CAVITE STATE UNIVERSITY

Don Severino delas Alas Campus

Indang, Cavite

CARE OF MOTHER, CHILD AT

RISK OR WITH PROBLEMS
(ACUTE AND CHRONIC)
NURS-10

Name of Student: ___________________________

Course, Level and Section: ___________________________

Academic Year: ___________________________

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 MODULE 15
Part 1

Health Problems
Common in Toddlers

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 PREFACE

The World Health Organization (WHO) has designated 2020 as the “International Year
of the Nurse and the Midwife,” in honor of the 200th anniversary of Florence Nightingale’s
birth (WHO, 2020). The many roles of the nurses are exemplified especially now during this
pandemic season. However, one of the vital responsibilities of a nurse in the nursing
discipline is to focus on the care for childbearing and childrearing families. In order to have
healthy adults and children.

Promoting the health of the childbearing woman is a significant consideration to

produce healthy children. Ensuring the health of children from birth to adulthood will yield
positive result. More forth, highlighting both preconceptual and prenatal care are essential
contributions to the health of a woman and fetus and to a family’s emotional preparation for
childbearing and childrearing.

As children mature and grow, consistent health supervision and support for the family
is needed. As children reach maturity and plan for their own families, a new cycle is expected
to begin, and new type of support becomes necessary. The nurse’s role in all these phases
focuses on promoting healthy growth and development of the child and family in health and
in illness. Although the field of nursing typically divides its concerns for families during
childbearing and childrearing into two separate entities, maternity care and child health care,
the full scope of nursing practice in this area is not two separate entities, but one: maternal
and child health nursing.

This module is designed to provide an overview and discuss the standards and
philosophies of maternal-child health care and how these standards and philosophies affect
care.

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 ABOUT THE AUTHOR

MARIBEL L. CHUA,MAN,RN
09298344868

Background
♥ Maribel Legaspi Chua, was born in Indang,Cavite and presently
hails from Cavite City, Is a Registered Nurse
Cavite State University
♥ She graduated at St. Joseph College, Cavite City
♥ Finished her Master’s degree major in Nursing Administration at Indang, Cavite, Philippines, 4122
La Salette University, Isabela
♥ Currently a clinical Instructor At Cavite State University –College
of Nursing , teaching Fundamentals of Nursing, Community health
Nursing & Maternal Child Health Nursing
♥ She had practiced her profession as an institutional nurse for 13
years and in the academe for 17 years now. Mrs. Chua is also the
designated Budget Officer of the CON.
mlchua_2020@yahoo.com

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 TABLE OF CONTENTS
Page
Cover Page………………………………………………………………………………………….1
Title page…………………………………………………………………………………………….1
Preface………………………………………………………………………………………………3
About the author………………………………………………………………………………… 4
Acknowledgement ………………………………………………………………………………
Table of contents………………………………………………………………………………...
Module Overview ……………………………………………………………………………….
Learning Outcomes……………………………………………………………………………...
Objectives………………………………………………………………………………………...
Methods/Instructional Technique………………………………………………………………
Materials………………………………………………………………………………………….
Module Instruction……………………………………………………………………………….
Topic 1.Burns ……………………………………………………………………………………
Epidemiology……………………………………………………………………………..
Causes of Burns………………………………………………………………………….

Rule of Nine………………………………………………………………………………
Classification of Burns…...... …………………………………………………………..
Different Phases Involved In Burn Care ………………………………………………
Complications-Burns And Scalds …………………………………………………....
Treating Burns And Scalds In Children ……………………………………………….
Preventive Measures You Can Take At Home ……………………………………….

Topic 2. Poisoning ………………….……………………………………………………….…..

Symptoms Of Poisoning ………………………………………………………………..
Causes Of Poisoning ……… ……………………..……………………………………….
Assessment Findings ………….…….……………………………………………………
Diagnosing Poisoning …………………………………………………………………….
Prevent Poisoning In Your Home…………………………………………………………
Different Types And Methods Of Poisoning Require Different, Immediate Treatment
Topic 3 Child abuse …………………………………………………………………………..…
Forms Of Child Maltreatment………………………………………………………..........
Specific Signs And Symptoms……………………………………………………………
Risk Factors ……………………………………………………………………………….
Complications ……………………………………………………………………………
Prevention
Topic 4 Cerebral palsy…………………………………………………………………………..
Symptoms ………………………………………………………………………………....
Causes ……………………………………………………………………………………..
Complications ……………………………………………………………………………….
Types Of Cerebral Palsy ……………………………………………………………………
Diagnosing Cerebral Palsy………………………………………………………………….
Conditions Associated With Cerebral Palsy …………………………………………….
Gross Motor Function Classification System (GMFCS) ……………………………….
Cerebral Palsy Treatment ……………………………………………………………..
Prevention ……………………………………………………………………………….

Activity …………………………………………………………………………………………..

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Post Test ……………………………………………………………………………………….
Rationale ……………………………………………………………………………………… .
Glossary……………………………………………………………………………………….. ..
References……………………………………………………………………………………….
Suggested links…………………………………………………………………………………..

Module Overview

Children are curious and like to explore their surroundings. They don’t know that hot water and
hot drinks can cause burns. A child’s sensitive skin burns far more easily than adult skin. Burns and
scalds are a major cause of serious injury in children from newborn to 14 years old. Children under
four years, especially those aged between one and two years, are most at risk due to their increased
mobility and natural curiosity. A severe scald can cause a serious injury and may mean a long stay in
hospital. It may also require painful skin grafts and years of treatment, and can result in permanent
scarring. A severe scald over a large skin area can cause death.
Children are curious and explore their world with all their senses, including taste. As a result, the home
and its surroundings can be a dangerous place when poisonous substances are inadvertently
ingested – every year millions of calls are made to poison control centres when this happens and
thousands of children are admitted to emergency departments. Poisoning patterns change according
to age group, type of exposure and the nature and dose of the poison.
Child abuse is a global social problem defined broadly as physical abuse, sexual abuse,
neglect, and emotional abuse of children by adults who are usually family or community members.
Human trafficking involves exploitation of children who are vulnerable due to extreme poverty, child
abuse, and other difficult social pressures. Maltreatment by parents and caregivers contributes to
insecure attachment systems for children, potentially leading to unhealthy internal working models of
relationships that may be transmitted to maltreated children's subsequent relationships, including
those with a new generation of children. Risk factors relative to child abuse can help intervening
professionals identify those children who may potentially be harmed, while protective factors can help
families and communities build personal and environmental strengths toward preventing
child maltreatment. Evidence-based treatment programs aimed at enhancing relationship capacity for
children and parents or caregivers are available to help maltreated children and their families address
severe relationship-disruptions characteristic of child abuse.
Cerebral palsy (CP) has been described as a group of disorders of the development of
movement and posture that are attributed to nonprogressive disturbances that occurred in the
developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by
disturbances of sensation, cognition, communication, perception, and/or behavior and/or a seizure
disorder. Diseases specific to the peripheral nerves of the spinal cord (e.g. spinal muscular atrophy,
myelomeningocele) or to the muscles (e.g. muscular dystrophies), although causing early motor
abnormalities, are not considered cerebral palsy

Learning Objectives:

After mastering the contents of this module, the student will be able to:

At the end of the activity the students will be able to:

1. Describe normal growth and development of a toddler as well as common parental concerns

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2. Formulate nursing diagnoses related to toddler growth and development or parental concerns
regarding growth and development
3. Implement nursing care to promote normal growth and development of a toddler, such as
discussing toddler developmental milestones with parents.

