HIGH RISK

SCHOOL-AGE
 OBJECTIVES
After the discussion the students should be able to:
✓Describe illnesses common among school-age children
✓Identify signs and symptoms of the most common
illnesses during the school age period.
✓Discuss the therapeutic management of the common
illnesses at this period.
✓Discuss the nursing interventions of the common
illnesses during
✓Ba able to apply these nursing intervention into actual/
simulated the school age years
✓Uphold Marian values as they apply nursing
interventions to clients in actual settings in the future.
 PEDICULOSIS (HEAD LICE)
• GENERAL
INFORMATION
1. Parasitic infestation
2. Adult lice are spread by
close physical contact
3. Occurs in school-age
children, particularly
those with long hair
 ASSESSMENT
• White eggs (nits) firmly attached to the base
of hair shafts
• Pruritus of the scalp
 NURSING INTERVENTIONS
• Institute skin isolation precautions (especially head
covering and gloves to prevent spread to self, other
staff and clients)
• Use special shampoo (Permethrin, Kwell) and comb
the hair (fine-tooth comb)
• Provide client teaching and discharge planning
concerning
1. How to check self and other family members and
how to treat them
2. Washing of clothes, bed linens; discouraging
sharing of combs and hats
 ACNE
• GENERAL INFORMATION
1. Skin condition associated
with increased
production of sebum
from sebaceous glands at
puberty due to hormonal
changes
2. Lesions include pustules,
papules and comedones
3. Majority of adolescents
experience some degree
of acne, mild to severe
4. Lesions occur most frequently on the face,
neck, shoulders and back
5. Caused by a variety of interrelated factors
including increased activity of sebaceous
glands, emotional stress, certain
medications, menstrual cycle
6. Secondary infection can complicate healing
of lesions
7. There is no evidence to support the value of
eliminating any foods from the diet; if cause
and effect can be established, however, a
particular food should be eliminated
 ASSESSMENT FINDINGS
• Appearance of lesions is variable and
fluctuating
• Systemic symptoms absent
• Psychologic problems such as social
withdrawal, low self-esteem, feelings of being
“ugly”
 NURSING INTERVENTIONS
• Discuss OTC products and their effects
• Benzoyl peroxide
• Instruct child in proper hygiene
1. Hand washing
2. Care of face
3. Not to pick or squeeze any lesions
• Demonstrate proper administration of topical
ointments and antibiotics if indicated
 SCABIES
• A parasitic skin disorder that causes severe itching
• Cause: Female mite (Sarcoptes scabiei) that burrows
into the skin and deposit eggs in areas that are tin
and moist
 ASSESSMENT
• Linear black burrows between fingers and toes and in
palms, axillae and groin
• Severe itching
 TREATMENT
• Treatment for all members of the family (as well as
close contacts of the child)
• DRUG THERAPY: Application of Lindane (Kwell)
lotion or Permethrin
 INTERVENTIONS
• Wash area thoroughly with soap and water to
promote healing
• Teach the child and parents to apply lindane or
permethrin from the neck down covering the entire
body, wait 15 minutes before dressing and avoid
bathing for 8-12 hours to ensure effectiveness of
therapy
• Do not apply lindane cream if skin is raw or inflamed
to avoid irritating the skin
• Explain to the child and parents that if skin irritation
or an allergic reaction develops, they should notify
the doctor immediately, stop using the cream and
wash it off thoroughly to avoid risk of an
anaphylactic reaction
 IMPETIGO
Causative Agent:B hemolytic streptococcus,
group A , Staphylococcus aureus, Methycillin-
resistant staphylococcus aureus
Incubation Period: 2 to 5 days
Period of communicability: from outbreak of
lesions until lesions are healed
Mode of transmission: direct contact with
lesions
Immunity: None
ASSESSMENT
➢It begins as a single papulovesicular lesion
surrounded by localized erythema. Soon,
more vesicles appear and become purulent,
ooze, and form honey-colored crusts

