Discussion About Growth And Developmental Patterns

Compare and contrast the growth and developmental patterns of two toddlers of different ages using Gordon’s functional health patterns. Describe and apply the components of Gordon’s functional health patterns as it applies to toddlers.

Instructions:

Post your discussion to the Moodle Discussion Forum. Word limit 500 words. Support your answers with the literature and provide citations and references in APA format. Reply to at least two other student posts with a reflection of their response.

Chapter 17

Infant

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Human development begins when a sperm penetrates a mature ovum
Infant depends completely on others, primarily the parents, to meet all needs
Developmental landmarks
To guide parents, nurse must know what behaviors to expect at certain age levels
Physical growth landmarks
Developmental tasks
Biology and Genetics

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Developmental Tasks

Physiological equilibrium
Task of survival: basic physiological functions
Oral stage of development
Stimulation and environmental interaction
Essential for infant development
Progressive connections of dendrites
Increases vascularization of brain structures
Increases myelination of brain/nerves
Infant should have auditory/visual stimuli
Radios, spoken voice, mobiles
Sense of touch important as well
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Concepts of Infant Development

Psychosocial development: Erikson
Trust vs mistrust
Trust influences future relationships
Infant needs maximum gratification/minimum frustration
Cognitive development: Piaget
Sensorimotor period
Mastering simple coordination activities through senses and motor activity

Reflexes
Responses following stimulation

Rooting and sucking reflex: assists survival

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Measuring Growth and Development
Denver Developmental Screening Test II
Screening tool birth to age 6
Screen at 3-4 months, 10 months, 3 years

Areas of development
Personal-social

Fine motor–adaptive

Language

Gross motor

CDC growth charts
Height, weight, head circumference
Plotted on standardized grid
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Gender and Race

Gender
Male: larger, more muscle mass, more motor activity
Female
More physically mature at birth

Less vulnerable to stress, greater response to tactile stimulation/pain

Impact on parental relationships/expectations
Race
Physical variations among people of different races
Diversity challenges in health assessment, nursing care
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Genetics

Maternal age
Down’s syndrome: >35 years old
Ethnic background
Eastern European Jews: Tay-Sachs
Blacks: sickle cell
Family history
Examples: Huntington’s chorea, hemophilia, mental retardation
Genetic counseling: informed decision re birth defects
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Genetics (Cont.)

Maternal reproductive history
Spontaneous abortions, stillbirths, previous children with genetic conditions
Maternal disease
Examples: Diabetes mellitus, seizure disorder, phenylketonuria
Nurse’s role
Case finding, referral, family education during genetic counseling process
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Gordon’s Functional Health Patterns

Health perception–health management pattern
Nutritional-metabolic pattern
Elimination pattern
Activity-exercise pattern
Sleep-rest pattern
Cognitive-perceptual pattern
Self-perception–self-concept pattern
Roles-relationships pattern
Sexuality-reproductive pattern
Coping–stress tolerance pattern
Values-beliefs pattern
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Health Perception—Health Management Pattern

Health promotion through parents
Promote competence in parents’ ability to act to enhance infant’s health
Identify problems
Family’s perception of good/bad health practices
Consequences of unhealthy practices
Help parents recognize infant susceptibility
Teach characteristics that influence health
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Nutritional-Metabolic Pattern
Essential Infant Nutrients

Water—supplied by breast milk
125-150 mL/kg/day first 6 months
125-135 mL/kg/day second 6 months
Protein: not to exceed 20%—kidney is immature
2.2 g/kg/day first 6 months
2 g/kg/day second 6 months
Fat: 3.8-6 g/kcal: breast milk is 50% fat
CHO—37% of calories in breast milk
Vitamins and minerals
Vitamin D supplementation (if breastfed)
Iron fortification by 6 months
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Nutritional-Metabolic Pattern

Food additives
May be present in commercial baby food
Homemade baby food
Avoid salt/sugar/additives
Nutrition problems
Under nutrition: inadequate calories or nutrients
Overnutrition: more calories and nutrients than needed
Baby food
If home prepared must cook without salt or sugar then blenderize food—economical option
Commercial food is safe, nutritious and high quality
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Nutritional-Metabolic Pattern (Cont.)
Breastfeeding: the perfect food
Exclusive: preferred method first 6 months
Continued: first year and beyond
Nurse’s role in encouraging breastfeeding
Introduction of solid foods
4-6 months: infant physiologically and developmentally ready
Recommendation: wait until 6 months to lower risk of food allergies
Sequence of solids: cereal, fruits, vegetables, meats
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Nutritional-Metabolic Pattern (Cont.)

