HEALTH PROBLEMS

COMMON IN
TODDLERS

BURNS 1
 BURN

• Injury to body tissue caused by excessive heat

(heat greater than 104°F or 40°C).

• Burn injuries tend to be more serious in

children than in adults, because the same size
burn covers a large surface of a child’s body.

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BURN ASSESSMENT
Burns are classified according to the
criteria of the American Burn Association
as:

• Minor
• Moderate
• Severe

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CLASSIFICATION OF BURNS
MINOR BURN
• First-degree burn or second degree burn
< 10% of body surface or
• Third-degree burn
< 2% of body surface
• No areas of the face, feet, hands or genitalia
burned.
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CLASSIFICATION OF BURNS

MODERATE BURN
• Second-degree burn between 10% to 20%
• On the face, hands, feet, or genitalia
• Third-degree burn < 10% of body surface
or if smoke inhalation has occurred.

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CLASSIFICATION OF BURNS

SEVERE BURN
• Second-degree burn > 20% of body surface or
• Third-degree > 10% of body surface.

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RULE OF NINE A method or system
used for making a rapid
FOR ADULTS
assessment of the area
of a burn.

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CHARACTERISTICS OF BURN
SEVERITY & DEPTH TISSUE INVOLVED

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CHARACTERISTICS OF BURN
APPEARANCE
• Erythematous,
• Dry,
• Painful

• Example:Sunburn

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CHARACTERISTICS OF BURN
APPEARANCE
• Blistered,
• Erythematous to white

• Example: Scalds

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 CHARACTERISTICS OF BURN
APPEARANCE

• Leathery; black or white; not sensitive to pain

• Example: Flame

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 EMERGENCY MANAGEMENT OF BURNS (MINOR
BURNS)

• Immediately apply ice to cool the skin and prevent further

burning.
• Application of an analgesic-antibiotic ointment and a gauze
bandage to prevent infection.

• The child should have a follow-up visit in 2 days to have the area
inspected for a secondary infection and to have the dressing
changed.

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 CAUTION: MINOR BURNS
• Caution parents to keep the dressing dry (no swimming or
getting the area wet while bathing for 1 week).

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EMERGENCY MANAGEMENT OF BURNS
(MODERATE BURNS)

• Do not rupture blisters; this invite infection

• Cover with a topical antibiotic such as silver sulfadiazine
and a bulky dressing to prevent damage to the denuded or
excoriated skin.

• The child usually is asked to return in 24 hours to assess

that pain control is adequate and there are no signs and
symptoms of infection.
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• Broken blisters may be debrided (cut away) to
remove possible necrotic tissue as the burn
heals.

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 EMERGENCY MANAGEMENT OF BURNS
(SEVERE BURNS)

• The child with a severe burn is critically injured and needs swift, sure care,
including fluid therapy, systemic antibiotic therapy, pain
management and physical therapy to survive the injury without a
disability caused by scarring , infection or contracture.

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THERAPY FOR BURNS
Open Burn Therapy
• burn is exposed to air; used for superficial burns or body parts
that are prone to infection, such as perineum
• ADVANTAGE: allows frequent inspection of site; allows child
to follow healing process.
• DISADVANTAGE: requires strict isolation to prevent
infection; area may scrape and bleed easily and impede healing.

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THERAPY FOR BURNS
Closed Burn Therapy
• burns is covered with non-adherent gauze; used for
moderate and severe burns.
• ADVANTAGE: provides better protection from injury; is
easier to turn and position child; allows child more
freedom to play.
• DISADVANTAGE: requires dressing changes that are
painful; possibility of infection may increase because of
dark, moist environment.

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• Burned area is covered with an antibacterial cream
and many layer of gauze.
• A synthetic skin covering (Biobrane), artificial
skin (Integra), or amniotic membrane from the
placentas can be used to help decrease infection
and protect granulation tissue.
• Netting is useful to hold dressing in place, because
it expands easily and need s no additional tape.

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TOPICAL THERAPY
Silver Sulfadiazine (Silvadene)
• Drug of choice for burn therapy to limit infection at the burn
site for children.

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TOPICAL THERAPY
Antiseptic solution such as povidone-iodine
(Betadine)
• May also used to inhibit bacterial and fungal growth.
• Unfortunately, iodine stings as it is applied and stains
skin and clothing brown. Dressing must be kept
continually wet to keep them from clinging to and
disrupting the healing tissue.

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TOPICAL THERAPY
Nitrofurazone (Furacin) cream
• If Pseudomonas is detected in cultures.

• If a topical cream is not effective against invading

organisms in the deeper tissue under the eschar, daily
injections of specific antibiotics into the deeper layer of
the burned area may be necessary.

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ESCHAROTOMY
(CUT INTO THE ESCHAR)
What is an Eschar?
• Is the tough, leathery scab that
forms over moderately or severely
burned areas. Fluid accumulates
rapidly under eschars, putting
pressure on underlying blood
vessels & nerves.

