Topics on exams
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- Bu səhifədəki naviqasiya:
- The answer is E.
- Thank You! Have fun raising your kids or helping others!
- ILLNESS AND DEATH IN CHILDHOOD AND ADOLESCENCE
The answer is A. This child demonstrating stranger anxiety (I.e., the infant’s tendency to cry and cling to the mother when a stranger approaches). Stranger anxiety is normal in infants between 6 and 12 months of age (max – 8 months). Stranger anxiety indicates that the infant has a specific attachment to his mother and is able to distinguish her from stranger. Infants exposed to multiple caregivers are less likely to show stranger anxiety than those exposed to only one caregiver.
commonly at what age?
The answer is E. The “Band-Aid” phase occurs most commonly in preschool children between 2,5 and 6 years of age. At this age, children become overly concerned about illness and injury; they want to put a bandage on every injury.
SCHOOL AGE, ADOLESCENCE AND ADULTHOOD LATENCY OR SCHOOL AGE (7-11 YRS)
MOTOR, SOCIAL AND COGNITIVE DEVELOPMENT
ADOLESCENCE:11-20 YRS EARLY ADOLESCENCE(11-14 )
MIDDLE ADOLESCENCE (14-17)
LATE ADOLESCENCE (17-20)
TEENAGE AND SEXUALITY
TEENAGE PREGNANCY
SPECIAL ISSUES IN CHILD DEVELOPMENT ILLNESS AND DEATH IN CHILDHOOD AND ADOLESCENCE: 1-DURING TODDLER YEARS( 18 MO-2.5 YRS): HOSPITALIZED CHILFDREN FEAR SEPERATION FROM PARENTS MORE THAN FRAR OF BODILY HARM, PAIN, OR DEATH. 2- DURING PRESCHOOL YEARS( 2.5-6YRS) CHILDS GREATEST FEAR WHEN HOSPITALIZED IS OF BODILY HARM.THEY DONOT UNDERSTAND FULL MEANING OF DEATH .THAEY EXPECT DEAD FRIEND, PET OR RELATIVE WILL COME BACK TO LIFE. 3-SCHOOL AGE CHILDRENS(7-11 YRS): COPE RELATIVELY WELL WITH HOSPITALIZATION.BEST AGE TO PERFORM ELECTIVE SURGERY. BY THIS AGE ,CHILDREN UNDERSTAND FINALITY OF DEATH. SPECIAL ISSUES IN CHILD DEVELOPMENT ADOPTION 1-ADOPTIVE CHILDREN ESPECIALLY THOSE ADOPTED AFTER INFANCY, MAY BE AT INCREASED RISK OF BEHAVIORAL PROBLEMS IN CHILDHOOD AND ADOLESCENCE. 2-CHILDRENS SHOULD TOLD BY THEIR PARENTS AT THE EARLIEST AGE THAT THEY ARE ADOPTED TO AVOID A CHANCE OF OTHERWS TELLING THEM FIRST
MORE THAN 3 MILLION ARE ANNUALLY REPORTED ABUSE, 50% OF THESE ARE CONFIRMED BY INVESTIGATIONS LIKELY THAT MANY CASES ARE UNREPORTED 2-DEFINING ABUSE: TISSUE DAMAGE NEGLECT
SEXUAL EXPLOITATION MENTAL CRUELTY 3-IS A MANDATORY REPORTABLE OFFENSE UP TO AGE 18; FAILURE TO DO SO IS A CRIMINAL OFFENSE IF THE CASE IS REPORTED IN ERROR , PHYSICIAN IS PROTECTED BY LEGAL LIABILITY YOU HAVE DUTY TO PROTECT CHILD,SO SEPARATE FROM PARENT 4-CLINICAL SIGNS: BROKEN BONES SEXUAL TRANSMITTED DISEASES IN A YOUNG CHILD 92% INJURIES ARE OF THE SOFT TISSUE 5%HAVE NO PHYSICAL SIGNS NON ACCIDENTAL BURNS HAVE VERY POOR PROGNOSIS ASSOCIATED WITH DEATH OR FOSTER HOME PLACEMENT IF BURN ON ARM & HAND, CAN BE ACCIDENT IF BURN IS ON ARMS NOT HAND, LIKELY TO BE ABUSE SHAKEN BABY SYNDROME:LOOK FOR BROKEN BLOOD VESSELS IN THE EYES (SUBCONJUCTIVAL BLEEDS) : CUPPING
CHILD SEXUAL ABUSE
ADULTHOOD EARLY ADULTHOOD (20-30YRS)
MIDDLE ADULTHOOD(30-46 YR)
LATE ADULTHOOD (46-60)
OLD AGE (60 AND OVER)
SEXUALITY. • Psychiatrists are bound to like some patients more than others, but if a physician feels a strong attraction to a patient and is tempted to act on the attraction, stepping back and dispassionately assessing the situation is essential.
• How a physician begins an interview provides a powerful first impression to patients, and the manner in which a doctor opens communication with a patient has potentially powerful effects on the way the remainder of the interview proceeds. • All physicians should initially make sure that they know the patients' names and that patients know physicians' names.
