Davao Doctors College, Inc.

College of Allied Health Sciences

Nursing Program

NRG 203: CARE OF MOTHER, CHILD AND ADOLESCENT

(WELL CLIENTS) GROWTH & DEVELOPMENT OF TODDLER
All a Nurse Needs to Know about Maternal-Child Nursing

Getting to Know the Course Instructor

Hello! I am Princess Fabrienne T. Panganiban, RN, and

I will be your instructor for NRG 203: CARE OF MOTHER,
CHILD, AND ADOLESCENT (WELL CLIENTS),
GROWTH AND DEVELOPMENT - TODDLER.

I am Ma’am Cess, a faculty member of the Nursing

Program of Davao Doctors College, Inc. I earned my degree
of BS in NURSING at DMMA College of Southern Philippines,
Davao City and I finished BS in Secondary Education at Rizal
Memorial College Davao City. I also gaining my Master’s in
Nursing degree in Davao Doctors College. I am also a public
servant in Educational Institution in Davao City and at the
same time a Staff Nurse in Davao Medical School Foundation
Hospital assigned in OB-Gyne.

I am handling Level II Student Nurses. It is expected that much effort both in their knowledge and
skills should be given emphasis on the level. It is my responsibility to supervise students in various
clinical areas.

I am looking forward to guiding you in learning this course well. If you want to reach me for any
academic-related concerns, you can reach me through the following:

Facebook account: Cess Panganiban

E-mail address: princesspanganiban@davaodoctors.edu.ph
Consultation hours: Mon 7:00PM-3:00PM

Introduction to the Course

The course NRG 203: Care of Mother, Child and Adolescent: Growth & Development of a
Toddler deals with concepts, principles, theories and techniques of nursing care management of a
well children at a Toddler stage. In this course, you are expected to provide nursing care to children
utilizing the nursing process. Presented below are the specific details of this course:

Course Number: NRG 203

Course Credits 9 units (4 units Lecture, 5 units RLE)

Davao Doctors College, Inc.
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Nursing Program

No of Hours (Lab): (20 hours/week for 18 weeks)

Placement: Second year, First Semester

Prerequisite: NRG 105, NRG 106

Schedule: MTWThFS 8-3

GOOGLE CLASSROOM:
Classroom:
CLASS CODE: hquiwow

Requirements in Completing the RLE Activities

Since most of our sessions for this semester will be delivered through distance/blended learning
activities, the submissions will also be done online. To do this, you need to have access to the
following applications:

1. Microsoft Office/Google Docs

2. Google Classroom
3. Google Meet (or any other teleconferencing app, duly agreed by the whole class)
4. Internet connectivity

Access to a printer and/or scanner is also a plus, but not a requirement.

Daily Activities
Every week, you are expected to follow through the following deliverable:
Day 1 (Monday/Thursday) Day 2 (Tuesday/Friday) Day 3 (Wednesday/Saturday)
Asynchronous Virtual Circle Virtual Circle

Completion of Module, to be Receiving of Handover Case Presentation (cont.)

submitted within the day
Case Presentation Weekly Quiz and Discussion of
Preparation of PPT Module and Quiz Answers
Presentation
Orientation of Next Week’s Activity
Davao Doctors College, Inc.
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Nursing Program

MODULE 8:
CARE OF MOTHER, CHILD AND ADOLESCENT
(WELL CLIENTS)
The Family with a TODDLER

Now that you are done acquainting yourself with the instructor and the course itself, please proceed
to Module 5: Care of MOTHER, CHILD & ADOLESCENT (The Family with a Toddler).

Term: First Semester S.Y. 2021-2022

Dates: Week 12: November 8–13, 2021
Class Schedule: MTWTHFS: 7 AM-3 PM
No. of Hours: 8 hours/meeting

Instructions
The case analysis manuscript may be handwritten or computer written. Observe pagination.
Once done, send the compilation of your group’s answers to your clinical instructor.

After the submission, prepare a PPT presentation for your case presentation slated for Days 2 and
3 of your RLE classes. Each member of the group is expected to present during the case
presentations.

Learning Outcomes
At the end of this module, you are expected to:
1. Describe the normal growth and development of an infant as well as common parental
concerns.
2. Assess an infant for normal growth and development milestones.
3. Formulate nursing diagnoses related to infant growth and development or parental concerns
regarding growth and development.
4. Use critical thinking to analyze methods of care for infants to be certain care is family-
centered.
5. Identify expected outcomes for nursing care of an infant.
6. Plan nursing care to meet an infant’s growth and development needs, such as anticipatory
guidance to prevent problems such as sleep disturbances.
7. Implement nursing care to promote normal growth and development of an infant, such as
discussing infant developmental milestones with parents.
8. Identify areas related to the care of an infant that could benefit from additional nursing
research or application of evidence-based practice.
9. Integrate knowledge of infant growth and development with the nursing process to achieve
quality maternal and child health nursing care
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Nursing Program

As you start with this module, you are free to consult and coordinate with your assigned clinical
instructor. Be sure to get his/her email address and contact number for collaboration and
assistance. Just keep going, you can do it!

