Children are unable to help themselves without guidance and direction in lifelong health

True or False

 health care representative on site, ensures coordinated care with all members of the health care team.  The school nurse may be the only health care provider in the child’s life.

learning disability

social and family health issues. They may face family crises, homelessness, immigration, poverty, violence, substance abuse, adolescent pregnancy

Demographics of Children’s Health in United States with a learning disability

·         5 million children aged 3–17 had a learning disability

Demographics of Children’s Health in United States that are poor

·         16.4 million children, or 22 percent, were poor

Demographics of Children’s Health in United States that are abused or naglected

·         More than 1.25 million, or 1 in every 58 children in the United States, were abused or neglected

Demographics of Children’s Health in United States that go to bed hungery 

·         1 in 4 American children go to bed hungry

Demographics of Children’s Health in United States that are uninsured

Demographics of Children’s Health in United States that have asthma

·         7.1 million children have asthma (10%)

What is the roll of the school nurse

Promotes a healthy school environment including the physical and emotional safety of the school community

Provides a variety of health education programs

Health awareness/healthy behaviors

Preventing illness/injury

Coping skills/problem solving

Parenting classes

Sex education

Substance abuse

Identification and prevention of Suicide

Teach teachers to assess health problems and report them appropriately

Nutrition, exercise, smoking prevention, communicable disease prevention, immunizations, acute and chronic illness prevention

School ground safety guidelines

School nurses provid screening and referral for health conditions that provide optimal outcomes through early assessments and interventions

T or F

What screening do school nurses do

Scoliosis

Hearing/vision

Tuberculosis

Developmental milestones

Specific screening would encompass particular population groups

o   Lead poisoning

o   Sickle cell anemia

o   Diabetes

What are the  individual nursing interventions for health care while at school by giving direct care to some students

Dispense medications

Perform needed procedures such as dressing changes, trach suctioning

Assist with treatment regimes i.e. diabetic and asthma care

What are the Expertise Needed in School Nursing

Child development/family dynamics

First aid/emergency care

Parenting skills

Drug abuse/child abuse

Health Education/counseling

Coping skills for stress/self esteem

Counseling/surveillance

Comprehensive assessment skills/nursing skills

Communicable diseases/std’s

Safety in schools/on playground

What is Mainstreaming

to integrate children with special needs with peers of the same age in a regular classroom.  alsoreferred to as normalization or inclusion. 

Although there may still be a need for some children to have separate special education classes, this practice is not the one most desired. 

There are Six Basic Requirements for Administration of Medications in Schools that school nurses may need to delegate to a non medical person.

What written info is need for Rx and non-Rx drugs

Medications are given only with parents’ written permission.

Medications requiring a prescription are given only on the written authorization of a physician.

There are Six Basic Requirements for Administration of Medications in Schools that school nurses may need to delegate to a non medical person.

How must the meds be labled and how is it charted?

For medications requiring a prescription there must be an individual, pharmacy-labeled bottle for each student.

Medications must be recorded by the school personnel who administer them.  This record states the student’s name, medication, dosage, time, and the person administering the medication.

There are Six Basic Requirements for Administration of Medications in Schools that school nurses may need to delegate to a non medical person.

how must the meds be stored?

There are Six Basic Requirements for Administration of Medications in Schools that school nurses may need to delegate to a non medical person.

What must the nurse teach the person giving the meds about identifying the correct child

Use Student identifiers that prevent medication mismanagement/errors such as pictures and date of birth

What are the Eight Major Concerns for Children’s Health in the United States besides Communicable, Acute and Chronic Diseases

Childhood Obesity, Drug and Alcohol Abuse, Smoking, Bullying, Internet Safety, Child Abuse and Neglect, Stress and coping skills, Motor Vehicle Accidents

When educating a group on Childhood Obesity what    topics should the nurse adress

Rates have tripled in the last 25 years.

