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PEDS > lecture 5 [school age + GI dysfunction + mental health] > Flashcards

lecture 5 [school age + GI dysfunction + mental health] Flashcards

1
Q

what is considered school age?

A

6-12 years old

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2
Q

how much do school age children grow per year?

A

5cm

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3
Q

by how much are school age children gaining weight annually?

A

2-3 kg

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4
Q

why do school age children have a lower center of gravity?

A
  • longer legs
  • varying body proportions
  • face grows faster than cranium
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5
Q

school age children lose their first deciduous tooth during this time

A

true

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6
Q

definition

prepubescence

A

a two-year span that begins at the end of middle childhood, ending before they turn 13

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7
Q

maturation of systems in school age children

GI tract

A
  • fewer upset stomachs
  • better glucose levels
  • increase appetite
  • can retain food for longer periods
  • less caloric needs
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8
Q

maturation of systems in school age children

renal

A

greater bladder capacity

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9
Q

maturation of systems in school age children

cardiovascular

A
  • heart grows slowly & smaller in relation to rest of body
  • slower HR
  • elevated BP
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10
Q

maturation of systems in school age children

respiratory

A

slower RR

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11
Q

maturation of systems in school age children

musculoskeletal

A
  • ossification
  • muscles still functionally immature
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12
Q

which stage of Erikson do school age children should have accomplised at this point?

“latency period”

A

sense of industry & accomplishment

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13
Q

what happens when they fail to develop at Erikson’s stage 4?

A

they develop a sense of inferiority

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14
Q

which concepts do school age children begin to understand based on Piaget’s cognitive stages?

A
  • concrete operations
  • conservation of properties
  • conceptual thinking
  • classification of objects
  • reading
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15
Q

peer groups & social acceptance become the most important aspect of school-aged child’s social development

A

true

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16
Q

what do school-aged children gain from acquiring peer groups or social acceptance?

A

independence from parents

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17
Q

what stage of play are school-aged children involved in?

A

team play

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18
Q

school-aged children have a relatively accurate & positive perception of their physical selves

A

true

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19
Q

limit setting for middle schoolers is only appropriate when it:

A
  • helps eliminate undesired behaviors
  • guides right behavior
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20
Q

physiological signs of stress & fear in school aged children

A
  • stomach pains
  • HA
  • bed-wetting
  • nightmares
  • trouble sleeping
  • trouble concentrating
  • stubborn or aggressve behavior
  • thumb sucking
  • change in eating habits
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21
Q

children typically eat what the family eats

A

true

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22
Q

how many hours of sleep a night do school age children typically need?

A

9-12

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23
Q

how can parents address bedtime resistance?

A

allowing later bedtimes as children get older

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24
Q

what are components of behavioral concerns that parents & HCPs need to look out for in school-aged children?

A
  • inattention
  • impulsiveness
  • hyperactivity
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25
Q

what are the criterion for diagnosing behavioral disorders?

A
  • present before 7 years old
  • present in two different settings
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26
Q

why is depression in children difficult to detect?

A
  • unable to express feelings
  • “acting out” their problems & concerns
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27
Q

characteristcs of chlidren w/ depression

Box 16-7

A
  • predominantly sad expression
  • solitary play
  • lack of interest in achievement
  • utterance of statement reflecting low self-esteem
  • nonspecific complaints of feelng unwell
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28
Q

how is enuresis diagnosed?

A

inappropriate bedwetting 2x/ week for three months before 5 years old

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29
Q

definition

primary enuresis

A

lack of physiological control over bladder

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30
Q

definition

secondary enuresis

A

bedwetting when asleep at night

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31
Q

what are the sex chromosome disorders commonly seen in school-age children?

A
  • Klinefelter syndrome
  • Turner syndrome
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32
Q

definition

Turner Syndrome

A

absence of one of the X-chromosomes

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33
Q

how does Turner syndrome typically affect girls?

A

renders infertility

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34
Q

how is Turner syndrome diagnosed at birth?

A
  • low posterior hairline
  • webbed neck
  • widely spaced nipples
  • edema of hands & feet
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35
Q

how is Turner syndrome diagnosed during pre-school years?

A

delayed growth

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36
Q

how is Turner syndrome diagnosed at puberty?

A
  • short stature
  • delayed sexual development
  • amenorrhea
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37
Q

how is Turner syndrome treated?

A
  • female hormone treatment
  • counseling
  • growth hormone for linear growth
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38
Q

definition

Klinefelter syndrome

A

the presence of one or more additional X chromosomes & only one Y chromosome

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39
Q

what are the characteristics of Klinefelter syndrome?

A
  • absence of virilization
  • small testes
  • cognitive impairment
  • gross motor skill difficulties
  • language delay
  • passivity
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40
Q

how is Klinefelter syndrome treated?

