Edward Christian Healy, M.B.A., M.D.

https://www.hopkinsmedicine.org/profiles/results/directory/profile/2290046/edward-healy

Models for developing trauma-informed behavioral health systems and trauma-specific services acne scar removal cream purchase bactroban 5 gm fast delivery. Models of community care for severe mental illness: A review of research on case management skin care clinic cheap bactroban 5 gm overnight delivery. Birth parents with trauma histories and the child welfare system: A guide for mental health professionals skin care advice buy generic bactroban 5 gm on line. The damaging consequences of violence and trauma: Facts acne clothing buy bactroban 5 gm online, discussion points, and recommendations for the behavioral health system. Cognitive recovery in socially deprived young children: the Bucharest Early Intervention Project. Childhood trauma, the neurobiology of adaptation and use-dependent development of the brain: How ?states becomes ?traits. Risking Connection: A training curriculum for working with survivors of childhood abuse. Development of an adolescent alcohol and other drug abuse screening scale: Personal Experience Screening Questionnaire. Assessing exposure to psychological and post-traumatic stress in the juvenile justice population. Sometimes, though, people experience so much anxiety that it interferes with their ability to function normally. In children, this disorder can begin as early as 7-9 months of age with ?stranger anxiety. Perhaps the most troubling problem about anxiety is the fact that if left untreated, it may results in the manifestation of more serious mental disorders like depression (Huberty, 2004). About 13 percent of youth 9 to 17 years of age experience some kind of anxiety disorder, with females more affected than males. A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. Note: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people. A panic attack is a discrete period of intense fear or discomfort, with four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes: 1. Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress. The thoughts, impulses, or images are not simply excessive worries about real-life problems (as in generalized anxiety disorder). The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action. The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without, as in thought insertion). There will also be four distinct diagnostic clusters instead of three: avoidance symptoms, arousal/reactivity symptoms, intrusion symptoms, and negative mood and cognitions. Participation in, witnessing or confrontation with an event(s) that involved actual/threatened death or serious injury, or threat to physical integrity of self/others. Note: Young children may exhibit these themes or aspects of the trauma through repetitive play. Manifestations might include a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, even when under the influence of alcohol. Intense psychological distress when exposed to internal or external cues that symbolize/resemble an aspect of the traumatic event(s). Physiological reactivity when exposed to internal or external cues that symbolize/resemble an aspect of the traumatic event(s). Efforts to avoid activities, place, or people that awaken recollections of the trauma. Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging. Developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached, as evidenced by three (or more) of the following: 1. Consistent failure to speak in specific social situations (in which there is an expectation for speaking. Comorbidity of Anxiety Disorders Most children with an anxiety disorder (79 percent) also suffer from other psychiatric conditions, mainly other anxiety disorders (Kendall, Brady & Verduin, 2001). Of course, some of this may be an artifact of the structure of the current nosological system (Achenbach, 1995). The degree of anxiety as perceived by the learner will be the determining factor on which type of impact it has. According to the Yerkes?Dodson law, there is an empirical relationship between performance and physiological arousal (anxiety) such that performance increases with mental or physiological arousal, but only up to a point. This law was developed in 1908 by psychologists Robert Yerkes and John Dillingham Dodson, both of whom were psychologists (Wikipedia, 2013). Specifically, Separation Anxiety Disorder and Generalized Anxiety Disorder may lead to learning problems because of refusal to attend school or pay attention in class. Since avoidance is common in all anxiety disorders, school attendance may suffer indirectly even if school performance per se is not anxiety-producing. Direct interviews, using developmentally appropriate language, are essential in the screening and diagnosis of anxiety disorders. Determine onset and development of symptoms, as well as the context in which the symptoms occur and are maintained. Gather information from multiple sources, including the youth, parents, and/or teachers. Children may be more aware of their inner distress while parents or teachers may have more awareness of family or school functioning. If screening indicates significant anxiety, conduct further evaluation to differentiate anxiety disorders from developmentally appropriate worries or fears. Rule out physical conditions that may present with anxiety like hyperthyroidism, asthma, seizure disorders, and lead intoxication. Look for comorbid conditions such as attention disorders, Asperger?s, bipolar, and depression (Connolly & Bernstein, 2007). However, the ?human factor means that, as individuals, we have some power over the way we respond to anxiety-provoking events and situations (MyOptumHealth, n. Learning to use active coping strategies, distraction strategies, and problem-focused rather than avoidant-focused coping have been encouraged in anxious youths (Connolly & Bernstein, 2007). While this initial study was very small (40 children), the results suggest that a family based intervention may