Transcript: Candace, Kira, Krystal A Child Who is Palliative What is Palliative Care? "Palliative care for children begins when an illness is identified and analyzed, and continues during the entire illness trajectory, aiming to alleviate physical, psychological, and social suffering" (Melin-Johansson, Axelsson, Jonson Grundberg & Hallqvist, 2014, p.61). What is Palliative Care? Similarities: Palliative care can be initiated at the beginning of an illness along with treatments aimed to cure Aims to improve quality of life Caregiving teams aid in decision making and establishing care goals Palliative care invloves many different disciplines Pediatric .VS. Adult Palliative Care Pediatric .VS. Adult Palliative Care Differences: Serious illness is not a "normal" condition for most children Medical decisions for young children are often made by their caregivers Pediatric palliative care can include play therapy, child life therapists and child behaviour specialists getpalliativecare.org Benefits of Palliative Care Benefits of Palliative Care Support Communication Comfort -Focuses on the whole child, while understanding how varying forms of treatment can affect the family as a whole -Support every step of the way, not only just a means of controling the childs symptoms, but also helping families understand treatment goals and options -Palliative care also ensures that children are provided with support through the maintinence of symptoms - Palliative care provides family with an overall extra layer of support, during such a difficult time , it is a resource in itself for families -Bereavement support is also an aspect of palliative care after the child has died getpalliativecare.org Childrens ideas regarding Death, What does it mean for them? Childrens ideas regarding Death, What does it mean for them? Varies depening on: Age Developmental Level Age and Developmental Differences in Response ... Children in this stage have limited understanding regarding accidental events, future and past time, not able to make discrepancies between living and nonliving - Outlook is that life is continuous with death, considered alternate states much like sleep and awake Age and Developmental Differences in Response to Death 1-3 Years 3-5 Years Concepts during this stage are crude and irreversible, unable to distinguish between reality and fantasy - Notion that death is reversible, because of child's egocentricity they are often convinced that they caused the death. Often death can be viewed as a personified entity (Bogeyman) 5-10 Years Thinking begins to become organized and logical, leading to some problem solving but child still lacks abstract reasoning - Child can percieve death as permanent and real. Sometimes may be unaccepting that death can happen to them or any of the people they care about, even though they are starting to know that people will die 10-13 Years Formal logic is starting to be incporated into thinking as well as abstract thoughts - Death viewed as real, final and universal. During this stage children may become more interested in the details such as the funeral, special care must be given to this age group as they will need to be provided with reassurance that they are cared for and loved Thinking is more refined and abstract, allowing this age group to vent emotions is very important - Mature and adult concept of death, may start to view death as an enemy at which they plan on fighting against or dealth can be percieved as failing and may present in this age group as giving up. 14-18 Years Hurwitz, C. A., Duncan, J. & Wolfe, J. (2004). Caring for the child with cancer at the close of life: "There are people who make it, and I'm hoping I'm one of them". Journal of the American Medical Association, 292(17), 2141-2149. Children's Subjective Experiences and Daily Struggles Children's Subjective Experiences and Daily Struggles Therapeutic Communication Emotional Support Physical Comfort Diversional Therapy Therapeutic Play Maintain Self Esteem (Adolescents) What Nurses can do for Children? What Nurses can do for Children? Familie's Subjective Experiences and Daily Struggles Familie's Subjective Experiences and Daily Struggles Financial Strain Emotional Strain (Frustration, Guilt) Breakdowns in Family Structure (Siblings, Spousal Roles) Lack of Self Care Loss of Caregiver Role Communication Empowering Normalization Support Encourage Self Care Encourage Respite Support (Resources) What Nurses can do for the Family? What Nurses can do for the Family? Resources Resources Courageous Parents Network Courageous Parents Network Normalize the Grief (Facilitate Positive Coping) Therapeutic Communication Create Memories Cultural and Spirtual Needs Bereavement Support Bereavement Support Gottlieb's 8 Core Values Gottlieb's 8 Core Values
