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NU 665 Midterm Exam – Questions & Correct Solutions
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NU 665 Midterm Exam – Questions & Correct SolutionsPCP as care coordinators - ANSWER -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 - ANSWER 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 - ANSWER -PCPs review notes and recommendations, looking
for missing or duplicate items
-May have an interdisciplinary clinic available
Tertiary care - ANSWER -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 - ANSWER -PCP in charge of arranging and
recognizing the need for services
Technology dependence and medication - ANSWER -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 - ANSWER -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 - ANSWER -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 - ANSWER -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 - ANSWER -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 - ANSWER -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
-Needs a wide range of services or protections
-More involved with mandated parental participation
-Eligibility - meet criteria of qualified disability - ADHD not included - developmental
delays, emotional disturbances, or SLD that affects learning or behavior
-Evaluation - a complete evaluation compiled by a team of professionals including
testing and information from a variety of sources; federally funded; must have written
consent to perform
-Provisions - it describes the child's learning problems, details services to be
provided, sets annual goals, and defines how progress will be measured; changes
made only in meeting and in collaboration with team; special provisions if suspected
or expelled; reevaluation every 3 years
Care coordination - ANSWER -PCPs are ideal - when they act as care
coordinators, this eases the burden on families, improves satisfaction, can help to
improve health care outcomes and minimize health care expenditures
-ideal because of their long-standing relationships with CHSCN and their ability to
help families navigate the complicated and often intimidating health care system
Health care issues for PCPs - ANSWER -Time consuming with being on the
phone, paperwork, reviewing medical records, and counseling parents
-Many providers have discomfort in caring for these children because of a lack of
knowledge of rare conditions or health care service requirements that may be
beyond the scope of most PCPs
-Poorly reimbursed
Patient-Centered HealthCare home plan - ANSWER -The ideal care model for
CSHCN
-Provides accessible, continuous, comprehensive, coordinated, compassionate,
culturally competent, and family centered care (parent knows their child best and
notice when issues arise; you know they know something is wrong -shared decision
making)
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