Night Terrors or Terror Disorder
Night terrors or terror disorder (pavor nocturnus) almost always occurs in children, not in adults. It is not common and is not to be confused with an occasional nightmare. In night terrors, a child awakens screaming and is panicky. Family members cannot console the child, who may be incoherent. After the terror passes, the child usually cannot? recall what caused it. The child will usually outgrow this condition. Blood found on a child?s pillow after an episode may indicate a psychomotor seizure disorder. A sleep study (polysomnogram) can help determine the cause.
Other Sleep Conditions
Somniloquism (sleep talking) is common in young people. It may or may not be associated with sleep walking. The person can often carry on a logical conversation, but will not remember it the next morning.
Insomnia is difficulty falling asleep. It may be caused by hyperkinesis (hyperactivity) or may be a symptom of an emotional problem.
Sleep apnea occurs when a person stops breathing for short periods of time during his or her regular sleeping hours. Physical defects may be the causative factor, and this condition is not uncommon in individuals who are obese. Typical results of sleep apnea include difficulty staying alert and awake and difficulty with concentration during the regular waking hours.
Eating Disorders
As children develop, their eating behaviors change. Food can take on new meanings in adolescence as a result of family stress or peer pressure.
Education is of prime importance in the care of a young person with an eating disorder. The adolescent needs to understand normal bodily functions and the need for nourishment to sustain these functions. Developing strong rapport with the adolescent is essential for his or her compliance.
Anorexia Nervosa
Most commonly seen in Caucasian, upper-middle-class, female adolescents (although some boys are affected), anorexia nervosa is characterized by extreme weight loss with no underlying physical cause (Box 73-1). Predisposing factors include perfectionist behavior, low self-esteem and, in 40% of the cases, a history of being mildly overweight.
BOX 73-1. Signs and Symptoms of Anorexia Nervosa
???? Extreme weight loss
???? Menstrual irregularities
???? Unexplained amenorrhea
???? Weakness
???? Fatigue
???? Light-headedness
???? Constipation
???? Low blood pressure
???? Bradycardia (slow pulse)
???? Hypokalemia (potassium deficiency)
???? Thinning hair
???? Distorted body image
???? Excessive exercising
???? Low body temperature
???? Dry skin
Anorexia nervosa usually begins with moderate efforts to lose weight and progresses to an obsession with any weight gain, causing severe anxiety. Weight loss reduces anxiety. Hunger is extreme and always present. Affected individuals are obsessed with being thin. They have a distorted body image, seeing themselves as overweight, even after they have become dangerously thin. Anorexia nervosa is a longterm psychological problem, involving complex family relationships.
Severe malnutrition must be treated before long-term counseling can begin. Most severe cases require hospitalization. Life-threatening complications include lowered blood pressure, bradycardia, hypokalemia (low potassium), and congestive heart failure. Death may occur.
Bulimia Nervosa
Bulimia nervosa, known as the ?gorge-purge syndrome,? is an eating disorder characterized by loss of control during overeating followed by purging. As with anorexia nervosa, bulimia is most commonly found in older adolescent and young adult females, although some boys are affected as well.
Typically, affected individuals rapidly eat large amounts of food, usually in secret. Following such binges, they attempt to purge their systems of food through self-induced vomiting or laxative and diuretic use. Recurrent vomiting can cause dental caries, erosion of enamel from the front teeth, and throat irritation from stomach hydrochloric acid. Electrolyte imbalances and even death are possible.
Feelings of guilt and depression are common during binges. Long-term counseling is necessary to overcome the disorder. Bulimic individuals are usually of normal weight or overweight; otherwise they fulfill the other criteria for anorexia nervosa.
Obesity
As assessed by body mass index (BMI), the incidence of overweight or near-overweight American children is around 30%. The trend cuts across all sex, age, racial, and ethnic groups. The most obese children are getting heavier, a risk factor for obese adulthood.
Obesity is defined as being in excess of 20% of optimal weight and can stem from the regular high consumption of calories, particularly from fats, resulting in excess accumulation of fatty tissue. The obese child is most often less active than the leaner child. Heredity is a factor in obesity. Obesity is rarely caused by slow thyroid function.
Obese children endure many psychological effects. Their socialization skills and self-esteem are greatly affected, which may lead to difficulties making friends and building healthy relationships. Treatment consists of diet and exercise with medical supervision, behavior modification, and counseling.
