Care of Mother and Child at Risk or with
Problems (Acute and Chronic)
LESSON TITLE: CARE OF A FAMILY WITH A HIGH-RISK Materials:
TODDLER
Pen, paper, index card, book, and class List
Learning Targets:
At the end of the module, students will be able to:
1. Define the common classifications of high-risk toddler and References:
describe common illnesses that occur in these
classifications of newborn. Pilliteri, Adele and Silbert-Flagg, JoAnne
2. Integrate the knowledge of the common classifications of (2018) Maternal and Child Health Nursing, 8th
high-risk toddler and describe common illnesses that occur Edition. USA: Lippincott Williams and Wilkins
in these classifications of newborn in formulating nursing
care plan in giving quality maternal and child health nursing
care.
A. LESSON PREVIEW/REVIEW
Instruction: Identify the following disorder based on the given description.
It occurs when the posterior laminae of the vertebrae fails to fuse Spina Bifida
If the meninges covering the spinal cord herniates through unformed Meningocele
vertebrae appearing as a protruding mass about the size of an orange
The spinal cord and meninges including CSF and nerves protrude through Myelomeningocele
the vertebrae
It is an excess of CSF in the ventricles of the subarachnoid space Hydrocephalus
It is the inflammation of the middle ear and is common after URTI Acute Otitis Media
B. MAIN LESSON
The instructor should discuss the following topics. Instruct students to take down notes.
COMMON SAFETY MEASURES TO PREVENT ACCIDENTS
1. POISONING DIAGNOSIS
⚫ Never present medication as candy. Buy 1. Blood lead test:
medications with childproof caps; put away ⚫ >10 mcg/dl(definite concern
immediately after use. ⚫ 2-10 mcg/dl(for consultation)
⚫ Never take medication in front of a child 2. Bone marrow biopsy
⚫ Place all medications and poisons in locked 3. CBC
cabinets or overhead shelves where children 4. Fe level
cannot reach them. 5. Xray of long bones
⚫ Always store food or substances in their original
container MANAGEMENT
⚫ Know the names of house plants and find out if ⚫ Chelation therapy (for long-term exposure)- EDTA
they are poisonous ⚫ For high dose in a short period:
⚫ Hang plants or set them up on high surfaces ⚫ Bowel irrigation using polyethylene glycol
beyond toddler’s grasp solution(cathartic)
⚫ Be certain that small batteries or magnets are out ⚫ Gastric lavage
of reach
⚫ Post telephone numbers of nearest poison control SALICYLATE POISONING
center by the telephone ⚫ OTC drug as analgesic, antipyretic, anti-
⚫ Inspect toys to be certain they are free of lead- inflammatory agent; also used to prevent
based paints thrombosis
⚫ ASA is colorless or white in crystalline, powder or
LEAD POISONING granular form
Found in: ⚫ Associated with Reye syndrome
⚫ old houses built before 1978(pre 1960’s)
⚫ Makeup PHASES OF SALICYLATE TOXICITY
This document is the property of PHINMA EDUCATION 1
Care of Mother and Child at Risk or with
Problems (Acute and Chronic)
⚫ Gasoline Phase1
⚫ Dust, ⚫ Hyperventilation due to respiratory alkalosis
⚫ toys ⚫ May last for 12 hours
Phase 2
Characteristics: ⚫ Paradoxic aciduria in the presence of respiratory
⚫ odorless & alkalosis due to K & NaHCO3 lost from kidneys
⚫ tasteless ⚫ Lasts for 12-24 hours
Phase 3
COMPLICATIONS ⚫ Dehydration,
⚫ Behavioral problems ⚫ Hypokalemia
⚫ Hearing loss ⚫ Progressive met acidosis
⚫ Decrease in IQ ⚫ Begins 4-6h post-ingestion in a young infant or
⚫ Stunted growth 24hours in an adolescent & adult
⚫ Kidney damage ⚫ N/V, diaphoresis & tinnitus are the earliest signs
of toxicity
SIGNS AND SYMPTOMS ⚫ Other early signs: vertigo, hyperventilation,
Abdominal cramping and pain (1st sign of high tachycardia & hyperactivity
dosage intake) ⚫ As toxicity progresses: agitation, delirium,
⚫ Other signs of high dose-intake: vomiting, hallucinations, convulsions, stupor
staggering walk, muscle weakness, seizures, ⚫ Hyperthermia indicates severe toxicity
coma
⚫ Anemia DIAGNOSIS
⚫ Irritability ⚫ Serum salicylate level test
⚫ Aggression ⚫ Toxicity: >40-50mg/dl
⚫ Headache ⚫ Serum electrolytes, BUN, creatinine
⚫ Constipation ⚫ urinalysis
BEFORE CALLING 911 MANAGEMENT
Identify: ⚫ Stabilizing ABC
⚫ Age ⚫ Limit absorption
⚫ Weight ⚫ Enhancing elimination
⚫ Condition ⚫ Supportive care
⚫ Name of product ingested Acute ingestion:
⚫ Date & time of ingestion ⚫ Gastric lavage
⚫ Amount swallowed ⚫ Activated charcoal(w/in 1h of ingestion
⚫ Whole bowel irrigation(WBI) with polyethylene
glycol
**NO antidote
2. BURNS 3. ASPIRATION
⚫ Buy flame-retardant clothing ⚫ Examine toys for small parts that can be
⚫ Cook on back burners of stove if possible turn aspirated; remove toys that can be dangerous
handles of pots towards back of stove to prevent ⚫ Do not feed toddler popcorn, peanuts, etc; urge
toddler from reaching up and pulling them down them not to eat while running.
