Nursing Care of Children and Adolescents (Exam #1)

Physical Growth in Adolescence

> Affected by diet, exercise, and hereditary factors (height, weight, and body build) > Adolescents have become taller and heavier; puberty is earlier > In early stages of adolescence, there are increases in body fat. > During growth spurts, muscle mass increases in boys and fat deposits increase in girls

Fire Safety (Schoolagers)

- All homes should have working smoke detectors and fire extinguishers. Change the batteries at least twice a year. - Have a fire-escape plan. - Practice fire-escape plan routinely. - Nobody should smoke in the home especially in bed. - Teach what to do in case of a fire: use fire extinguisher, call 911, and how to put out clothing fire. - Use stove and other cooking facilities under adult supervision. - All flammable materials and liquids should be stored safely. - Fireplaces should have protective gratings. - Teach children to avoid touching wires they might encounter while playing. - School-age children are eager to help parents with cooking and ironing. - They are curious about fire and are drawn to play with fire, matches, and fireworks.

Promoting Safety in Schoolagers

- Children become more independent with age - This independence leads to an increased self-confidence and decreased fears, which may contribute to accidents and injuries - May walk to school with peers who may influence his/her behavior - Increased independence may also increase exposure to dangerous situations such as the approach of strangers or unsafe streets - Nurses should promote safe habits - Unintentional injuries are the leading cause of death in children between 1 and 14 years of age - 13million children experience nonfatal unintentional injuries. - increased mobility, activity, and time away from parents increase the risk for unintentional injuries They need information and rules about car safety, pedestrian safety, bicycle and other sport safety, fire safety, and water safety

Promoting Growth and Development through Play in Schoolagers

- Cooperative play (cooperative activities = team sports) and solitary activities - School-age children have the coordination and intellect to participate with other children of their age in sports such as soccer, baseball, football, and tennis. The school-age child comprehends that his or her cooperation with others will lead to a unified whole for the team - Also, child learns rules and the value of playing by the rules - School-age children also enjoy solitary activities - May start collections (stamps, cars, etc.) - Scrapbooking or diary - May join clubs - Active play has decreased in recent years as television viewing, multimedia device use, and video games have increased. This trend has resulted in health risks such as obesity, type 2 diabetes, and cardiovascular problems.

Cultural Influences on Growth and Development for Schoolages

- Culture influences habits, beliefs, language, and values. - Differences in growth among children with different racial and cultural backgrounds - Cultural implications must be considered for all children and families in order to provide appropriate care.

Preventing Injury in Schoolager

- Discuss safety measures needed for: bikes, scooters, guns, skateboards, cars, water, and playground to decrease risk of injury related to those areas. - Discuss and develop a fire safety plan to decrease risk of injury related to fire. - Discuss appropriate safety equipment needed for each sport to decrease risk of injury. - Discuss appropriate sports to participate in depending on age, sex, and maturity of child to prevent possible injury and to promote child's self-esteem. - Instruct parents to post the Poison Control Center phone number (in the event of accidental ingestion, Poison Control can give parents the best advice for appropriate intervention). - Teach parents and child first-aid measures and child cardiopulmonary resuscitation (CPR) to minimize consequences of injury should they occur. - Discuss influence of peers on actions of school-age children to prevent possible injury due to mimicking behavior.

Guidelines for Television and Internet

- Establish a consistent time limit for any media use and develop a Family Media Plan. Establish media-free times, such as mealtime. - Monitor television programs and internet activity. - Prohibit television or video games with violence. - Do not put television, video games, or internet-connected devices in children's bedrooms. Place computers in an open area that allows easy monitoring by an adult. - Co-view television, video games, and internet content with the child. - Encourage sports, interactive play, and reading. - Teach your child internet safety, such as to never share personal information or meet a friend you have only met online without parental permission. Never share passwords. Never respond to a message that hurts your feelings or makes you uncomfortable. Never send mean messages over the internet. - Teach proper social media use. - Be a good role model.

Promoting Healthy Growth and Development in the Schoolager

- Family plays a critical role in promoting healthy growth and development - Respectful interchange of communication between the parent and child will foster self-esteem and self-confidence - This respect will give the child confidence in achieving personal, educational, and social goals appropriate for his or her age (nurses should assess for respect)

Maintaining Healthy Weight

- Have child keep food and exercise diary for 1 week to determine current patterns of eating and exercise. - Interview parents for their eating and exercising habits - Have child participate in grocery shopping - Develop reward system to increase self-esteem

Guidelines for Tobacco and Alcohol Education

- Inquire about tobacco and alcohol use. - Discuss the physical and social dangers of tobacco and alcohol use. - Urge parents to be good role models. - Limit reading and media materials about alcohol and tobacco use. - Discuss the influences of tobacco and alcohol use by peers. - Educate the child on spit tobacco. Let them know it is just as dangerous as smoking tobacco. - Educate the child on e-cigarettes and the dangers associated with them. - Advocate for a smoke-free environment in the home and other places frequented. - Avoid having tobacco and alcohol products readily available in the home.

Nurse's Role in School-Age Growth and Development

- Irregular spurts with a wide variation of sizes and shapes - This is a time when children compare themselves to peers and self-esteem is a central issue. - Children begin to seek independence from family and acceptance from peers - If hospitalized, the school-age child may miss school and the interactions with his or her peers. The school-age child may regress and exhibit behaviors of a younger child, such as needing special comfort toys or demanding attention from his or her parents (due to hospitalization) - Hospitalization can cause a loss of control (The school-age child is used to controlling his or her self-care and making choices about his or her meals and activities.) - Provide opportunities for the child to maintain independence, gain control, and increase self-esteem

Promoting Car Safety in Schoolagers

- Motor vehicle actions are common - School-age children should always sit in the rear seat (front-seat is dangerous due to airbags) - Child must be 40 lbs (44-8) for booster seat (with lap and shoulder belts) - When child is 8-12 (4ft 9in) they may get out of booster seat - Children under 10 should not be unsupervised pedestrians - Children younger than 13 years should not ride in front seat with an airbag - Teach children safe street and pedestrian practices. - Lap belt should lie low and flat on the hips. - Seatbelts fastened before starting the car. - Childproof locks for back seat - Look RLR before crossing the stress - Supervise young children - Only walk on sidewalks - Phones/devices should be put away when crossing the street - Watch for cars backing up in parking lots

Promoting Reading in School-Age Children

- Parents, read to and with your children. - Ask teachers and librarians for advice on books appropriate for your child. - Choose stories that the child can relate to if the child has difficulty reading. - Choose books with movement if the child has a short attention span. - Take advantage of all reading opportunities (cereal boxes, road signs). - Provide choices for the child to select a book of interest. - Talk about the text and ask questions to improve understanding. - Keep a record of what the child is reading. - Visit a library, get a library card, and check out books. - Parents, demonstrate role modeling through reading books.

