High Risk School Age

Question 2

What is Down Syndrome?

Answer 2

Trisomy 21, most common chromosomal disorder (1 in 800 pregnancies). Caused by extra copy of chromosome 21.

Question 3

Physical features of Down Syndrome?

Answer 3

Broad flat nose, Brushfield spots in eyes, extra eyelid fold, protruding tongue, flat back of head, short neck, low-set ears, poor muscle tone, short thick fingers, curved little finger.

Question 4

Complications associated with Down Syndrome?

Answer 4

Congenital heart defects (AVSD, VSD, ASD, PDA), duodenal atresia, cataracts, strabismus, respiratory infections, feeding difficulties due to large tongue.

Question 5

Management principles for Down Syndrome?

Answer 5

Parental acceptance, focus on functional level, individualized education plan (IEP), prevent injury, slow feeding to avoid choking, consistent nurturing environment.

Question 6

Nursing diagnosis for Down Syndrome?

Answer 6

Parental knowledge deficiency related to healthcare needs for a child with intellectual disability.

Question 7

Outcome evaluation for Down Syndrome nursing care?

Answer 7

Parents verbalize and demonstrate ability to meet child’s healthcare needs.

Question 8

Causes of intellectual disability?

Answer 8

Microcephaly, hydrocephaly, craniosynostosis, infections (rubella, meningitis), poisoning, brain tumors, deprivation, malnutrition (FAS).

Question 9

What is Hemophilia?

Answer 9

Sex-linked inherited coagulation disorder from asymptomatic carrier mother to affected son.

Question 10

Types of Hemophilia?

Answer 10

Type A: Factor VIII deficiency (classic hemophilia); Type B: Factor IX deficiency (Christmas disease); Type C: Factor XI deficiency.

Question 11

When does bleeding manifest in Hemophilia?

Answer 11

Infancy (cord cutting, immunizations, circumcision), toddlerhood (falls, mucosal bleeding), school-age (hemarthrosis), adolescence (epistaxis, hematuria, GI bleeding).

Question 12

Management of Hemophilia?

Answer 12

Prevent injury, apply direct pressure (no tourniquets), cold packs, immobilize bleeding site, Vitamin K, passive ROM after bleeding, avoid aspirin.

Question 13

Early signs of transfusion reaction in Hemophilia?

Answer 13

Back pain, chills, headache, fever, urticaria.

Question 14

What is Epilepsy?

Answer 14

Disease characterized by recurrent seizure episodes due to increased CNS activity; diagnosed with EEG.

Question 15

Management of Epilepsy?

Answer 15

Ketogenic diet (high fat, low carb), anticonvulsants (Tegretol, Valium), do not abruptly stop medications, reassess meds during adolescence.

Question 16

Types of Seizures?

Answer 16

Grand mal (tonic-clonic), Petit mal (absence), Jacksonian (localized muscle twitching, Todd’s paralysis).

Question 17

Features of Grand Mal seizure?

Answer 17

Tonic phase: body stiffens, clonic phase: jerking movements, unconsciousness, incontinence, post-ictal drowsiness.

Question 18

Features of Petit Mal seizure?

Answer 18

Brief staring spells, blinking, rapid recovery, common in children, triggered by hyperventilation or flashing lights.

Question 19

Features of Jacksonian seizure?

Answer 19

Start in one muscle group, spread across body, may cause Todd’s paralysis after.

Question 20

What is Juvenile Diabetes Mellitus?

Answer 20

Type 1 diabetes, onset before 15 years, requires lifelong insulin therapy.

Question 21

Differences between Juvenile and Adult Diabetes?

Answer 21

Juveniles: thinner, rapid onset, harder to control, active; Adults: often obese, slower onset.

Question 22

Management principles for Juvenile Diabetes?

Answer 22

Support positive attitude, recognize diabetic acidosis/insulin shock, educate on self-injection after 7 years old.

Question 23

Signs of Diabetic Ketoacidosis (DKA)?

Answer 23

High blood glucose, ketone production, acidosis, dehydration; needs insulin and fluids.

Question 24

Signs of Hyperosmolar Hyperglycemic State (HHS)?

Answer 24

Extremely high blood sugar without ketones, usually in type 2 diabetes.

Question 25

Differences between Diabetic Coma and Insulin Shock?

Answer 25

Coma: unconsciousness due to very high or low blood sugar; Shock: symptoms like anxiety, sweating, dizziness from low blood sugar.

Question 26

Treatment for Diabetic Coma?

Answer 26

Manage hyperglycemia with fluids, insulin, electrolytes.

Question 27

Treatment for Insulin Shock?

Answer 27

Give dextrose, glucagon injection, quick carbs (glucose tablets or juice).

