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By: Connie Watkins Bales, PhD

• Professor in Medicine
• Senior Fellow in the Center for the Study of Aging and Human Development

https://medicine.duke.edu/faculty/connie-watkins-bales-phd

Therapeutic management for children with cognitive impairments largely depends on community and educational resources 897 treatment plant rd order zyprexa 10mg amex. Identify three nursing diagnoses for the family of a child with a severe cognitive impairment medications parkinsons disease cheap 7.5 mg zyprexa overnight delivery. The most common type of living experience for a child with Down syndrome is to symptoms 5 weeks into pregnancy discount zyprexa 5 mg be reared. List four areas the nurse should assess when caring for the child with Down syndrome. Down syndrome is the most common genetic disorder causing moderate to severe mental retardation. In almost all instances, Down syndrome is the result of translocation of chromosome 21 to chromosome 15. When a child with Down syndrome is cared for in the hospital, it is important to keep the environment and schedule as close to the child�s usual environment and routines as possible. The use of alcohol during pregnancy is not totally necessary for a diagnosis of fetal alcohol syndrome. List four developmental areas in which qualitative impairment is seen in children with autism. Family child-rearing practices and parental personalities are the basis of the development of autism. Identify interventions to increase caloric intake when feeding the child with failure to thrive. Increasing calorie intake is the first medical treatment initiated for a child with failure to thrive. Brain growth and development can be affected by undernutrition in the first 2 years of life. Discover what support systems they are using both within the family and in the community. Spend some time in a local law library and research educational laws related to children with cognitive deficits. Interview an occupational therapist or other member of the multidisciplinary team. Routine pediatric follow-up data indicate that she has consistently achieved developmental milestones, but she reaches them much later than children of the same chronologic age. Identify potential community resources that you could use for Jean Marie and her family at this stage of evaluation. What would be your preliminary nursing diagnoses and interventions for Jean Marie Which question asked during a hospital admission assessment best indicates that the nurse understands the needs of a child with Down syndrome In developing a plan of care for an infant with fetal alcohol syndrome, the nurse would anticipate parents to report difficulty in the infant�s: a. What is the most appropriate response to a parent who asks the nurse, �What caused my child to have autism A 9-month-old infant hospitalized with a diagnosis of nonorganic failure to thrive most likely: a. Which guideline is appropriate for feeding a toddler who has not been gaining weight The nurse is conducting an in-service on the differential diagnosis of autism, intellectual disability and schizophrenia. Involuntary eye movements that make eyes appear 3 to be darting back and forth 4 5 4. Hearing loss resulting from damage to the conduction system between the brain-stem and the cerebral cortex 6 7. Combination of conductive and sensorineural hearing loss 218 Chapter 31 the Child with a Sensory Alteration Copyright � 2013, 2007, 2002 by Saunders, an imprint of Elsevier Inc.

Syndromes

• Loss of appetite
• Purpura
• Chills
• Are you actually shaking ?
• Increased cough or phlegm
• Unable to remember events since delirium began (anterograde amnesia)
• Cranial CT scan
• Weakness
• Genital warts (flesh-colored spots that are raised or flat, and may look like the top of a cauliflower)