Teacher, School, and Family Influences on Schoolagers

- School -> means to transmit values of society and to establish peer relationships. - Second to family, school exerts a profound influence on social development of a child - Parents who are positive and supportive promote a smooth entry into school. Parents who encourage clinging behaviors may delay a successful transition into school. - School-age years are a time for peer relationships, questioning of parents, and the potential for parental conflict but continued respect for family values. - Peer-group influence begins, testing parental and family values - Family's values still dominate - During late school age, children begin to show increased interest in peers and decreased interest in family functions. - Parents' awareness of this developmental trend and their continuing support for the child are important while they continue to enforce restrictions and control of behaviors. The school-ager is beginning to strive for independence, but parental authority and controls continue to impact choices and values. - Parents are not "pals"

Promoting Learning in Schoolagers

- School attendance and learning are very important to the school-age child. - Most children are excited about starting school and making new friends. They like the notion of getting books, having book bags, and having homework assignments. - Influenced by family, teachers, and peers - Children learn cooperation, competition, and the importance of following rules in a school. - Teachers can help foster feelings of industry and prevent feelings of inferiority. - Encouraging reading is an excellent way to promote learning in the school-age child. - Children enjoy begin read to and reading on their own. - 6-8 yrs -> Dr. Seuss (few words on pages) - 8-10 yrs -> more advanced reading skills (Harry Potter; classic novels) > Parents must collaborate with teachers and school personnel to ensure that the child is fulfilling the expectations and requirements for this age group in school. Parents must monitor the child's homework assignments and friends, and observe for any changes in behavior that would indicate school or behavioral problems. > School-age children of all ages benefit from books on topics related to things they may be experiencing, such as a visit to the hospital for a surgical procedure

Peer Relationships for Schoolagers

- Shaped by both parents and others - Peer relationships influence children's independence from parents - Peers play an important role in the approval and critiquing of skills of school-age children. - Previously, only parents and teachers were authorities, but now peers have an influence on self-perception. - Peer relationships help to support the school-age child by providing enough security to risk the parental conflict brought about when establishing independence. - Continuous peer relationships -> more important social interaction - Formation of groups with rules and values - Children learn to respect differing points of view that are represented in their groups. Peer groups establish norms and standards that signify acceptance or rejection. Children may modify behavior to gain acceptance.

Water Safety (Schoolagers)

- Teach children how to swim and to never play around or in water without adult supervision. - If swimming skill is limited, child must wear life preserver at all times. - An adult should always supervise children when they are swimming to prevent water-related accidents. - Child should know never to swim alone—if at all possible, swim only where there is a lifeguard. - Understand basic CPR. - Teach child to never run or fool around at edge of pool. - Drains in pool should be covered with appropriate cover. - Life jackets should be worn when on a boat. - Make sure water is deep enough to support diving.

Bicycle and Sport Safety (Schoolagers)

- Wear a helmet when riding a bicycle or scooter (Consumer Product Safety Commission) - Wear kneepads and elbow pads when skateboarding

Promoting Healthy Sleep and Rest in Schoolagers

> 12 hours for 6-8 years > 10-12 hours for 8-10 years > 9-10 hours for 10-12 years > Younger children may need nap > Night terrors or sleepwalking may occur in 6- to 8-year-olds, but should be resolved between the ages of 8 and 10 years. > In the older school-age child (11 to 12 years), encourage parents to allow a variation in the sleep schedule on the weekends and a regular schedule on weekdays.

Growth and Development of the Adolescent

> Adolescence = 11-20 years (transition from childhood to adulthood) > drastic changes in the physical, cognitive, psychosocial, and psychosexual areas. > Nurses should reduce risk-taking behaviors: drinking, drug use, sexual activity, and participating in reckless behavior or dangerous activities > The magnitude of physical changes during adolescence is second only to the growth in infancy. > Girls enter puberty: 9-10 yrs; Boys: 10-11

Physiologic Changes in Adolescence

> Adolescence is a time of metabolic slowing and of increasing size of some organs. > Neurological: - Neurons do not increase in number, but growth of the myelin sheath enables faster neural processing. > Respiratory: - the growth of the laryngeal cartilage, larynx, pharynx, vocal cords, and lungs produces the voice changes experienced in adolescence. These changes in the quality of the child's voice are often preceded with some voice instability where voice cracking is heard. - Both male and female voices deepen > Cardiovascular System: - Increase in size and strength of heart. - BP increases, HR decreases > GI System: - Wisdom teeth come in during 17-20 yrs - Liver, spleen, kidneys, and GI tract enlarge > Musculoskeletal: - The ossification of the skeletal system is incomplete until late adolescence in boys. - Ossification is more advanced in girls and occurs at an earlier age. > Integumentary System: - Skin becomes thick and tough - Androgens: sebaceous glands become more active on face, back, and genitals. - Due to the increased levels of testosterone during Tanner stages 4 and 5 in both boys and girls, both sexes may have increased sebum production, which may lead to the development of acne and oily hair.

Promoting Discipline for Adolescent

> Adolescents naturally misbehave or do not follow the rules of the house > Adolescents should know the rules and expectations. After they are established; parents must explain to the adolescent the consequences of breaking the rules. > The parent and the teen should collaborate on what the consequences will be if the rules are broken. > Parents must acknowledge and offer reinforcement and support when the teen follows the rules. Consistency and predictability are the cornerstones of discipline, and praise is the most powerful reinforcer of learning.

Self-Concept and Body Image of Adolescent

> Adolescents who perceive their body as being different than peers or as less than ideal may view themselves negatively. > Sexual characteristics are important to the adolescent's self-concept and body image. > Boys are concerned about the size of their penis and facial hair while girls are concerned about breast size and the onset of menstruation.

Sensory Development in the Schoolager

> All senses are mature > Vision screening programs are conducted by school nurses > Amblyopia (lazy eye) is reduced vision in an eye that has not been adequately used during early development. > Inadequate use can result from conditions such as strabismus (misalignment of the eyes), one eye being more nearsighted, farsighted, or astigmatic than the other eye. If untreated in childhood it can persist into adulthood causing permanent visual impairments > the condition is correctable with glasses or patching which forces the child to use the weaker eye. > Proper screening and referral, as well as notification to parents of the existing condition, are essential to the education and socialization of the school-age child.

Dating in Adolescence

> An interest in romantic partnerships occurs during adolescence (due to physical changes and body changes as well as peer pressure) > Teen dating can range from group dating to single dating to serious relationships. Most early adolescents spend more time in activities with mixed-sex groups, such as dances and parties, than they do dating as a couple. > Healthy romantic relationships in adolescence can assist the teen in developing a strong sense of self-identity and developing interpersonal skills, such as empathy, and are related to increased quality of adult relationships > The emotional ups and downs that accompany dating can help develop emotional resilience and coping skills. Romantic relationships at this stage are a great source of emotional support. Risks of being involved in unhealthy romantic relationships include dating violence and risky sexual activity such as sexually transmitted infections (STIs) and pregnancy. Adolescents do not automatically know what makes for a healthy relationship. They need to be educated on the right and wrong behaviors of dating and what behaviors make up a healthy relationship, such as open communication, honesty, and trust. > Should know signs of an unhealthy relationship and how to seek help

Motor Skill Development of Adolescent

> Because of this period of rapid growth spurts, teenagers may experience times of decreased coordination and have a diminished ability to perform previously learned skills, which can be worrisome for the teenager. > Gross: - Develops endurance, speed, accuracy; increased competitiveness > Fine: - Computer use has greatly increased fine motor skills

Foods High in Iron

> Beef, chicken, seafood, liver > Tofu > Nuts and seeds > Lentils and legumes > Eggs > Dark leafy veggies (spinach) > Iron fortified cereals, whole grain breads, pasta.

