School Aged Child- PEDS
Evan, an 11-year-old has been hospitalized for fracture femur caused by all-terrain vehicle (ATV) accident while his family was on vacation. The injury requires 2 weeks of traction, and the nurse notes that Evan appears bored and restless. Applying development theory, which of the following does the nurse select to distract Evan?
A board game requiring multiple players A video game for two on the large screen in the playroom
The nurse working in a pediatric clinic sees a child with a fading ecchymosis ring around his left eye. What is the most appropriate question to ask the child?
Did you get that black eye during sports?
Aliyah, age 16 was diagnosed with type 2 diabetes 3 months ago and was instructed by her nurse practitioner (NP) to eat fewer carbohydrates, lose weight, and exercise more. Today, she is following up with her NP. What is the most accurate way for the NP to assess Aliyah's compliance with the diet and exercise regimen?
Drawing blood for HbA1c levels
A nurse is discussing the best way to continue playing on the football team with a 16-year-old high school junior with type 1 diabetes. What should the nurse instruct the teen to do before exercising?
Eat a high protein snack of cheese, crackers, and turkey slices
signs and symptoms of type 1 diabetes
Excessive thirst, frequent urination, blurry vision, yeast infections, foot + abdominal pain, impotence, sores that don't heal, increased appetite with weight loss, breath that smells like fruit, fatigue, confusion.
Which of the following are initial symptoms of a new diagnosis of type 1 diabetes (TID)?
Fruity, sweet odor on breath Extreme thirst Frequent urination Increased appetite
Which of the following factors are associated with development of childhood obesity?
Genetics A sedentary lifestyle A high fat diet
Hypoglycemia Level One:
Glucose Level less than 70mg/dL but greater than 54mg/dL
Hypoglycemia Level Three:
Glucose level producing severe cognitive impairment needing immediate external recovery assistance
A nurse is participating in a discussion about prepubescence and preadolescence with a group of guardians of school age children. Which of the following information should the nurse include in the discussion
Growth differences between boys and girls become evident
insulin shock signs and symptoms
Headache Pale face Shallow respiration Weakness Palpations Moist skin Lack of coordination Confusion Diaphoresis
A nurse is reinforcing teaching with an adolescent who had diabetes mellites about manifestations of hypoglycemia. Which of the following findings should the nurse include?
Hunger Irritability Sweating and pallor
A nurse is reinforcing teaching with a child who has type 1 diabetes mellitus about self care. Which of the following statements by the child indicates understanding of the teaching?
I should drink a glass of milk when I am feeling irritable
11- and 12-Year-Olds
Intense, observant, energetic May be argumentative and meddlesome Hormone influence on physical growth more apparent Need freedom within limits and recognition they are no longer infants Less concerned with appearance Seem preoccupied Ability to concentrate decreases Group participation still important Interested in their bodies and watch for signs of growing up Need freedom within limits and recognition that they are no longer infants Should know why parents make a decision Conscience enables them to understand and accept reasonable discipline Will ignore constant verbal nagging Chores are good teaching tool for this age
Which situation would be considered child abuse, or maltreatment of a child, in most states in the United States?
Intentional harm directed at a child
A nurse is assisting with providing education about age-appropriate activities for the caregivers of a 6-year-old child. Which of the following activities should the nurse include in teaching?
Jumping rope
Six-year-old Josie refuses to play outside with the other children because " Mommy says that I shouldn't get my dress dirty." What development theory explains Josies behavior?
Kohlberg's theory of moral development
A nurse is caring for a 4-year-old boy admitted for observation for the ED. The child's mother reports a history of belly pain, bloody emesis, and seizures dating back 6 months with the latest seizure occurring this morning. The child is slender, pale, and slightly anemic. All other laboratory values are within normal limits. What condition should the nurse suspect?
Munchausen's syndrome by proxy
Which acts are types of child abuse or maltreatment ?
Physical Abuse Sexual Abuse Emotional Abuse Emotional Neglect Physical Neglect
A nursing instructor asks a student to define child abuse. Which response by the student indicates a need for clarification?
Preventing a child from participating in extracurricular activities within a school setting
The endocrine system is responsible for which of these body functions?
Regulating the childs metabolism Growth Fluid and electrolyte balance Stress response Sexual reproduction
The 7-year-old
Sets high standards for themselves Good sense of humor More modest Enjoys being active but also enjoys periods of rest Knows seasons and months Understands beginning concept of math Hands are steadier Active play still important Becoming more independent
Hyperglycemia:
Blood Glucose Range:
Hypoglycemia Level Two:
Less than 54mg/dL
glycosuria
glucose in the urine
An infant was born 36 hrs. ago. Laboratory tests have just been ordered for the neonatal screenings, including hypothyroidism. Why is this not the optimal time to test the infant thyroid level?