Client Education � Used in breastfeeding mothers because it does not interfere with lactation � Has a high level of pregnancy protection � There is need for compliance on a daily regimen � Unrelated to medications causing dry mouth buy zyprexa 2.5 mg otc sexual intercourse � May cause menstrual irregularities � If you forget to medications 7 purchase zyprexa 5mg with amex take one pill treatment anal fissure discount 7.5 mg zyprexa, take it as soon as you remember (see combined pills) � Return to the clinic immediately for a pregnancy check if 45 days have passed since your last menstrual period. Noncontraceptive Benefits � Does not affect lactation � Lighter shorter periods � Decreased breast tenderness � Do not increase blood clotting � Decrease dysmenorrhoea � Protect against endometrial cancer. Indication � Unprotected intercourse � Rape � Condom leakage � Condom breakage/slippage. They comprise of long acting progestogen usually administered as deep intramuscular injections. They act by: suppressing ovulation, inducing a thin atrophic endometrium, producing a thick cervical mucus difficult for 102 sperm penetration. Client Education � May be associated with heavy menses, amenorrhoea or spotting � Regular administration as required � Return to the clinic as scheduled to continue using this method � Return to the clinic if you suspect pregnancy, dizziness, heavy bleeding. Side effects: Users may experience menstrual irregularity (amenorrhoea, spotting, and rarely, heavy bleeding). Client Education � May be associated with prolonged menses, sporting or amenorrhoea � Requires a minor surgical procedure for insertion and removal � If possible return to the same clinic if you desire implant or removal � Return for removal any time you desire, but it can be kept in place for 5 years 103 � Return to the clinic if you: suspect pregnancy experience pain, swelling or pus at the implant site experience dizziness, headache. Side effects: Users may experience infection at insertion site, irregular menstrual bleeding (longer bleeding episodes, amenorrhoea, or spotting). A plastic device usually bound with copper wire and placed in the uterus through the cervix. Benefits � Highly and immediately effective � Longterm protection with immediate return to fertility upon removal � Do not interfere with intercourse � Can be used in women who are breastfeeding Side effects: Users may experience pain on insertion and increased menstrual bleeding and abdominal cramps. Client Education � Before every intercourse, place condom on erect penis, leaving tip empty to collect semen � Withdraw the penis from the vagina after each ejaculation while the penis is still erect � Remove condom after use � Do not reuse condoms � Discard used condom immediately in toilet or pit latrine � Using spermicides with condoms increases the effectiveness � Complications may include local irritation if allergic to latex/lubricants � May interfere with sexual pleasure for some people. The other ring forms the open edge of the device and remains outside the vagina after insertion. It can be inserted (up to 8 hours) before intercourse but must be removed immediately after. Client Education � Interferes with natural spontaneity of sexual act � May cause local irritation � May be difficult to insert by client � Low effectiveness as a contraceptive. Client Education � Diaphragm and cervical cap: by a provider and refitted after marked weight change (5kg gained or lost, or after child birth) 106 must be kept clean and stored properly must be used with spermicide � Diaphragm, cervical, or contraceptive sponge: can be inserted up to 6 hours before intercourse can remain in place for 6 hours (not longer than 24 hours) � Contraceptive sponge must be moistened with water to activate its spermicide; contraceptive sponge must never be reused and must not be used during menstruation. Side effects: Some users experience sensitivity to rubber or lubricants/spermicides; some diaphragm users experience increased frequency of urinary tract infection. Surgical Contraception Many factors have contributed to improved safety of Voluntary Surgical Contraceptive in the last 20 years: these include improved anaesthetic methods, better surgical techniques, asepsis, improved training of personnel and better selection and monitoring of clients. Benefits � Permanent, highly and immediately effective � No change in sexual function � Good for client if pregnancy would be a serious health risk 107 � Does not affect lactation Side effects: Some users experience minor pain and bleeding and wound infection following procedure. Client Education � Counselling necessary, permanent and irreversible � Use condom for at least 15 ejaculations � Return to the clinic if you experience: postoperative fever excessive swelling, pus or pain at the surgical site. Side effects: Some users experience minor swelling, pain, infection, and bruising following procedure. Periodic Abstinence (Natural Family Planning) Avoidance of sexual intercourse during ovulation and for a safety margin before and after ovulation. Various methods may be used to determine the fertile period: cervical mucus, basal body temperature, rhythm. Benefits � No physical side effects it is cheap � No need for prescriptions by medical person � Improved knowledge of reproductive system and possible closer relationship between couples. Client Education � Requires high motivation � Has a high failure rate � Assumes a regular, perfect menstrual cycle � Requires proper recordkeeping � Has no health risks, except for pregnancy. Consult a surgeon for drainage of pointing liver abscesses, bowel perforations (peritonitis), amoebomas and large bowel strictures � Amoebiasis and "vague" abdominal complaints: where amoebiasis is common, there is a tendency to blame any abdominal complaints on amoeba. Usually these patients have cysts in stool but no 109 evidence of invasive disease. Exclude other causes of abdominal pain � Asymptomatic cyst carriers: only treat cyst carrier if patient is a food handler. Do not waste metronidazole: use it for appropriate indications Prevention � Provision of safe drinking water and sanitary disposal of faeces are important preventive measures � Regular examination of food handlers and appropriate treatment when necessary. Diarrhoeal Diseases Diarrhoea is defined as occurrence of at least 3 loose or watery stools in a day.