Fifteen percent of all children in the U.S. are overweight and close

25% of Black and Hispanic children are obese 

Sedentary lifestyles have become the norm in the U.S. rather than engaging in sports and other exercise activities

Although children are overeating, they are eating many of the nutrients necessary for healthy growth and good physical health

When educating a group on Drug and Alcohol Abuse

   what topics should the nurse adress

Most common drugs are alcohol, marijuana, inhalants and prescription medications 

Only 10% of teens who are addicted receive treatment. 

About half of adolescents drink alcohol on a monthly basis

Substance abuse still remains a leading cause of injury and death in children

4.5 million teens smoke and nearly 6,000 start smoking each day

Almost all long-term smokers began before 19 years of age

More than half of all school aged children have been bullied at least once in their time spent in school

Concerns and threats for children range from predators, identity theft, cyberbullying, internet addiction, pornography, hate speech and gambling

One in five teens sent sexually suggestive pictures or image

When educating a group on Child Abuse and Neglect

  what topics should the nurse adress

When educating a group on Stress and coping skills

  what topics should the nurse adress

Nearly one third of teens feel anxiety, agitation on a daily basis without  using healthy coping skills

When educating a group on Motor Vehicle Accidents

   what topics should the nurse adress

Crashes are the leading cause of accidental death for all children from one year of age through the teenage years

1 in 7 Students in Grades K-12 is either a bully or a victim of bullying.

1 out of 20 students has seen a student with a gun at school.

What are the types of Bullying

hitting, kicking, pinching, punching, scratching, spitting or any other form of physical attack. Damage to or taking someone else’s belongings may also constitute as physical bullying

spreading nasty stories about someone, exclusion from social groups, being made the subject of malicious rumors, sending abusive mail, and email and text messages (cyber bullying)

The Nurses’ Role in School Violence is to establish Strong Cooperative Relationships Between Adults and Students which include:

1. Speaking about school violence in community and school meetings

2. Writing, producing, or promoting PSA’s that aim to reduce violence

3. Promoting the inclusion of articles about school violence in newspapers, bulletins and newsletters

4. Offering ongoing anger management and conflict resolution courses

5. Political activism for legislation/funding to reduce violence

6. Sponsor after school programs that encourage the students to engage in sports, volunteer work, etc.

What Actions can  Schools Take to Reduce Violence

Surveillance cameras, Increase security personnel

Decrease access by outsiders, Safety plans, drills

Identify gang activity, Policy to randomly search students/lockers

Make parents accountable for actions and financial losses due to violence

Expel students for threatened or real acts of violence, or with weapons on campus

Dial free access connections to emergency services on all phones

What key features may help in Identifying Potentially Violent Youths

Depression/Mood Swings

Obsession with violent media

Absence of appropriate anger management skills

History of bullying/fighting

Victimization of bullying

Obsession with weapons of all types

Evidence of cruelty to animals

Artwork, language or writing that displays violence

Social Isolation

Evidence of hero worship of violent people

Demographics on Teenage Pregnancy

Close to 410,000 infants were born to 15-19 year olds

Teen pregnancy accounts for more than $9 billion per year in costs to U.S. taxpayers for increased health care, foster care and other factors.

60% of U.S. Teen births were in black and Hispanic youth

Sexuality in Teenagers

The single most important influence on a teenager’s decision to begin sexual activity is the attitude and behaviors of peers

By the 19^th birthday, seven in 10 teens of both sexes have had intercourse

If a teen does not use a contraceptive there is a 90% chance of becoming pregnant within a year

15-24 year olds account for nearly half of the 19 million new cases of STI’s yearly in the U.S.

