HEALTH PROBLEMS COMMON IN SCHOOL-AGE CHILDREN
GROUP 1
Abdulkarim, Mardiya
Emmoh, R-jay
Ferrer, Aprylle Angelica
Macasinag, Mary Anne S.
Rico, Prince Reymark
OBJECTIVES
At the end of the discussion, the student nurse will be able to:
1. Define Diabetes Mellitus (DM) and Rheumatic Arthritis (Juvenile Idiopathic
Arthritis, JIA) and differentiate their major types.
2. Describe the underlying pathophysiology of DM and JIA.
3. Identify the common clinical manifestations of DM and JIA in school-age
children.
4. Enumerate and explain the diagnostic tests used for DM and JIA.
5. Discuss the treatment modalities and management strategies for DM and JIA.
6. Recognize the complications associated with DM and JIA and their treatments.
7. Explain essential nursing care interventions for pediatric patients with DM and
JIA.
THE SCHOOL-AGE PERIOD
The school-age period (6–12 years) is characterized by slow physical growth but rapid
cognitive development (Lowe, Godoy, Rhodes, et al., 2013). Children's development
varies widely, requiring assessment of each child's unique needs. Growth during this
period is subtle, with shifting interests and strong peer influence. This stage marks the
onset of independent decision-making, often causing conflicts with parents.
DIABETES MELLITUS
Diabetes mellitus is a long-term condition where the body cannot produce enough insulin
or use it effectively, resulting in high levels of sugar (glucose) in the blood. Insulin is a
hormone that helps move glucose into cells for energy. When this process is disrupted, it
leads to symptoms such as increased thirst, frequent urination, and weight loss.
Types of Diabetes Mellitus
Type 1 Diabetes Mellitus (T1DM)
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Usually develops in children and young adults.
Caused by the immune system attacking the insulin-producing beta cells in the
pancreas.
Results in little to no insulin production, so insulin must be provided from outside
(injections or pump).
Often presents with sudden symptoms like excessive thirst, frequent urination,
weight loss, and fatigue.
Type 2 Diabetes Mellitus (T2DM)
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More common in adults but increasingly seen in children due to obesity and
sedentary lifestyle.
Caused by insulin resistance and sometimes decreased insulin production.
May develop gradually and symptoms may be mild at first.
Often managed with diet, exercise, oral medications, and sometimes insulin.
Pathophysiology of Type 1 DM
1. Immune Attack – The body’s immune system attacks and destroys insulinproducing beta cells.
2. Insulin Deficiency – This results in an absolute deficiency of insulin.
3. Hyperglycemia – Without insulin, glucose accumulates in the blood.
4. Energy Starvation – Cells are starved of energy, leading to fat and protein
breakdown, weight loss, and ketosis.
Pathophysiology of Type 2 DM
1. Insulin Resistance – The body's cells become resistant to insulin.
2. Relative Insulin Deficiency – The pancreas cannot produce enough insulin to
overcome resistance.
3. Increased Glucose Production – The liver releases more glucose into the
bloodstream.
4. Chronic Hyperglycemia – Sustained high blood sugar eventually leads to beta cell
dysfunction.
Risk Factors for Type 1 DM
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5.
Genetic predisposition (family history)
Autoimmune diseases (e.g., thyroid disease, celiac disease)
Environmental triggers (e.g., viral infections like Coxsackievirus, rubella)
Low Vitamin D Levels
Early Cow's Milk Exposure or Short Breastfeeding
Risk Factors for Type 2 DM
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3.
4.
5.
6.
