Exam 3 Flashcards
How many pounds does a toddler gain per year?
4-6 lbs/yr, avg weight of a 2 y/o is 26.5 lbs; weight quadruples by 2.5 yrs
A toddler grows how many inches per year?
3 in/yr, growing in the legs rather than the trunk; general height an adult is twice the height of a 2 y/o
Fontanel closes by how many mo?
18mo
Brain growth is ____% complete by 2 y/o
75%
Vision of a toddler
Is 20/40, depth perception is still developing
Respiratory rate
24-30 resp/min
What type of breathing does a toddler do?
Abdominal breathing
Heart rate
80-100 bpm
Renal system
Increased functioning, not as easily dehydrated
Ear
Ear infections and URI are common; still short and straight, lymph nodes, adenoids, and tonsils large
Gross motor skills 12-15mo
Walk alone using wide stance, creeps up stairs on all 4s, throws ball with falling
Gross motor skills 18mo
Runs, falls easily, throws ball without falling
Gross motor skills 24mo
Can go up/down stairs with both feet, runs better, kicks ball
Gross motor skills 30mo
Jumps with both feet, can stand on 1 foot briefly
Fine motor skills 12-15mo
Builds tower of 2 blocks, scribbles with large crayon, uses cup well, rotates spoon
Fine motor skills 18mo
Builds tower of 3-4 blocks, turns 2-3 pages at a time, handles spoon without rotation
Fine motor skills 24mo
Builds tower of 6-7 blocks, turns 1 page at a time, turns door knob, unscrews lid, draws vertical/circular
Fine motor skills 30mo
Builds tower of 8 blocks, holds crayon, draws horizontal/cross
Psychosocial development of a toddler
Need for basic trust is satisfied, ready to give up dependence for control, independence, and autonomy
Erikson for toddlers
Sense of autonomy while overcoming sense of doubt and shame
- Trust in predictability and reliability of others; “holding on and letting go”
- Tolerate delayed gratification–understand when something is “forthcoming”
*Forthcoming: if you are good this week, we will go to the zoo; your birthday is this weekend
- Social modality of holding on and letting go– throwing objects and spitting food; using their hands, mouth, eyes, and sphincters (exploring boxes and cabinets)
- Ritualism and routines, increased security, reliability
- Awareness of no one will, success and failure, which in return causes doubt
Negativism
“No-no”, understands both saying/comprehending, mood swings
Language development of 12-15mo
4-6 words, “no-no” frequent
- One word sentences, 25% language intellegentable
Language development of 16-18mo
10 words, name 2-3 body parts (head, nose, bellybutton)
Language development of 19-24mo
300 words, 2-3 word phrases (refers to themselves by first name, talking incessantly)
- Multiword sentences, phrases, 65% speech understandable
Language development of 36mo
Gives first and last name, 1 color, 1000 words
Parallel play
When 2+ toddlers play near one another, without interacting directly
- Helps to develop social boundaries and sharing
Signs of readiness for toilet training
1) Awareness of urge
2) Interest/motivation to use the toilet
3) Dry for at least 2hrs
Toilet training
- Bowel before bladder
- Bladder control at night begins 4yrs for girls and 5yrs for boys
- May need reminding
- Face the toilet
- Emphasize pants/panties
- Positive reinforcement, avoid negative
- Hand washing
At what age does there need to be intervention if they are not dry during the day?
6yrs
Stress in toddlers
Common to regress with increased stress of hospital
- Don’t force child to live up to expected standards, try to ignore it
- Offer security object
- Allow parents to be present
- Choices
- BandAids
- Procedures in the treatment room
- Simple terminology
Regressing
Moving back on milestones the toddler has already achieved; can make the parents upset
Nutrition for 12-18mo
- Growth rate slows, still need sufficient calories/protein/calcium/fluids
- 3 meals, 2 snacks per day
- May take multivitamin
- 1/4-1/3 adult portions (3 y/o can have 3 tbsp of mashed potatoes)
- 24-48oz milk, 4-6oz juice limit
Nutrition for 18mo
Physiologic anorexia
- As long as they are gaining weight steadily, they are fine
- What food they are consuming, try and make it healthy
- Timing, length of meal, quality v quantity, routine, ritualism (same meal, same dishes, etc.)