What are the Physical and Social Problems with Teenage Pregnancies

Toxemia, PIH, nutritional deficiencies, prolonged labor, pelvic disproportion and C-Sections are highest in teen pregnancies

Health risks to the infant during pregnancy including death, prematurity, and low birth weight

The leading cause of infant mortality is low birth weight

There is a greater incidence of child abuse and neglect in children with teen parents

Only 50% of teen mothers have a high school diploma

Children of teenage mothers are more likely to  have more health problems and be welfare dependent

What are the Social Indicators that Predict Early Sex, Teenage Pregnancy and Non-Marital Childbearing

Sexually explicit media messages

Poverty

Community, family or friends relationships are disadvantaged, disorganized or dysfunctional, especially disconnection with parents

Increased public acceptance of unmarried mothers

Peer pressure – Earlier sexual debate, less likely birth control is used

Depression or Suicidal Ideations

Lack of Medically Accurate Sex Education

Evidence Based Teen Pregnancy Prevention Programs Address the Following Protective and Prevention Factors:

Knowledge of sexual issues, STD’s and methods of prevention

Perception of HIV and STD risks

Personal values about sex and abstinence

Attitudes toward condoms (pro and con)

Perception of peer norms and behavior about sex

Individual ability to refuse sex and to use condoms 

Intent to limit number of partners

Communication with parents or other caring adults about sex, condoms and contraception

Avoidance of places and situations that might lead to sex.

Intent to use a condom

What are Common Reasons Given by Teenagers for Irregular/Non-Use of Birth Control

Belief that pregnancy is not possible at the time of intercourse

The partner object to the use of birth control

Unwilling to appear to partner to be prepared to have sex

Lack of knowledge about methods or obtaining birth control

A belief that contraceptive use is wrong or dangerous

A belief that birth control methods are too difficult or unpleasant

What are common Prenatal Care Problems in teens

Economics, Lack of knowledge about the importance of prenatal care, Initiates in late pregnancy, Lack of transportation, Reluctance to tell parents, Lack of good nutrition – fear of getting fat. 

Difficulty accessing prenatal care

What should the nurse know about Autoerotic Asphyxiation and teens

Many adolescents die as a result of autoerotic asphyxiation and are mistakenly thought to have committed suicide. 

This practice of strangling or suffocating oneself to heighten sexual arousal and orgasm when the brain is deprived of oxygen often causes death or irreversible brain damage. 

Adolescents practice it because just before loss of consciousness, the person will experience euphoria, dizziness and lowered inhibition.

Many believe that teaching adolescents this primary prevention practice will actually give teens the idea. However, the reluctance to discuss avoiding this type of sexual behavior causes unnecessary suffering in our communities, families or the victims. 

What are the Risk Factors for Adolescent Suicide

Loss of significant relationship with friend, family member, or pet

Suicide of a friend, relative, or public figure

Homophobic response of family members to an adolescent’s sexual preference

Divorce of parents

Break-up with a girl or boyfriend

Unattainment of a significant goal i.e. acceptance at a particular college

Substance or alcohol abuse

Fighting with friends or significant people in their life

Accessible and loaded guns in the home

Incarceration or trouble with law enforcement

History of physical or sexual abuse

Poor coping skills

What are the Warning Signs of Potential Adolescent Suicide

1 in 10 adults do not feel they could effectively recognize an adolescent at risk for suicide

50% ineffective at offering support

Drastic Changes in behavior i.e. sudden withdrawal, isolating, trouble in school, sleeps a lot – energy plummets

Stated feelings of sadness, loneliness, hopelessness, or despair

Increased impulsive risk – taking behaviors

Alienating behaviors – aggression, irritability, hostility

Giving away possessions – especially those with special meaning

Preoccupation with death or dying

Sudden changes in personal appearance or hygiene

Previous suicide attempt or gesture

Direct suicidal comments such as “I wish I were dead”

Teenagers who talk about suicide don't commit suicide.

T/F

False

All messages of intent suicide such as verbal, written, art work or behavior are to be taken seriously

Teenagers who are serious about committing suicide oftine give clues

T/F

True

Giving away possessions, isolating from friends, increased incidences of accidents, pre-occupation about death in writing, music, and art, or comments about worthlessness and hopelessness are all clues to the person’s intent.

