UNIVERSITY OF SOUTHERN PHILIPPINES

FOUNDATION
College of Health Sciences
Department of Nursing
Salinas Drive, Lahug, Cebu City

Case Study of a Care of a

2-year-and-5-month Old (Toddler) Client

Group 1 Members

Aytona, Jamaica F.
Casia, Ashley
Casiao, Patricia
Ebillo, John
Gomez, Bhea
Josol, Kirstin
Magayanes, Jessica
Mondragon, Prince
Peralta, Anthony
Zozobrado, Aliyah

Clinical Instructor:

Dr. Ivy Villaceran-Gregorio

November 26, 2021

 INTRODUCTION

The early years is the building block of healthy child development and life‐
long learning. At the end of the first year of life, infants become toddlers. Between
ages one and three, physical growth slows as toddlers learn to master motor and
communication skills. Imitation continues to be a major element in normal
development, often taking the shape (Purdy, Elizabeth R.). During the toddler
period, the age span from 1 to 3 years, enormous changes take place in a child
and, consequently, in a family. During this period, children accomplish a wide array
of developmental tasks and change from largely immobile and preverbal infants
who are dependent on caregivers for the fulfillment of most needs to walking,
talking young children with a growing sense of autonomy or independence
(Pillitteri, Adele, 2014).

Nearly 1 in 4 parents say they have worried their child was or might be
delayed in their milestones. Parents feel either very confident (40%) or confident
(50%) about knowing when children should achieve most of their milestones, with
moms more likely than dads to be very confident (46% vs 33%). Most parents say
they learn about the age of children are supposed to meet milestones from
healthcare providers (80%). Other sources include family members (53%), the
internet (45%), experience with their other children (44%), friends (37%) and
childcare providers (28%). To check if their child is behind in developmental
milestones, parents report they have compared their children to a sibling (38%), a
friend’s children (34%), or other children in their family (28%). Dads are more
likely than moms to have compared their child to a friend’s children (41% vs 28%)
or to other children in their family (32% vs 25%).

In this case study, the student nurses aim to gather data that relates to the
growth and development of a toddler, not just in theory but most importantly to
assess physically, to be able to learn from this client or case. With the obtained
information, this will assist nursing practitioners and student nurses to broaden the
knowledge, skills, and competency in the chosen field of practice particularly in
providing nursing care or intervention to this age group (toddler).
 PATIENT’S PROFILE

Name: S.Y.L
Age: 2 years and 5 months
Sex: Male
Date of birth: June 04, 2019
Status: Single
Nationality: Filipino
Religion: Roman Catholic
Hospital name: Maternity Center
Date of admission: November 19, 2021
Time of admission: 08:00PM
Ward and bed no.
Case No.: 20210805
Physician: Dr. M.S, M.D
History of present illness:

A 2-year and 5-month old patient received on January 30, 2019 in the
laboratory for routine laboratory test. The collected blood sample shows the
hematocrit (0.36) indicates slightly below normal, and differential count result was
neutrophil (0.14) indicates above normal. However, the patient’s physical
appearance is apparently well and no indications of cyanosis, infection, injury or
inflammation.

Admitting diagnosis/ impression:

Basing on the physical assessment, the client is found to have unhealthy

eating habits and presence of scratches due to frequent itching. Aside from these
findings, our client shows no signs of any abnormalities and is considered well.
GENOGRAM
 DEVELOPMENTAL TASK

The client is 2 years and 5 months old which belongs to the second stage of
Erik Erikson's phases of psychological development is autonomy versus shame and
doubt. Between the ages of 18 months until 3 years, this period occurs. Children at
this age, according to Erikson, are focused on establishing a stronger feeling of self-
control. At this period of their life they’ll be forming a question in their minds if they
are able to do things themselves or not. Autonomy versus shame and doubt, builds
upon that earlier stage and lays the foundation for the future stages to come.

It is during this stage that children build the foundations of trust in the world.
As they progress into the second stage, however, it is important for young children
to begin developing a sense of personal independence and control. As they learn to
do things for themselves, they establish a sense of control over themselves as well
as some basic confidence in their own abilities. Toilet training plays a major role;
learning to control one’s body functions leads to a feeling of control and a sense of
independence. Other important events include gaining more control over food
choices, toy preferences, and clothing selection, it is an important part of
developing a sense of self-control and personal autonomy.

Children who accomplish this stage feel secure and confident, while those
who do not are left feeling insecure and self-conscious. This stage also acts as a
crucial stepping stone for future growth. Kids who are confident in their abilities are
more likely to succeed in later tasks such as social, academic, and other skills
mastery.

The client has not yet learned toilet training, an important event of this
phase, he is still using disposable diapers in elimination. The mother and her
immediate family member have not yet trained the client due to busy schedule.
Even though the client was not potty trained, he can verbalize “pee-pee” and also
communicate in his own way if his diaper feels full. The client also chooses the
clothes that he wants to wear in the daily. He prefers milk over solid foods, he is a
picky eater. He mostly plays his toy cars more than his other toys because he likes
them the most. To sum up, the client is in the process of achieving the feelings of
autonomy.

PEDIATRIC HEALTH ASSESSMENT

A. Prenatal History

The first prenatal check-up was at 12 weeks AOG, done every once a month
from a private doctor. During the intrauterine life of the child, there are no illnesses
and diseases detected with the both mother and child. The medications taken were
multivitamins and folic acid.

B. Obstetric History

The obstetric history of the patient’s mother is that she has been pregnant
once his only son has reached the age of viability, one full term child, no preterm
child, no abortion and one living child. During the course of the pregnancy the
mother did not drink alcohol and smoke cigarette.
C. Labor and delivery

The client’s gestational age during labor was 38 weeks, and the duration of
labor took 1 hour. The type of delivery used was NSVD and assisted with vacuum.
The type of anesthesia used during labor was Lidocaine. The client’s place of
delivery is at a Maternity Center. The client showed no complications and the
delivery was assisted by an obstetrician.

D. Birth History

The newborn's respiratory effort was unassisted and his characteristics of cry
were loud. There was no medication administered to the newborn, and the newborn
showed no signs of congenital anomalies. The client’s number of days or the length
of time spent at the hospital was 7 days.

E. Feeding History

The mother stated that her son prefers to drink milk rather than eat solid
foods, and also her likes to consume junk foods and chocolates, and doesn’t have
any diseases that can affect his nutritional-metabolic functions. Supplementary
feeding started approximately 1 year of age, the composition of his supplemental
feeding is Cerelac, vegetable and fruits that were cut into pieces. The child has a
fair appetite.

F. Health History

The client doesn’t have any previous illness, injuries, or operations. The
client also doesn’t have any OTC medication taken. At the same time, the client
doesn’t have any allergies to food, drug, and others. The client has been fully
immunized and received the complete doses of DPT, BCG, OPV, AMV, Hep B, and
Hib vaccines. The client weighed 8 kg at 6 months, and 10 kg when he reached 1
year old. The client’s height was 84 cm when he was 1 year old. The age of onset of
the primary teeth was at 6 months. The total number of teeth present was 20, 10
on the upper and 10 on the lower part.

G. Family History (Focus only in the immediate family members)

JJM is the mother of the group’s client SYML. She is 23 years old had been at
the college level. She is currently working as a Courier Associate in one of the
Logistic companies in Cebu City. MGM is the grandmother of the client and she is 48
years of age. She stays at home as a housewife and she is the one taking care of
the child most of the time when the mother of the client is away for work. KMM and
KMIM are the aunties of the client. KMIM is 28 years old, while KMM is 25. Both are
college graduates and they are now working as call center agents. PWM and AWM
are the uncles of the client. PWM is 21 years of age and currently a college student
while, AWM is 18 years old, a high school student. The grandfather of the client at
his mother's side was diagnosed with hypertension. Aside from that, the health of
the family is on the optimum level.

H. Developmental Milestones: (write the age when this milestone was

achieved)

Currently, there is no present of sensory defects in the child. Smile is present

on 4 months, sit with support at approximately 4months, stands with support at
approximately 5-6 months, says his first word which is “Papa” at 7 months, sit
unsupported at approximately 6 months, stand alone at 7 months, talked in
sentence at 1 year, roll over at 3 months, wald around 1 year and not yet in toilet
training.

General Survey:
 Client SYML is a 2 years and 5 months old client conceived by her mother
last June 4, 2019. During the physical assessment of the patient, the findings
appear to be within normal limits with minimal deviation such as presence of
Mongolian spots in the buttocks area of the client, distended abdomen due to his
milk consumption even at his age and heart rate of 69 bpm and blood pressure is
90/60 mmHg which due to his frequent activities during the assessment, mosquito
bites noted in the lower extremities which is a concern.

PSYCHOSOCIAL PROFILE

Health Practices

Every time the child eats, the child doesn’t eat with his parents since his
mother is busy, only his Lola eats with him. His Lola tries to give him delicious solid
foods but he refuses to eat it. The mother stated that her son prefers to drink milk
rather than eat solid foods, and also her likes to consume junk foods and
chocolates, and doesn’t have any diseases that can affect his nutritional-metabolic
functions. Supplementary started approximately 1 year of age, the composition of
supplemental feeding is Cerelac and vegetables. The child has a fair appetite.
Typical Day

The child’s typical day is that he will wake up at 7AM, ask for milk and play,
after playing he will then take a bath and ask again for milk and then rest. He stays
inside the house watch TV, run and play around the house, he has his Lola as his
baby sitter and he likes to play with her in their house. At night, he asks for milk,
and drinks it until he sleeps.

Nutritional Patterns

The mother stated that her son prefers to drink milk rather than eating solid
foods, and also, he likes to consume junk foods and chocolates. Supplementary
feeding started at approximately 1 year of age, the composition of supplemental
feeding is Cerelac and vegetables. The child is currently underweight due to his fair
appetite, the mother stated that her son prefers to drink milk rather than eat solid
foods and likes to consume junk foods and chocolates but doesn’t have any
diseases that can affect his nutritional-metabolic functions. The child started
breastfeeding 1 day after the delivery. Overall, he doesn’t have any diseases that
can affect his nutritional-metabolic functions.

Elimination Patterns

His excretory function is currently within normal range and he doesn’t have
any disease that may affect his digestive and urinary system. His usual stool
elimination pattern is twice a day from 9am to 7pm with a yellowish in color and
form and soft in consistency. His urination elimination pattern is very frequent from
8AM to 7PM with a pale-yellow color and normal consistency.

Activity and Exercise Patterns

Due to the pandemic the child can only play inside the house, with his toys,
run around the house, and he sometimes play with his cousin, if his cousin will visit
their household. He always wald and run around the house which makes him at risk
for injury and fall. The child doesn’t have any disease that affects his cardio-
respiratory system or musculoskeletal system.

Recreation/Hobbies

The child’s hobbies are watching movies, play his toy cars and play games in
the gadgets. He plays it every time he feels bored and wants to have fun. He also
loves to play together with his Lola and relatives whenever they will visit him.

Sleep and Rest Patterns:

Child appears physically rested, the child sleeps whenever he wants and
sleeps at approximately 8-9 hours every day as verbalized by the mother. There
are no bed rituals because he is being practiced by his family. He rests during
afternoon or after playing games and even rests after having temper tantrums.

Personal Habits

The personal habit of the child is to play around the house. Since the child
does not have any knowledge about vices and personal habits, the child’s parents
were asked because they may influence the child. Upon interview, the mother of
the child verbalizes that they drink alcohols only occasionally and none of their
family members are smoking.

Roles/Relationships/Self-Concept

Currently the relationship that plays an important role to his life is the
parent-child relationship. All members of the family are very happy and supportive
with the child. Child dresses accordingly to its gender. There is no unusual about
the child’s appearance.

Sexuality

The child starts to become conscious to his genitals through always touching
and watching it, he is not yet circumcised. The child starts to become curious
however he does not imitate the sex-role of other people.

Stress and Coping

Currently, the child starts to ask for things that he wants and if these
requests are not met the child begins to show temper tantrums by crying loudly,
roll overs and lie on the floor, scream and kick the person who he thinks is not
helping him. The child begins to communicate through the use of words just like
“no no no”.

