NURS 207: Promoting Pediatric Wellness in the Family & Community Elizabeth Hartman, MSN, RNC Allan...

NURS 207: Promoting Pediatric Wellness in the Family & Community

Elizabeth Hartman, MSN, RNCAllan J. V. Cresencia, MSN, RN

Christine Limann, BSN, RN

West Coast University - Los Angeles

Health Promotion of the School-Age Child and Family

Chapter 17

Promoting Optimum Growth and Development

• “School age” generally defined as 6 to 12 years

• Physiologically begins with shedding of first deciduous teeth and ends at puberty with acquisition of final permanent teeth

• Gradual growth and development

• Progress with physical and emotional maturity

Shedding Deciduous Teeth

Maturation of Systems

• Bladder capacity increases

• Heart smaller in relation to the rest of body

• Immune system increasingly effective

• Bones increase in ossification

• Physical maturity not necessarily correlated with emotional and social maturity

Prepubescence

• Defined as 2 years preceding puberty

• Typically occurs during preadolescence

• Varying ages from 9 to 12 (girls about 2 years earlier than boys)

• Average age of puberty is 12 in girls and 14 in boys

Psychosocial Development

• Relationships center around same-sex peers

• Freud described it as “latency” period of psychosexual development

Erikson:Developing a Sense of Industry

• Eager to develop skills and participate in meaningful and socially useful work

• Acquire sense of personal and interpersonal competence

• Growing sense of independence

• Peer approval is strong motivator

School-Age Children Are Motivated to Complete Tasks

Erikson: Inferiority

• Feelings may derive from self or social environment

• May occur if incapable or unprepared to assume the responsibilities associated with developing a sense of accomplishment

• All children feel some degree of inferiority regarding skill(s) they cannot master

Piaget: Cognitive Development

• Concrete operations• Use thought processes to experience events and

actions• Develop understanding of relationships between

things and ideas• Able to make judgments based on reason

(“conceptual thinking”)• CONSERVATION

School-Age Children Are Often Avid Collectors

Kohlberg: Moral Development

• Development of conscience and moral standards

• Age 6 to 7: reward and punishment guide choices

• Older school age: able to judge an act by the intentions that prompted it

• Rules and judgments become more founded on needs and desires of others

Spiritual Development

• Children think in very concrete terms

• Children expect punishment for misbehavior

• May view illness or injury as punishment for a real or imagined misdeed

Children Are Comforted by Prayer

Language Development

• Efficient language skills

• Important linguistic accomplishments

• Correct syntax, improved grammar, word usage

• “Metalinguistic awareness”

Social Development

• Importance of the peer group

• Identification with peers is a strong influence in child gaining independence from parents

• Sex roles strongly influenced by peer relationships

Engaging in Activities with a “Best Friend”

9-Year-Olds’ Club Rules

Relationships with Families

• Parents are primary influence in shaping child’s personality, behavior, and value system

• Increasing independence from parents is primary goal of middle childhood

• Children not ready to abandon parental control

Developing a Self-Concept

• Definition: a conscious awareness of a variety of self-perceptions (abilities, values, appearance, etc.)

• Importance of significant adults in shaping child’s self-concept

• Positive self-concept leads to feelings of self-respect, self-confidence, and happiness

Developing a Body Image

• Generally children like their physical selves less as they grow older

• Body image is influenced by significant others

• Increased awareness of “differences” may influence feelings of inferiority

Development of Sexuality

• Normal curiosity of childhood

• Attitudes toward sex

• Use of terminology

Sex Education

• Sex play as part of normal curiosity during preadolescence

• Middle childhood is ideal time for formal sex education• Life span approach• Information on sexual maturity and process of

reproduction• Effective communication with parents

Nurse’s Role in Sex Education

• Treat sex as normal part of growth and development

• Questions and answers

• Differentiate between “sex” and “sexuality”

• Values, problem-solving skills

• Open for communication with parents

Play

• Involves physical skill, intellectual ability, and fantasy

• Children form groups, cliques, clubs, secret societies

• Rules and rituals

• See need for rules in games they play

Activities Vary by Interest and Opportunity

Play (cont.)

