Exam 1 2/2

Growth & Development - Toddlers and Preschoolers

• Toddlers

  • Biologic development

    • Proportional growth

      • Weight

        • Average weight is 4 to 6 pounds/year

        • Quadruple birthweight by 2.5 years

      • Height

        • Average height increases approximately 3 inches per year

      • Head circumference

        • Equal to chess by one to two years

        • Slows 1/2 to 1 inch yearly

        • anterior frontal closes 12 to 18 months

      • Chest circumference

        • Exceeds heads circumference

        • Exceeds abdominal circumference after second year

  • Sensory development

    • Vision

      • 20/40 acceptable

      • Depth perception continues to develop

      • Strabismus

    • Hearing, smell, taste, touch

      • Uses senses to investigate food

  • Maturation of systems

    • Respiratory

      • Increase lung volume

      • Internal structures

    • Brain

      • Growth

      • Myelination

    • Integumentary

      • Functionally mature

      • More effective barrier against fluid loss

      • Growth

    • Digestive

      • Fairly complete

      • Elimination

      • Urine control

    • Immunologic

      • Antibodies well established

    • Thermoregulation

      • Maturing

  • Gross motor skills

    • Locomotion

      • 12 to 13 months, walk alone with wide stance

      • 18 months, try to run

      • 2 to 3 years, Improved coordination and equilibrium

      • Two years, walks up and downstairs

      • 2 1/2 years old, stand on 1 foot

  • Motor skill development

    • Explain Mechanical dexterity: 12-30 months of age

      • Give examples

Psychosocial Development of the Toddler (Erik Erikson)

• Autonomy vs. Shame/doubt

  • In this stage, they love to say no to everything. This is the stage when they want some independence

    • Autonomy

      • Achieved when parents encourage and provide opportunities for independent activities

    • Shame/doubt

      • Results in lack of confidence

Cognitive development of the toddler (Jean Piaget)

• Sensorimotor stage - Preoperational

  • Pre-operational phase

    • Beginning of phase at two years old

    • Face of transition that bridges behavior to more socialized Behavior

  • Sensory motor phase

    • Territory circular reaction; 12 to 18 months

    • Mental representation: 19 to 24 months

• Psychosocial: Getting their independence “ Me do”

• Egocentrism: Cognitive, everything is about them “ I want”

Social development of toddlers

• Attachment and language

  • Attachment

    • Two phases

      • Separation

      • Individuation

  • Language development

    • Increase comprehension level

    • Increase in vocabulary/words

    • Ability to understand speech, despite not being able to say those words

    • Gestures

    • More than 300 words in vocab by age 2

• Personal social behavior

  • Developing independence

  • Strong willed and volatile temperament

  • Kiss/hug parents

  • Kiss pictures

  • Kiss FaceTime

  • 15 months – feed self, drinks from cup, manages spoon, shoes/socks off

  • 24 months – use spoon well

  • 36 months – uses fork

  • 2 to 3 years – Eastwood family, Helps with chores, Removes clothes

• Play

  • Parallel play – alongside, not with

    • Ex: Have someone next to each other, but not talking or interacting

  • Assumes many forms and serves several functions

    • Alone, other children, adults

  • Toy selection

    • Imitated by environment

    • Push/pull toys (define and give an example)

    • Riding toys

  • Toy safety

    • Age appropriate

• Body image and sexual development

  • Sexual development

    • Early beginning

  • Vocabulary associated with body parts

    • Explain body parts at their level. They don’t know that something’s are not appropriate.

