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As a Nurse practitioner caring for young children, how would you perform the vision portion of the health supervision assessment? How would you screen this young child? what is normal? what is not?
Eating habits to be encouraged by parents of children with obe...
1). As a nurse practitioner caring for young children, how would you perform the vision portion
of the health supervision assessment? how would you screen this young child? what is
normal? what is not?
Ans: Birth to around 3 years of age should include:
+Assessing movement, alignment, pupils, and red reflex.
-- Starting around 2 months their eyes should begin tracking movement.
-- Starting around 3 months, the corneal light reflex can be performed to assess for
misalignment.
-- Cover testing begins at 6 months.
At 3 years, a formal visual acuity test should be completed (with either a tumbling E chart
or picture chart). Children who do not coorperate with test should be reassessed in 1
month - if still does not cooperate with test, they need to be refered.
REFER - All preterm infants, those with down syndrome, and those with family history of
amblyopia, strabismus, retinoblastoma, and retinal degeneration.
Abnormalities include:
+ abnormal red reflex
+ poor fixation on objects at 3 months
+ asymmetry in light reflex
+ presence of refixation movement in cover test
+ vision acuity less than 20/40 for kids aged 3-5 years (or a 2 line difference between the
eyes).
Dr. Montgomery
Please review Hay page 233 table 9-3 (recommended vision screening in the primary care
office). It is also important to know the minimal appropriate visual acuity when testing a
young child. At three years old formal visual acuity needs to be tested, and you would
expect to find a minimal acceptable acuity of 20/40. This information would be important
to review again (hint hint)
Hays page 233
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, 2). Eating habits to be encouraged by parents of children with obesity
Ans: The best answer is scheduled mealtimes, as many of you have noted. No sodas at
all is the best advice for parents.
3). How many minutes of daily physical activity is recommended for children?
Ans: 60 minutes/daily is the general recommendation for all children. The question was
about all children, not just those with HTN.
4). A very high total cholesterol level in a child most likely has a diagnosis of ___________?
Ans: JAMA Screening for Lipid Disorders in Children and Adolescents US Preventive
Services Task Force Recommendation Statement- pg 628, first paragraph--
Children with *familial hypercholesterolemia* can have TC and LDL-C levels 2 to 3 times
higher than those of unaffected children. ..1 The burden of familial hypercholesterolemia
is attributable to premature cardiovascular events in adulthood resulting from long-term
exposure to elevated serum cholesterol levels and atherosclerosis.
Dr. Lang:
Correct, with a very high total cholesterol, FH is the most probable diagnosis in children.
5). Recommendations about playing sports for a child with osgood schlatter's disease.
Ans: Bright Futures, pg. 94: "The athlete may participate [in sports] if he or she is not
limping at the end of a game or practice."
Dr. Lang:
The application question included that the child had been playing sports without
problems. The child may be released to play sports by the family practitioner.
6). Activities expected in children in the concrete thinking stage.
Ans: Dr. Lang:
Hay, pg. 79: "Concrete operations typically begin after age 6..the child is able to order,
number, and classify because these activities are related to concrete objects in the
environment..."
7). Uspstf recommendation guidelines for children with high bmi
Ans: USPSTF Guidelines, Obesity in Children and Adolescents, p. 80:
"Refer patients to comprehensive moderate- to high-intensity programs that include
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, *dietary, physical activity, and behavioral counseling components*."
Dr Lang
8). Age of children recommended to have routine lipid screening by aap and nhlbi.
Ans: USPSTF Lipid Sreening JAMA article p. 632 "The National Heart, Lung, and Blood
Institute's Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk
Reduction in Children and Adolescents and the American Academy of Pediatrics' Bright
Futures recommend universal screening before adolescence (ages 9 to 11 years) and
again after puberty (ages 17 to 21 years)".
Dr. Lang:
Yes, this is the correct answer.
9). Immunizations needed for 9 year old, when up to date at age 6.
Ans: Influenza is the only vaccine recommended. The next set of vaccines start in the
11-12 age group. per CDC vaccine schedule.
Dr. Lang:
This is the correct answer; the question indicated that the child was brought in TODAY.
Influenza is all that is needed.
10). When do you tell parents that intoeing found in a child is normal and nothing needs to be
done?
Ans: Dr Lang:
Most intoeing and outoeing is normal especially when bowleg walking is followed by
intoeing. This indicates you understand that the position of the legs/hips in utero can
cause initial outoeing but intoeing begins to occur with normalization of the feet forward
by age 6. While the other answers may give you some helpful information, *a history of
intoeing/outoeing in parents (and indeed examination of the parents)* can indicate that
the outoeing/intoeing may not resolve and may require intervention.
11). For all, please review the normal and abnormal findings for children who have vision and
hearing screenings and when to refer. also, much weakness was found in ability to apply
motivational interviewing techniques in patient scenarios.
Ans: Dr. Lang
12). Review key concepts related to the varicella vaccine.
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