• Team play

• Quiet games and activities

• Ego mastery

Selecting a Book with an Adult

Pride in Learning New Skills

Coping with Concerns Related to Normal Growth and

Development• School experience

• Second only to the family as socializing agent• Transmission of values of the society• Peer relationships become increasingly

important

Coping with Concerns Related to Normal Growth and Development (cont.)

• Teachers

• Parents

• Limit setting and discipline

• Dishonest behavior

• Stress and fear

Teachers’ Influence on Children

Latch-key Children

Promoting Optimum Health During the School Years

• Nutrition• Importance of balanced diet to promote growth• Quality of diet related to family’s pattern of

eating• Fast-food concerns

Sleep and Rest

• Average 9½ hours/night during school age but highly individualized

• Ages 8 to 11 may resist going to bed

• 12 years and up generally less resistant to bedtimes

Physical Activity

• Exercise essential for development and function

• Importance of physical fitness for children

Exercise and Activity

• Sports• Controversy regarding early participation in

competitive sports• Concerns with physical and emotional maturity in

competitive environment

• Acquisition of skills

• Generally like competition

Music Is a Favorite Form of Expression

Performing Household Tasks

Dental Health

• Permanent teeth eruption

• Good dental hygiene

• Prevention of dental caries

• Malocclusion

• Dental injury

• Dental evulsion—replacement or reattachment

School Health

• Responsibilities of parents, schools, and health departments

• Ongoing assessment, screening, and referrals

• Routine services, emergency care, and safety and infection control instruction

• Increase knowledge of health and health habits

Injury Prevention

• Most common cause of severe injury and death in school-age children is motor vehicle crashes—pedestrian and passenger

• Bicycle injuries—benefits of bike helmets

• Appropriate safety equipment for all sports

Bicycle Safety

Anticipatory Guidance—Care of Families

• Parents adjust to child’s increasing independence

• Parents provide support as unobtrusively as possible

• Child moves from narrow family relationships to broader world of relationships

Health Problems of Middle Childhood

Chapter 18

DISORDERS AFFECTING THE SKIN

Purposes of the Skin

• Protection

• Impermeability

• Heat regulation

• Sensation

Origin of Skin Lesions

• Contact with injurious agents

• Hereditary factors

• External factor that produces a reaction in the skin

• Systemic disease in which lesions are a manifestation

Examples of Age-Related Skin Manifestations

• Infants: birthmarks

• Early childhood: atopic dermatitis

• School-age children: ringworm

• Adolescents: acne

Dermatitis

• Pathophysiology

• Diagnostic evaluation

• History and symptoms: pruritus, sensation

• Objective findings: lesion

Types of Lesions• Papule• Macule• Vesicle/bulla• Pustule• Cyst• Patch• Plaque• Wheal• Striae

• Scale

• Crust

• Keloid

• Fissure

• Ulcer

• Petechiae

• Purpura

• Ecchymosis

Nursing Considerations

• Prevent spread of bacterial infection

• Prevent complications

Viral Skin Infections

• Most communicable diseases of childhood have characteristic rash

• Examples: verruca, herpes simplex types 1 and 2, varicella zoster, molluscum contagiosum

Fungal Skin Infections

• Superficial infections that live on the skin

• Also called dermatophytoses, tinea

• Transmission: person to person or infected animal to human

• Examples: tinea capitis, tinea corporis, tinea pedis, candidiasis

Scabies

• Inflammation occurs 30 to 60 days after exposure

• Topical treatment: scabicides such as permethrin 5% or lindane

• Oral treatment: ivermectin if body weight is greater than 15 kg

Scabies (cont.)

