Health Problems of the School Age Child
Card Set Information
Health Problems of the School Age Child
LCCC nursing pediatrics schoolage
For Gosselin's Final Exam
What are some s/s of school phobia? How can you help the child overcome school phobia?
Symptoms are often vague and disappear on weekends
The cause of school phobia should be investigated
Rule out physical causes and alleviate other causes
Encourage the child and promote return to school
Involve school team members if necessary
What are some s/s of ADD and ADHD?
Fidgets and squirms/difficulty sitting still
Difficulty following instructions
Difficulty taking turns
Dangerous activities without thinking of consequences
How is ADD/ADHD diagnosed?
Usually made after 3 years of age with no intellectual impairment
Must be having issues in multiple environments as symptoms may be a result of the environment
Team work needed between parents, drs, and teachers to confirm diagnosis
What medications are used for ADD/ADHD?
: CNS stimulant increases dopamine and norepinephrine. Avail in XR and transdermal patches
: like Ritalin
: Selective norepinephrine reuptake inhibitor
Side effects include insomnia (give before 6p), anorexia, weight loss, HTN, and may suppress growth with long term use
What interventions can be done to promote wellness for students with ADD/ADHD?
Consistent, structured environment
Give only one instruction at a time
Family support and supportive teachers at school
Goals include developing the child's self esteem, confidence, and academic success
What is the difference between idiopathic and secondary convulsive disorders? What are the different types of seizures?
: epilepsy presenting usually 4-8 yrs
: infection, head trauma, hemorrhage, tumor
What are the different kinds of seizures?
Grand Mal (tonic/clonic)
Akinetic (temporary loss of muscle control leads to falls)
Myoclonic (spasm of specific muscle group with no loss of conscience)
How are convulsive disorders diagnosed?
CT, brain scan, MRI
Physical and neurological assessment
What medications are used for convulsive disorders? What kind of diet is also helpful?
Antiepileptic Drugs (AED):
Fosphenytoin sodium (Cerebryx)
Valproic Acid (depakene)
Ketogenic diet- low carb diet wit adequate protein can help decrease seizures in children who have seizures that are uncontrolled
What teaching and interventions should be done for students with convulsive disorders?
Early diagnosis and control is key to prevent brain damage
Should not participate in sports where a fall could cause substantial injury
No unsupervised swimming or snorkeling
Some states prohibit driving
Should not combine anticonvulsant drugs and alcohol
What are some s/s of generalized allergies? How can general allergies by treated?
Restricted physical activity
Altered physical/personality development
: elimination or avoidance of agent, desensitization with allergy injections, treat reactions with epinephrine, antihistamines and steroids for symptomatic relief
What is Hay fever? What are the s/s? How is it treated?
Also called Allergic Rhinitis
In children, most often caused by animal danger, house dust, pollens, molds
: watery nasal discharge, postnasal drip, sneezing, allergic salute (wiping nose upward), dark circles around eyes
: antihistamine-decongestant dimetapp, claritin, zyrtec, singular, alavert, flonase
*its best to simply remove the allergen and prevent the allergy
Describe the pathophysiology of asthma
Spasms of the smooth muscle of bronchial tubes
Edema of mucus membranes
Increased production of this mucus
Leads to respiratory obstruction (reversible)
*triggered by hypersensitivity response to allergens, exercise, stress
*most common cause of school absence
What are some common triggers for asthma? What are the s/s?
Allergens, food, exercise, cold weather, irritants, stress, illness
-Coughing & dyspnea
-may be acute or slow onset
-more frequent at night
How is asthma diagnosed? Describe using a peak flow meter?
Pulmonary function tests
Definitive diagnosis is when the obstruction is reversed with bronchodilators
Peak flow meter can be used every day to measure lung function (green, yellow, red) and should be recorded to see problems that may be exacerbating
What medications are commonly used for asthma?
Beta Adrenergic Agonists
-do not use >3-4x daily (short acting)
-Serevent is long acting
: IV, PO, Inhaled
-Advair (flovent and serevent combination)
-monitor growth and rinse mouth after use
Mast Cell Stabilizer
: Cromolyn Sodium (Intal)
-exercise induced asthma
Acute status asthmaticus
Sub Q or Racemic Epi via nebulizer
What teaching should be done for students with asthma and their families?
Discuss the disease process and triggers
Recognition of impending attack
Need for environmental control
Avoidance of infection
Exercise and premedicating
How to use medication therapy and expected side effects
How do use nebulizer, MDI, spacer
What are the s/s of appendicitis? How is it treated?