Weaning: introducing infant to cup
Gradual process: usually 5-6 months
Developmental milestones
Infant extrusion reflex needs to be absent

Infant can sit only slightly supported

Able to turn head away to indicate food refusal

Avoid propping baby bottles
Danger of aspiration
Baby bottle syndrome—tooth decay
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Elimination Pattern

Bowel elimination
Develops pattern by second week of life
Breastfed stool
Softer consistency, clean smell, initially several stools daily; progresses to once daily or over several days

Bottlefed stool
Harder consistency, smellier

Similar to infant on solid food

Defecation involuntary
Delay toilet training until at least 18 months old

Urinary elimination
6-12 times/day first few months
Irregularly after first few months
Voiding involuntary
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Activity-Exercise Pattern

Activity through play
Exercise of senses (visual)
Solitary and repetitious
Promoting play is important!
Activity through stimulation
Parental stimulation important to development
Singing/music, rocking

Mirrors, face-to-face interaction

“Tummy time” needed to prevent flattening of head from sleeping supine
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Sleep-Rest Pattern

Sleep needs correlate to rate of growth
80% at birth
12 hours daily at 12 months
Promote infant’s sleep patterns
Sensitivity to sleep cycles, develop rituals
Not firm “schedule”
Sleep problems are highly prevalent
Bedtime rituals helpful
Brief arousals at night are normal for infants
Quiet room separate from parents is recommended
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Sleep – Rest Pattern
Sudden Infant Death Syndrome

Third leading cause of death in United States/Canada
Unknown cause
Risk factors
Prone sleeping, exposure to tobacco smoke, soft sleeping surfaces, hyperthermia, bed sharing, lack of breastfeeding, SIDS sibling, preterm, near-SIDS
Recommendations
Avoid risk factors
Supine sleep position, offer pacifier
Nurse’s role in family coping/grief
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Cognitive-Perceptual Pattern

Vision
Initial: eye muscles weak, vision unfocused, without meaning
Eye movements coordinate by 3 months
Eye movements mature by 6 months
Hearing
Acute ability; sound discrimination is an important developmental task
Smell
Fully developed; can differentiate odor of mother’s milk from others at 2 weeks
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Cognitive-Perceptual Pattern (Cont.)

Taste
Present at birth; salivation at 3 months of age
Touch and motion
Tactile sensation well developed
Touch relieves infant tensions and speeds neuromuscular development
Language development
Sensory stimulation important
Cooing by 2 months; babbling at 6 months, single words by 12 months
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Self-Perception–Self-Concept Pattern

Separating “me” from “non-me”
Developed through feedback
Effect of crying/smiling on others
Ability to use body to influence others
Messages infant receives from body
Differentiates “self” in mirror images
4 months of age
Develops body image as he or she experiences the environment through senses
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Roles-Relationships Pattern
Attachment and bonding
Establishment of maternal-infant bond
Influenced by previous life experiences
Theories of attachment
Freudian psychoanalytic theory
Social learning theory
Difficulties with attachment
Increased risk: child abuse, failure-to-thrive, behavior problems
Paternal attachment/bonding: engrossment
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Roles-Relationships Pattern
Child Abuse

Active or passive abuse at hands of parents or caregivers
Most common under age 3
Parenting not instinctive; response to inadequate parental coping
Women abuse more frequently
Men more severely; sexual abuse
Intergenerational cycle of behavior
Profound long-term effect on child
Community goals—ID and prevention
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Roles-Relationships Pattern
Child Abuse (Cont.)

