Tanner stage 1 and 2

pebertal hair in stage 2

what female age group are in Tanner stages 1-2

and have Thelarche  Pubertal hair?

Females ages 9 -11

School aged

School aged Females

caloric needs?

water?

other?

1. 70 kcal/kg       1400-2100 calories/day

2. 1800 - 2200 ml/water

3. Protein, calcium, fat

30% of total calories should be total fat intake

What Erickson's psychosocial developmental stage includes?

• Involved in multiple activities
• With success increased sense of self worth and feelings of competence
• With unrealistic expectations  inferiority and incompetence

What age group's cognitive level includes

• Egocentrism gone, see others’ points of view
• Actions, consequences , rethink action
• Classification; collections
• Follows rules; games, fairness
  Early  Wants to be the good child
  Late cooperate based on respect and  understands need to cooperate

School aged(age 6-12)

Industry vs inferiority

• With the increase in independence and motor skills come increase in preventable accidents.

Fatal

51% Motor vehicle

8% drowning

8% fire/ burns

non-fatal injuries

falls 37%

Struck by/against object 23%
Bites/stings 8%

• Increase coordination
  gross and fine motor
• Vision 20/20
• Language  complex linguistic awareness
   speak multiple languages
  double meanings, joke, puns

• Temperament differences
  easy, slow to warm and difficult
• Body Image
  pubertal changes
  body habitus
  clothing
• Family influence still strongest; prefer peer company

-mutual respect

-engaged cooperatively

 -screen time

 -adjustment and success in school, reading

 -body image, self esteem

  -childhood overweight
              parents fail to recognize
              OW parents  (JAANP, 3/09)  

School aged children

Nurse’s Role/Physical assessment

• Ht/Wt within the 3-97%

• Blood pressure <90%
     take from age 3, unless acute or chronic illness

Promote Safety on Motorized Vehicles

Promote Safety Fire Safety

Promote Water Safety

Reduce Dog Bites

Promote Nutrition and Reduce Overweight

Promote Healthy Teeth and gums

What age ??All terrain vehicles (ATV)

[image]

<16 years old

No children on adult size ATV

Smoke detectors, every floor, sleeping areas
Check batteries monthly, change annually
Fire retardant bed clothing
Fire escape plan
No smoking in bed
Supervise children cooking, around fireplaces, and  campfires

Swim instruction

Never swim alone, life guard

Life jacket on boat (<26 feet)
      -current law 6 years old
      -proposed 13 years old

Diving and sufficient water depth

• Parents should
  Socialize dogs with children,
• never leave dogs with young children, spay/neuter dogs, dogs history of viciousness
• Children should be taught
  never to pet a strange dog, 
• be still if confronted by a dog, roll into a ball if knocked down by a dog

• Assess
  Family meals, Restaurants, Fast foods, Drinks
  FH of overweight, recent wt loss or gain
  Exercise 60 minutes daily 
• Healthy People 2010 Goal
  Increase the proportion of persons who consume adequate fruit, vegetables and grains.
• Weight loss vs slow gain

• Brush 2-3 times daily, floss daily
• Assist until 7-10 years
• Bruxism
• Malocclusion, braces
• Fluoride supplement
• Sealants
• Diet

• Place sun screen on 30 minutes before going outside, liberally
• Reapply after perspiring, swimming
• Hats with brim
• Medication
• Avoid sun exposure between 10 am-4 pm
• Tanning parlors

• Lying, cheating, stealing
   Child’s level of development to understand consequences
  Educate parents as to child’s rationalization
  Natural consequences
  Child  responsibility to correct
• Bullying
• Bullying Acts
• Punching, shoving, and other acts that hurt people physically
• Spreading bad rumors about people
• Keeping certain people out of a "group"
• Teasing people in a mean way
• Getting certain people to "gang up" on others
• Electronic bullying (Cyber)
• Sending mean text, email, or instant messages
• Posting nasty pictures or messages about others in blogs or on Web sites
• Using someone else's user name to spread rumors or lies about someone
• Consequences of bullying
• 30% bullied, bullying
• Associated with later weapon carrying, and frequent fighting enough to cause serious injury
• depression and suicidal ideation
• Somatic complaints, later disease morbidity
• Domestic violence