⚫ Use cool mist vaporizer rather than steam ⚫ Do not leave a toddler alone with a balloon
vaporizer or remain in room when vaporizer is
operating so child is not tempted to play with it 4. FALLS
⚫ Keep screen in front of fireplace or heater. ⚫ Keep house windows closed or keep screens in
⚫ Monitor toddlers carefully when they are near lit place.
candles ⚫ Place gates at the top and bottom of stairs
⚫ Do not leave toddlers unsupervised near hot ⚫ Do not allow child to walk or run with sharp
water faucets. objects in hand or the mouth
⚫ Check temperature settings for hot water heater ⚫ Raise crib rails and check to make sure they are
and turn down thermostat if it is over 125F locked before walking away from the crib
⚫ Do not leave coffee/tea pots on a table where
child can reach them
⚫ Never drink hot beverages when a child is sitting
on your lap or playing within reach
This document is the property of PHINMA EDUCATION 2
Care of Mother and Child at Risk or with
Problems (Acute and Chronic)
⚫ Do not allow toddlers to blow out matches (teach
that fire is not fun); store matches out of reach.
⚫ Keep electrical cords and wires out of reach;
cover electrical outlets with safety plugs.
CHILD ABUSE
⚫ PHYSICAL ABUSE- child is beaten or burned PHYSICAL NEGLECT
⚫ NEGLECT- child is not fed, clothed, supervised ⚫ Child may appear unwashed, thin and
properly or offered medical care or educational malnourished or dressed inappropriately, such as
opportunities without mittens, coat or shoes in cold weather
⚫ PSYCHOLOGICAL/EMOTIONAL ABUSE- a child ⚫ Failing to bring a child for immunization or to seek
is made to feel unintelligent or inadequate early medical care for an infection, keeping a child
out of school or allowing a child to go
*Abuse places a child at immediate risk for harm and can unsupervised
also lead to long-term effects
PSYCHOLOGICAL ABUSE
Long term effects: ⚫ Includes constant belittling or threatening,
⚫ they tend to be angry, rejecting, isolating or exploiting a child
⚫ non-compliant, ⚫ It is the absence of positive parenting and is
⚫ hyperactive difficult to detect
⚫ poor self-control ⚫ Evident in parents who use only negative terms to
⚫ low self-esteem, describe a child
⚫ withdrawn
⚫ undiagnosed medical problems (anemia, otitis MUNCHAUSEN SYNDROME BY PROXY
media, lead poisoning, or STI’s ⚫ It refers to parents who repeatedly bring a child to
a health care facility and reports symptoms of
*Abused children tend to grow up as abusive parents illness when, in fact, the child is well
THEORIES OF CHILD ABUSE ⚫ The reporting causes the child to undergo
1. Special Parent: Parents Who Abuse needless diagnostic procedures or therapeutic
⚫ Most were abused as children regimens
⚫ Some have less self-control than other ⚫ The parent may deliberately inflict injury on the
parents child such as giving a laxative to induce diarrhea
⚫ Unfamiliar with normal growth and or slowly poisoning the child with a prescription
development of children and have unrealistic drug.