Physiologic anorexia
Decreased nutritional need, decreased appetite–picky, fussy, strong taste preference
When should a child’s first dentist visit be?
6-12mo (when first teeth are coming in and introduction of solids)
Dental health
- Parents brush child’s teeth; soft/nylon bristles, and floss after meals and at bedtime
- 6-8 strokes per section
- Can use toothpaste after 2y/o
- Frequent eating of sugar is worse than a large amount
Bottle caries
Broken down gum line
- 18mo-3y/o routinely giving bottle or juice before bed
How to prevent bottle caries
Eliminate bottle before bed completely, substitute bottle or juice for water, don’t use bottle as pacifier, and never coat pacifier with sweet substances
Burns
Extent of tissue destructed by heat source, duration of contact/exposure, conductivity of tissue involved, rate of heat energy dissipated by skin
Hot water scalds
Common in toddlers
- High temperature water (bathtub or pulling a pan off the stove)
Flame-related
Common in older children
- One of the most fatal burns
- Flame-abuse: 10-25%, playing with matches and lighters
TBSA (total burn surface area)
% surface burned, depth of burn
- 10% TBSA = life threatening
Thermal burn
Flame, hot surface, hot liquid
Electrical burn
Outlets, sucking on cords (path of electricity through the organs)
Chemical burn
Cleaning agents
Radioactive burn
Swallowed battery
Rule of Nines
The trunk, genitals, arms, and legs add up fast to be 10%, which is considered fatal burn wound
Emergency burn treatment
- Assess condition
- CABs (circulation, airway, breathing) first
- Stop burning process
- Minor–cool water, no ice
- Major–no water or ice
- Chemical burns–continuous water flush
- Remove all clothing and jewelry
- Cover burn, no ointments
- Provide reassurance
- Hospital: O2 PRN, IVs, NPO
Minor burn treatment
- Airway maintenance (if trauma to head/neck/chest = intubate)
- Pain meds/antipyretic
- Clean and debride
- Don’t break blisters, unless it’s a chemical burn
- May use abx ointment and dressing (occlusive dressing = hydrocolloid)
- Assess for secondary infection
Major burn treatment
- Fluid replacement–compensate for water/Na+ loss, fluid shifts to interstitial spaces = possible hypovolemic shock
- Balance Na+ level, restore circulating volume, perfusion, renal function, correct acidosis
First 24hr after major burn
- High IV rates (pound fluids)
- Urine 1mL/kg/hr–make sure kidneys are still working, can control BP/shock, fluid balance, filter blood
- Crystalloids: LR, NS (hydrate) first 24hr; after 24hr, Colloids: albumin and blood (build)
- Meds: ATBs PRN, morphine, versed (sedation), fentanyl, atarax, Benadryl (itching/irritation)
Nutrition after a major burn
- Hyperglycemia (D5/10 with hydration can cause)
- High protein, calories (regenerate skin, heat mechanism, dehydrate)
- Tube feedings/TPN
- Vitamin A, C, zinc
Management of a burn wound
- Prevent infection, remove dead tissue, close wound
- Debridement ASAP when stable
- Hydrotherapy 20min BID (cleans, loosens dead sin, easier to debride)
- Topicals: Silver sulfadiazine 1%
Homograph (cadavers)
For deep and partial-thickness burns, and extensive burns
Xenografts (pigs)
Superficial burns, pain control while healing; dressing is changed q2-3d, good for partial-thickness burns and scalds of hands/face
Synthetic skin coverings
Management of partial-thickness burns and donor sites
Sheet graft (whole piece of skin)