Case Analysis:
The Family with a Toddler

Case Scenario: Second Degree Accidental burn at Right Hand

Course in the Ward

Marty, a 27 month old toddler was admitted to the ER due to 2nd degree burn. During the interview
the mother, Mrs. Lorraine said that she left Marty playing on the sofa while she was preparing their
lunch. She went outside the house to throw the garbage and suddenly she heard Marty crying in
pain. She then saw Marty near the frying pan and it seemed that Marty stood near the pan and
dipped his hand. According to the mother she never thought that Marty would be curious about
what she was doing and that he would climb up near the stove. “Wala gyud ko ngdahum nga
musaka na diay na sya ug iyaha bah, lihukan pud lagi bataa oi..naluoy jud ko pagkakita nko sa
iyaha nga pirti niyang tiyabaw. mao gidala nako dayun sya sa ospital.”
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Nursing Program

When asked what she did before going to the hospital, she said that she just placed the hand over
the running water, cleaned the burned area and called her husband, Mr. George to meet her at the
hospital.
You were assigned to Marty’s care and was asked to do a thorough assessment and to conduct
an interview regarding Marty’s growth and development. Lorraine states that they live with Marty in
a house with his father George, an industrial engineer, 35 yrs old, Lorraine is a stay at home mom,
32, who have been married for 12 years. Marty’s older brother, Josh is 7 years old and in the first
grade. Marty had a normal birth and his mother Lorraine mentioned that there were no
complications or struggles during birth. Marty was born at 1:33PM on August 12, 2019 weighing
6.3 pounds. Marty now weighs 27.5 pounds. He got his first tooth at 6 months. He sat up by himself
and started crawling around eight months and was walking around at 13 to 14 months. One of the
recent activities that showcased his fine motor skills was his throwing a ball overarm in short
distances, stretching out arms to catch it, rolling the ball using the arms and hands and even kick-
in it. He does things with both hands, but most of the time he shows signs of being right handed.
He can do the puzzles that require putting pieces into an indented board, but he cannot do the
puzzles that create a whole picture yet. One area that Marty struggles with is being able to crawl
down stairs backwards. He probably would be able to do this but around 18 months, he fell down
a couple of stairs and now is scared, so he scoots on his bottom down the stairs. At this time his
parents are guiding Marty with his toilet training, he has a lot to learn to control his bladder and
bowel movement. He was always reminded by his mother to go to the toilet to pee or move the
bowel and eventually not use a diaper while at home.
Marty enjoys simple dances and rhythms especially when he hears music. One thing that he loves
more than anything is humming to the rhythm of the song and repeating what his mom Angie says.
He eats very well. He loves to munch steam carrots and fruits like apple and a piece of orange. He
has recently started to eat at the dinner table on a seat with the rest of the family. Marty still sleeps
through the night and then takes one hour to two hour nap during the afternoon. During his 2nd
birthday, his father George gifted him a ball that has different cut out shapes on it. He usually bonds
with his mom by playing with it. He then has to find the shape that correlates with the hole in the
ball and put the shape into the hole. One way his mom works with his cognitive development is by
having Marty name each color of the missing piece before he puts it into the ball. Marty is learning
and able to name at least 4 out of 8 different colors. When he draws he mostly scribbles and when
asked about what he drew, he does not answer, he only points at it and says his universal word,
“Josh” (his brother). He would also imitate others, one person that he imitates regularly is his
brother. He also learned how to put objects in and out of containers. He loves to play in the water
whenever he bathes every day, he learns how to put shampoo in his hair, make a bubble drop and
splashes the room with a lot of water. His mother will facilitate the proper final rinsing of water to
remove soap suds in his body. He knows how to dress himself with a simple shirt without a button.
Marty babbled loudly as an infant and his first word was “Dad” as Angie stated. At 24 months,
Marty talks with words and gestures. The words are not always clear, especially when he is excited.
His gestures mostly consist of pointing to objects in his story. He learned the word no, but did not
always respond to it. During the last couple of weeks, he has started to put together two or three
word sentences. One of them are “I out” “love you” and “ I am Marty” . He does not like to sit still
enough for most stories, but he will watch “Frozen” over and over. He does not know the names
though. To him, it is called, “fishy”. He also likes Sesame Street, more specifically he likes Elmo
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Nursing Program

