Toddler
What are the biological changes you expect to see in a toddler (12-36m)?
-bonus content:
What is rapprochement?
-physical growth slows
-birthweight 4x by 2.5 years old
- "potbellied" r/t abdominal musculature, short legs
- Fall a lot
-senses are well developed and used to explore
Rapprochement: toddler moves away and returns for reassurance
Biological changes in preschoolers (3-5y)
growth slows and stablizes
avg weight gain is 4.5-6.5 per year
slender sturdy build
most are toilet trained by now
good posture, appropriate exercise, and adequate nutrition are important at this age
Rubeola:
Precautions and transmission?
Precautions: Airborne
Transmission: Direct contact with droplets
Scarlet fever rash will be what and where?
red pinpoint lesions, more in joint folds, ABSENT ON FACE
Measles
Teach parents supportive management for fever and discomfort
use dimly lit room or sunglasses for photophobia
Use cool mist vaporizer, encourage fluids and soft bland foods
keep skin clean and dry
What is a good rule of thumb for toddler nutrition?
1 Tbsp per year of age
Quality over quantity
spoon by 18m
Cows milk should be 16-24 oz/day, too much l/t constipation, anemia, decrease intake of nutritious foods
airway is same size as pinky
no more than 4oz of juice and diluted with water
Magical thinking for preschooler: what it is and where might it get into trouble?
It is the egocentric though that their thoughts are all powerful.
It causes a problem because they feel responsible or guilty for their thoughts if they coincide with the occurrence of a wished event
which leads them to thinking they are bad
As nurses rephrase that to "you didn't do something bad" or "that was a bad thing to do" and not letting them think they are a "bad person"
Scarlet fever: Transmission and precautions?
Transmission: Direct contact, droplet spread, and indirect contact
Precautions: Droplet for the first 24 hours
Varicella: Rash itchy or not?
types of lesions seen?
The RASH IS ITCHY! (use pressure instead of scratch to prevent spread)
Lesions: Macule = small patches of redness not elevated
Papule = well defined bumps
Vesicle = circumscribed elevated, fluid filled
Chicken Pox
-maintain strict airborne isolation
-provide skin care; cool or aveeno baths and loose clothing
- administer antipyretics (NO Aspirin because of REYES syndrome)
- kiddo stays home till vesicles have dried (1 week)
-keep kiddo occupied
-Pressure instead of scratch to prevent spread
-antihistamines for itching
-immunocompromised patient (big concern for them because it can lead to death)
-administer acyclovir for high risk child
A child lies on the floor, kicks screams, breath holds. The child is safe and every one is ignoring the child. They are throwing this.
Double Jeopardy
When is this behavior not normal?
-Temper tantrum (remember safety is the biggest concern)
Double:
- >5 years old
Nursing managements for preschoolers?
-Therapeutic play
- BAND AIDS
- avoid unnecessary invasive procedures,
-provide reassurance
-provide comfort and safety
-provide emotional support = parents/lovie/family
-use appropriate terms (not saying go to sleep for surgery)
-reassure illness is not their fault
varicella: precautions and transmission?
P: Airborne
T: direct contact, airborne, and through contaminated objects
Measles: Rash and spots???
Rash starts on the head and spreads downwards
Koplik spots = irregular red spots with minute bluish-white center first seen in the buccal mucosa by molars 2 days before the rash
Scarlet Fever
Administer full course of antibiotics (PCN), analgesics and antipyretics
respiratory precautions for the 1st 24 hours after abc therapy
encourage fluids
no vaccines right now
What are the three signs that a toddler is ready to potty train?
-being aware of the urge to stool or void
-interest in using the toilet
- being dry for at least 2 hours during the day
Nutrition for Preschooler
-promote meals and discourage grazing
-encourage new foods
-teach socially acceptable behaviors at age
-avoid juice/soda r/t dental caries and obesity
-quality over quantity
-dont force food
-1/2 an adult portion
Giardiasis transmission
Fecal-oral route
contaminated water, food, animals
Name the best preventions for Rubeola (measles), Varicella (chicken pox), and Pertussis (whooping cough)?
VACCINES:
Rubeola (measles): MMR
Varicella (chicken pox): Varicella-Zoster
Pertussis (whooping cough): DTAP
Pertussis (Whooping cough)
get immunized for DTaP!
Immunization of pregnant women in 3rd tri to pass on to fetus
abx (often azithromycin) in early stages may have milder form of infection and limit spread
Symptomatic: support adequate nutrition if unable to take by mouth, increase fluids, humidified O2
Infectious until 5 days abx or 3 weeks if no abx
What are the 6 major toddler injuries?
Motor vehicle, drowning, bodily harm, choking and suffocation, poisons, falls
Injuries for preschooler
-tends to be less reckless than toddler
-accidental poisoning
-pedestrian motor vehicle accidents more prevalent
-teaching prevention (BICYCLE HELMETS)
-swim lessons for 5 year old
Pertussis: Precautions and transmission
P: droplet
T: droplet or direct contact
PINWORMS:
Who needs treatment? How many times?
Bonus:
What's the test for pinworms?
All family members will need treatment twice with pyrantel pamoate
Bonus: TAPE TEST
Lead Poisoning
minimize consequences of lead exposure
monitor for manifestations of lead toxicity
administer chelation therapy as prescribed (edetate calcium disodium, dimercaprol, succorer)
prepare the family and child for interventions (which vary based on lead levels
encourage fluids
monitor I&O
Urine testing