lecture 5 [school age + GI dysfunction + mental health] Flashcards
what is considered school age?
6-12 years old
how much do school age children grow per year?
5cm
by how much are school age children gaining weight annually?
2-3 kg
why do school age children have a lower center of gravity?
- longer legs
- varying body proportions
- face grows faster than cranium
school age children lose their first deciduous tooth during this time
true
definition
prepubescence
a two-year span that begins at the end of middle childhood, ending before they turn 13
maturation of systems in school age children
GI tract
- fewer upset stomachs
- better glucose levels
- increase appetite
- can retain food for longer periods
- less caloric needs
maturation of systems in school age children
renal
greater bladder capacity
maturation of systems in school age children
cardiovascular
- heart grows slowly & smaller in relation to rest of body
- slower HR
- elevated BP
maturation of systems in school age children
respiratory
slower RR
maturation of systems in school age children
musculoskeletal
- ossification
- muscles still functionally immature
which stage of Erikson do school age children should have accomplised at this point?
“latency period”
sense of industry & accomplishment
what happens when they fail to develop at Erikson’s stage 4?
they develop a sense of inferiority
which concepts do school age children begin to understand based on Piaget’s cognitive stages?
- concrete operations
- conservation of properties
- conceptual thinking
- classification of objects
- reading
peer groups & social acceptance become the most important aspect of school-aged child’s social development
true
what do school-aged children gain from acquiring peer groups or social acceptance?
independence from parents
what stage of play are school-aged children involved in?
team play
school-aged children have a relatively accurate & positive perception of their physical selves
true
limit setting for middle schoolers is only appropriate when it:
- helps eliminate undesired behaviors
- guides right behavior
physiological signs of stress & fear in school aged children
- stomach pains
- HA
- bed-wetting
- nightmares
- trouble sleeping
- trouble concentrating
- stubborn or aggressve behavior
- thumb sucking
- change in eating habits
children typically eat what the family eats
true
how many hours of sleep a night do school age children typically need?
9-12
how can parents address bedtime resistance?
allowing later bedtimes as children get older
what are components of behavioral concerns that parents & HCPs need to look out for in school-aged children?
- inattention
- impulsiveness
- hyperactivity
what are the criterion for diagnosing behavioral disorders?
- present before 7 years old
- present in two different settings
why is depression in children difficult to detect?
- unable to express feelings
- “acting out” their problems & concerns
characteristcs of chlidren w/ depression
Box 16-7
- predominantly sad expression
- solitary play
- lack of interest in achievement
- utterance of statement reflecting low self-esteem
- nonspecific complaints of feelng unwell
how is enuresis diagnosed?
inappropriate bedwetting 2x/ week for three months before 5 years old
definition
primary enuresis
lack of physiological control over bladder
definition
secondary enuresis
bedwetting when asleep at night
what are the sex chromosome disorders commonly seen in school-age children?
- Klinefelter syndrome
- Turner syndrome
definition
Turner Syndrome
absence of one of the X-chromosomes
how does Turner syndrome typically affect girls?
renders infertility
how is Turner syndrome diagnosed at birth?
- low posterior hairline
- webbed neck
- widely spaced nipples
- edema of hands & feet
how is Turner syndrome diagnosed during pre-school years?
delayed growth
how is Turner syndrome diagnosed at puberty?
- short stature
- delayed sexual development
- amenorrhea
how is Turner syndrome treated?
- female hormone treatment
- counseling
- growth hormone for linear growth
definition
Klinefelter syndrome
the presence of one or more additional X chromosomes & only one Y chromosome
what are the characteristics of Klinefelter syndrome?
- absence of virilization
- small testes
- cognitive impairment
- gross motor skill difficulties
- language delay
- passivity
how is Klinefelter syndrome treated?
administration of testosterone
what is the most prevalent case of severe injury & death among school-age children?