➢Commonly found in the face and extremities

 THERAPEUTIC MANAGEMENT
✓Penicillin or erythromycin (PO)
✓Mupirocin ointment (Bactroban) for 7-10 days
✓Wash crusts daily with soap and water
•RHEUMATIC
•FEVER
• RHEUMATIC FEVER is an inflammatory
disease of childhood
• It occurs 1-3 weeks after a group A beta-
hemolytic streptococcal infection and
may recur. RF results in antigen-antibody
complexes that ultimately destroy the
heart tissue
• RHEUMATIC HEART DISEASE refers to the
cardiac effects of RF and includes
pancarditis (inflammation of the heart
muscle, heart lining and sac around the
heart) during the early acute phase and
chronic heart valve disease later
 CAUSES
• Production of antibodies against group A
beta-hemolytic Streptococcus
• Untreated group A beta-hemolytic
Streptococcus infection
• 1%-5% of children infected with
Streptococcus develop RF
 NOTE:
Jones criteria where presence of
2 major signs or 1 major and 2 minors
+ history of sore throat will confirm
diagnosis
 ASSESSMENT FINDINGS
• The JONES CRITERIA for assessing MAJOR RF
include:
1. Carditis
A. Seen in 50% of clients
B. Aschoff nodules – areas of inflammation and
degeneration around heart valves, pericardium and
myocardium
C. Valvular insufficiency of mitral and aortic valves
possible
D. Cardiomegaly
E. Shortness of breath, hepatomegaly, edema
Aschoff nodules
2. Chorea (Sydenham’s chorea, St. Vitus’ dance): CNS
disorder characterized by abrupt, purposeless,
involuntary muscular movements
A. Gradual, insiduous onset: starts with personality
change or clumsiness
B. Mostly seen in prepubertal girls
C. May appear months after Strep infection
D. Lasts 1-3 months
E. Movements increase with excitement
3. Erythema marginatum – temporary disk-shaped,
nonpruritic, reddened macules that fade in the
center, leaving raised margins (resemble giraffe
spots)- trunk andextremities
chorea
4. Polyarthritis
A. Migratory, therefore, no contractures develop
B. Most common in large joints, which become red,
swollen, painful
C. Synovial fluid is sterile- most common symptoms
5. Subcutaneous nodules
A. Usually a sign of severe disease
B. Occur with active carditis
C. Firm, nontender nodes on bony prominences of joints
D. Lasts for weeks
• The JONES CRITERIA for assessing MINOR RF
include:
1. Anti-streptolysin-O (ASO) titer is elevated/ C-
reactive protein
2. ESR is increased
3. Electrocardiogram shows prolonged PR interval
4. Throat culture
5. X ray- enlarged heart
 NURSING DIAGNOSIS

• Decreased Cardiac Output

• Impaired Gas Exchange
• Imbalanced Nutrition: less than body
requirements
 TREATMENT
• Bed rest during fever and until ESR returns to normal
• Drug therapy
1. Analgesic: Aspirin for arthritis (pain)
2. Antibiotic: Penicillin to prevent additional damage
from future attacks ( Benzathine penicillin IM)
3. Phenobarbitals- to decrease chorea

