Nursing Care of Children and
Adolescents Exam #1 Questions With
New Update Solutions
Nursing Management of Eating Disorders
> Mostly outpatient; may take months
> Refeeding syndrome (cardiovascular, hematologic, and neurologic
complications) may occur in the severely malnourished adolescent with anorexia
if rapid nutritional replacement is given. Therefore, slow refeeding is essential to
avoid complications. Give phosphorus supplements as ordered.
> Assess VS for orthostatic hypotension, irregular/decreased pulse, hypothermia
> Aim for a weight goal of 0.5-2lbs a week
> Those with anorexia who display severe weight loss, unstable vital signs, food refusal,
or arrested pubertal development or who require enteral nutrition will need to be
hospitalized
> Assist the child and family to plan a suitably structured routine for the child that
includes meals, snacks, and appropriate physical activity.
> Use the physical findings associated with anorexia to educate the child about
the consequences of malnutrition and how they can be remedied with adequate
nutrient intake.
> Assess the child’s need for medical intervention for concomitant depression or
anxiety
> Use behavior or group therapy
Eating Disorders
> pica, rumination, anorexia nervosa, and bulimia.
,> Pica, which occurs most frequently in 2- to 3-year-olds, is an eating disorder in
which the child ingests (over at least a 1-month period) a nonnutritive material
such as paint, clay, or sand
> Primarily affect adolescents
> Anorexia nervosa is characterized by dramatic weight loss as a result of
decreased food intake and sharply increased physical exercise.
> Bulimia refers to a cycle of normal food intake, followed by binge eating and
then purging. Typically, the adolescent with bulimia remains at a near-normal
weight.
- Complications of anorexia and bulimia include fluid and electrolyte imbalance,
decreased blood volume, cardiac arrhythmias, esophagitis, rupture of the
esophagus or stomach, tooth loss, and menstrual problems.
Nursing Assessment for Eating Disorders
> Determine the health history, noting risk factors such as family history, female
gender, Caucasian race, preoccupation with appearance, obsessive traits, or low
self-esteem.
> Adolescents with anorexia may have a history of constipation, syncope, secondary
amenorrhea, abdominal pain, and periodic episodes of cold hands and feet.
> Parents usually note the chief complaint as weight loss. Note history of
depression in the child with bulimia.
> The anorexic is usually severely underweight, with a body mass index (BMI) of
less than 17. Note cachectic appearance, dry sallow skin, thinning scalp hair, soft
sparse body hair, and nail pitting. Note low temperature, bradycardia, or
hypotension. Listen for murmur.
> The adolescent with bulimia will be of normal weight or slightly overweight.
Inspect the hands for calluses on the backs of the knuckles and split fingernails.
Inspect the mouth and oropharynx for eroded dental enamel, red gums, and
inflamed throat from self-induced vomiting.
> Labs: Serum electrolytes and electrocardiogram (needed in adolescents with
anorexia because severe electrolyte disturbances and cardiac arrhythmias often
occur.)
(T/F) An adolescent with anorexia nervosa would most likely experience
amenorrhea, hypothermia, low blood pressure, and bradycardia. The nurse would
also note soft hair on the individual's back and arms.
True
Autism Spectrum Disorder
,> Onset in infancy and early childhood
> Autistic behaviors may be first noticed in infancy as developmental delays or
between the ages of 12 and 36 months when the child regresses or loses
previously acquired skills.
> Patho:
- Though the exact etiology of autism continues to be unknown, genetics has
been well studied in these children and ASD is mainly considered to be a genetic
disorder, though there may also be issues with brain connectivity
- Children with ASD display impaired social interactions and communication as
well as perseverative or stereotypic behaviors (may fail to develop interpersonal
relationships and experience social isolation)
> Therapeutic Management:
- There are no treatments available to cure autism.
- The goal of therapeutic management is for the child to reach optimal functioning
within the limitations of the disorder.
- Each child’s treatment is individualized; behavioral and communication
therapies are very important. Children with ASD respond very well to highly
structured educational environments; so, early, intensive behavioral
interventions are necessary.