MVA
what type of injury is most prevalent with MVA?
head injuries
teach child about helmet safety
11-12 year olds receive which vaccines for their first dose?
- MCV (meningococcal)
- HPV (human papillomavirus)
11-12 year olds can start receiving TDap as a booster
true
when is the second dose for HPV received?
2 months after first dose
when is the third dose for HPV received?
6 months after the second dose
how many months apart should multi-dose vaccines need to be administered for a child to “catch up”?
1-6 months
which vaccines do school age children need to have by the time they are 13 years old?
- DTap/ TDap
- HPV
- MCV
- PCV
- Flu/ COVID
- Hep A
- Hep B
- IPV
- MMR
- Varicella
GI differences in infants
(6)
- greater peristalsis
- deficient in enzymes
- ABD distension
- immature liver function
- smaller stomach capacity
why is ABD distension more common among infants?
gas is almost always present
what are the most common GI functional disorders?
- diarrhea (gastroenteritis)
- emesis
s/s of gastroenteritis
sudden increase in consistency & frequency of stools that can last up to 2 weeks
gastroenteritis is the leading cause of illness among children younger than 5 years old
true
what are the physiological implications of gastroenteritis?
- increased intestinal motility
- rapid emptying
- impaired absorption of nutrients
- excessive secretion of water & nutrients
- excessive excretion of electrolytes (Na+ and K+)
what are the most common causes of gastroenteritis?
- RV
- fecal-oral transmission
- Salmonella
- Shigella
what is the major concern with gastroenteritis?
- sepsis
- dehydration
s/s of gastroenteritis
- fever
- emesis followed by grassy green diarrhea
- ABD pain
- nausea
- bloody stools
why is it contraindicated to give antidiarrheal medications?
gastroenteritis is usually self-limiting
treatment
gastroenteritis
- small frequent oral hydration
- normal saline (or D5W wtih HCO3)
- avoid carbonated drinks, fruit juice, chicken broth
what is the rehydration regiment for children?
- 10mL/ kg each dirty diaper
- 40-50mL/ kg q4h
at what age is gastroenteritis most common?
3 months - 2 years
emesis in children is usually self-limiting and requires no further treatment
true
which conditions are usually associated with emesis?
- infectious disease
- increased ICP
- toxic ingestion
- food intolerance/ allergy
- mechanical obstruction of GI tract
- metabolic disorders
what does green bilious vomiting indicate?
bowel obstruction
what do curdled stomach contents indicate in emesis?
poor gastric emptying
what does the consistency & appearance of coffee grounds indicate in emesis?
GI bleeding
what are the various etiology of emesis?
- infection
- obstruction
- PUD
- appendicitis
- pancreatitis
- CNS disorder
- metabolic disorder
- pyloric stenosis
emesis
infection
- fever
- diarrhea
emesis
obstruction
constipation
emesis
PUD, appendicitis, pancreatitis
- localized ABD pain
- vomiting
emesis
CNS or metabolic disorder
- HA
- change in LOC
emesis
pyloric stenosis
projectile vomiting
congenital defects of the GI system?
- cleft lip
- cleft palate
- tracheoesophageal fistula
- pyloric stenosis
- Hirschsprung’s disease
types of hernias
- strangulated
- incarcerated
what causes cleft lip?
incomplete fusion of the oral cavity during intrauterine life
cleft lip/ palate feeding bottles
characteristics of cleft lip
- notched upper lip border
- nasal distortion
- either unilateral or bilateral involvement
what causes cleft palate?
incomplete fusion of palates during intrauterine life
characteristics of cleft palate
- visible or palpable gap in uvula
- soft palate
- hard palate
- incisive foramen w/ exposed nasal cavities
- nasal distortion
when can cleft palate be repaired?
between 6-12 months of age
usually before 2 years old
postop nursing care for cleft palate repair
- elevated supine position (or on side)
- cool mist tent
- blended diet
- elbow restraints
- advice to avoid sucking for 7-10 days
- no oral temps
for how long do children who had their cleft palate repaired stay in elbow restraints?