      • Ex: Boys touching their parts bc they have to pee or it itches

  • Sexual differences become obvious

  • Body image

Coping with the toddler

• toilet training

  • Bowel training accomplished before bladder

  • Nighttime bladder training may not be completed until 4 to 5 years

  • Daytime accidents are common

  • Curiosity about adults or siblings habits

  • And patient with wet or soiled diapers

  • Physical readiness

    • Voluntary control urine/bowel

    • Stay dry for two hours

    • Find motor skills to remove clothes

  • Mental readiness

    • Recognition of the urge

    • Communication skills to indicate urge

  • Psychological readiness

    • Express willingness to please parent

    • Abilities to sit – 5 to 8 minutes

  • Parental readiness

    • Recognition of child’s readiness

    • Willing to invest time

• Temper tantrum

  • Releases tension

    • Breath holding

    • Kicking feet

    • Screaming

  • Increased when child is ill, hungry, frustrated, or tired

  • Usually, last 5 minutes or less

  • IGNORE BEHAVIOR BUT ENSURE SAFEFTY

    • DO NOT REACT! But make sure they are safe

• Sibling rivalry

  • Natural jealousy

  • Resent changes in routine With addition of sibling

  • Merging families

• Negativism

  • “No” to everything

  • Assertion of control

  • Offer two appropriate choices

  • Reduce the opportunity for child to say no

  • Stay in routine

  • Stay calm & reassuring

  • Give choices!

    • Give two choices

• Stress

  • Small amounts are beneficial to learn coping

  • Identify source

  • Best approach is prevention

  • Activities should not exceed their coping ability

• Regression

  • Retreat from one’s level of functioning to past levels of behavior

  • Common in toddlers

  • Opportunity for parents to prepare for next stage of development

  • Fears are common

Health promotion of the toddler

• Nutrition

  • Whole milk until 2 years, limit to 2-3 cups daily

  • Physiologic anorexia due to decreased nutritional need and appetite

  • Picky, fussy eaters

    • The way to for them to learn textures, is to allow them to eat messy

  • Influenced by factors other than taste when choosing food (color)

  • Overwhelmed by large portions

  • Recommendations USDA & American Academy of Pediatrics on

    Nutrition

  • Give hand –held foods

  • Positive Eating Patterns

• Sleep and Activity

  • Average total sleep=10-13 hours

  • Most take 1 nap/day, stop by 3-4 years

  • Sleep problems, going to bed

  • Rituals, transitional objects

• Dental health

  • First visit soon after first teeth, 12-15 months

  • Oral hygiene, parents brush twice daily, small amount of paste (pea size)

  • Avoid caries

  • NO continuous juice sippy cups

    • LIMIT JUICE

  • No bottle propping at night (EVER)

  • Water at night

  • Fluoride rinses not recommended < 6 yrs

• Injury and Prevention

  • Choking

  • Suffocation

  • MVA - car seat

  • Falls

  • Bodily damage

  • Drowning

  • Burns and poisoning

    • Keep medication out of reach, put locks, and hidden

Preschool

• Proportional growth

  • Weight

    • Gains 4.5-6.5 pounds/year

    • Average weight

    • 3 years- 32lbs

    • 4 years- 36.5 lbs

    • 5 years- 43 lbs

  • Height

    • Gains 4.5-6.5 pounds/year

    • Average weight

    • 3 years- 32lbs

    • 4 years- 36.5 lbs

    • 5 years- 43 lbs

• Gross motor skill development

  • 3 years old

    • Walking, running, climbing jumping

    • Rides tricycle

    • Tiptoes, balances on 1 foot for a few seconds lbs

  • 4 years old

    • Skips & hops well on one foot

    • Catches ball reliably

  • 5 years old

    • Skips on alternate feet, jumps rope, learns to skate and swim

• Fine motor skill development

  • 3 years old

    • Copies circle

    • Imitations lines

    • Holds pen

    • Scribble name

  • 4 years old

    • Trace shapes

    • Tower 9-10 blocks

    • Builds bridge

    • Lace shoes

    • Use scissors

    • Pellets into a narrow neck toy

  • 5 years old

    • Uses writing tool well

• Gross motor + Fine motor

  • Preschoolers at four and five years are developing motor skills that allow them to play on sport teams

  • Preschoolers can work on creative things together as a group

Psychosocial development of the preschooler - Erik erikson

• initiative vs. guilt (EXPLAIN AND GIVE EXAMPLES)

  • Energetic learning

  • Developing a sense of initiative

  • Superego

  • Start to learn between good and bad.

Cognitive development of the preschooler - jean Piaget

• Preoperational Stage

  • Development

    • Readiness for school

  • Causality

    • Resembles logical thought

  • Magical thinking

    • Thoughts are all powerful

Social development of the preschooler

• Attachment

  • Characterized by:

    • Individuation-separation completed

    • Tolerate brief separations from parents

    • Cope with changes in daily routines

    • Gain security from familiar objects, toys, dolls, etc.