A

administration of testosterone

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41
Q

what is the most prevalent case of severe injury & death among school-age children?

A

MVA

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42
Q

what type of injury is most prevalent with MVA?

A

head injuries

teach child about helmet safety

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43
Q

11-12 year olds receive which vaccines for their first dose?

A
  • MCV (meningococcal)
  • HPV (human papillomavirus)
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44
Q

11-12 year olds can start receiving TDap as a booster

A

true

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45
Q

when is the second dose for HPV received?

A

2 months after first dose

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46
Q

when is the third dose for HPV received?

A

6 months after the second dose

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47
Q

how many months apart should multi-dose vaccines need to be administered for a child to “catch up”?

A

1-6 months

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48
Q

which vaccines do school age children need to have by the time they are 13 years old?

A
  1. DTap/ TDap
  2. HPV
  3. MCV
  4. PCV
  5. Flu/ COVID
  6. Hep A
  7. Hep B
  8. IPV
  9. MMR
  10. Varicella
49
Q

GI differences in infants

(6)

A
  • greater peristalsis
  • deficient in enzymes
  • ABD distension
  • immature liver function
  • smaller stomach capacity
50
Q

why is ABD distension more common among infants?

A

gas is almost always present

51
Q

what are the most common GI functional disorders?

A
  • diarrhea (gastroenteritis)
  • emesis
52
Q

s/s of gastroenteritis

A

sudden increase in consistency & frequency of stools that can last up to 2 weeks

53
Q

gastroenteritis is the leading cause of illness among children younger than 5 years old

A

true

54
Q

what are the physiological implications of gastroenteritis?

A
  • increased intestinal motility
  • rapid emptying
  • impaired absorption of nutrients
  • excessive secretion of water & nutrients
  • excessive excretion of electrolytes (Na+ and K+)
55
Q

what are the most common causes of gastroenteritis?

A
  • RV
  • fecal-oral transmission
  • Salmonella
  • Shigella
56
Q

what is the major concern with gastroenteritis?

A
  • sepsis
  • dehydration
57
Q

s/s of gastroenteritis

A
  • fever
  • emesis followed by grassy green diarrhea
  • ABD pain
  • nausea
  • bloody stools
58
Q

why is it contraindicated to give antidiarrheal medications?

A

gastroenteritis is usually self-limiting

59
Q

treatment

gastroenteritis

A
  • small frequent oral hydration
  • normal saline (or D5W wtih HCO3)
  • avoid carbonated drinks, fruit juice, chicken broth
60
Q

what is the rehydration regiment for children?

A
  • 10mL/ kg each dirty diaper
  • 40-50mL/ kg q4h
61
Q

at what age is gastroenteritis most common?

A

3 months - 2 years

62
Q

emesis in children is usually self-limiting and requires no further treatment

A

true

63
Q

which conditions are usually associated with emesis?

A
  • infectious disease
  • increased ICP
  • toxic ingestion
  • food intolerance/ allergy
  • mechanical obstruction of GI tract
  • metabolic disorders
64
Q

what does green bilious vomiting indicate?

A

bowel obstruction

65
Q

what do curdled stomach contents indicate in emesis?

A

poor gastric emptying

66
Q

what does the consistency & appearance of coffee grounds indicate in emesis?

A

GI bleeding

67
Q

what are the various etiology of emesis?

A
  • infection
  • obstruction
  • PUD
  • appendicitis
  • pancreatitis
  • CNS disorder
  • metabolic disorder
  • pyloric stenosis
68
Q

emesis

infection

A
  • fever
  • diarrhea
69
Q

emesis

obstruction

A

constipation

70
Q

emesis

PUD, appendicitis, pancreatitis

A
  • localized ABD pain
  • vomiting
71
Q

emesis

CNS or metabolic disorder

A
  • HA
  • change in LOC
72
Q

emesis

pyloric stenosis

A

projectile vomiting

73
Q

congenital defects of the GI system?

A
  • cleft lip
  • cleft palate
  • tracheoesophageal fistula
  • pyloric stenosis
  • Hirschsprung’s disease
74
Q

types of hernias

A
  • strangulated
  • incarcerated
75
Q

what causes cleft lip?

A

incomplete fusion of the oral cavity during intrauterine life

76
Q

cleft lip/ palate feeding bottles

A
77
Q

characteristics of cleft lip

A
  • notched upper lip border
  • nasal distortion
  • either unilateral or bilateral involvement
78
Q

what causes cleft palate?

A

incomplete fusion of palates during intrauterine life

79
Q

characteristics of cleft palate

A
  • visible or palpable gap in uvula
  • soft palate
  • hard palate
  • incisive foramen w/ exposed nasal cavities
  • nasal distortion
80
Q

when can cleft palate be repaired?

