Studied by 19 people
What age is considered a school age child?
6-12 years
Enlarged spleen
Splenomegaly
Eriksons stage (for school age)
Industry vs inferiority
child is a worker and producer and wants to accomplish tasks
competitiveness is common
Piaget stage (for school age)
child thinks and reasons in concrete terms
conservation (ability to recognize two equal quantities regardless of form)
reversibility: ability to think in either direction (dog is an animal, animal is a dog)
6 year old vocab and sleep/physical development
2500 words
need 11-13 hours of sleep per night
set limits on activities, they will become overtired
loss of temporary teeth
6-7 year old behavioral development
still have magical thinking (santa!)
can lie to escape punishment
group activities important
slightly more cautious
8 year old behavioral development
group activities such as girl scouts are important
same gender friends are prefered
poor losers, but competitive sports are enjoyed
9 year old behavioral development
worries such as (step on a crack breaks your mothers back)
10 hours of sleep are needed
multiply and do simple division
table manners
more responsibility
11-12 year old development
24-26 permanent teeth
table manners go away a bit
ability to concentrate decreases
do not want parents help
9 hours of sleep needed
Nutrition for school age child
Increase in calorie needs
higher for boys (usually 400 more than regular requirements for females)
Vaccines for school age children
Booster for Tdap (11 yrs)
Meningococcal (MCV) (11 yrs)
HPV (11 yrs)
By 6 years:
DTaP
polio
MMR
Varicella
Health maintenance for school age children
WCC every year
scoliosis checks
dentist 2x per year
minimum of 10 hours of sleep per night
Hospitalized school age child
better understanding of what is going on
concerned about looking different
privacy
ADHD/ADD in boys vs girls
more common in boys
increased incidence in family (suggests genetics)
boys exhibit more behavioral problems
girls exhibit more academic underachievement
Management of ADHD/ADD
Behavioral and medication approach most effective
(no medications for preschoolers 4-6)
SNRIs (selective norepi re-uptake inhibitors)
Alpha 2 agonists
TCAs (tricylic antidepressants)
Stimulants
Diagnosis of ADHD/ADD
symptoms must be present for 6 mo
manifestations are present between ages 4-18
must be identified in more than one setting (home, school)
must cause significant impairment to functioning: academic, social
DSM-IV-TR criteria
What causes ADHD/ADD
Not well understood
most likely a lack of dopamine
possibly an alteration in mid-brain causing reactions to every stimulus instead of selected ones
genetic factors
linked to fetal alcohol syndrome and lead toxicity
What type of resp. disease is asthma
Obstructive lung disease
Asthma meds
Fluticasone (inhaled corticosteriods)
salometrol (long acting B2 agonists)
Budesonide (inhaled corticosteriods)
formoterol (long acting B2 agonists)
formoterol (long acting B2 agonists)
Albuterol (short acting B2 agonist/rescue med)
methylprednisolone, prednisolone, prednisone (oral corticosterioids)
Peak flow procedure
Stand
Take the deepest breath possible
Blow out hard
Repeat 3 times
Record the highest of 3 measurements (wait 30 seconds in between attempts)
Types of asthma medications
inhaled corticosteroids
systemic corticosteroids (oral)
anti-inflammatory agents
leukotriene receptor antagonist (decrease airway resistance)
long acting B2 antagonists (long term)
Short acting B2 antagonists (albuterol) (acute attack)
anticholinergics
Diabetes S/S
Symptoms appear quickly in kids
Polydipsia (extreme thirst r/t frequent urination )
Polyuria (urination often, glucose in urine. High glucose body is trying to remove, leading to increased urination)
Polyphagia (eating more but still losing weight due to brain tearing down fat)
Wt. loss
Lethargy
Diabetic kedoacidosis
extremely low levels of insulin
CBG of >300
Carbs not turned into fuel for energy
Fat are used but can’t be completely broken down w/o insulin
Ketones build up and excreted in urine
causes - acidosis
Insulin
Rapid
lispro
aspart
glulisine
Short acting
Regular (usually mixed with NPH)
Intermediate acting
NPH (cloudy)
Long acting
glargine
detemir
Hypoglycemia
Blood glucose below 60
give juice, candy, if blood sugar goes back up, have child eat a small amount of protein or starch to prevent relapse
glucagon if severe
Acute Rheumatic Fever
caused by untreated step (throat or skin) (not common anymore)
starts 2-6 weeks post strep infection
body develops immune response to strep
major cause of permanent heart damage, dysfunction of heart valves
S/S of Acute Rheumatic Fever
Onset slow and subtle
FEVER
Subcutaneous nodules
Abdominal pain
Weight loss
Polyarthritis (red, hot joints, edema, elevated ESR [inflammation test])
low hemoglobin
macular rash on trunk
cyanosis
Chorea: CNS involvement with involuntary movement of muscles, stumbling, spilling things, grimace, laugh, cry RARE
Diagnosis for Rheumatic Fever
Jones Criteria
Two major manifestations (carditis, subcut nodules, polyarthritis, rash, chorea)
OR
One major and two minor manifestations (minor = fever, arthralgia AKA joint stiffness)
With evidence of recent strep infection
Treatment for ARF
prevent heart damage
supportive care
bed-rest
antibiotics for strep
steroids for severe carditis or CHF
What virus causes varicella (chicken pox)
Zoster (like a rooster because its chickenpox)
herpes zoster
Which rash shows up after a high fever goes away?
