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DRT > School Age Health & Issues > Flashcards

School Age Health & Issues Flashcards

1
Q

School Age - Ages

A

6-12 years old

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2
Q

School Age - Subjective Data

A

-Constipation
-Enuresis (normal until about age 9-10, then refer)

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3
Q

School Age - Depression Screening

A

-PHQ-9 - begin at age 12

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4
Q

School Age - Cholesterol Screening

A

-All children between 9-11 years must be screened regardless of family history

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5
Q

School Age - Vaccines

A

-2nd dose of MMR, Varicella, Tdap, memingococcal, HPV

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6
Q

School Age - Dental Health

A

-Cleaning every 6 months
-Permanent teeth start erupting at this age (proximal to distal)
-Brush twice daily
-Teach how to floss daily

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7
Q

School Age - Interview

A

-This age is where you start talking mostly to the child during the health interview process

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8
Q

School Age - Physical Exam

A

-Latent phase, not a lot of growth happens during this time

-Average 10-year-old male
*Weight: 54-102 lbs
*Height: 50.5-59 inches

-Average 10-year-old female
*Weight: 54-106 lbs
*Height: 50-59

-Average growth:
*Weight: 4-7 lbs/year
*Height: 2.5 inches/year

-Girls reach peak height velocity at ages 11-12, faster than boys
-Breast development begins in girls

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9
Q

School Age - BMI

A

Weight in kg
over
height in m2

-BMI 85th-95th percentile - overweight
-BMI >95th percentile - obese

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10
Q

School Age - Vital Signs

A

-Pulse: 60-95 bpm
-Respirations 14-22 breaths pm

-BP
*6-9 years: SBP 95-110 mmHg, DBP 60-73 mmHg
*10-11: SBP 100-119 mmHg, DBP 65-76 mmHg

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11
Q

School Age - Visual Acuity

A

-Approaches 20/20

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12
Q

School Age - Precocious Puberty

A

-Females: <8 years old
-Males: <9 years old

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13
Q

School Age - PPD

A

-Perform between ages 4-6

-Yearly screening for patients at high-risk areas: low socioeconomic status, residence in areas where TB is prevalent, exposure to TB, immigrant status

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14
Q

School Age - Hematocrit

A

-Bright Futures recommends hematocrit is tested annually because t can detect anemias before the child becomes symptomatic

-Normal Hct (6-12 years): 35 to 44 percent

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15
Q

School Age - Scoliosis

A

-Screened at school
-Adam’s Forward Bend Test or scoliometer
-XR can be used to determine degree of curvature

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16
Q

School Age - Motor Skills

A

-Hand dominance emerges

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17
Q

School Age - Cognitive Development (Jean Piaget)

A

-Concrete operational thinking stage
-New knowledge and sense of industry, like to work hard in school

-Language is fluid at this stage
*Grasps the concept of conservation
*Can use concepts of time and money
*Understands the concept of space

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18
Q

School Age - Psychosocial Development (Erik Erikson)

A

-Industry vs. inferiority

-Go into the outside world
-Development of self-esteem
-Feels competent in their abilities
-Plays with others and is capable of playing organized sports
-Behaves in a peer environment
-Towards late school age, peers become very important
-Start asking to do chores for money

19
Q

School Age - Psychosexual Development (Sigmund Freud)

A

-Latency stage (6-12 years)
-Repression of sexual urges, as children play mostly with same sex

20
Q

School Age - Anticipatory Guidelines

A

-Discipline - teach between right and wrong
-Consistency is really important
-Adults must role model behavior they want from the child
-Should be assigned regular duties/chores
-Reinforce honesty - expect that kids at this age will lie - confront the kid in a positive way
-Respect privacy
-Want to please parent

21
Q

School Age - Nutrition/Feeding

A

-Half of what they eat should be fruits and vegetables, and the other half should be grains and proteins - occasional treat
-Minimize junk food

22
Q

School Age - Injury Prevention

A

-Cigarettes, drugs, and alcohol abuse
-Safety - bike riding (wear helmet)

23
Q

School Age - Gun Safety

A

-Children need to be taught to treat every gun as if it is loaded
-Store guns unloaded, with bullets somewhere else
-Keep the guns and bullets locked up away from the child (gun safe) - hide the keys to the safe
-Do not leave any gun unattended while cleaning or when using it

24
Q

School Age - Sexuality

A

-Increased curiosity for sex starts at this age
-Communicate to them about STIs and HIV/AIDS
-Prepare girls for menstruation and boys for hormonal changes
-Provide accurate information regarding sex, and reinforce the information over time

25
Q

School Age - Sleep

A

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

26
Q

School Age - Developmental Warning Signs

A

-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)

27
Q

School Age - Obesity

A

-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

28
Q

School Age - Child Abuse & Neglect

A

-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!!!

29
Q

School Age - Child Abuse & Neglect S/S

A

-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

30
Q

School Age - Child Abuse & Neglect Differential Diagnoses

A

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

31
Q

School Age - Child Abuse & Neglect Diagnostic Studies

A

-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

32
Q

School Age - ADHD

A

-3 components:
*Inattention
*Impulsivity - high risk for injury
*Hyperactivity

-Boys are affected more than girls

33
Q

School Age - ADHD - Predisposing Factors

A

-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

34
Q

School Age - ADHD - S/S

A

-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

35
Q

School Age - ADHD - Inattention

A

-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

36
Q

School Age - ADHD - Impulsivity

A

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

37
Q

School Age - ADHD - Hyperactivity

A

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

38
Q

School Age - ADHD - Subtypes

A

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

39
Q

School Age - ADHD - Co-morbidities

A

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

40
Q

School Age - ADHD - Management

A

-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

41
Q

School Age - ADHD - Meds S/E

A

-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

42
Q

School Age - ADHD - Non-Pharmacological

A

-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

43
Q

School Age - ADHD - Legal

A

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

DRT (11 decks)

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