1. Art and Diseño

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Practical Nursing Series:
Pediatric Nursing
Pediatric Nursing builds on the concepts and skills for
previous courses. This full-color curriculum focuses on
nursing for the pediatric patient including: growth and
development; health promotion; care of the hospitalized
pediatric patient; care of the infant, toddler, preschool child,
school-age child, and adolescent. Pediatric Nursing is
designed to teach the nursing student focused nursing skills
and the ability to apply their knowledge to prepare for the
NCLEX-PN. A test bank CD is also available.
Modules include:
 Growth and Development of the Pediatric Patient
 Health Promotion of the Pediatric Patient
 Care of the Infant
 Care of the Toddler
 Care of the Preschool Child
 Care of the School-Age Child
 Care of the Adolescent
 Care of the Hospitalized Pediatric Patient
Practical Nursing:
Pediatric Nursing
2015
Teacher Edition: HO1302
Student Workbook: HO3302
Test Bank CD: HO8302
To order, call
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Copyright 2015 Oklahoma Department of Career and Technology Education
MODULE 4
CARE OF THE TODDLER
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T
oddlers have limited judgment skills yet
fierce determination for autonomy and
demand attention. Toddlers, who tend to
be egocentric and ritualistic, are often upset with
changes in routine and control. The nurse must be
ready to care for toddlers with special knowledge
about their developmental characteristics while using the nursing process for diseases and disorders,
which occur commonly in this developmental
period.
i
Review the Learning
Objectives with the
students. Look ahead
to the Learning Activities in this
module and plan to introduce
them.
LEARNING OBJECTIVES
1. Discuss the special nursing considerations for a child with autism.
2. Identify care for a toddler who has experienced an accidental poisoning.
3. Relate diagnostic tests and surgical procedures to the nursing care for the
toddler with common diseases/disorders.
4. Evaluate pharmacological effects of medications used to treat the toddler
with common diseases/disorders.
5. Discuss the nursing care for a toddler with common diseases/disorders.
6. Describe teaching needs for a family with a toddler with common diseases/
disorders.
Common Diseases and Disorders
•Wilms’Tumor
•Pneumonia
•Pinworms
•Fractures
•Deafness
•Dislocations
•Croup
•CerebralPalsy
•Epiglottitis
•HeadInjuries
•Bronchitis
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C I M C • P E D I AT R I C N U R S I N G
C I M C • P E D I AT R I C N U R S I N G
L E A R N I N G
O B J E C T I V E
O bj ect i v e Discuss the special nursing
considerations for a child with
autism.
A common disorder seen in toddlers is autism. This is
a developmental disorder which has several different
signs and symptoms. These specific types of autism are
referred to as autism spectrum disorders (ASDs).
A toddler with autism will exhibit:
•
Impairedsocialinteraction
•
I nabilitytocommunicatebothverballyandnonverbally
•
Repetitiveorunusualactivities
•
Unusualinterests
The latest statistic is showing that males are diagnosed four times more often than females, and about
three to six children out of every 1000 have symptoms of autism.
The first signs of autism may be the unresponsiveness
to eye contact and lack of interaction with parents.
The child appears withdrawn and social skills are
often late in developing or will not develop at all.
Often the child will have repetitive movements such
as rocking and twirling. The child will not accept
comforting or cuddling, which may be due to an abnormal sensitivity to sound, touch or other stimuli.
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The child appears different than other children, not
in physical appearance, but in social interaction.
Autism Fact Sheet – National
Institute of Neurological
Disorders
www.ninds.nih.gov/disorders/
autism/detail_autism.htm
Since there is no cure for this condition, nursing care
and medical treatment have long range implications.
The child’s condition is often treated by supporting
the symptoms such as administration of antidepressant medication to deal with anxiety, depression or
obsessive-compulsive disorders. Other medications
used for attention deficit disorders are used to decrease hyperactivity and impulsivity.
Autism Speaks
www.autismspeaks.org/
Nursing care must be directed toward support of the
child and family in living with the disorder and the
many associated symptoms.
Class Discussions
• Discuss the characteristics
of autism and the longterm prognosis for children diagnosed with this
disorder.
• Discuss the role of the
nurse in providing access
to resources to assist the
parents of the child with
autism.
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MODULE 4 • CARE OF THE TODDLER • STUDENT EDITION
3
Additional Learning Activity
In small groups, have students identify home or inpatient interventions for the following scenario and share their findings
with the class.
• An 11-year-old child is diagnosed with autism. The child’s father has abandoned the mother, and the mother is becoming overwhelmed with the child’s care. The child is very resistant to change, and the absence of his father in his daily
rituals has resulted in repeated, violent tantrums. He is under sensitive to pain and does not appear to have a concept of
danger to himself or others. Finally, he does not like to be touched.
MODULE 4 • CARE OF THE TODDLER • TEACHER EDITION
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Learning Activity
Answers
LEARNING ACTIVITY
Answers will vary.
