• HEALTH PROBLEMS COMMON IN SCHOOL AGE

• Diabetes Mellitus

• Diabetes Mellitus

• Data Base

• A. Peak incidence in the school-aged group

• B. Differences in diabetes in children and adults

• 1. Onset

• a. Rapid in children

• b. Insidious in adults

• 2. Obesity

• a. Not a factor in children

• b. Predisposing factor in adults

• Diabetes Mellitus

• 3. Dietary treatment

• a. Rarely adequate for children

• b. May be beneficial for some adults

• 4. Oral hypoglycemics

• a. Contraindicated for children

• b. May be beneficial for some adults

• 5. Insulin

• a. Almost universally necessary in children

• b. May be beneficial for some adults

• 6. Hypoglycemia and ketoacidosis

• a. Quite frequent in children

• b. More uncommon in adults

• 7. Degenerative vascular changes

• a. Develop after adolescence in children

• b. May be present at the time of diagnosis in adults

• C. Classification

• 1. Idiopathic

• a. Insulin dependent (IDDM): onset usually in childhood but can be

anytime

• b. Non-insulin dependent (NIDDM): appears to involve resistance to

insulin action and defective glucose-mediated insulin secretion

• c. Maturity-onset diabetes of youth (MODY): autosomal dominant

disorder; structurally abnormal insulin with decreased activity

• 2. Secondary: caused by exogenous factors; usually reversible if

primary disorder corrected

• D. Clinical findings

• 1. Juvenile onset diabetes is always type I insulin-dependent

diabetes mellitus (IDDM); not the same disease process as type II
non–insulin-dependent diabetes mellitus (NIDDM)

• 2. Onset: rapid, obvious

• 3. Child usually thin, underweight

• 4. Increased thirst, fluid intake, appetite, and urinary output

• 5. Hyperglycemia: ketoacidosis or diabetic coma

• a. Causes

• (1) Decreased insulin

• (2) Emotional stress

• (3) Fever

• (4) Infection

• (5) Increased food intake

• b. Symptoms

• (1) Weakness, drowsiness

• (2) Lack of appetite, thirst

• (3) Abdominal and/or generalized pain

• Rheumatic Fever

• Data Base

• A. Collagen disease: characterized by damage to connective tissue

and usually blood vessels

• B. Classification

• 1. Autoimmune reaction to group A, §-hemolytic streptococcal

pharyngitis

• 2. Self-limited; involves joints, skin, brain, and heart

• C. Clinical findings

• 1. Heart: mitral and aortic stenosis may occur

• 2. Joints: edema, inflammations, and effusion, especially in knees,

elbows, hips, shoulders, and wrists

• 3. Skin: erythematous macule with a clear center and wavy

demarcated border usually on trunk and proximal extremities

• 4. Neurologic: chorea

• 5. Low-grade fever, epistaxis, abdominal pain, arthralgia, weakness,

fatigue, pallor, anorexia, and weight loss

• D. Therapeutic interventions

• 1. Antibiotic therapy to eradicate organism and prevent recurrence

• 2. Prevention of permanent cardiac damage

• 3. Palliation of other symptoms

• Nursing Care of Children with Rheumatic Fever

• A. Assessment

• 1. Child/parent compliance with drug regimen

• 2. Symptom development

• 3. Nutritional intake

• 4. Activity level
• C. Planning/Implementation

• 1. Encourage bed rest to reduce workload of the heart

• 2. Encourage child to do schoolwork and keep up with class

• 3. Stimulate the development of quiet hobbies and collections

• 4. Gradually increase activities over a period of weeks to months

• 5. Handle painful joints carefully

• 6. Maintain proper body alignment to prevent deformities

• 7. Monitor need for pain medication and administer when necessary

• 8. Encourage an increased intake of nutritious fluids

• 9. Provide small, frequent, nutritious meals

• 10. Prevent invalidism by emphasizing abilities rather than

limitations

• 11. Maintain child's status in home and school by keeping channels

of communication open during illness

• 12. Help parents with home problems that may have served as
predisposing factors

• Juvenile Rheumatoid Arthritis

• Data Base

• A. Inflammatory disease of unknown cause

• B. Slight tendency to run in families

• C. Two peak ages of onset: 2 to 5 and 9 to 11 years of age

• D. Females affected somewhat more frequently than males

• Juvenile Rheumatoid Arthritis

• E. Classification

• 1. Systemic onset

• 2. Monoarticular or pauciarticular: involves a few joints; usually less

than five

• 3. Polyarticular: simultaneous involvement of four or more joints

• F. Clinical findings

• 1. Joint enlargement

• a. Chronic stiffness, pain, and limited motion, especially in morning

on awakening

• b. Spindle-fingers: thick proximal joint with slender tip

• 2. Low-grade fever

• 3. Erythematous rash on the trunk and extremities

• 4. Weight loss, fatigue, weakness

• 5. Tachycardia

• 6. Enlargement of the spleen, liver, and lymph nodes

• G. Therapeutic interventions

• 1. Medications

• a. Nonsteroidal antiinflammatory drugs (NSAIDs)

