Guided Lecture Notes

Chapter 31:Health Supervision

Learning Objective 1. Describe the principles of health supervision.

  • Teach your students that health supervision involves providing services proactively, with the goal of optimizing the child’s level of functioning, ensuring the child is growing and developing appropriately, and promoting health through childteaching. (Refer to PowerPoint slide 2.)
  • Discuss the settings for health care services including private physicians’ offices, community health departments, sliding-scale clinics, homeless shelters, daycare centers, and schools.
  • Define the term medical home: the physician or nurse practitioner who has a long-term and comprehensive relationship with the family, leading to comprehensive, continuous, coordinated, and cost-effective care. Discuss the characteristics of a medical home.(Refer to PowerPoint slide 3 andBox 9.1.)
  • Ask your students what is meant by a partnership of health with the child, family, and community. State that these partnerships allow for mutual goal setting, marshalling of resources, and development of optimal health practices. (Refer to PowerPoint slide 4.)
  • Identify the special issues that occur in health supervision and strategies to enhance successful interactions related to these situations. (Refer to PowerPoint slide 5.)
  • Emphasize the influence of the community on health supervision. Note that a community can be a contributor to a child’s health or be the cause of his or her illnesses. (Refer to PowerPoint slides 6 and 7.)

Learning Objective 2. Identify challenges to health supervision for children with chronic illnesses.

  • Tell your students that the child with a chronic illness needs to be assessed repeatedly to determine his or her health maintenance needs. Note that these assessments determine the frequency of visits and types of interventions needed.
  • Point out that an effective partnership among the child’s medical home, family, and community is vital for a child with a chronic illness. Coordination of specialty care, community agencies, and family support networks enhances the quality of life and health of these children.
  • State that the partnership must provide frequent psychosocial assessments for children with chronic illness and discuss the issues that should be covered in these assessments. (Refer to PowerPoint slide 8.)

Learning Objective 3. List the three components of a health supervision visit.

  • Review the three components of health supervision: developmental surveillance and screening; injury and disease prevention; and health promotion. (Refer to PowerPoint slides 9, 10, and 11.)
  • Point out that health supervision visits for children without health problems and appropriate growth and development are recommended at birth, within the first week of life; by 1month; then at 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, and 24 months; and then yearly until age 21. Note that children with special needs will have more frequent and intensive visits.
  • List the screenings included in each health supervision visit. (Refer to PowerPoint slide 12.)
  • Tell your students that developmental surveillance is an ongoing collection of skilled observations made over time during health care visits. List the components of developmental surveillance. (Refer to PowerPoint slides 13, 14, and 15 and Figure 9.1.)
  • Remind your students that the historical information obtained from the parent or primary caregiver about developmental milestones may indicate warning signs or identify risks for developmental delay. Review factors placing the infant or toddler at risk for developmental problems. (Refer to Table 9.1.)
  • Emphasize the point that any child who “loses” a developmental milestone—for example, the child able to sit without support who now cannot—needs an immediate full evaluation, since this indicates a significant neurologic problem.

Learning Objective 4. Use instruments appropriately for developmental surveillance and screening of children.

  • Review the developmental screening tools available to guide the nurse who is assessing development. (Refer to Table 9.2.)
  • Discuss the types of screening performed in health surveillance including risk assessments, universal screening, and selective screening. (Refer to PowerPoint slide 16 and Boxes 9.4, 9.5, 9.6, and 9.7.)
  • List specific types of screenings performed to diagnose a disorder. (Refer to PowerPoint slides 17 and 18, Table 9.3, and Figure 9.2.)
  • Review the criteria for a risk assessment for hearing loss. (Refer to PowerPoint slide 19 and Box 9.2.)
  • Show students the types of instruments used in developmental surveillance of children, including the Snellen chart and instruments used in the Weber and Rinne tests.
  • Discuss the steps to using a visionscreening chart. (Refer to PowerPoint slides 20, 21, and 22 and Figure 9.4.)

Learning Objective 5.Demonstrate knowledge of the principles of immunization.

  • Discuss the concepts of immunity, and define passive and active immunity. (Refer to PowerPoint slide 23.)
  • Teach your students that the classification of vaccines is based on the characteristics of the antigen present. Review the types of vaccines used for vaccinations. (Refer to PowerPoint slide 24.)
  • Show the students the latest immunization schedules, and discuss the "catch-up" schedule for children who have not been adequately vaccinated. (Refer to Tables 9.5, 9.6, and 9.7.)
  • Point out that the vaccines must be given by the correct route; not all are give intramuscularly. Discuss what must be documented in the child's permanent record following an immunization. (Refer to PowerPoint slide 25, Box 9.8, Figure 9.7, and Table 9.8.)
  • Describe the types of vaccines that are currently on the market. (Refer to PowerPoint slide 26.)

Learning Objective 6.Identify barriers to immunization.

  • Discuss the two permanent contraindications or precautions to vaccines, including(1) an anaphylactic or systemic allergic reaction to a vaccine component and(2) with pertussis immunization, encephalopathy without an identified cause within 7 days of the immunization.
  • Point out the many factors that lead to children not being fully immunized. Note that parental concerns about vaccine safety are a significant cause of inadequate immunization as well as having more than one physician. (Refer to Evidence-Based Practice 9.1.)
  • Note that using combination vaccines and establishing a medical home for every child, as well as offering free immunizations for low-income families, will alleviate many of the factors associated with lack of immunization.

Learning Objective 7.Identify the key components of health promotion.

  • Teach your students that health promotion focuses on maintaining or enhancing the physical and mental health of children.
  • State that partnership development is the key strategy for success when implementing a health promotion activity.

Learning Objective 8. Describe the role of anticipatory guidance in health promotion.

  • Tell your students that anticipatory guidance, in which nurses partner with parents to create a "roadmap" to optimal health, is regarded as primary prevention.
  • Review the topics for which nurses can provide anticipatory guidance to promote health in children. (Refer to PowerPoint slide 27, Box 9.9, and Teaching Guidelines 9.1, 9.2, and 9.3.)