Untitled

• Week 5 Pediatric Nursing with Julie Vandergrifft, BSN, RN will focus on the school-age child in Chapter 19.

Chapter 19.1 Objectives

• Define key terms.
• Contrast two major theoretical viewpoints of personality development.
• Describe children's physical and psychosocial development from 6 to 12 years, including age-specific events and appropriate guidance.
• Discuss how to help parents prepare children for school.
• List two ways school life affects a growing child.

General Characteristics (Ages 6-12)

• The children are more engrossed in fact than fantasy
• The develop first close peer relationships outside the family group
• The child is often judged by their performance
• The sense of industry and positive self-esteem development is directly influenced by peer group

Erikson: Stage of Industry

• During the industry vs. inferiority stage (ages 6-12), children focus more on the outside world, such as school, sports, hobbies, and peer relationships.
• They start comparing their skills to peers, and may experience feelings of pride or inferiority.
• For example, a 10-year-old praised for completing a difficult project and recognized by peers may develop pride and believe in their competence.

Freud: Sexual Latency

• The school aged child is in the period of sexual latency

Piaget: Concrete Operations

• The concrete operational stage is the third stage in Piaget's cognitive development theory, ages 7-11.
• During this stage, children develop more advanced reasoning and their thinking becomes better organized, more logical, and systematic.
• This stage involves seriation, reversibility, classification, conservation, transitivity, and overcoming egocentrism.

Physical Growth

• Physical growth slows until just before puberty.
• Weight gain is more rapid than increase in height.
• Brain has reached approximately adult size.
• Muscular coordination improves.
• Lower center of gravity.
• Size is not correlated with emotional maturity.
• Problems can occur when a child faces higher expectations because he or she is taller and heavier than peers.

Gender Identity

• Sex role development is influenced by parents.
• Differential treatment and identification occurs in the family and in society.
• School environment also influences the gender ID
• Aggressive behavior is more accepted in boys than in girls.
• Incorporating traditionally masculine and feminine positive attributes may lead to fuller human functioning.

Sex Education

• Sex Education is a lifelong process.
• It is better accomplished less by talking or formal instruction than by the climate of the home
• Answer questions should be answered simply
• Correct names for genitalia should be used.
• Private masturbation is normal.

Sexually Transmitted Infections (STIs)

• Education on how to prevent STIs and HIV/AIDS should be presented in simple terms.
• Providing factual and concrete information is essential.
• The harmful effects of drugs and unprotected sex should be communicated without scare tactics.

Physical, Mental, Emotional, and Social Development

• 6-Year-Old Child: Energetic and on-the-go. Likes to start tasks but does not always complete them. Talks for a purpose. Vocabulary consists of 2500 words. Requires 11-13 hours of sleep.
• 7-Year-Old Child: Sets high standards for themselves. Has a good sense of humor. Is more modest. Enjoys being active and periods of rest.
• 8-Year-Old Child: Wants to do everything. Can play alone for a longer time. Is creative. Enjoys group activities. Behaves better for company than for family. Hero-worship is evident.
• 9-Year-Old Child: Dependable. Shows more interest in family activities. Assumes more responsibility. More likely to complete tasks. Able to accept criticism. Worries and mild compulsions are common.
• 10-Year-Old Child: Marks beginning of preadolescence. Girls are more physically mature than boys. Begins to show self-direction. Wants to be independent. Group ideas are more important than individual ones. Sexual curiosity continues.
• 11 & 12-Year-Old Child: Intense, observant, energetic. May be argumentative and meddlesome. Hormone influence on physical growth is more apparent. Needs freedom within limits and recognition they are no longer infants.

Age-Appropriate Activities

• Competitive and cooperative play is predominant.
• 6-9 years: Simple board and number games, hopscotch, jump rope, collect rocks and stamps, ride bicycles, build simple models, join organized sports.
• 9-12 years: Make crafts, build models, collect things/engage in hobbies, solve jigsaw puzzles, play board and card games, join organized competitive sports.