Module Lessons
A. Burns
B. Poisoning
C. Child Abuse
D. Cerebral Palsy

Methods/Instructional Technique

 Assessment of Knowledge
 Interactive lecture discussion
 Group Discussion/ Audio Visual Presentation
 Individual Activity
 Supplementary Readings
 Post Evaluation
 Oral Questioning
 Listening
 Reflective journal and analysis

Materials

 Open educational resources

 Printed copy/ soft copy of handout
 Book reference
 Power point presentation
 LMS Platform
 Google Classroom
 Other Preferred Platform
Time Allotment

3 hours

Module Instruction: This module will serve as supplemental learning material to Second
Year Nursing students of Cavite State University enrolled in NURS 10. Use this as a guide
during the discussion as well as when complying with assigned requirements and activities.

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 Good luck and enjoy while learning!!!

A. BURNS

BURNS A burn is an injury that results

from direct exposure to any thermal,
electrical, chemical, or radiation source.

► It occurs when energy from a heat

source is transferred into body tissues
beyond what the body could hold leading to
tissue injury.

► It is characterized by severe skin

damage that causes the affected skin cells
to die.

EPIDEMIOLOGY
•An estimated 500, 000 people are treated
for minor burn injury annually.
•The number of patients who are hospitalized every year with burn injuries is more than 40, 000,
including 25, 000 people who require hospitalization in specialized burn centers across the country.
• The remaining 5, 000 hospitals see an average of three burns per year.
• Of those people admitted in burn centers,47% of their injuries occurred at home, 27% on the road,
8% are occupational, 5% are recreational, and the remaining 13% from other sources.
• 40% of these injuries are flame related, 30% scald injuries, 4% electrical, 3% chemical, and the
remaining unspecified.
• Males have greater than twice the chance of burn injury than women.
• Children below the age of 5 years are at high risk of burn injuries particularly scald burns
• In 2006 the National Injury Surveillance Unit reported that in Australia 191 children below 4 years
per 100 000 population, were hospitalized for burns.
• Rates for children between the ages of 5-9 yeas and 10-14 years were less than 50 per 100 000
population.
• 75% of the burn injury related hospitalization in infants (predominantly in children over 7 months of
age) and 63% in children aged 1-4 years were as a result of scalds.

CAUSES OF BURNS
● Chemical burns. A chemical burn can be caused by many substances, such as strong acids,
drain cleaners (lye), paint thinner, and gasoline that touches your skin can cause it to burn.
●Radiation burns. A radiation burn is the least common type. Sunburn is a type of radiation burn
and other exposure to nuclear radiation, like X-rays or radiation therapy to treat cancer, can also
cause these.
●Electrical burns. An electrical burn occurs when the skin comes into contact with an electrical
current and it passes through the body from faulty electrical wiring.
●Friction burns. A friction burn occurs when a hard object rubs off some of the skin. It’s both an
abrasion or scrape and a heat burn just like motorcycle and bike accidents and a carpet burn.

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●Cold burns. A cold burn also called “frostbite” occurs when the skin comes into direct contact with
something very cold for a prolonged period of time.

●Inhalation injury. An inhalation injury is caused by smoke associated with flame injury or inhaled
carbon monoxide which is a by-product of incomplete combustion.

SIGNS AND SYMPTOMS OF INFECTION:

► Fever greater than 101.5°
► Irritability/increased pain Increased redness around burn wound
► Foul odor
► Red rash
► Increased drainage

.BURN SIZE/Rule of Nine

Burn size is expressed as a percentage of the total body area affected by the burn.
The Wallace rule of nines is a tool used in pre-hospital and emergency medicine to estimate
the total body surface area (BSA) affected by a burn. In addition to determining burn severity, the
measurement of burn surface area is important for estimating patients' fluid requirements and
determining hospital admission criteria.

The size of the burn is expressed through percentage according to the total body surface area
(TBSA), Rule of Nines.

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ASSES FOR THE BURN DEPTH/CLASSIFIATION OF BURNS
Burn depth is assessed at 24 hours after injury as blisters and other injuries may evolve.

A. First Degree Burn (Superficial Partial Thickness Burn). In first-degree burn injuries,
the skin function remains intact, and transfer to a burn center is not required. They do NOT count
towards total body surface area (TBSA) burned.
This classification of burn depth affects
the epidermis leading to the following signs and
symptoms:
►Erythema
►Edema
►Pain but without blisters
►Fluid loss is MILD

B. Second Degree Burn (Deep Partial Thickness Burn). In second-degree burn injuries,
the skin function is lost. Deep partial-thickness injuries can easily convert to or require the same
management as full-thickness. The goal in an MCI (mass casualty incident) is to treat as many 2nd
degree injuries as possible in an outpatient setting.
This classification of burn depth affects the
dermis and epidermis leading to the following signs and
symptoms:
►Erythema
►Edema
►Pain with blisters
► to reddish skin
►Fluid loss is MODERATE

C. Third-Degree Burn (Full Thickness Burn). In third-degree burn injuries, skin function is
lost and grafting is required for functional healing. Third-degree burns will almost always require
hospital admission.
This classification of burn depth affects the
subcutaneous tissues, epidermis, and dermis leading to:
►Pearly white or charred appearance of the skin
►Mottled brown, black, or red burn site
►Pain is absent
►Fluid loss is SEVERE

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D. Fourth-Degree Burn (Deep Fullness Thickness Burn). In fourth-degree burn injuries, the
affected areas go through both layers of the skin and
underlying tissue as well as deeper tissue.
This classification of burn depth involves
the muscle and bone.
►Burned part is black/charred
►Fluid loss is VERY SEVERE
►Assess the burn size and extent.

DIFFERENT PHASES INVOLVED IN BURN CARE.

1. THE EMERGENT PHASE
The emergent phase refers to the first few days post-burn. The severity of the injury
sustained is determined. Urgent care is provided; intravenous therapy and wound care are started.
During this phase, vital signs are monitored and all fluids taken in and eliminated are recorded.
Observation is ongoing for signs of potential complications.
Stabilization occurs during the emergent period and includes the following:
• Airway/Breathing Smoke inhalation can cause swelling of the airway. The patient may need
a tube inserted to help with breathing and to give the lungs an opportunity to heal. The tube is
connected to a ventilator that pushes air in and out of the lungs. The patient is given medication to
keep them sedated and more comfortable.
• Hydration Burns cause body fluid loss. Intravenous lines are inserted to ensure that the
patient remains hydrated. A Foley catheter is inserted into the bladder to monitor fluid levels (output)
and is also used to keep peri-anal burns clean.
• Feeding tube (NG or NJ) A small tube inserted through the nose or mouth that extends into
the stomach. A feeding tube is inserted when the patient is intubated or has insufficient caloric
intake. Burn patients require additional calories and protein in order to heal.
• Initial debridement and dressing Once stabilized, wounds are cleaned and a burn dressing
is applied. The patient is then either transferred to the Pediatric Intensive Care Unit (PICU) or to the
Surgical/Trauma Unit. The location is based on specific care requirements.