• Caused by scabies mite as female burrows into the epidermis to deposit eggs and feces

• Inflamed, intense pruritus, excoriation

• Therapeutic management with scabicide (permethrin 5% preferred) for 30 to 60 days

• Treat all contacts

• Nursing considerations

Pediculosis Capitis (Head Lice)

• Very common, especially in school age

• Adult louse lives only 48 hours without human host; female louse has life span of 30 days

• Females lay eggs (nits) at base of hair shaft

• Nits hatch in 7 to 10 days

• Treatment: pediculicides and nit removal

• Preventing spread and recurrence

Systemic Mycotic (Fungal) Infections

• Invade viscera as well as the skin

• Wide spectrum of disease

• May appear as granulomatous ulcers, plaques, nodules, and abscesses

Rickettsial Infections

• Intracellular parasites generally transmitted by infected fleas, ticks, and mites

• Infections widely varied from benign and self-limiting to fatal

Lyme Disease

• Most common tick-borne disorder in United States

• Clinical stages

• Diagnosis and therapeutic management

• Vaccine against Lyme disease

• Focus on prevention

Cat Scratch Disease (CSD)

• Most common cause of regional lymphadenitis in pediatric population

• Usually follows the scratch or bite of an animal (90% cats)

• Usually benign, self-limiting course lasting 2 to 4 months

• Treatment: supportive

Contact Dermatitis

• Inflammatory reaction of skin to chemical

• Initial reaction in the exposed region

• Characteristic sharp delineation between inflamed and normal skin

• Primary irritant

• Sensitizing agent

• Examples: diaper dermatitis, reaction to wool, reaction to specific chemical

Poison Ivy, Oak, and Sumac

• Produce localized lesions

• Caused by urushiol from the plant’s leaves and stems

• Sensitivity may develop after one or two exposures and may change over time

• Therapeutic management

Poison Ivy

Foreign Bodies

• Wood splinters

• Cactus spines

• May require medical treatment if difficult to see or remove

Sunburn

• Ultraviolet A waves

• Ultraviolet B waves

• Importance of protection: sunscreen

Cold Injury: Chilblain

• Redness/swelling especially of hands

• Vasodilation, edema, bluish patches, itching

and burning; symptoms continue after

rewarming

• Usually resolve in a few days

• Tissue damage due to ice crystals in tissues

• Blisters appear 24 to 48 hours after rewarming

• Treatment of blisters similar to burn treatment

Cold Injury: Frostbite

Hypothermia

• Definition: less than 35° C

• Effect of decrease in core temperature



• Prevention

Drug Reactions

• Adverse drug reactions are most often seen in skin (rashes most common reaction)

• May be immediate or delayed following administration of the drug

• Treatment: discontinue the drug; give antihistamines, corticosteroid therapy if severe

Erythema Multiforme Exudativum

(Stevens-Johnson Syndrome)• Onset with flulike symptoms

• Balanitis, conjunctivitis, stomatitis

• Erythematous, papular rash

• Lesions on all surfaces (even palms and soles of feet) except scalp

• Prognosis

Stevens-Johnson Syndrome

Toxic Epidermal Necrolysis (TEN)

• Also called Lyell disease

• Clinical appearance is same as for staphylococcal scalded skin syndrome (SSSS)

• Protracted illness

• 25% to 50% mortality

• Precipitating factors: antiseizure medications, sulfa, penicillin

Neurofibromatosis-1

• Also called von Recklinghausen disease

• Autosomal dominant

• Initial presentation: café-au-lait spots, pigmented nevi, axillary/inguinal freckling

• Elephantiasis may occur


BITES AND STINGS

Arthropod Bites and Stings

• May cause mild to moderate discomfort

• Manage with symptomatic measures and prevention of secondary infection

• Bees: stinger penetrates the skin• Remove stinger ASAP• Sensitization to bee stings may result in

anaphylaxis

Arachnid Bites

• Most in United States are relatively harmless

• Scorpions, brown recluse spider, and black widow spider inject venom: potentially deadly

Ticks

• Partially embed in skin as they feed

• Remove by grasping tick close to point of attachment (with forceps)

• Preventive measures

Mammal Bites

• Common pediatric problem especially in children younger than 5 years old

• Wound care

• Prophylactic antibiotics for some types of bites

• Rabies concern

Snakebites

• Manifestations and morbidity are highly variable, based on species, size of snake, size of child, location of bite

• Maintain a calm response to the victim

• Apply loose tourniquet proximal to the bite: DO NOT OCCLUDE SYSTEMIC CIRCULATION

• Suction in appropriate cases

Human Bites

• Lacerations from teeth of other humans

• Risk of infection

• Wound care

DENTAL DISORDERS

Dental Caries

• Overall incidence decreased since introduction of fluoridation

• Continues to be principal oral problem in pediatric population

• Greatest vulnerability • Ages 4 to 8• Ages 12 to 18

Pathophysiology of Dental Caries

• Multifactorial• Host• Microorganisms• Substrate• Time

Pathophysiology of Dental Caries (cont.)