An improved mood means the suicide crisis is over.

T/F

False

Teens who complete suicide often showed improved mood and energy prior to their deaths. It often means the person’s ambivalence has ended and the decision has been made to commit suicide

Only teens with the diagnosis of depression kill themselves

T/F

False

Also at risk are people with schizophrenia, substance related disorders, panic disorder, PTSD, OCD, and manic phrase of bipolar disease.  Also, those who learn they have a terminal disease.

Always take seriously the expression of a wish to die

Provide a safe environment – remove self harm items

Obtain a verbal contract that the individual will not do anything to harm himself without talking to you or another adult

Ask direct questions in a calm manner

There is a Black Box Warning for SSRI Antidepressants Used to Treat Depression and Suicide Ideations in Young People

Research studies on treating depression in youth resulted in showing approximately 4% of adolescents and children taking SSRI antidepressant medications experience suicidal thinking or behaviors which is twice the rate of those taking placebos

a group of two or more persons related by blood, marriage, adoption, or emotional commitment who have a permanent relationship and who work and stay together to meet life’s goals and needs.

Extended family is the kin network

a child who is part of two nuclear families from divorce and joint custody

What is a Gang family

Family health as a unit encompasses more than the health status of individual family members.  Situations in which a holistic assessment of the family functioning is important include the following

Problems with adjusting to family development stages

Issues the family interpret as family issues

Problems with children in the family

Issues affecting relationships within the family

Psychiatric or hospital admission of a family member

Family crisis situation

A family crisis situation affecting the family that seems unsurvivable or unsolvable especially when something happens with the family unit that is sudden, unexpected and unpredictable

Purposes: obtain holistic view of family, identify how the family is organized, how family interact to carry out functions

What si the Division of Labor in a family assessment

Division of household tasks and roles in the family

Role strain – labors are inappropriately balanced and need to be modified

Help the family to avoid reinforcing role reversal patterns when children assume parental functions

What is a Distribution of Power and Authority in the family assessment

Dominance------family council--------absence of power

(Threat to self-esteem)                             (Confusion/chaos)

Prescribed by culture and by situation

Family members who have power must be consulted in changes in health behaviors are to occur

messages pass from one person to another in a chain like fashion that doesn’t allow from reciprocal discussion

– isolates a family member where one person is excluded from discussions

central person directs what communication will be passed between family member

there is reciprocal communication among all/family members

What are the Major challenges with the Beginning Family Stage

encompasses adjusting to the commitment to a new family unit and realignment of relationships with family of origin

What are the Major challenges with the Early Childbearing and School Aged Children stages

challenges balancing child rearing with financial and household tasks, including new parenting roles

What are the Major challenges with the Family with teenage children

need to maintain flexibility of children moving into independence while maintaining boundaries for them as well as keeping marriage relationships strong

include adjusting to exits from and entrances of new members into the family system, development of adult to adult relationships with children, dealing with possible deaths of own parents or declining health, relationships with grandchildren and preparing for eventual retirement from the work force

What are the Major challenges with retirement and old age

requires the strength to maintain functioning as a couple during declining health, dealing with the multiple losses of old age including death of spouse and others who have meaning in life and supporting children with their own challenges throughout the earlier family stages. 