1
NAME
Introduction
Observations can play a vital role in how the nurse cares for the patient with autism. The nurse must be able
to care for this type of patient with caring and understanding.
Activity
Visit the Autism Speaks website (www.autismspeaks.org/) and view the video clips of behaviors of children
with autism.
1. During the video, list all of the signs of autism that are noticeable. Next to each sign, identify what
would be a normal characteristic for a child of similar age.
2. From a nursing care plan book, list the nursing diagnosis that would be appropriate for this child.
3. Then list the nursing interventions that the nurse would suggest be added to a care plan for this child,
should the child get a severe sinus infection.
4. What activities should the nurse do to support the family during the time the child is experiencing this
infection?
Application
Share your results and compare with a classmate or the facilitator. Discuss why their results are different from
yours. What changes would you make to your identified results and why?
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C I M C • P E D I AT R I C N U R S I N G
C I M C • P E D I AT R I C N U R S I N G
L E A R N I N G
O B J E C T I V E
O bj ect i v e Identifycareforatoddlerwho
has experienced an accidental
poisoning.
I D E N T I F I C AT I O N O F
POISONING
Accidental poisonings occur frequently in toddlers
because of their natural curiosity and exploration.
Lacking the capacity to appreciate danger or hazards,
they may eat or drink anything that is near which may
include toxic substances. More than 90% of poisonings occur in the home. Frequently ingested substances include medications, cosmetic and personal care
products, plants and cleaning products.
Parents and caregivers must be alert to signs of poisoning. The child can be very quiet or crying loudly after
ingestingapoisonoussubstance.Iftheamountoftoxins is small the child may not show signs of swallowing
a poison. Caution parents and caregivers to always do
a walk through of a home, if visiting, and store chemicals out of reach of toddlers. Signs and symptoms of
poisoning will manifest according to the ingested
toxin. Common signs and symptoms may be the only
indicator of a poisoning. The nurse must be alert to
these signs in order to care for the patient properly.
Rememberthatthetoxinmaybeunknown.
Class Discussions
The universal phone number for PCC is 1-800-2221222. This center will direct parents on the correct
action to take regarding the specific substance that the
child has ingested. The nurse should tell the parents/
caregiver to post this or the local PCC phone number
nearorinthememoryoftheirtelephones.Incase
of emergency when the PCC phone number is not
available, parents can easily be reminded to call 911;
emergency operators can easily connect the caller to
the PCC.
• Discuss the role of the
nurse in treating the child
with acetaminophen poisoning.
• Discuss the role of the
nurse in educating parents
about the delivery of acetaminophen to their child.
• Discuss the signs and
symptoms of lead poisoning and the treatment
provided for children
affected.
• Discuss the steps that can
be taken to ensure that
the child is not exposed
to lead, and the role of the
nurse in educating parents
of small children about
the dangers associated
with lead exposure.
The PCC will ask for the following information:
•
Caller’snameandphonenumber
•
Thechild’sname,age,andweight
•
Anymedicalconditionsthechildhas
•
Anymedicinethechildistaking
•
Thenameoftheitemthechildswallowed
•
Thetimethechildswallowedthepoison,or
when the child was found, and an estimate of the
amount swallowed
The amount of certain toxic substances can be more
dangerous than others. Teach parents and caregivers
that even a small amount of some substance can be
life threatening. Acetaminophen is the most common
drug that children have access to and ingest.
Usingthisinformation,theexpertadvisestheparent
or caregiver what action should be taken immediately and if the child should be seen by a health care
provider.Ifthechildisunconscious,havingproblems
breathing or having seizures, the child should be seen
immediately by emergency personnel.
Classroom Activity
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Divide the class into four
groups. Assign each group
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one of the stages of acetaminophen poisoning, and have
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the group identify treatment
Ineverycaseofsuspectedoractualingestionofan
injurious agent, caregivers and nurses must be directed
to call the Poison Control Center (PCC) as soon
as ingestion is suspected and before they initiate any
intervention. Home remedies may waste valuable time
getting the child proper care or even worsen injuries.
and nursing interventions for
its assigned stage. Then have
each group share its results
with the class.
D i d You Know?
The American Academy of Pediatrics
(www.aap.org) provides many useful
tips for families regarding home safety
and prevention of poisoning.
MODULE 4 • CARE OF THE TODDLER • STUDENT EDITION
MODULE 4 • CARE OF THE TODDLER • TEACHER EDITION
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Additional Learning Activity
Most ingestion of poisons is managed at home. PCC
can provide instructions to minimize side effects.
However, families often experience an emotional crisis
when a child is accidentally poisoned. Parents may
feel grief, guilt and responsibility for the child’s injuries and resulting treatments. During acute care, the
parents need support without accusations or inference
of negligence. Because of their anxiety for their child
and emotional crisis, interventions to prevent poisoning recurrence are inappropriate in the emergency
phase of treatment. The insightful and sensitive nurse
and other health care providers can most effectively
promote safety measures once the child is recovering
or close to discharge. Prevention of accidental poisonings requires significant safety measures and supervision of young children in the home.