prevent anxiety in children whose parents have been diagnosed with an anxiety disorder. They are currently in the process of researching a larger number of participants (Ginsburg, 2009). Early Intervention Parental awareness of the effects of stressful situations on development of anxiety disorders is key to early intervention. Since parental response may exacerbate anxiety in children, awareness on the part of caregivers about this phenomenon is important. Children, especially younger ones, may not have the life-experience to correctly assess and make proper attributions of the likelihood of realistic outcomes of stressful events, and thus may become anxious when there is little to be realistically feared. Treatment the goal of any treatment for anxiety in youth should be to return the child to a typical level of functioning (Huberty, 2004). Start with a multimodal treatment approach that includes psychoeducation for the child and his/her parents about the disorder; consultation with school and primary care professionals; and cognitive-behavioral interventions (Connolly & Bernstein, 2007). Therefore, child-focused interventions may need to be supplemented with interventions that address parent-child relationships, improve family problem solving and parenting skills and reduce parental anxiety. Psychosocial Interventions for Specific Anxiety Disorders Generalized Anxiety Disorder? Youth further should learn to use positive ?self-talk as a strategy (The Child Anxiety Network, 2006). Commonly prescribed medications include Celexa, Lexapro, Luvox, Paxil, Prozac, and Zoloft.

Chapter 2: Program Activities 76 Caring for Our Children: National Health and Safety Performance Standards Transition reports on any symptoms that the child devel 2 acne on cheeks generic 5gm bactroban with visa. Another ongoing source of stress for an infant or a young All aspects of child care programs should be designed child is the separation from those they love and depend to facilitate parent/guardian input and involvement acne guide order cheap bactroban line. Caregivers/teachers should also clarify with whom the child the encouragement and involvement of parents/guard spends signifcant time and with whom the child has primary ians in the social and cognitive leaps of the child provides relationships as they will be key informants for the caregiv parents/guardians with the confdence vital to their sense of ers/teachers about the child and his/her needs acne killer purchase generic bactroban pills. Communication should be munication between the administrator acne with pus order cheap bactroban on line, caregiver/teacher sensitive to ethnic and cultural practices. The parent/guard and parent/guardian are essential to facilitate the involve ian/caregiver/teacher partnership models positive adult ment and commitment of parents/guardians. Int J Early Years Educ a child to a parent/guardian who appears impaired (see 7:229-39. A call to action: Family involvement as a consult local police or the local child protection agency critical component of teacher education programs. Establishing a Parents/guardians can be interviewed to see if the open successful family daycare home: A resource guide for providers. Caregivers of young children: Preventing and responding to programs: Issues, experiences, opportunities: Best practices child maltreatment. Parents/ b) To reach agreement on appropriate disciplinary guardians should be welcomed and encouraged to speak measures; freely to staff about concerns and suggestions. These planned conferences should occur: a) As part of the intake process; Parents/guardians who use child care services should be b) At each health update interval; regarded as active participants and partners in facilities that c) On a calendar basis, scheduled according to the meet their needs as well as their children?s. Compliance can be of age and for children with special health care measured by interviewing parents/guardians and staff. A goal recognize that parents/guardians have essential rights in of out-of-home care of infants and children is to identify helping to shape the kind of child care service their children parents/guardians who are in need of instruction so they receive (1). Parent/guardian support groups and parent/guardian meetings of all parents/guardians once or twice a year. This involvement at every level of facility planning and delivery standard avoids mention of procedures that are inappro are usually benefcial to the children, parents/guardians, priate to small family child care, as it does not require any and staff. Communication among parents/guardians whose explicit mechanism (such as a parent/guardian advisory children attend the same facility helps the parents/guardians council) for obtaining or offering parental/guardian input. Seeking consumer input is a tion increases when an understanding of the need and cornerstone of facility planning and evaluation. Centers can motivation for the intervention has been achieved through offer parents/guardians the chance to respond in writing. National Association of Child Care Resource and Referral Facilities should have in place complaint resolution proce Agencies. Facilities should develop mechanisms for holding Parents/Guardians formal and informal meetings between staff and groups of parents/guardians. Substantiated complaints and their Caregivers/teachers should establish parent/guardian resolution(s) should be posted in a prominent location. Caregivers/ cilities should post the complaint and resolution procedure teachers should have a regularly established means of where parents/guardians can easily see (or view) them. The care roles and to avoid confusion or conficts surrounding caregiver/teacher should record parental/guardian participa values. In addition to routine meetings, special meetings can tion in these on-site activities in the facility record. Complaint and reso lution documentation records can help program directors One strategy for supporting parents/guardians is to facili assess