PHYSICAL EXAMINATION
General Survey
Client SYML is a 2 years and 5 months old client conceived by her mother
last June 4, 2019. During the physical assessment of the patient, the findings
appear to be within normal limits with minimal deviation such as presence of
Mongolian spots in the buttocks area of the client, distended abdomen due to his
milk consumption even at his age and heart rate of 69 bpm and blood pressure is
90/60 mmHg which due to his frequent activities during the assessment, mosquito
bites noted in the lower extremities which is a concern.
 Systems Normal Abnormal Patients
Findings Findings Findings
General Toddler appears Lack of eye Client is clean,
Appearance to be stated age, contact. and has no
and Behavior is clean, appears Certain faces, unusual body
well nourished abnormal odor.
and has no posture, His clothing is in
unusual body hygiene, good condition
odor. abnormal and appropriate
Clothing is in behavior and for climate,
good condition abnormal posture is erect
and appropriate development. and relaxed,
for climate. proper hygiene
Child is alert, noted.
active, responds No abnormal
appropriately to behavior and
stress situation, development
and maintains noted.
eye contact.
Vital signs Temperature is Altered Temperature is
98.6⁰F temperature, 36.2⁰C.
Pulse rate is 70- pulse rate, Pulse rate is
110 bpm. respiratory rate, 69bpm.
Respiratory rate high blood Respiratory rate
is 20-28 cpm. pressure above is 26 cpm.
Blood pressure is 95% for age Blood pressure is
about 92-99/53- and sex. 90/60 mmHg.
66 mm Hg

Measurement A child gain only A child gains Client’s height is

about 5 to 6 lbs. above or below 84 cm and
(2.5 kg) and 5 in 5 to 6 lbs. (2.5 weight are 11
 (12 cm). kg) and above kilograms.
Head or below 5 in BMI is 15.6.
circumference (12 cm) in Client’s head
measurement height. circumference is
should fall Head 48 cm.
th
between the 5 circumference
th
and 95 measurement is
percentiles, and not between the
should be 5th and 95th
comparable to percentiles.
the child’s height
and weight
percentiles.
Skin should be Dry, rough, Skin is smooth
Skin smooth and flaky skin and intact.
intact (+) Lesions No lesions and
rashes noted.
Mongolian spot is
noted in the
buttocks area.
Mosquito bites
noted in the
lower
extremities.
Shinny and soft Alopecia Hair is evenly
Hair Vellus hair should Patchy hair distributed.
cover all over the Dry and flaky Hair is black and
body hair soft and shiny.
Vellus hair
covers all over
the body.
No alopecia and
 patchy hair
noted.
Nails are clean, Dirty, broken, Nails are clean
pink tones, Spoon nails, with pink tones
Nails 160degree angle Thickened nails and at 160
between the nail degrees between
base and the the nail base and
skin, Nails are the skin noted.
hard and
immobile, Nails
are smooth and
firm
Head Head is Very large head, Client’s head is
normocephalic presence of normocephalic
and symmetric, third fontanelle, and symmetric
there is a normal craniotabes, with full ROM
full ROM-up, hyperextension, noted.
down, and limited ROM, Client’s skull is
sideways. unusual generally round.
Skull is generally proportions and No tenderness,
round. No movements no masses and
tenderness upon noted. no lesions noted.
palpation.
(+) tenderness

(+) lesions
Neck Trachea is in Palpable thyroid Trachea is in
midline. Asymmetric midline.
Non palpable trachea. Non-palpable
thyroid and Distended neck, thyroid noted.
lymph nodes. shift in tracheal
position and
enlarged, firm
 lymph nodes.
Eyes Inner canthus (+) swelling No swelling,
distance Droopy eyelids symmetric and
approximately Sclera reddened no protrusions
2.5 cm, or yellowish in noted.
horizontal slant, coloration Sclera is white
no epicanthal Conjunctiva Conjunctiva is
folds. Outer inflames or clear and moist
canthus aligns reddened No exudates
with tips of the Absent of blink Pupil is 3mm in
pinnae. reflex size equally both
No swelling, non-reactive to sides.
discharges, or light and Corneal reflex
lesions of accommodation and blink reflex
eyelids. Wide-set present.
Sclera and position, upward
conjunctiva are slant and thick
clear and free of epicanthal folds
discharge,
lesions, redness
or lacerations.
Pupils are equal,
round, and
reactive to light
and
accommodation.
Eyebrows should
be symmetric in
shape and
movement. They
should not meet
midline.
 Eyelashes should
be evenly
distributed and
curled outward.
Normal visual
acuity is 20/70
right and left.
Should be able to
differentiate
colors by age
Ears The tops of the Ear are not Client’s ears are
pinna should equal bilaterally. equal in size
cross the eye- (+) drainage bilaterally.
occiput line and (+) lesions No drainage/
be within a 10- discharges and
degree angle of a Failure to lesions noted.
perpendicular respond to No unusual
line drawn from whispered structure or
the eye-occiput questions. markings
line to the lobe. appeared on the
No unusual pinna.
structure or Responds to
markings should whispered
appear on the questions.
pinna.
No excessive
cerumen,
discharge,
lesions,
excoriations, or
foreign body are
in external canal.
 Answers
whispered
questions.
Audiometry
results are within
normal age.
Mouth Oral mucosa (+) lesions, dry Oral mucosa,
should Pink and gingiva, and lips
(+) lesions,
moist, no lesions are pink and
bleeding,
noted. moist.
swelling
Gingiva should No lesions and
be Pink and Presence of cavities or dental
moist, no plaque and caries noted.
bleeding, dental caries
swelling and
lesions noted

Lips should be
soft and
hydrated

Teeth should be
No plaque and
caries noted

Nose Absence of (+) lesions, No lesions and

lesions, no swelling and sinus are non-
swelling and tenderness tender noted.
tenderness
noted.
Throat Trachea is in Palpable thyroid Gag and
midline. Asymmetric swallowing reflex
Non palpable trachea present.
 thyroid Absence of gag No lesions noted.
Presence of gag and swallowing
and swallowing reflex
reflex
Thorax and Regular Retractions and Client’s
Lungs breathing noted. grunting respiration rate
Unlabored sounds. Periods is 26 cpm.
breathing. of apnea. Regular
RR is 20-28 cpm. Dull tone, breathing noted.
Hyperresonance diminished Hyperresonance
tone should be breath sounds, tone noted
elicited. expiratory during the
No adventitious wheezes and percussion. No
sounds. stridor. adventitious
sounds noted.
Breasts Breasts are flat Redness, Client’s breasts
and symmetric. edema, and are flat and
tenderness symmetric
noted. without redness,
edema and
tenderness
noted.
Heart S1 and S2 Murmurs are S1 and S2
present and no heard present and no
murmurs Heart rate murmurs
Heart rate should above 130 or Capillary refill <2
be 90-110 bpm below 80 seconds
Rhythm should Capillary refill Rhythm +2
be +2 >3 Heart rate is
Capillary refill <2 69bpm

Abdomen Abdomen is Deviated Client’s abdomen

 prominent in umbilicus is pale compared
standing and Asymmetry to other parts of
supine positions. Scaphoid the body.
Pale coloration abdomen. Umbilicus is
noted. Umbilicus Inflammation, healed and is in
is located in discharge, and midline.
midline. redness of
Generalized umbilicus. Generalized
tympany and Diastasis recti tympany and
normal bowel and bulging normal bowel
sounds is heard. umbilicus. sounds is heard.
Umbilicus is pink, Marked
no discharge, peristaltic waves Abdomen is
odor, redness or and rigid distended.
herniation noted. abdomen.

Abdomen is soft
to palpation and
without masses
or tenderness.

Genitalia and Anal reflex Imperforated Anal reflex is

Anus present anus present.
Foreskin Foreskin does Foreskin
retractable not retract retractable
Urethral opening Non-palpable Urethral opening
at tip of penis scrotum at tip of penis
Palpable scrotum Urethral opening Palpable scrotum
at the tip
Musculoskeletal Feet and legs are Short, broad Client’s feet and
symmetric in extremities, legs are
size, shape, hyperextensible symmetric in
movement, and joints and size, shape,
positioning. palmar simian movement, and
Extremities crease. positioning.
should be ward Fixed-position His extremities
and mobile with (true) are warm and
adequate deformities, mobile with
capillary refill. talipes Varus, adequate
Toddlers display talipes capillary refill
lordotic posture. equinovarus noted.
Toddlers have a (clubfoot), Lordotic posture
wide-based gait neurovascular noted, with a
and are usually deficit. wide-based gait
bow-legged Kyphosis noted. and bow-legged.
(genu varum). “Toeing in” or Full ROM and no
Children aged 2- “toeing out” and swelling,
7 are usually abnormal gaits. redness, or
knock-kneed Limited ROM, tenderness
(genu valgum). swelling, noted.
Gait in older redness, and His muscle size
children is the tenderness and and strength are
same as in inadequate adequate for the
adults. muscle size and particular age
Full ROM and no strength. and equal
swelling, bilaterally.
redness, or
tenderness
noted.
Muscle size and
strength should
be adequate for
the particular
age and should
be equal
 bilaterally.
Neurologic Alertness, Presence of Respond to noise
responds to vocal fasciculation, and touch
stimuli tics No fasciculations,
No fasciculation, and tremors tics, or tremors
tics, or tremors noted.

are noted.

LABORATORY AND DIAGNOSTIC

TEST DAT DISORDERS SCREENIN INTERPRETATIO

E G RESULTS N
NEWBORN June Congenital Within Based on findings,
SCREENIN 5, Hypothyroidism Normal the infant does not
G TEST 2019 Limits have any
Congenital Adrenal Within abnormalities in
Hyperplasia (CAH) Normal the disorders
 Limits tested.
Galactosemia Within
Normal
Limits
Glucose-6- Within
Phosphate Normal
Dehydrogenase Limits
Deficiency
Amino Acid Within
Disorders Normal
Limits
Organic Acid Within
Disorders Normal
Limits
Fatty Acid Within
Disorders Normal
Limits
Hemoglobinopathie Within
s Normal
Limits
Biotinidase Within
Deficiency Normal
Limits
Cystic Fibrosis Within
Normal
Limits
Urea Cycle Within
Disorders Normal
Limits
TEST DATE TEST RESULT REFERENC INTERPRETATIO
S E RANGE N
Blood Januar FBS 89.83 70-110 Normal
y 30, (baseline
Chemistr mg/dl
2019
)
y

75 grams 113.39 0-200 mg/dl Normal

OGTT

TEST DATE TEST RESULTS

Serology/ January Anti-HIV I & II Non-reactive
Immunology 30, (Immunochromatography)
2019 HBs Ag (Qualitative) Non-reactive

TEST DATE EXAMINATI RESULT NORMA INTERPRETATI

ON L ON
RANGE
Hema January Blood Type O
tology 30,
2019
Rh Type Positive
Hemoglobin 120 (M) Normal
130-180

(F)
 120-160
Vol %
Hematocrit 0.36 (M) Possible
0.40- interpretation:
0.54 • Anemia
• Vitamin and
(F) mineral
0.37-47 deficiency
Vol % • Acute blood
loss
• Dietary
deficiencies
WBC 9.8 5-10 x Normal
10 9/L
RBC 4.0 (M) 4.5- Normal
6.0

(F)
4.0-5.5
x 10
12/L
Thrombocyte 318 140-440 Normal
x 10/L
DIFFERENTI
AL COUNT
Neutrophil 0.74 0.51- possible
0.67 interpretation:
• Acute
infections
 (neutrophilia)
Lymphocyte 0.21 0.21- Normal
0.35
Monocyte 0.05 0.02- Normal
0.08
Eosinophil 0.01 0.01- Normal
0.04
Basophil 0 0.0-0.01 Normal

TEST DATE RESULT

Urinalysis January 30, Physical Characteristics
2019 Color: Light Yellow
Transparency: Slightly clear
Chemical Parameters
Specific Gravity: 1.005
PH: 7. 0
Glucose: Negative
Protein: Negative
Ketone (Quali): 0.0
Nitrites: Negative
Leukocytes: 0 wbc/hpf
Blood: Negative
Microscopic Findings
RBC: 0/hpf
WBC: 1/hpf
Squamous Epithelial Cells:
None/lpf
Bacteria: Rare/hpf
Mucus Threads: None/hpf

SUMMARY OF SIGNIFICANT FINDINGS

HEALTH PATTERN PATIENT
MANIFESTATION
Nutritional-Metabolic The client body mass
Problem index is below normal
15.6 BMI indicates
Underweight.
Nutritional-Metabolic Mosquito bites can be
Pattern seen in the patient’s
lower extremities.
Activity Exercise Client verbalized bowel
Pattern elimination, and is able to
hold his urge to urinate
and defecate.
Health Perception – Toddler always grabbing
Health Management things that are kept in
Pattern cabinets.
Health Perception – Client is now practicing to
Health Management climb up and down the
Pattern stairs.
LABORATORY  Hematocrit levels –
0.36 (M) (N:0.40-
0.54 Vol %) (F)
(N:0.37-47 Vol %)
 Neutrophil – 0.74
(N:0.51-0.67)
ANATOMY AND PHYSIOLOGY
INTERPRETATION/
NURSING PROBLEM
Imbalanced nutrition: less
than body requirements
Impaired skin integrity
Readiness for enhanced
self-care (Toileting)
Risk for poisoning
Risk for injury
Upon the results that was
collected, the patient may
possibly be anemic from
the low hematocrit levels
and may have an acute
infection due to the rise
of neutrophils that was
discovered in the CBC
test.
 Infants and children are not miniature adults. Their anatomy differs from the
adult in a number of ways which should be considered in the proper design of
occupant restraint systems specific to their age.  While toddlers are making great
strides developmentally, their physical growth begins to slow.