Divide the class into groups,
and have them discuss the
common causes of lead
poisoning in children,
including environmental
exposure. Have each group
develop a list of methods
to prevent lead poisoning,
and then discuss these lists
as a class. Next, have student
pairs take turns role-playing
a nurse-parent interaction in
which a nurse is educating
a parent about preventing
lead poisoning.
IMPORTANT FACT!
The use of Ipecac is no longer an approved
treatment of poison due to the prolonged
vomiting that may occur. Encourage parents
and caregivers to dispose of any that may
still be in their homes.
Patient Care for the Poisoned Toddler
Disorder
Accidental
Poisoning
Structure Affected
Depends on toxin
ingested
•Lungs,mouth
throat
•Gastrointestinal
system
•Nervoussystem
•Cardiovascular
system
•Skin
Physical Findings
•Burninmouthand
throat
•Edemaaroundmouth
and throat
•Nausea/vomiting
•Signsofshock
•Anxietyandagitation
•Sweating
•Pallor
•Confusion
•Drowsiness
•Respiratorydistress
Nursing Care
•Assessairway,breathingand
consciousness
•Keepchildinside-lyingposition to prevent aspiration
•Determinetoxinifpossible
•Callpoisoncontrolcenteror
follow facility policy
•FollowdirectionfromPCC
•Monitorvitalsigns,noting
changes or abnormalities
•Administeroxygenasordered
•Giveactivatedcharcoalas
ordered
•Assessfor:
▶ Diaphoresis
▶ Anxiety
▶ Changes or worsening of
symptoms
•Teachparentorcaregiver:
▶ Needs of the child at home
▶ Poisoning prevention
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C I M C • P E D I AT R I C N U R S I N G
Additional Critical Thinking Question
Accidents are the leading cause of death in children. What are some of the characteristics of toddlers that put them at
increased risk for accidents?
Answer:
Toddlers have a new sense of independence, and they want to try new things. By nature, they are very curious and investigate by touching and tasting, which puts them at greater risk for burns, bites, and poisoning. Their increased mobility also
puts them at greater risk for injuries due to falls or running into dangerous areas. Toddlers lack an understanding of danger.
Combined with their curiosity and new mobility, this often leads them into dangerous situations.
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C I M C • P E D I AT R I C N U R S I N G
L E A R N I N G
Classroom Activity
O B J E C T I V E S
O bj ect i v e Discuss the nursing care for
Divide the students into small
groups. Assign each group a
disorder. Have the group develop a parent teaching poster
about the disorder.
toddlers with common diseases/
disorders.
O bj ect i v e Describe teaching needs for a
family with a toddler with common
diseases/disorders.
Additional Learning
Activities
COMMON DISEASES AND
DISORDERS OF THE TODDLER
Common diseases and disorders of toddlers vary from
life-altering disorders to disorders that cause temporary alterations in health such as pinworms.
• Assign each student a
disorder. Have the student write a paper in
APA format and present
a PowerPoint presentation to the class regarding
pathophysiology, signs
and symptoms, treatment
and nursing care.
• Divide the class into small
groups, and assign each
group one of the common
disorders of the toddler.
Have the groups research
the disorders, including
signs and symptoms, treatments, and nursing interventions. Have each group
present its findings to the
class.
Common Diseases and Disorders of the Toddler
Disorder
Pinworms
(Enterobiasis)
Structure Affected
Physical Findings
•Colon
•Severeitchingespecially around anus
•Irritability
•Inabilitytosleepwell
•Inattentive
Deafness
•Externalorinternal •Inabilitytohear
structures of the ear
Nursing Care
•Teachparentorcaregiver:
▶ How to perform tape test
▶ To repeat tape test for
several days
▶ To wash all clothes and
linens in hot water
•Teachparentorcaregiver:
▶ About speech development
▶ About the importance of
learning sign language
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Ta p e Te s t f o r P i n w o r m s
Obtain a piece of tape and wrap it to make a narrow wedge of sticky
tape by wrapping tape around itself with sticky side out. Place this
wedge of tape near the patient’s anus overnight. The pin worms will
become lodged on the tape. Once the specimen is collected, place it
in a glass jar or plastic bag, loosely. Tell the patient’s family to bring it
to the clinic or lab.
MODULE 4 • CARE OF THE TODDLER • STUDENT EDITION
MODULE 4 • CARE OF THE TODDLER • TEACHER EDITION
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Class Discussions
Disorder
Wilms’ Tumor
• Discuss the signs and
symptoms of Wilm’s
tumor and the diagnostic process used to
determine the origin and
extent of the tumor.
• Discuss the ways in
which nursing education
can help parents and
patient understand what
to expect as the treatment of Wilm’s tumor
proceeds.
