-

Diabetes o Where does the child fit in during teaching (5 yr old) Teaching mainly aim at parents Doll Medical play o To be less fearful How to teach food restriction Make it fun Child life and nutritionist can help The parent is leader in decision for child o 9 yr old Teach parents and 9 yr old o Age appropriate Know what the syndrome are o What the best way to give 9 year old of daily growth hormone shot o Explain things to them o Teach them to inject themselves

Common Health Problems - Infectious Mononucleosis o Acute, self-limiting infection o Common in ages <25 yrs o Increase in mononuclear elements of blood o General symptoms of infection o Pathophysiology of Infectious Mononucleosis Virus, mildly contagious, incubation period 4-6 weeks Transmission unknownoral secretions? Two forms Sporadicmore common Epidemic o S/S Early signs Fever Sore throat Cervical adenopathy Cardinal features Headache Malaise Fatigue Chills Low-grade fever Anorexia Common features Splenomegaly Hepatic involvement with possible jaundice

o Diagnostic Leukocyte count: normal or low Lymphocytic leukocytosis with atypical leukocytes Monospot test Rapid Sensitive Inexpensive High specificity o Therapeutic Management No specific treatment Symptom management Penicillin po for -hemolytic strep in some cases Steroids in some cases o Prognosis Self-limiting, usually uncomplicated Acute symptoms typically 7-10 days Fatigue may persist for 2-4 weeks o Nursing Considerations Comfort measures Relief of symptoms Determine appropriate activities based on course of disease Alert for signs/symptoms of depression Smoking o Smoking Statistics 199736.4% of high school students smoke cigarettes More students using smokeless tobacco and/or cigars Increasing rates in all racial, ethnic, and gender groups o Smoking Hazards Undisputed damage related to tobacco use Decreased lung function Addiction/dependence on nicotine Earlier age of smokingmore difficult to quit later in life o Why Do Kids Smoke? Imitation of adult behavior Peer pressure Perceived popularity of smokers Less likely to smoke if parents/family do not smoke Less likely to smoke with high performance sports activities o Smokeless Tobacco Increasing popularity Serious hazards Carcinogenic

Palatine petechiae Exudative pharyngitis/tonsillitis Macular eruption

 Periodontal disease, tooth erosion, soft tissue damage o Anti-Smoking Campaigns Peer-led programs Emphasize social consequences rather than LT health problems Use of multi-media images School and community settings Begin in elementary school and through high school o Health Problems Related to Sports Participation Acute overload injuries Overuse syndromes Repetitive micro trauma Inflammation of the involved structure C/O pain, tenderness, swelling, disability Examples: tennis elbow, Osgood-Schlatter disease - Stress Fractures o Occur as result of repeated muscle contraction o Seen most often in repetitive weight-bearing sports o Common symptoms Sharp, persistent, progressive or deep, dull ache Pain over the involved bony surface o Diagnosis Based on clinical observation, possibly bone scan o Therapeutic Management of Stress Fractures Restalleviate repetitive stress that initiated symptoms Training with alternative exercise regimens PT, cryotherapy, cold whirlpools Rx: NSAIDs for discomfort o Nurses Role in Sports for Children and Adolescents Evaluation for activities Prevention of injury Treatment of injuries Rehab after injuries Instruction to student and parents Altered Growth and Maturation - Often are the result of simple physiologic (constitutional) delay - Endocrine dysfunction - Chromosomal aberration - Chronic disease, e.g., malabsorption, asthma - Stress - Poor nutrition - Tall Stature o May cause anxiety, perceived social handicap among some clients o Gender perceptions related to height

o Use of estrogens to control height if initiated before menarche o Use of hormone therapy is controversial Short Stature o May be first manifestation of serious disorder o May be of no consequence to health o Most common cause world wide is inadequate nutrition o Also chronic disease, endocrine dysfunction, primary gonadal failure o Short Stature: Other Causes Congenital defects and disorders Inborn errors of metabolism Psychosocial (deprivation) dwarfism Definition: growth retardation in children >2 yrs old Environmental stress and delayed development When children are removed from deprived environment, growth proceeds at normal or increased rate Skeletal Disorders Affecting Growth o Replacement therapy for treatment of growth hormone deficiency o Management of deprivation dwarfism Testosterone therapy Growth hormone therapy Hormone therapies highly controversial in children with constitutional delay Sex Chromosome Abnormalities o Occur with relatively high frequency o Most caused by altered number of sex chromosomes Turner Syndrome o Absence of one of the X chromosomes 45,X o Females o Incidence 1:2500 female births o Diagnostic Diagnosed in preschool base on S/S Confirmed on basis of negative sex chromatin test o S/S Sterile Short stature No secondary sex characteristics Webbed neck Shield-shaped chest Widely spaced nipples Low posterior hairline o Treatment Hormone treatment Estrogen therapy Klinefelter Syndrome