2. THE ACUTE PHASE

The acute phase begins and remains until all full-thickness wounds are covered by skin grafts.

The objectives during this period include:

A. Removal of dead tissue (eschar) and covering the wounds with skin grafts (if required)
• WOUND CARE
Wound care may include wound cleaning, debridement, grafting, escharotomies and dressing
changes:
a• WOUND CLEANING
The first step involved in wound care is to clean the burned skin. Warm water and gauze is used to
remove dead tissue. This step is essential to wound healing and for preventing infection.

Prescribed topical agents are administered before the wound is covered with layers of dry
dressings.
● Use ointments. Antibiotic ointments or creams are frequently used to fight or treat
infections in patients with second-degree burns. Using these ointments may require the use
of bandages.

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 ● Regularly change dressings. Dressings may need to be changed regularly. The skin and
the burn wound should be washed gently with mild soap and rinsed well with tap water. Use
a soft wash cloth or piece of gauze to gently remove old medications.

b• DEBRIDEMENT

Debridement is the removal of necrotic tissues to prevent bacterial growth promoting wound
healing.
●Mechanical Debridement. Involves the use of forceps and scissors to trim away loose
necrotic tissues.
●Enzymatic Debridement. Involves the use of proteolytic or fibriolytic enzymes to digest
necrotic tissues.
●Surgical Debridement. Involves excision of loose necrotic tissues.
●Antimicrobial Agents or Ointments
●Silver Sulfadiazine. Once or twice daily.
●Open Method. The wound is left exposed to air after application.
●Close method. Sterile gauze is impregnated.

c. AUTOGRAFTING-
Autografting is the surgical removal of a superficial layer of the patient’s own unburned skin
(donor site) which is subsequently grafted to the patient’s excised open wound.

d. ESCHAROTOMIES The dead skin and tissue on a burn is called eschar. A burn that
surrounds a body part may cause the area to swell and tighten, subsequently impairing
blood flow to the area. When this occurs, Plastic Surgeons make an incision in the burned
area in order to relieve the pressure

e. DRESSING CHANGES This procedure may cause pain. Prior to the dressing change, a
nurse or doctor will give the patient medication to help control pain and diminish anxiety.

B. Preventing contractures
Positioning and splinting
●It is essential for the rehabilitation process to begin immediately following hospitalization and
continue through discharge.
●Both the Physiotherapist and Occupational Therapist closely monitor and oversee this aspect of
burn care.
●They will assess the patient’s need for splinting and positioning.
● An individualized program will be developed which will include range of motion exercises and
stretching to ensure all joints are loose and functional.
●Proper positioning is essential for optimal healing and to prevent contractures. If the joints are not
stretched regularly and positioned properly they eventually become tight and difficult to straighten.
●This will have a direct impact on function, rehabilitation potential and the patient’s ability to perform
daily activities.

C. Providing adequate nutrition

Diet
●The larger the burn size, the more nutrients are needed for healing.
●Provide additional calories. Patients need more calories than normal when they’re recovering
from a burn injury.
●That’s why nutrition is a major component of burn treatment.

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●A diet high in calories and protein supports the immune system to decrease risk of infection; helps
wounds heal faster; maintains muscle mass; and minimizes weight loss to support rehabilitation.

D. Psychological and social impact

●We are committed to meeting the individual psychological needs of the patient and family
throughout burn treatment and recovery.
●To facilitate this process we encourage parents and caregivers to collaborate with the team when
developing individualized care plans.
● These plans are designed to meet the child’s medical, rehabilitation and psychological needs as
well as the family’s needs throughout the different phases of recovery.

E. Pain Management
Pain due to burns can range from mild to severe to excruciating. Pain management, which includes
pharmacologic and nonpharmacologic approaches, is a central component of the complex issues
involved in treating patients with burns.
●NO intramuscular or subcutaneous administration because the patient is hypovolemic.
●Intravenous analgesics: Morphine, Demerol
●Oral administration is NOT considered due to GI dysfunction.
●Minor burns: per orem
●Nonpharmacological: Deep breathing exercises, guided imagery

3. THE REHABILITATION PHASE

●The rehabilitation phase involves resuming daily activities and helping your child to reach their
functional potential.
●Patients and families often report that the period following discharge is challenging. In fact, many
patients and families have expressed that the first 18 months following discharge from hospital are
often more difficult for the patient than the hospital stay itself.

The rehabilitation goals at this time include:

a. maintaining and increasing range of motion of joints, muscle strengthening, increasing functional
activities ex. exercise
b. reconstructive surgery (if needed)
c. emotional and psychological support.
d. scar management
Minimizing scars after a burn Compressive garments are used to reduce scarring. Children with
deep burns are required to wear compressive garments. For optimal results, the garments must be
worn 23 hours per day for up to two years following the burn injury and can only be removed while
bathing. You will need to have at least two sets of compressive garments so that one can be worn at
all times even during laundering

COMPLICATIONS-BURNS AND SCALDS

1. Shock
After a serious injury, it's possible to go into shock. Shock is a life-threatening condition that occurs
when there's an insufficient supply of oxygen to the body.

Signs and symptoms of shock include:

►a pale face
►cold or clammy skin
►a rapid pulse
►fast, shallow breathing

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 ►yawning
►unconsciousness

2. Heat exhaustion and heatstroke

Heat exhaustion and heatstroke are 2 heat-related health conditions that happen when the temperature
inside your body rises to 37 to 40C or above.
Both heat exhaustion and heatstroke can be very serious. They're often caused by being exposed to too
much sunlight or heat.

Symptoms of heat exhaustion and heatstroke include:

►extreme tiredness and lack of energy
►dizziness or fainting
►feeling sick or vomiting
►rapid pulse
►headache
►muscle pain
►irritability
►confusion
If a person with heat exhaustion is taken quickly to a cool place, given water to drink and has their
clothing loosened, they should start to feel better within half an hour.

3. Infection
◄it's uncomfortable, painful or smelly
◄high temperature of 38C or higher
◄signs of cellulitis, a bacterial infection that causes redness and swelling of the skin
◄an infected burn can cause blood poisoning (sepsis) or toxic shock syndrome. These serious
conditions can be fatal if not treated.

4. Scarring
A scar is a patch or line of tissue that remains after a wound has healed. Most minor burns
only leave minimal scarring.

Treatment:
-applying an emollient, such as aqueous cream or emulsifying ointment, 2 or 3 times a day
-using sunscreen with a high sun protection factor (SPF) to protect the healing area from the
sun when you're outside

5. Psychological impact
-Burns and scalds, especially severe ones, can cause long-lasting distress.
-After a burn or scald, some people report experiencing:
▪feelings of anxiety and stress
▪low mood and depression
▪a lack of confidence and self-esteem
-Some people recovering from a burn may also develop post-traumatic stress disorder
(PTSD), which can cause symptoms such as flashbacks, nightmares, and unwanted and
intrusive thoughts.

