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FNP: 1 > School Age > Flashcards

School Age Flashcards

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1
Q

Erkison Developmental Theory for school age

A

Industry v. Inferiority

  • Building, creating, accomplishing

Skills:

  • Relating to peers, kids want to be together
  • Teamwork/ team sports
  • Self discipline, mastering reading and arithmetic
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2
Q

Piaget Developmental Theory for school age

A

Concerte Operational Thinking

  • coherent organized thoughts
  • conservation of mass and volume
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3
Q

History for school age

A

Birth hx for patients 0-12 years (prenatal hx & immunizations)

Recurrent illnesses

Hospitalizations- do they use one setting?

Immunizations

Nutrition

Family illnesses

Exercise, activities, after school activities

Safety- poison control, locked guns, smoke alarms, window guards, access to telephones

Substance Use- are they sleepy?

Sexual experimentation

School performance *big one*

Developmental Milestones: Denver + met milestones?

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4
Q

What are common illnesses?

A

Otitis media/externa

Step

URI

Asthma

Heart murmur

Viral gastroenteritis

Appendicitis

Breaks/fractures in arms and legs

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5
Q

What tanner stage?

A

Tanner Stage: I

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6
Q

What tanner stage?

A

Tanner Stage: II

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7
Q

What tanner stage?

A

Tanner stage III

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8
Q

What tanner stage?

A

Tanner Stage IV

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9
Q

What tanner stage?

A

Tanner Stage V

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10
Q

What tanner stage?

A

Tanner Stage I

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11
Q

What tanner stage?

A

Tanner Stage II

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12
Q

What tanner stage?

A

Tanner Stage III

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13
Q

What tanner stage?

A

Tanner Stage IV

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14
Q

What tanner stage?

A

Tanner Stage: V

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15
Q

Physical exam componenets for school age

A
  • Vital signs, blood pressure, LMP Hx
  • Ht/Wt/BMI
  • Tanner staging (precocious puberty might be endocrine issue)
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16
Q

6-7 year old milestones

A

Stays busy

May loose first tooth

Practices skills to become better

Able to read age-appropriate books

Speaks in complete sentences, understands numbers, differentiates right and left, able to tell time

Cooperates and shares, plays with same gender

Likes to copy adults, jealous of others and siblings

Vision as sharp as an adult

Interest in how things work

Enunciates all sounds, able to use proper tenses, plurals, pronouns

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17
Q

8-9 year old milestones

A

Dresses and grooms self completely

Comprehends more things: fractions, space, can count backwards

Enjoys competition and games, likes clubs an groups

Begins to mix friends and play with friends of opposite gender

Able to use tools

More graceful with movement and abilities

Likes school and egar to learn

Accepts household chores

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18
Q

10-12 year old milestones

A

Remainder of adult teeth will develop

More independent

Friends very important and influential, like to talk on the phone

Increased interest in gender of interest

Reads well

Works on confidence and self-esteem

Thinks abstractly and expresses feelings well

Puberty starts

Start to form a sense of community

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19
Q

Cholesterol Screening: when and why in school age?

A

Universal screen: ages 9-11 and again 17-21 years

  • may be fasting or non-fasting depending on clinic

Screen before age 9:

  • positive family hx dyslipidemia or premature heart disease
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20
Q

High level risk factors for CVD in school age kids?

A
  • Parent/grandparent hx CVD <55 (M) or <65 (F)
  • Coronary artherosclerosis, peripheral vascular disease or cerebrovascular disease
  • BMI >97th percentile
  • DM Type I or II
  • HTN
  • Current Smoker
  • Chronic renal disease/end-stage renal disease
  • s/p any solid organ transplant
  • Hx: Kawaskai’s disease w/ coronary aneurysms
21
Q

PPD placement and MMR

A
  • PPD and MMR can be placed same day
  • If MMR given, wait at least a month to give PPD becuase immune system has mild suppression
  • MMR- live vaccine, dont give to pregnant or immunocompromised
  • PPD- not required in NY public schools, given based on risk factors
22
Q

Moderate level risk factors for CVD for school age kids

A
  • pre-diabetes
  • polycystic ovarian syndrome
  • chronic inflammatory disease
  • HIV infection
  • nephrotic syndrome
23
Q

Normal Pediatrics Cholesterol Levels

A

Total Cholesterol: >200

LDL >130

HDL <40

TG >130

24
Q

What supplements are typically seen in school aged kids?