Sheet of skin removed from donor and placed on recipient and sutured in place, often used for the face
Mesh graft (tiny holes in skin to cover a large area)
Removed from donor and tiny slits are made before placing on recipient
Nursing diagnosis for a burn wound
Pain, infection, fluid volume deficit, altered tissue perfusion, impaired mobility, nutrition, less than body requirements
- Assess for infection or sepsis 48-72hr post-burn (fever, paralytic ileus, temp. drop)
- Family, patient support and prevention
UTI
Bacteriuria, a/symptomatic, recurrent/persistent/febrile UTI, cystitis, urethritis, pyelonephritis, urosepsis
UTI assessment
Fever, poor feedings, fail to gain weight, thirst, diaper rash, pyuria
UTI diagnosis
Urine sample–common cross contamination methods: cotton ball in diaper, cup, hat, bag
Gold standard and most accurate: straight cath
Treatment for UTI
- Sulfa (Bacterium): good for kids, not many allergies
- Cephalo (Rocephin or Augmentin)
Nursing care for UTI
Fluids, frequent voiding, correct wiping (front to back), cotton pants, cranberry juice
Celiac disease
A malabsorption syndrome and autoimmune disorder; “gluten-induced enteropathy”, disease of the proximal small intestine with abnormal mucosa and permanent intolerance to gluten (wheat, rye, barley, oats)
Incidence of celiac disease
1% of people, most often European and Mediterranean
- Boys = girls
- Children with unexplained iron deficiency anemia, recurrent stomatitis, dental enamel defects, type 1 DM, Downs, selective immunoglobulin A def, autoimmune thyroid, Turners, Williams
Etiology of celiacs disease
Unknown; has familial/genetic and environmental factors, immunologically mediated small intestine enteropathy
Pathophysiology of celiac disease
Intolerance to the protein of gluten resulting in accumulation of toxic substances that causes villous atrophy and damages mucosal cells of the small intestine
- When body cannot digest gluten, there is an accumulation of toxic substances that damages the mucosa
Diagnosis of celiac disease
- Blood test: tissue transglutaminase and anti-endomysial antibodies if >18mo, + serologic markers
- UGI with biopsy of small intestine with characteristic changes of mucosal inflammation, crypt hyperplasia, and villous atrophy
Assessment of celiac disease
- Usually seen in younger children (1-5 y/o) when table diet begins, it can take mo to see s/s after introduction of gluten
- Failure to thrive, anorexia, altered LOC
- Abdominal distention, diarrhea, steatorrhea (large, pale, frothy, oily, foul-smelling stools)
-Crisis: acute, severe N/V/D, following an infection, with dehydration
Treatment of celiac disease
Dietary management–NO GLUTEN, sub with corn/rice
- Gluten may be in “hydrolyzed vegetable protein”, which is added to many foods
- May have lactose intolerance
- Specific deficiencies treated with supplements: iron, folic acid, fat-soluble vitamins
Nursing care of celiac disease
- Check grieving process
- Teach diet to prevent relapse: high in calorie and protein, simple carbs (fruits and veggies), low fat
~Inflamed bowel form pathologic process in absorption, avoid high fiber (raisins, nuts, raw fruits/veg)–poss. lactose-free if mucosa damage
~Gluten in foods for children, may be financial burden - Correct dehydration PRN
Croup syndromes
Generalized term applied to a syndrome complex characterized by hoarseness, resonate cough “barking” or “brassy”, inspiratory stridor (swelling), and respiratory distress