TREATING BURNS AND SCALDS IN CHILDREN

SCALD- is caused by something wet, such as hot water or steam.

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1. Soak the Burn
●Immediately put the burned area in cool -- not cold -- water or under a faucet.
●Keep the injury in water for at least five to 15 minutes.
●Do not use ice.
2. Remove Burned Clothing
●If the clothing is stuck to the skin, do not peel it away. Leave it in place and cut away the
clothing around it.
3. Cover the Burn
●Use nonstick gauze or a clean cloth.
●If the burn is mild, you may put on antibiotic ointment.
●Don't put butter, grease, or anything else on the burn, and do not pop any blisters.
4. Reduce Pain
●Use an infant or child-strength over-the-counter pain reliever such
as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for children ages 6 months and
older.
●Follow the dosing instructions on the bottle.
●Call a pediatrician first if your child has never taken this medication before.

PREVENTIVE MEASURES YOU CAN TAKE AT HOME:

◄Keep children out of the kitchen while cooking.
◄Turn pot handles toward the back of the stove.
◄Place a fire extinguisher in or near the kitchen.
◄Test smoke detectors once a month.
◄Replace smoke detectors every 10 years.
◄Keep water heater temperature under 120 degrees Fahrenheit.
◄Measure bath water temperature before use.
◄Lock up matches and lighters.
◄Install electrical outlet covers.
◄Check and discard electrical cords with exposed wires.
◄Keep chemicals out of reach, and wear gloves during chemical use.
◄Wear sunscreen every day, and avoid peak sunlight.
◄Ensure all smoking products are stubbed out completely.
◄Clean out dryer lint traps regularly.

B. POISONING

Poisoning occurs when any substance interferes with normal body functions after it is swallowed,
inhaled, injected, or absorbed. The branch of medicine that deals with the detection and treatment
of poisons is known as toxicology.

SYMPTOMS OF POISONING
►Nausea and/or vomiting
►Diarrhea
►Rash
►Redness or sores around the mouth
►Dry mouth
►Drooling or foaming at the mouth
►Trouble breathing

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 ►Dilated pupils (bigger than normal) or constricted pupils (smaller than normal)
►Confusion
►Fainting
►Shaking or seizures

CAUSES OF POISONING IN CHILDREN

1. Medications
Medications account for about half of potentially toxic exposures.
A child may ingest medications found in the home or a parent may unintentionally give a child more
than the correct dose.
2. Household Products and Pesticides
Poisoning can occur from the ingestion or inhalation of household substances, such as bleach or
toilet bowl cleaner, laundry detergent pods, pesticides or insecticides, glue, paint thinners and
removers, and oven and drain cleaners.
3. Carbon Monoxide
Dangerous levels of carbon monoxide, which is a colorless, odorless, and poisonous gas, may be
emitted from fuel-burning appliances that aren’t working properly or aren’t properly vented. These
include space heaters, furnaces, gas ranges and ovens, clothes dryers, gas water heaters, portable
generators, wood-burning fireplaces and stoves, and automobiles
4. Household Plants
Some indoor and outdoor plants contain toxins that can affect the stomach, heart, liver, respiratory
system, or skin. These include daffodils, dumb cane, foxglove, hydrangea, lilies, oleanders,
rhododendrons, and wisteria. Most common household indoor plants typically cause only mild
gastrointestinal symptoms
5. Alcohol, Nicotine, and Illicit Substances
Alcohol intoxication can affect children who drink alcoholic beverages, including wine, beer, and
liquor. Alcohol can also be found in perfume, mouthwash, cleaning products, hand sanitizers, and
over-the-counter cold medications. In children, alcohol poisoning can cause low blood sugar, which
can lead to seizures and coma.
6. Hydrocarbons
Hydrocarbons include gasoline, kerosene, lamp oil, lighter fluid, paint thinners and removers, and
motor oil. Young children may unintentionally ingest these fluids.
Exposure to these poisons can affect the respiratory and central nervous systems.

7. Batteries
Items such as watches, calculators, remote controls, and toys may be battery-powered. Children
may swallow small batteries, particularly flat “button” batteries. Batteries may contain alkaline
chemicals that can leak or generate an electrical current, which can cause burns or holes in the
esophagus.
8. Personal Care Products
Some personal care products, such as nail polish remover or perfume, can be poisonous if
ingested. Exposure to these products may lead to symptoms including vomiting, drowsiness, or
difficulty breathing.

DIAGNOSING POISONING
1. review medical history and do a physical exam.
2.. Most poisons can be detected in your blood or urine.
3. toxicology screen. This checks for common drugs using a urine or saliva sample.

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PREVENT POISONING IN YOUR HOME:
►Store medicine, cleaning and laundry products, (including detergent packets) paints/varnishes
and pesticides in their original packaging in locked cabinets or containers, out of sight and reach of
children. It is best to use traditional liquid or powder laundry detergents instead of detergent packets
until all children who live in or visit your home are at least 6 years old.
►Safety latches that automatically lock when you close a cabinet door can help to keep children
away from dangerous products, but there is always a chance the device will malfunction or the child
will defeat it. The safest place to store poisonous products is somewhere a child can't see or reach
or see.
►Purchase and keep all medicines in containers with safety caps. Discard unused medication.
Note that safety caps are designed to be child resistant but are not fully child proof. Never refer to
medicine as “candy” or another appealing name.
►Check the label each time you give a child medicine to ensure proper dosage. For liquid
medicines, use the dosing device that came with the medicine. Never use a kitchen spoon.
►If you use an e-cigarette, keep the liquid nicotine refills locked up out of children's reach and only
buy refills that use child-resistant packaging. A small amount of liquid nicotine spilled on the skin or
swallowed can be fatal to a child.
►Never place poisonous products in food or drink containers.
►Keep natural gas-powered appliances, furnaces, and coal, wood or kerosene stoves in safe
working order.
►Maintain working smoke and carbon monoxide detectors
►Secure remote controls, key fobs, greeting cards, and musical children’s books. These and other
devices may contain small button-cell batteries that can cause injury if ingested.
►Know the names of all plants in your home and yard. If you have young children or pets, consider
removing those that are poisonous

DIFFERENT TYPES AND METHODS OF POISONING REQUIRE DIFFERENT, IMMEDIATE

TREATMENT.
◄Swallowed poison. Take the item away from the child, and have the child spit out any remaining
substance. Do not make your child vomit. Do not use syrup of ipecac.
◄Swallowed battery. If your child has swallowed a button-cell battery or a battery is lodged in his
or her nose, ear, or throat, seek treatment in a hospital emergency department immediately. Serious
tissue damage can occur in as little as 2 hours.

