HEALTH PROBLEMS OF TODDLERS AND PRESCHOOLERS

Question 1

Four Major Types of Child Maltreatment

Answer 1

• Physical Abuse:
• Child neglect:
• Sexual abuse : (difficult to identify- may have no markings)
• Emotional abuse: (difficult to identify)

Question 2

Child Neglect

Answer 2

Neglect is generally defined as the failure of a parent or other person legally responsible for the child’s welfare to provide for the child’s basic needs and a adequate level of care
- Physical neglect : (food, meds, school)
- Emotional neglect:
- Emotional abuse:

Question 3

Child Abuse signs:

Answer 3

• May withdrawal from physical contact with adults
• Little eye contact with adults
• *Inappropriate response to pain
• Fractures in different stages of healing
• Burns on the buttocks, genitals, or sores on feet from immersion in hot liquids (especially in a specific shape)
• Rope burns from being tied
• Human bites
• Burns
• Child may protect abuser from fear of punishment
• Bruises and welts in shapes of objects
• Head injuries- skull and facial fractures

Question 4

Cultural practices

Answer 4

Cupping:
Coining- rubbing skin
- not abusive

Question 5

Recognizing an Abusive Parent

Answer 5

• Under or over concerned about child injury
• *The story doesn’t go along with the symptoms
• *Changes in story, lack of history
• Dependence on the child
• No sensitivity to child
• Requires the child to fulfill their love needs
• Critiques and makes fun of child
• Tendency to punish when child cannot satisfy parents’ demands

Question 6

Who Should Report Child Abuse?

Answer 6

• Anyone that suspects child abuse should report it
• The doctor, nurse, teacher, and social worker report an abusive action under penalty of law
• Call cps or 911
• you can always still report

Question 7

Munchausen Syndrome by Proxy (MSBP)

Answer 7

• Refers to illness that one person fabricates or induces in another person
• Young as neonates and as old as 21 years of age have been seen clinically with factitious illness by proxy

Question 8

Common presentation of MSBP:

Answer 8

• apnea
  — suffocation, drugs, poisoning
• Seizures
  — drugs, poisoning, asphyxiation
• Bleeding
  — adding blood to urine, vomit, etc, opening IV line
• Fevers, blood infection
  — injection of feces, saliva, contaminated water
• Vomiting
  — poisoning with drugs that cause vomiting
• Diarrhea
  — poisoning with laxatives, salt, mineral oil

Question 9

Warning Signs of MSBP:

Answer 9

• unexplained, Prolonged, recurrent, or extremely rare illness
• Discrepancies between clinical findings in history
• *Illness unresponsive to treatment
• *Signs and symptoms occurring on in parents presents
• *Parent knowledgeable about illness, procedures, and treatments
• Parent very interested in interacting with healthcare team members
• Parent, very attentive toward child (refuses to leave hospital)
• *Family members with similar symptoms

Question 10

Plumbism

Answer 10

lead poisoning

Question 11

lead poisoning lab amount=?

Answer 11

> 10mcg/ dl

Question 12

Lead poisoning screening

Answer 12

12-24 months

Question 13

Where is lead stored

Answer 13

brain, kidney, bone marrow, liver, teeth
- Slowly released over time

Question 14

Lead toxicity s/s

Answer 14

• interferes with RBC function- (bone marrow)
• May cause kidney destruction
• Lead encephalitis- (brain)
• Fatigue
• Headache
• Difficulty concentrating
• Hyperactivity- rules out lead toxicity
• Dizziness
• Glucose in Urine
• Ketones in urine
• Protein in urine
• Increased intercranial pressure
• Tissue ischemia
• High exposure: paralysis or death

Question 15

Sources of lead:

Answer 15

• Paint
• pottery
• cookware
• pool cue chalk
• dirt
• lead pipes
• exposure to lead in hobbies or occupations

Question 16

Lead poisoning assessment:

Answer 16

• CBC: RBC count
  — Reveals anemia and basophylic stippling may be apparent on a blood smear. This shows odd striation of basophils
• Serum iron: low
• Blood lead (Pb-B) level: high
  — A child with level between 10-14mcg needs to be retested to confirm levels.
  — *A child over 20Mcg are treated and 45 need hospitalization with treatment- severe toxicity
• BUN, creatinine- elevated
• Urinalysis
• X-ray:
  — Shows lead in the stomach as paint chips and lead lines may be present near the epiphyseal lines of long bones. The thickness of the lines shows the length of time ingestion has occurred.
• Detailed behavioral & environmental history
  — Assessment of where lead is coming from as well as child history of Ingestion’s

Question 17

Pica:

Answer 17

is a condition where a child will eat anything

Question 18

Gingival Lead Line:

Answer 18

Dark line in gums where lead gets stored

Question 19

Lead poisoning Treatment & Nursing Care

Answer 19

• Removal of Child from Lead Sources
• Chelation Therapy: IM inj that binds to lead to be excreted
  — If lead level is 20 mcg/dl or >
  — Severe lead toxicity= 70 or > mcg/dl
  — Assess for hypocalcemia and supplement as necessary
  — Gets rid of lead not s/e
• Assess for hypocalcemia: stored in bone/ replaces calcium in bone

Question 20

Chelation therapy medication’s

Answer 20

• (CDET) Calcium disodium ethylenediamine tetraacetate IM in large muscle mass are painful and may be combined with 0.5 ml of procaine get for 5-7 days, then the rest period, then second round of therapy
• Dime rap roll given with above if over 70mcg it has severe toxicity
• D-penicillamine: given orally after giving EdTA (CDET) for up to 3 to 6 months
• Succimer oral- taken for 19 days
• These agents remove lead from soft tissues and bone, but not from the red blood cells. It is eliminated into the urine.

Question 21

Removal of child from lead sources:
Nursing dx?

Answer 21

• This is difficult and parents have to understand they have to get child out of situation before permanent damage occurs. This may be an economic issue. Then have to block child’s access to windowsills and walls, usually also referred to social worker and home health care, because of need for follow up
• Nursing diagnosis: knowledge deficiency