The weight of an infant gains only about 5 to 6lb (2.5 kg). Subcutaneous
tissue (body fat) is a body component infrequently considered as a factor in the
proper design of protective devices for the infant body. This tissue tends to increase
rapidly in thickness during the first nine months following birth, which growth of the
body as a whole is much slower. After this period of high incremental change there
is a period of less rapid growth, so that by five years of age the thickness of the
subcutaneous layer is about half the thickness of the nine-month-old infant. After
the 2nd year gain in weight may become irregular and less predictable on a
monthly basis. As a general pattern, after the 2nd year and until the 9th year there
is a five-pound annual increment. Thus, at 5 years the body weight is six times the
birth weight and in the 10th year the weight of the body is ten times the birth
weight
 A toddler grows about 5 in (12 cm) a year during the toddler period, much
less than the rate of infant growth. During infancy and youth, long bones lengthen
entirely by interstitial growth of the epiphyseal plate cartilage and its replacement
by bone, and all bones grow in thickness by appositional growth. Most bones stop
growing during adolescence. However, some facial bones, such as those of the nose
and lower jaw, continue to grow almost imperceptibly throughout life. At birth,
most long bones of the skeleton are well ossified except for their epiphyses. After
birth, secondary ossification centers develop in a predictable sequence. The
epiphyseal plates persist and provide for long bone growth all through childhood
and the sex hormone–mediated growth spurt at adolescence. (Elaine N. Marieb,
2013)

Head circumference increases only about 2 cm during the second year

compared to about 12 cm during the first year. Head circumference equals chest
circumference at 6 months to 1 year of age. By 2 years, chest circumference has
grown greater than that of the head.

The body contour of a toddler is there is a prominent abdomen because

although they are walking well, their abdominal muscles are not yet strong enough
to support abdominal contents as well as they will later. There is a forward curve of
the spine at the sacral area which indicated being lordotic as they become more
experienced at walking, this will correct itself naturally and when walking, they
waddle or walk with a wide stance. (Adele Pillitteri, 2010)

By the second year, the ribs are more obliquely positioned, and the adult
form of breathing is established. Respiratory systems of a toddler are slightly slow
but continue to be mainly abdominal lumens of vessels and it enlarges
progressively so the threat of lower respiratory infection becomes less. (Elaine N.
Marieb, 2013)

Blood pressure is a measure of how hard the heart is working. It measures

the amount of pressure put on the veins and arteries by the blood that the heart is
pumping. Blood pressure levels tend to increase with height and weight, so larger
children will have slightly higher blood pressures. Girls often have a slightly higher
blood pressure than similarly sized boys. Pediatric blood pressure also increases
with age. Therefore, during toddler, blood pressure increases to about 99/64 mm
Hg.
Stomach secretions become more acid; therefore, gastrointestinal infections
also become less common. Therefore, stomach capacity increases to the point a
child can eat three meals a day. After 2 years, increases in abdominal
circumference at the umbilical level do not keep pace with the increases in thoracic
girth. Pelvic breadth is another dimension which is less subject to variations in body
posture and tonic activity of the muscular abdominal wall. 

Urinary and anal sphincters of the toddler are controllable and become
possible with complete myelination of the spinal cord so toilet training is possible.
Recognition of the sensations from bowel and bladder indicating the need to
defecate or pass urine as well as learning voluntary control over the bowel
and bladder sphincters and the associated required action of toileting is the process
that children achieve when they toilet train. This is a normal neurodevelopmental
process involving maturation of the nervous system rather like learning to sit and
talk. It is not something that children can be trained to do before their own nervous
systems are ready and inappropriately early potty-training attempts may be
doomed to fail and create frustration and disillusionment in both child and parent. 

IgG and IgM antibody production become mature at 2 years of age. The
passive immunity obtained during intrauterine life is no longer operative. (Adele
Pillitteri, 2010)

Eight new teeth (the canines and the first molars) erupt during the second
year. All 20 deciduous teeth are generally present by 2.5 to 3 years of age.

Since growth of the child is dependent upon the normal activity of growth
centers, protection of these centers is vital. Abnormalities of body stature and limb
mobility might result from injury to growth centers of the extremities. Similarly, in
the head, the arrangement of teeth as well as the facial profile can be affected by
traumatic injuries to the facial growth centers.

Unlike the adult, the organs of the chest are housed in an elastic and highly
compressible thoracic cage. Organs as the lungs and heart are extremely vulnerable
to nonpenetrating impacts to the chest. The smaller rib cage also means less
protection is offered to larger abdominal organs which would normally receive some
protection form the larger stronger rib cage of the adult. The highly elastic structure
of the thoracic cage is not amenable to direct trauma or loading of webbed
restraints in children.
 NURSING CARE PLAN

#1 Nursing Diagnosis: Imbalanced nutrition: less than body requirements related to unhealthy food
intake as evidence by BMI interpretation of underweight.

DEFINING SCIENTIFIC BASIS EXPECTED NURSING RATIONALE

CHARACTERISTIC OUTCOME INTERVENTIO
S N

Adequate nutrition is essential to Short Term:  Assess  Provide

Subjective data: meet the body’s demands. Several After 1 hour nutritional opportunity to
“dili man to siya tig diseases can greatly affect the of adequate status observe
kaon ug solid nga nutritional status of an individual, health continually deviations
food puro ra milk. this includes gastrointestinal teaching, the from
Kusog sad siya mu malabsorption, burns, cancer; client’s normal/patien
kaon ug chichiria ug physical factors (e.g., activity mother will t baseline and
chocolates.” As intolerance, pain, substance be able to influences
verbalized by the abuse); social factors (e.g., verbalize choice of
client’s mother economic status, financial understandin interventions.
constraint); psychological factors g on the
(e.g., dementia, depression, importance of  Assess  To monitor
grieving). In certain conditions such nutrition and client’s the changes in
as trauma, sepsis, surgery, and the proper weight and the client’s
 burns, adequate nutrition is vital to weaning height weight and
healing and recovery. Also, religious techniques. regularly height
and cultural factors greatly
influence the food habits of  Assess  To monitor
patients. client’s BMI changes of the
Objective data: regularly patient’s body
- BMI:15.6 mass index
(underweight)
- Weight: 11 kg  Note total  To reveal
- Height: 84 cm daily intake changes that
- Abdominal Judith, K. (2017, September 23). should be

circumference: Imbalanced nutrition: Less than made in the

50 cm body requirements – nursing Long term: client’s dietary

- MUAC: 12.2 cm diagnosis & care plan. Nurseslabs. After 1-3 intake

- Poor skin turgor Retrieved November 19, 2021, from days, the

- Skinny body https://nurseslabs.com/imbalanced client’s  Monitor  To monitor

appearance -nutrition-less-body-requirements/. mother will client’s input any problems

observed be able to and output in elimination

- Unhealthy eating properly wean

habits out the baby

- Hyperactive with solid

bowel sounds foods and

give proper
 To correct or
Vital signs: nutrition.  Assist in control
T: 36.2 °C developing underlying
PR: 79 bpm individualized causative
RR: 26 cpm regimen factors
BP: 90/60 mmHg
 To simulate
 Encourage appetite
client to
choose foods
that are
appealing

 Provide
 Ascertain patient sense
food of control;
likes/dislikes. enhances
participation
in care and
may improve
intake
  To stimulate
 Encourage the patient’s
mother to appetite that
prepare would
meals increase the
pleasant to intake of the
the sight and child
smell of the
client
 To meet the
 Conduct a nutritional
health needs of the
teaching that child
focuses on
the
techniques on
weaning out
the child
REFERENCES: Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2006). Nurse's pocket guide: Diagnoses,
prioritized interventions, and rationales.

Judith, K. (2017, September 23). Imbalanced nutrition: Less than body requirements – nursing diagnosis & care
plan. Nurseslabs. Retrieved November 19, 2021, from https://nurseslabs.com/imbalanced-nutrition-less-body-
requirements/.
#2 Nursing Diagnosis: Impaired skin integrity related to disruption of the epidermal layer of the skin as
manifested by presence of scratches on lower extremities

DEFINING SCIENTIFIC BASIS EXPECTED NURSING RATIONALE

CHARACTERISTICS OUTCOME INTERVENTION

Skin integrity relates to skin Short Term:  Assess/document skin  provide

Subjective data: health. A skin integrity After 1 hour daily. Describe lesions baseline
“nay daghang lamok problem might indicate the of adequate and avoid changes. information
mamaak sa iyang skin is damaged, exposed to health
paa.”as verbalized injury or inefficient to repair teaching the  Maintain/instruct good  skin friction
by the client’s and recover normally. client’s skin hygiene, wash caused by
mother. mother will thoroughly, pat dry wet or
be able to carefully, and massage wrinkled
verbalize the with lotion or sheets
safety appropriate cream. leads to
Wayne, G. (2019, March precautions irritation
20). Risk for impaired skin underlying and
integrity – nursing diagnosis the risk of potentiates
guide. Nurseslabs. Retrieved impairing the infection.
November 19, 2021, from skin  To monitor
 Asses the patient’s skin
https://nurseslabs.com/risk- integrity. any
turgor periodically
for-impaired-skin-integrity/. changes in
skin turgor
Objective data: throughout
 Disruption of the care
skin surface
 Presence of  To
hard, itchy, minimize
reddish-brown the
 Advise the patient’s
bumps seen incidence
mother to use mosquito
on the lower of having
repellant
extremities mosquito
cream/lotion/spray
 Frequently bites
seen patient Long term:
wearing only After 2-4
diaper days, the
 Presence of client’s
scratches on mother will
lower be able to  To monitor
extremities follow the progress of
 Client seen precautionary  Periodically wound
frequently measures to measure/remeasure healing.
scratching his prevent wound and observe for
lower impaired skin complication  Moisture
extremities integrity potentiates
 Slow healing  Limit/avoid use of plastic skin
 progress of materials (Diaper) and breakdown
wounds noted remove wet diapers
 presence of promptly  To avoid
skin mildly direct
compromised  Advise the patient’s contact of
observed mother to wear the child mosquitos
 client with clothes and long to the
complains of pants patient’s
discomfort skin
 decreased
strength and  To avoid
elasticity of getting
 Advise the patient’s
the skin due mosquito
mother to use mosquito
to changes in bites while
net
the collagen sleeping
fibers of the
dermis as  To prevent
observed any
 Poor skin breeding
 Encourage the patient’s
turgor sites of
mother to clean the
mosquitos
environment free of
or any
breeding grounds for
disease-
mosquitos or any
 vectors of disease- carrying
carrying organism by organisms.
checking any stagnant
water.
 maintaining
 Encourage the patient’s clean, dry
mother to conduct good skin
skin hygiene such as provides a
wash thoroughly, pat dry barrier to
carefully infection.
Patting skin
dry instead
of rubbing
reduces
risk of
dermal
trauma to
dry/fragile
skin.

