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NU665 Final Exam Study Guide – Complete With Solutions
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NU665 Final Exam Study Guide – Complete With Solutions
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NU665 Final Exam Study Guide – Complete With SolutionsPCP as care coordinators Correct Ans - -These children require heath maintenance, illness prevention, and developmental surveillance
-Traditional primary care needs - needed for routine vaccinations, common disease management, and family support and guidance -Collaboration among clinicians, case managers, family members, home care and school professionals, clinics, hospitals, and community-based services
-Gatekeeper and care coordinator - collaboration for all needs -PCHH - patient-centered health home - ideal model for managing complex health care needs
Differences between CSHCN (children with special health care needs) and without special needs Correct Ans - Table 7.1 -Mental health problems - ADD, mood disorders, autism, tic disorders -Atopic and rheumatic disorders - asthma, JRA, lupus
-Endocrine and metabolic diseases - growth disorders, adrenal disorders, disorders of sex development, thyroid disorders, inborn errors of metabolism,
DM, pituitary disorders -Congenital, genetic, or chromosomal defects - rare genetic diseases/syndrome
-Premature and/or very low birth weight infants
-Severe injuries or burns -Static or progressive neurologic and neuromuscular disorders - CP, global developmental delays, muscular dystrophy, spina bifida, seizure disorders
-Respiratory disorders - cystic fibrosis -CV disorders - cardiac defects, long-term effects of acquired CV disease
-GI disorders - IBD
-Childhood cancers
-Family psychosocial concerns - trauma/abuse, homelessness, undocumented immigration status, overwhelming needs with limited resources
Subspecialty care Correct Ans - -PCPs review notes and recommendations, looking for missing or duplicate items -May have an interdisciplinary clinic available Tertiary care Correct Ans - -PCP makes sure family has documentation
of child's condition, medications, etc. and knowledge of when to go to a higher level of care
Homecare and community services Correct Ans - -PCP in charge of arranging and recognizing the need for services
Technology dependence and medication Correct Ans - -Complex equipment such as home ventilators, enteral feeding pumps, wheelchairs, hospital beds, and nerve stimulations may be needed
-Low-tech supplies may include respiratory or feeding tubing, special formulas or diets, urinary catheters, and ostomy bags -Ongoing family education is essential to ensure the safe and effective use or all devices and to make sure that families know how to fix common complications without seeking urgent care
-Medications - be aware of polypharmacy - this leads to an increased risk of drug interactions and confusion about dosing and administration
-Ongoing review of medication necessity and limiting the use of medication to compounding pharmacies; PCPs can help find compounding pharmacies as many of these kids require liquid medications and cannot swallow pills
Costs and family burden Correct Ans - -Out-of-pocket costs and time spent caring for CSHCN can be significant and may lead to higher level care when care needs are not met -CSHCN are at risk for fragmented care, with poor team communication, crisis-driven health care, and insufficient caregiver support
Government resources for CSHCN Correct Ans - -Medicaid - many rely on this as their sole health care coverage
-SSI - provides financial help with care costs if the child has severe functional limitations caused by a physical and/or cognitive impairment likely to last longer than a year or to result in the child's death -Durable Medical equipment (DME) and reimbursement - essential to fill out paperwork properly
Community and school-based services Correct Ans - -Early intervention, public school services, financial assistance programs, respite care services, and support groups -Many developmental, educational, and psychosocial support services are provided in school settings by government and community -Smaller school districts lack resources to provide these services
Early intervention Correct Ans - -From birth to age 3 -May include developmental, speech, physical, and occupational therapy, audiology, assistive medical technology, family training assistance, social work services and service coordination -PCPs should refer any child with suspected disabilities or developmental delays to EI services for evaluation and therapy -Services are generally free, but other services may be billed so referral to social work may be needed
-After age 3, CSHCN transition to services through the public school system - IDEA and section 504 ensures free, appropriate education in the least restrictive environment possible for all children -Children with disabilities receive educational support in either general or special education classrooms, therapies including speech and OT, health care services needed during the school day, and emotional, behavioral, and psychologic services -PCPs should encourage parents of children receiving EI to contact their school before third birthday - they may be eligible for a 504 or IEP
IEP and 504 plans Correct Ans - -Children who do not meet criteria for
an IEP may be eligible for 504 plan if they follow the curriculum without modification but require additional assistance in school settings such as physical, sensory, or mental support
1. 504 plan
-Simple accommodations or minor changes; easier, faster, more flexible -Eligibility - based on identification of psychologic or physical disorder that limits a major life activity (learning or behavior)
-Evaluation - compiled by the school from a variety of sources to confirm assumption; no money to cover evaluation or support; can occur without parental knowledge or participation -Provisions - extra time to complete assignments, a copy of notes, providing a quiet place to take tests, or assistive technologies; no legal requirements for what is included, for parent involvement, or mandated reevaluation 2. IEP
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