Structure Affected
Physical Findings
Nursing Care
•KidneyRenal
•Abdominalswellingor Pre Procedure:
•Consents
System
mass:
•Prepasordered
▶ Firm
•Donotpalpatemass
▶ Nontender
▶ Confined to one
side
Monitor:
•Hematuria
•Vitalsigns
•Fatigueandmalaise
•Gastrointestinalactivity
•Hypertension
▶ Bowel sounds and move•Weightloss
ment
•Fever
•Abdominaldistention,pain
•Withmetastasis:
•Vomiting
▶ Dyspnea
•Urineoutput
•Signsofinfection
▶ Cough
▶ Shortness of
•TCBD
breath
▶ Chest pain
Teach parent or caregiver:
•Abouttheprocedure
•Aboutpost-operativeradiation or chemotherapy
Classroom Activity
Divide the class into two
groups. Assign one group
preoperative care and the
other postoperative care of
a child with Wilm’s tumor.
Have each group list nursing
interventions for its assigned stage. Next, in a class
discussion, have the students
compare their interventions
and discuss their rationale.
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C I M C • P E D I AT R I C N U R S I N G
C I M C • P E D I AT R I C N U R S I N G
Respiratory Conditions for the Toddler
Class Discussions
Respiratoryconditionsfortoddlersarequitescary
for the parents. The child often sounds extremely
bad, especially when they have croup or bronchitis.
The child can experience respiratory distress rapidly
and will need emergency care. Other respiratory conditions, such as bronchitis, sound bad, but are mild
and often resolve in 2-3 days.
• Discuss the signs and
symptoms of croup and
the specific indicators that
suggest the child should
be seen by a medical professional.
• Discuss the care required
for a 2-year-old child with
croup. Consider the role
of the nurse in guiding the
care of the child in both
home and hospital settings.
Respiratory Conditions for the Toddler
Disorder
Croup
Epiglottitis
Bronchitis
Pneumonia
Structure Affected
Physical Findings
•Larynx
•Loudbarkingcough
•Upperairway
•Respiratorydistress
•Trachea
•Swellingofthelarynx
•Bronchi
blocking air flow
•Temperatureelevation
•Epiglottis
•Sorethroat
•Painonswallowing
•Elevatedtemperature
•Strugglestogetair
into lungs and finds
sitting more comfortable
•Unabletorest
•Cranky
•Drooling
Nursing Care
•Monitorforrespiratorydistress, fever and irritability
•Teachparentorcaregiverto
avoid the flu and to get flu
vaccines for children
•Life-threateningconditionthat
demands immediate action
•Monitorrespirationrate
•Readpulseoximetryfrequently
•Allowchildtofindposition
of comfort
•Monitorvitalsigns.Ifpulse
and respiration are elevated,
report at once
•Increasedrestlessnessmaybe
sign of distress. Take action
quickly
•Administeroxygenasdirected
•Inflammationof
•Dryhackingcough
•Administeranalgesics,antilarge airways (tra•Symptomsgetworseat
pyretics, and humidity
chea and bronchi)
night
•Haveaparentorcaregiver
take child in bathroom and
•Coughthatdoesn’t
run shower to fill room with
result in sputum
humidity
•Bedrestbetweencoughingspells
•Givecoughmedicationsas
ordered
•Oneormorelobes •Fever
•Givemedicationsasordered
of lungs
•Respiratorydistress
•Encouragefluidsandfoods
•Beginsinbronchi- •Rapidrespirations
•Monitoroxygensaturation,
oles
•Chestpain
vital signs, pain level and
•Alveolarwalls
•Sternalretraction
respiratory rates
•Cyanosis
•Placeinisolationaccordingto
•Cranky
hospital policies, as indicated
•Lackofappetite
Classroom Activity
Have students work in pairs
to develop a teaching guide
for parents to use when their
child of 1, 2, or 3 years of
age has croup. Have students
include signs and symptoms,
treatment methods to use at
home, signs and symptoms of
respiratory distress, and guidance on when to seek medical
attention. Next, have students
take turns role-playing a
nurse-parent interaction in
which the nurse educates the
parent on caring for the child
with croup.
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MODULE 4 • CARE OF THE TODDLER • STUDENT EDITION
MODULE 4 • CARE OF THE TODDLER • TEACHER EDITION
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Musculoskeletal Disorders of the Toddler
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A child with musculoskeletal disorders presents
unique issues for the parent and nursing personnel.
Since children are highly mobile, conditions that
limit this mobility can have profound effects for
children. Not only does the child suffer from the
disease process, but they also suffer from the effects
of immobility. This immobility causes physical and
psychologicalcomplicationsforthepatient.Remember that the child and parent will need additional
support to counter the effects of lack of movement.