REFERENCES: Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2006). Nurse's pocket guide: Diagnoses,
prioritized interventions, and rationales.
#3 Nursing Diagnosis: Readiness for enhanced self-care related to the age group developmental task as
evidenced by expresses the desire to enhance independence in bowel elimination

Defining
Characteristics Scientific Basis Expected Outcome Nursing Rationale
Intervention
Toilet training is the Short term:  To establish  Helping the
Subjective Data: process of training a After 1 hr. of short term goals patient with
“akong anak kay mo child to use the adequate health to the client. setting realistic
storya na siya kung toilet for bowel and teaching the mother goals will reduce
gusto na siya malibang bladder use (i.e. will be able to frustration.
og mangihi bahalag wees and poos). understand and
nag diaper siya” Toilet training may verbalize the
start with a potty importance of toilet  Evaluate current  The efficacy of
“Kung puno na iya (small toilet bowl- training. levels of self-care the bowel or
diaper kay ma shaped device) or as optimum for bladder program
uncomfortable na siya you may skip this After an hour of abilities. will be improved
nya manawag na para and simply begin health teaching, the if the natural and
ilisdan iyang diaper” with the toilet. Most mother will be able personal patterns
as verbalized by the children will find it to initiate the proper of the patient are
mother. easier to control ways and taken into
their bowel before preparation for the consideration.
Objective Data: their bladder and it toilet training.
usually takes longer
 to learn to stay dry
 The client is able to throughout the night  Identify  To be able to
hold his urge to than daytime. Long term: strategies to formulate a
urinate. Admin, K. S. W. After 7 days, the enhance self- health teaching

 The client removes (2016, November mother will be able care. that is suitable

his diaper and 27). Toileting. Kid to report for the toddler

shorts whenever he Sense Child improvement of

feels the urge to Development. toilet training of

urinate or defecate. toddler.

 The client  Encourage  To let client be

communicates with After 7 days of client’s activities stimulated to try

his mother or effective toilet promoting toilet toilet training.

guardian whenever training, the child training.

he feels urinating was able to

and defecating. recognize, and use

 Change in client’s toileting as a routine  Educate client’s  To assist child’s

facial expression mother and developmental

when he wants to guardian on toilet task to be

eliminate. training. accomplished.

 The usage of
diapers was
 Implement  An appropriate
minimized due to
measures to level of assistive
the child prefer to
 urinate in the promote care can prevent
comfort room. independence, injury from
 The client is shown but intervene activities without
to have an interest when the patient causing
in potty training. cannot function. frustration.

 The client is
observed to void on  Provide privacy  Lack of privacy

a predictable while patient is may reduce the

schedule. toileting. patient’s ability

 The client is to empty bowel

observed to imitate and bladder.

the behavior of the

people who uses  Apply regular  An established

the toilet. routines, and routine becomes

 The client allow adequate rote and requires

demonstrated on time for the less effort. This

how to sit on the patient to helps the patient

potty chair with complete task. organize and

comfort carry out self-

care skills.
 The client’s diaper
is shown to be dry
often indicating the
less dependence of
 the diaper  Render  The patient’s
supervision for ability to perform
each activity until self-care
the patient measures may
exhibits the skill change often
effectively and is over time and
secured in will need to be
independent care assessed
regularly.
 Encourage the  This can prove to
client’s mother be frightening to
not to flush the the patient
toilet while the
patient is still on
it
 Encourage the  This is to avoid
client’s mother to for frustration for
use easy-to- both the mother
remove clothing and the child.
for the child
References: NANDA Book, Crocetti & Serwint, 2005, Nursing Care Plans Guideline for Planning and Documenting
Patient Care
#4 Nursing Diagnosis: Risk for poisoning related to impulsiveness of toddler as evidenced by the toddler
curiosity to the toddler’s surroundings.

DEFINING SCIENTIFIC BASIS EXPECTED NURSING INTERVENTION RATIONALE

CHARACTERISTICS OUTCOME

Accentuated risk of Short Term:  Stress importance of  To protect the

Subjective data: accidental exposure After 1 hour supervising infant/child child and have
“kusog na kayo mag to or ingestion of of adequate proper guidance
kuri kuri ang akong drugs or dangerous health for the child.
bata bisag unsa na products in doses teaching the
ang kuhaon niya e sufficient to cause client’s  Administer children’s  Open containers
butang sa iyang poisoning or the mother will be medications as drugs, not increase risk of
baba.”as verbalized adverse effects of able to candy. Recap medication accidental
by the client’s prescribed understand of containers immediately ingestions.
mother. medication or drug dangers of after obtaining current
use. poisoning and dosage
identify
Objective data: hazards that  Provide list of emergency  To use if
 Lack of proper could lead to numbers placed on poisoning
precaution Doenges, M. E., accidental telephone or nearby. occurs.
[Lack of Moorhouse, M. F., & poisoning.
supervision] Murr, A. C. (2006).  Encourage the client’s  To warn the
 Dangerous Nurse's pocket guide: mother to place stickers on child of harmful
 products such Diagnoses, prioritized drugs/ chemicals contents.
as pesticides interventions, and Long term:
and the like rationales. After 2-4  Carefully inspect the signs  It is important
are stored or days, the of ingestion of poisons, to look for signs
placed within client’s including an odor on the for ingestion of
reach of the mother will be breath, a trace of the poison before
child. able to substance on the clothing, initiating
 Medicines verbalize burns, or redness around treatment.
stored in understanding the mouth and lips, as well
unlocked of dangers of as signs of confusion,
cabinets are poisoning, vomiting or dyspnea.
accessible to identify
the child. hazards that  Periodically inspect the  To identify and
 Flaking, could lead to home environment for any correct risk
peeling of accidental safety risk factors in
paint or poisoning, to environment.
plaster in correct
presence of environmenta  Discuss safety cap and/or  To prevent easy
the child. l hazards as lock of medicines, cleaning accessibility of
 Unprotected identified, and products, paint/solvents the child to
contact with demonstrate and other harmful these
heavy metals necessary substances medications and
or chemicals. actions and harmful
 Toddler is lifestyle chemicals.
seen to changes to  Review drug side
interact with promote a effects/potential  To know the
items that are safe interactions with the possibilities of
battery environment client’s mother misuse, drug
operated that for the child. interactions,
is easy to and overdosing
remove and as with vitamin
take out. mega dosing,
 Container for and so on.
cigarettes is  Review sources of possible
accessible to water contamination  To identify
the toddler possible
 Emetic rat contaminants
poison is  Instruct in first aid
observed to measures or ascertain that  For the mother
be used on client’s mother has assess to on what to
the floor in to written literature when do in case
close potential exists for poisoning has
proximity to accidents/poisoning occurred.
the toddler
 Colorful
cosmetics is
 accessible to
the toddler
looking like
candy
 The toddler
shown
inquisitive
behavior
towards
exploring the
bathroom
while muriatic
acid is being
used on the
bathroom
floor
REFERENCES: Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2006). Nurse's pocket guide: Diagnoses,
prioritized interventions, and rationales.

#5 Nursing Diagnosis: Risk for: injury related to insufficient knowledge as evidenced by modifiable
factors

DEFINING SCIENTIFIC BASIS EXPECTED NURSING INTERVENTION RATIONALE

CHARACTERISTICS OUTCOME

Vulnerable to physical Short Term:  Evaluate developmental  Toddlers

Subjective data: damage due to After 1 hour level including the age mostly at
“Mu saka na siya sa environmental of adequate of the child greater
hagdanan siya ra conditions interacting health risk for
usa ug usahay dili pa with the individual’s teaching the poisoning
ma bantayan.”as adaptive and defensive client’s that
verbalized by the responses, which may mother will be would
client’s mother. compromise health. able to lead to
understand serious
the factors injury.
that
contribute to  Evaluate the family’s  May enhance
the response to violence in disregard for
possibilities the surrounding own/other’s
for injuries (neighborhood, TV) safety
and the steps
to correct
Objective data: situations.  Ascertain knowledge of  To prevent
 The client is safety needs/ injury injury in
observed to prevention and home.
be reaching to motivation.
 objects that Ackley, B. J., & Ladwig,
could easily G. B. (2017). Nursing
break and diagnosis handbook: An  Assess the family’s
could cause evidence-based guide socioeconomic status  There may
potential to planning care. be a
injury or cuts. Elsevier. relationship
 Environmental Long term: between
factors After 2-5 intentional
including the days, the injury rate
accessibility of client’s and those
the child to mother will be families
the gas stove able to living below
and harmful verbalize poverty level
chemical understanding  Determine potential for
products is of individual abusive behavior by  To
observed factors that family determine if
 The client is contribute to members/SO/Peers the cause of
seen to be possibility of injury or
playing with injury and possible risk
empty glass take steps to of inflicting
soda bottles. correct injury
 The client is situation(s),
observed to demonstrate  Identify  To promote
 be climbing on behaviors, interventions/safety safe physical
top of tables lifestyle devices environment
and objects. changes to and
 Placement of reduce risk individual
furniture that factors and safety
can easily hit protect the
the head of child from  Demonstrate/encourage  To avoid
the toddler is injury, modify use of techniques to injuring a
noted. environment reduce/manage stress family
 The toddler is as indicated and vent emotions, member or
shown to be to enhance such as anger, hostility the child
able to reach safety and because of
glass have the child uncontrolled
containers be free of anger
that could injury.
easily break  Provide  For later
when bibliotherapy/written review and
dropped. resources self-paced
 Piles of learning
scattered rugs
can be  Discuss need for and  To ensure
observed sources of supervision that the
throughout child is
 the rooms of under
the house. supervision
 The toddler’s when the
bed isn’t parent is
guarded by working or
side rails or busy
any protective
device that  It puts the
could prevent child’s risk
 Advise the client’s
the fall of the for
mother not to use a
toddler. drowning,
bath tub for bathing the
 The toddler is instead opt
baby
shown to be for showers
capable of
using the  Child
stairs passenger
 Educate parents
 The toddler is restraint
regarding proper car
exposed to systems
safety seat use
electric plugs have been
around the found to
house. greatly
reduce the
risk of injury
 and death
among child
passengers
REFERENCES: Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2006). Nurse's pocket guide: Diagnoses,
prioritized interventions, and rationales.

Name Classificatio Mechanism Indication Contraindicati

DRUG STUDY Adverse Reaction Nursing
of drug n of Action on Responsibiliti
es
Generic General In humans, an Ascorbic acid Known Acute or chronic BEFORE:
Name: Classificatio exogenous (vitamin C) hypersensitivity oxalate Assess:
Ascorbic n: Water source of is used to to any of its nephropathy Nutritional
acid soluble ascorbic acid prevent or component. (prolonged use; status: yellow
(Vitamin is required for treat low large doses). and dark
C) collagen levels of Gastrointestinal vegetables,
Functional
formation and vitamin C in disorders: Diarrhe yellow/orange
Classificatio
tissue repair people who a, nausea, fruits,
n: Vitamins
by acting as a do not get vomiting, vit A–fortified
Trade cofactor in the enough of heartburn. foods, liver,
Name: posttranslation the vitamin General egg yolks
Ceelin al formation of from their disorders and • Vit A
4- diets. Most administration deficiency:
hydroxyproline people who site decreased
in -Xaa-Pro- eat a normal conditions: Fatigu growth;
Gly- diet do not e, pain at the night
Patient’ sequences in need extra injection site. blindness; dry,
s Dose: collagens and ascorbic Nervous system brittle nails;
2.5 ml other proteins. acid. Low disorders: Dizzine hair
Ascorbic acid levels of ss, headache. loss; urinary
Maximu is reversibly vitamin C Vascular stones;
m Dose: oxidized to can result in disorders: Flushin increased
dehydroascorb a condition g. infection;
4ml
ic acid in the called hyperkeratosis
body. These scurvy. of skin; drying
two forms of Scurvy may of
Minimu the vitamin cause cornea
m Dose: are believed to symptoms
be important such as rash,
1ml
in oxidation- muscle DURING:
reduction weakness, Assess
reactions. The joint pain, therapeutic
vitamin is tiredness, or response:
involved in tooth loss. increased
tyrosine Vitamin C growth rate,
metabolism, plays an weight;
conversion of important absence of dry
folic acid to role in the skin
folinic acid, body. It is and mucous
carbohydrate needed to membranes,
metabolism, maintain the night blindness
synthesis of health of
lipids and skin,
proteins, iron cartilage, AFTER:
metabolism, teeth, bone,
resistance to and blood Instruct the
infections, and vessels. It is mother: That if
cellular also used to dose is missed,
respiration. protect your it should be
body's cells omitted.
from -That
damage. It ophthalmic
is known as exam may be
an re
antioxidant. Quired
OTHER This periodically
section throughout
contains therapy.
uses of this -Not to use
drug that are mineral oil
not listed in while taking
the approved this product
professional
labeling for To notify
the drug but prescriber of
that may be nausea,
prescribed vomiting, lip
by your cracking, loss
health care of hair,
professional. headache.
Use this
drug for a -Not to take
more than
 condition prescribed
that is listed amount
in this
section only
if it has been
so
prescribed
by your
health care
professional.
This vitamin
may also be
used with
other
vitamins for
a certain eye
condition
(macular
degeneration
).

HEALTH TEACHING PLAN

TOPIC #1: Growth and Development Pattern of Toddler

What is growth and development?