Prevention of child abuse: identification and intervention in families “at risk”
Identification of abuse when it occurs
Protection of abused/at-risk children
Scope of child abuse is extensive
650,000 infants and children annually
1,500 children die from abuse or neglect
Abuse occurs in every race, creed, or socioeconomic status
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Sexuality-Reproductive Pattern

Sexual identity begins at birth
Caretaker’s behavior secondary to gender
Infant’s sexuality
Gives direction to own responses through life

Infant characteristics
Great oral sensitivity
Enjoy skin-to-skin contact
Explores own body for pleasure in infancy
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Coping–Stress Tolerance Pattern

Developmental crisis
Necessary part of growth/development
Learning new skills
Situational crisis—not anticipated as part of normal growth/development
Separation from significant other
Protest: infant cries loudly; screams for mother

Despair: stops crying; withdrawn, apathetic

Withdrawal: ignores mother on her return

Infant: little initial coping ability
Gradually learned over time
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Values-Beliefs Pattern

Parents’ values/beliefs influence care/development of infant
Nursing interventions
Works within parental framework
Examines own attitudes in working with families
Influencing behavior
Modeling behavior

Serving as consultant (listening)

Expressing values/attitudes;

Remaining open to other approaches

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Physical Agents

Leading cause of death
Falls
Most common after 4 months (rolling over)
Do not leave unattended on raised surface
Burns
Deaths from smoke/toxic gasses
Swallowing/choking on foreign objects
Potential: any small object in mouth
Childproof environment
Infant CPR: parents and caregivers
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Biological Agents
AIDS

Acquired immunodeficiency syndrome (AIDS)
Transmission: pregnancy, delivery, breastfeeding
Symptoms usually during first year: infections, developmental delays, failure to thrive
WHO and UNAIDS recommendation
Male circumcision to reduce risk of heterosexually acquired HIV infection in men
Nursing role
Education of disease process, transmission
Prevention of AIDS transmission
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Biological Agents
Immunization

ICDC and AAP recommended schedule
Routine immunizations at birth; 1, 2, 4, 6 months; 12 months
Active immunization
Live, killed, or attenuated organism
Stimulates immune system to build immunity
Diphtheria; tetanus; acellular pertussis; inactivated polio; measles, mumps, and rubella
Passive immunization
Naturally occurs in newborns from maternal antibodies
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Chemical Agents

Drugs
Aspirin, acetaminophen, vitamins
Childproof packaging: not absolute
Prevention
Eliminate hazards from exploring infants

Supervise infants

Poison prevention
Plants—keep out of reach
Cleaners, household supplies
Lock

Safe storage

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Chemical Agents (Cont.)

Toxins: infants are vulnerable
Oral habits, unique diet
Longer life span—potential for damage
Pesticide exposure: food esp produce
Lead—disproportional exposure to infant
Breathe in more air, closer to ground
More mouth-breathing
Oral habits, greater GI absorption
Indoor air pollutants: smoke, carbon monoxide
Water pollution
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Motor Vehicles

Injuries
Improper restraint
Infant on adult lap
Distracting, potential for becoming projectile

Car seats
Rear-facing safety seat for infants to 20 lb
Shield-type of “infant-only” seat to 30 lb
Heat stroke
If left unattended in motor vehicle
Dangerous temperatures occur in 15-30 minutes
Nursing implications
Teach safety; support public awareness
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Radiation and Cancer

Radiation exposure
Natural background radiation (cosmic waves, soil, water, air)
Human made radiation (microwaves, electronic devices)
Infant vulnerability: rapidly growing and immature cells
Cancer
Leading cause of death from disease
Nurse’s role: risk-factor identification, screening, assessment, community education
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Determinants of Health
Day Care Community and Work

Growing need for day care
Center-based facility while parents at work
Separation traumatic for both child and parent
Ideal: mother/infant together 4-6 months before being placed in day care (enhances attachment)
Nurse’s role includes:
Counseling parents on types/screening day care
Helping parents understand separation and expected behaviors
Assisting parents to deal with separation behaviors
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Social Factors and Environment

Culture and ethnicity: from infant’s worldview
Power structure in the cultural group
Breastfeeding decisions
Traditional/folk beliefs
Language
Medium for understanding/working together
Strategies for removing communication barriers
Religion: impacts health
Decisions on treatment
Evaluation of health services
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Levels of Policy Making and Health
Legislation

National goal: improve infant health
Strategies to decrease infant mortality
Family planning services
Pregnancy/infant services
Educational efforts on prenatal care
Immunization efforts
Nursing’s role
Participate in development of health care policy
Coordination of community resources
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Economics and Nursing Role