KidsHealth.org – Type in
disorder in the search section
http://kidshealth.org/
Musculoskeletal Disorders of the Toddler
Disorder
Fractures
Dislocations
Structure Affected
Physical Findings
•Bones-broken
•Pain
•Articulationof
•Swelling
bones – dislocated •Deformity
Classroom Activity
Have students call out characteristics of adult bones
and characteristics of children’s bones, and list them
in two columns. Next, in
small groups, have students
discuss the distinctions between adults’ and children’s
bones and how treatment
and nursing interventions
for a toddler with a bone
fracture would differ from
that for an adult.
Nursing Care
Rest,applyiceandelevateaffected extremity if allowed
Routinecareforapatientwith
immobility:
•Preventskinbreakdown
•Treatconstipation
•Monitorrespiratoryrates
•Promotehealthyeating
•Provideage-appropriateplay
•Givemedicationasordered,
especially pain medications
Monitor the five P’s:
•Pain,pulses,pallor,paresthesia, paralysis
Provide cast care or traction care
Teach parent or caregiver:
•Aboutcareofthecast
•Theeffectsofimmobility
•Howtomonitorforpsychological symptoms
•Provideoptimumlevelof
wellness
•Increasemobility
•Maintainpropernutrition
•Preventcontractures
•Preventinjury
•Controlpain
•Promotecomfort
•Promotesafety
•Promoteself-care
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Cerebral palsy
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•Motordisorder
•Sensation
•Perception
•Communication
•Cognition
•Behavior
•Spasticmovements
•Slowtwistingmovements
•Rapidrepetitive
movements
•Uncoordinated
•Physicaldeformities
•Slurredspeech
•Nystagmus
•Visualdeficits
•Hearingimpairment
•Seizures
C I M C • P E D I AT R I C N U R S I N G
Class Discussions
• Discuss compartment syndrome and the role of the nurse in identifying signs that suggest neurovascular impairment as
a consequence of fractures.
• Discuss the process carried out to check the traction device and ensure its proper deployment.
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C I M C • P E D I AT R I C N U R S I N G
Musculoskeletal Disorders of the Toddler Continued
learning
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Structure Affected
Physical Findings
link
•Brain
•Lossofconsciousness
•Skull
•Dizziness
Concussion
•Confusion
•Increaseintracranial
EpiduralHemorpressure(ICP)
rhage (bleeding
•Slurredspeech
between dura mater
•Blurredvision
and cranium
•Nauseaandvomiting
•Severeheadache
Subdural hemor•Unequalpupilsize
rhage- venous bleed•Irritability
ing around the brain
•Seizures
•Paralysis
Disorder
HeadInjury
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Nursing Care
Monitor:
•SignsofICP
•Vitalsigns
•Neurologicchecks
•Drainagefromnoseorears
•Abnormalposturing
Lab Testing Online – Type in
test in the search section
http://labtestsonline.org/
•Teachparentorcaregiverto
awaken a sleeping child at
regular intervals
DIAGNOSTIC TESTS AND
SURGICAL PROCEDURES FOR
Relatediagnostictestsandsurgical
THE TODDLER
procedures to the nursing care for
L E A R N I N G
Obj ect i v e
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O B J E C T I V E S
the toddler with common diseases/
disorders.
Obj ect i v e Evaluatepharmacologicaleffects
of medications used to treat the
toddler with common diseases/
disorders.
Many of the diagnostic tests and surgical procedures
for adult patients are also done for the toddler.
Considerations to age-appropriate care must be part
of the nurse’s role when providing support for the
toddler having this type of medical care.
