Download Immunizations, cont.

Chapter 24
The Pediatric Examination
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
1
Pretest
True or False
1.
A pediatrician is a medical doctor who
specializes in the diagnosis and treatment of
disease in children.
2.
The first well-child visit is usually scheduled 1
week after birth.
3.
Length is measured with the child standing with
his back to the measuring device.
4.
Blood pressure should be taken on a child
starting at 8 years of age.
5.
It is best not to tell a child that an immunization
will hurt.
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
2
Pretest, cont.
True or False
6.
The vastus lateralis muscle site is recommended for
administering an injection to an infant.
7.
An MMR injection includes the following immunizations:
measles, meningitis, and rubella.
8.
A Vaccine Information Statement explains the benefits
and risks of a vaccine in lay terminology.
9.
The hepatitis B vaccine can be given to a newborn.
10. The blood specimen for a newborn screening test is
obtained from the infant's earlobe.
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
3
Content Outline
Introduction to the Pediatric Examination
1. Pediatrics deals with:
a. Care and development of children
b. Diagnosis and treatment of diseases in children
2. Pediatrician: medical doctor who
specializes in pediatrics
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
4
Pediatric Office Visits
1. Well-child visit (health maintenance visit)
a. Components
•
•
Evaluation of growth and development of child
Physical examination
– To detect any abnormal conditions associated with
child's stage of development
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
5
Pediatric Office Visits, cont.
• Anticipatory guidance
– Provides parents with information to prepare for
anticipated developmental events
– Assists parents in promoting child's well-being
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
6
Pediatric Office Visits, cont.
– Topics included are:
1)
2)
3)
4)
Safety
Nutrition
Sleep
Play
5)
6)
7)
Exercise
Development
Discipline
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
7
Pediatric Office Visits, cont.
b. Typical schedule for well-child visits
•
•
•
•
•
1 month
2 months
4 months
6 months
9 months
•
•
•
•
15 months
18 months
24 months
Yearly thereafter
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
8
Pediatric Office Visits, cont.
2. Sick-child visit: child exhibits signs and
symptoms of disease
a. Physician evaluates patient's condition to arrive at
a diagnosis and prescribe treatment
3. Procedures performed by medical assistant
during pediatric office visits:
a.
b.
c.
d.
Vital signs
Weight
Visual acuity
Assisting with physical examination
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
9
Developing a Rapport
1. Important to establish rapport with child
2. If trust and confidence gained:
a. Child more likely to cooperate during
examination or procedure
3. Requires special techniques
a. Based on age of child
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
10
Developing a Rapport, cont.
b. Examples:
• Toddlers: respond well to
making a game of the
procedure
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
11
Developing a Rapport, cont.
• School-age children:
explain purpose of an
instrument
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
12
Developing a Rapport, cont.
4. Explain procedure to children who are able
to understand
5. Approach child at his or her level of
understanding
a. Know what to expect from a child at a particular
age
• Both motor and social development
6. Realize that a child may regress when ill
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
13
Carrying the Infant
1. Lift and carry infant in a manner that is:
a. Safe
b. Comfortable
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
14
Carrying the Infant, cont.
2. Cradle position
a. Infant is cradled with his or
her body resting against
MA's chest
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
15
Carrying the Infant, cont.
3. Upright position
a. Infant is held upright while
resting against the MA's
chest
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
16
Growth Measurements
1. One of the best methods to evaluate
progress of child
2. Measured at each office visit and plotted on
growth chart:
a. Weight
b. Height (length)
c. Head circumference (up to 3 years)
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
17
Measuring Weight
3. Weight
a. Use:
• Determine nutritional needs
• Calculate proper medication dosage
b. Infants: measured in recumbent position
c. Older children: measured in standing position
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
18
Measuring Weight, cont.
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
19
Length
4. Length and height
a. Length
• Measured in children younger than 24 months
• Measured from vertex of head to heel in supine
position
• Two people are required to accurately determine
length
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
20
Measuring Length
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
21
Height
b. Height (stature)
• Older children: measured in
standing position
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
22
Head Circumference
5. Head circumference (HC)
a. Infancy: period of rapid brain growth
• Important to measure HC in children under age 3
– Plot on a growth chart
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
23
Head Circumference, cont.
b. Newborn HC range: 32-38 cm (12.5-15 inches)
c. 4-inch (10-cm) increase in HC: occurs in first
year of life
d. Important screening measure for:
•
•
Macroencephaly
Microencephaly
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
24
Chest Circumference
6. Chest circumference (CC)
a. At birth: HC is approximately 2 cm larger than
CC
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
25
Chest Circumference, cont.
b. Chest grows at faster rate than cranium
•
Between 6 months and 2 years: measurements are
about the same
– After age 2: CC is greater than HC
c. CC not typically measured on routine basis
•
Only when heart or lung abnormality is suspected
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
26
Growth Charts
1. Should be part of child's record
2. National Center for Health Statistics
developed growth charts to determine if
child's growth is normal
3. Identifies children with growth or nutritional
abnormalities
4. MA responsible for plotting child's
measurements on growth chart
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
27
Growth Charts, cont.
