School Age Children- 9 Flashcards
School age range
6-12
Vital signs
Explain the procedures to the child and allow him or her to choose, as appropriate, which side blood pressure will be taken, oral versus axillary temperature, and which finger to use for pulse oximetry.
O2
same as adult values (93% to 100%).
Fever
generally considered to be a temperature greater than 101.4°F or 38.5°C
high Fever-infection
High fevers greater than 104°F or 40°C in children do not indicate that the infection is more serious, as they may in adults, because less-refined pediatric immune systems may produce higher fevers than needed
Height/weight
Gain 3 kg/year in weight
Gain 5 cm/year in height
growth spurt
10 to 12 years for girls and around age 12 years for boys
FACES scale
used for younger school-age children.
downside noted with the FACES scale
some children will choose the smile face because that is the most desirable. In addition, if a child is feeling pain, he or she may automatically be drawn to the crying face, number 10.
visual analog scale or numeric of 1 to 10
Older school-age children
Fluid Requirements by Weight
11-20kg: 1000+50mL per each kg over 10kg
> 20kg: 1500 + 20mL per each kg over 20kg
Expected Urine Output 6-7y
1-2mL/kg/hr
Expected Urine Output 8-12y
.5-1mL/kg/hr
Annual assessments
check height, weight, body mass index (BMI), blood pressure, hearing, vision, and anemia. Immunizations should also be given as recommended by the schedule
Somatic complaints without verified diagnostic clinical data
may be an indication of school or home avoidance/problems, anxiety and stress, or depression
Skin
signs of abuse
Assess for dryness, rashes, eczema, abrasions, and contusions or scratches.
Head
Lice
dry/brittle- nutrition
open lesions- signs of trauma
symptoms or recent history of head trauma, including headaches, difficulty concentrating, or loss of consciousness.
Eyes
glasses
visual acuity
broken blood vessels, dryness, jaundice
Ears
hearing aid
hearing acuity
buildup of earwax
excess fluid
mouth/teeth
loss of baby teeth Orthodontic treatment Promotion of good dental hygiene Dental checkups every 6 months loose teeth
loss of baby teeth
starts with 6y molars
Tooth fairy
not everyone believes
Throat
Ensure the trachea is midline.
Inspect and palpate for an enlarged thyroid (goiter).
Assess for difficulty swallowing.
nose
blue/boggy- allergies
Assess for allergic rhinitis and treatments
Assess for frequent nosebleeds and mucosal dryness.
Assess for airflow, which may be restricted because of acute or chronic sinusitis.
Cardiovascular
Assess for any congenital cardiac anomalies by history and auscultation.
Innocent heart murmurs are very common in school-age children.
Normal S1 and S2
Innocent heart murmurs
Some cardiologists estimate that up to 90% of children aged 4 to 7 years have heart murmurs, often a result of turbulent blood flow at the aorta or pulmonary artery
Respiratory
asthma
lungs-clear
S/S chronic respiratory issues such as barrel chest and clubbed fingers.
skin color- pallor or cyanosis
encopresis
deliberate withholding of stool
Gastrointestinal/Genitourinary
Assess for enuresis, or urine incontinence
encopresis
Assess for constipation/diarrhea, acute or chronic, and any treatments the patient may be receiving.
Reproductive
Girls may experience menarche, the start of menses, near the end of this stage
The onset of puberty in boys will be accompanied by increased upper body mass, increased amount and thickness of hair on the body and genitalia, and nocturnal emissions, or the release of semen during sleep.
precocious puberty
defined as experiencing puberty before age 7 years for girls and before age 9 years for boys
Neurovascular/Musculoskeletal
Increased coordination
Increased fine motor skills
Increased balance
The ability to do complex tasks, such as riding a bike
Scoliosis checks beginning at age 12 years
Cognitive
Piaget’s cognitive developmental theory
Mastery of mathematics and reading skills
Classification and serialization of numbers
Understanding cause and effect
The ability to decenter
Psychological
Freud’s
Erikson
Freud
psychosexual development theory—age 6–12 years: latency stage
Erikson
psychosocial development-age 6 to 12 years: industry versus inferiority
Kohlberg’s
moral development: preconventional level
Social
Likes to forms clubs with rules and requirements
Likes to do favorite activities with a best friend
Usually socializes primarily with children of the same gender
Follows rules and understands consequences
Enjoys playing games
Enjoys having a collection of items, such as video games
Good Touch/Bad Touch
Use inspection of the genital area during the physical assessment as a springboard for discussing good/bad touches. Indicate which areas the child should report to a trusted adult if anyone touches them, including the breasts, buttocks, and genitals.