• Diagnostic evaluation

• Therapeutic management• Plasticized sealant• Removal of carious portions• Restoration of involved teeth

• Nursing considerations• Oral hygiene• Dietary influences

Periodontal Disease

• Inflammatory and degenerative condition involving the gums and supporting tissues

• Gingivitis

• Periodontitis

• Acute necrotizing ulcerative gingivitis (“trench mouth”)


Malocclusion

• Heredity

• Habits• Thumb sucking• Tongue thrusting

• Orthodontic treatment


Dental Trauma

• Tooth evulsion• Cold milk = osmolality to maintain evulsed tooth

• Reimplantation of teeth

• Emotional response

DISORDERS OF CONTINENCE

Enuresis

• “Bed wetting”

• More common in boys

• Usually ceases between 6 and 8 years of age

• Diagnosis • Developmental age of more than 5 years• Two times per week or more for 3 months• May have urgency, frequency

Enuresis (cont.)

• Organic causes• Structural defects• UTI, impaired kidney function, chronic renal

failure• Neurologic deficits, endocrine disorders

(diabetes)• Sickle cell disease

• Bladder volume of 300 to 350 ml is sufficient to hold a night’s urine

Psychologic Factors

• “Sleep more soundly than other children”

• Emotional factors

• Familial tendency

Treatment for Enuresis

• Drugs• Tofranil• Oxybutynin• DDAVP

• Bladder training

• Fluid restriction in evenings

• Interruption of sleep to void

• Conditioned reflex response device

Encopresis• Repeated voluntary or involuntary passage of feces

of normal or near normal consistency into places not appropriate for that purpose

• Not caused by any physiologic effect (e.g., laxative) or medical problem

• Primary encopresis = fecal incontinence after age 4 years

• Secondary encopresis = fecal incontinence in a child older than 4 years after period of prior established fecal continence

Encopresis (cont.)

• More common in males

• May follow psychological stress

• May be secondary to constipation or impaction

• Therapeutic management• Determine cause• Dietary intervention, management of constipation• Psychotherapeutic interventions

DISORDERS WITH BEHAVIORAL COMPONENTS

Attention Deficit Hyperactivity Disorder (ADHD)

• Etiology unknown; probably multifactorial

• Inattention, impulsiveness, and hyperactivity

• Typical onset before age 7

• Diagnostic criteria for ADHD

Therapeutic Management of ADHD

• Classroom

• Family education and counseling

• Behavioral therapy and/or psychotherapy for child

• Environmental manipulation

• Medication

Medications for ADHD

• Not all children benefit from pharmacologic therapy

• Stimulants• Dexedrine, Adderall• Ritalin

• Side effects: insomnia, anorexia and weight loss, hypertension; long-term use may suppress growth

Learning Disability (LD)

• Learning disability: a heterogeneous group of disorders with difficulties in acquisition and use of listening, speaking, reading, writing, reasoning, math and/or social skills

• Includes dyslexia, dysgraphia, dyscalculia, right/left confusion, and short attention span

Battery of Tests for LD and ADHD

• IQ

• Hand-eye coordination

• Visual and auditory perception

• Comprehension

• Memory

Therapeutic Management of LD• Primarily educational interventions

• Wide variation of diagnostic severity

Tic Disorders

• Definition: tic is an involuntary, recurrent, random, rapid, highly stereotyped movement or vocalization

• Increases with stress, decreases markedly with sleep

• Most are self-limiting, less than 1 year, usually resolve by late childhood or adolescence

Tourette Syndrome (TS)

