COMMON HEALTH PROBLEMS IN SCHOOLAGE CHILDREN

 PEDICULOSIS
Description
 Head lice
 Parasitic Infection
 Spread by close physical contact
 Occurs in school age, particularly with long hair

Findings
 White eggs firmly attached to base of hair shafts
 Pruritus of scalp

Management
 Special shampoos
 Fine tooth comb

Nursing Intervention
1. Institute skin isolation precautions
- Head covering
- Gloves
2. Use specific shampoo/comb
3. Provide health teachings on treatment and prevention
- Check on other family members
- Washing of bed linens
- No sharing of combs and hats

 IMPETIGO
Description
 Superficial bacterial infection of the outer layers of the skin
 Etiology: Staphylococcus aureus/ Beta H. streptococcus
 Incubation period – 2 to 5 days;
 Period of communicability – outbreak of lesion until healed
 Mode of transmission direct contact

Assessment Findings
 Well demarcated lesions
 Macules,vesicles, papule that rupture - moist erosion
 Once most area dries; honey colored crust
 Pruritus

Management
 Topical antibiotic – bactroban
 Systemic antibiotic - penicillin or erythromycin

Nursing Management
1. Implement skin isolation techniques
2. Soften skin and crust with burrow’s solution; then removes crust slowly
3. Cover lesion to prevent spread of infection
4. Remove crust gently
5. Administer antibiotics as ordered
6. Health teachings

 SCABIES (THE ITCH)

Description
 A contagious skin infestation caused by the scabies mite Sarcoptes scabiei
 Characterized by :
- superficial burrows
- intense pruritus(itching)
- Papular rash
 Mites are small eight-legged parasites,they are tiny (not visible with the naked eye), and burrow
into the skin to produce intense itching, which tends to be worse at night.
 Scabies may involve:
webs between the fingers,
wrists
Elbows
knees,
waist
umbilicus,
axillary folds,
around the nipples,
sides and backs of the feet,
genital area, and the buttocks.

Management
 Medication (SCABICIDES) - Permethrin cream / Lindane lotion
- Lindane should not be used in children younger than 2 years because of the risk of
neurotoxicity and seizures.
 Instruction:
body is scrubbed with soap
and water before application
left on the skin for 8 – 14 hours
then completely washed with warm water
 Stress importance of proper hygiene

Interventions
 When permethrin is used, the cream is massaged thoroughly and gently into all skin surfaces
from the head to the soles of the feet; care should be taken to avoid contact with the eyes.
 Household members and contacts of the infected child need to be treated at the same time.

 RHEUMATIC FEVER
Description
 An inflammatory disorder that may involve the connective tissue of heart, joints,lungs and brain
 Is an autoimmune disease that occurs as a reaction to a group A beta-hemolyticstreptococcal
infection
 It is precipitated by streptococcal infection which is undiagnosed and untreated
 Antigenic markers for streptococcal toxin closely resemble markers of the heart valves; this
resemblance causes antibodies made against the streptococcal to also attacks the heart valve

Assessment Findings
 Divided to major and minor symptoms according to Jones criteria
 5 major symptoms/criteria
1. Carditis - inflammation of the heart muscle around
- heart valves; aschoff’s nodules
2. Polyarthritis/Migratory Polyarthritis – a temporary migrating inflammation of the large joints
3. Chorea – Sydenham’s chorea; St. Vitus’ dance
- A CNS disorder characterized by abrupt, purposeless involuntary movement
4. Subcutaneous nodules – painless, firm collections of collagen fibers over bones or tendons
5. Erythema marginatum – transient, non pruritic rash (resembles giraffe spots)
  Minor symptoms/criteria
 Clinical findings
Arthralgia
Fever
 Laboratory findings
Erythrocyte sedimentation rate
C-reactive protein
antistreptolysin O (ASO) titer
ECG - Prolonged PR interval
leukocytosis
 Evidence of previous group A streptococcal infection
 (+) Throat culture or rapid streptococcal antigen test

 Two of the major criteria, or one major criterion plus two minor criteria, are present along
with evidence of streptococcal infection.
 Exceptions are chorea and indolent carditis each of which by itself can indicate rheumatic
fever.

Medical management
1. Drug therapy
a. Penicillin – used in acute phase
- given as prophylactic until age 20 or for 5 years
- Erythromycin as substitute
b. Salicylates – analgesics, anti-inflammatory, antipyretic effect
c. Steroids – anti-inflammatory effect
2. Bed rest – is essential during the active process of rheumatic fever to reduce cardiac workload
- 1 week to 6 months

Selected Nursing Diagnosis

 Acute pain related to inflammatory process
 Deficient diversional activity related to prescribed bed rest
 Activity intolerance related to pain and fatigue
 Risk for injury related to involuntary movement
 Risk for noncompliance with prophylactic drug therapy related to financial
 or emotional burden of lifelong therapy

 Whenever the child is to have oral surgery, including dental work, extra prophylactic
precaution should be taken, even in adulthood

 JUVENILE RHEUMATOID ARTHRITIS

Description
 Systemic, chronic disorder of connective tissue resulting from an autoimmune reaction
 Primarily involves joints
 results in eventual joint destruction
 affected by stress, climate
 genetic predisposition may increase the risk in some people
 More common in girls; peak age 1 to 3 years and 8 to 12 years
 Types
1. Monoarticular / pauciarticular - involving 4 joints or less joints usually large joints affected,
such as knee, ankles or elbow of one side of body (asymmetric)
- generally mild signs of arthritis
- mild fever
- Other symptoms such as:
- Iridocyclitis (eye inflammation)
- Uveitis (inflammation of the iris, ciliary body, choroid mebrane)
- Painless joint swelling with little redness

