Health & Illness

• Development level


  Where the person is at
• Development milestone


  Tasks that a child should achieve at a certain age
• Delayed


  Not meeting milestones
• Regression


  Once met milestones but no longer have that milestone
• Arrest


  Developmental progress stops
• Risk factors


  • Prenatal risks
  • Birth risk
  • Family risk
  • Situational risk
  • Social determinants
• Prenatal risks

  1st trimester of pregnancy = greatest risk for injury
• Birth risk


  Preterm, low birth weight, birth trauma, infection
• Family risk


  Low parental education, large family
• Situational risk


  Bullying, sexual abuse, acute life stress/school problems
• Social determinants


  Poverty, rural living, limited access to healthcare
• Assessment tools


  • Denver II (infants/toddlers)
  • Early language milestone scale (infants/toddlers)
  • HEADSS (adolescents)
  • Functional assessment (adults/older adults)
• Neural tube defects


  Congenital anomaly resulting from failure of the neural tube to close during fetal development
• Types of neural tube defects

  • Spinal bifida (occulta/manifesta)
  • Myelomeningocele
  • Meningocele
  • Encephalocele
  • Anencephaly
• Risk factors for neural tube defects


  • Folic acid deficiency
  • Maternal diabetes
• Diagnostics for neural tube defects

  • Prenatally with ultrasound
  • MSAFP (elevated NTD, decreased DS)
• Management of neural tube defects

  • Avoid latex
  • Keep sac moist and prone position
  • Prepare for surgery (72 hrs.)
• Cleft lip & palate


  Opening in the lip or palate at birth
• Risk factors for cleft lip & palate

  • Genetic factors
  • Environmental factors (teratogens)
• Interventions for cleft lip & palate

  • Trouble with feeding (lactation consultant)
  • Risk for aspiration (specialized feeding devices)
  • Surgical repair
• ADHD


  Difficulty focusing, hyperactivity, hyperkinesis, impulsivity
• Risk factors for ADHD

  • Family history
• Diagnostics for ADHD


  • Interview to discuss history and behaviors (Vanderbilt patent & teacher scale)
  • Abnormal behaviors in 2 different settings for 6 months
• Interventions for ADHD


  • Minimize environmental distraction
  • Behavioral therapy (reward system)
  • Remain free from injury
• Autism


  Impaired communication & social interaction patterns, repetitive, restrictive, stereotyped behaviors
• Risk factors for autism

  • Genetic abnormalities (downs syndrome)
  • Family history
  • Teratogens
  • Boys
  • Great age disparities in parents
• Clinical manifestations of autism


  • Obsessive behaviors
  • Emotional lability
  • Communication difficulties
  • "you" instead of "I"
  • Wide variety of intellectual ability, functioning
• Management of autism


  • Stimulants, SSRI's, mood stabilizers (to manage symptoms)
  • Stop harmful behaviors
• Interventions for autism


  • Prevent injury
  • Provide supportive care
  • IEPs
  • Enhance communication (short, direct sentences, visual aids)
• Cerebral palsy


  Insult to brain development that causes a group of chronic conditions affecting body movement, coordination, posture (nonprogressive)
• Prevention of cerebral palsy

  • Prevent preterm birth
  • Prevent maternal infection
• Manifestations of cerebral palsy

  • Delay in milestones
  • Primitive reflexes (reflexes do not go away at the appropriate time)
  • Not always intellectually disabled
• Diagnostics for cerebral palsy

  Clinical findings
• Management of cerebral palsy

  • Surgery (to improve mobility)
  • Baclofen
• Interventions for cerebral palsy

  • Prevent injury (assistive devices, adequate lighting, eliminate obstacles)
  • High calorie diet, supplements
• Labor - Stage 1


  • True labor - full cervical dilation & effacement (10 cm, 100% effaced)
  • Latent: 0 - 3 cm
  • Active: 4 - 7 cm
  • Transition: 8 - 10 (most intense, encouragement is needed)
• Assessment in Stage 1 labor

  • Cultural factors
  • Leopold maneuver (palpation of abdomen to determine fetal lie/presentation)
  • FHR and pattern
  • Contractions (frequency, intensity, duration)
  • Lab tests (urine specimen, blood tests, amniotic membranes & fluid, GBS)
• Interventions in Stage 1 labor

  • Voiding every 2 hours
  • Ambulation and positioning
  • Sacral counter pressure (for lower back pain)
• Labor - Stage 2


  • 10 cm - birth of baby
  • Latent: relatively calm w/ passive descent
  • Active: pushing & urge to bear down (Ferguson reflex/Valsalva maneuver)
• Prepare for birth in Stage 2


  • Lithotomy position
  • Continuous FHR monitoring
  • Ritgen maneuver (placing hand on perineum to avoid tearing)