- Families may use vitamins and nutritional supplements, herbs or restrictive
diets, music therapy, art therapy, and sensory integration techniques. To date,
these therapies have not been scientifically proven to improve autism
> Nursing Assessment
:
- Elicit the health history, noting delay or regression in developmental skills,
particularly speech and language abilities.
- The most common early characteristics are a consistent failure to orient to one’s
name, regard people directly, use gestures, and to develop speech
, - The child may be mute, utter only sounds (not words), or repeat words or
phrases over and over.
- The parent may report that the infant or toddler spends hours in repetitive activity and
demonstrates bizarre motor and stereotypic behaviors.
- The infant may resist cuddling, lack eye contact, be indifferent to touch or affection,
and have little change in facial expression
- Assess the child’s functional status, including behavior, nutrition, sleep, speech and
language, education needs, and developmental or neurologic limitations.
- Assist with screening, using an approved autism screening tool such as the
Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R), which is
recommended for administration at 18 months of age, and then again at 24 to 30
months of age
- Observe the infant or toddler for lack of eye contact, failure to look at objects pointed
to by the examiner, failure to point to himself or herself, failure to let his or her needs be
known, perseverative play activities, and unusual behavior such as hand flapping or
spinning.
Growth and Development of the Schoolager
> School Ages = 6-12 years old
> The focus of their world expands from family to teachers, peers, and other outside
influences (become more independent)
> It is during this time that children move toward abstract thinking and seek approval of
peers, teachers, and parents.
> Eye-hand-muscle coordination allows for sports. They value school attendance and
activities.
Physical Growth of Schoolager
> Grow 2.5 inches per year (6-7 cm) -> total increase is 1ft
> Increase weight by 7 lbs per year (3.5kg)
> Secondary sexual characteristics begin to appear
> In the early school-age years, girls and boys are similar in height and weight and
appear thinner and more graceful than in previous years.
> In later school age years, most girls begin to surpass boys in weight and height.
These differences are more apparent at the end of the middle-school years (may cause
Adolescents Exam #1 Questions With
New Update Solutions
Nursing Management of Eating Disorders
> Mostly outpatient; may take months
> Refeeding syndrome (cardiovascular, hematologic, and neurologic
complications) may occur in the severely malnourished adolescent with anorexia
if rapid nutritional replacement is given. Therefore, slow refeeding is essential to
avoid complications. Give phosphorus supplements as ordered.
> Assess VS for orthostatic hypotension, irregular/decreased pulse, hypothermia
> Aim for a weight goal of 0.5-2lbs a week
> Those with anorexia who display severe weight loss, unstable vital signs, food refusal,
or arrested pubertal development or who require enteral nutrition will need to be
hospitalized
> Assist the child and family to plan a suitably structured routine for the child that
includes meals, snacks, and appropriate physical activity.
> Use the physical findings associated with anorexia to educate the child about
the consequences of malnutrition and how they can be remedied with adequate
nutrient intake.
> Assess the child’s need for medical intervention for concomitant depression or
anxiety
> Use behavior or group therapy
Eating Disorders
> pica, rumination, anorexia nervosa, and bulimia.
,> Pica, which occurs most frequently in 2- to 3-year-olds, is an eating disorder in
which the child ingests (over at least a 1-month period) a nonnutritive material
such as paint, clay, or sand
> Primarily affect adolescents
> Anorexia nervosa is characterized by dramatic weight loss as a result of
decreased food intake and sharply increased physical exercise.
> Bulimia refers to a cycle of normal food intake, followed by binge eating and
then purging. Typically, the adolescent with bulimia remains at a near-normal
weight.
- Complications of anorexia and bulimia include fluid and electrolyte imbalance,
decreased blood volume, cardiac arrhythmias, esophagitis, rupture of the
esophagus or stomach, tooth loss, and menstrual problems.
Nursing Assessment for Eating Disorders
> Determine the health history, noting risk factors such as family history, female
gender, Caucasian race, preoccupation with appearance, obsessive traits, or low
self-esteem.