- Involves larynx area (epiglottis, glottis, trachea, and bronchi)
- Tends to be viral–H. influenzae type B, influenza, adenovirus, RSV, measles
- Common in toddlers, especially at night
- Can be medical emergency due to narrowed airways causing obstruction
- “Croup score” (0-15); dependent on stridor, retractions, air entry, color, LOC
- Nursing diagnosis: risk of suffocation
Epiglottitis
Medical emergency that requires emergency treatment–serious obstructive inflammatory process
Etiology of epiglottitis
H. flu, noninfectious is caused by smoke inhalation or foreign bodies
Incidence of epiglottitis
More boys than girls; late fall, early winter
Pathophysiology of epiglottitis
Sub-epiglottic swelling, possible URI prior, RAPID ONSET
Assessment of epiglottitis
Child will go to bed asymptomatic to awaken with sore throat and pain on swallowing, fever, and appears sicker than clinical findings
- Drooling, agitated, absence of cough
- Tripod position, tachycardia, tachypnea
- High fever, sore throat, dysphasia
- Stridor, coarse, retractions, pallor-cyanosis, and red/edematous epiglottis
Nursing care for epiglottitis
- Keep baby QUIET, DO NOT LOOK IN THROAT (laryngospasm)
- Cont. monitoring of respiratory status: O2 with increased humidity, elevate HOB 90*, pulse ox, blood gasses (if intubated), trach tray bedside
- Droplet isolation
- Meds: Ampicillin, Rocephin STAT, racemic epi, steroids
- Decrease temp, IVs
- Keep parents calm
Laryngotracheobronchitis (LTB)
Most common croup syndrome
Etiology of LTB
Parainfluenza, RSV, influenza A&B, mycoplasma pneumoniae
- Preceded with URI, then gradually descends to adjacent structures
Assessment of LTB
Gradual onset, with low-grade fever, usually goes to bed and wakes up with “barky” cough
- Stridor, then increased swelling of airway, dyspnea, retractions
- Diminished lung sounds, lower lobes first
- Irritable, pale/cyanotic (nasal flaring, intercostal retractions, tachypnea, cont. stridor)– unable to get air in
- Hypoxia, respiratory acidosis, then respiratory failure
Treatment of LTB
- Hospital: cool mist or croup tent
- Home: cool mist, open fridge, outside if cold, ride in car with windows down *anything to CONSTRICT blood vessels
- Meds: nebulized racemic epi for severe cases (mucosal vasoconstriction and decrease sub-epiglottic edema), Dexamethasone/Decadron (steroids)
- Mix O2 with helium (Heliox) to have lower density air to breathe
Nursing care for LTB
- NPO if increased stress/respiratory distress (RR >66 hold feedings)
- IVs and small freq feedings when tolerated
- Trach table bedside
Acute spasmodic laryngitis
Recurrent paroxysmal attacks of laryngeal obstruction that occur chiefly at night
Etiology of acute spasmodic laryngitis
Usually viral, least serious
Pathophysiology of acute spasmodic laryngitis
Inflammation of larynx “midnight croup”
- Paroxysmal attacks, usually at night, URI prior to onset
Assessment of acute spasmodic laryngitis
Child goes to bed well and suddenly awakens with barky cough, mild retractions, noisy inspirations with no fever in the morning, hoarse coughing at night
- Child appears anxious and restless
- Episode subsides in a few hours, child seems will next day, other than hoarseness
Treatment of acute spasmodic laryngitis
High humidity, cool mist, spasms–cold air
- Rest, possible steroids, racemic epi
Cystic fibrosis