◄Skin poison. Remove the child’s clothes and rinse the skin with lukewarm water for at least 15
minutes.
◄Eye poison. Flush the child’s eye by holding the eyelid open and pouring a steady stream of
room temperature water into the inner corner for 15 minutes.
◄Poisonous fumes. Take the child outside or into fresh air immediately. If the child has stopped
breathing, start cardiopulmonary resuscitation (CPR) and do not stop until the

C. CHILD ABUSE
Child abuse is when a parent or caregiver, whether through action or failing to act, causes injury,
death, emotional harm or risk of serious harm to a child. There are many forms of child
maltreatment, including neglect, physical abuse, sexual abuse, exploitation and emotional abuse.

17
FORMS OF CHILD MALTREATMENT
1. Physical Abuse
Physical abuse of a child is when a parent or caregiver causes
any non-accidental physical injury to a child. There are many
signs of physical abuse. If you see any of the following signs,
please get help right away.
◄28.3% of adults report being physically abused as a child.

2. Sexual abuse occurs when an adult uses a child for sexual

purposes or involves a child in sexual acts. It also includes
when a child who is older or more powerful uses another child
for sexual gratification or excitement.
◄20.7% of adults report being sexually abused as a child.

3. Emotional Abuse-When a parent or caregiver harms a child’s

mental and social development, or causes severe emotional harm,
it is considered emotional abuse. While a single incident may be
abuse, most often emotional abuse is a pattern of behavior that
causes damage over time.
◄10.6% of adults report being emotionally abused as a child.

4. Bullying & Cyberbullying

Bullying is the repeated, targeted, aggressive behavior, that uses
force, threats, teasing, and/or embarrassment to hurt children who
are younger or smaller, or over whom they have power.
Cyberbullying is the repeated, targeted, aggressive behavior that
takes place online, or on digital devices through email, chat, text, and
includes sending, posting, or sharing hurtful or embarrassing
information or images to exclude and shame the targeted person.

◄One out of every five (20.2%) students reports being bullied.

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5. Child Neglect
Child neglect is when a parent or caregiver does not give the care,
supervision, affection and support needed for a child’s health,
safety and well-being. Child neglect includes:
●Physical neglect and inadequate supervision
●Emotional neglect
●Medical neglect
●Educational neglect

6. Grooming
Grooming is the act of deliberately establishing an emotional
connection with a child to prepare the child for sexual abuse.
Grooming can happen in the physical world as well as on the Internet,
where law enforcement estimates there are 50,000 predators online
at any given time. Most at risk for grooming are youth who are
isolated, have low self-esteem, or somehow need attention.

SPECIFIC SIGNS AND SYMPTOMS.

1. Physical abuse signs and symptoms

● Unexplained injuries, such as bruises, fractures or burns
● Injuries that don't match the given explanation

2. Sexual abuse signs and symptoms

● Sexual behavior or knowledge that's inappropriate for the child's age
● Pregnancy or a sexually transmitted infection
● Blood in the child's underwear
● Statements that he or she was sexually abused
● Inappropriate sexual contact with other children

3. Emotional abuse signs and symptoms

● Delayed or inappropriate emotional development
● Loss of self-confidence or self-esteem
● Social withdrawal or a loss of interest or enthusiasm
● Depression
● Avoidance of certain situations, such as refusing to go to school or ride the bus
● Desperately seeks affection
● A decrease in school performance or loss of interest in school
● Loss of previously acquired developmental skills

4. Neglect signs and symptoms

● Poor growth or weight gain or being overweight
● Poor hygiene
● Lack of clothing or supplies to meet physical needs
● Taking food or money without permission
● Hiding food for later
● Poor record of school attendance

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● Lack of appropriate attention for medical, dental or psychological problems or lack of necessary
follow-up care

RISK FACTORS
●A history of being abused or neglected as a child
●Physical or mental illness, such as depression or post-traumatic stress disorder (PTSD)
●Family crisis or stress, including domestic violence and other marital conflicts, or single parenting
●A child in the family who is developmentally or physically disabled
●Financial stress, unemployment or poverty
●Social or extended family isolation
●Poor understanding of child development and parenting skills
●Alcohol, drugs or other substance abuse

COMPLICATIONS
1. Physical issues
●Premature death
●Physical disabilities
●Learning disabilities
●Substance abuse
●Health problems, such as heart disease, immune disorders, chronic lung disease and cancer

2. Behavioral issues
●Delinquent or violent behavior
●Abuse of others
Withdrawal
Suicide attempts or self-injury
●High-risk sexual behaviors or teen pregnancy
●Problems in school or not finishing high school
●Limited social and relationship skills
●Problems with work or staying employed
3. Emotional issues
●Low self-esteem
●Difficulty establishing or maintaining relationships
●Challenges with intimacy and trust
●An unhealthy view of parenthood
●Inability to cope with stress and frustrations
●An acceptance that violence is a normal part of relationships
4. Mental health disorders
●Eating disorders
●Personality disorders
●Behavior disorders
●Depression
●Anxiety disorders
●Post-traumatic stress disorder (PTSD)
●Sleep disturbances
●Attachment disorders

PREVENTION
♥Offer your child love and attention. Nurture your child, listen and be involved in his or her life to
develop trust and good communication. Encourage your child to tell you if there's a problem. A

20
supportive family environment and social networks can foster your child's self-esteem and sense of
self-worth.
♥ Don't respond in anger. If you feel overwhelmed or out of control, take a break. Don't take out your
anger on your child. Talk with your doctor or therapist about ways you can learn to cope with stress
and better interact with your child.
♥ Think supervision. Don't leave a young child home alone. In public, keep a close eye on your
child. Volunteer at school and for activities to get to know the adults who spend time with your child.
When old enough to go out without supervision, encourage your child to stay away from strangers
and to hang out with friends rather than be alone — and to tell you where he or she is at all times.
Find out who's supervising your child — for example, at a sleepover.
♥ Know your child's caregivers. Check references for babysitters and other caregivers. Make
irregular, but frequent, unannounced visits to observe what's happening. Don't allow substitutes for
your usual child care provider if you don't know the substitute.
♥ Emphasize when to say no. Make sure your child understands that he or she doesn't have to do
anything that seems scary or uncomfortable. Encourage your child to leave a threatening or
frightening situation immediately and seek help from a trusted adult. If something happens,
encourage your child to talk to you or another trusted adult about the episode. Assure your child that
it's OK to talk and that he or she won't get in trouble.

♥ Teach your child how to stay safe online. Put the computer in a common area of your home, not
the child's bedroom. Tell your child to let you know if an unknown person makes contact through a
social networking site. Report online harassment or inappropriate senders to your service provider
and local authorities, if necessary.

♥ Reach out. Meet the families in your neighborhood, including parents and children. Consider
joining a parent support group so that you have an appropriate place to vent your frustrations.
Develop a network of supportive family and friends
●Nearly 3 in 4 children - or 300 million children - aged 2–4 years regularly suffer physical
punishment and/or psychological violence at the hands of parents and caregivers
●One in 5 women and 1 in 13 men report having been sexually abused as a child aged 0-17 years.
●120 million girls and young women under 20 years of age have suffered some form of forced
sexual contact.
●Consequences of child maltreatment include impaired lifelong physical and mental health, and the
social and occupational outcomes can ultimately slow a country's economic and social
development.
●A child who is abused is more likely to abuse others as an adult so that violence is passed down
from one generation to the next. It is therefore critical to break this cycle of violence, and in so doing
create positive multi-generational impacts.
●Preventing child maltreatment before it starts is possible and requires a multisectoral approach.
●Effective prevention approaches include supporting parents and teaching positive parenting skills,
and enhancing laws to prohibit violent punishment.

