4 things you should consider when creating a presentation
Who is your audience?
What is your venue
Time how long is it?
What should you put on your slides
With font/words you should follow the ___ ___ rule
44 (title) 36 (text rule)
The 44 (title) 36 (text) rule states what?
that you should use a size 44 font for the title of the slide and a size 36 text for the body of the slide
Should you use a fancy font in a presentation?
No use one that is clear and ledgible
What does the Carriage Return Rule of presentations state?
relates the number of words/line per slide
5-8 lines per slide with 8 being the max lines per slide
also that if you are typing a line and it automatically carries onto the next line it is too long.
What are some things you should do when deciding your slide design for a presentation?
keep it clear and simple
stick to a single color or pattern for the background
avoide intense or bright colors for the font or background
cool color backgrounds
use textures
be consistent
Is it OK to use personal images in a presentation
No, but maybe if they are relevant
What is Susan's favorite font?
Tahoma Calibri
When should you use animations or transitions?
When they are appropriate to the flow of the lecture and highlitght important information
What is prime time slot to give a lecture at a conference?
10 am the second day
What some things you have to consider about audio/videotaping during a lecture?
is it permissible in the venue
are you ok with being recorded
is there a specific location that you need in order to stand so that you don't wander out of the camera view?
The following best describes how Susan approaches humor in presentations
C.
What is an "Endering hook"
something that "hooks" the audience and that stays with them after the lecture is a personal story or slightly off topic story that you use to personally touch the audience
(these never work for me btw, just a personal opinion...)
When should you deliever an "endering hook" in a presentation
in the beginning as the first 30 seconds of an intro and again at the end as a part of the wrap up.
What should you be mindful of when useing images in a presentation?
Copyright
always site images
document your own images as yours
document patient permission if using pt images
consider removing/obscuring images from hard copy or posted copies prior to release
possible disclaimer at the end
The most critical portion of a presentation is...
the first 30 seconds
What was the 3 top causes of death in 2007?
diseases of the heart
malignant neoplasm
cerebrovascular stroke
what were the top 3 causes of infant mortality in 2007?
congenital malformations
disorders of low birth weight
SIDS
Where do most americans want to die?
Home
Where do most Americans die?
Hospital
Using every intervention possible to see if it might help or prolong survival a few weeks is called what?
Exhaustion medicine
What are the 3 goals of Medical care?
Cure
Stabilization and maximization of function
Preparation for a comfortable death
What are some benifits of palliative care?
better QOL
Less depressive symptoms
longer median survival in patients recieving early palliative care
What is Autonomy?
"self rule" or "self determination" the ability of the patient to make their own informed decisions if they are of sound mind
Which of the following DOES NOT fall under the principle of autonomy?
B.
When a medical care provider acts in the best benifit of the patient to prevent or remove harm and to act to improve the patient situation it is called....
Benificence
Primum non nocere is the principle of ____
Non-malfeasance
A health care worker avoiding providing ineffective treatmetns or acting with malice towards a patient is acting under the principle of _____
Non-malfeasance
______ is a legal term that states that competent adults have the right to make their own medical treatment decisions
informed consent
Patients have the right to make ___s which will make decision in the future if the person becomes incapacitated or unable to make their own decisions
advanced directives
In case of mental incapacity the right to give or withold informed consent typically passes to the person's...
legal representative
close family member, agent, attorney, court apointed guardian
The right to be informed of medical donditiona nd progronis, the risks and benifits of a recommended proceedure and an explaination of the alternative procedures and treatments is required due to need for ___ consent
informed
A legal document which designates a trusted relative or firend to make health care decisions for you in the event you are unable to communicate your wishes is a ....
Health care proxy
A legal document which appoints a proxy (dosent have to be related or friend) to make decisions (not just medical but usually also financial) if the person is to become unconcious, mentally incompetent or unble to make decisions is called a _____
Power of attourney
What does it mean if a power of attourney is "durable"
it continues even if the person is to become mentally incompetent
an appointee in a power of attourney is called what?
a "attourney in fact" or an "agent"
Are living wills recognized in MA?
No
A document that designates treatment wishes. (document specifying desired life saving and life sustaining care in the event th eperson becomes both incapacitated and terminally ill) (not a DNR)
Living will
a NON legal document that provides a way for a person to express thier wishes beliefs and preferences reguarding healthcare to others
Values History
What are some things that a values history may include?
