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Nursing School

The School Age Child
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again, really detailed power point notes, not a lot of extra to write down...

The School Age Child


- Lead Poisoning: began in 1900's when lead was added to paint, decreased in the 50's & again in 1971 for “The Lead Paint Poisoning Act” in 1971 which provided funding for screening

- Causes: inhalation of fumes when houses are renovated, ingestion of led products (paints made before 1978), exposure to lead contaminated soil, pottery, ceramics, dyes, playground equipment

-Pathophysiology: retained lead largely stored in bone, during chronic ingestion the rate of absorption exceeds the rate of excretion, excess lead is deposited in tissues & circulatory system, 90% of lead attaches to erythrocytes so even when ingestion stops the lead is still present d/t slow excretion, children are more susceptible to lead absorption & they absorb 50% of exposed lead, adults absorb only 10%

- Systems affected:

            - Hematological System: prevents formation of hemoglobin resulting in anemia, anemia is the initial sign of the disease, when only present in the circulatory system the effects are reversible.

            - Renal System: changes cells in the proximal tubes resulting in abnormal excretion of glucose, proteins, & amino acids & phosphate, these effects are usually reversible

            - CNS: initially there is a shift of fluid in the brain r/t increased membrane permeability, this increase in intracranial pressure leads to convulsions, MR, paralysis, blindness, coma, & death; there are several behavioral changes that occur first: hyperactivity, aggression, impulsiveness, lethargy, irritability, & loss of newly acquired motor skills - not reversible in the CNS

- Diagnosis: blood lead level test - 10mcg/dL indicates that there is lead poisoning

- Treatment: management: use chelation therapy: removal of metal by combining it with another metal - mobilize the lead from the blood & soft tissue by enhancing its deposit in the bone where it’s normally stored & it’s excretion in urine

            - medications: chemet (Succimer) - oral & dimercaprol - injection

            - can also do blood transfusions, give iron d/t anemia, encourage fluids to aid excretion (IV & PO fluids), educate parents & kids, give Folic Acid (to increase RBC’s), & hospitalize child


- Growth & Development: gradual growth between infancy & puberty which are the fastest periods of growth

- gain 2 inches/year in height, gains 1-2 feet in height from 6-12, 4.5-6.5 pounds/year in weight, weight doubles from 6-12, child gets a little pudgy

- more graceful, taller, steadier, limber, more agile d/t proportional changes

- Fine Motor: print, write, musical instruments, telephone, computer

- Facial Changes: face grows faster than head, lose teeth, face is big


-GI: increased stomach capacity & decreased calorie need, blood glucose is better maintained, eats less than preschooler d/t food retained in stomach longer


- Immune System: can fight infection better


- Skeletal: ossification occurs but bones are more forgiving than in adults so fractures heal quickly


- Prepubescence: secondary sex characteristics age 9 girls get breast buds & menses usually follows within 2 years; girls 10-11, boys around age 12


- Freud: Oedipal & Electra complexes, boys want to kill dad & have mom; girls want to kill mom & have dad


- Erikson: Industry vs. Inferiority: sense of accomplishment for doing well

- egocentric, bossy, knows everything, temper tantrums

- successful completion leads to confidence, independence, & a sense of feeling good about self

- also begin to search for adults to identify w/ besides parent & starts to measure parent against new role model & probably decides that parent is a loser

- may revert to childish behavior, craves attention & needs constant praise & encouragement

- needs constant reassurance of worth & value & “goodness”

- peer relationships are very important, they learn to cooperate

- are trying to master skills, must learn to accept that they can’t master everything

- have trouble losing, not good at losing even into the early 20's


- Piaget:

- Concrete Operations - able to articulate a process & can perform the action mentally w/o having to act it out

            - see things (begin to) from other’s viewpoints, develop logical thought & perceive & reason

            1. Conservation - matter does not appear or disappear, physical properties are not changed by altering the way a thing appears

            2. Classification - grouping objects, putting things in order, sorting things

            3. Combinational Skills - math, telling time, & reading


- Spiritual Development: Stage 2 - Mythical Literal - “conscience” really starting to work, may accept that there is a God, will have their own view, pray for what they want and expect answers, can articulate their faith


- Social Development: Peers are important, conformity is expected, early school ages mix sexes, sexes separate as they get to age 10, there is bullying,

- Family: parents are key

- Play: team play, play sports, want rigid rules, ego master (sense of accomplishment)


- Body Image: girls may be ashamed around age 10 when develop breasts, prepare girls for breasts & menses

- prepare boys for nocturnal emissions

- Sex Education: parents are most important!! They also learn from school & peers (usually wrong)

NOTHING on this website is to take the place of a physician's advice. Everything in this site is meant to be only a helpful tool for me and my nursing student friends.

Feel compelled to help me get through college while working only part-time and driving a million miles a day? Well, I won't twist your arm, but all you have to do is push the button. Either way, the information is free.