lecture mod.9 & 10 notes

Type 1 Diabetes Mellitus

• Type 1 diabetes can be diagnosed as early as kindergarten, especially if the child is underweight
• Failure to thrive, indicated by a weight below the fifth percentile, can be a sign
• Diabetic Ketoacidosis (DKA) is a common presentation and may initially resemble a prolonged flu
• In DKA, parents might not suspect type 1 diabetes at first
• DKA involves glucose buildup and subsequent shutdown in the child
• Glucometer readings often show extremely high blood sugar levels

Management and Education of Type 1 Diabetes

• Extensive education is required for pediatric patients
• A honeymoon period, where blood sugar is relatively stable, may occur after initial regulation
• Managing diabetes is challenging due to rapid growth and activity levels in children
• Insulin pumps and continuous glucose monitors (CGMs) offer freedom and normalcy for pediatric patients

Emergency Medication for Type 1 Diabetes

• Type 1 diabetics should have glucagon available for emergencies
• Glucagon is in powder form and must be mixed before injection
• Glucagon is for when patients are conscious but cannot swallow due to severe hypoglycemia
• If the patient can swallow, administer juice, Coke, or glucose gel before glucagon.
• For known type 1 diabetics experiencing symptoms of hypoglycemia, administer glucagon without checking blood sugar first

Type 2 Diabetes Mellitus

• Type 2 diabetes is increasingly seen in children, even as young as fifth grade and middle school

Congenital Hypothyroidism

• Newborns are screened for congenital hypothyroidism at birth, similar to PKU screening; this is a state-mandated test
• Presentation includes: short stature, enlarged tongue, distended abdomen, and abnormal vital signs
• Treatment involves Levothyroxine

Congenital Adrenogenital Hyperplasia

• This condition is an autosomal recessive disorder due to a lack of cortisol
• Newborns typically have swollen genitals, making sex determination difficult
• Enlarged genitals may be present, but care should be taken in identifying the clitoris or penis
• Swelling of newborn genitals can also be due to maternal hormones, causing pseudo-periods and nipple discharge

Growth Hormone Disorders

• Regular pediatric care is crucial for monitoring growth
• Height and weight are checked in schools, along with BMI, as a screening measure
• Growth Hormone Deficiency may present as poor growth, particularly in height
• Precocious Puberty occurs before age 8 in females and 9 in males, leading to rapid growth followed by growth cessation
• Etiology of these disorders can include pituitary gland issues, such as tumors
• Treatment involves using human growth hormone to address hormone deficiencies

PKU (Phenylketonuria)

• PKU is a genetic metabolic disorder where the body cannot break down protein properly
• PKU is often detected early in life through metabolic tests
• Individuals with PKU may have very light skin and may be redheads
• Management involves a low-protein diet to prevent complications from unmetabolized protein
• Schools often have registered dietitians available to consult with students who have nutritional disorders like PKU

PKU Practice Question Example

• Identifying foods that are low in protein is key when choosing appropriate foods for someone with PKU
• Chocolate pudding should be avoided due to its high dairy content and protein levels

Newborn Screening for Metabolic Disorders

• Nurses perform heel sticks to collect blood samples for metabolic screening
• Applying warm compresses can help improve blood flow to the heel
• Blood is collected from the side of the heel to avoid direct contact with the bone
• Each state has different screening protocols

Pediatric Cancer: Bone Marrow Aspiration

• Bone marrow aspiration is performed to check for blood cancers and other malignancies
• The procedure involves inserting a large needle into the bone marrow, usually in the hip
• The needle is inserted through the skin, adipose tissue, and bone
• Anesthesia may be used, especially for younger children, to minimize discomfort and movement during the procedure

Nursing Considerations Post-Procedure (Bone Marrow Aspiration)

• Monitoring for bleeding is the priority because of the large needle used
• Apply a pressure bandage to the site to reduce bleeding
• Positioning the patient on the affected side can also help apply pressure

Patient and Parent Education (Bone Marrow Aspiration)

• Preparing the child and parents for the procedure is crucial due to its invasiveness
• Avoid startling the child with the equipment

Side Effects of Cancer Treatment

• Chemotherapy and radiation side effects in pediatric patients are similar to those in adults
• Providing basic care and comfort is a key focus
• Resources like Box 53.5 in a nursing textbook can provide detailed information on side effects and interventions

Leukemia in Pediatric Patients

• Leukemia involves uncontrolled proliferation of blood cells, which can manifest as an increase or decrease in cell counts
• Key concerns include fever due to compromised immune defenses; even a slight fever is worrisome
• Standard definition of fever (100.4°F) is less applicable because of immunocompromised state
• Vaccination status must be considered because pediatric patients may be under-vaccinated
• Inform caregivers that any sign of fever requires immediate medical attention

Wilms Tumor (Nephroblastoma)

• Wilms tumor is a tumor on the kidneys
• These tumors are staged like any other tumor
• Avoid palpating the abdomen if Wilms tumor is suspected or known, as it can be harmful
• It can sometimes be diagnosed in utero
• Most individuals have two kidneys, increasing the chances that at least one is functional

Developmental Considerations and Support

• Approach a 5-year-old differently than a 12-year-old
• Child Life Specialists explain medical procedures and conditions to patients and their families using kid-friendly methods

Impact on Family, Therapy, and Communication (Children's health)

