Health Problems of the School-Age Child

Question 1

Obesity: complications, treatment and prevention

Answer 1

-Knows definition of overweight and obesity
-BMI –> screening
-Significant increase in population w/ increased healthcare costs
-Contributes to poor outcomes –> physically and psychologically

Question 2

Etiology and pathophysiology

Answer 2

-Increased caloric intake that exceeds requirement & expenditure
-Multifactorial: Metabolic, Hypothalamic, Hereditary, Social, Cultural, Psychologic factors

Question 3

Complications of obesity

Answer 3

-Insulin resistance & Type 2 diabetes
-Fatty liver disease non-alcoholic (NAFLD)
-Pulmonary complications –> sleep apnea, exercise intolerance & asthma
-Musculoskeletal & abnormal growth acceleration
-Psychologic & Social Complications

Question 4

Therapeutic management

Answer 4

-Prevention & early recognition
-Diet modification
-Special diets –> ketogenic
-Physical activity
-Behavior modification
-Medication
-Surgical Techniques –> Bariatric surgery

Question 5

Disorders of continence: enuresis

Answer 5

-Bed wetting
-More common in boys
-Usually ceases between 6 and 8 years of age
-Primary versus secondary
-Etiology and pathophysiology
-Diagnostic evaluation: Developmental age greater than 5 years, Careful history of baseline information, Physical exam

Question 6

Therapeutic management: enuresis

Answer 6

-Behavioral therapy: Reward system, retention control training & waking schedule treatment
-Conditioning therapy: Child to awaken to urinate in response to a stimulus
-Drugs –> 2nd line treatment: Desmopressin (intranasal, preferred), anticholinergic therapy & imipramine
-Other therapies & treatments: Stream interruption training, overlearning, fluid restriction & self-monitoring (motivation therapy)
-Nursing Care Management

Question 7

Encopresis

Answer 7

-Repeated voluntary or involuntary passage of feces of normal or near normal consistency into places not appropriate for that purpose
-Etiology
-Primary vs secondary
-Clinical manifestations
-More common in males
-May follow psychological stress
-May be secondary to constipation or impaction
-Therapeutic management:
-Determine cause
-Dietary intervention
-Management of constipation
-Psychotherapeutic interventions

Question 8

Disorders w/ behavioral components: ADHD and LD

Answer 8

-ADHD: inattention, impulsiveness, hyperactivity, typical consent is before age 7
-LD: a heterogeneous group of disorders w/ difficulties in acquisition and use of listening, speaking, reading, writing, reasoning, mathematical, and/or social skills
-Will need diagnostic eval from specialist

Question 9

Battery of tests for LD and ADHD

Answer 9

-Complete and thorough multidisciplinary evaluation
-Medical and developmental evaluation
-Behavior checklist/assessment tools: IQ, Hand-eye coordination, Visual and auditory perception, Comprehension and memory

Question 10

Therapeutic management of ADHD

Answer 10

-Behavioral therapy
-Classroom structures
-Family education and counseling
-Environmental manipulation
-Medication – stimulants (LOTS of side effects)
-Psychotherapy, psychologic, and social therapies
-Nursing care management

Question 11

Medications for ADHD

Answer 11

-Not all children benefit from pharmacologic therapy
-Stimulants: dextroamphetamine (dexedrine), amphetamine, dextroamphetamine (adderall), methylphenidate (ritalin)
-Side effects: insomnia, anorexia and weight loss, HTN; used long term, may suppress growth

Question 12

PTSD

Answer 12

-Development of characteristic symptoms following exposure
to extremely traumatic experience or catastrophic event
-May function adequately but have foreboding regarding the
future

Question 13

PTSD: response to the event

Answer 13

-Initial response: Intense arousal; lasts 1 to 2 hours; “Fight or flight” response
-Second phase: Lasts approximately 2 weeks; Denial, period of quiescence
-Third phase: Appears to get worse; lasts 2 to 3 months

Question 14

PTSD: symptoms

Answer 14

-Depression, anxiety, conversion rxns
-Phobic symptoms, repetitive actions
-Flashbacks are common
-Inquiry about what has happened
-Nursing care mgmt

Question 15

School phobia

Answer 15

-Extreme reluctance to attend school for a sustained period as a result of severe anxiety or fear of school-related experience
-“School refusal” and “school avoidance”
-Etiology
-Physical symptoms: fear, separation, anxiety, illnesses

Question 16

Conversion rxns

Answer 16

-AKA hysteria, hysterical conversion reaction & childhood hysteria
-Sudden onset, traced to a precipitating event
-Symptoms: Abdominal pain, fainting, pseudoseizures, paralysis, headaches, visual field restriction
-Rule out true seizures with EEG

Question 17

Childhood depression

Answer 17

-Temporary: Acute depression precipitated by a traumatic event
-Types of depression: Chronic depression, Persistent depressive disorder (also called dysthymia), Psychotic depression, Seasonal affective disorder, Bipolar disorder
-Therapeutic management: Specially trained health team, Pharmacotherapy

Question 18

Anxiety

Answer 18

-Most common type of mental health disorder in children
-Symptoms of anxiety
-Therapeutic management

Question 19

Childhood schizophrenia

Answer 19

-Severe deviation in ego functioning
-Psychotic disorders that appear after age 4-5 years
-Characterized by gradual onset of neurotic symptoms
-Lack of contact w/ reality; “a world of his own”
-Nursing care