Body Image in Schoolagers

> Body image is how the school-ager perceives his or her body. > School-age children are very interested in peers' views and acceptances of their body, body changes, and clothing. > This age group may model themselves after parents, peers, and persons in movies or on television.

Bullying (Schoolager)

> Bullying = inflicting unwanted, repeated verbal, emotional, or physical aggression upon others and involving a power imbalance > cyberbullying is a growing concern > Bullies look for shy, weak, and defenseless victims > Children who bully most often have low self-esteem, poor grades, and poor interpersonal skills. > 10% of children are bullied daily > Most bullying occurs at school; boys and girls can be bullied > Boys are 2.5x more likely to be bullies > Bullied children often have increased episodes of headaches, stomachaches, sleep problems, anxiety, loneliness, depression, substance use, lower academic achievement, and suicidal tendencies

Self-Esteem Development in Schoolagers

> By the school-age years, children have received feedback related to their performance or tasks. The direction of this feedback influences the child's opinion of self-worth, which influences self-esteem and self-evaluation. > Children who have mastered the earlier developmental task of autonomy and initiative face the world with feelings of pride rather than shame > Significant adults in school-age children's lives can manipulate the environment to facilitate success. This success impacts the self-esteem of the child.

Pediculosis Capitis for the Schoolerage (Head Lice)

> Caused by Pediculus humanus capitis (head louse) > Transmission: - Direct contact with hair of infested people, less commonly with personal belongings, such as combs and hats, of those infested - Incubation = 6-10 days > S/S: - Extreme pruritus is most common symptoms. - Adult eggs (nits) may be seen behind the ears and at the nape of the neck. > Dx / Tx: - Dx: Identification of eggs, nymph, and lice - Tx: Washing hair with a pediculicide, such as permethrin, pyrethrins, lindane, malathion - Detection of living lice 24 hours after treatment suggests incorrect use, a very heavy infestation, reinfestation, or resistance to treatment. > Isolation/Control Measures/Concerns: - Contact precautions - Treatment check q2-3 days - Household and other close contacts should be examined and if infested treated. Bedmates should be treated prophylactically. - But to help avoid reinfestation, disinfection of clothing, headgear, pillowcases, towels, and other items used by the individual within the past 2 days by washing in hot water and drying on the hot cycle may be helpful. (can also seal nonwashable items in plastic bag for 10 days) - Soaking combs and hairbrushes in pediculicide, shampoo, or hot water - Lice infestation is not a sign of poor hygiene; all socioeconomic groups are affected.

Communication in Adolescence

> Colloquial speech (slang) increases, which can make communication with others more difficult

Coping Mechanisms

> Coping impairment related to altered self-esteem, poor relationship with parents and peers, participating in risk taking behaviors, insufficient resources and social support as evidenced by alteration in sleep pattern, destructive behavior toward others or self, frequent illness, inability to meet basic needs, insufficient coping strategies, risk taking behavior, substance misuse > Goal: Adolescent will demonstrate adequate coping abilities as evidenced by management of stress of adolescence and no evidence of participating in risk-taking behaviors. > Methods: - Encourage parents to provide unconditional love to improve self-esteem. - Assess for any evidence of any risk-taking behaviors (drugs, smoking, suicide) to identify need for early interventions. - Assess adolescent's knowledge of normal stress-facing teenagers to determine current knowledge. - Assess adolescent's present coping skills to determine areas for improvement/support.

Cultural Influences on Growth and Development of Adolescent

> Desire to fit in with peers can cause conflict with the adolescent's family and culture. > Experiencing a rite-of-passage ceremony to signal the adolescent's movement to adult status varies among cultures. The American culture does not universally have a rite of passage for teenagers. Some religious and social groups do have ceremonies that signal a movement toward the maturity of adulthood (e.g., the Jewish bar or bat mitzvah, the Catholic confirmation, and social debuts). > Major barrier to tasks of adolescence is socioeconomic status.

Nursing Assessment for Eating Disorders

> Determine the health history, noting risk factors such as family history, female gender, Caucasian race, preoccupation with appearance, obsessive traits, or low self-esteem. > Adolescents with anorexia may have a history of constipation, syncope, secondary amenorrhea, abdominal pain, and periodic episodes of cold hands and feet. > Parents usually note the chief complaint as weight loss. Note history of depression in the child with bulimia. > The anorexic is usually severely underweight, with a body mass index (BMI) of less than 17. Note cachectic appearance, dry sallow skin, thinning scalp hair, soft sparse body hair, and nail pitting. Note low temperature, bradycardia, or hypotension. Listen for murmur. > The adolescent with bulimia will be of normal weight or slightly overweight. Inspect the hands for calluses on the backs of the knuckles and split fingernails. Inspect the mouth and oropharynx for eroded dental enamel, red gums, and inflamed throat from self-induced vomiting. > Labs: Serum electrolytes and electrocardiogram (needed in adolescents with anorexia because severe electrolyte disturbances and cardiac arrhythmias often occur.)

Puberty Changes

> Early Adolescence (10-13 yrs): - Girls: Pubic hair curls and spreads over mons pubis; pigmentation of genitalia increases; breast bud and areola continue to enlarge (no separation of breasts); first menstrual period (average of 12) - Males: Pubic hair spreads laterally and curls; pigmentation increases; growth and enlargement of testes in scortum (reddish color) and continued lengthening of penis; leggy look due to extremities growing faster than trunk > Middle Adolescence (14-16 yrs): - Girls: Pubic hair becomes coarse and continues to grow; hair increases; areola and papilla separate from the contour of the breast to form a secondary mound - Males: Pub hair becomes coarser and takes on adult distribution; testes and scrotum continue to grow; scrotum darkens; penis grows in width and glans penis develops; may experience breast enlargement; vocal changes (due to rapid enlargement of larynx and pharynx and lung changes) > Late Adolescence (17-20 yrs): - Girls: mature pubic hair distribution and coarseness - Males: Mature pubic hair distribution and coarseness; breast enlargement disappears; adult size and shape of testes, scrotum, and penis; scrotal skin darkening

Promoting Learning for Adolescents

> Education is influenced by family, teachers, peers > School prepares adolescents for the future. Completing school prepares the adolescent for college or employment to make an adequate income. > Dropout rates are highest among Hispanic students > Those who drop out of school may lack skills needed to function in today's society. They are more likely to be unemployed, they have higher rates of incarceration, and have lower income levels and occupational status than those with a high school diploma > Healthy People 2030: - Increase the number of students who graduate with a high school diploma. - Encourage school attendance and completion when encountering teens for well-child or sick visits. - Refer children who have difficulty concentrating or learning for further evaluation. - Praise school accomplishments. > Other Activities: - Adolescents are involved in many other activities that influence learning. Some of these activities include - school activities such as band, choir, or clubs requiring high achievement - athletic activities in the school and community and sometimes in the state or region - art, sewing, and building classes = work activities when the late adolescent has a part-time job. - These activities all contribute to the growth, development, and education of the adolescent.