Poverty impacts infants
Infant mortality rates higher
Higher disease rates
Delayed language development
Nursing interventions
Assess family situation, infant status
Identify community resources
Family advocate in health care system
Participate in legislative process
Health planning council, concerned citizens group

Advisory capacity to local or state legislator

Well child visits—promote and maintain health
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Primary role is to provide the family with education (infancy is critical development period)
Additional roles: support and advocacy
Focusing on the nutritional needs of the infant during the first 18 months of life
Guidance to parents
Encouraging sound practices in the home to foster optimal conditions for normal growth and development
Nursing Application

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Chapter 18

Toddler

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Biology and Genetics

12-18 months → 3 years of age
Overview of developmental/physical changes
2-4 inches height/year; 4-6 lb weight/year
Continue to measure head circumference
May measure length (recumbent) or height (standing)
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Physical Characteristics
by System

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Kidneys Specific gravity similar to adults 500-600 mL urine at 2 years old Begin voluntary control
Gastrointestinal Functional maturity Needs more frequent meals/snacks Control of internal/external anal sphincters
Respiratory Lung capacity increases Respiratory rate decreases Smaller upper tract diameter (airway obstruction potential)
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Physical Characteristics
by System (Cont.)

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EENT Similar to infant Continued risk for otitis media
Endocrine Become functional (exception: reproductive)
Circulatory Blood pressure increases Heart rate decreases More effective thermoregulation
Immunity Active immunity/immunizations by 18 months Exposure to new/different organisms— begin to build immunity
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Physical Characteristics
by System (Cont.)

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Teeth All 20 primary teeth erupt by end of toddlerhood At risk of choking because of immature swallowing pattern
Musculoskeletal Increased size/strength of muscle fibers Myelination of corticospinal tract sufficient for most movement Voluntary motor movements often with involuntary movement on other side of body Does not show hand dominance
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Gordon’s Functional Health Patterns

Health perception–health management pattern
Nutritional-metabolic pattern
Elimination pattern
Activity-exercise pattern
Sleep-rest pattern
Cognitive-perceptual pattern
Self-perception–self-concept pattern
Roles-relationships pattern
Sexuality-reproductive pattern
Coping–stress tolerance pattern
Values-beliefs pattern
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Health Perception–
Health Management Pattern

Little understanding of health
Depend on caregivers for health management
Health behaviors (e.g., brushing teeth) part of taught rituals
Identify with behavior modeled by caregivers
Nutrition
Exercise
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Nutritional-Metabolic Pattern
Nutrition Principles

Ensure adequate iron intake
Moderate amount of milk (low in Fe)
Prevent dental caries: bedtime bottle only water
Juice overconsumption
Appetite decreased—assess intake over several days
Mealtime
Opportunity to offer healthy, age-appropriate choices
Avoid overattention/punishment re food behavior
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Elimination Pattern
Toilet Training

Major parental concern
Emotional/physical readiness—usually 18 months of age or older
Nurse provides anticipatory guidance to parents on:
Developmental readiness of child
Parental attitudes and process of toilet training
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Activity-Exercise Pattern

Always busy and exploring
Most waking hours at play
Exploring, imitating, creating rituals
Risk for injury
Parallel play: side-by-side, but independent play
Anticipatory guidance
Appropriate toys, opportunities for learning and social encounters, limit TV time
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Sleep-Rest Pattern

Need: 12 hours a day; one to two naps
Schedules are helpful to avoid overfatigue
Rituals help develop a sense of security
Night terrors
Normal, less frequent as child develops
Not fully awake
Instruct parent to speak soothingly, do not try to wake child
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Cognitive-Perceptual Pattern

Sensorimotor—preoperational
Egocentrism—world as relates to them
Object permanence
Play imperative—learn by repetition
Hearing—critical for language/speech
Hearing loss assessed at birth, can be tested during toddler, preschool years
Otitis media: leading cause of hearing loss in toddlers
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Cognitive-Perceptual Pattern (Cont.)
Vision
Amblyopia—diminished or loss of vision in one eye
Brain favors normal eye

Strabismus—deviation in line of vision
Management focused on making child use eye with reduced vision (lazy eye)

