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How to help ease separation anxiety in a toddler
Bring blankets and toys from home
support and visits from family and parents
maintain rituals and routines that the child has at home
Greatest fear is being seperated from parents: reassure that parents will come back
Why are toddlers more prone to otitis media (ear infection)
They have smaller and shorter Eustachian tubes
easier for bacteria/fluid to get trapped
less common after 4 years, common after 6-8 mo of age
What are some long term concerns of otitis media
hearing loss
speech delay
can lead to meningitis if not treated
S/S of otitis media (ear infection)
cough
congestion
pulling at ear
fever
S/S of epiglotitis
drooling
fever
tripod position
stridor
muffled voice
sudden sore throat
Life threatening medical emergency, rapid progression
Nsg management for epiglotitis
oxygen
maintain airway
no tongue blade, ect due to possibility of causing further spasm and closing of airway
What substances do you NOT want to induce vomiting after poising
corrosive substances (acidic things: cleaners, bleach)
in these cases, gastric lavage or activated charcoal are used
always call poison control before inducing vomiting no matter what is ingested
Antidote to acetaminophen
Acetalysteline (mucomyst)
Eirksons stage for preschoolers (3-5 yrs)
Initiative vs guilt
Piaget stage for preschoolers (3-5yrs)
preoperational thinking (box is fort, magic powers)
Weight and height increase in toddler (1-3 yrs)
weight increases about 4-6 lbs/year
height increases about 5 in/yr
spinal cord ossification is complete leading to control over urethral and anal sphincters
3 year play
playground
swings
jumping
playing store
Vocab of 3 year/vision
1000 words
vision still immature
What may preschool age kids fear in the hosptial?
That they are being punished
think erickons initiative vs GUILT stage
4 year small motor skills
using scissors
lace shoes
simple buttons
vocab of 4 year old
1,500 words
curious about gender, death, dying, may ask questions
Can a 4 year old tell the difference between fantasy and reality?
No
5 year (kindergarten) milestones
print first name
name days of week
hammer to pound nails
talk constantly
tricycle
2,100 word vocab
limit TV to 1-2 hours/day
Nutrition for toddler
simple, nourishing meals
2-3 glasses of milk per day (whole milk, skim after 2 years)
help brushing teeth
protein needs are high
Will a preschooler nap?
Depends, some do and some do not
normal
Primary vs secondary enuresis
Primary = child has never been dry (not wet bed)
Secondary= child who has been dry for 1 yr or more begins wetting bed again
Tx for enuresis
desmopressin acetate
imipramine
Medical care for preschooler
annual well child check
Amblyopia
Lazy eye
visual deficit, usually in one eye
brain shuts off input to defect eye
Strabismus
Cross eye
not able to direct both eyes towards object
tx by glasses, sometimes surgery
can lead to amblyopia
Vesicoureteral reflux
can cause recurrent UTIs
valve that should close off ureter when peeing leaks and urine backs up into kidneys/ureters
can cause renal damage, pyelonephritis
Diagnosis with ultrasound or voiding cystourethrography
Febrile seizure
usually occurs when temp raises too fast
simple = under 15 min, short
complex = over 15 min
generalized = all over
focal = one part of body (shaking arm or leg)
Care during a seizure
admin oxygen
provide safety
diazepam given if longer than 5 min
Neuro checks in pediatric patients
pupillary response
moving arms/legs equal?
facial symmetry
crying = good
Croup S/S
harsh barking (seal) cough
fever
stridor
(children have smaller air passages so they experience more narrowing with inflammation)
Tx for croup
increase fluids
hot steam showers
exposure to cold air/cool mist humidifiers
corticosteroids
inhaled epinephrine (monitor closely because relapse can occur after med has worn off)
Usually secondary to flu, RSV, pneumonia
Diet for peds with diarrhea
soy based formula
no fruit juices
BRAT diet
Tx for c-diff
Vancomycin
metronidazole
What do you asses on a child with a broken bone?