• Language development

  • Major mode of communication and social interaction

  • Talk incessantly, ask many questions

  • 3-4 years old

    • 3-4 word sentences

    • Speech is telegraphic bc of brevity

  • 4-5 years old

    • 4-5 word sentences

    • Questioning is at its peak

  • 5 years old

    • Contains approximately 2100 words

    • Can go have longer commands

  • 6 years old

    • Can use all part of speech correctly

    • Identify opposites

• Personal social behavior

  • Self assertion is a major theme

  • Preschoolers are more sociable and willing to please

  • Preschoolers become increasingly aware of their position and role in the family

  • 3 years old

    • May exceed boundaries

  • 4-5 years old

    • Little assistance with dresssing, eating, toileting

    • Can be trusted to obey warning of danger

  • 5 years old

    • Cares for self

    • Can call 911

• Play

  • 1. Activities that promote physical growth and refinement of motor skills

  • 2. Understands sharing but may not want to share.

  • 3. Imitative, imaginative, dramatic in play; imaginary playmates

  • 5. Understands sharing

  • 6. Dress up dolls, farm animals and equipment

  • 7. TV and videos have their places and parents should supervise selection of programs and limit hours.

  • 3 year old - parallel play

  • 4-5 years old - associative play

• Body image and sexual development

  • Aware of differences; big/little, skin color, race

  • Fear blood and insides will “leak” out of a bone is broken

  • Sex role identity, “Dressing” up

  • Sexual exploration

    • Beginning to understand their body

Coping with preschooler

• school experience

  • Learning group cooperations

  • Peer group experiences

  • Readiness for academics

    • 5 Rs recommended by the American Academy of Pediatrics Early Brain & Child Development

    • Preparing the child

  • Read → rhyme → routines → reward → relationships

• Sex education

  • Find out what the child knows &

    thinks

    Be honest with responses

    Understanding the broader

    concept of sexuality

• Aggression

  • Behavior intended to hurt person or destroy property.

  • Frustration

  • Modeling

    • Imitating the behavior of significant others

  • Reinforcement

  • Professional help for parenting

• Speech problems

  • Stuttering

    • Developmental stuttering:

      • common children aged 2 to 5 years

  • Dyslalia:

    • articulation problems

  • Screening & evaluation

• Stress and Fears

  • Teach parents the signs of stress in their preschool child

  • Teach child relaxation & guided imagery techniques

  • 3 years old

    • • Stubbornness

      • Belongings

      • Jealousy

      • Separation

      • Mealtime

      • Nap/Bedtime

      • Destructiveness

  • 4 years old

    • • Insecurity

      • Companionship

      • Sex

      • Activity level

      • Fears

      • Attention

  • 5 years old

    • • Approval

      • School

      • Worrying

      • Belongings

      • Procrastination

      • Name calling

Health promotion of the preschooler

• nutrition

  • Continue to limit juice

  • Food fads

  • Social aspects of mealtime

• Sleep and activity

  • Sleep 10-13 hrs per night for preschooler

  • Sleep problems

    • Night mare vs night terrors (GIVE EXAMPLE)

  • Sleep rituals

• Dental health

  • Eruption of primary teeth is complete in preschoolers

  • Need assistance with tooth brushing

  • Routine prophylaxis including fluoride supplements

• Injury and prevention (GIVE EXAMPLE)

  • Magical thinking

    • Imaginary friend

    • Watch tv, and try to act it out

  • MVA - car seat

  • Playground

  • Personal 911

Growth and development of the school age and adolescent

• school age 6-12 years old

• Biological development

  • Proportional growth

    • Height

      • Avaergae 2 in/year

    • Weight

      • Gain 4.5-6.5 ibs/year

    • Teeth

      • Permanent teeth at age 6

    • Sleep

      • 10-12 hrs/night

      • GIRLS GROW FASTER THAN BOYS

• Maturation of systems

  • GI

    • Glucose control

    • Caloric

  • Renal

    • Bladder

  • Cardiovascular

    • growth slows

    • VS adjust

  • Immunity

    • Increase in competence

  • Musculoskeletal

    • mineralization

    • Characteristic

  • Sexual maturity

    • Boys - 15

    • Girls - 12

    • Preadolescnece

      • No universal age to assume characteristics

Psychosocial development of the school age - Erik erikson

• industry vs inferiority

  • Industry

    • Stage of accomplishment

  • Inferiority

    • Failure to develop sense of accomplishment

  • Takes pleasure in completing tasks

Cognitive development - jean Piaget

• concrete operational

  • Use thought processes to experience events and actions

  • Develop understanding of relationships between things and ideas

  • Able to make judgments based on reason (“conceptual thinking”)