problem areas of the facility, staff, and services. It is most helpful to include an annotation encouraging parents/guardians whose document the proceedings of these meetings to facilitate children attend the same facility to communicate with one future communications and to ensure continuity of service another about the service. If parents/guard ians communicate with each other, they can share concerns Health and Behavior about the behavior of a specifc caregiver/teacher and can the facility should ask parents/guardians for information identify patterns of action suggestive of abuse/neglect. Some parents/ Health and safety education for children should include guardians may resist providing this information. If so, the physical, oral, mental, emotional, nutritional, and social caregiver/teacher should invite them to view this exchange health and should be integrated daily into the program of of information as an opportunity to express their own con activities, to include such topics as: cerns about the facility (1). The specialist/professional k) Confict management, violence prevention, and must also be certain that all communication shared with bullying prevention; caregivers/teachers is shared directly with the parent/guard l) Age-appropriate frst aid concepts; ian. These specialists may include, but are not limited to , m) Healthy and safe behaviors; physicians, registered nurses, child care health consultants, n) Poisoning prevention and poison safety; behavioral consultants. To be most useful, the service ers should integrate education to promote healthy and safe providers must share the therapeutic techniques with the behaviors (1). A child care health consultant can be helpful in a healthy and safe lifestyle (1,2). Learning and play Family Child Care Home have a reciprocal relationship; play experiences are closely related to learning (5). Opportunities for health promotion education in dren under their care, not only by making choices regard child care. The the program should strongly encourage all staff members Dietary Guidelines focus on increased healthy eating and to model healthy and safe behaviors and attitudes in their physical activity to reduce the current rate of overweight or contact with children in the indoor and outdoor learning/ obesity in American children (one in three in the nation) (6). Consultation can be sought from a child care Caregivers/teachers should talk about and model healthy health consultant or certifed health education specialist. Activities should be accompanied by words of encour the National Commission for Health Education Credentialing agement and praise for achievement. Facilities should encourage and support staff who wish to An extensive education program to make such experiential breastfeed their own infants and those who engage in gar learning possible indoors and outdoors should be sup dening to enhance interest in healthy food, science, inquiries ported by strong community resources in the form of both and learning. Staff are consistently a model for children and consultation and materials from sources such as the health should be cognizant of the environmental information and department, nutrition councils, and so forth. Suggestions for print messages they bring into the indoor and outdoor learn topics and methods of presentation are widely available (8). The labels and print messages that Examples include, but are not limited to , routine preventive are present in the indoor and outdoor learning/play environ care by health professionals, nutrition education and physi ment or family child care home should be in line with the cal activity to prevent obesity, crossing streets safely, how healthy and safe behaviors and attitudes they wish to impart to develop and use outdoor learning/play environments, car to the children. Facilities Family Child Care Home should strive for developing common language and under standing among all the partners. The transgender child: A handbook role of parents in preventing childhood obesity. A program Health and safety education for staff should include physi wide model of positive behavior support in early childhood settings. Promising partnerships: How to develop b) Healthy indoor and outdoor learning/play successful partnerships in your community. Opportunities for health promotion education in e) Monitoring developmental abilities, including child care. Risk Watch: Cluster randomized controlled trial g) Food safety; evaluating an injury prevention program. When talking with par n) Immunizations; ents/guardians, caregivers/teachers should take a general o) Gaining access to community resources; approach, while respecting cultural differences, acknowl p) Maternal or parental/guardian depression; 83 Chapter 2: Program Activities Caring for Our Children: National Health and Safety Performance Standards q) Exclusion policies; 2. Opportunities for health promotion education in procedures, poison awareness, vehicular, or bicycle, child care. Child choices to reduce exposure); care health consultation improves health and safety policies and practices. Child care c) Importance of outdoor play and learning; health consultation: Evidence based effectiveness. Promoting child hearing/vision screening, monitoring growth and development and behavioral health: Family child care providers perspectives. When values collide: Exploring a cross for developmental disabilities for children; cultural issue. Facilities should utilize opportunities for learning, such as the case of an illness present in the facility, to inform parents/guardians about illness and prevention strategies. Parent/guardian at titudes, beliefs, fears, and educational and socioeconomic levels all should be given consideration in planning and con ducting parent/guardian education (1,2). Parents/guardians should be involved closely with the facility and be actively involved in planning parent/guardian education activities. If done well, adult learning activities can be effective for edu cating parents/guardians.