Growth is the increase in the size of a structure. Human growth is orderly and predictable, but not even; it
follows a cyclical pattern while Development is the maturation of physiologic and psychosocial systems to a more
complex state.
Specific Objectives:
• To raise parental knowledge of their child's normal developmental changes or pattern.
• To assist parents in distinguishing between normal developing trends.
• To encourage healthy parenting in order to aid the toddler's growth.

General objectives:
Within 1hr and 35 minutes of active interaction with the toddler's parents, they will comprehend a toddler's
developmental duties and subsequent phases of growth. They can be aware of their participation in all of the
toddler's stages' vital duties to support positive change when the child develops.
LEARNING LEARNING LEARNING TIME ALLOTED TEACHING EVALUATION
OBJECTIVES CONTENT ACTIVITY STYLE
After 1hr and
- Within 1hr 35 minutes of
and 35 minutes active
of interactive interaction
learning, the with the
parents will be toddler’s
able to: parents, they
will
What is growth I. Attention 15 minutes Questioning comprehend a
DEFINE What is and development? Catching and Lecturing toddler's
growth and Growth is the Activity using a visual developmental
development increase in the size • Have you aid duties and
of a structure. notice the subsequent
Human growth is behavior of phases of
orderly and your child? growth. They
predictable, but not can be aware
even; it follows a of their
cyclical pattern participation in
while, development all of the
is the maturation of toddler's
physiologic and stages' vital
psychosocial duties to
systems to a more support
complex state. positive
change when
This affects the the child
physical growth of Lecture develops.
a child: proper
Growth:
• Weight- a
child gains only
about 5 to 6 lb.
(2.5)
• Height- 5 in
(12 cm) a year
during toddler period
• Head
circumference-
increases only about
2 cm during the
second year
compared to about
12 cm during the
first year
• Chest
circumference- by 2
years, chest grow
greater than that of
the head
• Body contour-
prominent abdomen
because although
they are walking
well, their abdominal
muscles are not yet
strong enough to
support abdominal
contents as well as
they will later.
 Teeth: eight new
teeth erupt
during the
second year. All
20 deciduous
teeth are
generally present
by 2.5 to 3 years
of age
Developmental
Milestones of a
child:
 Language
development
– A word that
is used
frequently by
toddlers and
that is a
manifestation
of their
 developing
autonomy is
“no”. Toddlers
may use the
word to mean
there are
refusing a
task or they
do not
understand it
or they may
only be
practicing a
sound that
they have
noticed has
potent effects
on those
around them.
 Emotional
development
– has 3
aspects,
autonomy,
socialization,
play behavior.
Autonomy is
when a child
has learned to
trust
themselves
and others
during the
infant year.
Socialization
is when a
child become
resistant to
sitting in laps
and being
cuddled. This
means the
child develops
independency
from their
guardian. At
15 months
they are still
enthusiastic
about
interacting
with people.
Play behavior
is when
children play
beside the
children next
to them, not
with them.
This side-by-
side play
called parallel
play is not
unfriendly but
is a normal
developmental
sequence that
occurs during
the toddler
 period.
 Cognitive
development
– Piaget
referred to
stage 5
(between 12
and 18
months) as a
tertiary
circular
reaction
stage,
describing a
toddler at this
stage as “little
scientist”,
because at
this period the
children are
interested in
discovering
new ways to
 handle objects
or new results
that different
actions can
achieve.

Principles of
Growth and
Development:
• Psychosexual
DEFINE AND development is a II. Attention 10 minutes Lecturing using
ENUMERATE specific type of Catching a visual aid
the principles of development that Activity
growth and refers to developing • Are you
development instincts or sensual aware of the
pleasure (Freudian theories that
theory). can aid you in
• Psychosocial raising your
development child?
• Moral
development is the
ability to know right
from wrong
and to apply these
to real-life
situations.
• Cognitive
development refers
to the ability to learn
or understand from
experience, to
acquire and retain
knowledge, to
respond to a new
situation, and solve
problems
 What is
developmental
task? A skill or a
growth responsibility
arising at a
DEFINE what a particular time in an Lecture 10 minutes Questioning and
developmental individual’s life, the proper Lecturing using
task is achievement of a visual aid
which will provide a
foundation for
the accomplishment
of
future tasks.

How our
understanding has
changed?
Child development
 that occurs from
birth to adulthood
DEFINE how was largely ignored III. Lecture 15 minutes Lecturing with
understanding throughout much of proper the use of a
have changed human history. visual aid
and its Children were often
importance. viewed simply as
small versions of
adults and little
attention was paid to
the many advances
in cognitive abilities,
language usage, and
physical growth that
occur during
childhood and
adolescence.

Why is it
important to study
how children
grow, learn and
change?
 An understanding of
child development is
essential because it
allows us to fully
appreciate the
changes of growth
and development
that children go
through from birth
and into early
adulthood.

Psychosocial
development:
Erikson's eight-stage
theory of
psychosocial
DEFINE AND development IV. Lecture 20 minutes Lecturing with
ENUMERATE describes growth proper the use of a
the Erik Erikson’s and change visual aid
psychosocial throughout life,
development of focusing on social
infant and interaction and
toddler, their conflicts that arise
important during different
events, and how stages of
their parents can development.
aid their child. Trust vs. Mistrust
(0- 18 mo.) -
Important Event:
Feeding – children
develop a sense of
trust when
caregivers provide
reliability, care, and
affection. A lack of
this will result to
mistrust. The
primary way you can
build trust with your
baby is to respond
when they try to
communicate with
you. Because babies
can't use words to
express themselves,
they use nonverbal
strategies to
communicate what
they're thinking and
feeling at all times.

Autonomy vs.
shame or doubt
(18 mo. -3 yr.) -
Important Event:
Toilet training –
children need to
develop a sense of
personal control
over physical skills
and a sense of
independence.
Success leads to
feeling of autonomy,
failure results in
feelings of shame
and doubt. The child
is ready for potty
train when the child
begins to notice
his/her diaper is full,
if the child can
verbalize “poo-poo”
or “pee-pee”, if the
child can control
his/her bladder.

Initiative vs Guilt
(3-5 years old)
Important Event:
Exploration -
During the initiative
versus guilt stage,
children begin to
assert their power
and control over the
world through
directing play and
other social
interaction. It is as
children enter the
preschool years that
they begin the third
stage of
psychosocial
development
centered on initiative
versus guilt. If they
have successfully
completed the
earlier two stages,
kids now have a
sense that the world
is trustworthy and
that they are able to
act independently.
Now it is important
for kids to learn that
they can exert
power over
themselves and the
world. They need to
try things on their
own and explore
their own abilities.
By doing this, they
can develop
ambition and
direction.

Industry vs
Inferiority (5- 13
years old)
Important Event:
School - The stage
occurs during
childhood between
the ages of
approximately five
and thirteen. If this
skill is successfully
achieved, it leads to
an ability that
contributes to
lifelong well-being. A
child's social world
expands
considerably as they
enter school and
gain new friendships
with peers. Through
social interactions,
children begin to
develop a sense of
pride in their
accomplishments
and abilities.

Identity vs Role
confusion (13- 21
years old)
Important Event:
Social
Relationship -
During this stage,
adolescents explore
their independence
and develop a sense
of self. As they
transition from
childhood to
adulthood, teens
may begin to feel
confused or insecure
about themselves
and how they fit into
society. As they seek
to establish a sense
of self, teens may
experiment with
different roles,
activities, and
behaviors. According
to Erikson, this is
important to the
process of forming a
strong identity and
developing a sense
of direction in life.

Intimacy vs
Isolation (21-40
years old)
Important Event:
Romantic
Relationship - The
major conflict at this
stage of life centers
on forming intimate,
loving relationships
with other people.
Success at this stage
leads to fulfilling
relationships.
Struggling at this
stage, on the other
hand, can result in
feelings of loneliness
and isolation.
Generativity vs
Stagnation (40-60
years old)
Important Event:
Work and
Parenthood -
During this time,
adults strive to
create or nurture
things that will
outlast them; often
by parenting
children or
contributing to
positive changes
that benefit other
people. Contributing
to society and doing
things to benefit
future generations
are important needs
at the generativity
versus stagnation
stage of
development.

Integrity vs
Despair (Above 60
years old)
Important Event:
Reflecting on life -
At each stage of
psychosocial
development, people
are faced with a
crisis that acts as a
turning point in
development.
Successfully
resolving the crisis
leads to developing
a psychological
virtue that
contributes to
 overall psychological
well-being. At the
integrity versus
despair stage, the
key conflict centers
on questioning
whether or not the
individual has led a
meaningful,
satisfying life.

Moral
Developmental
Theory:
Recognition of the
distinction between
good and evil or
between right and
DEFINE AND wrong; respect for 15 minutes
ENUMERATE and obedience to the
the Lawrence rules of proper
Kohlberg’s Moral conduct; the mental
Developmental disposition or
Theory, the characteristic of
preconventional, behaving in a
conventional and manner intended to
post- produce good
conventional results.
levels, and each
level has two Preconventional
distinct stages. Level (less than 6
years old) –
children don’t have a
personal code of
morality, and
instead moral
decisions are shaped
by the standards of
adults and the
consequences of
following or breaking
their rules. For
example, if an action
leads to punishment
is must be bad, and
if it leads to a
reward is must be
good.
Authority is outside
the individual and
children often make
moral decisions
based on the
physical
consequences of
actions.
Stage 1:
Obedience and
Punishment
Orientation - The
child/individual is
good in order to
avoid being
punished. If a
person is punished,
they must have
done wrong.
Stage 2:
Individualism and
Exchange - At this
stage, children
recognize that there
is not just one right
view that is handed
down by the
authorities. Different
individuals have
different viewpoints.

Conventional Level
(7-11 years) - the
second stage of
moral development,
and is characterized
by an acceptance of
social rules
concerning right and
wrong. At the
conventional level
(most adolescents
and adults), we
begin to internalize
the moral standards
of valued adult role
models.

Authority is
internalized but not
questioned, and
reasoning is based
on the norms of the
group to which the
person belongs.

Stage 3: Good
Interpersonal
Relationships - The
child/individual is
good in order to be
seen as being a
good person by
others. Therefore,
answers relate to
the approval of
others.

Stage 4:
Maintaining the
Social Order - The
child/individual
becomes aware of
the wider rules of
society, so
judgments concern
obeying the rules in
order to uphold the
law and to avoid
guilt.

Post-conventional
Level - is the third
stage of moral
development, and is
characterized by an
individuals’
understanding of
universal ethical
principles. These are
abstract and ill-
defined, but might
include: the
preservation of life
at all costs, and the
importance of
human dignity.

Individual judgment
is based on self-
chosen principles,
and moral reasoning
is based on
individual rights and
justice.

Stage 5: Social
Contract and
Individual Rights -
The child/individual
becomes aware that
while rules/laws
might exist for the
good of the greatest
number, there are
times when they will
work against the
interest of particular
individuals.

The issues are not

always clear-cut. For
example, in Heinz’s
dilemma, the
protection of life is
more important than
breaking the law
against stealing.

Stage 6: Universal
Principles - People
at this stage have
 developed their own
set of moral
guidelines which
may or may not fit
the law. The
principles apply to
everyone.
Cognitive
Developmental
Theory: theory
focuses not only on
understanding how
children acquire
knowledge, but also
DEFINE AND on understanding
ENUMERATE the nature of 10 minutes
the Jean Piaget’s intelligence. Early
Cognitive cognitive
Developmental development
Theory, children involves processes
move through based upon actions
four different and later progresses
stages of mental to changes in mental
development. operations.

Sensorimotor
stage (birth to 2
years) - During this
earliest stage of
cognitive
development, infants
and toddlers acquire
knowledge through
sensory experiences
and manipulating
objects. A child's
entire experience at
the earliest period of
this stage occurs
through basic
reflexes, senses, and
motor responses.

Piaget believed that

developing object
permanence or
object constancy,
the understanding
that objects continue
to exist even when
they cannot be seen,
was an important
element at this point
of development.

Preoperational
stage (ages 2 to
7) - The foundations
of language
development may
have been laid
during the previous
stage, but it is the
emergence of
language that is one
of the major
hallmarks of the
preoperational stage
of development.
Children become
much more skilled at
pretend play during
this stage of
development, yet
continue to think
very concretely
about the world
around them. Kids
learn through
pretend play but still
struggle with logic
and taking the point
of view of other
people. They also
often struggle with
understanding the
idea of constancy.

