School-Age and Adolescent Growth & Development Flashcards
School Agers
- Slow but steady growth
- They get taller and lose “baby fat.”
- Talking about kids age 6-12 years old
- Strength increases yet muscles remain functionally immature
- Toothless wonders/ ugly ducklings
- Overuse injury to muscles common to see in sports
GI
fewer stomach upsets seen
Bladder Capacity
Girls have a larger bladder capacity then boys.
Bones
Are now all calcified
Prepubescence
- time before puberty
- 2 years difference between boys and girls
- Girls average onset is 12-13
- Boys average onset is 14
Psychosocial Development
- Latency Period (Freud) kids are more tranquil
- Industry vs Inferiority (Erickson) kids are acquiring technical and social skills
- Ability to cooperate and deal with others
- Over Achievers: watch for compensation.
- Society values academics over athletics
- Repeated school failures will really defeat these kids
Cognitive Development
- Concrete operational stage (Piaget)
- Higher level thinking; can hold onto concepts
- Conservability: understanding of volume, mass. length
- Can now think backwards i.e. retrace previous steps
- Classification: means of grouping
- READING is the most significant skill a schoolager acquires.
Moral Developent
- Colburg’s Theory
- Young schoolagers (6-7 years) judge acts by their consequences; rewards/punishments drive actions.
- Older schoolagers are able to judge an act by the intention that prompted it. These kids are far less absolute and have an increased cooperation and level of respect.
Spiritual Development
- Want to learn about God
- Are fascinated with heaven and hell
- Find tremendous comfort in tradition
- Want and expect to be punished for misdeeds
- Find comfort in prayers
Language development
- Very efficient
- Can interpret directives without visual cues
- Develop metalinguistic awareness; jokes and riddles, magic kits.
Social Development
-Friends are now very important
-Joining groups
-Develop intimate friendships between same-sex peers “best friends”
-Clubs and cliques; security; exclusion of others may occur here.
Bullies: often defiant and antisocial-at greater risk for psych and criminal disorders
Self Concept Development / Self Esteem
- Nothing succeeds like success
- Self-confidence vs self-doubt
- Body image; comparison against others
- self-esteem is fragile
- parents, friends, teachers huge influences
- Grades and teachers/parents remarks can make or break a child
- Positive feelings equate to confidence in trying new things.
Sexuality Development
- Experimentalists
- Parents should assume the primary role in educating children regarding sexual behavior.
- School nurse: often caught in the middle of sex education.
- Be factual. Use proper terminology.
- Younger kids need the focus to be around respect and responsibility.
Play
- Kids need to be taught how to follow rules and how to be a “good sport.”
- Rules and rituals
- Team Play; can be very rough on kids if they aren’t taught about following rules and that they aren’t always going to win at everything they do.
Concerns related to normal growth and development
- Limit setting/discipline/restrictions is very important
- Withhold privileges
- Lying is viewed as normal
- Cheating is common; mostly unintended
- Stealing in younger kids is usually due to limited sense of property rights of others.
- Stress occurs from violence, fears, latchkey kids. Signs include crying, screaming, daydreams, acting out, aggression.
- Stress is highest in kids today compared to previous generations
- PTSD: replay over and over to help the child overcome the traumatic event.
Promoting optimal health
Nutrition: quality of food is very important. These kids will become junk food monsters if they are allowed to.
- Sleep and rest is now highly individualized but some kids will require 10 to 12 hours of rest a night.
- Physical fitness: kids need to participate in physical activity.
- Television and video games, may desensitize kids
- Dental health: more permanent teeth now in place
Anticipatory Guidance and Injury Prevention
- MVA: 2.5 x more fatalities as pedestrians
- Kids under 12 need to ride in the back seat of the car
- Head injury is the leading cause of bicycle fatalities
- Ride-on mower injuries
Health Problems
ADHD: developmentally abnormal inability to concentrate; etiology is poorly understood; treated with stimulants; behavior modification - time management, study skills, modify environment
Stages of Adolescence
Early Stage: 11-14 years old
Middle Stage: 14-17 years old
Late Stage: 18-20 years old
Adolescence
- period of profound biologic, intellectual, psychosocial, and economic change
- changes are shaped by the social environment in which the changes take place.