Overall attitude of life and health
Personal Relationships
Thoughts about independence and self sufficency
Living environment
Religious background and beliefs
relationships with doctors and other health
care givers
thoguhs about illness, death and dying
finances
funeral plans
optional questions
legal documents
What is the MA death with dignitiy act?
legislation that is proposed that may allow a physician to write a lethal dose of medication for a terminally ill patient.
Two people one of whom is not a fiamily member and who would not share the estate have to withness the signing of the request and attest that the patien is capable of acting voluntarily
the terminally ill patient has to repeat the request twice verbally at an interval of at least 15days
he would be counseled about alternatives like hospice care and pain control
the lethal dose would not be administered by a physician rther the patient would have to self administer it
A legal document signifying an order to helth care professionals not to perform CPR. Declines treatment in the event of cardiac arrest.
DNR do not resuscitate
T or F a DNR is easily revoked
True
T or F a DNR can be signed by a MD, PA, NP or CNA
False it can only be signed by an MD, PA or NP
What does MOLST stand for?
Massachusettes Medical Orders for Life Sustainging Treatment
What does AND stand for?
Allow Natural Death
What are some factors you should consider when assessing a patients dying process and how to approach them?
Trajectory of the illnees
persons perosnal cirumstances and values
economic and social status
ethinic and religous background
presences of family and friends
What are some comfort measures that go into effect in the care of a patient when they enter a palliative cares stage?
The non-accidental commision of any act by a caretaker upon a child under age 18 which causes or creates a substantial risk of physical or emotional injury
Abuse
T or F addiction to drug or drugs at birth is physical abuse
True
An act that constitutes a sexual offence under the laws of the commonwealth, or any sexual contact between a caretaker and a child under the care of that individual. (can occur in any setting in or out of the home)
Sexual Abuse
Failure by a caretaker, either deliberatly or through negligence or inability to take actions nessisary to provide a child with minimally adequate food, clothing, shelter, medical care, supervision, emotional stability, or other essential care.
Neglect
an impairment to or disorder of the intellectual or psychological capacity of a child as evidenced by observable and substantial reduciton in teh childs ability to function within a normal range of performance and behaivor
Emotional Injury
Abandonment is considered ___ in many states
Neglect
A child is considered abandoned when:
parients identity or whearabouts is unknown
the child has been left alone in circumstances where the child suffers serious harm
the parent failed to maintain contact with the child or provide reasonable support for a specified period of time
T or F it is considered abandonment when the parent is using a controlled substance that impairs the ability of the caregive to give adequate care for the child
T
What are some risk factors for abuse?
young parents with low educational attainment, past psychiatric history, history of child abuse, poverty, mother unemployed, poor social networks, high parity, single mother, reported domestic violence, re-ordered family, unintended pregnancy, low birth weight, fussy child
Would a bruise on the knees and shins of a child who plays soccer be considered signs of abuse?
No
Would buises on the torso, neck, buttocks or thighs of a child who is reported to be clumsy be signs of abuse?
Yes
Name some signs of abuse in children
Bruising welds or burns that cant be explained
withdrawn fearful or extreame behavior
clusters of bruises welts or burns
ear contusions
blunt force trauma
scalding
injuries where children don't usually get injured.
What are some signs of sexual abuse in children?
difficulty walking/sitting
pain or itching in the genital area
Torn, stained or bloody underclothing
frequent headaches or stomach aches
venereal disease
bruises or bleeding in external genitalia
feeling threatened by physical contact
inappropriate sex play or premature understanding of sex
frequent urinary or yeast infections
child freqently wants to go to the nurse
What are some signs of emotional injury?
sleeping problems
antisocial behavior
behavioral extreames
delays in emotional and intellecutal growth
speech disorders
inability to play as most of a cohort
Signs of Neglect
lack of medical or dental care
chronically dirty or unbathed
lack or adequate school attendance
lack of supervision
lack of proper nutrition
lack of adequate shealter
self destructive feelins or behavior
alcohol or drug abuse
what are 3 elements of substance abuse that are considered child abuse or neglect in the US
prenatal exposure of a child to harm due to the mothers use of an illegal drug or other substance
manufacture of methamphetamine in the presence of a child
selling, distributing or giving illegal drugs or alcohol to a child
(pronounced phonetically gow yaw), is an alternative form of medicine most commonly
practiced in Southeast Asia. The practice of coining involves rubbing
heated oil on the skin, most commonly the chest, back,
or shoulders, and then vigorously rubbing a coin over the area in a linear
fashion until a red mark is seen.