Transcript: How long it takes To become a pediatrican you need 4 years of college. Followed by 4 years of medical school. Then 3 to 5 years of residency. Pediatric School Curriculums I. Conduct a Patient/Parent Interview II. Perform a physical exam III. Written and verbal communication skills IV. Physical Findings/Laboratory Findings Top 5 Schools in the Country University of Minnesota Michigan State University University of Wisconsin University of Michiagn University of Washington Aprrox. Salary Pediatric Project (cc) photo by Franco Folini on Flickr (cc) photo by Metro Centric on Flickr Specialty Median Pediatric Allergy $195,973 Pediatric Cardiology $244,944 Pediatric Endocrinology $185,901 Pediatric Gastroenterology $236,700 Pediatric Hematology/Oncology $205,999 Pediatric Infectious Disease $199,165 It's that easy! The defintion of pediatrics- The medical branch of medicine that deals with the medical care of infants, children, and adolescents. Training The word "pediactrics and it's cognates mean "healer of children", They come from two Greek words: 'pais = child' and 'iatros = doctor or healer. Specialty Median Pediatric Intensive Care $265,913 Pediatric Nephrology $217,767 Pediatric Neurology $209,955 Pediatric Orthopedic Surgery $424,367 Pediatric Pulmonology $176,974 Pediatric Surgery $400,591 Pediatrics & Adolescent Medicine $202,832 By Jessica Hernandez and Auberth Bercy There are different types of pediatricians which gross different salaries. Listed below are a group of specialties and the salaries that go with them. (cc) photo by Metro Centric on Flickr The average age limit ranges from birth to 18 years of age. (cc) photo by jimmyharris on Flickr Pediatrics
Transcript: Name: Sebastien Augustin Subject: Pediatrics Question: What is the importance of Pediatricians in daily life? Objective: To help inform others of the importance and relevance of pediatrics. What is Pediatrics? Pediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician. Why did I choose Pediatrics 1.) I am choosing Pediatrics because I work really well with children, and prefer working with kids, over adults. 2.) Pediatrics is much more than just colds and ear infections and you will see and care for a wide variety of interesting and challenging illnesses, such as depression, asthma, anemia and whatever else you feel comfortable with. 3.) Pediatricians are not the best paid doctors, but their average salary of $135,000 a year will put you into the top 5th percentile of salaries in the United States. So while you likely won't become a millionaire in Pediatrics, you will make a nice living. 4.)You get to see your patients grow up... walking, their first day at school, playing sports, graduating, etc. Different Types of Pediatrics Behavioral Pediatrics-Pediatric specialists focusing on behavioral issues will have considerable knowledge of developmental disabilities, learning disabilities. General Outlook According to the U.S. Bureau of Labor Statistics (BLS), physicians and surgeons, the occupational category that pediatricians are grouped in, could see a 22% increase in jobs from 2008-2018. Qualifications Prospective pediatricians need to meet extensive educational requirements, often beginning with a bachelor's degree in a science-related area, such as biology or chemistry. After finishing their undergraduate programs, they must complete medical school and a pediatric residency before seeking licenses and specialty certification. Conclusion In conclusion, a pediatrician is a child doctor. The profession itself is a general field of medicine that can branch of into categories based on age groups. To become a pediatrician you need 1 bachelor's in a science related area and must go to medi- cal school. The pay ranges from $88,000 - $160,000 a year dep- ending on where you work. Thanks for Listening Pediatrics Child Abuse- A very challenging specialty, pediatric specialists who choose child abuse as their focus must be truly dedicated to helping children at risk. Preferred Field of Study Anesthesia-In cases where surgery on a child is necessary, having skilled pediatric specialists on hand who are trained in sedating children is crucial. Oncology-One of the most challenging specialties, pediatric oncology is the diagnosis and treatment of cancer as well as benign (non-cancerous) tumors.
Transcript: Career Presentation: Pediatrics What is a pediatrician? What are the common work tasks for a pediatrician? Education, Training and Experience: How to get a certificate and license for your career: How much can you earn? Some important tips: I hope you had a nice time watching! A pediatrician is physician who specializes in the care of minors- anywhere from infants to teenagers. Care for health of infants to teenagers Treat day to day illness like minor injuries, infectious diseases, and immunization Examine infants and children regularly to assess their growth and development Prescribe or administer treatment therapy, medication, vaccination, and other specialized medical care to treat or prevent illness disease, or injury in infants and children Advise patients, parents, or guardians, and community members concerning diet activity hygiene and disease prevention Treat children who have minor illnesses, acute and chronic health problems, and growth and development concerns Plan and execute medical care programs to aid in the mental and physical growth and development of children and adolescent To be licensed a physician must graduate from an accredited medical school, pass a licensing examination and complete 3 to 7 years of graduate medical education (internship, residency, and/or fellowship) Graduates of foreign medical schools generally can qualify for licensure after passing an examination and completing a U.S. residency The median annual salary for a pediatrician is $140,000 The top ten percent earn more than $145,000 and the lowest ten percent earn less than $67,000 People who wish to become physicians must have a desire to serve patients, be self-motivated, and be able to survive the pressures and long hours of medical education and practice Physicians must also have a good bedside manner, emotional stability, and the ability to make decisions in emergencies As you would have to with any career, you must decide if