, maternal infections, maternal alcoholism, or maternal insulin-dependent diabetes Down syndrome Genetic disorder due to one extra chromosome in all cells formed during fetal development; characteristic facial features Learning Outcome: Describe common pediatric diseases and disorders and their treatment. Congenital Heart Disease – blue lips and fingernails, signs of cyanosis in a newborn, are obvious indications of a cardiac defect. Down Syndrome The most common chromosomal abnormality in humans. Estimated risk for a down syndrome birth increases as maternal age increases.

Condition Description Hepatitis B Infection of liver; virus can be transmitted from the mother before or during birth; immunization available Respiratory Syncytial Virus (RSV) Major cause of lower respiratory infections; highly contagious; difficult to treat; antibiotics only treat any secondary infections Sudden Infant Death Syndrome Unexplained sudden death of an infant during sleep; usually occurs between 2 and 4months old; “back to sleep” Learning Outcome: Describe common pediatric diseases and disorders and their treatment. SIDS: Sudden infant death syndrome; to help prevent: Obtain good prenatal care Do not smoke, drink, or take drugs when pregnant Avoid pregnancy during teenage years Wait at least one year between pregnancies Use firm mattress and avoid covers, toys, pillows, bumper pads Keep crib in parent’s room until baby is 6 months old or use monitor Do not let babies sleep in adult beds Do not overheat infant with covers or clothing while sleeping Avoid exposing baby to smoke Breast-feed whenever possible Avoid exposure to people with respiratory infections; wash hands and clean anything that might come in contact with baby Offer baby a pacifier

Condition Description Spina bifida Defect of spinal development occurring during the first trimester of pregnancy; the spinal cord is not fully protected Viral gastroenteritis Inflammation of stomach and intestines; can cause dehydration and electrolyte imbalance due to fluid loss Learning Outcome: Describe common pediatric diseases and disorders and their treatment. Spina Bifida The treatment and outcome of spina bifida are based on the extent of damage. The neurologic conditions cannot be reversed. Viral Gastroenteritis – can be serious in young children if it causes extreme fluid loss that results in dehydration and electrolyte imbalances.

R I G H T ! Apply Your Knowledge ANSWER:
Matching: 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 children Down syndrome Cerebral palsy RSV JRA Impetigo Herpes simplex virus R I G H T ! F E D B Learning Outcome: Describe common pediatric diseases and disorders and their treatment. A C

Pediatric Patient Special Concerns
Detecting child abuse or neglect Watch for problems in relationship between child and parent/caregiver Observe for physical injuries and signs of neglect Document and report to physician Learning Outcomes: 40.6 Recognize special health concerns of pediatric patients. Possible signs of neglect include a dirty or neglected appearance, hunger, extreme sadness or fear, and an inability to communicate. Note any suspicions in the chart and report them to the doctor before he sees the patient.

Pediatric Patient Special Concerns (cont.)
Physician will examine for Internal injuries Malnutrition Lack of cognitive ability Some risk factors Stress Financial problems Abuse or neglect must be reported by law Learning Outcomes: 40.6 Recognize special health concerns of pediatric patients. The doctor will examine the child for: Internal injuries – tenderness when palpated or auscultated Malnutrition – tooth discoloration, unhealthy gums or skin color Lack of cognitive ability – dulled neurologic responses Risk factors for child abuse or neglect include stress, single parenthood, inadequate knowledge of normal developmental expectations, lack of family support, family hostility, financial problems, and mental health problems. Others are listed in the text. Intervention can significantly lower the rate of child abuse. If you suspect that a child is being abused or neglected while you are working as a medical assistant, you must inform your supervising licensed practitioner and contact the child protection agency in your community.

Eating disorders Adolescents Anorexia nervosa Bulimia nervosa Depression, substance abuse, and addiction Difficult to distinguish Family should be aware if issue Learning Outcomes: 40.6 Recognize special health concerns of pediatric patients. Eating disorders Pressure to look good may lead adolescents to develop abnormal eating behavior. Anorexia nervosa – starving oneself by not eating Bulimia nervosa – a pattern of binge eating and purging. Purging is done by vomiting, taking excessive doses of laxatives, abusing diuretics. Additional information about eating disorders is found in the Nutrition and Health chapter. Depression, Substance Abuse, and Addiction Signs of depression, addiction, and substance abuse in adolescents can be difficult to distinguish. Family members should be aware and willing to discuss signs of adolescent depression, substance abuse, and addiction with the doctor. Refer to Caution: Handle with Care feature Signs of Depression, Substance Abuse, and Addiction in Adolescents

Violence Suicide Be aware of warning sides Always take suicide threats seriously STIs and birth control information available from Schools Local health departments TV and the internet CDC Learning Outcomes: 40.6 Recognize special health concerns of pediatric patients. Violence Excessive exposure leads to insensitivity toward violence. Bullying, browbeating, or abusing is recognized as a cause of violence at school. Be aware of the warning signs of potential violence listed in the text. Suicide The third leading cause of death for people aged 15 to 24. Females are more likely to attempt suicide than males, but males are more likely to be successful in their first attempt at suicide. Be aware of the warning signs listed in the text. Always take the person seriously and report to physician Sexually Transmitted Infections and Birth Control Threaten long-term health and wellbeing Teens may engage in sex, they should be aware of STIs and their effects. Teens should know about pregnancy prevention. Refer to the chapter The Reproductive Systems for information on STIs and for additional information about birth control in the chapter Assisting in Reproductive and Urinary Specialties.

Superb! Apply Your Knowledge
List the warning signs of potential violence? ANSWER: They are: Frequent physical fighting Increased or serious use of drugs or alcohol Increase in risk-taking behavior Gang membership or strong desire to be in a gang Trouble controlling feelings such as anger Withdrawal from friends and usual activities Feeling rejected or alone Having been a victim of bullying Feeling constantly disrespected Failing to acknowledge the feelings or rights of others Learning Outcomes: 40.6 Recognize special health concerns of pediatric patients. Superb!

In Summary 40.1 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 Summary 40.3 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. 40.3 Immunizations provide patients with protection from infectious diseases. Throughout life, especially during childhood, immunizations are recommended. 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 vital signs, body measurements, vision and hearing tests, specimen collection, or administering immunizations and medications, follow the specific guidelines for the procedure and child.

In Summary 40.5 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 40 There are only two things a child will share willingly: communicable disease and his mother’s age. - Benjamin Spock

Assisting in Pediatrics

Similar presentations

Presentation on theme: "Assisting in Pediatrics"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

Assisting in Pediatrics

Similar presentations

Presentation on theme: "Assisting in Pediatrics"— Presentation transcript:

Similar presentations

About project

Feedback