o Most common of all chromosomal abnormalities 1 in 850 male births o Presence of one or more additional X chromosomes 47 XXY most common o Occurs in males o Rarely seen before puberty o Adolescent virilization fails o S/S May not be diagnosed until they present for infertility Azoospermia, No sperm in the semen Small testes Defective development of secondary sex characteristics Cognitive impairment of varying degrees Behavioral problems Possibly gross motor difficulties Poor verbal skills o Treatment Admin Testosterone To enhance masculine characteristics o Nursing management Primarily support for both syndrome Disorders Related to the Reproductive System - Primary amenorrhea o No secondary sex characteristics and no menarche by 14-15 years of age OR o Secondary sex characteristics present but no menarche by age 1616.5 years o No uterine bleeding after SMR 5 for 1 year or after breast development for 4 years - Secondary Amenorrhea o Absence of menses for 6 months or absence of three cycles after menstruation was previously established o Most common causepregnancy (even with primary amenorrhea) o Other causeseating disorders, stress, other causes of severe weight loss - Dysmenorrhea o Primary dysmenorrhea o Secondary dysmenorrhea o Therapeutic management NSAIDs Estrogen therapy Oral contraceptives Dietary changes

Vaginitis o Causes may be physical, chemical, or infectious o Diagnosis confirmed by vaginal exam, microscopic evaluation of vaginal secretions o Health teaching Male Reproductive Disorders - Most anomalies identified in early childhood - Infections (e.g., urethritis) - Hematuria - Penile problems (phimosis, trauma, carcinoma) - Scrotal varicocele - Testicular torsion - Gynecomastia o May occur with normal achievement of male puberty and resolves within 1 year o Can be caused by anabolic steroid use or endocrine disorders o Testosterone supplementation may aggravate gynecomastia o Plastic surgery? Health Problems Related to Sexuality - Sexual activity o Teen pregnancy o STDs - Rape/Sexual Assault o SANESexual Assault Nurse Examiners o Diagnostic valuation Obtain account of incident Sensitivity to victims emotional status Physical evidence Vaginal secretions for evidence of sperm, blood, DNA GC culture to r/o pre-existing condition HIV testing, other STD testing initially and at appropriate intervals - Rape Trauma Syndrome o Acute phase of disorganization o LT reorganization process Nightmares, fears, phobias, panic reactions Feelings of helplessness, powerlessness Victim recovery - Obesity o Defined as increase in body weight due to accumulation of excessive body fat relative to lean body mass o Obese: generally considered when weight >95th percentile for age, gender, and height o Overweight: generally considered when >90th percentile

Exercises, comfort measures

o 25%-30% of children are obese o Impact of Childhood Obesity Increase in type 2 diabetes Risk of adult obesity Hypertension, hyperlipidemia, cardiovascular disease Social isolation, low self-esteem, depression o Causes 5% due to underlying disease (hypothyroidism, other metabolic disease, CNS disorders) o Role of heredity o Inactivity o Patterns of eating behaviors o Diagnostic Evaluation Skin fold measurements Body mass index calculations Body fat measurements Diagnostics to r/o metabolic and endocrine disorders o Nursing Considerations Assessment, planning, implementation Diet, exercise, behavioral and group therapy Prevention, evaluation Medical therapies Pharmacologicgenerally not recommended in children Surgicalhazardous in children Anorexia Nervosa o Eating disorder: refusal to maintain normal body weight o Primarily in adolescent and young adult females o Mean age of onset 13.75 years, ranging from 10-25 years or more o Life threatening o Etiology/Pathophysiology of AN Etiology unclear Distinct psychologic component Diagnosis based on psychologic and behavioral criteria Relentless pursuit of thinness Distorted body image Media impact Concept of control o S/S Severe weight loss Altered metabolic activity Amenorrhea Bradycardia, decreased BP Hypothermia, cold intolerance Dry skin, brittle hair and nails

Appearance of lanugo o Therapeutic Treat life-threatening malnutrition IV, tube feedings Monitor CV status o Behavior modification o LT (life long?) treatment and management Bulimia o Eating disorder characterized by binge eating o May be followed by purging behaviors Laxative abuse Self-induced vomiting Diuretic abuse Rigorous exercise regimens o Up to eight or more cycles per day o Weight may be normal or slightly above normal o Weight may be lowbulimarexia o Tooth erosion, esophageal damage, other GI concerns o Psychologic issues Self-deprecating thought; depressed mood Hx of unsuccessful dieting; overweight in childhood Low impulse control o Therapeutic Management Similar to anorexia management Hospitalization to treat potassium depletion, esophageal damage Cardiac monitoring indicated Behavioral management Attention Deficit Hyperactivity Disorder (ADHD) and LD o ADHD: inattention, impulsiveness, and hyperactivity o ADHD typical onset before age 7 o LD (learning disability): a heterogeneous group of disorders with difficulties in acquisition and use of listening, speaking, reading, writing, reasoning, math, and/or social skills o Diagnostic Evaluation Quality of motor activity Developmentally inappropriate inattention, impulsivity, and hyperactivity Wide variation of severity Diagnostic criteria developed by American Psychiatric Association o Battery of Tests for LD and ADHD IQ Hand-eye coordination Visual and auditory perception