Characteristics to symptoms nausea fatigue buy 2.5mg zyprexa fast delivery consider in choos if many students are not nishing the program symptoms you have worms zyprexa 10 mg on line. Most top quality programs idea of training quality) medications used to treat bipolar disorder cheap zyprexa 20mg with mastercard, the strength of the have average match rates (across 5 years) of at research training, and (if applicable) the strength least 75%. Percentile scores are often evaluated more programs place very high priority on the psychology closely than the standardized scores. There are fewer strate data regarding admission criteria, called Graduate gies and �tricks� you can learn for this test; you Study in Psychology. If you were not a psychology the smaller the ratio between accepted applicants major, you will have to learn more new material. Contacting Potential Mentors � You can make sure your schools get your scores in time. Therefore, it is impor for clinical, counseling, and school psychology tant to be patient and forgiving when waiting for programs. It also is often a good 2 Deciding to Apply and Successfully Gaining Admission to Graduate Schools in Psychology 33 idea to carefully review information available on Letters of recommendation are extremely the program and the faculty member�s websites, important, so choose your recommenders wisely. Most faculty will be happy to use to decide whether you would be a good per answer your questions and correspond when pos son to have in the lab for 4�6 years; this is not sible. A bad or even a lukewarm letter dence is certainly not necessary and often plays of recommendation can denitely ruin your little to no role in your admissions outcome. Potential advisors will not If you do email professors, make sure your be impressed by letters that offer �faint praise�; emails are professional, are not overly wordy, your letters should come from people who know contain no typos, and do not include questions you very well and who will be able to offer very that are answered on the program�s website. Depending on your rela bers do not know if they will accept students until tionship with each letter writer and how orga later in the year; they may be waiting to hear nized they seem, it may be a good idea to send about funding, or they may want to see the appli reminders about upcoming deadlines as they cant pool before deciding whether or not they approach (but refrain from send an annoying want to interview people. In some programs, it is the administra No matter how or when you are asking some tive assistant who rst reviews all applications one to write you a letter of recommendation, and decides which ones will be passed on to fac remember that they are doing you a big favor. If you are rude or condescending in your Your goal should be to make your letter writers� email or phone contact with an administrative job as smooth and easy as possible. Make sure to assistant, the director of the program will probably ask exactly how they would like you to send them hear about it. Many professors are willing to sub mit recommendation materials online (and many programs now highly encourage or even require Letters of Recommendation this), but some professors prefer to submit the materials ofine. At least two should be from people with spective, it will be much easier and simpler if doctoral degrees in psychology. The people your letter writers submit their materials online, whom you ask to write your letters should know but you should respect their preferences, unless you well as a student. At least one of your letter you are applying to a program that requires that writers should be able to comment on your materials be submitted online. It some times may make sense to include four letters, but please keep in mind that doing so requires the Personal Statement more reading for bleary-eyed application review ers, and an extra letter does not gain you any the vast majority of personal statements follow extra credit. Next, a brief section describes the appli Conveying an accounting of your various cants� enthusiasm for one or more psychology responsibilities on research projects also can be undergraduate courses. Research experiences useful to help describe your readiness to assist then are described in succession. For each experi in ongoing projects in your graduate mentor�s ence, the title and principal investigator of the lab. You may even possess a particular skill that project are listed, followed by a list of the appli is lacking and needed in the lab; thus, you will cant�s responsibilities and tasks on the project. Many are extremely excited to have an the name of a specic potential mentor or two. Others may be mostly concerned with your accomplishes many of the main objectives that academic ability and interest in their research, the personal statement is meant to serve. It indeed knowing that they can train you to complete is important to clearly state research experiences, whatever tasks are needed in their lab. However, to express enthusiasm for and a match to a specic all graduate mentors likely are invested also in aspect of the graduate program, and to articulate seeing you succeed as an independent scholar. It also often is a Thus, we believe an applicant �can�t go wrong� good idea to identify a potential mentor.