Psychosocial Development of Adolescent

> Erikson: Identity vs. Role Confusion > As the adolescent is trying out many different roles in regard to his or her relationships with peers, family, community, and society, he or she is developing his or her own individual sense of self. > If the adolescent is not successful in forming his or her own sense of self, he or she develops a sense of role confusion or diffusion. > Looks for support from peers > Adolescent revisits each previous stage of development. > Erikson: - Early (10-13): Focuses on bodily changes; experiences frequent mood changes - Middle (14-16): Time of greatest conflict with parents/authority figures - Late (17-20): Able to understand implications of behavior and decisions; roles within peer groups established Piaget: - The adolescent progresses from a concrete framework of thinking to an abstract one. - He or she assumes others are just as interested in what interests him or her, which leads him or her to feel unique, special, and exceptional. That feeling of "being exceptional" leads to the risk-taking behaviors of which teenagers are well known. - Early: Egocentrical thinking - Middle: Abstract thinking and the belief she/he is invincible - Late: Less risk behaviors; develops realistic goals and career plans

Psychosocial Development in Schoolagers

> Erikson: Industry vs. Inferiority - During this time, the child is developing his or her sense of self-worth by becoming involved in multiple activities at home, at school, and in the community, which develops his or her cognitive and social skills. - child is very interested in learning how things are made and run - success in personal and social tasks - increased activities outside home (clubs and sports) - increased interactions with peers - increased interest in knowledge - satisfaction from achieving success in developing new skills leads him or her to an increased sense of self-worth and level of competence - inferiority occurs with repeated failures with little support or trust from those who are important to the child - child needs support and encouragement when not successful - if expectations are too high, the child will develop inferiority > Piaget: Concrete Operational (7-11) - Understands relationships among objects - In developing concrete operations, the child is able to assimilate and coordinate information about his or her world from different dimensions. - the child is able to see things from another person's POV and think through an action, anticipating its consequences and the possibility of having to rethink the action. - can used stored memories of past experiences to evaluate current situations. > Kohlberg: - Begins to exercise the "golden rule"

Physiologic Changes associated with Puberty

> Estrogen = Girls' Testosterone: Boys > Puberty is the result of triggers among the environment, the central nervous system, the hypothalamus, the pituitary gland, the gonads, and the adrenal glands. > Girls reach physical maturity before boys and menarche (first period) occurs between ages of 9-15. > Thelarche: Breast budding that occurs 9-11 years and is followed by the growth of pubic hair.

Promoting Appropriate Discipline for Schoolager

> Explain to parents that they should never belittle the child. Children may view parents and caretakers negatively if they are consistently belittled or insulted > When misbehaviors occur, the type and amount of discipline are based on different factors: - Developmental level of both the child and the parents - Severity of the misbehavior - Established rules of the family - Temperament of the child - Response of the child to rewards > Children should participate in developing a plan of action for misbehavior.

Fine Motor Skills in Schoolagers

> Eye-hand coordination and balance improve > Hand usage improves, becoming steadier and independent and granting an ease and precision that allows these children to write, print words, sew, or build models or other crafts. > Child 10-12 begins to exhibit manipulative skills comparable to adults. > School-age children take pride in activities that require dexterity and fine motor skills such as playing musical instruments

Promoting Personal Care for Adolescent

> General Hygiene: - Frequent baths and deodorant use (sweat glands) - Also, to decrease oily skin due to sex steroids and hormones, teach the adolescent to wash his or her face two to three times per day with plain unscented soap. Vigorous scrubbing should be discouraged because it could irritate the skin and lead to follicular rupture - Shampoo hair daily or every other day - Do not squeeze pimples > Caring for Body Piercings and Tattoos: - Generally, piercings are harmless, but there are potential complications - Qualified personnel using sterile needles should perform the procedure. Teach the adolescent to cleanse the pierced area twice a day and more often at some sites. - Some of the infections that may occur as a result of unclean tools include hepatitis, tetanus, tuberculosis, and HIV. - Nurses should educate adolescents about the risk of tattooing including blood-borne infections, such as hepatitis B and C, HIV, skin infections, scarring, bleeding, and allergic reactions to dyes used in the tattoo process - go to a licensed facility with licensed tattoo artists and to double check that all equipment used is disposable and/or sterilized - Teach teens to cleanse tattoos with an antibacterial soap and water several times a day and to keep the area moist with an ointment to prevent scab formation. > Preventing Suntanning: - Suntanning is popular among adolescents and is influenced by the media, which promotes a link between tan skin and beauty. - No such thing as a good tan - Most exposure to ultraviolet rays occurs during childhood and adolescence, thereby putting people at risk for the development of skin cancer. - Encourage sunscreen or sunblock use for water sports, beach activities, and participation in outdoor sports.

Physical Growth of Schoolager

> Grow 2.5 inches per year (6-7 cm) -> total increase is 1ft > Increase weight by 7 lbs per year (3.5kg) > Secondary sexual characteristics begin to appear > In the early school-age years, girls and boys are similar in height and weight and appear thinner and more graceful than in previous years. > In later school age years, most girls begin to surpass boys in weight and height. These differences are more apparent at the end of the middle-school years (may cause emotional problems). > Preadolescent boys and girls do not want to be different from peers of the same sex or the opposite sex. These differences, especially secondary sexual characteristics, are concerning and often a source of embarrassment for both sexes. > Physical maturity is not necessarily associated with emotional and social maturity. An 8-year-old who is the size of an 11-year-old will think and act like an 8-year-old. > Expectations placed on children are often unrealistic, which can impact self-esteem.

Promoting Nutrition for the Schoolager

> Growth, body composition, and body shape remain constant during late school-age years. Needed calories decrease while the appetite increases. > In preparation for adolescence, the body fat composition of school-age children increases. > Needs depend on age, gender, and activity > 1400 - 2200 calories > 45-65% carbs, 10-30% protein, 25-35% fat > 4-8: 1000 mg of calcium; 9-13 = 1300 mg of calcium > Calcium is needed for the development of strong bones and teeth. > School-age children should choose culturally appropriate foods and snacks from the U.S. Department of Agriculture's MyPlate. - 1/2 plate = fruits and veggies - 1/2 grains = whole grains - Lean proteins and calcium rich foods - Limited intake of fat and processed sugars > Overweight is classified as a body mass index (BMI) greater than 85% and obese is classified as a BMI greater than 95% (Goal is 5%-85%) > Healthy People 2030: Reduce proportion of children and adolescents who have obesity: Screen all children for the development of overweight as indicated by an increasing BMI for their age; Provide accurate diet counseling; Encourage daily physical activity; Counsel parents to limit television/computer time daily. > Never use food as a reward > To prevent obesity, establish regular mealtimes and offer healthy foods and snacks. Encourage parents to praise their child's good food choices and to role model appropriate eating and exercise.

School Refusal for Schoolagers

> Guidelines: - Return child to school. - Investigate cause of the fear. - Support child. - Collaborate with teachers. - Praise success in school attendance. > refusal to attend school or difficulty remaining in school for an entire day. > Some of the fears expressed by school-refusing children include separating from parents, riding the bus, tests, bullying, teacher reprimands, anxieties over toileting in a public bathroom, physical harm, or undressing in the locker room. > There may be altered schedules (partial days or decreased hours) to help promote a successful transition back to school

Guidelines for Lying (Schoolager)

> Help parents in understanding why the child is lying > When the child lies, calmly confront the child and explain why the behavior is not acceptable. > Educate parents that their behavior should reflect what they teach and expect from their child. > Educate parents that too-rigid or severe punishments can decrease the child's sense of worth. > Seek professional help if lying persists in the older school-age child, to rule out underlying problems. > In most cases, these behaviors (stealing/lying) will result in a good lesson learned and the child will outgrow them.