• Ages 5-9 tend to have fantasy-based ideas about death
• Ages 9-12 begin to understand that death is permanent and irreversible

Safety Concerns Chart

• Environmental: Poisonous frogs, snakes, alligators, big birds
• General Safety: Car seat, medication, stranger, water, suffocation, carbon monoxide, fire, and digital safety
• Fire Safety: Two-story houses, window accessibility, extinguishers, and fire blankets
• Transportation: Seat belts, monitoring driving habits via apps

Types of Burns

• First Degree: affects the outer layer of skin (epidermis)
• Second Degree: affects the epidermis and part of the dermis
• Third Degree: extends through the dermis, potentially damaging nerves

Burn Treatment Considerations

• Pain control is very imortant
• Prevent and control infection
• Debridement of dead tissue
• Utilize specialized pediatric burn care

Burn Common Causes

• Campfires
• Curling Irons
• Fireworks
• Ovens
• Barbecues (flat tops)
• Dishwashers

ADHD (Attention-Deficit/Hyperactivity Disorder)

• Diagnosis timing should be after age 5 or 6; kindergarten highlights ADHD symptoms
• Autism Spectrum Disorder needs to be diagnosed early, even if there is parental resistance

Autism Spectrum Disorder (ASD)

• Early intervention is key for ASD
• Signs of ASD present before 36 months
• Pediatricians screen for ASD around 12 months, 2 years, and 3 years

ADHD Management

• Routine is beneficial for children with ADHD
• Coping mechanisms are helpful
• Cognitive Behavioral Therapy (CBT) can be effective
• Medication can be a sensitive topic, especially in pediatrics
• Consider medication to help grasp foundational education if ADHD significantly impairs focus
• Missing foundational education can be hard to recover from
• A small dose of medication can help a child focus for a couple of hours in school

Grade Retention and Advancement

• Third grade is often when students may be held back
• Holding a student back more than one or two years is generally discouraged
• Consider similar actions for gifted children; advancing them more than one grade is usually not recommended
• Enrichment and Individualized Education Programs (IEPs) are preferred strategies
• Parents should be encouraged to enrich their children at home

Medications

• Mental health medications may require titration
• Puberty can affect the pharmacokinetics of medications
• If a medication like Strattera stops working during puberty, a different medication may be needed

Additional Mental Health Conditions

• Coping mechanisms are essential for Obsessive-Compulsive Disorder (OCD)
• It's important not to make children feel abnormal, especially with tic disorders or Tourette's
• Embrace and normalize the condition to promote understanding and acceptance

ODD (Oppositional Defiant Disorder)

• Approach these children with empathy, asking, "What happened to you?" rather than "What's wrong with you?"
• The causes can be varied, including upbringing and health conditions

Eating Disorders

• Increasingly seen in elementary school-aged children
• Disordered eating encompasses unhealthy eating behaviors
• Exercise is a significant component
• Often seeking control due to other uncontrollable aspects of their lives
• Therapy (outpatient, inpatient, support groups) is crucial and relapse is common
• Disordered easting can present as overeating

Tic Disorders vs. Tourette's Syndrome

• Tics have repeatedly motor and/or vocal actions.
• Tourette's Syndrome has two or more motor tics and at least one vocal tic

Tic Management

• Not all tics are Tourette's
• The current thought is ADHS meds can contribute to triggering tics
• The goal is to help children feel as typical as possible
• Minimize triggers which are often related to stress
• Focus on coping mechanisms
• Tics may not always be outgrown but are controllable
• Drawing attention to tics can worsen them

Tic Concern

• Early onset must be noted
• Impact on quality of life must be noted

Assistance with Tics

• Avoid negative or criticizing the child
• Reassure a child will overcome tics
• Minimze stress
• Educate all adults involved in childs life

Types of Neglect

• Under-reported and may stem from a lack of education and support within families.

Types of Sexual Abuse

• Most frequently reported to law enforcement.

Types of Physical Abuse

• Identified through indicators like spiral fractures, bruises at different stages, and burn marks

Abuse Indicators

• Fractures: Spiral fractures are a sign of physical abuse
• Bruises: Bruises at different stages of healing indicate ongoing abuse
• Burns: Unexplained burn marks should raise suspicion
• Inappropriate clothing: Heavy clothing could hide injuries

Recognition of Self-Neglect

• Self-neglect can manifest in older children and adolescents, presenting differently than neglect in younger children.
• Example: A student who consistently smells of urine may be experiencing a form of self-neglect related to a mental health crisis.

Harm

• Often correlates with mental health crises, especially in adolescents
• Cutting: A common form of self-harm
• Self-Burning: Another method of self-inflicted injury.

Non-Injurious Risky Behaviors

• Driving under the influence
• Substance abuse
• Reckless behavior
• Impulsivity
• Risky sexual behavior

Treating Harm

• Find alternative behaviors to replace self-harm:
• Self-harming behaviors often provide a form of relief, so replacements must serve a similar purpose.
• Therapy and Medication: A combination of talk therapy (like CBT) and medication is often the most effective approach.

Reporting

• Professionals are legally obligated to report suspected abuse or neglect.
• Report facts, not accusations; involve a colleague for support; remember, the investigation is conducted by others.

Real-World Challenges

• Systemic issues like understaffing and underpayment within CPS can hinder effective intervention.