PROGNOSIS depends on the extent of myocardial

involvement
Some cases might have permanent valve dysfunction.-
valve replacement
 INTERVENTIONS
• Monitor VS and I & O
• Institute safety measures for chorea; maintain a calm
environment, reduce stimulation, avoid the use of
forks or glass, and assist in walking to prevent injury
• Provide appropriate passive stimulation to maintain
growth and development
• Provide emotional support for long-term
convalescence to help relieve anxiety
• Use standard precautions to prevent reinfection
 JUVENILE RHEUMATOID ARTHRITIS
• Autoimmune disease of the connective tissue
• Characterized by chronic inflammation of the
synovia and possible joint destruction
• Episodes recur with remissions and
exacerbations
 CAUSES
• Autoimmune response
• Genetic predisposition
 ASSESSMENT FINDINGS
• Inflammation around the joints
• Stiffness
• Pain
• Guarding of the affected joints
• Diagnostics: elevated ESR, (+) ANA
(antinuclear antibody test), presence of
Rheumatoid factor
 TREATMENT
• Heat therapy: warm compress, baths
• Splint application
• Drug therapy: low-dose corticosteroids, low-
dose Methotrexate, NSAIDS: Naproxen,
Ibuprofen
 INTERVENTIONS
• Monitor joints for deformity to assess for early changes as a
complication of this disease process
• Administer medications as prescribed
• Assist with exercise and ROM activities to maintain joint
mobility
• Apply warm compresses or encourage the child to take a
warm bath in the morning to promote comfort and increase
mobility
• Apply splints to maintain position of function and prevent
contractures
• Provide assistive devices, if necessary
THE MUSCULOSKELETAL
SYSTEM
 ASSESSMENT
• HEALTH HISTORY
1. Presenting problem
a. Muscles weakness, loss of function of an
extremity
b. Delayed motor development
c. Injury
d. Pain, loss of sensation, tingling
e. Interference with normal activity or play
2. Family history: genetic disorders, skeletal
deformities
3. Inadequate nutrition (e.g., Vitamin D
deficiency cause rickets)
 PHYSICAL EXAMINATION
• General appearance: note any asymmetry, visible
deformities, swelling, quality of movement (ROM,
gait)
• Measure muscle strength
• Identify warmth and tenderness over bones and
joints
• Assess pain: note type, location, onset, relationship
to activity
• Perform examination in standing, lying and sitting
positions
 ANALYSIS
• Risk for Activity Intolerance
• Deficient Diversional Activity
• Pain
• Risk for Injury
• Impaired Physical Mobility
• Self-care Deficit
• Disturbed Body Image
• Risk for Impaired Skin Integrity
• Ineffective Tissue Perfusion
 INTERVENTIONS
GENERAL CAST CARE
• Turn the cast frequently to dry all sides
• Use palms to lift or turn a wet cast to prevent
indentations
• Expose as much of the cast to air as possible, but
cover exposed body parts
• Be aware of discomfort to the child because
chemical changes in the drying cast cause
temperature extremes against the chil’s skin
• Maintain a dry cast; wetting the cast softens it
and may cause skin irritation
• Smooth out the cast’s rough edges and petal
the edges
• Assess circulation: note the color,
temperature and edema of the digits; note the
child’s ability to wiggle the extremities
without tingling or numbness
• Assess any drainage or foul odor from the cast
• Prevent small objects or food from falling into
the cast
• Do not use powder on the skin near the cast;
it becomes a medium for bacteria when it
absorbs perspiration
TRACTION
• Check that the weights hang free
• Check for skin irritation, infection at pin sites and
neurovascular response of the extremity
• Prevent constipation by increasing fluids and fiber
• Prevent respiratory congestion by promoting
pulmonary hygiene using blowing games
• Provide pain relief if necessary
• Provide stimulation appropriate for the child
• BRYANT’S TRACTION
- This is the only traction designed specifically for the
lower extremities of the child under age 2; the
child’s body weight provides countertraction
- Legs are kept straight and extend 900 toward the
ceiling from the trunk; both legs are suspended
even if only one is affected
- The buttocks are slightly off the bed to ensure
sufficient and continuous traction on the legs
BRACES
• Provide skin care especially at the bony
prominences
• Check to ensure accurate fit as the child
grows
• When applying full body braces to the spastic
child, pu the feet in first
MILWAUKEE BRACE
• Attempts to slow the progression of spinal curvature
of less than 400 until bone growth stops
• Extends from the iliac crest of the pelvis to the chin
• Must be fitted
• Can be used until the child reaches skeletal maturity
• Must be worn 20-23 hours a day; may be removed
for bathing and swimming
BOSTON BRACE
• Functions the same as Milwaukee brace
• Extends from the axillary area to the iliac
crest; must be fitted
• Can be easily covered by clothing
 CLUBFOOT
• Also known as Talipes
• A congenital disorder in which the foot and
ankle are twisted and cannot be
manipulated into correct position
• Five forms:
1. Equinovarus: combination of positions
2. Talipes Calcaneus: dorsiflexion, as if walking
on one’s heels
3. Talipes equinus: plantar flexion, as if
pointing one’s toes
4. Talipes valgus:eversion of the ankles, with
feet turning out
5. Talipes varus: inversion of the ankles, with
the soles of the feet facing each other
CAUSES
• Arrested development during the 9th and 10th
weeks of embryonic life, when feet are formed
• Deformed talus and shortened Achilles tendon
• Possible genetic predisposition
 ASSESSMENT FINDINGS
• Deformity usually obvious at birth
• Inability to be corrected manually
• Diagnostic test: X-ray shows superimposition
of the talus and calcaneus and a ladder-like
appearance of the metatarsals
 TREATMENT
STAGES:
• Correcting the deformity either with a series of casts
to gradually stretch and realign the angle of the foot
and after cast removal, application of Denis Browne
splint at night until age 1 or surgical correction
• Maintaining the correction until the foot gains
normal muscle balance
• Observing the foot closely for several years to
prevent the deformity from recurring
 INTERVENTIONS
• Assess neurovascular status to ensure
circulation to foot with cast in place
• Ensure that shoes fit correctly to promote
comfort and prevent skin breakdown
• Prepare for surgery, if necessary
 FRACTURES
-break in the continuity or structure of bone