• Severe, complex form of tic disorder

• Onset ages 2 to 16; persists throughout life

• Etiology uncertain

• Diagnostic criteria

• Associated problems include ADHD, disruptive behavior, learning disabilities

Therapeutic Management of TS

• Symptomatic treatment

• Family support

• Pharmacologic interventions


Posttraumatic Stress Disorder (PTSD)

• Development of characteristic symptoms following exposure to extremely traumatic experience or catastrophic event

• May function adequately but have foreboding regarding the future

PTSD: Response to the Event

• Initial response• Intense arousal; lasts 1 to 2 hours• “Fight or flight” response

• Second phase• Lasts approximately 2 weeks• Denial, period of quiescence

• Third phase• Appears to get worse; lasts 2 to 3 months

PTSD Symptoms

• Depression, anxiety, conversion reactions

• Phobic symptoms, repetitive actions

• Flashbacks are common

• Inquiry about what has happened


School Phobia

• Defined as extreme reluctance to attend school for a sustained period as a result of severe anxiety or fear of school-related experiences

• Also called “school refusal” and “school avoidance”

• Most common in children older than 10 years

School Phobia (cont.)

• Physical symptoms

• Symptoms subside after staying at home

• No symptoms on weekends, holidays, etc.


Recurrent Abdominal Pain (RAP)

• May have psychogenic origin

• May have real pain

• Psychological aspects


Conversion Reactions

• Also called hysteria, hysterical conversion reaction, and childhood hysteria

• Sudden onset, traced to a precipitating event

• Symptoms: abdominal pain, fainting, pseudoseizures, paralysis, headaches, visual field restriction

• Rule out true seizures with EEG

Childhood Depression

• Temporary: acute depression precipitated by a traumatic event

• Chronic depression• May accompany chronic illness or disability• Familial circumstances


Childhood Schizophrenia

• Severe deviation in ego functioning

• Psychotic disorder that appears after ages 4 to 5

• Characterized by gradual onset of neurotic symptoms

• Lack of contact with reality; “A world of his own”


Health Promotion of the Adolescent and Family

Chapter 19

Promoting Optimum Growth and Development

• Complex interplay of biologic, cognitive, psychologic, and social change, perhaps more so than at any other time of life

• Change on multiple levels• Biologic maturation• Cognitive development• Psychologic development

Adolescence

• Early: ages 11 to 14

• Middle: ages 15 to 17

• Late: ages 18 to 20

Biologic Development

• Neuroendocrine events of puberty

Hormonal Interaction Between Hypothalamus, Pituitary, and

Gonads

Changes in Reproductive Hormones

• Females• Menarche• Ovulation

• Males

Pubertal Sexual Maturation

• Tanner stages 1 through 5

COGNITIVE DEVELOPMENT

Piaget: Emergence of Formal Operational Thought

• Formal operational thinking: ages 11 to 14

• Abstract terms, possibilities, and hypotheses

• Decision-making abilities increase

• May not use formal operational thought and reasoned decision making all the time— “choices”

• ADAPTATION

Adolescent Conceptions of Self

• Adolescent egocentrism

• Self-absorption

• Health-related beliefs:• Imaginary audience (everyone is watching)• Personal fable (won’t happen to me)

Changes in Social Cognition

• Understanding of others’ thoughts and feelings

• Mutual role taking

• Effect on health-related choices

Development of Value Autonomy

• Struggle to clarify values

• Development of a personal value system

• Gradual process in late adolescence

Moral Development

• Parallels advances in reasoning and social cognition

• Conventional level of moral reasoning

• Principled moral reasoning

Spiritual Development

• Religious beliefs may become more abstract during adolescence

• Late adolescents may reexamine and reevaluate beliefs and values of their childhood

PSYCHOSOCIAL DEVELOPMENT

Identity Development

• Social forces shape sense of self

• Identity achievement

• “Moratorium”

• “Foreclosure”

• “Identity diffusion”

Development of Autonomy

• Emotional autonomy

• Behavioral autonomy

• Value autonomy

Achievement

• Development of motives, capabilities, interests, and behaviors

• Progress toward occupational achievement

• Relationship between social class and educational and occupational achievement

Sexuality

• Hormonal, physical, cognitive, and social changes affect sexual development

• Body image

• Sexual identity

• Sexual orientation

Romantic Relationships Are Important During Adolescence

Intimacy

• Intimate relationship begins to emerge in adolescence

• Developmental course of intimacy• Self-focused• Role focused• Individual connected

