peds ob exam 2

What is school age?

6-12 years old

How is growth of a school age child?

slow and progressive

What happens to a school age child’s social and developmental maturity?

accelerates

How much does a school age child grow in height?

2\.5 inches a year

How much does a school age child grow in weight?

3-3.5 kg or 7 lbs

Who hits puberty and grows faster?

girls

What is the bladder capacity in school age children?

age + 2 ounces

What happens to the muscles of a school age child?

grows stronger so they have better coordination and strength

What happens to the bones of a school age child?

ossification continues but mineralization not complete until maturity

What happens to baby teeth in a school age child?

they are all lost

When does puberty typically start?

* between 9 to 12 years old
* average age of puberty for girls is 12
* average age of puberty for boys is 14

What is a common cause of angst in school age children?

hormones

Who does school age children center their relationships around?

their peers

What Erikson’s stage do school age children experience?

industry vs inferiority

What is an example of industry?

* after school activities
* schoolwork

What may cause inferiority in school age children?

high expectations

What are school age children developing?

* concrete operational thought
* able to problem solve
* able to reason
* able to sort

What may a school age children feel about punishment from God?

sees illness or injury as punishment for wrongdoings

How improved are a school age child’s fine and gross motor skills?

* fine motor skills are improved b/c of myelination
* gross motor skills are improved b/c of increased coordination, balance, and rhythm

What is amblyopia?

reduced vision in an eye that isn’t used adequately during early development

How is amblyopia treated?

eye patch over good eye so bad eye is strengthened

How can you improve self concept in a school age child?

* praise
* positive reinforcement

What does positive self concept lead to?

* self respect
* self confidence
* happiness

Who are significant adults?

adults that make positive interactions with a child

What happens to their self concept as school age children begin to grow physically?

increases and becomes positive

What may threaten a school age child’s self concept?

* acceptance of their peers
* may cause feelings of inferiority

Who are the primary influence of a school age child’s personality, behavior, and value system?

their peers/friends

What kind of play does school age children like?

* organized sports
* structured play
* being in groups and clubs
* team play
* cooperative
* quiet games and activities

What should you tell a child to wear if they are riding a bike, skateboarding, scooter or in line skating?

* helmet
* knee pads

What is the quality of the school age child’s diet based off of?

the family’s pattern of eating

How should you assess a school age child’s weight?

* family’s eating patterns
* how often they exercise

How is the night time routine of a school age child?

weans away from a consistent bedtime routine

How should you discipline a school age child?

* separate the deed from the doer
* keep the punishment to what the child did at the moment
* focus on present behaviors, don’t bring up past behaviors

Is sex a normal part of curiosity during childhood?

yes

When is the ideal time for formal sex education?

middle childhood

What are the school age child’s forms of socialization?

* family first
* school second

What happens to peer relationships school age children have?

they become increasingly important

What are some developmental concerns the school age child may have?

* school refusal
* bullying
* stress
* social media
* latchkey
* stealing, lying, cheating

What happens to an adolescent’s physical, cognitive, psychosocial, and psychosexual maturation?

rapidly matures

How do you describe adolescence?

* transition between childhood and adulthood
* beginning of onset of puberty and ending with cessation of body growth at 18-20 years old

Who completes bone ossification earlier?

girls

What is the first sign of puberty in boys?

teste enlargement

What is the first sign of puberty in girls?

breasts development

What Erikson’s stage are adolescents going through?

identity vs role confusion/diffusion

What are adolescents developing?

* formal operational thought
* egocentric thought
* able to think beyond present
* concerned about others

What is the concerns of an adolescent’s social development?

* able to define their identity independently
* acceptance by peers

How does the role of the parents of an adolescent change?

from protective and dependency to mutual affection and equality

How may an adolescent be rejected by their parent?

through emancipation

How may an adolescent feel about their self concept and body image?

* acute awareness of appearance in comparison of others
* blemishes and defects magnified unnecessarily

What does peer groups provide?

sense of belonging, strength, and power

What do peers form?

balance between dependence and autonomy

What is the number one cause of serious or fatal injury in adolescents?

car accidents

What is the number two cause of serious or fatal injury in adolescents?

* suicide
* suicide ideation
* suicide attempts

What are some concerns for adolescents?

* violence
* peer pressure to do drugs, drink, date
* substance use
* suicide

What should parents do when caring for adolescents?

* talk to them
* let go
* promote independence

How may a child protest?

* agitation
* resists caregivers
* inconsolable

How may a child experience despair?