4-6 weeks
pathology
tracheoesophageal fistula
rare malformation resulting from failed separation of esophagus & trachea
when does tracheoesophageal fistula typically occur?
4th week of gestation
what is the treatment for tracheoesophageal fistula?
emergency surgery (potentially esophageal replacement)
postop care for TEF
- gastrostomy tube
- tracheal suctioning (not to extend part surgical site)
definition
pyloric stenosis
hypertrophy of circular muscle of pylorus
causes obstruction & constriction
therapeutic procedures for pyloric stenosis
- pylorotomy
- laparotomy
hallmark signs of pyloric stenosis
- moveable mass in epigastrum
- projectile vomiting
- possible peristaltic wave while supine
- dehydration
how long after pylorotomy/ laparotomy can children be discharged?
2 days postop
postop care for pylorotomy/ laparotomy
(3)
- feeding 4-6 hours after (clear liquids only)
- within 24 hours progress to glucose to electrolyte fluids/ formula
- analgesics
pathology
Hirschsprung’s disease
congenital absence of ganglion cells in rectum & colon
characteristics of Hirschsprung’s disease
- decreased motility
- mechanical obstruction
s/s of Hirschsprung’s disease
- signs of enterocolitis
- chronic constipation
- ribbon-like & smelly stools
- no meconium in the first 24-48 hrs of life
- episodes of vomiting bile
- palpable fecal mass
- visible peristalsis
preop care for Hirschsprung’s disease
- monitor for enterocolitis
- enema
- oral ABX
postop care Hirschsprung’s disease
- NPO
- NG suction
- ABD assessment
- foley
- provide ostomy care
what is the surgical operation for Hirschsprung’s disease?
surgical removal of aganglionic section of bowel
(temporal colostomy can be required)
pathology
hernia
protrusion of a portion of an organ through an opening
indication
incarcerated hernia
cannot be easily reduced
indication
strangulated hernia
blood supply cut off to organ
needs emergency surgery
characteristic
celiac disease
intolerance to the protein gluten
which foods contain gluten?
- barley
- rye
- oats
- wheat
BROW
what is GERD?
the transfer of gastric contents into the esophagus
what are the complications of GERD?
- tissue damage
- poor weight gain
- esophagitis
- persistent respiratory symptoms
s/s of GERD
- excessive crying
- arching of back
- spitting up/ vomiting
- cough, wheezing, stridor, gag
- apnea
- bloody emesis
- difficulty swallowing
- CP
- heart burn
managements for GERD
- weight control
- small frequent meals
- avoid food that intensify reflux
- thickened feedings
- elevate HOB (or hold baby for one hour)
what are the medications for GERD?
- Ranitidine
- Omeprazole
what is the surgical management for severe case of GERD?
nissen fundoplication
closes the esophagus off from the stomach to prevent it going back in
what type of GI disorder is appendicitis?
inflammatory
what is the pathology of appendicitis?
inflammation of appendix
hallmark sign of appendicitis
pain at McBurney’s point
what are the diagnostic tests that can confirm appendicitis?
- CBC
- UA
- WBC
- CRP
what would a CT scan show for appendicitis?
enlarged appendix & thickening of appendiceal wall
what is the pathology for Celiac disease?
gluten-sensitive enteropathy
what are the types of GI dysfunctions involving malabsorption?
- short gut syndrome
- Celiac disease
what are the common manifestations of Celiac disease?
- ABD distension
- vomiting
- diarrhea w/ foul odor
- chronic malabsorption syndrome
what is the pathology for short gut syndrome?
decreased mucosa from extensive resection of small intestine
what are some causes of short gut syndrome?
- congenital anomalies
- ischemia
- trauma (volvulus)
- transplant
- prolonged TPN therapy