you would enjoy the day to day duties of a pediatrician, this includes working in the hospital and/or working in the clinic, taking care of sick and healthy children, and counseling parents about raising happy and healthy children Don’t like babies or toddlers? Then pediatrics is probably not for you, although you could work with older children and teen Don’t like learning? Then pediatrics is not for you Although you learn a lot in medical school and residency, one of the greatest challenges of being a doctor is to continue learning new things as technology advances and new medicines are discovered Personally I love being a pediatrician and it almost doesn’t seem like ‘work’ when I go to the office each day Another great thing about pediatrics is that you can work part time like me Although pediatrics can be a challenging career, in the end, it is a very rewarding one To become a pediatrician after high school, you have to go to a college for 4 years, or 2 years at a community college and then 2 years at a university Then you have to take the MCAT You MUST pass the MCAT medical exam in order to be accepted to a medical school You will then have to attend 4 years at a medical school (but a few medical schools offer combined undergraduate and medical school programs for 7 years instead of the customary 8 years) After finishing medical school you have to do 1 year internship and 2 years residency for hands on experience Now you can become a general pediatrician, but if you want to do specialization like pediatric surgery, pediatric neurology, etc. then you have to do 2 to 3 more years of training/fellowship
Transcript: Pediatrics: What's it all about? Nurses who specialize in pediatrics: Associates/ Bachelors degree Pharmacists: Doctor of Pharmacy Medical laboratory technicians: Associates degree Physical and speech therapists: Graduate and Masters degree Social workers Palliative care providers: (serious, chronic illnesses) Masters degree Scope of Practice: A day in the life of a pediatrician Thank You! Occupation Presentation: Pediatrics Kendra Burrow The Road to Pediatrics Teamwork Georgia Regents University~Johns Hopkins University~ Army Licensure & Certification: In order to become a pediatrician, I must pass the national exam, and be licensed by the state. Residency: I must complete 3 years of residency after I earn my degree. I will be doing an additional 3 years to gain my sub specialty in special needs. 1. Bachelors in Biology 2. Doctor of Medicine 3. Complete residency (clinical rotations 4. Medical License (state licensing) 5. Board Certification (optional) The following are the primary duties I will be responsible for when I become a pediatrician. I will have to be capable of preforming physical examinations in a prompt and respectful manner Maintaining strong communication skills with patients and coworkers is vital in the role of a pediatrician I should be able to successfully develop and explain a plan of care for patients when needed. Documentation is one of the most important steps in inpatient care in a pediatricians office. Without the "team" it's just work.(Who wants that?) Pediatricians specialize in health and wellness from birth to age 18. Pediatricians provide preventive measures for children and are responsible for treating those who are ill. These physicians are also play a key part in reducing child and infant mortality rate, control diseases, and provide comfort to chronically ill children. 62 ECG bpm
Transcript: Brain Gowth Compelted by age 10 Anticipatory Guidance Normal Growth & Develpment of the School Age Child Normal Growth & Development Education Overview Ages 6-12 years Treatment Cerebral Palsy in School Age Children Nursing Interventions
Transcript: Work at hospitals or private practices. Examine patients, obtain medical histories, and, order and perform diagnostic tests Background Information The typical work week is 50 hours a week; but it is common for a pediatrician to work overtime or to be on call. Bachelors degree: 4 years + Medical School: 4 years + Residency: 3-8 years ___________________________________ pediatrician! -Writing in research is commonly used in pediatrics. - Academic professional discourse is used to write on patient charts or when prescribing medication. -The pediatrician will use simplified language when speaking with both the parent and child. Type of writing and language used between $100,000- $160,000 A doctor specializing in the well being of children from birth through 21 Sources: -Career: Pediatricians. (n.d.). Big Future . Retrieved April 9, 2013, from https://bigfuture.collegeboard.org/careers/health-diagnosis- treatment-pediatricians -Ianelli, V. (n.d.). Being a Pediatrician. About Pediatrics - Pediatric Parenting and Medical Advice. Retrieved April 19, 2013, from http://pediatrics.about.com/cs/pediatriccareers/a/pedi_interview_ 2.htm -Lee, M. P. (1982). A Future In Pediatrics: Medical and non-medical careers in non medical careers. New York, New York: Simon and Schuester. - "Occupational outlook handbook". 2010-2011 Edition (pp. 381-385). (2010). Pediatrician. Maryland, Massachusents:Bernam 4501 Forbes Blvd, In -The Pediatrician. (n.d.). The Ohio State University Wexner Medical Center. Retrieved April 9, 2013, from http://medicalcenter.osu.edu/patientcare/healthcare Treating day to day illnesses that are common to children. Background Information: Pediatrician Can also specialize in serious medical conditions, pediatric surgery, treating autoimmune disorders, or serious chronic ailments.