• (1) Fever reduction in hours

• (2) Pain reduction in days, weeks

• (3) Antiinflammatory effects in 30 to 37 days

• b. Corticosteroids and aspirin

• G. Therapeutic interventions

• c. Cytotoxic drugs: reserved for clients with severe debilitating

disease unresponsive to NSAIDs and corticosteroids

• (1) Cyclophosphamide (Cytoxan)

• (2) Azathioprine (Imuran)

• (3) Chlorambucil (Leukeran)

• (4) Methotrexate (Folex PFS)

• 2. Physical therapy

• Nursing Care of Children with Juvenile Rheumatoid Arthritis

• A. Assessment
• 1. Physical health

• 2. Status of involved joints

• 3. Physical restrictions

• 4. Pain

• 5. Child's response to disease process

• C. Planning/Implementation

• 1. Emphasize that medication must be taken regularly, even in

periods of remission, to decrease inflammation and pain

• 2. Promote proper body alignment and provide passive range of

motion

• 3. Encourage a warm bath in the morning to decrease stiffness and

increase mobility

• 4. Encourage exercises such as swimming

• 5. Encourage parents to accept the child's illness but to limit the use
of the disease to foster dependency or control relationships

• 6. Teach the family why aspirin is given in large dosages

• 7. Encourage use of enteric-coated aspirin if there is GI irritability

• 8. Observe for signs of aspirin toxicity as demonstrated by tinnitus,

• vertigo, nausea, vomiting, sweating, and other signs of salicylate

poisoning

• SKIN INFECTIONS

• Pediculosis (Lice)

• Data Base

• A. Highly infectious infestation of head, body, or pubic hair

• B. Nits (grayish-white, oval eggs) attach to hair

• C. Severe itching may lead to secondary infection

• D. Treatment: special shampoo, use of a fine-toothed comb to remove nits

• Scabies
• Data Base

• A. Produced by itch mite

• B. Female burrows under the skin to lay eggs (usually in folds of skin)

• C. Intensely pruritic: scratching can lead to secondary infection with the

development of papules and vesicles

• D. Treatment: all members of the family must be treated, since it is highly

contagious

• 1. Must wear clean clothes

• 2. Must wash with sulfur or other special soap

• Ringworm (Fungal Disease)

• Data Base

• A. Scalp (tinea capitis)

• 1. Reddened, oval or round areas of alopecia

• 2. Treated topically or orally with an antifungal drug such as griseofulvin

• 3. Head should be covered to prevent spread of infection

• Ringworm (Fungal Disease)

• Data Base

• B. Feet (athlete's foot, tinea pedis)

• 1. Scaly fissures between toes, vesicles on sides of feet, pruritus

• 2. Particularly common in summer; contracted in swimming areas and

gymnasium locker rooms

• C. Treatment: griseofulvin, micronized (Fulvicin-U/F, Grifulvin V,

Grisactin)

• 1. Acts as an analog of purine and is incorporated into new epithelial

cells during synthesis of nucleic acids

• 2. Adverse effects: peripheral neuritis, vertigo, fever, dryness of

mouth, arthralgia, mild transient urticaria, nausea, diarrhea,

headache (may disappear as therapy continues), drowsiness, fatigue

• Intertrigo
• Data Base

• A. Excoriation of any adjacent body surfaces

• B. Caused by moisture and chafing

• Impetigo

• Data Base

• A. Bacterial infection of skin by streptococci or staphylococci

• B. Highly contagious; other areas of body frequently become infected

• C. Treatment: antibiotics systemically and locally; isolate child; keep from

scratching other areas of the body

• Nursing Care of Children with Skin Infections

• A. Assessment

• 1. Type of skin lesion

• 2. Pain

• 3. Parental knowledge of cause/treatment

• C. Planning/Implementation

• 1. Keep nails short to prevent injury from scratching

• 2. Administer medications to limit pruritus

• 3. Encourage daily bathing with tepid water; dry thoroughly

• C. Planning/Implementation

• 4. Prevent spread of infection to other members of the family

• a. Prevent direct contact between children

• b. Keep oozing lesions covered

• c. Prevent athlete's foot; do not walk barefooted; dry feet carefully;

wear lightweight shoes to decrease heat; disinfect shoes and socks

• 5. Teach proper hair care

• 7. Encourage completion of the full regimen of antimicrobial

medication
• 8. Avoid use of strong alkalis such as bleach in clothes washing

• 9. Keep area clean and dry, rinse wastes from skin

• 10. Expose area to light and air

• 11. Apply bland ointment at night

• 12. Encourage screening in schools to identify the source of infection