5. Use of growth charts
a. Compares child's weight and length (or height)
with children of same age
•
•
Example: 18-month-old boy: Weight: 25th percentile;
Height: 80th percentile
Interpretation
– 75% of 18-month-old boys weigh more; 25% weigh less
– 20% of 18-month-old boys are taller; 80% are shorter
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
28
Growth Charts, cont.
b. Look at child's growth pattern (primary use)
• Physician investigates significant changes in growth
pattern:
– Rapid rise
– Rapid drop
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
29
What Would You Do?
What Would You Not Do?
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
30
What Would You Do?
What Would You Not Do?
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
31
Pediatric Blood Pressure
Measurement
1. American Academy of Pediatrics
recommends:
a. Children 3 years of age and older: measure BP
annually
2. Purpose
a. Identify children at risk for developing
hypertension as adults
b. Identify children with kidney disease or heart
disease
•
Once treated: BP usually returns to normal
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
32
Pediatric Blood Pressure
Measurement, cont.
3. Overweight children: usually have higher BP
than those of normal weight
a. To reduce BP: weight loss through a prescribed
diet and physical activity
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
33
Pediatric Blood Pressure
Measurement, cont.
1. Use correct cuff size
a. If cuff too small: BP may be falsely high
b. If cuff too large: BP may be falsely low
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
34
Pediatric Blood Pressure
Measurement, cont.
2. Cuffs come in a variety of sizes
a. Measured in centimeters
b. Size of cuff: refers to inner inflatable bladder
(not cloth cover)
c. Name of cuff (child, adult)
• Does not necessarily imply that it's appropriate for
that age
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
35
Cuff Selection
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
36
Pediatric Blood Pressure
Measurement, cont.
3. Determining proper cuff size
a. Assess child's arm circumference: midpoint
between acromion process (shoulder) and
olecranon process (elbow)
b. Bladder of cuff should encircle 80%-100% of
arm
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
37
Determining Proper Cuff Size
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
38
Pediatric Blood Pressure
Measurement, cont.
1. Make sure child is relaxed
a. Apprehension can cause BP to be falsely high
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
39
Pediatric Blood Pressure
Measurement, cont.
2. To reduce anxiety:
a. Explain procedure
b. Allow child to handle equipment (if appropriate)
3. Measure BP after child has been sitting
quietly for 3-5 minutes
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
40
Blood Pressure
Classifications
1. Pediatric BP varies depending on:
a. Age
b. Height
c. Gender
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
41
Blood Pressure
Classifications, cont.
2. NHBPEP (National High Blood Pressure
Education Program)
a. Prepared a set of tables used to determine if
child's BP is higher than average among
children of same age and height
b. If BP higher than 90%-95% of other children of
same age, height, gender: may have
hypertension
c. Allows precise classification of BP according to
body size
•
Avoids misclassifying children at extreme ends of
normal growth
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
42
Blood Pressure
Classifications, cont.
•
Examples:
– A very tall child will not be mistakenly diagnosed as
having hypertension
– Hypertension will not be missed in a very short child
d. Can access NHBPEP tables at following
website:
http://www.nhlbi.nih.gov/guidelines/hypertensio
n/child_tbl.pdf
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
43
Blood Pressure
Classifications, cont.
3. BP varies throughout the day due to normal
fluctuations in:
a. Physical activity
b. Emotional stress
4. If child's BP elevated:
a. Two or more readings must be taken at
different visits: before diagnosis of
hypertension can be made
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
44
What Would You Do?
What Would You Not Do?
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
45
What Would You Do?
What Would You Not Do?
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
46
Collection of a Urine Specimen
1. Purpose
a. May be required as part of physical examination
• To perform a urinalysis to screen for disease
b. Assist in diagnosis of pathologic condition
c. Evaluate effectiveness of therapy
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
47
Collection of a Urine
Specimen, cont.
2. Pediatric urine collector
a. Used for infants or young children who cannot
urinate voluntarily
b. Consists of plastic disposable bag with
adhesive around the opening
• Adhesive attaches bag to genitalia
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
48
Pediatric Urine Collector
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
49
Pediatric Injections
1. Experience child has with early injections:
a. Influences his or her attitude toward later ones
2. Children old enough to understand: explain
procedure
a. Be honest and attempt to gain trust and
cooperation
•
•
Tell child it will hurt, but only for a short time
Explain that the medication will help child get better
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
50
Pediatric Injections, cont.