Condition characterized by exocrine (mucus producing glands) gland dysfunction that produces multisystem involvement, especially in the pulmonary and digestive system (impermiability of epithelial cells to chloride causing malabsorption syndrome)
Pathophysiology of cystic fibrosis
- Hereditary: autosomal recessive trait (from both parents 1:4)
- White, male = female
- Increased sweat electrolytes (chloride), increased viscosity of mucus glands, especially in the pancreas and lungs
- Earliest sign–newborn: blocked with thick meconium stool
Chromosome #7 and cystic fibrosis
Defective protein product “cystic fibrosis transmembrane regulator” (CFTR); that decreases chloride secretion and increased sodium absorption results in thick secretions mostly to the pancreas and lungs
- Instead of forming a thin, freely flowing secretion, the mucus glands produce a thick mucoprotein that accumulates and dilates them
- Small pathways (pancreas/bronchioles) become blocked as secretions coagulates
Cystic fibrosis in pancreas
- Decreased pancreatic secretion of bicarb and chloride in sweat
- Thick secretions blocks ducts = degenerates tissues (pancreatic fibrosis caused by cystic dilation of acini) = prevents enzymes from reaching duodenum = impaired digestion and absorption of nutrients (especially fat and protein) = intestinal obstruction/impacted stool (bulky stools, frothy from undigested fat and foul-smelling putrefied protein) = prolapsed rectum
- May also develop diabetes when sick (pancreatic structural changes)
Cystic fibrosis in liver
Focal biliary obstruction and fibrosis, which may develop into cirrhosis; possible liver to have fatty infiltration and regeneration, gallbladder may also have mucus blockage
Cystic fibrosis in lungs
- Increased viscosity makes thick secretions = less ciliary action to move mucus = difficult to expectorate thick mucus (bronchiectasis, atelectasis, hyperinflation) = stagnant mucus increases medium for bacterial growth = frequent infections cause scar tissue–less elastic, less way to exchange gas
- Decrease gas exchange, decreased PaCO2, increased CO2
Cystic fibrosis in reproductive
- Many males infertile–blocked ducts, decreased sperm
- Females infertile with mucus blocking cervix = not sperm entry
- Late development in both males and females
Assessment for cystic fibrosis
- Meconium ileus: newborn no stool, vomiting, dehydration, abdominal distention
- Failure to thrive, delayed growth
- Chronic sinusitis, nasal congestion
- Freq develop MRSA
- Hemoptysis (scarring of the lungs) later on
Assessment for cystic fibrosis in GI
- Increased appetite (early), decreased appetite (later)
- Large/frothy/bulky/foul-smelling stools
- Weight loss, tissue wasting, thin extremities
- Anemia
- Possible diabetes
Assessment for cystic fibrosis in pulmonary
- Beginning: wheezy respirations, dry, nonproductive cough
- Eventually: increased dyspnea, paroxysmal cough, obstructive emphysema and patchy atelectasis
- Productive: over-inflated, barrel chest (COPD), cyanosis, clubbing fingers/toes, bronchitis/bronchopneumonia
Diagnosis of cystic fibrosis
- All newborns are screened via blood test–immunoreactive trypsinogen (IRT), with DNA mutations
- History (CFTR gene)
- Sweat test–high levels of sodium and chloride (“salty taste”)
- Absence of pancreatic enzymes
- Respiratory difficulties–CXR patchy atelectasis and obstructive emphysema & PFT (pulmonary function test) sensitive indices lung function; abnormally small airway
What mEq in a sweat test determines CF?