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D. CEREBRAL PALSY

►Cerebral palsy (CP) is a group of permanent

movement problems that do not get worse over time
caused by damage to the motor control in Central
Nervous System of the developing brain.
►They cause physical disability, mainly in the areas of
body movement. There may also be problems with
sensation, depth perception, and communication ability .
►CP is the most common cause of motor disabilities in
childhood.
►According to the Centers for Disease Control and
Prevention (CDC)Trusted Source, it affects at least 1.5
to 4 out of every 1,000 children worldwide.

William John Little (1810–1894) was an English surgeon who is credited with the first
medical identification of spastic diplegia, when he observed it in the 186 0s amongst
children. ●While spasticity surely existed before that point, Little was the first person to
medically record the condition in writing.

●Thus, for many years, spastic diplegia was known as Little's Disease; only later did the
name change. Also, Little founded the Royal Orthopaedic Hospital of London.

SYMPTOMS OF CEREBRAL PALSY

They also vary depending on the part of the brain that was affected. Symptoms usually appear
before a child reaches age 3 or 4.

►delays in reaching motor skill milestones, such as rolling over, sitting up alone, or crawling
►variations in muscle tone, such as being too floppy or
too stiff
►delays in speech development and difficulty speaking
►spasticity, or stiff muscles and exaggerated reflexes
►ataxia, or a lack of muscle coordination
►tremors or involuntary movements
►excessive drooling and problems with swallowing
►difficulty walking
►favoring one side of the body, such as reaching with
one hand
►neurological problems, such as seizures, intellectual
disabilities, and blindness

CAUSES of CEREBRAL PALSY

Factors that can lead to problems with brain development include:

►Gene mutations that lead to abnormal development; 2% of all cerebral palsy cases are believed to
be due to a genetic cause.

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►Maternal health-Certain infections or toxic exposures during pregnancy can significantly increase
cerebral palsy risk to the baby.
Infections of particular concern include:
►Cytomegalovirus. This common virus causes flu-like symptoms and can lead to birth
defects if a mother has her first active infection during pregnancy.
►German measles (rubella). This viral infection can be prevented with a vaccine.

►Herpes. This can be passed from mother to child during pregnancy, affecting the womb
and placenta. Inflammation triggered by infection can damage the unborn baby's developing
nervous system.
►Syphilis. This is a sexually transmitted bacterial infection.
►Toxoplasmosis. This infection is caused by a parasite found in contaminated food, soil
and the feces of infected cats.
►Zika virus infection. Infants for whom maternal Zika infection causes their head size to be
smaller than normal (microcephaly) can develop cerebral palsy.
►Other conditions. Other conditions that can increase the risk of cerebral palsy include
thyroid problems, intellectual disabilities or seizures, and exposure to toxins, such as methyl
mercury.
►Infant illness
●Bacterial meningitis. This bacterial infection causes inflammation in the membranes
surrounding the brain and spinal cord.
●Viral encephalitis. This viral infection similarly causes inflammation in the membranes
surrounding the brain and spinal cord.
●Severe or untreated jaundice. Jaundice appears as a yellowing of the skin. The condition
occurs when certain byproducts of "used" blood cells aren't filtered from the bloodstream.
●Bleeding into the brain. This condition is commonly caused by the baby having a stroke in
the womb. (intracranial hemorrhage)
►Fetal stroke, a disruption of blood supply to the developing brain
►Traumatic head injury to an infant from a motor vehicle accident or fall
►Lack of oxygen(asphyxia neonatorum) to the brain related to difficult labor or delivery, although
birth-related asphyxia is much less commonly a cause than historically thought
►Other factors of pregnancy and birth
●Breech presentation. Babies with cerebral palsy are more likely to be in this feet-first
position at the beginning of labor rather than being headfirst.
●Low birth weight. Babies who weigh less than 5.5 pounds (2.5 kilograms) are at higher
risk of developing cerebral palsy. This risk increases as birth weight drops.
●Multiple babies. Cerebral palsy risk increases with the number of babies sharing the
uterus. If one or more of the babies die, the survivors' risk of cerebral palsy increases.
●Premature birth. Babies born fewer than 28 weeks into the pregnancy are at higher risk of
cerebral palsy. The earlier a baby is born, the greater the cerebral palsy risk

COMPLICATIONS
●Contracture. Contracture is muscle tissue shortening due to severe muscle tightening (spasticity).
Contracture can inhibit bone growth, cause bones to bend, and result in joint deformities, dislocation
or partial dislocation.
●Premature aging. Some type of premature aging will affect most people with cerebral palsy in
their 40s because of the strain the condition puts on their bodies.
●Malnutrition. Swallowing or feeding problems can make it difficult for someone who has cerebral
palsy, particularly an infant, to get enough nutrition. This can impair growth and weaken bones.
Some children need a feeding tube to get enough nutrition.

23
●health conditions. People with cerebral palsy might have mental health conditions, such as
depression. Social isolation and the challenges of coping with disabilities can contribute to
depression.
●Heart and lung disease. People with cerebral palsy may develop heart disease and lung disease
and breathing disorders.
●Osteoarthritis. Pressure on joints or abnormal alignment of joints from muscle spasticity may lead
to the early onset of this painful degenerative bone disease.

●Osteopenia. Fractures due to low bone density (osteopenia) can stem from several common
factors such as lack of mobility, nutritional shortcomings and anti-epileptic drug use.

TYPES OF CEREBRAL PALSY

1. Spastic cerebral palsy
Spastic CP is the most common type of CP, affecting approximately 80
percentTrusted Source of people with CP. It causes stiff muscles and
exaggerated reflexes, making it difficult to walk.
Many people with spastic CP have walking abnormalities, such as
crossing their knees or making scissorlike movements with their legs
while walking. Muscle weakness and paralysis may also be present.
The symptoms can affect the entire body or just one side of the body.
2. Dyskinetic cerebral palsy
People with dyskinetic CP have trouble controlling their body movements.
The disorder causes involuntary, abnormal movements in the arms, legs,
and hands.
In some cases, the face and tongue are also affected. The movements can
be slow and writhing or rapid and jerky. They can make it difficult for the
affected person to walk, sit, swallow, or talk.

3. Hypotonic cerebral palsy

Hypotonic CP causes diminished muscle tone and overly relaxed
muscles.
The arms and legs move very easily and appear floppy, like a rag
doll.
Babies with this type of CP have little control over their head and
may have trouble breathing. As they grow older, they may struggle
to sit up straight as a result of their weakened muscles.
They can also have difficulty speaking, poor reflexes, and walking
abnormalities.
4. Ataxic cerebral palsy
Ataxic CP is the least common type of CP. Ataxic CP is characterized
by voluntary muscle movements that often appear
disorganized, clumsy, or jerky.
People with this form of CP usually have problems with balance and
coordination. They may have difficulty walking and performing fine
motor functions, such as grasping objects and writing.