• Most patients do not speak freely unless they have privacy and are sure that their conversations cannot be overheard. • A patient may appear frightened or resistant at the beginning of an interview and may not want to answer questions. • Another important initial question is, "Why now?"
• OPEN-ENDED VERSUS CLOSED-ENDED QUESTIONS • REFLECTION • FACILITATION. • SILENCE. • CONFRONTATION • CLARIFICATION • INTERPRETATION. • SUMMATION • EXPLANATION • TRANSITION • SELF-REVELATION. • POSITIVE REINFORCEMENT. • REASSURANCE • ADVICE.
• a doctor repeats to a patient in a supportive manner something that the patient has said. • i.e., if a patient is speaking about fears of dying and the effects of talking about these fears with his or her family, the doctor may say, "It seems that you are concerned with becoming a burden to your family. FACILITATION • Doctors help patients continue in the interview by providing both verbal and nonverbal cues that encourage patients to keep talking. • Nodding the head, leaning forward in the chair, and saying, "Yes, and then ?" or "Uh-huh, go on," are all examples of facilitation.
• Silence can be used in many ways in normal conversations, even to indicate disapproval or disinterest. • In the doctor–patient relationship, however, silence may be constructive and in certain situations may allow patients to contemplate, to cry, or just to sit in an accepting, supportive environment where the doctor makes it clear that not every moment must be filled with talk.
• To point out to a patient something that the doctor thinks the patient is not paying attention to, is missing, or is in some way denying. • Confrontation must be done skillfully, so that patients are not forced to become hostile and defensive. CLARIFICATION. • In clarification, doctors attempt to get details from patients about what they have already said. For example, a doctor may say: "You are feeling depressed. When is it that you feel most depressed?"
• Most often used when a doctor states something about a patient's behavior or thinking that a patient may not be aware of. • The technique follows on the doctor's careful listening to the underlying themes and patterns in the patient's story. Interpretations usually help clarify interrelationships that the patient may not see.
• Periodically during the interview, a doctor can take a moment and briefly summarize what a patient has said thus far. • Doing so assures both patient and doctor that the doctor has heard the same information as the patient has actually conveyed. • For example, the doctor may say, "OK, I just want to make sure that I've got everything right up to this point." EXPLANATION. • Doctors explain treatment plans to patients in easily understandable language and allow patients to respond and ask questions. • For example, a doctor may say: "It is essential that you come into the hospital now because of the seriousness of your condition. You will be admitted tonight through the emergency room, and I will be there to make all the arrangements. You will be given a small dose of medication that will make you sleepy. The medication is called triazolam (Halcion), and the dose you will be getting is 0.125 mg. I will see you again first thing in the morning, and we'll go over all the procedures that will be required before anything else happens. Now, what are your questions? I know you must have some." TRANSITION. • The technique of transition allows doctors to convey the idea that enough information has been obtained on one subject; the doctor's words encourage patients to continue on to another subject. • For example, a doctor may say: "You've given me a good sense of that particular time in your life. It would be good now if you told me a bit more about an even earlier time in your life."
• can lead to increased trust and compliance and can be experienced as an empathic response of a concerned physician. • False reassurance, however, is essentially lying to a patient and can badly impair the patient's trust and compliance.
• In many situations it is not only acceptable but desirable for physicians to give patients advice.
• To be effective and to be perceived as empathic rather than as inappropriate or intrusive, the advice should be given only after patients are allowed to talk freely about their problems, so that physicians have an adequate information base from which to make suggestions.
• Physicians want patients to leave an interview feeling understood and respected and believing that all the pertinent and important information has been conveyed to an informed, empathic listener. • To this end, doctors should give patients a chance to ask questions and should let patients know as much as possible about future plans.
• Compliance, also known as adherence, is the degree to which a patient carries out the clinical recommendations of a treating physician. • Examples of compliance include keeping appointments, entering into and completing a treatment program, taking medications correctly, and following recommended changes in behavior or diet.
• Depressed Patients. • Histrionic Patients. • Dependent Patients. • Impulsive Patients • Narcissistic Patients • Obsessive Patients. • Paranoid Patients. • Isolated Patients • Demanding and Passive-Aggressive Patients. • Malingering Patients.
