lecture 5 [school age + GI dysfunction + mental health] Flashcards
(118 cards)
1
Q
what is considered school age?
A
6-12 years old
2
Q
how much do school age children grow per year?
A
5cm
3
Q
by how much are school age children gaining weight annually?
A
2-3 kg
4
Q
why do school age children have a lower center of gravity?
A
- longer legs
- varying body proportions
- face grows faster than cranium
5
Q
school age children lose their first deciduous tooth during this time
A
true
6
Q
definition
prepubescence
A
a two-year span that begins at the end of middle childhood, ending before they turn 13
7
Q
maturation of systems in school age children
GI tract
A
- fewer upset stomachs
- better glucose levels
- increase appetite
- can retain food for longer periods
- less caloric needs
8
Q
maturation of systems in school age children
renal
A
greater bladder capacity
9
Q
maturation of systems in school age children
cardiovascular
A
- heart grows slowly & smaller in relation to rest of body
- slower HR
- elevated BP
10
Q
maturation of systems in school age children
respiratory
A
slower RR
11
Q
maturation of systems in school age children
musculoskeletal
A
- ossification
- muscles still functionally immature
12
Q
which stage of Erikson do school age children should have accomplised at this point?
“latency period”
A
sense of industry & accomplishment
13
Q
what happens when they fail to develop at Erikson’s stage 4?
A
they develop a sense of inferiority
14
Q
which concepts do school age children begin to understand based on Piaget’s cognitive stages?
A
- concrete operations
- conservation of properties
- conceptual thinking
- classification of objects
- reading
15
Q
peer groups & social acceptance become the most important aspect of school-aged child’s social development
A
true
16
Q
what do school-aged children gain from acquiring peer groups or social acceptance?
A
independence from parents
17
Q
what stage of play are school-aged children involved in?
A
team play
18
Q
school-aged children have a relatively accurate & positive perception of their physical selves
A
true
19
Q
limit setting for middle schoolers is only appropriate when it:
A
- helps eliminate undesired behaviors
- guides right behavior
20
Q
physiological signs of stress & fear in school aged children
A
- stomach pains
- HA
- bed-wetting
- nightmares
- trouble sleeping
- trouble concentrating
- stubborn or aggressve behavior
- thumb sucking
- change in eating habits
21
Q
children typically eat what the family eats
A
true
22
Q
how many hours of sleep a night do school age children typically need?
A
9-12
23
Q
how can parents address bedtime resistance?
A
allowing later bedtimes as children get older
24
Q
what are components of behavioral concerns that parents & HCPs need to look out for in school-aged children?
A
- inattention
- impulsiveness
- hyperactivity
25
what are the criterion for diagnosing behavioral disorders?
* present before 7 years old
* present in two different settings
26
why is *depression* in children difficult to detect?
* unable to express feelings
* "acting out" their problems & concerns
27
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
28
how is *enuresis* diagnosed?
inappropriate bedwetting 2x/ week for three months before 5 years old
29
# definition
primary enuresis
lack of physiological control over bladder
30
# definition
secondary enuresis
bedwetting when asleep at night
31
what are the *sex chromosome* disorders commonly seen in school-age children?
* Klinefelter syndrome
* Turner syndrome
32
# definition
Turner Syndrome
absence of one of the X-chromosomes
33
how does *Turner syndrome* typically affect girls?
renders infertility
34
how is *Turner syndrome* diagnosed at birth?
* low posterior hairline
* webbed neck
* widely spaced nipples
* edema of hands & feet
35
how is *Turner syndrome* diagnosed during pre-school years?
delayed growth
36
how is *Turner syndrome* diagnosed at puberty?
* short stature
* delayed sexual development
* amenorrhea
37
how is *Turner syndrome* treated?
* female hormone treatment
* counseling
* growth hormone for linear growth
38
# definition
Klinefelter syndrome
the presence of one or more ***additional*** *X chromosomes* & only ***one*** *Y chromosome*
39
what are the characteristics of *Klinefelter syndrome*?
