prefinals quiz

• Toddler Development

  • Gross motor - walking, running, climbing
  • Fine motor - feeding themselves, drawing
  • Sensory/Cognitive - seeing, hearing, tasting, touching, and smelling
  • Language/Communication (speech) - saying single words, then sentences
  • Social/Emotional - playing with others, taking turns, doing fantasy play
• What are the Health Problems Common in Toddler? 4 and two common injuries

  • Burns
  • Poisoning
  • Child Abuse
  • Cerebral Palsy
  • Common Injuries - Drowning, Aspiration
• Burns


  Injuries to body tissue caused by excessive heat (greater than 40°C or 104°C)
• 2nd greatest cause of unintentional injury in 1- 4 y.o, 3rd most common cause of unintentional injury in children 5 - 14 y.o, every day, there are more than 300 children treated in emergency rooms for burn-related injuries
• Types of Burns

  • Thermal Burns - due to external heat sources
  • Radiation Burns - caused by prolonged exposure to ultraviolet rays
  • Chemical Burns - caused by strong acids, alkalis, detergents, or solvents
  • Electrical Burns - from electrical current
  • Friction Burns - from direct damage to the cells and from the heat generated by friction
• First Degree / Superficial Burn


  Affects only the epidermis, or outer layer of skin, appears red, dry, and with no blisters, feels mildly painful, heals 1 to 10 days by simpler regeneration
• Second Degree / Partial Thickness Burn


  Involves the epidermis and part of the dermis layer of the skin, appears red, blistered, and may be swollen, very painful, heals over 2 to 6 weeks by tissue regeneration
• Third Degree / Full Thickness Burn


  Involves the epidermis and full extent of dermis and may go into the subcutaneous tissue, appears white or charred and lacks sensation because the nerve endings are destroyed, skin grafting is usually necessary, healing takes months, scar tissue will cover the final healed site
• Fourth Degree Burn


  Full thickness burn extending into muscle and bone, skin grafting is necessary, muscle and bone may be permanently damages, scarring will cover the healed site
• Be certain to ask what caused the burn because different materials cause different degrees of burn, ask where the fire happened because fires in closed spaces are apt to cause more respiratory involvement than those in open areas
• Emergency Management of Minor Burns

  Immediately apply cool water to cool the skin, Application of Analgesic-antibiotic ointment and a gauze bandage to prevent infection, Keep dressing dry and change every 2 days
• Emergency Management of Moderate Burns

  Don't rupture blisters, Apply topical antibiotic (Silver Sulfadiazine - Silvadene) and dressing to prevent damage and infection, Broken blisters may be debrided
• Emergency Management of Severe Burns

  Fluid Therapy - LR or PNSS, Systemic antibiotic therapy, Pain mgt - Morphine sulfate IV, Physical Therapy - prevent contractures
• Emergency Management of Electrical Burns

  Clean with antiseptic solution (Half strength Hydrogen peroxide) 1:1, Monitor for airway obstruction, Provide bland liquid diet
• Burn → increased capillary permeability → hypoproteinemia (low protein levels in the blood), hyponatremia (concentration of sodium in your blood is abnormally low), hyperkalemia (high potassium levels in the blood), hypovolemia (low extracellular fluid (ECF) volume)
• Therapeutic Management of Burns


  • Topical Therapy - Silver sulfadiazine, Furacin (If with pseudomonas)
  • Escharotomy - cut into the eschar
  • Debridement - removal of necrotic tissue
  • Grafting - reduce fluid and electrolyte loss, pain, and infection - Allografting, Xenograft, Autografting
• Unintentional Injury Prevention Measures for Toddlers

  • Cook on the back burners of the stove, Use cool-mist type vaporizer, Keep screen in front of fireplace or heater, Monitor toddlers near lit candles, Check hot-water heater temperature, Don't leave coffee/tea pots on table, Buy flame-retardant clothing, Don't allow toddlers to blow out matches, Keep electric wires and cords out of reach
• According to the American Association of Poison Control Centers (AAPCC), there are more than 1 million reported poison exposures among children younger than 6 years of age yearly. 90% of the time it occurs in the child's home. 9,500 children will be hospitalized yearly for unsupervised ingestion of prescription medication
• Poison


  Any substance that is harmful to your body (swallow it, inhale it, inject it, or absorb it through your skin)
• Poison Prevention Tips for Parents