What might you see with a family that has too open Boundaries

(crisis prone)

Provides little or no control over what enters or exits the family environment, no rule setting, no healthy behaviors

(isolation)

Family fears any differences will not be accepted, children may not be able to cope with outside world

What might you see with a family that has Boundaries thta are Not agreed upon (disintegration)

Causes extreme conflict within the family unit

What is an Encourager r/t Informal roles of the family

– praises others and is able to draw others out and make them feel their ideas are important

What is an harmonizer r/t Informal roles of the family

mediate differences by use of humor and smoothing over

tends to be negative to all ideas

passively goes along with the group

wants nothing for self but sacrifices for others

identified problem member, serves as a safety valve, relieving family tensions

moves the family into unknown territory and new experiences

transmits and monitors communications among family members (often the mother)

fault finder and dictator

honored and accepted because of behaviors

identified as the most dependent one

locked into being he one who is most vulnerable because of poor physical/psychological health

Breadwinner, home maker

What are the characteristics of Healthy Families

communicate openly, confront each other when angry, write or call each other when separated

responsive to their individual members’ needs, promote each member’s growth

meet the changing family needs over time

attempt to overcome life’s problems/issues.  assume responsibility for coping and find solutions to meet new demands

Provides safe and hygienic. 

positive and supportive.  allows  for expression individuality

participate regularly in external groups/activities. 

use external resources suited to their families’ needs

What are the Community Health Nurses Goals When  Working with Families

Empowering families/coaching them to regain their power

Help families identify their top needs

Help families identify their strengths

Teaching families about health care services they can utilize for a specific need

Teaching families about communication patterns and resolving conflicts that are supportive of one another

Teaching the family healthy coping skills when faced with a family crisis

Family health and individual health strongly influence each other.  And, ultimately, family health affects community health

a systematic stereotyping of and discrimination against people because they are old.  An attitude that is dehumanizing and inhibits people from maximizing their potential

Most older people live in institutional settings

T/F

False

Only 5% of older people are in these settings

Approximately 3.6 million older Americans are in the labor force

What % of older people have incomes below the poverty level

Only 20% of older Americans are classified as poor or near poor

Old age begins at age 65

T/F?

False

In this country 65 was legislated as the age for Social Security Retirement benefits, but “old age” is very individual

How will you know if your pt has acomplished integrity

when individuals review their lives, accept what they have done and feel satisfied with their accomplishments. These individuals will attain wisdom, even when confronting death.

maintaining satisfying living arrangements, adjusting to retirement, safeguarding physical and mental health, continuing a social network of friends and family, maintaining an active role in the community

There are over 35 million people over 65 years of age and those seniors are increasing faster than younger populations or 13% of the population

1 in 5 people are expected to be 65 or older by 2035

Elderly women outnumber elderly men three to two

Our bodies are born to live 115 years if a person is free from disease and environmentally adverse conditions

1. 65-74

1. 74-84

What % of all prescription drugs  and

OTC's are used by the elderly 

30% of all prescription drugs are used by the elderly and 40% of all OTC medication

The elderly have an increased susceptibility to adverse drug reactions.

T/F?

Of these drugs which is the safest to give your elderly pt

A. Allegra

B. Benadryl

A. Allegra

(Benadryl is contraindicated d/t increase in falls/injuries, the long half life of this drug contributes to somnolence)

an order for your geriatric dementia pt reads:

chlorpromazine 10mg PO Q day

What is the nurses best action, Why?

Do not give the med, question the order. 

Thorazine is contraindicated for the elderly with dementia Increases death d/t orthostasis which causes a rebound tachycardia 

What should the nurse be aware of r/t Elder abuse/neglect

1,000,000 elderly are abused/neglected every year with family members or themselves as the perpetrators

The invisibility of the problem in the community is evident

When others abuse the elderly it can be physical, psychological, financial, or a violation of their rights

It is often occurs when there is a perceived lack of control over their lives – multiple losses

The losses experienced by the elderly are beyond their coping skills, loss of loved ones, friends, jobs, family moving away, home health

What should the nurse know about Arthritis

 in the elderly 

What should the nurse know about Cancer

 in the elderly 

What should the nurse know about Diabetes 

 in the elderly 

What should the nurse know about Cardiovascular disease 

 in the elderly 

HBP up age but needs to be high enough to have sufficient cerebral circulation to avoid dizziness

