LESSON PLAN

ON
Parentral medication in pediatrics

Submitted by: Ms. Prerna Sharma

Florence nightingale college of nursing, GTB hOSPITAL

IDENTIFICATION DATA

NAME OF THE STUDENT TEACHER: Prerna sharma

SUBJECT: Child Health Nursing

TOPIC: Parentral medication in pediatrics

GROUP OF STUDENTS: Bsc Nursing 5th semester

SIZE OF GROUP: 68

DURATION OF TEACHING: 60 min

METHOD OF TEACHING: Lecture cum Demonstration

DATE AND TIME OF TEACHING:

PREVIOUS KNOWLEDGE OF THE GROUP: The group has previous knowledge about parentral medication.

GENERAL OBJECTIVES:

At the end of the class the group will be able-

 To acquire knowledge on parentral medication and apply this knowledge in their nursing practice

At the end of the class the student teacher will be able-

 To develop skills in teaching learning activities

 To develop skills in effective use of audio visual aids
 To develop confidence in facing group
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OBJECTIVE
1. 1min INTRODUCTION

The term terrible twos is used to describe the toddler years, the
period from 12 to 36 years.

It is a time for intense exploration of the environment as children

attempt to find out how things work and how to control others
through temper tantrums, negativism and obstinacy

2. 1min
ANNOUNCEMENT OF THE TOPIC

Today the topic discuss will be the growth and development in

toddlers biologically, psychosocially, cognitive aspect, spiritual and
the problems faced and how to deal with these.
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3. 1min After the class the BIOLOGICAL DEVELOPMENT The student teacher explains What are the
group will be able: the proportional proportional changes
To explain the Proportional Changes development using in toddlers?
proportional transparencies
 Physical growth slows considerably during
changes in toddlers
toddlerhood. The average weight gain is 1.8 to 2.7 kg
per year
 The average weight at 2 years is 12 kg. The
birth weight is quadrupled by 21/2 years of age.
 The rate of increase is height also slows.
 The usual increment is an addition of 7.5 cm
per year and occurs mainly in elongation of the legs
rather than the trunk.
 The average height of a 2 year old is 86.6
cm.
 The rate of increase in head circumstance
slows somewhat by the end of infancy, and head
circumstance is usually equal to chest circumference
by 1 to 2 years of age.
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 Chest circumference continues to increase in

size and exceeds head circumference during the
toddler years.
 The chest’s shape also changes as the
transverse or lateral diameter exceeds the
4. 3 min To explain the anteroposterior diameter.
sensory changes The student teacher explains
and maturation of Sensory changes the sensory changes and What are the sensory
systems in toddlers maturation of systems changes in toddlers?
 The senses of hearing, smell, taste and touch
using transparencies.
become increasing well developed, co-ordinate with
each other and associated with other experiences.
 All of the senses are used to explore the
environment.
 Toddlers will visually inspect an object by
turning it over, they may taste it, smell it and touch it
several times before they are satisfied with their
investigation.
 They will shake it to see if it makes noise
and vigorously test its durability.

Maturation of systems

 Most of the physiologic systems are

relatively mature by the end of toddlerhood.
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 Volume of the respiratory tract and growth

of associated structures continue to increase during
early childhood, lessening some of the factors that
predisposed the child to frequent and serious
infections during infancy
 The digestive processes are fairly complete
by the beginning of toddlerhood.
 The acidity of the gastric contents
continues to increase and has a protective function,
since it is capable of destroying many types of
bacteria
 Stomach capacity increases to allow for the
usual schedule of three meals a day.
 One of the more prominent changes of the
gastrointestinal system is the voluntary control of
elimination.
 With complete myelination of the spinal
cord, control of the anal and urethral sphincters is
gradually achieved.
 The defense mechanisms of the skin and
blood, particularly phagocytosis are much more
efficient in toddlers than in infants.
 The production of antibodies is well
established.
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5. 2min To describe the Gross motor and fine motor development The student teacher Describe the fine and
gross and fine describes the fine and gross gross motor
motor development  The major gross motor skill during the motor development using development?
toddler years is the development of locomotion. transparencies.
 By 12 to 13 months of age toddlers walk
alone using a wide stance for extra balance, and
by 18 months they try to run but fall easily.
 Between 2 and 3 years of age, refinement
of the upright, biped position is evident in
improved co-ordination and equilibrium
 At age 2 years, toddlers can walk up and
down stairs, and by age 2 ½ years they can jump
using both feet, stand on one foot for a second or
two and manage a few steps on tiptoe.
 By the end of the second year they can
stand on one foot, walk on tiptoe and climb stairs
with alternate footing.
 Fine motor development is demonstrated
in increasingly skillful manual dexterity. For
example, by age 12 months toddlers are able to
grasp a very small object but are unable to release
it at will
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 At 15 months they can drop a raisin into a