Comprehension Memory o Therapeutic Management of ADHD Classroom Family education and counseling Behavioral and/or psychotherapy for child Environmental manipulation Medication Not all children benefit from pharmacologic therapy Stimulants o Dexedrine, Adderall o Ritalin Side effects o Insomnia, anorexia and weight loss, hypertension o LT may suppress growth o Therapeutic Management of LD Primarily educational interventions Wide variation of diagnostic severity o Nursing Considerations Community settings School nurses Hospital settings Enuresis o Bed wetting o More common in boys o Usually ceases between 6-8 yrs of age o Diagnosis Developmental age of >5 yrs 2x per wk or more for 3 months May have urgency, frequency o Organic causes Structural defects UTI, impaired kidney function, chronic renal failure Neurologic deficits, endocrine disorders (diabetes) Sickle cell disease Bladder volume of 300-350 mL is sufficient to hold a nights urine o Normal Bladder Capacity in Child Childs age + 2 = expected bladder capacity in ounces o Psychologic Factors Sleep more soundly than other children Emotional factors Familial tendency o Treatment for Enuresis

Encopresis o Repeated voluntary or involuntary passage of feces of normal or near normal consistency into places not appropriate for that purpose o Not caused by any physiologic effect, e.g., laxative or medical problem o Primary encopresis = fecal incontinence after age 4 o Secondary encopresis = >4 y.o. fecal incontinence after period of prior established fecal continence o More common in males o May follow psychologic stress o May be secondary to constipation or impaction o Therapeutic management Determine cause Dietary intervention, management of constipation Psychotherapeutic interventions Posttraumatic Stress Disorder (PTSD) o Development of characteristic symptoms following exposure to extremely traumatic experience or catastrophic event o May function adequately, but have foreboding regarding the future o PTSD: Response to the Event Initial response Intense arousal; lasts 1-2 hours Fight or flight response Second phase Lasts approximately 2 weeks Denial, period of quiescence Third phase Appears to get worse;lasts 2-3months o PTSD Symptoms Depression, anxiety, conversion reactions Phobic symptoms, repetitive actions Flashbacks are common Inquiry about what has happened School Phobia o Defined as extreme reluctance to attend school for a sustained period of time as a result of severe anxiety or fear of school-related experiences o Also called school refusal and school avoidance

Drugs Tofranil Oxybutynin DDAVP Bladder training Fluid restriction in evenings Interruption of sleep to void Conditioned reflex response device

o Most common in ages >10 yrs o Physical symptoms o Symptoms subside after staying at home o No symptoms on weekends, holidays, etc. Recurrent Abdominal Pain (RAP) o May have psychogenic origin o May have real pain o Psychologic aspects Conversion Reactions o AKA hysteria, hysterical conversion reaction, and childhood hysteria o Sudden onset, traced to a precipitating event o Symptoms: abdominal pain, fainting, pseudoseizures, paralysis, headaches, visual field restriction o R/O true seizures with EEG Childhood Depression o Temporary: acute depression precipitated by a traumatic event o Chronic depression May accompany chronic illness or disability Familial circumstances Childhood Schizophrenia o Severe deviation in ego functioning o Psychotic disorders that appear after age 4-5 o Characterized by gradual onset of neurotic symptoms o Lack of contact with reality; A world of his own Substance Abuse o Drug abuse, misuse, and addiction Voluntary behaviors Culturally defined Use of drugs for other than acceptable medical purpose o Drug tolerance and physical dependence Involuntary physical responses o Types of Drugs Abused Alcohol Cocaine Narcotics CNS depressants CNS stimulants Hallucinogens Inhalants o Nursing Considerations Acute care LT management Family needs/family support Prevention Suicide o Third leading cause of death in teens

o Suicide o Suicidal ideation o Suicide attempt/parasuicide Diabeties type 1 - Insulin for life - Goal is to maintain glucose level of less than 126 - Can be given o 2 or more injections o Continuous subcu infusion Using portable insulin pump Needle and catheter change every 48-72 hours Or at first sign of inflammation or 48-72 hours o Regular insulin admin at least 30 mins before meals o Rotate sights every 4-6 injections