expectations
⚫ The parents may be socially isolated with no 2 CLASSICAL FINDINGS
support people ⚫ 1st, the symptoms are not easily detected by
⚫ Excessive use of alcohol or drugs physical examination, only by history;
⚫ 2nd, the symptoms are present only when the
2. Special Child: Children Who Are Abused abuser is providing care and disappear when care
⚫ They may be less intelligent than other children in is provided by another person
the family
⚫ Unplanned The parent has some degree of medical or child care
⚫ With birth defect, premature or with illness knowledge, tends to stay with the child constantly
preventing bonding
SEXUAL ABUSE
3. Special Circumstance: Stress ⚫ It is any sexual contact between a child an
⚫ As simple as a blocked toilet, illness in the family, adult
job loss, financial constraints ⚫ Molestation- vague term than includes indecent
liberties-such as oral-genital contact, genital
SHAKEN BABY SYNDROME fondling and viewing or masturbation
⚫ Caused by repetitive, violent shaking of a small ⚫ Incest- sexual activity between family members
infant by the arms or shoulders, which causes a ⚫ Pornography and Prostitution- photographing
whiplash injury to the neck, edema to the or describing sexual acts by any medium involving
brainstem and distinct retinal hemorrhages children, or distributing such material in person or
by mail or fax or over the internet
RITUAL BASE
⚫ Cult-based, or religiously, spiritually or satanically-
This document is the property of PHINMA EDUCATION 3
Care of Mother and Child at Risk or with
Problems (Acute and Chronic)
motivated
⚫ May involve physical, sexual or psychological
abuse with bizarre or ceremonial activities
CEREBRAL PALSY
⚫ Definition: a group of nonprogressive disorders of 2. Dyskinetic or Athetoid type
upper motor neuron impairment that result in motor ⚫ It involves abnormal involuntary movement
dysfunction ⚫ ATHETOID means “wormlike”
⚫ Affected children may also have speech or ocular ⚫ A child with quadriplegia usually has impaired
difficulties, seizures, cognitive challenges, or speech (PSEUDOBULBULAR PALSY) but may
hyperactivity or may not be cognitively challenged. Swallowing
⚫ Muscle spasticity can lead to orthopedic or gait saliva may be difficult (DROOLS) and has
difficulties difficulty swallowing food
⚫ Exact cause: unknown but associated with LBW, ⚫ Early in life, the child is limp and flaccid. Later, in
prematurity, or birth injury place of voluntary movements, the child makes
PATHOPHYSIOLOGY slow, writhing motions.
⚫ Brain anoxia leads to cell destruction of the motor ⚫ It may involve all 4 extremities, plus the face, neck
tracts and tongue.
⚫ The child drools and speech is difficult to
TYPES OF CEREBRAL PALSY understand
1. Spastic Type ⚫ With stress, involuntary movements may become
Spasticity is excessive tone on the voluntary irregular and jerking (CHOREOID) with
muscles that results in loss of upper motor neuron disordered muscle tone (DYSKINETIC)
SYMPTOMS
⚫ hypertonic muscles, 3. Ataxic Type
⚫ abnormal clonus, ⚫ They have an awkward, wide-based gait
⚫ exaggeration of DTR, ⚫ On neurologic examinations, unable to perform
⚫ abnormal reflexes like (+) Babinski reflex, the finger-to-nose test or to perform rapid,
⚫ continuation of neonatal reflexes like tonic repetitive movements (tests of cerebellar function)
neck reflex or fine coordination movements
⚫ If they are held in a ventral suspension
position, they arch their backs and extend 4. Mixed Type
their arms and legs abnormally. ⚫ With symptoms of both spasticity and athetoid
⚫ They fail to demonstrate a parachute reflex if movements. Ataxic and athetoid movements may
lowered suddenly, failing to hold out their also be present together.
arms as if to break their fall. ⚫ This causes a severe degree of physical
⚫ Scissors gait because tight adductor thigh impairment
muscles cause their legs to cross when held
upright (may lead to a subluxated hip). ASSESSMENT
⚫ Tightening of the heel cord usually is so ⚫ History and physical assessment. Note possible
severe that children walk on their toes, unable anoxia during prenatal life.
to stretch the heel to touch the ground ⚫ Neurologic assessment, skull radiograph, CT
⚫ Spastic involvement may affect both Scan, MRI
extremities on 1 side (HEMIPLEGIA), all 4
extremities (QUADRIPLEGIA) or the lower LONG-TERM CARE
extremities (DIPLEGIA or PARAPLEGIA) ⚫ Help parents to encourage their children with CP
⚫ The involved arm may be shorter and may to reach their fullest potential within the limits of
have smaller muscle circumference their disorder
⚫ Most with hemiplegia have difficulty identifying ⚫ Evaluations at health care visits should note not
objects placed in their involved hand when only whether the child is achieving goals but also
their eyes are closed (ASTEREOGNOSIS) whether the child and family members find
⚫ Upon inspection of the child’s shoes, 1 heel satisfaction and acceptance in the child’s
will be more worn out than the other achievements
⚫ Listen to the parents and encourage verbalization
CHECK FOR UNDERSTANDING
The instructor will prepare 10 questions that can enhance critical thinking skills. Students will work by themselves to
answer these questions and write the rationale for each question.