Tanner Stages
- Sequence of development of secondary sexual characteristics that occurs in a predictable sequence.
- This sequence has been divided into a series of five phases termed the Tanner stages.
- Although the sequence of sexual development is predictable, the ages at which these changes occur and the rate of progression vary considerably among individuals.
- Stage 1: immature
- Stage 5: mature
- Females: stages describe pubertal development based on breast size and the shape and distribution of pubic hair.
- Males: stages describe pubertal development based on the size and shape of the penis and scrotum and the shape and distribution of pubic hair.
Cognitive Development
- Future-oriented thinking
- Can still “lose their mind” and do “silly” things; abandon rational thought
- Formal operational thinking
- Think in abstract terms, can theorize
Psychosocial development
- Identity vs Role confusion
- Develop autonomy; monitor friends
- Sense of sexuality is forming in these kids
- Intercourse by age 15: B 33%, G 20%
- Intercourse by 12th grade: B 64%, G 65%
- Immunize against STD’s: Hep B, HPV
Social Environment
- Family: divorced homes/dysfunctional; increase in lack of supervision in the home.
- Poverty increases drop out rates
- Peer groups: fill the void when no support available at home.
- Work: unskilled laborers; monitor their money and what they are spending it on
- Community: health promotion and education
Drinking/Peer Groups
Extremely common in teens!
Factors promoting adolescent health
- Mental pathology & alcoholism in parents are amongst most difficult challenges for kids.
- Coping skills for increased success is working, going to the library and playing team sports.
- Show competence in reading and language arts skills
Factors Hindering Adolescent Health
- Grade School: holding back destroys self-esteem
- Drugs, alcohol, smoking, criminal activity, and pregnancy before 18 are all unconventional behaviors that increase potential for greater troubles.
Adolescent Health Problems
- Acne: self-esteem challenges, tx with bcp’s or antibiotics; some meds may cause depression and suicidal ideation
- PID: upper genitourinary pain w/ motion or manipulation. Can lead to infertility
- Eating disorders: most common in over-achieving white females. May be related to traumatic conflict.
- 1:6 teens has had an STI
- Gonorrhea has highest rates in 15-19 year olds
- Chlamydia is most common STI in the U.S.
H.E.A.D.D.D.S.S.
Home Education Activities Depression Drugs Diet Sex Safety
Rape
- Highest rate in adolescent girls
- Vast majority of perpetrators are not strangers to the victim.
Intentional & Unintentional Injury
- You cannot release a suicidal child without intervention.
- Intentional injury accounts for 72% of adolescent death
- Leading cause of injury death is MVAs involving alcohol; unintentional injury
- Homicide is 2nd leading cause of death in adolescents, usually involving firearms
- About 8% of high schoolers report having attempted suicide once; gay/lesbian kids at very high risk; s/s include melancholy, dropping grades, family trouble, drugs, gay/lesbian; Girls usually attempt by O.D. and Guys usually complete via gun/hanging.
What accurately describes physical development during the school age years?
Child grows an average of 5cm (2”) per year.
What is characteristic of the psychosocial development of school age children?
Feelings of inferiority or lack of self worth that can be derived from children themselves or from the environment.
What describes the cognitive abilities of school age children?
They have the ability to place things in a logical order, to group and sort, and to hold a concept in their minds while making decisions on that concept.
What describes moral development in the younger school age child?
They know the rules and behaviors expected of them but do not understand the reason behind them.
A group of boys ages 9 & 10 have formed a “boys only” club that is open to neighborhood and school friends who have skate boards. This should be interpreted as:
Characteristic of social development at this age.
Bullying can be common during the school age years. The nurse should recognize that bullying;
Can have lasting effects on children.