<40 mEq to be negative; >60 mEq for positive
Treatment for cystic fibrosis
Prevent and minimize pulmonary complications, ensure adequate nutrition for growth, encourage appropriate physical activity, promote reasonable QOL for family and patient
Respiratory treatment for cystic fibrosis
Airway clearance therapy (ACT)– percussion and postural drainage, positive expiratory therapy (PEP), to breathe out with force through a device to loosen mucus to let air through airways (PEP valves, flutters, and acapellas)
- Exercise and breathing techniques
- Bronchodilators to open airways before/during ACTs
- Nebulized hypertonic saline improve airway hydration and increased mucus clearance
- Aerosolized Tobramycin can be used for pulmonary infections after ACT treatment
- Oxygen therapy
- Lung transplant
GI treatment for cystic fibrosis
Pancreatic enzyme replacement administered with meals and snacks; enzyme dosage is dependent on growth of patient and taken within 30min of eating– 10,000units of lipase/kg/day
- Well balanced, high protein, high calorie diet, increased carbs (110-200% increased)
- Multivitamins, vitamin E, K (liver clotting), A
- Antibiotics: Tobramycin, Ticar, Gentamicin, Piperacillin
- Steroids: Pomoenzyme given per RT (decreases mucus viscosity)
Nursing diagnosis for cystic fibrosis
Ineffective airway clearance, impaired gas exchange, altered nutrition, less than body requirements, activity intolerance
Nursing care for cystic fibrosis
- Assess lung sounds freq–observe cough, evidence of decreased activity/fatigue
- Observe freq and nature of stools and abdominal distention
Hospital: aerosol therapy, chest percussion, and postural drainage, daily weight; ACTs as normal with mechanical vest and breathing exercises *before eating; assess: respiratory pattern, work of breathing, auscultation, pulse ox, supplemental O2 PRN, watch for constipation - Encourage well-balanced diet: calcium, protein, carbs, calories, unrestricted fat, encourage fluids
- Freq steroids can cause osteoporosis
- Isolate from infected children, hand washing
- Allow venting having a terminal illness (med. life exp. 36.8 y/o)
Kawasaki’s disease
Acute, febrile, systemic vasculitis of unknown cause
Incidence of Kawasaki’s disease
Peaks in toddlers, more common in males, without treatments there is a 20-25% change to develop heart problems (coronary artery disease or aneurysm), can be resolved within 6-8wk
- Thought to be a trigger in genetically susceptible host
Pathophysiology of Kawasaki’s disease
- Initial stage: inflammation of arterioles, venules, and capillaries; dilation of coronary arteries with damage and possible coronary artery aneurysm
- Thrombocytosis with hypercoaguability within 3wks of fever
- Damaged vessels can enlarge up to 4-6wks
Death from Kawasaki’s disease
Usually due to blood clot, severe scar formation, or myocardial infarction
Diagnosis symptoms for Kawasaki’s disease
- Fever >5 days (unresponsive to antipyretics and antibiotics)
- Bilateral conjunctival infection with no exudates
- Oral membranes red, dry, “STRAWBERRY TONGUE”
- Edema of palms/soles, peeling of hands/feet
- Cervical lymphadenopathy–usually on 1 side
May have rash, (polymorphous), mostly found in perineal area; may develop arthritis, myocarditis, also very irritable
Diagnosis assessment for Kawasaki’s disease
Elevated WBCs (immature WBC “shift to left”), elevated liver function tests, and elevated inflammation markers (ESR (sed rate) and CRP (C-reactive protein)), anemia
- Echo shows enlarged coronary artery by day 7
Treatment of Kawasaki’s disease
- IV gamma globulin 2g/kg over 8-12hrs with salicylates (ASA) 100mg/kg/day given q6hr, then 3-5mg/kg after fever is gone for 6-8wks *ONLY TIME WE GIVE ASPIRIN
- Plavix, Coumadin, Lovenox
Nursing interventions for Kawasaki’s disease
Monitor cardiac status: I/O, daily weight, careful not to overload fluids
- Check for HF (decreased urinary output, gallop rhythm, tachycardia, respiratory distress)
Mouth care, quiet environment
- Decrease irritation (treating the symptomatic symptoms)
- No immunizations (MMR/varicella) *LIVE VAX during illness to keep immune system strong (globulins decrease antibodies)
- Watch s/s of aspirin overdose: ringing in ears, headache, dizziness, confusion