Latchkey Children

• Subjection to higher rate of accidents and at risk of feeling isolated and alone
• Back-up adult should be available in case of emergencies

Immunizations for Healthy School-Age Children 6-12 Years Include If Not Given Between 4-5 Years, Children Should Receive by Age 6

• Diphtheria and tetanus toxoids and pertussis (DTaP)
• Inactivated poliovirus (IPV)
• Measles, mumps, and rubella (MMR)
• Varicella
• Yearly seasonal influenza vaccine.
• Il to 12 years: Tetanus and diphtheria toxoids and pertussis vaccine (TDaP), Human papillomavirus vaccine (HPV); and meningococcal vaccine (MCV4)

Health Screenings

• Scoliosis is one health screening of school-age children for scoliosis to examine lateral curvature of the spine before and during growth spurts.
• Screening can take place at school or at health care facilities.

Pet Ownership

• Pets in close contact with children has the potential of transmitting disease.
• Allows the ill child who feels separated from other people to feel companionship and positive attitude.
• Children with disabilities especially benefit from interacting with pets.
• Age, allergies, and immune issues are major deciding factors.
• Infections can occur via contact with the pet's saliva, feces, or urine; by inhalation or skin contact with organisms.
• Risk factors can be further reduced if children are cautioned not to kiss pets, don't allow animals to sleep in bed, and perform hand hygiene.

Skin Development and Function

• The skin's main function is protection.
• It acts as the body's first line of defense against disease, prevents harmful passages of physical and chemical agents, prevents loss of water and electrolytes, and can regenerate and repair itself.

Skin Infections: Bacterial

• Impetigo: Caused by Staphylococcus. Presents as reddish macules that become vesicular, easily erupting, and form honey-colored crusts. Managed with topical or systemic antibiotics.
• Pyoderm: Caused by Staphylococcus Streptococcus. It involves deeper dermal infection with potential systemic effects and is managed with antibacterial soap and systemic antibiotics.
• Folliculitis: Often caused by S. aureus (including MRSA), infects hair follicles, treated with warm compresses and antibiotics, and may require incision for severe cases. MRSA infections may involve diluted bleach soaks.
• Furuncle/Carbuncle: Larger, swollen lesions due to S. aureus including MRSA. Treated with warm compresses, antibiotics, and potential incision/drainage for severe cases.
• Cellulitis: Caused by Streptococcus, Staphylococcus, or Haemophilus influenzae, characterized by swollen, red skin. Managed with oral or parenteral antibiotics and rest; it requires acute care for systemic effects.
• Staph. Scalded Skin Syndrome: Caused by S. aureus R, it presents with rough, macular erythema and bullae, managed with systemic antibiotics and gentle cleansing.

Skin Infections: Bites and Stings

• Mosquitoes, fleas, flies: cause papular urticaria and firm papules; managed with antipruritic agents, antihistamines, and baths.
• Bees, wasps: stings cause local reactions (wheal) and potential systemic reactions. Manage by scraping out the stinger, cleaning, and using cold compresses.
• Chiggers: papular urticaria after bites on warm areas. Apply topical corticosteroids.
• Ticks: attached ticks cause pruritic nodules. Remove with tweezers, cleaning the area.
• Brown Recluse Spiders: cause transient erythema followed by necrotic ulceration. Apply cool compresses.
• Black Widow Spiders: cause severe pain, erythema, potential paralysis, and systemic effects. Administer antivenin and muscle relaxants.
• Scorpions: severe pain, ascending paralysis requiring ICU care, administer antivenin while keeping patient calm.

Skin Infections: Viral

• Verruca (warts): Caused by human papillomavirus, presenting as elevated, rough papules. Managed through surgical removal.
• Verruca plantaris (plantar warts): Flat warts on the feet's plantar surface, surrounded by hyperkeratosis. Caustic solutions are applied, and pressure is decreased with insoles.
• Cold sore/fever blister: Herpes simplex virus type I creates itching vesicles, and exfoliation, treat with burrow solution. Use oral antivirals like acyclovir.
• Genital herpes: Herpes simplex virus type II. Use oral antiviral medication valacyclovir.
• Herpes zoster (shingles): Varicella-zoster virus. Neurologic pain, hyperesthesias. Use antivirals such as Acyclovir.
• Molluscum contagiosum: Poxvirus causes flesh-colored papules. Resolves spontaneously but may need chemical or cryogenic removal.