Medication dosing
Basing medication dosage on weight gives an accurate and safe dose for each patient.
Medication dosing should not be based on age because patient size may vary.
Oral medication
- syringe or cup
- food or drink as a reward if appropriate
- chaser
- numb tongue with popsicle
- pinch nose
- use caution with mixing meds with things that taste like candy
Subcutaneous Medications
-local anesthetics medicated cream when appropriate
IV Meds
- medical play helpful
- child life specialist can help
- non-dominant arm
- let them pick which side
- distractions
Eutectic Mixture of Lidocaine and Prilocaine (EMLA) Cream
It should be in place at least 45 minutes. The longer it is in place, the deeper it will penetrate; 2 hours is best for intramuscular injection. After 4 hours, it begins to lose its effectiveness and should be removed.
NURSING PROCEDURES
important to gain the trust of the child before beginning assessment or procedures. Explain procedures in an age-appropriate way. Do not lie if a procedure will be uncomfortable or painful; this will cause you to lose the child’s trust.
nursing procedures step by step
assess talk with child about recent problems nonthreatening touch privacy appropriate rewards have instruments ready and inform immediately before least to most invasive
Safety
Head injury prevention (symptoms may be minimal) bike/scooter safety pedestrian safety need for adult supervision
independence
- may be able to do many activities with less direct supervision.
- Children are able to play alone with adults nearby but should not be left unsupervised for any extended period.
- By the end of this phase, children will engage in unsupervised activities, such as staying home
- may start babysitting
- more team activities
babysit safety
Knowledge of fire safety
Care for and observation of children in various stages of growth and development
Basic first aid and possibly CPR
Many of these skills are taught in babysitting classes offered by hospitals and other organizations, such as the YMCA
nutrition
decreased caloric requirement compared with previous stages of development
high BMI in children
linked with increased lipid levels, insulin levels, and blood pressure
Exercise
Children should have at least 1 hour of physical activity a day
school avoidance/refusal/phobia
Child displays somatic symptoms such as a “stomachache” without any clinical basis, but only on school days.
Child refuses to attend school.
Various factors are associated with being a bully, a victim, or both, including:
Age
Lower socioeconomic status
Parents and caregivers with a high school or lower educational level
Poor health status, increased health needs, and mental health issues
Physical appearance
Poor academic achievement or social adjustment
Sexual orientation
The nurse caring for a school-age child should:
- Assess for both physical and psychological signs of bullying.
- Help caregivers find resources to assist with bullying.
- For children with special needs, assess the resources available at the school.
Sex ed the nurse should:
- Assess whether the caregivers have started to discuss sex with older school-age children.
- Be aware that discussing this subject can be difficult for caregivers.
- Help caregivers find resources to teach their children and creative ways to open the discussion.
two leading causes of death for children 5 to 14 years old
Unintentional injuries and cancer
ACUTE-CARE HOSPITALIZATION
- caregivers have active role
- bring items from home
- allow walks
- encourage visitation of siblings if possible
- siblings admitted together- near each other
- separate room for care
Pediatric Early Warning System (PEWS)
good tool to improve earlier identification of a deteriorating condition
behavior, Cardiovascular, respiratory
Child life specialists
offer a variety of services for children who are hospitalized and their families.
Pediatric Care Preferences
- Older school-age children seek more autonomy and may want to assist with their own care.
- All children in this age range will be curious about their care.
- Nurses should answer questions honestly at an age-appropriate level.
Role of the Primary Caregiver chronically ill child
- fatigue common
- active role
- knowledgeable about disease
- divorce more common
Home-Care Considerations chronically ill child
- need to have some control over their time and activities.
- School work should be kept up to date
- time for interaction with peers, either in person or over the phone or internet, should be allotted daily.