Question 28

Preventing Diabetic Emergencies?

Answer 28

Monitor blood glucose, recognize early symptoms, wear medical ID, educate family/friends.

Question 29

What is Asthma?

Answer 29

Allergic manifestation causing bronchial smooth muscle spasms, mucus overproduction, airway resistance.

Question 30

Signs and symptoms of Asthma?

Answer 30

Wheezing (especially on expiration), dyspnea, nasal flaring, cyanosis, thick secretions, respiratory acidosis.

Question 31

Supportive care for Asthma?

Answer 31

Low-concentration oxygen, hydration, vapor inhalations, high Fowler’s position, small frequent meals.

Question 32

Preventive measures for Asthma?

Answer 32

Avoid allergens, breathing exercises (blowing ping pong balls), emotional support, Cromolyn Sodium pre-wheezing.

Question 33

Management of acute Asthma attack?

Answer 33

Epinephrine SC injection, Isoproterenol nebulizer, Aminophylline IV, steroids for status asthmaticus.

Question 34

What is Leukemia?

Answer 34

Cancer of blood-forming organs; replacement of normal marrow with leukemic cells.

Question 35

Diagnosis of Leukemia?

Answer 35

Bone marrow aspiration (posterior iliac crest in children).

Question 36

Types of Leukemia?

Answer 36

Acute (ALL, AML) and Chronic (CLL, CML).

Question 37

Signs and Symptoms of Leukemia?

Answer 37

Anemia, petechiae, infections, hepatosplenomegaly, fever, weight loss, bone pain.

Question 38

Management principles for Leukemia?

Answer 38

Supportive care, blood transfusions, oral hygiene, chemotherapy, steroids, bone marrow biopsy, lumbar tap.

Question 39

Common cause of death in Leukemia?

Answer 39

Intracranial hemorrhage from septicemia and bleeding.

Question 40

What is Rheumatic Fever?

Answer 40

Autoimmune response to Group A beta-hemolytic strep infection; damages heart, joints, brain.

Question 41

Jones Criteria for diagnosing Rheumatic Fever?

Answer 41

2 major OR 1 major + 2 minor manifestations (carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules).

Question 42

Treatment for Rheumatic Fever?

Answer 42

Penicillin therapy, NSAIDs for inflammation, steroids (for severe carditis), monthly prophylaxis.

Question 43

Preventive therapy duration for Rheumatic Fever?

Answer 43

Until 21 years old (without heart damage) or 40 years old (with valve damage).

Question 44

What is Tonsillitis?

Answer 44

Infection of tonsils/adenoids (part of Waldeyer’s ring); protection decreases as child’s immunity grows.

Question 45

Signs of Chronic Tonsillitis?

Answer 45

Persistent sore throat, bad breath, mouth breathing, hoarse voice, cervical lymphadenopathy, difficulty swallowing.

Question 46

Indications for Tonsillectomy?

Answer 46

Dyspnea, peritonsillar abscesses, recurrent GABHS infections (≥3-4/year).

Question 47

Contraindications for Tonsillectomy?

Answer 47

Acute infection, blood dyscrasias, cleft palate.

Question 48

What is Appendicitis?

Answer 48

Inflammation of appendix, common cause of surgery in school-age children.

Question 49

Signs and Symptoms of Appendicitis?

Answer 49

Anorexia, nausea, RLQ pain (McBurney’s point), fever, rebound tenderness.

Question 50

Management of Appendicitis?

Answer 50

NPO, surgery (appendectomy), no palpation, laxatives, enemas or heat pre-op.

Question 51

Signs of ruptured appendix?

Answer 51

Sudden relief of pain, high fever, peritonitis risk; semi-Fowler's position post-op with drains.

Question 52

What is Scoliosis?

Answer 52

Lateral + rotational curvature of the spine >10°, affecting axial, coronal, sagittal planes.

Question 53

Types of Scoliosis?

Answer 53

Structural (true spinal curve), Functional (secondary to another problem like leg length difference).

Question 54

Most common type of scoliosis?

Answer 54

Idiopathic scoliosis (right thoracic convexity), 5x more common in females, onset 8–15 years.

Question 55

Assessment tools for Scoliosis?

Answer 55

Scoliometer (angle of trunk rotation >7° suggests 20° curve; confirm with X-ray).

Question 56

Management of Scoliosis?

Answer 56

<20°: observation every 6 months; >20°: bracing; >40°: spinal fusion surgery.

Question 57

Types of braces for Scoliosis?

Answer 57

Milwaukee brace (neck-high), Boston jacket, Charleston bending brace (night use).

Question 58

Nursing interventions for Scoliosis?

Answer 58

Encourage social activity, teach proper brace use, check for skin issues, avoid loosening straps.