S typhi can cause hepatosplenomegaly and generalized lymphadenopathy medications 44 175 buy zyprexa once a day, although the lymphadenopathy of Y enterocolitica is seldom generalized medications look up buy generic zyprexa 20 mg online. Generalized lymphadenopathy can occur in association with E chaffeensis medicine neurontin generic 20 mg zyprexa with amex, which causes human monocytic ehrlichiosis, a tick-borne disease. Figure 106-1 shows a Gram stain of a broth culture obtained from a beta-hemolytic colony from a blood agar plate revealing gram-positive cocci in chains identified as S pyogenes (group A streptococcus). Other major criteria include carditis (50-60% of cases), chorea (10-15% of cases), erythema marginatum (<3% of cases), and subcutaneous nodules (1% of cases). Nephrotic syndrome occurs in infants with congenital syphilis and is caused by immune complex disease. This results from excess antibody concentration that inhibits the formation of the antigen-antibody complex that is needed for flocculation. Some patients who are treated early with an antimicrobial agent never develop antibodies against B burgdorferi. Most patients with early disseminated Lyme disease and all patients with late disseminated disease (arthritis is the most common manifestation) have a strong IgG antibody response to B burgdorferi. The recommended duration of therapy is 28 days, compared with 14-21 days for early localized disease. On examination the patient is afebrile and has upper airway congestion, but you immediately note that this child appears small for his age, malnourished with loss of subcutaneous fat, and has an erythematous candidalappearing diaper rash. The mother states she has been concerned about her infant�s small size and has brought her baby to the doctor requesting advice to help her baby grow, but she has not seen a physician in 4 weeks. The child has been fed standard formula mixed appropriately by the mother since birth, and according to the mother the child is a good eater. The mother is 34 years old and has 2 other children at home who are well; both are in school and according to the mother have no growth problems. You measure the child�s weight, head circumference and height, and you plot the values on a growth curve (see Figures 107-1 and 107-2). Your immediate plan is to (A) review the past medical history, inquire about risk factors for immune system disorders, and perform screening tests. You are able to obtain your patient�s prior growth measurements from his pediatrician, and you find the following: birth weight, length, and head circumference were all at the 50th percentile. Only one subsequent visit occurred at 2 months of age when the child was between the 10th and 25th percentiles on the growth chart. Parental competency is affected by all of the family characteristics except (A) parental resources (B) maternal mental health (C) lack of college education (D) child characteristics (E) family social context 7. The most common form of child maltreatment is (A) physical abuse (B) sexual abuse (C) infanticide (D) neglect (E) lack of supervision 8. The number of annual reports made nationally to a child abuse hotline is (A) 60,000 (B) 1 million (C) 2 million (D) 3 million (E) 5 million 9. During the hospitalization the mother is engaging the child and the child takes nutrition well from the mother. She has just obtained a protective order from the courts with regard to her partner. Four months after you evaluated and reported a child for suspected child abuse, you receive a subpoena to appear in juvenile court. His siblings, who are 2 and 4 years of age, are evaluated and found to have mild malnutrition but have not seen a physician in more than a year. With regard to neglect, all of the following are true except (A) neglect is a failure to meet a child�s needs with regard to food, shelter, or clothing, and medical, emotional, and educational needs (B) neglect has variable manifestations (C) often neglect is defined in terms of acts of omission by the caretaker (D) harm or potential injury as a result of omission is often the basis for laws defining neglect (E) lack of supervision is not a category of neglect 15. Effective management of child neglect must rely on a systematic and thorough approach by the clinician. Which of the following is a false statement regarding the management of child neglect Your understanding of the etiology of this case had to do with social factors affecting safety and access to appropriate food and medical care.

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