An applicant whose contracted training period does not expire before the first day of the month of the examination will not be eligible for that examination skin care zahra cheap bactroban 5 gm without a prescription, even if all formal training has been completed earlier and the remaining time is used only for leave acne 404 nuke book download buy bactroban line. No credit will be given for subspecialty training during the core general pediatric residency or a chief residency acne light mask purchase cheap bactroban on line. The scholarly activity training requirements (as outlined in Section E below) apply to all Fellows beginning subspecialty training July 1 acne 3 days generic 5gm bactroban with mastercard, 2004, and thereafter. Those Fellows who began training prior to this date must meet the requirement for meaningful accomplishment in research, which was in place at the time they entered training (as outlined in Section F below). Fellows who began training before July 1, 2004, who had an interruption in training or off-cycle dates and who had a Scholarship Oversight Committee in place for at least 24 months may qualify for the requirement for Scholarly Activity. The program director is responsible for notifying all Fellows of the scholarly activity/research requirements necessary for certification upon entry to the subspecialty training program. Principles Regarding the Assessment of Scholarly Activity (for those who began training July 1, 2004, and there after) In addition to participating in a core curriculum in scholarly activities, all Fellows will be expected to engage in projects in which they develop hypotheses or in projects of substantive scholarly exploration and analysis that require critical thinking. Areas in which scholarly activity may be pursued include, but are not limited to: basic, clinical, or translational biomedicine; health services; quality improvement; bioethics; education; and public policy. In addition to biomedical research, examples of acceptable activities might include a critical meta-analysis of the literature, a systematic review of clinical practice, a critical analysis of public policy, or a curriculum development project with an assessment component. Involvement in scholarly activities must result in the generation of a specific written "work product. Signature of the Fellow, program director, and members of the Scholarship Oversight Committee on both the personal statement and work product of the Fellow as described above. Principles Regarding the Assessment of Meaningful Accomplishment in Research (for those who began training prior to July 1, 2004) Evidence of meaningful accomplishment in research must be submitted, including one or more of the following: a. First author of a hypothesis-driven research paper accepted for publication in a peer-reviewed journal deemed acceptable by the Subboard. A reprint of the paper, or a copy of the letter of acceptance by the journal and a copy of the manuscript, must be submitted. A thesis accepted as partial fulfillment of the requirements for a postgraduate degree in a field relevant to the subspecialty. The thesis or a research progress report as described in (e) must be submitted for review with documentation that the thesis was accepted and/or the degree awarded. First author of a hypothesis-driven research paper that has been submitted but not yet accepted for publication in a peer-reviewed journal deemed acceptable by the Subboard. A letter and/or electronic communication from the journal confirming the receipt of the manuscript must be included, as well as a copy of the submitted manuscript. A research progress report (signed by both the applicant and mentor) no more than five pages in length that must include (a) a statement of hypothesis, (b) delineation of methodology, (c) results and analysis, and (d) significance of the research. A research progress report may not be used to meet the requirement if an applicant is more than 2 years beyond completion of Fellowship training unless there are extenuating circumstances that may have prevented submission of a manuscript. Training Leading to Dual Pediatric Subspecialty Certification If an individual has completed 3 years of training in one subspecialty and the program director has verified both clinical competence and satisfactory completion of scholarly activity, he or she can become eligible to take an examination in a second subspecialty after 2 years of additional training, of which at least 1 year must be broad based clinical training. Individuals approved for subspecialty fast-tracking in the first subspecialty are also eligible for this pathway. An individual and his or her program director(s) may petition the Credentials Committees of two pediatric subspecialties with a proposal for a 4 or 5-year integrated training program that would meet the eligibility requirements for certification in both subspecialties. This petition must be approved before subspecialty training begins or early in the first year of subspecialty training. Training Leading to Eligibility for Combined (Internal Medicine-Pediatrics) Subspecialty Certification An individual who has completed internal medicine-pediatrics training should contact the American Board of Internal Medicine and the American Board of Pediatrics regarding opportunities for combined