3. Another person should be present to:
a. Help position child
b. Divert or restrain child, if needed
4. If child struggles/fights excessively:
a. Delay injection and consult physician
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
51
Types of Needles
1. Intramuscular (IM) injection
a. Gauge and length of needle based on:
• Consistency of med
– Thick, oily medications: require a larger needle lumen
• Size of child
– Needle must be long enough to reach muscle tissue
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
52
Types of Needles, cont.
b. Length of needle range: ⅝-1
inch
c. Gauge range: 22-25
• Depends on viscosity of
medication
2. Subcutaneous (SC) injection
a. Length of needle range: ⅜-½
inch
b. Gauge range: 23-25
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
53
Intramuscular Injection Sites
1. Site varies on the basis of child’s age
2. Injection site: indicated in package insert
accompanying med
a. Dorsogluteal site
•
Until child is walking, gluteus muscle is:
– Small and not well-developed
– Covered with a thick layer of fat
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
54
Dorsogluteal Site
•
Injection may come close to sciatic nerve
– Danger increased: if child squirming or fighting
•
Do not use gluteal site until child has been walking for
at least 1 year
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
55
Dorsogluteal Site, cont.
Courtesy Wyeth Laboratories, Madison, NJ
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
56
Vastus Lateralis Site
b. Vastus lateralis site
• Recommended for infants and young children
• Located on anterior surface of midlateral thigh
– Away from major nerves and blood vessels
– Muscle is large enough to accommodate the medication
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
57
Vastus Lateralis Site, cont.
Courtesy Wyeth Laboratories, Madison, NJ
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
58
Vastus Lateralis Site, cont.
•
Length of needle: depends on size of thigh
– 1 inch used most often
•
To administer injection:
– Infant is placed on back
– Thigh is grasped in order to:
1) Compress the muscle tissue
2) Stabilize the extremity
– Injection is administered into the compressed tissue
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
59
Deltoid Site
c. Deltoid site
• Deltoid muscle is shallow:
– Can accommodate only small amount of medication
• To administer injection:
– Muscle is grasped between thumb and fingers
– Needle inserted pointing slightly upward toward
shoulder
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
60
Deltoid Site, cont.
Courtesy Wyeth Laboratories, Madison, NJ
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
61
Intramuscular Injection Sites, cont.
•
After administering injection to an infant:
– Hold infant to provide comfort
– Show approval
1) So child associates something other than pain
with procedure
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
62
Immunizations
1. Immunity: resistance of the body to effects
of harmful agents, such as pathogenic
microorganisms and their toxins
2. Active, artificial immunization: process of
becoming immune through use of a vaccine
or toxoid
a. Vaccine: a suspension of attenuated
(weakened) or killed microorganisms
administered to an individual
• To prevent an infectious disease by stimulating the
production of antibodies in that individual
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
63
Immunizations, cont.
b. Toxoid: a toxin (poisonous substance produced
by a bacterium) that has been treated by heat
or chemicals to destroy its harmful properties
• It is administered to an individual to prevent an
infectious disease by stimulating the production of
antibodies in that individual
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
64
Immunizations, cont.
3. Purpose of childhood immunizations
a. Build body's defenses
b. Protect from certain infectious diseases
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
65
Immunizations, cont.
4. Administered to infants and young children
during well-child visits
a. American Academy of Pediatrics:
• Publishes a recommended childhood immunization
schedule annually (www.aap.org)
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
66
Immunization Schedule
From Department of Health and Human Services, Centers for Disease Control and Prevention, United States, 2008
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
67
Immunizations, cont.
5. Be familiar with each immunization including:
a.
b.
c.
d.
e.
Use
Common side effects
Route of administration
Dose
Method of storage
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
68
Immunizations, cont.
6. Package insert comes with each
immunization: contains info about drug
a. Physician’s Desk Reference (PDR) can also be
used to locate information
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
69
Immunizations, cont.
7. Immunizations administered to infants and
children:
a. Hep B: Hepatitis B vaccine (IM)
b. DTaP: Diphtheria and tetanus toxoids and
acellular pertussis vaccine (IM)
c. Hib: Haemophilus influenzae type b conjugate
vaccine (IM)
d. IPV: Inactivated polio vaccine (IM or SC)
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
70
Immunizations, cont.
e. MMR: Measles, mumps, and rubella vaccine
(SC)
f. Varicella: Chickenpox vaccine (SC)
g. PCV: Pneumococcal conjugate vaccine (IM)
8. Immunization record card provided to
parents
a. Instruct parent to bring to well-child visits
• Child's immunizations can be recorded
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
71
Immunizations, cont.
b. Instruct parents in:
•
•
Normal side effects of immunizations
What to do if side effects occur
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
72
Immunization Record
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
73
National Childhood Vaccine
Injury Act (NCVIA)
1. NCVIA became effective in 1988
2. Requires parents be provided with:
a. Information about benefits and risks of
childhood immunization
3. CDC developed vaccine information
statements (VISs)
a. Explains benefits and risks of immunizations in
lay terms
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
74
Vaccine Information Statement
Courtesy Centers for Disease Control and Prevention, Atlanta
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
75
National Childhood Vaccine
Injury Act (NCVIA), cont.