A

Vit. D: 400-600 units/day, for bone health and inflammation

May also see flouride- if not in water system

25
Q

What is the primary treatment for kids who are both:

  • over weight or obese
  • high TG or low HDL
A

Weight mgmt

including: improved diet, increased physical activity

26
Q

Name (4) common childhood illnesses for school age

A

Otitis externa

Asthma

Step Pharyngitis

Tinea Corporis/Capitus

27
Q

Otitis Externa

  • what is it?
  • causes?
A

What: inflammation of the external auditory canal

Causes: swimming, putting something in the ear

28
Q

Otitis externa: Signs & Symptoms

A
  • pain in ear, espeically tragus, aggrivated by moving the aurible
  • exudate in the ear canal
29
Q

Otitis Externa: Treatment & Follow up

A

Treatment:

  • first figure our if the infection is above or below the TM
  • need TM to be intact to prescribe medication
  • Medication: antibiotic/sterioid drops

Follow up:

  • f/u in 48-72 hours
  • may need to change treatment if it hasn’t gotte better
30
Q

Asthma: Signs and Symptoms

A

Note pattern, frequency, precipitating factors and duration

  • Coughing, SOB, wheezing on exhalation
  • Chest congestion and tightness
  • Sputum production
  • Insomnia r/t SOB, coughing, or wheezing at night
  • Bouts of coughing/ wheezing that increase with respiratory infection
  • Delayed recovery after a respiratory infection
  • Fatigue & dyspnea upon exertion (exercise-induced asthma)
31
Q

Asthma: Acute Attack

A

Tachycardia

Diaphoresis

Chest pain

Use of accessory muscles while breathing

Flaring of nares while breathing

Use of abdominal muscles while breathing

32
Q

Asthma: Diagnosis

A
  • Tests:
  • Spirometry (must be older than 6, taken at rest, after a challange and after med given, measures FVC and FEV-1sec)
  • Exhaled Nitric Oxide Tests (increased NO levels in asthma pt.)
  • 3 Criteria must be met:
  1. episodic symptoms of airflow obstruction are present
  2. airflow obstruction is at least partially reversible
  3. alternative diagnosis are excluded
  • Assess:
  • In the fall (must get flu shot and pneumo vax becuase increased risk of URI and pneumonia)
  • Family History: Asthma, allergy, sinusitis, rhinitis, or nasal polyps
  • Social History: Characteristics of home and living conditions (i.e. age, location, cooling and heating systems, wood-burning stoves, humidifiers, presence of mold and mildew and exposure to tobacco smoke). Find out triggers, schedule a comprehensive home visit/education
33
Q

Asthma: expected abnormals on physical exam

A

Skin: Atopic dermatitis/eczema, Manifestations of an allergic skin condition

HEENT: Increased nasal secretions, Mucosal swelling, Nasal polyps

Chest: Hyperexansion of the thorax, Use of accessory muscles, Hunched shoulders, Chest deformity

Respiratory: Adventitious breath sounds- wheezing during normal respirations, Prolonged phase of forced exhalation

34
Q

Asthma: differential diagnosis

A

Allergic rhinitis

Allergic Sinusitis

Foreign body in trachea or bronchus

Vocal chord dysfunction

Vascular rings or laryngeal webs

Laryngotracheomalacia

Tracheal stenosis

Bronchostenosis

Enlarged lymph nodes

Tumor in airway

Cystic fibrosis

Bronchopulmonary dysplasia

Heart disease

Aspiration from swallowing mechanism dysfunction

Gastroesophageal reflux

35
Q

Asthma: Medication

A

Goal: control chronic symptoms and prevent acute episodes

Long-term control medications

  • Inhaled corticosteroids
  • Combination inhalers- inhaled corticosteroids and a long-acting bronchodilator
  • Leukotriene modifiers
  • Cromolyn
  • Theophylline