Promoting Growth and Development through Sports and Physical Fitness (Adolescents)

> High levels of physical activity may reduce cardiovascular disease risk factors and provide disease prevention against cancer, obesity, osteoporosis, diabetes, and depression > Age group that spends the most time and energy participating in sports > Rapidly growing bones, muscles, joints, and tendons are more vulnerable to unusual strains and fractures. Incidence of concussions (which is considered a mild traumatic brain injury) is a growing concern in all teen athletes. > Know the warning signs of fatigue, dehydration, and injury > Nurse's role is prevent injuries > This education should include discouraging participation when the teen is tired or has an existing injury, encourage the use of proper well-fitting protective gear, and ensure the adolescent learns how to play a sport before participating in it. > U.S. Department of Health and Human Services recommends that adolescents participate in 60 minutes of moderate to vigorous physical activity each day

Promoting Healthy Weight for Adolescents

> Increase exercise > Make appropriate eating choices > Decrease caloric intake > Assess knowledge of parents and adolescent about nutritional needs of teenagers to determine deficits in knowledge. > Have adolescent keep a detailed food and exercise diary for 1 week to determine current patterns of eating and exercise. > Interview family in relationship to their eating habits and exercise habits to determine where adjustments might need to be made. > Discuss changes in a positive manner—talk about developing healthy eating habits instead of dieting to promote compliance. > Analyze preceding data, and base recommendations for changes on these data to promote compliance and to prioritize recommendations. > Discuss ways to decrease temptation to overeat, for example, eat slowly, put down the fork between bites, serve food on smaller plates, and count mouthfuls, to allow time to realize that you are full. > Have adolescent create meal plans and grocery shop to allow him or her some sense of control and decision-making. > Incorporate increase in daily exercise, which will stress sense of self-improvement to increase caloric expenditure and self-esteem. > Decrease TV/computer time to increase caloric expenditure. > Encourage peer exercise activities to increase peer interactions and to help teen to realize that others are like him or her. > Develop reward system to increase self-esteem. > Investigate joining weight loss program for adolescents to increase self-esteem and encourage weight loss.

Moral and Spiritual Development of Adolescent

> Increased spirituality and religious activities are related to increased healthy behaviors and decreased high-risk behaviors > Develop their own set of values and morals

Motor Vehicle Safety

> Largest number of injuries are due to motor vehicle crashes > However, driving is complex and requires judgments that the teen is often incapable of making (even if they have their license) > Adolescent is opposed to authority; takes risks > Teenagers are the least likely age group to wear a seat belt. Crashes involving adolescents are more likely to involve speeding, driving too fast for conditions, or following too close to the car in front of them >

Nursing Management of Eating Disorders

> Mostly outpatient; may take months > Refeeding syndrome (cardiovascular, hematologic, and neurologic complications) may occur in the severely malnourished adolescent with anorexia if rapid nutritional replacement is given. Therefore, slow refeeding is essential to avoid complications. Give phosphorus supplements as ordered. > Assess VS for orthostatic hypotension, irregular/decreased pulse, hypothermia > Aim for a weight goal of 0.5-2lbs a week > Those with anorexia who display severe weight loss, unstable vital signs, food refusal, or arrested pubertal development or who require enteral nutrition will need to be hospitalized > Assist the child and family to plan a suitably structured routine for the child that includes meals, snacks, and appropriate physical activity. > Use the physical findings associated with anorexia to educate the child about the consequences of malnutrition and how they can be remedied with adequate nutrient intake. > Assess the child's need for medical intervention for concomitant depression or anxiety > Use behavior or group therapy

Safety for Adolescent

> Motor Vehicle: - Do not drive or drive with someone who is impaired. - Have all passengers wear seat belts. - Do not use cell phone or text while driving, drink and drive, or drive when tired. > Bike: - Proper fitting helmet should: sit level, not tilted, and firmly and comfortably on the head; have strong wide Y-shaped straps and when you open your mouth should pull down a bit; not move with sudden pulling or twisting; never be worn over anything else - Should not wear headphones while riding a bike. > All-Terrain Vehicles: - Should not be operated by an adolescent younger than 16 years of age. > Water Safety: - Never swim alone—should, if at all possible, swim only where there is a life guard. - Learn basic cardiopulmonary resuscitation (CPR). - Do not swim if drinking alcohol or using drugs. > Firearms: - If guns are in household, should take firearm safety class, secure guns in safe place, use gun safety locks, and store bullets in separate place. - Never point a gun at a person. > Fire: - Avoid touching any downed power lines > Sports: - Wear appropriate protection devices for individual sport. > Sun: - Apply sunscreen prior to going out and reapply sunscreen often. - Limit sun exposure, especially between 10 a.m. and 2 p.m. > Toxins: - Teach the hazards of accepting illegal drugs, alcohol, dangerous drugs.

Promoting Nutrition for Adolescents

> Needs increase during adolescence due to accelerated growth and sexual maturation. > Obesity rates for adolescents have tripled. > Poor diet and physical inactivity have led to the mounting problem of obesity in this age group. > Nutritional Needs: - Teenagers have a need for increased calories, zinc, calcium, and iron for growth - 45-65% of calories come from carbs, 10-30% from protein, 25-35% from fat. - 1300mg of calcium - Males: 11 mg iron; Females: 15 mg - Protein: Females = 46; Boys = 52g

Abuse in Children (Schoolagers)

> Neglect is most common (60.8%) > 10.7% Physical Abuse, 7% sexual abuse > It is important for parents to teach children the concept of "good touch" versus "bad touch" prior to school-age years. Whenever the school-age child's behavior yields suspicion of physical or sexual abuse, the nurse should report to the appropriate authorities in his or her state.

Physiologic Changes in Schoolagers

> Neurologic: - Brain and skull grow very slowly (complete by 10 years). Shape of head is longer. > Respiratory: - The respiratory system continues to mature with the development of the lungs and alveoli, resulting in fewer respiratory infections. - RR decreases, abdominal breathing disappears, and respirations become diaphragmatic. - Frontal sinuses develop by 7 years. - Tonsils decrease in size. > Cardiovascular: - BP increases; HR decreases - Heart grows more slowly and is smaller compared to the rest of the body than at any other developmental stage > Gastrointestinal: - 20 primary deciduous teeth are lost, replaced by 28 of 32 permanent teeth. - Less GI upset - Stomach capacity increases., however, caloric needs are lower. > Genitourinary: - Bladder capacity increases (girls more boys) - Age in years + 2 oz Prepubescence: - Prepubescence occurs 2 years before puberty starts (10-12 years). - Prepubescence is characterized by the development of secondary sexual characteristics, a period of rapid growth for girls, and a period of continued growth for boys - 2 years difference between boys and girls. - Sexual development can lead to a negative perception of self and lowered self-esteem. - Early development in girls can lead to embarrassment, concern over physical appearance, and low self-esteem. - Delayed development in boys can lead to a negative self-concept, resulting in substance abuse or reckless use of nonautomobile vehicles. - Early development may lead to risk-taking behaviors in both boys and girls. - Nurses should educate late school-age child about body changes to reduce anxiety and promote comfort. > Musculoskeletal System: - Growth leads to greater coordination and strength - Muscles are still immature and can be injured easily. - Bones continue to ossify. > Immune: - Lymphatic tissue continues to grow until child is 9 years - IgA and IgG reach adult levels around 10 years - Improved lymphatic system reduces infections and produces greater antibodies.