What should the nurse know about Osteoporosis

  in the elderly 

acute/chronic pain fx’s ↓ physical activity ▲’s in body image, chronic depression

What do gerontological nurses need to understand r/t  the Iatrogenic Cascade and the older client needs.

the nurse should observe and care for the following:

Decreased physiological reserve and compensatory mechanisms

Atypical s/s of disease with many co-morbid conditions

Functional impairments including transient incontinence

Increases in polypharmacy, malnutrition and dehydration

Decreased self esteem and self advocacy

HCP that see all elderly as helpless and fragile

Maintain/improve self care capacity

Manage disease effectively

Boost body’s healing abilities

Prevent complications

Delay deteriorization/decline

Achieve highest possible quality of life

Die with comfort, peace and dignity

Slow acquisition of regular, low impact but progressively increasing (aerobic flexibility resistance)

Benefits : Increases sleep, mobility, strength, balance, mood and lifespan

Safety

Many accidents/injuries that render older adults to live independently are preventable

One of the leading causes of death: falls, MVA’s and fires Prevention of hazards in the home is critical 

Protect from heat, light, freezing and moisture

Don’t take medications in the dark and have them clearly labeled Don’t rely on memory.

fill at one pharmacy

Know any foods interactions

Review all meds with PCP once a year

Ask if lifestyle changes can be tried first.

Ask for medications that have been on the market for at least seven years.

Know why a medication is prescribed and what are the side effects

Don’t stop taking a medication or alter the dosage without approval from the PCP

Use Internet resources to get information about medications such as the AARP drug interaction checker

Unless contraindicated, have the elderly drink one quart of water daily in addition to other fluids in the diet

Reluctance to drink enough fluids: fear of incontinence, increased trips to the bathroom, decreased thirst sensation

maintain health, independence, quality of life, aging process is slowed.

What Five Factors Adversely Affect the Aging Experience:

( 5 I's)

Intellectual impairment – depression, dementia, delirium

Immobility

Incontinence

Iatrogenic drug reactions

Instability

Decrease in strength, flexibility, endurance

Decline in efficiency of internal organs

Loss of Bone Mass

Slower reflexes

Longer time to return from stressors

Decline in the senses

Increases in loss, grief and bereavement

Loss of control and independence

What is the Formula for Senior Adult Drug Dosages Based on the Creatinine Clearance

140 – age x IBW (Kg)/serum creatinine x 72 = Creatinine clearance for males

Take the creatinine clearance for males and times by .85 for females

100 lbs for the first 5 feet in height (weight of lean body mass)

·         Add 7 lbs for each inch in height over 5 feet for males

·         Add 5 lbs for each inch in height over 5 feet for females

the medication dosage will need to be adjusted down.

Call MD

70 year old female, 5 foot 4 inches tall, serum creatinine is 2.3

What is the Creatinine Clearance

and what action should the nurse take

140-70=70

120 divided by 2.2 = 54 Kg (Ideal Body Weight)

70 x 54= 3780

Serum Creatinine is 2.3 x 72 = 165.6

3780 divided by 165.6 = 22.82 x .85 = 19.39

Less than 50, will need to decrease normal adult dosages of medications

69 year old male, 5 foot 9 inches tall, serum creatinine is 1.5

What is his Creatinine Clearance

140-69 = 71

163 divided by 2.2 = 74 Kg (Ideal Body Weight)

71 x 74 = 5254

Serum Creatinine is 1.5 x 72 = 108

5254 divided by 108 = 48.64

Less than 50, do need to decrease normal adult dosage

73 year old female, 5 foot 6 inches tall, serum creatinine is 0.8

140 – 73 = 67

130 divided by 2.2 = 59 Kg. (Ideal Body Weight)

67 x 59 = 3953

Serum Creatinine is 0.8 x 72 = 57.6

3953 divided by 57.6 = 68.62

68.62 x .85 = 58.32

More than 50, doesn’t need to decrease normal adult dosage