narrow-necked bottle.
 Casting or throwing objects and retrieving
them become almost obsessive activities at about
15 months.
 By 18 months of age toddlers can throw a
ball overhand without losing their balance.
 By 2 years of age toddlers use their hands
to build towers and by 3 years of age they draw
circles on paper.
 Mastery of gross and fine motor skills is
evident in all phases of the child’s activity such as
play dressing, language comprehension, and
response to discipline, social interaction and
propensity for injuries.
 Activities occur less in isolation and more
in conjunction with other physical and mental
abilities to produce a purposeful result. For
example, the toddler walks to reach a new
location, releases a toy to pick it up or to choose a
new one, and scribbles to look at the image
produced.
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 The possibilities of the exploration,

investigation and manipulation of the
environment – and its hazards – are endless.
6. 3min To explain the
PSYCHOSOCIAL DEVELOPMENT The student teacher explain
psychosocial
the psychosocial Explain the
development in  Toddlers are faced with the mastery of development using charts psychosocial
toddlers
several important tasks. If the need for basic trust development?
has been satisfied, they are ready to give up
dependence for control, independence and
autonomy. Some of the specific tasks to be dealt
with include :-
 Differentiation of self from others,
particularly the mother.
 Toleration of separation from parent
 Ability to withstand delayed gratification
 Control over bodily functions
 Acquisition of socially acceptable
behavior
 Verbal means of communication
 Ability to interact with others in a less
egocentric manner
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 Mastery of these goals is only begun

during late infancy and the toddler years, task
such as developing interpersonal relationships
with others may not be completed until
adolescence.
 However, crucial foundations for
successful completion of such developmental
tasks are laid during these early formative years.

Developing a Sense of Autonomy (Erikson)

 According to Erikson, the developmental

task of toddlerhood is acquiring a sense of
autonomy while overcoming a sense of doubt and
shame.

 As infants gain trust in the predictability

and reliability of their parent, environment and
interaction with others they begin to discover that
their behavior is their own and that it has a
predictable, reliable effect on others.
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  Exerting their will has definite negative
consequences, whereas retraining dependent
submissive behavior is generally rewarded with
affection and approval.

 However continued dependence creates a

sense of doubt regarding their potential capacity
to control their actions. This doubt is
compounded by a sense of shame for feeling this
urge to revolt against other will and a fear that
they will exceed their own capacity for
manipulating the environment.

 The toddler has the newly gained

modality of holding on and letting go.

 To hold on and let go is evident with the

use of the hands, mouth, eyes and eventually, the
sphincters, when toilet training is begun

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OBJECTIVE ACTIVITY
  Emotions become strongly expressed,
usually in rapid mood swing.

 Many parents find the negativism

exasperating and instead of dealing with it, give
in to it, which further threatens children in their
search for learning acceptable methods of
interacting with others.
 As toddlers attempt to express their will
they often act with negativism, the persistent
negative response to requests. The words “no” or
“me do” can be the sole vocabulary.
 In contrast to negativism which frequently
disrupts the environment, ritualism, the need to
maintain sameness and reliability, provides a
sense of comfort. Toddlers can venture out with
security when they know that familiar people,
places and routine represent such a threat to these
children.

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  Opportunities for self-mastery are present
in appropriate play activities, toilet training, the
crises of sibling rivalry and successful
interactions with significant others.