Nurse's Role for Adolescents

> Nurses must be aware of the usual growth and development patterns for this age group so that they can assess the adolescent appropriately and provide guidance to the adolescent and his or her family. > Rapid growth > If the adolescent is hospitalized, growth and development may be altered. The adolescent is concerned about how the illness or injury will affect his or her body and body image. He or she fears pain and loss of privacy. The adolescent may experience anxiety about being separated from friends and loss of control. > Provide opportunities for them to maintain independence, participate in decisions, and encourage socialization with friends through phone, e-mail, and visits when possible. > His or her fluctuating relationships with parents and other adult figures may limit the teen from seeking assistance in dealing with the common issues of adolescence. In dealing with adolescents, be aware that they behave unpredictably, are inconsistent with their need for independence, have sensitive feelings, may interpret situations differently from what they are, think friends are extremely important, and have a strong desire to belong.

Recommendations for Obesity in Adolescents

> Nurses must make parents and adolescents aware of factors leading to obesity. > Nurses should recommended: - Proper nutrition and healthy food choices - Good eating habits, including eating a healthy breakfast daily - Decreased fast food intake - Physical activity for at least 60 minutes daily - Parents/adolescents exercising more at home - Parents living a healthy lifestyle - Decreasing nonactive computer and smartphone use and video, DVD, and television viewing

Autism Spectrum Disorder

> Onset in infancy and early childhood > Autistic behaviors may be first noticed in infancy as developmental delays or between the ages of 12 and 36 months when the child regresses or loses previously acquired skills. > Patho: - Though the exact etiology of autism continues to be unknown, genetics has been well studied in these children and ASD is mainly considered to be a genetic disorder, though there may also be issues with brain connectivity - Children with ASD display impaired social interactions and communication as well as perseverative or stereotypic behaviors (may fail to develop interpersonal relationships and experience social isolation) > Therapeutic Management: - There are no treatments available to cure autism. - The goal of therapeutic management is for the child to reach optimal functioning within the limitations of the disorder. - Each child's treatment is individualized; behavioral and communication therapies are very important. Children with ASD respond very well to highly structured educational environments; so, early, intensive behavioral interventions are necessary. - Families may use vitamins and nutritional supplements, herbs or restrictive diets, music therapy, art therapy, and sensory integration techniques. To date, these therapies have not been scientifically proven to improve autism > Nursing Assessment: - Elicit the health history, noting delay or regression in developmental skills, particularly speech and language abilities. - The most common early characteristics are a consistent failure to orient to one's name, regard people directly, use gestures, and to develop speech - The child may be mute, utter only sounds (not words), or repeat words or phrases over and over. - The parent may report that the infant or toddler spends hours in repetitive activity and demonstrates bizarre motor and stereotypic behaviors. - The infant may resist cuddling, lack eye contact, be indifferent to touch or affection, and have little change in facial expression - Assess the child's functional status, including behavior, nutrition, sleep, speech and language, education needs, and developmental or neurologic limitations. - Assist with screening, using an approved autism screening tool such as the Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R), which is recommended for administration at 18 months of age, and then again at 24 to 30 months of age - Observe the infant or toddler for lack of eye contact, failure to look at objects pointed to by the examiner, failure to point to himself or herself, failure to let his or her needs be known, perseverative play activities, and unusual behavior such as hand flapping or spinning.

Television, Video Games, and Internet for Schoolagers

> Parents should set limits on how much screen time the child can have. The AAP recommends parents place consistent limits on media time and type and there should be designated media-free times > Do not use electronics as rewards > No TV during dinner or in child's room

Importance of Peers (Adolescence)

> Peer groups play an essential role in the identity of the adolescent > Adolescent peer relationships are very important in providing opportunities to learn about negotiating differences; for recreation, companionship, and someone to share problems with; for learning peer loyalty; and for creating stability during transitions or times of stress. > Peers serve as credible sources of information, role model social behaviors, and act as sources of social reinforcement. > Peers can also have positive influences on each other, such as promoting college attendance, or negative influences, such as involvement with alcohol, drugs, or gangs. > Early and middle adolescence are periods when teens are prone to join gangs. > Parents must know their teen's friends and continue to be aware of potential problems while allowing the teen the independence to become his or her own person > Adolescents who do not have parental or adult supervision and opportunities for conversation with adults may be more susceptible to peer influences and at higher risk for poor peer selections.

Factors for Adolescent's Diet

> Peer pressure > Busy schedule > Concern about weight control > Convenience of fast food

Guidelines for Latchkey Kids

> Provide rules to follow and expectations, such as: - Not answering the door or phone - No friends in the house when parents are not home - No playing with fire > Teach child to call a trusted neighbor when help is needed and 911 in the event of emergency. > Post all resource numbers (even numbers you think your child may have memorized), including after-school helplines if available, in a clearly viewable spot. Include pediatrician's number and preferred hospital. > Enroll the child in an after-school program if available. > Discuss limitations of outside play. > Discuss limitations of television viewing and video game use. > Make sure the child knows how to contact the parent. > Set clear homework expectations. > DO NOT keep guns in the home. > Teach the child where first-aid supplies are located. > Teach the child household emergency procedures such as circuit breakers and water shut off valves. > Practice with your child. Have a trial run by leaving for a short time but staying close and role-playing situations that may occur. > Always check in with your child while you are away.

Promoting Healthy Teeth and Gums for Adolescent

> Rate of cavities decreases > Route dental visits every 6 months > Brush teeth 2-3 times a day > The use of dental devices/braces makes cleaning more difficult and contributes to gingivitis. > Tooth avulsion (knocked-out teeth) may occur during sports and other activities such as falls. The avulsed tooth should be reimplanted as soon as possible. The nurse may see the teen first so it is important that nurses know the proper procedure, which is to reinsert the tooth into its socket if possible or to store it in cool milk or normal saline for transport to the dentist.

Areas Affected by Emotional and Social Development

> Relationship with Parents > Self- Concept and Body Image > Importance of Peers > Sexuality and Dating

Injury Risk and Preventing Injury

> Risk Factors: developmental stage including increased motor and cognitive skills and feeling of invincibility > Discuss safety measures needed for the following: bikes, scooters, guns, skateboards, cars, and water to decrease risk of injury related to those areas. > Educate adolescents about the risk of overdose with substance use to prevent injury or death due to substance use. > Discuss and develop a fire safety plan to decrease risk of injury related to fire. > Discuss appropriate safety equipment needed for each sport to decrease risk of injury. > Discuss appropriate sports to participate in depending on age, sex, and maturity of adolescent to prevent possible injury. > Teach parents and adolescent first-aid measures and cardiopulmonary resuscitation (CPR) to minimize consequences of injury should it occur. > Discuss influence of peers upon actions of adolescents to prevent possible injury due to mimicking behavior.

Growth and Development of the Schoolager

> School Ages = 6-12 years old > The focus of their world expands from family to teachers, peers, and other outside influences (become more independent) > It is during this time that children move toward abstract thinking and seek approval of peers, teachers, and parents. > Eye-hand-muscle coordination allows for sports. They value school attendance and activities.

