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Lecture 2

NURSE-UN 1255 Lecture Notes - Lecture 2: Lead Poisoning, 18 Months, 6 Years

Nursing - Undergraduate
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Pediatrics Lecture Week 2
Well Child: Toddler-Preschool
Sophia is now 2 years old. She arrives at the Pediatric Clinic for her 2 year old exam.
Toddlers: 1-3yo
Preschoolers: 3-6yo
Leading cause of death (1-4yo) is unintentional injury
o Drowning, poisoning (cleaning, meds)
Motor Vehicle injuries is the leading cause of injury death
1992 (20 per 100,000)
2004 (10 per 100,000)
Decreasing due to rear facing car seat
Health supervision visits for Toddlers and Preschoolers
15 months
18 months
24 months
2 ½ years (30) getting cut out due to insurance doesn’t want to pay.
3 years (36) same
3 ½ years
4 years
5 years
6 years
1 2 3 4 1 yr understand ¼ ; 2 understand 1/2 ; 3- understand ¾; 4 understand all of what they are saying.
The nurse obtains Sophia’s height, weight, head circumference, BMI and vital signs
HR: 90
RR: 24
Temperature: 98.9 F (axillary)
BP: 80/60
(**see pg 46-47 for vital sign norms for age)
Height: 35 ½ in
Weight: 28 ½ lb
HC: 49 cm
BMI: 15.9 (starting at 2 yr old)
Sophias parents ask the nurse if her vitals and growth is normal:
Normal Values -
Heart Rate: 70-110
Respirations: 20-30

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Pediatrics Lecture Week 2
Temperature: 99 F
Blood Pressure: 90 105 / 55 70
Growth: 3 inches/year; 4 - 6 lbs./year
only concerned with major changes.
Developmental Screenings
17% of children have a developmental delay that’s why they have so many well visits
Less than half are identified prior to starting school now it is teacher’s responsibility to pick it up.
Early intervention (OT, PT, ST) can stimulate developmental milestones
Causes of developmental delays:
Genetic syndromes
Perinatal infections/toxin exposures (FAS)/hypoxia
Hypoxia during delivery
Vision impairments
Hearing impairments
Lead exposure
Developmental Screening Tools
Ages & Stages $15
Bayley Infant Screener $25
Infant development inventory $15
Denver Developmental Screening $58
Parents’ Evaluation of Development $15
CDC Developmental Milestones FREE
Learn the Signs. Act Early
Screenings and Services
Gross Motor Skills: movements that use the large muscles in the arms, legs, torso and feet (standing, walking,
running, jumping) PT
Fine Motor Skills: movements that use the small muscles of the fingers, toes, wrists, lips and tongue (grabbing
using thumb and index finger, hand to mouth, eating) OT
Oral/Motor Skills: language and communication, eating ST
o The more languages the kid is exposed to at a younger age, the more likely they will pick up all of them.
Can learn 3 languages at once.
Social/Emotional (eye contact, smiles, interaction) SE
Cognitive (learning, thinking, problem solving) SE
EIP provides PT, OT, ST and SE teacher
Developmental Milestones
18 months:
o walks up and down stairs holding on,
o runs,

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Pediatrics Lecture Week 2
o builds tower of 2-3 cubes,
o says 15 or more words,
o scribbles,
o self feeds (fingers),
o follows one step commands,
o points to 6 body parts
24 months:
o walks up and downstairs without help,
o can kick a ball forward,
o builds tower 6 cubes,
o feeds doll,
o says about 50 words or more,
o uses 2 word phrases,
o uses pronouns “I”, “me”,
o brush teeth with help, helps dress ,
o uses spoon,
o speech is 50% intelligible
CT: A 2 year old patient walks on his tiptoes, has repetitive speech and little eye contact.
o Not normal look further
o Walking on tiptoes and no eye contact can be early sign of autism
3 years old:
o pedals tricycle,
o broad jump,
o 3 to 4 word sentences,
o knows 2 actions,
o speech 75% understandable,
o build tower of 10 cubes,
o thumb wiggle,
o imitates horizontal line,
o wash and dry hands,
o put on T shirt
4 years old:
o hops,
o speech all understandable with complete sentences,
o follows three step commands,
o copy cross,
o draw person 2-4 parts,
o brush teeth no help,
o dress no help,
o can count 4 objects
o know more body parts
CT: What are we looking for in developmental screenings?
What if the child is developmentally delayed? What does that mean?
Developmental Milestone Tables
Table 26.2 Motor Skill Development 1-3yo
Table 26.3 Language Development in Toddlers
Table 26.4 Signs of Developmental Delay
Table 27.2 Motor Skill Development 3-5yo
Table 27.3 Communication Skills in the Preschool Child
Nutritional Assessment
Sophia’s parents report that she doesn’t like to eat but drinks plenty of milk. She does not like to sit down in her
high chair for feedings and therefore only eats a few bites of food and then takes her milk in a sippy cup as she is
roaming around the house. Her typical meals include:
o Breakfast: 4 bites of pancakes with syrup and 1 cup of milk
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