After 24 hours, there is a natural rise in the TSH
insulin shock
Also known as hypoglycemia Blood glucose level becomes abnormally low. Caused by too much insulin
Which burn marks on a child raises the suspicion of child abuse?
Burns around both feet with edges marked in a line above the ankle
The parents of a 10-year-old by diagnosed with type 2 diabetes ask the nurse what aspects of their son's diabetes management he should be involved in. Which response by the nurse is correct?
Carbohydrate counting Meal planning Choosing after school activities to increase exercise Recording blood sugar test results in a log Testing blood sugar at home as ordered
The loss of primary (deciduous) teeth and the eruption of permanent (secondary) teeth take place during the early school age years. The nurse explains to the family that their child will most likely lose which teeth first?
Central incisors
A nurse is collecting data from a child who has type 1 diabetes mellitus. Which of the following manifestations indicate of diabetic ketoacidosis?
Dehydration Mental confusion Fruity breath
Hypoglycemia (<60 mg/dl)
Hunger Lightheadedness & shakiness Headache Anxiety & irritability Pale, cool skin Diaphoresis Irritability Normal or shallow respirations Tachycardia & palpitations Strange & unusual feelings Decrease LOC Difficulty concentrating Change in emotional behavior Slurred speech Headache & blurred vision Seizures leading to coma
school age vaccines
MMR varicella influenza hep b DTAP
The 10-year-old
Marks beginning of preadolescence Girls more physically mature than boys Begins to show self-direction Wants to be independent Group ideas more important than individual ones Sexual curiosity continues Girls more poised than boys Slang terms used Begins to identify himself or herself with skills that pertain to the sex role Takes more interest in personal appearance Knows abstract numbers
7-11 years
Masters the concept of conservation Realize that physical elements do not magically appear and disappear Learns to tell time Awareness of the connection between things and ideas Classifies more complex information Able to read, which expands knowledge base Able to see the perspective of others Understand cause and effect Able to solve problems
According to Erikson, the greatest influence on a school aged child's readiness to master this stage of development is:
Mastery of the first three stages of psychosocial development
,.A nurse is reinforcing teaching about sick day management with a parent of a child who has type 1 diabetes mellitus. Which of the following instructions should the nurse include?
Monitor Blood glucose levels every 3 hrs. Test Urine for ketones Call provider if blood glucose is greater than 240mg/dL
In SIADH, the amount of antidiuretic hormone (ADH) being produced decreases. What would the nurse expect to observe in the patient with SIADH?
Oliguria
Detemir (Levemir)
Onset: 1 to 2 hrs Peak: None Duration: 19 to 20 hrs Maximum duration: 20 hrs Does not need to be given with meals *Long Acting*
Glargine (Lantus)
Onset: 1 to 2 hrs Peak: None Duration: 19 to 20 hrs Maximum duration: 24 hrs Does not need to be given with meals *Long Acting*
Lispro (Humalog) Aspart (Novolog) Glulisine (Apidra)
Onset: 15 to 30 hrs Peak: 1 to 2 hrs Duration: 3 to 4 hrs Maximum duration: 2 to 6 hrs Give up to 15 mins before meals *Rapid Acting*
NPH
Onset: 2 to 4 hrs Peak: 8 to 10 hrs Duration: 10 to 18 hrs Maximum duration: 14 to 20 hrs Do not need to be given with meals *Intermediate Acting*
Regular insulin
Onset: 30 to 1 hr Peak: 2 to 4 hrs Duration: 3 to 6 hrs Maximum duration: 6 to 8 hrs Give 30 mins before meals *Short Acting*
While assessing a young school aged child suspected of having been sexually abused, which observation would be most significant to the nurse?
The child inappropriate knowledge or interest in sexual activities or acts
A father brings his 13 year old son to the pediatric clinic and states that he is concerned that the teen his minimal body hair and a high voice. What is the most appropriate response by the nurse?
The is no concern at this time. Teens progress through puberty at various times
Which is one of the first clues that a child may have experienced abuse?
The nurse identifies that there is a discrepancy between the injury present and the reported history of the injury
While providing care at a summer camp for children, the nurse is approached by a counselor who asks what prepubescence is. What explanation by the nurse is correct?