Social Environments

• Ecological model

• Microsystems

• Mesosystems

• Exosystems

• Macrosystems

Families

• Changes in family structure and parent employment

• Parenting styles

• Socioeconomic influences

Peer Groups

• Significance in socialization

• Significance in development

• Value placed on peer relationships

The Peer Group Influences Adolescent Development

Schools

• Play increasingly important role in preparation for adulthood

• Parental involvement in schools

• Effect of academic success or failure on self-esteem

Work

• Workplace as fourth microsystem

• Positive or negative

• May encourage development of intellectual and social skills, autonomy

• May result in decreased interest in school, fewer extracurricular activities, and poorer grades

Community and Society

• Media influences

• Community’s economic resources play role in health and well-being of young people

• Resources for health promotion

Promoting Optimum Health During Adolescence

• Empowering individuals, families, and communities

• Power, authority, and opportunities to make healthy choices

• Risk reduction in areas of mental health, substance use, sexual behavior, violence, unintentional injury, nutrition, physical activity and fitness, and oral health

Adolescents’ Perspectives on Health

• Factors promoting adolescent health and well-being

• Contexts for adolescent health promotion

• School-based and school-linked health services

• Adolescent health screening• “Safe times”: method for screening interviews

with teens

Health Concerns of Adolescence

• Parenting and family adjustment

• Psychosocial adjustment

• Intentional and unintentional injury

• Dietary habits, eating disorders, and obesity

• Physical fitness

Snacking on Empty Calories Is Common Among Adolescents

Adolescent Physical Fitness

Health Concerns of Adolescence (cont.)

• Sexual behavior, STDs, and unintended pregnancy

• Use of tobacco, alcohol, and other substances

• Depression and suicide

• Physical, sexual, and emotional abuse

Coping with Stress

Health Concerns of Adolescence(cont.)

• School and learning problems

• Hypertension

• Hyperlipidemia

• Infectious diseases/immunizations

Health Promotion Among Special Groups of Adolescents

• Adolescents of color

• Gay, lesbian, and bisexual adolescents

• Rural adolescents

Physical Health Problems of Adolescence

Chapter 20

Acne

• More than 50% of adolescents affected

• Etiology• Familial aspect• Hormonal influence• Other influences

• Psychosocial ramifications• Self-esteem issues

Acne (cont.)

• Pathophysiology• Involves hair follicle and sebaceous glands• Comedogenesis

• Therapeutic management• General measures/overall health• Medications• Nursing considerations

Vision Changes

• Refractory errors peak in adolescence due to growth spurts

• Vision screening

• Myopia most common

Male Reproductive Health Problems

• Penile problems• Uncorrected congenital problems• HPV• Trauma

Testicular Tumors

• Usually malignant

• Testicular CA is most common solid tumor in males ages 15 to 34

• Testicular self-examination (TSE)

Varicocele

• Usually asymptomatic scrotal mass or aching sensation

• Occurs in about 15% of males

• Varicocelectomy controversial in adolescence

Epididymitis

• Causes• Infection (bacterial or viral)• Chemical irritant• Local trauma

• Presentation: pain, redness, swelling

• Treatment: analgesics, antibiotics, supportive care

Testicular Torsion

• Partial or complete venous occlusion with rotation of testicle

• Occurrence: 1 in 4000 males

• Peak onset: age 13

• Surgical emergency to prevent necrosis


Gynecomastia

• Normal if transient (less than 1 year’s duration) and during puberty

• Prepubescent or Tanner stage 5: need evaluation for adrenal or gonadal tumors, liver disease, or Klinefelter syndrome

• Drug induced: Ca++ channel blockers, H2 blockers, ketoconazoles, possibly marijuana

Female Reproductive Health Problems

• Gynecologic examination indicated• Menstrual disorders• Undiagnosed abdominal pain or pelvic mass• Sexually active and/or request contraception• Rape• Virginal, 18 years old• Requested by patient