7. 2min Explain the COGNITIVE DEVELOPMENT

cognitive The student teacher
development in SENSORIMOTOR AND PREOPERATIONAL PHASE explains the cognitive Explain the cognitive
toddlers (PIAGET) development using development?
transparensies
The period from 12 to 24 months of age is a continuation
of the final two stages of the sensorimotor phase.

Tertiary circular reactions :

 In the fifth stage of the sensorimotor

phase (13 to 18 months of age), the child uses
active experimentation to achieve previously
unattainable goals.

 Newly acquired physical skills are

increasingly important for the function they serve
rather than for the acts themselves.

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 The child incorporates the old learning of
secondary circular reactions with new skills and
applies the combined knowledge to new
situations, with emphasis on the results o the
experimentation.
 In this way there is the beginning of
rational judgment and intellectual reasoning.
 Awareness of a causal relationship
between two events is apparent.
 After flipping a light switch, toddlers are
aware that a reciprocal response occurs.
However, they are not able to transfer that
knowledge to new situations. Therefore every
time they see what appears to be a light switch,
they must reinvestigate its function. Such
behavior demonstrates the beginning of
categorizing data into distinct classes and
subclasses.
 Because classification of objects is still
rudimentary the appearance of an object denotes
its function.
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 The discovery of objects as objects leads

to the awareness of their spatial relationships.

 Object permanence has also advanced.

Invention of New Means Through Mental

Combinations

 From ages 19 to 24 months the child is in

the final sensorimotor stage.
 During this stage the child completes the
more primitive, autistic-like thought processes of
infancy and is prepared for the more complex
mental operations that occur during the phase of
preoperational thought.
 One of the most dramatic achievements of
this stage is in the area of object permanence.
Children will now actively search for an object in
several potential hiding places.
 In addition, they can infer a cause when
only experiencing the effect.
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 They can infer that an object was hidden

in any number of places even if they only saw the
original hiding place.

 Domestic mimicry and sex-role behavior

become increasingly common during this period
and during the second year.
 Identification with the parent of the same
gender becomes apparent by the second year and
represents the child’s intellectual ability to
differentiate different models of behavior and to
imitate them appropriately.

Preoperational phase

 At approximately 2 years of age the child

enters the preconceptual phase of cognitive
development, which lasts until about age 4 years.
The preconceptual phase is a subdivision of the
preoperational phase, which spans ages 2 to 7
years.
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 The preconceptual phase is primarily one

of transition that bridges the purely self-satisfying
behavior of infancy and the rudimentary
socialized behavior of latency.
 Preoperational thought implies that
children cannot think in terms of operations – the
ability to manipulate objects in relation to each
other in a logical fashion.

SPIRITUAL DEVELOPMENT The student teacher

8. 1min To explain the Explain the spiritual
spiritual explains the spiritual development in
 The child’s family and environment
development development using toddlers?
strongly influence the child’s perception of the
transparencies
world around him or her, and this often includes
spirituality

 Toddlers learn about God through the

words and the actions of that closet to them.
They have only a vague idea of God and religious
teachings because of their immature cognitive
processes; however, if God is spoken about with
reverence, young children associate God with
something special.
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 Toddlers begin to assimilate behaviors

associated with the divine (folding hands in
prayer).

 Routines such as saying prayers before

means or at bedtime can be important and
comforting. Because toddlers tend to find solace
in ritualistic behavior and routines, they
incorporate routines associated with religious
practices into their behavioral patterns, without
understanding all the implications of the rituals
9. 1min To explain the until later. The student teacher Explain the
body image explains the development development of body
development in of body image using image?
toddlers transparencies
DEVELOPMENT OF BODY IMAGE

 As in infancy, the development of body

image closely parallels cognitive development.
 Developing psychologic understanding
provides greater self-awareness and young
children learn to answer the question “who am I”.
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 They also learn that certain parts of the

body have various meanings; for example, during
toilet training the genitalia become significant
and cleanliness is emphasized.
 By 2 years of age they recognize gender
differences and refer to themselves by name and
then by pronoun.
 Gender identity is developed by age 3
years. Also by this time the child begins to
remember events with reference to their personal
significance, forming an autobiographic memory
that helps to establish a continuous identity
throughout life’s events.