training. Combined training petitions must be prospectively submitted either before training begins or in the first 3 to 6 months of Fellowship training and must be approved by both boards. All training in the internal medicine and pediatric subspecialty must be completed in order for an applicant to take a pediatric subspecialty certifying examination. Subspecialty "Fast-Tracking" A subspecialty fellow who is believed to have demonstrated accomplishment in research, either before or during residency, may have a part of the training requirement waived. Evidence of such accomplishment might include a PhD degree in a discipline relevant to the subspecialty or career path of the fellow, or sustained research achievement relevant to the subspecialty or career path of the fellow. The subspecialty program director may petition the Subboard to waive the research requirements or, for those beginning subspecialty training July 1, 2004, and thereafter, the requirement for scholarly activity, and to reduce the length of subspecialty training by as much as 1 year. This petition must be made either before the beginning of training or during the first year of training. This pathway is also available to candidates who have satisfactorily completed at least 3 years of non-accredited general pediatrics training. An individual who enters subspecialty training via the Special Alternative Pathway would not be eligible for subspecialty fast-tracking. A subspecialty fellow who receives a waiver by the Subboard must complete at least 2 years of training in the subspecialty with at least 1 year of broad-based clinical training. In order for an individual to be eligible for subspecialty certification, all requirements for general pediatrics certification must be fulfilled. Time-limited Eligibility for Initial Certification Examinations Beginning with the examinations administered in 2014, the American Board of Pediatrics will require that applicants have completed the training required for initial certification in the pediatric subspecialties within the previous 7 years. If the required training was not successfully completed within the previous 7 years, the applicant must complete an additional period of accredited training in order to apply for certification. A subspecialty Fellow who entered pediatric gastroenterology training before January 1, 1990, may apply for admission on the basis of completion of 2 years of Fellowship training in pediatric gastroenterology. Three years of full-time, broad-based Fellowship training in pediatric gastroenterology are required for Fellows entering training on or after January 1, 1990. Combined absences/leave in excess of 3 months during the 3 years of training, whether for vacation, parental leave, illness, etc, must be made up. If the program director believes that combined absences/leave that exceeds 3 months is justified, a letter of explanation should be sent by the director for review by the Credentials Committee. For a Fellow who began pediatric gastroenterology training on or after January 1, 1990, the following must be accomplished in order to become certified in the subspecialty:? A Verification of Competence Form must be completed by the program director(s) verifying satisfactory completion of the required training, evaluating clinical competence including professionalism, and providing evidence of scholarly activity/research;? The Fellow must meet either the criteria stated in the "Principles Regarding the Assessment of Scholarly Activity" or the criteria stated in the "Principles Regarding the Assessment of Meaningful Accomplishment in Research" as described in the General Criteria for Certification in the Pediatric Subspecialties. Fellows who began training after July 1, 2004, must meet the requirements for scholarly activity;? The Fellow must pass the subspecialty certifying examination A Fellow beginning part-time training after January 1, 1990, may complete the required training on a part time basis not to exceed 6 years. It should be noted that these criteria and conditions are subject to change without notice. Hlava, Patrick Gerner, jjjjjj y jjjjjj ooo ### Werner Dolak, Rosario Landi, Wolf D. Technological nosis endoscopic management; upper and lower gastrointestinal bleeding; improvements in endoscope design and endoscopic devices have endoscopic retrograde cholangiopancreatography; and endoscopic contributed to the evolution of pediatric endoscopy. Percutaneous endoscopic gastrostomy and endoscopy Endoscopy in the pediatric population has generally, to date, speci? It is not meant to be a comprehensive overview of a 2022 or sooner if new and relevant evidence becomes available. How, where, and when uncomplicated gastroesophageal reflux, functional gastrointesti endoscopy may be employed in pediatric management is particu nal disorders, or for diagnosing perforation. The key perform pediatric procedures, collaboration between adult gastro questions were prepared by the coordinating team (A. Each task force performed a systematic literature (6), from which information can be obtained from visualization and search to prepare evidence-based and well-balanced statements on biopsy of the mucosal surfaces of the esophagus, stomach, and their assigned key questions. The results of the events were reported (12 secondary bleeding following variceal relevant