The time period just before sexual maturity
Hyperglycemia > 250 mg/dl
Thirst Polyuria(early), oliguria (late) Nausea, vomiting, abdominal pain Skin warm, dry & flushed w/ poor turgor Dry mucous membranes Confusion Weakness Lethargy Weak pulse Diminished reflexes Rapid, deep breathing (Kussmaul respirations) w/ fruity breath due to ketones
a nurse is teaching an 11 year old about rotating injections sites for her insulin. Which response by the patient indicates that she understands the reason for rotating injection sites?
Using the same site can lead to changes in the fat under the skin
The 8-year-old
Wants to do everything Can play alone for a longer period of time Creative Enjoys group activities Behaves better for company than for family Hero-worship evident Arms and hands appear to grow faster than rest of body Muscles better developed Enjoys competitive sports Likes to argue Need to teach child how to express anger in an acceptable manner
A nurse is assisting with teaching a course about safety during the school age. Which of the following information should the nurse include in the course?
Wearing helmets when riding bicycles or skateboarding Implementing firearm safety Wearing seat belts
A 17-year-old male ask the nurse why he has to learn how to inject insulin rather than just take a pill like his grandmother does for her diabetes. What is the best response by the nurse?
You have a different type of diabetes that needs to be controlled by insulin injections
Munchausen syndrome
a condition in which the "patient" repeatedly makes up clinically convincing simulations of disease for the purpose of gaining medical attention
Diabetic Ketoacidosis (DKA)
•Ketonuria •Decreased serum bicarbonate concentration (decreased CO2 levels) and low pH •Hypertonic dehydration •Fruity odor to breath •Nausea •ALOC
insulin shock treatment
∙If conscious, give fruit juice (orange juice). ∙If unconscious, IV 50% dextrose (50 mL at 10mL per min). →Most patients regain consciousness in 5 to 10 minutes.
A nurse is assisting with conducting a well child visit with a child who is scheduled to receive the recommended immunizations for 11-12 years old. Which of the following should the nurse administer?
(IIV) (MenB-4C) (Tdap)
A nurse is reinforcing teaching with a school age child who has diabetes mellitus about insulin administration. Which of the following instructions should the nurse include?
You should give four to six injections in one area before switching sites
Scoliosis
abnormal lateral curvature of the spine
Lipodystrophy
atrophy of subcutaneous fat
type 1 diabetes mellitus
autoimmune condition with genetic predisposition for child to get
Which assessment is of the highest priority in caring for a young child suspected of being a victim of child abuse?
conducting developmental assessments to determine the level of cognitive processing
polyphagia
excessive hunger
polydipsia
excessive thirst
poluuria
excessive urination
Hyperkalemia
high levels of potassium in the blood
signs and symptoms of type 2 diabetes
hyperglycemia; polyuria; weight loss; glucosuria Late symptoms: due to destruction of capillaries - diabetic retinopathy (weakening eyes) - nephropathy (destruction of nephrons in kidney) - neuropathy (numbness)
When it comes to suspected child abuse, nurses, police officers, teachers and commercial film developers are all ________ ________
mandatory reporter
HbA1c
normal range: 4-6%
puberty
normally beings in girls between the ages of 8 and 12 and in boys between the ages of 9 and 14.
____________ _________________ begins before the age of 8 for the girls and before the age of 9 for boys
precocious puberty
type 2 diabetes mellitus
resistance to insulin; triggered by sedentary lifestyle and obesity
sexual latency
romantic love for the parent of the opposite sex diminishes, and children identify with the parent of the same sex
Prepubescence
the period before puberty when hormonal changes begin
The 6-Year-Old
• Energetic and on-the-go • Likes to start tasks, but does not always complete them • Talks for a purpose rather than for the sake of talking • Vocabulary consists of 2500 words • Requires 11 to 13 hours of sleep per night
The 9-year-old
Dependable Shows more interest in family activities Assumes more responsibility More likely to complete tasks More able to accept criticism for their actions Worries and mild compulsions are common Hand and eye coordination well-developed Manual activities are managed with skill About 10 hours of sleep are needed each night Permanent teeth still erupting More active in competitive sports
The parent of 7-year-old Heather bring her into the clinic for advice on her third pediculosis infestation in the last 6 months. Her mother describes Heathers intense interest in the performing art and shares that she had been in two musicals in the last year. What advice from the nurse is most appropriate?
Describe the importance of not sharing costumes with others and keeping personal items in a plastic bin away from other performing children
Precocius puberty
Develops sexual characteristics before puberty (before 8 - 9 y.o.) TREATMENT/MANAGEMENT Central PP => stabilize or slow characteristics DX/LABS Bone age uterus size ovary development GnRH testing: LH, FSH, estradiol, testosterone q 2 hours; admin GnRH IV CT/MRI *these females can get pregnant*