This document is the property of PHINMA EDUCATION 4
Care of Mother and Child at Risk or with
Problems (Acute and Chronic)
1. You are a school nurse and one of the children tells you about the spanking she received from her mother last night.
The girl tells you that her mother got very angry when she "talked-back" to her and this is what usually happens when she
is "bad." You suspect the child has been maltreated, and following organizational policy, you take her to the administrator.
There are no marks on the child and she says she is not in pain?
A. Call ChildLine
B. Make a GPS referral
C. Provide community resource recommendations
D. Call the police
E. Take no action
2. You are caring for a child in a pediatric ward, while assessing a parent who abused her child. Which of the following risk
factors would the nurse expect to find in this case?
A. Flexible role functioning between parents
B. History of the parent having been abused as a child
C. Single-parent home situation
D. Presence of parental mental illness
3. The following are common safety measure for Poisoning, EXCEPT
A. Buy medications with childproof caps; put away immediately after use.
B. Never take medication in front of a child
C. Do not leave toddlers unsupervised near hot water faucets
D. Place all medications and poisons in locked cabinets or overhead shelves where children cannot reach them.
4. The following are common safety measure for Burns, EXCEPT:
A. Keep screen in front of fireplace or heater.
B. Monitor toddlers carefully when they are near lit candles
C. Do not leave toddlers unsupervised near hot water faucets.
D. Be certain that small batteries or magnets are out of reach
5. Caused by repetitive, violent shaking of a small infant by the arms or shoulders, which causes a whiplash injury to the
neck, edema to the brainstem and distinct retinal hemorrhages:
A. Cerebral Palsy
B. Sexual Abuse
C. Shaken Baby Syndrome
D. Munchausen Syndrome by Proxy
6. It refers to parents who repeatedly bring a child to a health care facility and reports symptoms of illness when, in fact,
the child is well:
A. Cerebral Palsy
B. Sexual Abuse
C. Shaken Baby Syndrome
D. Munchausen Syndrome by Proxy
This document is the property of PHINMA EDUCATION 5
Care of Mother and Child at Risk or with
Problems (Acute and Chronic)
7. Vague term than includes indecent liberties-such as oral-genital contact, genital fondling and viewing or masturbation:
A. Physical Neglect
B. Molestation
C. Incest
D. Pornography and Prostitution
8. A parent failed to bring her child for routine immunization schedule and was reported to you that her child her sick for a
month with cough, colds and fever. You know that this type of abuse is:
A. Physical Neglect
B. Molestation
C. Incest
D. Pornography and Prostitution
9. You’re caring for an 8-year-old in a pediatric ward told you that she was being photographed by her father-in-law naked
and was asked to change her clothes in front of him for a couple of times with a cellphone camera. You know that the
child is experiencing:
A. Physical Neglect
B. Molestation
C. Incest
D. Pornography and Prostitution
10. Act of engaging in sexual intercourse with one's direct family member (siblings, parents, offspring):
A. Physical Neglect
B. Molestation
C. Incest
D. Pornography and Prostitution
C. LESSON WRAP-UP
AL Activity: CAT: 3-2-1 This strategy provides a structure for students to record their own comprehension and
summarize their learning. It also gives the teacher an opportunity to identify areas that need re-teaching, and areas of
student interest
Instructions:
1. As an exit ticket at the end of the class period
2. After the lesson, have each student record three things he or she learned from the lesson.
3. Next, have them record two things that they found interesting and that they’d like to learn more about.
4. Then, have students record one question they still have about the material.
5. Review the students’ responses. You can use this information to help develop future lessons and determine if some
This document is the property of PHINMA EDUCATION 6
Care of Mother and Child at Risk or with
Problems (Acute and Chronic)
of the material needs to be taught again.
Three things you learned:
1.
3.
Two things that you’d like to learn more about:
1.
2.
One question you still have:
1.
This document is the property of PHINMA EDUCATION 7