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MODULE 4 • CARE OF THE TODDLER • STUDENT EDITION
MODULE 4 • CARE OF THE TODDLER • TEACHER EDITION
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Diagnostic Tests and Surgical Procedures for the Toddler
Test
Throat culture
Purpose
•Identifymicroorganism
Blood cultures
Arterial blood
gases
•Determineblood
gases level
Laryngoscopy and •Visualizebronchi
bronchoscopy
and branches
•Obtaintissueor
fluid from lung
•Removeforeign
body obstruction
Procedure
•Usesterileswabtotouch
the posterior wall of the
throat
•Putswabintoappropriate
container according to facility policy
•Labelspecimenandtransport to lab
•Obtainthroughvenipuncture venous specimen
•Removeneedleusedtodraw
blood and replace with clean
needle
•Placebloodspecimeninto
culture bottles
•Labelculturebottle
•Gentlymixandtransportto
lab according to policy
•Preppatientandparentby
explaining procedure
•Assistlabpersonnelas
needed
•Applypressuretopuncture
site
Patient receives topical anesthesia
Scope is inserted into the trachea and into the bronchi and
bronchioles
•Biopsyspecimensand
washings are taken and sent
to lab
•Explaintheprocedure
•Assurethepatientandfamily that the test is painless
•AssisttheEEGtechnician
as needed
•Helpcleanpastefromhair
after procedure
Nursing Care
•Preparepatientbyexplaining that a specimen
is needed to find out why
they are sick
•Enlistparenthelpif
needed
•Demonstratehowthe
procedure will be done
and allow them to become familiar with the
swabs and equipment
•Encouragethepatientto
be still
•Givemedicationsas
ordered to promote optimum testing
•Allowparentorcaregiver
to hold child if needed
Pre Procedure
•PatientNPO,priorto
exam
•Requiressedation
Post Procedure
•Observeforhemorrhage
•Observefordifficulty
breathing
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Electroencephalography(EEG)
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•Determinebrain
activity
Teach parent or caregiver:
•Patientcannoteator
drink for 2 hours
•Reporthighfever
•Usesalinegarglesorlozenges if throat is sore
C I M C • P E D I AT R I C N U R S I N G
C I M C • P E D I AT R I C N U R S I N G
Diagnostic Tests and Surgical Procedures for the Toddler Continued
Test
CT Scan
MRI
Lung Scan/Ventilation-perfusion
Purpose
•Diagnosingtumors, nodules, hematomas, lesions,
cysts, abscesses,
pleural effusion
and enlarged
lymph nodes,
abnormal cardiac
tissue
Procedure
•CTscaniscross-sectional
visualization of tissues
which allows for identification of slight variations in
tissue thickness
•Maybewithorwithout
contrast (assess for allergies)
•Moreenhancedthanx-rays
•Spiralorhelicalversion
produces thinner slices and
data more enhanced
Nursing Care
Pre Procedure
•Explaintheprocedure
•Obtainconsent
•Assessforallergies
•Instructparentor
caregiver that pateint is
to be NPO according to
hospital policies
Post Procedure
•Encouragefluidstoassist
in dye excretion
•Answerquestionsabout
how they will find out
about the results
•Computerizedimages
•Nursingresponsibility
•Providesbetter
contrast between
which assist in identificaprior to exam is to check
for allergies in patient
normal and pathotion of subtle changes in
logic tissues
tissue structure
•Removeallmetalduring
the procedure due to the
•Reducesbone
magnet used for capturing the images
artifacts
•Assessifpatienthasany
implants or a pacemaker
•Toidentifyareas
•IVinjectionofradioisotope Pre Procedure
of ventilation and
given to patient
•Obtainconsent
perfusion to lungs
•Explaintheprocedure
•Gammaraydetectoris
•Assurethatexposureto
passed over the patient and
large amounts of radioacrecords uptake of radioisotivity will not occur
tope
•Administer10dropsof
Lugol’s solution sev•Patientisplacedinvarious
eral hours before test as
positions to visualize differblocking agent against
ent areas of the body
iodine 131
•Fastingisnotneeded
•Removejewelryaround
chest area
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Post Procedure
•ApplypressuretoIVsite
•Noradiationprecautions
are needed
MODULE 4 • CARE OF THE TODDLER • STUDENT EDITION
MODULE 4 • CARE OF THE TODDLER • TEACHER EDITION
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Diagnostic Tests and Surgical Procedures for the Toddler Continued
Test
X-Ray
Purpose
Visualization of
fracture or abnormal
soft tissue
Procedure
•Affectedareaisplacedunder the X-ray machine and
an image is captured
Nursing Care
•Explaintheprocedure
•Allowchildtoseeequipment
•Exhibitpatienceaschild
is allowed to position on
the exam table
•Allowparentorcaregiver
present if needed while
shielding parent from
x-ray beams
•Aftertest,assistchildand
parent or caregiver back
to exam room
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C I M C • P E D I AT R I C N U R S I N G
C I M C • P E D I AT R I C N U R S I N G
PHARMACOLOGICAL
C O N S I D E R AT I O N S F O R T H E
TODDLER
Toddlers often have to take medications before
diagnostic tests and procedures. They may also have
to take medications for medical conditions. Special
considerations for the toddler must be taken to
administer medications safely. Dosage calculations
must be done carefully and rechecked before administering the drug. Children are more susceptible to
sideeffectsandadversereactionsthanadults.Use
learning
w
ww
link
caution when giving toddlers medications. The following drugs are used for conditions in this module
in addition to drugs for pain relief and reduction of
complications of immobility.