2. Polyarticular
- multiple joints affected (five or more)
- usually small joints of finger and hands are affected also possibly weight-bearing
joints often same joint on both sides of the body(symmetrical) disability may be mild
or severe with periods of remission and exacerbations
- low grade fever
- Other symptoms such as:
- stiffness and minimal joint swelling – limited motion
- rheumatoid nodules

3. Systemic Disease with Polyarthritis (Still’s Disease)

- any joints might be affected
- begins with high fever associated with macular rash on chest, thigh
- Other symptoms included are:
- anemia
- anorexia
- weight loss
- splenomegaly, hepatomegaly, lymphadenopathy

Assessment Findings
 Painful joints, warm and swollen
 Muscle weakness
 Affected area has limited motion
 Crippling deformity – due to reversible changes in joint cartilage due to inflammation
 Fatigue, anorexia, malaise, weight loss

Diagnostic Tests
 X-ray
 CBC
 Erythrocyte sedimentation rate (ESR)
 C-reactive protein
 ANA
 Rheumatoid Factor

Medical management
 To relieve pain, restore function and maintain joint mobility

1. Drug Therapy
 Aspirin – analgesic and anti-inflammatory effect
 NSAIDS (nonsteroidal anti-inflammatory drugs)
 Gold compounds (Chrysotherapy)
 Corticosteroids
 Methotrexate

2. Physical Therapy/exercise – to minimize joint deformity

3. Surgery – to remove severely damaged joints
 - Total hip replacement
- Knee replacement
4. Heat application splinting

 Gold Therapy - It is believed that gold attaches itself to certain proteins (albumin). Once
absorbed into the cell, it is then purported to kill particular cells in order to affect the
inflammation and erosion of joints. It does not necessarily act as a cure, but is rather believed
to merely relieve symptoms of joint disease.

Nursing Interventions
1. Assess joints for pain, swelling, tenderness, or limitationof motion
2. Promote maintenance of joint mobility
3. Change position frequently
4. Promote comfort and relief of pain
5. Ensure bed rest
6. Provide heat treatments
7. Provide cold treatments as ordered – acute
8. Provide psychologic support and encourage to verbalize feelings

 DIABETES MELLITUS
Description
 Is a condition resulting from dysfunction of the beta (insulin- secreting) cells of islet of Langerhans in
the pancreas
 There is a lack pancreatic hormone – INSULIN which is essential for carbohydrate metabolism and
is important to the metabolism of fats and protein

Hyperglycemia
 Excessive accumulation of sugar in the bloodstream
2 major types:
1. DM Type I
- formerly called Insulin Dependent Diabetes (IDDM)
- Juvenile diabetes
- common in children; affect 1 in 1500 below 5 years and increases to 1 in every 350
children by age 16
- due to destruction of beta cells in the Islets of Langerhans
2. DM Type II
- Formerly called non insulin dependent
- occurs in adults / obese individual
- may result from partial deficiency of insulin production and insulin resistance
 Assessment Type I Type II

Age of onset 5 – 7 yr / puberty Increasily occuring in younger

children
Type of onset abrupt Gradual
Weight Marked wt loss Associated with obesity
changes
Other Polydipsia Polydipsia
symptoms Polyuria Polyuria
Polyphagia Fatigue
Fatigue Blurred vision
Blurred vision Glycosuria
Glycosuria Pruritus
Pruritus
therapy insulin Diet
Diet Regular exercise
Regular exdercise Hypoglycemic agent
Foot care Skin and foot care
Period 1-12 months after initial Not demonstrable
of remission diagnosis “honeymoon
period”

 DIABETIC KETOACIDOSIS (DKA)

Description
 Is a potentially life-threatening complication in patients with diabetes mellitus type I
 Ketones bodies, the acid end-product of fat breakdown, begin to accumulate in the blood stream and
spill into the urine
 Characterized by drowsiness, dry skin, flushed cheeks,and cherry –red lips, acetone breath with fruity
smell and Kussmaul breathing( abnormal increase in the depth and rate of the respiratory
movement)

Risk Factors for Type 1 Diabetes

 Autoimmunity
 Inherited (or genetic) factors
 Environmental
- A virus or chemical
- Injuring the pancreatic cells

Diagnosis
 Fasting blood sugar – 126 mg/dl
 Random blood sugar – 200 mg/dl
 2 hours oral glucose tolerance test (OGTT) – 200 mg/dl or greater
 Glycosylated hemoglobin – provide information about what the child’s glucose level have been
during the preceding 3 to 4 months

Management for Type I Diabetes

 Goal: to keep your blood sugars as close to normal as possible to prevent the complications
of diabetes
1. Insulin Therapy
- Dosage of insulin is adjusted according to blood glucose level
- A short acting and intermediate acting insulin is usually given (70/30 insulin)
- Adverse effect: insulin reaction (insulin shock or hypoglycemia)
 - Glucose monitoring
- Rotate site to prevent lipodystrophy/lipohypertrophy
2. Meal planning
- Calories should be made up of 50-60% carbohydrates,15 -20% protein, and no more
30% 0f fats
- Avoid simple sugar; serve complex carbohydrates
- Make sure the child would not skip meals
- Teach child about food plan so that he can independently choose food selection
3. Exercise
- Exercise decrease the blood glucose level because carbohydrates are being burned
for energy
4. Stress management
5. Blood glucose and urine ketone monitoring

Nursing Intervention
1. Provide special diet – diabetic diet
2. Monitor urine sugar or blood sugar levels
3. Observe for signs of hypoglycemia and hyperglycemia
4. Provide meticulous skin care
5. Monitor Intake and Output every shift, weigh daily
6. Provide emotional support
7. Observe for complications