What should the nurse include when giving parents guidelines about helping their children in school?
Communicate with teachers if there appears to be a problem.
Sleep problems in the school aged child are often demonstrated by:
Delaying tactics because they do not wish to go to bed.
The parents of an 8 year old girl tell the nurse that their daughter wants to join a soccer team. The nurse should suggest:
Sports participation is encouraged if the type of sport is appropriate to the child’s abilities.
The school nurse is discussing dental health with some children in 1st grade. What should be included?
Emphasize importance of brushing before bed.
When determining the etiology of a skin problem, which of the following is essential to the diagnosis of the lesions?
Careful inspection
The term used to describe an abnormal sensation such as burning or prickling is:
Paresthesia
Which of the following factors promotes wound healing?
Moist, crust-free wound environment.
A child falls on the playground and has a small laceration on the forearm. The school nurse should do which of the following to cleanse the wound?
Rinse the wound with sterile water or saline, using a syringe to generate mild pressure.
When applying wet compresses or dressings to the skin, the nurse should do which of the following?
Apply desired solution on cotton gauze or soft cotton cloths, such as clean handkerchiefs.
An important nursing consideration when caring for a child with impetigo contagiosa is which of the following?
Thoroughly wash hands and maintain cleanliness when caring for an infected child.
Ringworm, frequently found in schoolchildren, is caused by which of the following?
Fungus
Which of the following should the nurse include when explaining how to manage pediculosis capitis?
Remove nits with an extra-fine tooth comb or tweezers.
Matt’s mother tells the nurse that he keeps scratching the areas where he has poison ivy. The nurse’s response should be based on which of the following?
Scratching the lesions may cause them to become secondarily infected.
A boy scout sustains frostbite to his feet while out hiking in the mountains. Before he is transported to the nearest emergency treatment center, which of the following is important in managing his care?
Prevent him from walking any father.
A child has an evulsed (knocked out) tooth. The parents are reluctant to try to reimplant the tooth. What should the tooth be placed in for transport to the dentist?
Cold milk
Which of the following is an important consideration when the nurse is discussing enuresis with the parents of a young child?
Encourage the child to take charge of treatment interventions.
Which of the following is descriptive of attention deficit hyperactivity disorder (ADHD)?
Manifestations affect every aspect of the child’s life but are most obvious in the classroom.
A mother calls the school nurse saying that her daughter has developed school phobia. She has been out of school 3 days. The nurse’s recommendations should include which of the following?
Immediately return the child to school.
Which of the following is a characteristic of children with depression?
Change in appetite, resulting in weight loss or gain.
In the U.S., which of the following is approximate mean age of menarche?
12.55 years
By what age should one be concerned about pubertal delay in boys?
13.5 to 14 years
How does the peak of the pubertal growth velocity compare in girls and boys?
On average girls reach their peak growth rate 2 years earlier than boys.
According to Piaget, the adolescent is in the fourth stage of cognitive development, the period of:
Formal operations
While caring for hospitalized adolescents, the nurse observes that sometimes they are skeptical of their parents’ religious beliefs and practices. The nurse should recognize that this is which of the following?
Normal spiritual development
An adolescent boy tells the nurse that he has recently had homosexual feelings. The nurse’s response should be based on the knowledge that:
The adolescent should be encouraged to share his feelings and experiences.
Why do peer relationships become more important during adolescence?
Peer relationships provide adolescents with sources of social reinforcement.
The school nurse tells adolescents in the clinic that confidentiality and privacy will be maintained unless a life-threatening situation arises. This practice is:
Important in establishing trusting relationships.
The single greatest source of unintentional injury and death in the adolescent age-group involve which of the following?
Motor vehicle crashes.
When teaching the adolescent about the management of acne, the nurse should include which of the following interventions?
Clean face gently with a mild soap once or twice a day.
The school nurse is discussing testicular self-examination with adolescent males. Why is this important?