Promoting Healthy Teeth and Gums in Schoolager

> School-age children need to brush their teeth two to three times per day for 2 to 3 minutes each time with fluoridated toothpaste > Tooth brush replaced every 3-4 months > Floss once daily; reduce intake of sugar > May need help brushing until 7-10 yrs

Moral and Spiritual Development in Schoolagers

> Sense of morality is constantly being developed > Kohlberg (7-10): The 7- to 10-year-old usually follows rules out of a sense of being a "good" person. He or she wants to be a good person to parents, friends, and teachers and to himself or herself. > The adult is viewed as being right. > Golden Rule: treat others how you would like to be treated

Sexuality (Adolescent)

> Sexuality includes the thoughts, feelings, and behaviors related to the adolescent's sexual identity. > Adolescence is a time when teens may begin experimentation related to their sexual identity, orientation, and behavior. This experimentation is part of the process of sorting through their sexuality and does not define their sexual identity or orientation. > LGBTQ: face additional challenges include, questioning of their sexual identity, the complexity of coming out, and possible societal discrimination > The majority of sexual minoritized adolescents are healthy and well but some are at an increased risk for adverse outcomes such as depression, suicide, substance use, homelessness, sexually transmitted infections, and victimization - Encourage parents and teens to have discussions about sexuality. - Education for the adolescent should include a discussion about media influences and the use of sexuality to promote products. - Encourage parents to be aware of who their adolescents are dating and where they go on their dates. > Teaching Guidelines: - It should be your choice to engage in sexual relations. Do not be influenced by peers. When you say "no," be firm and clear about your position. - Pregnancy, sexually transmitted infections, and HIV infection can occur with any sexual encounter without the use of barrier methods of contraception. Use appropriate contraception if sexually active. Discuss abstinence as a contraceptive method. - Sexual activity in a mature relationship should be pleasurable to both parties. If your sexual partner is not interested in your pleasure, you need to reconsider the relationship.

School-Age Fears

> Shift away from pretend things to things that could happen to them in real life, such as natural disasters, others hurting them, and the death of a loved one. > Recognize the child's fears but do not cater to them. Help the child face his or her fears and teach the child coping strategies such as positive self-statements such as "I can do this" and relaxation techniques such as deep breathing and visualization

Promoting Healthy Sleep and Rest for Adolescents

> Sleep needed: 10 hours > The adolescent often experiences a change in sleep patterns that leads to feeling more awake at night and the desire to sleep later in the morning > Inadequate sleep leads to an increased risk of certain health and cognitive problems such as obesity, diabetes, poor mental health, problems with attention and negative effects on mood and motivation > Rapid growth may cause the need for more rest > Explain to parents the need to discourage late hours on school nights because they may affect school performance. Encourage the teen to go to bed at the same time at night and awaken at the same time in the morning, even on weekends > Healthy People 2030: - Increase the proportion of students in grades nine through 12 who get sufficient sleep. - Encourage consistent bedtimes. - Encourage teen to make bedroom dark, relaxing, and quiet. - Encourage no electronic devices in bedroom and limit light exposure and technology use in the evening hours. - Encourage regular exercise. - Limit caffeine and tobacco. - Educate and encourage local school officials to adopt later start schedule for teens.

Gross Motor Skills in Schoolagers

> Speed and accuracy increase > During the school-age years, coordination, balance, and rhythm improve, facilitating the opportunity to ride a two-wheeled bike, jump rope, dance, and participate in a variety of other sports > Older school-age children may become awkward due to their bodies growing faster than their ability to compensate. > Bicycling, skating, swimming (6-8); baseball and soccer (8-10) > Between the ages of 10 and 12 years, energy levels remain high but are more controlled and focused.

Firearm Safety in Schoolagers

> Teach child never to touch guns—tell an adult. > If there are guns in household, need to secure them in a safe place, use gun safety locks, store bullets in a separate place. > Never point a gun at a person.

Toxin Safety for Schoolagers

> Teach child the hazards of accepting illegal drugs, alcohol, or dangerous drugs. > Store potentially dangerous material in a safe place.

Promoting Proper Media Use for Adolescent

> Television, the internet, and other forms of media, such as smart phones, iPads, and social media sites, are a large force in teens lives today > With greater technology and media access comes benefits such as enhancing communication skills, increasing social connections, and improving technical skills, but risks also exists, such as cyberbullying, sexting, exposure to inappropriate content, privacy issues, internet addiction, and sleep deprivation. > Parents should: establishing consistent, reasonable rules about use of cell phones, texting, the internet and social media use, such as no media during meals and regular checking of privacy settings and online profiles for inappropriate content

Emotional and Social Development in Schoolagers

> Temperament = the way individuals behave (slow to warm up, easy and adaptable, difficult and easily frustrated) > The slow-to-warm child may be slow to adapt to changes. The slow-to-warm school-age child may exhibit discomfort when placed in different or new situations such as school. This child may need time to adjust to the new place or situation, and may demonstrate frustration with tears or somatic complaints. The slow-to-warm child should be allowed time to adjust to new situations and people (such as teachers) within his or her own time frame. > The difficult or easily distracted child may benefit from an introduction to the new experience and people by role-playing, by visiting the site and being introduced to the teachers, and by hearing stories or participating in conversations about the upcoming school experience. These children require patience, firmness, and understanding to make the transition into a new situation or experience such as school

Relationship with Parents

> The adolescent is striving for self-identity and increased independence. He or she spends more time with peers and less time with family and attending family functions. > This may lead to a family crisis, and the parents may respond by setting stricter limits or asking questions about the teen's activities and friends. Other parents may drop all rules and assume that the adolescent can manage himself or herself. Both of these responses increase tension in the family. > Adolescent attempts to establish independence; family tries to learn how to let go (can cause disequilibrium) > Families who listen to and continue to demonstrate affection for and acceptance of their adolescents have a more positive outcome. This does not mean that the family accepts all of the teen's ideas or actions, but they are willing to listen and attempt to negotiate some limits - Set rules and limits fairly - Set aside appropriate amount of time to discuss subject matter without interruptions. - Talk face to face. Be aware of body language. - Ask questions to see why he or she feels that way. - Ask him or her to be patient as you tell your thoughts. - Choose words carefully so he or she understands you. - Tell him or her exactly what you mean. - Give praise and approval to your teenager often. - Speak to your teenage as an equal—don't talk down to him or her. - Be aware of your tone of voice and body language. - Don't pretend you know all the answers. - Admit that you do make mistakes.

Promoting Healthy Eating Habits

> The nurse must understand normal growth and development of the adolescent in order to provide guidance that fits the quest for independence and the need for teens to make their own choices > Assess the amount of junkfood that the patient eats per day. > Planning should always include the adolescent. > 20.6% of adolescents are obese. > This increase in obesity in adolescents has led to increases in hypertension, heart disease, and type 2 diabetes. > factors causing obesity include poor food choices, unhealthy eating practices, and lack of exercise.