Roseola (rosy has the rash)
In mumps, what is complication in adults?
Infertility
Causes of pneumonia
aspiration
virus
drowning
bacteria
obstruction in lungs
inhalation
Patent Ductus Arteriosus
The passage between the pulmonary artery and aorta in fetus (ductus arteriosus), which should close in first 48 hours, is not closed
blood continues to pass from aorta into pulmonary artery causing too much high pressure oxygenated blood in the lungs
overburdens the pulmonary system, making heart work harder
Tx by ibuprofen to close shunts
Erickson’s stage for adolescents (13+)
Identity formation vs role confusion
determining who they are
Piaget’s theory for adolescents (13+)
Formal Operations:
Early adolescents take things literally
Thinking in abstract terms by middle adolescence
Older adolescents see a situation from many viewpoints
Ventricular septal defect
hole in between the right and left ventricle.
Oxygenated blood gets pushed from the left ventricle to the right ventricle.
loud murmur can be heard at left sternal border
Coarctation of the aorta
Tightening/narrowing of the aorta
high pulses in the upper extremities
weak pulses in the lower extremities
elevated BP in arms
Tanner staging
Development of sexual maturation (breasts, public hair, gentiles)
Tanner Stages
1-5
1: preadolescent
2: Early puberty
3: Middle puberty
4: Late puberty
5: Adult
Infectious mononucleosis
AKA Mono
caused by Epstein-Barr virus
causes flu like symptoms
can cause enlarged spleen
incubation 1-2 months
transmitted by saliva
When is puberty considered over
onset of menses
production of sperm
S/S of mononucleosis (Mono)
fever
sore throat
headache
fatigue
skin rash
malaise
enlarged lymph nodes
Nursing findings for patient with appendicitis
Absent or diminished BS
rigidity of abdomen
rebound tenderness (pressing down and releasing pressure fast causes pain)
What can happen with untreated scoliosis
back pain
fatigue
disability
thoracic insufficiency syndrome (restriction of lung growth and function due to deformity )
S/S of glomerululnephritis
Usually caused by strep of skin or throat
Urine is brown and can be bloody
hypertension
swelling of the eyes may occur + general swelling
abd pain and discomfort
fatigue
vomiting
urinary output is decreased
protein, RBC, WBC, in urine.
BUN is raised and so is creat.
Normal WBC count
4-11 ish
Leukemia
overproduction of immature WBC, so they are unable to do the usual WBC tasks such as fighting infection. Normal cells are crowded out (ie: less RBCs)
CBC with differential to dx: to see numbers of different types of WBCs
High white count common
Chest x-ray shows lymph nodes that run along side of sternum
Osteosarcoma
Bone cancer
found in long bones
Pain, limping, swelling
When do girls typically stop growing?
About 2 years after menarche
Annual health screening for adolescent
scoliosis screening
BMI calculation
Hgb and Hct
lipid screen
STI screening
what is the first manifestation of sexual maturation in boys?
testicular enlargement
Risk factors for development of asthma
family hx of asthma
family hx of allergies
exposure to smoke
low birth weight
being overweight
Varicella (chicken pox)
Incubation 14-16 days
communicability 1-2 days before lesions appear and until they are crusted over
Droplet, contact with patient or contaminated objects
rash starting in center of trunk
Pertussis (Whooping cough)
Caused by bordetella
Incubation 6-20 days
Communicability 4-6 weeks from onset
Contact with patient or objects, droplet
S/S of pertussis (whooping cough)
Coreza (dry cough)
coughing with a whoop at the end
vomiting (post coughing attack)
Rubella/Mumps (paramyoxovius)
Incubation 14-21 days
communicability 7 days before and 5 days after rash appears
Direct contact (with patient) and droplet
swollen glands
earache
flu like symptoms
rubeloa (measles)
Incubation 10-20 days
communicability 4 days before and 5 days after rash occurs
Direct contact (with patient), and droplet (airborne)
fever
conjunctivitis
flu symptoms
White spots in mouth rubethat appear before rash
rash starting on face and spreading downwards
Conjunctivitis (AKA pink eye)
Incubation: depends
Direct contact
pink color in sclera of eye
yellow/green drainage from eye
crusting of eyelids in the morning
Fifths disease
Incubation: 4-14 days
communicability: onset of manifestation until rash appears
Droplet, blood
Rash on face and extremities
Bulimia Nervosa
Binging (eating more than the average person in a 2 hour period) and then throwing it up
At least once a week for 3 months
Note 
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