School Age Child (Peds Test 3)

Diabetes: page 362, acutue rhumatic fever: ATI p. 114

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