Menstrual Disorders

• Primary amenorrhea: no menses by age 17

• Secondary amenorrhea: no menses for

6 months in previously menstruating female

• Irregular menses common in adolescence

Causes of Primary Amenorrhea

• Structural abnormality: septum, hymen, female circumcision

• Unresponsive to hormonal stimulation• Hypothalamic, pituitary, ovarian, uterine origin

• Systemic disorders• Thyroid dysfunction, prolonged or severe

infections, adrenal hyperplasia, DM, obesity, malnutrition

Causes of Secondary Amenorrhea

• Most common cause: pregnancy

• Stress, chronic illness, polycystic ovarian disease, anorexia, ovarian disturbance, phenothiazines, heroin

Menstrual Irregularities in the Female Athlete

• Delayed menarche

• Anovulation with dysfunctional bleeding

• Oligomenorrhea or amenorrhea with hypoestrogenic states

• Treatment options: trial of decreased exercise, oral contraceptives

Dysmenorrhea

• Primary dysmenorrhea

• Secondary dysmenorrhea

• Therapeutic management• NSAIDs• Estrogen therapy• Oral contraceptives• Dietary changes• Exercises, comfort measures

Endometriosis

• Definition: presence of endometrial glands and stroma outside of the normal intrauterine endometrial cavity

• Etiology unclear

• Treatment: medical, surgical, pharmacologic suppression


Premenstrual Syndrome (PMS)

• Symptoms

• Diagnosis

• Therapeutics • SSRIs• Nutrition/nutritional supplements• Supportive care

Dysfunctional Uterine Bleeding (DUB)

• Occurs in absence of pregnancy, infection, neoplasms, and known pathology

• Usually with anovulation

• Hormonal therapy treatments

• Surgical treatment (D&C)


Vaginitis and Vulvitis

• Causes may be physical, chemical, or infectious

• Diagnosis confirmed by vaginal exam, microscopic evaluation of vaginal secretions

• Health teaching

Infections

• Candidiasis

• Trichomoniasis

• Bacterial vaginosis (BV)

Health Problems Related to Sexuality

• Sexual activity among adolescents

• Sexual risk-taking behaviors

• Family influences

• Peer influences

Adolescent Pregnancy

• Rates of teen pregnancy in United States

• Physiologic aspects

• Pregnancy risks associated with teen pregnancy

• Nutritional needs

Infants of Adolescent Mothers

• Higher risk of prematurity

• Higher incidence of low birth weight

• Potential for developmental delay

• Cumulative risk factors for infant

Social and Economic Effects of Teen Pregnancy

• School/education disruption

• Social relationship deprivation

• Statistical risk of poverty

• Emotional effect on infant and parents

Adolescent Fathers

• Changing social expectations

• Legal rights

• Emotional effect

• Parenting skill development

• Economic effect

Adolescent Abortion

• Roe v. Wade 1973

• Counseling

• Associated risks

Contraception

• Methods• Prescription and nonprescription

• Use of contraception

• Conflict about sexual activity

• Desire for pregnancy


Rape

• SANE—sexual assault nurse examiners

• Diagnostic evaluation• Obtain account of incident• Sensitivity to victim’s emotional status• Physical evidence

• Vaginal secretions for evidence of sperm, blood, DNA

• GC culture to rule out preexisting condition

• HIV testing, other STD testing initially and at appropriate intervals

STDs

• Major cause of morbidity during adolescence and young adulthood

• Strong relationship between STDs and infertility

• Transmission and follow-up of contacts

Gonorrhea

• Cause: Neisseria gonorrhoeae

• Clinical manifestations

• Diagnosis


• Prevention

Chlamydia

• Cause: bacterium Chlamydia trachomatis


• Diagnosis


• Prevention

Human Papillomavirus

• Anogenital warts

• Strong link to cervical carcinoma


• Diagnosis


• Prevention

Pelvic Inflammatory Disease (PID)

• Infection of upper genital tract• Tubo-ovarian abcess• Salpingitis• Long-term effects: infertility due to tubal

scarring• Symptoms• Therapeutics• Nursing considerations

HIV and AIDS

• Time lag between infection with HIV and development of clinical AIDS

• Transmission

• Follow-up of sexual contacts

• Adolescent perception of risk of AIDS

Hepatitis B Virus (HBV)