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5. Mixed cerebral palsy
Some people have a combination of symptoms from the different types
of CP.
In most cases of mixed CP, people experience a mix of
spastic and dyskinetic .

CEREBRAL PALSY DIAGNOSED

A doctor will diagnose CP by taking a complete medical history, performing a physical exam that
includes a detailed neurological exam, and evaluating the symptoms. Additional testing can also be
performed:
►An electroencephalogram (EEG) is used to evaluate the electrical activity in the brain. It may be
ordered when someone is showing signs of epilepsy, which causes seizures.
►An MRI scan uses powerful magnets and radio waves to produce detailed images of the brain. It
can identify any abnormalities or injuries in the brain.
►A CT scan creates clear, cross-sectional images of the brain. It can also reveal any brain damage.
►A cranial ultrasound is a relatively quick and inexpensive method of using high-frequency sound
waves to get basic images of the brain in young infants.
►A sample of blood may be taken and tested to rule out other possible conditions, such as bleeding
disorders.

CONDITIONS ASSOCIATED WITH CEREBRAL PALSY

People with CP may have other problems, such as:
►communication difficulties, including speech and language disorders
►drooling
►spinal deformity such as scoliosis (curvature), lordosis (saddle back) and kyphosis (humpback)
►osteoarthritis
►contractures, which occur when the muscles get locked in painful positions
►incontinence
►osteopenia, or poor bone density that can make bones easily breakable
►dental problems

GROSS MOTOR FUNCTION CLASSIFICATION SYSTEM (GMFCS)

GMFCS Level I
Children walk at home, school, outdoors and in the community. They
can climb stairs without the use of a railing. Children perform gross motor
skills such as running and jumping, but speed, balance and coordination
are limited.

25
GMFCS Level II
Children walk in most settings and climb stairs holding onto a railing.
They may experience difficulty walking long distances and balancing on
uneven terrain, inclines, in crowded areas or confined spaces.
Children may walk with physical assistance, a handheld mobility device
or used wheeled mobility over long distances. Children have only
minimal ability to perform gross motor skills such as running and
jumping.

GMFCS Level III

Children walk using a hand-held mobility device in most indoor
settings. They may climb stairs holding onto a railing with
supervision or assistance. Children use wheeled mobility when
traveling long distances and may self-propel for shorter distances.

GMFCS Level IV
Children use methods of mobility that require physical assistance or
powered mobility in most settings. They may walk for short distances at
home with physical assistance or use powered mobility or a body
support walker when positioned. At school, outdoors and in the
community children are transported in a manual wheelchair or use
powered mobility.

GMFCS Level V
Children are transported in a manual wheelchair in all settings.
Children are limited in their ability to maintain antigravity head and
trunk postures and control leg and arm movements.

CEREBRAL PALSY TREATMENT

The goal of treatment is to improve limitations and prevent
complications
►Assistive aids
►Assistive aids include:
►eyeglasses
►hearing aids
►walking aids
►body braces
►wheelchairs
►Medications
Oral anticonvulsants and muscle relaxants are commonly used as first-line treatments
for CP. Your doctor might prescribe:
►diazepam (Valium)
►dantrolene (Dantrium)
►baclofen

26
 ►tizanidine (Zanaflex)
►Surgery
Orthopedic surgery may be used to relieve pain and improve mobility. It may also be
needed to release tight muscles or to correct bone abnormalities caused by spasticity.
Selective dorsal rhizotomy (SDR) might be recommended as a last resort to reduce
chronic pain or spasticity. It involves cutting nerves near the base of the spinal column.

OTHER TREATMENT
►speech therapy
►physical therapy
►occupational therapy
►recreational therapy
►counseling or psychotherapy
►social services consultations
Although stem cell therapy is being explored as a potential treatment for CP, research is still in the
early stages.

PREVENTION
●Make sure you're vaccinated. Getting vaccinated against diseases such as rubella, preferably
before getting pregnant, might prevent an infection that could cause fetal brain damage.
●Take care of yourself. The healthier you are heading into a pregnancy, the less likely you'll be to
develop an infection that results in cerebral palsy.
●Seek early and continuous prenatal care. Regular visits to your doctor during your pregnancy
are a good way to reduce health risks to you and your unborn baby. Seeing your doctor regularly
can help prevent premature birth, low birth weight and infections.
●Practice good child safety. Prevent head injuries by providing your child with a car seat, bicycle
helmet, safety rails on beds and appropriate supervision.
●Avoid alcohol, tobacco and illegal drugs. These have been linked to cerebral palsy risk.

ACTIVITY

A. POST TEST

1. What are the main causes of death among people who initially survive a severe burn?
A. Fever
B. Bacterial infections
C. Severe dehydration
D. B and C
The correct answer is D. Your skin protects your body from infection, stabilizes your body
temperature, and prevents fluid loss. Your body is highly vulnerable when the skin is injured
or lost.

2. You should seek medical help right away if a second-degree (partial thickness) burn is
larger than 3 inches in diameter, or if the burn is on certain areas of the body. Which parts
of the body can be critical?
A. Hands

27
B. Feet
C. Any major joint
D. All of the above
The correct answer is D. All of the above.
Swelling and blisters accompany second-degree (partial thickness) burns. Don't break the
blisters and don't apply ice. Remove all clothing, jewelry, and metal around the burned
area. Run cool, but not cold, water over the burned area for several minutes. Do not put
ointment or cream on the burned area. Do not break any blisters that form unless the doctor
tells you to do so. Cover the burned area with a clean, dry cloth.

3. In the case of a chemical burn to the skin, how should the affected area be treated?
A. Wash the area with soap
B. Flush the area for at least 20 minutes with cool, running water
C. Apply an ointment or butter
D. Cool the area with ice
The correct answer is B. Flush the area for at least 20 minutes with cool, running water.

Chemical burns can be caused by exposure to household cleaners, lawn and garden
products, fresh cement, or other chemicals, according to the ABA.
4. How should the eye be treated if a chemical splashes into it?
A. Let the eye tear to wash the chemical out
B. Cover the eye with a loose, moist dressing
C. Use milk to flush the eye
D. Flush the eye with clean drinking water
The correct answer is D. Flush the eye with clean drinking water.
You should continue to flush the eye until medical help arrives.

5. Which of these toxic substances is more likely to cause sickness in infants and elderly
adults?
A. Lead
B. Carbon monoxide
C. Bee venom
D. Bleach
E. Turpentine
The correct answer is B. Carbon monoxide.
Carbon monoxide is also more likely to cause sickness in people who have long-term
(chronic) health problems. Each year in the U.S., many people are treated in the
emergency room, are put in the hospital, or die from carbon monoxide poisoning.

6. Apply butter to burns; Butter is good for burns?

A. True
B. False
FALSE. A skin burn is delicate so you should not put ice or butter on the area. Doing so may
increase tissue damage. Butter holds heat in the skin, making the injury worse. The best thing to do
for minor burns is to hold the area under cool running water to decrease the temperature and soothe

28
pain. Use sterile gauze bandaging and nonstick dressing to cover the blistered skin. Use a light
touch and wrap the bandage loosely to minimize the risk of it sticking to the burned area

7.. Keep cuts and scrapes uncovered?

