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NU665 FINAL EXAM QUESTIONS AND DETAILED ANSWERS
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NU665 FINAL EXAM QUESTIONS AND DETAILED ANSWERS
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NU665 FINAL EXAM QUESTIONS AND DETAILEDANSWERS 2024-2025
PCP 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)
1. Plan of care - developed by PCP/designated care coordination, child and family;
collaboration with other providers, agencies, and organizations involved with the care of
the patient
2. Central record or database - pertinent medical information, including hospitalizations
and specialty care; updated medical list; equipment, supplies, therapies with product
information, suppliers, sizes
3. Care coordination - information-sharing among the child, family, and other providers;
referrals to other health care providers, collaboration with agencies to obtain necessary
services
4. Family support - support groups (online, national organization); parent-to-parent
groups, social work, mental health services
5. Communication - information sharing among specialists and other professionals;
families understanding of recommendations and treatment options, encouraging
families to keep pertinent information and share this information with health care
providers as needed
Shared plan of care - ANSWER--Comprehensive information compilation that, in
partnership with the family, allows individualized care coordination
1. Determine needs and strengths of child/family - consider each family's situation and
abilities, strengths and needs, medical conditions, psychosocial factors, child/family
development, environmental issues; financial strengths and needs
2. Develop necessary partnerships - identify how providers, caregivers, and children
work together; shared agreement on plan; account for family preferences and best
practices
3. Develop a plan of care - identify roles and responsibilities of providers and families;
include specific emergency care information; include fact sheets about rare conditions,
legal documents about guardianship and/or health care decision making
4. Implement the plan of care - update the plan of care as needs change; evaluate and
plan process at each encounter, assess progress towards goals and develop new goals
as needed
Respite care - ANSWER--Provide breaks from time to time -This can take place in
homes or in institutional settings
-Some states have assess to federal funds to help support these services for families
Support groups and services - ANSWER--These services are available through
community-based services, parent training groups, and national organizations
-Families should seek out services and get involved in educational, advocacy, and other
activities to alleviate stress and caregiver fatigue
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