Rescue medications

  • Short-acting bronchodilators

Allergy shots- immunotherapy

36
Q

Asthma: Patient Education

A
  • Never use antihistamines during an acute attack; they dry up respiratory secretions and can create mucous plugs
  • Postural drainage: child should lie on bed with head hanging over side
  • Side effects of medication
  • How to use a metered dose inhaler, dry-powder inhaler, and peak flow meter
  • Avoid/minimize exposure to allergens (mold, cigarette smoke, dust mites)
  • Notifying child’s school personnel
  • Give parent written instructions including medications, use of peak flow meter, use of metered dose inhaler, and indications for returning to office
  • Home monitoring: child’s response to medication in the morning and at bedtime yields the best information
37
Q

Asthma: Follow up

A

Routine: every 6 months

Immediately call if:

  • breathing difficult worsens
  • skin or lips turn blue
  • restlessness or sleeplessness occurs
  • chest pain
  • fever develops
38
Q

Strep Pharyngitis: Signs and Symptoms

A

Subjective:

  • acute onset of sore throat
  • fever
  • dysphagia

Physical Exam:

  • anterior swollen and tender cervical nodes
  • fever
  • purulent yellowish exudate on tonsils
  • tonsils and pharynx erythmatous

If epiglotitis is seen (drooling and tripod position): give steroids and call 9-1-1

39
Q

Strep Pharyngitis: Diagnostic Test

A

Rapid Strep test

GABHS- must specify what you are looking for, may treat before results come back

40
Q

Strep Pharyngitis: Differential Diagnosis

A
  • viral pharyngitis
  • infectious mononucleosis (lymphnodes will be huge and splenomegaly)
  • epiglottitis (emergency)
41
Q

Strep Pharyngitis: Treatment

A
  • Antibiotics
  • Tylenol- dose is weight dependent
  • warm saline gargles
  • fluids
42
Q

Tinea Corporis: Signs & Symptoms

A

“Ringworm” of the nonhairy skin: Superficial fungal infection on face, trunk, limbs

S&S

  • red, patch areas that scale and are oval in shape- well demarcated
  • ususally asymptomatic or mildly itchy
43
Q

Tinea Corporis: Treatment

A
  • Topical antifungal: apply daily for 2 weeks
  • Oral antifungal- can lead to drug induced hepititis
    • educate patient on dosing and timing
    • educate patient on GI symptoms
44
Q

Tinea Corporis: Patient Education

A

Caution sharing clothing and towels

45
Q

Tinea Capitus: Signs & Symptoms

A

“Ringworm” or Fungal Infection of the scalp

S&S

  • red, patch areas that scale and are oval in shape- well demarcated
  • CC: “My child has a spot on head without hair”
  • ususally asymptomatic or mildly itchy
  • may have enlarged anterior/posterior cervial lymphnodes
46
Q

Tinea Capitus: Treatment

A
  • Antifungal Shampoo
  • Oral antifungal- can lead to drug induced hepititis
    • educate patient on dosing and timing
    • educate patient on GI symptoms
47
Q

Sexual Abuse: Red flags

A
  • frequent UTOs
  • vagina/rectal d/c
  • decline in school performance
  • change in behavior, affect, appetite

Have a plan, know your resources, know the ER’s

48
Q

What should be considered if child is having school problems?

A
  • How long has it been going on? Acute, chronic, gradual?
  • Does it occur in all settings?
  • Birth history: APGAR, complications, term/premie
  • Family History: developmental delays, mental illness
  • Developmental History: meeting milestones? Drop?
  • Medical History: frequent ER visits
  • Physical Exam, including: hearing, vision,
  • Labs: lead poisioning, blood disorder, nutrition

FNP: 1 (8 decks)

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