Intermediate Competencies given a child as a client, the student utilize the nursing process to: 1.

Assess the child as to: 1.1 Physical growth and development of a toddler.

Content Nursing Assessment of Growth and Development of a Toddler Assessment of a toddler centers on the childs physical growth and skills development. Physical Growth - While toddlers are making great studies developmentally, their physical growth begins to slow. Weight, Height and Head Circumference- plot weight and height on a standard growth chart at each health core, visit to determine if progress is normal for each individual child. A child gains only about 5 to 6lbs (2.5kg) and 5in (12cm) a year during the toddler period.

Teaching-Learning Activities No. of Hours Classroom RLE Lec RLE Lecture Nursing discussion application of 2hrs. theories of Present an Freud, Erickson, illustration on Piaget assessing the average toddler

Evaluation Paper and Pencil Test

Head Circumference increase only about 2cm. during the second year compared to about 12cm. during the first year. Head Circumference equals chest circumference at 6mos. To 1year of age. By 2years, chest circumference has grown greater than that of the head. Body Contour Toddlers tend to have prominent abdomen- a pouchy belly- because although they are walking well, their abdominal muscles are not yet strong enough to support abdominal contents as well as they will later. They also have forward curve of the spine @ the sacral area (lordosis) as they walk longer, this will correct itself naturally. Body Systems - Body Systems continuous to mature during this time. - Respiration slow slightly but continue to be mainly abdominal. - The heart rate slows from 110 to 90bpm; BP increases to about 99/64mmHg

2. Assess the child as to: 2.1 Major developmental milestones of a toddler.

Teeth Eight new teeth (the canines and the first molar) erupt during the second year. All 20 decidous teeth are generally present 2.5 to 3 years of age. Developmental Milestones The developmental milestones of the toddler year are less numerous but no less dramatic than those of the infant year, because this is a period of slow and steady, not sudden growth. Toddler development is influenced to come extent by the amount of social contact and the number of opportunities children have to explore and experience new degrees of independence. Language Development Toddlerhood is a critical time for language development although even this varies among children, because in order to master language, children need practice time. A child who is 2 years old and does not talk in two-word, noun-verb, and simple sentences needs a careful assessment to determine the cause. Emotional Development Autonomy, The developmental task of the toddler years according to Erickson is the development of a sense of Autonomy vs. Shame or Doubt. Children who have learned to touch themselves and others during the infant year are better prepared to do this than those who cannot trust themselves or others. Lecture discussion Having been assigned to a toddler client. Conduct round table discussion. Paper and Pencil Test

Socialization Once toddlers are walking well, they become resistant to sitting in laps and being cuddled. This is not lack of a desire for socialization but a function of being independent. Fifteen-month old children are still enthusiastic about interacting with people, providing those people are willing to follow them where they want to go. Play Behavior All during the toddler period, children play beside the children next to them, not with them. This side to side play (often called parallel play) is not unfriendly but is a normal development sequence that occurs during the toddler period. Cautions parents that if 2 toddlers are going to play side to side, they must provide duplicate toys or an argument over one toy is likely to occur Cognitive Development A toddler enters the fifth and sixth stages of sensorimotor thought. Piaget referred to stage 5 (between 12 and 18 months) as a tertiary circular reaction stage, describing a toddler in their stage a little scientist Because of the childs interest in trying to discover new ways to handle objects or new result that different actions can achieve.

3. Assess the child as to: 3.1 Formulate nursing diagnosis that address wellness as well as both a potential for and or actual delay in growth and development of a toddler 3.2 Discuss the role in the care of : - Toddlers safety - Poisoning prevention

Planning and Implementation for Health Promotion of a Toddler and Family Toddlers tend to develop many upper respiratory and ear infections but otherwise core to health care facilities most often for health maintenance visits (recommended at 15, 18, and 24 months) and the immunizations are important at these time. Promoting Toddler Safety Accidents are the major cause of death in children of all ages. Accidental ingestions (poisoning) are the type of a accident that occurs most frequently in toddlers. Poisoning involves medicine, it most often occurs from ingestion of cleaning products. Aspiration or ingestion of small objects such as watch or hearing aid batteries, pencil erasers, or crayons is also a major danger for children of this age.

Lecture discussion

Ask students to formulate teaching plan focusing on common safety measures to prevent accidents during the toddler years.

Paper and Pencil Test

Lead Screening Lead is toxic to body tissue; ingestion of it can lead to nervous damage to the brain and nervous system, kidneys, and RBC. Levels as low as 10 to 15mg/dl, can cause learning and behavioral problem. High levels may result in seizures, cognitive challenges, coma, and even death. The beginning symptoms of lead poisoning include irritability, headache, fatigue and abdominal pain Discuss role of the nurse in promoting nutritional health of a toddler Identify toddlers nutritional needs Describe way in establishing toddlers healthy eating patterns Promoting Nutritional Health of a Toddler Because growth shows abruptly after the first year of life, a toddlers appetite becomes smaller than the infants. Children who are hungrily 2 months earlier now set and play with their food. If feeding problems begin, it is often because parents are unaware of their toddlers appetite has decreased and food consumption will be less. Allowing self-feeding is a major way to strengthen independence in a toddler. Toddler Nutrition Parents way become frustrated when trying to provide adequate nutrition for their toddlers because of a toddlers varying and unpredictable appetite and food preferences. Children ages 1 to 3 years should consume 1,300kcal daily. Protein and carbohydrates needs are often easily met during the toddler period; diets high in sugar should be avoided. Lecture discussion Paper and Pencil Test