* absence of virilization
* small testes
* cognitive impairment
* gross motor skill difficulties
* language delay
* passivity
40
how is *Klinefelter syndrome* treated?
administration of testosterone
41
what is the most prevalent case of severe injury & death among *school-age* children?
MVA
42
what type of injury is most prevalent with MVA?
head injuries
| teach child about helmet safety
43
11-12 year olds receive which vaccines for their first dose?
* MCV *(meningococcal)*
* HPV *(human papillomavirus)*
44
11-12 year olds can start receiving *TDap* as a booster
true
45
when is the second dose for *HPV* received?
2 months after first dose
46
when is the third dose for *HPV* received?
6 months after the second dose
47
how many months apart should multi-dose vaccines need to be administered for a child to "catch up"?
1-6 months
48
which vaccines do *school age* children need to have by the time they are 13 years old?
1. DTap/ TDap
2. HPV
3. MCV
4. PCV
5. Flu/ COVID
6. Hep A
7. Hep B
8. IPV
9. MMR
10. Varicella
49
GI differences in infants
| (6)
* greater peristalsis
* deficient in enzymes
* ABD distension
* immature liver function
* smaller stomach capacity
50
why is *ABD distension* more common among infants?
gas is almost always present
51
what are the most common *GI functional disorders*?
* diarrhea *(gastroenteritis)*
* emesis
52
s/s of *gastroenteritis*
sudden increase in consistency & frequency of stools that can last up to 2 weeks
53
*gastroenteritis* is the leading cause of illness among children younger than 5 years old
true
54
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+)
55
what are the most common causes of *gastroenteritis*?
* RV
* fecal-oral transmission
* Salmonella
* Shigella
56
what is the major concern with *gastroenteritis*?
* sepsis
* dehydration
57
s/s of *gastroenteritis*
* fever
* emesis followed by grassy green diarrhea
* ABD pain
* nausea
* bloody stools
58
why is it contraindicated to give *antidiarrheal medications*?
gastroenteritis is usually self-limiting
59
# treatment
gastroenteritis
* small frequent oral hydration
* normal saline (or D5W wtih HCO3)
* avoid carbonated drinks, fruit juice, chicken broth
60
what is the rehydration regiment for children?
* 10mL/ kg each dirty diaper
* 40-50mL/ kg q4h
61
at what age is *gastroenteritis* most common?
3 months - 2 years
62
*emesis* in children is usually self-limiting and requires no further treatment
true
63
which conditions are usually associated with *emesis*?
* infectious disease
* increased ICP
* toxic ingestion
* food intolerance/ allergy
* mechanical obstruction of GI tract
* metabolic disorders
64
what does *green bilious* vomiting indicate?
bowel obstruction
65
what do *curdled stomach contents* indicate in emesis?
poor gastric emptying
66
what does the consistency & appearance of coffee grounds indicate in emesis?
GI bleeding
67
what are the various etiology of *emesis*?
* infection
* obstruction
* PUD
* appendicitis
* pancreatitis
* CNS disorder
* metabolic disorder
* pyloric stenosis
68
# emesis
infection
* fever
* diarrhea
69
# emesis
obstruction
constipation
70
# emesis
PUD, appendicitis, pancreatitis
* localized ABD pain
* vomiting
71
# emesis
CNS or metabolic disorder
* HA
* change in LOC
72
# emesis
pyloric stenosis
projectile vomiting
73
congenital defects of the *GI system*?
* cleft lip
* cleft palate
* tracheoesophageal fistula
* pyloric stenosis
* Hirschsprung's disease
74
types of *hernias*
* strangulated
* incarcerated
75
what causes *cleft lip*?
incomplete fusion of the oral cavity during intrauterine life
76
cleft lip/ palate feeding bottles
77
characteristics of *cleft lip*
* notched upper lip border
* nasal distortion
* either unilateral or bilateral involvement
78
what causes *cleft palate*?
incomplete fusion of palates during intrauterine life
79
characteristics of *cleft palate*
* visible or palpable gap in uvula
* soft palate
* hard palate
* incisive foramen w/ exposed nasal cavities
* nasal distortion
80
when can *cleft palate* be repaired?
between 6-12 months of age
| usually before 2 years old
81
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
82
for how long do children who had their cleft palate repaired stay in elbow restraints?