3yr physical
- Potty trained
- Gain 2-3kg/yr
- Grow 2.5-3.5 in/yr
3yr gross motor
- Tricycle
- Broad jumping
- Upstairs alternating feet; downstairs with both feet
3yr fine motor
- Small objects through narrow opening
- Draws circle with face, not just stick figure
- Builds tower with 9-10 blocks
3yr language
- 900 words
- Talks to self incessantly
- Sentences with 6 syllables
3yr social
- Almost dresses self fully
- Knows own gender
- Can almost set table
- Starts associative play
4yr physical
- Slight decrease in pulse/resp
- Longer legs
4yr gross motor
- Hops on 1 foot
- Downstairs with alternating feet
- Catches ball well
4yr fine motor
- Uses scissors
- Laces shoes without bow
- Draws square, cross, and diamond
- Stick people with 3 parts
4yr language
- 1500 words
- Asks questions
- Tells exaggerated stories
- Few colors
- Sentence with 4-5 words
4yr social
- Very aggressive
- Shows off imaginary playmates
- Sex curiosity
- Sibling jealousy
5yr physical
- Slight decrease in pulse/resp
- Slight increase in systolic BP
- Permanent teeth
5yr gross motor
- Skips/hops
- Walks backwards
- Jumps rope
- Throws ball well
5yr fine motor
- Toes shoelaces
- Uses pencil well
- Draw triangle
- Draws man 7-9 parts
- Prints few letters
5yr language
- 2100 words (colors, days, coins)
- Asks meaning of words
- Sentences with >4-5 words
5yr social
- Less rebellious, more responsive
- Decreased fears
- Independent ADLs
- Group conformity
- Identifies with same sex parents
Erikson preschool
Initiative vs guilt
Initiative vs guilt
Energetic learning, sense of accomplishment vs inappropriate behavior–they feel guilt when they have inappropriate behavior
- Rivalry with same sex parent, may wish them harm
- Clarify that wishes don’t make things occur (strong imagination)
- Understands rules, but not why they are in place
Body image
- Aware of differences (race, ethnicity, pretty, ugly, big, small) by age 5
- Poorly defined body boundaries–not understanding that when someone draws blood that it’ll replenish
- Afraid of disrupting skin integrity; love BandAids to cover imperfections
Play for preschool
Provides social, mental, and physical development
- Associative: little organization or rules
- Imitative play, imaginative, and dramatic (dress-up, housekeeping, play store, etc.)3y
Play for preschool
Provides social, mental, and physical development
- Associative: little organization or rules
- Imitative play, imaginative, and dramatic (dress-up, housekeeping, play store, etc.)3y
3yr play
Tricycle, outdoor play, runs/jumps/climbs, construction sets (easy), large puzzles, dress-up 4
4yr play
Big wheels, doctor kits, ball games, skates, trains, play dough, paints, dress-up/role play
5yr play
Organized sports, flashcards, decreased make believe with increased reality, cooking, carpentry
Spiritual development in preschool
- Begins with development of a spiritual sense–prayers, mass, etc.
- Understanding influenced by increased cognitive abilities
- Right v wrong to avoid punishment (views hospital as a punishment)–will lie to avoid punishment
Fears of preschoolers
Dark
- Especially at bedtime with monsters (increased cognitive = increased fears)
- Logical persuasion: looking under bed together for monsters before going to bed
- Use a nightlight or favorite toy, quiet time, ritual at bedtime
- Stay in own bed, don’t ridicule, instead work with them and reassure them
Stress and aggression in preschool
Susceptible to stress due to lack of ability to cope, inability to express self correctly, parents must watch for s/s of stress and treat asap
- Stressors: birth of siblings, marital discord, separation and divorce, relocation, or illness
Best approach to handle stress
Prevention and monitoring level of stress in child’s life so it doesn’t exceed their coping ability
- Stress is carried in their bellies, stomach pain/nausea in children often don’t have a specific cause
Aggression
Behavior that attempts to hurt themselves/others or property
- Frustration leads to acting out (males)–children will displace anger, children who are fine at home may have discipline problems at school
- Modeling/imitating behavior of significant others (verbally/physically abusive): TV and video games