Promoting Adequate Intake with a Vegetarian Diet. Vegetarian diets are adequate for toddlers if parents are well informed about needed vitamins and minerals. A vegetarian diet can be easily designed for a toddler who prefers finger foods, because many vegetables, fruit and grains (e.g. pieces of oranges, peaches, raisins, chickpeas, tomatoes, and crackers) are easily eaten this way. Identify and describe ways in promoting toddlers development in daily activities: Dressing Sleeping Bathing Care of Teeth Promoting Toddler Development in Daily Activities. Lecture/Discussion A toddlers new independence and developing abilities in self-care, such as dressing, eating, and to limited extent hygiene; present special challenges for parents. Dressing By the end of the toddler period most children can put on their own socks, underpants, and undershirt. Some may also be able to pull on slacks, pullover shirts or simple dressers. Parents may be reluctant to encourage toddlers to dress themselves as it is often much easier and quicker to put their clothes will (usually) be wearing clothes in a correct way Sleep The amount of sleep children need gradually decreases as they grow older. They may begin the toddler period napping twice a day and sleeping 12hours each night, Paper and Pencil Test

and end with one nap and only 8hours sleep at night. Parents who are not aware that the need for sleep declines at this time may view a childs disinterest in sleeping as a problem. They may begin to resist naps, however, as well as nighttime sleep because they are aware for the first time that activities go on while they sleep Bathing The time for a toddlers bath should depend on the parents and childs wishes and schedule. Some parents prefer to bath a toddler before evening need because it has a quieting effect and prepare a child for eating, other prefer to give it at bedtime because it has relaxing effect and helps the child to sleep. Toddlers usually enjoy bath time, and parents should make an effort to make it fun by providing a toy, such as a rubber duck, boat or plastic fish. Care of Teeth Between meal snacks are important for growing children. Encourage parents to offer (bananas, pieces of apple, orange slices) or protein foods (cheese or pieces of chicken) rather than more traditional high carbohydrate items for snacks as cookies not only for the nutrition involved but because they help prevent caries more than sugar snacks by limiting exposure of the childs teeth to carbohydrates. Calcium (found un large amounts in milk, cheese and yoghurts) is important to the development of

strong teeth. Promoting Healthy Family Functioning Discuss role of the nurse in promoting healthy family functioning. Learning self-reliance is the primary goal of child during the toddler period. Because of this, some parents who enjoyed caring for their child as an infant may find it difficult to have their authority challenged by a toddler. Help parents to understand their responses to these attempts at independence are critical to the healthy development of their child. Parenting Concerns Associated with the Toddler Period. Illustrates by examples techniques in behavior modification related to: - Toilet training - Ritualistic behavior - Negativism discipline - Separation anxiety - Temper tantrums - Sibling Rivalry Parental concerns of the toddler period usually arise because of the conflict over autonomy A. Toilet Training Toilet training is one of the biggest tasks as toddler must achieve. There are so many theories concerning toilet training that understanding the procedure can become one of the biggest tasks of this period for parents. Some toddlers smear or play with feces. Often at about the same time that toilet training is started. B. Ritualistic Behavior Although toddlers spend great deal of time every day investigating new ways to do things and doing things they have never done before, they also enjoy ritualistic patterns Assigned student to Lecture/Discussion a toddler client focusing on: 1. Diversity care - Toilet training Performance evaluation checklist Paper and Pencil Test

C. Negativism Establishing their identities as separate individuals, toddlers typically go through a period of extreme negativism. They do not want to do anything a parent wants them to do. Their reply to every request is a very definite, No! D. Discipline Reminds parents that disciple and punishments are not interchangeable terms. Discipline means setting rules or road signs so children know what expected to them. Punishment is a consequence that result from breakdown in discipline E. Separation Anxiety Fear of being separated from parents begins at about 6months of age and persists throughout the preschool period. Separation anxiety is the universal fear of this age group. F. Temper Tantrums Temper Tantrums occurs as a natural consequence of toddlers development. The tantrums may be response to a unrealistic request by a parent. G. Sibling Rivalry Sibling Rivalry, or jealousy of younger siblings, can occur during the toddler period Discuss the nurses role in concerns of the family with a physically challenged or chronically Concerns of the Family with a Physically Challenged or Chronically Ill Toddler It may be a difficult for children with handicaps or disabilities to achieve a sense of autonomy or Paper and Pencil Test Lecture/ Discussion

Ill toddler.

independence because they will never be totally independent. A toddler with long term illness or who is physically challenged can be expected to exhibit normal toddler behaviors, such as temper tantrums, and to have normal outlooks, such as negativism. Nutrition of the Physically Challenged or Chronically Ill Toddler Toddler need experience feeding themselves it at all possible. Help parents accept the accidents that occur with self-feeding, particularly if the child has difficulty with coordination; suggest finger foods if possible.

Discuss the nurses role in nutrition and the physically challenged or chronically Ill toddlers.