Transcript: Neonatal Case Presentation Andy Shi Huang, JMS Medical College of Georgia Day 0 Day 0 BG is a 0-day old girl infant born at gestational age 39w2d at 2:22 PM 8/26/20, SVD. She was born to a G1P1001 mother, GBS-/RPR-/chlamy-. Mother had recent HSV infection exposure on 8/19/20, and prescribed Valtrex 1 week ago when exposure was noted. Mother is homeless and on probation with an ankle bracelet for unknown reason at the time. Father is inconsistently in fights with mother in hospital and an unreliable story teller. Parents appear to lack resources available on eventual discharge. Perinatal complications: Perinatal Complications Chorioamnionitis Maternal fever Fetal tachycardia Prolonged delivery (stuck in canal at 9.5 cm for several hours) Newborn Pertinents Newborn APGAR: 7 & 9, AGA Infant had an initial rectal temp of 102, and 30 minutes later, 100.3. Decreased activity and weak cry, and obvious pallor/gray color. Infant had some grunting but no sign of respiratory distress. Clearly ill-appearing and MAP of 32, cap refill prolonged (6-7 seconds) Mildly decreased tone and weak suck Stark bruising noted on posterior scalp & caput succedaneum Coin-sized patch of denuded skin and two pustular lesions No overt appearance of vesicles or herpetic lesions Labs Labs Plan Plan Decision made to place IV and evaluate and treat for sepsis, NS bolus ordered to improve BP. Amp/gent started due to high suspicion for sepsis and may require prolonged treatment. Blood culture pending. CBC/CRP ordered. DFCS referral made. Addendum: after a second NS bolus, BP MAP increased to 44, color improved. Day 1-2 Day 1-2 Receiving Amp/Gent. PO feeding well. Scalp wound still with notable erythema on parietal/occipital scalp with coin-sized patch of denuded skin (with topical mupirocin applied)- smaller. No overt appearance of vesicles/herpetic lesions. Afebrile. Birth weight change percentage: 4%. Repeat Labs CBC, CRP, + CMP. Labs Labs #1 Plan Plan Given the elevated liver enzymes with slightly increase in CRP despite amp+gent x24 + mother's history of very recent HSV exposure/infection 1 week ago, clinical suspicion for neonatal HSV is increased. Performed lumbar puncture for HSV workup/cultures, gram stain, cell count, and differential, protein and glucose Acyclovir 20 mg/kg/dose IV q8 initiated. Continue maintenance IVF overnight to aid in BP (stable). Emphasized with MOB/FOB repeatedly about possible duration of treatment of 7, and up to 21 days depending on bacterial/HSV cultures. (Faced difficulties during discussion). HSV manifestations Evidence Neonatal HSV can be classified into three main categories, localized, CNS, and disseminated disease. In our case, we were worried about disseminated, which is approximately 1/4 of neonatal HSV disease, presenting with multiple organs involvement such as the hepatitis (with elevated liver transaminases). CNS is frequently involved (60-75%) through a hematogenously acquired meningoencephalitis. Neonates with disseminated HSV often present in the first week of life with nonspecific signs and symptoms of neonatal sepsis, including temperature dysregulation, apnea, irritability, lethargy, respiratory distress, abdominal distension, hepatomegaly, and ascites. Rarely, neonates with HSV infection may present with fever alone. The diagnosis of disseminated neonatal HSV disease often is delayed until the second week of life, awaiting the results of evaluation for bacterial sepsis. Day 2-3 Along with several NS boluses, LP was performed last night due to concerns for HSV. HSV skin/wound cultures x 6 was sent last night. Gram stain positive for GPC in clusters with 5-10 WBC per HPF. CSF HSV PCR pending. CSF culture pending. Day 2-3 Labs Labs Plan Continue amp/gent/acyclovir pending cultures. Due to clinical presentation of sepsis, infant will require a minimum of 7 days treatment. Will adjust based on culture results. Plan If HSV positive... HSV of Eyes All neonates with virologically-confirmed HSV should have an ophthalmologic examination in addition to conjunctival HSV cultures to evaluate for eye involvement. Presents as neonatal keratoconjunctivitis: conjunctival inflammation, typically occurring within the first 30 days of life. Complications range from mild hyperemia and scant discharge to permanent scarring and blindness. Typically present initially with unilateral or bilateral lid edema, moderate amount of conjunctival injection, and nonpurulent discharge. Consult is recommended as retinopathy, cataracts and chorioretinitis can develop. Ophthalmia Neonatorum Treatment Treatment Empirical treatment should be started soon after sending the culture and tapered once the final results are back. Acyclovir IV 45mg/kg/day plus vidarabine 3% ointment 5x/day for 14-21 days depending on presence or absence of CNS involvement. The outcomes for most neonates with conjunctivitis are good, particularly with interprofessional intervention and monitoring. Gichuhi S et al. Risk factors for neonatal conjunctivitis
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