• Transmission via body fluids

• Effects on liver

• Maternal-infant transmission

• Immunization• Series begun at birth• Series of three IM injections• Goal to target children before onset of high-risk

behaviors

Behavioral Health Problems of Adolescence

Chapter 21

Obesity

• Defined as increase in body weight due to accumulation of excessive body fat relative to lean body mass

• Obese: generally considered when weight more than 95th percentile for age, gender, and height

• Overweight: generally considered when more than 90th percentile

• 25% to 30% of children are obese

Complex Relationships in

Adolescent Obesity

Effect of Childhood Obesity

• Increase in type 2 diabetes

• Risk of adult obesity

• Hypertension, hyperlipidemia, cardiovascular disease

• Social isolation, low self-esteem, depression

Causes of Childhood Obesity

• 5% due to underlying disease (hypothyroidism, other metabolic disease, CNS disorders)

• Role of heredity

• Inactivity

• Patterns of eating behaviors

Diagnostic Evaluation

• Skinfold measurements

• Body mass index (BMI) calculations

• Body fat measurements

• Diagnostics to rule out metabolic and endocrine disorders


• Assessment, planning, implementation

• Diet, exercise, behavioral and group therapy

• Prevention, evaluation

• Medical therapies• Pharmacologic: generally not recommended in

children• Surgical: hazardous in children

Anorexia Nervosa (AN)

• Eating disorder: refusal to maintain normal body weight

• Primarily in adolescent and young adult females

• Mean age of onset 13.75 years, ranging from 10 to 25 years or more

• LIFE THREATENING!

Etiology/Pathophysiology of AN

• Etiology unclear• Distinct psychological component• Diagnosis based on psychological and

behavioral criteria• Relentless pursuit of thinness• Distorted body image• Media influence• Concept of “control”

Clinical Manifestations of AN

• Severe weight loss

• Altered metabolic activity• Amenorrhea• Bradycardia, decreased BP• Hypothermia, cold intolerance• Dry skin, brittle hair and nails• Appearance of lanugo

Therapeutic Management of AN

• Treat life-threatening malnutrition• IV, tube feedings• Monitor CV status

• Behavior modification

• Long-term (lifelong?) treatment and management

Bulimia

• Eating disorder characterized by binge eating

• May be followed by purging behaviors • Laxative abuse• Self-induced vomiting• Diuretic abuse• Rigorous exercise regimens

• Up to eight or more cycles per day

Bulimia (cont.)

• Weight may be normal or slightly above

• Weight may be low: bulimarexia

• Tooth erosion, esophageal damage, other GI concerns

• Psychologic issues• Self-deprecating thoughts, depressed mood• History of unsuccessful dieting, overweight in

childhood• Low impulse control

Therapeutic Management

• Similar to anorexia management

• Hospitalization to treat potassium depletion, esophageal damage

• Cardiac monitoring indicated

• Behavioral management

“Fear of Fat” Syndrome

• Differs from AN

• Worry that being overweight will make them physically unattractive, jeopardize their health, and shorten life span

• Diets lacking in iron, calcium, zinc

• May stop growing and have delayed puberty

Substance Abuse

• Drug abuse, misuse, and addiction• Voluntary behaviors• Culturally defined• Use of drugs for other than acceptable medical

purpose

• Drug tolerance and physical dependence• Involuntary physical responses

Types of Drugs Abused

• Tobacco

• Alcohol

• Cocaine

• Narcotics

• CNS depressants

• CNS stimulants

• Hallucinogens

• Inhalants


• Acute care

• Long-term management

• Family needs/family support

• Prevention

Suicide

• Third leading cause of death in teens

• Suicide

• Suicidal ideation

• Suicide attempt/parasuicide

Suicide (cont.)

• Etiology

• Methods

• Motivation

• Diagnostic evaluation/therapeutic management


NURS 207: Promoting Pediatric Wellness in the Family & Community Elizabeth Hartman, MSN, RNC Allan...

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