A

between 6-12 months of age

usually before 2 years old

81
Q

postop nursing care for cleft palate repair

A
  • elevated supine position (or on side)
  • cool mist tent
  • blended diet
  • elbow restraints
  • advice to avoid sucking for 7-10 days
  • no oral temps
82
Q

for how long do children who had their cleft palate repaired stay in elbow restraints?

A

4-6 weeks

83
Q

pathology

tracheoesophageal fistula

A

rare malformation resulting from failed separation of esophagus & trachea

84
Q

when does tracheoesophageal fistula typically occur?

A

4th week of gestation

85
Q

what is the treatment for tracheoesophageal fistula?

A

emergency surgery (potentially esophageal replacement)

86
Q

postop care for TEF

A
  • gastrostomy tube
  • tracheal suctioning (not to extend part surgical site)
87
Q

definition

pyloric stenosis

A

hypertrophy of circular muscle of pylorus

causes obstruction & constriction

88
Q

therapeutic procedures for pyloric stenosis

A
  • pylorotomy
  • laparotomy
89
Q

hallmark signs of pyloric stenosis

A
  • moveable mass in epigastrum
  • projectile vomiting
  • possible peristaltic wave while supine
  • dehydration
90
Q

how long after pylorotomy/ laparotomy can children be discharged?

A

2 days postop

91
Q

postop care for pylorotomy/ laparotomy

(3)

A
  • feeding 4-6 hours after (clear liquids only)
  • within 24 hours progress to glucose to electrolyte fluids/ formula
  • analgesics
92
Q

pathology

Hirschsprung’s disease

A

congenital absence of ganglion cells in rectum & colon

93
Q

characteristics of Hirschsprung’s disease

A
  • decreased motility
  • mechanical obstruction
94
Q

s/s of Hirschsprung’s disease

A
  • signs of enterocolitis
  • chronic constipation
  • ribbon-like & smelly stools
  • no meconium in the first 24-48 hrs of life
  • episodes of vomiting bile
  • palpable fecal mass
  • visible peristalsis
95
Q

preop care for Hirschsprung’s disease

A
  • monitor for enterocolitis
  • enema
  • oral ABX
96
Q

postop care Hirschsprung’s disease

A
  • NPO
  • NG suction
  • ABD assessment
  • foley
  • provide ostomy care
97
Q

what is the surgical operation for Hirschsprung’s disease?

A

surgical removal of aganglionic section of bowel
(temporal colostomy can be required)

98
Q

pathology

hernia

A

protrusion of a portion of an organ through an opening

99
Q

indication

incarcerated hernia

A

cannot be easily reduced

100
Q

indication

strangulated hernia

A

blood supply cut off to organ

needs emergency surgery

101
Q

characteristic

celiac disease

A

intolerance to the protein gluten

102
Q

which foods contain gluten?

A
  • barley
  • rye
  • oats
  • wheat

BROW

103
Q

what is GERD?

A

the transfer of gastric contents into the esophagus

104
Q

what are the complications of GERD?

A
  • tissue damage
  • poor weight gain
  • esophagitis
  • persistent respiratory symptoms
105
Q

s/s of GERD

A
  • excessive crying
  • arching of back
  • spitting up/ vomiting
  • cough, wheezing, stridor, gag
  • apnea
  • bloody emesis
  • difficulty swallowing
  • CP
  • heart burn
106
Q

managements for GERD

A
  • weight control
  • small frequent meals
  • avoid food that intensify reflux
  • thickened feedings
  • elevate HOB (or hold baby for one hour)
107
Q

what are the medications for GERD?

A
  • Ranitidine
  • Omeprazole
108
Q

what is the surgical management for severe case of GERD?

A

nissen fundoplication

closes the esophagus off from the stomach to prevent it going back in

109
Q

what type of GI disorder is appendicitis?

A

inflammatory

110
Q

what is the pathology of appendicitis?

A

inflammation of appendix

111
Q

hallmark sign of appendicitis

A

pain at McBurney’s point

112
Q

what are the diagnostic tests that can confirm appendicitis?

A
  • CBC
  • UA
  • WBC
  • CRP
113
Q

what would a CT scan show for appendicitis?

A

enlarged appendix & thickening of appendiceal wall

114
Q

what is the pathology for Celiac disease?

A

gluten-sensitive enteropathy

115
Q

what are the types of GI dysfunctions involving malabsorption?

A
  • short gut syndrome
  • Celiac disease
116
Q

what are the common manifestations of Celiac disease?

A
  • ABD distension
  • vomiting
  • diarrhea w/ foul odor
  • chronic malabsorption syndrome
117
Q

what is the pathology for short gut syndrome?

A

decreased mucosa from extensive resection of small intestine

118
Q

what are some causes of short gut syndrome?

A
  • congenital anomalies
  • ischemia
  • trauma (volvulus)
  • transplant
  • prolonged TPN therapy

PEDS (11 decks)

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