Lyme Disease

• Lyme Disease is an infection from a tick carrying Borrelia burgdorferi.
• It can appear in three stages: Stage 1 occurs 3-30 days after the bite; Stage 2 occurs 3-10 weeks after the bite; and Stage 3 occurs 2-12 months after the bite.
• Antibiotics are administered.
• The antibiotic is Doxycycline for those over 8 years of age that tests positive, or the use of amoxicillin
• For those under 8 years, use Cefuroxime.
• Early signs include fever, chills, and headache.
• Later signs include facial Palsey and irregular heartbeat.

Skin Infections: Fungal

• Tinea capitis: Caused by fungi. Produces scaly lesions with alopecia on the scalp. Managed with selenium sulfide shampoos and oral griseofulvin.
• Tinea corporis: Caused by fungi. Presents as round/oval, eryth scaling that spread and cleared centrally. Managed with medications.
• Tinea cruris: Fungal infection of crural folds + thighs. Antifungal and cool baths can treat
• Tinea pedis: Fungal infection between toes + feet. Manage dryness with antifungal cream, and oral griseofulvin.
• Candidiasis: - Can occur in moist area. Candida treatment includes topical fungal ointments

Skin Infections: Infestations

• Pediculosis capitis (head lice): Caused by Pediculus humanus capitis. The Symptoms are small red bumps + eggs. Treatment include permethrin shampoo, spinosad topical + separate laundry.
• Scabies mite: Sarcoptes scabiei: Intensely itchy caused by rashes. Symptoms are pencil-like marks on the skin with a black dot, treated with a scabicide, and hygiene.

Burns

• Skin is thinner, leading to more serious depth of burn with lower temperatures and shorter exposures.
• Immature immune response systems in young children can cause shock and heart failure.
• Large body surface area results in greater fluid, electrolyte, and heat loss.
• Increased BMR results in increased protein and calorie needs.

Types of Burns

• Thermal - caused by fire or liquid
• Chemical - caused by corrosive powder
• Electrical - caused by electrical currents
• Radiation - caused by X-rays.

Grades of Burns

• Moderate: partial-thickness burn
• Major Grade: full thickness involving 10% or more of the body

The 6 C's of Burn Care

• The 6 C's of burn care include clothing, cooling, cleaning, chemoprophylaxis, covering and comforting/pain relief

Emergency Care

• Establish airway. Look for singed nasal hair
• Establish INT
• Testing of blood and bodies
• Nasogastric tube - empty stomach

Patient Centered Care: Minor Burns

• Stop burning
• Roll child in blanket
• Remove heat conductor
• Use tepid soaks - Not ice
• Flush chemical burns
• Cover the wound prevent contamination
• Check immunization status

Patient Centered Care: Major Burns

• Maintain the Airway!
• 100% oxygen
• Monitors Vital Signs
• IV point access is accessible
• Fluid replacement first 24 hours
• Isotonic crystalloid Solution (lactated ringers - early!)

Patient Centered Care: Major Burn: Manage Pain

• Establish ongoing monitoring to establish + effectiveness
• Avoid IM
• Use IV opioid analgesics + Monitor for respiratory depression
• Administer pain meds prior + nonpharma methods guide imaginary

Patient Centered Care: Major Burn: Prevent Infection

• Follow standard precautions
• Restrict plants and flowers due to risk contracts
• Change position with less visitors
• Limit visitors
• Use reverse isolation if prescribed
• Monitor for manifestations of infections report to the provider equipment
• Designated client equipment, administer tetanus toxoid in indicated .
• Administer antibiotics if infection is present .

Patient Centered Care: Major Burn

• High calories need is in effect + Protein
• Maintain core body alignment + splints
• Encourage movement
• Maintain the airway + Provide Support child needs comfort
• Use reverse isolation if prescribed
• Designated client equipment, administer tetanus toxoid in indicated

Complications of Burnts

• Inhalation Injury Damage or Thermal, monitor for inflammation or hoarseness
• Pulmonary problem- edema- Bacterial pneumonia , Monitor airway. Administer oxygen
• Systemic shock sepsis - Monitor laboratory values
• Wound Inrection - Asess , Monitor vital signs , get culture

Sunburns and Frostbite

• Sunburns*: Topical partially absorbs. Keep hydrated skin needs with rating to evaluation. zinc + titanium dioxide are effective
• Chilblains*: Cold injury with vesicles and ulcerative lesions that can occur.

Client Education

• Perform age - appropriate saftey measures for the home
• Avoid sun between 12 to 3 avoid + apply sunscreen
• Educated + assist for ADL exercise