Medicine Net – Type in disease in the search section
www.medicinenet.com
Medications used for the Toddler
Category and
Uses
Examples
Bronchodilators
Prevents broncho•AlbuterolSulfate spasm that occurs
•Salmeterol
with asthma
•Metaproterenol
Sulfate
Antihistamines
•Clemastine
•Diphenhydramine
•Loratadine
Anticholinergics
•Ipratropium
•Bromide
Decongestants
•Pseudoephedrine
•Phenylephrine
•Azelastine
Actions
Causes bronchodilation
by stimulating
beta-adrenergic
receptors
Medline Plus – Type in disorder in the search section
www.nlm.nih.gov/medlineplus/
Nursing
Considerations
•Drymouth
•Monitorheartrate
and blood pressure
•Muscletremors
•Tachycardia
•Increasefluid
•Hypertensionor
intake
hypotension
•Nottobeused
•Nervousness
with cardiac
•Insomnia
disease
Side Effects
Work by preventing mediator release from
mast cells
Relievessymptoms Blocks histaof allergic response mine receptors
•Drymouth
•Drowsiness
•Informparentsthat
child may become
drowsy
Reducesrhinorrhea Causes bronchodilation
by stimulating
beta-adrenergic
receptors and
blocking acetylcholine
Promotes vasocon- Causes vasoconstriction
striction of nasal
membranes
Reducesnasal
edema and rhinorrhea
•Anxiety
•Dizziness
•Headache
•Drymouth
•Nausea
•Vomiting
•Cough
•Anxiety
•Dizziness
•Tremors
•Headache
•Insomnia
•Hypertension
•Donotmixwith
cromolyn sodium
•Limitcaffeine
consumption
Drugs Online – Type in medication in the search section
www.drugs.com/
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MODULE 4 • CARE OF THE TODDLER • STUDENT EDITION
MODULE 4 • CARE OF THE TODDLER • TEACHER EDITION
•Takeearlyindayto
avoid sleeplessness
•Avoidtakingwith
hypertension, diabetes, glaucoma
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15
Medications used for the Toddler Continued
Category and
Examples
Antiinflammatories
•Hydrocortisone
•Methylprednisolone
•Beclomethasone
Uses
Actions
Decrease edema in
bronchial airway
Mebendazole
(Vermox)
Treatment for Pin
worms
Decreases
in edema in
airways and
a decrease in
production of
mucous, leading
to decrease in
inflammation
Inhibitsglucose
uptake of the
pinworm, causing it to die
Decrease mucus
production
•Dantrolene
Improvenerveand Interfereswith
sodium
muscle contractions intracellular
(Dantrolene)
function caus•Baclofen
ing a slowing of
(Lioresol)
muscle spasms
•Diazepam
(Valium)
•Botulinumtoxin
(Botox)
•Intrathecal
baclofen
Side Effects
•Headache
•Sorethroat
•Drymouth
•Cough
Nursing
Considerations
•Maymasksignsof
infection
•Monitorforedema
and weight gain
•Dizziness
•Assessstoolsfor
•Tinnitus
presence of pin
•Abdominalpain
worms
•Increaseliver
•Teachparentor
enzymes
caregiver:
▶ Signs of infection
▶ Wash clothing
and linens in
hot water
▶ Wash hands after every bowel
movement
▶Giveafter
meals to avoid
GIsymptoms
•Hypotonia
•MonitorI&O
•Sleepiness
•Checkforurinary
•Seizures
retention
•Nauseaand
•Monitorliverfuncvomiting
tions
•Headache
•Monitorfor:
▶ Weakness
▶ Depression
▶ Dizziness
▶ Drowsiness
▶ Pain in abdomen
•Administeredusing
pump that is surgically implanted into
mid abdomen
•Monitorforside
effects
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C I M C • P E D I AT R I C N U R S I N G
C I M C • P E D I AT R I C N U R S I N G
Medications used for the Toddler Continued
Category and
Uses
Actions
Examples
Treatment of
Arrest cell
Antineoplastics
•ActinomycinD Wilms’ tumor
production and
(dactinomycin)
block cancer cell
•Vincrinistine
growth
•Doxorubicin
•Etoposide
•Cyclophosphamide along
with mesna
Side Effects
Nursing
Considerations
Monitor:
•Bloodstudyabnormalities
•Respiratorystatus
•Nausea
•Vomiting
•Anorexia
•Hairloss
•Lowwhiteblood
cell counts
Assess:
•Nutritionalstatus
Radiationsideef•Neurologicalstatus
fects include
•Nausea
Teach parent or care•Fatigue
giver:
•Skinirritation
•Avoidaspirinor
•Diarrhea
NSAIDSbecause
of bleeding risk
•Watchforsignsof
anemia
•Childmaylosehair
•Increasefluids
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MODULE 4 • CARE OF THE TODDLER • STUDENT EDITION
MODULE 4 • CARE OF THE TODDLER • TEACHER EDITION
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KEY SUMMARY
• A common disorder seen in toddlers is autism. This is a developmental disorder which has
several different signs and symptoms. These specific types of autism are referred to as autism
spectrum disorders (ASDs). A toddler with autism will exhibit:
•Impairedsocialinteraction
•Inabilitytocommunicatebothverballyandnonverbally
•Repetitiveorunusualactivities
•Unusualinterests
• Accidental poisonings occur frequently in toddlers because of their natural curiosity and
exploration. Lacking the capacity to appreciate danger or hazards, they may eat or drink
anything that is near which may include toxic substances. More than 90% of poisonings
occur in the home; frequently ingested substances include medications, cosmetic and
personal care products, plants and cleaning products.