Social Development

• developing a self concept

  • Self concept

    • A conscious awareness of a variety of self-perceptions (abilities, values, appearance, etc.)

    • Importance of significant adults in shaping child’s self-

      concept

    • Positive self-concept leads to feelings of self-respect, self confidence, and happiness

  • Body image

    • Generally, children like their physical selves less as they grow older

    • Body image is influenced by significant others

    • Increased awareness of “differences” may influence feelings of inferiority

• Sexual development

  • Nurse role

    • Normal part of G&D

    • Differentiate

    • Values

    • Problem solving

  • Sex education

    • Normal Curiosity

    • Ideal time for formal sex education

    • Life span approach

• Play

  • Rules and rituals, team sports

  • Play is more competitive

  • Quiet games and activities

  • Clubs

  • Ego mastery

  • School Age children love to participate in sports activities

• School age children also like to participate in competitive sports activities

• School Age Children enjoy activities with someone else

• School Age Children can be involved in Activities that require practice

Health promotion

• nutrition

  • Decreased growth needs

  • Balanced diet from all food groups

  • May be picky, but willing to try new foods

  • Fast Food Concerns

• Sleep and rest

  • Average 9½ hour/night during school-age

    • 11½ hours for 5-year-olds and

    • 9 hours for 11-year-olds

    • Highly individualized

  • Ages 8 to 11 may resist going to bed

  • 12 years & older generally less resistant to bedtimes

• Injury prevention

  • Experience less fear in play, may imitate real life with tools and household objects

  • Risk-taking behaviors

    • MVA

    • ATV

    • Bicycle

    • Skate- Board

    • Scooters

Adolescent

• Biological development

  • Early age (11-14)

    • Changes of puberty and response to changes

  • Middle (15-17)

    • Transition to dominant peer orientation, preoccupations with dress appearance, etc.

  • Late (18-20)

    • Transition to adulthood, adult work role and relationship

• Neuroendocrine event of puberty

  • Triggered by hormonal influences & controlled by anterior pituitary gland in response to stimulus from the hypothalamus\

  • Initiation of puberty

  • Changes in reproductive system

    • Females (explain)

    • Males (explain)

• Puberty sexual maturation

  • Rapid growth; predictable

  • Onset varies

  • Girls, 9-13.5 years

    • Biggest indication for girls is breast development

  • Boys 9.5-14 years

    • Boys testicular enlargement

  • TANNER STAGES OF DEVELOPMENT (EXPLAIN, DETAILED, EXAMPLES)

• Adolescent growth

  • Lean body mass

    • Girls: rate peaks at menarche

    • Boys: early puberty

  • Fat mass

    • Girls: Increases in early puberty, continues following menarche

    • Boys: Peak deceleration at the time of their growth spurt

  • Peak height

    • Girls: 12 years, 6- 12 months prior to menarche

    • Boys: 14 years, following growth of testicles, penis, axillary and pubic hair

  • Peak weight

    • Girls: 6 months after PHV

    • Boys: simultaneously with height spurt

  • Linear growth

    • Girls: increase begins in early puberty

    • Boys: increase mid-puberty

  • Respiratory

    • Increased Vital capacity

  • Cardiovascular

    • Increased heart rate, blood volume, SBP

    • Decreased HR

  • Neurological

    • Continued brain growth

• Motor skills

  • Gross and fine motor skills are well developed

  • strength & endurance increase

Psychosocial development of the school age

• Identity vs Confusion (EXPLAIN)