Tenderness in RLQ (McBurney's Point & rebound tenderness)
*sudden absence of pain may be r/t rupture
: surgical removal
-NPO, IV access
-laxatives and enemas contraindicated
What is enuresis? How is it treated?
Involuntary urination after expected age of achieving voiding control (often occurs at night)
: DDAVP (synthetic vasopressin)
-avoid fluids prior to bed
-void before bed and at designated time at night
-provide positive reinforcement
-usually resolves by age 6-8
What is Encopresis? How is it treated?
Chronic involuntary fecal soiling beyond age when control is expected (3y/o)
Constipation can be a common cause
: increase fluids, fiber, dairy, lubricants
Usually resolves successfully, otherwise refer for psych counseling
What is rheumatic fever and what are the major manifestations?
Autoimmune reaction to group A Beta-hemolytic strep (like scarlet fever, strep throat, tonsillitis)
Affects connective tissues such as heart, lungs, joints, brain)
Follows infection by 1-5 weeks with slow/subtle s/s
Listlessness & Pallor
Anorexia & weight loss
Muscle, joint, abdom pain
: polyartritis, chorea (uncontrolled body movements), carditis
What are the minor and major criteria for rheumatic fever?
Called Jones criteria
: 1 major criteria OR 1 major and 2 minor
: carditis, polyarthritis, chorea, subcut nodules, erythema marginatum rash on trunk
: fever, arthalgia (general ache)
How is rheumatic fever treated? What complications are you concerned about?
Bedrest is essential during acute stage to decrease workload on heart
Monitor ESR, C-reactive protein, leukocytosis
Treated with ASA, penicillin (continued prophylactically for 5 yrs or age 21, possibly longer for cardiac complications), corticosteroids
*main concern is residual disease, esp cardiac (valve damage, such as mitral valve stenosis)
How is Juvenile Diabetes Mellitus diagnosed?
Fasting blood glucose >126
2 hour glucose >200
HbA1c- 7.5 indicator of glucose levels in last 3 mo (4-6 is normal level)
BUN, Creatinine and creatinine clearance to eval kidney function
How is Type 1 DM Therapeutically managed?
Glucose monitoring, with a goal range of less than 126 mg/dL
Measurement of HbA1c
UA for ketones, esp when ill (q3hr) or when glucose higher than 240 mg/dL
Exercise and carb counting
Teaching and compliance are key
What are the s/s of DKA? How is it treated?
: ketones in urine, high BG, fruity breath, kussmaul resps, cherry lips
: IV fluid and insulin, correct electrolyte imbalances and monitor resp function
What are the sick day rules for a child with DM? When should you call the Dr?
Monitor Blood Glucose frequently
Do not stop taking insulin
Check urine for ketones q3hr
Be careful with OTC meds
Have gave plan and ask for help (call Dr when BG >240 mg/dL)
What are the s/s of insulin shock and how is it treated? When should you notify the MD?
S/S of hypoglycemia (BG <60mg/dL)
Sweaty, tremors, unconscious
: give rapid carbs such as OJ, gluco tabs, then long carbs like peanut butter. If unconscious, give glucagon subcut or IM
Call MD if BG persists >60mg after 2 snacks or 3 tabs
Describe how children of different ages interact with their DM treatment
: focus teaching on parents
: knows injection sites and prepares skin for finger sticks
: knows foods not to eat, begins to help with injections, does own BG monitoring, needs many reminders
: does own injection and BG monitoring, understands more about foods, needs reminders
: knows if foods fit into plan
: plans meals and snacks, knows sliding scale, understands long term consequences but may still rebel
What is the difference between structural and nonstructural scoliosis? How is it tested and treated?
: spinal involvement in lateral curve
: muscular involvement of lateral curve
Screening with a scoliometer, forward bend test with hump on thoracic ribs (uneven scapula)
: electrical stimulation of muscles, Thoracic Lumbar Sacral Orthotic (TLSO) brace, traction, casts, spinal fusion (with or without rods)
What is Legg-Calve-Perthes Disease? What are the s/s and how is it treated?
Asceptic necrosis of the head of the femur which can be caused by trauma, but generally cause is unknown
S/S include pain in hip with limp, muscle spasm, limited mobility
Must not bear weight on the affected hip as 4 stages are completed spans from 18 mo-4 yrs (the head of femur will eventually reossify over that time)
Brace and reconstructive surgery
NSAIDs for pain
What is Osteomyelitis? What are the s/s and how is it treated?