publications were summarized in literature tables and banding/sclerotherapy, 2 colonoscopy-related perforations, 6 graded by the level of evidence and strength of recommendation anesthesia related) (8). Each task force perforations during colonoscopy) and 6 were anesthesia/sedation proposed statements on their assigned key questions which were related. Contraindications include diagnosis of in full length, and to Endoscopy for publication of an executive perforation (Table 1). Both the Guideline and Executive summary were issued Routine tissue sampling according to the indication, even in 2016/2017 and will be considered for review and update in 2021/ in the absence of visible endoscopic abnormalities, is of major 134 One pediatric children assessed the value of routine esophageal, gastric, and study showed that biopsies from the first and third part of the duodenal biopsies and new diagnoses based on biopsy samples duodenum were important when assessing a patient for suspected alone were identified in 17% and 11% (9,10).

Skilled pediatric personnel should carefully monitor chil Epiglottitis most commonly results from infection of dren for whom the diagnosis of epiglottitis is suspected at the supraglottic structures by H acne zap purchase 5 gm bactroban free shipping. The child and ganism can be isolated from the upper airway as well as the parents are usually extremely anxious skin care 9 cheap bactroban 5gm fast delivery, and the most from the blood acne 19 years old order bactroban online pills. Never force the child into a supine position acne x factor discount bactroban 5 gm on-line, because this Still, pediatric health professionals should not dismiss position may cause the inflamed epiglottis to obstruct the the risks of epiglottitis and its consequences, however, airway, compromise diaphragmatic excursion and air because organisms such as streptococci have risen as movement, or enable the child to choke on swallowed causes of epiglottitis (Faden, 2006). Give humidified ox Assessment ygen by face mask and keep the head of the bed elevated Diagnosis of epiglottitis is made primarily from clinical at all times. Consider epiglottitis in any child with acute upper Intravenous antibiotics (usually ampicillin or cefuroxime) airway obstruction and respiratory distress, including stri must be given as soon as possible. Upon strong suspicion dor, of sudden onset (developing over a few hours) accom or confirmation of the diagnosis, intubation should be panied by high fever (more than 102. Intubation sometimes is not possible because symptoms are preceded by symptoms of an upper respira of laryngospasm or severe swelling, and in these cases, tory infection. Epiglottitis seldom causes the ?barking placement of a tracheostomy is required (see Treatment cough characteristic of other croup syndromes. Observe whether the child assumes the and monitoring sedative medication, because the risk of ?tripod position, the hallmark of epiglottitis?the child accidental extubation is high. Mild sedation also allows refuses to lie down, preferring to sit upright and lean for the child to breathe spontaneously, making mechanical ward, mouth open, to attain the best airway possible and ventilation unnecessary. As the complications, monitor body temperature, and provide Chapter 16 n n the Child With Altered Respiratory Status 685 adequate fluid and calorie intake. Tell parents when they should expect the child nothing by mouth during the acute phase of the illness, to resume normal dietary habits and when discharge from and oral fluids and soft foods should not be provided until the hospital is expected. Begin teaching about adminis the child has demonstrated ability to tolerate extubation tration of oral antibiotics at home (to complete a 7-day (Clinical Judgment 16?1). As with any hospitalization, parental anxiety is high, especially if the child is admitted in acute respiratory dis Community Care tress. Initial information should include the course of age (see Chapter 8), if they are not already immunized. Daycare agement is accomplished; how the child will be given and nursery school contact groups should be managed on nutrition, hydration, and medication; and how long they an individual basis. The rapid progression and critical nature of this disorder peak incidence of this illness is in the 6-month to 3-year render it extremely frightening. Clinical Judgment 16?1 the Drooling Child Jimmy, a 5-year-old child, presents in the emergency shock)? No visual inspection of the oral cavity is room with respiratory stridor upon inspiration and a ever indicated if epiglottis is suspected. An upper respiratory problem, as distinguished by prefers to sit forward with his chin slightly pro inspiratory stridor resulting from an obstruction. His mother states that he developed the diffi In this case, the obstruction is a swollen cherry culty breathing ?so suddenly, and both mother and red epiglottis. Keep the child with his mother to help Questions reduce anxiousness and allow him to remain in the 1. What additional data would you collect during ?tripod position, because this helps maintain an your initial assessment? What interventions should be implemented to (trachea) spasm and obstruction from the swollen maintain a patent airway in this child? Heart rate, duration of fever, and other signs of re