and he knows his name. If he sees the object get hidden he will look for it, but he will not just go
and look for an object if told, unless it is his shoes. Marty has started to show signs of memory and
assimilation. One example of this is since he has been told that pots and pans that his mom is
cooking with are hot, he told Josh that the pizza pan he was holding was hot. He just pointed and
said “hot, hot”. Marty will respond to simple directions. For example, if you ask him to pick up his
trash, like a wrapper, he will throw it away in the trash bin. He will also pick up his toys if instructed,
most of the time. He has also started to use problem solving to figure things out. His mother Lorraine
used to shut doors to keep him out of things, now he has figured out how to open doors so that he
can still get to the things he wants and her mother will not let him have. Mrs. Lorraine also noticed
that he started to climb up the stairs and never imagined that he would climb over even up to their
stove because she clearly instructed their children not to go near the kitchen stove.
The family bonding for Marty started before he was even born by his father George talking to him
during the pregnancy. Lorraine avoided any possible teratogens and even avoided caffeine. She
also stated that she drank a lot of water and ate a lot of fruit during the pregnancy. Since Lorraine
reads to Josh every day, Marty got read to at the same time. Marty seems to be pretty open about
his emotions. When he is mad, he screams. When he is hurt, he cries. When he has done
something wrong and has gotten in trouble he simply looks down and gets sad. He has grown up
with mom Lorraine being home with him. Marty is known as a tornado, not because of temper but
because he is very energetic and into everything. He enjoys playing with everything from anyone’s
shoes to Little People toys. He enjoys being around people and has a blast playing with his toys or
with his family members. At times, whenever Marty gets upset and shows his frustrations, or resist
what his parents tell him to do like most children of his age. He show tantrums and can go through
many different moods within a short period of time. He does have a security blanket, and as long
as he has it he is usually okay. One Christmas break, the family hosted a small party with cousins
and friends. Marty is observed to be playing beside his cousin Ronan without interacting, but in a
few more minutes they will be imitating and copying what the other will be doing. When he is around
his cousin Ronan crying, he exhibits his caring attitude towards him by occasionally giving him his
blanket to try to calm him down. On one specific time, Marty threw a fit at McDonald’s because his
dad George would not let him hold his cup. His parents rule is he is not allowed to hold his cup
unless there is a lid on it, so he started throwing a fit by kicking and screaming but his dad
cooperated with him and calmed him down. The resolution was they would both hold onto the cup
as he took the drink.
Physical examination:
After endorsement you were asked to perform a physical assessment of Marty. During the physical
examination, Marty was crying uncontrollably and his mother and father were calming him down.
They were trying to give him his blanket but continued to be irritated and crying out of pain and
pointing towards his right hand. He has an IV in his left metacarpal vein, intact and patent with D5
LR 1 liter @ 112 ml/hour at a level of 950ml. His eyes were already swollen. There seems to be no
difficulty in breathing upon assessment. When the mother was asked how many teeth Marty has
she said that she counted recently and noticed he has around 20 teeth total. She was planning to
have him schedule a dentist appointment in the coming days. No other unusualities were noted at
the mouth. His skin is fair, soft and warm to touch. The affected hand started to have blisters,
redness is noted around the area and looks shiny. Aside from that there were no other unusualities
in the extremities. As soon as Marty quieted down, you continued your physical assessment. It
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Nursing Program

revealed that he has a protuberant abdomen and walks with a wide stance. He is still wearing his
diaper but according to the mother they already started potty training him. He sometimes has bed
wetting episodes but they understand that they do not need to punish him for that just like the
training they did with his brother Josh. He most often inform them if he needs to use the potty.
Labs were taken and to follow up results. Medications were ordered and started. Marty was placed
on I and O monitoring q hourly for 24 hours cc/cc then to shift to q 4 hours thereafter. You have
instructed the mother to keep the affected hand elevated and to call out if there are other concerns.
Weight: 27.5 pounds
Height: 85. 8 centimeters
Head circumference: 41.6 centimeters
Chest circumference: 43 cms
Vital signs : T= 36.3 degrees Celsius , RR= 29cpm, HR= 98bpm, BP: 100/65

Medication :
MMR (1st dose) given on 13 months of age
Hepatitis B vaccine (3rd dose) given on 15months of age
Haemophilus Influenza type b (Hib) 3rd dose given on 15months
DTap vaccine ( 4th dose) given on 18months
Ascorbic acid (Ceelin) 5ml P.O, OD
Iron + Vitamin B Complex (Ferlin syrup) 1ml P.O daily

November 9, 2021

Vital signs:
BP: 100/60
PR: 96
RR: 20
Pain: 4/10

Seen by Dr. Lariosa at 10 am with orders and carried out.