Testicular tumors during adolescence are generally malignant.
An adolescent asks the nurse what causes primary dysmenorrhea. The nurse’s response should include which of the following?
One factor is the onset of ovulatory cycles.
An adolescent girl tells the nurse she has some type of vaginitis. Which of the following clinical manifestations is most suggestive of candidiasis?
Vaginal pruritus
An adolescent tells the school nurse that she is pregnant. Her last menstrual period was 4 months ago. She has not received any medical care. She smokes but denies any other substance use. The priority nursing action is which of the following?
Refer her for prenatal care.
In planning sex education and contraceptive teaching for adolescents, the nurse should consider which of the following?
Teenagers frequently lack a fundamental understanding of fertility.
Prevention of pelvic inflammatory disease (PID) in adolescents is important because it:
Can have devastating effects on the reproductive tract of affected adolescents.
Which of the following statements is correct about childhood obesity?
Heredity is an important factor.
Nursing responsibilities in the management of adolescent obesity include which of the following?
Incorporate favorite foods into the child’s diet.
Anorexia nervosa is best described as:
Emaciation from self-inflicted starvation.
Which of the following symptoms would the nurse expect to observe during the physical assessment of an adolescent girl with severe weight loss and disrupted metabolism associated with anorexia nervosa?
Lowered body temperature.
An adolescent with bulimia has a low potassium level. The nurse is aware of the potential for which of the following complications?
Cardiac arrhythmias.
Which of the following is descriptive of bulimia during adolescence?
Consumption of large quantities of food used as a coping mechanism.
Correct terminology is necessary in understanding substance abuse. Physical dependence is which of the following?
Involuntary physiologic responses to the pharmacologic characteristics of drugs.
Drug abuse is suspected in an adolescent being seen in the emergency department. Which of the following physical signs is suggestive of barbiturate ingestion?
Ataxia
Which of the following statements is true about smoking in adolescence?
Smoking is less common when an adolescent’s parents disapprove of smoking.
Which of the following is associated with social drinking in adolescents?
Significant morbidity and mortality.
The nurse is caring for an adolescent brought to the hospital with acute drug toxicity. Cocaine is believed to be the drug involved. Initial data collection should include which of the following?
Method of administration
Which of the following statements is true about adolescents who attempt suicide?
Gay and lesbian adolescents are at high risk for suicide.
Which of the following is the most commonly used method in completed suicides?
Firearms
An adolescent girl tells the nurse that she thinks about death all of the time. The nurse asks her if she has a specific plan. This question should be considered which of the following?
An essential part of the assessment.
Pruritus
itching
anesthesia
absence of sensation
hyperesthesia
excessive sensitiveness
hypesthesia
diminished sensation
Atopic dermatitis
often associated with allergies, frequently begins in infancy.
Objective findings with skin issues
The skin lesion’s distribution, size, and morphologic characteristic provide significant information.
Usual extrinsic causes are physical, chemical, or allergic irritants or infectious agents such as bacteria, fungi, viruses, or animal parasites.
Intrinsic causes may be from a specific infection (chickenpox, measles), drug sensitization, or other allergic phenomena.
Abrasion
removal of the superficial layers of skin by rubbing or scraping
Avulsion
forcible pulling out or extraction of tissue
Laceration
Torn or jagged wound; accidental cut wound
Incision
Division of the skin made with a sharp object; cut
Penetrating wound
Disruption of the skin surface that extends into underlying tissue or into a body cavity
Puncture
Wound with a relatively small opening compared with the depth.
Primary intention wound healing
takes place when all layers of the wound margins are neatly approximated, as with a surgical incision.
Secondary intention wound healing
takes place in wounds that occur from ulceration and lacerations in which the edges cannot be approximated, such as with an avulsion or a third-degree burn.
Healing takes place from the edges inward and from the bottom of the wound upward until the defect is filled.
Tertiary intention wound healing
Takes place when suturing is delayed after injury or the wound later breaks down and is sutured or resutured when granulation is present.