Obesity and Overweight
Lack of Physical Activity
Family History of Diabetes
Unhealthy Eating Habits
High Blood Pressure or Cholesterol
Certain Ethnic Backgrounds (e.g., African American, Hispanic, Asian, Native
American)
Clinical Presentation
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Polyuria
Polydipsia
Polyphagia
Weight Loss (more common in T1DM)
Fatigue
Blurred Vision
Slow Wound Healing
Recurrent Infections
In T1DM: Diabetic Ketoacidosis (DKA) – symptoms include abdominal pain,
nausea, vomiting, fruity breath odor
Complications
Acute:
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Diabetic Ketoacidosis (DKA)
Hypoglycemia
Chronic:
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Retinopathy
Nephropathy
Neuropathy
Cardiovascular Disease
Delayed Physical Development
Diagnostic Tests
Test
Purpose
Normal
Findings
Findings
Fasting Plasma Glucose
Screening/Diagnosis ≥126 mg/dL = diabetes
<100 mg/dL
Oral Glucose Tolerance Test
(OGTT)
Screening/Diagnosis ≥200 mg/dL (2-hr)
<140 mg/dL
Random Plasma Glucose (RPG) Screening
≥200 mg/dL w/
symptoms
-
HbA1c
≥6.5% = diabetes
<5.7%
Long-term control
Test
Purpose
Findings
Normal
Findings
C-Peptide
Distinguish T1 vs T2 Low in T1, high in T2
0.5–2.0 ng/mL
Autoantibody Testing
Identify T1DM
Positive in T1
Negative
Urine Ketones/Glucose
Supportive
evidence
Often positive in T1
Negative
Genetic Testing
Rare/atypical cases
HLA-DR3/DR4 or MODY
genes
No risk alleles
Lipid Profile
Metabolic risk
Often abnormal in T2
Normal lipid
levels
Medical Management
Type 1 Diabetes
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Insulin Therapy
Glucose Monitoring
Diet and Exercise
Education and Support
Type 2 Diabetes
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Lifestyle Modifications
Oral Hypoglycemic Agents:
o Metformin (first-line)
o Sulfonylureas
o DPP-4 inhibitors
o SGLT2 inhibitors
o GLP-1 receptor agonists
For Both Types
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Management of comorbidities
Complication prevention
Ongoing patient education
Top 3 Nursing Diagnoses
1. Ineffective Health Management (00078)
Related to: complex regimen, lack of knowledge, insufficient resources
As evidenced by: elevated glucose, difficulty managing regimen
2. Risk for Unstable Blood Glucose Level (00179)
Related to: poor adherence, inconsistent monitoring, inactivity
3. Risk for Infection (00004)
Related to: hyperglycemia, poor circulation, invasive procedures
Nursing Management for DM
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Monitor Blood Glucose Levels
Administer Medications
Promote Effective Health Management
Prevent Infection
Encourage Lifestyle Modifications
Monitor for and Manage Complications
Provide Emotional and Psychosocial Support
RHEUMATIC ARTHRITIS
HEALTH PROBLEM COMMON IN SCHOOL AGE CHILDREN
Presented By : Group 1
RHEUMATIC ARTHRITIS
Rheumatic arthritis, also known as rheumatoid arthritis (RA), is a chronic, systemic
autoimmune disease characterized by persistent inflammation of the synovial joints,
leading to joint swelling, pain, stiffness, and potential joint destruction. It commonly
affects multiple joints symmetrically and may also involve extra-articular organs such as
the lungs, heart, and eyes.
RHEUMATOID ARTHRITIS IN SCHOOL-AGE CHILDREN
In children, rheumatoid arthritis is called Juvenile Idiopathic Arthritis (JIA) (also known
as juvenile rheumatoid arthritis or juvenile chronic arthritis).
JIA is a chronic autoimmune inflammatory disease characterized by persistent joint
inflammation (synovitis) leading to pain, swelling, and potential joint damage. It typically
presents before age 16 and lasts for at least 6 weeks. The disease can affect one or
multiple joints and may involve systemic features such as fever, rash, and organ
involvement.
TYPES OF JIA
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Oligoarticular JIA
Polyarticular JIA
Systemic JIA
Enthesitis-related arthritis
Psoriatic arthritis
Undifferentiated arthritis
PATHOPHYSIOLOGY OF JUVENILE IDIOPATHIC ARTHRITIS (JIA)
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Chronic Synovial Inflammation (Synovitis)
Pannus Formation
Joint Damage
Systemic Involvement
Growth Disturbances
RISK FACTORS FOR JIA
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Genetic predisposition
Female sex
Environmental triggers
Age at onset
HLA gene association
Ethnicity
CLINICAL PRESENTATION OF JIA
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Joint swelling, warmth, and tenderness
Morning stiffness
Reduced joint range of motion
Limping
Systemic symptoms
Fatigue and malaise
Growth disturbances
Eye involvement
COMPLICATIONS
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6.
7.
Chronic Joint Damage and Deformity
Growth Disturbances
Uveitis (Chronic Anterior)
Osteoporosis
Functional Impairment
Systemic Complications
Psychosocial Impact
DIAGNOSTIC TESTS FOR JIA
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Blood Tests: ESR, CRP, ANA, RF, Anti-CCP, HLA-B27
Joint Imaging: X-ray, MRI, Ultrasound
Eye Exam: Slit-lamp exam
MEDICAL MANAGEMENT OF JIA
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NSAIDs
DMARDs
Biologic Agents
Corticosteroids
Physical and Occupational Therapy
Regular Ophthalmologic Exams
TOP 3 NURSING DIAGNOSES (NANDA)
1. Impaired Physical Mobility
2. Chronic Pain
3. Risk for Injury
NURSING MANAGEMENT FOR JIA
Pain Management
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Assess and treat pain
Use of heat therapy
Teach relaxation techniques
Promote Mobility and Joint Function
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Assist with exercises
Encourage gentle physical activity
Educate on avoiding immobility
Prevent and Monitor for Complications
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Regular eye exams
Monitor infection, growth, and skin integrity
Administer Medications and Monitor Effects
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Administer DMARDs
Monitor for side effects
Educate on adherence
Promote Nutrition and Hydration
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Encourage balanced diet
Monitor weight
Educate on medication side effects
Psychosocial Support
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Support coping
Encourage emotional expression
Involve family and school
Health Education and Family Support
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Emphasize follow-up
Teach joint protection and energy conservation
Share support resources