5 ps
check finger movement
pulses
cap refill
checking feeling in hands (neurovascular status)
Compartment syndrome
complication of broken bone
causes damage to muscles and nearby nerves by pressure from swelling
paralysis and necrosis can occur
S/S: severe pain, numbness, tingling
Fat embolism
complication of fracture, usually of a long bone
S/S: SOB, jaundice, fever, confusion, increased HR, change in LOC
Findings of a child with cerebral palsy
jerky, involuntary movements
trouble with repetitive movements
scissoring gate (feet crossing over mid-line)
Meds to treat muscle spasms in CP
diazepam (can cause hallucinations)
Baclofen (may cause rapid eye movement)
Cushings triad
Increases systolic BP
deceased pulse
decreased respiration.
ABCs, assess for spinal injuries, check for drainage from ears and nose, monitor for fluid volume overload. Neruo checks frequently.
When can the carseat be flipped to forward face?
2 years
Vaccines that a 4-year-old is required to have before attending preschool
Tetanus vaccination (DTaP/DT/Td)
Polio vaccine (IVP) (OVP)
Measles/Mumps
Hib for influenza
Hepatitis B vaccination,
Pneumococcal vaccine (PCV)
Varicella vaccine (VAR)
Hepatitis A vaccination
Interventions to relieve a preschool child's anxiety in the hospital
providing bandaids for children who get shots since they have a fear of bodily harm
Letting them know when a procedure will hurt, it is ok to cry but they need to hold still
assure them that they are not being punished and this is not their fault, it is just something that will either help them heal or prevent them from getting sick.
let them hold the equipment so that they don't feel afraid of it.
Exam test for strabismus
Corneal light reflex test can be done by shining a light in the child's eye to look for a reflection in the pupils (at the same point/area as the other eye).
cover test : cover one eye while having the child focus on an object then uncover the eye to see if the covered eye is moving around or stood still (if the uncovered eye doesn't move its aligned/normal)
Common S/S of UTI in a preschooler
Lethargy
irritability
poor feeding
foul smelling urine
incontinence in a potty trained child
What is the most common UTI causing bacteria in a preschooler
E.Coli because they may wipe improperly
Common in females because the urethra is close to the anus.
what is a serious complication of untreated strep throat?
Rheumatic fever
can cause heart damage
Glomerulonephritis
causes kidney damage
What are other causes for a febrile seizure (other than a fever)
virus
encephalitis
meningitis
otitis media (ear infection)
What vaccines decrease need for a dx lumbar puncture
HiB influenzae
pneumonia
What age of child is a “toddler”
1-3 years
When are all 20 teeth generally done erupting?
2 years
Psycologic anorexia
when a toddlers appetite greatly decreases, may eat significantly less than before
worries parents, but is compleatly normal
Weight and height gain during preschool years (3-5), normal pulse rate
weight increases about 5lbs/year
2.5-3 inches/year height
Pulse rate 90-110 BPM
90% of brain growth achieved
Nutrition for preschoolers (3-5)
1600 cal/day
protien
iron
vtimains A and C
limit fruit juice to 4-6oz/day
Nursing management for otitis media
warm or cold compress placed on affected side
placed upright to decrease pain
if ear is draining, clean with sterile water or hydrogen peroxide
Risk factors for otitis media
smoking in the house, increased pacifier use, cleft palet
breastfeeding for first 6 mo decreases risk
Treatment for otitis media
Amoxicillin, augmentin
sometimes is viral, no need for antibiotics
Epiglottitis
Swelling of the tissue above vocal cords. Narrowing of airways
most common cause is haemophilus influenzae
S/S of fluid imbalance/dehydration
lethargy
slow turgor
cool to touch
sunken eyeballs
dry MM
less wet diapers
sunken fontanels
no tearing during crying
increase pulse, RR
low BP
Is cerebral palsy a progressive disorder?
No
How much food will a toddler eat compared to an adult?
1/4-1/3 an adult portion size
What size should the toddlers toy be to avoid choking?
larger than toddlers fist
Treatment for lead poisoning
calcium disodium edetate (CaEDTA)
british antilewistle (BAL)
Treatment for salicylate poisoning (ex aspirin)
No specific tx, gastric emptying usually used
3 year old developmental milestones
help dress and undress selves
use toilet and wash hands
eat independently
may revert to parallel play if uncomfortable
Note 
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