  • Stages

    • Early

      • Puberty startS

      • Altered self- concept

      • Compare bodies to others

      • Fantasy life, daydreams

      • Mood swingS

      • Needs limits and consistent

    • Middle

      • Is separate from parent

      • Can identify own values

      • Defines self (self- concept, strengths/weaknesses)

      • Partakes in peer group

    • Late

      • Achieves greater independence

      • Chooses a vocation

      • Finds an identity

      • Finds a mat

      • Develops own morality

      • Completes physical and emotional maturity

Cognitive development - jean Piaget

• formal operational

  • Formal operational thinking: ages 11 to 14

  • Abstract terms, possibilities, and hypotheses

  • Decision-making abilities increase

  • May not use formal operational thought and reasoned decision making all the time— “choices”

  • Develop abstract thinking, often unrealistic

  • Capable of scientific reasoning and formal logic

  • Enjoys intellectual abilities

  • Able to view problems comprehensively

Social development

• Play

  • Games and athletics

  • Competition and strong rules are important

  • Enjoys many activities: sports, videos, reading, hobbies, parties

• Health Concerns of Adolescence

  • Sexual behavior

  • Tanning

  • Abuse

  • Body art

  • Parenting

  • Learning problems

  • Depression/suicide

  • Physical fitnesss

  • Chronic disease

  • Eating habit/diet

  • Unintentional/intentional injury

  • Psychosocial adjustment

  • Tobacco/vaping/alcohol

• Technology as a social environment

  • Internet chat rooms & social networking sites have created “virtual” communities

  • Try out identities & interpersonal skills with wider network of people

  • Use of multiple types of technology at one time

  • Anonymity

  • Risks:

    • Cyberbullying

      • Distraction while driving

• Health promotion

  • Nutrition

    • Teach food pyramid and health choices

    • Calcium and protein need for bone and muscle growth

    • Inadequate diet can retard growth and delay sexual development

  • Injury prevention

    • Risk takers

    • Driving

    • Drowning

    • Burns

    • Poisoning - alcohol

    • Bodily damage

Health promotion

• Scabies

  • Caused by scabies mite as female burrows into the epidermis to deposit eggs and feces

  • Inflamed, intense pruritus, excoriation 30-60 days after exposure

  • Treatment

    • Treat all contacts

    • Topical

    • Permethrin 5% (scabicides) for 30 to 60 days

    • Lindane

    • Oral

    • Ivermectin if body weight is greater than 15 kg

  • Nursing considerations (GIVE A LIST)

• Pediculosis capitis (HEAD LICE)

  • Very common, especially in school age

  • Adult louse lives only 48 hours without human host; female louse has life span of 30 dayS

  • Females lay eggs (nits) at base of hair shafT

  • Nits hatch in 7 to 10 days

  • Treatment: pediculicides and nit removal

• Enuresis - besetting/urination

  • Bedwetting at least twice a week for 3 months past age 5, usually ceases 6-8 years of age

  • More common in boys

    • Primary

    • Secondary

    • Nocturnal

    • Diurnal

  • Organic causes

    • Structural defects

    • UTI, impaired kidney function, chronic renal failure

    • Neurologic deficits, endocrine disorders (diabetes)

    • Sickle cell disease

    • Bladder volume of 300 to 350 mL is sufficient to hold a night’s urine

  • Evaluation

    • Physical exam to rule out physical etiologies

    • Bladder capacity

    • Psychiatric evaluation

    • History

  • Management (goal 4-28 consecutive dry nights)

    • Conditioning therapy

    • Retention control training

    • Drug therapy

      • Tricyclic Antidepressants

      • Anti- Diuretics

      • Antispasmodic

      • DDAVP

    • Just Wait it Out Method

• Encopresis

  • Must occur once a month for past 3 months

    • Primary

    • Secondary

  • Characteristics

    • More common in males

    • May follow psychological stress

  • Signs & Symptoms

    • Abdominal pain/Cramping (no distention)

    • Palpable, moveable fecal mass

    • Normal or decreased bowel sounds

    • Malaise or HA

    • Anorexia, nausea, vomiting

    • Evidence of soiling, odor

    • Social withdrawal

  • Pathophysiology

    • Constipation

    • Impaction

  • Treatment

    • Determine cause

    • PsychotherapeutiC interventions

    • Regiment

      • Dietary changes

      • Fecal evacuation (laxatives, enemas)