Concrete
operational stage
(ages 7 to 11) -
During this stage,
children also become
less egocentric and
begin to think about
how other people
might think and feel.
Kids in the concrete
operational stage
also begin to
understand that
their thoughts are
unique to them and
that not everyone
else necessarily
shares their
thoughts, feelings,
and opinions.

While thinking
becomes much more
logical during the
concrete operational
state, it can also be
very rigid. Kids at
this point in
development tend to
struggle with
abstract and
hypothetical
concepts. The
egocentrism of the
previous stage
begins to disappear
as kids become
better at thinking
about how other
people might view a
situation.

Formal
operational stage
(ages 12 and up) -
The final stage of
Piaget's theory
involves an increase
in logic, the ability to
use deductive
reasoning, and an
understanding of
abstract ideas.

At this point, people

become capable of
seeing multiple
potential solutions to
problems and think
more scientifically
about the world
around them. The
ability to thinking
about abstract ideas
and situations is the
key hallmark of the
formal operational
stage of cognitive
development. The
ability to
systematically plan
for the future and
reason about
hypothetical
situations are also
critical abilities that
emerge during this
stage.
Topic#2: Teaching about Toilet training

What are the basic signs that the child is ready for toilet training?
Children might be ready for toilet training if they have dry nappies for up to two hours, know about
poo’s and wee’s, and can pull pants up and down.

Specific objectives
• To orient the parents about toilet training
• To acknowledge signs that the child is ready for a toilet training
• To recognize the different equipment needed for toilet training.
• To gain knowledge on how to prepare the child for toilet training
• To know how to get started with the toilet training
• To be aware of the setbacks and accidents during toilet training

General Objectives:
Within 1 hour and 5 minutes of mother teaching regarding the toilet training, the
Mother and guardian will be able to gain knowledge and verbalize understanding, and the child will also have some
ideas on how to perform it through performing it with his parents.
LEARNING LEARNING LEARNING TIME ALLOTED TEACHING EVALUATION
OBJECTIVES CONTENT ACTIVITY STYLE

If your child has Discussion with After 1 hour and

Toilet training had dry nappies Lecture 10 minutes visual aids such 5 minutes of
for up to two Proper as pamphlets, mother teaching
hours, charts and regarding the
understands the pictures. toilet training,
difference the
between poo and Mother and
wee, and can guardian will be
pull their pants able to gain
up and down, knowledge and
they may be verbalize
ready for toilet understanding,
training. and the child will
also have some
ideas on how to
perform it
You might see Discussion and through
Toilet training: signs that your Lecture 10 mins sharing performing it
signs that child is ready for Proper with his parents.
children are toilet training
ready from about two
years on. Some
children show
signs as early as
18 months, and
some might be
older than two
years. It might
be time for toilet
training if your
child:
• is walking and
can sit for short
periods.
• is becoming
generally more
independent,
including saying
‘no’ more often
• is becoming
interested in
watching others
go to the toilet
• has dry
nappies for up to
two hours
• tells you with
words or
gestures when
they do a poo or
wee in their
nappy
• begins to
dislike wearing a Discussion and
nappy, showing of
perhaps trying to pictures of the
pull it off when materials
it’s wet or soiled
• has regular,
soft, formed
bowel
movements
• can pull their
pants up and
 down
• can follow
simple
instructions like
‘Give the ball to
daddy’.

Potty or toilet-
Children can
Equipment for start toilet Lecture 5 minutes
toilet training training using a proper
potty or the
toilet. A potty is
easy to move
around, and
some children
find it less scary
than a toilet. On
the other hand,
the toilet is
where everybody
else does wees
and poos. If your
child will be
using the toilet,
you’ll also need:
• a step or
footstool – your
child can use this
for getting onto
the toilet and
resting their feet
while sitting
• a smaller seat
that fits securely
inside the big
toilet seat

▪ Start teaching
 the child some Discussions and
Preparing the words for going Lecture proper 10 minutes sharing
child for toilet to the toilet – for
training example, ‘wee’,
‘poo’ and ‘I need
to go’.
▪ When you
change the
child’s nappy,
put wet and dirty
nappies in the
potty – this can
help your child
understand what
the potty is for.
▪ Let their child
watch you or
other trusted
family members
using the toilet,
and talk about
what you’re
doing.
 ▪ Make sure your
child is eating
plenty of fibre
and drinking lots
of water, so your
child doesn’t get
constipated.
Constipation can
make toilet
training harder.

Try to make
toileting part of Discussions and
Getting started your child’s Lecture proper 20 mins sharing
with toilet regular daily
training routine.
• Encourage your
child to go to the
toilet when they
show signs like
wriggling around,
passing wind,
going quiet or
moving away
from you. But
don’t force your
child to go.

• Ask your child

about going to
the toilet when
they change
activities.

• If your child
doesn’t do a wee
or poo after 3 -5
minutes of sitting
on the potty or
 toilet, let your
child get off the
toilet. It’s best
not to sit your
child on the toilet
for too long,
because this will
feel like
punishment.

1. Pay attention
to your child if Discussions and
Setbacks and they say they Lecture proper 10 mins sharing
accidents while need the toilet
toilet training straight away.
They might be
right.

2. If you’re sure
your child hasn’t
done a poo or
wee in a while,
remind them
that they might
need to go. Your
child might be
too busy doing
an activity to go
to the toilet.

3. Check
whether your
child wants to go
to the toilet
during a long
playtime or
before an outing.
If your child
doesn’t want to
go, that’s fine.

4. Try to make
sure the potty or
toilet is always
easy to get to
and use.

5. Ask your child

to wee just
before going to
bed.
TOPIC #3: Awareness to prevent toddler poisoning

What is poisoning?
Accidental ingestions (poisoning) are the type of accident that occurs most frequently in toddlers. Children
are curious and use all of their senses, including taste, to investigate their surroundings. As a result, they can ingest
harmful compounds, the home, and its environment might be dangerous. Poisoning occurs when a hazardous
chemical is inhaled, ingested, injected, or absorbed, causing injury or death to the toddler.

Specific Objectives:
• To detect potential hazards in the home that could result in unintentional poisoning.
• To lessen the chances of a toddler becoming poisoned in the home.
• To promote a safety environment for the toddler to live.
• To show the actions/lifestyle changes that are required to promote a safe environment.
 To increase parents' awareness of the dangers of unintentional poisoning in a toddler.

General objectives:
Within 1 hour and 20 minutes of active interaction with the toddler's parents, the client will recognize the
risks of unintentional poisoning of their child in their home and the risks and interventions. They will also
demonstrate initiative to avoid poisoning.
LEARNING LEARNING LEARNING TIME ALLOTTED TEACHING EVALUATION
OBJECTIVES CONTENT ACTIVITY STYLE
LEARNING
- Within 1hr and After 1hr and 20
20 minutes of minutes of active
lecture interaction with
demonstration, the toddler's
the parents will parents, the
be able to client will
recognize the
Questioning and risks of
DEFINE What is I. Attention 10 minutes Lecturing using a unintentional
What is poisoning? Catching visual aid poisoning of
Poisoning Poisoning is when Activity their child in
cells are injured • Do you know their home and
or destroyed by about the risks and
the inhalation, poisoning? interventions.
ingestion, They will also
injection or demonstrate
absorption of a initiative to avoid
toxic substance. Lecture proper poisoning.
Key factors that
predict the
 severity and
outcome of
poisoning are the
nature, dose,
formulation and
route of exposure
of the poison;
exposure to other
poisons; state of
nutrition of the
child or (fasting
status); age and
pre-existing
health conditions.

DEFINE the According to the II. Attention 15 minutes Questioning and

scale of the World Health Catching Lecturing using a
problem. Organization, in Activity visual aid
partnership with
UNICEF: Mortality • Are you aware
rate: In 2004, of how risky
acute poisoning poisoning are for
caused more than infants?
45 000 deaths in
children and youth
under 20 years of
age – 13% of all
fatal accidental
poisonings
worldwide. The
rate of fatal
poisoning is Lecture proper
highest for
children under
one year, with
another slight
peak around 15
years. Fatal
poisoning rates in
low-income and
middle-income
countries are four
times that of high-
income countries.
Common
poisoning agents
include
pharmaceuticals,
household
products (e.g.,
bleach, cleaning
agents),
pesticides,
poisonous plants,
and bites from
insects and
animals.

Morbidity rate:
In some
countries,
poisoning death
rates are highest
in children under
one year, while
non-fatal
poisonings appear
more common
among children
aged 1 to 4.
Studies from both
low-income and
high-income
countries suggest
that poisonings
and their
management are
costly. For
example, a study
conducted in
South Africa
estimated that the
direct costs of
hospitalization
because of
paraffin poisoning
alone are at least
 US$ 1.4 million
per year.

Risk factors: III. Lecture

ENUMERATE • In young proper 25 minutes Lecturing with
the risk factors children are the use of a
of hazards or particularly visual aid
poisoning susceptible to the
ingestion of
poisons, especially
liquids, because
they are very
inquisitive, put
most items in
their mouths and
are unaware of
consequences.
• Because of their
smaller size and
less developed
physiology,
younger children
are more
vulnerable to
poisoning,
especially as they
get older.
Most drugs'
toxicity is
measured in
doses per
kilogram of body
weight.

• Over-the-
counter
preparations such
as paracetamol,
cough/ cold
remedies,
vitamins and iron
tablets,
antihistamines
and anti-
inflammatory
drugs.
• Household
products such as
bleach,
disinfectants,
detergents,
cleaning agents,
cosmetics,
vinegar.
•Paraffin/kerosene
• Pesticides,
including
insecticides,
• Rodenticides
and herbicides.
• Poisonous plants
• Animal or insect
bites.
ENUMERATE
interventions for Interventions IV: LECTURE Lecturing with
toddler poisoning Poisoning is a PROPER 25 minutes the use of a
problem that can visual aid
be avoided,
through the
application of
effective
techniques for
prevention.
• Removing the
poisoning agent
from
the environment
(e.g., removal of
poisonous plants;
removal of fuel
sources such as
bottled kerosene).
• Replacing the
poisoning agent
with
one of lower
toxicity
(e.g., replacing
aspirin with
paracetamol;
reformulating
methylated spirits
to
include ethyl
alcohol
rather than
methanol).

• Legislation (and
enforcement) of
child-resistant
packaging of
necessary
poisonous
agents (e.g.
medicines,
household
chemicals and
other
toxins).

• Reducing
toxicity of
poisoning agents
by packaging in
nonlethal
concentrations or
doses.

• Safely discard -
- all household
products and
medications that
are old or aren't
used regularly.

• Have the pets or

any animal within
household
premises be in
 cages and is/are
vaccinated.

ENUMERATE
signs of potential Signs of V. Lecture Lecturing with
poisoning in potential proper 10 minutes the use of a
toddler poisoning in visual aid
toddler:
• Difficulty
breathing
• Difficulty
speaking
• Dizziness
• Unconsciousness
• Foaming or
burning
of the mouth
• Cramps
• Nausea
• Vomiting
TOPIC #4: Proper nutrition and Ways to feed a toddler
What is Nutrition?
The process of taking in food and using it for growth, metabolism, and repair. Nutritional stages are
ingestion, digestion, absorption, transport, assimilation, and excretion.

What is Weaning?
Weaning is when a baby moves from breast milk to other sources of nourishment. Weaning your baby is a
process that takes patience and understanding from both you and your child.

Specific Objectives:
 To give the child the proper nutrition
 To provide new ways to get the child eat plenty
 To have the child be healthy and grow in proper process

General objectives:
Within 45 minutes of active interaction with the toddler's parents, they will be able to develop a method to be
creative and be aware of the nutrition they will be serving to their child.

LEARNING LEARNING CONTENT LEARNING TIME TEACHING EVALUATION

OBJECTIVES LEARNING ACTIVITY ALLOTTED STYLE
- Within 45 After 45
minutes of minutes of
lecture discussion
demonstration, about the
the parents will Proper
be able: Nutrition and
ways to feed a
toddler, the
DEFINE What is Nutrition - The I. Attention 5 minutes Visual aids parents will
Nutrition and process of taking in Catching Activity and print out know what
Malnutrition food and using it for • Do you know pictures nutrition its,
growth, metabolism, about Nutrition and the causes of
and repair. Nutritional Malnutrition? undernutrition
stages are ingestion, on toddlers,
digestion, absorption, Lecture proper factors that
transport, assimilation, contribute to
and excretion. poor nutrition
Malnutrition - and how to
Malnutrition is a serious present food to
condition that happens their children,
when how to
your diet does not entertain their
contain the right children while
amount of nutrients. eating the
 This can lead to stunted foods they
growth, which is don’t eat, and
associated with to
impaired cognitive
ability and reduced
school performance.