10. 2min To describe the DEVELOPMENT OF GENDER IDENTITY Explain the

The student teacher
development of development of gender
explains the development
gender identity Just as toddlers explore their environment, they also identity?
of gender identity using
explore their bodies and find that touching certain body transparencies
parts is pleasurable.
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 Sex-role differences become obvious to

children and are evident in much of their
imitative play. A sense of maleness or
femaleness, gender identity, is formed by age 3
years. Early attitudes are formed about
affectionate behaviors between adults from
observing parental and other adult sexual or
sensual activities. The student teacher
11. 1min To explain the Explain the social
explains the social
social development development?
development using
in toddlers
SOCIAL DEVELOPMENT transparencies.
 A major task of the toddler period is
differentiation of self from significant others,
usually the mother.
 The differentiation process consists of two
phases, separation, and the children’s emergence
from a symbiotic fusion with the mother and
individuation, those achievements that mark
children’s expression of their individual
characteristic in the environment.

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 OBJECTIVE ACTIVITY

 Toddlers have an increased understanding

and awareness of object permanence and some
ability to withstand delayed gratification and
tolerate moderate frustration.
 Transitional objects, such as a favorite
blanket or toy, provide security for children
especially when they are separated from parents
dealing with a new stress or just fatigued.
 Security objects often become so
important to toddlers that they refuse to let them
be taken away. Such behavior is normal; there is
no need to discourage this tendency.
 During separations, such as daycare,
hospitalization, or even staying overnight with a
relative, transitional objects should be provided to
minimize any fear or loneliness.
 Learning to tolerate and master brief
periods of separation is an important development
task for children in this age group.

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12. 1min To describe the LANGUAGE DEVELOPMENT The student teacher Explain the language
language  The most striking characteristic of describes language development ?
development language development during early childhood is development using
the increasing level of comprehension transparencies
 At age 1 year the child uses one-word
sentences or holophrases.
 By the age of 2 years the child uses
multiword sentences by stringing together two or
three words.
 Gestures precede or accompany each of
the language milestones upto 30 months of age
(putting phone to ear, pointing).
 Toddlers are developing skills of
independence, which are evident in all areas of
behavior.
 By 15 months children feed themselves,
drink well from a covered cup and manage a
spoon with considerable spilling.
 By 2 years they use a spoon well and by 3
years they may be using a fork.

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  In dressing, toddlers also demonstrate
strides in independence.
 The 15 month old child helps by putting
the arm or foot out for dressing and pulls shoes
and socks off.
 The 18 month – old child removes gloves,
helps with pullover shirts and may be able to
unzip.
 By age 2 years the toddler removes most
articles of clothing and puts on socks, shoes and
pants without regard for right or left and back or
front. Help is still needed to fasten clothes.
13. 1min To describe the The student teacher Explain the play in
play in toddlers PLAY describes play using toddlers
transparencies
 Play magnifies the toddler’s physical and
psychosocial development.
 Interaction with people becomes
increasingly important. The solitary play of
infancy progresses to parallel play – the toddler
plays alongside, not with, other children.
Although sensorimotor play is still prominent,
there is much less emphasis on the exclusive use
of one sensory modality.
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 Imitation is one of the most

distinguishing characteristics of play and enriches
children’s opportunity to engage in fantasy
 An increased locomotive skill make push-
pull toys, straddle trucks or cycles a small gym
and slide, balls of various sizes, and riding toys
appropriate for the energetic toddler.
 Certain aspects of play are related to
emerging linguistic abilities.
14. 5min To explain the The student teacher Explain the concerns
COPING WITH THE CONCERNS explains the concerns in
concerns in in toddlers?
toddlers toddlers using charts
TOILET TRAINING

 Five markers signal a child’s readiness to

toilet train: bladder readiness, bowel readiness,
cognitive readiness, motor readiness and psychologic
readiness.
 There is no universal right age for the
training.
 In this age, the child masters the majority of
essential gross motor skills , communicate intelligibly
and in less conflict with parents and is aware about
control of body and pleases the parent
 Bowel training before bladder training

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 SIBLING RIVALRY

 Children have a natural jealousy and

resentment toward a new child in the family or toward
other children in the family when a parent turns his
attention from them and interacts with their brother or
sister; this is referred to as sibling rivalry.
 Sibling rivalry tends to be most pronounced in
the firstborn who experiences dethronement(loss of
sole parental attention)
 Toddlers need to have a realistic idea of what
the newborn will be like.
 Parent should stress the activities that will
take place when the baby arrives such as diapering
breastfeeding bathing, dressing and at the same time
emphasize that routines such as reading stories or
going to park will remain the same.