  • Keep medicines and toxic products locked and away from children
  • Add the poison control number (1-800-222-1222) in your cell phone and make sure all caretakers do the same
  • Call the poison control center if you think your child has ingested anything that may be poisonous
  • If your child has ingested a poisonous product and collapses or stops breathing, call 911
  • Read labels carefully to administer the appropriate amount of medications
  • Safely dispose of unused, unneeded, or expired medications and vitamins
• Emergency Management of Poisoning at Home


  Call National Poison Control Center - What was swallowed, Child's weight and age and how long ago the poisoning occurred, Route of poisoning, Estimation of how much poison was taken, Child's present condition
• Emergency Management of Poisoning at the Health Care Facility


  Administer Activated Charcoal - Administered to conscious victims only, Give ASAP, Mix with water, adding a sweet syrup is suggested, Stools will appear black
• Acetaminophen Poisoning


  Causes extreme permanent liver destruction, After ingestion, child develops anorexia, nausea and vomiting, high Sgpt, Sgot, Antidote - Acetylcysteine or Activated charcoal
• Caustic Poisoning


  Ingestion of strong alkali, such as lye, which is contained in certain toilet bowl cleaners and hair products, Causes burns and tissue necrosis in the mouth, esophagus, and stomach, Don't let the child vomit
• Assessment of Caustic Poisoning

  Pain in mouth and throat, Drools saliva because of oral edema and inability to swallow, Mouth turns white, Vomits blood, mucus, and necrotic tissue, Tachycardia, tachypnea, pallor, and hypotension
• Therapeutic Management of Caustic Poisoning


  Bring child to nearest hospital, Don't administer Activated charcoal, IV morphine for pain, X-ray, Laryngoscopy and Esophagoscopy, Intubation or tracheostomy
• Iron Poisoning


  Large amount of iron is corrosive to the gastric mucosa and leads to severe gastric irritation in the child, Immediate Effects: Nausea and vomiting, Diarrhea, Abdominal pain, After 6 to 12 hours: Melena, Hematemesis, Cyanosis, Vasomotor collapse, Coagulation defects, Hepatic injury, Lethargy and coma
• Therapeutic Management of Iron Poisoning

  Don't give Activated charcoal, Stomach lavage, Administer Cathartics, Administer Maalox or Mylanta, Administer IV or IM Deferoxamine, GI X Ray, Liver studies
• Lead Poisoning


  Also called Plumbism, From ingestion of contaminated water, paint chips or paint dust, home-glazed pottery, fumes from burning or swallowing batteries, Leads to Hypochromic, microcytic anemia, Kidney destruction occurs, and leads to Encephalitis or inflammation of brain cells (toxic level)
• Assessment of Lead Poisoning

  Lethargy, Impulsiveness, Learning difficulties, Blood level of lead >5μg/dl [unsafe for children]
• Therapeutic Management of Lead Poisoning


  Lead levels >10-20 μg/100ml will be prescribed dimercaptosuccinic acid (DMSA) or succimer, Lead levels >45 μg/100ml will be treated with Dimercaprol (BAL) or edetate calcium disodium (CaEDTA), Don't give BAL to patients with peanuts allergy or G6PD deficiency
• Child Maltreatment


  Willful injury by one person to another, It may be physical, emotional or psychological, neglect, and sexual maltreatment
• Theories of Child Maltreatment


  • Special Parent - a parent has the potential to maltreat a child
  • Special Child - children who are maltreated
  • Special Circumstance - Stress
• Reporting of Suspected Child Maltreatment

  • Mandatory Reporters - professionals who are mandated by law to report child maltreatment
  • Permissive Reporters - encouraged to report suspected child abuse but are not required by law
• Indicators of Physical Abuse

  • Bruises, burns, head injuries, eye injuries, mouth injuries, human bites, chunks of hair pulled off the scalp, repetitive accidents, multiple wounds or fractures at different stages of healing
• Shaken Baby Syndrome


  Repetitive violent shaking of a small infant by the arms or shoulders, causing a whiplash injury to the neck, edema of brainstem or possibly subdural or retinal hemorrhage
• Indicators of Physical Neglect

  • Child is unwashed, Thin and malnourished, Dressed inappropriately, Failure to bring child to seek early medical help, Not requiring a child to attend school without setting up a home school
• Psychological Maltreatment


  Constant belittling, threatening, rejecting, isolating or exploiting a child
• Munchausen Syndrome by Proxy


  Refers to a parent who repeatedly brings a child to a health care facility and reports symptoms and illness when the child is well
• Indicators of Sexual Maltreatment

  • Difficulty walking or sitting, Gross evidence of trauma in the genitalia, oral or anal regions, STI, Pregnancy, Weight loss