Be alert to “red flags” of vision problems (next slide)
Taste and smell
Begin learning conditioned association between smell/taste; develop food aversions
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Red Flags of Vision Problems

Rubs eyes excessively
Shuts one eye, tilts head, sideways gaze
Difficulty with close vision
Blinks, frowns, squints on viewing objects
Holds book close to eyes
Red, encrusted or swollen eyelids
Inflamed or watery eyes
Recurrent styes
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Self-Perception–Self-Concept Pattern

Erikson: autonomy vs doubt/shame
Relinquish dependence on others
Need to explore world
Physically
Relationships—“NO” and temper tantrums
Guidance to parents
Safe environment
Promoting autonomy
Preventing and dealing with temper tantrums
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Roles-Relationship Pattern

Roles understood as they relate to child
Sibling rivalry: ongoing negotiation of roles and relationships
Imitate others
Prefer others’ possessions
Child abuse—nurse’s role
Need to be aware of potential; s/s abuse
Report when child abuse suspected
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Sexuality-Reproductive Pattern

Genital exploratory behavior and masturbation
Normal developmental process
Opportunity to learn about body
Parents reaction is variable
Nurse includes this subject when teaching about toilet training
Recommend using correct anatomical terms
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Coping–Stress Tolerance Pattern
Temperament

Individual style of emotional or behavioral response across situations
Foundation for coping
Influenced by environmental characteristics
Influences psychosocial adjustments
Nurse can assist parents in recognizing temperament and developing management strategies
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Values-Belief Pattern

Healthy behaviors reflect positive values/beliefs
Toddler’s environment
Teach right/wrong
Contribute to security, belonging, autonomy
Values/beliefs
Interactions with parents
Religious rituals/beliefs
Development facilitated by consistent behavioral expectations, reinforcing acceptable behavior
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Environmental Processes: Physical Agents

High risk for accidental injury
Structural hazards
“Baby-proof” the environment
Inspect for hazards in unfamiliar environments
Appropriate supervision
Toys
Inspect toys
Risk of small removable parts, batteries, toxic paint, sharp edges
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Environmental Processes: Physical Agents (Cont.)

Sports
Improper storage of guns, heavy equipment
Wear bike helmets
Drowning: highest risk ages 1-3
Can drown in water if covers nose/mouth
Danger: pools, tubs, toilets, pails of water
Burns
Hot liquids, electrical cords, fireplaces
Lower water heater to 120-125°F
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Motor Vehicle–Related Injury

One of leading causes of death 1-4 years
Child safety seats
Correct seat for weight of child
Proper installation of safety seat
Rear seat position preferred
Pedestrian accident potential at home
Killed/injured in driveway by backing vehicle
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Biological Agents and Poisoning

Biological agents
Potential of bioterrorism: talk about fears, appropriate precautions/response
Poisoning—greatest risk ages 1-2
Toddlers use mouth as way to explore environment
Medications, household products, plants, cigarettes, alcohol, cosmetics
Suspected poisoning—contact Poison Control Center
Lead—teach primary prevention, screening (secondary prevention)
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Determinants of Health:
Social Factors and Environment

Day care—HHS four-step approach
Interview potential provider and observe setting
Check references
Make decision based on specific criteria
Get and stay involved
Culture and ethnicity
Toddlers shaped by family values/beliefs
Knowledge, respect, negotiation across cultures needed for high-quality health outcomes
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Levels of Policy Making and Health
Legislation
Safety and injury prevention
Abuse and neglect protection
Assistance for handicapped children 0-3 years
Economics
Toddler mortality/morbidity rates increase in poverty
Medicaid, uninsured, SCHIP program
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Health Services/Delivery System
Health Care Delivery System

Adequacy of system significantly affects health of toddler
Routine assessment needed
Growth/development
Immunizations
Discussion of developmental concerns
Anticipatory guidance
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Provide education focused on the physical and developmental changes for toddler
Teach health-promotion activities to toddlers
Engage in screening activities
Promote routine health examinations and childhood immunization schedule
Educate parents about resources available in the community—many free or low cost
Nursing Application
Nursing Involvement with the Family

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Assignment: Asthma And Stepwise Management, NURS 6521: Advanced Pharmacology, Week 3