School Age Health & Issues Flashcards

Question

School Age - Sleep

Answer 1

-8-10 hours/night -Nightmares decrease -Night terrors should go away by age 12

Answer 2

-Younger school-age: *Poor adjustment to school *Frequent illness or need to stay home from school (can indicate bullying) *Lack of social interaction/peer problems -Older school-age: *Revert to dependent, shy, passive roles *Using illness to avoid responsibilities *Cannot make or keep friends *Poor school performance (feeling left behind) *Distructive behavior to express self (cutting)

Answer 3

-BMI >95th percentile -Children should get at least 60 minutes of outdoor play every day -Some disorders (Prader-Willi, Trisomy 21) can cause obesity -Some medications (risperidone - antipsychotics) can cause obesity -Management - meal planning and activity

Answer 4

-Definition: Acts of commission or omission, including physical, sexual, and emotional acts that endanger the health and development of a child -Abusers are typically known by the child - 80% of cases are the parents -Neglect is the most common form of abuse -Children with developmental delays have a higher risk for abuse -NPs are mandated reporters of abuse and neglect!!!

Answer 5

-Signs/symptoms: *History is vague and does not match the injuries *Parents delay seeking care for child *Fractures or bruises at different stages of healing *Soft tissue markings - hand print, objects, weapons, cigarette burn *Child-parent interaction is unusual *Physical needs of the child are not being met

Answer 6

-Differential Diagnoses: *Underlying diseases: osteogenesis imperfecta (brittle bone disease) - coagulopathies *Homeopathic or cultural practices - cupping or coining

Answer 7

-Diagnostic Studies: *Coag studies - platelets, PT/PTT - rules our coagulopathies *Serum calcium and phosphorus - rules out bone diseases like OI *Skeletal surveys - order for any child with soft tissue findings - picks up old fractures

Answer 8

-3 components: *Inattention *Impulsivity - high risk for injury *Hyperactivity -Boys are affected more than girls

Answer 9

-Biological Factors: *Genetics - higher risk if family history *Prenatal- maternal smoking during pregnancy *Perinatal - prematurity, fetal distress, prolonged labor, perinatal asphyxia *Postnatal - cerebral palsy, epilepsy, CNS trauma or infections -Environmental Factors: *Lead poisoning *Food dyes, additives, and sugar -Psychosocial Factors: *Disorganized or chaotic environments *Child abuse or neglect *Family history of ETOH *Developmental learning disorder

Answer 10

-Signs/symptoms: The rule of 6s *Must have 6 criteria from inattention, and 6 criteria combined between impulsivity and hyperactivity *Usually present before age 7 but as late as age 12 (6+6=12) *S/S persist for more than 6 months *S/S interfere with functioning in at least 2 environments (school and home) - direct observation in multiple settings is important for diagnosing

Answer 11

-Makes careless mistakes -Fails to pay attention to detail -Easily distracted -Difficulty concentrating long enough to complete tasks -Difficulties following instructions -Difficulties organizing task and activities

Answer 12

-Difficulties awaiting one's turn -Frequently blurting out answers -Interrupts or intrudes on others

Answer 13

-Fidgetiness -Difficulty remaining seated -Difficulty playing quietly -Subjective feelings of restlessness in adolescents -Difficulties with social relationships -Low frustration tolerance

Answer 14

-Predominantly inattentive -Predominantly hyperactive-impulsive -Combined type - most common

Answer 15

-Learning disabilities (at least 50%) -Psychiatric disorders: *Anxiety (25%) *Depression (30%) *Oppositional defiant disorder or conduct disorder (60%)

Answer 16

-Multimodal, not just treated with medications -Structures environment -Mental health referral -Pharmacological: *CNS stimulants (highly effective 70%-90%)- increase availability of neurotransmitters to increase focus and attention **Methylphenidates (Ritalin) **Amphetamines (Adderall, Adderall XR, Vyvanse) -Start slow and go slow, titrate up at weekly intervals, and get feedback from parents on effectiveness -Behavior changes can be seen as soon as 30-90 minutes from med admin -Short acting - last about 4 hours, need re-dosing (Adderall, Ritalin) -Long-acting - last about 8-12 hours (Adderall XR, Vyvanse) -Avoid evening doses to prevent insomnia -If the child does not respond to higher dosing of one stimulant, switch to another stimulant

Answer 17

-Cautions: *CV disease *HTN *Anxiety *Hx of drug abuse *Depression/suicide risk -S/E: *Insomnia *Anorexia *Weight loss *Temporary decrease in rate of growth *Tolerance of meds *Tics - only symptom that usually does not go away with prolonged medication use *HA *Stomach aches

Answer 18

-Cognitive, social skills, parenting therapy -Drug holidays *Maybe considered on an individual basis *May be used during time off school to give a break and help s/e

Answer 19

-Need to sign controlled substance abuse form -Perform drug testing to make sure they are taking the medication and not selling it