Nursing Interventions to decrease bullying

• Screen violence in home
• Educate parents
• Appropriate methods of handling anger, reward such methods
• Show child how it feels to be bullied

Nursing Interventions for children being bullied

• Did not cause bullying
• Increase the child’s self esteem
• Give the child strategies of handling bullying
• Form strong friendships

Intervene with school administrators

Care of the Hospitalized School Aged Child 

(Industry vs. inferiority)

• Generally healthy
  trauma, chronic illness

• Concerned about death and disability
• Fear injury and pain

SCHOOL-AGE HOSPITALIZED           NURSING INTERVENTIONS

Friendships

Schoolwork

Assist in own care

Activities that have a final product
Regression ?

Physiologic changes
Hormonal changes
         - skin sebaceous , exocrine, apocrine glands
        -menarche average 12.8 years
        - PHV male 4-12 inches/female 2 to 8 inches
        -Tanner stage 3-5
        -Respiratory system  RR, lung size
        -Musculoskeletal bone growth complete (ossification)

Secondary sexual characteristics  -   complete during middle adolescence

Developmental task

Early 11-14 includes?

Peers acceptance, but still desires family support, 

same sex

Developmental task

Middle 14-16

• Peer acceptance highest,
• adjusting to changes in body image, 
•  interest in opposite sex
• conflict with parents
  
  

Developmental task

late 17-20

More secure with body image,

role within peer group and sexual identity,

career goals,

independence from parents

Cognitive skills of the adolescent

Early

idealistic

challenges the way things are

Cognitive skills of the adolescent

Middle (14-16)

leads to feelings of invincibility and of omnipotence,

risk takers

rejection of prior held values,

religious,

cultural beliefs

Adolescent (11-20)

Identity vs role confusion

Motor skills include?

• Endurance

• Complicated play/sports rules

• Growth sports may produce coordination difficulties

Adolescent

• Relationship with parents
  rejects parents value system
  cultural  rites of passage
• Self-concept and body image
  less than ideal negative self concept
• Peer relationships
  strong effect, positive and negative
• Sexuality and dating
  heter, homo and bisexual  thoughts and behavior

• Set aside time to interview, do not appear rushed.
• Talk face to face, eye contact
• Speak to the adolescent as an equal, don’t talk down
• Use matter of fact specific words and describe what you mean
• Reassure Help adolescent feel normal, Other teens I see…or feel… or have told me…
• Praise the adolescent for having  a difficult discussion or making a tough decision
• Nonjudgmental no matter what you are told
• Neutral gender (partner)

• H:   Home
• E:   Education/Employment
• E:   Exercise/Eating
• A:   Activities
• D:   Drugs
• S:   Suicidality/Depression
• S:   Sexuality
• S:   Safety
• S:  Spirituality (Optional)

Who lives in the home with you?

• How are your relationships with siblings, parents, other relatives?
• Who do you go to for advice?
• What are the rules like at home?
• Is there a gun in your home?
• Ever been homeless or in shelter care?
• Ever been in foster care or group home?

• U.S. eighth-graders:

• 30% scored below basic math level

• 27% scored below basic reading level

• 8% of teens not attending school and not working

• 15% of 18-24 year olds not attending school, not working, and had only a high school degree

• What is the name of your school and what grade are you in?
• What grades do you get?
• How many days have you missed in the past year and what was the reason?
• Have you ever had any educational setbacks? Why?
• Have there been any recent school changes?
• What are your educational and life goals?

• What is the name of your school and what grade are you in?
• What grades do you get?
• How many days have you missed in the past year and what was the reason?
• Have you ever had any educational setbacks? Why?
• Have there been any recent school changes?
• What are your educational and life goals?

Between 10-16% of adolescents are overweight

Between 24-35% describe themselves as overweight

Up to 60% of adolescent females are trying to lose weight
16% 24 hours without eating

8% diet pills,  7.5% vomited or took laxatives

•          Anorexia nervosa

•          A disorder that involves a distorted body image and the pursuit of thinness through drastic means including starvation and excessive exercise.

•          Bulimia nervosa

•          This disorder involves a cycle of binge eating followed by purging in the form of vomiting, laxatives, or exercise.