      • Stool softeners

      • Bowel training

• Acne

  • More than 50% of adolescence affected

  • Etiology

    • Familial aspect

    • Hormonal influence

    • Other influence

  • Psychosocial ramifications

    • Self-esteem issues

  • Pathophysiology

    • Involves hair follicle and sebaceous glands

    • Comedogenic

  • Therapeutic management

    • General measures/overall health

    • Medications

    • Nursing considerations

• Male reproductive concerns

  • Testicular tumors

    • Malignant

    • Occurrence (TSE)

  • Varicocele

    • Asymptomatic

    • Occurrence

    • Varicocelectomy

  • Epidiymitis

    • Causes

    • Presentation

    • Treatment

  • Testicular torision

    • Partial/Complete

    • Occurrence

    • Onset

    • Treatment

    • Nursing

    • Considerations

  • Gynecomastia

    • Occurrence

    • Prepubescent

    • Drug Induced

    • Treatment

• Female reproduction concerns

  • Menstrual disorders

    • Primary amenorrhea

    • Secondary amenorrhea

    • Menstrual irregularities

  • Dysmenorrhea

  • Endometriosis

  • PMS

  • Dysfunctional Uterine Bleeding

• Endometriosis

  • Definition : presence of endometrial glands and stroma outside of the normal intrauterine endometrial Cavity

  • Etiology unclear

  • Treatment:

    • Medical

    • Surgical

    • Pharmacologic suppression

  • Nursing considerations

Health problems of the toddler and preschool

• sleep problems

• Initiation of sleep, staying asleep

• Nightmares vs Night Terrors

• Media use

• Consequences of sleep disturbances

• Cultural considerations

  • Co-sleeping

Communicable diseases

• Varicella - Zoster virus

  • Incubation period 2-3 weeks

  • Period communicability 1 day before eruption of lesions to days after first crop of vesicles have crusted.

  • Contact, droplet precautions

  • Nursing considerations:

    • Isolate

    • Skin care

    • Change linens daily

    • Keep child cool

    • Pressure to pruritic area rather than scratching

      • Keep from scraping, can lead to infection

• Fifth disease erythema infectiosum

  • Human Parvovirus B19

  • Rash in 3 stages

    • 1st- “slapped cheek” appearance, disappears 1-4 days

    • 2nd- upper and lower extremities, proximal-distal, may last 1 week or more

    • 3rd- rash reappears if irritated or traumatized

  • Supportive care-analgesic, antipyretics

  • No isolation necessary

  • Pregnant women

  • Low risk of fetal death with 1st trimester exposure

• Exanthem Subitum

  • Roseola Infantum

  • Human Herpes virus type 6

  • 6 months-3 years

  • Present with high fever, precipitous drop, then rash appears

  • Rash first on trunk then face and extremities

  • Supportive treatment

    • Antipyretics

• Scarlet Fever

  • Group A b-hemolytic streptococci

  • Incubation 2-4 days, with range of 1-7 days

  • During incubation period and clinical

    • illness (24-48 hours of abx therapy)

  • Period of communicability!

  • High fever, HA, vomiting, abdominal pain, malaise

  • Exanthema- rash appears within 12 hours of prodromal phase, sandpaper-like, increased density in groin/axilla

  • Exanthema - enlarged tonsils, exudate, beefy red pharynx, strawberry tongue

  • Medication

    • Antibiotic

  • Bedrest, analgesics, fluids

    • Especially during febrile phase

  • Return for follow-up

    • Testing

  • Complications (more detailed and examples)

Non-vaccine communicable diseases

• Conjunctivitis - “pink eye”

  • Etiology

    • Viral, bacterial, allergic, foreign body

    • Only bacterial is considered contagious

    • Assessment - itching, burning, scratchy eyelids, redness, edema, discharge

  • Nursing care

    • Instructions

      • Infection control measures, medication regimen

      • No school for 24 hours after therapy initiated (bacterial)

      • Accumulated secretionswiped from inner canthus, downward, and away from other eye

• Aphthous stomatitis (canker source)