Elimination Disorders
Enuresis (bed wetting) or encopresis (involuntary bowel movement) that continues into the school years with no physical cause requires a physician?s intervention. The cause is often emotional. Counseling or psychiatric assistance, in combination with medications, usually corrects the problem. Sometimes, a meatal stenosis needs to be surgically corrected. Encopresis most often requires intensive psychotherapy. In any event, family caregivers should not shame or belittle the child because such behavior may cause lasting psychological damage.
Behavioral Problems
Although behavioral problems in childhood may have a physical basis, more often the cause is an inability to establish healthy relationships with others. Emotional problems may be manifested by withdrawn or destructive behavior or by bizarre speech. Signs that a child may need professional assistance include an inability to control impulses or behavior, behavior that is very different from others in the same age group, lack of friends, difficulty in learning even though the child tests well, persistent physical symptoms that seem to have no physical basis, and specific deviant behaviors.
During the school-age period, children are spending more time away from home and assume more control over their daily intake of foods. A minimum of 30% of calories should come from fat, with only 10% coming from saturated fats and a 300-mg daily maximum of cholesterol to prevent heart disease. Iron intake is important, especially for girls beginning menses, to prevent iron deficiency anemia.
Middle childhood and adolescence is the time to put nutritional practices into effect that will prevent atherosclerosis, obesity, diabetes, and osteoporosis later in life. School-age children need a nutritious breakfast to prevent hypoglycemia and discomfort due to hunger, which may cause poor concentration and a shorter attention span. The school lunch program is designed to provide nutritious meals that are attractive to children. Advise parents to teach children how to make good food choices and to avoid nonnutritive, high-calorie, high-fat snacks. When introducing new foods at the table, advise parents to offer them one at a time in small servings. Encourage parents to provide a calm, relaxed atmosphere free of conflict at mealtime.
The rapid growth of adolescents is accompanied by increased nutritional requirements and a ravenous appetite. There is an increased need for protein as body mass increases and a need for calcium to promote bone density and prevent future osteoporosis. Peer pressure, commitments to activities, and the availability of fast foods often lead to poor food choices and a deficiency of vegetables, fruits, and milk in the diet.
The diabetic child requires the same nutrients as other children, with consistency in quantity of intake and regularity of mealtime. The diet must be individualized to meet the activity pattern of each child. Whichever method is used to regulate the diet, the regimen of food, insulin, and exercise must be balanced and must meet the requirements for growth and development.
Factors that influence childhood obesity include heredity, peer pressure, inactivity, sociocultural influences, and psychological factors. Obsessed with body image and weight, children often engage in fad diets, thereby depriving their bodies of nutrients essential for health. Encourage the family to implement a healthier, moderately low-fat diet and to engage in regular physical activity. To reduce fat and total calories, a 30% decrease in the previous caloric intake is suggested.
Education should focus on ways good nutrition can promote improved appearance. Nonjudgmental involvement of children in the process of ways to improve their nutrition will have better outcomes.
Special Considerations :LIFESPAN
Compliance with a therapeutic regimen is a problem for children and families, especially when dietary restrictions, frequent monitoring, or daily pharmacologic interventions are essential. The nurse needs to individualize the treatment plan according to the child?s developmental stage and foster the independence of the child in the management and control of chronic diseases. Client education should focus on the prevention of exacerbations and complications of the disease.
KEY POINTS
???? The common cold, sore throat, conjunctivitis, and mononucleosis are common in young adults; typically, they are treated with fluids, rest, and analgesics.
???? Lyme disease can be misdiagnosed because it imitates other disorders. Unless treated, it can cause serious health problems.
???? Acne vulgaris is treatable with topical and systemic medications.
???? Impetigo is highly contagious.
???? The most important aspect of treatment of Legg-Calv?-Perthes disease is maintaining the affected extremity as non-weight-bearing.
???? Scoliosis is more common in girls and must be treated to prevent serious defects related to curvature of the spine.
???? Anorexia nervosa and bulimia, although related to nutrition, are psychological disorders requiring long-term treatment.
???? Juvenile rheumatoid arthritis can lead to deformities, contractures, and impaired movement.
???? Children with IDDM and NIDDM need to monitor medications, diet, and exercise closely.
???? Retinitis pigmentosa is characterized by progressive, bilateral retinal degeneration that causes blindness.
???? Irritable bowel disease in adolescents is seen as Crohn?s disease and CUC.
???? Dysmenorrhea is the most common menstrual complaint of adolescent girls.
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