4. Before a child receives an immunization:
a. Appropriate VIS must be given to child's parent
or guardian
b. Parent must be given enough time to read VIS
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
76
National Childhood Vaccine
Injury Act (NCVIA), cont.
5. Information that must be charted in patient's
medical record (required by NCVIA)
a. Name and publication date of each VIS given
to parent
b. Date the VIS provided to parent
c. Date of administration of vaccine
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
77
National Childhood Vaccine
Injury Act (NCVIA), cont.
d. Manufacturer and lot number of vaccine
e. Signature/title of health care provider who
administered vaccine
f. Address of medical office where vaccine was
administered
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
78
Immunization Record
Modified from Immunization Action Coalition, St. Paul, Minn
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
79
What Would You Do?
What Would You Not Do?
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
80
What Would You Do?
What Would You Not Do?
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
81
Newborn Screening Test
1. Screens for presence of certain metabolic
and endocrine diseases
2. Diseases included in newborn screening
vary by state, but usually include:
a.
b.
c.
d.
e.
f.
g.
h.
Phenylketonuria (PKU)
Biotinidase deficiency
Congenital adrenal hyperplasia
Maple sugar disease
Congenital hypothyroidism
Galactosemia
Homocystinuria
Sickle cell anemia
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
82
Newborn Screening Test, cont.
3. PKU
a. Congenital hereditary disease
b. Caused by lack of the enzyme: phenylalanine
hydroxylase
• Needed to convert phenylalanine (an amino acid) into
tyrosine
– Tyrosine: needed for normal metabolic functioning
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
83
Newborn Screening Test, cont.
c. Without this enzyme: phenylalanine
accumulates in blood
d. If left untreated, causes:
•
•
•
Mental retardation
Tremors
Poor muscle coordination
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
84
Newborn Screening Test, cont.
e. If detected early:
•
Infant placed on special low-phenylalanine diet
f. If treatment is started before child reaches 3-4
weeks of age: normal development usually
occurs
g. Lifelong dietary restriction of phenylalanine
recommended
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
85
Newborn Screening Test, cont.
h. Uncommon condition
•
•
Affects 2 out of every 12,000 births
Early diagnosis leads to better prognosis
i. Phenylalanine can be detected in blood of an
affected child:
•
Only after intake of breast or formula milk
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
86
Newborn Screening Test, cont.
j. Formula-fed infants: can be tested earlier
because formula contains phenylalanine
k. Colostrum (first breast milk): does not contain
phenylalanine
•
Test results of breastfed infants: invalid until mother
begins producing milk
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
87
Newborn Screening Test, cont.
4. Newborn screening
a. All states require newborn screening
b. Best time to perform: between 1 and 7 days
after birth
c. In most states:
• Performed before infant leaves hospital
• If test results are abnormal or invalid
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
88
Newborn Screening Test, cont.
– Infant must be retested
1) Usually due to collection of an inadequate amount
of blood
2) Retesting: often performed in medical office
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
89
Newborn Screening Test, cont.
d. Performed on capillary blood
•
Obtained from lateral plantar surface of medial or
lateral heel
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
90
Newborn Screening Test, cont.
e. Specimen placed on special filter paper
attached to test card
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
91
Newborn Screening Test, cont.
f. Test mailed to outside laboratory.
g. If test is positive: further testing performed
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
92
Posttest
True or False
1.
2.
3.
4.
5.
A well-child visit is also referred to as a health
maintenance visit.
A reason for weighing a child is to determine
proper medication dosage of medication.
Growth charts can be used to identify children
with growth abnormalities.
Measuring pediatric blood pressure helps to
identify children at risk for developing type 1
diabetes.
Using a blood pressure cuff that is too large for
the child can result in a falsely low reading.
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
93
Posttest, cont.
True or False
6. The length of the needle used for a pediatric IM
injection depends on the amount of medication
being administered.
7. The resistance of the body to pathogenic
microorganisms or their toxins is known as
inflammation.
8. The recommended route of administration for
an MMR is subcutaneous.
9. Before administering a pediatric immunization,
the NCVIA requires that the parent sign a
consent form.
10. If PKU is left untreated, it can lead to
malnutrition.
Elsevier items and derived items © 2009 by Saunders, an
imprint of Elsevier Inc.
94