Infection of the bone (often staph and MRSA) usually from other primary infection
: fever, malaise, localized pain with tenderness, leukocytosis, ESR, pos blood cultures
: immeadiate and intense IV antibiotics, surgical I & D
-Combined PO and PICC line Vancomycin for 3mo
What is Duchenne Muscular Dystrophy? What are some s/s?
Pseudohypertrophic x-linked (Affects males, females carriers) degenerative disease of muscles
Child finds difficulty standing/walking
As larger muscles weaken, often WC dependent by 9-11 with resp and cardiac involvement by 20 y/o
Child may not be able to get up from squatting position (Gower's sign)
Lordosis, pelvic waddling, frequent falls
What are the initial findings for Duchenne muscular dystrophy?
Reach early developmental milestones, but have mild delays early in life
Between ages 3-7, delay in motor development
: difficulty walking, running, riding bike, climbing stairs, frequent falls
Mild to moderate cognitive impairment
What nursing interventions can be done for students with Duchenne muscular dystrophy?
ROM, PROM, stay as active as possible
Promote body alignment and skin integrity (WC, braces)
Monitor resp function
Surgical release of contractures
Support family in end of life decisions
What is JIA?
Juvenile idiopathic arthritis is the most common connective tissue disorder of childhood
Cause is unknown, often autoimmune
Most common in joints of knees and hands with peak incident ages 1-3 then 8-10
How is JIA treated?
If untreated, leads to irreversible damage to joint cartilage, ligaments, menisci, eventually causing complete immobility
Drug therapy focuses on decreasing inflammation
Steroids/immunosuppressants such as prednisone
Enteric Coated ASA (not to be used during viral illness for risk of Reyes)
Methotrexate to slow joint degeneration (enbrel if unsuccessful)
Exercise, splints, heat, ROM to prevent ankylosis of joint (immobility)
What nursing interventions and teaching can be done for JIA?
Rest, evaluate pain
Splint knees, hands, wrists during sleep to prevent deformities
Warm, moist heat prior to exercise
PT/OT, ROM, swimming is best
Allow time to complete self care
Work with school for adjusted schedule
Describe the different types of fractures
: fractured bone protrudes through the skin
: bone fragments have damaged other organs
: small fragments of bone are shattered into the surrounding tissue
: compressed side of bone bends, but the tension side breaks leading to an incomplete fracture
Lateral, oblique, spiral, torus (one bone crushed into another)
Describe which fractures are most common at various ages
: femur, tibia, humerus, wrist, fingers
Various stages of healing
Spiral fractures:physical abuse
Most common of all
What are physeal injuries and why are they concerning?
Weakest point of the long bone is the cartilage growth plate
May affect future bone growth
What are the clinical manifestations of fractures?
Pain or tenderness
Diminished functional use
May have bruising, severe muscular rigidity, crepitus
How are fractures treated? What are the different kinds of casts?
Treated with realignment, immobilization, casting, closed manipulation, surgical reduction, internal and external fixation, and traction
Casts can be fiberglass or plaster (plaster is heavy and takes a long time to dry)
Describe the different types of traction
Pulling force applied to an extremity or different part of body
Includes weights, ropes, pulleys used to realign and immobilize during healing
: Bryants (femoral), Bucks (hip, legg-calve-perthes), Russell (tibia), Dunlop/overhead (humerus)
Skeletal traction (applied directly to bones with pins and wires)
: halo vest, crutchfield tong
: Ilizarov external fixator used to lengthen the bone
What assessments need to be done for children with casts?
Pain and Point tenderness
Pulse distal to fracture point
Paresthesia distal to fracture point
Paralysis distal to fracture point
Foul odor, drainage, heat at point, looseness, tightness, altered skin integrity, protect from getting wet
What three fungal infections are common in children? How is it diagnosed and treated?
Can be diagnosed using black light, treated with antifungal topicals and possibly antifungal PO
Describe pedicilosis and its treatment
Lice infestation on head, body, pubic area
Treated with Permethine (Nix) and then nits removed with fine tooth comb
Launder everything in hot water or put in plastic bag for number of days
What is scabies? What are the s/s and how is it treated?
Skin infection of mites that burrow under the skin leading dark lines, esp in warm folds of body
Intense itching that lasts weeks after successful treatment
Treated with Elimite- put all over body at bed and rinsed off in morning. May be repeated and all close contacts should be treated