Therefore, provide oxygen support via face mask spiratory illness. When did or bag?valve mask ventilation as needed until the he last eat or drink (to assess for dehydration and physician is ready to intubate the child. Tachycardia, cardiac arrhythmias, or upper airway obstruction found in children with croup. Ensure that equipment Hoarseness occurs because the vocal cords swell; the for intubation and tracheostomy is readily available. Racemic epinephrine is is typically preceded by a mild upper respiratory infection believed to work via topical alpha-adrenergic stimulation, with symptoms of rhinorrhea, mild cough, and low-grade which causes mucosal vasoconstriction and leads to fever. Listen for hoarseness, administration of respiratory inhalation treatments at the inspiratory stridor, and the characteristic ?barking or prescribed frequency, to disrupt regular feeding and sleep brassy cough. Clinical signs, depending on the se Community Care verity of airway obstruction, may include suprasternal, substernal, and intercostal retractions; intermittent cya Two of the most important interventions are to minimize nosis during coughing; and altered mental status related anxiety and maximize opportunities for rest. A thorough re comfortable environment free from noxious stimuli less spiratory assessment is important, because the child with ens respiratory distress. Encourage children to engage in upper airway obstruction with mild hypoxia develops quiet play that provides diversion and reduces anxiety. Rarely, endotracheal tening to music, reading stories, and doing puzzles are intubation is necessary because of complete airway some examples. Diary products should of anxiety depends on many factors, including parental be avoided until respiratory status is stable. The child should be afebrile and General supportive measures for the child include hydra free from cough before returning to school or daycare. Provide information and support, respiratory condition, hydration is an important nursing emphasizing the short-lived nature of the illness. Encourage clear fluids, particularly fluids the child child who remains at home, help the parents to mobi prefers, unless respiratory distress is severe, in which case lize their extended family and community resources, to Chapter 16 n n the Child With Altered Respiratory Status 687 relieve them of some care responsibilities and provide 1. Central apnea is an impairment of the mechanisms that them opportunities for adequate rest. Obstructive apnea is usually caused by anatomic abnor Bacterial Tracheitis malities and occurs when nasal airflow is absent despite normal or exaggerated respiratory effort. Bacterial tra children younger than 1 year of age has been estimated at cheitis is a serious cause of airway obstruction, severe between 0. The overall mortality spiratory system development is such that the lungs and rate is 4%. With early recognition and treatment, out respiratory center of the brain are designed to breathe comes are generally very good. The most common causa and control respiration at term, although they are capable tive organisms are Staphylococcus aureus, H. Therefore, the Streptococcus pyogenes, and other anaerobic bacteria (Cha lungs and respiratory center of the premature infant have et al. The physician uses laryngoscopy or bronchos term for more severe disturbances of a frighteningly seri copy to confirm the diagnosis. These episodes have been formerly called obtained during the endoscopic procedure (Cha et al. Frequent tracheal suctioning is the infant and restore normal breathing (American Acad necessary to keep the airway patent, and often the child emy of Pediatrics, 2003). Apnea Acute apneic episodes with cyanosis in term infants can have a variety of treatable causes including seizures; Apnea is cessation of airflow in to and out of the lungs. The itoring by healthcare personnel, a thorough evaluation prognosis for these infants depends on the etiology and for possible causes, and parent training (see treatment of the underlying cause. Continuous cardiorespiratory moni Assessment toring and frequent assessment of color, breathing pat terns and effort, and tone are appropriate healthcare Apnea may present simply as a parental report of pro interventions. The most impor episodes of apnea can be discharged with home apnea tant element of assessment is, therefore, to obtain a care and bradycardia monitoring equipment. Agents such as theophylline, aminophylline, or caffeine Interview the witness to determine the color of the child are sometimes useful in decreasing the severity and fre when found (pale, or blue/cyanotic), whether the child quency of apneic episodes. These medications are central had any respirations, and whether the child was limp. As ter of the brain and therefore are sometimes effective in certain whether the apneic episode occurred when the treating central apnea only. Collaborate with other health ratory center, these drugs also act on the kidney, heart, care personnel to gain as much detail as possible about and skeletal and smooth muscles. Side effects include the event itself, the physical condition of the infant before tachycardia and increased diuresis. Parents and caregivers and after the event, and circumstances surrounding its must be taught to draw up and administer the medica occurrence.