Types of
Malnutrition:
KNOW Types of  Undernutrition Lecture proper 10 minutes
Malnutrition - This type of
malnutrition
results from not
getting enough
protein, calories
or
micronutrients.
It leads to low
weight-for-height
(wasting), height
for-age
(stunting) and
 weight-for-age
(underweight).
 Overnutrition -
Overconsumption
of certain
nutrients, such
as protein,
calories or fat,
can also lead to
malnutrition.
This usually
results in
overweight or
obesity

- Weaning is when
a baby moves
What is from breast milk Lecture Proper 5 minutes
Weaning? to other sources
of nourishment.
Weaning your
baby is a process
 that takes
patience and
understanding
from both you
and your child.

UNDERNUTRITION:
Undernutrition typically
What results from not getting 5 minutes
Undernutrition enough nutrients in
can cause your diet.
This can cause:
 Weight loss
 Hollow cheeks Question: What
and sunken eyes other causes?
 Dry hair and skin
 Delayed wound
healing
 Fatigue
 Loss of fat and
muscle mass
 FACTORS:
 Food insecurity 10 minutes
Factors or a lack of Question: What
contributing to access to a other factors?
Poor Nutrition sufficient and
affordable food
 Digestive
problems and
issues with
nutrient
absorption
 Inability to
obtain and
prepare foods
 Ways:
 Assess the diet
Effective ways and nutritional Lecture Proper 10 minutes Provide
to help the status of the sample
parents toddler pictures of
feeding their  Serve toddler level up food
toddler fruits and servings for
vegetables that the toddlers
are cut out
shapes of stars,
circle, their
favorite animal,
or level up the
presentation of
their food.
 Give them
supplements that
can boost their
appetite
TOPIC #5: Prevention and Management of Dengue
What is Dengue?
Dengue is a mosquito-borne viral infection, found in tropical and sub-tropical climates worldwide, mostly in
urban and semi-urban areas. The virus responsible for causing dengue, is called dengue virus (DENV). There are
four DENV serotypes, meaning that it is possible to be infected four times.

Specific Objectives:
 To protect toddler and people in the environment getting sick
 To avoid toddler getting dengue fever
 To know how to manage dengue before admitting to hospitals

General objectives:
Within 1 hour and 20 minutes of active interaction with the parents of the toddler will know how to prevent
the spread of the mosquito that causes dengue.

LEARNING LEARNING CONTENT LEARNING TIME ALLOTTED TEACHING EVALUATION

OBJECTIVES LEARNING ACTIVITY STYLE
- Within 1hr and After 1 hour and
20 minutes of 20 minutes of
lecture discussing the
demonstration, prevention and
the parents will management
be able: ways of dengue
the parents will
be alert on
DEFINE What is DENGUE - Dengue is a Attention 5 minutes Visual aids and detecting if their
Dengue? mosquito-borne viral Catching print out child is
infection, found in Activity pictures suspected to
tropical and sub-tropical have dengue
climates worldwide, fever and will get
mostly in urban and to clean the
semi-urban areas. The The rest containers that
virus responsible for is Lecture are filled with
causing dengue, is called proper water that they
dengue virus (DENV). store. They will
There are four DENV be able to catch
serotypes, meaning that on the
it is possible to be symptoms early
infected four times. on than later.

How is the Mode of

dengue Transmission: 5 minutes
transmitted? Mosquito to human
transmission. The virus
is transmitted to
humans through the
bites of infected female
mosquitoes, primarily
the Aedes aegypti
mosquito. Other species
within the Aedes genus
can also act as vectors,
but their contribution is
secondary to Aedes
aegypti.

Signs and Signs & Symptoms:

Symptoms of - Headache 10 minutes
Dengue - Muscle, bones or
joint paint
- Nausea and
Vomiting
- Pain behind the
eyes
 - Swollen glands
- Rash
- Sudden high fever
Warning signs for
severe dengue:
- Belly pain,
tenderness
- Vomiting at least
3 times in 24
hours
- Vomiting blood or
blood in the stool
- Bleeding from the
nose or gums
- Feeling tired,
restless, or
irritable

WHAT is Aedes - The dengue 10 minutes

aegypti? mosquito lays its
eggs on the walls
 of water-filled
containers in the
house and patio.
- The eggs hatched
when submerged
in water and can
survive for
months
- The cycle of the
dengue mosquito
takes 8 days and
occurs in water.
Adult mosquitoes
live for one month
- A few mosquitoes
per household can
produce large
dengue
outbreaks.
 Containers:
Common  Filled with 15 minutes
containers in water by
which eggs people:
develop - Drums, water
cisterns, gallon
buckets, small
buckets, plants in
water, decorative
fountains, broken
water meters,
animal drinking
bowls, portable
pools (not in use),
open or sealed
septic tanks.
 Filled with rain
water:
- Discarded tires,
bottles, pots,
pans, broken
appliances (toilet,
 washbasins,
refrigerators,
washing
machines)
- Boats and other
vehicles that can
hold rain water
- Items left outside
such as garbage
cans, paint trays,
tarps, toys and
coolers

Ways:
Avoid - Throw away, turn 15 minutes
production of over, empty or
adult store under a roof
mosquitoes: any container that
may accumulate
rain water.
- Always place a
tight lid on
 containers used
for water storage
(buckets, drums).
- Verify that there
are no larvae or
pupae in stored
water (empty the
container, wash
walls with a brush
to remove eggs,
rinse, and cover).
- Maintain running
water in
fountains,
artificial lakes or
estuaries. Place
fish (guppies,
betas) in
ornamental
fountains that are
always filled with
water.
- Empty ornamental
 fountains that are
not in use.
- Clean animal
drinking bowls
every day, taking
care to wash
away eggs.
- Ask the Water
Authority to
replace broken
water-meters.
- Repair broken
septic tanks and
cover vent pipes
with wire mesh.
- Protect boats and
vehicles from rain
with tarps that
don’t accumulate
water.
- Maintain
swimming pools in
good condition
 and appropriately
chlorinated.
Empty plastic
swimming pools
when not in use.

How to control:
- Use screens on
doors and
Mosquito windows. 10 minutes
Control
- Use patio
insecticides such
as Permethrin
(pesticide and
repellent) and
Allethrin (candles
and lanterns.
Wear long sleeve
shirts, long pants,
socks and closed
 shoes to avoid
mosquito bites at
dusk and dawn
especially.

- Use repellents
containing DEET
(N, N-diethyl-m-
toluamide) or
Picaridin on your
clothing and
exposed skin.
Follow
manufacturer’s
instructions and
CDC
recommendations.
(www.cdc.gov)

Dengue begins abruptly

after a typical incubation
period of 5–7 days, and
 the course follows 3
Ways to phases: febrile, critical,
Manage and convalescent. 10 minutes
dengue
Management:
- See a healthcare
provider if you
develop fever or
have symptoms of
dengue
- Rest as much as
possible
- Take paracetamol
to control fever
and relieve pain
- Drink plenty of
fluids to stay
hydrated. Drink
water or drinks
with added
electrolytes.
*Note: Symptoms of
dengue can become
sever within a few
hours. Severe dengue
is a medical
emergency
 DISCHARGE PLANNING

MEDICINE ● Continue to take vitamins and

supplements.

ENVIRONMENT ● Ensure that the client could

provide a clean environment.
● Encourage the client to use
mosquito net
● Poisonous and hazardous
chemicals should be out of
your child's sight and reach.
● Provide a calm, quiet
environment that is conducive
to sleep.
● Use of mosquito net.

TREATMENT ● Advise the mother to apply

lotion or mosquito repellant.

HEALTH EDUCATION ● Child safety at home

● Awareness to prevent toddler
poisoning.
● Disadvantages of prolonged
diaper use
● Practicality of Toilet training
● Genital Care of the toddler

OBSERVABLE SIGNS AND ● Advice for health provider for

SYMPTOMS any of the following signs and
symptoms:
○ Fever
○ Diarrhea
○ Dehydration
 ○ Cough
○ Skin Rashes
○ Constipation

DIET ● Supplemental bottle feeding

● Eat more solid foods for
growth and energy for
learning and playing.
○ High fiber foods to
avoid constipation.

SPIRITUALITY ● Encourage the patient to

continue religious practices
such as praying to lift up the
spirit.
 PEDIATRIC HEALTH ASSESSMENT FORM

CLIENT IN CONTEXT:
Name: ___________SYML__________________ Age:__2__ Sex_M__
Date of Birth: _June 4 2019_Birthplace: _Cebu City_Religion: Roman Catholic Nationality:
Filipino
Date of Admission: __November 19, 2021______ Address: Sition Bayanihan Lahug Cebu City__
Informant: ◘ Parent/s ◘ Guardian/s ◘ Child/Parent ◘ Other: _______________
Medical Diagnosis: ____________________________ Attending
Physician :_____________________

History of Present Illness:

Onset of complaint prior to admission:
___________________________________________________
Manner of Onset: ◘ acute ◘ chronic ◘ intermittent
Progress of Condition: ◘ Better ◘ Unchanged ◘ Worsen
Medications given to alleviate condition: ◘ OTC ◘ Prescribed

NEWBORN/INFANT HEALTH HISTORY

A. Prenatal History
Prenatal check-up done at what AOG:_12weeks_ Frequency of Prenatal Check-up: Once a
month
Prenatal done in/by: ◘ Hospital ◘ Health Center ◘ Private Doctor ◘ Hilot
Illness incurred during course of pregnancy: ____None_____________________________
Medications taken during pregnancy (OTC or prescribed): _Multivitamins, Folic Acid, ___

B. Obstetric History
G _1__ P _1__ T __1__ P __0__ A __0__ L __1___
Use of Tobacco: __none_____ Use of Alcohol: __none____ Use of drugs: __none____
C. Labor and Delivery
AOG during labor: _38 weeks __ Duration of Labor: _1hr__ Type of delivery: NSVD (Assisted)
Type of Anesthesia: _Lidocaine__ Place of Delivery: _Maternity Center_________
Complications: __None____________________________________________
Assisted by: ◘ Obstetrician ◘ Midwife ◘ Trained Hilot

D. Birth History
Respiratory Effort of Newborn: ◘ Unassisted ◘ Assisted
Character of Cry: ◘ Loud ◘ High Pitched ◘ Weak
Medications administered: _None_____________________________________
Presence of congenital anomalies: _None___________________________________
Length of baby's hospital stay: __7 days______________________________

E. Feeding History
First feeding was started at how many minutes/hours after birth: __1 day old____________
Method of feeding: ◘ Breastfeeding ◘ Bottle-fed ◘ NGT ◘ Mixed
Type of formula for bottle fed: __Similac____________________________________
Amount and Frequency: 2 oz every 2hrs_______________Age of Weaning: _4 months_
Age of supplemental feeding started: __1 year old_________________
Composition of supplemental feeding: _CERELAC, Fruits, and Vegetables_____
Vitamins taken: _Ascorbic acid with zinc (Ceelin)_________
Appetite: ◘ Good ◘ Fair ◘ Poor ◘ Diet Restrictions: ____________
Prescribed diet: __none__________________________________

F. Health History
Previous illness, injuries, operations: __None__________________________________
OTC Medications taken: __None________________________________________________
Allergies: ◘ Food ◘ Drug ◘ Others (Pls. Specify): _______________

Immunization Received: DPT 1 2 3 OPV 1 2 3 HepB 1 2 3

 BCG 1 AMV 1 Hib
Approximate weight (in kilograms) at: 6 months __8kg____ 1 year ____10kg______
Approximate height (in inches) at: 1 year __84cm_________ 4 years ______________
Dentition: Age of onset of primary teeth: _6 months__ Age of eruption of permanent teeth:
______ Present number of teeth: upper ____10________ lower ____10________

G. Family History (Focus only in the immediate family members)

Name Relationshi Age Health Status Education Occupation

p

MGM Grandmother 48 Healthy College level Housewife

KMIM Auntie 28 Healthy College Call Center

graduate

KMM Auntie 25 Healthy College Call Center

graduate

JJM Mother 23 Healthy College level Courier

Associate

PWM Uncle 21 Healthy College level Student

AWM Uncle 18 Healthy Highschool level Student

Family history of: ◘ heart disease ◘ stroke ◘ cancer

◘ other health conditions: __Hypertension______________________

H. Developmental Milestones: (write the age when this milestone was achieved)
Smile _4 months__ Sit with support 4 months_ Stand with support: 5-6 months Say first word
7 months
Hold head steadily 5 month Sit unsupported _6 months Stand alone 7 months
Talk in sentence __1 year___Roll over _3 months_ Wald around _1 year_ Toilet training
___N/A_____ Education: present grade: ___N/A_________________
General Survey:
Integumentary: Are there any abrasions, lacerations, or birthmarks? Mongolian Spot is noted
and mosquito bites
Head and Neck: Are there masses on the head or neck? none
Eyes, Ears, Nose, Mouth and Throat: Is there exudates in the eyes? none
Is the baby blinking? Yes
Does his or her eyes follow an object within 8 inches? Yes
Is there discharge from the ears, nose, and throat or nose congestion? None
Does the newborn respond to sound? Yes
Respiratory Characteristics, Lungs and Breathing: Is the newborn's lungs congested or gasping
for breath? No

Cardiovascular Characteristics: Is there cyanosis: __None_ Is the newborn alert? Yes

Temperature Regulation: Is body temperature maintained? Yes
Hepatic Regulation: Does the newborn have jaundice? None
Gastrointestinal Adaptation: Has the newborn passed tool? None
Has she or he vomited? None
Genitourinary Adaptation: Has the baby voided? Yes
Neurological Characteristics: How are extremities moving? Complete ROM
How does cry sound? Loud
Endocrine Characteristics: Is there evidence of fetal or maternal endocrine disease? None
Is the newborn jittery? No
Immunologic Adaptation: Are defenses maintained? Yes_
Sleep and Rest Patterns: What is the sleep pattern? 8 – 9 hrs of sleep
Relationships, Psychosocial Profile and Cultural/Ethnic Variations: How are family members
relating to the newborn? Family is very supportive when the newborn came into their life.