* feel hopeless
* quiet
* withdrawn
* apathetic

How may a child detach?

* becomes interested in the environment
* ignore parent’s return

What stressors may infant and toddlers experience with illness and hospitalization?

* separation anxiety
* fear of pain and mutilation
* loss of control
* regression

What stressors may preschoolers experience with illness and hospitalization?

* fear of injury and pain especially mutilation
* loss of control over environment
* separation anxiety less obvious and serious

What stressors may school age children experience with illness and hospitalization?

* may be distressed from being away from school and friends
* fear of disability, death, injury, pain
* asks questions about care

What stressors may adolescents experience with illness and hospitalization?

* being away from friends major source of anxiety
* loss of control
* fear of injury and pain

What factors seriously affect a child’s response to hospitalization?

* age and developmental level
* cognitive ability
* preparation
* parent and family response

What is the best way to teach children about procedures?

through play

How soon should preschoolers be taught about procedures and surgery?

1-2 hrs before, use pictures and visuals

How soon should school age children be taught about procedures and surgery?

3-5 hrs before, use facts

How soon should adolescents be taught about procedures and surgery?

7-10 hrs before, be detailed

What is conjuctivitis?

pinkeye

How does periorbital cellulitis present?

* purplish coloring around eyelid
* difficult to tell if bug bite or allergies

How do you treat nasolacrimal duct obstructions?

gently massage

What is nystagmus?

rapid eye movement

What is a common bacterial infection?

acute otitis media

What may indicate a child has acute otitis media?

infant pulls on ear

What is the cause of otitis media?

blockage in ear

How may otitis media be treated?

a tube put inside of ear keep it open

Why are children at an increased risk of dehydration?

higher respiration rate and metabolic rate = more water loss

What are signs of dehydration?

* tachycardia!!! earliest sign
* sunken fontanels = moderate sign
* decreased tears and urine output = moderate sign
* change in LOC and response to stimuli
* decreased skin turgor and cap refill = late sign

How can you check the skin turgor on a child?

* feet
* toes
* belly button

How is diarrhea and vomiting treated in children?

* oral rehydration
* pedialyte
* IV fluids

How to prevent diarrhea and vomiting from spreading?

wash your hands

What shouldn’t be given to children for diarrhea?

immodium

What do kids need for infection control?

* tonsils
* lymph nodes
* so no tonsil removal

What shouldn’t be given to kids in the hospital?

* latex balloons
* bandaids -- give if 2 yrs and older

What kind of immunity does maternal antibodies have in infants younger than 3 months?

passive immunity

Why does infection rates increase in infants 3-6 months?

being exposed to more people

What is most important nursing consideration for congenital laryngomalacia?

protect the airway

What may happen if congenital laryngomalacia is severe?

may need a breathing tube

How is congenital laryngomalacia treated?

nebulizer

What are some signs of respiratory infection?

* fever
* n/v
* lack of appetite -- if too much respiratory distress, don’t force to eat
* respiratory sounds -- crackles, wheezing, stridor, croup cough

How is respiratory infection treated?

* manage fever to prevent respiratory distress
* sit them up to ease respiratory effort
* control infection -- wash hands, cough into elbow
* encourage small amount of liquids
* no smoking!

How is bronchiolitis and RSV treated?

* no antibiotics!!
* treat the symptoms

What should you get if a child has siniusitis?

CT scan

How may tonsillitis be treated?

tonsillectomy

Why may tonsillitis/pharygnitis be caused by?

multiple strep infections

What should you monitor for after a child has a tonsillectomy?

* excessive swallowing!! may cause vomiting
* tachycardia
* hypotension
* signs of fresh blood in back of throat
* vomiting bright red blood
* restlessness not r/t pain

What are signs and symptoms of epiglottitis?

* drooling!!!
* dysphonia -- whispering!!!
* dysphagia
* distressed respiratory effort

What should you do for epiglottitis?

* get them to the OR
* keep airway protected!!!
* don’t upset the child, don’t touch just get them away
* if not treated airway closed and may needs to be trached :(

What are some risk factors for asthma?

* genetics
* premature birth
* secondhand smoke
* allergies

What are common asthma symptoms?

* coughing at night or with activity
* wheezing
* shortness of breath
* chest tightness/pain

How is asthma treated?

* assess respiratory effort and lung sounds
* semi fowlers
* admin 02 via humidified mask
* give rescue meds such as broncodilators, corticosteroids, anticholingerics
* keep child comfortable