A. True
B. False
FALSE. It is another common misconception that you should let wounds air out. What should you
put on cuts and scrapes? First wash the wound with soap and water and apply a thin layer of
antibiotic ointment. Then put a bandage on over the cut or scrape to keep dirt and bacteria out. A
bandage also protects a healing wound from rubbing against clothing. Bandages placed across the
width of a cut can help hold the edges together while the wound heals. You can use more than one
butterfly bandage to help the edges of a cut lined up to stay together.

9. You need to use hydrogen peroxide or rubbing alcohol to clean a wound?

A. True
B. False

FALSE. It is a common misconception that you should apply hydrogen peroxide or alcohol to
an injury. These can be harmful to the tissue and may inhibit healing. The best treatment for
cuts and scrapes involves first cleaning the wound with mild soap and fresh water. Rinse the
wound for several minutes. This helps remove debris, dirt, and bacteria. See your doctor right
away for wounds that are deep, gaping, large, or that do not stop bleeding after applying
pressure for several minutes.

10. Wounds need to be kept moist; should you keep injuries moist?
A. True
B. False

TRUE. Wounds that are moist heal more quickly compared to wounds that are not moist. Use
antibiotic ointment for cuts and scrapes to keep them moist. Creams and ointments also help
prevent bandages from sticking to the wound. Follow your doctor’s instructions for wound care.
Apply a thin layer of antibiotic ointment to a wound to help keep it moist and help reduce the risk of
infection

B. Formulate your own nursing care plan based on the scenario provided on this page.
Analyze the given scenario and identify priority nursing diagnosis. Use the Nursing Care
Plan format provided in the module in accomplishing this activity . Select 1 case ONLY.

Case1. A 4 year old boy, sustained burns today while playing with matches in a garage.
Unknown accelerant and his pants caught on fire, which he attempted to put out using his
hands. He sustained burns on both lower extremities. The burns are circumferential on the
right lower extremity extending from the ankle to the mid thigh and anteriorly on the left thigh.
He also has burns to both hands, palmer surfaces.

29
1. Describe components of the initial assessment for this patient.
2. Calculate % Body surface area burned using the Wallace rule of nines
3. Make a Nursing Care Plan for this specific patient.

Case 2. Robert is aged 4 years. His parents are concerned that he is still not sitting independently
and wish to discuss an alternative therapy, which claims to have good outcomes in helping children
to walk. The GP explains that Robert is currently functioning at GMFCS ( Gross Motor Function
Classification System) Level V and the growth motor curves are shown to the parents. Following
many discussions and substantial grief and disappointment, they come to understand that Robert
will never walk. They begin to concentrate more on his communication abilities and use the money
that they had saved for alternative therapy to help purchase an electronic communication device.

1. Make a Nursing Care Plan for this specific patient.

GLOSSARY

Antidote —A remedy to counteract a poison or injury. Also refers to a substance which cancels the
effect of homeopathic remedies
Emetic —A medication intended to cause vomiting. Emetics are sometimes used in aversion
therapy in place of electric shock. Their most common use in mainstream medicine is in treating
accidental poisoning.
Gastric lavage —Also called a stomach pump. For this procedure, a flexible tube is inserted
through the nose, down the throat, and into the stomach and the contents of the stomach are
suctioned out. The inside of the stomach is rinsed with a saline (salt water) solution.
Toxicology —The branch of medical pharmacology dealing with the detection, effects, and
antidotes of poisons.
Emotional Abuse -A pattern of behavior by adults that seriously interferes with a child’s cognitive,
emotional, psychological or social development
Familial Abuse And Neglect- Abuse or neglect committed by a parent, guardian, or member of the
family
Guidance And Touch Policy- The policy your program has developed that describes the
boundaries of acceptable and unacceptable discipline procedures and ways of touching children
Institutional Abuse And Neglect- Abuse or neglect that takes place outside of the child’s home
and is committed by someone in a supervisory role over the child (teacher, scout leader, etc.)
Neglect- Failure by a caregiver to provide needed, age-appropriate care although financially able to
do so or offered financial or other means to do so (U.S. Department of Health and Human Services,
2007)
Physical Abuse -Non-accidental trauma or injury

30
Sexual Abuse- The involvement of a child in any sexual touching, depiction, or activity

Burns Multidisciplinary Team – consist of Burns Consultant/Fellow, Burns Clinical Nurse

Consultant, Burns register/resident, Nurse Coordinator, Occupational Therapist, Physiotherapist,
Dietitian, Social Work, Play therapy, Specialist Clinics Team.

% TBSA – percentage of total body surface area burnt (not including erythema or superficial burns)
calculated using the Lund Browder chart.

Minor Burn – In paediatric burns a minor burn is considered to be less than 10% TBSA

Major Burn – In paediatric burns a major burn is considered to be more than 10% TBSA

Plastic Surgeon A surgical specialist whose expertise encompasses all areas of burn trauma care
Escharotomies The dead skin and tissue on a burn is called eschar. A burn that surrounds a body
part may cause the area to swell and tighten, subsequently impairing blood flow to the area. When
this occurs, Plastic Surgeons make an incision in the burned area in order to relieve the pressure.

Grafting -Deeper burns rarely heal on their own therefore requiring a skin graft. A skin graft is a
very thin piece of skin that is taken from an area of the body unaffected by the burn and then used
to cover the burn. The site from which the graft is removed will heal on its own in approximately 10-
14 days and can be used again for future grafting. The most common areas used as a donor site
include the legs, back and buttocks; less frequently used are the chest and arms.

REFERENCES

ᴥ Bayat A, Ramaiah R, Bhananker SM. Analgesia and sedation for children undergoing burn
wound care. Expert Rev Neurother. 2010;10:1747–59. [PubMed] [Google Scholar]

● Lam NN, Huong HTX, Tuan CA. Knowledge on emergency management for burn and mass
burn injuries amongst physicians working in emergency and trauma departments. Ann Burns
Fire Disasters. 2018 Jun 30;31(2):138-143. [PMC free article] [PubMed]

 Pilliteri, Adele (2018). Maternal & Child Health Nursing 8 th Edition. Philidelphia: Lippincot
Williams & Wilkins. C&E Publishing, Inc.
 Harold W. Baillie, et., al., (2018). Health Care Ethics 6th Edition. Pearson Education South
Asia Pte. Ltd.
 Kozier & Erbs. (2016) Fundamental of Nursing 8th Edition. Pearson International. C&E
Publishing, Inc.
 JoAnne Silbert – Flagg. Maternal & Child Health Nursing 8 th Edition. Wolters Kluwer
 Luxner, Karla L. (2006) Delmar’s Maternal – Infant Nursing Care Plans. Clifton Park, NY: Delmar
learning
 Ackley, Betty J. (2006). Nursing diagnosis handbook: a guide to planning care. 7th ed. PA. :St.
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