PSYCHOSOCIAL PROFILE (The Psychosocial profile should focus on the child's health
practices and behaviors that affect health and well-being).
Health Practices
When was the child's last check-up? _October 2021_ Usual OTC drugs: ___N/A_____________
Typical Day
What is the child's typical day like? _Inside the house watch tv and run and play around the
house_
Does he or she have a babysitter or go to day care or preschool? If so, does he or she enjoy it?
“Yes, his lola. Yes, he likes when he plays with his lola.”
What kind of day care situation is it (e.g. day-care center, child care in private home, babysitter
in
your own home)? Baby sitter in own home
How is the child doing in school?
_______________________________________________________
What subjects does the child like and dislike?
_____________________________________________
Is she or he is having problems with a particular subject, has she or he sought help?
______________ How many days of school does she or he usually miss every term?
____________________________

Nutritional Patterns
Is child still nursing or bottle feeding? If yes, how often? Bottle fed, 4 times a day 8 ounces
24-hour diet recall _Biscuit and milk
Ask the child to name her or his favorite foods and snacks: _Biscuit and milk________________
Eating patterns: ask, “How often do you eat breakfast?” “What do you usually have for lunch?”
” We eat our breakfast late, usually our lunch is just rice and fish.”

Elimination Patterns
Stool: Frequency: 2 – 3 times a day_Time period of day: 9am to 7pm Color: Yellowish to
brownish Consistency: Soft
Urination: Frequency: Frequent Time period of day: 8am – 7pm Color: Pale yellow
Consistency: _Normal
Problems with elimination: None
Activity and Exercise Patterns
Is the child very active: Yes, what does he or she enjoy doing? Running around the house,
watch tv and play cars
Is he or she supervised during activities? Supervised by the lola
Ask what the child enjoys doing outside the home: _Play with
friends___________________________
Does he or she play any sports? If so what?
__None____________________________________
Does he or she wear protective equipment?
___None________________________________________
What does the child like to do with his or her friends? Play toys and watch TV
How often does he or she watch TV during the week? Everyday
How much time does he or she spend on the computer?

Recreation/Hobbies
Ask about the parents' hobbies: _Watch movies_
What does the child do for fun? _Play cars and play with gadgets _
What hobbies does he or she have? _Play with toys

Sleep and Rest Patterns:

Ask about sleep patterns and naps, bedtime rituals: The child only sleep when he wants to
sleep, no bedtime rituals
The child usually goes to bed at: 8pm or 9pm and she or he awakens at 9am or 10am
Sleep problems: ◘ nightmares ◘ night terrors ◘ somnambulism
◘ enuresis ◘ others:
________________________________
How many hours does the child sleep? 8-9 hours
Personal Habits
Ask parents about their and other caregiver's personal habits. Do they smoke, drink alcohol or
use drugs? Drinks alcohol occasionally_
If they smoke cigarettes, how many do you smoke in an average day?
________________________
If you use alcohol, how much do you usually drink during the week? Depends if there are any
celebration_
If you use drugs, what type and what method?
___________________________________________

Roles/Relationships/Self-Concept
If there are siblings, ask the parent about the relationship:Half Brother, haven’t seen his
brother_
Ask the child, “Who lives at home with you?” __”tito, mama,
lola”_________________________
If she or he has siblings, ask about their relationship. _Yes, he has a sibling but he was not
able to meet his half-sibling.__________________________
Also ask,“Is there an audit in your life whom you feel comfortable talking with?”
_________________ Ask about peer relationships. Does the child have a special friend, and
what do they enjoy doing together? Yes his cousin and neighbor, they enjoy run around and
play cars_
Ask the child to describe herself or himself by saying, “Tell me about yourself.”
___________________
_____________________________________________________________________________
_____

Sexuality
Sex-role imitation observed: _None_ Does the child masturbate? No_

Stress and Coping

Does the child behave aggressively or have temper tantrums? _None__
Ask the child: “What makes you angry?”
_________________________________________________
Ask the child: “What do you do when you get angry?”
______________________________________ Ask the child: “What do you do to have fun or
relax?” ______________________________________

Developmental Tasks:
According to Erikson:

Autonomy vs. Shame and Doubt

During this stage children at this stage are focused on developing a sense of
personal control over physical skills and a sense of independence. They will start to
show clear preferences of what they want, they begone to exert the so called “me
do it stage”. Success on this stage will lead to virtue of will, meaning children will
become more confident and secure in their own ability. On the other hand, failure
on this stage will lead to shame and doubt.

According to Freud:

Anal stage (1 – 3 years old) – Erogenous Zone: Bowel and Bladder Control
During the anal stage, Freud believed that the primary focus of the libido was on
controlling bladder and bowel movements. Developing this control leads to a sense of
accomplishment and independence.
Freud suggested that an anal expulsive personality could develop in which the individual has
messy and destructive personality. If parents are too strict or begin toilet training too early,
Freud believed that an anal-retentive personality develops in which the individual is stringent,
orderly, rigid, and obsessive.
HEAD-TO-TOE PHYSICAL ASSESSMENT

Posture: ◘ flexed ◘ limp ◘ erect ◘ relaxed ◘ tense

Head Circumference: _48cm_________ Chest Circumference: __52cm__________________
Abdominal Circumference: __50cm_____________Length/Height:
____84cm________________
Weight: __11kg_________T __36.5C______PR___75bpm______RR____26cpm____BP 90/60
mm Hg

◘ Pain: location _________onset _________ duration ____________ characteristic

______________
aggravating factor ____________________ relieving factor ___________________________

Wong-Baker FACES Pain Rating Scale

No hurt Hurts little Hurts little Hurts even Hurts whole

Hurts bit more more lot

worst

Skin, Hair, Nails

Skin color and appearance: Light brown, smooth and intact ◘ Lesions: __None___ ◘ Others:
Presence of mosquito bites
Hair appearance: shinny and soft_ Distribution: _vellus hair covers the entire body__ ◘ lice
Appearance of nails: clean, no clubbing_
Head and Neck

Head: ◘ symmetrical ◘ scars: ___none___ ◘ lesions: ___None_____ ◘ others: __________

◘ lymph nodes palpable: ____no_________ ◘ thyroid nonpalpable
Anterior fontanel: Non palpable_ Posterior fontanel: _Non palpable Facial movement:
_present_
Facial features: _Symmetric __ Tonic neck reflex: _____________________

Eyes and Ears

Inspect eyes: _not swelling____ Position: _symmetric, not proruding______

Color of sclera: __White_______ Color of Conjunctiva: __Clear and moist______
◘ edema ◘ exudates Pupil size and equality: _3mm both sides____ Corneal/blink reflex:
__present___

Ear shape: _no unusual structure_ Position: ___ symmetric bilaterally ◘ Drainage: __None____
◘ hearing intact (3-4 yo) _____________________________________

Mouth, Nose and Throat

Appearance of mucus membranes lips, tongue and palate: __Pink and moist_________
◘ Sucking reflex ◘ Rooting reflex ◘ Gag and swallowing reflex ◘ extrusion reflex
Number of teeth: ____20___________ ◘ Wisdom teeth ◘ patent nostrils
Condition of sinuses: __not tender____________________________________________

Chest and Back

General appearance: _Smooth and rounded__________ Symmetry: ____Symmetric________

Chest expansion: _symmetrical___________ Respiratory rate: __26cpm__ Shape: _rounded_
Breast size: ___Flat and symmetric__________________ ◘ Drainage: ___none____________
Percussion findings: _____hyperresonance_____________________________________
Breath sounds: ___No adventitious sound____________________________________
Heart

Heart sounds: _S1 and S2 present and no murmurs__ Heart rate: __69bpm____ Rhythm:
____2+__ Capillary refill: _<2__ Peripheral pulse: _75bpm______

Abdomen

Appearance of abdomen: ___________Distended__________

Appearance of umbilical cord: ___healed with no discharge_____________________________
Palpation: ___soft and no masses______________________________________________
Percussion: ____generalized tympany _______________________________
Bowel sounds: ____Hyperresonance_________________________________________

Genitalia and Anus: ◘ patent rectum ◘ Anal reflex

Female: ◘ urinary meatus at miciline ◘ edema ◘ other findings: _______________

Male: ◘ foreskin retracts ◘ urethral opening at tip of penis ◘ palpable testes
◘ other findings: ________________________________________________________

Extremities: Number of fingers _10__ toes _10_ ◘ full ROM ◘ no clicks in joints
◘ normal curvature or spine ◘ equal muscle tone ◘ no weakness
◘ arms and legs symmetrical in size and movement
◘ other findings: ________________________________________________________

Neurologic

◘ Responds to noise ◘ Responds to touch ◘ Good balance ◘ Coordinated movement

Newborn Reflexes: ◘ moro ◘ Startle ◘ Tonic neck ◘ Palmar grasp
◘ stepping ◘ babinski ◘ plantar grasp ◘ rooting
◘ trunk incurvation ◘ landau ◘ parachute
Other reflexes: ◘ biceps ◘ triceps ◘ abdominal ◘ patellar
Current developmental assessment:

A. Gross motor skills

 Upon examining the patient, patient can stand, walk, sit, run, and jump on his own.

B. Fine motor-adaptive skills

 Upon examining the patient, able to differentiate color, able to trace shapes, able to
make scenarios while playing, and lastly able to choose his own preference of
clothing.

C. Language Skills

 The child can hear and listen to sounds

 The child can communicate, speak and make sentences
D. Personal and social skills

 Child able to practice clean his own hands through hand washing with assistance
 Child able to socialize well and to play games with other children.
 REFERENCES

Janet R. Weber, R. a. (2014). Health Assessment in Nursing, Fifth Edition. Wolters

Kluwer Health.

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2006). Nurse's pocket guide:
Diagnoses, prioritized interventions, and rationales.

NANDA Book, Crocetti & Serwint, 2005, Nursing Care Plans Guideline for Planning
and Documenting Patient Care

Elaine N. Marieb, R. P. (2013). Human Anatomy & Physiology, Ninth Edition.

Kluwer, W. (2017). Nursing 2017 DRUG HANDBOOK.

Milestones: How parents understand child development. National Poll on Children's

Health. (n.d.). Retrieved December 1, 2021, from
https://mottpoll.org/reports/milestones-how-parents-understand-child-
development.

Toilet training: A practical guide. Raising Children Network. (2020, July 30).
Retrieved December 1, 2021, from
https://raisingchildren.net.au/preschoolers/health-daily-care/toileting/toilet-
training-guide#:~:text=You%20might%20see%20signs%20that,for%20short
%20periods%20of%20time.

Final-poison fact sheet - world health organization. (n.d.). Retrieved December 1,

2021, from
https://www.who.int/violence_injury_prevention/child/injury/world_report/
Poisoning_english.pdf.