Between 10-16% of adolescents are overweight

Between 24-35% describe themselves as overweight

Up to 60% of adolescent females are trying to lose weight
16% 24 hours without eating
8% diet pills,  7.5% vomited or took laxatives

•          Anorexia nervosa

•          A disorder that involves a distorted body image and the pursuit of thinness through drastic means including starvation and excessive exercise.

•          Bulimia nervosa

•          This disorder involves a cycle of binge eating followed by purging in the form of vomiting, laxatives, or exercise.

Body image:

What  is your ideal weight?
Do you think you are too fat, too thin or just right?

What do you like about the way you look?

Foods with  calcium, iron, fiber, zinc in diet?

How many meals do you eat per day?

Bowel movement pattern and problems?

Thin: Do you exercise, ever vomited, used diuretics, laxatives?

Overweight: Do you drink soda/juice, whole milk? Exercise? TV

Body image:

What  is your ideal weight?
Do you think you are too fat, too thin or just right?

What do you like about the way you look?

Foods with  calcium, iron, fiber, zinc in diet?

How many meals do you eat per day?

Bowel movement pattern and problems?

Thin: Do you exercise, ever vomited, used diuretics, laxatives?

Overweight: Do you drink soda/juice, whole milk? Exercise? TV

• How do you like to spend your free time?
• Hobbies, clubs, religious/spiritual activities?
• Do you play any sports?
• How many hours of television/computer per day? Per week?

male and female

Males

10% seriously considered suicide

9% made suicide plan

4.6% attempted suicide

Females

19% seriously  considered suicide

13% made suicide plan

9.3% attempted suicide

• Menstrual history
• Sexual orientation
• Gender identity
• Age at first intercourse
• Vaginal, oral, anal sex history
• Contraceptive history
• Pregnancy history
• Timing of childbearing plans
• Number of lifetime sexual partners
• Number of partners in last 3-6 months
• History of STIs
• Sexual satisfaction
• History of survival sex, sexual victimization, unwanted or coerced sex

• 30% said they or someone they knew experienced dating violence
  11% of males and 9.3% of females report dating violence
• 11% females and 4.5% of males were forced to have sexual intercourse
• 30% of adolescents drove with someone who had been drinking alcohol

8-12% drove when drinking alcohol

Have you ever been forced to have sex or been touched in a way against your will?

By whom and is this still going on?

Who did you tell?

How does it affect your life now?

Has anyone ever hurt you on a repeated basis? At home, in school, or in your neighborhood

• What do you consider to be your religion?
• How often do you participate in religious activities?
• How important are your spiritual beliefs in your day-to-day life?
• How do your beliefs influence your health and attitudes about sex and contraception
• Nursing Interventions to Promote Health

• Wear seat belt
• No driving with impaired persons
• NO cell phone, texting while driving
• Establish driving rules between parent and adolescent; drive with supervision initially

• Screen all adolescents with HEEADSSS
  Adolescents are greater risk
  previous suicide attempt, depressed, FH of mental illness, family disruption, alcohol use, school or family difficulties, gay and lesbian adolescents
• Suicide well thought  out plan that includes method, place, time, and clear intent  at high risk
• Immediate hospitalization or ED transfer
• Nurse’s Role in Promoting Safety Firearms
• 82%  of homicide utilize guns
  17%  of students reported carrying a gun in the past 30 days (CDC, 2006)
• Absence of guns from the environment most effective method of control
  Guns must be kept locked, bullets stored separately
  Adolescents must be taught dangers of  playing with firearms

-Protein

-Calcium skeletal growth,   prevention osteoporosis

decrease soda consumption, inverse relationship with calcium

 Iron expansion of muscle mass, blood volume
 Zinc skeletal and bone tissue

• Infection
  during procedure unclean instruments
  piercing/henna parties
  following procedure
• Keloid formation

Metal allergies

• Identity vs. role diffusion
  Fears body image
  Separation from  friends
  Decreased support system
• Loss of control cause anger, withdrawal, no support system
  Non adherence with treatment

ADOLESCENT NURSING INTERVENTIONS DURING HOSPITALIZATION

• Include in care planning, give choices
  Explanation 7-10 days
• Answer questions honestly, privacy
• Body image concerns
  Adherence concerns
• Teen area, rec room
  Teen support group for chronic illness