TEMPER TANTRUMS

 Toddlers may assert their independence by

violently objecting to discipline by kicking, yelling,
etc.
 Tantrums are an indication of the child’s
inability to control emotions.

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OBJECTIVE ACTIVITY
  Toddlers are more prone to tantrums because
their strong drive for mastery and autonomy is
frustrated by adult figures or lack of motor and
cognitive skills
 Parents should ignore the tantrums provided
the behavior is not violent.
 The parents should be present to provide a
feeling of control and security to the child once when
the tantrum has subsided.

NEGATIVISM

 The negativism is not an expression of being

stubborn but a necessary assertion of self control.
 One method of dealing can be reducing
opportunities for a “no” answer.

REGRESSION

 The retreat of one’s present pattern of

functioning to past levels of behavior is referred to as
regression.
 Stress leads to regression
 The toddler may revert back to behaviors like:
refusal to use the potty chair, temper tantrums,
demand for bottle, etc.

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OBJECTIVE ACTIVITY
15. 5min Explain the ways to WAYS TO OPTIMAL HEALTH. The student teacher List down the ways to
optimal health explains the ways to optimal health in
NUTRITION optimal health using charts toddlers?
 Although the rate decreases but the
requirement for protein is 1.2/kg and calories is
102kcal/kg
 Nutritional counseling: The prevention of
childhood obesity and subsequent cardiovascular
disease needs to inculcate in the early childhood years.
 Appropriate mealtimes to be arranged.
 Mealtimes should be enjoyable and not be
forced.
 Grazing- nibbling and snacking is a good way
to ensure proper nutrition provided that appropriate
foods are offered.
 Dietary Guidelines: are necessary to promote
adequate energy and nutrient intake to support
physical, emotional, psychologic and cognitive
development.
 Milk, iron rich foods, calcium and vitamin D
foods, vitamin C foods are daily recommended.

SLEEP AND ACTIVITY

 Sleep problems are common during these

years.
 Establish a regular bedtime and pattern is
helpful.
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 Providing transitional objects can also reduce

child’s anxiety.
 Neurodevelopment is necessary for
developing child to participate in activities.

DENTAL HEALTH

 Regular dental examination is necessary as

the milk teeth are erupting.
 Removal of plaque: Oral hygiene measures
to be maintained to remove plaque, dental caries, and
periodontal disease.
 Low cariogenic Diet: The frequency and the
form of sugar consumed should be taken into
consideration

INJURY PREVENTION

 Toddlers prone to more injuries:

 Motor vehicles accidents can reduced by
playing in a safe area, supervise child driving cycle.
 Drowning can be prevented by supervision
 Burns ca n is avoided by keeping hot utensils
away from the reach of children.
 Poisoning can avoided by placing harmful
chemicals in locked cabinets

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 OBJECTIVE

16. 1min SUMMARY

The topic was about the growth and development in toddlers, their
physical, gross and fine motor, spiritual, language, cognitive
development in the toddlers and also the health concerns and aspects
to be cared about in toddlers.

CONCLUSION
17. 1min
The toddler stage form 12 to 36 months is an intense exploration of
the environment period and the nurse needs to be aware about the
various aspects of the developmental milestones to ponder upon any
misbalance in the normal functioning and manage it at the earliest in
children.

EVALUATION

The students are evaluated on the topic by giving questionnaires.

BIBLIOGRAPHY:
Dorothy R. Marlow’s Textbook of Pediatric Nursing, 6th Edition, Elsevier Publications, pg no.410-430

O.P.Ghai’s Essential pediatrics, 8th Edition, CBC Publishers, pg no. 94-98

WEBSITES

www.slideshare.net

www.wikipedia.com