Dressing was done by Wound Management Nurse

The affected area was clean and dry. Marty is calmer when talked to but cries when he feels pain.
He can be soothed easily compared yesterday upon admission. His IV site remained patent and
intact with an IV of D5 LR 1 liter with flowrate decreased to 100ml/hr at 10 am. According to the
mother he was able to void approximately around 80 ml according to the nurse who weighed his
diaper. He drinks a lot of water and milk with a total of 100 ml since 7 in the morning.

At 2 pm, the mother reported that Marty defecated once around 11 am. Had a total intake of 350
ml. He was able to void again twice and the mother said that it was around 120ml.
November 10, 2021

Vital signs:
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Nursing Program

BP: 95/60
PR: 96
RR: 21
Pain scale: 2/10

Seen by Dr. Lariosa with orders and carried out. Advised to go home the next day with home
medication to be instructed.
Dressing was done by Wound management Nurse

The affected area remained dry and healing well. Marty was in a much better mood. Plays with his
mother and toys. The mother was telling you that she was glad that they came immediately in the
hospital. She said that she should learn more on how to keep her son safe. That with Marty’s age
anything can be expected.
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program
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College of Allied Health Sciences
Nursing Program

Laboratory Results

CBC AND SERUM ELECTROLYTES

November 8, 2021 @ 1pm
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November 8, 2021 @ 1pm

Urinalysis: November 8, 2021 @ 1 pm

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Nursing Program

Chest X-ray: Normal Chest (November 21, 5 pm)

What to Do?

To immerse yourself in the care management of your patient, let us do some detailed description
of your patient care tasks. Using the Case Scenario assigned to you, you are expected to perform
the following:

1. Fill-up the needed data based on the given scenario/case.

2. Conduct a history taking and physical assessment of your patient. Discuss the health
history of the patient narrative, in chronological order as much as possible. Use the DDC
Health Assessment form for documenting PA findings.
3. Discuss the developmental milestones of your patient in chronological order in terms of:
a. Physical Growth
b. Gross Motor Development
c. Fine Motor Development
d. Socialization/ Language
e. Play
f. Senses
g. Emotional Development
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4. Interpret the therapeutics done for the patient: doctor’s orders, laboratory and diagnostic
tests done, and surgical procedures to be performed. Use format presented.
5. Present your drug study and IVF data. One drug study per student. Transcribe the IVF
and medications in the appropriate sheets.
6. Formulate a patient-centered care plan for your patient. Integrate in your care
intervention significant bio ethical and legal standards of patient care. One NCP per
student.
7. Document the care given by making a nurse documentation following the FDAR format
(individual).
8. Clinical Reasoning Questions - Collaboration: Accidents are the major cause of
death in children of all ages. Accidental ingestions (poisoning) are the type of
accident that occurs most frequently in toddlers (Dart & Rumack, 2008). A young 2
year old girl was admitted in Pedia Ward due to fever and cough. She was playing
with her toys unsupervised by the mother. Upon the return of the mother from the
restroom, she noticed that her child was chewing something on her mouth and
noticed that the child went through her bag on top of the child’s bed. Concerned with
what her daughter was eating, she then rush to her assigned nurse and raised her
concern. What is your best action regarding this?

Knowing that this is a safety concern, how would you tell the staff nurse? Follow the CUS method.

8. Clinical Reasoning Questions - Ethico-Moral-Legal:

During your morning shift you were assigned to a 2 year old toddler. While doing your morning
care and taking the VS of your patient, you noticed while she was playing, she wet herself. You
then talked calmly to the child and informed the mother. The mother angrily approached the child
and pulled the child’s hand while reprimanding her for wetting the bed. The mother was slapping
the leg of the child while removing her clothes with force causing the patient to cry.

What would be your nursing action in this situation? What ethical principle is applicable in this
scenario? Justify?
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Nursing Program

Have you answered all of the questions above? Great! You are now ready for to proceed
to the next part of the module

Congratulations! You have completed this module. You may now proceed to the weekly quiz.
Please wait for further instructions from you instructor

References:
Silbert-Flagg,J. & Pillitteri, A. (2018). Maternal & Child Health Nursing, Care of the childbearing &
Childrearing Family, 8th Edition. Wolter Kluwer Health

Berman, A., Snyder, S., & Frandsen, G. (2016). Kozier & Erb’s fundamentals of nursing: Concepts,
process, and practice (10th ed.). Pearson Education, Inc.

Website:
https://www.cdc.gov/growthcharts/background.htm

https://www.doh.gov.ph/expanded-program-on-immunization