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All Participant Forms and Health History Forms have been revised to reflect these changes. The implementation date for the revised forms and risk code assignments is October 1, 2015. In the event that your agency has to use outdated forms after the October 1, 2015 implementation date, you will still be in compliance as the changes are very minor and will not affect the certification process. All revised materials will be stocked at Business Ink with a revision date of October 2015 and will be available to order. To ensure that we have adequate stock, we recommend that Local Agencies do not order more than a two month supply at one time. Please order and begin using new forms by the end of December 2015 and recycle or discard the old forms at that time. Brief descriptions of the Risk Code revisions are outlined below and the three risk codes are attached to this memo. Of note, a threshold for the amount of time human milk can be safely stored in the refrigerator has been deleted as a risk criterion. American Academy of Pediatrics and Academy of Breastfeeding Medicine) about the length of time human milk can be safely stored in the refrigerator. Note: Risk Codes 361, 381 and 460 (all revised 10/2015) are attached to this Memo. An Equal Employment Opportunity Employer 361 Depression (P, B, N) Definition/ Presence of clinical depression, including postpartum depression. See the Clarification section for more information about self-reporting a diagnosis. Although depression can occur at any age, the average onset is around age 30 (1, 2). Depression has a variety of symptoms, but the most common are deep feelings of sadness or a marked loss of interest in pleasure or activities. Other symptoms of depression include: appetite changes resulting in unintended weight losses or gains, insomnia or oversleeping, loss of energy or increased fatigue, restlessness or irritability, feelings of worthlessness or inappropriate guilt and difficulty thinking, concentrating or making decisions (1-3). Further, depression can increase the risk for some chronic diseases such as coronary heart disease, myocardial infarction, chronic pain syndromes, premature aging, and impaired wound healing. Therefore, untreated depression has the potential to impact long term health status (4). For information about children and depression, please see the Clarification section. Between 14 and 23 percent of pregnant women will experience depressive symptoms (5, 6). Several studies have found that depression risk is highest during the last trimester of pregnancy (4). Women who experience depression during pregnancy are found to be less likely to seek prenatal care (3). Pregnant women with depression may be at risk for preeclampsia, preterm delivery or delivery of low birth weight infants and have higher perinatal mortality rates (5, 6). Pregnant Adolescents In the United States, 10 percent of women become pregnant during adolescence (7). The prevalence of teen pregnancy is highest among African and Native Americans, lower socioeconomic groups, and those living in stressful family environments. The prevalence rate of depression among pregnant adolescents is between 16 and 44 percent, which is almost twice as high as among their adult counterparts and non-pregnant adolescents (7). Adolescence is a stage of rapid metabolic, hormonal, physiological and developmental changes. Depressive symptoms are likely to emerge when the physiologic and psychological changes that occur during pregnancy are superimposed upon normal developmental change. Depression in young people often occurs with mental disorders, substance abuse disorders, or physical illnesses, such as diabetes (10). Pregnant adolescents with depressive symptoms are more likely to delay or refuse prenatal care and have subsequent, short interval pregnancies (within 24 months), both of which have shown to result in poor pregnancy outcomes (11, 12). Antidepressant Use in Pregnancy Negative consequences for the newborn such as fetal growth changes and shorter gestation periods have been associated with both depression symptoms and use of antidepressant medications during pregnancy. Although rare, some studies have linked fetal malformations, cardiac defects, pulmonary hypertension and reduced birth weight to antidepressant use during pregnancy, however, more research in this area is needed.

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