Summary of Schoolagers

> The onset of puberty may occur by the later school-age years. > Erikson's (1963) developmental task for the age group is the development of a sense of industry. > School-age children are capable of concrete operations, solving problems, and making decisions. They continue to need guidance, rules, and direction from parents. > The school-age child develops a conscience and knows cultural and social values. He or she can understand and obey rules. > The school-age child incorporates religious practices into his or her life, which may be a source of comfort during stressful times. > The nurse's role includes educating parents and school-age children in promoting health and safety. > Nurses should inform the school-age child about expected developmental changes in the body to promote self-esteem and self-confidence.

Firearm Safety

> The risk of dying from a firearm injury among 15- to 19-year-olds has been rising > Provide education about gun safety

Promoting Safety for the Adolescent

> Unintentional injuries are the leading causes of death in adolescents > Motor vehicle accidents are the leading cause of injury death followed by poisoning, primarily due to drug overdose from opioids > Males are more likely to die than females > Factors: increased physical growth, insufficient psychomotor coordination for the task, abundance of energy, impulsivity, peer pressure, and inexperience > Impulsivity, inexperience, and peer pressure may place the teen in a vulnerable situation between knowing what is right and wanting to impress peers. > May have feelings of invulnerability > Most serious or fatal injuries in adolescents are preventable

Communication and Language Development in Schoolagers

> Use plurals and pronouns > Develop metalinguistic awareness > School-age children may experiment with profanity and dirty jokes if exposed. This age group tends to imitate parents, family members, or others. Therefore, role modeling is very important.

Addressing Common Developmental Concerns for Adolescent

> Violence > Suicide > Homicide > Substance Use

Prevention of Tick-Borne Illnesses for the Schoolager

> Wear appropriate protective clothing when entering tick-infested areas. Clothing should fit tightly around wrists, waists, and ankles. Tuck pants into socks if possible. > After leaving the area, do a full body check for ticks and remove them promptly. > Examine gear, clothes, and pets for ticks. Tumble dry clothes and appropriate gear on high heat for an hour. > Insect repellent may provide temporary relief but may produce toxicity, especially in children, if used frequently or in large doses

Latchkey (Schoolager)

> With the increasing incidence of both parents in the workforce and many children living with just one parent, often times, children return home alone without adult supervision for a number of hours. > Most young children are not capable of handling stress or making decisions on their own before 11 or 12 years of age. > some school-age children are more mature and can be left alone by 8 to 10 years of age; maturity is the key, not the age > Many states have guidelines for when it is okay to leave a child home alone > Despite the level of maturity, children who are unsupervised are more likely to participate in risky behaviors such as smoking, drinking, and doing drugs > latchkey children may feel anxiety, stress, fear, boredom, loneliness, they miss more days of school, and have lower academic scores > If children come home to no supervision, they should know the names, addresses, and phone numbers of parents and a neighbor, as well as emergency numbers. They should be given rules about answering the door and the phone. They should tell anyone who comes to the door or who calls that mom or dad is home but busy at this time.

Violence in Adolescent

> growing concern > Health care providers need to provide education on the effects and ways to prevent youth violence along with supporting programs developed to curb youth violence. > Suicide: - Second leading cause of death in youths 10-24 - The National Center for Injury Prevention and Control (NCIPC) is working to create awareness of suicide as a serious public health problem and is developing strategies to reduce injuries and deaths due to suicide. > Homicide: - Third leading cause of death in children (mostly male and firearms) > Dating Violence: - Education on development of healthy relationships is important. - Risk Factors: inadequate parental supervision, condoning violence, substance use, prior victimization, having violent peers or friends involved in dating violence, depression or anxiety, learning difficulties or problems at school, history of aggression or bullying, and risky sexual practices - Healthy People 2030: Screen teens at all encounters for indications of dating violence; Teach safe and healthy relationship skills; Discuss with teen good relationship role models in their life. > Gangs: - Much of youth violence is caused by gangs - All socioeconomic groups are in gangs - Early intervention is important - Research has shown that increasing parental monitoring, increasing involvement in extracurricular activities, improving coping skills to deal with conflict, and educating about the negative consequences of gang membership may be beneficial in preventing gang membership

Eating Disorders

> pica, rumination, anorexia nervosa, and bulimia. > Pica, which occurs most frequently in 2- to 3-year-olds, is an eating disorder in which the child ingests (over at least a 1-month period) a nonnutritive material such as paint, clay, or sand > Primarily affect adolescents > Anorexia nervosa is characterized by dramatic weight loss as a result of decreased food intake and sharply increased physical exercise. > Bulimia refers to a cycle of normal food intake, followed by binge eating and then purging. Typically, the adolescent with bulimia remains at a near-normal weight. - Complications of anorexia and bulimia include fluid and electrolyte imbalance, decreased blood volume, cardiac arrhythmias, esophagitis, rupture of the esophagus or stomach, tooth loss, and menstrual problems.

Guidelines for Bullying (Schoolager)

BULLIED CHILD: > Educate parents whose children are at risk for being bullied, such as: - Children who appear different from the majority - Children who act different from the majority - Children who have low self-esteem - Children with a mental or psychological problem > Teach parents to role-play different scenarios the child may face at school; show the child different ways to react to being bullied. > Impress upon the child that he or she did not cause the bullying. > Develop ways to increase the child's self-esteem at home. > Discuss the situation with the teacher and develop a plan of care. BULLYING CHILD: > Educate parents on reasons why it is important to correct the behavior. > Discuss ways the child can appropriately show his or her anger and feelings. > Have parents help the child to see how it feels to be bullied. > Do not allow fighting at home. > Reward settling of conflicts without violence.

(T/F) African American girls on average reach menarche slightly earlier than Caucasian girls.

True

(T/F) All states, though varied, have enacted a Graduated Driving License (GDL) program, which allows teens to gain driving experience and limits risky circumstances (such as nighttime driving and driving with passengers) by providing a license in three stages (learners' permit, provisional license, and full license).

True

(T/F) An adolescent with anorexia nervosa would most likely experience amenorrhea, hypothermia, low blood pressure, and bradycardia. The nurse would also note soft hair on the individual's back and arms.

True

(T/F) In the late school-age years (10- to 12-year-olds), boys experience a slowed growth in height and increased weight gain, which may lead to obesity. During this time, girls may begin to have changes in the body that soften body lines.

True

(T/F) Preadolescence is a period of rapid growth, especially for girls.

True

(T/F) The first sign of pubertal changes in boys is testicular enlargement in response to testosterone secretion, usually occurring in Tanner stage 2.

True

Malocculusion

a condition in which the teeth are crowded, crooked, or misaligned. > may require braces.

Principle of Conservation

matter does not change when its form changes

Self-Esteem

the child's view of his or her individual worth. This view is impacted by feedback from family, teachers, and other authority figures.

Factors Contributing to Adolescent Violence

• Crowded conditions/housing • Low socioeconomic status • Limited parental supervision/involvement • Single-parent families/both parents in workforce • History of violent victimization • Poor family functioning • Access to guns or cars • Drug or alcohol use • Low self-esteem • Racism • Peer or gang pressure • Aggression

Risk Factors for Gang Involvement

• Delinquency involvement, especially at a young age • History of or victim of physical violence or aggression • Alcohol and drug use; drug dealing • Associated with delinquent or aggressive peers • Poverty/low socioeconomic status • Family with criminal history, drug or alcohol problems, violence in the home • Poor parental supervision/involvement • Poor academic performance • Living in a community with a large number of troubled youth, access to firearms and drugs