4-6 weeks
83
# pathology
tracheoesophageal fistula
rare malformation resulting from failed separation of esophagus & trachea
84
when does *tracheoesophageal fistula* typically occur?
4th week of gestation
85
what is the treatment for *tracheoesophageal fistula*?
emergency surgery *(potentially esophageal replacement)*
86
postop care for *TEF*
* gastrostomy tube
* tracheal suctioning *(not to extend part surgical site)*
87
# definition
pyloric stenosis
hypertrophy of circular muscle of pylorus
| causes obstruction & constriction
88
therapeutic procedures for *pyloric stenosis*
* pylorotomy
* laparotomy
89
hallmark signs of *pyloric stenosis*
* moveable mass in epigastrum
* projectile vomiting
* possible peristaltic wave while supine
* dehydration
90
how long after *pylorotomy/ laparotomy* can children be discharged?
2 days postop
91
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
92
# pathology
Hirschsprung's disease
congenital absence of ganglion cells in rectum & colon
93
characteristics of *Hirschsprung's disease*
* decreased motility
* mechanical obstruction
94
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
95
preop care for *Hirschsprung's disease*
* monitor for *enterocolitis*
* enema
* oral ABX
96
postop care *Hirschsprung's disease*
* NPO
* NG suction
* ABD assessment
* foley
* provide ostomy care
97
what is the surgical operation for *Hirschsprung's disease*?
surgical removal of aganglionic section of bowel
(temporal colostomy can be required)
98
# pathology
hernia
protrusion of a portion of an organ through an opening
99
# indication
incarcerated hernia
cannot be easily reduced
100
# indication
strangulated hernia
blood supply cut off to organ
| needs emergency surgery
101
# characteristic
celiac disease
intolerance to the protein gluten
102
which foods contain *gluten*?
* barley
* rye
* oats
* wheat
| BROW
103
what is *GERD*?
the transfer of gastric contents into the esophagus
104
what are the complications of *GERD*?
* tissue damage
* poor weight gain
* esophagitis
* persistent respiratory symptoms
105
s/s of *GERD*
* excessive crying
* arching of back
* spitting up/ vomiting
* cough, wheezing, stridor, gag
* apnea
* bloody emesis
* difficulty swallowing
* CP
* heart burn
106
managements for *GERD*
* weight control
* small frequent meals
* avoid food that intensify reflux
* thickened feedings
* elevate HOB (or hold baby for ***one hour***)
107
what are the medications for *GERD*?
* Ranitidine
* Omeprazole
108
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
109
what type of GI disorder is *appendicitis*?
inflammatory
110
what is the pathology of *appendicitis*?
inflammation of appendix
111
hallmark sign of *appendicitis*
pain at McBurney's point
112
what are the diagnostic tests that can confirm *appendicitis*?
* CBC
* UA
* WBC
* CRP
113
what would a CT scan show for *appendicitis*?
enlarged appendix & thickening of appendiceal wall
114
what is the pathology for *Celiac disease*?
gluten-sensitive enteropathy
115
what are the types of GI dysfunctions involving *malabsorption*?
* short gut syndrome
* Celiac disease
116
what are the common manifestations of *Celiac disease*?
* ABD distension
* vomiting
* diarrhea w/ foul odor
* chronic malabsorption syndrome
117
what is the pathology for *short gut syndrome*?
decreased mucosa from extensive resection of small intestine
118
what are some causes of *short gut syndrome*?
* congenital anomalies
* ischemia
* trauma (volvulus)
* transplant
* prolonged TPN therapy