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DEBRIDEMENT
• Removal of necrotic tissue from a burned area.
• Reduces the possibility of infection, because it
reduces the amount of dead tissue present on
which microorganisms could thrive.

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GRAFTING
Homografting or Allografting

• Is the placement of skin (sterilized and frozen) from

cadavers or a donor on the cleaned burn site.
• These grafts do not grow but provide a protective
covering for the area.

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GRAFTING

Heterografts or Xenografts
• In small children,
• From other sources, such as pig skin may be
used.

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GRAFTING
Autografting
• Is the process in which a layer of skin of both
epidermis and a part of the dermis (called a
split-thickness graft) is removed from a distal,
unburned portion of the child’s body and placed
at the prepared burn sit, where it will grow and
replace the burned skin.

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ADVANTAGES OF GRAFTING
• Reduces fluid and electrolyte loss,
• Reduces pain and
• Reduces the chance of infection

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NURSING RESPONSIBILITIES
AFTER GRAFTING
• Both donor and graft dressings should be
observed for fluid drainage and odor.
• Observe the child to determine whether there is
pain at either site.
• Monitor the child’s temperature every 4 hours.

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HEALTH PROBLEMS
COMMON IN
TODDLERS
POISONING 32
POISONING

• Occurs most commonly in children between the ages

of 2 and 3 years and in all socioeconomic groups.

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TOXICANT (POISON)
• any agent capable of producing a deleterious
response in a biological system

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COMMON AGENTS IN CHILDHOOD
POISONING INCLUDE:
• Soaps,
• Cosmetics
• Detergents or cleaners and
• Plants
• Over-the-counter drugs

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WHAT IS A POISON?
All substances are poisons;
there is none that is not a poison.
The right dose
differentiates a poison and a remedy.

Paracelsus

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DOSE
The amount of chemical entering the body
This is usually given as
mg of chemical/kg of body weight = mg/kg
The dose is dependent upon
* The environmental concentration
* The properties of the toxicant
* The frequency of exposure
* The length of exposure
* The exposure pathway
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 WHAT IS A RESPONSE?
The degree and spectra of responses depend upon the dose and
the organism--describe exposure conditions with description of
dose
• Change from normal state
– could be on the molecular, cellular, organ, or organism
level--the symptoms
• Local vs. Systemic

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WHAT IS A RESPONSE?

• Reversible vs. Irreversible

• Immediate vs. Delayed
• Graded vs. Quantal
– degrees of the same damage vs. all or none

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 EXPOSURE: PATHWAYS
• Routes and Sites of Exposure
– Ingestion (Gastrointestinal Tract)
– Inhalation (Lungs)
– Dermal/Topical (Skin)
– Injection
• intravenous, intramuscular, intraperitoneal
• Typical Effectiveness of Route of Exposure
iv > inhale > ip > im > ingest > topical

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EXPOSURE: DURATION
Acute < 24hr usually 1 exposure
Subacute 1 month repeated doses
Subchronic 1-3mo repeated doses
Chronic > 3mo repeated doses

• Over time, the amount of chemical in the body can build

up, it can redistribute, or it can overwhelm repair and
removal mechanisms

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ADME:
ABSORPTION, DISTRIBUTION,
METABOLISM, AND EXCRETION

• Once a living organism has been exposed to a toxicant, the

compound must get into the body and to its target site in an
active form in order to cause an adverse effect.

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ABSORPTION:
• ability of a chemical to enter the blood
(blood is in equilibrium with tissues)

• Inhalation--readily
absorb gases into the blood stream
via the alveoli. (Large alveolar surface, high blood
flow, and proximity of blood to alveolar air)

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ABSORPTION:

• Ingestion--absorption
through GI tract stomach
(acids), small intestine.

• Dermal--absorption
through epidermis (stratum
corneum), then dermis; site and condition of skin.

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DISTRIBUTION:
THE PROCESS IN WHICH A CHEMICAL AGENT
TRANSLOCATES THROUGHOUT THE BODY

• Blood carries the agent to and from its site of

action, storage depots, organs of transformation,
and organs of elimination
• Rate of distribution (rapid) dependent upon
– blood flow
– characteristics of toxicant (affinity for the tissue, and
the partition coefficient)
• Distribution may change over time
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 Distribution:
Storage and Binding
• Storage in Adipose tissue--Very lipophylic
compounds (DDT) will store in fat. Rapid
mobilization of the fat (starvation) can rapidly
increase blood concentration
• Storage in Bone--Chemicals analogous to
Calcium--Fluoride, Lead, Strontium
• Binding to Plasma proteins--can displace
endogenous compounds. Only free is
available for adverse effects or excretion
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TARGET ORGANS: ADVERSE EFFECT IS
DEPENDENT UPON THE CONCENTRATION OF ACTIVE
COMPOUND AT THE TARGET SITE FOR ENOUGH TIME

• Not all organs are affected equally

– greater susceptibility of the target organ
– higher concentration of active compound

• Liver--high blood flow, oxidative reactions

• Kidney--high blood flow, concentrates chemicals

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TARGET ORGANS:

• Lung--high blood flow, site of exposure

• Neurons--oxygen dependent, irreversible damage
• Myocardium--oxygen dependent
• Bone marrow, intestinal mucosa--rapid divide

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TARGET SITES:
MECHANISMS OF ACTION
• Adverse effects can occur at the level of the molecule, cell, organ, or
organism
• Molecularly, chemical can interact with

Proteins Lipids DNA

• Cellularly, chemical can
– interfere with receptor-ligand binding
– interfere with membrane function
– interfere with cellular energy production
– bind to biomolecules
– perturb homeostasis (Ca)
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EXCRETION:
TOXICANTS ARE ELIMINATED FROM THE BODY BY
SEVERAL ROUTES
• Urinary excretion

– water soluble products are filtered out of

the blood by the kidney and excreted into
the urine
• Exhalation

– Volatile compounds are exhaled by

breathing
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EXCRETION:

• Biliary Excretion via Fecal Excretion

– Compounds can be extracted by the liver

and excreted into the bile. The bile drains
into the small intestine and is eliminated
in the feces.
• Milk Sweat Saliva

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METABOLISM:
ADVERSE EFFECT DEPENDS ON THE CONCENTRATION OF
ACTIVE COMPOUND AT THE TARGET SITE OVER TIME

• The process by which the administered chemical

(parent compounds) are modified by the organism
by enzymatic reactions.

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METABOLISM:

• 1o objective--make chemical agents more water

soluble and easier to excrete
– decrease lipid solubility --> decrease amount at
target
– increase ionization --> increase excretion rate
--> decrease toxicity

• Bioactivation--Biotransformation can result in the

formation of reactive metabolites

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SUMMARY

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TOXICOLOGY

• Exposure + Hazard = Risk

• All substances can be a poison
• Dose determines the response
• Pathway, Duration of Frequency of Exposure and
Chemical determine Dose
• Absorption, Distribution, Metabolism & Excretion

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TOXICOLOGY

• The extent of the effect is dependent upon the

concentration of the active compound at its site of
action over time
• Individual variation of the organism will affect
ADME

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 EMERGENCY
MANAGEMENT OF
POISONING AT HOME

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INFORMATION PARENTS NEED TO PROVIDE
INCLUDES THE FOLLOWING:

• Child’s name, telephone number, address, weight, and age and

what the child swallowed
• How long ago the poisoning occurred
• The route of poisoning (oral, inhaled, sprayed on skin)
• How much of the poison the child took...

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INFORMATION PARENTS NEED TO PROVIDE
INCLUDES THE FOLLOWING:

• If the poison was in pill form, whether there are pills scattered
under a chair or if they are all missing - presumed swallowed
• What was swallowed; if the name of a medicine is not known,
what it was prescribed for and a description of (color, size,
shape of pills)

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INFORMATION PARENTS NEED TO PROVIDE
INCLUDES THE FOLLOWING:

• The child’s present condition (e.g., sleepy,

hyperactive, comatose)

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EMERGENCY MANAGEMENT OF
POISONING AT THE HEALTH
CARE FACILITY

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ACTIVATED CHARCOAL
• Either orally or by way of NG tube.
• Is supplied as a fine black power that is mixed
with water for administration...

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ACTIVATED CHARCOAL
• Is an antidote for poisoning

• ACTION: Absorbs toxic substances that have been

swallowed to prevent them from being absorbed from the
stomach
• POSSIBLE ADVERSE/SIDE EFFECTS: vomiting, diarrhea,
black stools

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NURSING IMPLICATIONS
(ACTIVATED CHARCOAL)
• Administer orally to conscious victims only
• Give the drug as soon as possible after poisoning
• Store the drug in a closed container, because it absorbs gases from the air
and is inactivated

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NURSING IMPLICATIONS
(ACTIVATED CHARCOAL)
• Know that the solution feels gritty/rough and tastes disagreeable, so young
children have difficulty swallowing the drug. May have to be administered
by NGT.
• Caution child or parent that stools will be black for several days after
administration.

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HOW TO PREVENT POISONINGS

• Read and follow labels before taking or giving medicines.

• Read and follow labels on household products. Don’t mix products!
• Use protective equipment when required.
• Store products in original containers.

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CHILD POISONINGS

A child in the U.S. needs a poison center every 30 seconds.

Most Dangerous Poisonings for Children Under Age 6

Medicines and Pesticides

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HOW TO PREVENT CHILD POISONINGS

• Use child-resistant packaging. Put tops on tightly.

• Lock products up so children can’t see or reach them.
• Do not let children watch adult taking medicine.
• Call medicines by their proper names.

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HEALTH PROBLEMS
COMMON IN
TODDLERS

CHILD ABUSE 69
SDL

• DEFINE
• MANIFESTATION OF ABUSED CHILD
• MANAGEMENT
• NURSING PROCESS

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HEALTH PROBLEMS
COMMON IN
TODDLERS
CEREBRAL PALSY
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SDL

• DEFINE
• PATHOPHYSIO
• MANAGEMENT
• NURSING PROCESS

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