Signs of wound infection are:
- increased erythema, especially beyond wound margin
- edema
- purulent exudate
- odor
- pain
- increased temperature
Wound Care
- don’t put anything in a wound that you wouldn’t put in your eye. The safest solution is normal saline.
- advise parents that the yellow gel forming under hydrocolloid dressings may look like pus and has a distinct odor (somewhat fruity) but is normal leakage.
- hydrogen peroxide and povidone-iodine are contraindicated for cleaning fresh, open wounds. Hydrogen peroxide can cause formation of subcutaneous gas when applied under pressure.
Atopic individuals
Those with a tendency to develop allergy
The treatment for scabies is:
the application of a scabicide
Pediculosis capitis
Head lice
Adult louse lives only about 48 hours when away from a human host.
Life span of the average female is 1 month.
Nits, or eggs, hatch in approximately 7 to 10 days.
Lyme disease
The most common tick-borne disorder in the United States.
-Enters through the saliva and feces of ticks, especially the deer tick.
Clinical manifestations of Lyme disease:
stage I: tick bite followed in 3 to 30 days by erythema migrans at the site of the bite. Large ring with raised, doughnut like border resulting in a bull’s eye appearance.
Stage II: 3 to 10 weeks after inoculation. Smaller annular lesions develop without the indurated center. If untreated they disappear in 3 to 4 weeks. May also have fever, headache, malaise, fatigue, anorexia, stiff neck, lymphadenopathy, splenomegaly, pink eye, sore throat, abdominal pain, and cough.
Stage III: systemic involvement of neurologic, cardiac, and musculoskeletal systems. Appears 2 to 12 months after inoculation. Arthritis may appear.
Cat Scratch Disease
Usually self-limiting. Resolves in 2 to 4 months.
Common s/s: lympadenitis.
Treatment is primarily supportive.
Contact dermatitis
an inflammatory reaction of the skin to chemical substances, natural or synthetic, that evoke a hypersensitivity response or to those agents that cause direct irritation.
Poison ivy, oak, and sumac
- Nevada, Hawaii, and Alaska appear to be free of any of these plants.
- Oak: west of the Rockies
- ivy: east of the Rockies
- sumac: southeast swamp areas
- Lesions do not spread by contact with the blister serum or by scratching.
- The lesions can become secondarily infected.
Sunburn
- maximum UV exposure occurs between 10am & 3pm
- shorter waves are more damaging/dangerous
- Tanning indicates sun injury
- risks of skin cancer begin in childhood
- Use at least SPF 15
Chilblain
Redness and swelling of the skin, occurs when extremities, usually the hands are exposed intermittently to temperatures of 30 to 60 degrees F.
Frostbite
tissue damage caused when excessive heat loss to local tissues allows ice crystals to form in tissues.
-amputation of extremities is usually delayed for 60 to 90 days unless there is evidence of gangrene because it is seldom possible to estimate the extent of tissue loss until new skin layers are revealed after the eschar layer separates.
Hypothermia
the cooling of the body’s core temperature to injurious levels, usually identified as below 95 degrees F.
-very young children and thin persons are at the greatest risk for hypothermia.
What are the most common manifestations of adverse drug reactions in children?
Rashes-exanthematous, urticarial, or eczematoid.
Stevens Johnson Syndrome
- the severe form of erythema multiforme characterized by lesions of the skin and mucous membranes, fever, and multiple systemic symptoms.
- it is very rare, is more common in males then females, and occurs at any age.
Dental Carries
The ages of greatest vulnerability are 4 to 8 years old for the primary dentition and 12 to 18 years for the secondary or permanent dentition.
Enuresis
- bed-wetting
- defined as intentional or involuntary passage of urine into the bed (usually at night) or into clothes during the day in children who are beyond the age when voluntary bladder control should normally have been acquired.
- It must occur at least 2 times a week for 3 months and the child must be at least 5 years old.
