Growth and Pain Objectives
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| IGF-1 | Growth hormone produced by the liver
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| Hypothalmus | secretes somatostatin and GNRH whihc both act on pituitary gland
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| GMRH | stimulates the pituitary to release GH
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| Somatostatin | inhibits the release of GH
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| GH | works to create protein synthesis in cells, and works with the IGF-1 to cause muscle and skeletal growth.
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| Dwarfism | GH deficiency
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| Gigantism | excess GH in children; excessive linear growth
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| Acromegaly | Excess GH in adults; enlarged hands, feet and facial features
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| Gynocomastia | caused by marijuana; abnormally large breasts in men
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| Relevant growth history in infants | bright wieght/length/height; pregnancy/birth complications; milestones/development patterns; disease or illness
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| Relevant growth history in children | Age of menarche; growth velocity; sports and peer involvement; sexual maturity rating
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| Pregnant women relevant grwoth history | Last menstrual cycle; wieght and weight gain; eating disorders (PICA); nausea/vomitting
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| Relevant growth history in older adults | difficulty in obtaining or preparing meals; trouble eating/chewing/swallowing; trouble feeding themselves
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| Measuring weight | no shoes or heaving clothing; ideally only in a gown
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| Measuring infant weight | special scale in grams. Naked, no diaper
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| Hip Measurement | Widest part of gluteal region
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| Waist Measurement | Midpoint between illiac crest and costal margin
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| Waist/Hip Ratio | Divide waist by hip. Should be less than 1 in men and less than .85 in women
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| High waist/hip ratio | Apple shape. Associated with a lot of medical conditions
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| Height Measurement | remove shoes. measure this in recumbent position until 2 years of age
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| Head circumference | every visit until 3 years of age, measure largest circumference
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| Macrocephaly | two or more standard deviations above normal distribution mean (rule out hydrocephally)
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| Microcephaly | two or more standard deviations below normal distribution (causes mental retardation)
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| Arm span Measurement | longest distance between fingers with arms abducted at a 90 degree angle from the body
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| Ballard Gestational Assessment Tool | used within 36 hours of birth; looks at 6 physical and 6 neuromuscular findings; EGA < 37 preterm; EGA 37-41 term; EGA > 41 Postterm
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| Sexual Maturity rating | in adolescents to dexcribe teh relationship to normal and abnormal pubertal development
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| Thelarche | Breast bud, first sign of puberty
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| Menarch | Development of menses; usually at SMP 3 or 4
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| Premature Menarche | before age 6 in African Americans and 7 in Caucasians
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| Adrenarche | development of pubic hair
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| Precocious puberty | premature menarche and adrenache
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| Males: first sign of puberty | enlargement of scrotum
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| Early puberty for males | before 9 y/o
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| Cushing Syndrome | excessive cortisol production by the adrenal complex. Characterized by weakness, weight gain, hyperpigmentation, oligomennorhea and decreased testosterone
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| Achondroplasia | genetic disorder resulting in decreased growth in cartilage in the epiphysis. Results in premature ossification
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| Pain Assessment | JCAHO requrires on every patient
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| interpretation of pain | unequal. Different for every person; note non-verbal communication
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| Perception of pain | age, emotion, culture, sleep, development
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| Pain Scales | 1-10
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