• Trained physicians not only have learned the knowledge base and techniques of the profession but also must confront, resolve, and incorporate many significant attitudinal issues involved in becoming skilled and effective in their fields • A lack of balance can lead physicians to feel overwhelmed, depressed, and burned out. • Many physicians are at risk for this lack of balance because of particular personality and coping styles prevalent among those drawn to the practice of medicine. • For instance, many medical students are perfectionistic, controlling, and obsessive. • These traits can be adaptive for physicians when balanced with healthy doses of self-knowledge, humility, humor, and kindness. AGE, DEATH AND BEREAVEMENT • The aged are the fastest-growing group in the population • Treatment of geriatric patients requires thorough understanding of their unique attributes and special needs: – Differences in medication administration and dosing – Greater awareness of Bio-Psycho-Social aspects of late life • By the year 2030 there will be 65 million people over the age of 65, roughly 20% of the population • Currently, 25% of people over 65 years of age have some form of mental illness
Why 65??? • Based on standard set forth by government • The federal government defines persons over 65 years of age as “senior citizens” – Age 65 = eligible to collect Social Security and Medicare • Thus, common age for retirement Normal Aging • Average life expectancy in US is 76 years: – Women: 78 years – Men: 72 years • Longest life expectancy is for Chinese-American females • Shortest life expectancy is for African-American men Erickson’s Theory of Development Throughout the Lifecycle • Late adulthood: ages 65 to death • Satisfaction and pride in past accomplishments vs. feelings of a wasted life – Has life has had meaning (lived well), or was it a series of missed opportunities and disappointments Integrity vs. Despair • Positive Outcome: If the adult views life with sense of fulfillment and unity with others, he will accept death, not fear it • Negative outcome: If there is despair, death is something that is feared, it is viewed as failure and emptiness
• Biological • Psychological • Social Biological Dimension Biological Dimension • Hormonal Changes: Decreased growth hormone leads to: – Increased body fat, decreased muscle mass/strength –Weight loss – Thinner skin – Decreased renal blood flow – Decreased bone density: osteoporosis Biology of Age and Sex • Hormones and Sexuality – Decreased Estrogen causes Menopausal symptoms: hot flashes, decreased libido – Decreased Testosterone usually causes decreased libido… • BUT NOT ALWAYS…
• Skin/Hair Changes – Wrinkling, thinner skin – Pallor from decreased skin vascularity and melanocytes – Gray hair Biological Dimension cont. • Blood pressure – Systolic blood pressure increases with age due to decreased vessel compliance – Postprandial hypotension can occur following high carbohydrate meals (due to excessive release of vasodilatory hormones) • Nutrition – Decreased appetite due to decreased resting metabolic rate and decreased physical activity, and sometimes decreased sense of smell
• Neurological changes – Decreased cerebral blood flow – Decreased brain weight
• Hepatic function is decreased due to: – Reduced blood flow and cardiac output • Enzyme activity is reduced • Absorption is decreased • Renal excretion is delayed due to – Changes in glomerular filtration rate and blood flow
• Protein-binding and albumin levels are diminished • Volume of distribution is increased due to: – Reductions in muscle mass, total body water and cardiac output • Total body fat increases relative to total body weight: – Lipophilic drugs will be diluted (most psychotropic medications are highly lipophilic) • Decrease hearing • Decrease vision • Immune system • Reduced bladder control. • Cardiac disorder • DM
• Alzheimer’s • Malignancy PSYCHOLOGICAL DIMENSION Cognitive Aging • Verbal task performance (defining words, reading comprehension) remains stable • Nonverbal task performance (rapid response to novel situation) declines with age
• Learning and Memory – Normal maintenance of small amounts of information for short-term memory – Decline in working memory • Reasoning and Cognitive Flexibility – Decline with age on abstract reasoning skills Personality, Mood, and Morale • Personality remains fairly constant with age (introversion-extroversion, aggressiveness, hostility) • Majority of older persons view their lives as enjoyable and productive • 25% of elderly have mental illness • Morale is maintained through intimate social companions
Social Dimension: Longevity • Longevity most closely associated with: – Continued physical and occupational activity – Advanced education – Presence of SOCIAL SUPPORT Social Dimension: Independence • Most elderly live independently – Only a quarter of elderly individuals are cared for by younger family members – Only 5% of the elderly spend their last years in a nursing home – Assisted living facilities allow for further independence Social Dimension: Losses • Losses are Prominent – Loss of social status, occupational status – Loss of spouses, family members, friends – Loss of functioning • Coping with these losses, and appropriately grieving them are an important part of successfully navigating the geriatric period Complicated/Pathological Grief • Often evolves into Major Depression • Onset may be delayed • Symptoms often excessive or intense • May be associated with active suicidal thoughts or psychotic symptoms • May be complicated by Alcohol use
• People at risk for pathologic grief include – Those who suffered a sudden or horrific loss – Socially isolated – Those with a history of traumatic losses – Those with an ambivalent relationship to the deceased Grief Therapy • Most who are grieving do not need or seek therapy
• Grief therapy involves working thru the stages of grief and serves to normalize the grieving process Grief Therapy • Therapy is more complicated if the deceased and the bereaved had an ambivalent relationship • Patients are encouraged to talk about their angry or ambivalent feelings about the deceased
Grief Therapy • Goal is not to “have things back the way they were”, but to work thru loss and move on • Stress that the grieving process is not easy Grief Therapy • Often well-intended friends, family, even physicians try to “distract” person from grieving. This may be counterproductive – Delaying onset of grieving process may mean loss of support system that naturally evolves after loss. Society often intimates that person should be “done grieving” after certain amount of time. Then, support network from friends/family disappears Grief Therapy • Mild sedatives for sleep may be useful, but long term use should be avoided • In order for patients to work through the grief stages, use of medications (such as benzodiazepines) as quick fixes or to “numb” symptoms may interfere with and delay the grieving process • Suicide Yüklə 0,87 Mb. Dostları ilə paylaş:
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