- Reinforcement can shape aggressive behavior: rewarding for aggression is negative (punishment) yet reinforcing, because it brings attention (children who are ignored until they hit a sibling)
Nutrition of preschooler
- Obesity is becoming a big challenge
- Should be eating 1/2 adult portion to maintain weight
5-2-0-1 framework
- 5 servings of fruits/veg
- 2 hours or less of media/TV screen time
- 0 servings of sugar
- 1 hour of physical activity
Child maltreatment
Physical abuse/neglect, emotional abuse/neglect, sexual abuse
Child maltreatment risk factors
POVERTY, poor parenting, possible lack of education, premature birth, parents abused as children, NONFAMILIAL CAREGIVER, chronic disability, POOR PARENTING ROLE MODLES, parent drug/alcohol abuse, social isolation, single parents
Neglect
Most common form; depriving of necessities–food, clothing, shelter, supervision, medical care, education
Physical neglect
Not taking care of daily needs
Emotional neglect
Not giving emotional support such as affection, attention (hard to prove to take child)
Emotional abuse
Deliberate attempt to destroy or significantly impair a child’s self-esteem or competence–rejection, isolation, terrorizing, ignoring, corrupting, verbally assaulting, overly pressuring
Emotional abuse
Deliberate attempt to destroy or significantly impair a child’s self-esteem or competence–rejection, isolation, terrorizing, ignoring, corrupting, verbally assaulting, overly pressuring
Physical abuse
Deliberate infliction of physical injury (bruising to brain injury)
Predisposing parental factors for physical abuse
Young parents, having live-in boy/girlfriend, low income, low education, substance abuse, poor parental role models, abused previously
Predisposing child factors for physical abuse
NOT THEIR FAULT, physical demands of children, unwanted children, premature infant, hyperactivity
Environmental characteristics for physical abuse
Chronic stress, divorce, poverty, unemployment, frequent moving, poor housing, substance abuse in the house
Abusive head trauma
Shaken baby, inflicted head injury, neuro-inflicted brain injury
- Often caregivers frustrated with persistent crying, stress, or depression
Shaken baby syndrome
Violent shaking, causing head trauma
- Caused by frustration of caregivers from child crying/fussiness
Shaken baby syndrome pathophysiology
Infants have large heads with large amount of water in the brain
- Violent shaking causes the brain to shear the skull, resulting in shearing forces that tear blood vessels and neurons
- Injuries as a result are intracranial bleeding (subdural, subarachnoid hematomas)
- 80% are retinal hemorrhages (retinal detachment)
Clinical manifestations of shaken baby syndrome
Flu-like s/s (N/V, altered LOC) or total unresponsiveness (seizures, apnea, bradycardia)
- Complications: seizures, blindness, hearing loss, developmental delays
Shaken baby syndrome prevention
Teach caregivers techniques to relive stress before it gets to that point, ask for help
Munchausen syndrome by proxy (MSP)
Illness that one person fabricates on another person, deliberately causing or falsifying histories and symptoms, or inducing symptoms
- Child may develop chronic invalidism or long lasting psych problems
Most common method and s/s of MSP
Poisoning–overdose on medications or poisoning food
- S/S: N/V/D, altered LOC
Assessment of MSP
- Is the child’s condition consistent with the facts?
- Do the tests match the reported history?
- Has anyone else witnessed the symptoms?
- Is the treatment provided primarily because of the caregiver’s demands?
Sexual abuse
Incest, molestation, exhibitionism, child porn, child prostitutes, pedophelia, sex trafficking
- Most often a person the child knows– 80% adults, others are adolescents/preadolescents, most are family members
- May be a parent, step-parent, sibling, teacher, coach
Nursing care for sexual abuse
- Assess, but be aware of own bias; remain nonjudgemental
- ALWAYS BELIEVE CHILD
- Assess warning signs of abuse
- Preventing and dealing with sexual abuse of children
- Support child: same nurses to develop trusting relationship, find alternative ways to handle stress (drawing, music, talking, 3rd person techniques), family members needed to support and help child cope