  • Benign, but painful

  • Onset associated with traumatic injury

  • 4-12 days

• Hermetic gingivostamotitis (herpes simplex type 1)

  • Primary infection-fever, pharynx erythematous and edematous, vesicles erupt on mucosa, cervical lymphadenitis, 5-14 days

  • Recurrent- vesicles on lips, precipitated by stress, trauma, exposure to sunlight

• Stomatitis

  • Pain management

    • Topical anesthetic, antihistamine

  • Treatment

    • Pain relief prior to meals, use of straws, soft toothbrush, soft foods

  • Monitor

    • Assess for S/S dehydration

  • Prevention

    • Prevent spread - autoinnocuable

• Intentional parasites

  • Giardiasis

    • Pathophysiology

      • Most common parasitic pathogen

      • 17%-50% prevalence in daycares during outbreaks

      • Fecal-oral route, food, animals

  • Clinical manifestations

    • Diarrhea, vomiting, anorexia, FTT, abdominal cramping, loose stools, constipation

    • Most infections resolve within 4-6 weeks

  • Diagnosis

    • Stool samples x3

    • EIA

    • ELISA

    • DFA

  • Management

    • Flagyl

    • Furoxone

    • Albenza

• Pinworms

  • Transmitted by fecal-oral route

    • Favored in crowded conditions

  • Clinical Manifestations

    • Intense perianal itching

  • Diagnosis

    • Tape-test

  • ManagemenT

    • Vermox (all family members)

      • Retreat in 2-3 weeks

• Ingestions

  • Commonly ingested medications with fatal consequences

    • Methyl salicylate (Bengay)

    • Camphor (Vicks vapor rub)

    • Topical imidazolines (Nasal decongestant)

    • Benzocaine (Orajel)

    • Diphenoxylate/atropine (Lomotil)

  • Most commonly ingested

  • Pharmaceuticals

    • Analgesics Gummy vitamins

    • Antacids Cough/Cold Meds

  • Non-pharmaceuticals

    • Cosmetics Pesticides

    • Cleaning products Arts/Craft

  • Treatments

    • Immediate concern for life support, CV or Respiratory intervention

      • Assessment

        • 1. Treat child first, not poison

        • 2. Terminate the exposure

        • 3. Identify the poison

        • 4. Remove the poison and prevent absorption

  • Poison control center

    • Call for any ingestion, call before any treatments

  • Medical treatments

    • Focused on gastric decontaminations

    • Emetics

      • Syrup of ipecac

        • No longed recommended

    • Gastric lavage

    • Activated charcoal

      • Binds in kidney, and excreted (pooped out)

    • Cathartics

      • Sorbitol

      • Mg citrate

      • Mg sulfate

        • Pooping it out, can dehydrate, monitor fluids/I&O

      • Antidotes

        • Mucomist

        • Naloxone

        • O2

        • Digibind

        • Flumazenil

• Education

  • Prevention of poisoning and recurrence

    • Educate regarding household items that may be toxic for a child

    • Locks on upper cabinets

• Lead poisoning

  • Pathophysiology

    • Lead found in erythrocytes, stored in bones and teeth, organs and tissues

    • Hematologic SysteM

    • Renal effects

    • Neurological

      • Disrupting neurotransmitter

  • Diagnostic evaluations

    • Venous blood sample

    • Capillary testing for screening only

    • Blood lead level (BLL)

      • Screening and diagnosis

  • Screening

    • Universal screening

      • BLL ages 1-2 years

      • High risk more often

    • Targeted screening

  • Therapeutic management

    • >20, anything from 10-20

    • Requires clinical management, environmental investigation, education

  • Chelation therapy

    • >45

    • Does not counteract effects of lead

    • Rebound phenomenon

    • High amounts of lead in body parts, will see an initial increase in BLL

  • Chelation agents

    • Succimer (Chemet)

      • Orally, small beads that can be sprinkled

      • 10mg/kg TID for 5 days then BID for 14 days

    • EDTA

      • IV/IM, used with BLL >40 and in conjunction with BAL when BLL > 70

      • BAL

        • Deep IM, BLL >70, not to be used with

          peanut allergy or G6PD

  • Education

    • Anticipatory guidance

    • Therapy

    • Diagnostics

    • Follow-up