CAUSES
• Childhood accidents: falls, motor vehicle
accidents
• Child abuse
• Pathologic conditions
 ASSESSMENT
• Bony crepitus
• Bruising
• Impaired sensation
• Loss of motor function
• Muscle spasm
• Pain or tenderness
• Paralysis
• Paresthesia
• Skeletal deformity
• Swelling
• Diagnostics: X-ray
 TREATMENT
• Casting
• Reduction and immobilization of the fracture
• Surgery
• Traction
 INTERVENTIONS
• Keep the child in proper alignment to promote
bone healing and prevent tissue damage
• Provide support above and below the fracture
site when moving the child to promote
comfort
• Elevate the fracture above the level of the
heart to promote venous return and decrease
edema
• Apply ice to the fracture to promote
vasoconstriction, which inhibits edema and
pain
• Monitor pulses distal to the fracture every 2-4
hours to assess blood flow to the distal
extremity
• Assess color, temperature and capillary refill to
determine whether the affected extremity is
adequately perfused
• Turn and reposition the child every 2 hours to
help relieve skin pressure and prevent skin
breakdown
• Protect cast from moisture and petal the
edges to promote healing of the fracture and
prevent skin breakdown
 JUVENILE RHEUMATOID ARTHRITIS
• Autoimmune disease of the connective tissue
• Characterized by chronic inflammation of the
synovia and possible joint destruction
• Episodes recur with remissions and
exacerbations
 CAUSES
• Autoimmune response
• Genetic predisposition
 ASSESSMENT FINDINGS
• Inflammation around the joints
• Stiffness
• Pain
• Guarding of the affected joints
• Diagnostics: elevated ESR, (+) ANA
(antinuclear antibody test), presence of
Rheumatoid factor
 TREATMENT
• Heat therapy: warm compress, baths
• Splint application
• Drug therapy: low-dose corticosteroids, low-
dose Methotrexate, NSAIDS: Naproxen,
Ibuprofen
 INTERVENTIONS
• Monitor joints for deformity to assess for early changes as a
complication of this disease process
• Administer medications as prescribed
• Assist with exercise and ROM activities to maintain joint
mobility
• Apply warm compresses or encourage the child to take a
warm bath in the morning to promote comfort and increase
mobility
• Apply splints to maintain position of function and prevent
contractures
• Provide assistive devices, if necessary
HIGH RISK ADOLESCENT
 SCOLIOSIS
• Lateral curvature of the spine, especially
among females
• Commonly identified at puberty and
throughout adolescence
• Stops progressing when bone growth stops
 CAUSES
• Nonstructural, functional, postural scoliosis:
nonprogressive C curve from poor posture,
unequal leg length and poor vision

• Structural or progressive: progressive S curve

with a primary and compensatory curvature
resulting in spinal and rib changes
 ASSESSMENT
• Nonstructural: when the child bends at the waist to
touch the toes, the curve in the spinal column
disappears

• Structural: when the child bends forward with the

knees straight and the arms hanging down toward
the feet, the spinal curve fails to straighten; the hips,
ribs, shoulders and shoulder blades are asymmetrical
 TREATMENT
• Nonstructural: corrective lenses, postural
exercises, shoe lifts

• Structural:
1. Electrical stimulation for mild to moderate
curvatures
2. Skin traction or halo femoral traction
3. Harrington, Luque or Cotrel – Dubousset
rods for curves >400
4. Possible prolonged bracing (Milwaukee or
Boston brace)
5. Spinal fusion with bone from the iliac crest
Thoracic-lumbar ortho device
 DEVELOPMENTAL HIP DYSPLASIA
• Dislocated hip
• Results from an abnormal development of the
hip socket
• Causes: breech delivery, fetal position in
utero, genetic predisposition, laxity of the
ligaments
 ASSESSMENT
• On the affected side, an increase number
of folds on the posterior thigh when the
child is supine with knees bent
• Appearance of a shortened limb on the
affected side
• Restricted abduction of the hips
• Barlow’s sign: A click is felt when the infant is
placed supine with hip flexed 900, knees fully
flexed and the hip brought into midabduction
• Ortolani’s click: Can be felt by the fingers st
the hip area as the femur head snaps out of
and back into the acetabulum. It is also
palpable during examination with the child’s
legs flexed and abducted
 TREATMENT
• Hip-spica cast or corrective surgery (for older
children)
• Bryant’s traction, if the acetabulum does not
deepen
• Casting or a Pavlik harness to keep the hips
and knees flexed and the hips abducted for at
least 3 months
 INTERVENTIONS
• Assess circulation before application of cast or
traction
• Provide skin care
• Give reassurance that early, prompt treatment will
probably result in complete correction to decrease
anxiety
• Assure the parents that the child will adjust to
restricted movement and return to normal sleeping,
eating and play in a few days to ease anxiety
 SAMPLE QUESTION
1. A child is diagnosed with developmental hip
dysplasia. Besides using the hip-spica cast,
which of the following devices is used in the
treatment of this condition?
A. Pillow
B. Denis Browne splint
C. Pavlik harness
D. Foot casts
 C
• A Pavlik harness is used to stabilize the hip. A
regular pillow is not sufficient. Denis Browne
splint is used to treat Talipes Equinovarus.
Foot casts are not effective