> Adolescents with anorexia may have a history of constipation, syncope, secondary
amenorrhea, abdominal pain, and periodic episodes of cold hands and feet.
> Parents usually note the chief complaint as weight loss. Note history of
depression in the child with bulimia.
> The anorexic is usually severely underweight, with a body mass index (BMI) of
less than 17. Note cachectic appearance, dry sallow skin, thinning scalp hair, soft
sparse body hair, and nail pitting. Note low temperature, bradycardia, or
hypotension. Listen for murmur.
> The adolescent with bulimia will be of normal weight or slightly overweight.
Inspect the hands for calluses on the backs of the knuckles and split fingernails.
Inspect the mouth and oropharynx for eroded dental enamel, red gums, and
inflamed throat from self-induced vomiting.
> Labs: Serum electrolytes and electrocardiogram (needed in adolescents with
anorexia because severe electrolyte disturbances and cardiac arrhythmias often
occur.)
(T/F) An adolescent with anorexia nervosa would most likely experience
amenorrhea, hypothermia, low blood pressure, and bradycardia. The nurse would
also note soft hair on the individual's back and arms.
True
Autism Spectrum Disorder
,> Onset in infancy and early childhood
> Autistic behaviors may be first noticed in infancy as developmental delays or
between the ages of 12 and 36 months when the child regresses or loses
previously acquired skills.
> Patho:
- Though the exact etiology of autism continues to be unknown, genetics has
been well studied in these children and ASD is mainly considered to be a genetic
disorder, though there may also be issues with brain connectivity
- Children with ASD display impaired social interactions and communication as
well as perseverative or stereotypic behaviors (may fail to develop interpersonal
relationships and experience social isolation)
> Therapeutic Management:
- There are no treatments available to cure autism.
- The goal of therapeutic management is for the child to reach optimal functioning
within the limitations of the disorder.
- Each child’s treatment is individualized; behavioral and communication
therapies are very important. Children with ASD respond very well to highly
structured educational environments; so, early, intensive behavioral
interventions are necessary.
- Families may use vitamins and nutritional supplements, herbs or restrictive
diets, music therapy, art therapy, and sensory integration techniques. To date,
these therapies have not been scientifically proven to improve autism
> Nursing Assessment
:
- Elicit the health history, noting delay or regression in developmental skills,
particularly speech and language abilities.
- The most common early characteristics are a consistent failure to orient to one’s
name, regard people directly, use gestures, and to develop speech
, - The child may be mute, utter only sounds (not words), or repeat words or
phrases over and over.
- The parent may report that the infant or toddler spends hours in repetitive activity and
demonstrates bizarre motor and stereotypic behaviors.
- The infant may resist cuddling, lack eye contact, be indifferent to touch or affection,
and have little change in facial expression
- Assess the child’s functional status, including behavior, nutrition, sleep, speech and
language, education needs, and developmental or neurologic limitations.
- Assist with screening, using an approved autism screening tool such as the
Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R), which is
recommended for administration at 18 months of age, and then again at 24 to 30
months of age
- Observe the infant or toddler for lack of eye contact, failure to look at objects pointed
to by the examiner, failure to point to himself or herself, failure to let his or her needs be
known, perseverative play activities, and unusual behavior such as hand flapping or
spinning.
Growth and Development of the Schoolager
> School Ages = 6-12 years old
> The focus of their world expands from family to teachers, peers, and other outside
influences (become more independent)
> It is during this time that children move toward abstract thinking and seek approval of
peers, teachers, and parents.
> Eye-hand-muscle coordination allows for sports. They value school attendance and
activities.
Physical Growth of Schoolager
> Grow 2.5 inches per year (6-7 cm) -> total increase is 1ft
> Increase weight by 7 lbs per year (3.5kg)
> Secondary sexual characteristics begin to appear
> In the early school-age years, girls and boys are similar in height and weight and
appear thinner and more graceful than in previous years.
> In later school age years, most girls begin to surpass boys in weight and height.
These differences are more apparent at the end of the middle-school years (may cause