Coining is believed to allow a path by which a "bad wind" can be released from the body.
This "wind" is believed to be the cause of the patient's illness. Advocates use this method to treat a
variety of minor ailments including fever, chills, headache, colds, and cough.
Cupping
Cupping refers to an ancient Chinese practice in which a cup is
applied to the skin and the pressure in the cup is reduced (by using change in
heat or by suctioning out air), so that the skin and superficial muscle layer
is drawn into and held in the cup. In
some cases, the cup may be moved while the suction of skin is active, causing a
regional pulling of the skin and muscle (the technique is called gliding
cupping).
Moxibustion
Moxibustion is a form of fire heat treatment that stimulates
specific acupuncture points of the body. The term is derived from the
Japanese "mogusa" meaning herb (mugwort) and the Latin "bustion" meaning
burning.
Photodermatitis
Photodermatitis, sometimes referred to as "sun poisoning" or photoallergy is a form of allergic contact dermatitis in which the allergen
must be activated by light to sensitize the allergic response, and to
cause a rash or other systemic effects on subsequent exposure. The
second and subsequent exposures produce photoallergic skin conditions
which are often eczematous.
Resembles burns of child abuse
Salting
application of salt to the skin or packing skin in salt
old turkish custom goal to improve the helath of the newborns skin
SEs epidermolysis and hypernatreamia
Caida de mollera
Mollera caida
(or caida de la mollera) is another folk illness which affects infants.
Mollera caida is the term for a
sunken fontanelle on a baby’s skull, from the Spanish
words mollera (head or
crown, but sometimes used to describe the fontanelle) and caida (fallen).
It is believed to be caused by a sudden bump or fall, or by the infant’s sudden
withdrawal from the breast during breastfeeding. Infants with mollera
caida may be fussy, not feed well, or have diarrhea. In Western medicine,
a sunken fontanelle has been identified as a sign of dehydration, which is
usually caused by diarrhea, poor feeding, or other conditions.
In some Hispanic cultures, a common treatment for mollera caida is pushing up on the inside of
the palate, on the roof of the infant’s mouth. Other treatments include
holding the baby upside down, sucking on the top of the fontanelle with one's
mouth, or applying raw egg or oil to the fontanelle. While the folk
treatments listed here are probably not harmful if done gently, they don’t do anything to treat the underlying
dehydration. In Western medicine, infants with sunken fontanelles should
be treated with fluid and electrolyte replacement, starting with oral
rehydration but progressing to IV rehydration if needed.
Treatments for "bolita" include
putting herbs, raw egg or soap over the fontanel
shaving the head over the fontanel
oral suction over the fontanel by a folk healer
pressure on teh hard palate
immerion of the top of the head in water
slapping the soles of teh feet or shaking the infant vertically while holding him or her upsidown
What testing should be included in a child whom you suspect is abused?
Labs for (hematology, chemistries for neglect, cultures for venerial disease)
Skeletal Survey (bodywide x ray for trauma or fractures, and fractures in various states of healing)
What are two types of fractures that are pathopneumonic for abuse?
posterior rib fractures and metaphyseal fractures
Fragmentation of the distal end of one or both femurs appearing at the
bone margins as a crescent-shaped osseous density paralleling the
metaphysis, which is seen on x-rays when the growth plate is
oblique to the radiographic beam;
Bucket handel fracture
Classic metaphyseal lesions, rib fractures especially posteior, scapular fractures, spinous process fractures, sternal fractures are all
B.
multiple fractures especially bilaterally, fracture of different ages, epiphyseal separtions, vertebral body fracture and subluxations, digital fractures and complex skull fractures are
A.
subperosteal new bone formation, clavicular fractures, long bone shaft fractures, and linear skull fractures are...
B.
Condition that may mimic fractures seen in child abuse
Ostiogenesis imperfecta
or Birthing fractures
___ is the imaging method of choice when imaging suspected inflicted head trauma
CT unenhanced
What is an opthalmologic sign of abuse you may see in children?
retinal hemorrhages
How should possibly incriminating statments made by an abusive parent be documented?
DIRECT QUOTE
T or F in MA you need permission to photograph injuries or lesions that are believed to be abusive in nature
False, you DO NOT need permission to photograph injuries for abuse documentation