• Common diseases and disorders of children vary from life-altering disorders to disorders that
cause temporary alterations in health such as pinworms.
• Respiratoryconditionsfortoddlersarefrighteningfortheparents.Thechildoftenhas
significant audible respiratory symptoms when they have croup or bronchitis. The child can
experience respiratory distress rapidly and will need emergency care.
• A child with musculoskeletal disorders presents unique issues for the parent and nursing
personnel. Since children are highly mobile, conditions that limit this mobility can have
profound effects for children. Not only does the child suffer from the disease process, but
also from the effects of immobility.
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• Many of the diagnostic tests and surgical procedures for adult patients are also done for
the toddler. Considerations for age-appropriate care must be part of the nurse’s role when
providing support for the toddler requiring medical care.
• Similar to diagnostic tests and procedures, toddlers take medications for conditions. Special
considerations for the toddler must be taken to administer medications safely. Dosage
calculations must be done carefully and rechecked before administering the drug.
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C I M C • P E D I AT R I C N U R S I N G
C I M C • P E D I AT R I C N U R S I N G
GLOSSARY
Autism: A developmental disorder, often identified in early childhood, characterized by
impaired social interaction, problems with verbal and nonverbal communication,
and unusual, repetitive, or severely limited activities and interests.
Concussion: A common type of traumatic brain injury.
Dislocation: The separation of two bones where they meet at a joint.
Fracture: A break in a bone.
Pneumonia: A respiratory illness caused by inflammation of the alveoli and terminal
airspaces in response to invasion by an infectious agent introduced into the lungs.
Wilms’ Tumor: A rare kidney cancer that primarily affects children. Also known as
nephroblastoma, it is the most common malignant tumor of the kidneys in
children.
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MODULE 4 • CARE OF THE TODDLER • STUDENT EDITION
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RESOURCE BIBLIOGRAPHY
Publications
American Academy of Pediatrics (2007). What are autism spectrum disorders and what are the
symptoms?
American Academy of Pediatrics (2007). What do I do if my child has been poisoned?
American Academy of Pediatrics Committee on Quality Improvement (1999). The Management of
Minor Closed Head Injury in Children. Pediatrics 104 (6), 1407-1415.
American Cancer Society (2008). How is Wilms Tumor diagnosed?
Cooley, W.C and AAP Committee on Children with Disabilities (2004). Providing a primary care
medical home for children and youth with cerebral palsy. Pediatrics 114:4, 1106-11113.
Bowden, V.R. and Greenberg, C.S. (2003). Pediatric Nursing Procedures. Philadelphia: Lippincott
Williams & Wilkins.
Hockenberry, M., Wilson, D. & Winkelstein, M.L. (2005). Wong’s Essentials of Pediatric Nursing (7th
ed.). St Louis: Elsevier.
Nursing Focus. Stillwater, OK: Oklahoma Department of Career and Technology Education, Curriculum
and Instructional Materials Center, 2002.
Online
American Academy of Pediatrics (AAP) Poison Prevention
www.aap.org/healthtopics/safety.cfm
Free Sample Provided by CIMC
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www.okcimc.com
National Center of Medical Home Initiatives for Children with Special Needs
www.medicalhomeinfo.org/how/care_delivery/cyshcn.aspx
American Cancer Society (ACS)
http://cancer.org
American Speech-Language-Hearing Association (ASHA)
www.asha.org/default.htm
Autism Information Center
www.cdc.gov/ncbddd/autism
Autism Society of America
www.autism-society.org/
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C I M C • P E D I AT R I C N U R S I N G
C I M C • P E D I AT R I C N U R S I N G
Autism Speaks
www.autismspeaks.org/
March of Dimes
www.marchofdimes.com/
United Cerebral Palsy (UCP)
www.ucp.org
Center for Patient Information and Resources
www.parentcenterhub.org
Chemotherapy
www.nlm.nih.gov/medlineplus/tutorials/chemotherapyintroduction/htm/index.htm
CT Scan
www.nlm.nih.gov/medlineplus/tutorials/ctscan/htm/_no_50_no_0.htm
Cerebral Palsy
www.nlm.nih.gov/medlineplus/tutorials/cerebralpalsy/htm/_no_50_no_0.htm
Fractures and Sprains
www.nlm.nih.gov/medlineplus/tutorials/fracturesandsprains/htm/index.htm
MRI
www.nlm.nih.gov/medlineplus/tutorials/mri/htm/index.htm
Newborn Screening
www.nlm.nih.gov/medlineplus/tutorials/newbornscreening/htm/_no_50_no_0.htm
Pneumonia
www.nlm.nih.gov/medlineplus/tutorials/pneumonia/htm/index.htm
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MODULE 4 • CARE OF THE TODDLER • STUDENT EDITION
MODULE 4 • CARE OF THE TODDLER • TEACHER EDITION
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NOTES
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C I M C • P E D I AT R I C N U R S I N G